<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potass...<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. <strong>Aim:</strong> This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. <strong>Methods:</strong> We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. <strong>Outcomes:</strong> Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. <strong>Conclusions:</strong> Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.展开更多
BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a plasma cell proliferative disorder.The syndrome is characterized by elevate...BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a plasma cell proliferative disorder.The syndrome is characterized by elevated plasma cells,platelets,and vascular endothelial growth factor levels.Although heart disease rarely occurs in POEMS syndrome,the death rate increases sharply after heart failure.We report a patient who initially presented with an endocrine disease and developed congestive heart failure related to POEMS syndrome 9 years later.CASE SUMMARY A 23-year-old woman with no history of menstruation and a 9-year history of type I diabetes reported feeling breathless after activities.She could not lie down and rest at night.Three months prior,she experienced pain and increased tension in her left thigh accompanied by tenderness and edema in both lower extremities.The chief complaint upon hospital admission was that blood sugar has increased for more than 9 years,pain in the left thigh,and edema in both legs for more than 2 mo.After a multisystem evaluation,she was diagnosed with POEMS syndrome.Her echocardiogram showed left ventricular dilation with systolic dysfunction,and the left ventricular ejection fraction was only 38%with severely elevated brain natriuretic peptide.She received a combination of dexamethasone and thalidomide for 1 mo,but her symptoms did not improve.Therefore,we added a two-per-week bortezomib injection.After 2 wk,the patient’s heart function had improved significantly.CONCLUSION This case provides information about the treatment of POEMS syndrome with complications and highlights the challenges of developing a standardized treatment.展开更多
Objectives To study change and the clinical significance of fibrinolysis in coronary heart disease(CHD) patients with angina pactoris(AP).Methods Levels of plas-min plasminogen activator inhibitor-1(PAI-1),tissue-type...Objectives To study change and the clinical significance of fibrinolysis in coronary heart disease(CHD) patients with angina pactoris(AP).Methods Levels of plas-min plasminogen activator inhibitor-1(PAI-1),tissue-type plasminogen activator(t-PA),fibrinogen(FIB) in 110 CHD patients with AP and 20 normal cases as control group were analyzed in the same ways.Results Levels of PAI-1,FIB in CHD patients with AP were significantly higher than those in control cases,and those of t-PA were significantly lower than control cases;Levels of PAI-1,FIB in UA patients with UA heart events were significantly higher than those in patients with SA,and those of t-PA were significantly lower than patients with SA;Levels of PAI-1,FIB in patients with AP events were significantly higher than those in patients without AP events,and those of t-PA were significantly lower than patients without AP events.Conclusions There was abnormal of fibrinolysis function in CHD patients with AP, specially in patients with UA or with AP events,the abnormal of fibrinolysis might be play an important rule in coronary heart disease(CHD) patients with angina pactoris.展开更多
Background Ethanol embolotherapy is considered an optimal choice for the treatment of arteriovenous malformations(AVMs);however,there are some complications associated with this treatment.This study aimed to prospecti...Background Ethanol embolotherapy is considered an optimal choice for the treatment of arteriovenous malformations(AVMs);however,there are some complications associated with this treatment.This study aimed to prospectively investigate systemic hemodynamic changes in high-flow AVMs using ethanol embolotherapy.Methods From September 2012 to September 2014,34 male patients and 26 female patients with AVMs who underwent embolotherapy(100 sessions in total)with absolute ethanol were included in this study.Invasive systolic blood pressure(SBP)and heart rate(HR)were recorded before and after each injection and throughout the procedure.Differences between the initial and highest SBP(ΔmaxSP)and HR values(ΔmaxHR),as well as the initial and final SBP(ΔSP)and HR(ΔHR)values,were analyzed.We aimed to explore the potential association between these values and the amount of ethanol that was used.Results The total ethanol used was variable(0.01–0.40 mL/kg;mean,0.20 mL/kg).SBP and HR increased after ethanol injection in most sessions(91 in 100 sessions).SBP decreased in 9 sessions(9 in 100 sessions),while HR,oxygen saturation,and end-tidal CO2 decreased in one of the 9 sessions.ΔmaxSP andΔmaxHR averaged 38.4 mmHg and 27.8 bpm,respectively(both P<0.05),whileΔSP andΔHR averaged 3.4 mmHg and 4.0 bpm,respectively(both P<0.05).ΔmaxSP andΔmaxHR were positively correlated with the total dose of ethanol injected.Conclusions Elevations in SBP and HR during ethanol embolotherapy are common,temporary,and most likely pain-mediated;these increases tend to be positively correlated with ethanol dose.Hypotension may be regarded as an acute complication of ethanol embolotherapy.Hypotension combined with bradycardia,oxygen desaturation,and decreased end-tidal CO2 may be a potential predictor of cardiovascular collapse.展开更多
