Banxia Xiexintang Regulates Autophagy of Interstitial Cells of Cajal in Gastric Antrum of Rats with Gastric Electric Dysrhythmia / 中国实验方剂学杂志

ObjectiveTo observe the effect of Banxia Xiexintang on the autophagy of interstitial cells of Cajal （ICCs） in the gastric antrum of rats with gastric electric dysrhythmia， and explore the protective effect and regulatory mechanism. MethodThirty-two SD rats were randomly assigned into a normal group， a model group， a Banxia Xiexintang （24.68 g·kg-1） group， and a positive drug （2.7 mg·kg-1） group. The rat model of gastric electric dysrhythmia was established by the method of dieting every other day and drinking dilute hydrochloric acid， and Banxia Xiexintang and the positive drug were administrated for intervention. The body weight of each rat was recorded weekly. The gastric electric activity was recorded by the biological function experimental system. The ultrastructural changes of the gastric antrum tissue were observed by a transmission electron microscope. The co-expression of receptor tyrosine kinase （c-kit）/mammalian homolog of yeast Atg6 （Beclin1） in the gastric antrum tissue was detected by double immunofluorescence labeling method. The expression of microtubule-associated protein 1 light chain 3B （LC3B） and p62 protein in the gastric antrum tissue was determined by Western blot， and the LC3BⅡ/Ⅰ ratio was calculated. ResultCompared with the normal group， the modeling reduced the body weight （P<0.01） and decreased the dominant frequency and dominant power of gastric electricity （P<0.01）. In addition， the modeling caused ultrastructural damage of ICCs in gastric antrum， degeneration and necrosis of organelles， and appearance of a small number of autophagic vesicles. The results of double immunofluorescence labeling showed that the modeling inhibited the positive expression of c-kit and promoted the positive expression of Beclin1 in gastric antrum tissue. Western blot results showed that the modeling increased the ratio of LC3BⅡ/Ⅰ （P<0.01） and down-regulated the expression of p62 protein （P<0.01） in the gastric antrum tissue. Compared with the model group， Banxia Xiexintang and the positive drug increased the body weight （P<0.01） and the dominant frequency and dominant power of gastric electricity （P<0.01）， repaired the ultrastructural damage of ICCs in gastric antrum tissue， promoted the positive expression of c-kit and inhibited the positive expression of Beclin1 in the gastric antrum tissue. Furthermore， Banxia Xiexintang up-regulated the expression of p62 （P<0.05） and inhibited the transformation of LC3BⅠ into LC3BⅡ in gastric antrum tissue （P<0.05）. ConclusionBy regulating the expression of autophagy-related proteins， Banxia Xiexintang can reduce the autophagy and regulate the number and structure of ICCs and thus improve the gastric electric rhythm of rats， which preliminarily explains the mechanism of Banxia Xiexintang in the treatment of epigastric stuffiness.

Clinical Characteristics and Independent Factors Related to Long-Term Outcomes in Patients with Left Isomerism

BACKGROUND AND OBJECTIVES: We studied the results of patient management for left isomerism (LI) and sought to determine factors that may influence survival and prognosis. SUBJECTS AND METHODS: We reviewed the medical records of 76 patients who were compatible with LI criteria between 1982 and 2014. RESULTS: Of the total study population, 29 patients (38.1%) had functional univentricular heart disease, 43 patients (56.5%) had cardiac anomalies suitable for biventricular hearts, and four patients (5.2%) had normal heart structure. Extracardiac anomalies were noted in 38.1% of the study population, including biliary atresia in 7.8% of all patients. Of the 25 patients who underwent Kawashima procedures, 24.0% developed pulmonary arteriovenous fistulas (PAVFs). During the median follow-up period of 11.4 years (range: 1 day to 32 years), 14 patients died. The 10-year, 20-year, and 30-year survival rates were 87%, 84%, and 76%, respectively. Preoperative dysrhythmia and uncorrected atrioventricular valve regurgitation were significantly associated with late death. There was no significant difference in the number of surgical procedures and in survival expectancy between patients in the functional single-ventricle group and in the biventricular group. However, late mortality was higher in functional single-ventricle patients after 18 years of age. CONCLUSION: Patients with LI need to be carefully followed, not only for late cardiovascular problems such as dysrhythmia, valve regurgitation, and the development of PAVFs, but also for noncardiac systemic manifestations.

