Objective To study the effect of adaptive support ventilation (ASV) in treatment of severe asthma.Methods Forty-nine cases of severe asthma were divided into ASV group (25 cases) and control group (24 cases,tradition mechanical ventilation).The arterial blood gas,respiratory dynamics,mechanical ventilation time,hospital stay and thorax barotrauma was compared between two groups.Results The arterial blood gas and respiratory dynamics was improved after mechanical ventilation compared with that before mechanical ventilation in two groups,and there was significant difference (P ＜ 0.05 or ＜ 0.01).The airway peak voltage,lung dynamic compliance and platform pressure after mechanical ventilation of 2,12 and 24 h in ASV group was better than that in control group[2 h:(33 ± 12) cm H2O(1 cm H2O =0.098kPa) vs.(37 ± 11) cm H2O,(16 ± 9) ml/cm H2O vs.(17 ± 10) ml/cm H2O,(27 ± 6) cm H2O vs.(30 ±12) cm H2O; 12 h:(23 ± 12) cm H2O vs.(25 ± 11) cm H2O,(28 ± 6) ml/cm H2O vs.(23 ± 10) ml/cm H2O,(20 ±6) cm H2O vs.(25 ±4) cm H2O; 24 h:(18 ± 12) cm H2O vs.(20 ± 11) cm H2O,(32 ±9)ml/cm H2O vs.(28 ± 10) ml/cm H2O,(12 ±7) cm H2O vs.(16 ±7) cm H2O],and there was significant difference(P＜ 0.05 or ＜ 0.01).The mechanical ventilation time and hospital stay in ASV group was shorter than that in control group [(46 ± 8) h vs.(56 ± 6) h,(7 ± 2) d vs.(10 ± 3) d],and there was significant difference (P＜ 0.01).The thorax barotrauma was not observed in ASV group; 3 cases showed subcutaneous emphysema and 2 cases showed pneumothorax in control group.Conclusions ASV mode could decrease airway peak voltage and platform pressure,improve arterial blood gas and lung dynamic compliance,shorten mechanical ventilation time and hospital stay.It is safe and effective for patients with severe asthma.

Objective To investigate the changes of coagulation function and blood rheology in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and effects of depside salt from salvia miltiorrhiza.Methods The patients with AECOPD were randomly divided into depside salt from salvia miltiorrhiza anticoagulation group (45 patients) and conventional treatment group (45 patients).At the same time 50 normal were choosed as control group (50 patients).On the 14th day after treatment,4 indexes of coagulation,D-dimer and of blood rheology in depside salt from salvia miltiorrhiza anticoagulation group and conventional treatment group were determine and compared with those of normal control group.Results The levels of Fbg (4.6 ± 0.7) g/L and D-dimer (1.58 ± 1.13) mg/L were significantly different between depside salt from salvia miltiorrhiza anticoagulation group and normal controls.After depside salt from salvia miltiorrhiza anticoagulation,The levels of FbgFbg (3.3 ± 1.2) g/L and D-dimer (0.48 ± 0.36)mg/L were decreased significantly (P ＜ 0.01).The 1 evels of Fbg (3.3 ± 1.2) g/L and D-dimer (0.48 ± 0.36)mg/L were decreased significantly in depside salt from salvia miltiorrhiza anticoagulation group compared with those in Conventional treatment group (P ＜ 0.01).But PT,APTT and TT level were not significantly different in three groups (P ＜0.05).After treatment,hemodynamic indexes:whole blood high shearing viscosity (4.76 ± 1.35)mPa.S,low shearing viscosity (8.69 ± 2.36) mPa.S plasma viscosity (2.32 ± 0.26) mPa.S and hematocrit (40.3 ± 2.38)％ in depside salt from salvia miltiorrhiza anticoagulation group indicated significant differences compared to those in Conventional treatment group[(5.50.3 ± 1.34) mPa.S,(12.30 ± 2.30) mPa.S,(2.32 ± 0.26) mPa.S,(47.89 ± 3.13)％)] (P ＜ 0.01).Conclusion Patients with in AECOPD have hypercoagulable state.depside salt from salvia miltiorrhiza could improved hypercoagulable state in acute exacerbation of chronic obstructive pulmonary disease and decrease blood viscosity.

