Auricular fibrillation

There is many progresses in term of comprehension of physiopathologic mechanisms and also therapeutic indications. The increase of treatment modalities need a clear strategy and an adapted choice from pharmacologic, to surgical, external electric shock, prophylactic cardiac stimulation, implantable auricular defibrillation, and ablative methods.     

桂枝汤合耳穴疗法治疗荨麻疹临床观察

目的 观察桂枝汤合耳穴疗法埋籽治疗慢性荨麻疹的临床疗效.方法 对55例慢性荨麻疹患者以桂枝汤合耳穴疗法埋籽治疗.结果 实验组有效40例,无效7例;对照组有效25例,无效20例.结论 桂枝汤合耳穴埋籽治疗荨麻疹治疗有效.     

行为生活方式干预及耳穴贴压对血脂异常人群干预的效果分析

目的观察行为生活方式干预及耳穴贴压对血脂异常人群的干预效果,为早期综合调脂治疗提供临床依据。方法对六榕街社区582例血脂异常中、低危人群进行为期15个月的治疗性行为生活方式干预及耳穴贴压治疗,随机分成三组：治疗性行为生活方式干预及耳穴贴压组（治疗组）,耳穴贴压组（对照1组）,单纯行为生活方式干预组（对照2组）,比较三组在干预后血脂水平及危险因素变化的情况。结果干预15个月后,治疗组与对照1组和对照2组干预后比较：TC、TG、LDL-C、HDL-C值差异有统计学意义（p〈0.01）,FBS、2hPG、BMI、血压值差异有统计学意义（p〈0.05）,对照1组与对照2组干预后血脂异常及危险因素差异无统计学意义（p〉0.05）;治疗组、对照1组、对照2组三组干预后总有效率分别为91.6%、82.7%、81.8%,治疗组与对照1组和对照2组比较差异有统计学意义（p〈0.01）。结论治疗性行为生活方式干预及耳穴贴压联合治疗对血脂异常中、低危人群效果显著,此方法操作简便、费用低廉,易于在社区推广,在慢性病的一级和二级预防上有着广阔的前景。     

Treatment of fetal cardiac arrhythmias

Fetal cardiac arrhythmias are usually first suspected on the basis of auscultatory findings during routine examination in pregnancy. With improved ultrasonic equipment a more accurate diagnosis of the type of arrhythmia can be made, associated problems such as structural cardiac defects and cardiac compromise can be recognized, and the effects of intrauterine treatment schedules can be closely monitored. The success of intrauterine therapy depends first and foremost on accurate intrauterine diagnosis. Until now intrauterine therapy for fetal cardiac arrhythmias has remained almost entirely restricted to pharmacological interventions.     

Inotropic Drugs in the Treatment of Heart Failure

For the long-term treatment of patients with chronic heart failure, there is as yet no satisfactory substitute for cardiac glycosides. But the availability of drugs with selective inotropic and reduced electrophysiologic effects may not be far off. Even then, inotropic therapy will probably have to be handled with great care and awareness of the inherent risks.     

鼻翼基底细胞癌手术Ⅰ期修复的探讨

目的探讨侵犯鼻翼软骨的鼻翼基底细胞癌手术Ⅰ期修复的合适方式。方法根据鼻翼缺损的范围、浸润深度对19例鼻翼基底细胞癌采用游离耳廓复合组织瓣和耳廓复合组织瓣联合鼻唇沟皮瓣两种方法进行Ⅰ期修复,并进行随访,分析两种修复方法在鼻翼缺损修复中的优缺点。结果全部病例均手术成功,无皮瓣整体坏死出现。联合修复的12例患者术后均未出现移植物皮肤颜色改变和水疱形成的情况。有1例术后6个月时出现鼻孔边缘粘连导致狭窄,经再次手术恢复正常;1例鼻孔稍外翻。单纯游离耳廓复合组织瓣修复的7例患者中有1例部分组织瓣皮肤有缺血。结论对缺损面积较大（1×1.5cm2～2.0×2.5cm2）、侵犯鼻前庭皮肤的病例可以采用耳廓复合组织瓣联合邻近转移皮瓣进行鼻翼全层修复,而对缺损面积小于1×1.5cm2的病例可以单纯采用耳廓复合组织瓣进行修复。     

