不稳定型心绞痛和非ST段抬高心肌梗死的介入治疗

急性冠状动脉综合征(ACS)的病理生理基础是由于冠状动脉粥样硬化斑块破裂,诱发血栓形成导致的急性心肌缺血综合征。以不稳定型心绞痛(UA)和非ST段抬高心肌梗死(NSTEMI)为表现的非ST段抬高ACS,一般由富含血小板的白色血栓堵塞冠状动脉所致;而ST段抬高急性心肌梗死(STEMI)常为富含纤维蛋白原的红色血栓导致冠状动脉内完全闭塞所致。再灌注治疗[溶栓或直接经皮冠状动脉介入治疗(PCI)],明显降低STEMI患者近期和远期病死率早已被公认。但UA和NSTEMI患者的临床表现与危险程度极不相同,其治疗方法及预后也不尽相同。1危险分层对U…     

Treatment of slow/no-reflow phenomenon with intracoronary nitroprusside injection in primary coronary intervention for acute myocardial infarction.

Slow/no-reflow phenomenon is a serious problem complicating primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and is associated with a poor prognosis. From January 2002 to November 2002, 11 of the 70 consecutive patients with ST elevation AMI who were subjected to primary PCI using balloon angioplasty and/or stenting developed slow/no-reflow phenomenon (TIMI 1 flow in 2, TIMI 2 in 8, and TIMI 2.5 in 1). They were 10 men and 1 woman, aged 64 +/- 11 years (range, 46-81). The culprit vessels were six in the left anterior descending coronary artery, three in the right coronary artery, one in the left circumflex coronary artery, and one in saphenous vein graft. Multiple bolus doses (100 microg) of nitroprusside were injected into the index artery through the guiding catheter using a 3 ml syringe until the TIMI flow grade improved by at least one grade or the systolic pressure decline below 80 mm Hg (one patient). The total drug dose varied from 100 to 700 microg. Following the drug treatment, angiographic TIMI flow grade improved by at least one grade in 9 (82%) of the 11 patients (P = 0.007). The TIMI frame counts significantly decreased from 36 +/- 17 frame counts to 16 +/- 11 frame counts (P = 0.012). All patients were discharged without major adverse cardiovascular events. Intracoronary bolus injection of nitroprusside using a 3 ml syringe appears to be a feasible, safe, and effective technique for the management of slow/no-reflow phenomenon complicating primary PCI.     

Detection of inadvertent catheter movement into a pulmonary vein during radiofrequency catheter ablation by real-time impedance monitoring

Introduction: During radiofrequency ablation to encircle or isolate the pulmonary veins (PVs), applications of radiofrequency energy within a PV may result in stenosis. The aim of this study was to determine whether monitoring of real-time impedance facilitates detection of inadvertent catheter movement into a PV.
Methods and Results: In 30 consecutive patients (mean age 53 ± 11 years) who underwent a left atrial ablation procedure, the three-dimensional geometry of the left atrium, the PVs, and their ostia were reconstructed using an electroanatomic mapping system. The PV ostia were identified based on venography, changes in electrogram morphology, and manual and fluoroscopic feedback as the catheter was withdrawn from the PV into the left atrium. Real-time impedance was measured at the ostium, inside the PV at approximately 1 and 3 cm from the ostium, in the left atrial appendage, and at the posterior left atrial wall. There was an impedance gradient from the distal PV (127 ± 30 Ω) to the proximal PV (108 ± 15 Ω) to the ostium (98 ± 11 Ω) in each PV (P < 0.01). There was no significant impedance difference between the ostial and left atrial sites. During applications of radiofrequency energy, movement of the ablation catheter into a PV was accurately detected in 80% of the cases (20) when there was an abrupt increase of ≥4 Ω in real-time impedance.
Conclusion: There is a significant impedance gradient from the distal PV to the left atrium. Continuous monitoring of the real-time impedance facilitates detection of inadvertent catheter movement into a PV during applications of radiofrequency energy. (J Cardiovasc Electrophysiol, Vol. 15, pp. 1-5, June 2004)     

