生理性与非生理性起搏时心室激动顺序,收缩同步性和心室功…

应用计算机－核素心室造影对２０例病态窦房结综合征（ＳＳＳ）患者分别于植入生理性ＡＡＩ和非生理性ＶＶＩ起搏器前后进行了时相分析（ＰＡ）、等相位电影、心功能参数的测定和对比研究。结果表明：ＡＡＩ起搏不仅保持正常的心室激动顺序（ＶＡＳ）、而且增加心室收缩的同步性（ＶＳＳ），从而左室收缩功能（ＬＶＳＦ）和舒张功能（ＬＶＤＦ）亦有相应提高；ＶＶＩ起搏后ＶＡＳ异常，ＶＳＳ和ＬＶＳＦ降低，但ＬＶＤＦ有代偿性增加     

心脏起搏生理性心脏起搏的新进展

ｌ 生理性起搏概念与类型 生理性心脏起搏，是相对于右室心尖部起搏而言。传统概念是指起搏时保持房室顺序收缩，和（或）随机体代谢需要而改变起搏频率的起搏方式。近年来，更完善的生理性起搏还包括双心房或双心室同步起搏。使心肌激动顺序更接近自身生理活动。生理性心脏起搏主要包括：心房按需起搏（ＡＡＩ，ＡＡＴ），心房同步心室起搏（ＶＡＴ，ＶＤＤ），全自动起搏（ＤＤＤ），频率自适应型起搏（ｒａｔｅ ｒｅｓｐｏｎｓｉｖｅ ｐａｃｅ）。２ 各类生理性心脏起搏适应证、禁忌证及进展２．１ 心房生理性起搏 心房按需起搏是最简单…     

高血压病心室活动同步性和收缩功能的核素心室造影研究

应用计算机－核素心室造影（ＥＲＮＡ）对１２０例各期高血压患者和２０例正常人进行左室收缩功能（ＬＶＳＦ）参数测定，并通过位相分析得到心室活动同步性（ＶＳＳ）参数心室相角程（ＰＳ）和半高竞（ＦＷＨＭ）。结果表明：高血压病Ⅰ期组ＬＶＳＦ参数在正常或超常水平；Ⅱ期患者与Ⅰ期患者比较，其ＬＶＥＦ和１／３ＥＦ降低（Ｐ＜０．０５）且ＰＳ和ＦＷＨＭ增宽（ＰＭ＜０．０５），提示存在ＶＳＳ损伤；Ⅲ期ＬＶＳＦ各参数均较Ⅰ、Ⅱ期明显降低（Ｐ＜０．０１），ＰＳ和ＦＷＨＭ更增宽（Ｐ＜０．０１）。ＬＶＥＦ与ＰＳ和ＦＷＨＭ呈负相关（ｒ＝－０．５４，－０．５０，Ｐ＜０．０５）。ＰＳ和ＦＷＨＭ增竟是ＶＳＳ损伤表现．计算机－ＥＲＮＡ在高血压病分期诊断、治疗和判断预后上有重要意义。     

超声心动图对急性心肌梗塞后左心室结构和功能的评价

目的 动脉观察急性心肌梗塞后左室结构和功能的变化,评价溶栓治疗对梗塞后心室重构的影响。方法 对２８例首发急性心肌梗塞患者于梗塞后第４周和第１２周进行超声心动图观察。所测参数有：左室舒张末期和收缩末期容积指数（ＬＶＥＤＶＩ,ＬＶＥＳＶＩ）及射血分数（ＥＦ）。结果 急性心肌梗塞患者ＬＶＥＤＶＩ,ＬＶＥＳＶＩ均明显增高;栓组ＬＶＥＤＶＩ,ＬＶＥＳＶＩ无明显变化,ＥＦ升高,未溶栓组ＬＶＥＤＶＩ,ＬＶＥＳＶ     

