BACKGROUND:Pre-excited atrial fibrillation (AF) is associated with increased risk of life-threatening events. However, at times, patients with pre-excited AF still repetitively suffer from hemodynamic disturbance, with resistance to acute treatments of antiarrhythmic therapy and cardioversion.METHODS:To evaluate the feasibility in correcting hemodynamic disturbance, patients with pre-excited AF who underwent catheter ablation of accessory pathway as an emergency procedure, were retrospectively collected from two centers of China. The medical records of patients were analyzed and summarized in this case series.RESULTS:Five patients with pre-excited AF who received emergency catheter ablation of accessory pathway, were collected from two contributor centers and reported in this case series. All collected patients still repetitively suffered from hemodynamic disturbance induced by rapid anterograde conduction of AF via pathway, even guideline recommended acute interventions of intravenous antiarrhythmic therapy and cardioversion had been performed. Finally, as an emergency procedure, catheter ablation of accessory pathway was performed in collected patients. Correspondingly, the hemodynamic unstable status was greatly relieved. Meanwhile, all collected patients with high risk of pre-excited AF were combined with left-sided accessory pathway, with shortest RR interval of widened pre-excited QRS complex less than 250 ms. Thus, combination with left-sided pathway is proposed as an indicator for the increased risk of life-threatening events in patients with high risk of pre-excited AF.CONCLUSIONS:Emergency catheter ablation of accessory pathway is an effective option for the acute managements of patients with high risk of pre-excited AF in unstable hemodynamics, which is resistant to antiarrhythmic therapy and cardioversion.

长期以来,人们都将低钠饮食视为对心力衰竭患者进行病情管理的重要一环.一般认为减少钠盐的摄入有助于减轻心力衰竭患者的水钠潴留及其心脏的循环负荷.但目前对于心力衰竭患者保持低钠饮食对改善其病情的具体作用仍缺乏高质量的循证医学证据,并且对限钠量尚无定论.有学者指出,应改变心力衰竭患者的饮食模式而非限制其单一营养素的摄入.在本文中,笔者主要是介绍关于心力衰竭患者低钠饮食的研究进展.

1 病例资料 患者男性,48岁,因"反复活动后喘累3年"入院. 患者3年前开始出现活动后喘累,于院外行超声心动图(具体结果不详),考虑为"肥厚型心肌病",嘱口服药物治疗. 后患者不定期于门诊随访,间断口服"培哚普利、美托洛尔、呋塞米、螺内酯".

沙库巴曲缬沙坦(sacubitril/valsartan,LCZ696)作为治疗顽固性心力衰竭的新型药物,亦是首个用于临床的血管紧张素受体-脑啡肽酶抑制剂(angiotensin receptor-neprilysin inhibitor,ARNI).该药物的安全性、耐受性及心衰治疗临床获益已经在大量的临床试验中得到充分验证,美国、欧洲、中国等临床指南已推荐该药用于治疗心力衰竭.同时,目前也有较多的试验表明ARNI不仅仅在慢性心力衰竭患者能够获益,在肺动脉高压、高血压、慢性肾病等也展现出临床应用前景.

目的:探讨荷叶碱对泡沫细胞形成的影响及其可能的分子机制.方法:体外培养人单核-巨噬细胞系THP-1,利用氧化型低密度脂蛋白(Ox-LDL)诱导建立泡沫细胞模型,同时用5、10和20μmol/L荷叶碱进行干预.采用油红O染色观察细胞内脂质沉积;用试剂盒测定细胞总胆固醇含量;通过Western blot法检测微管相关蛋白1轻链3(LC3)、P62、磷酸化蛋白激酶B(p-Akt)和磷酸化哺乳动物雷帕霉素靶蛋白(p-mTOR)蛋白水平,免疫荧光检测自噬流,透射电镜检测自噬小体,评估细胞内自噬水平及自噬相关通路的变化.利用自噬抑制剂3-甲基腺嘌呤(3-MA)抑制细胞自噬,观察荷叶碱是否通过调控自噬抑制泡沫细胞形成.结果:与正常对照组相比,Ox-LDL组细胞内脂质沉积和总胆固醇含量显著增加.与Ox-LDL组相比,荷叶碱组细胞内脂质沉积和总胆固醇含量显著减少,自噬流显著增强,自噬小体增多;3-MA处理后,荷叶碱抑制细胞泡沫化的作用被削弱.荷叶碱降低p-mTOR和p-Akt蛋白水平.结论:荷叶碱可能通过抑制磷脂酰肌醇3-激酶(PI3K)/Akt/mTOR通路促进自噬,减少细胞内脂质沉积,从而抑制泡沫细胞形成.

