Challenging situation of coronary artery anomaly associated with ischemia and/or risk of sudden death

Coronary artery anomaly is known as one of the causes of angina pectoris and sudden death and is an important clinical entity that cannot be overlooked.The incidence of coronary artery anomalies is as low as 1%-2%of the general population,even when the various types are combined.Coronary anomalies are practically challenging when the left and right coronary ostium are not found around their normal positions during coronary angiography with a catheter.If there is atherosclerotic stenosis of the coronary artery with an anomaly and percutaneous coronary intervention(PCI)is required,the suitability of the guiding catheter at the entrance and the adequate back up force of the guiding catheter are issues.The level of PCI risk itself should also be considered on a caseby-case basis.In this case,emission computed tomography in the R-1 subtype single coronary artery proved that ischemia occurred in an area where the coronary artery was not visible to the naked eye.Meticulous follow-up would be crucial,because sudden death may occur in single coronary arteries.To prevent atherosclerosis with full efforts is also important,as the authors indicated admirably.

Analysis of gravity wave activity during stratospheric sudden warmings in the northern hemisphere

Due to the significant changes they bring to high latitude stratospheric temperature and wind,stratospheric sudden warmings(SSWs)can have an impact on the propagation and energy distribution of gravity waves(GWs).The variation characteristics of GWs during SSWs have always been an important issue.Using temperature data from January to March in 2014−2016,provided by the Constellation Observing System for Meteorology,Ionosphere and Climate(COSMIC)mission,we have analyzed global GW activity at 15−40 km in the Northern Hemisphere during SSW events.During the SSWs that we studied,the stratospheric temperature rose in one or two longitudinal regions in the Northern Hemisphere;the areas affected extended to the east of 90°W.During these SSWs,the potential energy density(E_(p)of GWs expanded and covered a larger range of longitude and altitude,exhibiting an eastward and downward extension.The E_(p)usually increased,while partially filtered by the eastward zonal winds.When zonal winds weakened or turned westward,E_(p)began to strengthen.After SSWs,the E_(p)usually decreased.These observations can serve as a reference for analyzing the interaction mechanism between SSWs and GWs in future work.

The sudden ocean warming and its potential influences on earlyfrozen landfast ice in the Prydz Bay, East Antarctica

The ocean conditions beneath the ice cover play a key role in understanding the sea ice mass balance in the polar regions.An integrated high-frequency ice-ocean observation system,including Acoustic Doppler Velocimeter,Conductivity-Temperature-Depth Sensor,and Sea Ice Mass Balance Array(SIMBA),was deployed in the landfast ice region close to the Chinese Zhongshan Station in Antarctica.A sudden ocean warming of 0.14℃(p<0.01)was observed beneath early-frozen landfast ice,from(−1.60±0.03)℃during April 16-19 to(−1.46±0.07)℃during April 20-23,2021,which is the only significant warming event in the nearly 8-month records.The sudden ocean warming brought a double rise in oceanic heat flux,from(21.7±11.1)W/m^(2) during April 16-19 to(44.8±21.3)W/m^(2) during April 20-23,2021,which shifted the original growth phase at the ice bottom,leading to a 2 cm melting,as shown from SIMBA and borehole observations.Simultaneously,the slowdown of ice bottom freezing decreased salt rejection,and the daily trend of observed ocean salinity changed from+0.02 d^(-1) during April 16-19,2021 to+0.003 d^(-1) during April 20-23,2021.The potential reasons are increased air temperature due to the transit cyclones and the weakened vertical ocean mixing due to the tide phase transformation from semi-diurnal to diurnal.The high-frequency observations within the ice-ocean boundary layer enhance the comprehensive investigation of the ocean’s influence on ice evolution at a daily scale.

Modified intratympanic steroid therapy for sudden sensorineural hearing loss via tympanic tube and gelfoam as a salvage treatment

