犬心Marshall韧带及冠状窦的应用解剖

目的观测犬Marshall韧带(LOM)和冠状窦(CS)肌纤维的解剖结构。方法利用大体解剖方法观测40只犬心的LOM及CS的结构特征并做统计学分析。结果LOM位于左心耳后部左右肺静脉之间,始端连于CS在左心耳后方,向左上肺静脉移行到心包表面。LOM长2.61+0.95cm,宽0.18+0.04cm,与CS夹角为115.81+14.32,距离左心耳上缘0.58+0.52cm;CS长2.84+0.85cm,宽0.43+0.07cm,表面肌桥有3种肌纤维走行,其中环形19例(47.5%),纵形15例(37.5%),斜形6例(15%)。结论犬心LOM和CS上有肌丝走行,其来源及结构与人类相似,但形态有其特异性,可能是引起心房颤动的原因。     

Marshall韧带在肺静脉触发性房颤中的作用

目的:研究Marshall韧带在肺静脉触发性房颤中的作用.方法:20只犬随机分为Marshall韧带消融组(组1)及Marshall 韧带假消融组(组2)各10只,建立肺静脉触发性房颤模型.组1 Marshall韧带消融.组2 Marshall韧带假消融后,两组均消融肺静脉.比较两组的电生理图,不应期,房颤诱发率差异.结果:组1经Marshall韧带消融后,房颤时心内电图示Marshall韧带及PV处电激动频率减慢,组2无变化.组1房颤诱发率在Marshall韧带消融前后分别为:84%4±4%VS 79%4±4%,P=O.02;组2房颤诱发率在Marshall韧带假消融前后分别为:83%±4%VS 80%±3%,P=O.11.肺静脉及消融后,组1房颤诱发率在肺静脉消融前后分别为:79%±4%VS 42%±6%,P=O.00;组2房颤诱发率在肺静脉消融前后分别为:80%±3%VS47%4±14%,P=O.00.组1房颤模型建立后,Marshall韧带消融后,肺静脉消融后不应期为:1224±7VS 136±9VS 148±9,P相似文献   

MSCT对房颤患者左心耳形态结构的评估及对左心耳血栓的诊断价值

目的 探究多层螺旋CT (MSCT)对房颤患者左心耳形态结构的评估及对左心耳血栓的诊断价值。方法 选取82例拟行房颤射频消融术的患者作为研究对象,并在1周内进行经食管超声心动图(TEE)检查及MSCT检测,以TEE检查结果为参照标准,观察分析MSCT对房颤患者左心耳形态结构评估及对左心耳血栓的诊断效能。结果 经MSCT检查82例患者左心房容积为(120.32±25.21) mL,左心耳容积为(10.21±4.32) mL;左心耳口部面积53.35～500.40 mm2;长径11.34～35.12 mm,短径7.38～29.00 mm;左心耳嵴的长度(23.85±3.41)mm,宽度(3.69±1.24)mm,左心耳基部同冠状动脉左回旋支的距离为1.41～6.69(3.67±0.82) mm。82例患者经TEE检查其中32例发生左心耳血栓,检出率为39.02%,Kappa值为0.80,以TEE检查结果为参照标准,MSCT检查左心耳血栓的检出率为32.93%,Kappa值为0.67,两者左心耳血栓诊断结果比较,差异无统计学意义(P>0.05);MSCT诊断房颤患者左心耳血栓的灵敏度为...     

