Retour au travail après un accident coronarien aigu

BackgroundReturn to work (RTW) after acute coronary syndrome (ACS) is an important issue for the patient's future.AimsThe study aim was to determine whether RTW practice complies with guidelines or is delayed by failure in patient management. We analysed the factors influencing RTW beyond the 90-day period recommended by guidelines.MethodsWe conducted a survey of 216 self-employed workers admitted to the hospital for ACS using self-report questionnaires and medical examination. Factors influencing RTW, occupational and cardiac features, and recall and source of medical information were investigated.ResultsNinety-three of 216 patients did not return to work by 90 days, despite good cardiac performance in 30 cases (32 %). The mean sick leave duration was 93.3 ± 103.7 days. Advice concerning return to work was completely missing for 44 % of patients. Cardiac performance was independent of sick leave duration, but was correlated with the likelihood of RTW (P < 0.001). Patients assimilated about 70 % of the medical information they were provided, but only 53 % of work-related information. Recall of work-related information was better among patients admitted to a rehabilitation facility (65 %) compared to those who did not receive rehabilitation (P < 0.05).ConclusionCardiologists should assess the patient's cardiac performance within 2 months after ACS. Patient management should also include cardiac rehabilitation or therapeutic education toward improving information recall.     

Malodorous volatile organic sulfur compounds: Sources,sinks and significance in inland waters

Volatile Organic Sulfur Compounds (VOSCs) are instrumental in global S-cycling and greenhouse gas production. VOSCs occur across a diversity of inland waters, and with widespread eutrophication and climate change, are increasingly linked with malodours in organic-rich waterbodies and drinking-water supplies. Compared with marine systems, the role of VOSCs in biogeochemical processes is far less well characterized for inland waters, and often involves different physicochemical and biological processes. This review provides an updated synthesis of VOSCs in inland waters, focusing on compounds known to cause malodours. We examine the major limnological and biochemical processes involved in the formation and degradation of alkylthiols, dialkylsulfides, dialkylpolysulfides, and other organosulfur compounds under different oxygen, salinity and mixing regimes, and key phototropic and heterotrophic microbial producers and degraders (bacteria, cyanobacteria, and algae) in these environs. The data show VOSC levels which vary significantly, sometimes far exceeding human odor thresholds, generated by a diversity of biota, biochemical pathways, enzymes and precursors. We also draw attention to major issues in sampling and analytical artifacts which bias and preclude comparisons among studies, and highlight significant knowledge gaps that need addressing with careful, appropriate methods to provide a more robust understanding of the potential effects of continued global development.     

Beta‐amyloid protein (25–35) disrupts hippocampal network activity: Role of Fyn‐kinase

Early cognitive deficit characteristic of early Alzheimer's disease seems to be produced by the soluble forms of β‐amyloid protein. Such cognitive deficit correlates with neuronal network dysfunction that is reflected as alterations in the electroencephalogram of both Alzheimer patients and transgenic murine models of such disease. Correspondingly, recent studies have demonstrated that chronic exposure to βAP affects hippocampal oscillatory properties. However, it is still unclear if such neuronal network dysfunction results from a direct action of βAP on the hippocampal circuit or it is secondary to the chronic presence of the protein in the brain. Therefore, we aimed to explore the effect of acute exposure to βAP_25–35 on hippocampal network activity both in vitro and in vivo, as well as on intrinsic and synaptic properties of hippocampal neurons. We found that βAP_25–35, reversibly, affects spontaneous hippocampal population activity in vitro. Such effect is not produced by the inverse sequence βAP_35–25 and is reproduced by the full‐length peptide βAP_1–42. Correspondingly βAP_25–35, but not the inverse sequence βAP_35–25, reduces theta‐like activity recorded from the hippocampus in vivo. The βAP_25–35‐induced disruption in hippocampal network activity correlates with a reduction in spontaneous neuronal activity and synaptic transmission, as well as with an inhibition in the subthreshold oscillations produced by pyramidal neurons in vitro. Finally, we studied the involvement of Fyn‐kinase on the βAP_25–35‐induced disruption in hippocampal network activity in vitro. Interestingly, we found that such phenomenon is not observed in slices obtained from Fyn‐knockout mice. In conclusion, our data suggest that βAP acutely affects proper hippocampal function through a Fyn‐dependent mechanism. We propose that such alteration might be related to the cognitive impairment observed, at least, during the early phases of Alzheimer's disease. © 2009 Wiley‐Liss, Inc.     

