激素替代疗法对脑死亡猪的心脏功能保护作用观察

将16头健康瑞典家猪随机分为激素组与对照组，各8头。建立脑死亡模型后，对照组静脉补充林格液和低分子右旋糖酐维持内环境稳定；激素组除此之外，还给予肾上腺素与去甲肾上腺素、甲状腺素（T3、T4）、氢化可的松、抗利尿激素替代治疗。监测两组24h平均动脉压（MAP）、中心静脉压（CVP）、心脏射血分数（LVEF）、总尿量和心功能变化情况。结果显示脑死亡8h后对照组MAP为（64.2±9.3）mmHg，明显低于激素组的（81.8±6.3）mmHg，P〈0.05；12h后对照组LVEF为（55.2±4.15）％，明显低于激素疗法组的（70.0±4.12）％，P〈0.05；24h后对照组CVP为（15.00±2.09）cmH2O，24h尿量为（9.000±1.225）L，明显高于激素组的（7.70±2.25）cmH2O及（4.364±0.265）L，P均〈0.05。认为激素替代疗法可以有效地保护脑死亡猪的心脏功能。     

肥厚性心肌病患者合并心房颤动的危险因素分析

目的 探讨肥厚性心肌病合并心房颤动患者的危险因素。方法 纳入2015-01至2018-03间在我院住院的肥厚性心肌病的患者69例（HCM组）及肥厚性心肌病合并房颤患者23例（HCM-AF组）,统计患者临床资料及相关检查结果。以Logistic回归分析肥厚性心肌病患者发生房颤的危险因素。结果 单因素分析结果显示,HCM组与HCM-AF组在NYHA分级（2.33±0.69比3.00±0.85）、病程[1.0（1.0,2.0）年比5.5（1.1,17.5）年]、淋巴细胞计数（1.92±0.73比1.59±0.40）、NLR（2.27±1.20比3.37±2.32）、N末端B型利钠肽原[696.50（243.75,1788.00）pg/mL比1746.50（602.25,7719.75）pg/mL]、总胆固醇（4.28±0.96mmol/L比3.54±0.77mmol/L）、甘油三酯（1.98±1.68mmol/L比1.15±0.53mmol/L）、低密度脂蛋白胆固醇（2.34±0.76mmol/L比1.84±0.65mmol/L）、左心房内经（38.48±6.65mm比46.21±11.03mm）、左室射血分数（57.95±6.70比53.86±7.71）的差异均有统计学意义（P<0.05）。多因素Logistic回归分析发现,NYHA分级（OR=5.15, 95% CI 1.03~25.70,P<0.05）、病程（OR=1.20, 95% CI 1.04~1.39,P<0.05）、NLR（OR=2.03, 95% CI 1.10~3.76,P<0.05）、左心房内经（OR=1.10, 95% CI 1.02~1.19,P<0.05）是肥厚性心肌病患者发生房颤的独立危险因素。结论 NYHA分级差、病程长、NLR高和左心房内经增大是肥厚性心肌病患者发生房颤的独立危险因素。     

Genomic determination of CR1 CD35 density polymorphism on erythrocytes of patients with gallbladder carcinoma

AIM: To study the changes of quantitative expression, adhering activity and genomic density polymorphism of complement types in erythrocytes (CR1) of patients with gallbladder carcinoma and the related clinical significance.METHODS: Polymerase chain reaction (PCR), HindⅢ restrdion enzyme digestion, quantitative assay of CR1 and adhering activity assay of CR1 in erythrocytes were used.RESULIFS: The number and adhering actvity of CR1 in patients with gallbladder carcinoma (0.738±0.23, 45.9±5.7) were significantly lower than those in chronic cholecystitis and cholecystolithiasis (1.078±0.21, 55.1±5.9) and healthy controls (1.252±0.31, 64.2±7.4) (P<0.01). The number and adhering activity of CR1 in patients with chronic cholecystitis and cholecystolithiasis (1.078±0.21, 55.1±5.9) were significantly lower than those in healthy controls (1.252±0.31, 64.2±7.4) (P<0.05). There was a positive correlation between quantitative expression and adhering activity of CR1 (r = 0.79, P<0.01).Compared with those on preoperative day (0.738±0.23,45.4±4.9), the number and adhering activity of CR1 in patients with gallbladder carcinoma decreased greatly on the third postoperative day (0.310±0.25, 31.8±5.1) (P<0.01), and on the first postoperative week (0.480±0.25, 38.9±5.2) (P<0.01), but they were increased slightly than those on the preoperative day (P>0.05). The number and adhering activity of CR1 recovered in the second postoperative week (0.740±0.24, 46.8±5.9) (P<0.01) and increased greatly in the third postoperative week (0.858±0.35, 52.7±5.8) (P<0.01) in comparison with those on the preoperative day and in the first postoperative week. The number and adhering activity of CR1 of gallbladder carcinoma patients with infiltrating, adjacent lymphogenous and distant organ metastases were significantly lower than those of gallbladder carcinoma patients without them (P<0.01). No difference was observed between the patients with gallbladder carcinoma and healthy individuals in the spot mutation rate of CR1 density gene (%2 = 0.521, P>0.05).The distribution of expression was 67.8% in high expression genomic type, 24.8% in moderate expression genomic type,and 7.4% in low expression genomic type. The number and adhering activity of CR1 high expression genomic type gallbladder carcinomas (0.749±0.22, 42.1±6.2) were significantly lower than those of healthy individuals(1.240±0.29, 63.9±7.2), and were also significantly lower than those of healthy individuals (0.921±0.23, 54.8±7.1), but no difference was observed between the number and adhering activity of CR1 lower expression genomic type gallbladder carcinomas (0.582±0.18, 44.3*_5.5) and those of healthy individuals (0.610±0.20, 45.8±5.7) (P>0.05).CONCLUSION: Defective expression of CR1 in gallbladder carcinoma is mostly acquired through central peripheral mechanisms. The changes in CR1 quantitative expression and adhering activity are consanguineously related to the development and metastasis in gallbladder carcinoma.     