无水乙醇经心外膜消融犬Marshall韧带方法学研究

目的 :评价直视下经心外膜无水乙醇化学消融Marshall韧带对犬Marshall韧带电位的影响。方法 :对19只犬直视下经心外膜应用自制梳状电极对Marshall韧带进行标测 ,其中连续对可记录到Marshall韧带电位的 11只犬 ,在Marshall韧带冠状静脉窦入口处及其中段与左心房连接处采用无水乙醇注射化学消融方法 ,消融Marshall韧带使其Marshall韧带电位消失。结果 :11只犬经心外膜无水乙醇化学消融方法消融Mar shall韧带 ,Marshall韧带电位消失率 10 0 % ,其中 9只犬Marshall韧带心外膜双极电图呈“V”字形 ,在Marshall韧带冠状静脉窦入口处消融后Marshall韧带电位全部消失 ;2只Marshall韧带心外膜双极电图呈“Y”字形 ,不仅在Marshall韧带冠状静脉窦入口处消融 ,而且在Marshall韧带中段电位提前处消融 ,经上述两处消融后 ,Marshall韧带电位全部消失。结论 :无水乙醇化学消融Marshall韧带方法简单 ,消融成功率高 ,安全可靠。     

左心耳及其毗邻形态结构对心房颤动导管射频消融术后复发的预测价值

目的:探讨左心耳及其毗邻形态结构对心房颤动(房颤)导管射频消融术后复发的预测价值.方法:选取2018年1月至12月接受射频消融术的110例房颤患者,术前均接受256层螺旋CT心脏检查,测量左心耳嵴长度和宽度,左心耳体积和开口面积,肺静脉开口面积.在术后第3、6、9、12个月进行门诊或电话随访.以消融术后1 a房颤复发为...     

犬Marshall韧带和房颤的关系及其电隔离方法探讨

目的：研究犬Marshall韧带和心房颤动的关系,探讨电隔离Marshall韧带的方法。方法：对20只健康家犬干预Marshall韧带,根据干预方式不同,分为近中段剪断组（A组）及无水乙醇消融组（B组）。将各组内及两组间干预前后房颤诱发率进行对比并作统计学分析处理。结果：A组干预前房颤诱发率为85．7％（6／7）;干预后为71．4％（5／7）。干预前后房颤诱发率无显著性差异,P〉0．05。B组消融之前,房颤诱发率为81．8％（9／11）;消融后为9．1％（1/11）。干预前后房颤诱发率有显著性差异,P〈0．01。干预前A、B两组间房颤诱发率无显著差异（P〉0．05）。干预后A、B两组间房颤诱发率有显著差异（P〈0．05）。结论：犬Marshall韧带在房颤的发生和维持中起到重要作用;Marshall韧带关键的消融部位是其在冠状静脉窦和／或左房入口处;消融终点是Marshall韧带电位完全消失。     

房颤的肺静脉解剖及电生理

房颤(atrial fibrillation,AF)是心脏疾病中最常见的心律失常,其发病机制尚不明确,多发子波折返学说被临床及实验研究所证实,被大家公认[1,2].但近年来,房颤的局灶触发机制越来越被电生理界所重视,对一些有选择的患者进行局灶消融能终止房颤.而这些局灶触发灶可以在Marshall韧带、冠状窦口、界嵴、腔静脉等部位存在,但是90%的触发灶发生在肺静脉,基础医学及临床医学表明,肺静脉(pulmonary veins,PV)在局灶性房颤的发生及维持中起着主要作用[3,4].但是在器质性心脏病伴永久性房颤中,肺静脉所起的作用目前仍难以脱离多发子波学说.     

