A renal artery aneurysm incidentally found at operation. Should it be resected?

A rare case of a patient with a ruptured abdominal aortic aneurysm (AAA) and an incidentally found left renal artery aneurysm (RAA) is presented. Successful repair of both aneurysms was simultaneously performed. The indications for such a surgical approach are also discussed.     

慢性肝病患者肝螺杆菌血清抗体水平分析

目的分析不同病因慢性肝病患者血清肝螺杆菌抗体(抗H.hepaticus-IgG)相对抗体活性(RAA)以及螺杆菌抗原之间的交叉反应。方法随机选取不同病因的慢性肝病患者(CLD)76例(其中慢性乙型病毒性肝病27例、慢性丙型病毒性肝病25例、自身免疫性肝炎8例和慢性酒精性肝病16例)、健康献血者80名以及体检人群80名,应用ELISA方法检测吸收试验前后血清中抗H.hepaticus-IgG相对抗体活性。结果 CLD患者抗H.hepaticus-IgG抗体的RAA明显高于献血者和普通人群组(P<0.001);CLD患者和普通体检人群抗H.pylori-IgG抗体的RAA平均值明显高于献血者(P<0.001);CLD患者中除自身免疫性肝炎患者外,慢性乙型肝炎患者、慢性丙型肝炎及酒精性肝病患者抗H.hepaticus-IgG抗体的相对抗体活性反应均明显增高,慢性丙型肝炎患者抗H.hepaticus-IgG抗体的RAA值明显高于其他肝病患者(P<0.001),吸收试验前后抗H.hepaticus-IgG抗体的RAA值无显著性变化(P>0.05)。结论 H.hepaticus和H.pylori的细胞表面蛋白具有较高的交叉反应,慢性肝病患者抗H.hepaticus-IgG抗体反应在吸收试验后仍保持较高水平。     

非瓣膜性房颤患者右心耳右心房超声特征与心肌细胞凋亡关系的研究

目的研究非瓣膜性心房纤颤（NV-AF）右心耳（RAA）及右心房超声特征与心房肌细胞凋亡的关系。方法采用经食管超声观察25例NV-AF患者（观察组）和15例窦性心律者（对照组）的RAA及右心房变化,心肌细胞原位末端标记法（TUNEL法）检测RAA的心肌细胞凋亡指数。结果观察组RAA耳充血、排血峰速及速度积分、RAA及右心房射血分数均较对照组显著减小,RAA面积增大,心房肌细胞凋亡指数增高（P〈 0．05）。RAA内自发性超声造影（SEC）现象检出率占16％,RAA及右心房内未发现血栓。对照组未检出SEC或血栓。相关分析显示,心房肌细胞凋亡指数与RAA充流、排血峰速、RAA及右房射血分数呈负相关（P均〈 0．05）,而与RAA及右心房面积呈正相关（P均〈0．05）,与右心室射血分数无相关性（P〉0．05）。结论NV-AF患者的RAA及右心房改变与心房肌细胞凋亡密切相关,心肌细胞凋亡是其病理过程的中间或基础环节之一。     

Stent-assisted Coil Embolisation of Wide-necked Renal Artery Aneurysms

IntroductionA wide-necked saccular renal artery aneurysm (RAA) arising from the left posterior segmental was not reported before and can be treated by stent-assisted coil embolisation.Case reportA 69-year-old man presented with RAA arising from left posterior renal segmental artery, which was a saccular wide-necked RAA that was 2.5 cm in size. He underwent endovascular coil embolisation assisted with a self-expanding nitinol stent that originally had been constructed for the treatment of intracranial aneurysm. Distal renal infarction occurred in stented segmental artery.DiscussionDistal infarction after stent-assisted coil embolisation should be considered as a possible complication in the treatment of RAA in relatively small renal segmental artery.     