生理性起搏与心室起搏对冠心病心律失常患者心脏耐力,生存质量及心功能的

目的：比较生理性起搏与心室起搏对缓慢型心律失常心脏耐力、生存质量及心功能的影响，方法：安置心室起搏器（ＶＶＩ型起搏器）３３８例，生理性起搏器８２例（其中双腔起搏器３２例）术后进行随访。结果：安置两种起捕器后患心脏耐力生存质量提高，心功能明显改善，晕阙症全部消失，尤以生理性起搏明显。结论：生理性起搏对患心脏耐力、生存质量及心功能的改善作用更好。     

门控心血池断层显像测定冠心病患者左室容积和功能的研究

对１０例正常人和２６例冠心病患者进行了门控心血池断层显像，测定其左室舒张末期容积（ＩＶＥＤＶ）、左室收缩末期容积（ＬＶＥＳＶ）、每搏射血量（ＳＶ）及左室射血分数（ＬＶＥＦ）。结果显示：冠心病组的ＬＶＥＤＶ、ＬＶＥＳＶ＞正常对照组，ＬＶＥＦ＜正常对照组，ＳＶ在二组之间无显著性差异。重复性试验表明左室容积测定结果稳定。认为门控心血池断层显像是一种直接、准确的无创伤性测定左室功能的显像方法，对冠心病左室功能评价有临床应用价值。     

超声心动图评价房间隔缺损患者左心室收缩功能

用超声心动图检测２８例继发孔型房间隔缺损（ＡＳＤ）患者及４０例正常人左心室收缩功能（ＬＶＳＦ）。结果表明：ＡＳＤ患者左室射血分值（ＬＶＥＦ）、短轴缩短分数（ＬＶＦＳ）、每搏量（ＳＶ）、心输出量（ＣＯ）、主动脉瓣口血流速度（ＡＶ）、速度时间积分（ＡＶＩ）均较正常人明显降低（Ｐ＜０．００１～０．０５），左室射血前期（ＬＰＥＰ）延长（Ｐ＜０．０１）、射血时间（ＬＶＥＴ）缩短（Ｐ＜０．０５）、ＬＰＥＰ／ＬＶＥＴ增大（Ｐ＜０．０１），且ＬＶＥＦ、ＬＶＦＳ、ＳＶ、ＣＯ、ＡＶ、ＡＶＩ与肺／体循环量比值（Ｑｐ／Ｑｓ）呈中度负相关（ｒ＝－０．３９～－０．７８，Ｐ＜０．０５）。结论认为：ＡＳＤ患者ＬＶＳＦ存在一定程度的减退，并推测其机理可能与ＡＳＤ患者因右室容量超荷所致的左室扩张性降低、舒张末容积减小、室间隔运动异常及左室几何形态改变等有关     

超声心动图及多普勒超声探测非胰岛素依赖型糖尿病患者左室功能

应用超声心图及多普勒超声检测１０３例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者和５１例健康人左心室功能和结构参数。结果：各组ＮＩＤＤＭ患者左室舒张功能均有异常，收缩功能障碍仅见于伴大血管病变者。与正常人比较，糖尿病患者ＰＶＡ和ＰＶＡ／ＰＶＥ升高，ＰＶＥ和ＭＥＦ降低；ＬＶＳＴ、ＬＶＰＷＴ、ＬＶＭ和ＬＶＭＩ增加；伴大血管变者ＳＶ、ＣＯ及ＥＦ均减少。结论：ＮＩＤＤＭ患者常见左室功能障碍，甚至可见于无血管并发     

