Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction

AbstractOBJECTIVESTo determine the clinical features of a novel heart syndrome with transient left ventricular (LV) apical ballooning, but without coronary artery stenosis, that mimics acute myocardial infarction, we performed a multicenter retrospective enrollment study.BACKGROUNDOnly several case presentations have been reported with regard to this syndrome.METHODSWe analyzed 88 patients (12 men and 76 women), aged 67 ± 13 years, who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies.RESULTSThirty-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had emotional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or excessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave formation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56%) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York Heart Association function on discharge. The LV ejection fraction improved from 41 ± 11% to 64 ± 10%. Transient intraventricular pressure gradient and provocative vasospasm were documented in 13/72 (18%) and 10/48 (21%) of the patients, respectively. During follow-up for 13 ± 14 months, two patients showed recurrence, and one died suddenly.CONCLUSIONSA novel cardiomyopathy with transient apical ballooning was reported. Emotional or physical stress might play a key role in this cardiomyopathy, but the precise etiologic basis still remains unclear

PCR-Dipstick-Oriented Surveillance and Characterization of mcr-1- and Carbapenemase-Carrying Enterobacteriaceae in a Thai Hospital

Colistin is used as an alternative therapeutic for carbapenemase-producing Enterobacteriaceae (CPE) infections which are spreading at a very high rate due to the transfer of carbapenemase genes through mobile genetic elements. Due to the emergence of mcr-1, the plasmid-mediated colistin resistance gene, mcr-1-positive Enterobacteriaceae (MCRPEn) pose a high risk for the transfer of mcr-1-carrying plasmid to CPE, leading to a situation with no treatment alternatives for infections caused by Enterobacteriaceae possessing both mcr-1 and carbapenemase genes. Here, we report the application of PCR-dipstick-oriented surveillance strategy to control MCRPEn and CPE by conducting the PCR-dipstick technique for the detection of MCRPEn and CPE in a tertiary care hospital in Thailand and comparing its efficacy with conventional surveillance method. Our surveillance results showed a high MCRPEn (5.9%) and CPE (8.7%) carriage rate among the 219 rectal swab specimens examined. Three different CPE clones were determined by pulsed-field gel electrophoresis (PFGE) whereas only two MCRPEn isolates were found to be closely related as shown by single nucleotide polymorphism-based phylogenetic analysis. Whole genome sequencing (WGS) and plasmid analysis showed that MCRPEn carried mcr-1 in two plasmids types—IncX4 and IncI2 with ~99% identity to the previously reported mcr-1-carrying plasmids. The identification of both MCRPEn and CPE in the same specimen indicates the plausibility of plasmid-mediated transfer of mcr-1 genes leading to the emergence of colistin- and carbapenem-resistant Enterobacteriaceae. The rapidity (<2 h) and robust sensitivity (100%)/specificity (~99%) of PCR-dipstick show that this specimen-direct screening method could aid in implementing infection control measures at the earliest to control the dissemination of MCRPEn and CPE

脳卒中患者に対する低頻度反復経頭蓋磁気刺激と運動療法の併用が損傷側手指ピンチ動作の筋活動に与える影響 シングルケースにおける検討

近年、反復経頭蓋磁気刺激（repetitive transcranial magnetic stimulation； rTMS）は脳卒中患者上肢に対するアプローチとして有効性が示唆されている。その中で非損傷運動野への1Hz でのrTMS と手指運動を併用することによって損傷側手指の課題成績の増大等が報告されている。しかしながら筋活動に及ぼす影響は一貫した結果が報告されていない。そこで非損傷運動野への1Hz でのrTMS が筋活動に与える影響を検証した。今回、脳卒中患者1 例に対して非損傷側運動野への疑似刺激（sham-TMS）、1Hz-rTMS（real-TMS）の2 群の介入を実施し、1Hz-rTMS が損傷側手指の筋活動に与える影響を検証した。介入はsham-TMS、real-TMS 後にそれぞれ手指運動を15 分実施した。対象者には両側の第一背側骨間筋（first dorsal interosseous； FDI）に電極を設置し、筋活動を記録した。評価はrTMS 前（pre）、後（post1）、手指運動後（post2）に単純ピンチ反応課題をさせ、EMG-onset からpeak までのEMG 振幅を記録した。またpre、post₁ に非損傷側FDI より記録される運動誘発電位（Motor Evoked Potential； MEP）の振幅を記録した。結果はFDI においてreal-TMS におけるpost1 のMEP 振幅はpre と比較して有意に減少した。real-TMS におけるEMG 振幅はpost1、post2 において有意に増加し、群間比較はpost1、2においてsham と比較し、有意に増加した。これらより本症例において手指運動前に非損傷側運動野に1Hz-rTMS を行うことにより非損傷側運動野の興奮性が抑制され、手指運動による筋活動は手指運動のみより増加することが示された。This study was designed to examine the effect of repetitive transcranial magnetic stimulation（rTMS） on motor deficits of affect hand in a patient with stroke. The patient was a woman with left hemiplegia persisting month after stroke. The conditions received 1 Hz rTMS over the unaffected hemisphere before motor training of pinch function, or sham rTMS before motor training of pinch function. We evaluated the electromyography（EMG） amplitude of the affected first dorsal interosseous（FDI） and the motor evoked potential（MEP） of the affected motor cortex by TMS. The MEP amplitude after 1 Hz rTMS significantly decreased than the MEP amplitude before 1 Hz rTMS. The EMG amplitude after 1 Hz rTMS and after motor training pinch function significantly increased than the EMG amplitude before 1 Hz rTMS and sham rTMS condition. These findings indicate that 1 Hz rTMS improved EMG activity and hand function

食塩感受性高血圧ラットにおける心筋収縮効率と収縮性に対する酸素消費は代償性左室肥大から心不全に至る過程においても保持される

京都大学0048新制・論文博士博士(医学)乙第9912号論医博第1661号新制||医||699(附属図書館)UT51-98-U185(主査)教授 米田 正始, 教授 野間 昭典, 教授 篠山 重威学位規則第4条第2項該当Doctor of Medical ScienceKyoto UniversityDA