右心室间隔部希氏束附近室性期前收缩心电图与射频消融

目的 报道右心室流入道间隔部希氏束附近起源室性期前收缩体表心电图特征及射频消融效果。方法 无器质性心脏病频发性室性期前收缩5例,分析其12导联体表心电图室性期前收缩特点;病人接受心内电生理检查,于右心室流入道行激动与起搏标测,以心室激动较体表QRS波提早、消融导管远端起搏图形与体表心电图室性期前收缩相似部位为消融靶点。结果 室性期前收缩QRS波形态：5例病人Ⅰ导联和Ⅱ导联QRS波均呈R型,Ⅲ导联、aVF导联以低振幅波为主,V1导联均呈QS型,胸导联较早转变成qR或R型（发生于V2或V3）,V5、V6均呈高R型;室性期前收缩QRS波时限为110～120ms。5例病人分别于前间隔（2例）、中间隔（1例）、后间隔（2例）标测到消融靶点,放电后前间隔部、后间隔部病人室性期前收缩均消失,中间隔病人消融失败。无房室传导阻滞并发症。随访8～30个月,成功病例未应用抗心律失常药物,无室性期前收缩发作。结论 右心室流入道间隔部希氏束附近起源室性期前收缩体表心电图具有明显的特征,认识这些特征有助于导管标测与射频消融,消融此部位室性期前收缩安全、有效。     

射频导管消融特发性左心室流出道室性心动过速

目的 探讨特发性左心室流出道室性心动过速(室速)心电图特点及射频导管消融结果。方法 对5例未发现器质性心脏病的左心室流出道室速患者行12导联心电图、动态心电图、心内电生理检查及射频导管消融治疗。结果5例患者心电图Ⅱ、Ⅲ、aVF导联呈R波；Ⅰ导联呈rs或QS波，振幅大于0．5mV；V1导联呈rs或RS波，胸前导联R波移行发生于V2～V3；aVR和aVL导联呈QS波，3例患者的消融靶点在左冠状窦口内，2例位于主动脉瓣下，随访6个月，无1例复发。结论 左心室流出道室速有特殊心电图表现，射频导管消融是首选的治疗措施。     

Carto指引下儿童三尖瓣环起源室性早搏射频消融一例

1例3岁10个月男性患儿因频发室性早搏入院行射频消融术,室性早搏12导联体表心电图提示胸前导联呈左束支传导阻滞图形,Ⅰ、Ⅱ、Ⅲ、aVF导联主波向上,呈R型,aVL导联呈rs型,aVR导联深倒,呈QS型,QRS波时限约98 ms,术中根据消融导管的X线影像及三维电解剖证实为三尖瓣环12点钟位置起源,邻近希氏束。     

导管射频消融治疗起源邻近希氏束的特发性左心室心动过速

目的 阐明起源自邻近希氏束的特发性左心室心动过速（ILVT）的标测和消融方法。方法 对6例起源自邻近希氏束部位的ILVT进行了成功的导管射频消融治疗。经逆行法在左心室间隔面标测最早浦肯野电位，以最早浦肯野电位记录点和／或标测电极机械损伤能明确终止心动过速的地点作为消融靶点。结果 （1）消融成功率83.3%（5／6），1例多形室性心动过速（室速）在一点消融后3种形态室速均不能被诱发，随访2－48个月无复发。失败1例，是在成功消融室速的同时并发了完全性房室阻滞；（2）标测结果：心动过速时HV（H－QRS）间期是15－20ms。6例均在左心室间隔邻近希氏束或左束支部位滑动导管时终止心动过速，最早浦肯野电位较H波提前6－16ms、较QRS提前25－36ms。5例在窦性心律下消融，1例在心动过速时消融。结论 导管射频消融对起源于邻近希氏束的ILVT也具有较高的成功率；标测导管易因机械性损伤而终止心动过速；心动过速时最早浦肯野电位并结合机械损伤能终止心动过速的地点是确定消融靶点的方法，在窦性心律下放电是避免发生完全房室阻滞的关键。     

右室流出道室性期前收缩的心电图特征及射频消融治疗

目的:探讨右室流出道室性期前收缩(室性早搏,室早)的心电图特征和评价单导管法消融单形性右室流出道室性早搏的有效性、安全性和实用性。方法:对52例心脏结构正常的右室流出道单形性室早的心电图特征进行分析并行单导管射频消融。采用起搏标测法,以起搏时与自发室性早搏形态波形态完全相同点为消融靶点。结果:右室流出道的室性早搏体表12导联心电图特征,呈完全性左束支阻滞形态,Ⅰ导联呈rs、m、QS及R型,aVR、aVL均呈QS型,Ⅱ、Ⅲ、aVF、V5~6导联均呈单向R波型,胸前导联R波移行区常在V3、V4导联之后。成功消融结果显示26例室早起源右室流出道间隔部:其中前间隔7例、中间隔5例、后间隔14例,游离壁21例:其中前游离壁6例、后游离壁15例,希氏束附近1例,肺动脉瓣下1例。消融即刻成功率94%(49/52),未成功的3例。手术操作时间30~150 min,X线曝光时间5~29 min。术后随访2~48个月无复发。结论:起源于右室流出道的室性早搏有其独特的心电图表现,单导管射频消融可有效、安全地消融心脏结构正常的右室流出道单形性室性早搏。     

