单用磁导航导管法和联合Lasso法行射频消融治疗阵发性心房颤动

目的 :比较单用磁导航(remote magnetic navigation, RMN)导管和联合环形标测电极(circular mapping catheter, CMC)在RMN指导下行心房颤动(房颤)消融的安全性、有效性以及手术相关参数。方法:入选2016年5月至2017年3月期间阵发性房颤患者60例,随机分为2组,分别用RMN导管法(RMN组)和联合Lasso法(CMC组)行环肺静脉前庭电隔离(pulmonary vein antrum isolation, PVAI)。主要研究终点为急性双侧PVAI成功率和空白期后手术成功率;次要研究终点为手术相关参数,包括X线暴露时间、消融时间、左心房操作时间和手术相关并发症。术后复发患者再次手术均采用联合Lasso法。术后3个月、6个月、1年随访动态心电图,观察房颤复发情况。结果:RMN组和CMC组急性PVAI成功率分别为97.3%和98.5%,差异无统计学意义(P>0.05)。与RMN组相比,CMC组X线暴露时间明显延长[(6.4±1.5) min比(8.8±1.5) min,P0.05)。术后平均随访(9.7±4.4)个月,2组房颤消融成功率RMN组比CMC组为76.7%比86.7%,差异无统计学意义(P>0.05)。结论:RMN指导的阵发性房颤行PVAI时,RMN法和联合Lasso法均安全、有效;同时,RMN法有助于减少X线暴露时间。     

导管射频消融治疗高龄心房颤动患者的临床评价

目的评价高龄心房颤动(AF)患者接受导管射频消融治疗的有效性和安全性。方法纳入2008年1月至2014年8月在大连医科大学附属第一医院行房颤射频消融(RA)的877例患者,按年龄分为老年组(≥75岁)68例、年轻老年组(65～74岁)320例及对照组(65岁)489例。记录3组患者的临床资料,分析对比3组患者术中并发症、手术时间、X线曝光时间,比较术后血栓栓塞率、再住院率、二次手术率、术后抗心律失常药物服用率以及术后缓慢心室率比例。消融成功的定义:术后心电图或动态心电图未再出现持续时间超过30 s的房颤。采用SPSS 19.0统计软件,根据数据类型分别采用x~2检验、方差分析或LSD检验进行分析。应用Kaplan-Meier分析分别比较持续性AF和阵发性AF不同年龄患者的导管消融成功率。结果消融过程及安全性评价:3组患者术中并发症(5.9%vs 3.1%vs 2.9%)、手术时间[(196.65±34.45)vs(196.03±40.02)vs(194.36±37.89)min]、X射线曝光时间[(19.81±6.73)vs(19.44±6.45)vs(18.69±6.00)min],差异均无统计学意义。疗效评价:3组患者随访(21.45±6.31)个月,其术后血栓栓塞率(4.4%vs 3.4%vs 2.5%)、再住院率(23.5%vs 22.2%vs18.0%)及二次手术率(11.8%vs 12.8%vs 12.3%),差异无统计学意义。但是,老年组患者在术后长期使用抗心律失常药物的比例相对较低(13.2%vs 29.4%vs 20.0%,P=0.001),术后动态心电图出现缓慢心室率的比例较高(23.5%vs 15.6%vs12.3%,P=0.033)。Kaplan-Meier生存分析结果显示持续性AF和阵发性AF不同年龄患者的导管消融成功率差异无统计学意义。结论老年心房颤动患者的导管消融成功率和安全性与年轻患者相似。     

