Persistent painless ST-segment depression after exercise testing and the effect of age

The relation between the duration of ischemic ST-segment depression (1 mm or more 60 ms after the J point) and the clinical awareness of chest pain was studied in 31 patients (aged 39-73 years) undergoing symptom-limited, graded treadmill exercise testing. The response of these patients to nitrate therapy (spray or sublingual tablet) given immediately on cessation of exercise was also studied. During exercise, angina pectoris appeared at an estimated workload of 4.6 +/- 2.2 metabolic equivalents (METS) (mean +/- SD), and pathological ST-segment depression at 4.9 +/- 1.9 METS (p = NS.) On cessation of exercise, angina disappeared after 3.0 +/- 1.9 min, but ST-segment depression persisted for more than twice as long (6.6 +/- 4.1 min) (p less than 0.0001). The ratio of time to ST-segment recovery/time to relief of pain (a quantitative measure of silent ischemia during recovery) increased with age (r = 0.49, p = 0.002), and in 16 patients over 60 years of age was higher than in 15 younger patients (3.6 +/- 2.5 vs. 2.1 +/- 1.4) (p less than 0.04). The silent ischemia ratio after exercise tended to decrease, although not significantly so (p = 0.2), in patients who received oral nitrates; there was no difference in the response to spray or tablet in this regard. We conclude that ST-segment depression frequently persists after relief of exercise-induced angina pectoris and more so in elderly patients.     

Anti-Ischaemic Response to Sublingual Nitroglycerin During Oral Administration of Isosorbide Dinitrate in Patients with Stable Angina Pectoris: When does Cross-Tolerance Occur?

The purpose of this study was to evaluate the efficacy of sublingual nitroglycerin (NTG) during treatment with oral sustained-release isosorbide dinitrate (ISDN) in two doses: 80 mg and 120 mg. In a double-blind crossover design study 38 men with stable angina initially received either an oral placebo (OP) or ISDN. All patients received either NTG 0.5 mg or sublingual placebo (SLP) 2.5 h after OP ingestion, but only NTG 2.5 h after ISDN. The same pattern was used in the first ingestion and in long-term OP or ISDN therapy for 7 days (OP and ISDN every 6 h, and ISDN once daily). The efficacy of NTG was evaluated by analyzing walking time to ischaemia (WTI) during exercise tests performed 5 minutes after NTG or SLP administration, and the efficacy of ISDN 2 h and 6 h after oral ingestion. In the first ingestion NTG significantly improved WTI (p < 0.0001) by 42.7% after OP, by 46.5% after 80 mg ISDN and by 52.1% after 120 mg. After long-term OP therapy NTG prolonged WTI (p < 0.01) by 15.6%, during once-daily ISDN treatment, an 80 mg dose prolonged WTI by 22.8% and a dose of 120 mg by 36.5%. However, NTG did not improve WTI in q.i.d. therapy. Six hours after the first 80 mg ISDN ingestion WTI improved (p < 0.0001) by 66.0%, and after 120 mg by 58.4%. Following once-daily therapy ISDN prolonged WTI (p < 0.0001) by 27.2% after an 80 mg dose and by 36.2% after a dose of 120 mg. No improvement was observed in q.i.d. treatment. Thus, severe tolerance to ISDN abolishes the anti-ischaemic effects of NTG, and appropriate regimens of ISDN have considerable anti-anginal effects during chronic administration.     

Detection of serum nitrite and nitrate in primary biliary cirrhosis: possible role of nitric oxide in bile duct injury

BACKGROUND: The role of nitric oxide synthase (NOS) in autoimmune disease is gaining increased attention because of the relationships between NOS activity and T-lymphocyte subpopulations and, in particular, the influence of NO on cytokine production by Th1 versus Th2 cells. In addition, there is evidence that both the liver and infiltrating hepatic T cells have inducible NOS-2 activity. METHODS: We studied serum levels of nitrite (NO2-) and nitrate (NO3-) in groups of patients with liver disease secondary to hepatitis B, hepatitis C, autoimmune hepatitis and primary biliary cirrhosis (PBC). Simultaneously, in a nested subpopulation, we studied the liver expression of NOS-2. RESULTS: Interestingly, there was a significant elevation both of nitrite and of nitrate in patients with PBC but not other liver diseases. Despite such increments, there was no correlation of the levels of nitrite and nitrate with sera levels of tumor necrosis factor-alpha, interferon-gamma, alanine aminotransferase, total bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase, platelet count, IgG, IgM, antimitochondrial antibodies or prothrombin time. These data were extended by demonstrating the expression of NOS-2 by immunohistochemistry in 13/14 patients with PBC, including in 9/14 patient hepatocyte populations and 4/14 bile duct cells. In contrast, NOS-2 expression was noted in hepatitis B and hepatitis C, but only found within mononuclear cells. CONCLUSION: Our data suggest that NO produced through NOS-2 may play a role in the pathogenesis of bile duct injury in some PBC patients.     

