Adverse effects of direct current cardioversion on cardiac pacemakers and electrodes Is external cardioversion contraindicated in patients with permanent pacing systems?

Use of pacing in sick sinus syndrome and recent developments in pacemaker therapy for intermittent atrial fibrillation raise the question of whether external electrical cardioversion should be used for termination of atrial fibrillation. This paper analyzes three cases of pacemaker and/or electrode dysfunction appearing after direct current (DC) cardioversion for termination of atrial fibrillation. Despite similar conditions during cardioversion in all cases, different dysfunctions reflecting damage to the pulse generator and/or a rise of the stimulation threshold in both, atrial and ventricular leads, have been observed. The possible mechanisms for these effects are discussed and recommendations for the management of cardioversion in patients with permanent pacemaker systems are given.     

Management strategies for gastrointestinal,erectile, bladder,and sudomotor dysfunction in patients with diabetes

There are substantial advances in understanding disordered gastrointestinal autonomic dysfunction in diabetes. It occurs frequently. The underlying pathogenesis is complex involving defects in multiple interacting cell types of the myenteric plexus as well. These defects may be irreversible or reversible. Gastrointestinal symptoms represent a major and generally underestimated source of morbidity for escalating health care costs in diabetes. Acute changes in glycaemia are both determinants and consequences of altered gastrointestinal motility. 35–90% of diabetic men have moderate‐to‐severe erectile dysfunction (ED). ED shares common risk factors with CVD. Diagnosis is based on medical/sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to patient's complaints and risk factors. Treatment is based on PDE5‐inhibitors (PDE5‐I). Other explorations may be useful in patients who do not respond to PDE5‐I. Patients at high cardiovascular risk should be stabilized by their cardiologists before sexual activity is considered or ED treatment is recommended. Estimates on bladder dysfunction prevalence are 43–87% of type 1 and 25% of type 2 diabetic patients, respectively. Common symptoms include dysuria, frequency, urgency, nocturia and incomplete bladder emptying. Diagnosis should use validated questionnaire for lower urinary tract symptoms. The type of bladder dysfunction is readily characterized with complete urodynamic testing. Sudomotor dysfunction is a cause of dry skin and is associated with foot ulcerations. Sudomotor function can be assessed by thermoregulatory sweat testing, quantitative sudomotor axon reflex test, sympathetic skin response, quantitative direct/indirect axon reflex testing and the indicator plaster. Copyright © 2011 John Wiley & Sons, Ltd.     

围产期心肌病9例临床分析

目的:总结围产期心肌病的发病、危险因素、疗效及预后,为围产期心肌病的诊治提供循证医学证据。方法:入选2010年7月至2013年7月在我院心内科治疗的心肌病患者768例,其中围产期心肌病患者9例,回顾性分析其一般临床资料、发病率、危险因素、治疗效果及预后。结果:9例患者占单中心同期心肌病患者的1.2%(9/768),占40岁以下女性心肌病患者的31.0%(9/29)。年龄(27±4)岁。以双下肢水肿或腹水为主要表现的右心室功能不全者5例。超声示左心室收缩功能不全8例,胸片检查心胸比增大8例。患者常规接受抗心力衰竭、营养心肌等治疗,症状及体征好转后出院。随访12个月,8例患者左心室收缩功能均恢复。结论:围产期心肌病在40岁以下女性心肌病患者中发病率较高,以左心室功能不全为主要特征,超声心动图及胸片可评价患者心功能及有无心影增大,协助诊断。常规抗心力衰竭及营养心肌治疗有效,预后较好。     

咪达唑仑多次使用对小鼠学习记忆的影响

目的观察不同剂量的咪达唑仑多次使用对小鼠学习记忆的影响。方法100只KM小鼠分层随机区组设计,分为M1、M2、M3、M4组和生理盐水（NS）组,每组20只,各组再随机选取10只,参加跳台实验或避暗实验。M1、M2、M3和M4组分别以咪达唑仑0.5、1、2和4 mg/kg,NS组以10 ml/kg生理盐水腹腔注射,3次/d,连续10 d后,进行训练,24 h后进行记忆测验,以潜伏期和错误次数作为记忆成绩的指标。结果M1、M2、M3、M4组与NS组比较,M2、M3和M4组与M1组比较,M3和M4组与M2组比较,潜伏期缩短、错误次数次数增多（P〈0.05）;但M3组与M4组比较,潜伏期和错误次数相似（P〉0.05）。结论多次使用咪达唑仑对记忆的影响有一定剂量依赖性,但其记忆抑制作用有封顶效应。     

Syndrome of Nonobstructive Coronary Artery Diseases: A Comprehensive Overview of Open Artery Ischemia

Syndromes of cardiac ischemia with nonobstructive coronary arteries have been increasingly recognized as a clinical entity with heterogeneous clinical presentations, commonly encountered in women. Knowledge of pathophysiology and clinical risk factors is key to ensuring appropriate diagnostic evaluation and management for these often-neglected patients. In this review, we discuss the epidemiology, risk factors, and clinical presentations of these syndromes. We provide algorithms for diagnosis and management of these entities based on current scientific knowledge and highlight some of the key knowledge gaps and ongoing trials in this emerging field.     