Approaching Long Term Cardiac Rhythm Monitoring Using Advanced Arm Worn Sensors and ECG Recovery Techniques.

According to recent British Heart Foundation statistics, one in six men and more than one in ten women die from coronary heart disease (CHD) in the UK. This equates to almost 74,000 deaths per annum from CHD alone. More worryingly, every week, 12 apparently fit and healthy young people aged 35 and under, die from undiagnosed cardiac conditions. In both circumstances, monitoring is preformed only when triggered by an event. Unfortunately, this may be too late in the large majority of cases. For instance, there is evidence suggesting that most indiscernible cardiac abnormalities are made detectable by ECG through the act of suddenly standing upright. This infers that the condition would be detectable during the course of everyday ambulatory activity and highlights the need for a long term monitoring device. Current diagnostic equipment consists of the Holter monitor for extended periods up to 36 hours and the implantable loop recorder (ILR) for monitoring up to 3 years. The diagnostic yield of the ECG monitoring strategy is greatly increased as the monitoring period increases. Therefore, for subjects that exhibit symptoms of cardiac involvement that are transient in nature, the ILR offers the best opportunity for diagnosis. However, the ILR is inserted under the surface of the skin in the upper chest area and requires a surgical procedure, with associated risks, which makes ILR’s a costly and inconvenient option in many cases. The need for a non-invasive long term monitoring device, which is comfortable to wear along the arm and able to provide reliable ECG monitoring, has been addressed by many, in several lines of approach to a solution. This review details the current state of the art and any pending limitations. It then presents key multidisciplinary solutions on the different aspects of the problem, which will still require integration in order to realise such a device.

Clinical effects of progressive time phase selective light therapy on shift work disorder patients / 中华行为医学与脑科学杂志

Objective To research the effects of progressive time phase selective light (PTPSL)therapy on shift work disorder patients.Methods 24 shift work disorder patients were randomlv divided into PTPSL group and control group.Both groups received treatment for 12 days including 6 days during the night shift time and 6 days during the day shift time continuously.The clinical effects were evaluated by Karolinska Sleepiness Scale (KSS),Leeds sleep evaluation questionnaire (LSEQ) and core body temperature rhythm.Results (1) During the night shift time,PTPSL group patients were better in score LSEQ and KSS(discerned for 39.80 ± 2.89,6.59 ±0.48) than control group' s(discerned for 36.86 ± 3.88,6.98 ± 2.03) ; temperature curve peak phase in PTPSL group moved backward greater than that of control group((8.35 ± 0.82) h vs (7.45 ± 1.05) h) ; and the difference was statistical significance(P ＜ 0.05).During the day shift time,PTPSL group patients were better in score LSEQ and KSS(discerned for 45.57 ± 2.77,6.33 ± 0.48) than control group' s (discerned for 40.35 ± 4.19,6.82 ± 1.03),temperature curve peak phase in PTPSL group moved forward greater than that of control group((7.37 ± 0.94)h vs (6.31 ±1.37)h),and the difference was statistical significance(P＜0.05).Conclusion PTPSL can adjust shift sleep disorder patients' mussily sleep rhythm system in order,and make the inner rhythm svstem and external schedules tend to be consistent,and provides a new treatment choice for shift sleep disorders.

