An interesting electrocardiogram caused by lead reversal.

BACKGROUND: During normal sinus rhythm, atrial depolarization is conducted from right atrium to left atrium through Bachmann's bundle, and a normal P wave axis which is measured on the frontal plane is between 0º and + 75º. The change of P wave polarity is helpful for the analysis of origin point. CASE PRESENTATION: We report a patient with negative P wave in lead I. The characteristics of QRS complex in leads V1 to V6 are helpful to preliminarily differential diagnosis. The 12-lead electrocardiogram (ECG) with correct limb leads (right arm-left arm) placement shows sinus rhythm with complete right bundle branch block (RBBB). CONCLUSIONS: The change of P wave polarity as well as characteristics of QRS complex can help identify limb-lead reversals.

In vitro and in vivo antiproliferative activity on lung cancer of two acylhydrazone based zinc(II) complexes.

Two acylhydrazone based zinc(II) complexes [Zn(HL)2Cl2(CH3OH)2] (Zn1) and [ZnL(AC)]2 (Zn2) were synthesized from 3-(1-(salicyloylhydrazono)ethyl) pyridine (HL). Single crystal X-ray structure analyses showed that complexes Zn1 and Zn2 have a zero-dimensional monomer or dimer structure. Antiproliferative activity studies revealed that Zn1 and Zn2 are both more effective against A549 cells than cisplatin. The results of the reactive oxygen species (ROS) generation assay on A549 cells showed that both Zn1 and Zn2 induced apoptosis through ROS accumulation. The apoptosis-inducing and cell cycle arrest effects of Zn1 and Zn2 on A549 cells indicated that the antitumor effect was achieved through apoptosis induction and inhibition of DNA synthesis by blocking the G0/G1 phase of the cell cycle. What's more, the results of wound-healing assay showed that Zn1 and Zn2 could inhibit the migration of A549 cells. Western blot analysis further demonstrated that Zn1 and Zn2 induced cell apoptosis through the mitochondrial pathway, in which process, the expression level of cytochrome C, cleaved-PARP, cleaved-caspase 3 and cleaved-caspase 9 proteins increased while pro-caspase 3 and pro-caspase 9 expression decreased. In vivo anticancer evaluation demonstrated that both Zn1 and Zn2 complexes effectively inhibited tumor growth without causing significant toxicity in systemic organs.

Cytochalasans and azaphilones: suitable chemotaxonomic markers for the Chaetomium species.

The accurate taxonomic concept of the fungal Chaetomium species has been a hard work due to morphological similarity. Chemotaxonomy based on secondary metabolites is a powerful tool for taxonomical purposes, which could be used as an auxiliary reference to solve the problems encountered in the classification of Chaetomium. Among secondary metabolites produced by Chaetomium, cytochalasans and azaphilones exhibited a pattern of distribution and frequency of occurrence that establish them as chemotaxonomic markers for the Chaetomium species. This review attempted to elucidate the composition of the Chaetomium species and its relationship with classical taxonomy by summarizing the pattern of cytochalasans and azaphilones distribution and biosynthesis in the Chaetomium species. KEY POINTS: • Secondary metabolites from the genus Chaetomium are summarized. • Cytochalasans and azaphilones could be characteristic metabolites of the Chaetomium species. • Cytochalasans and azaphilones could be used to analyze for taxonomical purposes.

Chrysomya bezziana: a case report in a dog from Southern China and review of the Chinese literature.

Chrysomya bezziana is an obligate, myiasis-causing fly in humans and warm-blooded animals throughout the tropical and subtropical Old World. We report a case of cutaneous myiasis due to C. bezziana in a dog from Guangxi province in China. A total of 35 maggots were removed from the lesions. Direct sequencing of the mitochondrial cytochrome b gene showed that the specimen belonged to haplotype CB_bezz02, which was previously reported in Malaysia and the Gulf region. This paper also reviews reported cases of screwworm myiasis from humans and animals in China. Geographical records indicate that the distribution of C. bezziana is expanding, suggesting that an integrated pest management control should be taken into consideration in China.

Preexcitation syndrome: experimental study on the electrocardiogram of antegradely conducting accessory pathway.

