右房房性心动过速的导管标测和消融

目的】探讨右房房速的导管标测和消融方法。【方法】常规电生理检查确诊3例右房房速后,多极标测导管在右房内弯曲、旋转粗标右房的不同面,寻找较体表心电图P波提前的相对较早的心房内电图,以此电图的电极对作为参考点,消融导管通过Swartz鞘在该点附近仔细标测,寻找最早心房激动点消融。射频消融的能量从15W开始逐渐递增至25W。【结果】3例右房房速消融成功。消融成功部位的心房内电图较P波提前40～50ms。终止房速初始放电能量为15W,时间在5s内。放电次数2～4次。X线暴光时间28～36min。【结论】多极标测导管粗标,消融导管经Swartz鞘细标寻找最早心房激动消融右房房速的方法简单有效     

右房房性心动过速的导管标测和消融

目的 探讨右房房速的导管标测和消融方法。方法 常规电生理检查确诊３例右房房速后，多极标测导管在右房内弯曲、旋转粗标右房的不同面，寻找较体表心电图Ｐ波提前的相对较早的心房内电图，以此电图的电极对作为参考点，消融导管通过Ｓｗａｔｒｚ鞘在该点附近仔细标测，寻找最早心房激动点消融。射频消融的人１５Ｗ开始逐渐递增至２５Ｗ。结果 ３例右房房速消融成功。消融成功部位的心房内电图较Ｐ波提前４０～５０ｍｓ。终止房速     

非接触心内膜激动标测系统指导疑难心律失常消融的临床研究

目的 研究非接触心内膜激动标测系统指导疑难心律失常的标测与消融的有效性与优越性。方法 12例患者，男性9例，女性3例，年龄28-76岁，电生理检查为右室特发性室性早搏1例，左室特发性室性心动过速2例，左房房性心动过速1例，右房房性心动过速2例，左房心房颤动6例．其中4例常规电生理标测消融末成功，1例成功后复发．经股静脉置入64极球囊电极和射频消融导管至同一心腔．计算机标测系统首先构建心腔几何构型，然后建立心动过速的腔内等电势图，分析心动过速的起源点及关键峡部，利用计算机导航系统指导消融导管至拟定靶点处进行消融，结果 1例起源于右室流出道偏间隔的室性早搏患者行片状消融获得成功；2例左室特发性室性心动过速标测其心动过速起源于左后中间隔及左后间隔区域行片状消融成功；1例左房房性心动过速标测其心动过速起源于右肺下静脉间隔部并指引消融导管行右肺下静脉至二尖瓣之间线性消融获得成功；2例右房房性心动过速巾1例标测其最早激动点位于下腔静脉口，此处行环状消融获得成功，另1例位于上腔静脉后方穿过界嵴中部线性消融获得成功；6例左房房颤患者1例在窦性心律卜标测其敛房颤房早起源于左右上肺静脉之间，行线性消融成功，另5例在房颤发作下标测其房颤起源折返部位，分别行右上下肺静脉、左上下肺静脉、左右上肺静脉之间、左下肺静脉与二尖瓣峡部之间线件消融成功，12例患者术中、术后均无并发症，随访2—26个月，无1例复发．结论 非接触心内膜激动标测系统指导心律失常的心内膜标测与消融是安全有效的，对复杂、难治性心律失常的电生理机制的阐明和指导消融具有较好的临床应用价值，     

心腔内超声指导下射频消融治疗心耳起源房性心动过速

目的:探讨心腔内超声指导下射频消融治疗心耳起源房性心动过速(房速)的有效性及安全性.方法:选取20例心耳起源房速患者,先用压力消融导管进行心腔解剖重构和激动顺序标测;提示心耳局灶起源后再用心腔内超声导管对心耳进行解剖重建,构建心耳内部分叶结构;最后用心耳局部激动顺序标测,明确定位起源,采用压力消融导管消融治疗.结果:2...     

Carto三维标测系统指导下心房颤动/扑动个体化消融原则的临床分析

目的 探讨个体化消融原则的临床效果及右房的作用.方法 房扑/房颤患者82例,男性42例,女性40例,年龄18～77(48.5±10.3)岁,左房内径26～52(35.4±5.3)mm.其中53例为阵发性房颤,14例为持续性房颤,15例为典型房扑.所有患者在Carto指导下进行个体化消融原则,以房扑/房颤被终止且不被诱发、肺静脉电位消失为消融终点.随访成功的定义为未服用抗心律失常药物、无任何症状性房性心律失常发作至少3个月.结果 ①随访时间3～28(13.4±3.3)个月,房扑和阵发性房颤消融随访成功率88.2%,持续性房颤仅为57.1%(P<0.05).2例有心包压塞,1例合并假性动脉瘤.无肺静脉狭窄等血管严重并发症.②阵发性房颤53例,其中10例为局灶性房早、短阵房速诱发的房颤(4例病灶位于右房内),8例行靶静脉线性消融,这类亚组手术无任何心律失常发作.其余43例阵发性房颤患者均行环肺静脉线性消融术,合并典型(4例)和非典型(6例)房扑者外加三/二尖瓣峡部消融.③15例典型房扑(4例为持续性房扑)患者,均行三尖瓣峡部消融,4例合并房颤者外加双侧肺静脉线性消融.④14例持续性房颤均经历了消融由房颤转变为房扑的过程,6例被消融终止和8例电复律复为窦律,半数分别进行了三/二尖瓣峡部消融和冠状静脉窦内消融,2例合并了起源于右房的房扑和房速.结论 Carto指导下房颤/房扑个体化消融可获得较好的临床疗效,右房的作用不能忽略.     

