Electromyographic study of facial expressions during pathological laughing and crying.

We studied facial expressions during pathological laughing and crying in 6 patients using EMG investigation. Increased EMG discharges of M. frontalis and M. corrugator supercilii are characteristic of pathological laughing and crying in addition to an increase of EMG discharges of M. orbicularis oculi, M. levator labii superiors, M. zygomaticus major, M. risorius and M. mentalis which we observed during natural laughing. Its patterns of facial expressions are similar to that of crying in normals. From the fact that normals show the same expression of laughing and crying in an extreme emotional outburst, we speculate that pathological laughing and crying is maximal manifestations of facial expressions caused by a release phenomenon of the upper center.     

双对吻挤压与经典挤压技术治疗冠状动脉分叉病变的前瞻性、随机、多中心研究

目的 比较双对吻挤压(DK crush)和经典挤压技术治疗冠状动脉分叉病变的临床效果.方法 311例真性分叉病变患者随机分入DK crush组(n=155)和经典挤压组(n=156),随访时间8个月.一级及二级终点分别为主要心脏不良事件(MACE,包括心肌梗死、心原性死亡和靶病变血运重建)和血管直径再狭窄及晚期丢失.结果 DK crush组糖尿病患者较多.经典挤压组及DKcrush组最终对吻扩张(FKBI)成功率分别为76%和100%(P＜0.001).DK crush术式的不足包括造影剂用量大(P=0.04)、球囊数量多(P＜0.01)、手术时间长(P＜0.001),但是对吻扩张不满意率显著减少(27.6%比6.3%,P＜0.01).临床随访率为100%,冠状动脉造影随访率为82%.经典挤压组累计再狭窄率为32.3%,而DK crush组为20.3%(P=0.01),经典挤压组分支血管再狭窄率高(24.4%比12.3%,P=0.01),而两组间主干血管再狭窄率差异无统计学意义.经典挤压组术后8个月时的累计MACE发生率为24.4%(FKBI失败组为35.9%,FKBI成功组为19.7%),显著高于DK crush组(11.4%,P=0.02).经典挤压组血栓栓塞率为3.2%(FKBI失败组为5.1%,FKBI成功组为1.7%),而DK crush组为1.3%(P＞0.05).经典挤压组术后8个月时无靶病变血运重建生存率为75.4%(FKBI失败组为71.2%,FKBI成功组为77.6%),而DK crush组为89.5%(P=0.002).结论 DK crush可能是治疗冠状动脉分叉病变的较佳术式.     

Clinical effectiveness of the Prostar XL suture-mediated percutaneous vascular closure device following PCI: results of the Perclose AcceleRated Ambulation and DISchargE (PARADISE) Trial

BACKGROUND: The Prostar XL is a hemostasis device designed to percutaneously close the arterial puncture site with two nonabsorbable sutures. The Early Discharge and Economical effectiveness study for New hemostasis device (EDEN) trial, which was performed in Japan, showed that the Prostar XL device shortened time to hemostasis, time to ambulation and the average length of hospital stay, and decreased local vascular complications. However, the ooze of blood from the puncture site incision requires relatively longer time to ambulation. OBJECTIVES: The Perclose AcceleRated Ambulation and DISchargE (PARADISE) trial was performed to assess the effectiveness of the Prostar XL device on patient comfort, shortened time to ambulation and discharge from hospital by minimizing the oozing problem. METHODS: This multicenter, non-randomized registry was designed to compare times to hemostasis, ambulation and discharge, as well as the incidence of peripheral vascular complications in Prostar XL patients with the conventional manual compression group in the EDEN trial. Hydrochloride lidocaine containing 1% epinephrine was used as local anesthesia to reduce blood oozing. RESULTS: Between September 1999 and March 2000, a total of 109 patients were enrolled in this study. The closure device was successfully placed in 108 of 109 attempts. Time to hemostasis was significantly less than with the conventional manual compression group in the EDEN trial. Times to ambulation and discharge were significantly less than with the Prostar XL and conventional manual compression groups in the EDEN trial. CONCLUSION: We conclude that the Prostar XL device plus hydrochloride lidocaine containing 1% epinephrine as local anesthesia appears to be a safe and effective method to achieve hemostasis, and to improve times to ambulation and discharge after interventional procedures.     