BACKGROUND: Preexcitation syndrome is characterized by a dominant delta wave on the baseline electrocardiogram (ECG), resulting from the change in QRS initial vector by the accessory pathway (AP). This study is to explore the effect of ventricular preexcitation on the QRS initial, maximal and terminal vector in an experimental rabbit with preexcitation syndrome induced by programmed electrical stimulation. METHODS: Rabbits (n = 10) were randomized for the experimental model of ventricular preexcitation. Sensing and stimulating electrode catheters were placed in the high right atrium and along epicardial surface of atrioventricular groove of the left ventricular anterior wall, respectively. Programmed premature stimulation S2 was synchronized with P wave and utilized to stimulate the ventricle. The ECG recorded the electrical activity of the heart. As compared with the QRS complex during sinus rhythm, paced QRS was assessed regarding the initial, maximal and terminal vector. PS2 interval and PR interval were also measured and analyzed. RESULTS: Preexcitation was successfully simulated by ventricular pacing in the rabbits, including (1) Complete preexcitation: PS2 interval was less than PR interval; the difference was more than or equal to 47.00 ± 7.53 ms. (2) Incomplete preexcitation: PS2 interval was less than PR interval; the difference was less than 47.00 ± 7.53 ms. (3) Incomplete latent preexcitation: PS2 interval was more than or equal to PR interval; the difference was less than or equal to 13.00 ± 3.50 ms. (4) Complete latent preexcitation: PS2 interval was more than or equal to PR interval; the difference was more than 13.00 ± 3.50 ms. CONCLUSIONS: The difference in the relative conduction velocity of the atrioventricular node versus the AP pathways determines the degree of preexcitation and different manifestation on ECG. The QRS terminal vector also reflects the ventricle preexcitation, indicating a valuable sign for the diagnosis of atypical or latent preexcitation.

Recurrent extensive anterior myocardial infarction with left and right bundle branch block.

The diagnosis of myocardial infarction with left bundle branch block is difficult. We report a case of 56-year-old man with old extensive anterior myocardial infarction and left bundle branch block (masked each other). The recurrent myocardial infarction indicated right bundle branch block and first-degree atrioventricular block, making a clear diagnosis of complicated and interesting ECG.

Electrocardiogram: his bundle potentials can be recorded noninvasively beat by beat on surface electrocardiogram.

BACKGROUND: The micro waveform of His bundle potential can't be recorded beat-to-beat on surface electrocardiogram yet. We have found that the micro-wavelets before QRS complex may be related to atrioventricular conduction system potentials. This study is to explore the possibility of His bundle potential can be noninvasively recorded on surface electrocardiogram. METHODS: We randomized 65 patients undergoing radiofrequency catheter ablation of paroxysmal superventricular tachycardia (exclude overt Wolff-Parkinson-White syndrome) to receive "conventional electrocardiogram" and "new electrocardiogram" before the procedure. His bundle electrogram was collected during the procedure. Comparative analysis of PAs (PA interval recorded on surface electrocardiogram), AHs (AH interval recorded on surface electrocardiogram) and HVs (HV interval recorded on surface electrocardiogram) interval recorded on surface "new electrocardiogram" and PA, AH, HV interval recorded on His bundle electrogram was investigated. RESULTS: There was no difference (P > 0.05) between groups in HVs interval (49.63 ± 6.19 ms) and HV interval (49.35 ± 6.49 ms). Results of correlational analysis found that HVS interval was significantly positively associated with HV interval (r = 0.929; P < 0.01). CONCLUSIONS: His bundle potentials can be noninvasively recorded on surface electrocardiogram. Noninvasive His bundle potential tracing might represent a new method for locating the site of atrioventricular block and identifying the origin of a wide QRS complex.

Prediction of Pulmonary Arterial Hypertension in Chronic Obstructive Lung Disease from Three-Dimensional Vectorcardiographic Parameters.

AIM: The objective of our study was to assess diagnostic value of three-dimensional (3D) vectorcardiographic (VCG) parameters in detecting pulmonary arterial hypertension (PAH) in chronic obstructive lung disease (COLD) with and without right ventricular hypertrophy (RVH). METHODS: The study group of 62 patients with COPD was stratified on the basis of color Doppler echocardiographic findings into three subgroups: non-PAH (n = 23), PAH without RVH (n = 22), and PAH with RVH (n = 17). Pairwise differences between the subgroups were evaluated by one-way analysis of variance, and Pearson correlation analysis was used to evaluate the significance of the correlations between pulmonary arterial systolic pressure (PASP) and various VCG parameters. RESULTS: The azimuth of the QRS vector decreased from -24° in the non-PAH group to -62° in PAH without RVH and to -140° in PAH with RVH (P < 0.01 for pairwise differences between all three groups). Similar significant decrease was observed for the azimuth of the ventricular gradient (VG) vector. Spatial QRS/T angle increased from 69° in the non-PAH group to 115° in PAH without RVH (P < 0.01). In the PAH group with RVH, QRS/T angle was 94° (P < 0.05 for difference from the non-PAH group). There was a significant correlation between PASP and QRS/T angle (r = 0.89, P < 0.05) and between PASP and the azimuth of the VG vector (r = 0.86, P < 0.05). PASP increase from linear regression model was 0.8 mmHg for a QRS/T angle increase by 10° and 1.3 mmHg for each 10° increase in the azimuth of the VG vector. CONCLUSION: 3DVCG parameters are potentially useful for predicting PASP in COLD patients, and possibly also for differentiation between COLD patients with PAH and RVH from those without RVH.