Effect of Bachmann's bundle pacing on atrial fibrillation: electrophysiologic assessment

BACKGROUND: It has recently been reported that simultaneous multisite atrial pacing, Bachmann's bundle (BB) pacing, and coronary sinus (CS) pacing are useful for preventing the induction of atrial fibrillation (AF). HYPOTHESIS: We investigated whether a simple pacing approach via BB could reduce the induction of AF by extrastimuli (S2) from the right atrial appendage (RAA). METHODS: Programmed electrical stimulation was performed from the RAA and the area of BB at the superior aspect of the atrial septum, and bipolar recordings were obtained from the RAA, BB, and CS in 14 patients. RESULTS: In five patients, AF was induced with critically timed RAA-S2 delivered during RAA pacing. However, AF was not induced in any patient when RAA-S2 was delivered during BB pacing. The duration of the P wave during BB pacing was significantly shorter than that during RAA pacing and sinus rhythm (BB 80 +/- 16 ms vs. RAA 106 +/- 36 ms vs. sinus rhythm 100 +/- 24 ms, p < 0.05). The intra-atrial conduction time to the distal coronary sinus (CSd) caused by early S2 at the RAA was significantly reduced by BB pacing (BB 114 +/- 22 ms vs. RAA 157 +/- 35 ms, p < 0.001). CONCLUSION: Bachmann's bundle pacing reduces atrial conduction time caused by RAA-S2 and may be useful for preventing the induction of AF.     

Frequency of aberrant subclavian artery, arch laterality, and associated intracardiac anomalies detected by echocardiography

Tetralogy of Fallot is generally considered to be the most common congenital heart defect associated with an aberrant subclavian artery (ASA), but the prevalence of ASA in patients with other cardiac anomalies is not well described. The pediatric echocardiography database, with 15,871 initial echocardiograms, was searched for all patients with ASA. Arch laterality and associated intracardiac anomalies were documented for each patient. ASA was found in 226 patients, of whom 171 had a left aortic arch (LAA) and 55 had a right aortic arch (RAA). The occurrence of ASA was 1% in patients with LAA (171 of 15,650) and 25% in patients with RAA (55 of 221; p = 0.001). Intracardiac anatomy was normal in 32% of patients with ASA/LAA and 25% with ASA/RAA. Conotruncal anomalies occurred more frequently with ASA/RAA than ASA/LAA (36% vs 18%; p = 0.01). Atrioventricular canal defects accounted for 10% and left-sided cardiac obstructive lesions accounted for 11% of subjects with ASA/LAA. ASA was rarely associated with d-transposition of the great arteries (1 of 226) and double-outlet right ventricle (5 of 226). The prevalence of ASA was highest in patients with interrupted aortic arch (11 of 38; 29%). In patients with tetralogy of Fallot, the overall prevalence of ASA was 8% (34 of 447), but was higher with RAA (16 of 103; 16%). The highest prevalence of ASA occurred in the subgroup of patients with tetralogy of Fallot with pulmonary atresia and RAA (6 of 25; 24%). In conclusion, ASA was more common in patients with RAA, especially with conotruncal anomalies. In patients with LAA, hypoplastic left heart syndrome, aortic coarctation, and atrioventricular canal defects were commonly associated with ASA.     

Right Atrial Appendage Function in Different Etiologies of Permanent Atrial Fibrillation: A Transesophageal Echocardiography and Tissue Doppler Imaging Study