目的 探讨冠状动脉钙化积分(CACS)与脉压差(PPD)的相关性.方法 回顾性分析2017年1月至2018年6月重庆医科大学附属第二医院收治的906例行冠状动脉血管成像(CCTA)的住院患者的临床资料,按有无高血压分为高血压组(485例)和正常血压组(421例),比较2组患者中不同PPD者CACS情况;再根据CACS结果分为CACS=0(477例)、1～<100(256例)、≥100(173例)3个亚组,分别比较3个亚组患者的PPD水平,以探讨CACS与PPD的相关性.结果 (1)906例患者PPD与CACS呈显著正相关(r=0.146,P=0.008),且高血压组、正常血压组患者PPD与CACS均呈正相关(r=0.103、0.101,P=0.023、0.038).(2)高血压组患者中CACS≥100组患者的平均PPD[(63.60±18.11)mm Hg](1 mm Hg=0.133 kPa)明显大于CACS=0组[(57.49±14.25)mm Hg];正常血压组患者中CACS≥100组患者平均PPD[(54.08±14.19)mm Hg]均明显大于CACS=0组[(47.53±11.48)mm Hg]及CACS为1～<100组[(48.04±12.34)mm Hg],差异均有统计学意义(P<0.05).结论 无论有无高血压疾病的基础,行CCTA的住院患者CACS与PPD均呈正相关.

目的 探讨血清游离脂肪酸(FFA)水平与冠状动脉(冠脉)粥样硬化斑块形成的相关性.方法 回顾性分析2017年1月至2018年6月该院收治的590例住院患者的临床资料,基于电子病历系统收集相关资料,采用冠脉螺旋CT评估冠脉狭窄程度.将590例住院患者分为斑块组(322例)和无斑块组(268例),将322例斑块组患者分为狭窄大于或等于50％组(114例)和狭窄0～50％组(208例).统计分析各组患者FFA水平的差异.结果 斑块组患者FFA水平为(497±215)μEq/L,无斑块组患者FFA水平为(517±223)μEq/L,狭窄大于或等于50％组FFA水平为(489±216)μEq/L,狭窄0～ 50％组患者FFA水平为(503±215)μEq/L,各组患者FFA水平比较,差异均无统计学意义(P＞0.05).不同年龄、性别,是否服用他汀类药物,是否合并糖尿病患者FFA水平比较,差异均无统计学意义(P＞0.05).FFA与其他传统危险因素无关(P＞0.05),未发现FFA是冠脉粥样斑块形成的独立危险因素.结论 FFA与冠脉粥样斑块的形成无关.

Objective This study was performed to observe the effect of radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF) and to explore the risk factors for late recurrence of atrial fibrillation (LRAF) after a single RFCA session. Methods In this retrospective study, 243 patients with PAF underwent RFCA and were followed up regularly. Results At a median follow-up of 37 months after a single procedure, 60.5% of patients maintained sinus rhythm (SR), and at a median follow-up of 42 months after multiple procedures, 74.9% of patients maintained SR. The statistically significant risk factors for LRAF after a single RFCA session were the left atrial diameter (LAD), left inferior pulmonary vein superior–inferior diameter (LIPV SID), PV number variation, circumferential pulmonary vein isolation (CPVI) combined with additional ablation, and early recurrence of atrial fibrillation (ERAF). The best cut-off value for LAD was 35.5 mm. Conclusions During a 3-year follow-up, about 70% of the patients with PAF maintained SR. LRAF after a single procedure was associated with the LAD, LIPV SID, PV number variation, CPVI combined with additional ablation, and ERAF.

