Mechanical pulmonic valve thrombosis: expanding role of cardiac CT and multimodality imaging

We report a case of a 44-year-old man with a clinical history of Tetralogy of Fallot status post staged surgical correction with mechanical pulmonic valve replacement who presented with progressive exertional dyspnea in the setting of non-compliance with anticoagulation. In the context of this suggestive clinical presentation, the diagnosis of mechanical pulmonic valve thrombosis (MPVT) was made possible via multimodality imaging, including transthoracic echocardiogram and cardiac computed tomography angiography. Due to the uncommon nature of the condition, the patient was treated with systemic thrombolysis and anticoagulation using evidence-based guidelines, largely extrapolated from left-sided mechanical valve thrombosis. Our case underscores the importance of anticoagulation in MPVT and recognizing the features of MPVT on clinical history, physical examination, and multimodality imaging. It is essential to understand the pivotal role of multimodality imaging in the assessment of MPVT and realize the limitations of available data regarding the management of MPVT in the current era.     

Weekly Nowcasting of New COVID-19 Cases Using Past Viral Load Measurements

The rapid spread of the coronavirus disease COVID-19 has imposed clinical and financial burdens on hospitals and governments attempting to provide patients with medical care and implement disease-controlling policies. The transmissibility of the disease was shown to be correlated with the patient’s viral load, which can be measured during testing using the cycle threshold (Ct). Previous models have utilized Ct to forecast the trajectory of the spread, which can provide valuable information to better allocate resources and change policies. However, these models combined other variables specific to medical institutions or came in the form of compartmental models that rely on epidemiological assumptions, all of which could impose prediction uncertainties. In this study, we overcome these limitations using data-driven modeling that utilizes Ct and previous number of cases, two institution-independent variables. We collected three groups of patients (n = 6296, n = 3228, and n = 12,096) from different time periods to train, validate, and independently validate the models. We used three machine learning algorithms and three deep learning algorithms that can model the temporal dynamic behavior of the number of cases. The endpoint was 7-week forward number of cases, and the prediction was evaluated using mean square error (MSE). The sequence-to-sequence model showed the best prediction during validation (MSE = 0.025), while polynomial regression (OLS) and support vector machine regression (SVR) had better performance during independent validation (MSE = 0.1596, and MSE = 0.16754, respectively), which exhibited better generalizability of the latter. The OLS and SVR models were used on a dataset from an external institution and showed promise in predicting COVID-19 incidences across institutions. These models may support clinical and logistic decision-making after prospective validation.     

氨茶碱联合黄芪治疗病毒性心肌炎致难治性缓慢心律失常的临床观察

目的 探讨快速静滴氨茶碱联合口服黄芪治疗病毒性心肌炎合并缓慢性心律失常的临床意义。方法 对1990年3月～2000年3月的心动过缓患者36例,在提高心室率、心肌缺血性改变和临床症状改善,进行心电图、超声心动图和阿托品运动试验前后比较。结果 发现氨茶碱组总有效率达91.7％,与对照组比较有显著性差异(P<0.01)。结论 氨茶碱和黄芪具有起效快、易接受的优点,特别对老年人及Adamo-Stores综合征可免戴心脏起搏器,是临床简易有效的治疗方法。     

Aminotetralins as selective beta-adrenergic agonists.

Aminotetralin derivatives M-8 and JOD-176, were studied in relation to isoproterenol for beta-adrenergic activity. M-8 and JOD-176 were found to be very weak in activating cardiac beta-receptors. These compounds were also found to be considerably more active in uterine and bronchial smooth muscle. Because these compounds were also shown to be very inactive in vascular smooth muscle, the possibility that beta-receptors in different smooth muscle types may also differ was suggested.     

