Reversible,Complete Atrioventricular Block Caused by Primary Cardiac Lymphoma in a Nonimmunocompromised Patient

PCL in a Nonimmunocompromised Patient Primary cardiac lymphoma (PCL) is a rare entity that commonly presents as a heart rhythm disorder. We describe a previously healthy, immunocompetent patient presenting with complete atrioventricular block (AVB). The patient was found to have a cardiac mass on magnetic resonance imaging and underwent percutaneous biopsy eventually diagnosing PCL. After pacemaker implantation, the patient's tumor responded rapidly to chemotherapy and the AVB completely resolved. In otherwise healthy patients presenting with AV block, cardiac tumor should be considered. Additionally, if PCL is diagnosed and the patient is clinically stable with AVB, it may be reasonable to delay pacemaker implantation until the clinical response to chemotherapy is evaluated. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1386‐1389, December 2012)     

糙叶五加茎化学成分研究

目的基于脂多糖(LPS)诱导的巨噬细胞RAW264.7和小胶质细胞BV2为生物活性导向模型研究糙叶五加Acanthopanax henryi茎的化学成分。方法采用硅胶柱色谱、凝胶柱色谱、制备薄层及重结晶等方法进行分离纯化,利用波谱分析结合理化性质鉴定化合物的结构。结果从糙叶五加茎甲醇提取物的醋酸乙酯萃取部位中分离得到18个化合物,分别鉴定为对羟基苯甲酸(1)、反式对羟基肉桂酸(2)、反式咖啡酸甲酯(3)、咖啡酸(4)、反式松柏醛(5)、丁香醛(6)、香草醛(7)、6-甲氧基-7-羟基香豆素(8)、反式芥子醛(9)、十一烷二酸单甲酯(10)、(-)-芝麻素(11)、3-O-咖啡酰奎宁酸(12)、5-O-咖啡酰奎宁酸(13)、1,3-双咖啡酰奎宁酸(14)、1,4-双咖啡酰奎宁酸(15)、1,5-双咖啡酰奎宁酸(16)、豆甾醇(17)、β-谷甾醇(18)。结论化合物10为首次从五加科植物中分离得到;除化合物12、14、17、18外,其他化合物均为首次从该植物中分离得到。     

Rosmarinic Acid Induces Apoptosis of Activated T Cells from Rheumatoid Arthritis Patients via Mitochondrial Pathway

T cells play an important role in the initiation and the progression of rheumatoid arthritis (RA) and depletion of potentially pathogenic T cells was suggested as an important therapeutic protocol. We determined if rosmarinic acid (RosA), known as a secondary metabolite from herbal plants, had apoptotic activity toward T cells from RA patients and further verified target T-cell subsets. CD3(+)CD25(+) activated T-cell subsets from most of the RA patients displayed significantly higher apoptosis rates than did the PBMCs and total CD3(+) T cells. Furthermore, activated and effector CD4(+) T cells, including CD4(+)CD25(+) and CD4(+)CD45RO(+) T cells, had a tendency of being more susceptible to RosA-induced apoptosis than that of resting and na?ve T-cell subsets. RosA induced the release of cytochrome c from mitochondria and the blockage of mitochondrial depolarization inhibited apoptosis. Taken together, these results suggest that RosA induces apoptosis of activated T-cell subsets from RA patients via a mitochondrial pathway.     

The Atrial Electrogram During Clinical Electrophysiologic Studies: Onset versus the Local/Intrinsic Deflection

The Local Atrial Deflection. Introduction : As a wave front passes unfiltered bipolar recording electrodes, the point of local depolarization is marked by a maximal change in voltage, i.e., the intrinsic deflection. However, during electrophysiologic studies, the depolarization (A) on the lead recording the His-bundle potential traditionally has been measured at the first rapid reproducible deflection on a filtered electrogram. This methodology permits considerable latitude for subjective interpretation. The purpose of this study was to assess the timing of the atrial electrogram using the intrinsic deflection of relatively unfiltered electrograms (0.1-4.0 to 1,250 Hz) or the equivalent on filtered recordings. Methods and Results : To do this we studied 70 patients without evidence of atrial or atrioventricular (AV) nodal disease, documenting the difference in timing between the A wave as traditionally measured and as measured at its peak local deflection (A_L) determined from simultaneously recorded filtered and relatively unfiltered electrograms. New ranges based on the A_L were established for timing of intra-atrial and AV nodal conduction intervals. The P-A (41 ± 11 msec) was significantly shorter than the P-A_L (55 ± 12) and the A-H (80 ± 20) was longer than the A_L-H (66 ± 21 msec), both P <0.001. Interobserver differences in measurements were smaller when using the local (A_L) rather than traditional criteria. Conclusions : Conventional measurement of the A deflection provides only a rough estimate of local depolarization of the atrium near the AV node. The criteria proposed in the present article may (1) provide a better estimate of the timing of local depolarization; (2) have application in computerized timing of intervals; and (3) decrease technical problems and subjective error.     