Background: Previous studies showed that radiofrequency energy delivery of the renal artery could induce an immediate and substantial blood pressure (BP)-elevation response, which might be indicative of the increase in central sympathetic nervous activity. Objective: The current study was to investigate whether the presence of BP-elevation response to radiofrequency energy delivery can serve as a surrogate to predict BP reduction following renal artery sympathetic denervation (RDN). Method: Data were collected on 67 patients undergoing RDN for drug-resistant hypertension. The BP-elevation response to radiofrequency application was defined as elevation of SBP by at least 10mmHg during radiofrequency energy delivery. The extent of BP reduction at 1, 3, 6, 12 months after RDN were analyzed. Multivariable linear regression analysis of baseline and procedural characteristics was performed to identify the determinants of BP reduction after RDN. Results: Ten patients (14.9%) were classified as nonresponders to radiofrequency delivery and showed significantly lower BP reduction compared with responders. The SBP reductions of radiofrequency delivery responders vs. nonresponders were 31.2 +/- 8.6 vs. 11.4 +/- 8.6 mmHg, 36.3 +/- 10.0 vs. 14.6 +/- 10.6 mmHg, 39.9 +/- 9.9 vs. 15.2 +/- 8.8 mmHg, and 40.0 +/- 8.7/13.5 +/- 5.8 mmHg (P<0.001 for all) at 1, 3, 6, and 12 months, respectively. On multiple linear regression analysis, higher baseline office SBP, the presence of BP-elevation response to radiofrequency energy delivery, and especially larger number of BP-elevation response points, were independent predictors of SBP reduction at 6-month and 12-month follow-up. Conclusion: Baseline SBP and BP-elevation response during radiofrequency ablation, as well as larger positive response points to radiofrequency energy delivery could be an effective intraprocedural predictive markers to long-term procedural success of RDN.

目的 观察在他莫昔芬诱导下,心肌特异性Hdac3基因缺失对小鼠心脏病理结构及其心脏功能的影响.方法 利用Cre/Loxp基因重组系统,将Hdac3loxp/loxp小鼠与Myh6-creERT小鼠进行杂交,获得带有心肌特异性启动子的Myh6-creERT/Hdac3loxp/loxp小鼠,并按随机数字表法将28只8周龄雄性Myh6-creERT/Hdac3loxp/loxp小鼠分为对照组、模型组.模型组小鼠腹腔注射0.2 mL他莫昔芬(40 mg/mL),每天1次,连续5d,从而诱导性敲除心肌特异性Hdac3基因;对照组小鼠注射0.2 mL的玉米油.在模型建立后第1、4周,采用经胸二维超声心动图检测两组小鼠舒张末期室间隔厚度(diastolic interventricular septum,IVSd)、舒张末期左室后壁厚度(diastolic left ventricular posterior wall,LVPWd)、射血分数(ejection fraction,EF)、左室短轴缩短率(fractional shortening,FS).随后获取并观察小鼠心脏组织,采用HE染色、Masson三色染色、天狼星红染色、WGA免疫荧光染色检测小鼠心脏病理改变.采用TUNEL检测心肌细胞凋亡水平,Western blot检测DNA损伤相关指标.结果 Hdac3基因缺失后,与对照组相比,模型组小鼠IVSd与LVPWd明显增高(P＜0.05),EF与FS明显降低(P＜0.05).病理学观察结果显示,与对照组相比,模型组小鼠于Hdac3基因敲除后第1周,心肌细胞排列紊乱,横断面显示心肌细胞肥大,间质纤维化增多,伴有少量的炎症细胞浸润;第4周可见弥漫的心肌纤维化与肥大不规则的心肌细胞.TUNEL免疫荧光染色显示模型组凋亡细胞较对照组显著增多(P＜0.05);Western blot检测结果显示,模型组γH2AX蛋白表达量显著高于对照组(P＜0.05).结论 小鼠心肌特异性Hdac3基因的缺失能够引起DNA损伤并诱导心肌细胞凋亡,导致心肌细胞发生病理性结构改变及心脏功能降低,最终引起心室重构.

