Microcatheters for antegrade recanalization of chronic total coronary occlusions: Feasibility and safety of the corsair - A retrospective registry-based single operator experience

BackgroundThe Corsair collateral channel dilator was designed for retrograde passage in cases of coronary chronic total occlusion (CTO). Its antegrade use is discouraged and the number of published studies regarding such use is limited. Our single-operator experience examines the feasibility and safety of the Corsair in antegrade recanalization of chronic CTOs in a large cohort.MethodsWe queried the European Registry of Chronic Total Occlusion (ERCTO) for all microcatheters used in antegrade recanalizations between 2008 and 2016. We also retrospectively assessed all 722 coronary interventions for CTOs (624 antegrade, 98 retrograde) between January 2008 and December 2016, performed by a single operator who primarily applied the Corsair as antegrade microcatheter. Patient, procedure, and outcome data was analyzed.ResultsIn 17,787 cases performed by 93 operators contributing to the ERCTO database, there were 3294 with information on microcatheter type. The FineCross MG (73.9 %) was the most commonly used microcatheter. The Corsair was used in only 1.2 % (excluding patients in the single-operator cohort). In the same period 45.7 % (n = 285) of all 624 antegrade cases handled by our single operator were performed using the Corsair, with no exclusions due to anatomical or morphological criteria. The procedural success rate was 93.7 %. There were 2 cases of cardiac tamponade, 5 cases of minor perforation, and one catheter tip fracture.ConclusionsThe Corsair is rarely used for antegrade recanalization. In this single-operator experience, the antegrade use of the Corsair was safe. The success rate was high, although causative conclusions cannot be drawn.     

Pharmacological Profile of U‐37883A,a Channel Blocker of Smooth Muscle‐Type ATP‐Sensitive K+ Channels

U‐37883A (PNU‐37883A, guanidine; 4‐morpholinecarboximidine‐N‐1‐adamantyl‐N′‐cyclohexyl hydrochloride) was originally developed as a potential diuretic with specific binding in kidney and vascular smooth muscle rather than in brain or pancreatic β cells. U‐37883A inhibits ATP‐sensitive K⁺ channels (K_ATP channels) in vascular smooth muscle at submicromolar concentrations whilst even at high concentrations (≥10 μM) it has no inhibitory effect at pancreatic, cardiac or skeletal K_ATP channels. Thus, it is generally thought that U‐37883A is a selective inhibitor of vascular smooth muscle K_ATP channels. Approximately one decade ago, K_ATP channels were cloned and found to consist of at least two subunits: an inwardly‐rectifying K⁺ channel six family (K_ir6.x; K_ir6.1 and K_ir6.2) which forms the ion conducting pore and a modulatory sulphonylurea receptor (SUR.x; SUR1, SUR2A, and SUR2B) that accounts for several pharmacological properties. It is generally believed that different combinations of K_ir6.x and SUR.x determine the molecular properties of K_ATP channels. Thus, K_ir6.2/SUR1 channel represents the pancreatic β‐cell K_ATP channel, K_ir6.2/SUR2A channel is thought to represent the cardiac K_ATP channel, whereas K_ir6.1/SUR2B channel is likely to represent the vascular smooth muscle K_ATP channel. Recent molecular studies have shown that U‐37883A selectively suppresses the activity of recombinant K_ATP channels which contain K_ir6.1 subunits in the channel pore unit. It was thus thought that U‐37883A was a selective pharmacological tool which could be used to investigate the activity of vascular smooth muscle K_ATP channels. However, due to its multiple pharmacological actions on several ion channels and poor tissue selectivity, U‐37883A should not be viewed as a selective blocker of smooth muscle K_ATP channels.     

