A 35 years old woman presented with an acute meningeal syndrome following an intra ventricular haemorrhage without subarachnoid haemorrhage. The angiography demonstrated a 6 mm partially thrombosed saccular aneurysm at the plexal point of the right anterior choroidal artery (AChoA). It was surgically approached inside the ventricle through a trans-temporal corticotomy. The aneurysm was excised after distal exclusion of the feeding artery under motor-evoked potentials monitoring. Of the 19 cases of distal AChoA aneurysm neurosurgical treatment, this is the only one performed under electrophysiology monitoring, a simple and safe method to detect and prevent motor tract ischemia. We discuss this rare case, along with a comprehensible review of the literature of the previous surgical cases of distal AChoA aneurysms.
Aneurysm* ; Angiography ; Arteries* ; Choroid* ; Electrophysiology ; Evoked Potentials, Motor ; Female ; Humans ; Intracranial Aneurysm ; Ischemia ; Methods

Neurogastroenterology and motility disorders of the gastrointestinal (GI) tract encompass a broad spectrum of diseases involving the GI tract and central nervous system. They have varied pathophysiology, clinical presentation and management, and make up a substantial proportion of outpatient clinic visits. Typically, patients experience persistent symptoms referable to the GI tract despite normal endoscopic and radiologic findings. An appropriate evaluation is thus important in the patient's care. Advances in technology and understanding of the disease pathophysiology have provided better insight into the physiological basis of disease and a more rational approach to patient management. While technological advances serve to explain patients' persistent symptoms, they should be balanced against the costs of diagnostic tests. This review highlights the GI investigative modalities employed to evaluate patients with persistent GI symptoms in the absence of a structural lesion, with particular emphasis on investigative modalities available locally and the clinical impact of such tools.
Electrophysiology ; Endoscopy ; Esophagus ; physiopathology ; Gastric Emptying ; Gastroenterology ; instrumentation ; methods ; Gastrointestinal Diseases ; diagnosis ; Gastrointestinal Tract ; physiopathology ; Humans ; Hydrogen-Ion Concentration ; Intestine, Small ; physiopathology ; Magnetic Resonance Imaging

OBJECTIVETo observe the effects of adipose-derived mesenchymal stem cells (ADSCs) with continous over-expression of glial cell line-derived neurotrophic factor (GDNF) on the motor function recovery and nerve regeneration of sciatic nerve of rats after electrical injury.

METHODSFive SD rats were collected to prepare ADSCs with over-expression of GDNF. One hundred and fifty SD rats were divided into normal control group (N), GDNF-ADSCs group (GA), ADSCs group (A), GDNF group (G), and physiological saline group (P) according to the random number table, with 30 rats in each group. Rats in group N were routinely fed without treatment, and rats in the other 4 groups were inflicted with electrical injury on sciatic nerve of thigh of the right hind leg. Rats in groups GA, A, G, and P were respectively injected with 100 µL suspension of ADSCs with over-expression of GDNF (1 x 10(7) cells per mL), 100 [µL ADSCs suspension (1 x 10(7) cells per mL), 100 µL GDNF solution (100 mg/L) , and 100 µL physiological saline to the surface of the injured nerves immediately after injury. Six rats of each group were collected for measuring hind limb stride from post injury week (PIW) 1 to 8, and morphology of the sciatic nerves was observed in PIW 8. In PIW 4, the protein expression of GDNF of sciatic nerves of the rest rats in each group was determined with Western blotting. Data were processed with one-way analysis of variance, analysis of variance of repeated measurement, and SNK test.

