重新认识aVR导联在心律失常诊断中的价值

体表心电图是一种快速、廉价、无创的临床检查方法.aVR导联是心电图（ECG）六轴系统中惟一位于右上象限的导联（图1）,这一导联的设置在心电图设计之初具有重要的作用,但随着现代心电学的发展,人们更加关注左胸导联,aVR导联的作用被逐渐忽略,许多心电工作者认为aVR导联仅是Ⅰ、Ⅱ导联平均值的翻转,它所提供的心电信息已经包含在Ⅰ、Ⅱ导联中,但实际上aVR导联却有其不容忽视的重要价值,aVR导联指向-150°的位置,它反映了心脏右上部如右心室流出道与室间隔基底部的心电活动,     

Angiotensin-converting enzyme I/D gene polymorphisms and effects of left ventricular hypertrophy in Turkish myocardial infarction patients

OBJECTIVE: Since the initial report of the association of the deletion/insertion (D/I) polymorphism in the gene for angiotensin-converting enzyme (ACE) with myocardial infarction (MI), there has been considerable controversy. Some have found the D allele to be associated with MI, coronary heart disease (CHD) or other cardiac pathologies, while others have not. In view of the clinical importance of the ACE as a major marker of cardiovascular diseases, we investigated the I/D polymorphism of the ACE gene in Turkish patients with acute myocardial infarction in comparison with control subjects. METHODS AND RESULTS: Polymerase chain reaction, and agarose gel electrophoresis techniques were used to determine the ACE genotype in 214 subjects. The frequencies of ACE D and ACE I allele among the patients with acute myocardial infarction were 65.54% and 36.45% and in the control subjects 57.62% and 42.37%, respectively. ACE DD genotypes were found higher in patients with left ventricular hypertrophy (LVH) than without LVH (55.6% vs. 37.7%; X2: 2.534, p > 0.05). CONCLUSIONS: The ACE D allele is more frequent in patients with acute myocardial infarction than in controls. Moreover ACE DD genotype might be associated with an increased risk of left ventricular hypertrophy.     

The effectiveness of a shared conference experience in improving undergraduate medical and nursing students’ attitudes towards inter-professional education in an Asian country: a before and after study

Background

In recent years, increasing emphasis has been placed on the importance of collaboration within multi-disciplinary healthcare teams, so as to facilitate holistic patient care and thus allow improved treatment outcomes. There is hence an urgent need to educate healthcare undergraduates early in their professional careers on the importance of and complexities involved in cooperating with counterparts from other allied healthcare professions. In conjunction with this, a milestone student-led conference for undergraduate students, the 9th Student Medical-Nursing Education Conference (SMEC), was organised in 2013 to provide a unique opportunity for shared learning among the entire cohort of undergraduate medical and nursing students in Singapore matriculating in that year.

Methods

This study evaluated the effectiveness of the 9th SMEC 2013 as a shared conference experience in improving the attitudes of undergraduate medical and nursing students in Singapore towards inter-professional education (IPE). A 19-point Readiness for Inter-Professional Learning Scale (RIPLS) questionnaire comprising three subscales was administered to participants both before and after the conference. 352 responses were collected, giving a response rate of 75.1 %. Results were analysed using paired-samples t-tests with statistical significance set at p?=?0.05.

Results

Improvements in overall scores for both medical and nursing students were reported for all three RIPLS subscales. Examining the RIPLS items individually, significant improvement in scores for both medical and nursing students was obtained in all 19 items. Prior exposure to IPE activities was not a predictor of improvement in IPE attitudes.

Conclusion

The authors propose that student-led jointly-organised conference experiences are effective in improving healthcare students’ attitudes towards IPE. This study provides valuable insights to facilitate the development of further IPE programs to allow for the rapid and effective promotion of cooperation and collaboration between students across various healthcare disciplines.

     

α-细辛脑原位凝胶初步稳定性的研究

目的:考察α-细辛脑原位凝胶的稳定性。方法:通过考察温度、湿度、光照、离心力对制剂的外观形状和含量变化,确定该制剂的保存方法及有效期限。结果:在4℃冰箱避光密封保存,该制剂在6个月内稳定性良好。结论:该制剂稳定性符合要求。     

火针治疗寻常疣的临床观察

目的观察火针治疗寻常疣的临床疗效。方法将160例寻常疣患者随机分为治疗组和对照组,每组80例。对照组采用疣体内局部注射聚肌胞治疗,治疗组采用火针治疗。治疗周期为28 d,观察临床疗效,比较寻常疣自拟综合分级评分、治疗时VAS疼痛评分的变化情况,同时评价安全性。结果①试验过程中,治疗组脱落3例,对照组脱落6例,最终完成试验者151例,其中治疗组77例,对照组74例。②治疗组总有效率97.4%,对照组总有效率73.0%;两组临床疗效比较,治疗组优于对照组(P<0.05)。③第2次治疗前、第3次治疗前与第1次治疗前组内比较,两组寻常疣自拟综合分级评分差异无统计学意义(P>0.05);第4次治疗前与第1次治疗前组内比较,两组寻常疣自拟综合分级评分差异有统计学意义(P<0.05)。第2次治疗前、第3次治疗前组间比较,寻常疣自拟综合分级评分差异无统计学意义(P>0.05);第4次治疗前组间比较,治疗组寻常疣自拟综合分级评分少于对照组(P<0.05)。④第1次治疗时组间比较,VAS疼痛评分差异无统计学意义(P>0.05);第2次治疗、第3次治疗、第4次治疗时组间比较,治疗组治疗时VAS疼痛评分少于对照组(P<0.05)。⑤试验过程中,两组均未见明显不良反应。结论火针治疗寻常疣疗效满意,与聚肌胞注射疗法相比,能更好地改善患者的临床症状,且治疗时疼痛小,安全性好,值得临床进一步推广应用。     

A Deductive Mapping Strategy for Atrial Tachycardia Following Atrial Fibrillation Ablation: Importance of Localized Reentry

Background: Atrial tachycardia (AT) occurring following catheter ablation of persistent atrial fibrillation (AF) may be challenging to map and ablate because their mechanism and location is unpredictable and may be multiple in an individual patient.
Methods and Results: A prospective cohort of 128 consecutive patients presenting 246 AT in the context of prior AF ablation was investigated. Using activation and entrainment mapping and applying the consensus definition of AT, we evaluated a deductive diagnostic approach based on up to three steps: (1) cycle length regularity, (2) search for macroreentry (i.e., involving >2 separate atrial segments), and (3) if macroreentry excluded, search for focal origin giving a centrifugal activation of the atria. A total of 238/246 (97%) sustained AT (mean cycle length [CL] 284 ± 87 ms) were successfully mapped (single AT, 51 pts; multiple AT, 77 pts) with a diagnostic time of 10 ± 8 min per tachycardia. AT were macroreentrant in 109 (46%) and focal in 129 (54%). Of the latter, only 34 focal AT originated from a discrete point site fulfilling the consensus criteria, while a distinct mechanism, localized reentry (AT that was neither macro reentry nor focal), was identified in 95. Localized reentry was defined by (1) electrograms covering ≥75% of the cycle length of AT within an area covering a single or 2 contiguous segments, (2) postpacing interval (PPI) < 30 ms at the site, (3) an identifiable zone of slow conduction, and (4) centrifugal activation of the atrium from the area.
Conclusions: This prospective study demonstrates the feasibility of rapid and accurate identification of all types of postablation AT in a large cohort of patients and describes the dominant role of localized reentry as a novel mechanism of AT.