Association of adiponectin mutation with type 2 diabetes: a candidate gene for the insulin resistance syndrome

Adiponectin, also referred to as AdipoQ or ACRP30, is a plasma protein produced and secreted exclusively from adipose tissue. The protein contains a collagen-like domain and a C1q-like globular domain. A protease-generated globular segment enhances fatty acid oxidation in muscles, thereby modulating lipid and glucose metabolism. Plasma adiponectin levels are inversely correlated with the severity of insulin resistance. A recent genome-wide scan study mapped a susceptibility locus for type 2 diabetes and the metabolic syndrome to chromosome 3q27, where the adiponectin gene is located. Here, we screened Japanese patients with type 2 diabetes and age- and BMI-matched nondiabetic control subjects for mutations in adiponectin gene. We identified four missense mutations (R112C, I164T, R221S, and H241P) in the globular domain. Among these mutations, the frequency of I164T mutation was significantly higher in type 2 diabetic patients than in age- and BMI- matched control subjects (P < 0.01). Furthermore, plasma adiponectin concentrations of subjects carrying I164T mutation were lower than those of subjects without the mutation. All the subjects carrying I164T mutation showed some feature of metabolic syndrome, including hypertension, hyperlipidemia, diabetes, and atherosclerosis. Our findings suggest that I164T mutation is associated with low plasma adiponectin concentration and type 2 diabetes.     

Objective evaluation of laughing

The method for an objective evaluation of laughing by using a polygraphic recording (EMG of the zygomatic muscle, GSR, plethysmogram, pneumogram, body movement and phonation) is demonstrated. ‘Laughing score’, which is an index for intensity and frequency of laughing calculated from polygraphic recordings, correlated well with the subjective rating of laughing by experimenters. It was also shown that laughing scores differed from person to person among normal subjects and that laughing reaction decreased over the age of 40.     

Isolated dissecting aneurysm of the superior mesenteric artery: intravascular ultrasound (IVUS) images

A case of the isolated dissection of the superior mesenteric artery (SMA) is presented, with the intravascular ultrasound (IVUS) images. Abdominal computed tomography revealed an intraluminal hematoma in the proximal portion of the SMA in a 57-year-old man complaining of persistent abdominal pain. Selective angiography showed narrowing of the SMA. The most compatible diagnosis was a dissection of the SMA, however, the possibility of SMA thromboembolisms could not be denied. Transcatheter suction removal of thrombi would be reconmmended for SMA thromboembolisms, however, intraarterial suction should be avoided so as not to injure the internal surface of the intima in cases of dissection of SMA. The IVUS images clearly demonstrated the condition of the true and false lumen of the dissecting region in detail. Transluminal balloon angioplasty of the true lumen and systemic anticoagulation treatment resulted in uneventful recovery. Demonstration of the exact condition in the dissecting region using IVUS is useful for selecting therapeutic strategies in cases with isolated dissecting aneurysm of the SMA.     

Successful surgical treatment of an infected right coronary artery aneurysm-to-right ventricle fistula after sirolimus-eluting stent implantation

The development of infected coronary aneurismal fistula following stenting seems exceedingly rare. A sirolimus-eluting stent (SES) was implanted in a 70-year-old male patient for acute coronary syndrome. His fever persisted despite treatment with adapted antibiotics. Coronary angiography and 16-multidetector row computed tomography demonstrated the huge right coronary aneurysm forming a fistula to the right ventricle. The aneurysm was excised by surgical treatment. Histopathological examination of the resected mass revealed leucocyte infiltration at the stent site, which lead to the diagnosis of mycotic aneurysm. SESs may play a potential role in locally blunting the innate response to bacterial agents.     

Perioperative multivessel coronary vasospasm as a cause of cardiogenic shock immediately after off-pump coronary artery bypass grafting surgery: a case report

Perioperative coronary vasospasm has been recognized as a possible cause of myocardial infarction or low output syndrome after open heart operations. A 57-year-old male suffered cardiogenic shock immediately after off-pump coronary artery bypass grafting surgery. Emergent angiography performed under intraaortic balloon pumping and percutaneous cardiopulmonary support revealed severe multivessel coronary vasospasm which was effectively treated with a high dose intracoronary administration of isosorbide dinitrate. Emergent angiography for patients with cardiogenic shock after open heart operation is feasible and effective for the diagnosis and treatment of perioperative coronary vasospasm.     

Young woman with repeated late stent thrombosis: a case report

A 34-year-old woman with hypertension, obesity, and history of smoking presented with unstable angina and severe stenosis of the proximal left anterior descending artery. Percutaneous coronary intervention was performed with stent implantation resulting in adequate expansion. She was treated with aspirin and ticlopidine for 1 month, then only aspirin for 1 month. One year after stenting, she presented with acute myocardial infarction and total occlusion at the stent. Balloon angioplasty was performed. She took ticlopidine and aspirin for 9 months. Two months later, she presented with acute myocardial infarction with reocclusion at the stent. Blood examination showed no manifest collagen disease or thrombophilia. This case of repeated late stent thrombosis occurred in a young woman not treated by brachytherapy.