Objectives: Several studies exist on the left atrial appendage function (LAA) in permanent atrial fibrillation (AF). However, knowledge about the right atrial appendage (RAA) function is limited. We investigated RAA function with TEE and tissue Doppler imaging (TDI) in permanent AF patients with different etiologies and evaluated predictive parameters of right atrial spontaneous echo contrast (SEC) and thrombi. Methods: Patients with permanent AF developed due to three different etiologies (20 mitral stenosis, 44 hypertension, 20 hyperthyroidism) and 23 subjects with sinus rhythm were included into the study. RAA was examined with TEE and pulsed‐wave and TDI velocities of RAA were measured. Results: Both PW‐Doppler and TDI velocities were significantly impaired in all AF groups compared to controls. The lowest velocities were recorded in mitral stenosis patients. Right atrial moderate–severe SEC was observed in 75% of the mitral stenosis patients, in 25% of hypertensive patients, and in 30% of hyperthyroidism patients. Right atrial thrombus was observed in 25% of mitral stenosis, 4.5% of hypertension, and in none of the hyperthyroidism patients. In the multivariate analysis, the most important parameter associated with the severity of RAA SEC was the percent change in RAA area (B =−0.034, P = 0.03). Conclusion: In patients with permanent AF, impairment of RAA function and development of right atrial SEC‐thrombus are closely related to the underlying etiology. These results suggested that evaluation of RAA functions may have an incremental value over the assessment of the LAA for determining thromboembolic risk. (Echocardiography 2010;27:384‐393)     

Electrocardiographic characteristics in low atrial septum pacing

AIM: The aim of the study was to compare P-wave morphology and duration in pacing from the low right atrial septal wall and the high right atrial appendage (RAA). METHODS: The electrocardiogram (ECG) of 50 patients with low atrial septum (LAS) pacing and that of 50 patients with RAA pacing were compared with their electrocardiogram during sinus rhythm. RESULTS: In the frontal plane, patients with LAS pacing showed a superior P-wave axis between -60 degrees and -90 degrees . In all patients with RAA pacing, a P-wave axis between 0 degrees and +90 degrees was observed as in sinus rhythm. In the horizontal plane, all patients with LAS pacing had an anterior P-wave axis between +90 degrees and +210 degrees , whereas all patients with RAA pacing had a posterior P-wave axis between -30 degrees and -90 degrees . The terminal part of biphasic P waves in lead V 1 in LAS pacing was always positive, a pattern that was never observed in P waves of sinus origin or in RAA pacing. P-wave duration was longer with RAA pacing compared with LAS pacing (115 +/- 19 vs 80 +/- 14 milliseconds [ P < .01]). CONCLUSION: The total atrial activation time during LAS pacing is shorter than that during RAA pacing. The electrical atrial activation sequences in LAS pacing and RAA pacing are significantly different. The morphology of biphasic P waves in lead V1 during LAS pacing suggests that the initial part of activation occurs in the left atrium and the terminal part in the right atrium.     

Prevention of chronic atrial fibrillation by pacing in the region of Bachmann's bundle: results of a multicenter randomized trial

INTRODUCTION: Atrial pacing locations that decrease atrial activation and recovery time may be preferable in patients with a history of atrial arrhythmias. This multicenter prospective randomized study compared the efficacy of Bachmann's bundle (BB) region pacing to right atrial appendage (RAA) pacing in patients with recurrent paroxysmal atrial fibrillation (AF). METHODS AND RESULTS: Patients with standard pacing indications (n = 120, 70+/-11 years) were randomized to atrial pacing in either the RAA (n = 57) or BB region (n = 63). Implantation time was similar between groups (88+/-36 min [n = 38] for BB vs 83+/-34 min [n = 34] for RAA). No differences in pacing threshold, impedance, or sensing between BB and RAA groups were observed at implantation or after the 6-week, 6-month, and 1-year follow-up periods. Average length of follow-up was 12.6+/-7.4 months for the BB group and 11.8+/-8.0 months for the RAA pacing group. The percentage of atrial pacing was similar between groups (61%+/-34% RAA vs 65%+/-31% BB at 2 weeks after implant). BB atrial pacing significantly (P < 0.05) shortened p wave duration compared with sinus rhythm (123+/-21 msec vs 132+/-21 msec, n = 50) 2 weeks after implant. In contrast, p wave duration was longer during atrial pacing from the RAA position compared with sinus rhythm (148+/-23 msec vs 123+/-23 msec, n = 37). Additionally, p wave duration was shorter during BB pacing than during RAA pacing. Patients with BB pacing had a higher (P < 0.05) rate of survival free from chronic AF (75%) compared with patients with RAA pacing (47%) at 1 year. CONCLUSION: BB region pacing is safe and effective for attenuating the progression of AF.     

