产前B 超诊断胎儿完全性大动脉转位的超声特征观察

目的:探讨产前B超对胎儿完全性大动脉转位的临床诊断价值。方法:回顾性分析2012年2月至2015年11月我院收治的4例胎儿完全性大动脉转位的B超特征,并对比病理结果。结果:4例完全性大动脉转位胎儿中,1例室间隔缺损,3例四腔心切面正常。左右两室流出道切面情况:4例胎儿大动脉与心室连接关系存在异常,2例胎儿室间隔膜部存在缺损症状。三血管气管切面情况:4例胎儿均仅可见2条血管。结论:对左右两心室流出道切面及三血管气管切面进行观察可得,胎儿完全性大动脉转位具有较为明显的B超特征,产前对胎儿完全性大动脉转位进行B超诊断具有较好的临床价值,建议在医疗单位推广应用。     

Congenitally Corrected Transposition of Great Arteries with Severe Rhythm Disturbances

Within recent years, much scientific attention has been devoted to adults with congenital heart disease (CHD) and probable complications. Congenitally corrected transposition of the great arteries (CCTGA) is a rare, complex form of congenital heart defects. CCTGA is characterized by atrioventricular (AV) and ventriculoarterial (VA) discordance and, hence, by a physiologically normal direction of blood flow. The development of complete AV block and global ventricular dysfunction has been identified as the cause of cardiac death. Although the development of arrhythmias represents a major cause of morbidity and mortality in patients with CHD, the account of all implantations of pacemakers and implantable cardioverter defibrillators (ICD) is less than one percent. This paper presents a case of CCTGA with severe rhythm disorders, discusses probable treatment options, and offers indications of ICD implantation in patients with CHD.     

Transvenous pacing through the pulmonary valve in a patient with cyanotic congenital heart disease after Glenn shunt – A case report

Bradyarrhythmia requiring pacing is infrequently encountered in patients with complex cyanotic congenital heart disease. Even though epicardial pacing is the preferred mode, rarely, a need for endocardial lead implantation arises.Patients with cavopulmonary shunts limit access to the venous atria and ventricles, necessitating alternate methods of pacemaker implantation. We report transvenous endocardial lead implantation by an unconventional method in a patient with congenitally corrected transposition of great arteries after a bidirectional Glenn shunt.     

Implantation of Total Artificial Heart in Congenital Heart Disease

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital heart disease (CHD), the malformed heart presents a challenge to TAH implantation. In the case presented here, a 17 year-old patient with congenital transposition of the great arteries (CCTGA) experienced progressively worsening HF due to his congenital condition. He was hospitalized multiple times and received an implantable cardioverter defibrillator (ICD). However, his condition soon deteriorated to end-stage HF with multisystem organ failure. Due to the patient''s grave clinical condition and the presence of complex cardiac lesions, the decision was made to proceed with a TAH. The abnormal arrangement of the patient''s ventricles and great arteries required modifications to the TAH during implantation.With the TAH in place, the patient was able to return home and regain strength and physical well-being while awaiting a donor heart. He was successfully bridged to heart transplantation 5 months after receiving the device. This report highlights the TAH is feasible even in patients with structurally abnormal hearts, with technical modification.     

Sieving alive or after fixation: effects of sieving procedure on macrobenthic diversity,density and community structure

