运动性心律失常

运动性心律失常是指发生于机体剧烈运动期间或之后的心律失常。临床表现不一,从心悸、头晕、晕厥、心绞痛、急性心肌梗死和充血性心力衰竭,甚至到心脏性猝死。运动性心律失常可见于心肌缺血,如患有动脉粥样硬化性心脏病以及患有原发性或继发性心肌病的患者。然而,也可能发生在似乎健康的个体。在后一组人群中,运动性心律失常可以是良性的,但也可以是获得性(如药物诱发)或先天性(如先天性长QT综合征或致心律失常性右室发育不良)心电活动或结构的异常而呈恶性。这种潜在病理生理学机制的复杂性,使运动性心律失常的诊断和治疗成为临床医学上的…     

Mechanical trauma as a cause of late complications: after AneuRx Stent Graft repair of abdominal aortic aneurysms

We present a series of 4 patients in whom mechanical trauma was identified as a factor in the development of late complications after AneuRx Stent Graft placement for repair of abdominal aortic aneurysms. In all 4 patients, Type I or III endoleaks (and pseudoaneurysms in 2 patients) were discovered several months after abdominal aortic aneurysm repair with the AneuRx device. Two patients had sustained blunt abdominal trauma in a car accident one had suffered a traumatic fall, and another had been participating in vigorous rowing activity. In all patients, the trauma had occurred several months before the diagnosis of endoleak or pseudoaneurysm (or both) was established. In all patients, follow-up computed tomographic scans identified the complications. In conclusion, blunt mechanical injury is an unrecognized factor contributing to the late failure of endovascular stent grafts. Vigorous physical activity may also contribute to graft disruption or to the separation of modular components.     

Spinal cord stimulation relieves chemotherapy-induced pain: a clinical case report

We present two patients with chemotherapy-induced painful neuropathy that had been poorly controlled with medications but successfully treated with spinal cord stimulation (SCS). A trial period of SCS provided effective pain relief in both patients who subsequently underwent permanent stimulator implantation. Psychophysical tests were performed before and after the implantation of trial and permanent stimulators. SCS improved pain scores and facilitated a reduction of medications. Both patients reported improved gait and one of them also reported an increase in leg flexibility. Psychophysical tests demonstrated an improvement in touch and sharpness detection thresholds. In summary, SCS offers a therapeutic option for patients with chemotherapy-induced peripheral neuropathy who have poor pain relief with standard medical treatment.     

Encainide for atrial fibrillation associated with Wolff-Parkinson-White syndrome

Thirty-six patients with a history of atrial fibrillation and Wolff-Parkinson-White syndrome were treated with oral encainide, 175 ± 44 ing/day, after undergoing baseline drug-free electrophysiologic studies. The mean age was 38 ± 15 years, with structural heart disease present in only 3 patients. Nine patients had only paroxysmal atrial fibrillation and 27 patients had both atrial fibrillation and atrioventricular reciprocating tachycardia (AVRT). Symptoms were present for a mean of 195 ± 168 months and were treated with an average of 2.7 ± 1.6 drugs before encainide. Anterograde block in the accessory pathway occurred in 12 of 30 patients (40%) and retrograde block accessory pathway occurred in 10 of 24 patients in whom comparison could be made. AVRT was initiated in 29 of 36 patients during the control study and could be initiated in 19 of 29 patients while receiving encainide.

Drug efficacy was determined by the clinical response judged completely effective, partially effective or ineffective. During a mean follow-up of 30.1 ± 25 months, 24 patients (67%) continued to take encainide. Encainide was completely effective in 14 of 24 patients and partially effective in another 7 patients. Noncardiac side effects were mild and generally resolved, and required discontinuance in only 1 patient. More frequent AVRT occurred in 2 patients, but was managed with dose reduction and the addition of a β blocker. Three patients had ventricular tachycardia requiring discontinuance; however 2 of 3 patients had a history of ventricular tachycardia before receiving encainide. Encainide is an effective and safe agent for treating atrial fibrillation in patients with Wolff-Parkinson-White syndrome.     