三种微颗粒水平在糖尿病血管病变中的意义

Objective To investigate the levels of mieropartieles originated from platelet (PMP),endothelium (EMP),and tissue factor-bearing microparticles (TF+ MP) in diabetes mellitus and to analyze its relationship with diabetic angiopathy.Methods PMP,EMP or TF+ MP were measured in 106 cases of diabetes mellitus and 50 controls by flow eytometry.The differences of EMP between groups of diabetic macrovascular disease and diabetic microvascular disease were determined.Results The levels of EMP in diabetic patients were higher than that in the control(164.20±128.88 vs 63.81±40.84,P<0.05).Diabetic cases with complication showed higher expression level of EMP than those without complications(184.12±152.77,188.21±149.55 vs 138.53±99.87,both P<0.05).However,no distinct increase was observed in PMP and TF+ MP level in diabetes groups compared with control group.Conclusions Endothelial dysfunction,may contribute to the increased level of EMP in patients with diabetes,especially those complicated with vascular diseases.EMP level may be used to evaluate the status of endothelial function and the development of diabetic angiopathy.     

三种微颗粒水平在糖尿病血管病变中的意义

Objective To investigate the levels of mieropartieles originated from platelet (PMP),endothelium (EMP),and tissue factor-bearing microparticles (TF+ MP) in diabetes mellitus and to analyze its relationship with diabetic angiopathy.Methods PMP,EMP or TF+ MP were measured in 106 cases of diabetes mellitus and 50 controls by flow eytometry.The differences of EMP between groups of diabetic macrovascular disease and diabetic microvascular disease were determined.Results The levels of EMP in diabetic patients were higher than that in the control(164.20±128.88 vs 63.81±40.84,P<0.05).Diabetic cases with complication showed higher expression level of EMP than those without complications(184.12±152.77,188.21±149.55 vs 138.53±99.87,both P<0.05).However,no distinct increase was observed in PMP and TF+ MP level in diabetes groups compared with control group.Conclusions Endothelial dysfunction,may contribute to the increased level of EMP in patients with diabetes,especially those complicated with vascular diseases.EMP level may be used to evaluate the status of endothelial function and the development of diabetic angiopathy.     

Sexual evaluation and treatment of ageing males with haemophilia

Summary. Sexual dysfunction is common in ageing men and may be exacerbated by the special medical issues and psychological problems associated with haemophilia. Sexual healthcare for men with haemophilia (MWH) requires a background understanding of common patterns of sexual function and dysfunction in the ageing male, expectable sexual complications of haemophilia and related comorbidities, and of sexually related psychological issues. Healthcare providers who treat MWH must be able to elicit a sexual history sufficient to differentiate problems involving a loss of sexual desire from ejaculatory difficulties and erectile dysfunction (ED). Other necessary skills include evaluating patients with ED for treatable causes, distinguishing organic from psychogenic ED, using phosphodieterase‐5 inhibitors as first‐line treatment for ED, and referring to specialized sexual urology and mental health professionals when appropriate.     

Coronary endothelial dysfunction is associated with erectile dysfunction and elevated asymmetric dimethylarginine in patients with early atherosclerosis.

AIMS: Coronary endothelial dysfunction (CED) precedes atherosclerosis and is associated with cardiovascular events. Both CED and erectile dysfunction (ED) are partly mediated by impairment in the nitric oxide pathway. ED is associated with established coronary atherosclerosis, but its relationship with early coronary atherosclerosis and CED is unknown. This study was designed to test the hypothesis that CED is associated with ED in men with early coronary atherosclerosis. Moreover, the role of the nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) was investigated; ADMA is a novel endogenous competitive inhibitor of nitric oxide synthase and has been shown to be an independent marker for cardiovascular disease. METHODS AND RESULTS: Fifty-six men without obstructive coronary artery disease (CAD) who underwent coronary endothelial function testing were studied. ADMA levels were determined and all men were asked to complete the International Index of Erectile Function-5 questionnaire to assess erectile function. Patients were divided according to the presence (n = 32) or absence (n = 24) of CED. Men with CED had significant impairment of erectile function (P = 0.008) and significantly higher ADMA levels (0.50 +/- 0.06 vs. 0.45 +/- 0.07 ng/mL, P = 0.017) compared with men with normal endothelial function. Erectile function positively correlated with coronary endothelial function. This correlation was independent of age, body mass index, high-density lipoprotein, C-reactive protein, homeostasis model assessment of insulin resistance index, and smoking status. CONCLUSION: CED is independently associated with ED and plasma ADMA concentration in men with early coronary atherosclerosis. This study further supports the role of the endothelium in systemic vascular diseases and the role of ADMA in the systemic manifestations of endothelial dysfunction.     

