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Biomedical subjects

C H Cheng

Publications and source records attributed to C H Cheng.

At least 163 records · Page 9Linked to original sources

An antifreeze glycopeptide gene from the antarctic cod Notothenia coriiceps neglecta encodes a polyprotein of high peptide copy number.

The antarctic fish Notothenia coriiceps neglecta synthesizes eight antifreeze glycopeptides (AFGP 1-8; Mr 2600-34,000) to avoid freezing in its ice-laden freezing habitat. We report here the sequence of one of its AFGP genes. The structural gene contains 46 tandemly repeated segments, each encoding one AFGP peptide plus a 3-amino acid spacer. Most of the repeats (44/46) code for peptides of AFGP 8; the remaining 2 code for peptides of AFGP 7. At least 2 of the 3 amino acids in the spacers could act as substrate for chymotrypsin-like proteases. The nucleotide sequence between the translation initiation codon (ATG) and the first AFGP-coding segment is G + T-rich and encodes a presumptive 37-residue signal peptide of unusual sequence. Primer extension establishes the transcription start site at nucleotide 43 upstream from ATG. CAAT and TATA boxes begin at nucleotides 53 and 49, respectively, upstream from the transcription start site. The polyadenylylation signal, AATAAA, is located approximately 240 nucleotides downstream from the termination codon. A mRNA (approximately 3 kilobases) was found that matches the size of this AFGP gene. Thus, this AFGP gene encodes a secreted, high-copy-number polyprotein that is processed posttranslationally to produce active AFGPs.

Amino Acid Sequence↗

Haemodynamics of induced atrial fibrillation: a comparative assessment with sinus rhythm, atrial and ventricular pacing.

The haemodynamics and myocardial lactate consumption during induced atrial fibrillation (AF) were studied in 10 patients with paroxysmal AF. Their mean age (+/- SD) was 61 +/- 5 years and none had clinical evidence of ischaemic or rheumatic heart disease. Compared with sinus rhythm, the onset of AF was associated with a reduction in systolic blood pressure (152 +/- 13 mmHg) in AF vs 169 +/- 23 mmHg in sinus rhythm, P less than 0.01). There was no consistent change in cardiac output at the onset of AF compared with sinus rhythm, but the cardiac output was lower compared with regular atrial pacing at rates similar to those of induced AF (3.85 +/- 0.76 vs 4.38 +/- 0.89 l min-1, P less than 0.02). Compared with sinus rhythm or rate-matched atrial pacing, AF was associated with an elevated pulmonary arterial pressure (24.2 +/- 5.6 mmHg in AF vs 17.9 +/- 14.4 mmHg in sinus rhythm, P less than 0.01) and pulmonary arterial wedge pressure (18.6 +/- 5.6 vs 9.7 +/- 3.9 mmHg, P less than 0.01). The haemodynamic changes during AF were similar to those seen during regular ventricular pacing at an equivalent rate, although the latter was associated with a lower systolic blood pressure (152 +/- 13 mmHg in AF vs 136 +/- 25 mmHg in ventricular pacing, P less than 0.05) and higher right atrial pressure (8.2 +/- 4.4 vs 11.5 +/- 7.5 mmHg respectively, P less than 0.05), presumably due to the deleterious effects of cannon 'a' waves.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

'Leopard' syndrome.

'Leopard' syndrome is a rare inherited disorder associated with a high prevalence of cardiac abnormalities. General anaesthesia for dental treatment in a patient who had cardiomyopathy and bizarre electrocardiographic abnormalities associated with this syndrome is described. A thorough cardiac assessment is advised in a patient with multiple lentigines, although no clinical symptoms or signs may be found. Even if no cardiac abnormality is found before it is better to re-assess the patient, since abnormalities may develop later. The assessment should be repeated if any abnormality was detected before but without clinical significance, since the disease is progressive and may progress more rapidly in some patients than in others.

Adolescent↗

Importance of heart rate modulation on the cardiac hemodynamics during postexercise recovery.

