Sinus node exit,crista terminalis conduction,interatrial connection,and wavefront collision: Key features of human atrial activation in sinus rhythm

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EEG source estimation in a rare patient with cold‐induced reflex epilepsy

Temperature‐related reflex epilepsy most often takes the form of hot water epilepsy, but very rarely, reflex epilepsy is related to cold temperature. We report a 70‐year‐old male who had seizures triggered by cold sensations in the body. Four antiepileptic drugs were taken during the drug treatment, and oxcarbazepine was the most effective at stopping the seizures. We implemented clinical seizure induction and obtained EEG data from an interictal period and two complete ictal periods. Source estimation was performed to identify and map the primary sources involved in the seizures on the cortical level. We found that β rhythm appeared on the prefrontal lobes during the whole ictal period. The low‐frequency slow δ and θ rhythms, especially the δ rhythm, appeared in the occipital lobe in the early ictal stage and propagated to the right temporal lobe in the mid‐late ictal stage. The prefrontal lobe and right temporal lobe were mainly involved in the generation and propagation of the epileptic activities. This study provides a valuable reference for clinical drug therapy and provides insights into the characteristics of the brain activities involved in cold‐induced reflex epilepsy. [Published with video sequences].     

《胎产大法》之助孕用药思想浅析

《胎产大法》是一本将理论和临床相结合的产科专著,注重胎产理法方药的研究,论述祥备,重视临床,简单实用,在中医妇产科学古籍中颇具特色,分为上下两卷,其选方用药也独具特色,本文将重点阐述上卷中助孕用药的思想,分析其特色之处,目的在于发掘中医妇产科古籍中精华,为现代中医妇产科临床服务。     

Efficacy of Oral Anticoagulation in Stroke Prevention among Sinus-Rhythm Patients Who Lack Left Atrial Mechanical Contraction after Cryoablation

The customary recommendation is that oral anticoagulation be withdrawn a few months after cryoablation for atrial fibrillation, independently of left atrial mechanical contraction in patients in sinus rhythm. Recently, a 5-fold increase in stroke has been described in sinus-rhythm patients who lack atrial mechanical contraction. One aim of this study was to evaluate the efficacy of oral anticoagulation in preventing postoperative stroke in such patients.This prospective study divided 154 sinus-rhythm patients into 2 groups, depending on the presence (108 patients) or absence (46 patients) of left atrial mechanical contraction at 6 months after surgery, and monitored them annually for 5 years. Those without left atrial contraction were maintained on acenocumarol. The primary endpoint was the occurrence of ischemic stroke.The median follow-up period was 29 ± 16 months; 4 patients (2.5%), all belonging to the group with preserved atrial contraction, had ischemic stroke; the group of patients without left atrial contraction had no episodes of stroke during follow-up. Logistic binary regression analyses showed no evidence of factors independently predictive of stroke.Among anticoagulated patients in sinus rhythm without left atrial contraction, we found the incidence of stroke to be zero. In a small, nonrandomized group such as this, we cannot discount the element of chance, yet we suggest that maintaining anticoagulation might lower the incidence of stroke in this population.     

高龄老年高血压患者血压昼夜节律和脉压变化特征探讨

目的探讨高龄老年高血压患者血压昼夜节律和脉压变化的特点。方法将老年高血压患者346例按年龄分为2组:老年高血压组(A组)186例,年龄60~79岁;高龄老年高血压组(B组)160例,年龄80~99岁。分析2组患者动态血压参数、动态血压昼夜节律异常发生率。结果24h平均舒张压(24hDBP)高龄老年高血压组低于老年高血压组(P0.001)。老年高血压组和高龄老年高血压组24h动态脉压(24hAPP)分别为(62.06±11.79)和(66.73±11.45)mmHg。日间平均压(dABP)老年高血压组高于高龄老年高血压组(P0.01)。24hAPP老年高血压组低于高龄老年高血压组(P0.001)。老年高血压组和高龄老年高血压组血压昼夜节律异常率分别为82.80%和90.63%。结论老年高血压患者随着年龄的增大,24hDBP呈现降低趋势,24hAPP呈现增高趋势。老年高血压患者血压昼夜节律特征多数表现为非杓型和反杓型血压,且多数血压昼夜节律消失。随增龄变化老年高血压患者昼夜节律异常率增高,增龄是血压昼夜节律消失的一个重要因素。     

Use of the Adverse Outcome Pathway (AOP) framework to evaluate species concordance and human relevance of Dibutyl phthalate (DBP)-induced male reproductive toxicity

Dibutyl phthalate (DBP) is a phthalate ester used as a plasticizer, and solvent. Studies using rats consistently report that DBP exposure disrupts normal development of the male reproductive system in part via inhibition of androgen synthesis. However, studies using xenograft models report that in human fetal testis DBP exposure is unlikely to impair testosterone synthesis. These results question the validity of the rat model for assessment of male reproductive effects caused by DBP. The Adverse Outcome Pathway (AOP) framework was used to evaluate the available evidence for DBP-induced toxicity to the male reproductive system. Three relevant biological elements were identified: 1) fetal rats are more sensitive than other rodents and human fetal xenografts to DBP-induced anti-androgenic effects, 2) DBP-induced androgen-independent adverse outcomes are conserved amongst different mammalian models and human fetal testis xenografts, and 3) DBP-induced anti-androgenic effects are conserved in different mammalian species when exposure occurs during postnatal life stages.     

Preconception,Pregnancy, Birthing,and Lactation Needs of Transgender Men

Planned and unplanned pregnancies are occurring among transgender men. Although the literature highlights the fact that many transgender men retain their reproductive pelvic organs and desire pregnancy, there is a dearth of information on best practices and standards of care guiding perinatal care for this population. A literature review was conducted to explore the reproductive health needs of transgender men related to reproductive desires, contraception, family planning, fertility preservation, pregnancy, birth, and lactation. Findings show that pregnant and birthing transgender men are reporting feelings of invisibility, isolation, and loneliness in highly gendered perinatal care environments. A lack of gender-affirming perinatal environments and experienced providers is contributing to the avoidance of care by transgender men and further discrimination in an already marginalized population. More research attention is needed to understand the reproductive health needs of pregnant and birthing transgender men and to optimize the care they receive.     

The Clitoris—An Appraisal of its Reproductive Function During the Fertile Years: Why Was It,and Still Is,Overlooked in Accounts of Female Sexual Arousal

Stimulating the clitoris activates the brain to instigate changes in the female genital tract, namely, the enhancement of vaginal blood flow that increases vaginal luminal pO₂, vaginal transudate (lubrication) facilitating painless penile penetration and partial neutralization of the basal luminal acidic pH, vaginal tenting, and ballooning delaying sperm transport and allowing semen de-coagulation and capacitation (sperm activation) factors to act until arousal ends (often by orgasm induction). All these genital changes taken together are of major importance in facilitating the possibility of reproductive success (and thus gene propagation) no matter how or when the clitoris is stimulated—they reveal its overlooked reproductive function. Of course, also commensurate with these changes, is its activation of sexual pleasure. The clitoris thus has both procreative (reproductive) and recreative (pleasure) functions of equal importance. Clitoridectomy creates not only sexual disability but also a reproductive disability. Clin. Anat. 32:136–145, 2019. © 2019 Wiley Periodicals, Inc.