阵发性心房颤动的动态心电图特征研究

目的 探讨阵发性心房颤动发生的动态心电图特征. 方法 对38例阵发性心房颤动患者和24例非阵发性心房颤动患者的动态心电图进行分析,测定和计算房性期前收缩偶联间期和房性期前收缩指数. 结果 阵发性心房颤动共发作291次,其中221次由房性期前收缩诱发（75.95%）.诱发心房颤动的房性期前收缩与未诱发心房颤动的房性期前收缩比较,偶联间期较短,期前收缩指数较小,差异有统计学意义（P〈0.05）.心房颤动发作前1h房性期前收缩和短阵房性心动过速频率增加.35.75%阵发性心房颤动发生时出现明显的长短周期现象. 结论 房性期前收缩是阵发性心房颤动发生的主要因素,长短周期现象是阵发性心房颤动发生的重要电生理机制.     

肌袖性房性心律失常的动态心电图特征分析

目的探讨肌袖性房性心律失常的动态心电图(DEC)特征。方法对比8例肌袖性房性心律失常与10例非肌袖性房性心律失常患者的临床和DEC特点。结果肌袖性房性心律失常有频发房性期前收缩,短阵房性心动过速,心房扑动,均发生短阵心房颤动,发作时间为2~15min不等,诱发心房颤动的房性期前收缩联律间期(0.24±0.03)s,明显短于对照组房性期前收缩联律间期(0.34±0.05)s(P<0.01)。结论肌袖性房性心律失常的DEC中窦性心律、房性心动过速、心房扑动、心房颤动交替转换,诱发心房颤动发作的房性期前收缩联律间期短,几乎均呈“P-on-T”现象。     

阵发性心房颤动发作前心律变化特点的分析

运用动态心电图分析阵发性心房颤动发作前心律失常情况、诱发阵发性心房颤动房性期前收缩复合波 (APCs)的特点 ,为临床可能采取的预防措施提供指导作用。1　资料与方法选自 2 0 0 2年 11月～ 2 0 0 3年 6月在我院检查有阵发性心房颤动的患者 30例 ,年龄 6 0～ 77(6 4 .7± 4 .9)岁。入选标准 :2 4h动态心电图检查中记录到阵发性心房颤动 (持续 30s以上并能自行转复窦性心律 )的发作过程 ,排除植入心脏起搏器的患者。采用MortaraH ScribeⅡ 12导联动态心电图分析系统 ,对心房颤动发作前 12 0s内的心电图进行记录 ,人工详细分析 ,并将其平…     

阵发性心房颤动初始节律的动态心电图观察

目的观察阵发性心房颤动（PAf）初始节律的心电触发因素及其部位,并探讨其临床意义。方法对50例PAf患者的动态心电图进行人工回放,记录心房颤动（Af）发作次数、发作前三个心房周期及联律间期和发作前120s和30s内的房性期前收缩数,并根据触发Af的房性期前收缩的P波形态确定房性期前收缩部位。结果50例PAf患者共290次Af发作,心电触发因素中房性期前收缩占86．2％,窦性心动过缓占7．58％,心房扑动占2．75％,房性心动过速占3．45％;房性期前收缩来源于左心房上部占71．2％,左心房下部占12．0％,右心房上部占10．0％,右心房下部占2．0％,不能定位占4．8％;触发Af的房性期前收缩比未触发Af的房性期前收缩的联律间期缩短40ms以上;在PAf发作前120s和前30s期间内房性早搏发生频率由1．1次／min分别增加到4．2次／min和6．4次／min。结论房性期前收缩是PAf最主要的触发因素,长一短周期现象是PAf发作的重要启动机制,12导联动态心电图作为一种无创性的检查方法对阵发性房颤的临床诊治有重要的参考价值。     

房性期前收缩在诱发阵发性心房颤动的诊断价值

目的探讨24h动态心电图（DCG）过程中观察房性期前收缩（PAS）与阵发性心房颤动（Pf）的关系。方法对56例经DCG检测，观察PAS与Pf的关系。结果56例Pf者均伴有频发PAS（24hPAS〉100个），短阵房性心动过速4-4例，阵发性心房扑动2例。其中45例Pf由PAS诱发，占80％。9例由短阵性房性心动过速诱发，占15％。2例由短阵心房扑动诱发。占0．4％。结论频发PAS者心房颤动的发生率很高，早期发现频发PAS需及时治疗，以减少心房颤动发生。     

