Papulolinear Collagenoma with Arborizing Arrangement: Report of a Case

Abstract:  Connective tissue nevi of collagen type are now classified in four major subtypes. In addition to the clinicopathological features of papulolinear collagenoma, which is considered as a variant of isolated collagen harmatoma, the case we present has a unique arborizing pattern.     

兔腰椎间盘内显微注射方法的相关问题及其解剖学特点

目的：测量兔腰椎间盘解剖学数据，并探讨兔腰椎间盘内显微注射方法中的相关问题。方法：实验于2004-10在中山大学附属第二医院完成。实验动物选择三四月龄的新西兰大白兔10只，麻醉后空气栓塞法处死，取出腰椎间盘观察其解剖结构。并测量椎间盘纤维环前后径长度，测量前部纤维环前后径长度，测量椎间盘前正中点到髓核中心点的长度。取同样10只白兔，麻醉后，右侧卧位，沿左侧12肋末向下至髂嵴做纵切口，切开胸腰筋膜后层，在骶棘肌和腰方肌的外缘与胸腰筋膜前层间钝性分离。推开腰椎间盘前方筋膜和前纵韧带，以椎体前方的纵性骨棘为标志从腰椎间盘前方中心点处垂直进针，以微量注射器注入25μL黑色墨水作为标记。体会显露椎体和椎间盘的入路和手术方式，观察侧方手术入路能否良好显露腰椎间盘，能否较好的完成椎间盘内注射。观察椎间盘内注射的入针点，进针长度，进针角度，注射剂量，注入结果。小心取出注射入墨水的兔脊柱（包含L1～L7范围），共计70个，迅速置入-20℃低温冷冻，2h后取出，微解冻后以尖刀从中间水平切开椎间盘，观察墨水注入髓核的情况。结果：20只动物实验过程中无死亡，全部进入结果分析。①解剖学观察：兔髂嵴短，平髂嵴最高点连线在俯卧位时经过L6棘突，可做为手术操作的体表标志。椎间盘为三明治结构，上下为软骨终板，与上下方椎体相连；由外向内依次为外层纤维环、内层纤维环、移行区、髓核。②手术入路：顺利显露出L3～L6椎间盘，显露操作时间平均为15min，共计70个椎间盘。⑧椎间盘内注射方法：选择在嵴状突起于椎间盘水平中线的交点即为进针点，保持进针深度3mm，注射最大液体量25μL。注射效果理想者64个，其中L3～L6椎间盘共计40个，注射效果良好者39个，成功率97．2％。结论：通过对兔腰椎间盘的部分解剖学数据，椎间盘纤维注射的注射方式、手术入路的选择，进针点、进针长度、进针角度的确定、注射液体量的观察及实践，证明以本方法进行腰椎间盘内微量注射操作规范，可取得理想效果。     

Gender Differences in the Clinical Characteristics and Atrioventricular Nodal Conduction Properties in Patients With Atrioventricular Nodal Reentrant Tachycardia

Gender Differences in Patients With AVNRT. Introduction: The detailed electrophysiological characteristics of the gender differences associated with atrioventricular nodal reentrant tachycardia (AVNRT) have not been clarified. This study investigated the gender‐related electrophysiological differences in a large series of patients undergoing radiofrequency catheter ablation. Methods and Results: A total of 2,088 consecutive AVNRT patients (men/women 869/1,219) who underwent catheter ablation were enrolled in this study. We evaluated the gender differences in their electrophysiological characteristics. Women had a significantly younger age of onset, higher incidence of multiple jumps, shorter AH interval, atrial effective refractory period (ERP), anterograde fast pathway ERP, anterograde slow pathway ERP, and retrograde slow pathway ERP, and longer ventricular ERP than men. The incidence of baseline ventriculoatrial dissociation was lower in women than in men. Women needed less isoproterenol/atropine to induce AVNRT. No gender differences in the radiation exposure time, procedure time, complication rate, acute success rate, or second procedure rate were noted. Both typical and atypical AVNRT were more predominant in women. In the patients with atypical AVNRT, there was no significant gender difference in incidence of baseline ventriculoatrial dissociation; however, the retrograde slow pathway ERP was significantly shorter in women than in men. Women of premenopausal age (≤50 years old) had a significantly higher incidence of anterograde multiple jumps and a retrograde jump phenomenon, and a shorter anterograde slow pathway ERP and retrograde slow pathway ERP than those of women over 50 years old. Conclusion: Gender differences in the anterograde and retrograde AV nodal electrophysiology were noted in the patients with AVNRT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1114‐1119)     