超声心动图对室壁瘤切除术后左心功能的初步研究

１１例患者于室壁瘤切除术前后进行了超声心动图检查。其中男１０例，女１例，年龄３９至６８岁。心尖部室壁瘤９例，下后壁室壁瘤２例。１０例患者室壁瘤切除术（ＬＶＡ）的同时进行了ＣＡＢＧ。ＥＤＶ、ＥＤＶＩ、ＥＳＶ、ＥＳＶＩ和ＳＶ于ＬＶＡ后明显减少（Ｐ＜０．０５－０．００１），ＨＲ增加，ＥＦ、ＣＯ和ＣＩ无明显变化。二尖瓣血流频谱显示所有患者舒张功能类型和Ｅ峰流速、Ｅ峰压差、Ａ峰流速、Ａ峰压差及ＩＶＲＴ手术前后均没有明显改变（Ｐ＞０．０５）。所以，ＬＶＡ可明显减低室壁瘤患者的ＥＤＶ、ＥＤＶＩ、ＥＳＶ、ＥＳＶＩ，使上述指标趋于正常；ＳＶ可出现下降但ＥＦ、ＣＯ和ＣＩ无变化。二尖瓣血流频谱的变化显示ＬＶＡ对左室舒张功能无明显影响。上述结论还有待进一步证实。     

尿毒症心脏病变的超声心动图及多普勒研究

目的：探讨超声心动图及多普勒在尿毒症患者所致心脏病变的诊断中的应用价值。方法：本文选用３０例超声心动图及多普勒资料完整的病例作为病例组并随机抽取正常人３０例作为对照组。结果：尿毒症组与对照组各测值统计学处理，差异显著。左室腔明显扩大，左室心肌重量和左空心肌重量指数明显增加（Ｐ＜０．０１），左室收缩功能ＥＦ与ＦＳ无差异（Ｐ＞０．０５），反映泵血功能的ＳＶ、ＥＳＶ、ＥＤＶ和ＣＯ增高（Ｐ＜０．０５－Ｐ＜０．０１）；反映左室舒张功能的二尖瓣血流频谱Ａ峰、ＡＩ、Ｅ／Ａ和 ＩＶＲＴ均有增大（ Ｐ＜ ０．０５－ Ｐ＜ ０．０１），肺静脉血流频谱 Ｄ波、ＤＩ和 ＲＦＩ明显减少， Ｓ／Ｄ ＡＲ和 ＡＲＤ均有明显增加（Ｐ＜０．０１），左室舒张功能下降明显。结论：超声心动图与多普勒在尿毒症患者心脏病变的检查诊断中有极高的应用价值。     

Causes of death in patients with rheumatic diseases in Moscow

AIM: To study causes of death of rheumatic patients in Moscow. MATERIAL AND METHODS: Autopsy protocols for 1999-2002 were analysed for two pathoanatomic departments of Moscow. RESULTS: Rheumatic diseases were detected in 165 cases (2.0% of overall number of autopsies in these departments). Rheumatic heart disease (RHD) was stated in 99 (60.0%) cases, rheumatic fever relapse (RFR) in 4 (2.4%), rheumatoid arthritis (RA) in 28 (17.0%), systemic lupus erythematosus (SLE) in 8 (4.8%), systemic sclerosis (SS) in 3 (1.8%), ankylosing spondilarthritis (AS) in 2 (1.2%), systemic vasculitis (SV) in 2 (1.2%), osteoarthrosis in 11 (7.3%), gout in 3 (1.8%), polymyositis in 1 (0.6%). RHD patients died of decompensated circulation (DC) (54%), acute heart failure (AHF) (14%), thromboembolism (TE) (6%), other causes (26%). RF patients died of TE (n = 2), DC (n = 1), AHF (n = 1). Out of 28 RA patients, 5 patients died of secondary amyloidosis, 3 of DC, 7 of AHF, 1 of TE, 5 of infectious complications, 7 of other causes. SLE patients died of uremia (n = 2), acute adrenal failure (n = 1), infectious complications (n = 2), AHF (n = 2), brain edema (n = 1). CONCLUSION: Among rheumatic diseases, rheumatic heart valve disease was most severe as it caused the highest mortality. Cardiovascular pathology caused death in most of the rheumatic patients.     

