Heparin monitoring during cardiopulmonary bypass surgery using the one-step point-of-care whole blood anti-factor-Xa clotting assay heptest-POC-Hi

The activated clotting time (ACT) generally used for monitoring heparinization during cardiopulmonary bypass (CPB) surgery does not specifically measure heparin anticoagulant activities. This may result in heparin over- or under-dose and subsequent severe adverse events. A new point-of-care whole blood clotting assay (Heptest POC-Hi [HPOCH]) for quantifying heparin anticoagulant activity specifically was compared with ACT and anti-factor Xa (anti-Xa) heparin plasma levels (Coatest heparin) in 125 patients undergoing CPB surgery. The analytical reliability of the HPOCH and the influence of preanalytical variables on assay results were also examined. The ACT and HPOCH clotting times determined throughout the entire observation period correlated closely (n=683; r = 0.80; p < .0001). Similarly, there was a significant linear correlation between HPOCH and Coatest anti-Xa levels (n=352; r = 0.87; p < .0001). Pre- and post-CBP values of HPOCH, ACT, and anti-Xa plasma levels correlated closely with each other (correlation coefficients between r = 0.90 and r = 0.99; p < .0001). During CPB, there was no significant relationship between ACT and whole blood or plasma heparin levels determined by HPOCH (n=157; r = 0.19) and the chromogenic anti-Xa assay (n=157; r = 0.04), respectively. In contrast, HPOCH and anti-Xa plasma levels correlated strongly during CPB (n=157; r = 0.57; p < .0001). However, bias analysis showed that the HPOCH and Coatest heparin could not be used interchangeably. The HPOCH was well reproducible and not influenced by aprotinin, hemodilution, or other factors affecting ACT. The HPOCH seems to be a promising new tool for specific on-site measurement of heparin activities in whole blood during CPB.     

Prevalent Hypertension and Stroke in the Sleep Heart Health Study: Association with an ECG-derived Spectrographic Marker of Cardiopulmonary Coupling

Study Objectives:

The electrocardiogram (ECG)-based sleep spectrogram generates a map of cardiopulmonary coupling based on heart rate variability and respiration derived from QRS amplitude variations. A distinct spectrographic phenotype, designated as narrow-band elevated low frequency coupling (e-LFC_NB), has been associated with central apneas and periodic breathing and predicts sleep laboratory failure of continuous positive airway pressure therapy. This study assesses, at a population level, the associations of this spectrographic biomarker with prevalent cardiovascular disease using the Sleep Heart Health Study (SHHS)-I dataset.

Design:

Retrospective analysis of the Sleep Heart Health Study-I dataset.

Setting:

Laboratory for complex physiologic signals analysis.

Measurements and Results:

The fully-automated ECG-derived sleep spectrogram technique was applied to 5247 (of the original 6441) polysomnograms from the SHHS-I. Associations were estimated with use of various drugs and pathologies including prevalent hypertension and cardiovascular and cerebrovascular disease. Increasing with age and more common in males, e-LFC_NB is also associated with greater severity of sleep apnea and fragmented sleep. After adjustment for potential confounders, an independent association with prevalent hypertension and stroke was found.

Conclusions:

An ECG-derived spectrographic marker related to low frequency cardiopulmonary coupling is associated with greater sleep apnea severity. Whether this biomarker is solely a sign of more severe disease or whether it reflects primary alterations in sleep apnea pathophysiology (which may either cause or result from sleep apnea) is unknown. This ECG-based spectral marker is associated with a higher prevalence of hypertension and stroke.

Citation:

Thomas RJ; Weiss MD; Mietus JE; Peng CK; Goldberger AL; Gottlieb DJ. Prevalent hypertension and stroke in the sleep heart health study: association with an ECG-derived spectrographic marker of cardiopulmonary coupling. SLEEP 2009;32(7):897-904.     