Protective effect of Weikang decoction and partial ingredients on model rat with gastric mucosa ulcer

AIM, To investigate the protective mechanisms of Weikang (WK) decoction on gastric mucosae. METHODS: Ninety rats were randomly divided into nine groups of 10 each, namely group, model group, group with large WK dosage, group with medium WK dosage, group with small WK dosage, group with herbs of jianpiyiqi (strengthening the spleen and replenishing qi), group with herbs of yangxuehuoxue (invigorating the circulation of and nourishing the blood), group with herbs of qingrejiedu (clearing away the heat-evils and toxic materials), group with colloidal bismuth pectin (CBP) capsules. According to the method adopted by Yang Xuesong, except normal control group, chronic gastric ulcer was induced with 100% acetic acid. On the sixth day after moldmaking, WK decoction was administered, respectively at doses of 20, 10 and 5 g/kg to rats of the WK groups, or the group swith herbs of jianpiyiqi, yangxuehuoxue and qingrejiedu, 10 mL/kg was separately administered to each group every day. For the group with CBP capsules, medicine was dissolved with water and doses 15 times of human therapeutic dose were administered (10 mL/kg solution containing 0.35% CBP). Rats of other groups were fed with physiological saline (10 mL/kg every day) .Administration lasted for 16 d. Rats were killed on d 22 after mold making to observe changes of gastric mucosa. The mucus thickness of gastric mucosa surface was measured. Levels of epidermal growth factor (EGF) in gastric juice, nitric oxide (NO) in gastric tissue, endothelin (ET) in plasma, superoxide dismutase (SOD) in plasma, malondialdehyde (MDA) in plasma and prostaglandin I2 (PGI2) were examined. RESULTS: Compared with control group, ulceration was found in gastric mucosa of model group rats. The mucus thickness of gastric mucosa surface, the levels of EGF, NO, 6-K-PGF1α and SOD decreased significantly in the model group (EGF: 0.818±0.18 vs 2.168±0.375, NO: 0.213±0.049 vs0.601±0.081, 6-K-PGF1α: 59.7±6.3 vs 96.6±8.30, SOD: 128.6±15.0 vs 196.6±35.3, P<0.01), the levels of ET (179.96±37.40 vs 46.64±21.20, P<0.01) and MDA (48.2±4.5 vs 15.7±4.8, P<0.01) increased. Compared with model group, the thickness of regenerative mucosa increased, glandular arrangement was in order, and cystic dilative glands decreased, while the mucus thickness of gastric mucosa surface increased (20 g/kg WK: 51.3±2.9 vs 23.2±8.4, 10 g/kg WK: 43.3±2.9 vs 23.2±8.4, 5 g/kg WK：36.1±7.2 vs 23.2±8.4, jianpiyiqi: 35.4±5.6 vs 23.2±8.4, yangxuehuoxue: 33.1±8.9 vs 23.2±8.4, qingrejiedu: 31.0±8.0 vs 23.2±8.4 and CBP: 38.2±3.5 vs 23.2±8.4, P<0.05-0.01). The levels of EGF (20 g/kg WK: 1.364±0.12 vs 0.818±0.18, 10 g/kg WK: 1.359±0.24 vs 0.818±0.18, 5 g/kg WK: 1.245±0.31 vs 0.818±0.18, jianpiyiqi： 1.025±0.45 vs 0.818±0.18, yangxuehuoxue: 1.03±0.29 vs 0.818±0.18, qingrejiedu: 