探索不用Halo电极射频消融治疗典型心房扑动的方法

目的探讨不用Halo电极消融典型心房扑动(AF)的方法和右心房峡部传导时间间期的意义。方法对9例AF患者进行了心脏电生理检查和射频消融。将普通标测电极分别放置高位右房(HRA、A点)、低位右房(LRA、B点)、希氏束(His、C点)、冠状窦(CS、CS34为D点),标测AF发作时右房激动顺序,起搏时测量右心房峡部传导时间间期,然后,对峡部行线形消融直至双向传导阻滞,测量右心房峡部传导时间间期(BD、DB)。结果不用Halo电极成功消融所有典型心房扑动病例,消融后冠状窦口处起搏时,起搏信号至右房下侧壁的时间间期(DB=140.7±66.1ms)和右房下侧壁起搏时起搏信号至冠状窦口CS34的时间间期(BD=123.2±42.1ms)均较消融前(DB=66.0±12.5ms,BD=62.5±13.0ms)明显延长,P<0.01。结论不用Halo电极能成功消融典型心房扑动(AF),右心房峡部传导时间间期的定量测定可作为判断峡部完全性双向传导阻滞的方法之一。     

Radiofrequency electromagnetic radiation from cell phone causes defective testicular function in male Wistar rats

Cell phones have become an integral part of everyday life. As cell phone usage has become more widespread, concerns have increased regarding the harmful effects of radiofrequency electromagnetic radiation from these devices. The current study was undertaken to investigate the effects of the emitted radiation by cell phones on testicular histomorphometry and biochemical analyses. Adult male Wistar rats weighing 180–200 g were randomly allotted to control, group A (switched off mode exposure), group B (1‐hr exposure), group C (2‐hr exposure) and group D (3‐hr exposure). The animals were exposed to radiofrequency electromagnetic radiation of cell phone for a period of 28 days. Histomorphometry, biochemical and histological investigations were carried out. The histomorphometric parameters showed no significant change (p < .05) in the levels of germinal epithelial diameter in all the experimental groups compared with the control group. There was no significant change (p < .05) in cross‐sectional diameter of all the experimental groups compared with the control group. Group D rats showed a significant decrease (p ? .05) in lumen diameter compared with group B rats. There was an uneven distribution of germinal epithelial cells in groups B, C and D. However, there was degeneration of the epithelia cells in group D when compared to the control and group B rats. Sera levels of malondialdehyde (MDA) and superoxide dismutase (SOD), which are markers of reactive oxygen species, significantly increased (MDA) and decreased (SOD), respectively, in all the experimental groups compared with the control group. Also sera levels of gonadotropic hormones (FSH, LH and testosterone) significantly decreased (p < .05) in groups C and D compared with the control group. The study demonstrates that chronic exposure to radiofrequency electromagnetic radiation of cell phone leads to defective testicular function that is associated with increased oxidative stress and decreased gonadotropic hormonal profile.     

经皮射频消融术与腹腔镜肝癌切除术治疗小肝癌的临床疗效观察

【摘要】 目的 对比经皮射频消融术与腹腔镜肝切除术治疗小肝癌的临床疗效。方法 选择2011年1月至2015年12月在我院诊治的126例小肝癌患者,根据治疗方法的不同分为两组,采用腹腔镜肝癌切除术者61例（腹腔镜肝癌切除术组）,采用经皮射频消融术者65例（经皮射频消融术组）,观察两组预后情况。结果 所有患者顺利完成手术,腹腔镜肝癌切除术组无中转开腹情况。经皮射频消融术组完全消融,术后1个月的疼痛、肺部感染、出血、恶心呕吐等并发症发生率(83%)低于腹腔镜肝癌切除术组(267%)(P＜005)。两组术后1个月的血清丙氨酸氨基转移酶（ALT）与门冬氨酸氨基转移酶（AST）水平低于术前(P＜005),同时经皮射频消融术组术后1个月的的血清ALT与AST明显低于腹腔镜肝癌切除术组(P＜005)。经皮射频消融术组的生存时间与无瘤生存时间分别为（3421±298）月和（2720±311）月均高于腹腔镜肝癌切除术组（2844±419）月和（2298±378）月(P＜005)。结论 相对于腹腔镜肝切除术,经皮射频消融术在小肝癌治疗中的应用成功率高,有利于促进肝功能的恢复,减少术后并发症的发生,从而延长肝细胞癌患者的生存时间。     

Vial usage,device dead space,vaccine wastage,and dose accuracy of intradermal delivery devices for inactivated poliovirus vaccine (IPV)

