Ventricular arrhythmias during ergonovine-induced episodes of variant angina

Of 95 consecutive patients with active variant angina who underwent ergonovine testing in the coronary care unit while off treatment, 24 (25%) developed serious ventricular arrhythmias: ventricular tachycardia in eight, bigeminy in seven, pairs in five, and frequent ventricular extrasystoles in four. Ergonovine-induced arrhythmias were observed more often in patients with anterior than inferior ST segment elevation (p less than 0.05). ST segment elevation was significantly higher (10.3 +/- 8.1 vs 3.1 +/- 2.1 mm) in patients who developed arrhythmias. All ventricular arrhythmias began within 3 minutes after the onset of ST segment elevation. The intravenous administration of nitroglycerin eliminated arrhythmias in 22 of 24 cases; in only two patients did ventricular arrhythmias develop after the administration of nitroglycerin. Serious ventricular arrhythmias were found during spontaneous variant angina attacks in 14 of 24 patients with ergonovine-induced arrhythmias compared to 16 of 71 patients without ergonovine-induced arrhythmias (p less than 0.001). We conclude that arrhythmias during ergonovine testing are most often caused by ischemia and not reperfusion. Patients with arrhythmias during ergonovine-induced attacks are more likely to have arrhythmias during spontaneous attacks.     

Ergonovine testing to detect spontaneous remissions of variant angina during long-term treatment with calcium antagonist drugs

A subgroup of 22 patients with variant angina who had responded well to calcium antagonist drugs were studied to determine if ergonovine testing could help assess the need for continued therapy. Before treatment all 22 patients exhibited angina with S-T elevation during ergonovine testing done in the coronary care unit according to a previously described protocol with sequential ergonovine doses of 0.0125, 0.025, 0.05, 0.1, 0.2, 0.3 and 0.4 mg administered at 5 minute intervals. After 9.4 ± 4.7 (range 1 to 24) months of treatment (nifedipine 7 patients, diltiazem 3, verapamil 8, perhexiline 3, nifedipine and diltiazem 1), all patients were free from anginal attacks. Medication was discontinued and ergonovine testing repeated 24 to 48 hours later (3 weeks for perhexiline). In 12 of the 22 patiénts, angina or S-T segment shifts did not occur during the second ergonovine test to a maximal dose of 0.4 mg. Treatment was not restarted in these patients and all 12 remain free of variant anginal attacks 4.2 ± 2.9 (range 1 to 13) months later. In seven patients angina and S-T elevation occurred during the second ergonovine test, in the same electrocardiographic leads as during the test before treatment. In three patients the ergonovine test induced angina with S-T depression in the leads where S-T elevation had occurred during the previous test. Treatment was reinstituted in these 10 patients with a positive test. No complications resulted from ergonovine testing in any patient.We conclude that in many patients with variant angina, symptoms will disappear spontaneously and the ergonovine test will revert to negative. Treatment with calcium antagonist drugs can probably be safely discontinued in some patients with variant angina; ergonovine testing appears to be helpful in identifying such patients. Longer periods of follow-up are required to confirm that symptoms do not recur.     

A novel mutation in CDH11, encoding cadherin‐11, cause Branchioskeletogenital (Elsahy‐Waters) syndrome

Cadherins are cell‐adhesion molecules that control morphogenesis, cell migration, and cell shape changes during multiple developmental processes. Until now four distinct cadherins have been implicated in human Mendelian disorders, mainly featuring skin, retinal and hearing manifestations. Branchio‐skeleto‐genital (or Elsahy‐Waters) syndrome (BSGS) is an ultra‐rare condition featuring a characteristic face, premature loss of teeth, vertebral and genital anomalies, and intellectual disability. We have studied two sibs with BSGS originally described by Castori et al. in 2010. Exome sequencing led to the identification of a novel homozygous nonsense variant in the first exon of the cadherin‐11 gene (CDH11), which results in a prematurely truncated form of the protein. Recessive variants in CDH11 have been recently demonstrated in two other sporadic patients and a pair of sisters affected by BSGS. Although the function of this cadherin (also termed Osteoblast‐Cadherin) is not completely understood, its prevalent expression in osteoblastic cell lines and up‐regulation during differentiation suggest a specific function in bone formation and development. This study identifies a novel loss‐of‐function variant in CDH11 as a cause of BSGS and supports the role of cadherin‐11 as a key player in axial and craniofacial malformations.     

The Use of Radionuclide Retinal Scintigraphy for the Assessment of Retinopathy in Diabetes Mellitus

A computerized radiotracer technique for the detection of loss of retinal vascular integrity secondary to diabetes is presented. Radionuclide retinal scintigraphy with Technetium-99m DTPA was performed on 40 insulindependent diabetics and 10 nondiabetics. A ratio of eye to brain activity was used to eliminate errors associated with absolute counting. Ratios were found to be significantly higher in diabetics, especially those with active neovascularization. This technique may prove useful in the assessment and staging of eyes prone to retinopathy.     