冷冻导管消融与射频消融治疗房室结折返性心动过速对比分析

目的比较冷冻导管消融与射频消融治疗房室结折返性心动过速的有效性和安全性。方法回顾性分析中国医科大学附属第四医院2014年6月至2016年5月122例房室结折返性心动过速行导管消融术的患者,其中冷冻导管消融组56例,采用8 mm冷冻大头消融导管;射频消融组66例。比较两组患者成功率、复发率、房室传导阻滞发生率、手术时间及X线曝光量的情况。结果两组患者年龄、性别、器质性心脏病史、手术成功率比较,差异均无统计学意义(均P0.05);但射频消融组患者手术时间[(70.00±7.50)min比(66.29±4.72)min,P=0.001]、X线曝光量[(837.52±138.38)m Sv比(674.14±126.12)m Sv,P0.001]显著大于冷冻导管消融组,差异均有统计学意义。结论采用8 mm冷冻大头导管消融治疗房室结折返性心动过速安全有效,较普通射频消融术有潜在优势。     

射频消融与冷冻球囊杂交有可能提高导管消融治疗心房颤动的成功率

心房颤动(AF)的导管消融存在技术瓶颈,成功率低、复发率高是困扰电生理医生的难题。射频导管消融(RFCA)和冷冻球囊消融(CBA)是目前的两大主流技术,但均存在各自的优缺点,近年来将两种技术进行杂交的术式正逐渐兴起,有可能提高导管消融治疗AF的远期成功率。     

Marshall静脉无水乙醇消融联合导管射频消融术治疗阵发性心房颤动的应用研究

目的 比较Marshall静脉(VOM)无水乙醇消融联合导管射频消融术与单纯导管射频消融术治疗阵发性心房颤动(PAF)的有效性和安全性。方法 依据是否行VOM无水乙醇消融将199例PAF患者分为对照组(单纯行导管射频消融术)148例和观察组(VOM无水乙醇消融联合导管射频消融术)51例。比较两组患者手术相关资料、术后6、12、18个月心房颤动(AF)复发情况及手术并发症、脑卒中、死亡发生情况。结果 观察组患者总手术时间及总透视时间均长于对照组(P<0.05),而两组即时环肺静脉电隔离(CPVI)成功患者比例比较差异无统计学意义(P>0.05)。术后6个月两组AF复发患者比例比较差异无统计学意义(P>0.05),而术后12个月、18个月观察组AF复发患者比例均低于对照组(P<0.05)。随访期间,两组发生严重血管并发症患者比例比较差异无统计学意义(P>0.05),两组患者均未出现心脏压塞、心房食管瘘、脑卒中、死亡等。结论 VOM无水乙醇消融联合导管射频消融术治疗PAF安全、可靠,其远期疗效优于单纯行导管射频消融术。     

射频导管消融治疗主动脉左冠状窦室性心律失常疗效观察

目的探讨射频导管消融治疗起源于主动脉左冠状窦室性心律失常的临床疗效。方法 12例起源于主动脉左冠状窦的心律失常患者行射频消融治疗。采用激动顺序标测及起搏标测相结合,靶点V波较体表心电图QRS波群提前至少20ms,温控大头导管温度55℃,射频功率15～30w放电240s射频消融。随访患者射频消融治疗后的近期及远期疗效。结果靶点位于主动脉左冠状窦左冠状动脉开口下方1～2cm,即刻成功率为100。术中及术后无并发症发生。术后1个月内,12例患者复查动态心电图,室性早搏（室早）的次数由术前（15273±2056）次/24h,降为消融后的（656±135）次/24h,射频消融前后差异有显著统计学意义（P〈0.01）。术后3个月11例患者室早消失,1例复发,再次行单导管法消融成功。结论射频消融治疗起源于主动脉左冠状窦的室性心律失常安全有效,并能根治该类型室性心律失常的发作。     

