摘要：Ayurvedic and other alternative medical practi-tioners throughout the world have been using pulse diagnosis to detect disease and the organ at distress by feeling the palpations at three close yet precise positions of the radial artery. This paper presents a robust electro-mechanical system, ‘Nadi Yantra’ which uses piezoelectric based pressure sensors to capture the signals from the radial artery. Morphology of the waveforms obtained from our system concurs with standard physiological arterial signals. Reproducibility and stability of the system has been verified. Signal processing techniques were applied to obtain features such as amplitude, power spectral density, bandpower and spectral centroid to reflect variations in signals from the three channels. Further, wavelet based techniques were used to process the pressure signals and percussion peaks were identified. The interval between the percussion peaks was used to calculate Heart Rate Varibility (HRV), a useful tool for assessing the status of the autonomic nervous system of the human body non-invasively. Time domain indices were calculated from direct measurement of peak-peak (PP) intervals and from differences between the PP intervals. Frequency domain indices such as very low frequency (VLF) power, low frequency (LF) power, high frequency (HF) power, LF/HF ratio were also calculated. Thereafter, nonlinear Poincare analysis was carried out. A map of consecutive PP intervals was fitted to an ellipse using least squares method. Results from 7 datasets are depicted in this paper. A novel pressure pulse recording instrument is deve loped for the objective assessment of the ancient sci-ence of pulse diagnosis. The features calculated using multi resolution wavelet analysis show potential in the evaluation of the autonomic nervous system of the human body.

摘要：ASCOT-BPLA(Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm,盎格鲁斯堪的维亚心脏终点事件试验-降压部分)的分支研究ASCOT-CAF(E)(Conduit artery Functional Endpoint,传输动脉功能性终点),其结果最近已经发表[1],引起人们很大兴趣.本文就此研究的一些背景知识、设计与结果,对ASCOT-BPLA的意义以及对高血压治疗策略影响等问题作些介绍。

摘要：Objectives: Amiodarone administration is presently considered in the prevention of new-onset postoperative atrial fibrillation (PAF) after cardiac operations, but relapse of PAF requiring anticoagulation therapy at hospital discharge is prevalent despite amiodarone prophylaxis. PAF is also associated with increased morbidity and mortality including complications resulting from long-term anticoagulation therapy. Currently, the most effective therapy to prevent PAF after cardiac surgery remains undetermined. Inflammatory mechanisms may be partly responsible for PAF. Minocycline, a tetracycline antibiotic, has specifically an atrial myocytes anti-apoptotic effect, decreases right atrial tissue inflammation and oxidative stress activity. These observations led to this trial’s hypothesis that the addition of minocycline to amiodarone may favorably affect suppression of PAF. Methods: This trial compares the efficacy and safety of minocycline plus amiodarone versus amiodarone alone, in the prevention of PAF among adult patients undergoing cardiac procedures. All patients receive Beta-blocker agent. The primary outcome is PAF occurrence. Secondary outcomes include thromboembolic stroke, need for pharmacologic or electric cardioversion, mediastinal exploration for sepsis or for anticoagulation-related bleeding, serious drug side effects, length of hospital stay and 30-day mortality from cardiovascular causes. Results: This is an ongoing prospective single center randomized controlled clinical trial. Conclusion: The trial provides information on the comparative effectiveness of this low-risk prevention therapy of PAF that could be integrated in clinical practice. (*** number, NCT 01422148).

摘要：作为冠心病的主要外科治疗手段,冠状动脉旁路移植术（coronary artery bypass graft,CABG）技术成熟并疗效显著,但仍有多种因素造成术后卒中等脑血管意外的发生,术中升主动脉操作,如对升主动脉钳夹造成的主动脉壁钙化斑块碎片脱落是最主要的原因[1].虽然非体外循环CABG避免了心肺转流插管、冷灌等升主动脉操作,使得因钙化斑块碎片脱落的相关并发症减少[2],但传统的桥血管近端吻合方式仍不能避免侧壁钳部分钳夹升主动脉所带来的风险.为减少主动脉斑块的脱落,各种主动脉近端吻合装置、主动脉隔离装置及新的手术技术先后被应用于临床,但或因效果不佳,或因价格昂贵,未获广泛推广.2007年5月至2011年5月,我院心血管外科自行设计了一种新的主动脉吻合口阻塞技术,可避免使用侧壁钳,完成不钳夹主动脉壁桥血管近端吻合.

