Natural history and risk factors of long-term mortality in acute coronary syndrome patients with cardiogenic shock

PurposeCardiogenic shock (CS) is a severe complication of acute coronary syndromes (ACS). Intra-aortic balloon pump (IABP) is considered important mechanical therapy for acute CS. We aimed to analyze the natural history and possible prognostic factors in patients with CS complicating ACS.Patients/methodsAll 126 patients (mean age 65.8 ± 12.5 years), who were hospitalized in single center due to an episode of CS in the course of ACS, had IABP and were scheduled for coronary angiography. The assessed end-point was 5-year death from any cause.ResultsMedian left ventricle ejection fraction (LVEF) 28% (interquartile range (IQR) 23–35%), 39 patients (31%) were female, in 91 (72%) the initial diagnosis was ST-elevation myocardial infarction (STEMI). Mean time on the IABP was 3.8 ± 3 days. During index hospitalization there were 56 deaths (44%). Other 27 patients (out of 70 discharged – 38.5%) died during 5-year follow-up. In univariate logistic regression, the significant effect on long term mortality had age, female gender, reduced ejection fraction below 31% and hypotension on admission. The out of hospital survival was also determined by age, gender and hypotension, while LVEF lost its predictive value The multivariate survival analysis both in whole group and in patients discharged from hospital was independently affected by age and hypotension on the admission.ConclusionsThe mortality of patients with CS despite treatment with IABP remains very high, especially during the in-hospital period and early after discharge. Among assessed parameters age and hypotension on the admission are the most important predictors of adverse long term prognosis.     

Long QT Syndrome in Pregnancy: Are Vaginal Delivery and Use of Oxytocin Permitted? A Case Report

BackgroundPatients with congenital long QT syndrome (LQTS) are at increased risk of ventricular arrhythmia, particularly during labour and the puerperium.CaseA 28-year-old primigravida with known LQTS underwent induction of labour at 41 weeks’ gestation using a Foley catheter balloon and IV oxytocin. Vaginal delivery with passive second stage and outlet forceps was undertaken with early epidural analgesia to prevent tachycardia and psychological stress. The patient gave birth to a healthy female, and had an uncomplicated postpartum period under continuous electrocardiogram monitoring.ConclusionVaginal delivery with use of oxytocin for the induction of labour can be safely undertaken in patients with LQTS.     

Aging and Counseling:

Counselors are needed to help meet the mental health needs of older person; yet, to be effective they must understand fully the special needs of the older population. Counseling, an applied psychological science, is thus a field of study where gerontology curricula can be implemented optimally in a partnership manner. This article reviews the historical evolvement of gerocounselors and includes resources for special training of these professionals. Suggestions and resources for development of training programs and integration of gerontology and counseling curricula are provided.     

LncRNA RP11-79H23.3在膀胱癌细胞中的作用及其发生、发展的研究

背景与目的：虽然许多长链非编码RNA(long non-coding RNA，lncRNA)的异常表达与膀胱癌的发生有密切关系，但对于lncRNA RP11-79H23.3暂未见报道。该研究旨在探讨lncRNA RP11-79H23.3在膀胱癌EJ细胞中的作用及其发生、发展的机制。方法：采用微阵列方法对4对膀胱癌患者的癌和癌旁组织进行组学分析，随后用实时荧光定量聚合酶链反应(real-time fluorescent quantitative polymerase chain reaction，RTFQ-PCR)检测膀胱癌组织、癌旁组织及正常人膀胱上皮细胞sv-HUC-1、膀胱癌EJ细胞中RP11-79H23.3的表达。通过转染pIRES2-RP11-79H23.3上调该基因后，采用细胞计数试剂盒(cell counting kit-8，CCK-8)和EdU的方法检测EJ细胞的增殖活性，通过Transwell小室和平板划痕实验分别检测EJ细胞的侵袭和迁移能力，应用流式细胞术、Hoechst33342及Tunel检测细胞凋亡，应用细胞免疫荧光检测PTEN在膀胱癌细胞中的定位，采用鬼笔环肽染色观察细胞骨架形成，应用蛋白［质］印迹法(Western blot)分析过表达RP11-79H23.3后EJ细胞中PI3K/AKT信号通路中相关蛋白的表达情况。结果：LncRNA RP11-79H23.3在膀胱癌组织和膀胱癌EJ细胞中表达下调(P ＜0.001，P＜0.01)，pIRES2-RP11-79H23.3转染EJ细胞结果显示，RP11-79H23.3的表达量较转染前显著增加(P＜0.01)。上调RP11-79H23.3的表达可诱导膀胱癌EJ细胞的凋亡，相反，转染pIRES2-EGFP可促进EJ细胞的增殖、侵袭和迁移能力，同时，Western blot结果显示，转染pIRES2-RP11-79H23.3后可上调PTEN在EJ细胞中的表达，下调p-PI3K、p-AKT及p-Gsk3β蛋白的表达(P＜0.05)。结论：LncRNA RP11-79H23.3在膀胱癌组织和膀胱癌EJ细胞中低表达(P＜0.001，P＜0.01)，并且过表达RP11-79H23.3会降低膀胱癌细胞增殖、侵袭和迁移能力，其作用机制可能与PI3K/AKT信号通路有关。提示lncRNA RP11-79H23.3在膀胱癌恶性肿瘤中发挥重要的作用，可能会成为治疗膀胱癌的药物作用靶点。     

Iatrogenic life-threating condition in a patient with multiple rare disorders

Andersen–Tawil syndrome (long QT syndrome 7) is a rare inherited disorder, characterized by periodic paralysis, long QT, ventricular arrhythmias and skeletal abnormalities.A 52-year-old female with a history of long QT-syndrome, ICD implantation (secondary prevention of cardiac arrest) and systemic vasculitis was admitted due to an electrical storm caused by endocarditis. She was admitted again short after discharge due to multi-organ failure, which was caused probably by withdrawal of steroids and VKA. Characteristic dysmorphic features resulted in Andersen–Tawil syndrome suspicion.If patients have one rare disorder they should not be excluded from further diagnostics, and very detailed outpatient care.