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701.
J Weisser-Thomas VA Ferrari A Lakghomi LM Lickfett G Nickenig HH Schild D Thomas 《The British journal of radiology》2014,87(1038)
Objective
Cardiac MR (CMR) identifies the substrate of ventricular arrhythmia (VA) in cardiomyopathies and coronary heart disease. However, little is known about the value of CMR in patients with VA without previously known cardiac disorders.Methods
76 patients with VA (Lown ≥2) without known cardiac disease after regular diagnostic work-up were studied with CMR, and findings were correlated with electrocardiogram (ECG) and electrophysiological stimulation (EPS). Structural abnormalities matching the VA origin as defined by ECG and/or EPS, or a CMR-detected cardiac condition known to cause arrhythmia were defined as VA substrate. CMR findings were defined as clinically relevant, if resulting in a new diagnosis, change of treatment or additional diagnostic procedure.Results
44/76 patients demonstrated pathological CMR findings. In 24/76 patients, the pathology was detected by CMR and not by echocardiography. CMR-based diagnoses of cardiac disease were established in 20/76 patients, and all were morphological substrates for VA. In seven patients, the location of the CMR finding (scar) directly matched the VA origin. CMR findings resulted in a change of treatment in 21 patients and/or additional diagnostics in 8 patients.Conclusion
Undetected cardiac conditions are frequent causes of VA. This is the first study demonstrating the value of CMR for detection of morphological substrate and/or underlying cardiac disorders in VA patients without known cardiac disease.Advances in knowledge
The high incidence of clinically relevant CMR findings which were not detected during initial diagnostic work-up strongly supports the use of CMR to screen VA patients for underlying heart disease.Although the value of cardiac MR (CMR) for the diagnosis of cardiac diseases such as myocarditis is undisputed, CMR is also predictive of patients at high risk for ventricular arrhythmias (VAs) with conditions such as hypertrophic cardiomyopathy (HCM) and coronary heart disease (CHD).1–3 Recent studies have demonstrated the ability of CMR to identify the anatomical correlate of VA in those patients. This anatomical correlate has been characterized by CMR as a structural abnormality (e.g. fibrosis or peri-infarct region), which may go undetected using other non-invasive imaging modalities.4,5 A number of studies have been undertaken, or are ongoing, to further elucidate the added value of CMR in patients with known cardiac conditions, to improve risk stratification for VA and to optimize therapy.1,6–8 However, little is known to date regarding the added value of CMR for detection of an arrhythmogenic substrate or underlying cardiac condition in patients who present with VAs without known cardiac disease.Thus, the purpose of this study was to investigate the added value of CMR in patients with VAs for detection of underlying heart disease and an arrhythmogenic morphological substrate, and also to investigate the clinical relevance of CMR in those patients with positive findings. 相似文献702.
703.
LE Staniaszek LM Norris DA Kendall DA Barrett V Chapman 《British journal of pharmacology》2010,160(3):669-676
Background and purpose:
ATP-sensitive potassium channels (KATP channels) in beta cells are a major target for insulinotropic drugs. Here, we studied the effects of selected stimulatory and inhibitory pharmacological agents in islets lacking KATP channels.Experimental approach:
We compared insulin secretion (IS) and cytosolic calcium ([Ca2+]c) changes in islets isolated from control mice and mice lacking sulphonylurea receptor1 (SUR1), and thus KATP channels in their beta cells (Sur1KO).Key results:
While similarly increasing [Ca2+]c and IS in controls, agents binding to site A (tolbutamide) or site B (meglitinide) of SUR1 were ineffective in Sur1KO islets. Of two non-selective blockers of potassium channels, quinine was inactive, whereas tetraethylammonium was more active in Sur1KO compared with control islets. Phentolamine, efaroxan and alinidine, three imidazolines binding to KIR6.2 (pore of KATP channels), stimulated control islets, but only phentolamine retained weaker stimulatory effects on [Ca2+]c and IS in Sur1KO islets. Neither KATP channel opener (diazoxide, pinacidil) inhibited Sur1KO islets. Calcium channel blockers (nimodipine, verapamil) or diphenylhydantoin decreased [Ca2+]c and IS in both types of islets, verapamil and diphenylhydantoin being more efficient in Sur1KO islets. Activation of α2-adrenoceptors or dopamine receptors strongly inhibited IS while partially (clonidine > dopamine) lowering [Ca2+]c (control > Sur1KO islets).Conclusions and implications:
Those drugs retaining effects on IS in islets lacking KATP channels, also affected [Ca2+]c, indicating actions on other ionic channels. The greater effects of some inhibitors in Sur1KO than in control islets might be relevant to medical treatment of congenital hyperinsulinism caused by inactivating mutations of KATP channels. 相似文献704.
Noelene K. Jeffers PhD CNM IBCLC Lucinda Canty PhD CNM FACNM Michelle Drew DNP MPH CNM FNP-C FACNM Nikia Grayson DNP MPH MA CNM FNP-C Jamarah Amani LM Ebony Marcelle DNP CNM FACNM Alexis Dunn Amore PhD CNM FACNM FAAN 《分娩》2023,50(2):267-272
Racial concordance has been identified as a potential strategy to improve the perinatal health of Black women and birthing people by mitigating implicit bias and improving mutual trust, healthy communication, and satisfaction. In a recent article published in BIRTH: Issues in Perinatal Care, Bogdan-Lovis et al. surveyed 200 Black women to determine whether they possessed a race and gender practitioner preference for their birth practitioner and examined whether race and gender concordance was associated with greater birth satisfaction and perceived respect, trust, practitioner competence, empathy, and use of inclusive communication. In this commentary, written by a group of Black midwives, we respond to the study and offer a vision for race-concordant care that encompasses cultural safety provided in a community-based setting. 相似文献
705.