Medicine
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Review Case Reports
Dexmedetomidine-associated hypothermia in critical trauma: A case report and literature analysis.
Hypothermia, defined as a core body temperature below 35°C, is a common and serious complication in severe trauma patients, often worsened by hemorrhage and medical interventions. Dexmedetomidine, an α2-adrenergic agonist used for sedation in intensive care units, has known thermoregulatory effects; however, its association with hypothermia in trauma patients remains insufficiently explored. ⋯ This case highlights dexmedetomidine's potential to induce hypothermia in critically ill trauma patients. It stresses the importance of careful temperature monitoring and proactive thermoregulation during sedative administration in intensive care. Further research is needed to explore the prevalence and mechanisms of dexmedetomidine-associated hypothermia in trauma populations.
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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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Observational Study
Newly developed DWI hyperintensities and changes in cerebral blood flow after carotid stent placement for unilateral symptomatic carotid artery stenosis.
This study aimed to evaluate changes in cerebral blood flow and perioperative outcomes in patients with unilateral symptomatic carotid artery stenosis before and after carotid artery stenting (CAS), providing insights to guide surgical decision-making. Ninety-six patients with moderate to severe unilateral symptomatic carotid artery stenosis (>50%) admitted to the Neurology Department of the Second Affiliated Hospital of Zhejiang University from June 2023 to April 2024 were included. All patients underwent CAS and magnetic resonance imaging, including diffusion-weighted imaging (DWI) and 3D quasi-continuous arterial spin-labeled perfusion imaging, within 3 days preoperatively and on the third postoperative day. ⋯ Preoperative frontal-parietal cerebral blood flow was lower in the microembolic group compared to the non-embolic group (P < .05). Microemboli are common after CAS but are unlikely to result from immediate hemodynamic changes. Instead, they appear to be associated with chronic preoperative hypoperfusion, which impairs cerebral blood flow regulation.
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Esophageal cancer is a relatively common malignant tumor of the digestive tract. Patients with esophageal cancer show a high incidence of aspiration after surgery, which has a serious impact on their prognosis and rehabilitation. Nevertheless, while existing and past endeavors have concentrated on enhancing the diagnostic and therapeutic strategies for esophageal cancer, the necessity of preventing pneumonia caused by postoperative aspiration remains to be adequately addressed. ⋯ Clinically, it is necessary to select appropriate assessment tools for the swallowing function. Research indicates that the application of risk prediction models can better assess aspiration in patients after esophageal cancer surgery, bridge gaps in qualitative analysis, and alter the clinical outcomes of patients. Predictive models for dysphagia screening in patients after esophagectomy have significant clinical advantages and exhibit good clinical applicability.
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Review Case Reports
Prenatal phenotype of PNKP-related microcephaly, seizures, and developmental delay: A case report and literature review.
Microcephaly, epilepsy, and developmental delay (MCSZ) is a rare neurodevelopmental disorder associated with autosomal recessive inheritance of mutations in the polynucleotide kinase 3'-phosphatase (PNKP) gene. Prompt identification and management are essential, as delayed diagnosis or intervention may result in severe complications or mortality. In this case, prenatal screening in the second trimester detected fetal microcephaly with a gradual decline in head circumference, prompting the decision to terminate the pregnancy. Subsequent genetic analysis of the fetal tissue confirmed the presence of compound heterozygous mutations in the PNKP gene. ⋯ MCSZ, a condition caused by PNKP mutations, is exceedingly rare. Women with a history of adverse pregnancy outcomes should undergo close monitoring during prenatal checkups. If fetal microcephaly is detected, it is essential to strictly follow obstetric guidelines for prenatal care, such as comprehensive cranial magnetic resonance imaging and genetic testing for confirmation. Avoidance of consanguineous marriages is advised. Early detection and timely intervention are key to preventing adverse pregnancy outcomes.