High-Density Circumferential Pulmonary Vein Mapping with a 20-Pole Expandable Circular Mapping Catheter

The differentiation of pulmonary vein (PV) electrograms from atrial far-field signals during PV isolation (PVI) for atrial fibrillation (AF) may be difficult. In addition, owing to highly variable PV ostial sizes, current fixed-diameter circular PV mapping catheters may not yield optimal electrograms. We evaluated an expandable, circular 15–25 mm diameter, 20-pole mapping catheter for PV mapping during sustained AF in 25 patients. After selective PV angiography to define the ostial position and size, the catheter was introduced into each PV and withdrawn to the most stable proximal position, with optimal wall contact ensured by progressive loop expansion. At each PV ostium, electrograms recorded at high resolution (HR) were compared with those recorded at a resolution similar to that of a standard 10-pole Lasso catheter. After PVI performed during ongoing AF, the presence of residual far-field potentials (FFP) under both set-ups was compared. We mapped 97 PV, including 4 pairs with common ostia. In the HR recordings, the PV potentials had greater amplitude (0.5 ± 0.1 vs 0.3 ± 0.1 mV, P = 0.001) and fragmentation, whereas left atrial FFP were minimized. After successful isolation of all PV, FFP were observed in 33% of left superior and 28% of left inferior PV on the HR recordings, compared to 66% and 61%, respectively under normal resolution. Catheter stability and optimal wall contact, in combination with HR electrograms can optimize circumferential PV mapping during AF and improve the discrimination of FFP postablation.     

p21WAF1与p27KIP1真核双表达载体的构建鉴定及在胃癌细胞中的表达

目的 构建p21WAF1与p27KIP1真核双表达载体,体外转染胃癌7901细胞,观察其在胃癌细胞中的表达及相关特性.方法 提取人全血总RNA,利用逆转录-聚合酶链反应(RT-PCR)扩增p21WAF1和p27WAF1基因并将其分别克隆到真核双表达载体pIRES中构建重组质粒pIPES-p27KIP1-p21WAF1,经酶切和测序鉴定重组质粒.脂质体介导重组质粒plRES-p27KIP1.p21WAF1"转染胃癌7901细胞,收集并提取转染后12、24、48、72 h和5 d各细胞的总RNA,逆转录成cDNA,荧光定量聚合酶链反应(FQ-PCR)检测各细胞中p21WAF1和p27KIP1在RNA水平的表达.带有绿色荧光蛋白的pIRES-EGFP作为对照.结果 RT-PCR扩增分别获得约500和600 bp大小的产物,重组质粒pIRES-p27KIP1.p21WAF1经酶切和测序鉴定证实为p21WAF1和p27KIP1基因.转染胃癌7901细胞48 h时转染率为68%.与空质粒对照组比较,重组质粒转染胃癌7901细胞12、24、48、72 h和5 d后FQ-PCR证实p27KIP1的Ct值(cycle threshold,Ct)分别减少8.2、10、10、7.4和6.7,p21WAF1的Ct值分别减少7.4、8.2、8.2、6.3和5.70其中24 h和48 h的Ct值减少最大.结论 真核双表达载体pIRES-p27KIP1.p21WAF1构建成功并能在胃癌7901细胞内高效表达.     

留置超滑乳胶气囊导尿管并发症的原因分析及对策

目的探讨留置超滑乳胶气囊导尿管并发症的原因及对策。方法对586例留置超滑乳胶气囊导尿管患者进行观察,回顾分析。结果留置超滑导尿管并发症与导尿方法、规范操作、留置导尿管的时间及相关知识宣教有关。结论严格无菌操作,选择合适的导尿管、缩短留置尿管的时间是降低并发症的重要措施。     

