Objective The aim was to investigate the manupulation and the localization of LV Lead, and to evaluate LV Lead usefulness in biventricular pacing.Methods 9 Patients with enlarged left ventricle, chronic heart failure, CLBBB and refractory to chemical therapy were selected in this study, including 8 males and 1 female. Coronary sinus venography was performed by injecting contrast medium retrogradely at coronary sinus ostium in 7 cases or antegradely into left coronary artery in 2 cases. LV lead was introduced to CS and localized at targeting vein of LV through a "peel away" guiding sheath, which was placed in CS via left subclavian vein route. Results Coronary sinus and its tributaris were clearly visualized by both antegrate cardiac venography and retrograte cardiac venography. 2187 leads were implanted into targeting veins through "peel away" guiding sheaths in 6 cases and directly introduced in 2 cases, while in other case the lead was inserted into coronary sinus directly after a failed procedure via a "peel away" guiding sheath. The leads were placed in great cardiac vein in 1 case, lateral LV vein in 2 cases, left posterior LV vein in 2 case and left posterolateral veins in 4 cases. The acute pacing and sensing thresholds measuered during the implanting procedure were in normal limits. 2187 leads were still fully functional without dislocalization during follow up of average 253 days. Conclusion CS and its tributaries can be clearly shown by antegrate and retrograte venographies. The introduction of 2187 left ventricular pacing is easily performed directly or through a preformed "peel away" guiding sheath. LV epicardium pacing by 2187 LV lead implanted through CS is feasible and reliable.

Accurate judgment of conditions and prognosis has important clinical significance in improving survival rate and optimal distribution of liver source in patients with liver failure. This article reviews the current application of prognostic markers for liver failure such as alanine aminotransferase, aspartate aminotransferase, total bilirubin, prothrombin time, prothrombin time activity, and international normalized ratio and summarizes the new markers discovered in recent years, such as inflammatory response-related markers, neutrophil gelatinase-associated lipocalin, immune response-related markers, keratin, intestinal flora, microRNAs, liver failure autoantigen and autoantibody, and hemodynamic disorder. It is pointed out that the prognosis of liver failure is affected by many factors and there is still a lack of more sensitive and effective markers and a standardized prognostic scoring system. The new markers used alone or in combination with traditional markers may help to improve the sensitivity and specificity of prognostic evaluation of liver failure.

OBJECTIVETo investigate a possibility to improve the security of pulse-activating injection by comparing the difference of pseudoanaphylactoid reactions (PR) induced by pulse-activating injection before and after improving technology.

METHODThe analysis of vascular permeability of the mice's ears: ICR mouse were divided into different test groups, and intravenously injected with solutions of different concentration of pulse-activating injection before and after improving technology, positive control Compound 48/80 and 5% glucose injection. All test substances were mixed with 0. 4% Evans blue. The reaction and vascular permeability of the ears were observed and measured 30 min after injection. The vascular permeability of the rat's skin: the rats were intravenous injected with 0. 6% Evans blue normal saline solution first, 10 minutes later, the same test substances were intradermal injected into the back of rats, there are 16 injected spots in the back of rat. The rats were sacrificed and the diameter of locus ceruleus and the content of Evans blue leaked out were measured 20 min after injection.

RESULTPulse-activating injection before improving technology with dose of 16.7 mL x kg(-1) ( in 1.67 times the clinical dose ) caused obvious vascular hyperpermeability in ICR mice. In the group of pulse-activating injection before improving technology with dose of 10 mL x kg(-1) (in clinic equivalent dose), no obvious vascular hyperpermeability in the ears were observed. The degrees of vascular hyperpermeability in the group of pulse-activating injection after improving technology with dose of 16.7 mL x kg(-1) were more lessen than the same dose of injection before improving technology. Pulse-activating injection before improving technology caused obvious exudation, oedema locus ceruleus in the injection site of rat's back, and it showed a certain dose-effect relation. Pulse-activating injection after improving technology caused locus ceruleus in the injection site too, but the diameters of the locus ceruleus were shorter than the diameters in the group of pulse-activating injection before improving technology, and the contents of leaked out Evans blue were fewer. All of these showed that PR of skin induced by pulse-activating injection after improving technology is alleviated.

CONCLUSIONPulse-activating injection before improving technology cause obvious vascular hyperpermeability, but the same dose of pulse-activating injection after improving technology can't cause obvious vascular hyperpermeability. The result indicated that the pulse-activating injection before improving technology can cause PR, improving technology can lessen the degree of PR induced by the injection.

Anaphylaxis ; chemically induced ; Animals ; Capillary Permeability ; drug effects ; Injections, Intravenous ; methods ; Male ; Mice ; Mice, Inbred ICR ; Rats ; Skin ; drug effects