高钙对兔窦房结的负性变时作用

本文采用常规微电极技术在离体兔心窦房结标本上研究了细胞外钙离子浓度([Ca~(2 )]_0)对窦房结的变时性作用。结果显示,[Ca~(2 )]_0的递增(1.1—5.5mM),对窦性周期(CL)大于400ms 的标本引起双相变时作用,但对CL小于400ms的标本却引起负性变时作用。阿托品(0.5mg/l)和心得安(0.2mg/l)对[Ca~(2 )]_0 的变时作用无明显影响。随着[Ca~(2 )]_0的递增,窦房结优势起搏细胞的动作电位幅度、最大舒张期电位和0期最大除极速度均降低,舒张期自动除极化斜率增加,起始电位上移,动作电位时程(APD)延长。高[Ca~(2 )]_0时窦房结起搏细胞的有效不应期(ERP)延长、ERP/APD增大,ERP点的阈值提高(P<0.01)。 上述结果表明,高[Ca~(2 )]_0引起窦房结的负性变时效应,这种作用不是通过交感和副交感神经的传递,而可能是 Ca~(2 )直接作用于窦房结起搏细胞引起其电活动改变的结果。     

Efficacy and safety of leadless pacemaker: A systematic review,pooled analysis and meta-analysis

BackgroundLeadless pacemakers have been designed as an alternative to transvenous systems which avoid some of the complications associated with transvenous devices. We aim to perform a systematic review of the literature to report the safety and efficacy findings of leadless pacemakers.MethodsWe searched MEDLINE and EMBASE to identify studies reporting the safety, efficacy and outcomes of patients implanted with a leadless pacemaker. The pooled rate of adverse events was determined and random-effects meta-analysis was performed to compare rates of adverse outcomes for leadless compared to transvenous pacemakers.ResultsA total of 18 studies were included with 2496 patients implanted with a leadless pacemaker and success rates range between 95.5 and 100%. The device or procedure related death rate was 0.3% while any complication and pericardial tamponade occurred in 3.1% and 1.4% of patients, respectively. Other complications such as pericardial effusion, device dislodgement, device revision, device malfunction, access site complications and infection occurred in less than 1% of patients. Meta-analysis of four studies suggests that there was no difference in hematoma (RR 0.67 95%CI 0.21–2.18, 3 studies), pericardial effusion (RR 0.59 95%CI 0.15–2.25, 3 studies), device dislocation (RR 0.33 95%CI 0.06–1.74, 3 studies), any complication (RR 0.44 95%CI 0.17–1.09, 4 studies) and death (RR 0.45 95%CI 0.15–1.35, 2 studies) comparing patients who received leadless and transvenous pacemakers.ConclusionLeadless pacemakers are safe and effective for patients who have an indication for single chamber ventricular pacing and the findings appear to be comparable to transvenous pacemakers.     

临时起搏器经皮冠状动脉介入术治疗高风险冠状动脉病变的效果观察

目的分析并总结采用临时起搏器在实施经皮冠状动脉介入术治疗高风险冠状动脉病变中的应用效果。方法回顾性分析在临时起搏器支持下实施PCI的18例高危病人的临床资料,分析临时起搏器置入以及冠脉介入的操作情况。结果本组病人置入临时起搏电极起搏成功率达到100％。结论联合应用临时起搏器与经皮冠脉介入术治疗急性心肌梗死（AMI）与慢性血管闭塞性病变患者,能够降低经皮冠脉介入术治疗中由于严重心律失常导致的血液动力学改变,使病人尽快恢复正常心率以及各主要脏器的供血,减少患者的病死率,具有较高的安全性,值得在临床上广泛推广应用。     

Second‐order cooperation: Cooperative offspring as a living public good arising from second‐order selection on non‐cooperative individuals

Switching rate between cooperating and non‐cooperating genotypes is a crucial social evolution factor, often neglected by game theory‐inspired theoretical and experimental frameworks. We show that the evolution of alleles increasing the mutation or phenotypic switching rates toward cooperation is in itself a social dilemma. Although cooperative offspring are often unlikely to reproduce, due to high cost of cooperation, they can be seen both as a living public good and a part of the extended parental phenotype. The competition between individuals that generate cooperators and ones that do not is often more relevant than the competition between cooperators and non‐cooperators. The dilemma of second‐order cooperation we describe relates directly to eusociality, but can be also interpreted as a division of labor or a soma‐germline distinction. The results of our simulations shine a new light on what Darwin had already termed a “special difficulty” of evolutionary theory and describe a novel type of cooperation dynamics.     