The Novel Electrophysiology of Complex Fractionated Atrial Electrograms: Insight from Noncontact Unipolar Electrograms

Unipolar Characteristics of CFAEs. Background: The noncontact mapping (NCM) system possesses the merit of global endocardial recording for unipolar and activation mapping. Objective: We aimed to evaluate the unipolar electrogram characteristics and activation pattern over the bipolar complex fractionated atrial electrogram (CFAE) sites during atrial fibrillation (AF). Methods: Twenty patients (age 55 ± 11 years old, 15 males) who underwent NCM and ablation of AF (paroxysmal/persistent = 13/7) were included. Both contact bipolar (32–300 Hz) and NCM virtual unipolar electrograms (0.5–300 Hz) were simultaneously recorded along with the activation pattern (total 223 sites, 11 ± 4 sites/patient). A CFAE was defined as a mean bipolar cycle length of ≤ 120 ms with an intervening isoelectric interval of more than 50 ms (Group 1A, n = 63, rapid repetitive CFAEs) or continuous fractionated activity (Group 1B, n = 59, continuous fractionated CFAEs), measured over a 7.2‐second duration. Group 2 consisted of those with a bipolar cycle length of more than 120 ms (n = 101). Results: The Group 1A CFAE sites exhibited a shorter unipolar electrogram cycle length (129 ± 11 vs 164 ± 20 ms, P < 0.001), and higher percentage of an S‐wave predominant pattern (QS or rS wave, 63 ± 13% vs 35 ± 13%, P < 0.001) than the Group 2 non‐CFAE sites. There was a linear correlation between the bipolar and unipolar cycle lengths (P < 0.001, R = 0.87). Most of the Group 1A CFAEs were located over arrhythmogenic pulmonary vein ostia or nonpulmonary vein ectopy with repetitive activations from those ectopies (62%) or the pivot points of the turning wavefronts (21%), whereas the Group 1B CFAEs exhibited a passive activation (44%) or slow conduction (31%). Conclusions: The bipolar repetitive and continuous fractionated CFAEs represented different activation patterns. The former was associated with an S wave predominant unipolar morphology which may represent an important focus for maintaining AF. (J Cardiovasc Electrophysiol, Vol. 21, pp. 640‐648, June 2010)     

传统中国医疗伦理对当代美德医疗伦理学可作的贡献

晚近20年,英语世界道德哲学的最重大发展是美德伦理学的复兴。除了新亚里士多德学派,还有休谟学派、尼采学派及基督教学派等。同样的复兴也在医疗伦理学中发生。影响世界的Beauchamp与Childress的《生命医疗伦理学原则》,也在最新版本（第6版,2009年）中不再批评美德伦理学,而且承认其优点。从此书的第三版开始分析,看书的作者如何在以后三次修订版中,修改自己对美德伦理学的立场。与现代西方不同,古代中国医疗伦理的著述,是规则导向与关德导向并重,这肯定受了儒家文化的影响。儒家伦理学一直是美德导向,今天西方美德伦理学也要向孔孟取经。礼失求诸野,今天西方的医疗伦理学都强调美德的重要性,中国的医疗伦理学难道还只停留在讨论四个道德原则的运用吗？再者,我们要提出切合这个时代需要的修养工夫,这样不单是对当代中国医疗伦理的建设,也是对世界性美德医疗伦理学的贡献。     

