Thyroid storm in a pregnant woman with COVID-19 infection: A case report and review of literatures

BACKGROUND The severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) has been found to be responsible for the recent global pandemic known as coronavirus disease 2019(COVID-19). SARS-CoV-2 infections not only result in significant respiratory symptoms but also cause several extrapulmonary manifestations, such as thrombotic complications, myocardial dysfunction and arrhythmia, thyroid dysfunction, acute kidney injury, gastrointestinal symptoms, neurological symptoms, ocular symptoms, and dermatological complications. We present the first documented case of thyroid storm in a pregnant woman precipitated by SARS-CoV-2.CASE SUMMARY A 42-year-old multiparous woman at 35 + 2 wk of gestation visited the emergency room(ER) with altered mentation, seizures, tachycardia, and high fever. The patient showed no remarkable events in the prenatal examination, and the nasopharyngeal COVID-19 polymerase chain reaction(PCR) test was positive two days before the ER visit. The results of laboratory tests, such as liver function test,serum electrolytes, blood glucose, blood urea nitrogen, and creatinine, were all within the normal ranges. However, the thyroid function test showed hyperthyroidism, and the nasopharyngeal COVID-19 PCR test was positive, as expected. No specific findings were observed on the brain computed tomography,and there were no signs of lateralization on neurological examination. Fetal heartbeat and movement were good, and there were no significant uterine contractions. The initial impression was atypical eclampsia. However, the patient’s condition worsened, and a cesarean section was performed under general anesthesia;a healthy boy was delivered, and 12 h after delivery, the patient’s seizures disappeared and consciousness was restored. The patient was referred to an endocrinologist for hyperthyroidism, and a thyroid storm with Graves’ disease was diagnosed. Here, SARS-CoV-2 was believed to be the trigger for the thyroid storm, considering that the patient tested positive for COVID-19 two days before the seizures.CONCLUSION In pregnant women presenting with seizures or changes in consciousness, the possibility of a thyroid storm should be considered. There are various causes for a thyroid storm, but given the recent pandemic, it is necessary to bear in mind that the thyroid storm may be precipitated by COVID-19.

Therapeutic plasma exchange and a double plasma molecular absorption system in the treatment of thyroid storm with severe liver injury: A case report

BACKGROUND Thyroid storm is resistant to conventional treatments including antithyroid drugs and 131I therapeutic means.Plasma exchange(PE)and double plasma molecular absorption system(DPMAS)can be used as an effective treatment for thyroid storm with severe liver injury.CASE SUMMARY A 52-year-old woman presented with a 10-day history of nausea and vomiting accompanied by yellowing of the skin and mucosa.Further,her free T3(FT3)and FT4 levels were significantly elevated,whereas her thyrotropin level was reduced.After admission,her condition continued to deteriorate,and she presented with continued high fever,vomiting,palpitation,and shortness of breath.After being diagnosed with thyroid storm,the patient was immediately treated with PE combined with DPMAS.Her symptoms improved immediately.After three PE+DPMAS treatments,and she was discharged from the hospital.She was treated with methylprednisolone and methylthimidazole.After six months,the patient spontaneously discontinued methylthimidazole treatment.Her previous clinical manifestations and liver dysfunction reoccurred.The patient was treated with PE+DPMAS two times,and her condition rapidly improved.Liver histopathology indicated immunological liver injury.CONCLUSION Our experience suggests that PE combined with DPMAS can effectively relieve the development of thyroid storm.

Wavelet analysis of coastal-trapped waves along the China coast generated by winter storms in 2008

This study applies the wavelet analysis to the tidal gauge records, alongshore winds, atmospheric temperature and pressure along the China coast in winter 2008. The analysis results show three events of sea level oscillations （SLOs） on the shelf induced by winter storms. The first event occurred from January 9 to 21. The SLO periods were double-peaked at 1.6-5.3 and 7.0-16.0 d with the power densities of 0.04-0.05 and 0.10-0.15 m^2.d, respectively. The second event occurred from February 5 to 18. The SLO period was single-peaked at 2.3-3.5 d with power density of 0.03-0.04 m^2.d. The third event occurred from February 20 to March 8. The SLO periods were double- peaked at 1.5-4.3 and 6.1-8.2 d with the power densities of 0.08-0.11 and 0.02-0.08 me.d, respectively. The SLOs propagated along the coast from Zhejiang in north to Guangdong in south. The phase speeds ranged about 9-29 m/s from Kanmen to Pingtan, 5-11 m/s from Xiamen to Huizhou and 11-22 m/s from Huizhou to Shuidong. The dispersion relation of the SLOs shows their nature of coastal-trapped wave.