Background: Sudden sensorineural hearing loss(SSNHL) is a prevalent emergency in ear, nose, and throat practice. Previous studies have demonstrated that intratympanic steroid therapy(IST) can serve as a salvage treatment for SSNHL after the failure of systemic steroid therapy(SST).Objective: This study aimed to analyze the efficacy of modified IST involving the insertion of a tympanic tube and gelfoam as a salvage treatment for patients with SSNHL, and to explore its associated factors.Methods: Totally, 74 patients who were aged 22–81 years with SSNHL were enrolled and allocated to either the control group(n = 25) or the treatment group(n = 49) based on their treatment modalities. All patients received SST lasting for at least 7 days. Subsequently, patients in the treatment group, after SST failure, underwent IST twice a week for 2–6 weeks, while the control group did not. Efficacy was assessed by the improvement in pure tone average at the affected frequency at the beginning and end of IST.Results: Hearing improvement in all patients after IST in the treatment group was 9.71 ± 14.84 dB, with significant improvement at affected frequencies(250-8000 Hz) compared with the control group(P < 0.05). The findings indicated the duration from the onset of SSNHL to the beginning of IST as an independent factor for pure tone average improvement after treatment(P = 0.002), whereas age, duration of SST, and time of IST were not(P > 0.05).Conclusion: The modified IST was demonstrated to be a safe and effective method as a salvage treatment for SSNHL. This study explored the efficacy of a modified IST approach, incorporating the utilization of tympanic tubes and gelfoam as key components. The findings underscore the advantages of gelfoam as a strategic drug carrier placed in the round window niche. By minimizing drug loss, extending action time, and increasing perilymph concentration, gelfoam enhances the therapeutic impact of IST, contributing to improved hearing outcomes in patients with SSNHL.

Long-term variation of Arctic Sudden Stratospheric Warmings(SSW)and potential causes

Utilizing the European Centre for Medium-Range Weather Forecast(ECMWF)Reanalysis v5(ERA5),for the first time,we have confirmed close links among Sudden Stratospheric Warmings(SSWs)in the Northern Hemisphere(NH),the polar vortices,and stratospheric Planetary Waves(PWs)by analyzing and comparing their trends.Interestingly,within overall increasing trends,the duration and strength of SSWs exhibit increasing and decreasing trends before and after the winter of 2002,respectively.To reveal possible physical mechanisms driving these trends,we analyzed the long-term trends of the winter(from December to February)polar vortices and of stratospheric PWs with zonal wave number 1.Notably,our results show that in all three time periods(the entire period of 41winters,1980 to 2020,and the two subperiods—1980-2002 and 2002-2020)enhancing SSWs were always accompanied by weakening winter polar vortices and strengthening polar PWs like Stationary Planetary Waves(SPWs)and 16-day waves,and vice versa.This is the first proof,based on ERA5 long-term trend data,that weakening polar vortices and enhancing stratospheric PWs(especially SPWs)could cause an increase in SSWs.

Evaluation of angiotensin converting enzyme insertion/deletion, alpha adducin (ADD1) G460W, and IL-10 gene polymorphisms, and determination of prognostic effects in idiopathic sudden sensorineural hearing loss

Objective:The aim of this study was to examine angiotensin converting enzyme(ACE)insertion/deletion,alpha adducin,and interleukin-10(IL-10)gene polymorphisms(GPs)in terms of both idiopathic sudden sensorineural hearing loss(ISSNHL)risk and their potential prognostic effects.Methods:The study group consisted of 70 patients and the control group consisted of 50 patients.Venous blood samples were analyzed for relevant GPs via kompetitive allele-specific polymerase chain reaction.Age,sex,affected side,tinnitus,and vertiginous symptom status,number of days between symptom onset and hospital admission,pure tone audiometry results at admission and after treatment were included in the study.Data were compared statistically.Results:The D allele of ACE insertion/deletion GP was significantly more frequent in patients with ISSNHL than in the control group(p=0.032).II genotype was associated with a reduced risk of ISSNHL(p=0.036).The amount of hearing loss was significantly higher in patients with the TT genotype(p=0.027)and T allele of the IL-10 GP(p=0.035)than in the patients without this allele.Severe hearing loss was a poor prognostic factor(p=0.008).Conclusions:The D allele of ACE insertion/deletion GP may be involved in the ISSNHL etiology.Due to the association of this allele with occlusive vascular pathologies,ischemia is believed to be a common pathway in the etiopathogenesis of ISSNHL.

Clinical characteristics and analysis of vestibular-evoked myogenic potentials in patients with sudden sensorineural hearing loss in different ages

