Why cardiologists should be interested in air pollution

Despite major improvements in air quality resulting from increasingly stringent legislation, there remains a strong association between daily mortality and current levels of air pollution. Growing epidemiological evidence suggests that many, perhaps the majority, of these deaths are caused by cardiovascular disease.     

依靠科学与协作 战胜传染性非典型肺炎

一场人类与传染性非典型肺炎的无硝烟的战争，正在中国和世界各地区展开。迄今为止，传染性非典型肺炎已波及近30个国家和地区，全世界有4000余人患病，死亡人数超过250人。在中国大陆，已有近4000人患病，150余人死亡。目前在某些地区仍有扩大的趋势。据估计，传染性非典型肺     

Renal dysfunction in acute congestive heart failure: a common problem for cardiologists and nephrologists

The term acute heart failure (AHF) refers to a clinical syndrome with typical symptoms and signs, in which a structural or functional heart abnormality leads to defective oxygen delivery. The term cardiorenal syndrome has been proposed to outline the strict interplay between cardiac and renal function. In the setting of acute cardiac decompensation, acute kidney injury (AKI) is generally referred to as cardiorenal syndrome type 1. In this review, we summarize the fundamental pathophysiological aspects of both AHF and AHF-related AKI. We also review the latest therapeutic options, including both pharmacological ones, such as loop diuretics, potassium-sparing diuretics and vaptans, and non-pharmacological ones, such as ultrafiltration, and their impact on patients’ outcome. We discuss the pathophysiology of diuretic resistance, a common occurrence in these patients, reviewing the available strategies to treat it and highlighting how a close collaboration between cardiologists and nephrologists is frequently crucial for the management of this complication. Finally, we discuss three new promising non-pharmacological tools for the prevention of AHF recurrence, including two methods that exploit sympathetic denervation and one technique that acts by increasing vagal tone.     

Schnitzler syndrome: an under-diagnosed clinical entity

Schnitzler syndrome is considered to be a rare disorder characterized by a monoclonal IgM protein and chronic urticaria that is associated with considerable morbidity. We hypothesized that the syndrome may be under-recognized and patients may be deprived of highly effective therapy in the form of anakinra. We performed a retrospective search of the dysproteinemia database at Mayo Clinic as well as the medical records of all patients with chronic urticaria to determine the true incidence of the disease. We compared patients with the diagnosis of Schnitzler syndrome and those who met the criteria but in whom the syndrome was not recognized. Comparisons between groups were performed and survival curves determined. We identified 16 patients with diagnosed Schnitzler syndrome and an additional 46 patients who met diagnostic criteria. The monoclonal protein was IgMκ in 94% of patients. Therapy with anakinra in 4 patients led to rapid and complete resolution of symptoms. The median overall survival for this syndrome is over 12.8 years. Progression to lymphoma was only observed in 8% of patients; this is lower than previous reports. Schnitzler syndrome may be present in up to 1.5% of patients with a monoclonal IgM in their serum and likely under-recognized as a clinical syndrome.     

Lemierre's syndrome: still an important clinical entity

We report a case of Lemierre's syndrome caused by Fusobacterium necrophorum and discuss characteristics of this potentially fatal condition which, though rare, may have a rising frequency. Familiarity with the signs and symptoms of Lemierre's syndrome is therefore of great importance.     

房性心动过速——不容忽视的心律失常

It has been well known since at least the 1950s that chronic tachycardia can alter cardiac structure and func-tion. Atrial tachycardia (AT) is a common tachyarrhythmia originating from atrium which can be seen in patients with or without organic heart diseases. AT can occur as nonsustained, paroxysmal, incessant and chronic tachycardia. Ectopic automaticity, triggered activity and reentry may be the mechanisms of the arrhythmia. The classification of atrial tachycardia based on arrhythmogenic site and mechanism may be the better one for the purpose of clinical study and strategies of treatment. Currently available antiarrhythmic drugs have limited efficacy for acute termination of AT. Ibutilide can immediate terminate recurrent atial tachycardia after catheter ablation of atrial fibrilla-tion safety and effectively. Radiofrequency catheter ablation may be effectively performed under the guide of electroanatomic mapping in these patients. And, radiofrequency also can decrease stroke risk, improve ventricular function with a reduction in all cause mortality, cardiac and possibly arrhythmic mortality.     

对Wolfram综合征的诊断应当慎之又慎

编辑部:中华内分泌代谢杂志今年第四期又一次报告了一例Wolfram综合征患者[1],这是贵刊创刊20年以来第三次报告此病。首次报告的Wolfram综合征二例患者曾引起笔者的质疑[2,3],后在上海市糖尿病研究所项坤三、陆惠娟、林辛等医师的帮助下,经基因诊断最后证实为线粒体tRNAleuA324     

ERCP and SARS-COV-2: an urgent procedure that should be immune

Abstract

Background

Radical changes to clinical and endoscopy practice have been rapidly introduced following the spread of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Urgent endoscopies are, however, intended to proceed as normal with additional personal protective procedures. A perceived reduction in hospital attendances may suggest a number of urgently indicated endoscopic retrograde cholangio-pancreatographies (ERCPs) are being missed.

Objectives and Methods: A review of all ERCPs carried out in a large tertiary referral endoscopy unit under healthcare restrictions was compared to the same time period in previous years. The intention was to determine if ERCPs are proceeding as normal or if there is a difference in referral characteristics.