RESULTSCompared with that of group N, the hind limb stride values in groups GA, A, G, and P were significantly lower at each time point (with P values below 0.05). Compared with those of group P, the hind limb stride values in group GA from PIW 3 to 8, in group A in PIW 3, 5, and 7, and in group G in PIW 3, 5, 7, and 8 were significantly longer (with P values below 0.05). The hind limb stride values in group GA from PIW 4 to 8 were respectively (10.83 ± 0.97), (13.25 ± 1.40), (12.86 ± 1.42), (14.06 ± 1.50), and (15.09 ± 1.17) cm, which were significantly longer than those in group A [(8.90 ± 0.82), (9.03 ± 0.57), (9.27 ± 0.36), (9.86 ± 0.36), and (9.52 ± 0.58) cm] and group G [(8.87 ± 0.69), (8.51 ± 1.18), (9.34 ± 0.87), (9.76 ± 0.67), and (9.50 ± 1.22) cm], with P values below 0.05. Compared with that of group N, the number of myelinated nerve fibers of sciatic nerves was obviously decreased in group P but obviously increased in groups GA, A, and G; the diameter of axons was obviously shorter, and the myelin thickness was obviously increased in groups GA, A, G, and P in PIW 8 (with P values below 0.05). The number of myelinated nerve fibers in group GA was 31.2 ± 0.8, which was significantly higher than that in group A (23.7 ± 2.7), group G (22.3 ± 2.7), or group P (9.3 ± 2.8), with P values below 0.05. The diameter values of axons among groups P, A, G, and GA were similar (with P values above 0.05). The myelin thickness of rats in group GA was (3.41 ± 0.34) µm, which was significantly thicker than that in group A [(2.64 ± 0.37) µm] or group G [(2.41 ± 0.34) µm], with P values below 0.05. In PIW 4, the protein expression of GDNF of sciatic nerves was significantly higher in groups P, A, G, and GA than in group N (with P values below 0.05), and the protein expression of GDNF in group GA was significantly higher than that in group P, A, or G (with P values below 0.05).

CONCLUSIONSADSCs over-expressing GDNF protein can obviously promote the motor function recovery and nerve regeneration of sciatic nerve of rats after electrical injury.

Adipose Tissue ; Animals ; Electrophysiology ; Glial Cell Line-Derived Neurotrophic Factor ; genetics ; metabolism ; Mesenchymal Stem Cell Transplantation ; methods ; Mesenchymal Stromal Cells ; metabolism ; Nerve Crush ; Nerve Regeneration ; physiology ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; pathology ; physiology

BACKGROUNDNonfluoroscopic three-dimensional electroanatomical system is widely used nowadays, but X-ray remains indispensable for complex electrophysiology procedures. This study aimed to evaluate the value of optimized parameter setting and different projection position to reduce X-ray radiation dose rates.

METHODSFrom June 2013 to October 2013, 105 consecutive patients who underwent complex ablation were enrolled in the study. After the ablation, the radiation dose rates were measured by two different settings (default setting and optimized setting) with three projection positions (posteroanterior [PA] projection; left anterior oblique [LAO] 30° projection; and LAO 45° projection). The parameter of preset voltage, pulse width, critical voltage, peak voltage, noise reduction, edge enhancement, pulse rate, and dose per frame was modified in the optimized setting.

RESULTSThe optimized setting reduced radiation dose rates by 87.5% (1.7 Gy/min vs. 13.6 Gy/min, P < 0.001) in PA, 87.3% (2.5 Gy/min vs. 19.7 Gy/min, P < 0.001) in LAO 30°, 85.9% (3.1 Gy/min vs. 22.1 Gy/min, P < 0.001) in LAO 45°. Increase the angle of projection position will increase the radiation dose rate.

CONCLUSIONSWe can reduce X-ray radiation dose rates by adjusting the parameter setting of X-ray system. Avoiding oblique projection of large angle is another way to reduce X-ray radiation dose rates.

Adult ; Aged ; Arrhythmias, Cardiac ; surgery ; Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Electrophysiology ; Female ; Fluoroscopy ; methods ; Humans ; Male ; Middle Aged ; Radiation Dosage

OBJECTIVETo observe the effect of bronchoalveolar lavage on the heart rhythm and conduction of children with severe pneumonia through monitoring the electrocardiogram change of different step of the bronchoalveolar lavage, for proving the safety of the operation of bronchoalveolar lavage from the perspective of cardiac electrophysiology.

METHODFrom July 2011 to March 2012, 30 patients who were hospitalized in pneumology department of Dalian Children's Hospital and met the inclusion criteria and therapeutic indications of bronchoalveolar lavage were chosen. They were 3 to 12 years old, the average age was 5.3 years, including 17 boys and 13 girls, the ratio of boys and girls is 1.3: 1. Continuous sampling the electrocardiogram before and during the process including anesthesia, entering into glottis, lavage, aspiration, and revive, and recording the heart rate, rhythm amplitude and width of P wave, the PR interval, the form and width of QRS complex were also measured. The recorded data were analyzed and statistical analysis to reflect the change of the cardiac electrophysiology.

