Clinical study of the ascending aorta wall motion by velocity vector imaging in patients with primary hypertension

We studied the wall motion characteristics of the ascending aorta by velocity vector imaging （VVI） in primary hypertension patients. The ascending aortas both in 30 patients with primary hypertension and 30 normal controls were examined by Acuson sequoia 512 equiped with VVI. The maximum velocity （Vs, Ve） of every point on the anterior wall of ascending aorta both in systole and diastole was measured. The aortic diameter was wider in the hypertension patients than that in the healthy subjects （P〈0.05）. The movement amplitude of the anterior wall of the ascending aorta in long axis view in the hypertension patients was lower than that in the healthy subjects （P〈0.05）. The motion and time to peak in systole of each point of the ascending aorta in the healthy subjects had no significant difference （P〉0.05）. The velocity curves of the anterior wall of ascending aorta both in the hypertension and healthy subjects were regular, and the curve in systole was named S wave and that in diastole named E wave. The velocity of S wave and E wave was slower in the hypertension patients than that in the healthy subjects （P〈0.05）. The time to peak of S wave on the anterior wall of ascending aorta in systole was shorter in the hypertension patients than in the healthy subjects （P〈0.05）. VVI could be used to accurately and directly observe the movement character of the ascending aorta walls, which would help us understand the elasticity of great arteries in patients with hypertension.     

Predictors of atrial fibrillation after coronary artery bypass graft surgery

Objective To identify the clinical predictors of atrial fibrillation (AF) after coronary artery bypass grafting (CABG).Methods 322 consecutive patients who had undergone isolated CABG were reviewed. Preoperative, intraoperative and postoperative data were collected. Patients were grouped according to whether AF appeared postoperatively.Results AF occurred in 75 patients (23.3%). Most cases of AF (85.6%) appeared on or before the third postoperative day. The mean age for patients with AF was 62.5 years compared with 56.7 years for patients without AF ( P <0.05). The mean aortic crossclamp time for patients with AF was 67 min compared with 60.3 min for patients without AF ( P <0.05). The mean duration of cardiopulmonary bypass for patients with AF was 109.6 min compared with 97.3 min for patients without AF ( P <0.05). The mean duration of mechanical ventilation for patients with AF was 19.1 h compared with 15.7h for patients without AF ( P <0.05). Multivariate logistic regression analysis was used to identify the following independent predictors of postoperative AF ( P <0.05): age≥65 years (OR 2.7; 95% CI 1.5 to 5.1), lesions in the right coronary artery (OR 2.5; 95% CI 1.4 to 4.5), and early postoperative withdrawal of β blocker (OR 3.9; 95% CI 2.1 to 7.7).Conclusions AF remains the most common complication after CABG. Age and lesions in the right coronary artery can influence the incidence of AF, and β blocker and magnesium may be the most economical and effective prevention for AF early after CABG.     

Correlation of Thl7 cells and CD4＋CD25＋ regulatory T cells with clinical parameters in patients with systemic sclerosis

Background Systemic sclerosis （SSc） is an autoimmune disease that has three major components： inflammation, fibrosis, and vasculopathy. T-helper 17 cell （Th17） and regulatory T cell （Treg） are considered to be critical for autoimmune disease pathogenesis. The role of Th17 and Treg in SSc is still unclear. The aim of this study was to detect the presence of Th17s and CD4＊CD25~ Tregs in peripheral blood samples from SSc patients and to investigate the possible roles of these two T cell subsets in SSc pathogenesis. Methods Th17s （CD4 and IL-17 positive） and CD4＊CD25~ Tregs （CD4, CD25 and Foxp3 positive） in the peripheral blood mononuclear cells of 53 SSc patients and 27 healthy controls were counted by flow cytometry. The differences between SSc and control patients were analyzed. Clinical parameters, including disease duration, duration of the second symptoms, Modified Rodnan Skin Score （MRSS）, anti-topoisomerase I antibody, anti-U1 ribonucleoprotein （RNP） antibody, systemic involvements, pulmonary function test （PFT） and high resolution computed tomography （HRCT） score were prospectively collected following EUSTAR （EULAR scleroderma trial and research group） protocols. The correlations between the experimental and clinical data were investigated. Results The ratio of Th17 in SSc patients was significantly elevated compared to healthy controls （8.74% vs. 4.41%, P 〈0.001）. The amount of Th17 was positively correlated with disease duration （R=-0.531, P=-0.013） and duration of the second symptoms （R=-0.505, P=0.023）. The ratio of CD4＊CD25＊ Treg in SSc patients also significantly differed from the healthy controls （3.04% vs. 2.24%, P=0.018）. Elevated Tregs were more frequently observed in patients with a high interstitial lung disease （ILD） score on computed tomography （24/36） compared with patients with normal ILD scores （4/12, ,P=-0.043）. Elevated Tregs were also more often observed in patients with low carbon monoxide diffusing capacity     