BACKGROUND Numerous studies have found that patients experiencing sudden sensorineural hearing loss(SSHL),with or without accompanying vertigo,often show impaired vestibular function.However,there is a dearth of studies analyzing vestibularevoked myogenic potentials(VEMPs)in SSHL patients across various age groups.AIM To investigate vestibular condition in SSHL patients across various age demographics.METHODS Clinical data of 84 SSHL patients were investigated retrospectively.Audiometry,cervical vestibular evoked myogenic potentials(c-VEMPs),and ocular vestibular evoked myogenic potentials(o-VEMPs)were conducted on these patients.Parameters assessed included the latencies of P1 and N1 waves,as well as the amplitudes of P1–N1 waves.Moreover,the study evaluated the influence of factors such as sex,affected side,configuration of hearing loss,and presence of accompanying vertigo.RESULTS Among the 84 SSHL patients,no significant differences were observed among the three groups in terms of gender,affected side,and the presence or absence of vertigo.Group II(aged 41–60 years)had the highest number of SSHL cases.The rates of absent o-VEMPs in the affected ears were 20.83%,31.58%,and 22.72%for the three age groups,respectively,with no statistically significant difference among them.The rates of absent c-VEMPs in the affected ears were 8.3%,34.21%,and 18.18%for the three age groups,respectively,with significant differences.In the unaffected ears,there were differences observed in the extraction rates of o-VEMPs in the unaffected ears among the age groups.In the three age groups,no significant differences were noted in the three age groups in the latencies of P1 and N1 waves or in the amplitude of N1–P1 waves for c-VEMPs and o-VEMPs,either on the affected side or on the unaffected side,across the three age groups.CONCLUSION The extraction rate of VEMPs is more valuable than parameters.Regardless of the presence of vertigo,vestibular organs are involved in SSHL.Notably,SSHL patients aged 41–60 appear more susceptible to damage to the inferior vestibular nerve and saccule.

Therapeutic efficacy of methylprednisolone sodium succinate via diverse administration routes for mid-to high-frequency sudden sensorineural hearing loss

BACKGROUND Sudden sensorineural hearing loss(SSNHL),characterized by a rapid and unexplained loss of hearing,particularly at moderate to high frequencies,presents a significant clinical challenge.The therapeutic use of methylprednisolone sodium succinate(MPSS)via different administration routes,in combination with conventional medications,remains a topic of interest.AIM To compare the therapeutic efficacy of MPSS administered via different routes in combination with conventional drugs for the treatment of mid-to high-frequency SSNHL.METHODS The medical records of 109 patients with mid-to high-frequency SSNHL were analyzed.The patients were divided into three groups based on the route of administration:Group A[intratympanic(IT)injection of MPSS combined with mecobalamin and Ginkgo biloba leaf extract injection],Group B(intravenous injection of MPSS combined with mecobalamin and Ginkgo biloba leaf extract injection),and Group C(single IT injection of MPSS).The intervention effects were compared and analyzed.RESULTS The posttreatment auditory thresholds in Group A(21.23±3.34)were significantly lower than those in Groups B(28.52±3.36)and C(30.23±4.21;P<0.05).Group A also exhibited a significantly greater speech recognition rate(92.23±5.34)than Groups B and C.The disappearance time of tinnitus,time to hearing recovery,and disappearance time of vertigo in Group A were significantly shorter than those in Groups B and C(P<0.05).The total effective rate in Group A(97.56%)was significantly greater than that in Groups B and C(77.14%and 78.79%,χ^(2)=7.898,P=0.019).Moreover,the incidence of adverse reactions in Groups A and C was significantly lower than that in Group B(4.88%,3.03%vs 2.57%,χ^(2)=11.443,P=0.003),and the recurrence rate in Group A was significantly lower than that in Groups B and C(2.44%vs 20.00%vs 21.21%,χ^(2)=7.120,P=0.028).CONCLUSION IT injection of MPSS combined with conventional treatment demonstrates superior efficacy and safety compared to systemic administration via intravenous infusion and a single IT injection of MPSS.This approach effectively improves patients'hearing and reduces the risk of disease recurrence.

Protocol of Investigation on Sudden Death at Autopsy, Including Molecular, Genetic and Toxicology Testing

The role of the autopsy: 1) Whether the death is ascribable to a natural or unnatural cause and when natural, if cardiac or extra-cardiac;2) The nosology of the cardiac diseases and the mechanism of cardiac death, whether arrhythmic or mechanical;3) If the cardiac disease is inherited, screening and counselling of the next of kin is required. About 30% of sudden deaths is ascribable to genetically determined morbid entities, mostly transmissible with the autosomal dominant pattern of inheritance, so that 50% of the first degree relatives are genetically affected (“carriers”) and exposed at risk;4) If toxic or illicit drug abuse was involved.

Discussion on the Prevention and Control Countermeasures of Sudden Disasters on Protected Vegetable in Hebei Province

Protected vegetable production made the traditional agriculture gradually get rid of the shackles of nature, broke the seasonal traditional agriculture and realized the anti season list of agricultural products. While protected vegetables often encountered sudden disasters in production and were restricted with the conditions of low temperature and weak light. Aimed at the sudden disasters of protected vegetable production in Hebei Province,the countermeasures for disaster prevention and control were put forward from the aspects of variety selection, seedling treatment technology,grafting technique,cultivation and management,flower and fruit retention technology,application of exogenous substance,rational fertilization,transgenic technology and so on,in order to reduce production risks and cut loss,realize that protected vegetable production is safe,good-quality and efficient.