Catheter ablation has been wildly used to treat atrial fibrillation (AF) and has achieved a better efficacy for paroxysmal AF (PAF) but not for persistent AF (PerAF). Furthermore, a few data on the efficacy and safety of catheter ablation for PerAF were reported. This study aimed to investigate long-term efficacy of radiofrequency catheter ablation (RFCA) for PerAF and explore predictors of late recurrence of atrial fibrillation (LRAF). A total of 92 consecutive patients with PerAF (64 males, aged 56.42 +/- 11.24 years) were enrolled in this study and accepted circumferential pulmonary vein isolation (CPVI) alone or CPVI combined additional ablation. Maintenance rate of sinus rhythm (SR) was 40.2% after a single procedure with median follow-up of 15 months and 52.2% after mean 1.3 +/- 0.6 procedures with median follow-up of 26 months. Long-term SR maintenance rate was no statistical difference between patients with CPVI alone and with CPVI combined additional ablation (48.6% vs 35.1%, log rank test, P =. 152). Patients with AF duration < 24 months had a higher long-term SR maintenance rate than those with AF duration = 24 months (55.6% vs 30.4%, log rank test, P = .022). AF duration (OR = 1.015, 95% CI 1.001-1.030, P =. 015), and early recurrence of AF (ERAF) (OR = 10.654, 95% CI 3.853-29.460, P < .001) were predictors of LRAF after a single procedure. In conclusion, long- term maintenance SR rate was 52.2% in patients with PerAF after multiple procedures with a median over 2-year follow-up. Patients with AF duration < 24 months had better outcome. AF duration and ERAF were predictors of LRAF after a single procedure.

AIM:To investigate the effects of eplerenone (Epl) on thyroid hormone (T3) induced myocardial electrical remodeling .METHODS:The ventricles of 1~3 d neonatal rats were digested with 0.125%trypsin and 0.08%collagenase type 2.The cell suspension was replated for 90 min to reduce the proportion of non-myocardial cells.The isola-ted cardiomyocytes were randomly divided into control group , T3 group, Epl group and T3+Epl group.The cardiomyocytes were identified by immunofluorescence staining .The viability of the cardiomyocytes was measured by CCK-8 assay.The ex-pression of Kv1.5, Kv4.3, Cav1.2, connexin 40 (Cx40) and Cx43 at mRNA and protein levels was determined by immu-nofluorescence staining , real-time PCR and Western blot .RESULTS:The results of the cell immunofluorescence labeling conformed that the cultured cells were cardiomyocytes with more than 95%positive staining of sarcomeric α-actinin.Com-pared with control group , the mRNA and protein levels of Kv1.5, Kv4.3, Cav1.2 and Cx40 were increased, but the ex-pression of Cx43 was decreased in T3 group.The mRNA and protein levels of Kv1.5, Kv4.3, Cav1.2 and Cx40 were de-creased, but the expression of Cx43 was increased in Eplerenone group .Compared with T3 group, the mRNA and protein expression levels of Kv1.5, Kv4.3, Cav1.2 and Cx40 were decreased, but the expression of Cx43 was increased in T3+Epl group.CONCLUSION:Eplerenone partly reverses T3-induced myocardial electrical remodeling .

目的 观察和分析较低活化凝血时间(ACT)条件下心房颤动(房颤) 肖融术的安全性及其主要并发症的危险因素.方法 收集并整理于我院行射频或冷冻球囊消融术的231例房颤患者的临床资料.按 肖融术中所测ACT的平均值(以下简称ACT)分为＜200 s,200 ～＜ 250 s和≥250 s 3组,计算并比较各组栓塞及出血并发症的发生率,再按是否发生出血并发症分为出血并发症组和未出血并发症组,按病例对照研究进行单因素分析和多因素logistic回归分析,分析出血并发症的危险因素.结果 全部患者发生并发症13例,总发生率为5.6％,＜200s,200～ ＜250 s和≥250 s 3组的总发生率分别为4％、3％和13％,≥250组总发生率显著高于200～＜ 250 s组(P＜0.05).≥250 s组出血并发症发生率显著高于200 ～＜ 250 s组(11％ vs.1％,P＜0.01),3组其他并发症无显著差异.多因素logistic回归分析结果提示手术耗时(P＜0.01,OR=1.025,95％ CI:1.007 ～1.043)、公斤体质量肝素注射量(P＜0.01,OR=1.067,95％CI:1.020 ～1.116)及术中ACT(P＜0.01,OR=1.065,95％C1:1.017 ～1.114)是出血并发症的独立危险因素.结论 对CHADS2评分＜2分的房颤患者,将消融术中ACT维持在200 ～＜ 250 s是相对安全的.手术耗时、公斤体质量肝素注射量及术中ACT是发生出血并发症的独立危险因素.