头穴丛刺结合丰富环境刺激对缺氧缺血性脑损伤新生大鼠内源性神经干细胞增殖迁移的影响

目的探讨头穴丛刺结合丰富环境刺激对缺氧缺血性脑损伤(HIBD)新生大鼠内源性神经干细胞(NSCs)增殖及迁移的影响。方法用Rice法建立HIBD动物模型,随机分为假手术组、造模组、头穴丛刺组、丰富环境刺激组和头穴丛刺结合丰富环境刺激组,每组24只,每组又分为3d、7d、14d。应用免疫组化法观察5-溴脱氧尿核苷(BrdU)和巢蛋白(nestin)阳性细胞数。结果与造模组同期比较,3d、7d、14d头穴丛刺组、丰富环境刺激组侧脑室下区(SVZ)和大脑皮层BrdU、nestin阳性细胞数明显增加(P<0.01);头穴丛刺结合丰富环境刺激组BrdU、nestin阳性细胞数高于同期头穴丛刺组和丰富环境刺激组(P<0.05)。结论头穴丛刺结合丰富环境刺激可促进HIBD新生大鼠SVZ和大脑皮层区内源性NSCs的增殖迁移。     

Spinal 5-HT(2) and 5-HT(3) receptors mediate low, but not high, frequency TENS-induced antihyperalgesia in rats

Transcutaneous electrical nerve stimulation (TENS) is a form of non-pharmacological treatment for pain. Involvement of descending inhibitory systems is implicated in TENS-induced analgesia. In the present study, the roles of spinal 5-HT and alpha(2)-adrenoceptors in TENS analgesia were investigated in rats. Hyperalgesia was induced by inflaming the knee joint with 3% kaolin-carrageenan mixture and assessed by measuring paw withdrawal latency (PWL) to heat before and 4 h after injection. The (1). alpha(2)-adrenergic antagonist yohimbine (30 microg), (2). 5-HT antagonist methysergide (5-HT(1). and 5-HT(2). 30 microg), one of the 5-HT receptor subtype antagonists, (3). NAN-190 (5-HT(1A), 15 microg), (4). ketanserin (5-HT(2A), 30 microg), (5). MDL-72222 (5-HT(3), 12 microg), or (6). vehicle was administered intrathecally prior to TENS treatment. Low (4 Hz) or high (100 Hz) frequency TENS at sensory intensity was then applied to the inflamed knee for 20 min and PWL was determined. Selectivity of the antagonists used was confirmed using respective agonists administered intrathecally. Yohimbine had no effect on the antihyperalgesia produced by low or high frequency TENS. Methysergide and MDL-72222 prevented the antihyperalgesia produced by low, but not high, frequency TENS. Ketanserin attenuated the antihyperalgesic effects of low frequency TENS whereas NAN-190 had no effect. The results from the present study show that spinal 5-HT receptors mediate low, but not high, frequency TENS-induced antihyperalgesia through activation of 5-HT(2A) and 5-HT(3) receptors in rats. Furthermore, spinal noradrenergic receptors are not involved in either low or high frequency TENS antihyperalgesia.     

C-反应蛋白对急性肺栓塞预后的评估

目的 探讨血浆C-反应蛋白(CRP)水平对评估急性肺栓塞患者预后的价值.方法 56例急性肺栓塞患者,通过螺旋CT、肺动脉造影(CTPA)、磁共振显像(MRI)、肺动脉造影确诊,入院后均行CRP、心电图(ECG)、超声心动图(UCG)、动脉血气分析等检查.结果 CRP≥10 mg/L共24例,其中大面积肺栓塞12例(50.0%),次大面积11例(45.8%),小面积栓塞1例(4.2%),死亡6例(25.0%);UCG示右心室功能不全24例(100.0%),肺动脉高压24例(100.0%),心电图示右心室负荷过重20例(83.3%),PaO2<60mm Hg 22例(91.7%);晕厥8例(33.3%),心源性休克9例(37.5%).CRP<10 mg/L者32例,其中大面积肺栓塞3例(9.4%),次大面积6例(18.8%),小面积23例(71.8%),死亡1例(6.3%);UCG示右心室功能不全13例(40.6%),肺动脉高压16例(50.0%),心电图示右心室负荷过重15例(46.9%),PaO2<60mm Hg 11例(34.4%);晕厥2例(6.3%),心源性休克4例(12.5%).2组比较,大面积栓塞发生率、病死率、次大面积栓塞发生率差异均有统计学意义(P<0.01或P<0.05),辅助检查右心室功能不全、肺动脉高压、右心室负荷过重、PaO2<60 mm Hg发生率差异均有统计学意义(P均<0.01),症状和体征中晕厥、心源性休克发生率差异均有统计学意义(P均<0.05).结论 CRP可作为急性肺栓塞患者的预后指标,可以帮助明确危险分层,指导治疗.     

