Gender Differences in the Clinical Characteristics and Atrioventricular Nodal Conduction Properties in Patients With Atrioventricular Nodal Reentrant Tachycardia

Gender Differences in Patients With AVNRT. Introduction: The detailed electrophysiological characteristics of the gender differences associated with atrioventricular nodal reentrant tachycardia (AVNRT) have not been clarified. This study investigated the gender‐related electrophysiological differences in a large series of patients undergoing radiofrequency catheter ablation. Methods and Results: A total of 2,088 consecutive AVNRT patients (men/women 869/1,219) who underwent catheter ablation were enrolled in this study. We evaluated the gender differences in their electrophysiological characteristics. Women had a significantly younger age of onset, higher incidence of multiple jumps, shorter AH interval, atrial effective refractory period (ERP), anterograde fast pathway ERP, anterograde slow pathway ERP, and retrograde slow pathway ERP, and longer ventricular ERP than men. The incidence of baseline ventriculoatrial dissociation was lower in women than in men. Women needed less isoproterenol/atropine to induce AVNRT. No gender differences in the radiation exposure time, procedure time, complication rate, acute success rate, or second procedure rate were noted. Both typical and atypical AVNRT were more predominant in women. In the patients with atypical AVNRT, there was no significant gender difference in incidence of baseline ventriculoatrial dissociation; however, the retrograde slow pathway ERP was significantly shorter in women than in men. Women of premenopausal age (≤50 years old) had a significantly higher incidence of anterograde multiple jumps and a retrograde jump phenomenon, and a shorter anterograde slow pathway ERP and retrograde slow pathway ERP than those of women over 50 years old. Conclusion: Gender differences in the anterograde and retrograde AV nodal electrophysiology were noted in the patients with AVNRT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1114‐1119)     

The Novel Electrophysiology of Complex Fractionated Atrial Electrograms: Insight from Noncontact Unipolar Electrograms

Unipolar Characteristics of CFAEs. Background: The noncontact mapping (NCM) system possesses the merit of global endocardial recording for unipolar and activation mapping. Objective: We aimed to evaluate the unipolar electrogram characteristics and activation pattern over the bipolar complex fractionated atrial electrogram (CFAE) sites during atrial fibrillation (AF). Methods: Twenty patients (age 55 ± 11 years old, 15 males) who underwent NCM and ablation of AF (paroxysmal/persistent = 13/7) were included. Both contact bipolar (32–300 Hz) and NCM virtual unipolar electrograms (0.5–300 Hz) were simultaneously recorded along with the activation pattern (total 223 sites, 11 ± 4 sites/patient). A CFAE was defined as a mean bipolar cycle length of ≤ 120 ms with an intervening isoelectric interval of more than 50 ms (Group 1A, n = 63, rapid repetitive CFAEs) or continuous fractionated activity (Group 1B, n = 59, continuous fractionated CFAEs), measured over a 7.2‐second duration. Group 2 consisted of those with a bipolar cycle length of more than 120 ms (n = 101). Results: The Group 1A CFAE sites exhibited a shorter unipolar electrogram cycle length (129 ± 11 vs 164 ± 20 ms, P < 0.001), and higher percentage of an S‐wave predominant pattern (QS or rS wave, 63 ± 13% vs 35 ± 13%, P < 0.001) than the Group 2 non‐CFAE sites. There was a linear correlation between the bipolar and unipolar cycle lengths (P < 0.001, R = 0.87). Most of the Group 1A CFAEs were located over arrhythmogenic pulmonary vein ostia or nonpulmonary vein ectopy with repetitive activations from those ectopies (62%) or the pivot points of the turning wavefronts (21%), whereas the Group 1B CFAEs exhibited a passive activation (44%) or slow conduction (31%). Conclusions: The bipolar repetitive and continuous fractionated CFAEs represented different activation patterns. The former was associated with an S wave predominant unipolar morphology which may represent an important focus for maintaining AF. (J Cardiovasc Electrophysiol, Vol. 21, pp. 640‐648, June 2010)     

传统中国医疗伦理对当代美德医疗伦理学可作的贡献

晚近20年,英语世界道德哲学的最重大发展是美德伦理学的复兴。除了新亚里士多德学派,还有休谟学派、尼采学派及基督教学派等。同样的复兴也在医疗伦理学中发生。影响世界的Beauchamp与Childress的《生命医疗伦理学原则》,也在最新版本（第6版,2009年）中不再批评美德伦理学,而且承认其优点。从此书的第三版开始分析,看书的作者如何在以后三次修订版中,修改自己对美德伦理学的立场。与现代西方不同,古代中国医疗伦理的著述,是规则导向与关德导向并重,这肯定受了儒家文化的影响。儒家伦理学一直是美德导向,今天西方美德伦理学也要向孔孟取经。礼失求诸野,今天西方的医疗伦理学都强调美德的重要性,中国的医疗伦理学难道还只停留在讨论四个道德原则的运用吗？再者,我们要提出切合这个时代需要的修养工夫,这样不单是对当代中国医疗伦理的建设,也是对世界性美德医疗伦理学的贡献。     

英国药学教育制度对我国药学教育发展的启示

目的:探讨英国药学教育制度对我国药学教育发展的启示。方法:分析英国药学教育制度的成功之处及其缺点,提出对我国药学教育未来发展的建议。结果与结论:英国药学教育以培训药学硕士为主,其教学内容需遵从英国药物政务局的全国统一指示性药学教学大纲,教学及考试方式以案例教学法和临床能力测验为主,有效地规范了全国的药学教育,使课程的质量和学生能力达到较高水平。这些制度对我国药学教育有正面的参考价值,也有实施的可能性。     