BACKGROUND:Circumferential pulmonary vein antrum ablations guided by CARTO system or integration of a computed tomographic or magnetic resonance imaging scan (CARTO-Merge) are two main locating methods.Theoretically,CARTO-Merge provides a detailed appreciation of the pulmonary vein anatomy,however,whether it can improve the safety and success of catheter ablation of atrial fibrillation remains uncertainly.OBJECTIVE:To explore the effect of CT image integration into three-dimensional (3D) electroanatomical mapping system on clinical outcomes of catheter ablation of atrial fibrillation.DESIGN,TIME AND SETTING:The randomized contrast observation was performed at Department of Cardiology of Beijing Anzhen Hospital from October 2005 to May 2007.PARTICIPANTS:A total of 93 patients with drugs refractory,paroxysmal atrial fibrillation who underwent circumferential pulmonary vein antrum ablation.METHODS:All patients underwent circumferential pulmonary vein antrum ablation using irdgated radiofreguency ablation with the endpoint of electrical isolation.Ablation was guided by 3D mapping alone in 50 patients (CARTO group) or by CT image integration in 43 patients (CARTO-Merge group).MAIN OUTCOME MEASURES:Procedure-related parameters,such as procedure duration,fluoroscopy duration,cumulative success rate and complication,were compared between the two groups.RESULTS:Pulmonary veins were isolated in all patients.After (12.6±2.9) months follow-up,73 (78.5%) patients did not have recurrence of atrial fibrillation at 3 month after the procedure.The fluoroscopy time in CARTO group was significant longer than that in CARTO-Merge group (P<0.05).The mean procedure duration,radiofrequency ablation duration,procedure-related complication and cumulative success rate were comparable between the 2 groups.CONCLUSION:Circumferential pulmonary vein antrum ablation guided by 3D mapping alone or by CT integration had similar safety and success rate in paroxysmal atrial fibrillation patients.But CT integration,which facilitated to a detailed representation of the anatomy of left atrium,is associated with reduced fluoroscopy duration.

Objective To study the effects of ?2-adrenergic receptor gene Arg16Gly polymorphism on blood lipid and apolipoprotein ratio and its role in blood lipid and apolipoprotein ratio mediated by high carbohydrate/low fat (HC/LF) diet in healthy young persons.Methods Fifty-six healthy young volunteers had regular diet for 7 d followed by HC/LF diet for 6 d.Twelve-hour fasting venous blood samples were collected on days 1,8 and 14 to measure blood lipid and apolipoprotein (apo) AI and B100 levels,and to calculate ratios of TG/HDL-C,log (TG/HDL-C),TC/HDL-C,LDL-C/HDL-C and apoAI/apoB100.DNA was isolated from genome.Arg16Gly polymorphism was analyzed by PCR-RFLP.Results No significant difference was found in the baseline lipid and apolipoprotein ratio in subjects with AA genotype and G carriers before and after regular or HC/LF diet.The ratios of TG/HDL-C (P=0.017),log (TG/HDL-C) (P=0.031),and apoAI/apoB100 (P=0.006) were significantly higher,while those of TC/HDL-C (P=0.001) and LDL-C/HDL-C (P

Objective:To explore the efficacy and safety of Rasburicase therapy in critically ill children su-ffering from advanced Burkitt′s lymphoma.Methods:A retrospective analysis of children with advanced Burkitt′s lymphoma was admitted to Pediatric Intensive Care Unit, the First Affiliated Hospital of Sun Yat-Sen University, from January 2015 to May 2020 and accepted treatment.According to the uric acid-lowering therapies, patients were divided into 2 groups, namely Rasburicase group (Group R) and traditional treatment group (Group T), to compare the effects of hypouricemic treatment and the prognosis between the 2 groups.Results:Twenty-nine children with advanced Burkitt′s lymphoma were included in this study, with 13 cases (44.83%) of stage Ⅲ and 16 cases (55.17%) of stage Ⅳ.Abdominal mass/ abdominal distension (13 cases, 44.83%) and abdominal pain (7 cases, 24.14%) were the main reasons of initial medical visit attendance.The most common primary tumor site was abdominal/ pelvic cavity (21 cases, 72.41%), followed by head or neck (6 cases, 20.69%). There were 15 cases in Group R and 14 cases in group T. No significant differences in serum creatinine, lactate dehydrogenase and uric acid were detected between the 2 groups (all P>0.05). The proportion of serum uric acid recovery rate of 24 hours and 72 hours after initial treatment in Group R were significantly higher than those in T group (85.71% vs.25.00%, 100.00% vs.25.00%, all P<0.01). Although there were no obvious differences in the incidence of tumor lysis syndrome between the 2 groups (33.33% vs.64.29%, P=0.096), the incidence of acute renal injury, renal replacement therapy requirement, serious complications and the 28 day mortality in Group R were remarkably lower than those in Group T (33.33% vs.85.71%, 13.33% vs.64.29%, 20.00% vs.78.57%, 0 vs.35.71%, all P< 0.05). Conclusions:Rasburicase can effectively reduce the serum uric acid level and decrease the incidence of acute kidney injury and other severe complications, thus improving the prognosis of children experiencing advanced Burkitt′s lymphoma.