Nonscheduled consultation in oncologic patients. How many of them are true emergencies? An observational prospective study

Oncologic emergencies have been extensively described and clearly defined. In oncology daily practice, cancer patients seek nonscheduled medical care in situations they perceive as a medical emergency, but which may not be a true emergency. The aim of the study was to identify the main symptoms leading to a nonscheduled consultation (NSC) and their relationship to the type of cancer, and to evaluate whether the diagnosis at discharge of patients admitted as result of a NSC correlates with a true oncologic emergency. This was a prospective observational study. Between July 2002 and April 2003, 365 NSCs were recorded. The most frequent baseline diseases were breast cancer (70), lung cancer (67), gastrointestinal cancer (52), lymphoma (42) and ovarian cancer (22). The most common symptoms for consultation were: fever (84), pain (81), cutaneous manifestations (26), dyspnea (23), bleeding (16) and abdominal distention (16). Overall, 114 of 365 NSCs (31%) resulted in admission. The most frequent symptoms resulting in admission were fever (42), pain (16), dyspnea (11), vomiting (9), neurologic manifestations (7), abdominal distention (6) and anuria (6). At discharge, only 30 patients (26%) admitted after a NSC were diagnosed with a defined oncologic emergency: febrile neutropenia (13), intestinal occlusion (12), obstructive uropathy (4) and abdominal perforation (1). True emergencies were not the most frequent causes of NSC at our institution.     

临床分离多重耐药菌的分布及变化趋势

目的了解2013年至2015年多重耐药菌(MDROs)的分布及变化趋势,为临床有效控制多重耐药菌(MDROs)感染提供依据。方法应用WHONET5.6软件,对2013年至2015年主要MDROs分布及变化趋势进行分析。结果 2013年至2015年共分离出病原菌2232株,其中多重耐药菌株(MDROs)896株,占全部病原菌的40.1%;主要MDROs构成比依次为ESBL-ECO(30.1%)、CRAB(20.0%)、MRSCNS(13.2%)、ESBL-KPN(10.5%)、MDRPA(7.9%)、MRSA(4.7%);896株多重耐药菌主要分布在重症医学科、老年科、神经外科、泌尿外科、神经内科,临床分离出主要多重耐药菌株最多的标本为痰(42.3%),依次是中段尿(19.6%)、血液(19.2%)、分泌物(10.7%);ESBL-ECO三年检出率相对稳定;2015年ESBL-KPN检出率(37.0%),明显低于2013年(52.8%)、2014年(56.7%);2015年MRSCNS检出率(78.0%),明显低于2014年(96.6%)、2013年(83.0%);2015年MDRPA检出率(14.1%)低于2013年(26.4%)、2014年(33.7%);2015 CRAB年检出率(68.7%),低于2013年(77.4%)、2014年(83.7%);MRSA2015年检出率(37.5%),较2013年(31.2%)、2014年(27.0%)有所增加;特殊耐药菌株CRKPN检出率三年保持稳定(4.0%、4.5%、4.1%),2015年CRPA检出率(12.5%)显著低于2014年(28.9%),2015年CRECO检出率(2.5%)高于2013年(0%)、2014年(0.8%)。结论多重耐药菌已逐渐成为医院感染的主要病原菌,我院CRAB检出率较高,MRSA、CRECO有逐年增高的趋势,应采取综合措施进行积极有效的预防与控制。     

