J波对急性心肌梗死后恶性室性心律失常预测价值的研究

目的 研究急性心肌梗死(AM)后出现J波的患者跨壁复极离散度变化及其与恶性室性心律失常的关系,评价J波预测AM后恶性室性心律失常的临床价值.方法 回顾性分析130例急性ST段抬高型心肌梗死(STEMI )患者的心电图(ECG)及相关临床资料,根据ECG结果 分为J波组(21例)和无J波组(109例),比较两组临床情况、心肌梗死部位、恶性室性心律失常发生率、QT离散度(QTd),T波峰-末间期(TpTe).再将J波组分为恶性室性心律失常亚组(6例)和无恶性室性心律失常亚组(15例),并比较两组的QTd及TpTe ,结果 AM后J波的出现率为16.15%,J波组下壁梗死发生率(52.38%)明显高于无J波组(26.61%,P<0.05),恶性室性心律失常的发生率(28.57)也明显高于无J波组(1.83%,P<0.01),且QTd,TpTc(分别为76±19,121士33ms)较无J波组(分别为47±19,99±26ms)明显延长(P<0.01).与TpTe的正常值(92ms)相比,J波组的TpTe明显延长(P<0.01);J波组发生恶性室性心律失常者的QTd及TpTe(分别为97±15,157±27ms)均比无恶性室性心律失常者(分别为68±13,107±52ms)明显延长(P<0.01).结论 心电图J波提示心室跨壁复极离散度增加,可作为AMI患者恶性室性心律失常的预测指标.出现J波且伴随心室跨壁复极离散度显著增加者为AM后恶性室性心律失常的高危人群.     

高原地区高血压病心律失常分析

目的:探讨高原地区原发性高血压心律失常与心肌缺血,左室肥厚,血压水平之间的关系。方法:对住院的405例原发性高血压患者血压水平,心电图,24 h动态心电图,超声心动图等临床资料进行回顾性分析研究。结果:高原地区原发性高血压左室肥厚发生率50.86%,心肌供血不足发生率54.01%,室性心律失常发生率61.23%,房性心律失常发生率81.98%。左室肥厚组室性心律失常的发生率显著高于无左室肥厚组(P<0.01);心肌缺血组发生心律失常较无心肌缺血组有高度显著差异(P<0.01)。结论:高原地区高血压病心律失常的发生与高原地区低氧环境及左室肥厚,心肌缺血,血压水平等综合因素有关。     

尿激酶溶栓治疗对急性心肌梗死患者QT离散度的影响

目的:观察尿激酶溶栓治疗对急性心肌梗死(AMI)患者QT离散度的影响。方法:对48例急性心肌梗死患者在发病6h内予以尿激酶溶栓治疗,比较AMI溶栓成功组与溶栓失败组治疗前后QT离散度(QTd)和QT离散度校正值(QTcd),比较各组溶栓前和溶栓治疗后7d内复杂室性心律失常(CVA)事件发生率。结果:AMI溶栓成功组治疗7d后QTd或QTcd较失败组显著减少(P<0.05),CVA事件的发生率显著低于溶栓失败组(P<0.05)。结论:尿激酶溶栓治疗可减小AMI患者的QTd或QTcd,减少CVA的发生,提高AMI患者的生存率。     

高压氧辅助治疗对糖尿病患者心电图QT离散度影响的临床观察

目的 探讨HBO辅助治疗对糖尿病患者心电图QT离散度的影响.方法 2型糖尿病患者102例,分成HBO组60例和常规组42例,2组均给予常规治疗,HBO组再行20次HBO治疗.所有患者在行HBO治疗前和HBO治疗20次后测定心率、血压、心脏射血分数、血清钾和空腹血糖及糖化血红蛋白,并行心电图检查,测量QT间期,计算QTd和QTcd.结果 QTcd在HBO治疗前后分别为(59.8±17.4)ms和(52.2±15.5)ms,两者比较差异有统计学意义(P<0.05).结论 HBO辅助治疗可以降低QTd,可减少糖尿病患者发生恶性心律失常和心源性猝死的机率.     

左心室肥厚并急性心肌梗死室性电风暴心电图对预后的影响

目的 探讨沿海居民高血压性左室肥厚(left ventricular hypertrophy,LNH)并急性心肌梗死(acute myocardial infarction,AMI)后心电图特征性改变,评估室性电风暴与临床预后危险分层.方法 选择急诊住院有高皿压性LVH并AMI室性电风暴(室速或室颤)317例(Ⅱ组),另选无高血压性LVH室性电风暴AMI 109例(Ⅰ组)进行心电图检查和持续心电监护,分析心电图特征与临床高危特点.结果 室性电风暴组以高血压LVH并AMI患者心电图指标心房终末电势异常、∑ST段抬高振幅、ST段抬高导联数、QTc间期延长、对应导联ST段振幅下移等特征,梗死部位以前壁或复合前壁,并以左前降支合并回旋支或/和右冠脉完全闭塞多支病变为主,与Ⅰ组比较差异有统计学意义(P<0.05或P<0.01),临床并发泵衰竭、AMI扩展、住院病死率、室性电风暴AMI发病后6 h内发生率明显增多(P<0.01).结论 高血压性LVH并AMI室性电风暴患者,心电图多项指标异常对临床预后有预测作用.     