IntroductionIntradermal delivery of a fractional dose of inactivated poliovirus vaccine (IPV) offers potential benefits compared to intramuscular (IM) delivery, including possible cost reductions and easing of IPV supply shortages. Objectives of this study were to assess intradermal delivery devices for dead space, wastage generated by the filling process, dose accuracy, and total number of doses that can be delivered per vial.MethodsDevices tested included syringes with staked (fixed) needles (autodisable syringes and syringes used with intradermal adapters), a luer-slip needle and syringe, a mini-needle syringe, a hollow microneedle device, and disposable-syringe jet injectors with their associated filling adapters. Each device was used to withdraw 0.1-mL fractional doses from single-dose IM glass vials which were then ejected into a beaker. Both vial and device were weighed before and after filling and again after expulsion of liquid to record change in volume at each stage of the process. Data were used to calculate the number of doses that could potentially be obtained from multidose vials.ResultsResults show wide variability in dead space, dose accuracy, overall wastage, and total number of doses that can be obtained per vial among intradermal delivery devices. Syringes with staked needles had relatively low dead space and low overall wastage, and could achieve a greater number of doses per vial compared to syringes with a detachable luer-slip needle. Of the disposable-syringe jet injectors tested, one was comparable to syringes with staked needles.DiscussionIf intradermal delivery of IPV is introduced, selection of an intradermal delivery device can have a substantial impact on vaccine wasted during administration, and thus on the required quantity of vaccine that needs to be purchased. An ideal intradermal delivery device should be not only safe, reliable, accurate, and acceptable to users and vaccine recipients, but should also have low dead space, high dose accuracy, and low overall wastage to maximize the potential number of doses that can be withdrawn and delivered.     

呼出气一氧化氮指导支气管哮喘患者使用吸入性糖皮质激素治疗效果的研究

目的：对呼出气一氧化氮（fractional exhaled nitric oxide,FeNO）指导支气管哮喘患者使用吸入性糖皮质激素（inhaled corticosteroids,ICS）治疗效果的分析。方法：选取2019年1—12月在南京鼓楼医院呼吸与危重症医学科收治的支气管哮喘患者,共38例,根据初始FeNO值分为观察组（FeNO>30 ppb）与对照组（FeNO≤30 ppb）,2组患者均给予布地奈德福莫特罗或沙美特罗替卡松粉雾剂,对比2组患者用药后的支气管哮喘症状控制情况、炎症改善情况、症状缓解和消失时间、支气管哮喘症状控制水平和用药依从性。结果：观察组支气管哮喘症状总控制率（100%）明显大于对照组（73.68%）（P<0.05）;使用药物治疗后,观察组的FeNO值出现显著降低（P<0.01）,与对照组相比ACT评分显著提高（P<0.01）,症状缓解时间与症状消失时间明显减少（P<0.05）。2组患者治疗后的用药依从性良好,无明显差异（P>0.05）。结论：FeNO指导支气管哮喘患者使用ICS具有其独特的优势,是个性化评估和管理炎症性气道疾病的有利工具。     

复发性肝癌重复肝切除术与射频消融治疗现状 *

肝细胞癌(hepatocellular carcinoma, HCC)切除术后复发是一种常见现象。由于复发率高,远期生存率仍不尽人意。5年复发率为60%~80%,其中大部分为肝内复发。手术切除及射频消融(radiofrequency ablation, RFA)治疗被认为是复发性肝癌的有效治疗方式。关于如何选择治疗方法仍有争议。本文复习了近年来关于这两种治疗方式效果的文献,着重讨论如何合理选择两种治疗方式,得出重复手术切除(repeat surgery resection, RSR)仍是首选治疗方式,RFA可作为无法手术患者的最佳替代治疗方法。     

带套囊气管导管在小儿全身麻醉扁桃体射频消融术中的应用*

目的 研究小儿扁桃体射频消融术全身麻醉气管插管时带套囊气管导管应用的安全性。方法 选取2017年11月—2018年1月天津市儿童医院全身麻醉下行扁桃体射频消融术患儿100例。根据气管导管有无套囊选择情况,随机分为带套囊气管导管组（T组）和不带套囊气管导管组（N组）,主要观察指标为拔管后有无喘鸣,次要观察指标为控制呼吸时有无漏气、插管后是否换管、拔管后SpO2最低值以及术后插管相关并发症。结果 两组患儿性别构成、年龄、体重和插管管号等一般情况比较差异无统计学意义（P?>0.05）。两组患儿术中情况比较发现,两组患儿机械通气时间比较,差异无统计学意义（P?>0.05）;T组患儿中有1例术中出现漏气,有1例更换气管导管,N组患儿中有11例出现术中漏气,有8例更换气管导管,两组比较差异有统计学意义（P?<0.05）;两组患儿术毕拔管时喘鸣和拔管后SpO2最低值比较差异无统计学意义（P?>0.05）,但T组患儿拔管时未吸出气管内血性分泌物,N组患儿拔管时有6例出现气管内血性分泌物,两组比较差异有统计学意义（P?<0.05）。结论 带套囊气管导管可安全用于8岁以下小儿行全身麻醉下扁桃体射频消融术,且不增加小儿拔管术后喘鸣发生率。