The influence of heart rate changes on the recovery of cardiac hemodynamics and lactate clearance after exercise was studied in nine patients with complete atrioventricular (AV) block treated with programmable pacemakers. A preliminary treadmill exercise test in which the pacing rate was externally increased stepwise from 70 to 130 bpm was performed to determine the maximum exercise duration. Two exercise tests involving an equal amount of exercise load were performed, the pacing rate was either programmed to the basic rate (abrupt decay) or gradually (modulated decay) immediately after exercise termination. Compared with abrupt decay, modulated decay resulted in a higher mean arterial pressure (100 +/- 4 mmHg vs 91 +/- 5 mmHg, P less than 0.05) and diastolic pressure (76 +/- 4 mmHg vs 59 +/- 4 mmHg, P less than 0.001) immediately on exercise termination. Immediately after exercise and during modulated decay, cardiac output (represented by Doppler derived minute distance) declined gradually and was determined mainly by a higher pacing rate without significant changes in stroke volume. On the other hand, minute distance fell abruptly during abrupt decay (996 +/- 107 m at peak exercise and 561 +/- 88 m immediately after a rate change at exercise termination, P less than 0.01) with a corresponding abrupt increase in systemic vascular resistance. This was later compensated by a gradual increase in stroke volume during the recovery period. The cumulative cardiac output between the two rate changes equalized at the 4th minute of recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Reentrant fascicular tachycardia with cycle length alternans: insights into the tachycardia mechanism and origin.

This report details the electrophysiology of a unique case of reentrant fascicular tachycardia in a patient without structural heart disease. Persistent cycle length alternans, with constant fluctuation in alternate RR intervals, occurred during tachycardia. A distinct mode of spontaneous termination of tachycardia was observed. The findings were consistent with the presence of decremental conduction properties in the tachycardia circuit or decremental dual functional pathways within one limb of the circuit. These observations provide further evidence in support of a fascicular origin of the tachycardia.

Bundle of His↗

Rate responsive pacing with a minute ventilation sensing pacemaker during pregnancy and delivery.

A minute ventilation sensing rate responsive pacemaker was implanted in a 29-week pregnant woman with symptomatic complete atrioventricular (AV) block under echocardiographic and electrocardiographic (ECG) guidance. Satisfactory rate responses during a submaximal treadmill exercise test and daily activities were achieved. The course of pregnancy and cesarean section is discussed. During the cesarean section and after the delivery of the baby, changes in the ventilator settings confirmed that the pacing rate was closely correlated with both the tidal volume (r = 0.94, P less than 0.01) and the respiratory rate (r = 0.93, P less than 0.05).

Activities of Daily Living↗

Pacemaker mediated tachycardias in single chamber rate responsive pacing.

Although pacemaker mediated tachycardias are classically associated with dual chamber pacemakers, single chamber rate responsive pacemakers are also susceptible to such tachycardias under special circumstances. A unipolar activity sensing rate responsive pacemaker (Activitrax 8403) was implanted in an 83-year-old man with complete atrioventricular block. The pacemaker was programmed at an output of 5 V, activity threshold medium, rate response 5, and lower and upper rates of 70 and 125 beats/min, respectively. He presented with palpitations at rest and muscle twitching of the pacemaker pocket 4 months after implantation. Examination confirmed that the pacemaker had flipped over, resulting in pocket pacing which in turn activated the activity sensor, resulting in a rate response. The increase in pacing rate lead to a higher frequency of pocket pacing, thus leading to positive feedback increase in rate. With the patient at rest, pacemaker mediated rates were 106, 91, and 74 beats/min at low, medium and high thresholds, respectively. Decreasing the output to 2.5 V eliminated pocket pacing and the tachycardia. As a result of the reversal of the pacemaker, a similar rate response during exercise could only be achieved at a more sensitive rate responsive setting. Thus, pacemaker mediated tachycardia can complicate pacemaker "flipping" in single chamber activity sensing rate responsive pacemakers. Methods for the avoidance and treatment of pacemaker flipping are discussed. A review of other sensor mediated tachycardias is also presented.