Interpretation and Use of Natriuretic Peptides in Non-Congestive Heart Failure Settings

Natriuretic peptides (NPs) have been found to be useful markers in differentiating acute dyspneic patients presenting to the emergency department (ED) and emerged as potent prognostic markers for patients with congestive heart failure (CHF). The best-established and widely used clinical application of BNP and NT-proBNP testing is for the emergent diagnosis of CHF in patients presenting with acute dyspnea. Nevertheless, elevated NPs levels can be found in many circumstances involving left ventricular (LV) dysfunction or hypertrophy; right ventricular (RV) dysfunction secondary to pulmonary diseases; cardiac inflammatory or infectious diseases; endocrinology diseases and high output status without decreased LV ejection fraction. Even in the absence of significant clinical evidence of volume overload or LV dysfunction, markedly elevated NP levels can be found in patients with multiple comorbidities with a certain degree of prognostic value. Potential clinical applications of NPs are expanded accompanied by emerging reports regarding screening the presence of secondary cardiac dysfunction; monitoring the therapeutic responses, risk stratifications and providing prognostic values in many settings. Clinicians need to have expanded knowledge regarding the interpretation of elevated NPs levels and potential clinical applications of NPs. Clinicians should recognize that currently the only reasonable application for routine practice is limited to differentiation of acute dyspnea, rule-out-diagnostic-tests, monitoring of therapeutic responses and prognosis of acute or decompensated CHF. The rationales as well the potential applications of NPs in these settings are discussed in this review article.

Toxicologic Features and Management in Aconitine Intoxication Following Ingestion of Herbal Tablets Containing Aconitum Species

PURPOSE: Unrefined tablets prepared from Aconitum tubers are occasionally used in Korean folk medicine. This study defines the potential sources, clinical toxicology, and treatment of aconitine poisoning. METHODS: A retrospective survey was conducted in 63 patients in the ED of a tertiary University Hospital with suspected toxicity from an unrefined tablet prepared from Aconitum tubers from 1999 to 2007. RESULTS: A total of 63 cases enrolled included 26 men and 37 women, aged 30 to 86 years. Forty-eight patients ingested aconitine tablets as digestives, 26 tablets on average. After a latent period of 30 to 450 minutes, patients developed a combination of neurologic (87.3%), gastrointestinal (82.5%), cardiopulmonary (41.3%), and other (28.6%) features typical of aconitine poisoning. Initial ECG abnormalities revealed dysrhythmia (61.9%), conduction disturbance (42.9%), and abnormal waveforms (39.7%), with 28.6% of patients having normal ECGs. All patients received supportive treatment or close observation regardless of ingestion amounts. Patients with hypotension or ventricular arrhythmia were treated with inotropic agents or amiodarone. CONCLUSION: Toxicologic signs and symptoms can occur after the consumption of aconitine tablets, regardless of ingestion amount. The risk occurs because of inadequately processed aconitine roots. This study will provide important data for public education and distribution regulations for Aconitum sp. in Korea.

The Effect of Ondansetron on the Corrected QT Interval of Electrocardiography during General Anesthesia / 대한마취과학회지

BACKGOUND: Prolongation of the corrected QT interval (QTc) has a potential risk of inducing life-threatening cardiac dysrhythmia. Although 5-HT3 antagonists are useful antiemetics, several cases of cardiac dysrhythmia after administration of 5-HT3 antagonists have been reported. Therefore, this study was conducted to evaluate the changes in QTc interval that occur after administration of a clinical dose of ondansetron during general anesthesia. METHODS: Seventy-five patients, who underwent elective surgery under standardized general anesthesia were evaluated. After anesthetic induction, the patients were given either normal saline, 2 mg or 4 mg of iv ondansetron. The QTc on the electrocardiogram was measured immediately prior to administration of the treatment drug and then every minute after injection of the study drug for 10 minutes, 12 and 15 minutes. RESULTS: There were no differences observed in the baseline QTc of the different treatment groups. In addition, there were no significant changes in the QTc interval of the control group, however, the QTc interval was prolonged significantly in both the ondansetron 2 mg and 4 mg groups. Further, DeltaQTc (the difference in QTc interval from the baseline value) was significantly prolonged in the ondansetron 2 mg and 4 mg groups when compared with the control group. There were no differences in the number of patients who showed abnormal QTc and there were no incidences of dysrhythmia in any of the three groups. CONCLUSIONS: Ondansetron administration for emesis prophylaxis during general anesthesia was associated with statistically significant prolongation of the QTc interval. The authors recommend that caution be used when ondansetron is administered to prevent and/or treat postoperative nausea and vomiting, particularly in patients who have a prolonged QTc interval.