1.02±0.47 vs 0.818±0.18 and CBP:1.237±0.20 vs 0.818±0.18, P<0.05-0.01), NO (20 g/kg WK: 0.480±0.026 vs 0.213±0.049, 10 g/kg WK: 0.390±0.055 vs 0.213±0.049, 5 g/kg WK: 0.394±0.026 vs 0.213±0.049, jianpiyiqi: 0.393±0.123 vs 0.213±0.049, yangxuehuoxue: 0.463±0.077 vs 0.213±0.049, qingrejiedu: 0.382±0.082 vs 0.213±0.049 and CBP： 0.395±0.053 vs 0.213±0.049, P<0.05-0.01), 6-K-PGF1α (20 g/kg WK: 86.8±7.6 vs 59.7±6.3, 10 g/kg WK: 77.9±7.0 vs 59.7±6.3, 5 g/kg WK:70.0±5.4 vs 59.7±6.3, jianpiyiqi: 73.5±12.2 vs 59.7±6.3, yangxuehuoxue: 65.1±5.3 vs 59.7±6.3, qingrejiedu: 76.9±14.6 vs 59.7±6.3, and CBP: 93.7±10.7 vs 59.7±6.3, P<0.05-0.01) and SOD (20 g/kg WK: 186.4±19.9 vs 128.6±15.0, 10 g/kg WK: 168.2±21.7 vs 128.6+15.0, 5 g/kg WK: 155.6±21.6 vs 128.6±15.0, jianpiyiqi: 168.0±85.3 vs 128.6±15.0, yangxuehuoxue: 165.0±34.0 vs 128.6±15.0, qingrejiedu: 168.2±24.9 vs 128.6±15.0, and CBP: 156.3±18.1 vs 128.6±15.0, P<0.05-0.01) significantly increased. The levels of ET (20 g/kg WK: 81.30±17.20 vs 179.96±37.40, 10 g/kg WK: 83.40±25.90 vs 179.96±37.40, 5 g/kg WK: 93.87±20.70 vs 179.96±37.40, jianpiyiqi: 130.67±43.66 vs 179.96±37.40, yangxuehuoxue: 115.88±34.09 vs 179.96±37.40, qingrejiedu: 108.22±36.97 vs 179.96+37.40,and CBP: 91.96±19.0 vs 179.96±37.40, P<0.01) and MDA (20 g/kg WK: 21.6±7.4 vs 48.2±4.5, 10 g/kg WK: 32.2±7.3 vs 48.2±4.5, 5 g/kg WK: 34.2±6.2 vs 48.2+4.5, jianpiyiqi: 34.9±13.8 vs 48.2±4.5, yangxuehuoxue: 35.5±16.7 vs 48.2±4.5, qingrejiedu: 42.2±17.6 vs 48.2±4.5, and CBP: 30.1±6.1 vs 48.2±4.5, P<0.05-0.01) obviously decreased. The 20 g/kg WK group was better than 10 g/kg (the mucus thickness: 51.3±2.9 vs 43.3±2.9, NO: 0.480±0.026 vs 0.390±0.055, SOD: 186.4±19.9 vs 168.2±21.7, P<0.01) and 5 g/kg (the mucus thickness: 51.3±2.9 vs 36.1±7.2, NO: 0.480±0.026 vs 0.394±0.026, SOD: 186.4±19.9 vs 155.6±21.6, P<0.01) groups and CBP group (the mucus thickness: 51.3±2.9 vs 38.2±3.5, NO: 0.480±0.026 vs 0.395±0.053, SOD: 186.4±19.9 vs 156.3±18.1, P<0.01) in the mucus thickness, NO and SOD levels and better than 10 g/kg (86.8±7.6 vs 77.9±7.0, P<0.05) and 5 g/kg (86.8±7.6 vs 70.0±5.4, P<0.05) groups in 6-K-PGF1α level, 10 g/kg WK group was better than 5 g/kg WK (the mucus thickness: 43.3±2.9 vs 36.1±7.2, P<0.01, SOD: 168.2±21.7 vs 155.6±21.6, P<0.05) and CBP groups (the mucus thickness: 43.3±2.9 vs 38.2±3.5, P<0.01, SOD: 168.2±21.7 vs 156.3±18.1, P<0.05) in the mucus thickness and SOD level. In compound group, jianpiyiqi group, yangxuehuoxue group, qingrejiedu group, the level of ET was decreased, NO contents were increased in gastric tissue of ulcers in rats. CONCLUSION: WK decoction and separated recipes have significantly protective effect on ethanol-induced gastric mucosal injury. They can increase the content of EGF in gastric juice, PGI2 SOD in plasma and NO in gastric tissues, thicken the mucus on the gastric mucosa, and decrease the impairing factor MDA, ET in plasma.     