Fatigue severity of patients with idiopathic chronic fatigue compared to healthy subjects

OBJECTIVE:To analyze the fatigue severity of patients with idiopathic chronic fatigue(ICF) and to compare the severity of this group with that of healthy subjects.METHODS:one hundred and nine ICF patients and 98 healthy subjects were enrolled in this study.Fatigue severity was measured using the Korean-translated Chalder fatigue severity questionnaire.All subjects scored each item on a 10-point scale as a self-rating numeric scale(NRS),and additionally rated their feeling of general fatigue by visual analogue scale(VAS).RESULTS:The total NRS scores of patients with ICF was 53 ± 15 compared with 25 ± 14 of healthy subjects(2.4 folds for physical symptoms vs.1.7 folds for mental symptoms respectively).The VAS scores of patients with ICF were 2.7 times as high as those of healthy subjects.CONCLUSION:This report is the first to compare the severity of fatigue between ICF patients and healthy subjects.This study contains reference data applicable for the management of this disorder in field of complementary and alternative medicine.     

Predictors of post coronary artery bypass grafting atrial fibrillation

Objective: To investigate the incidence and relative risk factors of post coronary artery bypass grafting(post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF group and a non-AF group. Statistical analysis was used to compare the data between the two groups and screen for risk factors of post-CABG AF. Results: 103/312(33.01%) patients developed post-CABG AF. Univariate analysis showed that patients in AF group compared with those in non-AF group were more likely to have advanced age (≥ 70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement ( ≥40 mm), a history of AF, prolonged p-wave duration ( ≥ 120 ms) and increased number of grafts (≥3). Multivariate logistic regression analysis showed that advanced age (≥70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm) and a history of AF were highly related to post-CABG AF. Conclusion: The incidence of AF in patients following CABG was 33.01% in this study. Advanced age, early postoperative withdrawal of β-blockers,hypertension, left atrial enlargement and a history of AF were independent risk factors of post-CABG AF.     

视神经炎患者血清胆红素水平

Background Bilirubin is the end product of heme catabolism and has strong antioxidant properties. Serum bilirubin levels are reported to be reduced in patients with multiple sclerosis （MS） and neuromyelitis optica （NMO）. The pathophysiology of optic neuritis （ON） resembles that of MS; however, the role of endogenous bilirubin in ON is unclear. The aim of this study is to measure serum bilirubin levels in patients with ON, and to investigate the correlation between ON and serum antioxidant status of bilirubin. Methods Serum levels of bilirubin were measured in 42 patients with ON, 50 patients with multiple sclerosis （MS）, 48 patients with neuromyelitis optica （NMO） and 48 healthy control subjects. Results Serum total bilirubin （Tbil）, direct bilirubin （Dbil） and indirect bilirubin （Ibil） levels in patients with ON were significantly lower than those in the healthy controls. However, no statistical significance was found between levels in the ON and MS, ON and NMO, and MS and NMO groups. In patients with ON, serum Tbil, Dbil, and Ibil levels were lower in those with recurrence or those with ON for a longer duration （〉1 year）. Moreover, Tbil, Dbil, and Ibil concentrations were lower in patients with papillitis than in those with retrobulbar type ON, but the differences were not statistically significant. Conclusions Low antioxidant status may exist in patients with ON. But serum levels of Tbil, Dbil, and Ibil did not correlate with clinical presentations, such as recurrence, duration of disease and subtypes of ON. Low antioxidant status already existed in MS or NMO patients before systemic symptoms appeared.     