Endogenous antioxidant defense induction by melon superoxide dismutase reduces cardiac hypertrophy in spontaneously hypertensive rats

We assessed the influence of SODB, a melon superoxide dismutase (SOD), on left ventricular (LV) hypertrophy in SHR. SODB (4 or 40U SOD) was given orally for 4 or 28 days to SHR. For each treatment period, LV weight index (LVWI) and cardiomyocytes size were measured. SOD, glutathione peroxidase (GPx) and catalase expressions, and LV production and presence of superoxide anion were determined. Pro-inflammatory markers were also measured. SODB reduced LVWI and cardiomyocytes size after 4 or 28 days. Cardiac SOD and GPx increased by 30–40% with SODB. The presence but not production of superoxide anion was significantly reduced by SODB. No effect of SODB was detected on inflammatory status in any group. The beneficial effect of SODB on cardiac hypertrophy seems to be related to the stimulation of endogenous antioxidant defense, suggesting that SODB may be of interest as a dietary supplementation during conventional antihypertensive therapy.     

耳穴贴压治疗中风后失眠32例

目的观察辩证耳穴贴压对中风后失眠患者睡眠质量的影响。方法将中风后失眠患者64例,随机分为实验组和对照组各32例,对照组给予口服艾司唑仑治疗,实验组给予耳穴贴压治疗,治疗前后采用匹兹堡睡眠质量指数量表（PSOI）、脑卒中专用生活质量量表（SS-QOL）进行评分并比较2组患者疗效。结果2组患者治疗前PSQI,SS-QOL评分无差别,治疗后比较,实验组PSQI评分低于对照组,而SS-QOL评分高于对照组（P〈0．05）;实验组的总有效率为90．6％,对照组为81．2％,2组比较差异有统计学意义（x2=4．153,P〈0．05）。结论耳穴贴压可以有效治疗中风后失眠,提高患者的生活质量。     

综合减肥疗法的临床疗效观察

目的观察综合减肥疗法对超重/肥胖患者的临床疗效。方法应用综合减肥疗法,包括体质辨识、医学营养治疗、中医食疗、耳穴贴压、中药制剂、有氧运动等综合治疗手段,治疗86例超重/肥胖患者8～12 w,治疗前后对体重、腰围、臀围、体重指数(BMI)等指标进行检测与评价。结果 86例超重/肥胖患者治疗前后自身对照比较,体重、BMI、腰围、臀围数值均有显著降低(p<0.01)。结论综合减肥疗法,对超重/肥胖患者减轻体重疗效显著,值得推荐临床使用。     

耳穴贴压对围绝经期睡眠障碍患者干预效果的Meta分析

目的采用Meta分析的方法评价耳穴贴压对围绝经期睡眠障碍患者的干预效果。方法计算机检索Wanfang Data、CNKI、VIP、CBM、PubMed、The Cochrane library、Web of science中耳穴贴压对围绝经期睡眠障碍患者干预效果的随机对照试验(RCTs),检索时间为建库至2019年7月31日。两名研究者分别筛选文献、提取数据及文献质量评价后,数据分析使用Revman 5.3软件。结果最终纳入8篇RCT,531例患者。Meta分析结果显示:对围绝经期睡眠障碍患者实施耳穴贴压的有效率[RR=1.18,95%CI(1.10~1.27),Z=4.39,P<0.0001]、睡眠改善情况(匹兹堡睡眠指数)[SMD=-0.90,95%CI(-1.29,-0.52),P<0.0001],均高于对照组。结论耳穴贴压能提高围绝经期睡眠障碍治疗的有效率,改善患者的失眠状况。     