Although catheter ablation treatment of paroxysmal atrial fibrillation (PAF) has achieved a significant efficacy, AF recurrence remains high and the reason of high recurrence rate is unclear. This study aimed to investigate long-term efficacy of radiofrequency catheter ablation (RFCA) for PAF and

研究生教育是高等教育中的最高层次,肩负着为国家培养高层次专门人才的重任.培养高质量的研究生是研究生导师的职责和意愿,也是对研究生导师的基本要求.研究生导师处于研究生培养的核心地位.因此,提高研究生的综合素质,确保研究生的培养质量,需要一个强大的研究生培养队伍即研究生导师队伍.加强导师队伍建设及导师的管理和评价至关重要.但在导师队伍建设过程中,研究生导师如何进行遴选、导师的胜任力如何是评价研究生教育改革诸多环节中的重要的一环.目前,研究生导师遴选标准比较单一,研究生管理部门也多是对导师的基本条件进行审定,而且各高校研究生导师遴选标准亦比较相似,对导师的评价指标体系也不是十分完善,且常常带有明显的功利倾向等问题 [1].如何解决这些问题也是近年研究生教育改革的重要课题.在"重庆市研究生教育教学改革研究项目"的资助下,本课题组构建了"研究生导师胜任力评价体系"[2].本文简述了这一体系的构建,并重点就这一体系在研究生导师管理中的初步实践作了总结.

Objective: To assess efficacy and safety of renal denervation (RDN) for heart failure (HF). Background: RDN has been demonstrated to be an effective method in lowing overactive sympathetic nerve. However, it's feasibility and efficacy for HF is unclear. Methods: In this randomized, controlled pilot study, patients with HF were randomly assigned in 1: 1 ratio to undergo RDN plus optimal medical therapy (RDN group) or only optimal medical therapy (control group). Before randomization, patients received optimal medical therapy at least half a year. Primary efficacy end point was the change in LVEF over six months; secondary efficacy end points were the change in six-minute walk distance and SF-36 Health Survey scores over six months. Results: Up to Apr 2015, sixty symptomatic HF patients were successfully enrolled into study. Thirty patients were randomly assigned to RDN group and 30 patients were randomly assigned to control group. All patients completed six months follow up. During follow up, no severe adverse events were observed. Blood pressure was stable in both groups. Patients in RDN group had shown a significant improvement in LVEF (P< 0.001), SMWD (P=0.043), NYHA class (P < 0.001), NT-proBNP (P < 0.001) and office heart rate (P=0.008). Compared with control group, RDN patients were associated with significant improvement in all domains of SF-36 but bodily pain (P=0.74). No significant change in estimate glomerular filtration nor complication of renal artery stenosis were observed. Conclusions: Results imply that RDN could be safely applied to treatment of HF and probably improve cardiac systolic function and patients' quality of life. (C) 2016 Wiley Periodicals, Inc.