Anesthetic Management of a Patient with Brugada Syndrome: A case report / 대한마취과학회지

Brugada syndrome is characterized by a distinctive electrocardiographic pattern (right bundle branch block and a ST segment elevation in the right precordial leads), but without structural heart disease. It is a rare genetic disorder, with an autosomal dominant inheritance pattern. Many factors during general anesthesia (medication, bradycardia, temperature changes) can precipitate malignant dysrhythmia in this patient, so careful choice of anesthetics is required. We experienced the anesthetic management of a 50-year-old male patient with Brugada syndrome, who underwent an emergency operation, under general anesthesia for acute appendicitis. Surgery was performed uneventfully, and the patient was discharged without complication.

Anesthetic Management of a Patient with Brugada Syndrome: A case report / 대한마취과학회지

Brugada syndrome is characterized by a distinctive electrocardiographic pattern (right bundle branch block and a ST segment elevation in the right precordial leads), but without structural heart disease. It is a rare genetic disorder, with an autosomal dominant inheritance pattern. Many factors during general anesthesia (medication, bradycardia, temperature changes) can precipitate malignant dysrhythmia in this patient, so careful choice of anesthetics is required. We experienced the anesthetic management of a 50-year-old male patient with Brugada syndrome, who underwent an emergency operation, under general anesthesia for acute appendicitis. Surgery was performed uneventfully, and the patient was discharged without complication.

Aconitine Intoxication Following Ingestion of Folk Recipes Containing Aconitum Species

PURPOSE: Preparations of Aconitum roots in Chinese and Korean medicine are carefully prescribe for analgesic, antirheumatic and neurologic indications. However, in Korean folk medicine, a crude medical herb prepared from Aconitum is still used as form of a decoction or an unrefined tablet. Potential hazards of these medicinal herbs are poisoning and occasional fatalities due to low margins of safety. This study was conducted to document the adverse effects related to the use of these folk recipes that resulted in the emergency department (ED) admission. METHODS: A retrospective survey was conducted of 30 patients presented to the ED of a tertiary University Hospital with suspected adverse effects from folk recipes containing Aconitum over a three-year period from 1999 to 2001. The patients was analyzed according to sex, age, intention of use, residential area, vital signs on ED presentation, time to presentation, time to discharge or ECG normalization, frequency of chief complaints, and ECG abnormalities. RESULTS: The patients' mean age was around 67 years old. The patients were predominantly female (22 patients) and from rural areas (21 patients). The drug effects of Aconitum were not appreciated by almost all the patients. Of the chief complaints, nausea or vomiting was most common (76.7%). Time to presentation in the ED varied (30 ~ 930 minutes), which suggests that the occurrence of symptoms is directly related to the amount of aconitine in folk recipes containing Aconitum. Upon the arrival, most of the patients were hypotensive (MAP: 62 mmHg), but heart rates were normal or tachycardic. The ECG findings were variable, and, except for one case, normal sinus rhythm was restored within 24 hours without pharmacological intervention. CONCLUSION: This research demonstrates the need to emphasize public announcement to deter the injudicious use of folk recipes containing Aconitum species.

