中医药治疗糖尿病视网膜病变回眸研究

糖尿病视网膜病变的病因病机以气阴亏虚为本,气滞血瘀为标,并临床实践中辨病与辨证相结合,眼底检查与中医脉证互参进行综合辨证治疗,已成为共识.目前临床辨证分型及组方用药较灵活多变,为此统计举出近10年来使用频率前40位和各功能归类中前6位的中药,并综合归纳了基本辨证分型和组方用药,供实验研究和临床使用参考.     

Is there an overlap between Brugada syndrome and arrhythmogenic right ventricular cardiomyopathy/dysplasia?

The Brugada syndrome is a congenital syndrome displaying an autosomal dominant mode of transmission in patients with a structurally normal heart. The disease has been linked to mutations in SCN5A , a gene located on the short arm of chromosome 3 (p21-24) that encodes for the alpha subunit of the sodium channel. The syndrome is characterized by a dynamic ST-segment elevation (accentuated J wave) in leads V 1 to V 3 of the ECG followed by negative T wave. Right bundle-branch block of varying degrees is observed in some patients. The syndrome is associated with syncope and a relatively high incidence of sudden cardiac death secondary to the development of polymorphic ventricular tachycardia that may degenerate into ventricular fibrillation. An acquired form of the Brugada syndrome is also recognized, caused by a wide variety of drugs and conditions that alter the balance of currents active during the early phases of the action potential. Among patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia, there is a subpopulation with a clinical and electrocardiographic pattern similar to that of the Brugada syndrome. These cases of arrhythmogenic right ventricular cardiomyopathy/dysplasia are thought to represent an early or concealed form of the disease. This review examines the overlap between these 2 syndromes.     

Sustained Bundle Branch Reentry in a Patient with Hypertrophic Cardiomyopathy and Nondilated Left Ventricle

Ventricular tachycardia is a well-known complication in patients withhypertrophic cardiomyopathy. We report the case of a patient withhypertrophic cardiomyo<->pathy with easily inducible monomorphic ventriculartachycardia. Electrophysiology study demonstrated that bundle branch reentrywas the mechanism of the tachycardia. The tachycardia was renderednon-inducible by radiofrequency ablation of the right bundle branch.     

Presence of pancreatic glucagon in the portal plasma of human neonates. Differences in the insulin and glucagon responses to glucose between normal infants and infants from diabetic mothers

Summary Human neonates have been studied during the first hours of life. Blood glucose, portal plasma insulin and glucagon have been determined both at regular intervals up to 24 h after birth and during an intravenous glucose load performed at the 24th h. A material presenting the immunological characteristics of pancreatic glucagon has been found in the portal plasma of both normal infants and infants from diabetic mothers (IDM). The intravenous glucose load did not suppress plasma glucagon in the normal neonates nor in the IDM. Higher portal plasma glucagon values were observed in the late phase of the intravenous glucose load in normal neonates compared to IDM. Portal plasma insulin has been found higher in IDM both at the 24th h of life and during the early phase of the intravenous glucose tolerance test. The hypothesis is put forward that the behaviour difference in glucagon secretion might be a consequence of the relative nyperinsulinism of IDM with insulin facilitating the entry of glucose into the cell thus permitting a more effective glucagon suppression.Chargé de Recherches du Fonds National de la Recherche scientifique, Belgium.     

1例疑似心肌炎的儿童扩张型心肌病外科诊治报告

【摘要】目的：报告1例疑似心肌炎的儿童扩张型心肌病（dilated cardiomyopathy，DCM）在体外膜肺氧合（Extracorporeal membrane oxygenation，ECMO）辅助下成功原位心脏移植的案例并分享诊治经验。方法：对2019年武汉协和医院心外科收治的1例诊断为扩张型心肌病在ECMO辅助下行原位心脏移植的患儿的临床资料进行分析，查阅文献分析病因诊断及诊治经过。结果：7岁儿童因“咳嗽21天，加重伴心慌、呼吸困难10天”，由外院带ECMO和气管插管转入我院。患儿内科药物治疗及ECMO辅助14天后心功能仍差，结合病史、诊治经过及检查资料考虑扩张型心肌病，行原位心脏移植后顺利撤除ECMO，术后心肌病检结果支持诊断。结论：病因诊断对治疗策略的选择至关重要。目前国内儿童DCM以心脏移植为主要治疗手段。     

Clinical usefulness of electrophysiologic testing in patients with ventricular tachycardia and chronic chagasic cardiomyopathy treated with amiodarone or sotalol