三维标测系统指导下希氏束旁室性期前收缩的射频消融及心电图分析

目的:探讨三维标测系统指导下经导管射频消融起源于希氏束旁室性期前收缩(室早)的疗效及安全性。方法:对7例起源于希氏束旁频发室早的患者在三维标测系统指导下行射频消融治疗,其中5例采用Car-to标测系统,2例采用Ensite Array系统。采用Carto标测系统者经股静脉送入消融大头至右室,在室早发作时采点建模,建立右室解剖结构及电激动顺序三维图像;采用Ensite Array标测系统者经股静脉送入Array球囊电极至右室流出道,利用消融大头采点,建立右室三维图,并对室早激动起源及出口进行实时标测。在右室三维解剖图上标示出希氏束位置,观察最早激动点与希氏束的距离,对心律失常的最早激动部位消融。冷盐水大头消融功率为25W,温度为43℃,0.9%氯化钠溶液流量消融时17～20ml/min,放电间隙2ml/min。结果:7例患者室早体表心电图呈左束支传导阻滞图形,Ⅰ、Ⅱ、aVL、aVF导联为直立的R波,Ⅲ导联为R、rs、rS、rsR,均为RⅡ>RaVF>RⅢ,V1导联为QS型。7例患者均在希氏束旁标测到最早激动点,位于希氏束上方(11.29±2.98)mm处,在最早激动点及附近消融成功,室早消失,与术前同样条件静脉滴注异丙肾上腺素不能诱发室早。2例患者术中出现右束支传导阻滞,1例经术中推注地塞米松10mg后转复正常,另1例术后4d心电图转复正常。随访12～28个月,无复发。结论:三维标测系统指导下经导管射频消融起源于希氏束旁室早安全有效。     

经主动脉窦途径射频消融心动过速临床研究

目的:探讨经主动脉窦途径导管射频消融治愈的快速性心律失常患者的心电图特点及射频消融情况.方法:回顾性分析17例室性心动过速/室性期前收缩、前间隔房性心动过速及前间隔旁路等该类患者的体表心电图、及消融成功时靶点电图等心电生理学特征.结果:经主动脉窦途径导管射频消融治愈室性心动过速/室性期前收缩12例,其中起源于左冠状动脉窦(左冠窦)10例、右冠状动脉窦(右冠窦)2例;源于无冠状动脉窦(无冠窦)的局灶性前间隔房性心动过速3例及前间隔旁路2例.室性心动过速/室性期前收缩心电图特点:Ⅱ、Ⅲ和aVF导联为高大R波,胸导联R波移行较早,V1导联r/S波振幅比≥30%,r波时限(82.2±16.4)ms,V1导联中r/QRS波时限比≥50%,V5、V6导联为高振幅R波、无s波.有效消融靶点心内电图示心室波明显比体表心电图QRS波提前(35.2±21.6)ms.前间隔房性心动过速均能被心房刺激反复诱发和终止,其心电图特点:房性心动过速时P波间期明显窄于窦律时P波间期,Ⅰ、aVL导联P波正向,Ⅱ、Ⅲ和aVF导联P呈负正双向.在心房标测中提示最早的心房激动在希氏(His)束区,但在主动脉无冠窦内标测的心房激动较His束区的心房波提前,其解剖定位于His束上后方,消融靶点无His束电位.前间隔旁路心电图示:窦性心律时呈窄QRS波形,未见预激波,心动过速呈窄QRS形,在无冠窦内记录到最早心房激动点,且无His束电位.17例均消融成功.结论:源于主动脉窦内的室性心动过速/室性期前收缩、前间隔房性心动过速和前间隔旁路具有相对的心内电生理学特征,常规心内膜途径消融困难时应该考虑从主动脉窦途径标测消融策略,把握消融导管与冠状动脉的关系,导管消融治疗安全而有效.     