Effects of Preexcitation Syndrome on Terminal QRS Vector Observed in Spatial Vector.

BACKGROUND: Preexcitation syndrome could affect terminal QRS vector, which is not emphasized in clinic. In this study, we made a comparison between vectorcardiogram (VCG) before and after ablation to observe the change of terminal QRS vector. Furthermore, the relationship between the change of terminal QRS vector and accessory pathway (AP) as well as the change of initial QRS vector (delta vector) was analyzed. METHODS: Thirty patients who were proved to have a single AP by ablation were included. All patients were divided into seven groups based on the AP location. Comparison between VCG before and after ablation was made to observe the change of terminal and delta vector. The relationship between the change of terminal QRS vector and AP location as well as delta vector was analyzed. RESULTS: (1) All 30 patients had a change in terminal QRS vector (elevation and/or azimuth) in comparison to postablation VCG. (2) The change of terminal QRS vector was related to delta vector and AP location. The agreement and consistency between the change of terminal QRS vector and delta vector were 91.65% and 0.856 (P < 0.01), respectively. CONCLUSIONS: (1) Both initial and terminal QRS vector are affected by the antegrade conduction of AP. The change of terminal QRS vector is related to the AP location and delta vector. (2) The effect of preexcitation syndrome on QRS terminal vector is shown as more intuitive and easy in spatial vector by comparison with electrocardiogram, which is helpful for the diagnosis of atypical preexcitation and localization of AP.

Hyperkalemia-induced Brugada pattern with electrical alternans.

The Brugada syndrome is a genetic disease (mutation of the SCN5A gene) that predisposes to syncope and life-threatening sudden cardiac death. The case highlights the importance of recognizing hyperkalemia, as potential triggers of the acquired Brugada sign with electrical alternans.

Preexcitation syndrome with myocardial infarction complicated by atrioventricular block in both normal and accessory pathways?

The preexcitation syndrome may either simulate myocardial infarction (MI) or mask it. The rapid anterograde conduction through accessory pathway may obscure atrioventricular (AV) block of the normal AV-nodal tract. To our knowledge, the case of various degree AV-nodal and bypass tract block after MI in a patient with preexcitation syndrome has been infrequently reported. We report a complex case of preexcitation syndrome presenting with first-degree and transient third-degree AV blocks in both normal and accessory pathways after acute MI. Subsequently, we further discuss the diagnosis of MI in preexcitation syndrome and analyze the electrocardiographic character of AV block in preexcitation syndrome.

A novel methionine metabolism-related signature predicts prognosis and immunotherapy response in lung adenocarcinoma.

Recent research revealed methionine metabolism as a key mediator of tumor initiation and immune evasion. However, the relationship between methionine metabolism and tumor microenvironment (TME) in lung adenocarcinoma (LUAD) remains unknown. Here, we comprehensively analyzed the genomic alterations, expression patterns, and prognostic values of 68 methionine-related regulators (MRGs) in LUAD. We found that most MRGs were highly prognostic based on 30 datasets including 5024 LUAD patients. Three distinct MRG modification patterns were identified, which showed significant differences in clinical outcomes and TME characteristics: The C2 subtype was characterized by higher immune score, while the C3 subtype had more malignant cells and worse survival. We developed a MethScore to measure the level of methionine metabolism in LUAD. MethScore was positively correlated with T-cell dysfunction and tumor-associated macrophages (TAMs), indicating a dysfunctional TME phenotype in the high MethScore group. In addition, two immunotherapy cohorts confirmed that patients with a lower MethScore exhibited significant clinical benefits. Our study highlights the important role of methionine metabolism in modeling the TME. Evaluating methionine modification patterns will enhance our understanding of TME characteristics and can guide more effective immunotherapy strategies.

Efficacy analysis of axillary approach in the treatment of Ideberg type I and II scapular glenoid fractures: Case series.

