Feasibility and safety of right ventricular endomyocardial biopsy via the right internal jugular vein approach / 中华心血管病杂志

Objective: To evaluate the feasibility and safety of right ventricular endomyocardial biopsy (EMB) via the right internal jugular vein approach. Methods: It was a retrospective and descriptive study. A total of 272 patients, who underwent right ventricular EMB from December 2014 to June 2020 in Fuwai Hospital and Peking Union Medical College Hospital were enrolled. The preliminary diagnosis included suspected myocarditis, myocardiopathy, unexplained heart failure etc after exclusion of coronary heart disease. Clinical characteristics including age, sex, height, weight, NYHA functional class, NT-proBNP, chest radiography, echocardiography, and hemodynamics parameters were collected at baseline. EMB was performed via right internal jugular vein approach under the biplane fluoroscopic guidance. Success rate was calculated in this study. Complications related to operation were recorded according the following definitions. Major complications included death, urgent cardiac surgery, advanced cardiac life support, pericardiocentesis in cardiac tamponade, permanent complete atrioventricular block requiring permanent pacing etc. Minor complications included pericardial effusion without pericardiocentesis, temporary (lasting less than 24 hours) or permanent right bundle-branch block, temporary Mobitz type Ⅱ atrioventricular block (AV block) with AV conduction 2∶1 requiring medical treatment with atropine, or additive temporary pacing, non-sustained ventricular tachycardia with long runs of more than 10 ventricular complexes, and an episode of atrial fibrillation lasting less than 12 hours or cardioversion of atrial fibrillation. Other complications included tricuspid anterior chorda rupture and new onset tricuspid regurgitation after EMB. Results: In this study, right ventricular EMB were performed successfully in 270 patients, the total success rate was 99.3% (270/272), and EMB were failed in 2 (0.7%) patients. Age of the enrolled patients was (42.7±16.9) years, and there were 164 (60.3%) males. Major complication including cardiac tamponade requiring pericardiocentesis occurred in 2 (0.7%) patients. Minor complications such as small amount pericardial effusion occurred in 18 (6.6%) patients, tricuspid anterior chorda rupture occurred in 1 (0.4%) patient. No patient died, or requiring permanent pacing, or requiring emergency cardiac surgery. The complication rate was 9.3% (13/140), 7.8% (7/90), and 2.4% (1/42) in operators with 1, 2, and 3 years' experience. Conclusions: EMB via the right jugular vein approach under fluoroscopic guidance is a simple, safe and feasible procedure. The complication rates decrease significantly with increasing operator experience.

Relationship between serum bilirubin levels and optic neuritis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bilirubin is the end product of heme catabolism and has strong antioxidant properties. Serum bilirubin levels are reported to be reduced in patients with multiple sclerosis (MS) and neuromyelitis optica (NMO). The pathophysiology of optic neuritis (ON) resembles that of MS; however, the role of endogenous bilirubin in ON is unclear. The aim of this study is to measure serum bilirubin levels in patients with ON, and to investigate the correlation between ON and serum antioxidant status of bilirubin.</p><p><b>METHODS</b>Serum levels of bilirubin were measured in 42 patients with ON, 50 patients with multiple sclerosis (MS), 48 patients with neuromyelitis optica (NMO) and 48 healthy control subjects.</p><p><b>RESULTS</b>Serum total bilirubin (Tbil), direct bilirubin (Dbil) and indirect bilirubin (Ibil) levels in patients with ON were significantly lower than those in the healthy controls. However, no statistical significance was found between levels in the ON and MS, ON and NMO, and MS and NMO groups. In patients with ON, serum Tbil, Dbil, and Ibil levels were lower in those with recurrence or those with ON for a longer duration (≥ 1 year). Moreover, Tbil, Dbil, and Ibil concentrations were lower in patients with papillitis than in those with retrobulbar type ON, but the differences were not statistically significant.</p><p><b>CONCLUSIONS</b>Low antioxidant status may exist in patients with ON. But serum levels of Tbil, Dbil, and Ibil did not correlate with clinical presentations, such as recurrence, duration of disease and subtypes of ON. Low antioxidant status already existed in MS or NMO patients before systemic symptoms appeared.</p>

Level of β-amyloid peptide in cerebrospinal fluid of patients with multiple sclerosis and clinically isolated syndrome and its significance / 中华神经医学杂志

Objective To investigate the concentration of β-amyloid peptide 42 (Aβ42) in cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS) and its first clinical event-clinically isolated syndrome (CIS), and explore its associations with duration, disability severity and total T2-hyperintense lesion numbers in MRI. Methods Thirty-three patients with MS, 23 patients with CIS and 13 controls were investigated in this study. The disability severity of patients with MS and CIS in attack period was assessed by Expanded Disability Status Scale (EDSS). MRI scanning of brain, spinal cord or optic nerve was performed. And Aβ42 concentration in CSF was assessed by liquid chip assay. Results No significant differences of Aβ42 concentrations in CSF from patients with MS and CIS in attack period were noted as compared with those from controls ([104.78±13.73]pg/mL, [134.13±25.06] pg/mL vs. [137.02±23.35]pg/mL, P>0.05). ButAβ42 concentration in CSF from patients with secondary progressive MS (SPMS, [167.99±36.39]pg/mL) was significantly higher than that from patients with relapsing-remitting MS (RRMS, [92.74±13.64] pg/mL, P=0.042). No correlations of Aβ42 concentration in CSF with the duration of MS and CIS and scores of EDSS were noted in patients with MS and CIS (P> 0.05). The concentration of Aβ42 in CSF from patients with MS with a duration for more than one year lower than the ones with a duration for less than one year, but the difference was not significant (P>0.05). Total T2-hyperintense lesion numbers in MRI of patients with MS and CIS were positively correlated with Aβ42 concentration in CSF (MS patients: r=0.507, P=0.038; CIS patients:r=0.485,P=0.049). Aβ42 concentration in CSF from patients with MS with total T2-hyperintense lesions ≥4 (129.34±19.96) was significantly higher than that from the ones with total T2-hyperintense lesions <4 (73.51±12.60, P=0.049). Conclusion Axonal damage in patients with SPMS is more severe than that in patients with RRMS.Increased CSF Aβ42-level in patients with MS is a feature of disease progression. There is a possible relation between T2-hyperintense lesion load and axonal damage in patients with MS.