老年2型糖尿病患者认知功能障碍影响因素分析

目的探讨老年2型糖尿病(T2DM)患者认知功能障碍发生的影响因素。方法回顾性分析2017年6月至2018年5月首都医科大学宣武医院内分泌科2型糖尿病患者204例,根据简易版蒙特利尔认知评估(MoCA)量表结果分为认知功能障碍组98例和认知功能正常组106例。记录2组患者实验室检查结果,慢性肾脏病流行病学合作研究(CKD-EPI)公式计算估算肾小球滤过率(eGFR)。采用SPSS 19.0统计软件对数据进行分析。组间比较采用t检验、Mann-Whitney U检验或χ~2检验。多因素logistic回归分析认知功能障碍的危险因素。结果认知功能障碍组相比认知功能正常组患者年龄[(68.4±7.7)vs(66.0±6.7)岁]、骨质疏松[35.71%(35/98)vs 19.81%(21/106)]和eGFR60 ml/(min·1.73 m~2)比例[26.53%(26/98)vs 12.26%(13/106)]高,MoCA分值[(20.36±4.07)vs(27.02±1.49)分]和受教育时间[(8.85±4.14)vs(12.35±3.30)年]低,差异均具有统计学意义(P0.05)。多因素logistic回归分析结果表明年龄(OR=1.05, 95%CI 1.01～1.10;P=0.011)和eGFR60 ml/(min·1.73 m~2)[OR=2.15, 95%CI 1.08～4.26;P=0.029]为老年2型糖尿病患者认知功能障碍的独立危险因素。结论年龄和eGFR60 ml/(min·1.73 m~2)是老年2型糖尿病患者认知功能障碍的危险因素,控制患者血糖同时要监测患者肾功能,预防认知功能障碍的发生和进展。     

Correlates for erectile and ejaculatory dysfunction in older Dutch men: a community-based study

OBJECTIVES: We estimated correlates for erectile dysfunction (ED) (defined as a report of erections of severely reduced rigidity or no erections) and ejaculatory dysfunction (EjD) (defined as a report of ejaculations with significantly reduced volume or no ejaculations) in a large community sample of older men. DESIGN: A community-based study. SETTING: Krimpen aan den IJssel, a municipality near Rotterdam, The Netherlands. PARTICIPANTS: A total of 1,688 (50% of the eligible) men age 50 to 78. MEASUREMENTS: Presence of ED and EjD (International Continence Society sex questionnaire), urinary tract symptoms (international prostate symptom score), prostate enlargement (transrectal ultrasonography), urinary flow obstruction (uroflowmetry), obesity (body mass index), chronic obstructive pulmonary disease (COPD), diabetes mellitus, and cardiovascular problems. Determined marital status, educational level, and smoking and drinking habits. Population attributable risk (PAR) was estimated for correlates that yielded from multiple logistic regression models on ED and EjD. RESULTS: Multiple logistic regression analyses yielded the following correlates for significant ED: age, smoking, obesity, urinary tract symptoms, and treatment for cardiovascular problems and COPD. Age, erectile function, urinary symptoms, and previous prostate operations proved to be correlates for significant EjD. Urinary symptoms and obesity have the highest PAR for ED, whereas decreased erectile function has the highest PAR for EjD. CONCLUSIONS: Age, obesity, and urinary tract symptoms are the most-important correlates of significant ED in the population. Cardiac problems, COPD, and smoking are other independent correlates. Significant EjD is largely related to age, decreased erectile function, and previous prostate surgery.     

Asymptomatic Left Ventricular Dysfunction and Metabolic Syndrome: Results from an Italian Multicenter Study

Context:

Metabolic syndrome (MS) is a cluster of interrelated common clinical disorders, including obesity, insulin resistance, glucose intolerance, hypertension and dyslipidemia, associated with a greater risk of atherosclerotic cardiovascular disease than any of its individual components. Although MS is associated with increased cardiovascular risk (CVR), its relationship with heart failure (HF) and left ventricular (LV) dysfunction is not fully understood.

Aims:

We sought to determine whether MS is associated to LV systolic and diastolic dysfunction in a sample of patients with MS and no symptoms for HF.