Although combining datasets is often needed to unravel large-scale or long-term patterns in benthos ecology, this is frequently hampered by differences in technical design of the individual studies. One element that often vary among macrobenthic studies is the sieving procedure: sieving alive versus sieving after fixation. This study therefore aimed at the qualification and quantification of the impact of sieving procedure, using a 1 mm mesh sized sieve, at three levels of ecological organisation: (1) diversity, (2) species and taxon density, and (3) community structure. To include a maximum suite of macrobenthic species and to evaluate the community-specific effects, the impact of sieving procedure was investigated within four widely spread macrobenthos communities in the Belgian part of the North Sea. Sieving alive negatively impacted all tested diversity measures (S, N₁, N₂, N_∞, H′, ES ₁₀₀ and J′): community-dependent relative losses of up to 35% were observed. However, most trends were ambiguous and statistically non-significant. Community- and taxon-dependent impacts were detected at the level of density. Mainly polychaetes were found to be negatively impacted by sieving alive (relative losses maximum 81%): especially small, interstitial polychaetes (e.g. Hesionura elongata and Spio filicornis) tend to actively escape from the sieve (relative loss up to 100%). Next to size, also behaviour, the presence of head appendages, the depth of the sampling stations and sampling season are believed to influence the sieving procedure impact. While detailed community composition was impacted (ANOSIM dissimilarity: maximum 85%), no major impact on the differentiation between the investigated communities was detected. The present study thus demonstrated that combining data, retrieved with a different sieving procedure can be useful, but its reliability will mainly depend on the type of questions one wants to answer. In all cases caution at all levels of ecological organisation is advised.     

转座酶的人工改造与修饰

转座子是基因组中能发生移动和自主复制的DNA片段,随着人们在分子水平上对转座子结构和功能认识的不断深化,许多转座子已被改造为遗传分析的工具应用于基因功能分析、基因转化和基因治疗。然而,天然转座子的转座能力不高是转座子的开发和利用的主要障碍,近几年来,科学家们运用生物信息学和蛋白质工程相结合的方法来构建活性的转座酶,通过氨基酸优化的方法获得自然界不存在的超活性的转座酶,显著地提高了转座子的转座效率,应用于植物转基因和基因标签技术;另一方面,通过蛋白质融合技术构建转座酶嵌合体,改造转座子插入特性,实现其插入位点的人工调控,应用于基因治疗。     

Prospective timing in pigeons: Isolating temporal perception in the time-left procedure

In the time-left procedure, a task used to study prospective timing, animals choose between two stimuli that signal different delays to reinforcement. Trials begin with one stimulus signaling C seconds to reinforcement and, at different moments since its onset, another stimulus, signaling S seconds to reinforcement, with C > S, is introduced. Optimal performance consists in choosing the stimulus signaling the shorter time to reinforcement. Animals have been found to perform in this optimal way. However, this procedure is complex and variables other than time may be responsible for the results. In two experiments with pigeons we sought to improve the time-left procedure to better isolate the effect of time in the animals’ behavior. We attempted to control for two confounding variables, the asymmetry in the time markers from training to testing and the cost of switching between the two response alternatives. We conclude that in the time-left task pigeons seem indeed to regulate their behavior based on time because, with our improved procedure, they still chose the stimulus associated with the shorter time to food. However, our version of the procedure created new interpretative difficulties, strengthening the idea that the time-left procedure may be too complex to study timing.     

Inadvertent Lead Placement In The Left Ventricle: A Case Report And Brief Review

Inadvertent lead placement in the left ventricle (LV) is an uncommon and often under-diagnosed complication of cardiac device implantation. Thromboembolic (TE) events are common and usually secondary to fibrosis or thrombus formation on or around the lead. Anticoagulation can prevent TE events. Percutaneous and surgical LV lead extractions have been performed successfully, but the risks of percutaneous lead removal are not well-defined. In this report, we describe a case of inadvertent LV lead placement and briefly review the contemporary literature.     

Is cardiac CT a reproducible alternative for cardiac MR in adult patients with a systemic right ventricle?

Objective

20 % of patients with a systemic RV are pacemaker dependent, and unsuitable to undergo cardiac magnetic resonance (CMR). Multidetector row computed tomography (MDCT) could provide a reproducible alternative to CMR in these patients. The aim of this study was to compare variability of MDCT with CMR.

Methods

Thirty-five patients with systemic RV underwent either MDCT (n = 15) or CMR (n = 20). Systemic RV volumes and ejection fraction were obtained, and intra- and interobserver variability for both modalities were assessed and compared.

