Medicine
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To evaluate myocardial synchronized exercise and clinical prognosis in patients with heart failure preserved ejection fraction (HFpEF), we utilized two-dimensional speckle tracking (2D-STI) stratified strain imaging. We retrospectively summarized 146 patients diagnosed with HFpEF in our hospital from January 2022 to January 2023. 2D-STI combined with stratified strain imaging was used to measure the overall left ventricular global longitudinal strain (LVGLS), the sub-endocardium, mid-myocardium, sub-epicardium LS of the left ventricle, as well as the basal, intermediate, and apical LS, the peak strain dispersion (PSD) and the transmural pressure difference, the postsystolic shortening (PSS), and early systolic lengthening. They were categorized into adverse and better prognosis groups based on major adverse cardiac events (MACE). ⋯ Compared to pretreatment in the better group at 1-month follow-up, LVGLS, sub-endocardium, mid-level, sub-epicardium LS, PSD, and PSS values improved significantly (P < .05), but the adverse group did not (P > .05). Multivariate Cox regression demonstrated that pretreatment LVGLS (HR = 1.362, 95% CI = 1.026-1.809, P = .033), sub-epicardium LS (HR = 1.669, 95% CI = 1.068-2.609, P = .025), and PSD values (HR = 1.075, 95% CI = 1.014-1.140, P = .015) were important predictors of the occurrence of MACE in patients with HFpEF. The receiver operating curves manifested that the area under the curve of pretreatment LVGLS, sub-epicardium LS, and PSD values for predicting the occurrence of MACE were 0.812 (95% CI = 0.730-0.894, P < .001), 0.847 (95% CI = 0.775-0.919, P < .001), and 0.924 (95% CI = 0.863-0.984, P < .001). 2D-STI combined with stratified strain imaging can provide a more comprehensive, objective, and accurate assessment of myocardial synchronized exercise and clinical prognosis in patients with HFpEF, and LVGLS, sub-epicardium LS, and PSD values can be used in clinical practice as noninvasive, sensitive indicators for predicting the occurrence of MACE.
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Quadricuspid aortic valve (QAV) is a rare condition with a very low incidence. Anomalous aortic origin of a coronary artery (AAOCA) is the most prevalent form of coronary anomaly. One variant of AAOCA is the anomalous aortic origin of the left coronary artery from the right coronary sinus (L-AAOCA). It is even rarer for QAV to occur in combination with AAOCA. ⋯ The timely diagnosis of this incorporated cardiac anomaly, or rather its accidental discovery, led to successful surgical correction, eliminating the future risk of cardiac ischemia or SCD.
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Observational Study
Endoscopic evacuation of supratentorial hematoma: A hemostatic strategy for surgeons.
Endoscopic hematoma evacuation has become well received for its high evacuation rate in patients with intracerebral hematoma. Effective hemostatic procedure is the key to the success of the procedure. Any single method cannot solve all kinds of intraoperative bleeding, The key to hemostasis is to identify the type of bleeding and take the best hemostasis method during endoscopic surgery. ⋯ No patient experienced postoperative re-bleeding. These findings indicated that most patients will experience different degrees of intraoperative bleeding during endoscopic hematoma evacuation. A hemostatic strategy based on intraoperative bleeding grade resulted in efficiency and safety.
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Pregnant women with gestational diabetes mellitus undergoing glucocorticoid treatment to prevent neonatal respiratory distress syndrome could have increased glucose level. We performed a retrospective study and reviewed gestational diabetic women who received an intramuscular dexamethasone injection (6 mg, every 12 hours, 4 times) in our hospital between December 2018 and June 2020. Eligible pregnant women were assigned to the study group (with simultaneous subcutaneous insulin detemir injection, 2-4 units per day) or the control group (without insulin detemir injection). ⋯ There were no statistically significant differences in the fasting blood glucose levels between the 2 groups. Dexamethasone administration increased the blood glucose levels in the pregnant women with gestational diabetes mellitus. A short-course of low-dose insulin detemir administration effectively lowered the blood glucose levels in these women.
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Cardiac papillary fibroelastoma (CPF) is a rare cardiac tumor that can lead to severe and potentially fatal complications such as stroke, myocardial infarction, and sudden cardiac death. The rarity of CPF makes it challenging for clinicians to diagnose and treat, highlighting the importance of timely and accurate diagnosis to prevent catastrophic outcomes. This case report aims to contribute to the clinical understanding of CPF involving the mitral valve (MV), providing insights into diagnosis and treatment strategies. ⋯ Echocardiography is a valuable diagnostic tool for identifying CPF and guide treatment decisions. This case emphasizes the importance of recognizing this rare valve tumor for timely clinical intervention.