Characterics of upper digestive tract diseasesin fishermen of the Bohai Bay

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Association between the circadian course of endogenous noradrenaline and the hematopoietic cell cycle in mouse bone marrow

Abstract

Because of its potential as a low cost first-line monotherapy for the most common vulvovaginal infections, we evaluated fenticonazole nitrate in a prospective, open-label, multicenter pilot study with 101 sexually active women (per-protocol; 16 to 61 years of age) with vulvovaginitis involving single or mixed infections with Candida albicans, Trichomonas vaginalis, and/or Gardnerella vaginalis. Fenticonazole nitrate (1 g) was administered as vaginal ovules, once daily on days 1 and 3. Eradication (direct phase-contrast microscopy of vaginal swabs and/or microbiological culture) on day 8 was 90% (C. albicans, 26/29, p <0.001), 70% (T. vaginalis, 7/10, p = 0.161), 67% (G. vaginalis, 22/33, p <0.009), and 45% (mixed infection, 13/29, p = 0.001). After 28 days, relapse was 0% for candidiasis and trichomoniasis, 27% (6/22) for G. vaginalis, and 23% (3/13) for mixed infection. Overall, eradication of all offending pathogens was achieved in 67% of the total per-protocol population, with a relapse rate of only 16%. Score sums for symptoms improved from 7.0 (baseline) to 1.7 (day 8), and 0.71 (day 28), (p < 0.001). Treatment was safe and well tolerated.

The results of our pilot study suggest that application of fenticonazole nitrate 1 g intravaginal ovules on 2 alternate days is a suitable first-line treatment of vulvovaginitis with acceptable broad-spectrum efficacy against the most commonly involved pathogens and with a low rate of early relapse, reserving antibiotics for patients with treatment failure or relapse of infection. Our results should encourage further examination of this approach in larger and well controlled clinical trials.     

皮硝外敷袋的制作与应用

皮硝外敷在临床上广泛应用于肝硬化、胰腺炎、腹膜炎等患者,将其外敷于腹部可以减轻腹胀、腹痛等不适症状。传统方法,用毛巾或治疗巾将皮硝包裹后外敷患者腹部,用胶布固定。缺点是皮硝不易固定、易移位、易外漏,皮硝遇热溶解变硬,易污染病服,也增加了对皮肤的刺激与摩擦。为此,我科于2013年3月,应用医用腹带进行改良制作了皮硝外敷袋,效果满意。现介绍如下。     

Amyl nitrate induced methaemagloblinaemia masquerading as fat embolus in distal tibial fracture

A 51-year-old man was admitted with distal metaphyseal tibial fracture after falling whilst intoxicated by alcohol. In the emergency department he was found to be hypoxic, with normal chest radiography. It transpired that he had also inhaled amyl nitrate (Poppers) and was diagnosed with methaemogloblinaemia. Initial concerns of fat embolus however led to delay to surgery and unnecessary CT pulmonary angiogram. His methaemogloblinaemia was appropriately managed and his tibial fracture was treated operatively without complication.We report this case to raise awareness of methaemogloblinaemia associated with the abuse of inhaled amyl nitrate when treating patients who have sustained injury whist intoxicated. Appropriate investigation can prevent delayed management of this unusual but potentially life-threatening drug reaction.     

Nitrite in exhaled breath condensate as a marker of nitrossative stress in the airways of patients with asthma,COPD, and idiopathic pulmonary fibrosis

Background: Nitrite and nitrate are exhaled in droplets of an aerosol during breathing and can be assayed in the exhaled breath condensate (EBC) as markers of nitrossative stress in the airways of patients with asthma, COPD, and idiopathic pulmonary fibrosis (IPF). Subjects and methods: Using HPLC with fluorescence detection, nitrite and nitrate were assayed in EBC of 14 atopic patients with mild‐to‐moderate stable asthma, 18 atopic asthmatics with exacerbation, 14 COPD patients without exacerbation, 18 patients with exacerbated COPD, 13 patients with active IPF, and in 29 healthy subjects. Results: The geometric mean [exp(mean±SD)] EBC concentrations of nitrite (micromol/l) in patients with asthma [5.1(2.1–12.3)], exacerbation of asthma [5.1(2.8–9.6)], exacerbation of COPD [5.3(3.2–8.7)], and with IPF [5.5(2.9–10.2)] were higher (P<0.05) compared with those of healthy subjects [2.9(1.6–5.3)] and patients with stable COPD [3.0(1.3–6.7)]. Nitrite concentration increased with decreased lung function of patients with asthma (r_s=?0.31, P<0.02). Presumably owing to the contamination of the EBC sample with nitrate during collection, nitrate levels were highly variable among healthy subjects and higher compared with all groups of patients. Conclusion: EBC nitrite is a suitable marker of nitrossative stress in adult patients with lung diseases but cannot differentiate controlled and exacerbated asthma. Further improvements to the methods of EBC collection and sample handling are warranted. J. Clin. Lab. Anal. 24:317–322, 2010. © 2010 Wiley‐Liss, Inc.     

Development and validation of fixed‐time method for the determination of isoxsuprine hydrochloride in commercial dosages forms

The main aim of this work was to develop a kinetic spectrophotometric method for the quantitative analysis of isoxsuprine hydrochloride in commercial tablets. The method is based on the reaction of isoxsuprine hydrochloride (ISx) with hydroxylamine hydrochloride and ammonium cerium (IV) nitrate in sulphuric acid medium at room temperature which resulted in the formation of yellow‐coloured product peaking at 380 nm. The reaction is followed spectrophotometrically by measuring the absorbance as a function of time. Fixed time method (ΔA = A₄–A₂, where A₂ and A₄ refer to absorbance measurements taken at 2 and 4 min, respectively) was adopted for constructing the calibration curve which was found to be linear over the concentration range of 30–80 µgmL^?1 with molar absorptivity of 5.95 × 10³ L mol^?1 cm^?1. The method has been applied successfully to the determination of isoxsuprine hydrochloride in tablets. Statistical comparison (point and interval hypothesis tests) of the results showed that there is no significant difference between the proposed method and reference method. Copyright © 2010 John Wiley & Sons, Ltd.