All images courtesy of the artists■Loretta Yang Hui-shan (杨惠姗) and Chang Yi (张毅) are inseparable.They have done everything together,including giving up stardom 20 years ago to pursue a career in contemporary gla...All images courtesy of the artists■Loretta Yang Hui-shan (杨惠姗) and Chang Yi (张毅) are inseparable.They have done everything together,including giving up stardom 20 years ago to pursue a career in contemporary glass art.With two Golden Horse awards and a prize from the展开更多
目的分析正中开胸心脏瓣膜置换患者应用基于健康行为改变整合理论(integrated theory of health behavior change,ITHBC)健康教育的效果。方法选取2022年7月—2023年6月广西壮族自治区人民医院收治的正中开胸心脏瓣膜置换患者120例,将...目的分析正中开胸心脏瓣膜置换患者应用基于健康行为改变整合理论(integrated theory of health behavior change,ITHBC)健康教育的效果。方法选取2022年7月—2023年6月广西壮族自治区人民医院收治的正中开胸心脏瓣膜置换患者120例,将其根据不同健康教育方式分为对照组(60例,常规健康教育)与观察组(60例,常规健康教育+基于ITHBC理论的健康教育)。2组均干预4个月。比较2组护理的依从性、满意度(干预后),干预前后心理状态、生活质量、自我管理能力。结果观察组各项指标依从率(合理饮食96.67%、定期复诊95.00%、作息规律96.67%、情绪稳定98.33%、按医嘱用药96.67%)均高于对照组(合理饮食86.67%、定期复诊83.33%、作息规律85.00%、情绪稳定86.67%、按医嘱用药86.67%)(P<0.05)。干预后,观察组满意度高于对照组(P<0.05)。相较于干预前,2组干预后的焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)评分、生活质量各项评分降低,且组间进行对比,观察组较低(P<0.05)。干预后,2组自我管理能力各项评分均升高,且观察组较对照组低(P<0.05)。结论正中开胸心脏瓣膜置换患者应用基于ITHBC理论的健康教育,可有助于提高患者依从性,改善生活质量,增强自我管理能力,消除不良情绪,进而获得患者认可,且有助于为临床改善正中开胸心脏瓣膜置换患者预后提供参考及依据。展开更多
Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be as...Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be associated with foetal distress. Decelerations and foetal bradycardia have been described after any type of effective labour analgesia. This review addresses the questions if certain analgesic techniques and/or analgesics lead to clinically relevant FHR changes, what is their aetiology, and how we should manage these FHR changes.展开更多
Background and Aim Vascular smooth muscle cell （SMC） phenotype change is a hallmark of vascu-lar remodeling, which can be regulated via MicroRNAs （miRNAs）-dependent mechanism. We recently identified Asymmetric dim...Background and Aim Vascular smooth muscle cell （SMC） phenotype change is a hallmark of vascu-lar remodeling, which can be regulated via MicroRNAs （miRNAs）-dependent mechanism. We recently identified Asymmetric dimethylarginine （ADMA） positively correlates to vascular remodeling-based diseases. Here, we hy-pothesized that ADMA induces SMC phenotypic change via a miRNA-dependent mechanism. Methods and Results Microarray analysis enabled the identification of 7 deregulated microRNAs in ADMA-treated human aortic artery smooth muscle cells （hASMCs）. miR-182 was validated by real-time-PCR. Isobaric tags for relative and absolute quantitation （iTRAQ） based analysis of the hASMC proteome revealed that transfection of an miR-182 inhibitor sig- nificantly increased myeloid-associated differentiation marker （MYADM）, which was verified using Western blot and reporter activity quantization with the MYADM 3＇-UTR dual-luciferase reporter system, miR-182 knockdown further repressed Sprouty2 and enhanced MYADM, leading to ERICZMAP kinase-dependent and MYADM-depend- ent hASMC phenotypic change including proliferation, migration and differentiation marker gene expression change. In vivo, adeno-miR-182 markedly suppressed carotid neointimal formation by using balloon-injured rat carotid artery model, specifically via decreased MYADM expression. Atherosclerotic lesions from patients with high ADMA plas- ma levels exhibited decreased miR-182 expression levels and elevated MYADM expression levels. In patients with coronary heart disease （n- 164）, the miR-182 expression level in plasma was negatively correlated with the plas- ma ADMA levels. Conclusions miR-182 is a novel SMC phenotypic modulator by targeting MYADM and can be a potential therapeutic target combating vascular remodeling-associated diseases. Reduced plasma miR-182 levels might be a new predictor of high vascular remodeling risk especially in patient with coronary heart disease.展开更多
Objective To establish the mitral regurgitation swine model and study the change of hydrogen sulfide(H2S)system in chronic heart failure model.Methods Miniature pigs were randomly divided into two groups,the control g...Objective To establish the mitral regurgitation swine model and study the change of hydrogen sulfide(H2S)system in chronic heart failure model.Methods Miniature pigs were randomly divided into two groups,the control group(n=6)and mitral regurgitation group(n=6).Chronic heart failure models were established by pulling mitral chordal through a small incision extracorporeal.展开更多
文摘<strong>Background:</strong> Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. <strong>Aim:</strong> This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. <strong>Methods:</strong> We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. <strong>Outcomes:</strong> Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. <strong>Conclusions:</strong> Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.