De Winter syndrome and ST-segment elevation myocardial infarction can evolve into one another: Report of two cases

BACKGROUND The de Winter electrocardiography(ECG)pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain.The previous view was that the de Winter ECG pattern is static.CASE SUMMARY A 65-year-old man presented with sudden chest pain at rest associated with diaphoresis for 55 min.The first ECG showed only T-wave inversion in III and aVF leads.Another ECG was performed at the 100th minute,showing upsloping ST segments depressed with tall and symmetrical T waves in the precordial leads;the J point was raised by 0.1 mV at the aVR lead.The patient was referred to our catheterization laboratory.A third ECG showed ST segment elevation by 0.2 mV in the I and aVL leads.The patient underwent emergency coronary angiography,which revealed complete proximal left anterior descending coronary(LAD)occlusion.The second patient presented with a 1-h history of sudden-onset,severe,substernal crushing chest pain.The first ECG showed STsegment elevation(0.1–1.7 mV)in I,aVL,and precordial leads.The patient was referred to the catheterization laboratory.On arrival,his symptoms alleviated,and ECG showed that the ST-segments had significantly fallen back.The third ECG showed a typical de Winter pattern.Coronary angiography revealed 99%stenosis of the middle LAD.CONCLUSION The de Winter ECG pattern is transient and dynamic,and it reflects proximal or mid-LAD subtotal occlusion rather than total occlusion.

Observational Analyses of Baroclinic Boundary Layer Characteristics during One Frontal Winter Snowstorm

The evolution and characteristics of the baroclinic boundary layer for one frontal winter snowstorm were analyzed by using the well-documented dataset during Intensive Observation Period (IOP) 17 of STORM-FEST. It is found that when the warm moist air was lifted across the front, a great amount of latent heat release because of snowing increased the frontal temperature contrast to intensify frontogenesis. It is shown in the zig-zag section diagram of potential temperature that when the frontogenesis got stronger, a cold trough was formed and both low-level jet (LLJ) and upper-level jet (ULJ) emerged ahead of the front. In the strongest stage of frontogenesis, the frontal contrast of potential temperature of cold trough reached as high as 20 K. Hereafter the LLJ ahead of the front tended to weaken and the LLJ behind the front tended to strengthen. The frontal circulation system was dominated by the cold air advection behind the front, which transported the cold air behind the front forward to the warm area ahead of the front to weaken the cold trough and finally frontolysis occurred. It is shown by the analyses of turbulent characteristics of frontal baroclinic boundary-layer that the vertical shear (WV) above the boundary layer was very large, and the pumping of the strong wind shear in turbulent energy budget made the characteristic variables within the PBL well mixed. Sufficient moisture carried by southerly flow from the Mexico Gulf, and the strong baroclinity of the frontal boundary layer played key roles in this frontal winter snowstorm, and the large-scale ULJ behind the cold front is also advantageous to the development of the convective boundary layer.

A Case Study of a Typical Dust Storm Event over the Loess Plateau of Northwest China

Enhanced observational meteorological elements,energy fluxes,and the concentration of dust aerosols collected from the Semi-Arid Climate Observatory and Laboratory(SACOL) during a typical dust storm period in March 2010 at Lanzhou were used in this paper to investigate the impact of dust aerosols on near surface atmospheric variables and energy budgets.The results show that the entire dust storm event was associated with high wind velocities and decreasing air pressure,and the air changed from cold and wet to warm and dry and then recovered to its initial state.The response of energy fluxes occurred behind meteorological elements.At high dust concentration periods,the net radiation was significantly less in the daytime and higher at night,while the heat fluxes displayed the same trend,indicating the weakening of the land-atmosphere energy exchange.The results can be used to provide verification for numerical model results in semi-arid areas.

