Epsilon‐Like Electrocardiographic Pattern in a Patient with Brugada Syndrome

Both Brugada syndrome (BrS) and arrhythmogenic right ventricle dysplasia/cardiomyopathy (ARVD/C) can cause repolarization abnormalities in right precordial leads and predispose to sudden cardiac death (SCD) due to ventricular arrhythmias. Although there is controversy over whether BrS is distinct from ARVD/C, it is believed that both are different clinical entities with respect to both the clinical presentation and the genetic predisposition. The coexistence of these two relatively rare clinical entities is also reported, but, some hypothesized that it is more possible that disease of the right ventricular muscle might accentuate the Brugada electrocardiographic pattern. In clinic practice, there may be cases where the dividing line is not so clear. We report a 33‐year‐old male presenting with recurrent syncope, who has a peculiar pattern of coved‐type ST‐segment elevation (ST‐SE) with epsilon‐like wave in right precordial leads.     

Prediction of extubation outcome: a randomised, controlled trial with automatic tube compensation vs. pressure support ventilation

Introduction  

Tolerance of a spontaneous breathing trial is an evidence-based strategy to predict successful weaning from mechanical ventilation. Some patients may not tolerate the trial because of the respiratory load imposed by the endotracheal tube, so varying levels of respiratory support are widely used during the trial. Automatic tube compensation (ATC), specifically developed to overcome the imposed work of breathing because of artificial airways, appears ideally suited for the weaning process. We further evaluated the use of ATC in this setting.     

Vascular endothelial growth factor (VEGF) response to dental trauma: a preliminary study in rats

Abstract –  Background : Successful periodontal healing and pulpal revascularization after trauma may be age-related. After dental trauma, age-related impaired angiogenesis may play a role in the revascularization rate during the healing process. Objectives : The aim of the present preliminary in vivo study was to detect the presence of vascular endothelial growth factor (VEGF) in venous and whole blood from the alveolar socket immediately post-tooth extraction. Materials and methods : The study consisted of 16 Wistar rats divided into two groups: eight young (6 weeks) with incomplete root development and open apices, and eight adult (4 months) with complete root development. One first mandibular molar was extracted and whole blood from the alveolar socket collected immediately and at 5, 10 and 15 min post-extraction. Venous blood samples were collected immediately pre- and 24-h post-extraction. All samples were tested for VEGF. Results : Increased VEGF levels were found in the venous blood 24 h post-extraction, with a significant difference in the young rats ( P  < 0.05). The increased VEGF serum concentration in the young rats was significantly higher (12.2 ± 4.6 pg ml⁻¹, median 12.1) than that in the adult rats (7.6 ± 3.8 pg ml⁻¹, median 6.7) ( P  = 0.037). VEGF at the extraction site was not significantly different at 15 min post-extraction. At the extraction site, there was no significant difference of VEGF concentration between young and adult rats. Conclusions : Young rats had higher post-extraction serum VEGF levels, which may contribute to the healing process after dental trauma.     

Three-Dimensional Printing Assisted Preoperative Surgical Planning for Cerebral Arteriovenous Malformation

ObjectiveThe aim of this study to investigate the benefits of patient-based 3-dimensional (3D) cerebral arteriovenous malformation (AVM) models for preoperative surgical planning and education. MethodsFifteen patients were operated on for AVMs between 2015 and 2019 with patient-based 3D models. Ten patients’ preoperative cranial angiogram screenings were evaluated preoperatively or perioperatively via patient-based 3D models. Two patients needed emergent surgical intervention; their models were solely designed based on their AVMs and used during the operation. However, the other patients who underwent elective surgery had the modeling starting from the skull base. These models were used both preoperatively and perioperatively. The benefits of patients arising from treatment with these models were evaluated via patient files and radiological data. ResultsFifteen patients (10 males and five females) between 16 and 66 years underwent surgery. The mean age of the patients was 40.0±14.72. The most frequent symptom patients observed were headaches. Four patients had intracranial bleeding; the symptom of admission was a loss of consciousness. Two patients (13.3%) belonged to Spetzler-Martin (SM) grade I, four (26.7%) belonged to SM grade II, eight (53.3%) belonged to SM grade III, and one (6.7%) belonged to SM grade IV. The mean operation duration was 3.44±0.47 hours. Three patients (20%) developed transient neurologic deficits postoperatively, whereas three other patients died (20%). ConclusionSeveral technological innovations have emerged in recent years to reduce undesired outcomes and support the surgical team. For example, 3D models have been employed in various surgical procedures in the last decade. The routine usage of patient-based 3D models will not only support better surgical planning and practice, but it will also be useful in educating assistants and explaining the situation to the patient as well.     

Effects of adrenalectomy and corticosterone replacement on the hypothalamic–pituitary response to neural stimuli

In this study we examined whether circulating glucocorticoids (GC) have a permissive facilitatory role in the hypothalamo–pituitary–adrenal (HPA) axis responses to neural or metabolic stimuli. In control sham operated rats the exposure to photic or acoustic neural stimuli and to either cytoglucopenia induced by 2-deoxyglucose (2-DG) or to hypoglycemia induced by insulin caused a significant 5-fold increase in serum ACTH as compared to basal non-stress levels. In adrenalectomized (Adex) rats tested under basal conditions at 4, 7 and 14 days post-Adex, serum ACTH gradually increased in a time-dependent manner, Also, at 4 days post-Adex the median eminence (ME) content of CRH-41 was markedly depleted but gradually recovered to control levels at 7 and 14 days post-Adex. The serum ACTH responses to both photic and acoustic stimuli tested at the same time points were completely inhibited. In contrast, administration of either insulin or 2-DG caused a marked increase in serum ACTH levels. In Adex rats, implanted with low corticosterone (CS) pellets which produced basal serum levels of CS, ME CRH-41 levels and serum ACTH were similar to control sham operated animals. Exposure to both neural stimuli resulted in a significant depletion in CRH-41 ME content and in a rise in serum ACTH as in the respective controls. On the other hand in rats implanted with high CS pellets which produced stress typical CS serum levels, the ME CRH-41 and serum ACTH responses to both stimuli were markedly inhibited. These results suggest that (1) the HPA axis responses to neural stimuli but not to metabolic stimuli require the presence of circulating GC (2), the lack of ACTH response to neural stimuli in Adex rats may not be related to the low CRH-41 ME content.     

