阵发性心房颤动局灶消融后复发病例的大静脉肌袖电隔离治疗

对肺静脉内点消融治疗术后随访 2 2± 1 1 .1个月内的心房颤动 (简称房颤 )复发病例 ,在Lasso标测导管指引下 ,进行再次心内电生理检查及大静脉肌袖电隔离治疗。探讨点消融治疗阵发性房颤后复发的机制 ,并对再次经验性大静脉肌袖电隔离治疗的结果进行分析与评价。 5例患者共接受心内电生理标测和电隔离治疗 6次 (一例行第二次电隔离 ) ,除一例行右下肺静脉靶肌袖的电隔离外 ,其余病例均进行了经验性全部大静脉的电隔离 ,共电隔离心脏大静脉 1 5根 ,其中肺静脉 1 3根、上腔静脉 2根 ,即刻电隔离成功率 1 0 0 %。术后随访 1 1 .8± 8.9个月 ,均无房颤复发。因此 ,对于阵发性房颤导管射频点消融后复发病例进行经验性全部大静脉肌袖电隔离治疗可以满意控制房颤的发作。     

电烧伤大鼠血清诱导单核细胞分泌VEGF对单核-内皮细胞黏附作用的影响

目的:观察电烧伤大鼠血清诱导的单核细胞分泌血管内皮生长因子(VEGF)的水平,探讨其对单核细胞与血管内皮细胞黏附作用的影响。方法:制做电烧伤大鼠模型,制备电烧伤大鼠血清,同时制备正常大鼠血清作为对照。采用夹心ELISA法检测正常大鼠血清和电烧伤大鼠血清中VEGF及其可溶性受体s Flt-1含量。按照随机数字表法将人单核细胞株THP-1细胞分为正常血清组和电烧伤血清组,ELISA法检测2组细胞上清液中VEGF和s Flt-1含量。按照随机数字表法将人单核细胞株THP-1细胞分为正常血清组、烧伤血清组、正常血清+阻断剂组和烧伤血清+阻断剂组。取培养3 h、6 h的THP-1细胞,加入单层血管内皮细胞株EA.hy926细胞,行单核-内皮细胞黏附检测。结果:大鼠电烧伤后血清VEGF水平较正常大鼠显著增加,s Flt-1水平较正常大鼠明显减少。电烧伤血清诱导THP-1细胞分泌VEGF,s Flt-1水平随之减少。电烧伤血清可促进单核细胞与内皮细胞的黏附作用,s Flt-1可抑制电烧伤血清诱导的单核细胞与内皮细胞的黏附作用。结论:电烧伤大鼠血清诱导单核细胞分泌VEGF,从而促进单核-内皮细胞黏附。阻断VEGF的生物学效应,可有效抑制单核-内皮细胞的黏附。     

Model of cardiac arrest in rats established by modified transcutaneous electrical stimulation on epicardium北大核心CSCD

Objective To establish the cardiac arrest (CA) model in rats by modified transcutaneous elcctrical stimulation on epicardium. Methods This study was performed in the Emergency Medicine laboratory in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. After 10 Sprague-Dawley male rats weighing 330-380 g were anesthetized, two acupuncture needles connected to the anode and cathode of a stimulator were transcutaneously inserted into the epicardium as electrodes. The puncture points were located quantitatively according to the anatomical structure of the rat chest. The electrical stimulation was maintained for 3 minutes to induce ventricular fibrillation(VF). Cardiopulmonary resuscitation (CPR) included chest compressions, intravenous adrenaline and defibrillation operated at 6 min after a period of nonintervention. Results CA was induced after the implement of the effective electrical stimulation in all ten rats in this experiment. The average current intensity to induce VF was (1.80 ± 0.59) mA, the average time to induce CA was (5.07 ± 237) s, the average time of the total electrical stimulation was (187.50 ± 12.75) s and the total time of CA was 6 min. At the end of the electrical stimulation, 9 rats presented VF and 1 rat showed pulseless electrical activity. The restoration of spontaneous circulation was achieved in all 10 rats. The average time of CPR was(190.90±68.60) s, the mean numbers of defibrillation werc(1.20 ± 0.63), and he average number of adrenaline application were (1.20 ± 0.42) times. Neither visible hemorrhage on epicardium nor gross pulmonary congestion was observed. Conclusions The modified transcutaneous electrical stimulation on epicardium to produce CA model in rats is an easily applicable and effective technique. This model may provide an alternative for experimental research of CPR. © 2018 Chinese Medical Association. All rights reserved.     