Objective To evaluate the clinical efficacy and safety of catheter ablation for atrial fibrillation in elderly patients.Methods From September 2008 to October 2011,a total of 420 consecutive patients undergoing catheter ablation of atrial fibrillation (AF) were selected.The patients were divided into 3 age groups:30 59 yr group (n=279),60-74 yr group (n=100),and 75-87 yr group (n =41).The effect of operation and complications during operative and postoperative periods were evaluated.Patients were followed up for at least 6 months,and the rate of atrial fibrillation reocurrence and life quality were recorded.Results Among 480 catheter ablation procedures,in 7 (1.5％) patients occurred main complications,while in 5 (1.0％) patients appeared other complications.The incidence of main complications in 3 groups were 1.1％ (3 patients),2.0％ (2 patients) and 4.9％ (2 patients) respectively,other complication rates in 3 groups were 0.7％ (2 patients),1.0％ (1 patient) and 4.9％ (2 patients) respectively and there were no differences between groups (all P＞0.05).During follow-up,the cases without AF relapse were 68.5％ (191 patients),66.0％ (66 patients) and 57.1％ (23 patients) respectively,and the patients with AF paroxysm were 21.1％ (59 patients),21.0％ (21 patients),29.3％ (12 patients) respectively,and there was no significant difference between groups (all P＞0.05).And no difference was found in improvement degree of life quality among three groups (P＞0.05).Conclusions Catheter ablation is safe and effective in elderly patients.For patients over 75 years with many types of cardiovascular diseases,catheter ablation is effective to control the relapse of AF,can significantly improve the quality of life,and has no increased risk of complications.

Objective:To investigate the level of plasma Betatrophin in pregnant women with gestational diabetes mellitus (GDM) and its correlation with the control of blood glucose.Methods:Forty-five pregnant women with GDM(GDM group) who received regular obstetric examinations in the Huaihua First People′s Hospital from July 2019 to January 2021 and 50 pregnant women with normal glucose tolerance (NGT) (NGT group) during the same period were enrolled in this study. Blood glucose and blood lipid indicators were collected, plasma Betatrophin level was detected, Logistic regression analysis was used to screen the influencing factors of blood glucose control effect, the pregnancy outcome was followed up, the predictive value of Betatrophin level in blood glucose control and pregnancy outcome was evaluated by receiver operating characteristic (ROC) curve.Results:The levels of systolic blood pressure, diastolic blood pressure, fasting plasma glucose (FPG), 2 h postpartum blood glucose (2 h PG), glycosylated hemoglobin (HbA 1c), fasting insulin (FINS), 2 h postprandial insulin (2 h FINS), insulin resistance index (HOMA-IR), low density lipoprotein cholesterin (LDL-C) and plasma Betatrophin in the GDM group were higher than those in the NGT group, and insulin function index (HOMA-β) and high density lipoprotein cholesterin (HDL-C) were lower than those in the NGT group ( P<0.05). Pearson correlation analysis showed that plasma Betatrophin level was positively correlated with HbA 1c and HOMA-IR in pregnant women and the GDM group ( r = 0.310, 0.314, 0.341, 0.333; P<0.05). In the GDM group, 12 patients with poor glucose control, 33 patients with good glucose control, the FPG, HbA 1c, HOMA-IR and plasma Betatrophin levels in poor glucose control patients were higher than those in good glucose control patients, HOMA-β was lower than that in the good glucose control patients: (5.82 ± 0.98)mmol/L vs. (5.04 ± 1.11) mmol/L, (9.78 ± 2.15)% vs. (8.22 ± 1.41)%, 2.71 ± 0.56 vs. 2.24 ± 0.48, (1 345.12 ± 256.32) ng/L vs. (1 165.10 ± 217.41) ng/L, 144.15 ± 22.71 vs. 158.63 ± 20.26, there were statistical differences ( P<0.05). The area under the curve of plasma Betatrophin level to predict the effect of blood glucose control was 0.775. A total of 8 pregnant women with GDM had poor pregnancy outcome, and the area under the curve predicted pregnancy outcome by plasma Betatrophin level was 0.728. Conclusions:The level of plasma Betatrophin in patients with GDM is closely related to the degree of insulin resistance and the effect of blood glucose control, and can provide some reference for clinical evaluation and therapeutic effect prediction.