隐性高血压病人中心动脉压及增强指数

目的探讨“隐性高血压”与中心动脉压及动脉硬化的关系。方法采用脉搏波分析仪记录89例临床诊断为血压正常(偶测血压<140/90 mm Hg)及75例高血压(偶测血压≥140/90 mm Hg或正在服用降压药物者)患者的桡动脉脉搏波,经计算机自动转换为相应的中心动脉脉搏波,并分析中心动脉压力及反映全身动脉硬化的增强指数(AIx)。结果小样本人群中,隐性高血压的患病率为15.7%。与血压正常(偶测血压<140/90 mm Hg及白昼动态血压<135/85 mm Hg)组相比,隐性高血压组的血浆总胆固醇及低密度脂蛋白胆固醇浓度、饮酒的比例显著增高;中心动脉收缩压、舒张压、收缩末期压及中心动脉增强压分别增加14.8 mm Hg(CI5.6~24.0 mm Hg)、9.1 mm Hg(CI3.1~15.1 mm Hg)、14.0mm Hg(CI5.8~22.2)及4.2(CI0.6~7.8 mm Hg),增强指数增加11.9%(CI2.8%~20.9%)。虽然隐性高血压组的偶测血压显著低于高血压组,经年龄、性别及身高调整后,两组的白昼动态血压、中心动脉收缩压、舒张压、增强压及增强指数均无显著差异。结论隐性高血压患者的中心动脉压力及增强指数升高,提示动脉顺应性下降,动脉硬化。这些血液动力学的改变可能增加心血管病危险,对其进行评价有助于偶测血压正常者的危险分层。     

Decrease in bispectral index prior to cardiovascular collapse during Caesarean sections

We report a case of significant reduction in bispectral index (BIS) associated with suspected amniotic fluid embolism (AFE) that occurred prior to change in haemodynamic variables. The patient was a 29‐year‐old nulliparous, who was admitted for Caesarean section under general anaesthesia in the 33rd week of pregnancy. After the baby was born, the BIS value suddenly decreased to 0, with suppression ratio of 100. One minute later, saturation decreased abruptly to 85%, end‐tidal carbon dioxide (EtCO₂) decreased to 5 mmHg, peak inspiratory pressure increased to 35 cm H₂O, and non‐invasive blood pressure (BP) failed to obtain a reading. After administration of vasoactive drugs, the systolic BP was maintained at 100 mmHg or higher, the BIS value rose to 10–20, and the EtCO₂ increased to 24–33 mmHg. In this case, the BIS monitoring may provide an earlier warning of impending cardiovascular collapse in the case of AFE.     

Increased Range of Motion and Decreased Strength of the Thumb in Massage Practitioners with Thumb Pain

The purpose of this study was to compare the range of motion (ROM) and strength of the metacarpophalangeal (MP) and interphalangeal (IP) joints among massage practitioners with and without thumb pain and control subjects. Sixteen massage practitioners with thumb pain, 16 practitioners without thumb pain, and 16 control subjects participated in this study. ROM of flexion, extension, and abduction in the MP joint; ROM of flexion and extension in the IP joint of the thumb; strength of the flexor pollicis brevis (FPB), extensor pollicis brevis (EPB), abductor pollicis brevis, flexor pollicis longus (FPL), and extensor pollicis longus measured in all subjects. ROM of extension and abduction in the MP joint were significantly increased in massage practitioners with and without thumb pain compared with control subjects. ROM of extension in the IP joint was significantly increased in massage practitioners with thumb pain compared with those without thumb pain. The strength of the EPB and FPL muscle was significantly decreased in massage practitioners with thumb pain compared with those without thumb pain and control subjects, respectively. In addition, there was significantly increased EPB/FPB strength in massage practitioners without thumb pain compared to those with thumb pain and control subjects.     

经皮肾镜取石术的研究现状及并发症防治策略

回顾分析了近几年有关经皮肾镜取石术(PCNL)的文献,对其在通道大小,体位摆置,定位方法,碎石方式等方面不同选择的优劣进行了总结和评价,同时从导致PCNL并发症的原因出发,探讨其防治策略的有效性。