Decreased Gastric Body Mucosa Obestatin Expression in Abdominal Obesity Patients With Normal Body Mass Index

<正>The aim of the study was to investigate whether the expression of obestatin in gastric body mucosa in abdominal obesity patients with norma body mass index(BMI)is different compared with healthy controls.Twenty abdominal obesity patients with normal BMI and twenty healthy controls were included in the study.The number of     

Clinical profile and outcomes of atrial fibrillation in elderly patients with acute myocardial infarction

Background Atrial fibrillation （AF） occurs commonly in patients with acute myocardial infarction （MI） and is associated with an increased long-term mortality. This study aimed to investigate the clinical characteristics and outcomes of AF in in-hospital elderly Chinese patients with acute MI.
Methods A total of 967 patients with acute MI, aged 〉65 years, were categorized on the basis of the absence or presence of AF. Patients with documented AF were classified into two subgroups： the ongoing AF group and the new-onset AF group. We retrospectively evaluated the clinical profile, in-hospital outcomes, and effects of revascularization on the incidence of AF in elderly patients with acute MI.
Results AF was documented in 100 （11.53%） patients and the incidence of new-onset AF was 6.51% during hospitalization. History of old MI and cerebrovascular events were more common in patients with AF than in those without AF （P 〈0.001, P 〈0.01, respectively）. The incidence of AF was higher in patients with non-ST elevated MI （P=0.014）, inferior wall MI （P=0.004） and cardiac function of Killip class Ⅲ or Ⅳ （P=-0.008）. Patients with AF had more complication of pneumonia （P=0.003） and longer hospital stay. Left circumflex coronary artery involvement was more common in patients with AF （compared with patients without AF, P 〈0.001）. Percutaneous coronary intervention or coronary artery bypass grafting significantly decreased the incidence of new-onset AF from 7.97% to 3.82% （P=0.017）. AF depended to heart failure, increased the in-hospital mortality.
Conclusions AF is common in elderly patients with acute MI and is associated with poorer clinical outcomes. Revascularization reduces the incidence of AF and thus improves the clinical outcomes in these patients.     

Interstitial nephritis and interstitial nephropathy

930568 The production and significance of IL4in patients with idiopathic nephroctic syndrome.YAO Zhi(姚智),et al.Dept Immunol,BeijingMed Univ,Beijing,100083,Natl Med J China1993;73(5):261—263.Samples of serum and PBMC were collected atthe same time from 42 pediatric patients with id-iopathic nephrotic syndrome(INS)and 28 age—matched healthy individuals.The level os IgE inserum was detected and IL4 in supernatant ofPHA-activated PBMC assayed by sandwichELISA.The levels of IL4 and IgE in healthy in-dividuals were 400～500 pg/ml and 50～100 U/ml respectively,and those of IL and IgE in theINS patients were on the average 1080～4000Pg/ml and 380～1000 U/ml.Positive correla-     

P波离散度对特发性阵发性心房颤动的预测价值

目的 :探讨P波离散度 (Pd)对特发性、阵发性心房颤动的预测价值。方法 :观察 32例特发性、阵发性心房颤动患者的最大P波时限 (Pmax)、最小P波时限 (Pmin) 、Pd ,并与 30例健康对照者作对比分析。结果 :Pmax:心房颤动组非常显著高于对照组〔(12 0 8± 12 6 )ms比 (10 1 2± 11 9)ms,P <0 0 1〕 ;Pd :心房颤动组非常显著高于对照组〔(47.6± 13.4 )ms比 (2 7 9± 9 8)ms,P <0 0 1)〕 ;Pmin两组间差别无统计学意义。心房颤动组Pmax>110ms、Pd≥ 4 0ms的例数显著高于对照组 (P <0 0 1)。结论 :Pd可作为预测特发性、阵发性心房颤动发生的一个新指标。     

P波离散度与甲状腺功能亢进症并发阵发性心房颤动的关系

目的评价P波离散度及左房内径对甲状腺功能亢进症患者发生房颤的预测价值。方法 42例甲状腺功能亢进症患者按是否伴有房颤分为房颤组(n=20)和无房颤组(n=22),分别测量两组患者的心电图P波最大时限、P波最小时限并计算P波离散度,同时用超声心动图测量左房内径,对这些指标进行两组间的比较。结果房颤组较无房颤组P波最大时限、P波离散度及左房内径明显增加(P0.01);房颤组与无房颤组患者比较,心电图P波最大时限140ms、P波离散度40ms、左房直径均有显著性差异。结论 P波最大时限140ms、P波离散度40ms和左房直径增大是预测甲状腺功能亢进症并发阵发性房颤的有效指标。     