Relationship between lymphocyte apoptosis and endotoxin translocation after thermal injury in rats

AIM：To investigate the relationship between lymphocyte papotosis in peripheral blood,spleen and mesenteric lymph nodes(MLN)and endotoxin translocation after thermal injury in rats.METHODS:In a wistar rat model infilicted with 30% TBSA Ⅲdegree scalding,serum LPS levels in portal vein and vena cava were quantified by tachypleus amebocyte lysate(TAL) technique.The analysis of peripheral bolld lymphocyte was employed in in situ Cell Death Detection Kit and evaluated by flow cytometry.Apoptotic lymphocytes in paraffinembedded spleen and MLN sections were examined by histologic analysis,in situ deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL)and peroxidase(POD) staining.The imagines were taken by Cooldccd camera system,and the count and optical density value (transmission light) of apoptotic lymphocytes were analyzed with software Spot and lmagine proplus 4.10a(IPP4.10a).RESULTS:In the Period of 3 to 48 postburn hours(PBHs) serum LPS level(×10%3EU.L^-1)in portal vein(2.11±0.02,5.66±0.20,3.70±0.22,2.56±0.28,0.90±0.11)was higher than that in vena cava(0.63±0.01,.1.53±0.18,0.83±0.32,0.52±0.12,0.23±0.02,P<0.01),but both increased sharply in postburn rats(P<0.01)and reached a peak at 6 PBH.Analysius of apoptotic lymphocytes showed that the proportion(%) of postburn apoptotic cells was much higher than that in healthy rats(8.34±1.53,8.13±1.81,20.77±3.94,23.90±3.92,11.23±1.35and 13.26±2.09at3,6,12,24,48and 72 PBH,respectively,vs 3.99±1.72,P<0.01)especially after 6 PBH.The concentrations of lymphocytic apoptosis at 12 and 24 PBH were markedly higher than that at other time points.Meantime,few apoptotic lymphocytes were found in normal MLN,but increased postburn obviously(3±1vs 546±83,285±39,149±30,58±10,36±11and 33±9in turn,P<0.01),especially at 3 PBH,whereas apoptotic lymphocytes were concentrated in splenic cortex before the burn and decreased obviously during 72PBHs(499±186vs12±8,19±15,12±7,100±15,123±25and 226±26in turn,P<0.01) though a slight rise was found in the medulla after 24 PHB Optical density of apoptotic lymplhocytes was significantly reduced in spleen in the 24 PBHs and raised in MLN during 48 PBHs than that prior to the burn,respectively.CONCLUSION:Gut-origin LPS is a major cause of endotoxemia taken place early in rate following severe thermal injury and could induce extensive lymphocyts apoptosis in blood and MLN,which suggests an immunosuppression state could follow the initial injury and favores a septic state based on apoptotic mechanism.     

快速起搏心房对犬心房电生理特性改变的研究

目的:研究心房颤动时心房肌的电生理改变。方法:快速持续起搏犬右心房24h制作房颤模型。比较起搏前(P0)、起搏后6h(P6)、12h(P12)和24h(P24)各时段的血压、心房传导速度和房颤波周长(atrial fibrillation cycle length,AFCL)的变化来分析心房肌的电生理改变。结果:起搏后平均动脉血压在P12[(126.06±7.01)mmHg]和P24时[(118.56±8.26)mmHg]较P0[(138.23±5.42)mmHg]明显下降。起搏24h后,P波时间是(78.91±6.21)ms,PA间期是(94±7.89)ms,与起搏前比较有显著延长(P<0.05)。连续快速起搏右心房在P6、P12和P24时的房颤自发维持的时间分别是5~10s、3~5min和15~20min。在起搏前和起搏后不同时间段,左房AFCL明显短于右房AFCL。右房房颤自发持续时间5~10s和15~20min的AFCL分别是(131.86±5.32)ms和(112.45±5.27)ms,P<0.05;左房房颤自发持续时间5~10s和15~20min的AFCL分别是(99.53±4.96)ms和(84...     

Evidences for vagus nerve in maintenance of immune balance and transmission of immune information from gut to brain in STM-infected rats