腔内隔绝术治疗Stanford B型胸主动脉夹层8例

目的　探讨腔内隔绝术治疗StanfordB型主动脉夹层的适应证选择、并发症防治及疗效。方法　分析 2 0 0 2 - 0 4～ 2 0 0 3- 0 4完成的 8例StanfordB型主动脉夹层的微创腔内隔绝术 (即经股动脉或髂动脉将支架 -人造血管复合移植物导入主动脉、封闭夹层裂口 )。移植物长度 97～ 99mm ,直径 34～ 4 2mm。结果　 8例均获成功。术后无死亡、截瘫及心、肺、肾等严重并发症。平均随访 (9 5± 4 6 )个月全部存活 ,无迟发内漏。结论　腔内隔绝术治疗StanfordB型主动脉夹层安全、有效 ,可作为治疗本病的首选方法。     

A research for the relationship between human papillomavirus and human uterine cervical carcinoma

Summary Biopsies from 318 cases with squamous cell carcinoma of the uterine cervix, 48 with cervical and vulvar condylomata, 14 with cervical intraepithelial neoplasia (CIN), 34 with chronic cervicitis and 24 with normal cervical epithelium were collected from different geographic regions with different cervical cancer mortalities. The DNA · DNA dot-blot and Southern blot hybridization results show that there is a close relationship between HPV-16 and the uterine cervical squamous cell carcinoma in China. One very interesting observation is that the finding of HPV-16-homologous DNA differs significantly among five geographic regions, and corresponds with the mortalities from cervical cancer of these five regions. HPV-11 was found mainly in benign lesions. The rate of detection of HPV-16 in Chinese women increased from 8.3% in normal cervical epithelium to 20% in chronic cervicitis, 28% in cervical condyloma, 50% in CIN and 60.4% in cervical cancer. It is suggested that HPV-16 infection may be an etiological factor in the development of human cervical carcinoma. From the results of Southern blot hybridization, it appeared that HPV-16 DNA had been integrated into the genome of the host cell in cervical cancer. Whereas the HPV-16 DNA sequence was only present as an episome in normal cervical epithelium and cervical benign lesions. The rate of occurence of E6-E7 genes is the highest (88.9%) compared with that of other subgenomic fragments of HPV-16 in specimens of human cervical cancer in China. This implies that E6 and E7 may be the oncogenic genes of HPV-16 and play an important role in the carcinogenesis of human cervical epithelial cells. The amplification and rearrangement of the c-myc protooncogene are closely associated with the occurrence of cervical cancer. The results presented here revealed that the activated c-myc oncogene may cooperate with HPV-16 in the carcinogenic processes.Abbreviations HPV Human papillomavirus - CIN cervical intraepithelial neoplasia - SSC standard saline citrate     

Phenotyping of malignant hematopoietic cells

Summary 1255 cases of leukemia-lymphoma were tested between 1972 and 1984 by multiple marker analysis. Routine leukemia phenotyping was performed using standard morphological and cytochemical techniques in combination with clinical and histo-pathological information; the main emphasis was put on immunological surface marker analysis using erythrocyte rosette assays, TdT and a large panel of poly- and monoclonal antibody tests. The 1255 cases were divided into these major types and subtypes: 349 cases of ALL and related immature T- and Burkitt-lymphomas (cALL, pre B-ALL, B-ALL and Burkitt-lymphomas, T-ALL and immature, mostly leukemic T-lymphomas, Null-ALL), 454 cases of mature T- and B-cell malignancies (T-CLL, mycosis fungoides, Sezary-syndrome, T-lymphomas, B-CLL, hairy cell leukemia, multiple myeloma, B-lymphomas), 263 cases of acute myeloid leukemias (AML, AMMoL/AMoL), 182 cases of chronic myeloid leukemias (CML in chronic phase, CMoL, CML in blast crisis), 6 cases of erythroleukemia and 1 case of megakaryoblastic leukemia. A simplified classification scheme which has been used in our laboratories is presented. Phenotyping is of diagnostic, prognostic and therapeutic relevance, most evidently for patients with ALL. Routine leukemia phenotyping should be performed with highly standardized techniques and reagents and by combining information from several fields in the multiple marker analysis. New areas of leukemia research might become very useful for the routine procedure of phenotyping.Abbreviations ALL acute lymphoblastic leukemia - AML acute myeloblastic leukemia - AMMoL acute myelomonoblastic leukemia - AMoL acute monoblastic leukemia - cALL common ALL - CLL chronic lymphocytic leukemia - CML chronic myelocytic leukemia - CML-BC CML in blastic crisis - CMoL chronic monocytic leukemia     