Social and biological reinforcement in an open psychiatric ward

A brief experimental incentive program was conducted in an open ward, in a New York State psychiatric hospital. Patients had to complete four target behaviors, without being reminded, by noon each day. They were first reinforced socially, receiving publicly posted stars against their names; later, only those who had earned a star were admitted to the dining room for lunch. Computations were based on eight patients who lived in the ward for the 3 months of the study, and who served as their own controls. During the base line period the level of performance was very low; it rose when stars were given as reinforcement, and more so when stars were added to food. The program was economical in terms of money, training and effort.     

Lipid Abnormalities in Persons Living With HIV Infection

Lipid abnormalities are prevalent among persons living with HIV infection and contribute to increasing the risk of cardiovascular events. Antiretroviral therapy (ART) is associated with lipid abnormalities, most commonly hypertriglyceridemia, but also increases in low-density lipoprotein cholesterol and total cholesterol. Different classes of ART, and different drugs within classes, have differing effects on lipid levels, but in general newer drugs have more favourable effects compared with older ones. Low-level inflammation and chronic immune activation act on lipids through a variety of mechanisms to make them more atherogenic. As a consequence, risk is higher than would be expected for any given cholesterol level. Clinical outcome trials of cholesterol-lowering therapies have not yet been completed in people living with HIV, so that treatment decisions depend on extrapolation from studies in uninfected populations. Traditional risk assessment tools underestimate cardiovascular risk in individuals with HIV. Statins are the mainstay of lipid-lowering drug treatment; however, drug–drug interactions with ART must be considered. Simvastatin and lovastatin are contraindicated in patients taking protease inhibitors, and the dose of atorvastatin and rosuvastatin should be limited to 40 mg and 10 mg/d with some ART combinations. Switching from older forms of ART to lipid-friendly newer ones is a useful strategy as long as virologic suppression is maintained, but adding a statin lowers low-density lipoprotein cholesterol more effectively. Studies indicate that lipid abnormalities are not treated as aggressively in individuals living with HIV as they are in uninfected people, making this an opportunity to improve care.     

环境与疾病理论奠基人——希波克拉底

希波克拉底(Hippocrates, 460-370 BC), 古希腊名医, 西方医学奠基人。他是人类医学历史长河中的“里程碑式人物”, 被认为是历史上第一位流行病学家。他创造了“四体液学说”医学理论, 使人类医学摆脱神学, 迈入自然医学模式; 他辛勤笔耕on Airs, Waters, and Places著作, 奠定了两千多年的流行病学思想基础; 他以高尚的医德为人称道, 其《希波克拉底誓言》传颂至今; 他与门徒集成大作《希波克拉底文集》, 传育了一代代医者。故, 希波克拉底被尊称为“医学之父”。     

福建晋江细菌种类及分布调查

目的了解福建晋江水中细菌的种类和分布情况。方法用水样采集器采集晋江10个不同地方的水样,水样经增菌培养和细菌分离,进行细菌学鉴定。结果从10份水样中分离出细菌258株,其中肠杆菌科细菌144株(55.8%),弧菌科细菌42株(16.3%),非发酵菌32株(12.4%),芽胞杆菌属细菌23株(8.9%),革兰阳性球菌17株(6.6%)。结论晋江水中细菌种类及分布的调查对于该水域细菌感染的防治具有一定的意义。     

改良式腹膜外剖宫产术512例临床分析

目的探讨改良式腹膜外剖宫产术的临床应用效果。方法对2005年11月至2010年12月在上海交通大学医学院苏州九龙医院和苏州大学附属瑞华医院行改良式腹膜外剖宫产术512例(改良组)与顶侧入联合式腹膜外剖宫产术427例(对照组)的临床资料进行回顾性分析。结果改良组手术时间(27.58±3.23)min、手术开始至胎儿娩出时间(5.9±1.47)min短于对照组(35.40±2.28)min、(9.26±1.63)min,差异有统计学意义(P<0.05)。改良组术中出血量、产钳助娩率、新生儿窒息率与对照组比较,差异无统计学意义(P>0.05)。术后肛门排气时间、住院时间、术后病率、术后镇痛药使用及C反应蛋白(CRP)、白细胞计数,改良组均明显少于对照组,差异有统计学意义。结论改良式腹膜外剖宫产术具有手术时间短,胎儿娩出快,术野暴露充分,侵袭性小,术后恢复快,适应证广等优点,是一种安全、可行的剖宫产术式。     

水样残渣量与总放射性水平之间的关系分析

目的 为了解水样残渣量与总α总β放射性水平之间的关系。方法 选择苏州地区不同水体作为研究对象,应用BH1216型低本底α/β放射性测量装置,用²⁴¹Am和优级纯氯化钾分别作为总α和总β放射性测量的标准源,采用中等厚度相对测量法测定样品中的总α总β放射性活度。结果 水样残渣量与总α放射性活度之间相关性较好(r=0.517,P(0.01),而残渣量与总β放射性活度之间的相关性相对较差(r=0.435,0.01结论 水体的放射性随着其矿化度的增大而增大,应当对水处理过程中降低放射性核素浓度的措施进行探讨和规范化,确保饮用水中放射性核素的水平保持在可合理达到的尽可能低的水平。