Aged↗

Hypocalcemic heart failure in end-stage renal disease.

A 37-year-old woman presented with hypocalcemic heart failure complicating end-stage renal disease. Heart failure persisted despite conventional therapy but improved after correction of hypocalcemia. Continuous monitoring of left ventricular function by radionuclide study during calcium replacement showed dramatic improvement. Our case showed that hypocalcemia could be a rare but reversible cause of frank heart failure in uremic patients.

Adult↗

Doppler-echo evaluation of left ventricular diastolic filling in patient with mixed connective tissue disease.

Left ventricular diastolic function was assessed in 17 patients (2 males and 15 females; mean age 44 +/- 9 years) with mixed connective tissue disease (MCTD) and 18 sex- and age-matched healthy control subjects (2 males and 16 females; mean age 44 +/- 8 years) by means of M-mode and pulsed Doppler echocardiography. None had clinical evidence of overt myocardial disease or abnormal left ventricular systolic function. Compared with the control group, patients with MCTD had a significantly longer isovolumic relaxation time (IVRT) (59 +/- 7 versus 70 +/- 12 ms; p less than 0.01), a lower peak early diastolic flow velocity (E) (0.79 +/- 0.10 versus 0.70 +/- 0.07 m/s; p less than 0.005), a higher peak late diastolic flow velocity due to atrial contraction (A) (0.47 +/- 0.08 versus 0.54 +/- 0.08 m/s; p less than 0.05) and a reduced E/A ratio (1.72 +/- 0.37 versus 1.33 +/- 0.26; p less than 0.005). Although there was no significant correlation of left ventricular diastolic filling indexes with age, heart rate, left ventricular end-diastolic and end-systolic dimensions, interventricular septal and left ventricular posterior wall thickness, and fractional shortening, the duration of illness was significantly related to IVRT (r = 0.62; p less than 0.01), peak A (r = 0.79; p less than 0.001) and velocity half-time (r = 0.54; p less than 0.05). The results suggest the presence of an abnormal left ventricular diastolic filling pattern in patients with MCTD and may represent myocardial involvement in this disease.

Adult↗

Occult fatal pulmonary embolism with disseminated intravascular coagulation. An unusual case masquerading as miliary tuberculosis.

We report a fatal case of occult pulmonary embolism complicating bronchogenic carcinoma which presented with rapidly progressive pulmonary miliary shadows and respiratory failure. A clotting profile abnormality compatible with disseminated intravascular coagulation was noted. Postmortem examination showed extensive clots occluding the major pulmonary vessels and areas of pulmonary infarcts. Histologic examination revealed fibrin deposition in the microvasculature compatible with DIC. Cases of pulmonary embolism with DIC have previously been reported, but this is the first case with pathologic confirmation. Thus, unusual presentation with diffuse lung shadow and DIC should not deter the clinician from correct diagnosis so that appropriate treatment can be promptly started.

Adult↗

Partial purification of prolactin-like substance from snake (Ptyas mucosa) pituitaries.

Pituitary extract of the common rat snake (Ptyas mucosa) was found to be capable of displacing the binding of 125I-labelled ovine prolactin to female rat liver membranes, suggesting the presence of prolactin-like substance in snake pituitary. The snake prolactin-like substance was unadsorbed on Concanavalin A-Sepharose, but adsorbed on DEAE-cellulose. The partially purified snake prolactin-like substance was also capable of displacing the binding of 125I-labelled ovine prolactin to snake kidney and large intestine membranes. Chromatographic fractions derived from snake pituitary and which possessed potent growth hormone receptor binding activity were devoid of prolactin receptor binding activity, suggesting the existence of distinct prolactin-like and growth hormone-like substances in snake pituitary.

Animals↗

Successful resuscitation and survival following massive overdose of metoprolol.