Objective To identify the electrophysiological charateristics and cause of ridge gap related reentry after MI ablation in atrial ifbrillation patients. Methods Activation and entrainment mapping was performed in 82 redo cases for OAT recurrence in whom MI was ablated during the index produre. Once ridge gap related reentry was conifrmed, detailed mapping was performed in MI and ridge region. In addition, in 36 cases undergoing MI ablation and fulfilling criterion for bidirectional block, differential pacing was repeated at the ridge to identify a ridge gap. Results Out of 82 redo cases for OAT recurrence in whom MI was ablated during the index produre, 7 (8.5%) was found to be ridge gap related reentry. TCL was (247.9±19.2) ms, and the left atrial endocardial activation time was (145.4±17.7) ms, accounting for (58.5±3.2)%of TCL. However, wide double potential was recorded along the previous ablated MI line where PPI was (34.3±6.6) ms longer than TCL, while PPI was signiifcantly shorter at the ridge[PPI-TCL (11.4±3.9) ms, P<0.001]. Tachycardia was terminated at the ridge in 6 cases and at the corresponding site in coronary sinus in 1 case. No recurrence was found during follow-up for (11.1±4.5) months. In addition, in 36 patients undergoing MI ablation in whom criterion of bi-directional block was fuliflled, conduction gap located at the ridge was found in 5 (13.9%) cases. Conclusions MI ridge gap related reentry is a distinctive OAT, in which the ridge was used as the critical isthmus, whereas the previous ablated MI line is not part of the reentry. MI pseudo-block due to the ridge gap may lead to this type of recurrent tachycardia.

Objective To observe the management and outcome of the cardiac tamponade patients during the ablation procedure using two different anticoagulation strategies. Methods All the patients developed tamponade during the ablation procedure were enrolled from January 2007 to December 2013 in our center. In group 1, warfarin was discontinued 3 to 5 days before the procedure and low molecular weight heparin (LMWH) was administered subcutaneously until ablation procedure day. In group 2, warfarin was not discontinued and the international normalized ratio INR was to maintained between 2 and 3. Results There were 27 patients (0.6%) developed cardiac tamponade out of a total 4487 patients received ablation in our center. The baseline clinical characteristics including age, left atrium, the heparin dose and ACT during the procedure had no signiifcant difference between the groups, except that the INR was higher in the group 2 (0.9±0.1 vs. 2.3±0.5, P<0.001). There was no signiifcant difference in the amount of pericardiac drainage between the two groups (365±222 ml vs. 506±300 ml, P=0.137). Two patients in group 1 patient (11.1%) and 1 in group 2 (11.1%) needed emergency surgical repair (P>0.999). The median hospital day was similar in the 2 groups [(9.6±3.3) d vs. (12.1±4.5) d, P=0.167]. There were no other serious complications and no hospital death. Conclusions Non-discontinuation of warfarin during peri-procedural catheter ablation of AF is not signiifcantly different to bridging with LMWH in the management and outcome of acute cardiac tamponade.

Objective Identify the mechanism of induced atrial arrhythmias after pulmonary vein isolation (PVI) in patients with paroxysmal atrial ifbrillation(PAF), and investigate its long-term prognosis. Methods All patients with PAF undergoing PVI and induction test afterwards between Feburary 2010 and October 2010 were included. The induction protocol was rapid pacing initiated at cycle length of 250 ms with progressive shortening in a decrement of 10 ms down to 180 ms or refractoriness. Isoproterenol of 2-4μg/min was administrated as well. Inducibility was deifned as induction of atrial arrhythmia lasting >1 min. The mechanism of induced tachycardia was identiifed by activation mapping and entrainment mapping under the guidance of CARTO system. All patients were followed up by 36 months. Results Forty-nine atrial tachycardia were induced in 39 (19.7%) patients, including 35 organized atrial tachycardia (OAT) and 14 atrial ifbrillation (AF). The LA diameter was signiifcantly larger in inducible group than non-inducible group (39.5±6.6 mm vs. 36.7±5.2 mm, P=0.004). Macroreentry was the most common mechanism in induced OATs (28, 80.0%), and mitral isthmus was the most common critical site (20, 40.8%), followed by cavo-tricuspid isthmus (12, 24.5%), PV (6, 12.2%), LA septum (4, 8.2%), superior vena cava (3, 6.1%) and LA roof (1, 2.0%). Conclusions The most common mechanism of induced tachycardia by IV isoproterenol and rapid pacing is MI and CTI dependent after PVI in PAF patients, which can be succssefully eliminated by liner ablation, not increasing long-term recurrence rate.