Prevalence and clinical relevance of the morphological substrate of ventricular arrhythmias in patients without known cardiac conditions detected by cardiovascular MR

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.     

Using a clinic based creativity initiative to reduce HIV related stigma at the Infectious Diseases Institute, Mulago National Referral Hospital, Uganda

Background

Stigma has been associated with chronic health conditions such as HIV/AIDS, leprosy, tuberculosis, Mental illness and Epilepsy. Different forms of stigma have been identified: enacted stigma, perceived stigma, and self stigma. Stigma is increasingly regarded as a key driver of the HIV/AIDS epidemic and has a major impact on public health interventions.

Objectives

The initiative was to provide activities in the clinic while patients waited to be seen by healthcare professionals. It was envisaged this would contribute to reduction of clinic based stigma felt by clients.

Methods

This was a repeated cross-sectional survey (October–November 2005 and March–April 2007) that was conducted at the Infectious Diseases Institute clinic (IDC) at Mulago, the national referral hospital in Uganda. We utilized quantitative (survey) and qualitative (key informants, focus group discussions) methods to collect the data. Data were collected on stigma before the creativity initiative intervention was implemented, and a second phase survey was conducted to assess effectiveness of the interventions.

Results

Clients who attended the IDC before the creativity intervention were about twice as likely to fear catching an infection as those who came after the intervention. The proportion that had fears to be seen by a friend or relative at the clinic decreased. Thus during the implementation of the Creativity intervention, HIV related stigma was reduced in this clinic setting.

Conclusions

The creativity intervention helped to build self esteem and improved communication among those attending the clinic; there was observed ambiance at the clinic and clients became empowered, with creative, communication and networking skills. Improved knowledge and communication are key in addressing self stigma among HIV positive individuals.     

高龄冠心病患者经皮冠状动脉介入治疗与冠状动脉旁路移植术的比较

目的比较高龄患者经皮冠状动脉介入治疗（PCI）支架术与冠状动脉旁路移植术（CABG）对住院与临床随访结果的影响。方法212例高龄（年龄〉75岁）患者,根据血运重建方式的不同将其分为PCI支架组149例和CABG组63例,记录其临床与造影特征、血运重建情况和住院临床结果等资料,并进行临床随访。主要观察终点为住院与随访主要不良心脑血管事件（MACCE）。所有资料采用SPSS13．0软件进行统计分析,以P〈0．05为差异有统计学意义。结果与CABG组相比,PCI组的院内MACCE发生率较低（2．0％vs12．7％,χ2=10．3,P〈0．05）;院内死亡率较低（2．O％V87．9％,χ^2=4．3,P〈0．05）。多因素Logistic回归分析显示,CABG组院内MACCE发生的风险显著高于PCI组（P〈0．05）。平均随访19个月（中位时间579d）显示,2组MACCE（17．2％VS13．7％,P=0．57）、再次血运重建（P〉0．05）、卒中发生率均无统计学意义（P〉0．05）。多因素Cox回归分析表明,与CABG组相比,PCI组随访期间MACCE风险较低（P〈0．05）。结论与CABG相比,高龄冠心病患者PCI术后的院内及随访主要不良心脑血管事件发生率较低。     

