Delayed improvement of autonomic nervous abnormality after the Maze procedure: time and frequency domain analysis of heart rate variability using 24 hour Holter monitoring

Objective—To analyse heart rate variability in patients with atrial fibrillation after the Maze procedure, to investigate whether the procedure damages the cardiac autonomic fibres supplying the sinus node.
Design and patients—Time and frequency domain analyses of RR variability were performed using 24 hour Holter monitoring one month after surgery in 12 patients with atrial fibrillation who underwent the Maze procedure (Maze group) and in seven patients who underwent cardiac surgery without the Maze procedure (control group). Mean RR intervals (mRR) and the standard deviation of successive RR intervals (SDRR) were determined by time domain analysis, and high frequency (HF), low frequency (LF), and total power (TP) spectral components of RR variability were calculated by frequency domain analysis. Holter monitoring was also performed at six and 12 months after cardiac surgery in the Maze group.
Results—Circadian variation (mean (SD)) in mRR (daytime to night time difference: 119 (60) v 302 (143) ms), SDRR (daytime: 8.4 (3.3) v 37.0 (12.0) ms), TP (daytime: 46.7 (16.0) v 171.8 (30.4) ms), HF (daytime: 19.6 (9.9) v 36.7 (7.1) ms²), and LF/HF (daytime: 0.31 (0.07) v 1.18 (0.46)) was decreased in the Maze group at one month compared with the control group (p < 0.01), but showed improvement at six and 12 months (p < 0.05).
Conclusions—Surgery combined with the Maze procedure markedly suppressed the circadian variation of heart rate over a 24 hour period within one month after surgery, mainly because of damage to the innervation of the sinus node. However, at six and 12 months there was restoration of circadian variation, probably as the result of reinnervation of the sinus node.

Keywords: autonomic nervous system;  heart rate variability;  Maze procedure     

Effects of audio stimulation on gastric myoelectrical activity and sympathovagal balance in healthy adolescents and adults

Aim: The primary aim of this study was to investigate the effects of different audio stimulations on gastric myoelectrical activity and sympathovagal balance in adolescents compared with adults. Methods: The study was performed in 11 adults and 12 adolescents. Each subject underwent two sessions, one for classical music, and the other for noise. Each session consisted of 30 min of baseline, 30 min of fasting audio stimulation, a test meal, 30 min of fed audio stimulation, and 30 min of recovery. Electrocardiogram and electrogastrogram were both recorded throughout each session. Results: (i) In the fasting state, both classical music and noise impaired gastric slow wave activity in adolescents. In adults, noise had no effects while classical music moderately improved slow wave rhythmicity. (ii) In the fed state, neither noise nor music had any effects on gastric slow waves. (iii) In the fasting state, both noise and music increased the sympathovagal balance in adolescents; in adults only noise had such an effect. (iv) The test meal increased the sympathovagal balance in all groups. Conclusions: Gastric slow waves and the sympathovagal balance are more strongly affected by audio stimulation in adolescents than in adults. The test meal normalizes the audio stimulation‐induced differences between the groups.     

Acute exacerbation of chronic obstructive pulmonary disease: Influence of social factors in determining length of hospital stay and readmission rates

BACKGROUND:

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading reason for hospitalization in Canada and a significant financial burden on hospital resources. Identifying factors that influence the time a patient spends in the hospital and readmission rates will allow for better use of scarce hospital resources.

OBJECTIVES:

To determine the factors that influence length of stay (LOS) in the hospital and readmission for patients with AECOPD in an inner-city hospital.

METHODS:

Using the Providence Health Records, a retrospective review of patients admitted to St Paul’s Hospital (Vancouver, British Columbia) during the winter of 2006 to 2007 (six months) with a diagnosis of AECOPD, was conducted. Exacerbations were classified according to Anthonisen criteria to determine the severity of exacerbation on admission. Severity of COPD was scored using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. For comparative analysis, severity of disease (GOLD criteria), age, sex and smoking history were matched.

RESULTS:

Of 109 admissions reviewed, 66 were single admissions (61%) and 43 were readmissions (39%). The number of readmissions ranged from two to nine (mean of 3.3 readmissions). More than 85% of admissions had the severity of COPD equal to or greater than GOLD stage 3. The significant indicators for readmission were GOLD status (P<0.001), number of related comorbidities (OR 1.47, 95% CI 1.10 to 1.97; P<0.009) and marital status (single) (OR 4.18, 95% CI 1.03 to 17.02; P<0.046). The requirement for social work involvement during hospital admission was associated with a prolonged LOS (P<0.05).

CONCLUSIONS:

The results of the present study show that disease severity (GOLD status) and number of comorbidities are associated with readmission rates of patients with AECOPD. Interestingly, social factors such as marital status and the need for social work intervention are also linked to readmission rates and LOS, respectively, in patients with AECOPD.     

Effect of experimental thyrotoxicosis on oxidative phosphorylation in rat liver, kidney and brain mitochondria

Coupled phosphorylation was examined in liver, kidney and brain mitochondria from rats made thyrotoxic by injecting repeated doses of triiodothyronine. Liver and kidney mitochondria were maximally affected under these conditions, whereas effects on brain mitochondria were marginal. State-3 respiration rates with succinate decreased considerably in all the tissues, whereas glutamate oxidation increased in liver, but decreased in kidney and brain mitochondria. Oxidation rates of beta-hydroxybutyrate decreased in kidney and brain mitochondria but were not significantly affected in liver mitochondria. Oxidation of ascorbate + TMPD was not affected. State-4 respiration rates increased in general with all the substrates resulting in lowering of the RCI. The ADP/O ratios decreased in a site-specific manner in the mitochondria from the three tissues. The content of cytochrome b decreased in all three tissues, whereas the content of cytochrome c + c1 increased in liver and kidney but decreased in brain. The content of cytochrome a, however, was not significantly affected. Basal and Mg2+-stimulated ATPase activities increased in mitochondria of liver and kidney but not in those of brain; total ATPase activities, however, were not altered. The results imply that excessive levels of thyroid hormones over normal in the serum can lead to impairment of mitochondrial energy metabolism in a tissue-specific manner.     