Results

We found the intra- and interobserver variability of volumes and function measurements of the systemic RV obtained with MDCT to be higher compared with those obtained with CMR. However, these differences in variability were not significant, the only exception being the interobserver variability of systemic RV stroke volume.

Conclusions

MDCT provides a reproducible alternative to CMR for volumes and function assessment in patients with a systemic RV.     

Implantation of the Micra transcatheter pacing system: A single center North India experience

BackgroundThe leadless pacemaking transcatheter system, Micra, is a miniaturized, single-chamber pacemaker system. We report herein our experience with implantation of the Micra TPS system.ObjectiveThe current study was conducted to evaluate the safety and efficacy of the leadless Micra Transcatheter Pacemaker System (Medtronic).Research design and methodsThis was a prospective single centre nonrandomized study without controls. A transcatheter pacemaker was implanted in patients who had guideline based indications for ventricular pacing. 28 subjects were screened based on the selection criteria. Mica TPS was implanted. Parameters assessed were: duration of procedure (from femoral vein puncture to venous access closure), fluoroscopy time, number of device repositions, periprocedural electrical measurements (sensing, threshold and impedance) and in-hospital, intermediate to long term adverse events related to procedure.Result and conclusions: The device was successfully implanted in 28 subjects. The mean intraoperative sensing value was 9.04 ± 1.5 mV and the impedance was 766.89 ± 213.9 Ω. At discharge from hospital, those values were 13.2 ± 15.83 mV and 855 ± 111.7, respectively. The recommended pacing threshold value as achieved in all subjects was 0.78 V, i.e. ≤ 1 V at 0.24 ms. There was no adverse event or complications reported for any of the subjects. Mean time from hospitalization to discharge was 1.5 days. Implantation of leadless pacemakers is feasible, safe and provides advantages over the conventional system.     

儿童毒蛇咬伤的特点与程序化救治的疗效观察

目的通过分析儿童毒蛇咬伤的特点,评价程序化综合救治方法对儿童毒蛇咬伤的疗效。方法通过观察17例毒蛇咬伤儿童的临床特点,尽早进行病情预测,同时根据毒蛇咬伤的临床病情分型予程序化综合救治。监测病情变化、伤口愈合情况及平均住院时间。结果儿童毒蛇咬伤的特点为不明种类毒蛇咬伤多,症状较成人严重,易发生并发症。经过早期程序化综合救治总有效率100%,伤口渗血、肿胀明显缓解,无1例死亡,平均留观时间4.5天。结论根据儿童毒蛇咬伤特点,早期准确预测和尽快应用程序化救治能提高毒蛇咬伤疗效。     

9 例盖氏骨折术后骨不连合并下尺桡关节炎的疗效分析

目的:探讨手术治疗盖氐骨折术后骨不连合并下尺桡关节炎的方法和临床疗效。方法:对2010年1月至2015年6月收治的9例盖氐骨折术后骨不连合并下尺桡关节炎患者的临床资料进行回顾性分析,评价其骨不连愈合率、前臂旋转活动度,采用DASH问卷评估上肢功能,记录术中及术后并发症的发生情况。结果:9例患者随访13-78个月,平均45.4个月所有骨不连在24周都获得愈合,愈合时间12-24周;术后前臂旋转功能平均115.56±26.74°,显著高于术前(P0.01);而DASH评分从术前48.56±8.71分降至20.11±8.08分(P0.05);根据Anderson前臂功能评分标准,优2例,良5例,中2例,优良率为77.8%所有患者均对手术效果十分满意。结论:尺骨头切除术联合桡骨切开植骨内固定术操作简单有效,可显著改善盖氐骨折术后骨不连合并下尺桡关节炎患者的上肢功能。     

The large spectrum of pulmonary complications following illicit drug use: Features and mechanisms

