肺动脉栓塞的64层螺旋CT血管成像技术分析

目的从技术上探讨64层螺旋CT肺动脉造影对肺栓塞的诊断的价值。方法对62例临床疑诊肺栓塞的患者行64排螺旋CT肺动脉造影检查,采用最大密度投影(MIP)、多平面重建(MPR)、曲面重建(CPR)、容积漫游(VR)及仿真内窥镜等后处理技术,分析所获得的相关CT资料。结果64排多层螺旋CT肺动脉造影可较准确、清晰、全面地显示24例累及肺动脉及其分支共152处栓子的位置、形态、范围和程度。结论64排多层螺旋CT肺动脉造影是肺栓塞及时准确无创的诊断方法,是临床诊断肺栓塞的首选筛查办法,对肺动脉栓塞的诊断具有明显的技术优势。     

三维标测环肺静脉前庭隔离术后肺静脉狭窄的相关因素

目的：探讨房颤射频消融术后肺静脉狭窄的相关因素,为其预防提供依据。方法：收集113例射频消融房颤患者的临床资料,记录射频术中消融时间、阻抗和温度;术后6个月64层CT左房-肺静脉重建随访,统计肺静脉狭窄的发生率;多元Logistic回归分析肺静脉狭窄的相关因素。结果：依据肺静脉数量计算的肺静脉狭窄率为3．4％,按照患者数量计算的肺静脉狭窄率为7．7％。多元Logistic回归分析,初始50例手术较其后病例的OR为2．167,95％CI=I．038-9．857,P=0．046,消融时间在总消融时间均数之上的患者比在均数之下者OR为2．856,95％CI=1．352-6．043,P=0．021。结论：初始50例手术和消融时间长是房颤射频消融术后肺静脉狭窄的相关因素。     

Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation

Cryoballoon ablation (CBA) is an established therapy for atrial fibrillation (AF). Pulmonary vein (PV) occlusion is essential for achieving antral contact and PV isolation and is typically assessed by contrast injection. We present a novel method of direct pressure monitoring for assessment of PV occlusion.Transcatheter pressure is monitored during balloon advancement to the PV antrum. Pressure is recorded via a single pressure transducer connected to the inner lumen of the cryoballoon. Pressure curve characteristics are used to assess occlusion in conjunction with fluoroscopic or intracardiac echocardiography (ICE) guidance. PV occlusion is confirmed when loss of typical left atrial (LA) pressure waveform is observed with recordings of PA pressure characteristics (no A wave and rapid V wave upstroke). Complete pulmonary vein occlusion as assessed with this technique has been confirmed with concurrent contrast utilization during the initial testing of the technique and has been shown to be highly accurate and readily reproducible.We evaluated the efficacy of this novel technique in 35 patients. A total of 128 veins were assessed for occlusion with the cryoballoon utilizing the pressure monitoring technique; occlusive pressure was demonstrated in 113 veins with resultant successful pulmonary vein isolation in 111 veins (98.2%). Occlusion was confirmed with subsequent contrast injection during the initial ten procedures, after which contrast utilization was rapidly reduced or eliminated given the highly accurate identification of occlusive pressure waveform with limited initial training.Verification of PV occlusive pressure during CBA is a novel approach to assessing effective PV occlusion and it accurately predicts electrical isolation. Utilization of this method results in significant decrease in fluoroscopy time and volume of contrast.     

静脉桥狭窄家兔动物模型的建立

目的建立冠心病冠状动脉旁路移植术后移植静脉桥狭窄的动物模型。方法取3.0～3.5 kg普通新西兰兔8只,取同侧颈外静脉与颈总动脉进行端端吻合,吻合时采用间断缝合的方法。结果术后2周、4周取下静脉桥及对侧颈外静脉,光镜下见静脉桥新生内膜形成,中膜增厚,弹力纤维减少;胶原纤维不均匀性增厚。结论本模型能反映冠状动脉旁路移植术后静脉桥狭窄的情况,可满意模拟人冠状动脉旁路移植术后大隐静脉桥的病理变化。     

Placement Of A Coronary Sinus Pacing Lead From A Sub-occluded Left Subclavian Vein Using A Collateral Vein To The Right Subclavian Vein

Upgrading of a pacing system in the presence of a subclavian occlusion is technically challenging. We describe the case of a patient who underwent a successful upgrading procedure of an implantable cardioverter-defibrillator (ICD) to a biventricular defibrillator (ICD-CRT) in the presence of a suboccluded left subclavian vein, using a collateral vein that drained into the contralateral subclavian vein.     