文摘BACKGROUND Polyneuropathy,organomegaly,endocrinopathy,M-protein,and skin changes(POEMS)syndrome is a rare paraneoplastic syndrome caused by a plasma cell proliferative disorder.The syndrome is characterized by elevated plasma cells,platelets,and vascular endothelial growth factor levels.Although heart disease rarely occurs in POEMS syndrome,the death rate increases sharply after heart failure.We report a patient who initially presented with an endocrine disease and developed congestive heart failure related to POEMS syndrome 9 years later.CASE SUMMARY A 23-year-old woman with no history of menstruation and a 9-year history of type I diabetes reported feeling breathless after activities.She could not lie down and rest at night.Three months prior,she experienced pain and increased tension in her left thigh accompanied by tenderness and edema in both lower extremities.The chief complaint upon hospital admission was that blood sugar has increased for more than 9 years,pain in the left thigh,and edema in both legs for more than 2 mo.After a multisystem evaluation,she was diagnosed with POEMS syndrome.Her echocardiogram showed left ventricular dilation with systolic dysfunction,and the left ventricular ejection fraction was only 38%with severely elevated brain natriuretic peptide.She received a combination of dexamethasone and thalidomide for 1 mo,but her symptoms did not improve.Therefore,we added a two-per-week bortezomib injection.After 2 wk,the patient’s heart function had improved significantly.CONCLUSION This case provides information about the treatment of POEMS syndrome with complications and highlights the challenges of developing a standardized treatment.
文摘Objectives To study change and the clinical significance of fibrinolysis in coronary heart disease(CHD) patients with angina pactoris(AP).Methods Levels of plas-min plasminogen activator inhibitor-1(PAI-1),tissue-type plasminogen activator(t-PA),fibrinogen(FIB) in 110 CHD patients with AP and 20 normal cases as control group were analyzed in the same ways.Results Levels of PAI-1,FIB in CHD patients with AP were significantly higher than those in control cases,and those of t-PA were significantly lower than control cases;Levels of PAI-1,FIB in UA patients with UA heart events were significantly higher than those in patients with SA,and those of t-PA were significantly lower than patients with SA;Levels of PAI-1,FIB in patients with AP events were significantly higher than those in patients without AP events,and those of t-PA were significantly lower than patients without AP events.Conclusions There was abnormal of fibrinolysis function in CHD patients with AP, specially in patients with UA or with AP events,the abnormal of fibrinolysis might be play an important rule in coronary heart disease(CHD) patients with angina pactoris.
文摘Background Ethanol embolotherapy is considered an optimal choice for the treatment of arteriovenous malformations(AVMs);however,there are some complications associated with this treatment.This study aimed to prospectively investigate systemic hemodynamic changes in high-flow AVMs using ethanol embolotherapy.Methods From September 2012 to September 2014,34 male patients and 26 female patients with AVMs who underwent embolotherapy(100 sessions in total)with absolute ethanol were included in this study.Invasive systolic blood pressure(SBP)and heart rate(HR)were recorded before and after each injection and throughout the procedure.Differences between the initial and highest SBP(ΔmaxSP)and HR values(ΔmaxHR),as well as the initial and final SBP(ΔSP)and HR(ΔHR)values,were analyzed.We aimed to explore the potential association between these values and the amount of ethanol that was used.Results The total ethanol used was variable(0.01–0.40 mL/kg;mean,0.20 mL/kg).SBP and HR increased after ethanol injection in most sessions(91 in 100 sessions).SBP decreased in 9 sessions(9 in 100 sessions),while HR,oxygen saturation,and end-tidal CO2 decreased in one of the 9 sessions.ΔmaxSP andΔmaxHR averaged 38.4 mmHg and 27.8 bpm,respectively(both P<0.05),whileΔSP andΔHR averaged 3.4 mmHg and 4.0 bpm,respectively(both P<0.05).ΔmaxSP andΔmaxHR were positively correlated with the total dose of ethanol injected.Conclusions Elevations in SBP and HR during ethanol embolotherapy are common,temporary,and most likely pain-mediated;these increases tend to be positively correlated with ethanol dose.Hypotension may be regarded as an acute complication of ethanol embolotherapy.Hypotension combined with bradycardia,oxygen desaturation,and decreased end-tidal CO2 may be a potential predictor of cardiovascular collapse.