Electrical characteristics of low atrial septum pacing compared with right atrial appendage pacing.

AIM: The study was designed to compare the electrical characteristics of atrial leads placed in the low atrial septum (LAS) with those placed in the right atrial appendage (RAA) associated with dual chamber pacing. METHODS: In 86 patients an active-fixation (St. Jude Medical's Tendril DX model 1388T) atrial lead was positioned in RAA and in 86 patients the same model atrial lead was placed in the LAS. Pacing thresholds, sensing thresholds, impedances and the Far Field paced R-Wave (FFRW) amplitude and timing were compared at 6 weeks and at 3 and 6 months. RESULTS: The pacing threshold did not differ between groups. Sensed voltage of the P-wave was higher in the LAS compared with the RAA at 3 and 6 months (P=0.004). Impedance was higher in the LAS at 6 weeks and 3 months (P=0.002) but this difference was no longer significant at 6 months (P=0.05). The atrial sensed FFRW voltage was significantly higher in the LAS position compared with the RAA at 3 and 6 months follow-up (P=0.0002). FFRW voltage>1 mV was seen in 87% of the RAA pacing group and in 94% of the LAS pacing group (P=ns). The time between the ventricular pacing stimulus and the sensed FFRW in the atrium, (V spike-FFRW) in RAA was longer than in LAS at all follow-up measurements (P=0.006). CONCLUSIONS: The electrical characteristics of LAS pacing makes this alternative position in the atrium safe and feasible. Though statistical differences were found in P-wave sensing (LAS higher voltage than in the RAA) and FFRW sensing was higher in the LAS compared with the RAA this did not interfere with the clinical applicability of the LAS as alternative pacing site.     

Comparative Expression of Proteins in Left and Right Atrial Appendages From Patients With Mitral Valve Disease at Sinus Rhythm and Atrial Fibrillation

Proteomics and Atrial Appendages. Introduction: The objective was to compare by proteomics the expression of proteins associated with the cytoskeleton, energetic metabolism, and cardiac cytoprotection between left atrial appendages (LAA) and right atrial appendages (RAA) obtained from patients with mitral valve disease both in sinus rhythm (SR, n = 6) and in permanent atrial fibrillation (AF, n = 11). Methods and Results: Samples from RAA and LAA were obtained from the same patient. Proteins were separated in 2‐dimensional electrophoresis and identified by mass spectrometry. LAA from SR patients upexpressed α‐actin isotype 1 and desmin isotypes 3 and 5 with respect to RAA. In LAA from AF patients were upexpressed cardiac α‐actin isotypes 1 and 2, tropomyosin α‐ and β‐chains, and myosin light chain embryonic muscle/atrial isoform with respect to LAA from SR patients. In RAA from AF patients also upexpressed different cytoskeleton associated proteins with respect to RAA from SR patients. Different energetic metabolism‐associated proteins were upexpressed in LAA and RAA from AF with respect those from SR patients. In AF patients, the expression of proteins associated with cardiac cytoprotection such as gluthatione‐S‐transferase, heat shock protein (Hsp) 27, and different Hsp60 isotypes, were higher in RAA but not in LAA with respect to the corresponding appendages in SR patients. Conclusions: For each individual patient RAA and LAA showed a similar level of proteins expressed associated with cytoskeleton, energetic metabolism, and cardiac cytoprotection. There were more differences in the level of proteins associated with the above‐mentioned mechanisms between the atrial appendages from AF with respect to SR patients, which may open new targets for drugs. (J Cardiovasc Electrophysiol, Vol. 21, pp. 859‐868, August 2010)     

