Subcostal echocardiography to determine right ventricular pacing catheter position and control advancement of electrode catheters in intracardiac electrophysiologic studies: M mode and two dimensional studies

To assess the value of subcostal echocardiography in determining the position of a right ventricular pacing catheter, M mode and two dimensional echocardiography was performed from four different locations in 30 patients. Subcostal M mode echocardiography had a higher detection rate of the pacing catheter than did the precordial M mode examination. However, with M mode echocardiography it was not possible to determine the position of the pacing catheter from any of the locations. The subcostal two dimensional echocardiography demonstrated the full length of the pacing catheter in the right heart chambers and its anatomic position in all patients and proved superior to the precordial approach. This technique allowed the detection of complications related to pacing catheters. A pacing catheter ejected from the ventricular cavity was found in the inferior vena cava. Perforation of the ventricular septum with a bipolar electrode for temporary pacing was also diagnosed.

Subcostal two dimensional echocardiography was used in 20 patients as an additional technique for controlling the advancement of electrode catheters in right heart intracardiac electrophysiologic studies. The electrode catheters were successfully positioned at all routine sites in all patients except one. Thus, subcostal two dimensional echocardiography has advantages over fluoroscopy in the determination of pacing catheter position and in controlling the advancement of electrode catheters in intracardiac electrophysiologic studies.     

Electrophysiology in Fisher syndrome

Fisher syndrome (FS), a variant of Guillain–Barré syndrome (GBS), is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia. The lesion sites for these unique clinical features include the oculomotor nerves and group 1a neurons in the dorsal root ganglion, and the presence of FS is determined by the expression of ganglioside GQ1b in the human nervous system. Neurophysiological findings suggest that ataxia and areflexia are due to an impaired proprioceptive afferent system. Typically, the soleus H-reflex is absent and a body-sway analysis using posturography shows a 1-Hz peak, which indicates proprioception dysfunction. Sensory nerve action potentials and somatosensory-evoked potentials are abnormal in approximately 30% of FS patients, indicating the occasional involvement of cutaneous (group 2) afferents. During the disease course, approximately 15% of FS patients suffer an overlap of axonal GBS with nerve conduction abnormalities that reflect axonal dysfunction. This review summarizes electrophysiological abnormalities and their clinical significance in FS.     

Legislative policy to support children of parents with a mental illness: revolution or evolution?

In 2014, a Mental Health Act was introduced in Victoria, Australia which mandated clinicians to recognize and support consumers’ children. Interviews were conducted with 11 clinical adult mental health professionals about their views and experiences of the introduction of the Act and its impact on their practices. Interviews revealed that sections of the Act relating to consumers’ children were not promoted within organizations and did not result in revolutionary practice change. Instead, practice development staff within organizations were viewed as the main drivers of practices to support consumers’ children. Suggestions are made for enhancing the impact of legislation to promote practice change.     

microRNA-34a靶向调控血管内皮生长因子对U87脑胶质瘤细胞侵袭、增殖的影响

目的探究microRNA-34a靶向调控血管内皮生长因子(VEGF)对U87脑胶质瘤细胞侵袭、增殖的影响。方法将microRNA-34a NC、microRNA-34a inhibtor、microRNA-34a mimic分别转染至U87脑胶质瘤细胞,依次设为NC组、miR-34a inhibtor组、miR-34a mimic组,比较三组脑胶质瘤细胞U87增殖、侵袭、迁移情况,荧光素活性,VEGF mRNA与蛋白表达情况。结果转染后,miR-34a mimic组细胞增值抑制率高于NC组和miR-34a inhibtor组(P0.05);转染48 h后,miR-34a mimic组细胞侵袭、迁移能力低于NC组和miR-34a inhibtor组(P0.05),miR-34a inhibtor组高于NC组(P0.05);转染48 h后,miR-34a inhibtor组、miR-34a mimic组VEGF mRNA、蛋白相对水平分别高于、低于NC组[mRNA:(2.34±0.32)、(0.49±0.03)vs(1.00±0.06);蛋白:(2.42±0.16)、(0.43±0.06)vs(1.00±0.10)](F=256.230、83.750,均P0.05)。结论 microRNA-34a可以抑制脑胶质瘤细胞增殖、侵袭和迁移,其机制可能与抑制VEGF基因表达有关。[国际神经病学神经外科学杂志, 2021, 48(2):143-148]     

Four and a half LIM protein 1 gene mutations cause four distinct human myopathies: a comprehensive review of the clinical, histological and pathological features

Mutations in the four and a half LIM protein 1 (FHL1) gene were recently identified as the cause of four distinct skeletal muscle diseases. Since the initial report outlining the first fhl1 mutation in 2008, over 25 different mutations have been identified in patients with reducing body myopathy, X-linked myopathy characterized by postural muscle atrophy, scapuloperoneal myopathy and Emery-Dreifuss muscular dystrophy. Reducing body myopathy was first described four decades ago, its underlying genetic cause was unknown until the discovery of fhl1 mutations. X-linked myopathy characterized by postural muscle atrophy is a novel disease where fhl1 mutations are the only cause. This review will profile each of the FHL1, with a comprehensive analysis of mutations, a comparison of the clinical and histopathological features and will present several hypotheses for the possible disease mechanism(s).     