High scored thyroid storm after stomach cancer perforation: A case report

BACKGROUND Thyroid storm is a life-threatening emergency.Reportedly,the prevalence of thyroid storm is 1%-2%among patients admitted to the hospital for thyrotoxicosis.Burch and Wartofsky(1993)introduced a scoring system using precise clinical criteria to identify thyroid storms.Only 17 cases of thyroid storm with a score>70 points have been reported.Although thyroid storms are uncommon,their clinical findings resemble those of sepsis.CASE SUMMARY A 48-year-old man was referred to the emergency room from a local clinic owing to suspicion of gastric ulcer perforation;medications for hypertension,diabetes mellitus,and hyperthyroidism had been suspended 1 year prior to this visit.We performed an emergency distal gastrectomy with Billroth II anastomosis for gastric cardia cancer perforation,and the patient was referred to the surgical intensive care unit(ICU).On the 2nd d in the ICU,his body temperature(BT)increased to 41.3℃ at 19:00,with the thyroid storm score(90 points)peaking at 18:00(BT;41.2℃,pulse rate;138/min,irritable status).The patient was administered propylthiouracil,intravenous glucocorticoids,acetaminophen,and Lugol’s solution daily.Subsequently,we performed bladder irrigation with cold saline using a Foley catheter and applied a hypothermic blanket to decrease the patient's BT.His vital signs were stable on the 8th day in the ICU.CONCLUSION Thyroid storms are uncommon,with few reports in the literature;however,their clinical findings resemble those of sepsis and require further investigation.Since an untreated thyroid storm results in a high mortality rate,it should be investigated when managing sepsis.

Two Hundred and Seventeen Cases of Winter Diseases Treated with Acupoint Stimulation in Summer

217 cases of chronic bronchitis and asthma were clinically treated and analyzed for the effects of combining electric stimulation with topical application of drug on acupoints. The results suggested that the combined therapy was superior to unitary therapy (P<0.05). It is indicated that the combined therapy has a good curative effect in both short- and long-terms.

Sedimentary record of a late Holocene storm event in Laizhou Bay,Bohai Sea,China

The Bohai Sea is influenced by numerous extreme oceanic wave events in history.However,it is often difficult to determine the types of these events due to the lack of detailed historical records,causing uncertainty in the reconstruction of historical coastal disasters.We investigated an anomalous sand layer in the Xiliyu Village by the coast of Laizhou Bay,Shandong,from which an extreme event deposit was identified using a multi-proxy approach including grain size distribution,geochemistry,and magnetic susceptibility.This event was dated 2700–3100 a bp,and caused inundation of a large coastal area of Laizhou Bay.By comparing historical records with instrumental data,we believe that the event deposit was generated by a severe storm surge with wind speed of>34.9 m/s.

Saco-Casco Bays Inundation Modeling of Five Winter Storms

Coastal inundation along the northeast coast of the United States is usually caused by strong winter storms(WS).However,the accurate prediction of coastal inundation due to the WS is challenging.Therefore,our study aims to develop a unique high-resolution modeling system to accurately predict the coastal inundation in the ungauged coastal areas of Saco-Casco Bays and map the flood risk zones to potential sea level rise due to these storms.Hindcasts of five classic WS in 2014-2015 were studied.The inundation models are based on FVCOM that uses unstructured grid to capture the minor to significant flooding near the shallow areas of the bays,harbor entrance and river banks.In this study,topography has been generated from the NOAA’s integrated dataset of Portland,ME 1/3 arc-second MHW digital elevation model.The model runs were driven by two different sets of meteorological(NECOFS WRF and NOAA’s NAM WRF)forcing to examine the effect of spatial resolution on the predicted inundation.The study reveals that among the five storm surge cases,WS-III produces a maximum surge of 0.7 m and WS-II cause a minimum surge of 0.3 m.In all scenarios,southward wind-driven coastal current flowing towards Biddeford Pool,Pine Point and Camp Ellis forms a small-scale eddy which causes significant inundation however strength of the current varies accordingly.Sensitivity experiments have been carried out using NECOFS WRF simulation products with varying parameters of marshland elevation and bottom friction to understand the influence of intertidal storage on the predicted flooding.

