Long-Term Follow-Up After Right Atrial Radiofrequency Catheter Treatment of Paroxysmal Atrial Fibrillation

Catheter ablation of paroxysmal atrial fibrillation using long linear lesions in the right atrium is still under investigation, and its long-term follow-up is unknown. Methods: Thirty-six men and nine women (aged 51 ± 12 years) with symptomatic daily episodes of AF for 6 ± 5 years despite the use of 4.7 ± 1.5 antiarrhythmic drugs were studied between July 1994 and January 1996. Progressively longer ablation lines were performed in 3 groups of 15 consecutive patients each, using a 14-electrode catheter or a single-electrode dragging technique. Success was defined as atrial fibrillation elimination or recurrence for no longer than 6 hours over 3 months of observation. Patients who had fewer than 6 hours of atrial fibrillation per month were considered "improved." Medium- (11 ± 4 months) and long-term (26 ± 5 months) results were assessed clinically from a patient's diary and from Holter recordings. Results: After a follow-up of 11 months, 24 patients had a favorable result of the ablation procedure with or without additional antiarrhythmic drug therapy, representing 53% of the original cohort. After 26 ± 5 months of follow-up, these successful results were reduced to 17 patients (37%). Conclusions: After linear atrial ablation, a significant long-term attrition of arrhythmia-free patients was observed. This may be due to a combination of disease progression, incomplete linear block, and ineffective ablation of arrhythmogenic triggers.     

Incidence and Prevention of Cardiac Tamponade Complicating Ablation for Atrial Fibrillation

Cardiac tamponade complicating catheter ablation of atrial fibrillation (AF) occurs in approximately 1% of pulmonary vein isolation (PVI), and up to 6% of linear ablation procedures. We reviewed 348 consecutive AF ablation (including repeat) procedures over 1 year, which all included PVI, with additional linear lesions at the mitral isthmus in 73%, and cavotricuspid isthmus (CTI) in 76%. An irrigated-tip ablation catheter was used, with power limited to 25–35 W for PVI and 45–60 W for linear lesions. Tamponade occurred in seven men and three women (2.9% of the population) during the creation of linear ablation lesions. Mechanical perforations occurred in two patients, and "popping" during radiofrequency (RF) energy delivery at the mitral isthmus in six, and at the CTI in two patients. Peak RF power was significantly higher in patients with than without tamponade (53 ± 4 W vs 48 ± 7 W; P = 0.02), and was greater than 48 W in all cases of "popping." In the following year, RF power for linear ablation was limited to ≤42 W. Among 398 procedures, tamponade occurred in four patients (1.0%; P = 0.047 vs first year), three from "popping" and one from mechanical trauma. Procedural success rate remained the same despite reduction of power. Risk of tamponade was highest during linear ablation, mainly associated with high energy delivery and "popping." Reducing the energy limited, though did not eliminate this complication.     

激素联合脂多糖诱导兔早期股骨头坏死实验研究

目的观察激素联合脂多糖诱导早期兔股骨头坏死的实验效果。方法键康雄性新西兰大白兔30只,随机分为实验组（25只）和对照组（5只）。实验组连续2d每日静脉注射脂多糖10μg／kg．再连续3d每日肌肉注射甲泼尼龙20mg/kg;对照组注射同等剂量的生理盐水。5周后行CT扫描所有兔髋关节．并随机处死实验组和对照组兔各4只．行显微CT扫描股骨近端和组织切片观察。结果CT扫描显示实验组兔股骨头有不同程度的骨密度不均匀。显做CT显示骨质疏松和软骨下骨囊性化．周围可见硬化骨。组织学切片见骨细胞陷窝空疏、脂肪细胞增多及部分血管俭塞。结论激素联合脂多糖能安全便捷地诱导兔早期股骨头坏死模型。     

Cost Analysis of Catheter Ablation for Paroxysmal Atrial Fibrillation

WEERASOORIYA, R., et al. : Cost Analysis of Catheter Ablation for Paroxysmal Atrial Fibrillation . RF ablation for paroxysmal atrial fibrillation (PAF) is a curative treatment, which when successful, eliminates the need to take antiarrhythmic drugs, be anticoagulated, and have recurrent physician visits or hospital admissions. The authors performed a retrospective cost comparison of RF ablation versus drug therapy for PAF. The study population consisted of 118 consecutive patients with symptomatic, drug refractory PAF who underwent   1.52 ± 0.71   RF ablation procedures (range 1–4) for PAF. During a follow-up of 32 ± 15 weeks, 85 (72%) patients remained free of clinical recurrence in absence of antiarrhythmic drugs. The cost of RF ablation was calculated in the year 2001 euros on the basis of resource use. The mean cost of pharmacologic treatment prior to ablation was 1,590 euros/patient per year. The initial cost of RF ablation for PAF was 4,715 euros, then 445 euros/year. After 5 years, the cost of RF ablation was below that of ongoing medical management, and continued to diverge thereafter. RF catheter ablation may be a cost-effective alternative to long-term drug therapy in patients with symptomatic, drug refractory PAF. (PACE 2003; 26[Pt. II]:292–294)     