口腔矫治器对阻塞性睡眠呼吸暂停综合征合并高血压患者血压的影响

目的探讨二维可调式口腔矫治器（OA）治疗阻塞性睡眠呼吸暂停综合征（OSAS）合并高血压患者时,对其血压的影响。方法 106例确诊为中度OSAS合并原发性高血压患者,规范口服降压药物治疗3个月以上,血压控制欠佳,采用二维可调式OA治疗;75例能按医嘱坚持OA治疗6个月以上为实验组;22例OA治疗时间少于三分之一作为对照组;9例患者间歇性OA治疗时间大于三分之一,没有纳入研究。统计分析实验组和对照组OA治疗前后呼吸紊乱指数（RDI）、最低氧饱和度（SaO2）以及平均收缩压（MSBP）、平均舒张压（MDBP）、脉压差（PP）。结果实验组RDI、SaO2均比OA治疗前明显改善,差异有统计学意义（P〈0.05）;对照组RDI、SaO2也比OA治疗前有改善,但差异无统计学意义（P〉0.05）。实验组MSBP、MDBP均比OA治疗前显著下降,血压恢复到正常水平,差异有统计学意义（P〈0.05）;而对照组MSBP、MDBP无改善（P〉0.05）。实验组OA治疗后,PP有所下降,但与治疗前比较差异无统计学意义（P〉0.05）;而对照组在6个月后PP升高,差异有统计学意义（P〈0.05）。组间比较MSBP、MDBP、PP三个血压参数：在治疗前实验组与对照组差异均无统计学意义（P〉0.05）,在治疗后实验组比对照组均有下降,差异均有统计学意义（P〈0.05）。结论对药物降压治疗效果不理想合并中度OSAS的高血压患者,二维可调式OA治疗可有效控制血压。     

英国药学教育制度对我国药学教育发展的启示

目的:探讨英国药学教育制度对我国药学教育发展的启示。方法:分析英国药学教育制度的成功之处及其缺点,提出对我国药学教育未来发展的建议。结果与结论:英国药学教育以培训药学硕士为主,其教学内容需遵从英国药物政务局的全国统一指示性药学教学大纲,教学及考试方式以案例教学法和临床能力测验为主,有效地规范了全国的药学教育,使课程的质量和学生能力达到较高水平。这些制度对我国药学教育有正面的参考价值,也有实施的可能性。     

Characteristic abnormal findings of ambulatory blood pressure indicative of hypertensive target organ complications

To study the correlation between ambulatory blood pressure andtarget organ complications of hypertension, ambulatory bloodpressure monitoring was performed on 290 patients with mildto moderate essential hypertension before treatment. Their targetorgan complications of hypertension were assessed by ECG, chestX-ray, urinalysis and an eye-fundus examination. An average ambulatory diastolic blood pressure value greaterthan the casual diastolic blood pressure was found in 35% ofsubjects with ECG evidence of left ventricular hypertrophy (LVH)and 5. 2% of subjects without (P<0.0001); in 36. 5% of patientswith chest roentgenographic evidence of LVH and 8.4% of patientswithout (P< 0.0001); in 38. 5% of patients with proteinuriaand 11% of patients without (P< 0. 0001); and in 27. 1% ofsubjects with retinopathy and 10. 7% of subjects without (P<0.01).A similar result was observed for the systolic blood pressure.A reversed circadian pattern of ambulatory diastolic blood pressurewas observed in 32. 5% of patients with ECG evidence of LVHand 12. 9% without (P< 0. 0001); in 28. 8% of patients withchest roentgenographic evidence of LVH and 16% without (P<0.05); in 26. 9% of subjects with proteinuria and 17. 4% without(P<0. 05); in 37. 5% of patients with retinopathy and 14.5% without (P<0.0001). A similar result was also demonstratedfor ambulatory systolic blood pressure. There was a close relationshipbetween the blood pressure load and hypertensive target organcomplications in terms of LVH and proteinuria, and between significantnocturnal reduction of ambulatory systolic blood pressure andLVH. The ambulatory blood pressure average also seemed to beara good relationship to LVH. In this study, 24 h ambulatory blood pressure monitoring revealeda close relationship between hypertensive target organ damage(ECG and chest roentgenographic evidence of L VH, proteinuriaand retinopathy) and the parameters of such measurements interms of blood pressure pattern (reversed circadian pattern),comparisons between casual blood pressure and ambulatory bloodpressure in addition to pressure load, and blood pressure average.