RESULTThe incidence of heart rate increase was 100.0%, 26 (86.7%) patients began to emerge after anesthesia, the rest of the patients also developed heart rate increase after the start of bronchoscopic operation. All patients had sinus tachycardia, and were most obvious in the progress of lavage and revive. In the process of entering into glottis, lavage, aspiration, 13 (43.3%) patients had arrhythmia episodes. Types of arrhythmia included sinus bradycardia, atrioventricular block and premature beat. Incidences of intraoperative arrhythmia compared with the pre- and post-operation were all statistically significantly different (P = 0.00). The most common arrhythmia were premature beat, in 17 of the 30 cases there were premature beat including 9 cases with atrial premature beats and 8 cases ventricular premature contraction. Two patients had III° atrioventricular block accompanied by serious sinus bradycardia. All kinds of arrhythmias except sinus tachycardia disappeared after the operation was ended. Five patients (16.7%) had PR interval prolongation. Five patients (16.7%) had incomplete right bundle branch block (IRBBB) . Incidences of IRBBB compared with the pre-operation and post-operation were all not significantly different [13.3% (n = 4) vs. 0(n = 0) and 3.3% (n = 1), all P > 0.05]. Different operating progress made no significant difference in the measurement value of electrocardiogram[13.3% (n = 4) vs. 0(n = 0) and 3.3% (n = 1), all P > 0.05], but showed the most notable effect on heart rate.

CONCLUSIONBronchoalveolar lavage can influence the heart rhythm and conduction, but most of the influence with pathological significance are transient. Cardiac electrophysiological changes were the most obvious in endotracheal operation with the risk of malignant arrhythmia but the risk is low, the bronchoalveolar lavage technique is safe. The contingency plans for dealing with all kinds of adverse reactions must be ready before the operations of bronchoalveolar lavage. During the procedure, the patient's ECG changes should be closely monitored to reduce the incidence of adverse reactions.

Arrhythmias, Cardiac ; etiology ; physiopathology ; Bronchoalveolar Lavage ; adverse effects ; methods ; Bronchoscopy ; adverse effects ; methods ; Cardiac Complexes, Premature ; etiology ; physiopathology ; Cardiac Electrophysiology ; Child ; Child, Preschool ; Electrocardiography ; Female ; Heart Block ; etiology ; physiopathology ; Heart Rate ; physiology ; Humans ; Hypoxia ; etiology ; physiopathology ; Male ; Pneumonia ; pathology ; therapy

BACKGROUNDBone marrow derived mesenchymal stem cells (BMdMSCs) can differentiate into cardiomyocyte-like cells induced by different inductors individually or collectively. In this study, by inducing BMdMSCs with p53 inhibitor (p-fifty three inhibitor-alpha, PFT-α), 5-azacytidine (5-AZA), angiotensin-II (Ang-II) and bone morphogenic protein-2 (BMP-2) we compared the influences of four inductors on the differentiation of rat BMdMSCs into caridomyocyte like-cells.

METHODSBMdMSCs were collected from the bone marrow of Sprague Dawley rats and after the fourth generation, the purified cells were divided into five groups: 5-AZA (10 µmol/L), Ang-II (0.1 µmol/L), PFT-α (20 µmol/L), BMP-2 (10 µg/L) and control. The purity of the BMdMSCs and the cardiac differentiation rates were obtained by flow cytometry. The expressions of cTnT in the BMdMSCs after four weeks of induction were detected by immunofluorescence and the expressions of cTnI and Cx43 detected by Western blotting. The green fluorescent levels reflecting intracellular calcium transient function were determined by laser scanning confocal microscopy. The total potassium current levels of cells were measured on patch clamp.

RESULTSAll inductors affected to a different degree the differentiation of BMdMSCs into cardiomyocyte-like cells and the expressions of cTnT, cTnI and Cx43 suggesting that the combination of inductors could be an improved method for cardiac regenerative medicine. In addition, the total potassium current level and calcium transient in PFT-α cardiomyocyte-like cells were higher than other groups.

CONCLUSIONSThe cardiac differentiation of BMdMSCs induced by PFT-α, 5-AZA, Ang-II and BMP-2 has been improved at different levels. PFT-α has an advantage of differentiation rate and electrophysiological function over other inductors.