导管射频消融右心室流出道特发性室性心动过速两种标测方法的比较

观察连续起搏标测法指导右心室流出道室性心动过速(室速 )导管射频消融治疗的实际作用。选择经心内电生理检查确诊且适合进行导管射频消融治疗的连续 2 7例右心室流出道室速病例进入观察 ,按随机数字表法分为间断起搏标测组和连续起搏标测组。间断起搏标测组的标测步骤为 :1根据自发右心室流出道室速心电图判断起源部位 ;2将大头电极送至预定部位 ,以等于或接近于自发室速的频率起搏右心室流出道 ,记录 12导联起搏心电图 ;3停止起搏 ,比较室速心电图和起搏心电图的 QRS波形态、振幅和持续时间 ;4如果两者在任何 1个导联上存在差异 ,则相应…     

希氏束旁起源房性心动过速心电生理特征及射频消融疗效

目的分析起源于希氏束旁房性心动过速(房速)的心电生理特征及射频消融治疗效果。方法选自2009年1月至2014年5月在首都医科大学附属北京安贞医院心内科就诊的经心内电生理检查和射频消融证实起源点位于希氏束旁的房速,简称希氏束旁房速18例,其中男2例,女16例,年龄31~68(40±9)岁,病史1~10年。对患者临床特征、心电生理特点及射频消融疗效进行分析。结果希氏束旁房速大多为女性,16例表现为阵发性,为心房或心室程序刺激诱发和终止,2例为无休止心动过速。所有患者房速心电图P波窄而低幅,Ⅱ,Ⅲ,a VF和V1导联P波负正双向,Ⅰ、a VL导联为直立,V2~V6导联P波负向。右房激动标测示心内最早激动位于希氏束附近,并领先于体表P波起始(15±3)ms。16例患者于无冠窦内消融成功,2例于右房希氏束旁消融成功,均无并发症,随访12个月所有患者均无心动过速复发。结论希氏束旁房速有独特的临床特征,心电图特征及心房内激动顺序,应首选无冠窦途径消融,长期随访房速行射频消融治疗安全有效。     

三维标测系统指导射频消融治疗三尖瓣环游离壁起源的室性心律失常临床分析

目的探讨三尖瓣环游离壁起源的室性心律失常(VAs)体表心电图特点及三维标测系统指导下射频消融治疗的效果。方法回顾性分析2016年10月至2017年10月在北京安贞医院住院的连续9例起源于三尖瓣环游离壁的VAs患者。所有患者均在三维标测系统指导下采用压力监测导管进行激动标测和基质标测,行射频消融治疗,分析患者12导联心电图QRS波特征。结果 9例VAs患者经射频消融即刻成功8例(8/9),失败1例(1/9),后经心外膜标测消融,心内膜、心外膜均可见大片异常电压区,所有患者均无并发症发生。起源于三尖瓣环游离壁的VAs患者心电图特征表现为左束支传导阻滞,V1、V2导联呈r S型,Ⅰ、V5及V6导联呈R型,胸前导联移行区通常在V4或之后,由三尖瓣环后侧壁到侧壁再到前侧壁,下壁导联R(r)波逐渐增高,而S(s)波逐渐变浅甚至消失,同时R(r)波呈Ⅱa VFⅢ,S(s)波呈ⅢaVFⅡ。结论三维标测系统指导射频消融治疗三尖瓣环游离壁起源的VAs安全有效,该部位起源的VAs患者有典型心电图特征,部分超声心动图结构正常的患者继发于致心律失常性右心室心肌病,可能为其早期表现。     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

Weighing the QT Intervals with the Slope or the Amplitude of the T Wave

Objective: The reproducibility of QT interval measurements is low, even for the mean QT interval based on the standard ECG. In this study we analyzed whether the reproducibility of the mean weighed QT interval was better than the simple mean QT interval. The weighing was based on the amplitude of the T wave or the slope of the steepest tangent on the terminal part of the T wave. Material and methods: 12‐lead ECGs of 130 postmyocardial infarction patients were obtained. The QT intervals were measured by the tangent‐method on two occasions by the same observer Mismatch QT intervals were defined as QT intervals that were measured at only one occasion. Sixteen ECGs were rejected. The data were split into 34 and 80 ECGs for optimization and validation of the weighing, respectively. The weighed QT dispersion was calculated as the weighed mean of the three longest minus the weighed mean of the three shortest QT intervals. Results: Weighing with the slope increased the reproducibility by 41% (P = 3 10^‐6), but weighing with the amplitude reduced it by 20% (P = 0.02). However, if measurements with errors above 75 ms were rejected, weighing with the slope or the amplitude increased the reproducibility with 26% and 20% (P = 0.02), respectively. Weighing did not change the reproducibility of the weighed QT dispersion. Conclusion: Weighing with the slope improved the reproducibility of the mean weighed QT interval. However, if measurements with errors above 75 ms were rejected, weighing with the amplitude also increased the reproducibility. Weighing did not change the reproducibility of the weighed QT dispersion. Weighing is particularly efficient at reducing the negative impact of mismatch QT intervals on the reproducibility. A.N.E. 2002;7(1):4–9     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