心肌肌钙蛋白T水平与急性心源性肺水肿患者短期和长期预后的关系

目的:观察心肌肌钙蛋白T水平与急性心源性肺水肿患者短期和长期预后关系。方法:84例急性心源性肺水肿患者,排除急性心肌梗塞,如患者cTNT<0.1ng/ml则进入实验1组,cTNT≥0.1ng/ml分入2组,分别于入院后6及12h采血测cTNT。结果:46例(55%)患者cTNT≥0.1ng/ml。32例(38%)在随访期间死亡。2组患者既往有冠心病史的占72%,1组占50%,(P=0.04),2组患者年龄较1组大,(平均68岁vs61岁;P=0.021),1组患者3年存活率76%,2组患者3年死亡率29%。结论:cTNT≥0.1ng/ml与急性心源性肺水肿患者长期生存率低有关,是愈后差的预测因素。     

卡托普利防治腹主动脉狭窄性高血压大鼠心肌肥厚的形态定量研究

方法选用腹主动脉狭窄的大鼠实验性心肌肥厚模型,采用光镜、电镜形态计量手段,定量观察了血管紧张素转换酶抑制剂卡托普利防治心肌肥厚的作用,并比较了倍他乐克对心肌肥厚的作用。结果卡托普利组大鼠的全心／体重比、心肌组织／间质比、心肌细胞横径及心肌细胞线粒体体密度与对照组类似（p＞0．05）,明显不同于心肌肥厚组（p＜0．05）,而倍他乐克组上述多指标与心肌肥厚组相似（p＞0．05）。本实验表明卡托普利通过保护心肌细胞及间质而使心肌组织免遭损伤因素刺激发生肥厚的作用,即对大鼠高血压性。心肌肥厚具有良好的防治作用。     

食管癌、贲门癌切除术后食管胃器械吻合术213例临床观察

目的：探讨器械吻合器在治疗食管癌、贲门癌中的临床价值。方法：通过回顾分析，将213例食管癌、贲门癌切除术行器械吻合器吻合作为观察组，将同期208例食管癌、贲门癌切除术行传统手工吻合作为对照组，并将两组进行比较分析，观察两组术后吻合口瘘、吻合口狭窄及吻合口出血的发生率。结果：观察组中无吻合口瘘发生，发生率0．00％，对照组中有8例并发吻合口瘘，发生率3．85％，两组比较有统计学差异（P＜0．05）；观察组中仅有1例并发吻合口狭窄，发生率0．47％，对照组中有11例并发吻合口狭窄，发生率5．29％，两组比较有统计学差异（P＜0．01）；观察组中有1例并发吻合口出血，发生率0．47％，对照组2例吻合口出血，发生率0．96％，两组比较无统计学差异（P＞0．05）。结论：食管癌、贲门癌切除术应用器械吻合器进行食管胃听合术后吻合口瘘和吻合口狭窄的发生率低，吻合效果满意，临床应用价值乐观。     

妊娠期糖尿病营养治疗进展

妊娠期糖尿病(GDM)营养治疗主要通过评估患者个人情况后制订合适的能量摄入计划,如限制糖类的摄入量,通过血糖指数/血糖负荷理论配合食品交换份法来搭配食物。科学搭配膳食三大营养素可为孕妇提供最佳的营养,促进适当的孕期体质量增加,达到理想的血糖控制水平,为胎儿正常生长发育提供足够的能量。该文就GDM营养治疗的基本治疗和最新进展进行综述。     

自我放松训练对心功能的影响

自我放松训练是建立在催眠暗示基础上的一种心理疗法。我们用XG—Ⅱ型血液循环功能测试仪对22例自我放松训练者放松前后测试,结果表明在放松训练中,心脏每搏输出量明显增加,而心脏指数无明显改变,提示它可以改善心功能。     

NSF-Based Analysis of the Structural Stressing State of Trussed Steel and a Concrete Box Girder

This paper analyses the characteristics of the mechanical behavior of a trussed steel and concrete box beam under bending conditions based on the structural stressing state theory and the numerical shape function method. Firstly, the parametric generalized strain energy density was introduced to characterize the structural stressing state of trussed steel stud concrete box girders, and the strain energy density sum was plotted. Then the Mann-Kendall criterion was used to discriminate the leap point of the curve change and to redefine the structural failure load. By analyzing the strain and displacement, the existence of a sudden change in the structural response during the load-bearing process was again demonstrated. Afterwards, the numerical shape function method was used to extend the strain data, and further in-depth analyses of strain/stress fields and internal forces were carried out to show in detail the working characteristics of each under load. Through an in-depth analysis from different angles, the rationality of updating the failure load was verified. Finally, the effects of different structure parameters on the evolution of the structural stresses of the members were analyzed in a transversal comparison. The analysis results of the stress state of a steel-concrete truss structure reveal the working behavior characteristics of a steel-concrete truss structure from a new angle, which provides a reference for the design of a steel-concrete truss structure in the future.