食管电生理检查在鉴别宽QRS波心动过速中的诊断价值

目的:分析食管电生理检查在宽QRS波心动过速(WCT)中的诊断临床价值。方法:对WCT患者采用DF-5A型电生理剌激仪实施食管电生理检查,并分别采用3种ECG检测标准:Brugada四步法、aVR导联四步法、RWPT法对WCT进行检测,分析四种方法诊断的准确率,对VT的敏感性和特异性。结果:84例WCT患者中,VT 47例,SVT 37例;应用Brugada四步法正确诊断率85.7%;aVR导联四步法,正确诊断率69.0%;RWPT法正确诊断率为63.1%,食管电生理检查正确诊断率为98.8%;Brugada 4步法、aVR单导联法、RWPT法、食管电生理检查法的VT敏感性分别为82.9%、80.9%、38.2%、97.8%;Brugada 4步法、aVR单导联法、RWPT法、食管电生理检查法的VT特异性分别为86.8%、60.6%、79.5%、100%;Brugada 4步法、aVR单导联法、RWPT法、食管电生理检查法的准确率、敏感性、特异性差异有显著统计学意义(P<0.05)。结论:食管电生理检查鉴别宽QRS波心动过速,诊断效果好,准确性高。     

食管电生理在快速性心律失常中的应用

目的探讨食管电生理在快速性心律失常中的应用价值。方法随机选择2017年1月至2018年12月梅州市人民医院202例因快速性心律失常行心脏射频消融术患者为研究对象,所有患者术前经食管电生理检查,将食管电生理检查结果与心内电生理进行检查对比。结果以心内电生理结果为准,食管电生理诊断符合率为94.06%;食管电生理与心内电生理对房室结内折返性心动过速(AVNRT)、房室折返性心动过速(AVRT)、房性心动过速(AT)、心房颤动(Af)、分支型室速(VT)检出率对比差异无统计学意义(P0.05)。结论食管电生理在快速性心律失常中诊断准确率高,且能明确疾病分型,值得推广。     

Brugada四步诊断法在宽QRS波心动过速中的应用价值

目的：探讨Brugada四步诊断法在宽QRS波心动过速中的鉴别诊断价值,方法：对78例经食管心房调搏、射频消融术及心内电生理检查确诊的宽QRS波心动过速者的心电图,按Brugada四步判断方法进行分析。结果：78例患者诊断符合率分别为：SVT伴室内差传者90.3%(28/31);VT者93.3%(28/30）;SVT伴原有束支传导阻滞者87.5%(7/8);9例预激综合征伴旁道前向传导者均误判为“室速”。结论：该诊断法对大多数宽QRS波心动过速有鉴别诊断价值,但对预激综合征伴旁道前向传导所致的宽QRS波心动过速的诊断价值不大。     

心电轴偏转在心电图诊断宽QRS波心动过速中的应用价值

目的 分析心电轴偏转在体表心电图诊断宽QRS波心动过速（WCT）中的作用。方法 选择2018年2月至2019年1月广州医科大学附属第二医院经电生理检查证实的WCT患者124例,回顾性分析患者的临床资料,应用查表法计算WCT和窦性心律下QRS波额面心电轴偏转情况,评估其在体表心电图中鉴别诊断WCT中的临床价值。结果 经电生理检查WCT发现,其中室性心动过速（VT）96例（77.4%）,室上性心动过速（SVT）28例（22.6%）。WCT中体表心电图QRS波电轴偏转>68°时检出VT、SVT阳性高于电轴偏转>130°（P<0.05）;电轴在无人区与电轴偏转>130°时的诊断特异度分别达到100.0%,但敏感度较低（21.86%、27.08%）,右束支阻滞型（RBBB）合并电轴左偏多见于VT,其诊断特异度为91.67%;电轴偏转>68°在诊断VT具有较高的特异度（91.67%）、敏感度（54.17%）。结论 QRS波额面电轴偏转可准确鉴别诊断WCT,可作为基层医院心脏急症辅助诊断的方式,值得临床推荐应用。     

食管心电图在鉴别宽QRS波心动过速中的诊断价值

宽QRS波心动过速 (wideQRScomplextachycardia ,WRT)是指QRS波时限大于 0 .1 2s,心室率每分钟大于 1 0 0次的心动过速。WRT是一种较常见的心血管病急症之一 ,其诊断方法主要依靠心电图记录 ,既往心电图上许多鉴别标准经实践证明存在一定局限性 ,容易误诊 ;因误诊而采用不适当治疗导致严重后果者屡有发生 ,故对WRT的正确诊断与处理 ,具有重要的临床意义。食管心电图 (ESO)对WRT的鉴别诊断具有明显优越性 ,本研究对 38例WRT用Brugada四步诊断法和食管导联心电图进行结果对照 ,然后通过射频消融术及心内电生理检查确定其诊断 ,探讨ESO的鉴别     

