HeartMate II left ventricular assist device; early European experience

OBJECTIVE: The novel axial flow left ventricular assist device HeartMate II was introduced into clinical practice in Europe as part of the pilot study and after CE approval in November 2005. In order to get an overview of the use and performance of the device in Europe a group of investigators was founded to compare the initial results. METHODS: In a retrospective analysis of the first 101 consecutive cases in Europe, data were collected with regard to postoperative outcome and severe adverse events and anticoagulation protocols. Results were stratified by intention to treat as a bridge to transplant or as chronic support therapy in heart failure (destination therapy). RESULTS: In 70% of patients, the HeartMate II was intended as a bridge to transplant therapy, in 30%, it was used as a destination therapy device. The perioperative mortality post implant was 20% in the bridge to transplant patients and 7% in the destination therapy arm. However, after 1 year a comparable survival was observed in both groups (69% destination therapy, 63% bridge to transplant). Main causes of death were multiple organ failure (n=12) and cerebrovascular accidents (n=5). All, but one cerebrovascular accident occurred in the first 9 days after surgery. Only one other death was reported thereafter and there was no mechanical failure of the device. CONCLUSIONS: Even in the early experience the HeartMate II was used as a chronic support device in a substantial number of patients in Europe. Although the total experience is still limited, the incidence of cerebrovascular accidents is very low and the survival beyond the perioperative period is excellent.     

Interaction of MSG taste with nutrition: perspectives in consummatory behavior and digestion

Studies in the taste system of mammals indicate that monosodium glutamate (MSG) produces a unique taste sensation termed umami. As a derivative of glutamic acid, MSG is a naturally occurring nutrient in many foods; its commercial use to improve food palatability for humans is well documented. Behavioral studies with experimental animals have revealed that preference for MSG in solutions and selection of MSG-flavored diets can be explained by sensory means with no appreciable effects on preference by postingestive consequences. However, preference for umami-flavored fluids is reduced by feeding rats low-protein diets or low quality protein. MSG-flavored diets, initially unpreferred, were subsequently highly selected. However, the adulteration of diets by MSG either did not or only slightly increased food intake. In light of the significant contribution of MSG to diet taste, apparently as a signal coupled to dietary proteins, physiological studies have been initiated to reveal its role as a stimulator of the cephalic phase of pancreatic exocrine secretion. Modified sham-feeding experiments with dogs have shown that oral stimulation by MSG produced significant stimulation of both pancreatic flow and protein output in conscious dogs.     

新疆维吾尔自治区库车县维吾尔族人类免疫缺陷病毒感染者血清自身抗体及人类白细胞抗原-B27检测的临床意义初探

目的初步探讨新疆维吾尔自治区库车县维吾尔族人类免疫缺陷病毒(HIV)感染者血清自身抗体、人类白细胞表面抗原(HLA)-B27检测的临床意义。方法收集2016年5月至2017年3月在新疆维吾尔自治区库车县传染病医院登记随访的727例维吾尔族HIV感染者的临床资料和实验室检查,同时抽取HIV感染者及390例同民族健康志愿者外周血,检测抗核抗体(ANA)、抗环瓜氨酸多肽(CCP)抗体、抗可提取性核抗原(ENAs)抗体及HLA-B27。结果维吾尔族HIV感染者727例,男性317例,女性410例,年龄(35.52±13.44)岁,病程(6.34±3.05)年,其中697(95.87%)例正在接受高效抗逆转录病毒治疗(HAART),治疗时间(5.52±3.47)年。202例HIV感染者CD4^+T细胞数(520±271)个/μl,20例HIV感染者病毒载量(108139±20498)拷贝/ml。238例(32.74%)HIV感染者出现风湿病症状,其中以口眼干(15.41%)、脱发(9.90%)、关节痛(8.94%)最常见。HIV感染者ANA阳性率为33.43%(243/727),高于健康对照者(17.43%),差异有统计学意义(P<0.001),以1∶100低滴度阳性为主。与健康对照者比,HIV感染者抗U1核糖核蛋白抗体阳性率高(1.10%),而抗SSA抗体(0.14%)、抗CCP抗体(0.28%)阳性率较低。HAART者ANA阳性率(32.71%)较未治疗者(50.00%)低。相关性分析发现,抗逆转录病毒治疗时间、CD4^+T细胞数、病毒载量与ANA无相关性(r值分别为0.061、0.047、0.121,P值均<0.05)。仅1例(0.14%)女性HIV感染者HLA-B27阳性,低于健康对照者(3.08%;P<0.001)。HIV感染者中仅发现1例合并类风湿关节炎。结论维吾尔族HIV感染者可出现多种风湿病表现,且血清中可检测到多种自身抗体,临床上极易与风湿病混淆,因此,对有多种风湿病表现的患者应警惕HIV感染的可能。     

Quinolone resistance is associated with increased risk of invasive illness or death during infection with Salmonella serotype Typhimurium

In a registry-based cohort study, we determined the risk of invasive illness or death associated with infection with quinolone-resistant Salmonella serotype Typhimurium. We linked data from the Danish surveillance registry of enteric pathogens with data from the Danish civil registration system and 2 national health registries. Of 1323 patients infected with Salmonella Typhimurium, 46 (3.5%) were hospitalized due an invasive illness within 90 days of infection, and 16 (1.2%) died within 90 days of infection. After adjustment for age, sex, and comorbidity, infection with quinolone-resistant Salmonella Typhimurium was associated with a 3.15-fold (95% confidence interval, 1.39-7.10-fold) higher risk of invasive illness or death within 90 days of infection, compared with that observed for infection with pansusceptible strains.     