心房同步双心室起搏（CRT）治疗在慢性充血性心力衰竭中的应用进展

本文是在目前在药物治疗方法相对成熟，各国慢性心力衰竭的病死率仍然很高的情况下，进一步探讨心脏同步化治疗在慢性心力衰竭中的应用，经研究证明，心房同步双心室起搏（CRT）能增加左室充盈时间，减少间隔部运动障碍，降低二尖瓣返流，以改善心力衰竭病人由于室内传导异常会导致心室不同步化，进而产生反常间隔室壁运动，收缩前二尖瓣返流，降低左室舒张充盈时间等症状。CRT治疗，短期内将适应衰竭心脏的生化改变，有利于加强心脏功能，不增加耗氧量，改善血液动力学。CRT结合相应的药物（ACEI、β-受体阻制剂及醛固酮拮抗剂）治疗有待续症状的病人，将明显改善难治性心衰患者的功能状态及生活质量。     

Cardiovascular diseases in modern maritime industry

Acute cardiovascular diseases (CVD) are the main natural causes of death in industrialized countries - both at sea and on land. Seafarers face very specific job-related cardiac risk factors, such as time pressure, long working hours, or high stress factors onboard [1, 2]. Taking into consideration the healthy worker effect of seafarers, cardiac risk factors are shown to occur slightly more frequently in seafarers than in the general population. Owing to the lack of health professionals onboard and the limited treatment options of events at sea, effective cardiopulmonary resuscitation is often delayed and the outcome of cardiac events may be worse compared to that in other occupations ashore. Seafarers' medical surveillance examinations should be used more intensively as an opportunity for education of crews in CVD risks and the possibilities to reduce them. Further, enhancement of treatment options (e.g. by implementation of advanced therapy and diagnostics such as telemedicine or AED onboard) may contribute to improved CVD prognosis at sea.     

Extracorporeal photopheresis: a review on the immunological aspects and clinical applications

Extracorporeal photopheresis (ECP) was hailed as a new therapeutic concept for the treatment of diseases caused by aberrant T lymphocytes since it was first described more than twenty years ago. Advances in molecular biology and immunology have allowed a greater understanding of the mechanisms involved in ECP. As a result, ECP is being increasingly considered as a safe and promising immunomodulatory therapy with diverse clinical applications. At present ECP is approved by the FDA for the treatment of cutaneous T-cell lymphoma (CTCL). ECP is considered a relatively safe and promising immunomodulatory therapy with diverse clinical applications reported in the literature. ECP has been used in the treatment of patients following acute allograft rejection in cardiac, lung, renal or liver transplantation, graft-versus-host disease, systemic lupus erythematosus, systemic scleroderma, rheumatoid arthritis and pemphigus vulgaris. The use of ECP as a novel form of therapy is in constant evolution with newer studies focusing on the treatment of patients with Crohn's disease and the immunological effects of ECP in children with type 1 diabetes mellitus. However, because the exact mechanism by which ECP exerts its effects remains to be described in detail and because important questions regarding the use of ECP in the clinical setting, such as length of therapy or design of specific protocols, concomitant use of immunosupressive therapy, patient characteristics, long term side effects, assessment of therapy efficacy and cost effectiveness continue to remain unanswered, the exact role of ECP cannot be fully established except in the case of patients with CTCL and GvHD. Nevertheless, future clinical studies with ECP can be done with the objective of designing more appropriate treatment protocols based on expected patient response and with a side effect profile that is fairly tolerable.     

Cardiac involvement in inflammatory disease: systemic lupus erythematosus, rheumatic fever, and Kawasaki disease

This review focuses on treatment and preventive issues relevant to cardiac problems associated with systemic lupus erythematosus, acute rheumatic fever, and Kawasaki disease in adolescence. Cardiac abnormalities occur as a result of the immune dysfunction and as side effects of therapy. With increased survival, more cardiac complications are being detected. Screening for cardiac risk factors, such as cigarette smoking, hypertension, obesity, and hypercholesterolemia, should begin in adolescence.     