Subjects and Methods:

We enrolled 6422 consecutive asymptomatic patients admitted to echo-lab for a routine echocardiogram. We calculated LV systolic and diastolic function, by Simpson biplane method and validated Doppler parameters, respectively. MS was diagnosed if three or more CVR factors were found.

Results:

LV systolic function was evaluated in 6175 patients (96.2%). In the group of patients without MS (n = 5630), the prevalence of systolic dysfunction was 10.8% (n = 607) while in the group of patients with MS (n = 545) it was 12.5% (n = 87), (RR1.57; CI 95% 1.2-2.0; P < 0.001). Diastolic function was evaluated in 3936 patients (61.3%). In the group of patients without MS (n = 3566) the prevalence of diastolic dysfunction was 33.3% (n = 1187), while in patients with MS (n = 370) it was 45.7% (n = 169), (RR1.68; CI95% 1.3-2.0; P < 0.001). After adjustment for age and gender, MS proved to be an independent predictor of LV systolic and diastolic dysfunction.

Conclusions:

Our data show that asymptomatic LV systolic and diastolic dysfunction, is correlated with MS and demonstrate that echocardiography is a useful tool to detect patients at high risk for HF. Echocardiography in asymptomatic patients with MS may lead to a therapy initiation at early stages to prevent future cardiovascular events and HF.     

Quality of life in older patients with systolic and diastolic heart failure

AIMS: To get insight into the quality of life of a clinical practice sample of patients with heart failure that are admitted to the hospital. Secondly to determine differences between patients with systolic and diastolic dysfunction and finally to describe factors relating to quality of life. METHODS: Three dimensions of quality of life (functional capabilities, symptoms and psychosocial adjustment to illness) were assessed during interviews of 186 patients with chronic heart failure. In addition, data on demographic, clinical and self-care characteristics were collected and patients completed a 6-min walk. RESULTS: On average patients walked 172 m in 6 min and reported functioning in daily life at a mean level of 4.5 MET. Patients experienced four different symptoms of heart failure. Most of them described dyspnea, fatigue, sleep disturbance and ankle oedema. Problems with psychosocial adaptation occurred mostly in social and vocational domains. Overall well-being of patients was rated as 6.4 on a 10-point scale. In regard to quality of life, the only differences between patients with systolic and diastolic heart failure was the occurrence of ankle oedema and health-care orientation. The variance in components of quality of life were partly explained by demographics and clinical characteristics. All three dimensions of quality of life were related to ability for self-care. CONCLUSION: Patients with heart failure seen in clinical practice are often not comparable to patients described in major clinical trials or patients that are admitted for transplant evaluation. Their functional capabilities are more compromised, but they may have fewer problems with psychosocial adjustment. Patients with normal systolic dysfunction also report a low quality of life. It could be important to enhance self-care abilities of patients to improve psychosocial adaptation to illness.     

左室舒张性心功能障碍超声左心形态、功能及运动耐量的改变50例分析

对核素心血池扫描证实的５０例左室舒张性心功能障碍（ＬＶＤＤ）病例、２６例左室收缩性心功能障碍（ＬＶＳＨＦ）病例进行Ｍ型、二维、多普勒超声心动图及活动平板运动试验检测，并以２０例正常人为对照组（ＣＧ）。结果表明：（１）左心形态学改变：与ＬＶＳＨＦ组比较，ＬＶＤＤ组左房内径（ＬＡＤ）、左室内径（ＬＶＤ）无明显增加，室间隔厚度（ＩＶＳＴ）、左室后壁厚度（ＰＷＴ）增加。与ＣＧ组比较，ＬＶＤＤ组ＬＡＤ、ＩＶＳＴ、ＰＷＴ增加，但ＬＶＤ差异无显著性。（２）ＬＶＤＤ组收缩功能指标：左室射血分数（ＬＶＥＦ）、心脏指数（ＣＩ）与ＣＧ组比较差异无显著性，ＬＶＳＨＦ组与ＣＧ组比较，ＬＶＳＨＦ组ＬＶＥＦ、ＣＩ减低。与ＣＧ组比较，ＬＶＤＤ组左室舒张功能指标：二尖瓣舒张早期流速峰值（ＥＰＦＶ）、二尖瓣舒张早、晚期流速峰值比（Ｅ／Ａ）、舒张早期减速度（ＤＣ）比ＣＧ组减低，二尖瓣舒张晚期流速峰值（ＡＰＦＶ）、等容舒张时间（ＩＲＴ）较ＣＧ组增高。ＬＶＤＤ组各左室舒张功能指标与ＬＶＳＨＦ组差异无显著性。（３）ＬＶＤＤ组运动时间、运动当量显著低于ＣＧ组，但高于ＬＶＳＨＦ组。