AIM：To determine whether salmonella Typhimurium(STM) in gastrointestinal tract can induce the functional activation of brain,whether the vagus nerve involves in signaling immune infomation from gastrointestinal tract to brain and how it influences the immune function under natural infection condition.METHODS:Animal model of gastrointestinal tract infection in the rat was established by an intuation of Salmonella Typhimurium(STM) into stomach to minic the condition of natural bacteria infection,Subdiagphragmatic vagotomy was performed in some of the animals 28 days before infection The changes of Fos expression visualized with immunohistochemistry technique in hypothalamic paraventricular nucleus(pVN) and superaoptic nuclesu (SON)were conted.Meanwhilie,the percentage and the Mean Intensities of Flurescent (MIFs)of CD4+ and CD8+ T cells in peripheral blood were measured by using flow cytometry(FCM),and the pathological changes in ileum and mesenteric lymph node were observed in HE stained sections.RESULTS:In bacteria-stimulated groups,inflammatory pathological changes were seen in ileum and mesenteric lymph node,The percentages of CD4+ T cells in peripheral blood were decreased from 43%±4.5%to 34%±4.9%(P<0.5)and MIFs of CD8+ T cells were also decreased from 2.9±0.39to 2.1±0.36(P<0.05)with STM stimulation.All of them proved that our STM-infection model was reliable Fos immunoreactive(Fos-ir) cells in PVN and SON incerased significantly with STM stimulation,from 189±41 to467±62(P<0.05)and from 64±21 to 282±47(P<0.05)individually,which suggested that STM in gastointestinal tract induced the functional activation of brain Subdiagphragmatic vagotomy attenuated FOs expression in PVN and SON induced by STM,from 467±62to 226±45(P<0.05)and from 282±47to 71±19(P<0.05)individually,and restored the decreased percentages of CD4+ T cells induced by STM from 34%±4.9% to original level 44%±6.0%(P<0.05).In addition,subdiagphragmatic vagotomy itself also decreased the percentages of CD8+ T cells (from 28%±3.0%to 21%±5.9%),P<0.05 and MIFs of CD4+(from 6.6±0.6to4.9±1.0P<0.05)and CD8+ T cells (from 2.9±0.39to 1.4±0.34,P<0.05).Both of them manifested the important role of vagus nerve in transmitting immune information from gut to brain and maintaining the immune balance of the organism.CONCLUSION:Vagus nerve dose involve in transmitting adbominal immune informaton into the brain in STM infection condition and play an important role in maintenance of the immune balance of the oranism.     

The effects of anisodamine and dobutamine on gur mucosal blood flow during gut ischemia／reperfusion

AIM：To detemine if anisodamine is able to augment mucsal perfusion during gut I/R ischemia-reperfusion METHODS:A jejunal sac was formend in Sperague Dawley rat.A Laser Doppler probe and a tonometer were inserted into the sac thich was filled with saline.The superior mesenteric artery was occluded(SMAO)for 60 minutes followed by 90 minutes of reperfusion.At the end of 60 minutes of SMAO.either 0.2mg/kg of anisodmine or dobutamine was injected into the jejunal sac.Lase Doppler mucosal blood flow and regional PCO2(PrCO2) measurements were made .RESULTS:Mucosal blood flow was significantly increased at 30,60 and 90 minutes of reperfusion(R30,R60,R90)when intraluminal anisodamine or dobutamine was present compared to intraluminal saline only(44±3.3%or 48±4.1%vs 37±2.6%at R30,57±5.0%,57±5.0%or56±4.7%vs45±2.7%at R60,64±3.3%or56±4.2%.vs48±3.4%at R90,respectively P<0.05),Blood flow changes were also reflected by lowering of jejunal PrCO2 measurements after imtraluminal anisodamine or dobutamine compared with that of the saline controls(41±3.1mmHg or 44±3.0mmHg vs49±3.7mmHg at R30,38±3.7mmHg or 40±2.1mmHg vs47±3.8mmHg at R60,34±2.1mmHg or 39±3.0mmHg vs46±3.4mmHg at R90,respectively,P<0.05),Most interesting finding was that there were significantly higher mucosal blood flow and lower jejunal PrCO2 in anisodamine group than those in dobutamine group at 90 minutes of reperfusion(64±3.3%vs56±4.2%for blood flow or 34±2.1mmHg vs39±3.0mmHg for PrCOs,respectively,P<0.05).suggesting that anisodamine had a more lasting effect on mucosal perfusion than dobutamine.CONCLUSION.Intraluminal anisodamine and dobutamine can augment mucosal blood flow during gut I/R and alleviate mucosal acidosis.The results provided benifical effects on the treatment of splanchnic hypoperfusion following traumatic or burn shock.     

Changes of gastric and intestinal blood flow, serum phospholipase A2 and interleukin-1β in rats with acute necrotizing pancreatitis

AIM: To explore the relationship between gastric and intestinal microcirculatory impairment and inflammatory mediators released in rats with acute necrotizing pancreatitis (ANP). METHODS: A total of 64 rats were randomized into control group and ANP group. ANP model was induced by injection of 5% sodium taurocholate under the pancreatic membrane. Radioactive biomicrosphere technique was used to measure the gastric and intestinal tissue blood flow at 2 and 12 h after the induction of ANP, meanwhile serum phospholipase A2 (PLA2) activities and interleukin-lβ levels were determined. Pathologic changes in pancreas, gastric and intestinal mucosae were studied. RESULTS: The gastric blood flow in ANP group (0.62±0.06and 0.35±0.05) mL/(min·g) was significantly lower than that in control group (0.86±0.11 and 0.85±0.06) mL/(min·g) (P<0.01) at 2 and 12 h after induction of ANP. The intestinal blood flow in ANP group (0.80±0.07 and 0.50±0.06) mL/(min·g) was significantly lower than that in control group (1.56±0.18 and 1.61±0.11) mL/(min·g) (P<0.01). Serum PLA2 activities (94.29±9.96 and 103.71±14.40) U/L and IL-Iβ levels (0.78±0.13 and 0.83±0.20) μg/Lin ANP group were higher than those in control group (65.27±10.52 and 66.63±9.81) U/L, (0.32±0.06 and 0.33±0.07)μg/L (P<0.01). At 2 and 12 h after introduction of the model, typical pathologic changes were found in ANP. Compared with control group, the gastric and intestinal mucosal pathologic changes were aggravated significantly (P<0.01) at 12 h after induction of ANP. Gastric and intestinal mucosal necrosis, multiple ulcer and hemorrhage occurred. CONCLUSION: Decrease of gastric and intestinal blood flow and increase of inflammatory mediators occur simultaneously early in ANP, both of them are importantpat hogenic factors for gastric and intestinal mucosal injury in ANP.     