扶他林治疗心脏电除颤所致电灼伤的疗效观察

目的观察扶他林对心脏电除颤所致电灼伤的治疗效果及安全性。方法 2011年1月至2014年12月在我院就诊的因电除颤引起的皮肤电灼伤患者66例,按照不同的治疗方法随机分为硫酸镁湿敷组、扶他林治疗组,每组33例。硫酸镁组采用50%硫酸镁湿敷,3次/d,连续5~7 d;扶他林组在局部皮肤发红处涂抹薄层扶他林,3次/d,连续5~7 d。比较两组的治疗效果及安全性。结果硫酸镁湿敷组显效13例(39.4%),有效15例(45.6%),无效5例(15.0%);扶他林治疗组显效25例(75.8%),有效8例(24.2%),无效0例。扶他林治疗组疗效优于硫酸镁湿敷组,两组比较差异具有统计学意义(P<0.05)。两组均无药物不良反应发生。结论扶他林治疗心脏电除颤所致电灼伤的效果好于硫酸镁湿敷,且无明显的药物不良反应,是治疗心脏电除颤所致电灼伤的一种非常有效且安全的药物。     

慢性压力超负荷左室电重构的异质性及离子基础

目的研究慢性压力超负荷左室电重构的异质性及离子基础。方法新西兰兔通过肾上腹主动脉次全结扎诱发左室慢性压力超负荷。采用全细胞膜片钳技术分别记录对照组及手术组左室内膜、中层及外膜细胞的动作电位，慢激活的延迟整流钾电流（IKs）及快激活的延迟整流钾电流（IKr）等。结果与对照组比较，基础周长为2S时，手术组左室内膜、中层及外膜细胞的动作电位复极90％的时程（APD90）分别延长27．7％、27．2％（P〈0．05或0．01）、19．6％（P〉0．05）；对照组中层细胞的APD90较外膜细胞长50．8％，而手术组为60．4％；在测试电位为＋50mV时，手术组左室内膜、中层及外膜细胞IKs尾电流密度分别减小26．1％、36．3％（P均〈0．05）、23．0％（P〉0．05）；IKr尾电流密度分别减小31．7％、30．5％、30．0％（P〈0．01或0．05）。对照组外膜细胞的IKs尾电流密度较中层细胞大49．1％，而手术组为77．6％；两组三层细胞之间IKr尾电流密度均无差别。结论正常兔左室存在跨壁复极异质性，心肌肥厚时进一步扩大，IKs分布及下调的不均一性是其离子流基础。     

培哚普利与硫氮唑酮联合治疗阵发性心房颤动

为探讨培哚普利 +硫氮唑酮对控制阵发心房颤动 (简称房颤 )发作和左心房扩张的疗效 ,将阵发性房颤分为硫氮唑酮组 (Ⅰ组 )和培哚普利 +硫氮唑酮组 (Ⅱ组 ) ,二组根据左房内径大小分为左房正常组 (Ⅰa=33例、Ⅱa =33例 ) ,左房扩大组 (Ⅰb =34例、Ⅱb =31例 )。Ⅰ组给予硫氮唑酮 30mg 2次 /日或 3次 /日 ;Ⅱ组给予硫氮唑酮 30mg 2次 /日 +培哚普利 4mg 1次 /日。所有患者均治疗 3年。结果 :①各组房颤年发作次数治疗后均有显著减少 (P <0 .0 5 )。②Ⅰb、Ⅱa、Ⅱb组治疗后的房颤持续时间显著缩短 (P <0 .0 5 )。③房颤的年发作次数治疗后 1,2 ,3年间 ,Ⅰa、Ⅱa组显著高于Ⅰb、Ⅱb组 (P <0 .0 5 )。④随治疗时间的延长 ,Ⅱ组左房扩张的增幅明显低于Ⅰ组 (P <0 .0 5 )。结论 :硫氮唑酮和培哚普利 +硫氮唑酮治疗阵发性房颤均可减少房颤的发作 ,但后者优于前者 ,培哚普利 +硫氮唑酮治疗可明显减慢左房的扩张速度。     

射频导管消融电学隔离心脏大静脉治疗阵发性心房颤动的临床应用

目的评价射频导管消融电学隔离心脏大静脉预防阵发性心房颤动(房颤)发作的疗效。方法83例患者,男性58例、女性25例,年龄15～76平均(605±185)岁,有阵发性房颤病史2～15年,曾服数种抗心律失常药物疗效不佳。41例患者合并有高血压病,所有患者均无明显器质性心脏病改变。常规行心脏大静脉造影,测量靶静脉直径,将10极肺静脉环状标测导管(Lasso导管)放置在靶静脉开口内05cm处,以Lasso导管为指导,把温控大头电极导管放置于靶静脉开口处行电学隔离。结果83例患者共电学隔离大静脉343条。包括左上肺静脉(LSPV)83条,右上肺静脉(RSPV)83条,左下肺静脉(LIPV)82条,右下肺静脉(RIPV)42条,上腔静脉(SVC)53条,其中2例LSPV与LIPV共同开口。每条肺静脉行1～4段消融(平均每条消融25段),即刻电学隔离成功大静脉337条。随访2～31个月,其中50例停服抗心律失常药物后无房颤发生,13例患者房颤发作明显减少,20例患者房颤发作消融前后无明显变化。并发症有2例术中出现左侧大量胸腔积血,1例心肺复苏5天后出现脑死亡。发现肺静脉狭窄21例,其中轻度狭窄15例,重度狭窄6例,无肺静脉闭塞。结论(1)成功的心脏大静脉电学隔离治疗阵发性房颤的总有效率达到75%左右;(2)由于很难确定靶肺静脉,成功电学隔离各心脏大静脉有可能提高治愈率;(3)此     