经食管心脏电生理检查诊断快速心律失常的应用价值分析

目的:研究分析经食管心脏电生理检查诊断心律失常的临床应用.方法:选取该院2013年3月至2015年3月期间收治的快速心律失常患者90例,随机将患者分为对照组和观察组,每组45例患者,对照组患者给予体表心电图检测,观察组患者行食管心脏电生理检查,观察和记录两组患者的心律失常的检出率,并进行比较.结果:对照组患者应用体表心电图检出快速心律失常患者29例,检出率为64.4％,观察组患者应用食管心脏电生理检查检出心律失常患者40例,检出率为88.9％,组间检出率比较观察组高于对照组(P＜0.05).结论:经食管心脏电生理检查可快速诊断心律失常患者,与体表心电图检测比较,检出率明显提高,可在临床诊断中广泛应用.     

宽QRS波心动过速的临床鉴别及急诊处理

目的 探讨宽QRS心动过速的临床鉴别及急诊处理原则。方法 对急诊收治的21例宽QRS心动过速患者的临床资料、心电图检查及治疗方法进行回顾性分析。结果 1例心肌梗死患者死亡，其余20例均能复律成功，临床效果明显。结论 病史体检及体表心电图是临床诊断宽QRS心动时速的最主要方法；Brugada四步法是鉴别诊断的重要手段；急诊处理首要原则是纠正血流动力学障碍，鉴别有困难时，按室性心动过速（VT）治疗。     

食管与心内电生理检查诊断室上性心动过速的对比研究

目的探讨食管电生理检查对室上性心动过速(SVT)诊断及分型的准确性。方法对192例SVT患者的食管电生理检查和心内电生理检查结果进行对照比较。结果2种电生理检查对房室结双径路(DAVNP)、房结折返性心动过速(AVNRT)、房室折返性心动过速(AVRT)、常见的顺向型房室折返性心动过速(OAVRT)、左侧房室旁道(LAP)、右侧房室旁道(RAP)的诊断率相一致,差异无统计学意义(P>0.05),但食管电生理检查对间隔旁道(SAP)参与的AVRT与房性心动过速(AT)的诊断率较心内电生理检查低(P<0.05)。结论食管电生理对常见SVT的诊断及分型与心内电生理有相似的价值,且具有无创、简便、费用低等特点。     

电生理检查对室上性心动过速(SVT)诊断及分型的准确性分析

目的:对电生理检查对室上性心动过速(SVT)诊断情况以及分型的准确性进行分析。方法:随机抽取室上性心动过速临床患者178例,对其分别采取术前食管电生理检查和术中心内电生理检查,对检查结果进行比较分析,对诊断价值进行评价。结果:两种电生理检查的结果之间存在的差异较小,只是对于间隔旁道(SAP)参与的AVRT与房性心动过速(AT)的诊断率而言食管电生理检查较心内电生理检查低。结论:采用电生理检查对室上性心动过速进行诊断具有很好的临床应用价值,值得对其予以推广。     

50例室上性宽QRS心动过速的临床分析

目的:对自然发生的室上性宽QRS心动过速的临床特征、心电图特点进行分析,并用Brugada四步诊断法与室速进行鉴别诊断,评价其敏感性.方法:选择入院时为心动过速的患者,符合窦性P波消失、心室率＞100次/分且QRS时限≥0.12S,心脏电生理检查明确诊断后,采用单盲法回顾性的分析12导联体表心电图的形态学特征,独立做出诊断后,计算Brugada四步诊断法的敏感性并评价其实用性,同时分析其临床特征及血液动力学改变.结果:入选50例室上性宽QRS心动过速患者,46例诊断为室上速伴束支传导阻滞或心室内差异性传导,敏感性92%;心室率＜180次/分组与心室率＞180次/分组,两组的的平均收缩压、平均舒张压及平均动脉压(平均动脉压=舒张压 l/3脉压差)均有差别,心率较快组血压较低,P值＜0.05,差别有统计学意义.结论:Brugada法对室上性宽QRS心动过速的鉴别诊断有重要意义,正确的诊断和及时的处理对患者至关重要.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.