Carto merge技术指导永久性心房颤动射频消融

目的探讨Carto merge技术指导永久性心房颤动射频消融的作用和优势。方法用Carto merge技术指导射频消融治疗永久性心房颤动15例。术中用Carto导管标测和构建左心房和肺静脉的电解剖图,然后与术前心脏核磁共振造影的三维图像进行数据整合形成二者的复合图形(Carto merge)。首先在Carto merge的指导下行双侧上下肺静脉环线消融,直到Lasso标测证实所有肺静脉均达到电隔离效果,如心房颤动不终止,依次进一步消融左房顶部线、二尖瓣峡部线及三尖瓣峡部线,如上述部位消融后心房颤动仍未终止,即行同步直流电复律恢复窦性心律。结果15例患者中2例在消融过程中心房颤动自行终止,13例均经直流电复律。3例患者分别于术后24h、1和5周时复发持续性心房颤动。其余患者经1～10个月随访,均维持窦性心律。近期手术成功率为80%。结论Carto merge技术可有效地指导永久性房颤的射频消融,结合单Lasso标测,可简化操作,提高消融手术的成功率。     

联合Carto三维标测系统和单根Lasso电极指导心房颤动环肺静脉左房线性导管射频消融

目的评价Carto三维标测系统联合单根Lasso电极指导心房颤动(简称房颤)导管射频消融的效果。方法4例阵发性房颤患者,其中1例伴阵发性房扑,3例男性、1例女性,年龄(52±10)岁,房颤发作期限(3.3±1.8)年。术前心脏CT成像,术中运用Carto系统重建左房三维结构,并指导导管标测和消融;以冷肝素盐水灌注导管,行环肺静脉消融和左房顶部的线性消融术,消融完毕后,如患者仍显示为房颤,遂给予心律平70mg静脉注射,未见房颤复律,再给予100J行同步电复律。术后随访观察。结果4例均消融成功,平均消融导管射频消融(43±6)min,曝光时间为(48±7)min,未发生心脏穿孔和肺静脉狭窄等严重并发症,随访4~12个月无复发病例。结论联合应用Carto三维标测系统和单根Lasso电极指导进行房颤导管射频消融安全有效,使用单根Lasso电极较使用双根Lasso电极可以显著降低消融成本。     

EnSite-NavX导航下射频消融大折返房性心动过速8例

目的：探讨8例大折返房性心动过速的电生理特点及射频消融策略。方法：经电生理检查确诊大折返房性心动过速8例。常规电生理检查初步确定房速所在心腔,使用EnSite-NavX三维标测系统建立靶心腔的三维构型,分析心动过速的起源点或缓慢传导区,制定相应的消融策略,使用冷盐水灌注导管消融。结果：8例患者有4例为房颤环肺静脉左房线性消融术后发作的房速,电压和激动标测显示存在瘢痕区;2例为房间隔缺损修补术后围绕右房游离壁切口瘢痕和三尖瓣环的折返性房速;另外2例为三尖瓣环折返的房速。8例患者即时消融成功,1例术后随访仍有阵发性房速发作,给予药物控制心室率治疗。结论：大折返房性心动过速的电生理机制较复杂,通过三维标测系统能阐明其机制,并有效指导消融。     

紊乱性房性心动过速的机制探讨

目的观察紊乱性房性心动过速的临床及电生理表现,探讨紊乱性房速的电生理机制。方法8例反复心悸患者,经体表12导联静态心电图或12导动态心电图诊断为紊乱性房性心动过速,行电生理标测准确定位房速的起源部位,进而行射频消融治疗。在窦性心律下应用三维标测系统先构建左房及肺静脉解剖图,之后在Remap模式下行激动标测,确定房性期前收缩（PACs）和（或）房速（AT）发作时首个心房搏动的最早激动起源位置。用盐水灌注导管先在最早激动处进行消融,若PACs或短暂AT消失则认定为有效。如果标测AT起源于肺静脉,若消融前伴频发PACs和短阵持续性AT,消融一侧肺静脉后均立刻消失,可较肯定确定其起源,则只进行单侧肺静脉消融;若术中自发PACs和短阵AT较少,考虑到存在起源于其他肺静脉的可能性,则行左右双侧肺静脉消融直至经Lasso电极证实达到完全电隔离。术后1周内复查动态心电图并随访至术后24个月。结果8例患者术中都有自发性PACs及短暂非持续性AT。经标测确定最早激动点分别起源于RSPV4例、RIPV1例、LSPV3例。8例患者局部消融后PACs和房性心动过速均消失。其中4例行单侧肺静脉消融达到完全电隔离;另4例行左右双侧肺静脉消融至完全电隔离。消融前后PACs数量分别为17815．3&#177;10870．5和26．9&#177;17．2;术前AT阵数为312．5&#177;536．3,消融后无AT发作,并无任何其他心律失常发生。结论部分紊乱性房速的机制可能是位于肺静脉单个起搏点的自律性异常所致,由于异位激动的传导路径以及传导速度的不一致导致了P’波的多形性以及心房紊乱心律的发生。     

常规电生理标测射频导管消融术治疗局灶性右心房房性心动过速

目的观察常规电生理标测射频导管消融术(RFCA)治疗局灶性右心房房性心动过速(房速)的疗效及安全性。方法对16例右心房房速患者行RFCA治疗,所有患者均采用房速发作时激动顺序标测法确定心房最早激动点。结果房速消融成功率为87.5%(14/16),术中和术后无并发症发生,术后随访(2.5±2.1)年,仅1例复发。结论常规电生理标测RFCA治疗局灶性右心房房速安全、可行,成功率较高。     

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.     

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.