基于重组酶介导等温扩增技术的细粒棘球绦虫核酸检测方法的建立

目的　建立一种基于重组酶介导等温扩增技术（RAA）的细粒棘球绦虫核酸检测方法。方法　针对细粒棘球绦虫12S rRNA基因序列片段,设计、筛选并合成RAA特异性扩增引物和荧光检测探针,构建细粒棘球绦虫荧光RAA检测方法。分别以含靶序列的不同拷贝数重组质粒和不同浓度细粒棘球绦虫基因组DNA为模板进行荧光RAA扩增,评价其检测灵敏度;分别以细粒棘球绦虫、多房棘球绦虫、日本血吸虫、曼氏血吸虫、十二指肠钩虫、华支睾吸虫、牛带绦虫、曼氏迭宫绦虫、猪带绦虫基因组DNA为模板进行荧光RAA扩增,评价其检测特异性。结果　成功建立了细粒棘球绦虫荧光RAA检测法,在39 ℃条件下20 min内可以实现对细粒棘球绦虫基因组DNA特异性扩增,最低可以检测出10拷贝/μL含靶序列的重组质粒DNA和0.1 ng/μL细粒棘球绦虫基因组DNA样本,具备较高敏感性;对多房棘球绦虫、日本血吸虫、曼氏血吸虫、十二指肠钩虫、华支睾吸虫、牛带绦虫、曼氏迭宫绦虫、猪带绦虫基因组DNA均无阳性扩增,具备较高特异性;且该荧光RAA法可成功检出细粒球绦虫包囊中DNA。结论　成功建立了一种快速、灵敏、特异的可用于细粒棘球绦虫核酸检测的荧光RAA法。     

Cardiac hemodynamics and proinflammatory cytokines during biatrial and right atrial appendage pacing in patients with interatrial block

Purpose

Interatrial block (IAB) frequently coexists with sinus node disease and is considered a risk factor of left atrial dysfunction, atrial arrhythmias, and heart failure development. Conventional right atrial appendage (RAA) pacing impairs intra- and interatrial conductions and consequently prolongs P wave duration. Biatrial (BiA) pacing helps correct IAB, but its advantageous influence remains controversial. The aim of the study was to compare the effects of BiA and RAA pacing on cardiac hemodynamics and serum concentrations of inflammatory markers and neuropeptides.

Methods

Twenty-eight patients with IAB and preserved atrio-ventricular conduction treated with BiA pacing were studied. Standard invasive hemodynamic measurements were performed during BiA and RAA pacings. Furthermore, the influence of 1 week of BiA and RAA pacing on neuropeptides: atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) and markers of inflammation: high sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and neopterin was examined.

Results

BiA pacing resulted in significant increase of cardiac output (CO) and reduction of pulmonary capillary wedge pressure. We demonstrated significantly lower concentrations of ANP, hs-CRP, IL-6, and neopterin after 1 week of BiA in comparison to RAA pacing. BNP levels remained unchanged.

Conclusions

BiA pacing in comparison to RAA pacing improves hemodynamic performance in patients with IAB and preserved atrio-ventricular conduction. BiA pacing is associated with reduction of ANP and markers of inflammation (hs-CRP, IL-6, and neopterin).     

基于荧光重组酶介导等温扩增技术的利什曼原虫核酸检测方法的建立

目的 建立一种基于荧光重组酶介导等温扩增(recombinase-aided isothermal amplification,RAA)技术的检测利什曼原虫核酸的方法.方法 针对利什曼原虫内转录间隔基因序列1(ITS1)基因设计用于RAA检测的特异性引物和探针,通过引物配对筛选、引物和探针浓度优化,建立检测利什曼原虫核...     

Focal Atrial Tachycardia Originating from the Right Atrial Appendage: First Successful Cryoballoon Isolation

Electrical Isolation of the Right Atrial Appendage Using the Cryoballoon. Focal atrial tachycardias (AT) can arise from the right atrial appendage (RAA). However, conventional catheter mapping and radiofrequency (RF) ablation inside the RAA is associated with the risk of cardiac perforation. The cryoballoon catheter represents a novel ablation device that was originally developed to facilitate pulmonary vein isolation. This report describes the first successful RAA isolation using a cryoballoon in a patient with an incessant focal RAA AT despite previous irrigated tip endo- and epicardial ablation attempts. Further, cryoballoon ablation targets beyond pulmonary veins may evolve.     