左房增大对起搏器术后的老年阵发性房颤患者再发房颤的影响

目的：探讨植入心脏起搏器的老年阵发性房颤患者再发房颤（包括无症状性房颤）发生率及左房容积指数对再发房颤的影响。方法：收集2012年1月-2013年12月在我院起搏器门诊长期随访且未服用抗心律失常药物的起搏器术后老年阵发性房颤患者148例,记录基线特征、超声心动图参数及随访期间内房颤发生情况。分别根据左房容积指数及房颤负荷进行分组,应用Cox回归分析探讨起搏器检测的再发房颤及房颤高负荷的危险因素。结果：患者平均随访时间为22.79个月,期间57.43%的患者再发房颤,22.97%的患者为房颤高负荷,15.54%的患者为无症状房颤。多因素Cox回归分析发现左房增大分别是再发房颤及房颤高负荷的独立危险因素。结论：左房容积指数是预测起搏器术后老年阵发性房颤患者房颤复发及房颤高负荷的独立危险因素。     

An unusual ‘bow tie’ image in pacemaker implantation

Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.     

Transcatheter leadless permanent pacemaker in complex congenital heart disease with interrupted inferior vena cava: A challenging implantation

31 years lady with complete atrioventricular canal defect, large primum atrial septal defect (ASD), inlet ventricular septal defect (VSD) and Eisenmenger syndrome, presented with atrial flutter and complete heart block. She was not suitable for corrective cardiac surgery and not yet indicated for heart-lung transplantation. She was advised single chamber permanent pacemaker and eventually Micra VR transcatheter leadless pacemaker was finalised for her. Transcatheter leadless pacemaker was deployed in her RV septum despite some unforeseen technical problems. This patient had intrahepatic interruption of IVC with Azygous continuation draining into SVC but this altered venovascular course was detected only fluoroscopically midway during the pacemaker implantation procedure and this was not detected in the preprocedural transthoracic echocardiography. This abnormal venous course was clearly demonstrated in the cardiac CT which was performed only after completion of the pacemaker implantation procedure in this patient. The technical challenges encountered mainly were mostly during the manipulation of the 27F delivery catheter of Micra through this altered cardiovascular anatomy via transfemoral approach and also due to the presence of septal defects. Thus, transcatheter leadless permanent pacemaker was implanted successfully through transfemoral access in this complex congenital heart disease with interrupted IVC and azygous continuation. Besides transthoracic echocardiography, it may be better to perform transesophageal echocardiography or even preferably radiological imaging like cardiac CT or MRI prior to transcatheter leadless pacemaker implantation in patients with complex congenital heart disease to understand the cardiovascular anatomy and plan the procedure.     

Silver‐spoon upbringing improves early‐life fitness but promotes reproductive ageing in a wild bird

Early‐life conditions can have long‐lasting effects and organisms that experience a poor start in life are often expected to age at a faster rate. Alternatively, individuals raised in high‐quality environments can overinvest in early‐reproduction resulting in rapid ageing. Here we use a long‐term experimental manipulation of early‐life conditions in a natural population of collared flycatchers (Ficedula albicollis), to show that females raised in a low‐competition environment (artificially reduced broods) have higher early‐life reproduction but lower late‐life reproduction than females raised in high‐competition environment (artificially increased broods). Reproductive success of high‐competition females peaked in late‐life, when low‐competition females were already in steep reproductive decline and suffered from a higher mortality rate. Our results demonstrate that ‘silver‐spoon’ natal conditions increase female early‐life performance at the cost of faster reproductive ageing and increased late‐life mortality. These findings demonstrate experimentally that natal environment shapes individual variation in reproductive and actuarial ageing in nature.     

Early life expenditure in sexual competition is associated with increased reproductive senescence in male red deer

The evolutionary theories of senescence predict that investment in reproduction in early life should come at the cost of reduced somatic maintenance, and thus earlier or more rapid senescence. There is now growing support for such trade-offs in wild vertebrates, but these exclusively come from females. Here, we test this prediction in male red deer (Cervus elaphus) using detailed longitudinal data collected over a 40-year field study. We show that males which had larger harems and thereby allocated more resources to reproduction during early adulthood experienced higher rates of senescence in both harem size and rut duration. Males that carried antlers with more points during early life did not show more pronounced declines in reproductive traits in later life. Overall, we demonstrate that sexual competition shapes male reproductive senescence in wild red deer populations and provide rare empirical support for the disposable soma theory of ageing in males of polygynous vertebrate species.