Transient left bundle branch block after posture change to the prone position during general anesthesia: A case report

Rationale:The prone position is commonly used in spinal surgery. There have been many studies on hemodynamic changes in the prone position during general anesthesia. We report a rare case of transient left bundle branch block (LBBB) in a prone position.Patient concern:Electrocardiogram (ECG) of a 64-year-old man scheduled for spinal surgery showed normal sinus rhythm change to LBBB after posture change to the prone position.Diagnosis:Twelve lead ECG revealed LBBB. His coronary angio-computed tomography results showed right coronary artery with 30% to 40% stenosis and left circumflex artery with 40% to 50% stenosis. The patient was diagnosed with stable angina and second-degree atrioventricular block of Mobitz type II.Intervention:Nitroglycerin was administered intravenously during surgery. Adequate oxygen was supplied to the patient. After surgery, the patient was prescribed clopidogrel, statins, angiotensin II receptor blocker, and a permanent pacemaker was inserted.Outcome:Surgery was completed without complications. After surgery, the transient LBBB changed to a normal sinus rhythm. The patient did not complain of chest pain or dyspnea.Lesson:The prone position causes significant hemodynamic changes. A high risk of cardiovascular disease may cause ischemic heart disease and ECG changes. Therefore, careful management is necessary.     

Additional bedtime H2‐receptor antagonist for the control of nocturnal gastric acid breakthrough: A Cochrane systematic review

OBJECTIVES: To assess the effectiveness and safety of additional bedtime H₂‐receptor antagonists (H₂RAs) in suppressing nocturnal gastric acid breakthrough (NAB) via a systematic review. METHODS: Eligible trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2004), MEDLINE (January 1966–June 2004), EMBASE (January 1980–June 2004) and CINAHL (January 1982–June 2004). Additional hand‐searching was conducted on the proceedings of correlated conferences, eight important Chinese journals and references of all included trials. All randomized controlled trials evaluating H₂RAs for the control of NAB were eligible for inclusion. The systematic review was conducted using methods recommended by The Cochrane Collaboration. RESULTS: Only two randomized crossover studies, comprising 32 participants, met the inclusion criteria. Because the design, dosage and duration of the treatments were different between the studies, it was not possible to conduct meta‐analysis. There were no consistent conclusions found between the two included studies in evaluating H₂RAs for the control of NAB. CONCLUSIONS: No implications for practice at this stage can be concluded. Appropriately designed large‐scale randomized controlled trials with long‐term follow up are needed to determine the effects of additional bedtime H₂RAs in suppressing NAB.     

Genetic variations of HSD11B2 in hypertensive patients and in the general population, six rare missense/frameshift mutations.

Mutations in the gene encoding 11beta-hydroxysteroid dehydrogenase type 2, HSD11B2, cause a rare monogenic juvenile hypertensive syndrome called apparent mineralocorticoid excess (AME). In AME, defective HSD11B2 enzyme activity results in overstimulation of the mineralocorticoid receptor (MR) by cortisol, causing sodium retention, hypokalemia, and salt-dependent hypertension. Here, we have studied whether genetic variations in HDS11B2 are implicated in essential hypertension in Japanese hypertensives and the general population. By sequencing the entire coding region and the promoter region of HDS11B2 in 953 Japanese hypertensives, we identified five missense mutations in 11 patients (L14F, n = 5; R74H, n = 1; R147H, n = 3; T156I, n = 1; R335H, n = 1) and one novel frameshift mutation (4884Gdel, n = 1) in a heterozygous state, in addition to 19 genetic variations. All genetic variations identified were rare, with minor allele frequencies less than 0.005. Four of 12 patients with the missense/frameshift mutations showed renal failure. Four missense mutations, L14F, R74H, R147H, and R335H, were successfully genotyped in the general population, with a sample size of 3,655 individuals (2,175 normotensives and 1,480 hypertensives). Mutations L14F, R74H, R147H, and R335H were identified in hypertensives (n = 6, 8, 3, and 0, respectively) and normotensives (n = 8, 12, 5, and 0, respectively) with a similar frequency, suggesting that these missense mutations may not strongly affect the etiology of essential hypertension. Since the allele frequency of all of the genetic variations identified in this study was rare, an association study was not conducted. Taken together, our results indicate that missense mutations in HSD11B2 do not substantially contribute to essential hypertension in Japanese.     

应用64层CT一次扫描完成心脏冠脉成像及心功能分析的可行性初步研究

目的研究64层CT一次扫描同时完成心脏冠脉成像及心功能分析的可行性。方法96例患者均行MSCT心脏成像扫描和MR心脏检查,数据分别按照冠脉成像和心功能分析要求进行重建和后处理,评估。结果1271段冠脉血管中有约99%血管显示清晰,达到诊断要求;心功能分析数据左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室每搏输出量(LVSV)、左室射血分数(LVEF)、左室心肌容积(LVMV)与MR相关数据的相关系数分别为0.84、0.91、0.94、0.89、0.88。结论MSCT可以在一次扫描中完成冠脉成像和心功能数据采集,具有极高应用价值。     

管理人员职业紧张常模及转换表研制

目的中高层管理人员、一般管理人员职业紧张常模、应用表、分级标准研究。方法采用职业紧张量表(OSI-R),对中高层管理人员263例、一般管理人员569例,共计832例常模样本进行研究。结果首先,采用OSI-R量表分别研制了中高层管理人员、一般管理人员职业紧张常模;其次,在常模的基础上,分别研制了常模样本粗分转换为T分表。职业紧张程度分级职业任务和紧张反应问卷中,T分≥70分者,为高度职业紧张、紧张反应;T分在60分至69分范围内者,为中度职业紧张、紧张反应;T分在40分至59分范围内者,为适度职业紧张和紧张反应;处于正常范围。T分低于40分者,为相对缺乏职业紧张和紧张反应。在应对资源问卷中,T分低于30分者,表明高度缺乏应对资源;T分在30分至39分范围内者,表明中度缺乏应对资源;T分在40分至59分范围之间者,具有适度的应对资源,属于正常范围;T分≥60分者,表明有很强的应对资源。结论将职业紧张的模式结合中高层管理人员、一般管理人员职业紧张常模及应用表,分别针对不同个体主要紧张源、紧张反应、应对资源,采取有针对性的干预(组织、个体)措施,以降低中高层管理人员、一般管理人员职业紧张程度,保护和促进工作能力是职业卫生领域面临的重要任务之一。     

妇科门诊子宫颈病变常识问卷调查

目的了解我院门诊就诊者对子宫颈病变相关知识的认识。方法自制问卷调查表，采用无记名，当面问卷调查方式。结果从调查100例就诊者中，未做过健康体检、妇科盆腔检查和宫颈刮片检查分别为34例、24例和52例。对宫颈癌的认识不知道者53例。结论建议相关部门加强对妇女的健康教育，提高其健康意识，强化临床医生的防癌意识和对子宫病变的规范化诊治。