P波最大时限和P波离散度对高血压合并阵发性心房颤动患者的预测价值

目的探讨P波最大时限（Pmax）和P波离散度（Pd）对高血压合并阵发性心房颤动（PAF）患者的预测价值。方法采用12导联同步心电图记录方法测定82例高血压合并阵发性心房颤动（PAF）患者（观察组）的Pmax、P波最短时限（Pmin）和Pd,同时与66例原发性高血压不合并PAF的患者（对照组）进行比较,分析上述指标对高血压合并PAF发作预测的敏感度、特异度和阳性预测值。结果观察组Pmax和Pd分别为（120.5±10.0）ms和（47.6±9.0）ms,均显著高于对照组[（101.5±6.5）ms和（28.5±7.5）ms],组间比较差异有统计学意义（P〈0.05）;Pmax预测PAF的敏感度为84.5%,特异度为72.0%,阳性预测值为82.4%;Pd预测PAF的敏感度为78.0%,特异度为80.0%,阳性预测值为86.1%;两者联合应用的敏感度为79.3%,特异度为89.0%,阳性预测值为91.7%。结论 Pmax和Pd是预测高血压合并PAF的两个简便可靠的心电图指标,两者联合应用可提高预测的特异性和阳性预测值。     

P波离散度与阵发性房颤的关系探讨

目的探讨体表心电图P波离散度(Pwd)与心房纤颤(AF)的关系。方法81例AF患者,无器质性心脏病的AF患者36例为A组,合并器质性心脏病的AF患者45例为B组,测量其体表心电图的Pwd、P波最大时限(Pmax)并与45例健康对照组(C组)对比分析。以Pmax≥110ms和Pwd≥40ms为阳性标准,评估Pmax、Pwd和Pmax+Pwd对AF的预测价值。结果A组、B组分别与C组比较,Pmax、Pwd差异均有统计学意义(P<0.05),A组与B组比较无显著差异(P>0.05)。Pmax≥110ms时,预测AF的敏感性为85.6%,特异性为84.5%,阳性预测值为82.7%;Pwd≥40ms时,预测AF的敏感性为88.4%,特异性为89.7%,阳性预测值为85.9%:2个指标结合时预测AF的敏感性为78.7%,特异性为91.5%,阳性预测值为90.2%。结论体表心电图Pwd是预测房颤的有效指标,而当Pmax与Pwd相结合时预测房颤的特异性和准确性更高。     

P波离散度与老年高血压病并发心房颤动的关系

目的　探讨P波离散度对老年高血压病并发心房颤动的影响。方法　观察 5 0例老年高血压病并发阵发性心房颤动患者 (观察组 )的最大P波时限 (Pmax)、P波离散度 (Pd) ,并与 5 0例老年高血压病无阵发性心房颤动患者 (对照组 )比较。结果　观察组和对照组的Pmax分别为 12 4.3 1± 10 .11ms和 10 6.12± 8.16ms ,Pd分别为 48.98± 7.81ms和 3 5 .69± 5 .0 6ms ,前者均大于后者 (P <0 .0 1)。在观察组 ,Pmax≥ 110ms时 ,预测敏感性为 76% ,特异性为 77.5 % ;Pd≥ 40ms时 ,预测敏感性为 96% ,特异性为90 %。结论　Pd可能是预测老年高血压病并发阵发性心房颤动发生的敏感心电图指标之一。     

糖尿病并阵发性心房颤动患者P波离散度的临床研究

目的:探讨P波离散度(Pd)能否预测糖尿病患者伴发的阵发性心房颤动的发生。方法:观察42例有阵发性心房颤动病史的糖尿病患者(A组)的最大P波时限(Pmax)、最小P波时限(Pmin)、P波离散度(Pd)及左房内径(LAI))并与42例无阵发性心房颤动病史的糖尿病患者(B组)比较。结果:Pmax及Pd A组显著高于B组;Pmin、LAD无统计学差异。Pmax>110 ms、Pd>40ms时,预测心房颤动敏感性较高;Pmax>110ms+Pd>40ms时,预测心房颤动的特异性明显增高。结论:Pd增高可预测糖尿病患者伴发的阵发性心房颤动的发生,Pmax>110 ms+Pd>40 ms联用时可提高预测心房颤动的特异性。     

