目的 探讨择期经皮冠状动脉介入治疗(PCI)患者血脂水平的变异性与C反应蛋白(CRP)水平之间的关系.方法 选择择期PCI术后1年内在门诊接受了至少3次随访检查的4567例患者的病历资料,随访包括常规血脂水平和炎症指标,评估血脂变异性和CRP水平之间的相关性.结果 多元线性回归结果显示,HDL-C(mean)是CRP均值升高的保护因素(t=-12.01,P<0.05),HDL-C(STDEV)是CRP均值升高的危险因素(t=7.49,P<0.05);同时,HDL-C(mean)是CRP水平变异性的保护因素(t=-11.05,P<0.05),LDL-C(mean)、HDL-C(STDEV)是CRP水平变异性的危险因素(t分别=4.34、7.12,P均<0.05).结论 HDL-C(STDEV)是CRP平均水平和变异性的危险因素,而HDL-C(mean)是CRP平均水平和变异性的保护因素.

目的 观察MR兼容心脏起搏器植入患者MR检查的安全性.方法 回顾分析2015年8月至2017年8月浙江大学医学院附属邵逸夫医院147例植入MRI兼容双腔起搏器患者的完整临床资料,其中非2型糖尿病107例,2型糖尿病40例,比较两组患者术中、术后1、2、3个月心房及心室感知、阈值、阻抗.分析1.5T MRI检查后这些参数、电池电量变化及MRI图像质量.结果 糖尿病与非糖尿病患者术中及术后3月内的起搏器参数比较,差异无统计学意义(P>0.05).术后11例患者进行16次1.5T MRI检查,其中头颅5次、脊椎4次、关节3次、腹部、心脏各2次.单次和多次MRI检查均未引发起搏参数异常、起搏器工作异常及电量异常耗损.除心脏MRI图像外其余MRI图像均很好达到了诊断要求.结论 2型糖尿病对MRI兼容起搏器急性期起搏参数影响不大,1.5T MRI检查是安全的且不影响起搏器功能.

目的:探讨以团队为基础的教学法(TBL)在解剖学理论与实验课中的应用效果及对自主学习习惯的影响.方法:在解剖学实验课和理论课中,比较TBL实施前后阶段及相同时间点实验组和对照组的考试成绩和形成性评价结果.结果:实验课实验组平均成绩显著高于对照组(P＜0.05),虽然理论课平均成绩无组间差异,但实验组成绩优良率明显高于对照组,优良率与TBL实施显著相关(P＜0.05).两课学生的预习习惯与TBL显著相关(P＜0.01).结论:TBL可以提高解剖学学生知识获取,有效促进学生预习.

Objective The purpose of this study was to explore the long-term safety and clinical outcomes of permanent His-bundle pacing(HBP). Methods We consecutively recruited 105 patients scheduled to have permanent HBP implantation from January 2013 to December 2017 at Sir Run Run Shaw Hospital,Zhejiang University College of Medicine and explored the parameter changes and clinical outcomes. Results Eighty-eight patients received permanent HBP successfully(64 with selective HBP and 24 with non-selective HBP). In permanent HBP,the acute pacing threshold was(1.3±0.7) V/0.4 ms,and the sensed potentials were(4.1±3.5) mV,and the impedance was(582.7±157.6) Ω. During median follow-up of 15 months,the threshold and the sensed potentials had no significant difference compared with the measurements at implantation respectively. Median NYHA functional class was improved compared with pre-implantation. left ventricular ejection fraction(LVEF)increased from baseline in patients with reduced LVEF(n=33)while no significant change was found in patients with preserved LVEF. The rehospitalization rate was 15.9%(n=14), with 11 patitents due to heart failure. Conclusion Permanent HBP is feasible and safe for patients with a standard pacemaker indication,particularly for the patients with systolic heart failure.

体内及体外实验证实尿酸有氧化及抗氧化的双重特性,通过促血管平滑肌细胞增殖并诱导C反应蛋白表达参与动脉粥样硬化的过程。尿酸通过减少NO产生导致血管内皮功能障碍。大量研究显示尿酸与心血管疾病密切相关。本文综述了血尿酸致心血管疾病可能机制的几个方面及研究现状。