Animals ; Blotting, Western ; Bone Marrow Cells ; cytology ; Cell Differentiation ; physiology ; Cells, Cultured ; Electrophysiology ; methods ; Male ; Mesenchymal Stromal Cells ; cytology ; Myocytes, Cardiac ; cytology ; Rats ; Rats, Sprague-Dawley

BACKGROUNDVarious tissue engineering strategies have been developed to facilitate axonal regeneration after spinal cord injury. This study aimed to investigate whether neural stem cells (NSCs) could survive in poly(L-lactic-co-glycolic acid) (PLGA) scaffolds and, when cografted with Schwann cells (SCs), could be induced to differentiate towards neurons which form synaptic connection and eventually facilitate axonal regeneration and myelination and motor function.

METHODSNSCs and SCs which were seeded within the directional PLGA scaffolds were implanted in hemisected adult rat spinal cord. Control rats were similarly injured and implanted of scaffolds with or without NSCs. Survival, migration, differentiation, synaptic formation of NSCs, axonal regeneration and myelination and motor function were analyzed. Student's t test was used to determine differences in surviving percentage of NSCs. One-way analysis of variance (ANOVA) was used to determine the differences in the number of axons myelinated in the scaffolds, the mean latency and amplitude of cortical motor evoked potentials (CMEPs) and Basso, Beattie & Bresnahan locomotor rating scale (BBB) score. The χ(2) test was used to determine the differences in recovery percentage of CMEPs.

RESULTSNSCs survived, but the majority migrated into adjacent host cord and died mostly. Survival rate of NSCs with SCs was higher than that of NSCs without SCs ((1.7831 ± 0.0402)% vs. (1.4911 ± 0.0313)%, P < 0.001). Cografted with SCs, NSCs were induced to differentiate towards neurons and might form synaptic connection. The mean number of myelinated axons in PLGA + NSCs + SCs group was more than that in PLGA + NSCs group and in PLGA group ((110.25 ± 30.46) vs. (18.25 ± 3.30) and (11.25 ± 5.54), P < 0.01). The percentage of CMEPs recovery in PLGA + NSCs + SCs group was higher than in the other groups (84.8% vs. 50.0% and 37.5%, P < 0.05). The amplitude of CMEPs in PLGA + NSCs + SCs group was higher than in the other groups ((1452.63 ± 331.70) µV vs. (428.84 ± 193.01) µV and (117.33 ± 14.40) µV, P < 0.05). Ipsilateral retransection resulted in disappearance again and functional loss of CMEPs for a few days. But contralateral retransection completely damaged the bilateral motor function.

CONCLUSIONSNSCs can survive in PLGA scaffolds, and SCs promote NSCs to survive and differentiate towards neurons in vivo which even might form synaptic connection. The scaffolds seeded with cells facilitate axonal regeneration and myelination and motor function recovery. But regenerating axons have limited contribution to motor function recovery.

Animals ; Axons ; physiology ; Cells, Cultured ; Electrophysiology ; Female ; Fluorescent Antibody Technique ; Lactic Acid ; chemistry ; Nerve Regeneration ; physiology ; Neural Stem Cells ; cytology ; Polyglycolic Acid ; chemistry ; Pregnancy ; Rats ; Rats, Wistar ; Schwann Cells ; cytology ; Spinal Cord Injuries ; therapy ; Tissue Engineering ; methods ; Tissue Scaffolds ; chemistry

Multifocal visual electrophysiology, consisting of multifocal electroretinography (mfERG) and multifocal visual evoked potential (mfVEP), can objectively evaluate retina function and retina-cortical conduction pathway status by stimulating many local retinal regions and obtaining each local response simultaneously. Having many advantages such as short testing time and high sensitivity, it has been widely used in clinical ophthalmology, especially in the diagnosis of retinal disease and glaucoma. It is a new objective technique in clinical forensic medicine involving visual function evaluation of ocular trauma in particular. This article summarizes the way of stimulation, the position of electrodes, the way of analysis, the visual function evaluation of mfERG and mfVEP, and discussed the value of multifocal visual electrophysiology in forensic medicine.
Electrodes ; Electrophysiology ; Electroretinography/methods* ; Evoked Potentials, Visual/physiology* ; Eye Injuries/physiopathology* ; Forensic Medicine/methods* ; Glaucoma/physiopathology* ; Humans ; Image Processing, Computer-Assisted ; Retina/physiopathology* ; Retinal Diseases/physiopathology* ; Vision, Ocular/physiology* ; Visual Acuity/physiology* ; Visual Fields/physiology*

BACKGROUNDHATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation (AF). The purpose of this study was to determine if HATCH score could predict recurrence after catheter ablation of AF.