缬沙坦对高血压合并阵发性心房颤动患者P波离散度的影响

目的：评价缬沙坦对高血压病并阵发性心房颤动（简称PAF）患者P波离散度（Pd）和最大P波时限（Pmax）的影响,探讨其对房颤预防及治疗作用。方法：68例高血压合并阵发性心房颤动的患者被随机分成治疗组和对照组,每组34例。治疗组给予缬沙坦治疗,对照组给予非血管紧张素转化酶抑制剂（ACEI）类及非血管紧张素受体拮抗剂（ARBs）类降压药治疗,观察药物治疗6个月前后心电图（ECG）中的Pmax和Pd及超声心动图（UCG）中的左房舒张末内径（LADd）、左室收缩末内径（LVDs）、左室舒张末内径（LVDd）的变化。结果：治疗组Pmax、Pd、LADd均与对照组比较有显著性差异（P〈0．05）,药物治疗6个月后,缬沙坦治疗能降低PAF患者Pmax和Pd,改善患者左房功能。结论：治疗组的Pnlax、Pd和LADd与对照组相比有显著性差异,缬沙坦治疗能显著降低高血压合并PAF患者的Pmax和Pd,改善左房功能。     

年龄和肥胖对体表心电图P波离散度的影响

目的探讨年龄和肥胖对体表心电图P波离散度（P wave dispersion,Pd）的影响。方法选择226例体检健康者,根据年龄分为青年组（18～44岁）、中年组（45～59岁）和老年组（≥60岁）。根据体重指数（body mass index,BMI）分为正常组（18.5BMI23）、超重组（23BMI25）、肥胖组（25BMI30）和严重肥胖组（BMI30）。用12导同步心电图记录方法测定P波离散度（Pd）和P波最大时限（P wave maximum,Pmax）。结果肥胖组和严重肥胖组的Pd和Pmax明显长于正常组（Pd：36.2±9.4msvs27.7±9.6ms,P〈0.05;41.4±11.2msvs27.7±9.6ms,P〈0.01;Pmax：119.3±10.7msvs105.1±10.4ms,P〈0.05;125.2±10.6msvs105.1±10.4ms,P〈0.01）,而年龄变化对Pd和Pmax无明显影响。结论肥胖影响P波离散度和P波最大时限,年龄对两者无明显影响。     

急性心肌梗死并发阵发性心房颤动的心电学预测

①目的　探讨最大P波时限 (Pmax)、P波离散度 (Pd)和P波时限变异 (Pv)预测急性心肌梗死并发阵发性心房颤动的意义。②方法　观察 4 0例急性心肌梗死并发阵发性心房颤动病人 (Ⅰ组 )的Pmax、Pd、Pv ,并与 4 0例急性心肌梗死无并发阵发性心房颤动的病人 (Ⅱ组 )比较。③结果　Ⅰ组病人Pmax、Pd和Pv显著大于Ⅱ组 (t=2 .79～ 6 .6 2 ,P <0 .0 1 )。Pmax为 1 1 0ms、Pd为 4 0ms、Pv为 1 80ms2 时三者预测急性心肌梗死并发阵发性心房颤动的灵敏度分别是 78%、74 %、70 % ,特异度分别是 77.35 %、6 9.6 2 %、6 7.75 %。④结论　Pmax、Pd和Pv均可预测急性心肌梗死并发阵发性心房颤动的发生     

心房扩大与P波离散度

目的探讨心房扩大与P波离散度的关系。方法测量经超声心动图确诊心房扩大的55例患者和50例健康人的心电图P波最大时限（Pmax）和P波离散度（Pd），以Pmax□110ms，Pd□140ms为阳性标准，评估心房扩大与Pd的关系。结果与正常对照组比较，心房扩大组的Pd值明显增大，其差异有非常显著性。两组比较，Pmax无明显差异。Pd值用于诊断心房扩大的阳性率明显高于Pmax。结论心房扩大可导致Pd值增大，Pd值可作为诊断心房扩大的一个有用的观察指标。