家兔动脉成形术后血管内膜增殖与普伐他汀联合阿司匹林的干预效应

目的:观察普伐他汀、阿司匹林联用对家兔颈动脉血管成形术后内膜增殖进展的影响及其作用机制。方法:实验于2002-03/12在北京中医药大学教育部中医内科学重点学科实验室完成。雄性日本大耳白兔30只,体质量1.8～2.0kg,动物适应性喂养1周后随机数字表法分为正常对照组(n=9)、假手术组(n=6)、模型组(n=9)、治疗组(n=6)。模型组和治疗组动物氯胺酮、速眠新混合肌注麻醉,沿气管正中切开皮肤,剥离颈总动脉,给予电刺激。术后第2天开始饲喂高脂饲料(胆固醇:0.7%,猪油:3%,普通饲料96.3%);正常对照组无任何干预措施;假手术组仅剥离颈总动脉,不做电刺激,喂高脂饲料;动物连续喂养8周后超声评价颈总动脉,根据B超选择颈总动脉有斑块或血流明显改变者作颈总动脉球囊扩张术。正常对照组、模型组、假手术组喂普通饲料,治疗组喂普伐他汀与阿司匹林含药饲料(普伐他汀5.046mg/kg,阿司匹林2.268g/kg),4周后测血脂和C-反应蛋白浓度、血清一氧化氮及转化生长因子β水平,观察颈动脉组织病理形态学改变,半定量分析增生内膜中胶原含量的变化,免疫组织化学方法分析增生内膜中巨噬细胞和平滑肌细胞阳性百分率。结果:纳入大耳白兔30只,正常对照组中途死亡1只,死因为牙齿畸型影响进食;模型组1只因电刺激8周时超声评价颈动脉未形成斑块及血流无明显改变而剔出实验,进入分析28只。与模型组比,普伐他汀与阿司匹林联用4周后,治疗组胆固醇及三酰甘油水平明显下降[(4.12±2.30),(0.74±0.17)mmol/L;(0.47±0.27),(0.39±0.14)mmol/L;P<0.05],血清C-反应蛋白水平和转化生长因子β水平均降低[(0.86±0.27),(0.57±0.30)mg/L;(3.45±0.77),(3.23±0.34)ng/L;P<0.05],一氧化氮水平升高[(41.79±35.78),(90.14±32.54)mmol/L;P<0.05],动脉内膜增殖程度明显减轻,管腔狭窄率降低,内中膜厚度及内中膜面积比降低[(71.91±14.90)%,(47.20±18.74)%;(0.41±0.17),(0.26±0.04)mm;1.66±0.63,0.78±0.34;P均<0.05],动脉内膜胶原含量减少(30.92±10.05,21.93±5.81,P<0.01),动脉内膜巨噬细胞阳性百分率降低[(13.94±4.91)%,(7.29±7.28)%,P<0.05],平滑肌细胞含量无明显差异(38.37±5.67,35.79±10.68,P>0.05)。结论:普伐他汀与阿司匹林联用具有抑制内膜增生和减少新生内膜胶原含量的作用,其机制与两药抑制炎症反应、保护内皮功能及抑制细胞外基质生成等有关。     

巢式逆转录-聚合酶链反应扩增人骨形成蛋白2全长cDNA及其真核表达载体的构建

目的:利用巢式逆转录-聚合酶链反应扩增的方法,从肌肉组织中扩增人骨形成蛋白2全长cDNA并构建真核表达载体系统。方法:实验于2003-10/2005-10在苏州大学基因工程教研室和北京大学第三医院骨科实验室完成。提取成人肌肉组织内的总RNA,设计内外两对引物以巢式逆转录-聚合酶链反应扩增方法分两次扩增出人骨形成蛋白2全长1188bp基因,经T-A克隆装入pUCM-T质粒载体内,测序验证后,将克隆质粒以Hind Ⅲ和Xba Ⅰ双酶切后与pcDNA3.0载体相连接,构建真核表达载体系统。结果:利用巢式逆转录-聚合酶链反应扩增方法能从成人肌肉组织内扩增出1188bp的人骨形成蛋白2全长cDNA基因,其测序结果显示与Genebank报道序列完全相符。将扩增序列双酶切后与pcDNA3.0载体相连接,经电泳验证,能构建人骨形成蛋白2全长基因的真核表达系统。结论:巢式逆转录-聚合酶链反应扩增方法能从成人肌肉组织内扩增出人骨形成蛋白2全长cDNA基因,并克隆构建真核表达载体系统,为下一步基因组织工程人工骨实验奠定基础。     

抗癌药物的研究:4-氯苯氧乙酰胺衍生物的合成

Since compounds Ⅲ and Ⅳ possess retinoid-like action and analogues of Ⅰ inhibit some cancer cells ,seventeen derivatives of chlorophenoxy acetamide were synthesized.Of the seven compounds screened ,two exhibit cytostatic activity(1 and　2).Mass spectra showeda　special expulsion of SO2 and CO from the sulfonamide compounds,Nuclear magnetic resonancesplitting patterns of these compounds also showed interesting features.     

腹膜后平滑肌瘤病误诊1例

1病理报告女,45岁,医务工作者.2003-10入我院肿瘤科.自述6 mo前无明显诱因,出现下腹部隐痛,呈进行性加重,疼痛与体位变化无关,但咳嗽、活动时加重,并向腰、骶部放射,伴有乏力、全身不适.无意中自己在腹部触膜到一5 cm×5 cm大小的包块,故要求住院进一步确诊.患病后食纳尚可,二便正常,质量无变化.     

The effects of amyloid-beta on hippocampal glutamatergic receptor and transporter expression

正The leading form of dementia worldwide, Alzheimer 's disease(AD) is a common neurodegenerative disorder.The underlying causes of AD are not well understood, and no current treatments are preventing the onset or delay progression of the disease.Currently, most investigation is directed towards the amyloid-beta(Aβ) and tau pathologies,     

Beyond “patient-provider race matching.” Black midwives clarify a vision for race-concordant care to achieve equity in Black perinatal health: A commentary on “Do Black birthing persons prefer a Black health care provider during birth? Race concordance in birth”

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.