ANALYSIS OF ECG. MONITORING DURING CENTRIFUGE TRAINING IN PILOTS, ROKAF (Dysrhythmia and G-LOC)

The ROKAF(Republic of Korea Air Force ) has been conducting high G-training with new centrifuge training equipment at Aeromedical Research and Training Center(AMRTC) to enhance G-tolerance since July 1995. All trainees routinely have received ECG monitoring during High G training, both for safety and medical evaluation. The purpose of this study was to estimate the incidence of cardiac dysrhythmia among the fighter pilots of ROKAF and other countries and to investigate the relationship between G-induced loss of consciousness (G-LOC) and the presence of dysrhythmia during High-G training. The electrocardiographic responses of 417 fighter pilots exposed to the standard centrifuge high-G training profile were analysed. Dysrhythmias were observed in 204(42.7%) of the sessions, Ventricular ectopy occurred In 143(29.9% ) and supraventricular ectopy showed in 56(11.7%) of the sessions. G-induced loss of consciousness(G-LOC) occurred in 15%(62 pilots) of the trainees. Dysrhythmias associated with G-LOC were recorded In 23(37%), however, aeromedically serious arrhythmias were not observed. 41%(25/61) of dysrhythmias appeared in ROR(Rapid Onset Rate), whereas 27.9%(17/61) of them in GOR (Gradual Onset Rate). Although riding the centrifuge is a stressful experience in aircrews, the presence of the serious arrhythmias could potentially result in sudden incapacitation during flight. Therefore, ECG monitoring of aircrews during centrifuge training is hlghly recommended for their safety as well as aeromedical policy.

Atelectasis and Ventricular Tachycardia after Induction of Anesthesia / 대한마취과학회지

A frequent dilemma facing the anesthesiologist is the patient with respiratory tract symptoms. The risks of anesthesia and surgery in these patients have not been clearly established. We present a case in which a potentially serious respiratory complication had arisen. The patient had symptoms of coughing and mucous production. She was a heavy smoker. However, there was no history of pulmonary disease. This report describes a patient who developed left upper lobar collapse after induction of general anesthesia and tachydysrhythmia resulting in ventricular tachycardia and myocardial ischemia.

" TOTI " Method for Difficult Orotracheal Intubation in Adult Patients / 대한마취과학회지

This report is a prospective study comparing conventional direct laryngoseopy with tube-over-tube intubation ("TOTI") method in 42 male patients, whose tracheas were difficult to intubate. ("TOTI") method using two different-sized endotracheal tubes, the newly devised technique has not been mentioned yet. And the comparative studies have not been performed to evaluate relative efficacy, speed, or incidence of complications for the conventional versus "TOTI" method in endotracheal intubation. Overall number of attempts (mean+/-SE) in conventional group was 3.62+/-0.37(range; 1-8), while "TOTI" one was 1.1+/-0.07 (range; 1-2). The time required for intubation ranged from 25 to 64 seconds in TOTI group and 37 to 2015 sec in conventional one, average (mean+/-SE) 37.19+/-1.87 and 542.71+/-111.54sec, respectively. No complications of endotracheal intubation occured in "TOTI" group, whereas in coventional one there occurred fourteen patients with sore throat, seven with hoarseness and five with temporary short-lived dysrhythmia.

A Case Report of Ventricular Dysrhythmia in a Patient with Sinus Bradycardia and Low Blood Pressure / 대한마취과학회지

Sinus Bradycardia per se does not necessitate therapy. In fact, its presence often implies good health or a good prognosis. A 56-year-old patient, whose pulse rate was about 35 beats per minute and blood pressure was 80/50 mmHg, underwent total gastrectomy under general anesthesia. Ventricular dysrhythmia occurred after the second dose of gallamine managed with lidocaine, and after the administration of atropine and ephednne managed with hydralazine. Authors report this case with the evaluation of references.

A Case Report of Ventricular Dysrhythmia in a Patient with Sinus Bradycardia and Low Blood Pressure / 대한마취과학회지

Sinus Bradycardia per se does not necessitate therapy. In fact, its presence often implies good health or a good prognosis. A 56-year-old patient, whose pulse rate was about 35 beats per minute and blood pressure was 80/50 mmHg, underwent total gastrectomy under general anesthesia. Ventricular dysrhythmia occurred after the second dose of gallamine managed with lidocaine, and after the administration of atropine and ephednne managed with hydralazine. Authors report this case with the evaluation of references.