应用压力感知消融导管治疗阵发性心房颤动的疗效

目的报道应用压力感知消融导管进行环肺静脉隔离术(CPVI)治疗阵发性心房颤动(简称房颤)的远期疗效。方法总计连续206例非瓣膜病性阵发性房颤患者,其中前103例接受非压力感知的冷盐水灌注射频导管消融(对照组),后103例接受压力感知的冷盐水灌注射频导管消融(ST组)。两组的消融策略均为三维电解剖标测系统(CARTO)指导下的CPVI。对比两组放电时间、X线透视时间,每例患者的随访时间均为18个月。结果随访18个月,ST组(92/103)的成功率显著高于对照组(76/103)成功率(89.3%vs 73.8%,P=0.004)。14例术后复发患者接受了再次导管消融术,其中ST导管组5例,对照导管组9例。前者的肺静脉传导远期恢复率显著低于后者[30%(6/20)vs 63.9%(23/36),P=0.025]。对影响单次消融手术成功率的多因素进行分析显示,术中使用ST导管为影响预后的独立相关因素(P=0.006;OR 2.9;95%CI 1.35~6.23)。结论和非压力感知冷盐水灌注消融导管相比,使用具有压力感知功能的冷盐水灌注消融导管对阵发性房颤患者进行CPVI具有更低的肺静脉传导恢复率和更高的随访成功率。     

应用压力监测导管射频消融特发性右室流出道室性心律失常的临床研究

目的初步探讨应用压力监测消融导管治疗特发性右室流出道室性心律失常(RVOT-VAs)的临床疗效和安全性。方法将符合入选标准的拟行导管射频消融治疗的特发性RVOT-VAs病例分为两组,压力导管(CFC)组使用ThermoCoolSmartTouch压力导管进行射频消融,非压力导管(NCFC)组使用非压力导管进行射频消融。记录和比较两组病例的消融靶点、消融时间、无效放电次数、手术时间、X线曝光时间和曝光剂量等术中观察指标,并记录和比较两组病例的即刻成功率、单次手术成功率、再次手术和复发率等手术疗效指标和手术并发症等安全性指标。结果共纳入92例特发性RVOT-VAs患者,包括频发室性早搏患者77例,持续性室性心动过速患者15例,其中CFC组47例,NCFC组45例。CFC组的单次手术成功率明显高于NCFC组(93.6%vs 77.8%,P=0.029),且再次手术率更低(4.3%vs 17.8%,P=0.048),两组的即刻成功率、复发率和并发症发生率比较未达到统计学差异;CFC组的无效消融放电次数更少,总的手术时间较短(P<0.001),CFC组的X线曝光时间和剂量较低(P<0.05)。结论使用压力监测消融导管治疗特发性右室流出道室性心律失常的疗效和安全性优于非压力监测消融导管。     

FACT模式在心房颤动导管消融治疗中的应用经验

目的探讨FACT(Fusion影像融合+Agilis鞘+CoolFlex消融导管+Tactful精准有效的)模式在心房颤动(AF)患者进行导管消融治疗中的应用经验。方法选取2015年7月至2016年4月在北京大学人民医院电生理中心行导管消融治疗的AF患者43例,均应用FACT模式完成导管消融治疗。观察手术时间、X射线用量及并发症情况,随访手术成功率。结果应用FACT消融模式治疗AF的手术时间为(86±21.7)min,放射线量为(55±19.7)mGy,平均随访11.8个月,成功率为79.1%。结论 FACT消融模式在AF患者消融术中具有一定的优势,可以提高手术成功率,缩短手术时间,减少射线量,具有较好的安全性和有效性。     

经导管射频消融治疗流出道起源室性期前收缩临床观察

目的探讨经导管射频消融治疗流出道起源室性期前收缩的方法和疗效。方法回顾性分析36例流36例起源室性期前收缩患者行射频消融治疗的临床资料，着重分析射频消融治疗的方法、结果及随访观察。结果36例患者中35洌消融治疗后期前收缩完全消失．成功率97．2％（35／36），其中11例患者合并器质性心脏病，存行经导管射频消融治疗后症状明显改善。手术时间为（77．1±18．3）min，消融时间（356．4±127．4）s，术中、术后无并发症．随访6个月，1例复发，复发率2．9％（1／35）．结论经导管射频消融治疗心事流叶道室性期前收缩的成功率高、安全性好、手术并发症少，远期效果较好．对合并器质性心脏病的患者也可选择行射频消融治疗.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.