Treatment of severe peptic ulcer haemorrhage with the heat probe

From September to December 1986, 30 cases of persistent upper gastrointestinal bleeding were collected and treated, via the endoscope, with a heat probe. All cases had either gastric or duodenal ulcers. Ten cases were in shock. After treatment, all bleeding episodes initially stopped, but six cases (20%) re-bled. Five cases received repeat heat probe therapy and did not re-bleed thereafter. Thus the ultimate success rate was 96.7% (29/30). Twenty of 21 ulcers (94.3%) were found to be healed with scars 2 months after therapy. During therapy and the follow-up period, only one complication occurred and this was a mild aspiration pneumonia. The heat probe is an ideal haemostatic device for severe non-variceal upper gastrointestinal bleeding.     

DEFECTIVE SPONTANEOUS AND BACTERIAL LIPOPOLYSACCHARIDE-STIMULATED PRODUCTION OF INTERLEUKIN-1 RECEPTOR ANTAGONIST BY POLYMORPHONUCLEAR NEUTROPHILS OF PATIENTS WITH ACTIVE SYSTEMIC LUPUS ERYTHEMATOSUS

Interleukin-1 receptor antagonist (IL-lra) binds competitivelyto IL-1 receptors but does not transduce the signal which blocksthe biological activities induced by IL-1. In this study, polymorphonuclearneutrophils (PMN) and mononuclear cells (MNC from the patientswith active systemic lupus erythematosus (SLE) (n = 11), inactiveSLE (n = 13) and normal individuals (n = 13) were compared forthe IL-lra producing capacity of these cells. PMN and MNC ata concentration of 1 x 10⁶ cells/ml were incubated with mediumalone (spontaneous) or stimulated with lipopolysaccharide (LPS,100 ng/ml) for 24 h. The IL-lra concentration in the supernatantswas quantified by ELISA method. Both spontaneous and LPS-stimulatedproduction of IL-lra by PMN, but not by MNC, of active SLE weresignificantly lower than that of inactive SLE or normal groups.Prednisolone (1 and 5 µg/ml) did not change the productionof IL-lra by normal PMN either spontaneously or LPS-stimulationin in vitro study. Moreover, the IL-lra producing capacity ofPMN in seven active SLE on admission and after intensive immunosupprcssivetreatment was measured. These results suggest that the defectiveIL-lra production by SLE-PMN is relevant to disease activityand may be regarded as a new indicator of disease activity inpatients with active SLE. KEY WORDS: Interleukin-1 receptor antagonist, Polymorphonuclear neutrophil, Systemic lupus erythematosus, Bacterial lipopolysaccharide     

Coronary Blood Flow Produced by Muscle Contractions Induced by Intracardiac Electrical CPR during Ventricular Fibrillation

It has been reported that transthoracic electrical cardiopulmonary resuscitation (ECPR) generates coronary perfusion pressures (CPP) similar to manual chest compressions (MCC). We hypothesized that intracardiac ECPR produces similar CPP.
Methods: ECPR pulse train protocols were applied for 20 seconds in a porcine model following 10 seconds of ventricular fibrillation (VF), using a defibrillator housing electrode and a right ventricular coil (IC-ECPR). Each protocol consisted of 200-ms electrical pulse trains applied at a rate of 100 pulse trains/min. The protocols were grouped in skeletal-based versus cardiac-based stimulation measurements. CPP was recorded and compared to historical MCC values generated by a similar experimental design. CPP > 15 mm Hg at 30 seconds of VF following the application of an IC-ECPR protocol was defined as successful.
Results: Mean CPP for all intracardiac ECPR pulse train protocols at 30 seconds of VF was 14.8 ± 3.8 mm Hg (n = 39). Mean CPP in seven successful skeletal-based IC-ECPR protocols was 19.4 ± 3.2 mm Hg, and mean CPP in 10 successful cardiac-based IC-ECPR protocols was 17.4 ± 2.1 mm Hg. Reported CPP for 15 MCC experiments at 30 seconds of VF was 22.9 ± 9.4 mm Hg (P = 0.35 compared to skeletal-based IC-ECPR, P = 0.08 compared to cardiac-based IC-ECPR).
Conclusions: Intracardiac applied electrical CPR produced observable skeletal muscle contractions, measurable pressure pulses, and coronary perfusion pressures similar to MCC during a brief episode of untreated VF.     