Investigation of Genetically Mediated Child Effects on Maltreatment

Theory and empirical evidence suggest that children’s genetically influenced characteristics help to shape the environments they experience, including the parenting they ‘receive’. The extent of these genetically-mediated child effects on childhood maltreatment is not well known. The present study estimates the magnitude of genetically mediated child effects on maltreatment in 3,297 twins and siblings who were part of a large nationally representative sample of adolescents (ADD health). Participants in early adulthood retrospectively reported their experiences of physical and sexual maltreatment and neglect. Results are consistent with small genetically-mediated child effects on physical maltreatment and neglect, and none on sexual maltreatment, and all three forms of maltreatment are influenced mainly by idiosyncratic individual circumstances. Edited by Deborah Finkel.     

Inbred mouse strains differ in multiple hippocampal activity traits

A major challenge in neuroscience is to identify genes that influence specific behaviors and to understand the intermediary neuronal mechanisms. One approach is to identify so-called endophenotypes at different levels of neuronal organization from synapse to brain activity. An endophenotype is a quantitative trait that is closer to the gene action than behavior, and potentially a marker of neuronal mechanisms underlying behavior. Hippocampal activity and, in particular, hippocampal oscillations have been suggested to underlie various cognitive and motor functions. To identify quantitative traits that are potentially useful for identifying genes influencing hippocampal activity, we measured gamma oscillations and spontaneous activity in acute hippocampal slices from eight inbred mouse strains under three experimental conditions. We estimated the heritability of more than 200 quantitative traits derived from this activity. We observed significant differences between the different mouse strains, particularly in the amplitude of the activity and the correlation between activities in different hippocampal subregions. Interestingly, these traits had a low genetic correlation between the three experimental conditions, which suggests that different genetic components influence the activity in different conditions. Our findings show that several traits of hippocampal gamma oscillations and spontaneous activity are heritable and could thus be potentially useful in gene-finding strategies based on endophenotypes.     

放射性肺损伤相关临床因素的研究

目的:观察接受放射治疗的肺癌患者发生有症状的放射性肺损伤(SRILI)的临床相关因素。方法:对2002-2006年符合入组条件的306例肺癌病例进行回顾性分析,分析发生SRILI(≥Ⅱ级放射性肺毒副反应)病例的临床相关因素。使用SPSS13.0统计软件进行统计分析。结果:所观察到的肺癌放疗患者中,发生SRILI为7.2%(22/306)。单因素和多因素分析肿瘤部位(中心型/周围型)均与SRILI相关,P<0.05;多因素分析中,肿瘤部位和慢性阻塞性肺疾病有统计学意义。结论:周围型肺癌发生SRILI的风险高于中心型肺癌;合并慢性阻塞性肺疾病的患者发生SRILI的风险高于未患慢性阻塞性肺疾病者。     

阻塞性睡眠呼吸暂停低通气综合征与高血压的关系探讨

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与高血压的关系。方法将62例经多导睡眠图监测仪监测证实为OSAHS的患者分为伴高血压（34例）和无高血压（28例）2组,比较2组患者的呼吸暂停低通气指数、最低血氧饱和度、呼吸暂停最长时间、觉醒指数,同时测量2组患者睡前、醒时血压。结果 OSAHS伴高血压组与无高血压组比较,呼吸暂停低通气指数〔（65.2±20.1）vs（36.7±18.4）次/h〕、呼吸暂停最长时间〔（58.4±10.7）vs（46.3±12.5）s〕、觉醒指数〔（41.2±13.6）vs（20.4±11.7）次/h〕差异均有统计学意义（P均〈0.05）。伴高血压组最低血氧饱和度低于无高血压组〔（67±11）%vs（75±10）%〕（P〈0.05）。OSAHS伴高血压组的睡前和醒时血压均明显高于无高血压组（P均〈0.05）,且OSAHS伴高血压组醒时血压明显高于睡前血压（P〈0.05）;而OSAHS无高血压组的醒时血压与睡前血压相比差异无统计学意义（P〉0.05）。结论 OSAHS与高血压关系密切,OSAHS可能是引起或加重高血压的病因之一     

Isolation of narciprimine from Cyrtanthus contractus (Amaryllidaceae) and evaluation of its acetylcholinesterase inhibitory activity

Ethnopharmacological relevance

Plants of the family Amaryllidaceae are used widely in traditional medicine in South Africa. Several of these, including representatives of the genus Cyrtanthus find use in the treatment of mental illness and age-related dementia.