INTRODUCTION: This study assessed the role of electrophysiologic testing to identify therapeutic strategies for the treatment of patients with sustained ventricular tachycardia (VT) and chronic chagasic cardiomyopathy treated with amiodarone or sotalol. METHODS AND RESULTS: One hundred fifteen patients [69 men (60%); mean age 52 +/- 10 years] with chagasic cardiomyopathy presenting with symptomatic VT were studied after loading with Class III antiarrhythmic drugs; 78 had a history of sustained VT, and 37 with symptomatic nonsustained VT had sustained VT induced at baseline electrophysiologic study. All but 12 patients also underwent baseline electrophysiologic study. Mean left ventricular ejection fraction was 0.49 +/- 0.14. Based on results of electrophysiologic study after loading with Class III drugs, patients were divided into three groups: group 1 (n = 23) had no sustained VT induced; group 2 (n = 45) had only tolerated sustained VT induced; and group 3 (n = 47) had hemodynamically unstable sustained VT induced. After a mean follow-up of 52 +/- 32 months, total mortality rate was 39.1%; it was significantly higher in group 3 than in groups 2 and 1 [69%, 22.2%, and 26%, respectively, P < 0.0001, hazard ratio (HR) 10.4, 95% confidence interval (CI) 3.8, 21.8]. There was no significant difference in total mortality rate between groups 1 and 2 (P = 0.40, HR 1.5, 95% CI 0.75, 4.58). Cardiac mortality and sudden cardiac death rates also were higher in group 3 patients. CONCLUSION: In patients with chagasic cardiomyopathy and sustained VT, electrophysiologic testing can predict long-term efficacy of Class III antiarrhythmic drugs. This may help in the selection of patients for implantable cardioverter defibrillator therapy.     

The additive prognostic value of restrictive pattern and dipyridamole-induced contractile reserve in idiopathic dilated cardiomyopathy

BACKGROUND: Diastolic dysfunction and lack of contractile reserve are unfavorable prognostic predictors in patients with dilated cardiomyopathy (DCM). AIMS: This study aims to assess whether diastolic dysfunction and lack of dipyridamole-induced contractile reserve were additive predictors of poor outcome in patients with DCM. METHODS: A total of 116 patients with DCM and ejection fraction (EF<35%) were studied by dipyridamole echo (0.84 mg/kg over 10 min). At rest, a restrictive filling pattern was defined as: E/A ratio >2 and an E-wave deceleration time of <140 ms on transmitral flow velocity profile. RESULTS: Rest wall motion score index (WMSI) was 2.2+/-0.3 and decreased to 1.9+/-0.41 after dipyridamole (p<0.001). During follow-up (median 26.5 months), 22 cardiac deaths occurred. At multivariate analysis, dipyridamole-induced contractile reserve yielded significant incremental prognostic value (RR=0.275, p<0.006) over NYHA class (RR=1.971, p<0.03), angiotensin-converting enzyme inhibitor therapy (RR=0.173, p<0.001), and left ventricular end-diastolic diameter (RR=1.131, p<0.001). The worst prognostic combination was the presence of restrictive pattern at rest and the absence of contractile reserve (deltaWMSI<0.15). CONCLUSION: In patients with DCM, the ominous combination of restrictive transmitral flow pattern and lack of contractile reserve during dipyridamole stress predicts an unfavourable outcome.     

Assessment of the Systolic Left Ventricular Myocardial Velocity Profile and Gradient Using Tissue Doppler Imaging in Patients with Hypertrophic Cardiomyopathy

To determine the systolic characteristics of the hypertrophied myocardium in patients with hypertrophic cardiomyopathy (HCM), we evaluated the left ventricular [left ventricle (LV)] myocardial velocity profile (MVP) and gradient obtained from tissue Doppler imaging (TDI). Transmural wall-motion velocities in the ventricular septum and LV posterior wall were recorded in 12 patients with asymmetric septal hypertrophy and 12 healthy volunteers, and their profiles and gradients were determined. The maximum systolic myocardial velocity gradient in the ventricular septum was significantly lower in the HCM group than in the control group (0.88 ± 0.35 versus 2.24 ± 0.41; P < 0.001), whereas the gradient in the LV posterior wall was only slightly lower in the HCM group than in the control group (2.69 ± 0.82 versus 3.45 ± 0.96). In the control group, the MVPs in the ventricular septum and LV posterior wall were closely linear, suggesting that the transmural velocity is uniform during systole. MVPs in the ventricular septum and LV posterior wall in the HCM group also were closely linear, whereas the distribution of velocities in the ventricular septum was fairly dispersed compared with the control group. The myocardial velocity gradient on the right ventricular side of the ventricular septum decreased or disappeared in the patients with HCM, suggesting a nonuniform distribution of velocities. In conclusion, the MVP and gradient obtained from TDI may represent new indices for evaluating regional LV contractile abnormality in patients with HCM.     

Reduced transcapillary escape of albumin during acute blood pressure-lowering in Type 1 (insulin-dependent) diabetic patients with nephropathy

Summary The effect of acute arterial blood pressure lowering upon albumin extravasation was studied in 10 patients with nephropathy and retinopathy due to long-standing Type 1 (insulin-dependent) diabetes. The following variables were measured: transcapillary escape rate of albumin (initial disappearance of intravenously injected ¹²⁵I-labelled human serum albumin), and urinary albumin excretion rate (radial immuno-diffusion). The study was performed twice within 2 weeks, with the patients receiving an intravenous injection of either clonidine (225 g) or saline (0.154 mmol/l). The clonidine injection induced the following changes: arterial blood pressure decreased from 134/87 to 107/73 mmHg (p<0.01), transcapillary escape rate of albumin declined from 8.1 to 6.7% of the intravascular mass of albumin/h (p<0.01), albuminuria diminished from 1434 to 815 g/min (p<0.01), and plasma volume raised slightly from 2916 to 2995ml (p<0.05). Our findings demonstrate that the enhanced albumin passage through the wall of the microvasculature characteristically found in long-term Type 1 diabetic patients with clinical microangiopathy is pressure-dependent to a large extent. This may be due to elevated hydrostatic pressure in the microcirculation.