重组酶介导的斯氏并殖吸虫等温扩增荧光检测方法的建立及检测效果初步评价

目的 建立一种基于重组酶介导的等温扩增(recombinase-aided isothermal amplification,RAA)技术的斯氏并殖吸虫快速核酸检测方法,并对其检测效果进行初步评价.方法 从溪蟹样本中分离出斯氏并殖吸虫、卫氏并殖吸虫和三平正并殖吸虫囊蚴,提取基因组DNA进行分子鉴定.以斯氏并殖吸虫线粒体...     

低位房间隔起搏的临床应用

目的行低位房间隔(LAS,Koch三角处)起搏并与右心耳(RAA)起搏进行比较和评价。方法60例需置入DDD起搏器的患者,随机分为RAA起搏组和LAS起搏组各30例,其中LAS组先将主动螺旋固定电极导线放置在RAA测量起搏参数后再将其植入LAS,而RAA组则用被动翼状电极导线直接固定在RAA。分别测量不同部位的起搏参数,比较手术成功率、X线曝光时间、术中及术后脱位率。结果两个部位的起搏电压阈值、阻抗无明显差别,但腔内P波振幅LAS明显高于RAA(3.8±0.7 mV vs 2.2±0.8 mV),LAS起搏的P波宽度明显短于RAA起搏的P波宽度(88±18 ms vs 154±37 ms)。与RAA组相比,LAS组的手术成功率偏低(90%vs 100%),手术曝光时间亦明显延长(128±45 s vs 12±4 s),术中脱位率在低位房间隔明显高于右心耳(33.3%vs 0%)。结论LAS起搏是可行的,能较RAA起搏明显缩短心房激动时间,但植入手术较传统RAA起搏复杂。     

荧光重组酶聚合酶扩增/CRISPR-Cas12a快速检测恶性疟原虫方法的建立与初步评价

目的 建立一种基于重组酶聚合酶扩增(recombinase-aided amplification,RAA)和CRISPR-Cas12a系统的荧光快速检测恶性疟原虫方法,并对其检测效能进行初步评价。方法 选择恶性疟原虫18S核糖体RNA(rRNA)基因为靶序列,设计和合成3组RAA引物及CRISPR来源RNA(crRNA),选择最佳组合并优化反应条件,建立荧光RAA/CRISPRCas12a检测方法。构建包括靶标区的恶性疟原虫3D7株18S rRNA基因质粒,将质粒浓度分别稀释成1 000、100、10、1拷贝数/μL进行荧光RAA/CRISPR-Cas12a反应,评价荧光RAA/CRISPR-Cas12a法检测敏感度;分别以间日疟原虫、三日疟原虫、卵形疟原虫、乙型肝炎病毒、人类免疫缺陷病毒、梅毒螺旋体基因组DNA为模板,进行荧光RAA/CRISPR-Cas12a反应,评价荧光RAA/CRISPR-Cas12a法检测特异度。分别采用荧光RAA/CRISPR-Cas12a法和巢式PCR法对50份疟疾临床样本进行检测,比较两种方法检测一致性。体外培养恶性疟原虫3D7株,经培养后获得的培养物...     

The renin-angiotensin-aldosterone system in children and adolescents with nephrogenic hypertension

Renin-angiotensin-aldosterone (RAA) function was studied in children with secondary hypertension of 2 varieties: vasorenal hypertension (VRH) and arterial hypertension (AH) associated with chronic pyelonephritis. Children with VRH showed RAA activation that depended on the duration of the disease for its markedness. A direct correlation found between ABP, on the one hand, and plasma renin activity and blood aldosterone level, on the other, is evidence of the latter's involvement in VRH pathogenesis. In AH that is due to chronic pyelonephritis, RAA activation was also demonstrated, however, its pathogenetic involvement was only documented in children with urinary passage disorders (vesico-renal reflux), whereas in the rest RAA activation was not a primary cause of BP elevation.