RATIONALE: To investigate the clinical efficacy of the axillary approach in the surgical treatment of Ideberg type I and II scapular glenoid fractures. PATIENT CONCERNS AND DIAGNOSIS: Retrospective analysis of 13 cases of scapular glenoid fracture treated in the affiliated Hospital of Jining Medical College, Jiaxiang County People hospital, Zoucheng City people Hospital, Yanzhou District People Hospital, and Juancheng County people Hospital from December 2020 to January 2022. Eight males (including 1 bilateral) and 5 females, with an average age of 57.5 years (range from 33 to 75 years). According to Ideberg classification, there were 10 cases of type I a, 1 case of type I a combined with type I b, and 2 cases of type II. All patients were treated with axillary approach surgery and 7 patients with combined anterior shoulder dislocation were treated by first-stage manipulation and second-stage reoperation. Seven patients were fixed with a wire anchor, 3 patients with type I a were fixed with a "T" plate, and 5 patients were complicated with rotator cuff tear and were repaired with a wire anchor. At the last follow-up, the Constant-Murley shoulder function score, visual analog score, DASH score, and Hawkins grade were used to evaluate shoulder function, pain, and stability after treatment. INTERVENTION: The intervention was to treat patients with Ideberg type I and II scaphoid fractures using an axillary approach. OUTCOMES: All 13 patients in this group were followed up thoroughly, and the follow-up time was 12 to 25 months, with an average of 18.6 months. The operation time was 65 to 135 minutes, with an average of 85.6 minutes. Intraoperative blood loss ranged from 20 to 120 mL, averaging 55.6 mL. The duration of hospitalization ranged from 7 to 22 days, with an average of 9.6 days. The surgical incisions of all patients were grade-A healing. Bone healing of glenoid fractures was observed 3 months after the operation. LESSONS: The axillary approach for Ideberg type I and II scapular glenoid fractures is a feasible surgical approach with complete access through the muscle gap, minimal surgical trauma, mild postoperative pain, and satisfactory clinical results.

Comprehensive characterization of TGFB1 across hematological malignancies.

TGFB1, which encodes TGF-ß1, a potent cytokine regulating varies cellular processes including immune responses. TGF-ß1 plays context-dependent roles in cancers and is increasingly recognized as a therapeutic target to enhance immunotherapy responses. We comprehensively evaluated expression of TGFB1 and its clinical and biological effects across hematological malignancies. TGFB1 expression was first explored using data from the GTEx, CCLE, and TCGA databases. The expression and clinical significances of TGFB1 in hematological malignancies were analyzed using Hemap and our In Silico curated datasets. We also analyzed the relationship between TGFB1 with immune scores and immune cell infiltrations in Hemap. We further assessed the value of TGFB1 in predicting immunotherapy response using TIDE and real-world immunotherapy datasets. TGFB1 showed a hematologic-tissue-specific expression pattern both across normal tissues and cancer types. TGFB1 expression were broadly dysregulated in blood cancers and generally associated with adverse prognosis. TGFB1 expression were associated with distinct TME properties among different blood cancer types. In addition, TGFB1 expression was found to be a useful marker in predicting immunotherapy responses. Our results suggest that TGFB1 is broadly dysregulated in hematological malignancies. TGFB1 might regulate the immune microenvironment in a cancer-type-specific manner, which could be applied in the development of new targeted drugs for immunotherapy.

Three metal complexes with a pyridyl Schiff base: cytotoxicity, migration and mechanism of apoptosis.

Three metal complexes [CuL(NO3)]n (1), [Cd(HL)(NO3)2]n (2) and [EuL(HCOOH)(H2O)(NO3)2] (3) were synthesized with a pyridyl Schiff ligand L (N'-[(1E)-pyridin-2-ylmethylidene]pyridine-4-carbohydrazide). A crystallographic study revealed that complexes 1 and 2 have a chain structure, and complex 3 is a zero-dimensional monomer. In vitro cytotoxicity studies showed that complex 2 had the best antiproliferative activity against SMMC-7721 cells and complex 3 had the best antiproliferative activity against MDA-MB-231 cells with single-digit IC50 values, both exceeding those of the control drug cisplatin by far. The cell invasion and migration ability through the transwell assay and wound-healing assay showed that the selected complexes could inhibit the invasion and migration of cancer cells. The Hoechst staining assay and ROS generation assay with SMMC-7721 cells indicated that the cytotoxic effects of complex 2 involved apoptosis induction through ROS accumulation. The apoptosis-inducing and cell cycle arrest effects of complex 2 on SMMC-7721 cells indicated that the antitumor effect was achieved through apoptosis induction and inhibition of DNA synthesis by blocking the G0/G1 phase of the cell cycle. In addition, complex 2 showed significant inhibition against B. dysentery with an inhibition circle diameter of 24 mm.