Rare case of perforated giant gastric ulcer with concurrent thyroid storm:A case report

BACKGROUND Thyroid storm is an uncommon condition manifesting in severe thyrotoxicosis with a high mortality rate.The concurrence of peptic ulcer disease and hyperthyroidism is rare due to concurrent activation of both the sympathetic and parasympathetic pathways.We present a case of perforated giant gastric ulcer with concurrent thyroid storm who underwent damage control surgery with emergency patch repair with falciform ligament and recovered well.CASE SUMMARY A 53-year-old male chronic smoker,with no previous medical history,presented with severe generalized abdominal pain and vomiting for one day duration.Further history revealed weight loss,diarrhea,and anxiety over the past three months.On clinical examination,patient was febrile with temperature of 38.6 Degrees Celsius and tachycardic at 130-140 beats per minute,his blood pressure was low at 90/50mmHg.His abdomen was tender with generalized peritonism.In view of his clinical history,a thyroid screen was ordered which showed raised thyroxine(T4)levels of 90.3 pmol/L and low thyroxine stimulating hormone(TSH)levels of 0.005μU/mL.Chest X-ray showed no sub-diaphragmatic free air,but contrasted CT scan revealed pneumoperitoneum with large amount of intraabdominal free fluid.The working diagnosis was perforated peptic ulcer complicated by thyroid storm.An urgent endocrinologist consult was made,and patient was started on beta blocker and intravenous steroids pre-operatively.The patient underwent emergency laparotomy with washout and patch repair of the perforated gastric ulcer.Patient was monitored post-operatively in intensive care unit and required IV hydrocortisone and Lugol’s iodine.Histology of the ulcer edges showed no malignancy.On post-operative day seven,T4 decreased to 20.4 pmol/L,TSH was 0.005 mLU/L.His thyroid function test subsequently normalized 3 mo post-operatively with T418.1 pmol/L,TSH 1.91 mLU/L.Patient’s recovery was otherwise uneventful.Thyroid receptor antibody subsequently was positive,and patient was managed for Grave’s disease by the endocrinologist.CONCLUSION This case highlights the rare but life-threatening clinical emergency of peptic ulcer perforation complicated by thyroid storm.Multidisciplinary perioperative management is crucial to optimize patient for surgery and damage control principles should be taken for an acute surgical patient with concurrent endocrine crisis.

Thyrotoxicosis in patients with a history of Graves'disease after SARS-CoV-2 vaccination(adenovirus vector vaccine):Two case reports

BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)which were approved for emergency use have been administered on a large scale globally to contain the pandemic coronavirus disease 2019(COVID-19)and to save lives.Vaccine safety is one of the issues under surveillance and a possible correlation between vaccines and thyroid function has been reported.However,reports of the impact of coronavirus vaccines on those with Graves’disease(GD)are rare.CASE SUMMARY This paper presents two patients with underlying GD in remission,both developed thyrotoxicosis and one developed thyroid storm following the adenovirus-vectored vaccine(Oxford-AstraZeneca,United Kingdom).The objective of this article is to raise awareness regarding a possible association between COVID-19 vaccination and the onset of thyroid dysfunction in patients with underlying GD in remission.CONCLUSION Receiving either the mRNA or an adenovirus-vectored vaccine for SARS-CoV-2could be safe under effective treatment.Vaccine induced thyroid dysfunction has been reported,but the pathophysiology still not well understood.Further investigation is required to evaluate the possible predisposing factors for developing thyrotoxicosis especially in patients with underlying GD.However,early awareness of thyroid dysfunction following vaccination could avoid a lifethreatening event.

