Two dimensional echocardiographic evaluation of exercise-induced left and right ventricular asynergy: Correlation with thallium scanning

Adequate real time two dimensional echocardiograms were prospectively obtained before and immediately after graded treadmill exercise testing in 41 of 48 patients who underwent cardiac catheterization for suspected coronary artery disease. Findings were correlated with thallium perfusion scans performed 5 to 10 minutes and 3 hours after the same exercise test. Exercise-induced wall motion abnormalities were detected in 19 of 23 patients with significant coronary artery disease and no prior myocardial infarction as well as in all 5 patients with known previous infarction. Three patients with coronary artery disease experienced new isolated right ventricular asynergy with exercise that would have been missed if only the left ventricle had been evaluated. Exercise-induced thallium perfusion defects showed good correlation with exercise-induced asynergy as detected with echocardiography. Two dimensional echocardiography performed immediately after treadmill stress testing is a feasible and rewarding technique in the evaluation of patients suspected to have coronary artery disease.     

Ventricular arrhythmias and cardiac hemodynamics in patients with myocardial infarction. Comparison of the acute and post-hospitalization phases

Sixty-six patients with myocardial infarction (MI) were studied during the acute hospital phase and during the six months after hospital discharge. The clinical characteristics, location of infarction, and data from right heart catheterization were studied in an attempt to determine what factors were associated with ventricular rhythm disturbance.Those patients with serious ventricular arrhythmias (SVA) in the acute phase of infarction were found to have a significantly greater degree of myocardial dysfunction as measured by pulmonary artery and pulmonary wedge pressure than patients with more normal rhythm (p<.05). Clinical classification of patients and location of infarction were not helpful in predicting SVA during the acute infarction period.Knowledge of hemodynamic data, presence of SVA and clinical characteristics in the acute infarction period were of no value in predicting the occurrence of SVA after hospital discharge. Patients having had an acute diaphragmatic infarction were found to have a higher incidence of SVA after hospital discharge.     

CD39+ regulatory T cells modulate the immune response to carbamazepine in HLA-B*15:02 carriers

The HLA-B*15:02 allele is associated with an increased risk of developing carbamazepine (CBZ)-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Many studies, however, have demonstrated that a large majority of HLA-B*15:02 individuals are unlikely to develop the adverse drug reaction while on CBZ. This phenomenon suggests that other factors that modulate the allergic immune response, such as regulatory T cells (Tregs), might contribute to an uncontrolled immune response in SJS/TEN. Peripheral blood mononuclear cells (PBMCs) from 15 healthy HLA-B*15:02 carriers were isolated to investigate the role of Tregs in controlling the immune response towards CBZ. Recognition of CBZ was assessed using enzyme linked immunosorbent spot (ELISPOT) assay for IFN-γ, and the donor T-cell profiles were quantified by flow cytometry to differentiate CBZ responders from non-responders. As CD39 expression on Tregs promotes immune tolerance, we investigated the mechanisms of Treg suppression using inhibitors targeting the CD39/adenosinergic pathway. PBMCs from seven donors (responders) produced high levels of IFN-γ when re-exposed to CBZ, while eight donors (non-responders) did not. Flow cytometric analysis revealed that non-responders produced significantly higher frequencies of CD4⁺CD25⁺CD127^loCD39⁺FoxP3⁺ Tregs compared to responders. CD39 inhibition using POM-1 inhibitor converted five of the eight non-responders into responders (P < 0.05). Higher frequencies of CD4⁺CD25⁺CD127^loCD39⁺FoxP3⁺ Tregs was correlated with lower production of IFN-γ (P < 0.01). Our data suggest that CD4⁺CD25⁺CD127^loCD39⁺FoxP3⁺ Tregs may play a role in promoting CBZ tolerance in HLA-B*15:02 carriers. The CD39/adenosinergic axis can be a potential target to alleviate the uncontrolled immune response during this adverse drug event.     

三叉神经痛患者微血管减压术后卡马西平戒断反应的临床表现和原因分析

目的：研究三叉神经痛患者微血管减压术后卡马西平戒断反应的发生情况,并对可能的相关因素进行探讨。方法：对90例诊断为原发性三叉神经痛并行微血管减压术的患者手术前、后进行卡马西平血药浓度测定,观察术后临床表现,评估术后卡马西平戒断反应的发生情况,并对患者的一般情况（年龄、性别、病程）,血管压迫情况（部位、程度）,术中及术后情况（手术时间、术后疗效、并发症）,卡马西平服药情况（服药时间、服药剂量、手术前、后卡马西平血药浓度、术后血药浓度降低值）各可能因素进行分析,采用SAS16.2软件包对结果进行χ2或Fisher检验。结果：术后卡马西平戒断反应的发生率为28.9%,戒断反应的症状主要包括失眠、烦躁、手足震颤、幻觉和剧烈头痛。术前有无卡马西平服用史（P=0.0001）、服药剂量（P=0.0277）和术后血药浓度下降多少（P=0.0213）与戒断反应的发生呈显著相关。结论：术前大剂量使用卡马西平和术后血药浓度大幅度下降,是导致发生三叉神经痛患者微血管减压术后出现卡马西平戒断反应的重要因素。     