Distinct regions of the slo subunit determine differential BKCa channel responses to ethanol

BACKGROUND: Ethanol at clinically relevant concentrations increases BKCa channel activity in dorsal root ganglia neurons, GH3 cells, and neurohypophysial terminals, leading to decreases in cell excitability and peptide release. In contrast, ethanol inhibits BKCa channels from aortic myocytes, which likely contributes to alcohol-induced aortic constriction. The mechanisms that determine differential BKCa channel responses to ethanol are unknown. We hypothesized that nonconserved regions in the BKCa channel-forming subunit (slo) are major contributors to the differential alcohol responses of different BKCa channel phenotypes. METHODS: We constructed chimeras by interchanging the core and the tail domains of two BKCa channel-forming subunits (mslo and bslo) that, after expression, differentially respond to ethanol (activation and inhibition, respectively), and studied ethanol action on these mbslo and bmslo chimeric channels using single-channel, patch-clamp techniques. RESULTS AND CONCLUSION: Data from cell-free membranes patches demonstrate that the activity of channels that share a mslo-type core-linker (wt mslo and the mbslo chimera) is consistently and significantly potentiated by acute exposure to ethanol. Thus, a mslo tail is not necessary for ethanol potentiation of slo channels. In contrast, the activity of channels that share a bslo-type core-linker (wt bslo and the bmslo chimera) display heterogenous responses to ethanol: inhibition (in the majority of cases), refractoriness, or activation. Overall, our data indicate that the slo core-linker is a critical region likely contributing to the differential responses of BKCa channels to ethanol.     

电压门控钠通道亚单位在大鼠肠易激综合征模型中变化的研究

背景：电压门控钠通道（VGSC）在神经元动作电位的产生和传递中起着极为重要的作用。近年来它与内脏高敏感性的关系越来越受到重视。目的：探讨VGSC亚单位的变化与大鼠肠易激综合征（IBS）内脏高敏感性之间的关系。方法：以新生大鼠直肠内气囊扩张制作IBS的动物模型，在其成年后取L6-S2脊髓背根神经节，采用逆转录聚合酶链反应（RT-PCR）半定量法对背根神经节细胞表面VGSC Nav1．1、Nav1．6、Nav1．7、Nav1．8和Nav1．9五种α亚单位mRNA的含量进行检测．并以原位杂交的方法对Nav1．8的表达进一步加以确认；采用酶联免疫吸附试验（ELISA）法对大鼠肠道组织神经生长因子（NGF）的含量进行检测。结果：背根神经节细胞表面仅亚单位Nav1．8mRNA的表达增加，而Nav1．1、Nav1．6、Nav1．7和Nav1．9的表达没有改变，原位杂交定性分析也证实造模组Nav1．8含量增加；造模组肠道组织NGF的含量显著高于对照组。结论：新生大鼠直肠内气囊扩张使其脊髓背根神经节细胞Nay1．8mRNA的表达增加，而其他几种常见仅亚单位的含量均未发生改变。这种变化可能与肠道组织NGF表达的增加有关。     

“肠病治肝”的理论探析与临床拾萃

"肝与大肠别通"理论首见于李梃的《医学入门》,其区别于"胆属肝"、"大肠属肺"表里脏腑络属关系,揭示脏腑之间另一种联系,故称别通。中医认为肝与大肠生理上都与水谷精微的运化输布、气机升降、腑气传导等功能相关,足厥阴肝经与手阳明大肠经之间存在间接联系。故其病理可相互影响,气机疏泄失常,肠腑传导失职则出现腹泻或便秘或大便溏结不调;肝不藏血,影响肠道血络,故可见便血等病理变化。近代医家杨维杰[1]提出脏腑气化相通为"脏腑别通"理论的实质。而随着现代医学进步,西医亦发现肝与肠可相互影响,提出"肠-肝轴"、"肝肠循环"等概念,为"肝与大肠别通"理论提供解剖生理、微观生物学上的解释。本文从肝与大肠生理、病理及经脉络属等方面探析其相关性,并以"肝与大肠别通"理论为指导思想浅析调肝经治疗肠腑病在针灸临床治疗中的运用,丰富针灸治疗肠腑病的思路。     