BACKGROUND:The efficacy of short-term antiarrhythmic drugs (AADs) use compared with no-AADs prescription after catheter ablation of atrial fibrillation (AF) in preventing atrial arrhythmia recurrence is uncertain. METHODS:We searched PubMed, Embase, and the Cochrane Library through December 2015 to identify randomized controlled trials (RCTs) which evaluated the efficacy of short-term AADs use compared with no-AADs prescription after AF ablation in preventing atrial arrhythmia recurrence. The primary outcome was labeled as early atrial arrhythmia recurrence within 3 months after ablation. Secondary outcome was defined as late recurrence after 3 months of ablation. Random-effects model or fixed-effects model was used to estimate relative risks (RRs) with 95% confidence intervals (CIs). RESULTS:Six RCTs with 2,667 patients were included into this meta-analysis. Compared with no-AADs administration after AF ablation, short-term AADs use was associated with significant reduction of early atrial arrhythmia recurrence (RR, 0.68; 95% CI, 0.52-0.87; p = 0.003). Trial sequential analysis (TSA) showed that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, establishing sufficient and conclusive evidence. However, compared with no-AADs prescription, short-term AADs use after AF ablation didn't significantly reduce the risk of late atrial arrhythmia recurrence (RR, 0.92; 95% CI, 0.83-1.03; p = 0.15). TSA supported this result; meanwhile the estimated required information size (1,486 patients) was also met. CONCLUSION:Short-term use of AADs after AF ablation can significantly decrease the risk of early atrial arrhythmia recurrence but not lead to corresponding reduction in risk of late atrial arrhythmia recurrence.

Objective: To understand the cognition status for risk factors and early symptoms of stroke via face to face questionnaire survey in 336 in-hospital patients with atrial ifbrillation (AF). <br> Methods: A face to face questionnaire survey was conducted by uniformly trained investigators in 336 AF patients who were admitted in our hospital more than 3 days from 2014-04-01 to 2014-10-01. <br> Results: There were 300/336 AF patients ifnished the questionnaire and among them 131 (43.7%) patients know that AF may increase the risk of stroke and 169 (56.3%) patients unknown or uncertain. There were 41.3%-79.3% patients having cognition for early symptoms of stroke and only 25.3% (76/300) patients may identify all 5 early signs of stroke. <br> Conclusion: In our research, AF patients had poor cognition for the risk and early signs of stroke. Medical professional should intensify the propaganda and education for stroke prevention.

BackgroundRenal denervation (RDN) is used to manage blood pressure (BP) in patients with resistant hypertension (rHT), but effectiveness is still a concern, and key arterial portion for successful RDN is not clear.ObjectiveThe aim of this study was to investigate the efficacy and safety of proximal versus full‐length renal artery ablation in patients with resistant hypertension (rHT).MethodsForty‐seven patients with rHT were randomly assigned to receive full‐length ablation (n = 23) or proximal ablation (n = 24) of the renal arteries. All lesions were treated with radiofrequency energy via a saline‐irrigated catheter. Office BP was measured during 12 months of follow‐up and ambulatory BP at baseline and 6 months (n = 15 in each group).ResultsCompared with full‐length ablation, proximal ablation reduced the number of ablation points in both the right (6.1 ± 0.7 vs. 3.3 ± 0.6, P < 0.001) and the left renal arteries (6.2 ± 0.7 vs. 3.3 ± 0.8, P < 0.001), with significantly shorter RF delivery time (P < 0.001), but higher RF power (P = 0.011). Baseline office BPs was 179.4 ± 13.7/102.8 ± 9.4 mm Hg in the full‐length group and 181.9 ± 12.8/103.5 ± 8.9 mm Hg in the proximal group (P > 0.5). Similar office BPs was reduced by −39.4 ± 11.5/−20.9 ± 7.1 mm Hg at 6 months and −38.2 ± 10.3/−21.5 ± 5.8 mm Hg at 12 months in the full‐length group (P < 0.001), −42.0 ± 11.6/−21.4 ± 7.9 mm Hg at 6 months and −40.9 ± 10.3/−22.1 ± 5.6 mm Hg at 12 months in the proximal group (P < 0.001), and progressive BP reductions were observed over the 6 months (P < 0.001) in both groups. The drop in ambulatory 24‐hr SBP and DBP were significantly less than the drop in office BP (P < 0.001). No renovascular or other adverse complications were observed.ConclusionsThe results indicate that proximal RDN has a similar efficacy and safety profile compared with full‐length RDN, and propose the proximal artery as the key portion for RDN. © 2016 Wiley Periodicals, Inc.