侵染扁豆的三叶草黄脉病毒的鉴定

1987年从泰安表现系统花叶的扁豆上分离到一个分离物B_2,汁液摩擦接种9科38种植物,它可侵染5科10种植物,在扁豆和昆诺藜上引起系统花叶,在苋色藜上引起局部枯斑。该分离物钝化温度为60—65℃,稀释限点为10~(-3)—10~(-4),体外存活期为3—5天。可由桃蚜传播;病毒粒体线条状,大小为700—760×12nm病叶细胞内有风轮状内含体,该分离物与三叶草黄脉病毒的抗血清有明显的-阳性反应。根据这些特性,该病毒属于马铃薯丫病毒组的三叶草黄脉病毒。     

Percutaneous Transvenous Angioplasty of Left Innominate Vein Stenosis Following Right Side Permanent Pacemaker Implantation- A Left Femoral Vein to Left Axillary Vein Approach

Central venous stenosis after the insertion of a permanent pacemaker is a well recognized complication. This late complication is encountered when there is a need to change the pacemaker lead or extract it. We describe a young male who had such a complication after many years after right side pacemaker implantation. The lesion was managed percutaneously leading to placement of a new lead from the left side.     

64层螺旋CT脑血管造影在颅内动脉瘤诊断中的应用

目的:探讨64层螺旋CT血管造影(CTA)对颅内动脉瘤的诊断价值。方法:回顾性分析54例临床怀疑为颅内动脉瘤,并同时行64层CTA和DSA检查的病例,其中47例疑诊动脉瘤患者行动脉瘤夹闭手术,将MSCTA,DSA与手术结果对照。结果:54患者中经MSCTA检出57个动脉瘤,DSA检出55个动脉瘤,另7例MSCTA和DSA均未检出动脉瘤,余47例接受手术并检出58个动脉瘤。64层CTA发现动脉瘤的敏感性为96.6%,特异性为87.5%,准确性为96.5%,阳性预测值为98.2,阴性预测值为77.7。MIP和VR技术对动脉瘤的形态、分支血管、血栓和钙化方面的显示优于DSA。结论:64层CTA诊断颅内动脉瘤具有较好的异性、敏感性及三维显示能力,具有较高的临床应用价值。。     

阿托伐他汀对慢性阻塞性肺疾病合并肺动脉高压患者外周血ROCK2激酶活性及肺动脉压力的影响

目的：探讨口服阿托伐他汀片对慢性阻塞性肺疾病（chronic obstructive pulmonary Disease,COPD）合并肺动脉高压（pul-monary hypertension,PH）患者外周血ROCK2激酶活性及肺动脉压力的影响。方法：选取COPD合并PH患者60例为研究对象,并将其随机分为对照组（给予吸氧、抗感染、化痰、平喘等基础治疗）和阿托伐他汀治疗组（在基础治疗的基础上给予阿托伐他汀片20mg／d治疗）;随访观察周期12周,于试验开始前和结束后检测外周血ROCK2的活性,利用彩色多普勒检测肺动脉压力的变化,肺功能变化（测定FEV1,FVC）。结果：与对照组比较,阿托伐他汀治疗可显著降低患者血浆中ROCK2的水平（P〈0．01）;降低患者的肺动脉压力,改善患者的肺功能（FEV1,FVC）,P均〈0．05。结论：在常规吸氧、抗感染等治疗的基础上,联合应用阿托伐他汀可显著降低ROCK2激酶的活性和肺动脉压力,从而改善肺功能。     

Vein density of angiosperms as a paleoclimate proxy: a case study using fossil leaves of Zelkova and Machilus

Using vein density to study the relationship between plants and environment is an important topic for paleoclimate and paleoenvironment studies. In this paper, the vein density of fossil plants Zelkova ungeri Kovats, Machilus tiantaiensis Ding et Sun and their NLRs was analyzed using the one-dimensional analysis and two-dimensional analysis approaches. The mechanism of vein density responses to the environment variation was also discussed. Further, the differences of the vein density between the fossil and extant leaves were compared. The results indicated that the vein density of Z. schneideriana Hand.-Mazz. and M. pingii Cheng ex Yang increased closely with the increase of precipitation but not closely related with the variation of temperature. The vein density of Z. ungeri and M. tiantaiensis was respectively higher than that of their NLRs. Thus we deduced that the precipitation in eastern Zhejiang Province during the late Miocene was higher than that of nowadays and the paleoclimate was more humid at that time.     