Elucidation of the vasoactive intestinal peptide pharmacophore for VPAC(2) receptors in human and rat and comparison to the pharmacophore for VPAC(1) receptors

Vasoactive intestinal peptide (VIP) functions as a neurotransmitter involved in a number of physiological and pathological conditions. The actions of VIP are mediated through VPAC(1) and VPAC(2). In contrast to VPAC(1), which has been extensively studied, little is known about the pharmacology of VPAC(2). In this study we investigated the VIP pharmacophore for VPAC(2) by using alanine and D-amino acid scanning. We found significant species differences, and the human VPAC(2) (hVPAC(2)) expressed in Chinese hamster ovary (CHO) cells, which have been used in previous studies, differed significantly from the native hVPAC(2) in Sup T(1) cells and hVPAC(2) expressed in PANC1 cells. There was a close agreement between binding affinities and potencies for VPAC(2) activation. The amino acids whose backbone or side chain orientations were most important for high affinity potency are Asp(3), Phe(6), Thr(7), Tyr(10), Arg(12), Tyr(22), and Leu(23), whereas the side chains of Ser(2), Asp(8), Asn(9), Gln(16), Val(19), Lys(20), Lys(21), Asn(24), and Ser(25) are not essential. Comparison of the VIP pharmacophore between hVPAC(1) and hVPAC(2) demonstrated that the side chains of Thr(7), Tyr(10), Thr(11), and Tyr(22) were much more critical for high affinity for the hVPAC(2) than the hVPAC(1). In contrast, the orientation of the side chain of Asn(24) was more important for high affinity for the hVPAC(1). This study shows that in assessing the pharmacophore of VIP analogs for the VPAC(2), important species differences need to be considered as well as the expression system used. These results of our study should be useful for designing VPAC subtype-selective analogs, simplified analogs, and possibly metabolically stable analogs.     

Lepirudin in patients with heparin-induced thrombocytopenia – results of the third prospective study (HAT-3) and a combined analysis of HAT-1, HAT-2, and HAT-3

OBJECTIVES: To assess efficacy and safety of lepirudin in patients with heparin-induced thrombocytopenia (HIT) in a prospective study (HAT-3) as well as in a combined analysis of all HAT study data. PATIENTS/METHODS: Patients with laboratory-confirmed HIT were treated with lepirudin in three different aPTT-adjusted dose regimen and during cardiopulmonary bypass (CPB). Endpoints were new thromboembolic complications (TEC), limb amputations, and death and major bleeding. A historical control group (n = 120) was used for comparison. RESULTS: After start of lepirudin in 205 patients treated in HAT-3, the combined endpoint occurred in 43 (21.0%). Thirty (14.6%) patients died, 10 (4.9%) underwent limb amputation, and 11 (5.4%) new TECs occurred. Major bleeding occurred in 40 patients (19.5%) (seven during CPB surgery). Combining all prospective HAT trials (n = 403), after start of lepirudin treatment, the combined endpoint occurred in 82 patients (20.3%), with 47 deaths (11.7%), 22 limb amputations (5.5%), 30 new TECs (7.4%), and 71 (17.6%) major bleedings. Compared with the historical control group (log-rank test), the combined endpoint after start of treatment was reduced (29.7% vs. 52.1%, P = 0.0473), primarily because of reduction in new thromboses (11.9% vs. 32.1%, P = 0.0008). Mean lepirudin maintenance doses ranged from 0.07 to 0.11 mg kg(-1) h(-1). Major bleeding was more frequent in the lepirudin-treated patients (29.4% vs. 9.1%, P = 0.0148). CONCLUSIONS: The rate of new TECs in HIT patients is low after start of lepirudin treatment. The rate of major bleeding of 17.6% might be reduced by reducing the starting dose to 0.1 mg kg(-1) h(-1).