Gallbladder motility in patients with hepatic cirrhosis before and after portal azygous disconnection

AIM:To determine and compare the effect of vagus nerve on gallbladder motility in patients with hepatic cirrhosis before and after portal azygous disconnection (PAD).METHODS: PAD operation (or Hassab‘s operation) was performed on 18 patients with portal hypertension, and anterior and posterior vagal trunks were cut. On d 3 before operation and d 10 after operation, ^99mTc-EHIDA 185 MBq was administered intravenously to the patients, and scintigraphy was performed at 0.25 rain/frame. A standard fat meal was administered 30 rain after scintigraphy, and dynamic imaging was performed 60 rain after the fat meal. Following appearance of the region of interest (ROI) in gallbladder, the time-activity curve of ROI was established. The following seven parameters were used: radioactivity at 30 min after injection of ^99mTc-EHIDA (RC 30min), bile emptying fraction (EF), bile emptying period (EP), emptying rate (ER), latent period (LP), latent period radiocounting increment (LI), and latent period radiocounting increment rate (LR).RESULTS: The RC 30 min decreased significantly after operation, compared with that before operation (2 693.6+ 2 406.9 vs 5 606.8±2 625.4, P<0.05). The radiocounting Of gallbladder increased gradually during LP. LP after operation was significantly longer than that before operation (13.36±5.92 vs 2.24±1.48, P<0.01). LI and LR after operation were significantly higher than those before operation (2 861.62±028.3 vs 331.21±421.02, and 113.42±49.52 vs 7.57±10.75, respectively, both P<0.01). EP after operation was significantly shorter than that before operation (18.5+6.3 vs 24.1+6.4, P<0.05). EF and ER after operation were significantly lower than those before operation (13.1+5.4 vs 32.3±16.3, and 0.7±0.3 vs 1.4±0.8, respectively, both P<0.01).CONCLUSION: PAD operation is a good clinical model in studying the effect of vagus on gallbladder motility. The gallbladder tension after PAD operation decreases significantly during the interdigestive phase. The latent pedod of gallbladder contraction prolongs and the motility weakens apparently after a standard fat meal. Human vagus influences the gallbladder motility, and cutting of the nerve inhibits the gallbladder motility.     

肥厚性心肌病心电图及动态心电图分析

目的观察肥厚性心肌病的心电图及动态心电图特点。方法对经超声心动图诊断确诊的88例肥厚性心肌病患者的心电图和动态心电图检查结果进行回顾性分析。结果最常见的心电图和动态心电图异常是ST-T改变,达73．86％～92．05％,其次是左心室肥大,达59．09％。动态心电图显示,肥厚型梗阻性与非梗阻性心肌病的频发室性期前收缩发生率分别为30％与2．g％,多形和成对的室性期前收缩、RonT现象发生率分别为45％与16．2％,短阵室性心动过速速发生率分别为40％与13．2％,两组间差异均有统计学意义（P〈0．05）。结论肥厚型心肌病心电图的主要表现为ST—T改变和左心室肥大,动态心电图有助于室性心律失常的诊断。     

恢复期亚急型和慢型克山病患者动态心电图特点及预后意义

目的 观察恢复期亚急型和慢型克山病患者动态心电图（DCG）特点，探讨其预后意义。方法 选择恢复期亚急型和慢型克山病患者88例，进行心电图（ECG）和DCG检查，并长期随访，以观察终点结果死亡或存活分组对比分析。结果 恢复期亚急型克山病患者在ECG90．3％正常情况下，84．9％的DCG出现异常。慢型ECG及DCG异常检出率都很高，分别为94．7％和100．0％。亚急型DCG异常检出率室早最高，为77．4％，其中成对室早51．6％，室速32．3％；房早次之41．9％。慢型DCG异常检出率室早最高，为96．5％，其中频发室早75．4％，成对室早51．6％，室速32．3％；房早次之82．2％。死亡组与存活组对比，死亡组ECG房早、室早、ST-T改变较存活组检出率高（P〈0．05）。死亡组与存活组DCG室早总检出率无差异（P〉0．05），但成对室早和室速检出率较存活组高（P〈0．05）。结论 房性与室性心律失常是恢复期亚急型和慢型克山病的DCG特征，亚急型ECG正常，DCG高异常检出率；慢型ECG及DCG均高异常检出率。成对室早和室速对预后有重要意义。     