The Virtual Coronary Angiography Method

This article is devoted to the development of a virtual coronary angiography method, a noninvasive method of evaluation of the state of the human coronary artery. Registration and processing of the signal of peripheral arterial blood pulsation against the background of a functional test with controlled respiration form the basis of the method. A mathematical model of the relationship between relative change in spectral evaluations of the variability of the cardiac rhythm and the degree of coronary-artery stenosis was developed. Clinical testing, which demonstrated the high efficiency of the proposed virtual coronary angiography method when examining patients with different states of coronary arteries, was conducted.     

64排CT血管造影在脑动静脉畸形诊断中的价值

目的：探讨64排CT血管造影（computedtomography angiographycTA）对脑动静脉畸形（cerebral arefiovenousmalformation,AVM）的诊断价值。方法：16例AVM患者,均行64排螺旋CT血管造影检查,使用多种重建方法,由两名有经验的医生对畸形血管团进行分析。结果：16例均为单发瘤巢,16例AVM均显示了大小不等的畸形血管团及供血动脉和引流静脉,其中,2例同时伴脑出血（12．5％）,3例有出血后软化灶形成（18．75％）,16例发现有供血动脉31支,16例发现有明确的引流静脉21支。结论：64排CTA安全．快速．结合多种重建方法．可以清晰显示AVM的供血动脉、瘤巢．引流静脉．为临床治疗提供了可靠的信息．     

The Wall Eclipsing Sign on Pulmonary Artery Computed Tomography Angiography Is Pathognomonic for Pulmonary Artery Sarcoma

Background

The objective of this study was to evaluate the imaging characteristics of pulmonary artery sarcoma (PAS) on pulmonary artery computed tomography angiography (PACTA) that can be used to differentiate between PAS and pulmonary thromboembolic diseases, including chronic thromboembolic pulmonary hypertension (CTEPH) and acute pulmonary embolism (APE).

Methods

The clinical data and imaging characteristics of 12 patients with PAS, 156 patients with CTEPH, and 426 patients with APE who were treated at Beijing Anzhen Hospital from January 2007 to August 2013 were retrospectively analyzed. All patients underwent PACTA before treatment, and the diagnoses of PAS and CTEPH were all confirmed by surgical biopsy.

Results

All 12 PAS patients were initially misdiagnosed and received inappropriate thrombolytic and/or anticoagulant therapy before they were referred for surgical intervention. The mean time from PACTA to surgical intervention was 5.5±3.7 months (range 2–11 months). On PACTA, the PAS lesion always eclipsed the wall of the pulmonary artery before infiltrating outside the pulmonary artery, which was termed the wall eclipsing sign. This sign was observed in all PAS patients but was not observed in any CTEPH or APE patients.

Conclusions

PAS is a rare neoplasm with a poor prognosis, and is easily misdiagnosed as thromboembolic disease. The wall eclipsing sign on PACTA is pathognomonic for PAS, and patients with this sign should be investigated to confirm the diagnosis and should undergo surgical intervention as soon as possible, rather than receiving thrombolytic or anticoagulant therapy.     

Balloon Venoplasty of Subclavian Vein and Brachiocephalic Junction to Enable Left Ventricular Lead Placement for Cardiac Resynchronisation Therapy

This report describes the successful implantation of a LV lead using balloon venoplasty to overcome a very tight stenosis of the right subclavian vein / brachiocephalic junction for cardiac resynchronisation therapy (CRT-P) in a patient with a right sided CRT-P system and a failed epicardial LV lead. It is important for device implanters to be familiar with interventional equipments and techniques such as balloon venoplasty to overcome difficult venous access.     