球囊导管加压注射法子宫输卵管造影对不孕症的应用价值

目的探讨利用球囊导管加压注射泛影葡胺行子宫输卵管造影的应用价值。方法对219例不孕症用76%泛影葡胺采用球囊导管加压注射法作子宫输卵管造影检查,并在透视下实时点片。结果普通注射时双侧输卵管显示185例(84.47%),单侧显示24例;加压注射后203例(92.69%)双侧输卵管显示,单侧显示14例,成功率100%。子宫畸形见于9例,输卵管异常131例,造影剂弥散与吸收异常104例。结论利用球囊导管加压注射水溶性造影剂,可以明显提高子宫输卵管造影质量及输卵管再通效果,有重要的临床价值。     

Successful treatment with balloon dilatation using a double‐balloon enteroscope for a stricture in the small bowel of a patient with Crohn's disease

The requirement for endoscopic access to a stricture is a major limitation of the endoscopic dilatation for the treatment of strictures in the gastrointestinal tract. We have developed the double‐balloon enteroscopy method that enables visualization of the entire small bowel. In addition, double‐balloon enteroscopy has a potential for the interventional therapy including dilatation of strictures. We present here a case of jejunal strictures in a 47‐year‐old woman with Crohn's disease successfully treated with a balloon catheter in combination with double‐balloon enteroscopy. Balloon dilation with double‐balloon enteroscopy is a promising method for the treatment of small bowel strictures in Crohn's disease.     

射频消融治疗阵发性室上性心动过速复发原因分析

目的：分析阵发性室上性心动过速患者行射频消融术（RFCA）后复发的原因，探讨降低RFCA复发的方法。方法：128例阵发性室上性心动过速患者，行RFCA治疗，术后每3－6个月随访1次，随访4－70个月。结果：128例患者中，复发10例，总复发率7．81％，其中房室结折返性心运过速复发率为7．89％，左侧房室旁路介导心运过速复发率5．56％，右侧旁路介导心动过速复发率16．67％。行射频消融术前70例患者中复发率11．43％，后58例复发率3．45％。结论：精确的靶点标测、熟练的操作技巧以及消融方式的正确运用是降低RFCA复发率的关键。     

Double congenital bronchoesophageal fistulae in an adult

We report adult congenital bronchoesophageal fistula with both symptomatic fistula and asymptomatic one. A 56-year-old woman with a history of cough after drinking fluids was diagnosed as bronchoesophageal fistula by upper gastrointestinal series that showed a diverticulum in the middle portion of the esophagus with a fistula between the esophagus and right lower lung. Esophagoscopy revealed an orifice of the fistula located 27 cm from the incisors. Computed tomography showed chronic inflammatory change with bronchiectasis in the S6 segment of the right lung. The patient underwent video assisted thoracic surgery that identified two fistulae without missing a symptomatic one, and both were successfully resected. The fistulae were lined by squamous epithelium and smooth muscle without evidence of malignancy, infection or chronic inflammation that were histologically compatible with congenital fistulae.     

中空双头加压螺纹钉加折断式螺钉治疗股骨颈骨折

目的:为了提高股骨颈骨折固定强度和愈合率,减少骨坏死及其它并发症.方法:应用中空双头加压螺纹钉加折断式螺钉治疗股骨颈骨折.结果:经35例临床应用及术后平均28个月随访,优良率为88.6%.结论:本手术切口小、创伤小、出血少、时间短、固定较可靠,便于功能锻炼,术后恢复良好.     

双J管临床应用及美蓝在置管术中的作用

目的探讨双J管(双J输尿管支架管)在泌尿系疾病治疗中的应用效果以及美蓝在置放术中的作用。方法对215例患者采用放置双J管作内支架和内引流治疗,近期48例术中以美蓝协助定位。结果术后留置尿管5~7d,无切口感染、尿瘘等并发症。术后1~3个月拔除双J管,随访3~6个月,肾功能、肾积水明显好转,吻合口通畅。以美蓝协助定位者无双J管上移致拔管困难。结论双J管具有内支架和内引流作用,操作简单,引流效果好,并发症少,缩短住院时间。以美蓝协助定位,值得推广应用。