Assessment of Left Ventricular Ejection Fraction Calculation on Long-axis Views From Cardiac Magnetic Resonance Imaging in Patients With Acute Myocardial Infarction

To assess left ventricular ejection fraction (LVEF) accurately, cardiac magnetic resonance (CMR) can be indicated and lays on the evaluation of multiple slices of the left ventricle in short axis (CMR_SAX). The objective of this study was to assess another method consisting of the evaluation of 2 long-axis slices (CMR_LAX) for LVEF determination in acute myocardial infarction.One hundred patients underwent CMR 2 to 4 days after acute myocardial infarction. LVEF was computed by the area-length method on horizontal and vertical CMR_LAX images. Those results were compared to reference values obtained on contiguous CMR_SAX images in one hand, and to values obtained from transthoracic echocardiography (TTE) in the other hand. For CMR_SAX and TTE, LVEF was computed with Simpson method. Reproducibility of LVEF measurements was additionally determined. The accuracy of volume measurements was assessed against reference aortic stroke volumes obtained by phase-contrast MR imaging.LVEF from CMR_LAX had a mean value of 47 ± 8% and were on average 5% higher than reference LVEF from CMR_SAX (42 ± 8%), closer to routine values from TTE_LAX (49 ± 8%), much better correlated with the reference LVEF from CMR_SAX (R = 0.88) than that from TTE (R = 0.58), obtained with a higher reproducibility than with the 2 other techniques (% of interobserver variability: CMR_LAX 5%, CMR_SAX 11%, and TTE 13%), and obtained with 4-fold lower recording and calculation times than for CMR_SAX. Apart from this, CMR_LAX stroke volume was well correlated with phase-contrast values (R = 0.81).In patients with predominantly regional contractility abnormalities, the determination of LVEF by CMR_LAX is twice more reproducible than the reference CMR_SAX method, even though the LVEF is consistently overestimated compared with CMR_SAX. However, the CMR_LAX LVEF determination provides values closer to TTE measurements, the most available and commonly used method in clinical practice, clinical trials, and guidelines in ischemic cardiomyopathy. Moreover, LVEF determination by CMR_LAX allows a 63% gain of acquisition/reading time compared with CMR_SAX. Thus, despite the fact that LVEF obtained from CMR_SAX remains the gold standard, CMR_LAX should be considered to shorten the overall imaging acquisition and reading time as a putative replacement.     

Cannabinoid hyperemesis syndrome in two French emergency departments: a prospective cohort

Chronic cannabis use can be associated with uncontrollable vomiting and abdominal pain. Diagnostic criteria for cannabinoid hyperemesis syndrome (CHS) were defined in 2012 by Simonetto et al. The objectives of this study were to describe the prevalence of CHS, the patients' epidemiological characteristics, and to show the difficulties encountered in caring for these patients in emergency departments, the extent of health care and an unsuitable follow‐up in general practices. A prospective cohort of patients with CHS was recruited among a target population of patients leaving the adult emergency services of the Marseille hospitals Nord and La Timone between October 2017 and July 2018, with abdominal pain syndrome of unidentified etiology. Inclusion criteria for the CHS cohort were chronic cannabis use associated with nausea and vomiting. There were 48 patients included in the CHS cohort who took cannabis daily, in a target population of 2 848 patients (i.e. 1.6%). A hot shower was the most effective symptomatic treatment in 54.2% of cases. Patients suffering from CHS spent significantly more hours in emergency departments (11 vs. 6.5), and, on average, visits were more frequent (4.9 vs. 3). 20.3% of them were hospitalized to continue pain medication. Once out of hospital, follow‐up was limited, and weaning off cannabis, the only etiological treatment, was difficult to set up. Informing patients about CHS is essential, and a hot shower could be systematically proposed, thus limiting an unnecessary extent of health care. CHS is genuine, medical staff should be made aware of it in occupational training, and it should be seriously considered in health policies.     

医院-家庭过渡期有氧运动对轻中度稳定期COPD的作用

目的 探讨医院-家庭过渡期有氧运动在轻中度稳定期慢性阻塞性肺疾病(COPD)患者中的应用效果.方法 选取2017年7月至2019年7月该院就诊的轻中度稳定期COPD患者100例为研究对象,分为试验组和对照组,每组50例.在医院-家庭过渡期间,对照组给予常规药物处理及门诊呼吸功能训练、氧疗等,试验组在对照组的基础上给予有氧运动,治疗10周后比较2组肺功能、血气功能、6分钟步行试验(6 MWT)、日常活动能力(ADL)、呼吸困难评价(BS)评分、生活质量变化[采用圣乔治呼吸问卷(SGRQ)进行评估],并比较2组不良反应发生情况.结果 治疗10周后,试验组用力肺活量(FVC)、第一秒用力呼气容积(FEV1)及FEV1/FVC均显著高于对照组,差异有统计学意义(P<0.05);试验组动脉氧分压、6 MWT均显著高于对照组,二氧化碳分压显著低于对照组,差异有统计学意义(P<0.05).试验组ADL评分显著高于对照组,BS评分显著低于对照组,差异有统计学意义(P<0.05);试验组呼吸症状、活动能力、疾病影响及SGRQ总分均显著低于对照组,差异有统计学意义(P<0.05).2组均未出现心肌梗死、脑出血、心绞痛等严重不良事件.结论 医院-家庭过渡期有氧运动可显著提升轻中度稳定期COPD患者心、肺功能及日常生活能力,缓解呼吸困难症状,提高生活质量.     

LC-MS/MS同时测定人血浆中14种胆汁酸及其在环孢素肝毒性研究中的应用

目的建立UPLC-MS/MS同时定量检测人血浆中14种胆汁酸的浓度,探索环孢素肝毒性与胆汁酸的关系。方法采用蛋白沉淀法处理血浆样本,使用ACQUITY UPLC? HSS T3(2. 1 mm×150 mm,1. 8μm)色谱柱,流动相为水(4mmol·L^-1乙酸铵)-95%乙腈,梯度洗脱,流速0. 3 mL·min-1,检测时间15 min。检测系统采用电喷雾离子源,负离子模式。结果 14种胆汁酸的线性范围良好,批内和批间RSD均<15%,准确度均在87%~116%之间,提取回收率在101%~120%之间。以胆酸(CA)为主的胆汁酸与环孢素的浓度相关性良好,提示环孢素改变患者的肝毒性可能与胆汁酸相关。结论该方法方便准确、灵敏度高,能够满足人血浆中多种胆汁酸的含量测定,可以用于环孢素引起肝毒性的进一步基础研究。