氟哌噻吨美利曲辛对频发室性期前收缩伴有焦虑状态患者的影响

目的治疗室性期前收缩时加用氟哌噻吨美利曲辛,观察其对治疗效果的影响。方法选择频发室性期前收缩合并焦虑状态的患者80例,随机分为治疗组40例和对照组40例。对照组常规抗心律失常治疗,治疗组在常规治疗的基础上加服氟哌噻吨美利曲辛(每片含氟哌噻吨0.5mg和美利曲辛10mg),早、午各一片口服。观察治疗前后2组汉密尔顿焦虑量表评分变化及治疗效果。结果与治疗前比较,治疗组治疗4周后汉密尔顿焦虑量表评分由(21.49±3.38)分降低至(9.24±1.16)分,室性期前收缩次数由(7625±2025)次降至(981±138)次,差异有统计学意义(P<0.05)。与对照组比较,治疗组期前收缩改善总有效率明显提高,差异有统计学意义(87.5%vs45.0%,P<0.05)。结论服用氟哌噻吨美利曲辛能降低室性期前收缩合并焦虑患者汉密尔顿焦虑量表评分,减少期前收缩次数,改善症状。     

老年高血压合并糖尿病患者心率变异性分析

目的分析老年高血压合并糖尿病患者的心率变异性（HRV）。方法 77例老年高血压病患者根据是否合并糖尿病分成两组,单纯高血压病组（n=49）及高血压病合并糖尿病组（n=28）,采用动态心电图（DCG）观察两组患者心律失常、缺血性ST-T改变及HRV情况,分析两组患者代谢及HRV指标特点并进行组间比较。结果高血压合并糖尿病组患者的体质指数、血尿素氮、血尿酸、收缩压及空腹血糖水平均高于单纯高血压组患者,高密度脂蛋白胆固醇低于单纯高血压组,差异均有统计学意义（P〈0.05）。两组患者的平均心率、夜间心率、HRV时域参数及室性早搏、非持续性心动过速及缺血性ST-T改变检出率的均有统计学差异（P〈0.05）。结论老年高血压病合并糖尿病患者HRV明显减低,且易于发生室性心律失常及心肌缺血。     

左西孟旦、米力农与多巴酚丁胺治疗急性失代偿心力衰竭患者临床疗效及安全性评价

【摘要】目的：探讨左西孟旦、米力农和多巴酚丁胺三种药物治疗急性失代偿心力衰竭患者的临床疗效和安全性。方法：将我院2015年7月~2017年7月间收治的急性失代偿心力衰竭患者随机分为左西孟旦组、米力农组和多巴酚丁胺组,,每组50 例,并分别给予左西孟旦、米力农与多巴酚丁胺治疗3d。比较治疗前后三组的疗效、心功能指标(LVIDd、LVEF、FS)、血清学指标(NT-proBNP、ET-1、NE)、血流动力学指标(PCWP、PAMP、RAP、SVR)以及不良反应发生率。结果：治疗后,西孟旦组的有效率显著高于米力农组和多巴酚丁胺组(P&lt;0.05);三组的LVIDd、LVEF、FS、NT-proBNP、ET-1、NE、PCWP、PAMP、RAP、SVR水平均显著优于治疗前(P&lt;0.05);米力农组和多巴酚丁胺组的LVEF、FS、NT-proBNP、ET-1、NE水平均显著低于左西孟旦组(P&lt;0.05),PCWP、PAMP与SVR水平均显著高于左西孟旦组(P&lt;0.05);三组间的LVIDd、RAP水平比较差异无统计学意义(P&gt;0.05);左西孟旦组的不良反应发生率明显低于米力农组和多巴酚丁胺组(P&lt;0.05)。结论：左西孟旦治疗急性失代偿期心力衰竭患者的疗效显著,且安全性高,值得临床推广。     

稳心颗粒用于有症状良性室性早搏的疗效观察

目的：评价中药稳心颗粒对有症状良性室性早搏的治疗效果。方法：选择普通健康者和未查出心脏原发、继发病变。却自觉有室性早搏相关症状(心悸、气短、胸闷、头晕，甚至心神不宁)者且非住院病人74例随机分为对照组(40例)和治疗组(34例)，对照组给予调整植物神经药物谷维素，个别加用镇静药安定；治疗组服用稳心颗粒．分别测定治疗前及治疗4周后动态心电图和观察病人的临床症状。结果：对照组及治疗组显效率分别为15．0％、44．1％，总有效率分别为50．0％、73．5％。结论：室性早搏多为气阴两虚、气滞血瘀引起，稳心颗粒对良性室性早搏的疗效确切。     

