双层止血带子宫下段捆绑下子宫重建在前置胎盘产后出血中的应用效果

目的探讨双层止血带子宫下段捆绑下子宫重建在前置胎盘产后出血中的应用效果。方法选取我院妇产科2016年6月至2019年6月收治的60例前置胎盘产后出血患者,随机将其分为对照组和研究组,每组30例。对照组接受常规止血治疗,研究组在常规治疗的基础上采用双层止血带子宫下段捆绑下子宫重建治疗。比较两组的治疗效果。结果研究组的术中出血量及术后24 h出血量均少于对照组,止血时间短于对照组(P<0.05),且研究组没有子宫切除患者,对照组有2例患者因为止血效果不佳进行了子宫切除手术。研究组的术后输血量少于对照组(P<0.05);两组的术后输血、腹部切口感染、产褥感染及贫血发生率均无显著差异(P>0.05)。两组的新生儿脐动脉血pH值、PCO2、PO2、Apgar评分和体重无显著差异(P>0.05)。结论双层止血带子宫下段捆绑下子宫重建在前置胎盘产后出血患者中的止血效果显著,能够减少术中和术后的出血量,安全性高,疗效确切,且对新生儿无不利影响,母婴安全,值得临床推广。     

Assessment of Permanent Selective His Bundle Pacing in Left Ventricular Synchronization Using 3-D Speckle Tracking Echocardiography

The study described here aimed to evaluate left ventricular (LV) systolic mechanical synchronization during permanent selective His bundle pacing (SHBP) using 3-D speckle-tracking echocardiography post-operatively and 6 mo after pacemaker implantation in 62 patients randomly assigned to SHBP (n?=?32) or right ventricular apical pacing (RVAP, n?=?30). A standard apex four-chamber view was exposed and was transformed into full-volume mode under 3-D echocardiography. Three-dimensional speckle-tracking echocardiography was analyzed offline. The primary endpoint was LV mechanical synchronization post-operatively and during the 6-mo follow-up. Significant LV dyssynchrony was detected while evaluating the maximum time difference and standard deviation of 16-segment systolic time to peak 3-D strain at 1 wk and 6 mo. The pacing thresholds were significantly higher in the SHBP than in the RVAP group throughout follow-up. The R-wave amplitude was significantly lower in the SHBP group than with RVAP. The pacing parameters during SHBP were as stable as during conventional RVAP during the mid-term follow-up. In conclusion, 3-D speckle-tracking echocardiography is feasible and provides a more convenient method for evaluating LV synchrony.     

Update on Bayés’ syndrome: the association between an interatrial block and supraventricular arrhythmias

Introduction: The past few years have given rise to extensive research on an interatrial block and its clinical relevance, mainly its association with supraventricular arrhythmias. In 2015, the authors of this article reviewed the Bayes syndrome for the first time and after three years there has been so much evidence accumulated that it seems reasonable to rewrite an update, based fundamentally on the new findings. Focused on its relationship with cardioembolic strokes, today efforts are being targeted at understanding its pathophysiology, its diagnosis, and its prognostic implications, in order to learn if it should be treated.

Areas covered: A non-systematic review of the literature was developed using the Pubmed and Cochrane databases, focusing on randomized clinical trials and large observational studies that evaluated new physiopathological and epidemiological aspects, new clinical scenarios in which it has been assessed and its association with dementia. Finally, those studies that proposed new possible treatments were reviewed.

Expert commentary: Interatrial block is not only a predictor of supraventricular arrhythmias, is a subclinical disease that might be considered as a marker of risk for adverse outcomes. Although there is some evidence to suggest that early treatment may be beneficial, potential therapies have yet to be investigated.     

Multiple myocardial bridges associated with left‐ventricular dysfunction,intermittent left bundle branch block,and cardiac memory: A case report

Myocardial bridges are a congenital anomaly in which a segment of the coronary artery takes a “tunneled” intramuscular course. Few reports have associated myocardial bridges with left‐ventricular dysfunction in patients with ischemia. Intermittent left bundle branch block is a conduction disturbance that has been described to be associated with myocardial bridges and cardiac memory. This study reports unusual associations of multiple myocardial bridges, angina, left‐ventricular dysfunction, intermittent left bundle branch block, and cardiac memory.     

