Spontaneous Termination of Ventricular Tachycardia with Variable Patterns and Variable Mechanisms?

A 43-year-old man, with repeated episodes of postmyocardial infarction monomorpbic VT, had three forms of induced sustained VT in the electrophysiology lab. The three forms of VT had variable termination patterns with no change, decrease, or increase of cycle length.     

重组腺病毒对烫伤大鼠肝组织核因子-κB活性的调控

目的　探索腺病毒介导IκBα基因对烫伤大鼠肝组织核转录因子NF κB活性的调控作用。　方法　应用重组缺陷型腺病毒载体 (AdIκBα)预处理大鼠 ,烫伤后不同时相点取肝组织 ,提取组织核蛋白 ,与r-3 2 PATP标记的NF κB特异性探针共同反应 ,利用凝胶电泳迁移率改变分析方法(EMSA)检测NF κB/DNA结合活性 ;提取肝组织总RNA ,用RT PCR法检测IL 1β、TNFαmRNA的表达。结果　与正常对照组相比 ,烫伤组致伤后 0 .5hNF κB/DNA结合活性显著增强 ,至伤后 2 4h ,仍保持较强结合活性。AdIκBα预处理组 ,大鼠NF κB/DNA结合活性略高于正常 ,但显著低于烫伤组。RT PCR分析 ,大鼠烫伤后 0 .5h与对照组相比 ,IL 1β、TNFα表达显著升高 ,持续至伤后 2 4h ;AdIκBα预处理组 ,IL β和TNFα表达显著低于烫伤组。 　结论　大鼠严重烫伤后 ,肝组织细胞内NF κB迅速活化 ,IL 1β和TNFα的表达随之显著增强 ;经AdIκBα预处理能显著抑制大鼠严重烫伤后肝组织NF κB的活化 ,并下调IL 1β、TNFα的表达。     

腹腔镜小儿疝修补术86例的手术配合

目的：探讨腹腔镜小儿腹股沟疝修补术的手术配合方法。方法：对86例腹股沟疝患儿行腹腔镜疝修补术。做好术前心理护理、器械准备,严格无菌技术操作及加强医护密切配合。结果：本组86例患儿术后恢复快,术后住院2～5d,平均3d。出院后随访3～24个月,无复发及出现其他并发症,患儿均获得满意治疗效果。结论：充分的术前准备,术中医护的密切配合是手术成功的关键。     

脑死亡来源供肝肝移植9例临床分析

目的总结使用脑死亡来源供肝肝移植的临床经验,初步分析脑死亡来源供肝应用于临床的安全性。方法2006年1月至2007年12月我院器官移植科共实施9例脑死亡来源供肝肝移植。供体年龄16～43岁,死于颅脑外伤7例,死于脑血管意外2例,器官切取前平均动脉压(105±5.2)mmHg(1mmHg=1.333kPa)(6例需使用升压药物),肝功能检测丙氨酸转氨酶(175±40)U/L,天冬氨酸转氨酶(180±46)U/L,总胆红素(40±8.6)mmol/L。受者年龄(48.6±10.1)岁,男性8例,女性1例;术前诊断为肝硬化5例,肝癌4例,术前MELD评分(27.6±6.7)分。结果供肝冷缺血时间为(7.4±2.8)h,所有患者手术顺利。1例于术后7天死于肾功能衰竭。8例受者康复出院并随访6～24个月,1例于术后24个月死于肿瘤复发,其他并发症发生包括急性排斥反应2例,胆道狭窄并感染1例,胆道缺血1例,肺部感染1例。结论按照我们选择脑死亡供肝的原则,肝移植受者术后近期及中期预后良好,具有临床应用前景。     

中国汉族人vWF基因HhaⅠ和SmaⅠ限制性片段长度多态性研究

为了解中国汉族人vWF基因HhaⅠ和SmaⅠ限制性片段长度多态性特点,应用PCR技术结合HhaⅠ和SmaⅠ酶切分析研究了48个汉族人96条染色体等位基因的杂合情况。结果发现,96条染色体中HhaⅠ~ :HhaⅠ~-和SmaⅠ~ :SmaⅠ~-染色体的频率均分别为0.38:0.62(36:60),理论杂合率为0.47,且发现HhaⅠ和SmaⅠ呈完全连锁,未发现HhaⅠ~ /SmaⅠ~-或HhaⅠ~-/SmaⅠ~ 染色体。提示在我国汉族人群中,在vWF基因的5’端均存在HhaⅠ和SmaⅠ的多态性位点。新的vWF基因分子遗传标记的建立和应用,对vWD的遗传咨询和产前诊断具有较高的实用价值。     