高血压患者心率变异性的临床分析

通过对８２例高血压患者和６３例年龄相当的正常人２４小时心率变异性分析的研究表明：（１）高血压患者时域分析和频域分析的各项参数指标均减低。（２）高血压患者植物神经２４小时昼夜变化与正常人有差异，高频部分夜间明显降低，标志副交感神经活动失调（Ｐ＜０．０５）。（３）高血压伴心肌缺血者与无心肌缺血者的高频／低频比值差异有显著性（Ｐ＜０．０５）。     

幽门螺杆菌阳性胃溃疡除菌治疗的临床研究

目的研究根除幽门螺杆菌（Hp）治疗对Hp阳性的胃溃疡愈合率、愈合质量及复发的影响。方法将68例Hp阳性的胃溃疡患者随机分为除菌组和非除菌组，除菌组给予奥美拉唑20mg＋阿莫西林0．5g＋呋喃唑酮0．1g口服，2次／d，1周后奥美拉唑改为20mg，1次／d，共治疗4周。非除菌组单独给予奥美拉唑，剂量方法同上。分别于4周及1年后复查胃镜。结果除菌组和非除菌组比较，4周后溃疡愈合率差异无统计学意义（分别为97．4％和90％，P〉0．05），但两组溃疡愈合质量比较差异有统计学意义。1年后两组溃疡复发率比较，除菌组低于非除菌组，差异有统计学意义（分别为6．7％和59．3％，P〈0．01），Hp根除率除菌组高于非除菌组，差异有统计学意义（分别为86．7％和3．7％，P〈0．01）。结论Hp感染与胃溃疡存在相关性，根除Hp治疗不仅可以提高溃疡的愈合质量，而且还可以减少溃疡的复发。     

应变/应变率成像定量评价高血压病合并阵发性心房颤动患者左心房功能的临床研究

目的 运用应变／应变率成像技术评价高血压病合并心房颤动（房颤）时心房肌的收缩舒张特性，探讨高血压病和房性心律失常特别是阵发性房颤对心房肌收缩舒张特性的影响。方法 32例健康志愿者和110例高血压病患者被纳入研究，分为4组：对照组（A组），单纯高血压病组（B组），高血压病合并短阵房性心动过速组（C组），高血压病合并阵发性房颤组（D组）。所有研究对象均进行超声心动图和应变／应变率成像检查。结果 与A组相比，D组心率校正的舒张晚期应变率达峰时间、舒张早期应变率差值（AESR）、舒张晚期应变率差值（AASR）和心率校正的舒张晚期应变率达峰时间差值（ATASRc）的差异具有统计学意义。与B组相比，D组的收缩期应变率（SSR）、△ASR、△TASRc、△ESR的差异具有统计学意义。结论 高血压病合并阵发性房颤时，左心房心肌储存器功能受损表现为储存血液势能的能力不变，而效率下降；阵发性房颤损伤了高血压病患者心房肌的传导性，降低了左心房整体的助力泵功能，同时增加了左心房行使管道功能的时间。应变率指标能够无创性定量评价高血压病合并阵发性房颤患者左心房的功能异常。     

连云港市1995～2005年碘缺乏病防治10年效果评价

目的全面了解连云港市碘缺乏病防治状况,评价防治效果。方法按照《全国IDD防治监测方案》和《江苏省市、县消除碘缺乏病考核评审方案》,使用PPS法抽样,在全市范围内抽取1 000多名8~10岁学生进行甲状腺肿大率调查和尿碘含量检测,以及学生家庭食用盐进行碘含量测定,并抽取五年级学生和学校附近家庭主妇进行IDD知识问卷调查。结果碘盐覆盖率从1995年的59.10%上升到2005年的92.82%,甲状腺肿大率从1995年的43.78%下降到2005年的2.02%,尿碘中位数从1995年的71.25μg/L上升到2005年的170.40μg/L。结论综合病情和各项监测指标,我市推行"全民食用加碘盐防治碘缺乏病"措施10年后,达到了消除碘缺乏病的目标。     

Herpes simplex encephalitis and subsequent cytomegalovirus encephalitis after chemoradiotherapy for central nervous system lymphoma: a case report and literature review

Neurological complications during the treatment of hematological malignancies have a wide range of causes. Treatment-related leukoencephalopathy has been recognized as a major complication of combined chemotherapy and radiotherapy for central nervous system (CNS) lymphoma, and can complicate the diagnosis of CNS infection. Herein, we present a patient with diffuse large B-cell lymphoma who developed herpes simplex encephalitis (HSE) and subsequent cytomegalovirus encephalitis after chemoradiotherapy for CNS relapse. Although cerebrospinal fluid examination (CSF) showed no significant pleocytosis, brain magnetic resonance imaging and polymerase chain reaction analysis of the CSF were useful in the diagnosis. With a review of the literature on the association between HSE and radiotherapy for CNS malignancies, our case suggests that an awareness of viral encephalitis is important in the differential diagnosis of acute neurologic disturbance during chemoradiotherapy for CNS lymphoma.     

河南省安阳市人群肠道寄生虫感染调查

2002年安阳市人群肠道寄生虫感染率为4.11%;未发现多虫感染者;EPG为548.88。安阳市人群寄生虫感染率较1990年呈显著下降。