Objective To investigate the efficacy and safety of segmental electrical isolation of pulmonary veins (PVs) during atrial fibrillation (AF) Methods Nine patients were included, of whom 4 had recently persistent AF (3～4 months) and 5 suffored from paroxysmal AF occurred AF frequently We adopted one transseptal procedure Lasso mapping catheter and ablation catheter were positioned into target pulmonary vein ostium through the same site of atrial septum RF ablation was applied at the pulmonary vein potential (PVP) breakthrough using thermo control RF catheter during AF Results Twenty nine PVs were targeted for segmental RF ablation and isolated completely PVPs in target PVs were in higher spike and more frequent than left atrial potentials There were no complications associated with the procedure Seven patients were converted to sinus rhythm during the procedure Two patients restored sinus rhythm by cardioversion Conclusion It is suggested that the method of segmental PV isolation during AF is safe and has higher success rate It is not necessary to stop antiarrhymic drugs before RF ablation This study provides a reliable method for segmental electrical isolation of pulmonary veins in patients with persistent AF

Objective To investigate electrophysiologic characteristics,the original site of atrial tachycardia(AT)and the results of radiofrequency catheter ablation(RFCA)in children without structural heart disease.Methods Electrophysiologic study and RFCA were performed in 46 children with AT.The site of origin of AT was mapped by using activation mapping during tachycardia.Magnetic electroanatomical mapping(CARTO system)for ablation of atrial tachycardia was performed in 4 patients.Preselecting a temperature of 50~60 ℃ was selected for ablation.Results Electrophysiologic study verified that the mechanism of all the tachycardias in 46 children was focal AT,which might be short paroxysmal,paroxysmal or persistent.1 child also had atrioventricular nodal reentrant tachycardia.ATs were successfully ablated in 41 children(89%),in which 39 had one original site(27 foci in right atrium and 12 foci in left atrium),2 had at least two original sites.Conclusion The success rate of RFCA in ATs of children without structural heart disease was relatively high.Atrial taclycardia could be eliminated by radiofrequency current with safety and efficacy.

Objective To investigate the efficacy and safety of the segmental electrical isolation of pulmonary veins (PVs) in patients with paroxysmal atrial fibrillation (PAF). Methods Thirty-nine patients (28 males, 11 females) with recurrent documented symptomatic PAF were included. In order to avoid the risk of cardiac tamponand, we adopted one transseptal procedure and obtained unselective angiography of all PVs and left atrial appendage using pigtail catheter. Lasso mapping catheter and ablation catheter were put into target pulmonary vein ostium through the same site of atrial septum. We routinely mapped the right inferior PV lest any pulmonary vein potential (PVP) that triggered PAF should be omitted. RF ablation was applied at the PVP breakthrough and slightly right and left by moving the RF catheter. Results Eighty-five PVs were targeted for segmental RF ablation. Eight-one were isolated completely. Immediate successful rate was 95%. There was not any complication associated with the procedure. Conclusion It is suggested that the method of segmental PV isolation has a higher cure rate and a shorter procedure time compared with other traditional methods. It can minimize the lesion of pulmonary veins and avoid PV stenosis.

0 05 There was 1 case of cardiac tamponand and 1 case of 60% stenosis of the left superior PV associated with the procedure Conclusion ERAF after segmental PV isolation is common, occurring in approximately 39% of patients with paroxysmal AF However, approximately 35% of ERAF patients without early repeat ablation have no further AF during long term follow up It is suggested that temporary antiarrhymic drug therapy may be more appropriate than early repeat ablation in patients with ERAF

Objective The aim of this study was to investigate the mechanisms and the possible treatment of early and frequent recurrence of atrial fibrillation after segmental pulmonary veins isolation (PVI) in patients with paroxysmal atrial fibrillation (AF). Methods and Results Guided by Lasso mapping catheter, segmental pulmonary veins isolation was performed using radiofrequency energy in 54 consecutive patients (mean age 53?15 years) with recurrent documented symptomatic paroxysmal AF. Early recurrence of AF and rapid atrial arrhythmia occurred in 10 out of 54 patients (18.5%) within two weeks after PVI. 4 out of 10 patients (7.4 %) experienced early and frequent recurrence of atrial fibrillation and atrial tachyarrhythmia, which we termed as “atrial arrhythmic storm". The 4 patients were treated with class Ⅰ and Ⅲ antiarrhythmic drugs for 3 months. The “atrial arrhythmic storm" subided apparently and disappeared within two weeks after antiarrhythmic drug therapy. Only 1 patient still suffered from paroxysmal AF after drug control at mean follow-up of 3 months. After repeat ablation, there was no occurrence of AF and atrial arrhythmia in this patient.Conclusion A few paroxysmal atrial fibrillation patients experienced “atrial arrhythmic storm" after segmental pulmonary veins isolation. It is suggested that “atrial arrhythmic storm" after PVI may due to a lot of factors and combined antiarrhythmic drug therapy may be feasible. Early repeat ablation in patients with “atrial arrhythmic storm" may not be necessary.

Objective To analyze the electrophysiological characteristics of atrioventricular nodal reentrant tachycardia(AVNRT) requiring ablation at the mitral annulus.Methods Ablation was carried out at the mitral annulus by mapping the slow pathway with resetting method in order to acquire the electrophysiological parameters needed for successful ablation of AVNRT.Results Three cases with AVNRT who had prior failed ablation were successfully ablated by targeting the slow pathway located at the mitral annulus.The location of the left-sided slow pathway was selected by a positive resetting response and verified by junctional automaticity elicited by radiofrequency application and elimination of tachycardia.Conclusion AVNRT refractory to ablation of slow pathway at the posteroseptal area may require ablation at the mitral annulus.Resetting response may help to locate the slow pathway along the mitral annulus.