新生儿窒息后血清心肌肌钙蛋白T和心肌酶检测结果分析

目的探讨新生儿窒息后血清心肌肌钙蛋白T(cTnT)和心肌酶浓度变化与窒息程度的相关性。方法采用日立7600生化分析仪和罗氏2010电化学发光免疫分析仪检测窒息新生儿血清心肌酶和cTnT浓度。结果新生儿窒息后血清心肌酶活性显著增高,其增高程度与新生儿窒息程度呈正比;血清cTnT浓度增高与新生儿窒息后是否发生心血管并发症呈正相关。结论窒息并发心力衰竭的新生儿通过检测血清cTnT和心肌酶能及早发现心肌损害,并判断其严重程度。     

Electrophysiologic Characteristics and Radiofrequency Catheter Ablation in Patients with Clockwise Atrial Flutter

RF Catheter Ablation of Clockwise Atrial Flutter. introduction: Although the mechanism and radiofrequency catheter ablation of counterclockwise (typical) atrial flutter have been studied extensively, information about the electrocardiographic and electropbysiologic characteristics and effects of radiofrequency ablation in patients with clockwise atrial flutter is limited. Methods and Results: Thirty consecutive patients with clinically documented paroxysmal clockwise atrial flutter were studied. Endocardial recordings and entrainment study using a “halo” catheter with 10 electrode pairs in the right atrium were performed. Radiofrequency energy was applied to the inferior vena cava-tricuspid annulus (IVC-TA) and/or coronary sinus ostium-tricuspid annulus (CSO-TA) isthmus to evaluate the effects of linear catheter ablation. Eighteen patients had both counterclockwise and clockwise atrial flutters, and 12 patients had only clockwise atrial flutter. Both forms of atrial flutter had similar flutter cycle lengths (232 ± 30 vs 226 ± 25 msec, P = 0.526) but reverse activation sequences. Right atrial pacing at a cycle length 20 msec shorter than the flutter cycle length from the CSO-TA isthmus, IVC-TA isthmus, and the area between the two isthmuses revealed concealed entrainment with stimulus-to-P wave intervals of 32 ± 19, 95 ± 14, and 50 ± 17 msec (P = 0.022) in the counterclockwise form, and 110 ± 12, 40 ± 20, and 60 ± 15 msec (P = 0.018) in the clockwise form. In clockwise atrial flutter, 20 patients with biphasic P waves in the inferior leads had the presumed exit site of slow conduction area located at the low posterolateral right atrium; 10 patients with positive P waves in the inferior leads had the presumed exit site located at the mid-high posterolateral right atrium. Among the 18 patients with both forms of atrial flutter, linear ablation lesions directed at the IVC-TA isthmus eliminated both forms of atrial flutter in 14 patients; in the remaining 4 patients. CSO-TA linear lesions eliminated the counterclockwise form and IVC-TA lesions eliminated the clockwise form. Among the 12 patients with the clockwise form only, CSO-TA linear lesions eliminated flutter in 2 and IVC-TA linear lesions eliminated flutter in 10 patients. Successful ablation was confirmed by creation of bidirectional conduction block in the IVC-TA and/or CSO-TA isthmus during pacing from the proximal coronary sinus and right posterolateral atrium sandwiching the linear lesions. During the follow-up period of 17 ± 8 months, 2 patients had recurrence of clockwise atrial flutter, 1 patient had new onset of atypical atrial flutter, and 2 patients had new onset of atrial fibrillation. Conclusions: Counterclockwise and clockwise atrial flutters may have overlapping slow conduction areas with different exit sites. Radiofrequency catheter ablation using the linear method directed at the IVC-TA and CSO-TA isthmuses was feasible and effective in treating both forms of atrial flutter.     

局限性非外伤性脑软化灶相关癫痫的手术治疗

目的 探讨软化灶切除联合多处软膜下横切治疗局限性非外伤性脑软化灶相关癫痫的方法 和效果.方法 28例非外伤性脑软化灶相关癫痫患者根据发作时症状、MRI、发作间期正电子发射计算机断层扫描(PET)和视频脑电图(VEEG)检查,确定致痫灶,进行全软化灶切除,软化灶周边辅以多处软膜下横切.术后随访1年以上,按Engel标准分级评价癫痫控制情况.结果 术后1年,患者达到Engle Ⅰ级6例,Ⅱ级11例,Ⅲ级9例,Ⅳ级2例.软化灶局限、远离功能区、不伴有脑萎缩的患者癫痫控制率(Engle Ⅰ～Ⅱ)在80%以上,优于其他患者(P＜0.05).结论 全软化灶切除联合多处软膜下横切可安全、有效地治疗非外伤性脑软化灶性癫痫,软化灶局限、远离功能区、不伴有脑萎缩的患者往往预后良好.     

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)