Nicotine is a Selective Pharmacological Chaperone of Acetylcholine Receptor Number and Stoichiometry. Implications for Drug Discovery

The acronym SePhaChARNS, for “selective pharmacological chaperoning of acetylcholine receptor number and stoichiometry,” is introduced. We hypothesize that SePhaChARNS underlies classical observations that chronic exposure to nicotine causes “upregulation” of nicotinic receptors (nAChRs). If the hypothesis is proven, (1) SePhaChARNS is the molecular mechanism of the first step in neuroadaptation to chronic nicotine; and (2) nicotine addiction is partially a disease of excessive chaperoning. The chaperone is a pharmacological one, nicotine; and the chaperoned molecules are α4β2* nAChRs. SePhaChARNS may also underlie two inadvertent therapeutic effects of tobacco use: (1) the inverse correlation between tobacco use and Parkinson’s disease; and (2) the suppression of seizures by nicotine in autosomal dominant nocturnal frontal lobe epilepsy. SePhaChARNS arises from the thermodynamics of pharmacological chaperoning: ligand binding, especially at subunit interfaces, stabilizes AChRs during assembly and maturation, and this stabilization is most pronounced for the highest-affinity subunit compositions, stoichiometries, and functional states of receptors. Several chemical and pharmacokinetic characteristics render exogenous nicotine a more potent pharmacological chaperone than endogenous acetylcholine. SePhaChARNS is modified by desensitized states of nAChRs, by acid trapping of nicotine in organelles, and by other aspects of proteostasis. SePhaChARNS is selective at the cellular, and possibly subcellular, levels because of variations in the detailed nAChR subunit composition, as well as in expression of auxiliary proteins such as lynx. One important implication of the SePhaChARNS hypothesis is that therapeutically relevant nicotinic receptor drugs could be discovered by studying events in intracellular compartments rather than exclusively at the surface membrane.     

Occurrennce and impact of community-acquired and nosocomial rotavirus infections — a hospital-based study over 10 y

The need for a rotavirus vaccine in any particular country depends primarily on the number of hospitalized cases. Since only limited data are available for Germany, we undertook a retrospective hospital-based analysis in order to gather further information. From 1987 through 1996, a total of 3618 inpatients were hospitalized with a diagnosis of gastroenteritis (ICD 9). In 892 (25%) of them the causative organism wasa rotavirus. During the same period, 1886 (out of 8383; 22%) stool speciment tested in the hospital laboratory were obtained from rotavirus-positive inpatients. In 49.2% the infection was community-acquired, and in the remainder of nosocomial origin. Infants under 4 months of age(n=709; 38%) predominated among both the nosocomial and community-acquired infections. Premature neonates made up 26% of the nosocomial, but only 2% of the community-acquired cases of diarrhoea. The winter peak (January) was most pronounced in the age group 4-12 months, but in those more than 1 y old the peak came a month later. The median hospitalization time for community-acquired cases was 4 d (mean 5.9 d).The mortality was 0.1%. Rotavirus infection must therefore be regarded as a considerable burden, particularly with regard to infants and young children. Furthermore, the morbidity due to nosocomial infection with the rotavirus, analysed here in a long-term observational study, is unexpectedly high. □ Hospital-based study, nosocomial infection, rotavirus     

Oral health findings in athletes with intellectual disabilities at the NYC Special Olympics

This study collected data to describe the oral health in Special Olympics athletes with intellectual disabilities from New York City, using the standardized Special Olympics, Special Smiles protocol. A total of 664 self‐selected athletes with intellectual disabilities were screened between 2005 and 2008. A standardized form was used for data collection. Screenings were performed using available light or flashlight, tongue depressor, and disposable mirror. Oral hygiene, reports of oral pain, untreated caries, missing and filled teeth were recorded. The majority of the athletes were 20 years of age or older (52%). Of the examined athletes, 9% reported oral pain, 8% needed urgent care, 28% had untreated caries, 60% had filled teeth, and 32% had signs of gingival disease. Mouthguards were recommended for 26% of athletes. Our findings offer an initial evaluation of the oral health of Special Olympics athletes with intellectual disabilities in New York City. Results showed high preventive and restorative oral health needs in the Special Olympics population.