Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery

OBJECTIVES: This study was conducted to evaluate follow-up results in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent either percutaneous transluminal septal myocardial ablation (PTSMA) or septal myectomy. BACKGROUND: Controversy exists with regard to these two forms of treatment for patients with HOCM. METHODS: Of 51 patients with HOCM treated, 25 were treated by PTSMA and 26 patients via myectomy. Two-dimensional echocardiograms were performed before both procedures, immediately afterwards and at a three-month follow-up. The New York Heart Association (NYHA) functional class was obtained before the procedures and at follow-up. RESULTS: Interventricular septal thickness was significantly reduced at follow-up in both groups (2.3 +/- 0.4 cm vs. 1.9 +/- 0.4 cm for septal ablation and 2.4 +/- 0.6 cm vs. 1.7 +/- 0.2 cm for myectomy, both p < 0.001). Estimated by continuous-wave Doppler, the resting pressure gradient (PG) across the left ventricular outflow tract (LVOT) significantly decreased immediately after the procedures in both groups (64 +/- 39 mm Hg vs. 28 +/- 29 mm Hg for PTSMA, 62 +/- 43 mm Hg vs. 7 +/- 7 mm Hg for myectomy, both p < 0.0001). At three-month follow-up, the resting PG remained lower in the PTSMA and myectomy groups (24 +/- 19 mm Hg and 11 +/- 6 mm Hg, respectively, vs. those before procedures, both p < 0.0001). The NYHA functional class was also significantly improved in both groups (3.5 +/- 0.5 vs. 1.9 +/- 0.7 for PTSMA, 3.3 +/- 0.5 vs. 1.5 +/- 0.7 for myectomy, both p < 0.0001). CONCLUSIONS: Both myectomy and PTSMA reduce LVOT obstruction and significantly improve NYHA functional class in patients with HOCM. However, there are benefits and drawbacks for each therapeutic method that must be counterbalanced when deciding on treatment for LVOT obstruction.     

腹型肥胖患者左心室长轴收缩及舒张功能与肥胖程度相关性研究

目的探讨腹型肥胖患者左心室长轴收缩及舒张功能与肥胖程度的相关性。方法 35例腹型肥胖患者(腹型肥胖组)与29例健康者(对照组)行超声心动图检查,采用组织多普勒技术M型模式测量二尖瓣环6个位点二尖瓣环收缩期位移(mitral annular systolic displacement,MADs),采用PW模式测量二尖瓣环室间隔侧E和A并计算E/A,比较2组上述参数值,并行腰臀比与MADs相关指标及E/A的相关性分析。结果腹型肥胖组体质量、腰围、腰臀比、左心房内径、室间隔厚度及舒张压高于对照组(P<0.05);E/A,E/A<1比例及6个位点MADs低于对照组(P<0.05);腰臀比与MADs的6个位点及E/A均呈负相关(P<0.05)。结论腹型肥胖患者肥胖程度与左心室长轴收缩功能与舒张功能呈负相关。     

Is hyperemesis gravidarum associated with placental weight and the placental weight-to-birth weight ratio? A population-based Norwegian cohort study

Introduction

Studies have suggested a link between placental weight, placental weight-to-birth weight ratio (PW/BW) and adult health. Hyperemesis gravidarum (HG) may also have implications for adult health. No studies on HG and placental characteristics have been identified. We therefore explored the relationship between HG, placental weight and the PW/BW-ratio in a population-based cohort.

Methods

Singleton births to primiparous women between 1999 and 2009 with data on HG, placental weight and birth weight in the Medical Birth Registry of Norway (MBRN) comprised the study base (n = 200,390). HG was defined through ICD-10 code 021.0, 021.1 and 021.9. Gender and gestational age specific percentile curves for placenta weight and PW/BW ratio were used to define those below the 10th and above the 90th percentile of both outcomes. Associations between HG and dichotomous outcomes were studied by multiple logistic regression. Multiple linear regression was applied to study placental weight as a continuous variable. Male and female offspring were analyzed separately.

Results

The prevalence of HG was 1.2%. Women with HG and female offspring had significantly higher risk of a PW/BW-ratio above the 90th percentile (OR = 1.17, 95% CI: 1.03–1.34). HG and PW/BW-ratio below the 10th percentile were inversely associated (OR = 0.70, 95% CI: 0.56–0.89). For male offspring no association was observed for HG and PW/BW-ratio below the 10th or above the 90th percentile.

Discussion/conclusions

We observed positive associations between HG and high PW/BW ratio limited to female offspring only. The high PW/BW-ratio suggests that there may be a possible link between HG and adult health.     