丛针浅刺结合电针治疗三叉神经痛疗效观察

目的通过观察丛针浅刺结合电针治疗三叉神经痛(trigeminal neuralgia,TN)的临床疗效,明确其与卡马西平相比是否具有优势。方法将符合纳入标准的44例受试者随机分为治疗组24例和对照组20例。治疗组采用丛针浅刺结合2/100 Hz电针治疗;对照组口服卡马西平片治疗。采用视觉模拟量表(VAS)和简要面部疼痛概况量表(BPI-Facial),观察两组受试者治疗前、治疗2周、治疗4周和治疗结束后2个月(随访期)的疼痛变化。结果与治疗前比较,对照组治疗2周和随访期VAS评分、BPI-Facial评分明显减少(P<0.05),治疗组治疗2周、治疗4周和随访期VAS评分、BPI-Facial评分均明显减少(P<0.05)。治疗组治疗2周、治疗4周和随访期VAS评分及BPI-Facial评分低于对照组(P<0.05)。结论丛针浅刺结合电针治疗TN在疼痛缓解程度、疼痛对面部特定活动及日常生活影响的短时效应、长时效应和后效应上,均优于卡马西平。     

ICP-MS与原子荧光光谱法测定化妆品中砷、汞含量的比较

目的 通过对比ICP-MS法和原子荧光光谱法测定化妆品中砷和汞的含量,为化妆品中砷、汞的测定提供准确、可靠、简便的方法.方法 采用微波消解技术,对仪器的工作条件进行优化,分别用ICP-MS法和原子荧光光谱法测定化妆品中砷和汞的含量.结果 两种方法线性范围良好(r≥0.999 5),ICP-MS法中砷和汞的检出限分别为0...     

糖尿病并发冠心病患者血中TXB_2、6—Keto—PGF_(1α)和LPO的含量变化及其临床意义

应用放射免疫法和硫代巴比妥酸荧光法测定了52例糖尿病并发冠心病患者血中TXB_26—keto—PGF_(1α)和LPO的含量,并与37例非糖尿病性冠心病患者作了对比分析。结果发现:糖尿病并发冠心病患者血中TXB_2、LPO含量和TXB_2/6—Keto—PGF_(1α)比值明显增高,6—Keto—PGF_(12)含量无明显变化。提示糖尿病并发冠心病患者体内TXA_2/PGF_(1α)比例失衡和氧自由基的氧化损伤反应较无糖尿病的冠心病患者严重。这可能是糖尿病患者冠心病发病率高、起病早、发展快、病情重、预后差的重要原因之一。     

卡马西平治疗前庭阵发症的疗效观察

目的 观察及评价卡马西平在前庭阵发症治疗中的临床疗效.方法 对2009年9月-2010年3月经眩晕门诊诊断的前庭阵发症患者20例,予以卡马西平进行干预后每月随访1次并进行疗效评价,共随访及评价3个月.结果 经随访观察,予以卡马西平干预后患者头晕的发作频率,发作程度较治疗前显著改善,且不良反应较轻,耐受性良好.结论 卡马西平治疗前庭阵发症有效且安全,值得临床推荐.     

多药耐药蛋白对大鼠皮层细胞外液卡马西平和苯妥英钠影响的研究

目的观察多药耐药蛋白(multidrugresistance-associatedprotein,MRP)拮抗剂丙磺舒对大鼠大脑皮层细胞外液卡马西平和苯妥英钠含量的影响,证明MRP能够减少皮层内抗癫痫药物的浓度,探讨脑内表达MRP和难治性癫痫多药耐药的关系。方法在健康大鼠大脑皮层内安置微透析探针,腹腔注射卡马西平(20mg/kg)和苯妥英钠(50mg/kg),在给药后不同时间点收集透析液,并用高效液相检测其中的药物浓度,通过微透析探针局部给于丙磺舒,观察后者能否提高大鼠大脑皮层细胞外液卡马西平和苯妥英钠的浓度。结果丙磺舒升高了皮层细胞外液中卡马西平和苯妥英钠的药物浓度,前者在给药后45min～120min显著增高(P<0.05),后者在给药后30min～150min显著增高(P<0.05)。结论MRP具有限制卡马西平和苯妥英钠通过血脑屏障的作用,引起抗癫痫药物在大鼠大脑皮层细胞外液中分布减低,MRP表达增加可能参与了难治性癫痫多药耐药机制的形成。