Aim of the study

Based on the distribution of central nervous system-activating alkaloidal constituents within the genus Cyrtanthus, Cyrtanthus contractus was here explored for such compounds which could interact with acetylcholinesterase (AChE), of significance in the progression of neurodegeneration associated with Alzheimer's disease.

Materials and methods

The known phenanthridone alkaloid narciprimine was isolated via column chromatography of the ethanolic extract of bulbs of Cyrtanthus contractus. The structure of the compound was determined by high field 2D NMR and mass spectroscopic techniques. The classical method of Ellman et al. was used in the determination of AChE inhibitory activity.

Results

The isolation of narciprimine from Cyrtanthus contractus is a landmark find since it has previously only been identified in Zephyranthes, Narcissus and Lycoris, genera endemic to the Americas, Europe and Asia, respectively. Narciprimine exhibited micromolar inhibitory activity (IC₅₀ 78.9) against the enzyme acetylcholinesterase.

Conclusion

This work represents the first isolation of narciprimine from an African Amaryllidaceae species, which may be of chemotaxonomic significance. The AChE inhibitory activity of narciprimine, taken together with activities of other structurally similar inhibitors within the series affords further insight to the structural details of the lycorine alkaloid acetylcholinesterase inhibitory pharmacophore.     

食管鳞癌抑癌基因甲基化表达的相关性分析

[目的]研究食管鳞癌肿瘤组织及外周血多基因甲基化状态,以及不同基因甲基化的相关性。[方法]应用real-time MSP技术对76例食管鳞癌患者肿瘤组织、配对的癌旁正常组织、术前外周血中APC、RARβ2、CDH1、p16INK4α、RASSF1A抑癌基因的甲基化状态进行检测。随机选取60名年龄配对的健康志愿者外周血浆DNA作对照。[结果]肿瘤组织APC、RARβ2、CDH1、p16INK4α、RASSF1A的甲基化率显著高于对应癌旁正常组织（P=0.000）。术前外周血中这5种基因的甲基化率显著高于健康对照组（P=0.000）。RARβ2、CDH1、p16INK4α、RASSF1A甲基化有显著性相关,APC与这4个基因甲基化无相关性。[结论]食管癌患者癌组织及外周血抑癌基因APC、RARβ2、CDH1、p16INK4α、RASSF1A高甲基化,RARβ2、CDH1、p16INK4α、RASSF1A甲基化有显著相关性。     

无创心脏血流动力学监测仪与超声心动图检测心功能指标的相关性分析

目的探讨CHMT3002心脏无创血流动力学监测仪评价临床患者心功能的可能性。方法选择上海市中山医院住院病人26例．其中心功能不全组11例,心功能1级对照组15例。在对每一例研究对象行超声心动图检查后立即行无创心脏血流动力学检测。采用线性相关分析及Bland-Altman一致性分析方法对两者进行相关性及一致性分析。结果两种仪器对LVEF、SV、SVI、CO、CI、EDV、LVET及PEP／LVET等指标的检测数值具有线性相关关系,而对PEP的检测数值无明显相关性。其中,两种方法在检测LVEF、LVET指标方面具有较好一致性,在SV、SVI、CO、CI、EDV方面的一致性一般．而对PEP、PEP／LVET检测的一致性则较差。结论CHMT3002心脏血流动力学监测仪的检测尚能较真实地反映患者心脏功能情况,但其并不能替代超声心动图对心功能的评价。     

35例院前猝死患者急救体会

目的：探讨提高猝死复苏成功率的有效途径。方法：对35例猝死患者院前现场抢救的临床资料进行分析。结果：现场复苏成功率为14．29％,远期存活率为8．57％。结论：院前猝死是院前急救的主要急危重症之一。缩短急救半径、减少呼叫等待时间,早期电击除颤和气管插管是救治院前猝死的重要措施;重视脑复苏,对公众普及CPR技术及相应的急救技能是提高院前心肺复苏的成功率的关键。