Development of a consumer survey for behavioral health services.

A consumer survey was designed to assess the quality of mental health and substance abuse services and evaluate insurance plans that provide such services. This paper describes the development of the Consumer Assessment of Behavioral Health Services instrument, which began with a review of existing consumer satisfaction surveys and input from several groups working toward development of nationally standardized satisfaction instruments. Consumer focus groups were used to ensure that all the important domains of quality were included, and group members were interviewed to ensure that all items on the instrument were understandable. Results of a pilot test conducted with 160 consumers, 82 enrolled in Medicaid plans and 78 in commercial plans, suggested that the survey was able to distinguish between the two groups in terms of evaluations of their care and insurance plans. Future efforts will focus on further testing of larger, more diverse samples and on developing scoring and reporting formats for the survey that will be useful to consumers and purchasers in choosing behavioral health services and plans.     

Atrioventricular plane motion during dobutamine-atropine stress echocardiography: the biphasic response in healthy subjects revisited.

This study was undertaken to establish normal values for the systolic atrioventricular plane motion (AVPM) from base to apex during dobutamine-atropine stress echocardiography (DASE) and to compare them with those of patients with coronary artery disease. The AVPM was measured at baseline, low dose and peak dobutamine-atropine infusion in 20 patients referred for coronary angiography and in 20 control subjects. Atrioventricular plane motion was measured at the posterior, anterior, septal, and lateral positions of the mitral annulus in the apical 2- and 4-chamber views by an observer blinded to clinical and angiographic data. In healthy subjects undergoing DASE, AVPM initially increased but subsequently decreased to below baseline values at peak stress. Atrioventricular plane motion at any stage and the changes therein during DASE were within the normal reference interval in the majority of patients. In conclusion, AVPM decreased during DASE in healthy subjects and was not a sensitive marker of coronary artery disease.     

Dyspareunia, back pain and chronic pelvic pain: the importance of this pain complex in gynecological practice and its relation with grandmultiparity and pelvic relaxation.

The aim of this study was to evaluate the correlation between severe dyspareunia, back pain, dysmenorrhea and chronic pelvic pain (CPP), and the relationship of each pain type with various sociodemographic factors, pelvic relaxation and high parity. Two hundred thirty-five premenstrual individuals were included. The prevalences of CPP, deep dyspareunia, dysmenorrhea and back pain were found to be 80.4, 30.6, 57.0 and 57.4%, respectively. Marriage duration was longer (p < 0. 01) and also parity was higher (p < 0.0001) in CPP cases than controls. However, none of the demographic factors had a significant correlation with dyspareunia, back pain and dysmenorrhea. CPP was correlated with both back pain (r = 0.18, p < 0.005) and dyspareunia (r = 0.19, p < 0.004). However, there was no correlation between back pain and dyspareunia. On the other hand, dysmenorrhea did not show a correlation with any pain types. While grandmultiparity had a significant effect on CPP (p < 0.0001), it did not have a significant effect on other pain types in a MANOVA model. CPP is very often seen in our population and it often makes a pain complex with dyspareunia and back pain. The prevention of grandmultiparity is important to decrease the incidence of CPP.     

C-reactive protein is a significant predictor of vascular calcification of both aorta and hand arteries

Although evidence has accumulated indicating a close relationship between inflammation and atherosclerosis, the relationship between inflammation and vascular calcification in patients with chronic renal failure is unclear. In the present study, the relationship between C-reactive protein (CRP) and vascular calcification in dialysis patients was examined. Vascular calcification of the aorta and hand arteries of 512 hemodialysis patients without significant infection (age 58.8 +/- 10.1 y; 305 men, 207 women) were examined by roentgenography of the lateral abdomen and hands, respectively. Patients with a mean CRP level greater than 1.0 mg/L (n = 254) were older than those with a CRP level less than or equal to 1.0 mg/L (n = 258) and had a longer duration of dialysis, lower serum albumin level, and higher phosphate level ( P < .01, P < .05, P < .001, and P < .01, respectively). Prevalence of vascular calcification of aorta and hand arteries in the former group was significantly higher than in the latter (65.0% versus 43.8% for aorta, P < .0001; and 25.0% versus 14.7% for hand arteries, P < .01). In a multivariate logistic regression analysis adjusted for age, hemodialysis duration, sex, levels of calcium and phosphate, and presence of diabetes, CRP level was a significant predictor for the presence of aortic calcification (odds ratio for highest versus lowest quartile, 2.669; 95% confidence interval, 1.539-5.421, P = .0010) and of calcification of hand arteries (odds ratio, 2.243; 95% confidence interval, 1.039-4.841; P = .0395). In conclusion, the present study shows that increased levels of CRP are significantly associated with the presence of vascular calcification in both aorta and hand arteries (ie, with both atheromatous and medial forms of calcification), indicating evidence for a relationship between inflammation and vascular calcification in hemodialysis patients.