Periodicity in metastatic tumour growth demonstrated in the human liver at autopsy. Preliminary report

The present study is based on 1,069 autopsies made up of stomach, breast, renal and colonic cancer. Periodicity is described in the liver weight index (liver weight/body height) at death in patients with liver metastases. The seasonal variation tended to be more marked in females and among older patients, and it differed with tumour type. A period with maximum deaths tended to follow that of maximum liver weight index. A periodic difference previously reported in a small series of malignant melanomas is thus not an isolated phenomenon. This indicates that basic biological pathways concerned with the control of tumour growth may be involved. How the system works remains an open question.     

High dose intravenous immunoglobulin may be complicated by myocardial infarction

Intravenous immunoglobulin [IVIg] is useful for treating several clinical conditions and is largely considered safe, without major adverse events. Here we report a case of acute ST elevation myocardial infarction associated with high dose IVIg administration in a previously healthy 69-year-old male patient of Guillain Barre syndrome. The case is being reported to emphasize the need for treating physicians to be aware of thrombotic complications associated with IVIg. The thrombotic complications associated with IVIg are reviewed in brief, and the measures to reduce them are discussed.     

Serum antibody levels to 4 periodontal pathogens remain unaltered after mechanical therapy of juvenile periodontitis

Serum antibody titers to Actinobacillus actinomycetemcomitans (A.a.) Y4, Bacteroides gingivalis, Capnocytophaga ochracea and Eubacterium saburreum were determined with an enzyme immunoassay in 12 patients with juvenile periodontitis (JP) at the beginning of treatment and 16 to 32 months later after clinically successful mechanical therapy without antibiotics. The values were compared to corresponding data obtained from 26 age- and sex-matched individuals with a healthy periodontium. 6 JP patients had significantly increased levels of IgG and IgA antibodies to A.a. and 2 patients had increased IgG and IgA antibodies to C.ochracea. About 75% of the JP patients had a level of IgG antibody to B.gingivalis and E.saburreum which was more than one SD lower than the mean of the healthy controls, and in the IgA class 80-100% had such decreased levels of antibodies to these bacteria. In the IgM class, the JP patients by and large had normal levels of antibodies to the 4 bacteria. After treatment, antibodies to A.a. had decreased in only 3 patients, but the levels were still significantly higher than in healthy controls. Minimal alterations were observed in the levels of antibodies to B.gingivalis, C.ochracea and E.saburreum after treatment.     

Low density lipoprotein receptors in cultured skin fibroblasts from psoriasis patients

Low density lipoprotein (LDL) receptor activity, measured as 125I-LDL association and degradation at 37 degrees C, was determined in cultured fibroblasts from involved as well as uninvolved skin obtained from 20 psoriasis patients. The same analyses were conducted in fibroblasts from two reference groups consisting of 19 heterozygotes for familial hypercholesterolemia and 16 normal subjects, respectively. Psoriasis patients had significantly lower LDL receptor activity than normals, and it was comparable to that of the heterozygotes for familial hypercholesterolemia. The reduced LDL receptor activity was not accompanied by an increase in total serum cholesterol. The psoriasis patients had a significant reduction in apo-B concentration, but did not differ from the normals in the other serum lipid or lipoprotein parameters. There was no difference in LDL receptor activity between involved and uninvolved skin from psoriasis patients. These results suggest that there is an abnormal cell membrane in dermal fibroblasts from psoriasis patients. Since their total serum cholesterol is normal, their low LDL receptor activity may be confined to dermal cells, leaving the hepatic lipid metabolism normal. The pathogenetic significance of this finding is unknown.     

乌鲁木齐市维吾尔族中学生营养知识态度与饮食行为的调查研究

目的了解乌鲁木齐市维吾尔族中学生营养知识、态度和饮食行为的现状,为培养科学合理的饮食行为和营养健康教育提供科学依据。方法采用随机整群抽样方法抽取了乌鲁木齐市4个区的4所维吾尔族中学学生887名,采用自制调查问卷进行调查。结果营养知识分数为(4.23±1.99)分,男女生的营养知识差异无统计学意义。维生素C的良好来源(58.8%)和钙元素的良好来源(51.8%)等知识掌握比较好;喜欢喝饮料(59.4%)和吃西式快餐(39.9%)的程度高于喜好吃零食等,差异有统计学意义(P﹤0.01);饮料、奶油甜食食用频率较高,豆类食用频率相对较少。结论乌鲁木齐市维吾尔族中学生整体的营养知识水平不高,饮食习惯不太合理,应结合当地情况积极开展各项措施,培养中学生形成合理科学的饮食行为。