Optimal entropy squeezing sudden generation and its control for an effective two-level moving atom entanglement with the two-mode coherent fields

From the viewpoint of quantum information, this paper proposes a concept and a definition of the atomic optimal entropy squeezing sudden generation （AOESSG） for the system of an effective two-level moving atom which entangles with the two-mode coherent fields. It also researches the relationship between the AOESSG and entanglement sudden death of the atom-fields, and discusses the influences of atomic initial state on the AOESSG and obtains the system parameter which controls the AOESSG.

Sudden cardiac arrest in a patient with epilepsy induced by chronic inflammation on the cerebral surface

The present study analyzed a patient with epilepsy due to chronic inflammation on the cerebral surface underwent sudden cardiac arrest. Paradoxical brain discharge, which occurred prior to epileptic seizures, induced a sudden cardiac arrest. However, when the focal brain pressure was relieved, cardiac arrest disappeared. A 27-year-old male patient underwent pre-surgical ram monitoring for 160 hours. During monitoring, secondary tonic-clonic seizures occurred five times. A burst of paradoxical brain discharges occurred at 2-19 seconds （mean 8 seconds） prior to epileptic seizures. After 2-3 seconds, sudden cardiac arrest occurred and lasted for 12-22 seconds （average 16 seconds）. The heart rate subsequently returned to a normal rate. Results revealed arachnoid pachymenia and adhesions, as well as mucus on the focal cerebral surface, combined with poor circulation and increased pressure, lntracranial electrodes were placed using surgical methods. Following removal of the arachnoid adhesions and mucus on the local cerebral surface, paradoxical brain discharge and epileptic seizures occurred three times, but sudden cardiac arrest was not recorded during 150-hour monitoring. Post-surgical histological examination indicated meningitis. Experimental findings suggested that paradoxical brain discharge led to cardiac arrest instead of epileptic seizures; the insult was associated with chronic inflammation on the cerebral surface, which subsequently led to hypertension and poor blood circulation in focal cerebral areas.

The Possible Influence of Stratospheric Sudden Warming on East Asian Weather

By analyzing the linkage of the Northern Annular Mode （NAM） anomaly to the East Asian jet and the East Asian trough during Stratospheric Sudden Warming （SSW）, the influence of SSW on East Asian weather is studied. The results show that the East Asian jet is strengthened and the East Asian trough is deepened during SSW. With the downward propagation of SSW, the strengthened East Asian jet and the East Asian trough would move southward, expand westward and gradually influence the area of north and northeastern China. This implies that the winter monsoon tends to be enhanced over East Asia during SSW.

Early repolarization syndrome: A cause of sudden cardiac death

Early repolarization syndrome(ERS), demonstrated as J-point elevation on an electrocardiograph, was formerly thought to be a benign entity, but the recent studies have demonstrated that it can be linked to a considerable risk of life- threatening arrhythmias and sudden cardiac death(SCD). Early repolarization characteristics associated with SCD include high-amplitude J-point elevation, horizontal and/or downslopping ST segments, and inferior and/or lateral leads location. The prevalence of ERS varies between 3% and 24%, depending on age, sex and J-point elevation(0.05 m V vs 0.1 m V) being the main determinants.ERS patients are sporadic and they are at a higher risk of having recurrent cardiac events. Implantable cardioverter-defibrillator implantation and isoproterenol are the suggested therapies in this set of patients. On the other hand, asymptomatic patients with ERS are common and have a better prognosis. The risk stratification in asymptomatic patients with ERS still remains a grey area. This review provides an outline of the up-to-date evidence associated with ERS and the risk of life- threatening arrhythmias. Further prospective studies are required to elucidate the mechanisms of ventricular arrhythmogenesis in patients with ERS.

Sudden sensorineural hearing loss-A contemporary review of management issues

Sudden sensorineural hearing loss(SSNHL)is an enigmatic entity,with obscure pathophysiology and debatable efficacy of the treatment agents used.An underlying cause is identified in only 10-15%of cases.The management of the remaining patients,classified as‘idiopathic’,is empirical,and is conventionally with systemic steroids,vasodilator therapy,rheological agents,and antioxidants,to list a few amongst the host of the agents employed for the treatment.The availability of conflicting outcomes and lack of conclusive evidence has resulted in the propagation of consensus-based treatment protocols.In the present review,we discuss the various controversial issues and newer developments in the management of idiopathic SSNHL.The current review aims to present a narrative outlook of the updated evidence base available from PUBMED,augmented with relevant designated publications.