人静脉移植物基质金属蛋白酶-2和波型蛋白的表达

目的:探讨人静脉移植物基质金属蛋白酶-2(Matrix Metalloproteinase-2,MMP-2)和波型蛋白(Vimentin)的表达情况。方法:应用免疫荧光组织化学技术对30个静脉移植物再塞标本中MMP-2、Vimentin的表达进行了检测,用激光共聚焦显微镜拍片,图片用Silicon Graphics Octane进行处理。结果:在正常静脉血管,有少量MMP-2的表达;Vimentin的表达较弱。在静脉移植的血管, MMP-2的表达显著增加,是正常血管的3．5倍;Vimentin(波形蛋白)在中膜和内膜的表达明显增多。另外,统计分析表明MMP-2在新内膜的表达均显著高于在中膜的表达(P＜0．01)。结论:在静脉移植物的新内膜,MMP-2和Vimentin的表达均上调,提示这些重要分子在新内膜的形成和静脉再狭窄的病理过程中具有重要的作用。     

Characterization of Active-Site Residues of the NIa Protease from Tobacco Vein Mottling Virus

Nuclear inclusion a (NIa) protease of tobacco vein mottling virus is responsible for the processing of the viral polyprotein into functional proteins. In order to identify the active-site residues of the TVMV NIa protease, the putative active-site residues, His-46, Asp-81 and Cys-151, were mutated individually to generate H46R, H46A, D81E, D81N, C151S, and C151A, and their mutational effects on the proteolytic activities were examined. Proteolytic activity was completely abolished by the mutations of H46R, H46A, D81N, and C151A, suggesting that the three residues are crucial for catalysis. The mutation of D81E decreased k_cat marginally by about 4.7-fold and increased K_m by about 8-fold, suggesting that the aspartic acid at position 81 is important for substrate binding but can be substituted by glutamate without any significant decrease in catalysis. The replacement of Cys-151 by Ser to mimic the catalytic triad of chymotrypsin-like serine protease resulted in the drastic decrease in k_cat by about 1,260-fold. This result might be due to the difference of the active-site geometry between the NIa protease and chymotrypsin. The protease exhibited a bell-shaped pH-dependent profile with a maximum activity approximately at pH 8.3 and with the abrupt changes at the respective pK_m values of approximately 6.6 and 9.2, implying the involvement of a histidine residue in catalysis. Taken together, these results demonstrate that the three residues, His-46, Asp-81, and Cys-151, play a crucial role in catalysis of the TVMV NIa protease.     

Omega-3 Polyunsaturated Fatty Acid Supplementation Reduced Atrial Fibrillation Recurrence after Pulmonary Vein Antrum Isolation

Objective

To assess if patients treated with omega-3(n-3) polyunsaturated fatty acids (PUFAS) had lower procedural failure rates compared to an untreated population.

Methods and Results

From January 2004 to 2007, 1500 PVAI patients underwent catheter ablation. Two hundred and eighty five (19%) patients were treated with PUFAs. These patients were matched in a nested case controlled analysis. After matching, there were 129 patients in the PUFA group and 129 in the control group. Thirty-five (27.1%) patients in the study group had early recurrence vs. 57 (44.1%) in the control group p-value< 0.0001. Twenty-nine (23.2%) patients in the PUFA group vs. 41 (31.7%) in the non-PUFA group had procedural failure (p-value < 0.003). There were no significant differences in complications in the PUFA and non-PUFA groups.

Conclusion

Patients treated with PUFAs had lower incidences of early recurrence and procedural failure compared to an untreated population.     

A Method for Generating Pulmonary Neutrophilia Using Aerosolized Lipopolysaccharide

Acute lung injury (ALI) is a severe disease characterized by alveolar neutrophilia, with limited treatment options and high mortality. Experimental models of ALI are key in enhancing our understanding of disease pathogenesis. Lipopolysaccharide (LPS) derived from gram positive bacteria induces neutrophilic inflammation in the airways and lung parenchyma of mice. Efficient pulmonary delivery of compounds such as LPS is, however, difficult to achieve. In the approach described here, pulmonary delivery in mice is achieved by challenge to aerosolized Pseudomonas aeruginosa LPS. Dissolved LPS was aerosolized by a nebulizer connected to compressed air. Mice were exposed to a continuous flow of LPS aerosol in a Plexiglas box for 10 min, followed by 2 min conditioning after the aerosol was discontinued. Tracheal intubation and subsequent bronchoalveolar lavage, followed by formalin perfusion was next performed, which allows for characterization of the sterile pulmonary inflammation. Aerosolized LPS generates a pulmonary inflammation characterized by alveolar neutrophilia, detected in bronchoalveolar lavage and by histological assessment. This technique can be set up at a small cost with few appliances, and requires minimal training and expertise. The exposure system can thus be routinely performed at any laboratory, with the potential to enhance our understanding of lung pathology.