银杏叶片联合钙离子通道阻滞剂治疗高血压病的系统评价

运用Meta分析方法评价银杏叶片联合钙离子通道阻滞剂(CCB)治疗原发性高血压的临床疗效。方法检索PubMed、Cochrane Libray、EMBASE、维普、中国知网数据库(CNKI)、万方数据库、中国生物医学文献服务系统(SinoMed)关于银杏叶片治疗原发性高血压的临床随机对照试验,检索时间从建库以来至2018年9月30日,根据纳入和排除标准共纳入12项研究,1244例患者,使用Review Manager 5.3软件进行Meta分析。结果①银杏叶片联合CCB降压疗效优于单用CCB[OR=4.67,95%CI(3.25,6.71),P<0.00001];②两组收缩压[MD=-11.27,95%CI(-15.32,-7.21),P<0.00001],舒张压[MD=-8.41,95%CI(-8.94,-7.88),P<0.00001];③两组血清一氧化氮(NO)水平[MD=10.62,95%CI(8.48,12.76),P<0.00001],血清内皮素(ET)水平[MD=-1.05,95%CI(-1.31,-0.79),P<0.00001]。结论银杏叶片联合CCB可以提高降压疗效,但纳入研究方法学治疗偏低,可能影响到本研究的可靠性,仍需要高质量的RCT证实。     

Excitation of rat cerebellar Golgi cells by ethanol: further characterization of the mechanism

Background: Studies with rodents suggest that acute ethanol exposure impairs information flow through the cerebellar cortex, in part, by increasing GABAergic input to granule cells. Experiments suggest that an increase in the excitability of specialized GABAergic interneurons that regulate granule cell activity (i.e., Golgi cells [GoCs]) contributes to this effect. In GoCs, ethanol increases spontaneous action potential firing frequency, decreases the afterhyperpolarization amplitude, and depolarizes the membrane potential. Studies suggest that these effects could be mediated by inhibition of the Na⁺/K⁺ ATPase. The purpose of this study was to characterize the potential role of other GoC conductances in the mechanism of action of ethanol. Methods: Computer modeling techniques and patch‐clamp electrophysiological recordings with acute slices from rat cerebella were used for these studies. Results: Computer modeling suggested that modulation of subthreshold Na⁺ channels, hyperpolarization‐activated currents, and several K⁺ conductances could explain some but not all actions of ethanol on GoCs. Electrophysiological studies did not find evidence consistent with a contribution of these conductances. Quinidine, a nonselective blocker of several types of channels (including several K⁺ channels) that also antagonizes the Na⁺/K⁺ ATPase, reduced the effect of ethanol on GoC firing. Conclusions: These findings further support that ethanol increases GoC excitability via modulation of the Na⁺/K⁺ ATPase and suggest that a quinidine‐sensitive K⁺ channel may also play a role in the mechanism of action of ethanol.     

The golombok rust inventory of marital state (GRIMS)

The Golombok Rust Inventory of Marital State (GRIMS) is a new short (28 item) questionnaire for the assessment of the quality of a relationship. The GRIMS is a companion test to the Golombok Rust Inventory of Sexual Satisfaction (GRISS) which is in use in sex therapy and sexual dysfunction clinics and research. Its development and construction are described, together with details of item analysis and other psychometric procedures. The scale, which can be used for either men or women, has good reliability (.90 for women and .92 for men). Content and face validity are good. Some evidence of discriminative validity is also given. The GRIMS will have clinical and research application for marriage guidance and marital therapy clinics. Some further consideration is given to various differences between men and women in their perceptions of a good relationship.     

Impulsive versus reflective influences on health behavior: a theoretical framework and empirical review

Abstract

Often, health behavior seems to be governed not only by reasoned attitudes and goal-directed behavior but also by impulsive influences. The notion of a conflict between reflective and impulsive processing which is incorporated in prominent dual-system accounts (e.g., Metcalfe & Mischel, 1999 Metcalfe, J. and Mischel, W. 1999. A hot/cool system analysis of delay of gratification: Dynamics of willpower. Psychological Review, 106: 3–19. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Strack & Deutsch, 2004 Strack, F. and Deutsch, R. 2004. Reflective and impulsive determinants of social behavior. Personality and Social Psychology Review, 8: 220–247. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) may yield important benefits for the understanding and prediction of health-related behavior. In this article, we suggest a basic framework for the prediction of health-related behavior which combines (a) reflective influences (as measured via self-report), (b) impulsive influences (as measured via implicit measures), and (c) situational or dispositional moderators that shift the weight between reflective and impulsive influences. The practical utility of such a framework is demonstrated by drawing on recent evidence from several areas of health psychology such as eating, drinking, drug abuse, and sexual behavior. Implications for the understanding of health behavior and applied health interventions are discussed.