Hyperbaric Oxygen Treatment Improves Hearing Level via Attenuating TLR4/NF-κB Mediated Inflammation in Sudden Sensorineural Hearing Loss Patients

Objective Hyperbaric oxygen treatment(HBOT)has demonstrated efficacy in improving hearing levels of patients with idiopathic sudden sensorineural hearing loss(ISSHL);however,the underlying mechanisms are not well understood.HBOT alleviates the inflammatory response,which is mediated by Toll-like receptor(TLR)4 and nuclear factor(NF)-κB.In this study we investigated whether HBOT attenuates inflammation in ISHHL patients via alteration of TLR4 and NF-κB expression.Methods ISHHL patients(n=120)and healthy control subjects(n=20)were enrolled in this study.Patients were randomly divided into medicine group treated with medicine only(n=60)and HBO group receiving both HBOT and medicine(n=60).Audiometric testing was performed pre-and posttreatment.TLR4,NF-кB,and TNF-αexpression in peripheral blood of ISSHL patients and healthy control subjects was assessed by ELISA before and after treatment.Results TLR4,NF-κB,and TNF-αlevels were upregulated in ISSHL patients relative to healthy control subjects;the levels were decreased following treatment and were lower in the HBO group than that in the medicine group post-treatment(P<0.05 and P<0.01).Conclusion HBOT alleviates hearing loss in ISSHL patients by suppressing the inflammatory response induced by TLR4 and NF-κB signaling.

Sudden sensorineural hearing loss(SSHL) following a local anesthetic dental procedure

Acute sensorineural hearing loss is an uncommon phenomenon in dentistry.We describe the case of a 79-year-old male who presented with acute sensorineural hearing loss occurring 2 days after a tooth extraction procedure under local anesthesia.Possible mechanisms are discussed.He was treated with vasodilators(Ginaton and Alprostadil Injection)and Mecobalamin injection with benefit.High dose oral steroids(1 mg/kg)and low molecular weight dextran were used.

Neurocysticercosis causing sudden death:a case report

We report an acute case of a native man from Bolivia suffered from cephalalgia which rapidly worsened and ended in his sudden and unexpected death.Magnetic resonance imaging(MRI) of the brain was obtained.Features demonstrated on brain MRI scan were consistent with a diagnosis of neurocysticercosis(NCC).An autopsy showed the presence of intraventricular Taenia solium(T.solium) cysts which caused blockage of cerebrospinal fluid and secondary hydrocephalus.Due to the increasing travel movements of people neurocysticercosis must be considered as a cause of unexplained sudden death.

The influences of dipole-dipole interaction and detuning on the sudden death of entanglement between two atoms in the Tavis-Cummings model

The influences of dipole-dipole interaction and detuning on the entanglement between two atoms with different initial tripartite entangled W-like states in the Tavis Cummings model have been investigated by means of Wootters＇ concurrence, respectively. The results show that the entanglement between the two atoms can be enhanced via appropriately tuning the strength of dipole-dipole interaction of two atoms or the detunings between atom and cavity, and the so-called sudden death effect can he weakened simultaneously.

Sub-seasonal to Seasonal Hindcasts of Stratospheric Sudden Warming by BCC_CSM1.1(m):A Comparison with ECMWF

This study focuses on model predictive skill with respect to stratospheric sudden warming(SSW) events by comparing the hindcast results of BCC_CSM1.1(m) with those of the ECMWF's model under the sub-seasonal to seasonal prediction project of the World Weather Research Program and World Climate Research Program. When the hindcasts are initiated less than two weeks before SSW onset, BCC_CSM and ECMWF show comparable predictive skill in terms of the temporal evolution of the stratospheric circumpolar westerlies and polar temperature up to 30 days after SSW onset. However, with earlier hindcast initialization, the predictive skill of BCC_CSM gradually decreases, and the reproduced maximum circulation anomalies in the hindcasts initiated four weeks before SSW onset replicate only 10% of the circulation anomaly intensities in observations. The earliest successful prediction of the breakdown of the stratospheric polar vortex accompanying SSW onset for BCC_CSM(ECMWF) is the hindcast initiated two(three) weeks earlier. The predictive skills of both models during SSW winters are always higher than that during non-SSW winters, in relation to the successfully captured tropospheric precursors and the associated upward propagation of planetary waves by the model initializations. To narrow the gap in SSW predictive skill between BCC_CSM and ECMWF, ensemble forecasts and error corrections are performed with BCC_CSM. The SSW predictive skill in the ensemble hindcasts and the error corrections are improved compared with the previous control forecasts.