CD14-Mac-1 interactions in Bacillus anthracis spore internalization by macrophages

Anthrax, a potentially lethal disease of animals and humans, is caused by the Gram-positive spore-forming bacterium Bacillus anthracis. The outermost exosporium layer of B. anthracis spores contains an external hair-like nap formed by the glycoprotein BclA. Recognition of BclA by the integrin Mac-1 promotes spore uptake by professional phagocytes, resulting in the carriage of spores to sites of spore germination and bacterial growth in distant lymphoid organs. We show that CD14 binds to rhamnose residues of BclA and acts as a coreceptor for spore binding by Mac-1. In this process, CD14 induces signals involving TLR2 and PI3k that promote inside-out activation of Mac-1, thereby enhancing spore internalization by macrophages. As observed with mice lacking Mac-1, CD14^−/− mice are also more resistant than wild-type mice to infection by B. anthracis spores. Additionally, after B. anthracis spore challenge of CD14^−/− mice, interference with the CD14-mediated signaling pathways results in increased mortality. Our results show that the binding and uptake of B. anthracis spores by phagocytic cells is a dynamic process and involves multiple receptors and signaling pathways.     

Multiple Concealed Accessory Pathways Associate with Antegrade Triple AV Nodal Pathways and Catheter Ablation

This article describes a 54-year-old man with incessant supraven-tricular tachycardia refractory to antiarrhythmic drugs. Multiple concealed accessory pathways associated with antegrade triple AV nodal pathways were documented by a series of successful catheter ablations and detailed electrophysiological studies. After the left-wall accessory pathways were abolished with two courses of multiple low energy shocks, another two accessory pathways, one near the os of coronary sinus and the other near the site of the His bundle, were documented by programmed premature ventricular stimulation. This was followed by a third course of shocks to the os of coronary sinus for ablating posteroseptal AP and a fourth course of shock to proximal His bundle for control of SVT with a septal accessory pathway as a retrograde limb and AV nodal pathways as an antegrade limb. Without medications, the patient has remained asymptomatic even during moderate physical activity over a follow-up period of 36 months. His ECG showed sinus rhythm with persistence of right bundle branch block.     

C5a-C5aR在脓毒症中的作用

脓毒症中补体系统的过度激活导致大量C5a的产生,并诱导其受体(C5aR)在细胞上的表达异常,C5a-C5aR相互作用调节炎症介质的表达、干扰凝血通路和诱导中性粒细胞功能障碍,最终导致器官功能损伤.     

Radiofrequency Catheter Ablation of Posteroseptal Accessory Pathways–Results of a Step-by-Step Ablation Approach

Introduction: Transcatheter radiofrequency ablation of posteroseptal accessory pathways (AP) is challenging. A number of different interventional approaches have been suggested by different groups. The selection of the initial approach is crucial in order to reduce radiation exposure and the number of unsuccessful lesions applied. We present our ablation technique as guided by a simplified electrocardiographic analysis of the delta wave polarity and the electrophysiologic mapping results. Methods and Results: Out of 35 manifest APs encountered in the right (n=17) or the left posteroseptum (n=18) in 35 patients, 34 were successfully ablated. Despite their left sided location, 7 of the 18 left sided APs were ablated after switching from an initial arterial to a venous approach looking for an appropriate target site in the right posteroseptal space or within the coronary sinus network. The other 11 left sided APs were ablated in the mitral ring, on 2 occasions, on their atrial aspect through a retrograde transmitral approach. On the contrary, 16 of the 17 right sided APs were successfully ablated exclusively through a venous approach. Fourteen of these were ablated in the right posteroseptum, in 2 cases, only after reaching their ventricular aspect. Two right sided APs were interrupted in the coronary sinus os and the middle cardiac vein respectively. Conclusion: It appears that even though the electrocardiographic and electrophysiologic location of the AP in the posteroseptal space helps select the appropriate initial approach, it does not always guarantee a successful ablation procedure in the expected site of the corresponding atrioventricular ring. Not uncommonly, it will be necessary to look after intermediate target sites within the coronary sinus to improve the overall ablation success rate.     

预激综合征患者多旁路的射频消融

１７４例预激综合征患者中１３例（７．５％）具有多旁路（２９条）。２９条旁路中２１条由基础电生理检查证实，８条在阻断其它旁路后显现。４例在双侧，９例在单侧消融。平均放电３２±１４次后将２７条（９３．１％）旁路阻断。多旁路与单旁路消融成功率相似（９３．１％ＶＳ９４．０％，Ｐ＞０．０５）；但放电次数多（３２±１４ＶＳ１４±１１，Ｐ＜０．０５），消融时程长（３．６±０．８ｈＶＳ２．１±０．９ｈ，Ｐ＜０．０１）；多旁路组复发率高（７．６％ＶＳ１．９％，Ｐ＜０．０１）．本研究证实射频消融是根治多旁路患者的有效方法。     

The Sonic hedgehog signaling pathway involved in the expression of RACK1 in the pulmonary microvascular endothelial cells induced by lipopolysaccharide北大核心CSCD