Early prediction of encephalopathic transformation in children with benign epilepsy with centro-temporal spikes

BackgroundMost children with Benign epilepsy with centro-temporal spikes (BECTS) undergo remission during late adolescence and do not require treatment. In a small group of patients, the condition may evolve to encephalopathic syndromes including epileptic encephalopathy with continuous spike-and-wave during sleep (ECSWS), or Landau-Kleffner Syndrome (LKS). Development of prediction models for early identification of at-risk children is of utmost importance.AimTo develop a predictive model of encephalopathic transformation using data-driven approaches, reveal complex interactions to identify potential risk factors.MethodsData were collected from a cohort of 91 patients diagnosed with BECTS treated between the years 2005–2017 at a pediatric neurology institute. Data on the initial presentation was collected based on a novel BECTS ontology and used to discover potential risk factors and to build a predictive model. Statistical and machine learning methods were compared.ResultsA subgroup of 18 children had encephalopathic transformation. The least absolute shrinkage and selection operator (LASSO) regression Model with Elastic Net was able to successfully detect children with ECSWS or LKS. Sensitivity and specificity were 0.83 and 0.44. The most notable risk factors were fronto-temporal and temporo-parietal localization of epileptic foci, semiology of seizure involving dysarthria or somatosensory auras.ConclusionNovel prediction model for early identification of patients with BECTS at risk for ECSWS or LKS. This model can be used as a screening tool and assist physicians to consider special management for children predicted at high-risk. Clinical application of machine learning methods opens new frontiers of personalized patient care and treatment.     

The effect of applied pressure on the electrical impedance of the bladder tissue using small and large probes

There are a number of studies using electrical impedance spectroscopy, a minimally invasive technique, as a tissue characterizing method with different probe sizes (usually with larger probe diameters than that used in this work). In urinary bladder studies the probe size are limited to 2 mm diameter, in order to pass through the working channel of the cystoscope to measure the impedance inside the urinary bladder. Thus, bio-impedance of the human urothelium can only be measured using a small sized probe for in vivo studies. Different pressures were applied with this probe and it was demonstrated that increasing the applied pressure over the probe would increase the measured electrical impedance of the bladder tissue. Therefore, the effect of applied pressure on the resulting electrical impedance was considered in this study (all of the measurements were taken on points that had benign histology). An excessive amount of the applied pressure beyond the first visible indentation (first recordable reading) pressure has a significant effect on the impedance of the bladder tissue (p < 0.001). Then, to reduce the effect of pressure on the measured bio-impedance, the effect of a larger probe (10 mm diameter) was considered (p < 0.001). Increasing the probe contact area is one way to reduce the pressure effect on measurements; however this is difficult in practice in the in vivo situation.     

Effects of a 2-, 3- and 4-electrode stimulator design on current dispersion on the surface and into the limb during electrical stimulation in controls and patients with wounds

Electrical stimulation is a widely used modality in the field of physical therapy and exercise physiology. The most common method for the application of electrical stimulation is a two-electrode system where one electrode is the source and the other is a reference. However, recent studies report that a more effective delivery system can be achieved if more than two electrodes are used. In the present investigation, the circuitry to deliver electrical stimulation through a 2-, 3- or 4-electrode delivery system was designed. The system was evaluated by its ability to deliver current on the surface of the skin as well as deep into the quadriceps muscle in six control subjects and in and around wounds in six other subjects. The results of the experiments showed that much better depth of penetration was achieved in a 4-electrode system (one electrode was on the opposite side of the limb and three electrodes were on top of the limb) than in either a 2- or a 3-electrode delivery system. In non-wounded skin, given the same current from the stimulator, the current in the quadriceps muscle was found to be double with a 4-electrode versus a 2-electrode system. In wounds, this same finding was seen. Here, blood flow, an indicator of the effectiveness of electrical stimulation in wounds, was three times higher if a multi-channel stimulator was used versus a 2-channel stimulator. Thus a multi-channel electrical stimulation system is more effective than a 2-electrode system.