When Blades broke my heart

Takotsubo cardiomyopathy (TCM) was first described about 30 years ago. It has been attributed to the sudden catecholamine surge in relation to severe stress, which can cause multi-vessel coronary spasms and myocardial apical ballooning. Football supporters are prone to develop severe stress due to sudden changes in match results. This case presents a football supporter of Sheffield United (the Blades) who was admitted to the hospital with cardiac sounding chest pain following a last minute goal by the opposing team. The necessary investigations were carried out including coronary angiogram and echocardiogram. He was diagnosed with TCM following a left ventricular angiogram demonstrating the typical appearance of the octopus pot.Key words: acute chest pain, cardiomyopathy, catecholamine surge, coronary spasm     

乙型肝炎肝衰竭发生机制中的三重打击

肝衰竭发生发展的机制十分复杂,因此一直是研究的热点.在肝衰竭的发生发展过程中,出现大量肝细胞死亡是最核心的事件.然而,肝衰竭的肝组织病理学检查显示:     

Read my lips.

The leading hairy edge of the lip is claimed to be related to peptic ulcer disease. Implications of this relationship are examined in light of psychiatric and probabilistic possibilities.     

Evidence that heart connexin43 is a phosphoprotein.

Cardiac gap junctions permit the conduction and propagation of the electrical impulses that are responsible for the synchronous contraction of the myocardium (Page and Manjunath, 1986). Cardiac gap junctions are formed by the association of connexin molecules within the plasma membrane of heart cells. They create aqueous channels that permit exchange of ions and other small molecules between adjacent cells. Intercellular communication via these channels may be regulated by phosphorylation. cAMP was shown to increase junctional conductance and stimulate phosphorylation of connexin32 in cultures of dissociated liver hepatocytes (Saez et al., 1986). Furthermore, a 47 kDa protein purified from dog heart gap junctions was phosphorylated in vitro by the catalytic subunit of protein kinase A (Pressler and Hathaway, 1987). Other studies have demonstrated that cAMP enhanced junctional conductance in intact heart and isolated heart cells (De Mello, 1986; De Mello and van Loon, 1987; Burt and Spray, 1988). This report provides direct evidence that the heart gap junction protein, connexin43, from unstimulated heart tissues and cultured myocytes is phosphorylated stoichiometrically in vivo. Phosphorylation of 45 and 47 kDa connexin43-related proteins occurred predominantly on serine. In addition, the 47 kDa protein contained a low-level of phosphothreonine.     

Patients'' observations of bioprosthetic valve failure: "my heart is honking, doctor".

Audible cardiac murmurs are uncommon and may indicate severe native valve dysfunction. In six patients with bioprosthetic mitral valves audible honking systolic murmurs suddenly developed. Doppler echocardiography showed characteristic striated regurgitant signals. At operation each prosthesis had torn cusps. New audible murmurs and striated Doppler signals originating from mitral bioprosthetic valves are indicators of cusp tears. Recognition of this is important because early detection of prosthetic valve dysfunction may improve subsequent surgical outcome.     

Interaction of myogenic and neurogenic mechanisms that control heart rate.

Interaction of neurogenic and myogenic factors that control heart rate was studied. Sympathetic nerve actions and stretch of the sinoatrial node both have an accelerator effect which appears to be competitive, and additive rather than facilitatory. In contrast with this, the accelerator effects of sinoatrial node stretch were proportionately greater when stretch was applied during a slowing produced by vagus nerve stimulation. The hyperpolarizing effect of vagus nerve stimulation or acetylcholine apparently potentiates the accelerator effects consquent to the depolarizing actions of stretch. The myogenic reaction can be considered as playing a role in maintaining cardiac output and preventing excessive slowing or diastolic distension and a deficient circulation.