伊伐布雷定对慢性心衰伴室性心率失常兔模型HCN通道的影响

目的 观察伊伐布雷定对慢性心衰伴室性心率失常兔模型超级化激活环核苷酸门控阳离子通道（HCN）的影响。方法 纳入由华中科技大学同济医学院实验动物中心提供的80只健康成年大白兔为研究对象，随机分为正常对照组（20只，予以0.9%生理盐水）和慢性心衰组（60只，经耳缘静注异丙肾上腺素0.3mg/kg&#183;d）。待慢性心衰组造模满意后将BW-200生理无线遥测心电系统芯片植入兔皮下，将其分为模型组（30只，0.9%生理盐水，洗胃，持续2周）和伊伐布雷定组（30只，伊伐布雷定7mg/kg&#183;d，持续2周）。分别于起搏前（0周）、起搏4周、6周（药物干预2周后），观察四组心率（HR）、左心室舒张末期内径（LVEDd）、左心室收缩末期内径（LVESd）、左室射血分数（LVEF）、心室有效不应期（ERP）、ERP 离散度（dERP）、室性心律失常（VA）诱发率、心室颤动阈值（VFT）变化，并分析HCN2、HCN4通道表达水平。结果 起搏4、6周后， 慢性心衰组HR、LVEDd、LVESd、ERP、dERP、VA诱发率均显著高于起搏前及正常对照组（P＜0.05），LVEF显著低于起搏前及正常对照组（P＜0.05）；其中，起搏4周后，伊伐布雷定组HR、LVEDd、LVESd、LVEF、ERP、dERP、VFT较模型组均无统计学意义（P＞0.05）；起搏6周后，伊伐布雷定组HR、LVEDd、ERP、VA诱发率显著低于模型组（P＜0.05），VFT显著高于模型组（P＜0.05），但LVESd、LVEF、dERP较模型组均无统计学意义（P＞0.05）。慢性心衰组HCN2通道和HCN4通道的mRNA、microRNA-1、microRNA-133及蛋白表达水平均显著高于正常对照组（P＜0.05）；其中，伊伐布雷定组上述指标均显著低于模型组（P＜0.05）。结论 伊伐布雷定能有效降低慢性心衰兔心率，缩短ERP值，诱导慢性心衰兔室性心律失常诱发率下降，改善心室颤动阈值，并降低慢性心衰兔心室肌HCN2通道和HCN4通道表达水平，有助于指导慢性心衰伴室性心率失常临床治疗。     

Arrhythmia resulting from sensing malfunction in a P wave triggered pacemaker

P wave triggered pacemakers can produce complicated arrhythmias during normal function. A ventricular, R wave inhibited pacemaker and an atrial sensing pacemaker were both present and functioning normally in the patient reported here. A premature paced beat was observed every 12th beat which resulted from discharge of the atrial sensing pacemaker. This arrhythmia appeared because a “P” wave occurred during the noise sampling period of the atrial sensing pacemaker, disabling the demand function and resulting in generator discharge on or near the T wave of a preceding unsensed beat while the pacemaker was in the asynchronous mode.     

1，6－二磷酸果糖治疗心功能不全的临床观察

作者时３０例心功能不全及其并发的各种心律失常患者，应用１，６－二磷酸果糖（ＦＤＰ）治疗。通过临床、超声心动图和动态心电图检测，结果表明ＦＤＰ可明显改善心脏收缩及舒张功能，使射血分数、左室收缩末期容积增加，每搏输出量、心输出量明显增加，２５例冠心病患者临床症状及体征明显改善。本组室性心律失常检出率为１００％。治疗后消失率为６２．９％，其中复杂室性早搏占２８．５％。４例风心病所致快速房颤治疗后３例消失，结果提示:ＦＤＰ是治疗心功能不全并发各种心律失常的有效措施之一。     

小剂量甲状腺素治疗顽固性心功能不全临床观察

目的:探讨小剂量甲状腺素治疗顽固性心功能不全的疗效。方法:26例经2周常规治疗效果不佳者作为治疗组,同期随机未予以甲状腺素治疗者19例为对照组,治疗组加甲状腺素20mg 1次/日,口服1月,观察、随访治疗前、后心功能、心脏射血分数(EF)、左室短轴缩短率(FS)、左室舒张期内径(LVDd)和血T3值的变化。结果:治疗组治疗后心功能明显改善,心脏射血分数增加,左室内径缩小(P<0.01),与对照组比较具有显著性差异(P<0.05),治疗组在治疗期间无不良反应发生。结论:小剂量甲状腺素治疗顽固性心功能不全是可取的。