Endocrine Therapy of Transsexualism and Potential Complications of Long-Term Treatment

Physiological principles of the interrelationship of sex hormones and their regulation are the foundation of understanding appropriate treatment of the transsexual patient. While both genetic males and females have estrogens and androgens, the quantitative sex hormone production is genetically predetermined by sex hormone production both in the gonads and via peripheral conversion of hormone precursors to sex steroids. Sex hormones exert a negative feedback on the hypothalamus and pituitary gland whereby gonadotropin-releasing hormone (GnRH), pituitary luteinizing hormone (LH), and follicle-stimulating hormone (FSH) are regulated or suppressed by the endogenous levels of these hormones. Sexhormonal therapyinduces attenuated GnRH stimulation of LH and FSH causing a reduction of serum sexhormone levels. It is clear that estrogen as well as androgen therapy have a dual role: (i) induction of feminization or virilization and (ii) suppression of the hypothalamic-pituitary-gonadal axis leading to a reduction of endogenous estradiol or testosterone secretion. Cross-sex hormonal treatment may have substantial medical side effects. The smallest dosage of hormonal therapy compatible with the above clinical aims should be used.     

耳穴贴压联合五音疗法对急性心肌梗死患者焦虑的影响

目的：探讨耳穴贴压联合五音疗法对急性心肌梗死患者焦虑的影响。方法：选取经焦虑自评量表（SAS）评估有焦虑症状的急性心肌梗死患者80例,按随机数字表法分为对照组和观察组,每组各40例。两组均予常规治疗和健康教育,观察组在此基础上,取神门、心、交感、皮质下贴压进行干预,同时辅以五音疗法,2个疗程后评价效果。结果：干预后观察组的SAS评分明显低于对照组,两组比较差异有统计学意义（P〈0.01）。结论：耳穴贴压联合五音疗法可明显缓解患者焦虑情绪,有利于治疗的顺利进行,提高患者的生活质量。     

MRI测量腹部脂肪在针灸减肥中的应用价值

目的探讨针灸治疗单纯性肥胖中MRI测量腹部脂肪的应用价值。方法对42例单纯性肥胖患者进行电针加耳穴治疗,应用MRI检测出各患者针灸治疗前后腹壁皮下脂肪含量（SA）与腹腔内脏脂肪含量（VA）,并按照治疗前的VA/SA≤0.6（A组）和VA/SA〉0.6（B组）分为两组,比较治疗前的SA、VA、BMI及VA/SA。结果两组患者的SA、VA、BMI在治疗前后有显著性差异（P〈0.01）,而A组VA/SA无显著性差异（P〉0.05）,B组VA/SA有显著性差异（P〈0.05）。结论电针加耳穴治疗单纯性肥胖不仅能有效减少SA和VA,而且能改善患者的VA和SA的不良分布。     

Reperfusion therapy for patients with an acute myocardial infarct with ST-segment elevation: fibrinolysis versus transport to a cardiac center for primary angioplasty

Although fibrinolytic therapy for acute myocardial infarction is widely used and can be administered prior to hospitalisation, it is only successful in restoring full early coronary patency in about 60% of patients and has a 0.5% to 1% risk of severe side effects. Primary percutaneous coronary angioplasty carried out as an alternative to fibrinolysis avoids the risk of fibrinolytic therapy and restores patency in nearly 90% of cases. Data from randomised trials of primary angioplasty versus fibrinolytic therapy in acute myocardial infarction reveal that angioplasty results in a significant reduction in mortality. Furthermore, primary angioplasty can be improved by means of a new pre-angioplasty drug therapy (so-called facilitated primary angioplasty). Transport to a cardiac centre for primary angioplasty (of which there are 14 in the Netherlands) is feasible and safe. Although the time to treatment is delayed by a further 90 minutes, it tends to save lives and prevent strokes and it also significantly reduces the incidence of reinfarction. Interestingly, the time gained to treatment with prehospital fibrinolytic therapy compared to in-hospital therapy gave an outcome similar to that found upon comparing transport and primary angioplasty. Rescue procedures (angioplasty) within 24 hours are necessary in about 30% of patients who are initially treated with lytic therapy. These results support prehospital triage for fibrinolysis or transport to a cardiac centre, where early angioplasty can be performed if clinically indicated. A trial to determine the policy of choice is at present being conducted in the Netherlands.