血清含量对HaCaT细胞生长特性及迁移能力的影响

[目的] 考察不同血清含量以及培养不同时间对人永生化角质形成细胞(HaCaT)细胞的生长及迁移特性的影响,为HaCaT细胞划痕实验条件优化提供实验数据支撑。[方法] 培养HaCaT细胞,按10%血清浓度全培基(全培基阳性对照组)、2%低浓度血清培基(低血清培基组)及无血清培基(对照组)分组,通过进行细胞划痕实验,CCK-8细胞活力检测、Brdu细胞增殖实验,分析HaCaT生长特性。[结果] 在24 h内,低血清培基组HaCaT细胞与全培基组相比,细胞增殖能力无明显差异,细胞活力有增高的趋势。细胞孵育48 h后,全培基组细胞增殖能力及活力明显升高。24~48 h,全培基组细胞增殖能力及细胞活力的提升速度明显高于低血清培基组。[结论] 培养基中血清含量对HaCaT细胞生长特性及迁移能力具有重要影响,培养24 h内低血清培养条件有利于划痕实验的观察与测定。     

枳实薤白桂枝颗粒对异丙肾上腺素所致心肌缺血大鼠血液流变学和抗氧化作用的影响

目的研究枳实薤白桂枝颗粒对心肌缺血模型大鼠血流变指标和抗氧化作用的影响,为新药开发和临床应用提供药效学依据。方法经标准II导联心电图筛选合格的雄性SD大鼠,随机分成正常组、模型组、枳实薤白桂枝颗粒高剂量组、中剂量组和低剂量组、阳性对照组。各组先连续7天灌胃给予相应药物,从第5天开始,除正常组外其余各组同时腹腔注射异丙肾上腺素(5 mg/kg),连续3 d,制备心肌缺血模型。检测大鼠血液流变学指标变化,分光光度法检测血中MDA、SOD、GSHPx和NO水平。结果与正常组相比,模型组大鼠的全血粘度、血浆粘度和纤维蛋白原水平明显升高,MDA和GSH-Px水平显著升高,SOD、NO水平明显降低,差异有统计学意义(P<0.05);与模型组相比,各治疗组上述指标均有不同程度改善,差异有统计学意义(P<0.05)。结论枳实薤白桂枝颗粒可能通过清除氧自由基、提高机体抗氧化能力,从而改善心肌缺血大鼠血液粘浓凝聚的状态,起到保护心肌的目的 。     

胸腔镜下二尖瓣手术的体外循环管理（附80例报告）

目的总结胸腔镜下二尖瓣心脏外科手术的体外循环(CPB)管理经验和方法。方法 2013年1月-2017年6月80例胸腔镜下二尖瓣置换术,CPB采用中、浅低温,全部采用股动静脉插管,并在CPB中予以负压辅助静脉吸引,术中全部采用HTK液灌注心肌予以心肌保护,对CPB建立方法、CPB过程及手术后结果进行评价。结果 80例心脏二尖瓣疾病患者全部予以痊愈出院。全部患者CPB转流时间为97~308(192.2±54.2)min;升主动脉阻断时间为50~233(130.8±46.9)min;辅助转流时间为30~53(41.8±8.1)min。术后呼吸辅助时间6~24(20.6±14.1)h;术后ICU时间为2~6(3.3±2.6)d;术后住院时间7~10 d;术中及术后无股动静脉插管相关并发症,患者术后均恢复良好,脱机良好,无严重并发症。出院随访时间3~12个月,结果满意。结论胸腔镜下二尖瓣手术中,CPB方法安全、可行,开展此手术的初期CPB时间和主动脉阻断时间较传统手术时间较长,应加强CPB的管理,避免术中术后产生CPB相关性并发症。