Economic Losses from Winter Storms

China’s economic losses from the January winter storms keep escalating. The Ministry of Civil Affairs estimated that the direct economic losses valued

A Case Study of Ocean-Atmosphere Interactions during the Passage of an Extra-Tropical Cyclone in the Vicinity of Cape Hatteras, North Carolina

The authors document the interaction of the atmosphere and ocean during the formation and passage of an Extra-Tropical Cyclone, which is a Nor-Easter, winter storm that formed in the southern apex of the Middle Atlantic Bight near Cape Hatteras North Carolina, between February 15 and 18, 1996. While Nor-Easters per se, which have formed along the Atlantic Eastern Seaboard of the United States have been studied for decades, the actual atmospheric-oceanic mechanics and thermodynamics in the formation of a Nor-Easter has never been documented. We report on having done so with in-situ observations and data-based calculations and a numerical model. The in-situ observations were made via a Control Volume consisting of an array of Eulerian Oceanic-Atmospheric Moorings with current meters, temperature and salinity sensors and meteorological towers. We find that Gulf Stream waters were located surrounding the mooring array, and that with the invasion of cold dry atmospheric air, there was a rapid loss of heat from the ocean to the atmosphere via latent and sensible surface heat flux during the cyclogenesis onset of the storm. A unique feature of this storm was that neither satellite nor buoy data showed significant sea surface cooling in the control volume. The findings indicate that storm winds drove warm saline waters from the Gulf Stream across the continental shelf into the control volume, accounting for a 51 cm rise in water level along the coast. This lateral heat advection provided heat to the control volume of 3.4e+18 Joules. On average, the heat loss at the surface of the control volume, via sensible and latent heat fluxes and radiation, was 0.7e+18 Joules, corresponding to a surface heat flux of -600 Watts per Meter2 (W/m2). However, the heat lost by the control volume as latent and sensible heat fluxes was less than the heat it received via lateral heat advection, resulting in the lack of an often-observed sea surface cooling during other winter storms. The serendipitous and detailed observations and calculations reveal a climatological flywheel in this region, documenting the role of ETCs in the global heat balance.

浙闽海域冬季悬沙锋的次中尺度现象

次中尺度运动是海洋中重要的动力过程,但是目前对浙闽海域悬沙锋的次中尺度现象及其动力特征的关注较少。本文基于高时空分辨率的GOCI卫星遥感影像、实测表层悬沙浓度数据以及海表涡流数据等,研究了悬沙锋时空分布特征及其次中尺度过程。研究结果表明,浙闽近岸的悬沙锋在冬季普遍发育,主要分布在浙闽海域20~25m等深线附近,但在浙江北部约29°N海域和台湾岛北部26~27°N海域锋面向海突出,指示了近海高浓度悬浮泥沙的向海输运;浙闽悬沙锋次中尺度现象显著,多表现相对涡度的气旋性涡旋;悬沙锋位置逐步向南移动,主要与冬季偏北风产生的西南向沿岸流有关;冬季大风事件有利于锋面次中尺度过程发育。

卫星遥感北大西洋风暴“尤尼斯”生成和发展特征

2022年2月中旬,北大西洋冬季风暴“尤尼斯”(Eunice)给欧洲中、西部带来严重自然灾害。以卫星观测数据为主,研究了“尤尼斯”发生的环境场、卫星水汽图像干侵入特征、对流层中高层位涡强迫对爆发性发展的影响等。结果表明:“尤尼斯”活动期间,北半球高纬度西半球偏冷、东半球偏暖,极涡偏向北美大陆,北美极区附近平均气温偏低。“尤尼斯”的生成和北美极区附近极涡分裂南下的冷空气沿着西风带东传有关。爆发性发展期间,海平面气压下降率约40 hPa/(24 h),远超爆发性发展指标(24 hPa/(24 h)),且出现在海温正距平区。格陵兰岛南部气旋提供的极区冷空气对爆发性发展尤为重要,该冷空气在北大西洋洋面形成强西北风转偏西风,表现为排列整齐的大范围细胞状积云一直延伸至风暴中心附近,卫星水汽图像上表现为快速增强的干侵入特征,并伴有高位涡异常。发展至最强阶段,高位涡向下伸展,400 hPa最强高位涡区位于风暴中心的正上方,500 hPa以下高位涡向东南方向倾斜,并伴随着对流层中、下层强下沉运动,下沉运动为低空风速增强提供了一定的高空能量来源,高位涡侵入的下方也有利于低层气旋式环流发展。