经食管超声心动图诊断房颤患者左心房/左心耳内血栓的临床价值

目的探讨经食管超声心动图诊断房颤患者左心房/左心耳内血栓的临床价值。方法选取该院2015年5月‐2017年5月收治的心房震颤患者120例为本研究观察组,其中阵发性震颤107例、持续性震颤13例;选取同期入该院体检的心功能正常的健康志愿者120例为本研究对照组。观察组患者均接受肺静脉隔离(PVI)治疗,并于术前行经食管超声心动图检测左心房及左心耳内血栓情况;比较观察组与对照组患者左心房/左心耳超声心动图参数、伴有和不伴有自发性显影的房颤患者超声心动图参数;并利用受试者工作特征曲线(ROC曲线)分析超声心动图对左心房/左心耳内血栓的诊断价值。结果阵发性房颤组患者左心房前后径、左心房左右径和左心耳最大的排空速度(Lev)均明显低于对照组(P0.05);阵发性房颤组患者左心耳面积变化率以及左心耳最大的充盈速度(Lfv)均明显大于对照组(P0.05);持续性房颤组患者左心房前后径、左心房左右径均明显大于对照组和阵发性房颤组患者(P0.05);持续性房颤组患者左心耳面积变化率、左心耳Lev以及左心耳Lfv均明显小于对照组和阵发性房颤组患者(P0.05);120例房颤患者中有自发性显影41例,无自发性显影79;有自发性显影组患者左心房前后径、左心房左右径均明显大于无自发性显影组患者(P0.05);有自发性显影组患者左心耳面积变化率、左心耳Lev以及左心耳Lfv均明显小于无自发性显影组患者(P0.05);观察组患者经食管超声心动图诊断敏感度为90.63%,特异度为92.05%,阳性预测值(PPV)为80.56%,阴性预测值(NPV)为96.43%;ROC曲线分析显示曲线下面积为0.913(0.846,0.980)。结论经食管超声心动图能有效评价房颤患者左心房/左心耳的状况,对房颤患者左心房/左心耳内血栓的诊断具有较高应用价值。     

西藏小型猪细胞色素b基因序列的比较

目的观测犬心心腔主要结构,为心脏比较解剖学积累一定的资料。方法10％甲醛固定犬心45例,一周后解剖并观测二尖瓣复合体、三尖瓣复合体、肺动脉瓣环、主动脉瓣环、肺静脉、前后腔静脉、冠状窦和卵圆窝,统计学处理后与人的心脏进行比较分析。结果①犬心左心室呈圆锥形,分为左心室流入道及左心室流出道,其流入道主要结构为二尖瓣复合体。二尖瓣环周径为49．16±10．00mm,腱索总数为16．72±2．76条。左心室流出道主要结构为主动脉瓣、主动脉窦、主动脉口。主动脉瓣环周径为34．55±8．00mm;②犬心右心室主要结构有三尖瓣复合体、肺动脉瓣、假腱索、隔缘肉柱等。三尖瓣环周径为71．03±14．02mm,肺动脉瓣环周径为35．97±8．17mm;③犬心左右心房的主要结构有前后腔静脉、肺静脉、冠状窦和卵圆窝。前腔、后腔静脉口径分别为43．91±10．17mm、37．67±10．54mm。肺静脉平均为29．44±12．71mm。冠状窦口径平均为14．12±4．00mm。其中冠状窦口呈圆形的占89．7％,唇形的占10．3％。卵圆窝发现率为100％。结论犬心的主要结构与人类相似,但大小及假腱索、腱索总数有一定差异。     

非瓣膜性房颤经食道超声心动图的研究

目的探讨TEE检测非瓣膜性房颤左心耳的大小及功能与左心耳内血栓形成之间的关系,为临床进行风险评估、判断愈后及指导治疗等方面提供重要依据。方法采用TEE对41例非瓣膜性房颤伴有或不伴有高血压患者进行左心耳检测,根据左心耳的形态特点,测量出左心耳入口的宽度、左心耳顶部到入口的长度,同样用描记法测出左心耳舒张末容积,运用脉冲多普勒测出左心耳血流充盈与排空速度,检测左心耳内透声情况及有无血栓。结果41例房颤患者中左心耳血栓7例,有血栓组与无血栓组的左心耳的大小、容积无显著性差异,而左心耳的峰值血流排空速度差异具有显著性;随房颤病程变化,左心耳容积具有显著性差异(P<0.05);房颤伴高血压组与不伴高血压组上述指标亦具有显著性差异。结论左心耳大小、形态的改变,功能的减低,血流速度的减慢是房颤患者左心耳内血栓形成的重要危险因素。因此,对左心耳大小、形态及功能的检测可以帮助临床进行风险评估、判断愈后以及指导治疗等方面都有着重要的临床价值。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.