Stromelysin-1 promoter 5A/6A polymorphism is an independent genetic prognostic risk factor and interacts with smoking cessation after index premature myocardial infarction

OBJECTIVE: To evaluate the prognostic roles of multiple polymorphisms and smoking cessation for premature myocardial infarction (MI). METHODS: We studied 170 patients with MI onset before the age of 45 years (range 27-45 years, 84% men) and analyzed the traditional risk factors and several candidate genes' associations with their subsequent coronary events. RESULTS: Follow-up data were available for a total of 162 individuals (95.3%) with the other 38 individuals (4.7%) being lost-to-follow-up premature MI patients. During a mean period of 4.43 years' follow-up, diabetes mellitus (DM), hypertension, hypercholesterolemia and Killip's status > or =II were more frequent among patients with subsequent cardiac events (all P-values <0.05). The frequency of 5A allele of stromelysin-1 gene was significantly higher among event group (P = 0.01). Smoking cessation after MI, use of beta-blocker or angiotensin-converting enzyme inhibitor (ACEI) could improve outcome (all P-values <0.05). After multivariate analysis, we found that DM was an independent risk factor for survival [Hazard ratio (HR) 2.45, P = 0.01]. Successful smoking cessation and therapy with ACEI could have a protective effect (HR 0.33 and 0.09, P = 0.01 and <0.01, respectively). The stromelysin-1 5A gene polymorphism was also an independent survival predictor (HR 2.51, P = 0.03). In addition, smoking cessation could significantly modify the risk, especially among patients with 5A allele polymorphism (HR 6.75 vs. 1.50). CONCLUSION: We thus conclude that the stromelysin-1 gene polymorphism alone or in combination with smoking cessation can influence the prognosis after index premature MI.     

Conduction Properties of the Crista Terminalis in Patients with Typical Atrial Flutter: Basis for a Line of Block in the Reentrant Circuit

Conduction Properties of the Crista Terminalis . Introduction: Previous mapping studies in patients with typical atrial flutter have demonstrated the crista terminalis to he a posterior harrier of the reentrant circuit forming a line of block. However, the functional role of the crista terminalis in patients with or without a history of atrial flutter is not well known. The aim of this study was to determine whether the conduction properties of the crista terminalis are different between patients with and those without a history of atrial flutter. Methods and Results: The study population consisted of 12 patients with clinically documented atrial flutter (group 1) and 12 patients with paroxysmal supraventricular tachycardia as well as induced atrial flutter (group 2). A 7-French, 20-pole, deflectable Halo catheter was positioned around the tricuspid annulus. A 7-French, 20-pole Crista catheter was placed along the crista terminalis identified by the recording of double potentials with opposite activation sequences during typical atrial flutter. After sinus rhythm was restored, pacing from the low posterior right atrium near the crista terminalis was performed at multiple cycle length to 2:1 atrial capture. No double potentials were recorded along the crista terminalis during sinus rhythm in both groups. In group 1, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 638 ± 119 msec. After infusion of propranolol, it was prolonged to 832 ± 93 msec without change of the interdeflection intervals of double potentials. In group 2, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 214 ± 23 msec. After infusion of procainamide, it was prolonged to 306 ± 36 msec with increase of interdeflection interval of double potentials. Conclusion: The crista terminalis forms a line of transverse conduction block during typical atrial flutter. Poor transverse conduction property in the crista terminalis may be the requisite substrate for clinical occurrence of typical atrial flutter.     

爪蟾视觉发育过程中抑制性GABAa受体功能的变化

目的 :阐明从幼年 (变态脱尾后 2～ 12周 )到成年 (变态脱尾后 5～ 10月 )爪蟾的视顶盖神经元突触受体变化。 方法 :盲法脑片全细胞电压钳技术。结果 :成年视顶盖神经元的微抑制性突触后电流 (mIPSCs)的发放频率 (Hz)和平均振幅 (pA)分别为 2 .6 5± 0 .6 9和 9.82± 1.30 ,而幼年的分别为 0 .6 8± 0 .2 3和 15 .36± 2 .4 0 ,其中成年动物的mIPSCs的频率是幼年频率的 3.90倍 ;乙酰胆碱受体 (nAChR)激动剂carbachol均可使幼年及成年的mIPSCs频率增加 ,增强效率有所不同 ,幼年增加至对照组的 192 .0 % ,而成年组仅为 14 6 .2 %。 结论 :随着视顶盖神经元的成熟 ,其突触GABAa受体功能也相应增强。     

正常髌股关节在体运动学研究回顾

髌骨轨迹不良被认为是引起髌股疼痛综合征的主要病理生理机制之一。本文回顾迄今已发表的正常髌股关节运动分析结果，介绍正常髌股关节在不同功能活动下的6自由度运动动态特征。髌骨内外移位、翻转、前后移位以及屈曲在不同的功能运动中都存在较为统一的运动模式。然而，不同测量方法限制了研究之间的深入比较。今后广泛运用动态磁共振成像（magnetic resonance imaging,MRI）或/和双平面正交荧光透视成像系统（dual fluoroscopic imaging system，DFIS），规范坐标系的建立或骨性形态参数的定义与使用，并增加实验的样本量，将有助于明确在体髌股关节6自由度运动的特征，完善对髌股关节动态功能的临床评价依据。