口腔矫治器对阻塞性睡眠呼吸暂停综合征合并高血压患者血压的影响

目的探讨二维可调式口腔矫治器（OA）治疗阻塞性睡眠呼吸暂停综合征（OSAS）合并高血压患者时,对其血压的影响。方法 106例确诊为中度OSAS合并原发性高血压患者,规范口服降压药物治疗3个月以上,血压控制欠佳,采用二维可调式OA治疗;75例能按医嘱坚持OA治疗6个月以上为实验组;22例OA治疗时间少于三分之一作为对照组;9例患者间歇性OA治疗时间大于三分之一,没有纳入研究。统计分析实验组和对照组OA治疗前后呼吸紊乱指数（RDI）、最低氧饱和度（SaO2）以及平均收缩压（MSBP）、平均舒张压（MDBP）、脉压差（PP）。结果实验组RDI、SaO2均比OA治疗前明显改善,差异有统计学意义（P〈0.05）;对照组RDI、SaO2也比OA治疗前有改善,但差异无统计学意义（P〉0.05）。实验组MSBP、MDBP均比OA治疗前显著下降,血压恢复到正常水平,差异有统计学意义（P〈0.05）;而对照组MSBP、MDBP无改善（P〉0.05）。实验组OA治疗后,PP有所下降,但与治疗前比较差异无统计学意义（P〉0.05）;而对照组在6个月后PP升高,差异有统计学意义（P〈0.05）。组间比较MSBP、MDBP、PP三个血压参数：在治疗前实验组与对照组差异均无统计学意义（P〉0.05）,在治疗后实验组比对照组均有下降,差异均有统计学意义（P〈0.05）。结论对药物降压治疗效果不理想合并中度OSAS的高血压患者,二维可调式OA治疗可有效控制血压。     

The mediating effects of structural empowerment on job satisfaction for nurses in long-term care facilities

Aims The purpose of this study was to explore the mediating effects of work empowerment on job satisfaction for nurses in long-term care facilities in Taiwan. Background Previous research has noted that job satisfaction is an important factor that reflects upon the work environment and the characteristics of the job itself. It is important to link work empowerment to job satisfaction among nurses. Methods This research study used a cross-sectional design. A total of 65 nurses participated in the study. Regression models and Sobel tests were fitted to evaluate the relationship between work empowerment and job satisfaction. Results Structural empowerment mediated the effects of psychological empowerment on job satisfaction (standardized β = 0.46, Sobel test: z = 2.69, P = 0.007). Conclusions Both psychological and structural empowerment positively correlated with job satisfaction among nurses in long-term care facilities. The structural empowerment had a mediating effect on job satisfaction. Implications for nursing management The managers of long-term care facilities should create an empowering work environment for nurses by providing them with available resources and by involving them in the developmental goals of the facilities. The critical structural components of an empowered workplace can contribute to the psychological empowerment of nurses and increase their job satisfaction.     

Prevalence of anti-HCV among Chinese patients with acute and chronic liver disease

To assess whether the hepatitis C virus plays an important role in Chinese patients with acute and chronic liver disease, antibodies to HCV (anti-HCV) were measured by enzyme immunoassay in 67 patients with type A and B acute viral hepatitis, 165 patients with non-A, non-B (NANB) hepatitis, 438 patients with chronic hepatitis, 200 patients with postnecrotic liver cirrhosis, 72 patients with alcoholic liver disease, 55 patients with non-alcoholic fatty liver, 24 patients with toxic and drug-induced hepatitis, and 20 patients with other chronic liver diseases. Anti-HCV was not detected in sera from patients with type A and B acute viral hepatitis, toxic and drug-induced hepatitis, primary biliary cirrhosis, Wilson's disease, or lupoid hepatitis. The anti-HCV prevalence was found to be highest in patients with NANB hepatitis (59% in sporadic and 73.2% in transfusion-associated), 16.4% in non-alcoholic fatty liver, 5.6% in alcoholic liver disease, 6.8% in chronic hepatitis, and 16% in postnecrotic liver cirrhosis. In patients with chronic hepatitis, the anti-HCV prevalence was significantly higher in HBsAg-negative (15/34, 44.1%) than in HBsAg-positive cases (15/404, 3.7%; P less than 0.0001). The results indicate that HCV is a major agent of NANB hepatitis and plays an important role in HBsAg-negative chronic liver disease in Taiwan.     

间断性肝门阻断下肝细胞超微结构变化和应激基因的表达研究

目的　研究间断肝门阻断对肝细胞结构及应激基因变化的影响。方法　选择 33例和 14例 (分别作为实验组和对照组 ) ,采用半定量RT PCR方法和电子显微镜技术检测肝叶切除前后应激基因TNF α、IL 6、HSP70A和HSC70的表达状况及细胞超微结构的改变。结果　热休克基因家族HSP70A和HSC70在间断肝门血流阻断组阻断前后的mRNA表达分别为 1 5± 0 2 9,2 0 3± 0 5 3(u =0 92 ,Ρ <0 0 5 ) ;1 6 9± 0 47,1 86± 0 36 (u =1 0 ,Ρ <0 0 5 )。在对照组 ,HSP70A和HSC70切肝前后的表达值分别为 1 39± 0 2 2 ,0 92± 0 3(P >0 0 5 ) ;1 32± 0 19,1 2 8± 0 2 6 (P >0 0 5 )。TNF α和IL 6在两组中无明显差异。电子显微镜下发现阻断组肝细胞及肝窦内皮细胞的超微结构保持正常。结论　间断肝门血流阻断方法能诱导肝组织热休克基因家族高表达 ,这对保持肝细胞间的稳定和正常的超微结构非常重要。