动态心电图对阵发性心房颤动心电触发机制的分析

目的探讨阵发性心房颤动(PAf)心电触发因素及其部位,并评价其临床意义。方法对45例PAf患者的动态心电图人工回放,记录心房颤动(Af)发作次数、发作时间、发作前三个心房周期、联律间期,并根据触发Af的房性期前收缩的P波形态确定房性期前收缩部位。结果45例PAf患者共248次Af发作,心电触发因素中房性期前收缩占84.97%,窦性心动过缓占7.73%,心房扑动占2.14%,房性心动过速占2.57%;房性期前收缩来源于左心房上部占69.96%,左心房下部占12.02%,右心房上部占9.87%,右心房下部占3.86%;触发Af的房性期前收缩比未触发Af的房性期前收缩的联律间期缩短25ms以上;PAf发作存在23:00~1:00及9:00~11:00两个高峰,13:00~15:00一个低谷;PAf大多在短-长-短周期后发作,占62.23%,长-长-短周期后发作占21.89%。结论左心房上部房性期前收缩是PAf主要的触发因素,长-短周期现象是PAf发作的重要启动机制,自主神经失衡在PAf发作中起协同作用。动态心电图能对PAf治疗提供很大帮助。     

房性期前收缩诱发阵发性心房颤动患者动态心电图与心脏彩超检查的临床分析

目的对房性期前收缩诱发阵发性心房颤动(房颤)患者动态心电图(DCG)与心脏彩超(PAF)检查结果进行临床分析。方法选择55例阵发性房颤患者与55例非阵发性房颤患者的动态心电图与心脏彩超检查结果进行比较分析,并经彩超检查测量左房大小。结果阵发性房颤组24小时房性期前收缩发生次数明显多于对照组;引发房颤的房性期前收缩联律间期明显短于对照组房性期前收缩联律间期;房颤组组内数据相比,引发房颤的房性期前收缩联律间期短于房颤发作前最近一次单发的房性期前收缩的联律间期;房颤组左房内径与对照组比较差异无统计学意义,但对于房颤持续时间大于1h的患者,其左房内径明显大于对照组。结论阵发性房颤的发作和维持与房性期前收缩的提早量以及发生频率、左心房的大小及自主神经的调控能力等有密切关系。阵发性房颤维持时间的长短与心房增大的程度亦有临床意义。     

阵发性房性心动过速的动态心电图分析

目的探讨动态心电图对阵发性房性心动过速的诊断意义。方法分析32例伴有心脏疾患发生房性心动过速者,与12例无心脏器质性疾患发生的房性心动过速者作对照,观察房性心动过速发生的昼夜节律并统计短阵性房性心动过速的频率和持续时间、与发作相关的房性期前收缩的偶联间期。结果检出阵发性房性心动过速者44例(11.3%),心脏病组32例检出率13%,对照组12例检出率8.4%(χ2=42.8,p<0.001),两组差异有显著意义。患者房性心动过速以右房房速发生率为高。心脏病组房性心动过速时发作的阵数、房速率及持续时间与对照组比较差异均有统计学意义,而发作时联律差异无统计学意义;昼夜节律变化在心脏病组不明显而在对照组明显。结论动态心电图检测对阵发性房性心动过速的临床诊断,指导治疗和评价疗效有重要意义。     

阵发性心房颤动的动态心电图分析

目的 通过24 h动态心电图观察阵发性心房颤动,分析阵发性心房颤动的发作特点.方法 对32例阵发性心房颤动患者的24 h心房颤动的发生、持续时间和次数进行统计.结果 32例阵发性心房颤动患者心房颤动的发生和持续时间均有2个高峰,发生高峰在0∶00～1∶00和15∶00～16∶00,持续高峰在2∶00～4∶00和16∶00～18∶00时间段,终止高峰在8∶00～10∶00.结论 阵发性心房颤动的发作、持续均有2个高峰期,有着昼夜节律性规律,夜间发作多见于无器质性心脏疾病、年龄偏小、男性患者,持续时间较长的阵发性心房颤动多见于有器质性心脏疾病、老年患者.     

间歇性预激、房性期前收缩伴室内差异性传导1例

患者男性。43岁。因阵发性心悸、气短3个月,复发2h入院。门诊拟诊：冠心病。入院当天查24h动态心电图（三通道V5、V1、V3记录）示：基本图形为窦性。P—R间期0．16s,QRS波时限0．09s。当发生房性期前收缩时为宽大畸形的QRS波,时限为0．14s,P—R间期为0．10s,QRS波起始部可见delta波,24h内多源性室性期前收缩60个。成对型期前收缩3个。在12：39的第2个QRS波形和21：59的第2、3个QRS波形为代偿间期不完全。动态心电图诊断：①窦性心律;②间歇性预激、房性期前收缩伴室内差异性传导。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.