METHODSThe data of 488 consecutive paroxysmal AF patients who underwent an index circumferential pulmonary veins (PV) ablation were retrospectively analyzed. Of these patients, 250 (51.2%) patients had HATCH score = 0, 185 (37.9%) patients had HATCH score = 1, and 53 (10.9%) patients had HATCH score ≥ 2 (28 patients had HATCH score = 2, 23 patients had HATCH score = 3, and 2 patients had HATCH score = 4).

RESULTSThe patients with HATCH score ≥ 2 had significantly larger left atrium size, the largest left ventricular end systolic diameter, and the lowest ejection fraction. After a mean follow-up of (823 ± 532) days, the recurrence rates were 36.4%, 37.8% and 28.3% from the HATCH score = 0, HATCH score = 1 to HATCH score ≥ 2 categories (P = 0.498). Univariate analysis revealed that left atrium size, body mass index, and failure of PV isolation were predictors of AF recurrence. After adjustment for body mass index, left atrial size and PV isolation, the HATCH score was not an independent predictor of recurrence (HR = 0.92, 95% confidence interval = 0.76 - 1.12, P = 0.406) in multivariate analysis.

CONCLUSIONHATCH score has no value in prediction of AF recurrence after catheter ablation.

Adult ; Aged ; Atrial Fibrillation ; therapy ; Body Mass Index ; Catheter Ablation ; methods ; Electrophysiology ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged

BACKGROUNDIt has been reported that endogenous or exogenous hydrogen sulfide (H(2)S) exerts physiological effects in the vertebrate cardiovascular system. We have also demonstrated that H(2)S acts as an important regulator of electrophysiological properties in guinea pig papillary muscles and on pacemaker cells in sinoatrial nodes of rabbits. This study was to observe the electrophysiological effects of H(2)S on human atrial fibers.

METHODSHuman atrial samples were collected during cardiac surgery. Parameters of action potential in human atrial specialized fibers were recorded using a standard intracellular microelectrode technique.

RESULTSNaHS (H(2)S donor) (50, 100 and 200 µmol/L) decreased the amplitude of action potential (APA), maximal rate of depolarization (V(max)), velocity of diastolic (phase 4) depolarization (VDD) and rate of pacemaker firing (RPF), and shortened the duration of 90% repolarization (APD(90)) in a concentration-dependent manner. ATP-sensitive K(+) (K(ATP)) channel blocker glibenclamide (Gli, 20 µmol/L) partially blocked the effects of NaHS (100 µmol/L) on human atrial fiber cells. The L-type Ca(2+) channel agonist Bay K8644 (0.5 µmol/L) also partially blocked the effects of NaHS (100 µmol/L). An inhibitor of cystathionine γ-lyase (CSE), DL-propargylglycine (PPG, 200 µmol/L), increased APA, V(max), VDD and RPF, and prolonged APD(90).

CONCLUSIONSH(2)S exerts a negative chronotropic action and accelerates the repolarization of human atrial specialized fibers, possibly as a result of increases in potassium efflux through the opening of K(ATP) channels and a concomitant decrease in calcium influx. Endogenous H(2)S may be generated by CSE and act as an important regulator of electrophysiological properties in human atrial fibers.

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; pharmacology ; Action Potentials ; drug effects ; Calcium Channel Agonists ; pharmacology ; Calcium Channels, L-Type ; metabolism ; Cystathionine gamma-Lyase ; metabolism ; Electrophysiology ; methods ; Glyburide ; pharmacology ; Heart Atria ; drug effects ; metabolism ; Humans ; Hydrogen Sulfide ; metabolism ; In Vitro Techniques ; KATP Channels ; antagonists & inhibitors ; metabolism ; Sulfides ; pharmacology