摘要：Baek等于1980年首次将下斜方肌肌皮瓣(lower trapezius myocutaneous flap, LTMF)应用于头颈部重建[1],随后该组织瓣逐步得到了推广和应用,并成为头颈重建常用的带蒂组织瓣之一.传统的LTMF是以颈横动脉的浅支作为血管蒂,后来的研究证实了颈横动脉的深支(肩胛背动脉)在LTMF血供中的作用,并提出了术中将该动脉包含在LTMF内的意义[2,3].晚近又出现了单纯以肩胛背动脉为血管蒂的扩展斜方肌皮瓣(extended lower trapezius myocutaneous flap,ELTMF)或肩胛背动脉皮瓣(dorsal scapular artery flap,DSAF)[4～6].ELTMF优于传统LTMF的是其皮岛设计位于斜方肌的更远端,因而有更长的血管蒂,而且组织瓣制备时无需切断斜方肌的上部肌纤维,从而大大改善了患者术后的肩功能.本文对LTMF及DSAF作一简介.

摘要：动脉硬化性肾动脉疾病(renal artery disease RAD)和其他动脉硬化性血管疾病包括冠状动脉疾病,常常是共存的.作者通过前瞻性设计,对200例怀疑冠心病而行冠状动脉造影的患者常规给予肾动脉造影,旨在了解肾动脉狭窄发生率以及与之相关的危险因素.1 资料与方法

摘要：冠状动脉瘘（coronary artery fistula，CAF）是指冠状动脉与心腔、冠状静脉（或冠状静脉窦）、肺动脉或其他血管形成的异常通道，其发生率约为0．27％～0．40％[1-2]。我院心内科自2004年起开展CAF的经导管介入治疗，效果良好，现报告如下。1资料与方法 1.1一般资料 2004年5月~2013年12月于我院经冠状动脉造影确诊为CAF患者共63例，其中男性39例、女性24例，年龄26～85岁。

摘要：在5年前的JAMA杂志上，我称赞了从事重症监护专业的人员，因为他们开始认真地对肺动脉插管（pulmonary artery catheterization，PAC）在高危手术患者和重症监护（ICU）患者中的疗效进行评估，这是一项很困难的工作。我之所以这么认为，是因为自20世纪70年代该技术在临床出现后的，它已经被广泛应用于ICU和围手术期患者，但目前仍缺乏高质量的证据支持其应用。1996年发表的一项回顾性观察研究表明，使用PAC可能会引起不良的结局。因此，采用前瞻性随机化研究设计对PAC进行合理研究是从当前临床实践中“后退”的严格而必要的一步，这决不是一个简单的过程。在本期JAMA杂志中发表了2篇重要的关于这一评估过程的文章，这使我们得以及时回顾近期的研究，并思考从中获得的信息。

摘要：背景：尽管有证据显示，降压治疗对高血压患者有效，但是其对冠心病(coronary artery disease，CAD)的安全性及疗效的数据仅见于大型试验的亚组分析。目的：在采用钙拈抗剂治疗方案(calcium antagonist strategy，CAS)或非钙拮抗剂治疗方案(non-calcium antagonist strategy，NCAS)的高血压CAD患者中进行比较。设计、地点和参试者：随机、开标(open-label)、盲法终点研究。研究于1997年9月至2003年2月在14个国家的862家单位的22576例高血压CAD患者中进行。患者年龄≥50岁。干预：患者随机接受CAS(盐酸维拉帕米缓释剂)或NCAS(阿替洛尔)。两种治疗均有详细的剂量及用药方案。高血压预防、检查、评估和治疗全国联合委员会第7次报告(JNC ⅥI)指出，如果患者存在糖尿病或肾损伤，收缩压应<130mmHg、舒张压应<85mmHg的建议，给予群多普利和／或双氢克尿塞以便达到目标血压。对有心力衰竭、糖尿病或肾损伤的患者还建议给予群多普利。主要观察指标：全因死亡，首发非致死性心肌梗死或非致死性脑卒中；心血管残废、心绞痛、不良事件、住院以及24个月时血压控制情况。结果：在24个月时，CAS组有6391例(81．5％)服用维拉帕米缓释剂；4934例(62．9％)服用群多普利；3430例(43．7％)服用双氢克尿塞。NCAS组有6083例(77．5％)服用阿替洛尔；4733例(60．3％)服用双氢克尿塞；4113例(52．4％)服用群多普利。在61835病人一年随访之后(每例平均2．7年)，2269例患者发生主要结局事件，两种治疗方案无统计学显著差异(CAS为9．93％，NCAS为10．17％；相对危险度[relative risk，RR]，0．98；95％可信区间[confidence interval[CI]，0．90～1．06]。两组两年内血压控制情况相似。CAS组达到JNCⅦ目标血压者分别为65．0％(收缩压)和88．5％(舒张压)，NCAS组为64．0％(收缩压)和88．1％(舒张压)。CAS组总共有71．7％而NCAS有70．7％的患者达到收缩压<140mmHg、舒张压<90mmHg的水平。结论：对高血压CAD患者而言，以维拉帕米+群多普利为基础的治疗方案与以阿替洛尔+双氢克尿塞为基础的方案一样有效。