2-DE、CDFI、PW和CDPI诊断原发性肝癌

目的 :观察分析CDFI和CDPI对HCC血供的特点以及PW探测肿瘤血流动力学改变。方法 :对 1 39例HCC的 1 94个瘤体进行CDFI和CDPI观察 ,应用PW对每例最大瘤体 6种血流参数进行控测 ,对V1 、RI进行分析。结果 :CDFI对肿瘤血流显示率为 94.3 % ;CDPI为 97.4 % ;PW检出搏动性血流频谱为 93 .5 % ,Vmax为 1 4 5cm·s- 1 ,最小为 1 2cm·s- 1 (78.3± 8.4) ;最大RI0 .83 ,最小 0 .2 3(0 .61± 0 .1 3) ,其中RI>7.0占 71 .5 % ,搏动性与持续性水纹状血流频谱同时检出率为 48.2 %。结论 :①对HCC瘤体观察所获血流信息CDPI较CDFI敏感 ,PW探及搏动性血流频谱的检出具有确诊意义 ;②瘤体的血供以动脉为主 ,部分为动脉与静脉双重血供 ;③血流动力学改变绝大多数为高速高阻型 ,亦有低速低阻型。     

Passive exposure to pollutants from conventional cigarettes and new electronic smoking devices (IQOS,e-cigarette) in passenger cars

Smoking in car interiors is of particular concern because concentrations of potentially harmful substances can be expected to be high in such small spaces. To assess the potential exposure for occupants, especially children, we performed a comprehensive evaluation of the pollution in 7 passenger cars while tobacco cigarettes and new electronic smoking products (IQOS, e-cigarette) were being smoked. We collected data on the indoor climate and indoor air pollution with fine and ultrafine particles and volatile organic compounds while the cars were being driven. Smoking of an IQOS had almost no effect on the mean number concentration (NC) of fine particles (>300?nm) or on the PM_2.5 concentration in the interior. In contrast, the NC of particles with a diameter of 25–300?nm markedly increased in all vehicles (1.6–12.3?×?10⁴/cm³). When an e-cigarette was vaped in the interior, 5 of the 7 tested cars showed a strong increase in the PM_2.5 concentration to 75–490?μg/m³. The highest PM_2.5 levels (64-1988?μg/m³) were measured while tobacco cigarettes were being smoked. With the e-cigarette, the concentration of propylene glycol increased in 5 car interiors to 50–762?μg/m³, whereby the German indoor health precaution guide value for propylene glycol was exceeded in 3 vehicles and the health hazard guide value in one. In 4 vehicles, the nicotine concentration also increased to 4–10?μg/m³ while the e-cigarette was being used. The nicotine concentrations associated with the IQOS and e-cigarette were comparable, whereas the highest nicotine levels (8–140?μg/m³) were reached with tobacco cigarettes. Cigarette use also led to pollution of the room air with formaldehyde (18.5–56.5?μg/m³), acetaldehyde (26.5–141.5?μg/m³), and acetone (27.8–75.8?μg/m³). Tobacco cigarettes, e-cigarettes, and the IQOS are all avoidable sources of indoor pollutants. To protect the health of other non-smoking passengers, especially that of sensitive individuals such as children and pregnant women, these products should not be used in cars.     

Clusters of Legionnaires' disease in period hotels with complex water systems: lessons learnt in the West Midlands,UK

Background

In 2017 there were two distinct clusters of local travel-associated Legionnaires' disease associated with period hotels built in the 17th and 18th centuries in the West Midlands, UK. Both hotels had undergone frequent structural modifications. Five cases occurred 3 months to 2 years apart. The aim of this report is to share the learning from the investigations and challenges faced in achieving control of Legionella pneumophila in the water systems of dated buildings.

PW与PW-DTI成像技术在尿毒症患者左室舒张功能评价中的应用价值

目的探讨脉冲多普勒法(PW)与脉冲多普勒组织成像(PW-DTI)技术在评价尿毒症患者左心室舒张功能中的价值。方法对130例尿毒症患者分别采用脉冲波多普勒法(PW)测量二尖瓣口前向血流速度参数:舒张早期峰值速度(E)、舒张晚期峰值速度(A),计算E/A比值;采用PW-DTI技术测量左室侧壁、前壁、下壁、室间隔的二尖瓣环水平DTI参数:舒张早期峰值速度(Em)、舒张晚期峰值速度(Am),计算Em/Am比值;对比分析两种检测方法。结果 PW-DTI对尿毒症患者左心室舒张功能异常检出率为86.15%,明显高于PW的60.0%,其差异有统计学意义(χ2=22.59,P0.01)。结论 PW-DTI技术可以实时定量地反映心肌运动的方向与速度,客观评价左心室舒张功能,有效避免频谱多普勒检查存在的假性正常化现象。