模拟航海刺激对大鼠丙泊酚麻醉敏感性的影响及机制探讨

目的 探讨模拟航海刺激对大鼠丙泊酚麻醉敏感性的影响,为海上环境下丙泊酚的合理使用提供依据.方法 以大鼠条件性厌食症作为判断指标,采用仿制Crampton旋转刺激器制作大鼠运动病模型.研究包含两部分:(1)150只SD大鼠按数字表法随机平分为对照组和旋转组,再根据丙泊酚使用剂量不同将2组大鼠分为150、200、250、300、400 mg/kg 5个亚组(每组n=15),观测大鼠活动和行为变化、大鼠入睡率、睡眠潜伏期、睡眠持续时间等.(2)32只SD大鼠按数字表法随机分为对照组(Ⅰ组)、旋转组(Ⅱ组)、麻醉组(Ⅲ组)和旋转后再麻醉组(Ⅳ组),每组8只,分别检测4组大鼠之大脑皮层、下丘脑和海马组织的乙酰胆碱、去甲肾上腺素、γ-氨基丁酸及谷氨酸含量.结果 在150 ～250 mg/kg范围内,随着使用剂量的增加,丙泊酚对大鼠的镇静作用逐步加强(P＜0.01).当丙泊酚剂量为150、200、250 mg/kg时,旋转组和对照组大鼠睡眠持续时间分别为(21.33±8.08)、(67.67 ±21.07)、(97.38±23.79) min和(13.15 ±7.64)、(42.60 ±20.79)、(73.40±21.28) min,组间比较其差异均有统计学意义(P＜0.01).中枢神经递质的变化趋势是:在大脑皮层和下丘脑组织,Ⅱ组主要体现为升高,Ⅲ组主要表现为降低,Ⅳ组则有“强化”Ⅲ组的作用,使各神经递质数值更进一步降低;在海马组织,与Ⅰ组相比,其他各组神经递质均有降低,其均值为Ⅰ组＞Ⅱ组＞Ⅲ组＞Ⅳ组.结论 在临床常用剂量(150 ～ 250 mg/kg)范围内,模拟航海刺激可明显增加大鼠对丙泊酚麻醉的敏感性,但其作用机制尚需进一步研究.     

西藏高原地区237例胃癌构成分析

胃癌是我国常见恶性肿瘤,病死率高,以往报道西藏地区为我国胃癌高发区之一[1],近年来此地区胃癌检出患者不断增多,对人民群众的健康造成严重威胁。为进一步了解高原地区胃癌临床特点,现对我院2009年1月至2012年12月住院治疗的237例胃癌患者的临床资料进行回顾性分析,现报告如下。     

生肌化瘀方对糖尿病大鼠皮肤溃疡组织中MMP-3及TIMP-1表达的影响

目的探讨生肌化瘀方对糖尿病大鼠皮肤溃疡创面组织中基质金属蛋白酶-3（MMP-3）和基质金属蛋白酶组织抑制剂-1（TIMP-1）表达的影响效应。方法以糖尿病大鼠皮肤溃疡模型为研究对象,采用不同配伍比例的生肌化瘀方（生肌方与化瘀方分别按2：1、1：1和1：2比例组合）进行干预,采用West—ernblot法检测皮肤渍疡组织中MMP．3蛋白表达,免疫组化法检测TIMP．1蛋白表达。结果在成模各时间点,各组糖尿病大鼠血糖水平差异无统计学意义（P〉0．05）,而与正常创面组比较显著升高（P〈0．01）。创面面积处理前后差值方面,生肌化瘀3号方组、正常创面组均明显优于糖尿病溃疡模型组（P〈0．05）。Westernblot法检测结果显示：生肌化瘀2号方组MMP-3蛋白表达高于生肌化瘀3号方组（P〈0．05）。免疫组化法检测结果显示：生肌化瘀2号方组TlMP．1蛋白的表达低于糖尿病溃疡模型组和生肌化瘀1号方组（P〈0．05）,生肌化瘀3号方组的表达高于生肌化瘀2号方组（P〈0．01）。结论在创面修复早期,采用生肌化瘀3号方生肌方有利于促进创面愈合;在创面愈合晚期,采用生肌化瘀2号方可能有利于抑制病理性瘢痕的形成。     

甲嘎松汤提取工艺的正交设计法优选

目的建立同时测定甲嘎松汤中两种成分含量的高效液相色谱法,采用正交设计法优选甲嘎松汤中有效成分的提取工艺。方法以6-姜辣素和去氢二异丁香酚的总含量为指标,采用正交实验,对提取时间、乙醇体积分数及乙醇用量进行考察,优化提取条件。结果最佳提取工艺条件为加30倍90%的乙醇,超声30 min。结论该提取工艺合理,有效成分提取效率较高。