不稳定性心绞痛患者冠脉介入治疗对Q-T离散度的影响及临床意义

目的　对比观察不稳定性心绞痛患者经皮冠状动脉介入治疗与药物治疗对Q T离散度(QTd)的影响。方法　测量不稳定性心绞痛患者 6 8例、正常对照者 4 0例的QTd和QTcd。其中 4 5例患者接受了PTCA或支架置入治疗 ,2 3例患者接受药物治疗。结果　不稳定性心绞痛患者QTd或QTcd较正常对照者显著增加 (P <0 .0 1)。介入治疗组和药物治疗组治疗后QTd或QTcd均较治疗前明显缩短(P <0 .0 1)。介入治疗组治疗后QTd或QTcd较药物治疗组明显缩短 (P <0 .0 5 )。随访 6个月 ,介入治疗组发生室性心律失常 2例、心绞痛 3例、心肌梗死 2例、再次接受介入治疗 2例。药物治疗组发生室性心律失常 5例、心绞痛 5例、心肌梗死 2例、接受介入治疗 5例、猝死 1例。结论　不稳定性心绞痛患者冠状动脉介入治疗后QTd或QTcd降低程度明显大于药物治疗者 ,从而显著减少心血管事件的发生。不稳定性心绞痛患者有必要尽早进行冠状造影及介入治疗     

老年人原发性高血压血压晨峰与心率变异性及心脏重构关系的探讨

 目的 探讨老年人原发性高血压血压晨峰(morning blood pressure surge, MBPS)与心率变异性(heart rate variability ,HRV)及心脏重构的关系.方法 将明确诊断的老年人原发性高血压51例行动态血压监测、动态心电图监测(Holter)及超声心动图检查.根据MBPS程度是否超过50 mmHg(1 mmHg=0.133 kPa)分为MBPS≥50 mmHg组(A组)和MBPS＜50 mmHg组(B组),将两组患者的临床情况、HRV、左心室肥厚(left ventricular hypertrophy ,LVH)及室性心律失常等指标进行比较.结果 两组患者临床情况比较差异无统计学意义(P＞0.05);A组低频功率/高频功率(LF/HF)比值、LF值高于B组(P＜0.01和P＜0.05);A组LVH及室性心律失常发生率高于B组(P＜0.05).结论 老年人原发性高血压MBPS程度加剧与HRV及心脏重构有密切关系,是发生心脏事件的重要因素.     

老年冠心病动态心电图特点

分析老年冠心病184例,年龄60～83岁(平均66.30岁),其中无症状心肌缺血(SMI)组116例(63.04％),有症状组68例(36.90％)。SMI组与有症状组24h动态心电图(DCG)比较,室性心律失常(47.48％:26.32％),Lowm'sⅡ级以上室性心律失常(33.09％:21.50％),短阵室速(10,07％:7.89％)均高于有症状组,两组相比有显著差异(P<0.05)。所以SMI组急性心肌梗塞和心脏猝死发生率均高于有症状组。对缺血型ST—T改变检出普通心电图明显高于DCG,SMI组93.10％:31.03％,有症状组94.12％:36.76％。     

脑出血患者QTd及心肌酶谱的变化及意义

 目的探讨脑出血时心电图QT离散度(QTd)及血清心肌酶谱变化,客观评价脑出血病情及继发心脏损害的危险性。方法对54例脑出血患者及46例健康者的心电图QTd及血清谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸磷酸激酶(CK)等心肌酶谱进行检测,并作了对照分析。结果脑出血患者QTd明显增加,心肌酶谱各项检测指标显著异常,与对照组比较,P＜0.01或P＜0.05,并与脑出血量多少相关。QTd增加与心肌酶谱多项指标升高呈正相关。结论脑出血患者心电图QTd及心肌酶谱显著异常。对QTd及心肌酶谱检测有助于判断脑出血病情及心脏受累程度,有利于脑源性猝死的预防。     

QT离散度及T波峰末间期在急性心肌梗死经皮冠状动脉介入治疗中的应用价值

目的 :探讨经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗急性心肌梗死(acute myocardial infarction,AMI)前后,患者QT离散度(QT dispersion,QTd)及T波峰末间期(T peak-T end interval,Tp-Te)的变化及意义。方法 :选择80例成功实施PCI术的AMI患者为AMI组;同期100例在本院体检健康者为对照组。分别记录PCI术前、术后2、4、8、24 h及3、5、7 d的心电图,测量各个时期的QTd和Tp-Te值并行统计学分析。PCI术后随访3个月,根据有无恶性心律失常(malignant arrhythmia,MA)分为心律失常组和非心律失常组,比较术前及术后第7天QTd和Tp-Te值。结果:AMI组QTd和Tp-Te值明显高于对照组(P0.01)。AMI患者PCI治疗4 h后QTd和Tp-Te值显著减少(P0.01)。心律失常组较非心律失常组QTd和Tp-Te值明显延长(P0.01)。结论:AMI患者PCI治疗前后QTd和Tp-Te值显著减少。PCI能降低心肌复极离散度,提高心肌电稳定性,明显改善AMI患者预后。QTd和Tp-Te可作为预测AMI患者PCI术后发生恶性心律失常的敏感指标。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.