A 23-year-old female was found unconscious and deteriorated rapidly to cardiac asystole. Prolonged resuscitation was required, and she remained in severe cardiogenic shock, despite high doses of positive inotropic agents. Massive beta-adrenoceptor blocker overdose was suspected (and subsequently confirmed). IV administration of glucagon was followed by prompt haemodynamic improvement and recovery, illustrating the beneficial role of glucagon in overwhelming beta-adrenoceptor blockade.

Adult↗

Echocardiographic identification of mitral valvular abnormalities in patients with mixed connective tissue disease.

To evaluate cardiac involvement in mixed connective tissue disease (MCTD), M-mode, 2-dimensional and pulsed Doppler echocardiography were performed in 17 patients with MCTD. Pericardial abnormalities were present in 4 patients (24%), including small pericardial effusion (less than 1 cm) in 2 patients and pericardial thickening in 2 patients. Verrucous thickening of the mitral valve was detected in 2 patients (12%) by 2-dimensional echocardiography. Pulsed Doppler echocardiography revealed the presence of mild mitral regurgitation in one of them. To our knowledge, such mitral valve abnormalities have not been reported. Future larger studies are needed in order to evaluate the incidence and natural evolution of these mitral valvular abnormalities.

Adult↗

Structures of antifreeze peptides from the antarctic eel pout, Austrolycicthys brachycephalus.

The antarctic eel pout, Austrolycicthys brachycephalus, synthesizes two predominant antifreeze peptides (AFPs) which, based on purification yields, make up about 94 and 6%, respectively, of the antifreezes in its serum. The amino acid sequences of these two AFPs, AB1 and AB2, were determined using automated sequencing, and compositional analyses of peptide fragments from enzymatic digests, and verified by molecular masses obtained with Fast Atom Bombardment Mass spectrometry. Substantial homologies in amino acid sequence exist between the AFPs of Austrolycicthys and those of other Southern and Northern eel pouts. 72% of the residues of AB1, and 84% of AB2, are identical to those of an AFP from another antarctic eel pout, Rhigophila dearborni. Between AB1 and AB2, 83% of the residues are identical. Secondary structure data based on circular dichroism studies indicated AB1 to be a random chain, but a sharp thermal transition of CD spectra around 30 degrees C suggested the presence of definite secondary or tertiary structure.

Amino Acid Sequence↗

Myxomatous mitral valve degeneration complicating asymptomatic cor triatriatum.

Cor triatriatum presenting in adulthood is extremely rare. This paper reports a case of cor triatriatum initially masquerading as mitral stenosis, which was later complicated by myxomatous mitral valve degeneration with severe regurgitation, which necessitated mitral valvular replacement. To the authors' knowledge, such a combination has not been reported in the literature.

Cor Triatriatum↗

The use of nifedipine in patients with Eisenmenger's syndrome complicating patency of the arterial duct.

Nifedipine has a vasodilatory effect on both the systemic and the pulmonary circulation. Its preferential effect on reducing the pulmonary vascular resistance has been studied in patients with primary pulmonary hypertension. In 4 patients with the Eisenmenger's syndrome complicating patency of the arterial duct (ductus arteriosus), we have studied the possibility of this selective pulmonary vasodilatory effect of nifedipine in reducing the right-to-left shunting. The degree of differential cyanosis was taken to reflect the right-to-left shunting. This was assessed continuously by 2 pulse oximeters applied to the right arm and leg. After sublingual nifedipine, the oxygen saturation of the right leg increased from pretreatment value of 79 +/- 5% (mean +/- SEM) to a maximum of 84 +/- 3% (P less than 0.01). Such a beneficial effect was maximal in the first 2 hours. On maintenance therapy, symptom-limited cycle ergometry showed increased exercise duration with comparable degrees of arterial desaturation and there was symptomatic improvement. This improvement disappeared on changing to placebo. It was concluded that nifedipine reduced right-to-left shunting and improved symptomatology.

Administration, Sublingual↗