文摘All images courtesy of the artists■Loretta Yang Hui-shan (杨惠姗) and Chang Yi (张毅) are inseparable.They have done everything together,including giving up stardom 20 years ago to pursue a career in contemporary glass art.With two Golden Horse awards and a prize from the
文摘目的分析正中开胸心脏瓣膜置换患者应用基于健康行为改变整合理论(integrated theory of health behavior change,ITHBC)健康教育的效果。方法选取2022年7月—2023年6月广西壮族自治区人民医院收治的正中开胸心脏瓣膜置换患者120例,将其根据不同健康教育方式分为对照组(60例,常规健康教育)与观察组(60例,常规健康教育+基于ITHBC理论的健康教育)。2组均干预4个月。比较2组护理的依从性、满意度(干预后),干预前后心理状态、生活质量、自我管理能力。结果观察组各项指标依从率(合理饮食96.67%、定期复诊95.00%、作息规律96.67%、情绪稳定98.33%、按医嘱用药96.67%)均高于对照组(合理饮食86.67%、定期复诊83.33%、作息规律85.00%、情绪稳定86.67%、按医嘱用药86.67%)(P<0.05)。干预后,观察组满意度高于对照组(P<0.05)。相较于干预前,2组干预后的焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)评分、生活质量各项评分降低,且组间进行对比,观察组较低(P<0.05)。干预后,2组自我管理能力各项评分均升高,且观察组较对照组低(P<0.05)。结论正中开胸心脏瓣膜置换患者应用基于ITHBC理论的健康教育,可有助于提高患者依从性,改善生活质量,增强自我管理能力,消除不良情绪,进而获得患者认可,且有助于为临床改善正中开胸心脏瓣膜置换患者预后提供参考及依据。
文摘Foetal well-being during labour is of utmost importance. One of the ways to attempt to assess foetal well-being is by recording foetal heart rate (FHR). Loss of variability and deceleration patterns are known to be associated with foetal distress. Decelerations and foetal bradycardia have been described after any type of effective labour analgesia. This review addresses the questions if certain analgesic techniques and/or analgesics lead to clinically relevant FHR changes, what is their aetiology, and how we should manage these FHR changes.
文摘Background and Aim Vascular smooth muscle cell （SMC） phenotype change is a hallmark of vascu-lar remodeling, which can be regulated via MicroRNAs （miRNAs）-dependent mechanism. We recently identified Asymmetric dimethylarginine （ADMA） positively correlates to vascular remodeling-based diseases. Here, we hy-pothesized that ADMA induces SMC phenotypic change via a miRNA-dependent mechanism. Methods and Results Microarray analysis enabled the identification of 7 deregulated microRNAs in ADMA-treated human aortic artery smooth muscle cells （hASMCs）. miR-182 was validated by real-time-PCR. Isobaric tags for relative and absolute quantitation （iTRAQ） based analysis of the hASMC proteome revealed that transfection of an miR-182 inhibitor sig- nificantly increased myeloid-associated differentiation marker （MYADM）, which was verified using Western blot and reporter activity quantization with the MYADM 3＇-UTR dual-luciferase reporter system, miR-182 knockdown further repressed Sprouty2 and enhanced MYADM, leading to ERICZMAP kinase-dependent and MYADM-depend- ent hASMC phenotypic change including proliferation, migration and differentiation marker gene expression change. In vivo, adeno-miR-182 markedly suppressed carotid neointimal formation by using balloon-injured rat carotid artery model, specifically via decreased MYADM expression. Atherosclerotic lesions from patients with high ADMA plas- ma levels exhibited decreased miR-182 expression levels and elevated MYADM expression levels. In patients with coronary heart disease （n- 164）, the miR-182 expression level in plasma was negatively correlated with the plas- ma ADMA levels. Conclusions miR-182 is a novel SMC phenotypic modulator by targeting MYADM and can be a potential therapeutic target combating vascular remodeling-associated diseases. Reduced plasma miR-182 levels might be a new predictor of high vascular remodeling risk especially in patient with coronary heart disease.
文摘Objective To establish the mitral regurgitation swine model and study the change of hydrogen sulfide(H2S)system in chronic heart failure model.Methods Miniature pigs were randomly divided into two groups,the control group(n=6)and mitral regurgitation group(n=6).Chronic heart failure models were established by pulling mitral chordal through a small incision extracorporeal.