Split crest con strumenti vibranti a bassa frequenza: un caso clinico

Objectives

Split-crest osteotomies are used to increase the thickness of edentulous ridges during implant insertion. The purpose of this case report is to illustrate the advantages of performing these procedures with low-frequency vibration, air-driven, non-piezoelectric handpieces, which are the most suitable instruments for carrying out thin osteotomies.

Materials and methods

We report the case of a 68-year-old patient with edentulous ridge at sites 4.5, 4.6, and 4.7. The crest was thin and the masticatory mucosa reduced. First, the ridge was osteotomized with vibrating tools on a sonic, air-driven handpiece (Sonosurgery^®, Komet/Brasseler, Lemgo, Deutschland), and the vestibular cortical plate was distracted. Tapered implants were inserted during the same session, and the spaces between the implants were filled with equine collagen sponge.

Results and conclusions

The procedure resulted in substantial augmentation of the horizontal thickness of the edentulous ridge and masticatory mucosa, which allowed satisfactory implant prosthetic rehabilitation of the posterior lower right sector. Thanks to the angles and reduced thickness (0.25 mm) of their cutting surfaces, the sonic air-driven tools allowed us to make thin, highly precise osteotomies.     

Failed B cell survival factor trials support the importance of memory B cells in multiple sclerosis

Clinical trials are probably the most informative experiments to help an understanding of multiple sclerosis (MS) biology. Recent successes with CD20‐depleting antibodies have focused attention towards B cell subsets as important mediators in MS. The trial of tabalumab (NTC00882999), which inhibits B cell activation factor (BAFF), is reported and reviewed and this trial is contrasted with the trial on the inhibition of a proliferation‐inducing ligand (APRIL) and BAFF using atacicept (NCT00642902). Both tabalumab and atacicept induce depletion of mature B cells and inhibit antibody formation, but they fail to deplete memory B cells and do not inhibit relapsing MS. Atacicept is reported to augment memory B cell responses and may precipitate relapse, suggesting the importance of APRIL. However, BAFF inhibition can enhance peripheral blood memory B cell responses, which was not associated with augmented relapse. Although other interpretations are possible, these data further support the hypothesis that memory B cells may be of central importance in relapsing MS, as they are the major CD20+ B cell subset expressing APRIL receptors. They also suggest that quantitative and/or qualitative differences in B cell responses or other factors, such as an immune‐regulatory effect associated with APRIL, may be important in determining whether MS reactivates following neutralization of peripheral B cell maturation and survival factors.     

Subtle sex differences in vasopressin mRNA expression in the embryonic mouse brain

Arginine vasopressin (AVP) is a neuropeptide which acts centrally to modulate numerous social behaviors. One receptor subtype through which these effects occur is the AVP 1a receptor (AVPR1A). The modulatory effects of Avp via the AVPR1A varies by species as well as sex, since both AVP and the AVPR1A tend to be expressed more prominently in males. Beyond these neuromodulatory effects there are also indications that the AVP system may play a role in early development to, in part, organize sex‐specific neural circuitry that is important to sexually dimorphic social behaviors in adulthood. However, to date, AVP's role in early development is poorly understood, particularly with respect to its differential effect on males and females. In order to determine the timing and distribution of the AVP system in early brain development, we examined the brains of male and female C57BL/6J mice between embryonic day (E) 12.5 and postnatal day (P) 2 and quantified Avp and Avpr1a mRNA using qPCR and AVPR1A protein using receptor autoradiography. The mRNA for Avp was measurable in males and females starting at E14.5, with males producing more than females, while Avpr1a mRNA was found as early as E12.5, with no difference in expression between sexes. AVPR1A binding was observed in both sexes starting at E16.5, and while there were no observed sex differences, binding density and the number of neuroanatomical areas did increase over time. These data are significant as they provide the first whole‐brain characterization of the vasopressin system in the embryonic mouse. Further, these findings are consistent with data from other species, that have documented a sex difference in the vasopressin system during early brain formation.     

Investigation of the miRNA146a and miRNA155 gene expression levels in patients with multiple sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disease and the most common neurodegenerative status. MicroRNAs play an important role in macrophage response to inflammatory processes, and alterations in miRNA levels trigger the inactivation of specific T lymphocytes. As a result, these factors can lead to autoimmune diseases such as MS. Therefore, to determine the role of MicroRNA-146a and MicroRNA-155 in MS patients, their expression levels in serum of MS patients were compared with healthy controls.In this study, the expression levels of MicroRNA-146a and MicroRNA-155 in 30 serum samples of MS and healthy patients as a control group. MicroRNA extraction and cDNA synthesis was performed according manufacture protocols. The expression levels of MicroRNAs were evaluated by Real Time-PCR.MicroRNA-146a and MicroRNA-155 levels were increased in patients with MS compared to controls. The results demonstrated that EDSS score are increased with increasing level of MicroRNA-146a and MicroRNA-155. ROC curve analysis showed that the area under curve (AUC) was significant for MicroRNA-146a and MicroRNA-155.Increased expression levels of MicroRNA-146a and MicroRNA-155 may be associated with the pathogenesis of MS disease. If this study is conducted in a larger sample population and the above results can be used to identify patients or control patients who are under medical care.