Metabolite changes with age measured by proton magnetic resonance spectroscopy in normal subjects

Abstract  To determine whether there are metabolite changes in the left medial temporal and frontal lobes with aging, we performed proton magnetic resonance spectroscopy in 36 normal subjects. The N-acetylaspartate/creatine-phosphocreatine ratio in the medial temporal lobe tended to be decreased in subjects over 60 years of age. The ratio decrease in the frontal lobe related to aging was lower than that in the medial temporal lobe. There were no significant differences in the metabolite ratios between males and females. These findings suggest that structures in the medial temporal lobe may be more susceptible to neuronal dysfunction associated with aging than those in the frontal lobe.     

上海图书馆馆藏抄本医书《增补〈病机提要〉》考析

[目的]通过对上海图书馆藏孤抄本医书《增补〈病机提要〉》的研究,以辨明其作者,并对该书的内容及价值进行介绍。[方法]从地方志中的相关记载入手,以辨明该书编著者;并利用地方志中的有关资料,系统梳理编著者的生平及著作情况;运用文献学方法,对《增补〈病机提要〉》的内容进行考察。[结果]通过研究地方志,发现该书由明代医家陈时荣原著,后经名医秦景明增订而成;并对秦氏的生平、籍贯、交游、学术传承及著作情况等作了梳理;研究是书内容后发现,该书体例精当,便于查检,论治精详,征引广泛,具有临床应用手册的性质,又经秦氏增补,具有较高的理论和临床价值,值得深入研究。[结论]以《增补〈病机提要〉》为例,稿抄本医书中蕴藏着丰富的宝藏,是中医古籍文献的重要组成部分,具有很高的学术和临床价值,希望更多有志之士投身于此,使其学渐为兴盛。     

Conduction Delay in Right Ventricle as a Marker for Identifying High‐Risk Patients With Brugada Syndrome

Conduction Delay as a Marker for Brugada Syndrome. Objectives: To evaluate the significance of conduction delay (CD) in the right ventricle (RV) in Brugada syndrome (BS) as a marker for risk stratification of sudden death. Methods: Twenty‐five patients with BS (7 with documented ventricular fibrillation (VF), 8 with syncope, and 10 without symptoms) and 10 control subjects were paced from the RV apex using 8 beats of drive pacing and a single extra‐stimulus. CDs in the right ventricular outflow tract (RVOT) (CD‐RV) and in the lateral left ventricle (L‐LV) (CD‐LV), and the local electrogram durations at a single extra‐stimulus in RVOT (D‐RV) and L‐LV (D‐LV) were calculated. We also evaluated changes in 12‐lead ECG parameters in 16 patients with BS after pilsicainide challenge test (Pilsicainide‐test). Results: Maximal CD‐RV and maximal D‐RV were significantly larger than maximal CD‐LV and maximal D‐LV in BS (26 ± 10 and 105 ± 15 vs 20 ± 6 and 92 ± 15 ms, P < 0.05, respectively). Maximal CD‐RV and maximal D‐RV in patients with documented VF were the largest among the 3 groups. There was a significant positive correlation between maximal CD‐RV or maximal D‐RV and changes in QRS duration in leads V2 and V5 and in S wave duration in lead II and V5 after Pilsicainide‐test (CD‐RV; r = 0.54, 0.51, 0.56, and 0.53: D‐RV; r = 0.55, 0.5, 0.57, and 0.53, P < 0.05, respectively). In control subjects, there were no significant differences. Conclusions: CD in RV was a useful marker for identifying high‐risk patients with BS. CD in the RV, especially in the RVOT epicardium, may be related to arrhythmias in BS. (J Cardiovasc Electrophysiol, Vol. 21, pp. 688‐696, June 2010)     

Application of a Remodeled Stiegmann-ligator to Esophageal Varix

Abstract: The Stiegmann-ligator has been recently proved to be useful for the treatment of esophageal varices. With those ligators, however, we found difficulty in performing ligation when the pathological change was on the tangent line or relatively large, such as F₃, or associated with concentrated RC signs. To overcome these problems, we modified the Stiegmann O-ring ligator by diagonally cutting the tip of the inner sleeve. Using this ligator, we conducted some animal-model experiments and clinical trials. In all cases, the remodeled ligator covered a wider range of lesions. We no longer encountered difficulties in performing ligation with the remodeled ligator when pathological changes were on the tangent line. The procedure did not cause any complications apart from temporary chest discomfort after surgery.     

Malignant lymphoma of the urethra: report of a case with detection of Epstein–Barr virus genome in the tumour cells

We report a primary non-Hodgkin's B-cell lymphoma of the urethra in a 78-year-old female. Serum antibodies for Epstein–Barr virus (EBV) were negative, but there was a 40-fold increase in antibodies to EBV-associated nuclear antigen. Using PCR and in situ hybridization techniques, EBV genome was found in the tumour cell nuclei.     

Enhancement of J–ST-Segment Elevation by the Glucose and Insulin Test in Brugada Syndrome

NOGAMI, A., et al. : Enhancement of J–ST-Segment Elevation by the Glucose and Insulin Test in Brugada Syndrome. The effects of glucose and insulin on J–ST-segment elevation were evaluated in seven men   (mean age 45 ± 10 years)   with Brugada syndrome. Six patients had been reanimated from VF and one patient had experienced syncope. The effects of intravenous (1) pilsicainide 50 mg, (2) glucose 50 g, and (3) glucose 50 g plus regular insulin 10 IU on the precordial ECG leads were examined. Pilsicainide significantly enhanced J-ST elevation in all patients and induced VF in 1 patient. A significant accentuation of the abnormal J-ST configuration was observed in all patients at a mean of   51 ± 40   minutes after glucose and insulin infusion. Changes in blood glucose and serum potassium concentration were   111 ± 158 mg/dL   and   −0.30 ± 0.48 mEq/L   , respectively. These changes were not directly related to the ECG changes. Glucose infusion without insulin caused a subtle increase in J-ST elevation. In conclusion, the administration of glucose and insulin safely unmasked or accentuation the J–ST-segment elevation in Brugada syndrome. Blood glucose and insulin concentrations may be factors modulating the circadian or day-to-day ECG variations in this syndrome. (PACE 2003; 26[Pt. II]:332–337)     

A retrospective study on the patterns of sequential fluctuation of serum alpha-fetoprotein level during progression from liver cirrhosis to hepatocellular carcinoma

The patterns of sequential fluctuation of serum alpha-fetoprotein levels were analysed in 218 patients with liver cirrhosis in whom the serum alpha-fetoprotein levels were regularly and serially measured for more than 1 year. In the group of patients with persistently abnormal high values (greater than 50 ng/mL) over a follow-up period of more than 1 year, the incidence of the subsequent development of hepatocellular carcinoma was statistically and significantly higher (44%) compared to the other groups which showed normal (less than 20 ng/mL) or low abnormal levels (21-50 ng/mL) (16%), and transient abnormal high levels (greater than 50 ng/mL for a period of less than 1 year, mostly within 5 months) or fluctuated repeatedly between normal and transient abnormal high levels (23%). Hepatocellular carcinoma developed in 48 patients more than 2 years after the diagnosis of liver cirrhosis, and the fluctuating patterns of serum alpha-fetoprotein levels were analysed in these patients. The serum alpha-fetoprotein levels in 10 of these 48 patients stayed below 50 ng/mL until about 2.0-10.0 months before the detection of hepatocellular carcinoma and then increased steadily until the time of hepatocellular carcinoma detection. In these 10 patients, the monthly increasing ratios were approximately 1.6-4.8 times the previous values.