Ambulatory Rhythm Monitoring to Detect Late High-Grade Atrioventricular Block Following Transcatheter Aortic Valve Replacement

BackgroundHigh-grade atrioventricular block (H-AVB) is a well-described in-hospital complication of transcatheter aortic valve replacement (TAVR). Delayed high-grade atrioventricular block (DH-AVB) has not been systematically studied among outpatients post-TAVR, using latest-generation TAVR technology and in the early post-TAVR discharge era.ObjectivesThe purpose of this study was to assess utility of ambulatory event monitoring (AEM) in identifying post-TAVR DH-AVB and associated risk factors.MethodsPatients without pre-existing pacing device undergoing TAVR at the University of Colorado Hospital from October 2016 to March 2018, and who did not require permanent pacemaker implantation pre-discharge, were discharged with 30-day AEM to assess for DH-AVB (≥2 days post-TAVR). Clinical and follow-up data were collected and compared among those without incident H-AVB.ResultsAmong 150 consecutive TAVR patients without a prior pacing device, 18 (12%) developed H-AVB necessitating permanent pacemaker <2 days post-TAVR, 1 died pre-discharge, and 13 declined AEM; 118 had 30-day AEM data. DH-AVB occurred in 12 (10% of AEM patients, 8% of total cohort) a median of 6 days (range 3 to 24 days) post-TAVR. DH-AVB versus non-AVB patients were more likely to have hypertension and right bundle branch block (RBBB). Sensitivity and specificity of RBBB in predicting DH-AVB was 27% and 94%, respectively.ConclusionsDH-AVB is an underappreciated complication of TAVR among patients without pre-procedure pacing devices, occurring at rates similar to in-hospital, acute post-TAVR H-AVB. RBBB is a risk factor for DH-AVB but has poor sensitivity, and other predictors remain unclear. In this single-center analysis, AEM was helpful in expeditious identification and treatment of 10% of post-TAVR outpatients. Prospective study is needed to clarify incidence, risk factors, and patient selection for outpatient monitoring.     

ACC/AHA Versus ESC Guidelines on Heart Failure: JACC Guideline Comparison

The 2013 (with updates in 2016 and 2017) American College of Cardiology/American Heart Association and 2016 European Society of Cardiology guidelines provide practical evidence-based clinical guidelines for the diagnosis and treatment of both acute and chronic heart failure (HF). Both guidelines address noninvasive and invasive testing to establish the diagnosis of HF with reduced ejection fraction and HF with preserved ejection fraction. Extensive trial evidence supports the use of guideline-directed medical therapy and device-based therapies for the optimal management of patients with HF with reduced ejection fraction. Specific recommendations are also provided for HF with preserved ejection fraction although the evidence is substantially weaker. Management of medical comorbidities is now addressed in both guidelines. Acute HF and end-stage disease requiring advanced therapies are also discussed. This review compares specific recommendations across the spectrum of HF phenotypes and disease severity, highlights areas where differences exist, and lists consequential studies published since the latest guidelines.     

双内侧切口单束解剖重建前交叉韧带

目的：观察关节镜下运用内侧双切口单束解剖重建前交叉韧带的早期疗效。方法：于2010年6月～2010年12月,在35例关节镜下前交叉韧带重建手术中,采用内侧双切口单束解剖重建技术,RIGIDfix固定股骨端和Intrafix固定胫骨端,以Lysholm评分评价手术前后膝关节功能。结果：35例患者均获得随访。术后随访12～24个月,平均18个月。术后膝关节活动范围均超过120°,无伸膝受限。Lysholm评分从术前（43.52±6.21）分增加到术后（90.12±5.62）分,差异有统计学意义（P〈0.01）。结论：关节镜下运用内侧双切口单束解剖重建技术术中视野更好,能获得更低移植物倾斜度,能获得更好的旋转稳定性,可获得满意近期疗效。     

F1 (CBA × C57) mice show superior hearing in old age relative to their parental strains: Hybrid vigor or a new animal model for “Golden Ears”?

Age-related hearing loss - presbycusis - is the most common communication problem and third most prevalent chronic medical disorder of the aged. The CBA and C57BL/6 mouse strains are useful for studying features of presbycusis. The CBA loses its hearing slowly, like most humans. Because the C57 develops a rapid, high frequency hearing loss by middle age, it has an “old” ear but a relatively young brain, a model that helps separate peripheral (cochlear) from central (brain) etiologies. This field of sensory neuroscience lacks a good mouse model for the 5-10% of aged humans with normal cochlear sensitivity, but who have trouble perceiving speech in background noise. We hypothesized that F1 (CBA × C57) hybrids would have better hearing than either parental strain. Measurements of peripheral auditory sensitivity supported this hypothesis, however, a rapid decline in the auditory efferent feedback system, did not. Therefore, F1s might be an optimal model for studying cases where the peripheral hearing is quite good in old age; thereby allowing isolation of central auditory changes due to brain neurodegeneration.