Damage to lungs may occur from systemic as well as inhalational exposure to various illegal drugs of abuse. Aspiration pneumonia probably represents the most common pulmonary complication in relation to consciousness impairment. Some pulmonary consequences may be specifically related to one given drug. Prolonged smoking of marijuana may result in respiratory symptoms suggestive of obstructive lung disease. Non-cardiogenic pulmonary edema has been attributed to heroin, despite debated mechanisms including attempted inspiration against a closed glottis, hypoxic damage to alveolar integrity, neurogenic vasoactive response to stress, and opiate-induced anaphylactoid reaction. Naloxone-related precipitated withdrawal resulting in massive sympathetic response with heart stunning has been mistakenly implicated. In crack users, acute respiratory syndromes called “crack-lung” with fever, hemoptysis, dyspnea, and pulmonary infiltration on chest X-rays have been reported up-to 48 h after free-base cocaine inhalation, with features of pulmonary edema, interstitial pneumonia, diffuse alveolar hemorrhage, and eosinophil infiltration. The high-temperature of volatilized cocaine and the presence of impurities, as well as cocaine-induced local vasoconstriction have been suggested to explain alveolar damage. Some other drug-related pulmonary insults result from the route of drug self-administration. In intravenous drug users, granulomatous pneumonia with multinodular patterns on thoracic imaging is due to drug contaminants like talcum. Septic embolism from right-sided endocarditis represents an alternative diagnosis in case of sepsis from pulmonary origin. Following inhalation, pneumothorax, and pneumomediastinum have been attributed to increased intrathoracic pressure in relation to vigorous coughing or repeated Valsalva maneuvers, in an attempt to absorb the maximal possible drug amount. In conclusion, pulmonary consequences of illicit drugs are various, resulting in both acute life-threatening conditions and long-term functional respiratory sequelae. A better understanding of their spectrum and the implicated mechanisms of injury should help to improve patient management.     

International Courts and State Compliance: An Investigation of the Law of the Sea Cases

This article investigates the effect of dispute settlement decisions under the 1982 United Nations Convention on the Law of the Sea (UNCLOS) and whether and how states, particularly great powers, comply with these decisions. State practice suggests that an overwhelming majority of the decisions by UNCLOS dispute settlement bodies have been implemented. Significantly, not only small states but also the permanent members of the United Nations Security Council have complied with UNCLOS dispute settlement decisions even when they “lost” in the proceedings that were unilaterally initiated against them.     

末次冰期南海巽他陆架上的植被和气候——17962孔孢粉记录

提供了南海大陆坡上17962孔深海沉积物的孢粉记录.该孔长8 m,底部14C年龄为30 000 a BP,跨越了深海氧同位素3期、末次冰期、冰消期和全新世几个地质历史阶段.孢粉记录显示末次冰期低海面时南海南部出露的陆架上覆盖了低地雨林.同时,在邻近的岛屿上山地雨林扩张,表明气候比现在凉,但是没有变干的迹象.冰消期植被和气候都经历了快速变暖和变凉的波动.全新世时,红树林和低地雨林的扩张以及孢粉沉积率的明显降低均表明气候变暖,海面上升,大陆架被淹没.     

The end effector of circadian heart rate variation: the sinoatrial node pacemaker cell

Cardiovascular function is regulated by the rhythmicity of circadian, infradian and ultradian clocks. Specific time scales of different cell types drive their functions: circadian gene regulation at hours scale, activation-inactivation cycles of ion channels at millisecond scales, the heart''s beating rate at hundreds of millisecond scales, and low frequency autonomic signaling at cycles of tens of seconds. Heart rate and rhythm are modulated by a hierarchical clock system: autonomic signaling from the brain releases neurotransmitters from the vagus and sympathetic nerves to the heart’s pacemaker cells and activate receptors on the cell. These receptors activating ultradian clock functions embedded within pacemaker cells include sarcoplasmic reticulum rhythmic spontaneous Ca²⁺ cycling, rhythmic ion channel current activation and inactivation, and rhythmic oscillatory mitochondria ATP production. Here we summarize the evidence that intrinsic pacemaker cell mechanisms are the end effector of the hierarchical brain-heart circadian clock system. [BMB Reports 2015; 48(12): 677-684]