Serum levels of leptin, insulin like growth factor (IGF)Ⅰ, IGF binding protein 1(IGFBP1), fasting insulin (FINS) were determined in 36 patients with polycystic ovary syndrome (PCOS) and 26 control subjects. The results showed that serum leptin, IGF Ⅰ, FINS in PCOS patients were significantly higher than those in control subjects, and serum IGFBP1 level was significantly lower than that in control subjects. Serum leptin was positively correlated with FINS in PCOS patients.

Objective To investigate the prognostic implications of the size of left atrium with catheter ablation of atrial fibrillation.Methods Forty-two consecutive patients with symptomatic and drug-refractory paroxysmal or persistent AF admitted from 2005 May to 2006 November were included in the present study.The mean age was 60?12 years and 25 patients(58%)were male.Paroxysmal AF was present in 37 patients(88%)and persistent AF in 5 patients(12%).A 3D electroanatomic map of the LA including the pulmonary vein(PV)ostia was constructed with a nonfluoroscopic navigation system(Carto,Biosense Webster).The left and right PVs were encircled by continuous radiofrequency ablation lines.The left atrial diameter(LAD)was measured by 2D-guided M-mode echocardiography,in terms of anteroposterior diameter,left-right diameter and superior-inferior diameter by ”Simpson” method.Left atrial volume(LAV)was calculated by ”Pumbo” method.Body surface area(BSA)(m2)was used for indexing body size variables.The respective formulae are:left atrial volume index(LAVI)=LAV/BSA(mL/m2);left atrial diameter index(LADI)=LAD/BSA.Results Fifteen patients(34%)suffered from recurrent AF after 3 months of follow up.The LAVI of the recurrent group of patients was(68.19?23.68)mL/m2 compared with that of the non-recurrent group of(52.07?17.34)ml/m2(P=0.019).Logistic regression analysis revealed LAVI was the only independent risk factor of recurrence(OR=1.04,95% CI 0.99-1.09,P=0.04).Age(P=0.806),sex(P=0.338),AF history(P=0.46),hypertension(P=0.963),LAD(P=0.41),LADI(P=0.093),LAV(P=0.471),LVEF(P=0.91)between the 2 groups had no statistic differences.Conclusion Left atrial volume index(LAVI)is a better parameter compared with LAD,LADI and LAV in reflecting the left atrial size.LAVI is an independent predictor of recurrence of AF after catheter ablation.We found that LAVI≥55 mL/m2 was the strongest predictor,independent of age and other clinical parameters.

In order to explore the significance of enterovirus environmental surveillance of sewage,two sewage treatment plants in Fuzhou City were selected as sentinel surveillance sites.One sewage sample was collected from entrance of each plant every month,and total 48 samples were studied from 2013 to 2014 in Fuzhou City.Using the RD,L20B and Hep-2 cell lines to isolate the viruses,44 of the 48 sewage samples (91.67％) were positive,268 strains were isolated which covered at least 22 enterovirus serotypes.The peak season of virus isolation from sewage was in February and July which was two months earlier than patient surveillance.Eehovirus type 7 (Echo 7) was the predominant serotype in 2013 with 58 isolations (43.61％),and in 2014 echovirus type 6 (ECHO 6) became the predominant serotype with 85 isolates (62.96％),among the strains isolated from sewage sample.Phylogenetic analysis found that the predominant serotype Echo 6 and Echo 7 isolated from sewage were more diversified than that from clinical cases during the same period,and were high homology with isolates form patients which belong to same branch in phylogenetic tree.In conclusion,enterovirus environmental sewage surveillance is an effective approach,and could be more sensitive than patient surveillance.

Objective To elucidate the CT characteristics and pathology of acute miliary pulmonary tuberculosis (AMPT). Methods The CT features of AMPT in 25 cases were analyzed retrospectively, and the CT features in HIV-seronegative and HIV-seropositive patients were compared by 2-sided exact propability Chi-square test. Two lung specimens were inflated and fixed by Heitzman's method. HRCT scans, gross specimen section (80-150 μm) and histologic section (5 μm) were performed on dry lung specimens and CT-pathologic correlation was conducted. The distribution of micronodules in the secondary lobule on HRCT and pathology in one specimen was evaluated by Chi-square test. Results Twenty five patients with AMPT were included in this study, including 11 HIV-seropositive patients and 14 HIV-seronegative patients. HRCT showed diffuse micronodules randomly distributed throughout both lungs in 25 patients, and ground-glass opacity (17 patients)was the predominant complicated finding. Coalescence of nodules and consolidation in HIV-seropositive patients (5 and 6 patients) were markedly higher than that in HIV-seronegative patients (none). In lung specimens, most nodules located in the lung parenchyma between the central bronchovascular bundle and the perilobular structures (792 and 560 nodules), which located in the interlobular septum pathologically. The distribution of micronodules in the secondary lobule showed on HRCT (1060 nodules)and pathology(864 nodules) was not significantly difference(x2=2.814,P＞0.05). HRCT showed ground-glass opacities when ARDS occured, which were pulmonary edema,inflammation and hyaline membrane on alveolar wall pathologically. Conclusions The HRCT characteristic of nodule distribution in AMPT is random. ARDS should be suspected when diffuse ground-glass opacities appear on HRCT.