大骨节病病区水,粮实验对动物的骨和软骨中化学元素组成的影响

用质子激发 X 线荧光分析方法(PIXE)测定了大骨节病病区和非病区的水、粮以及用该水粮喂养的大白鼠的肋软骨和硬骨中22种化学元素的含量。结果发现水粮中存在差异的元素反应在用该水粮喂养的大白鼠的骨、软骨中也存在差异,含量都低的元素有 P、Mn、Cu、As、Zn。都高的有铅。其中锌低在水、粮、硬骨和软骨中都完全一致呈非常显著性差异(p<0.01)。提示病区水、粮中化学元素对骨质的影响不是单一元素缺乏或过多所致,而是多种元素的复合因素。     

Assessment of the Soft-Tissue Seal at the Interface between the Base of the Fixed Denture Pontic and the Oral Mucosa

Fixed dentures (bridges) are often selected as a treatment option for a defective prosthesis. In this study, we assess the contact condition between the base of the pontic and oral mucosa, and examine the effect of prosthetic preparation and material biocompatibility. The molars were removed and replaced with experimental implants with a free-end type bridge superstructure after one week. In Experiment 1, we assessed different types of prosthetic pre-treatment: (1) the untreated control group (Con: mucosa recovering from the tooth extraction); (2) the laser irradiation group (Las: mucosa recovering after the damage caused by a CO₂ laser); and (3) the tooth extraction group (Ext: mucosa recovering immediately after the teeth extraction). In Experiment 2, five materials (titanium, zirconia, porcelain, gold-platinum alloy, and self-curing resin) were placed at the base of the bridge pontic. Four weeks after the placement of the bridge, the mucosa adjacent to the pontic base was histologically analyzed. In Experiment 1, the Con and Las groups exhibited no formation of an epithelial sealing structure on the pontic base. In the Ext group, adherent epithelium was observed. In Experiment 2, the sealing properties at the pontic interface were superior for titanium and the zirconia compared with those made of porcelain or gold-platinum alloy. In the resin group, a clear delay in epithelial healing was observed.     

高胆红素血症对肿瘤标志物测定的影响探讨

目的探讨高胆红素血症对Ca19-9、Ca24-2和CEA检测的影响.方法对320例胆管、胆囊良恶性疾病病人,15例胆囊炎病人的胆汁和血清以及10例肝硬化、10例黄疸肝炎病人进行Ca19-9、Ca24-2和CEA检测.结果在良性胆管、胆囊疾病中,Ca19-9的假阳性最高;在胆红素增高的良性疾病中,Ca19-9假阳性率达46.7%;15例胆汁和血清以及10例肝硬化和10例黄疸肝炎病人中,Ca19-9的假阳性率分别为93%、20%、80%和80%.结论高胆红素血症对Ca19-9检测影响最明显,胆囊、胆管良恶性疾病鉴别时,以Ca24-2和CEA检测为佳.     

Echocardiography in the Emergency Department: From the Perspective of the Emergency Physician and the Cardiologist

Echocardiography performed in the emergency department must adapt to this new setting for noninvasive diagnostic testing. Emergency physicians require echocardiography to provide rapid diagnosis in life-threatening emergencies. New initiatives are being proposed by emergency physicians in the delivery of this test. Cardiologists now use echocardiography in the emergency-department to make the diagnosis of heart disease earlier and with greater accuracy.     

Tracing the protectors path from the germ line to the genome

One of the basic principles that nature uses in evolution is to recycle successful concepts and create new functions by modifying existing units. This conservatism in evolution has resulted in an astonishingly high sequence identity of genes, even between evolutionarily distant species such as the nematode Caenorhabditis elegans and Homo sapiens. The recycling of successful concepts in conjunction with gene duplication events has also led to the existence of highly homologous proteins within the genome of many species. Often, these homologous proteins show similar, yet distinct functions that, in combination with their individual tissue distribution, define their specific physiological role. One prominent example is the p53 protein family, which consists of p53, p63, and p73. Recent advances in understanding the specific biological functions of these members have shed some light onto the evolution of this crucial protein family, from a germ line-specific quality-control factor to a somatic tumor suppressor. Furthermore, structures of the oligomerization domains of the mammalian paralogs, p53 and p73, and invertebrate orthologs, CEP-1 and DMP53, have delineated evolutionary changes and revealed that the oligomerization domain of p53 lacks additional stabilizing structural elements present in all other p53 family members. This suggests that p53 is the most recent evolutionary member of this protein family and predicts a mechanism for p53 activation.