Objective To explore the effect of expression of protein kinase C receptor l(RACKl) induced by lipopolysaccharide (LPS) on Sonic hedgehog(SHH) signaling pathway in rat puhnonary microvascular endothelial cells (RPMVEC). Methods The healthy male SPF grade SD rat with 100-120 g body weight were gotten from the laboratory animal center of Annui province. Using immunocytochemistry method, the expression of RACK 1 protein in RPMVECs was detected, cultured RPMVECs were randomly divided into different groups as LPS dose-dependent group, SAG(smoothened Agonist, a SHH signaling pathway specific agonist) dose-dependent group, LPS time-dependent group, SAG time-dependent group and LPS+SAG group. In LPS dose-dependent groups, RPMVECs were cultured with 0.1, 1, 10 mg/L LPS for 8 h. In LPS time-dependent groups, RPMVECs were cultured with 10 mg/L LPS for 0, 2, 4, 8, 12, 24 h. In SAG dose-dependent groups, RPMVECs were cultured with 0.1, 1, 10 u, mol/L for 8 h. In SAG time-dependent groups, RPMVECs were cultured with 1 u, mol/L SAG for 0, 2, 4, 8, 12, 24 h. In LPS+SAG group, RPMVECs were cultured with 1 u. mol/L SAG 8 h after 10 mg/L LPS treatment for 1 h. In addition, blank group, LPS group and SAG group were set for control. Western blot were used to detect the level of RACK1 and RT-PCR were used to detect the expression of GLI-1 mRNA after intervention. Results Immunocytochemistry revealed that RACK1 were present in RPMVEC. 1. In LPS dose-dependent groups (0, 0.1, 1, 10 mg/L), the level of RACK 1 elevated as LPS dose increased correspondingly with inter-group difference (P<0.05); the relative expression levels of GLI-1 mRNA were (1.109 ± 0.063), (1.039 ± 0.135), (0.813 ± 0.066), (0.770 ± 0.105), (1 mg/L vs. 10 mg/L, P>0.05; the rest P<0.05). In LPS time-dependent groups, the relative expression level of RACK1 at 2 h (0.370 ± 0.010) was higher than that at 0 h (0.329 ± 0.008), peaked at 12 h (1.296 ± 0.048), and compared with 0 h, there was significant differences (F=l 272.204, P<0.05). The relative expression level of GLI-1 mRNA was decreased at 2 h (0.929 ± 0.007), and compared with 0 h(1.089 ± 0.042), there was significant differences (F=306.609, /><0.05). 2. In SAG dose-dependent groups, there was no significant difference in level of RACK1 between groups(all P>0.05). The relative expression levels of GLI-1 mRNA were (1.109 ± 0.063), (1.169±0.052), (3.468 ±0.128), (3.434±0.054), (0 μ.mol/L vs. 0.1 μ.mol/L and l μmol/L vs. 10 μ.mol/L, P>0.05, the rest P<0.05). Among SAG time-dependent groups, there was no significant difference in levels of RACK1 protein(P>0.05). The relative expression level of GLI-1 mRNA increased at 2 h (3.027 ± 0.065), and compared with 0 h (2.651 ± 0.123), there was significant differences (F= 132.841, P<0.05). 3. In LPS+SAG intervention groups, the expression of RACK1 was lower than that in LPS group (0.831 ± 0.040 vs. 1.189 ± 0.149, P<0.05), and the expression of GLI-1 mRNA was higher than that in LPS group (2.720 ± 0.130 vs. 0.796 ± 0.082, P<0.05). Conclusions The LPS up-regulates the expression of RACK 1 in RPMVECs, and the activated SHH signaling pathway can down-regulate the expression of RACK 1 induced by LPS in RPMVECs. © 2018 Chinese Medical Association. All rights reserved.     

miRNA-126-3p 与先天性心脏病肺动脉高压发病机制相关性的临床研究

目的：探讨 miRNA-126-3p 与肺动脉高压（以下简称肺高压）发病机制的相关性。方法选取25例先天性心脏病患者,其中,肺高压患者11例,对照组14例,采用 qRT-PCR 法检测其肺组织 miRNA-126-3p 的表达,并采用 starBase 进行靶基因预测,并从 mRNA 水平和蛋白水平进行验证。结果肺高压患者与对照组在年龄、性别、生化指标检查等方面比较差异无统计学意义（P＞0．05）;肺高压患者 miRNA-126-3p 表达水平与对照组比较差异有统计学意义（P＜0．01）;生物信息学预测发现 miRNA-126-3p 的生物学功能主要与结合蛋白、信号转导、细胞分化、调控细胞形态、调控 MAPK 和胰岛素受体信号通路等有关,其靶基因主要有 VEGFA 、SPRED1、PIK3R2等;肺高压组的 VEGFA 表达在 mRNA 水平和蛋白水平与对照组比较差异有统计学意义（P＜0．01）;miRNA-126-3p 与 VEGFA 呈现正相关（P＜0．01）。结论 miRNA-126-3p 可能通过调控 VEGFA 参与先天性心脏病相关性肺动脉高压发病。