1例暴发性心肌炎青少年频发电风暴行体外膜肺氧合治疗的护理

总结1例暴发性心肌炎青少年频发电风暴行体外膜肺氧合(ECMO)治疗的抢救护理过程。护理要点:电风暴风险预见与急救护理;ECMO治疗与护理;阶梯式心脏康复运动方案实施;家庭式参与改善病人负性情绪。通过积极治疗和护理措施的精准实施,44 d后病人康复出院,持续随访6个月,目前状况良好。

Assimilating All-sky Infrared Radiances from Himawari-8 Using the 3DVar Method for the Prediction of a Severe Storm over North China

Although radar observations capture storm structures with high spatiotemporal resolutions, they are limited within the storm region after the precipitation formed. Geostationary satellites data cover the gaps in the radar network prior to the formation of the precipitation for the storms and their environment. The study explores the effects of assimilating the water vapor channel radiances from Himawari-8 data with Weather Research and Forecasting model data assimilation system(WRFDA) for a severe storm case over north China. A fast cloud detection scheme for Advanced Himawari imager(AHI)radiance is enhanced in the framework of the WRFDA system initially in this study. The bias corrections, the cloud detection for the clear-sky AHI radiance, and the observation error modeling for cloudy radiance are conducted before the data assimilation. All AHI radiance observations are fully applied without any quality control for all-sky AHI radiance data assimilation. Results show that the simulated all-sky AHI radiance fits the observations better by using the cloud dependent observation error model, further improving the cloud heights. The all-sky AHI radiance assimilation adjusts all types of hydrometeor variables, especially cloud water and precipitation snow. It is proven that assimilating all-sky AHI data improves hydrometeor specifications when verified against the radar reflectivity. Consequently, the assimilation of AHI observations under the all-sky condition has an overall improved impact on both the precipitation locations and intensity compared to the experiment with only conventional and AHI clear-sky radiance data.

Effects of winds,tides and storm surges on ocean surface waves in the Sea of Japan

Ocean surface waves are strongly forced by high wind conditions associated with winter storms in the Sea of Japan. They are also modulated by tides and storm surges. The effects of the variability in surface wind forcing, tides and storm surges on the waves are investigated using a wave model, a high-resolution atmospheric mesoscale model and a hydrodynamic ocean circulation model. Five month-long wave model simulations are inducted to examine the sensitivity of ocean waves to various wind forcing fields, tides and storm surges during January 1997. Compared with observed mean wave parameters, results indicate that the high frequency variability in the surface wind filed has very great effect on wave simulation. Tides and storm surges have a significant impact on the waves in nearshores of the Tsushima-kaihyS, but not for other regions in the Sea of Japan. High spatial and temporal resolution and good quality surface wind products will be crucial for the prediction of surface waves in the JES and other marginal seas, especially near the coastal regions.

Human menstrual blood-derived stem cells as immunoregulatory therapy in COVID-19:A case report and review of the literature

BACKGROUND The coronavirus disease 2019(COVID-19)caused by novel coronavirus 2019 in December 2019 has spread all around the globe and has caused a pandemic.There is still no current effective guidance on the clinical management of COVID-19.Mesenchymal stem cell therapy has been shown to be one of the therapeutic approaches to alleviate pneumonia and symptoms through their immunomodulatory effect in COVID-19 patients.CASE SUMMARY We describe the first confirmed case of COVID-19 in Hangzhou to explore the role of human menstrual blood-derived stem cells(MenSCs)in the treatment of COVID-19.Moreover,we review the immunomodulation effect including nonspecific and specific immune functions of MenSCs for the therapy of COVID-19.CONCLUSION MenSCs can be helpful to find a promising therapeutic approach for COVID-19.