Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy, non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous coronary vasospasm, leading to right ventricular myocardial injury and failure, and shock. She responded quickly to intravenous normal saline bolus infusion, but had irreversible neurological sequelae. Additionally, she had atrial fibrillation preceding ischemic ventricular fibrillation, a rare finding in coronary vasospasm-related cardiac arrest. We suggest immediate coronary angiography of patients in sudden arrhythmic cardiac arrest with acute right ventricular failure for a prompt, accurate diagnosis and appropriate management of the coronary vasospasm.
Aged ; Coronary Angiography ; Coronary Vasospasm ; diagnosis ; diagnostic imaging ; Death, Sudden, Cardiac ; pathology ; Electrocardiography ; Female ; Humans

Objective To investigate the diagnostic accuracy of 64-slice spiral computed tomography(MSCT)in detecting coronary artery lesions and to analyze the impacts of coronary artery calcium on its diagnostic accuracy.Methods Sixty patients underwent 64-MSCT coronary angiography and conventional coronary angiography(CCA).Calcium scoring was estimated on plain scans.The diagnostic accuracy of MSCT to detect significant lesions(≥50%)was evaluated referring to quantitative coronary angiography(QCA).The impacts of coronary artery calcium on the diagnostic accuracy was analyzed.Results A total of 797 segments were diagnositc.The overall sensitivity,specificity,positive predictive value and negative predictive value of 64-MSCT were 96%(174/182),98%(601/615),93% (174/188),and 99%(601/609),respectively.When calcium score ≥100(Agatston score),the specificity and positive predictive value of 64-MSCT was 63%(12/19)and 81%(30/37), respectively.Conclusion In patients with no or mild coronary calcification,the 64-MSCT coronary angiography had a reliable detection of coronary artery stenoses.But severe calcification in coronary artery may degrade diagnostic specificity and positive predictive value of MSCT coronary angiography.

Background/Aims: Ineffective esophageal motility (IEM) is common in patients with gastroesophageal reflux disease (GERD) and can be associated with poor esophageal contraction reserve on multiple rapid swallows. Alterations in the esophageal microbiome have been reported in GERD, but the relationship to presence or absence of contraction reserve in IEM patients has not been evaluated. We aim to investigate whether contraction reserve influences esophageal microbiome alterations in patients with GERD and IEM. Methods: We prospectively enrolled GERD patients with normal endoscopy and evaluated esophageal motility and contraction reserve with multiple rapid swallows during high-resolution manometry. The esophageal mucosa was biopsied for DNA extraction and 16S ribosomal RNA gene V3-V4 (Illumina)/full-length (Pacbio) amplicon sequencing analysis. Results: Among the 56 recruited patients, 20 had normal motility (NM), 19 had IEM with contraction reserve (IEM-R), and 17 had IEM without contraction reserve (IEM-NR). Esophageal microbiome analysis showed a significant decrease in microbial richness in patients with IEM-NR when compared to NM. The beta diversity revealed different microbiome profiles between patients with NM or IEM-R and IEM-NR (P = 0.037). Several esophageal bacterial taxa were characteristic in patients with IEM-NR, including reduced Prevotella spp.and Veillonella dispar, and enriched Fusobacterium nucleatum. In a microbiome-based random forest model for predicting IEM-NR, an area under the receiver operating characteristic curve of 0.81 was yielded. Conclusions In symptomatic GERD patients with normal endoscopic findings, the esophageal microbiome differs based on contraction reserve among IEM. Absent contraction reserve appears to alter the physiology and microbiota of the esophagus.

OBJECTIVETo appraise the value of clinical treatment of percutaneous reduction and fixation of osteoporotic fractures for the proximal humerus in a geriatric population.

METHODSPostoperation complication, mortality in hospital and within the first three months postoperation, operation time, blood transfusion requirement, the functional outcome of the shoulder had been analysed and observed in 37 cases for open and closed fixation.

RESULTSClosed reduction provided the benefit of obtaining and holding adequate reduction without the soft-tissue dissection of open reduction and internal fixation. The general complication and mortality in the first three months postoperation in the open reduction and internal fixation cases were more severe than the percutaneous cases.

CONCLUSIONSOpen operation increases the risk of the geriatric population with osteoporotic proximal humerus fracture; percutaneous reduction and fixation may be preferable.

Aged ; Aged, 80 and over ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Osteoporosis ; complications ; Postoperative Complications ; prevention & control ; Shoulder Fractures ; etiology ; surgery ; Treatment Outcome

Congenital coronary sinus anomalies are extremely rare, and they have received relatively little attention. This is probably due to the lack of both clinical symptoms and significant cardiac functional disturbance. We present two cases of a coronary sinus anomaly and briefly review the literature. Recognizing and being familiar with the variations of a congenital coronary sinus anomaly in congenital heart disease may avoid a misinterpretation of cardiac catheterization findings and the troublesome disruption of coronary sinus blood return during the surgical management of cardiac lesions.
Coronary Sinus/*abnormalities/*radiography ; Female ; Humans ; Middle Aged ; *Tomography, X-Ray Computed

OBJECTIVETo access the efficacy of posterior short-segment fixation for single level thoracolumbar burst fractures without spinal injury using CYL-pedicle screw.

METHODSFrom September 2007 to December 2009, 74 cases who underwent posterior short-segment fixation for single level thoracolumbar burst fractures (Denis burst fracture type A, B, C) without spinal injury were analyzed retrospectively. There were 53 male and 21 female, mean age was (39 ± 15) years. Neither of them treated with direct decompression, grafting or fusion. Changes in the anterior vertebral height ratio, vertebral wedge angle, Cobb angle, regional angle were measured preoperatively, postoperatively, before implant removal, and at final follow-up to find the statistic difference. Pain status and work status were evaluated using Denis criterion. The incidence of incision infection, screw breakage, iatrogenic spinal injury were recorded as well.

RESULTSThe time of follow-up was (20 ± 11) months, no significant change was noted in anterior vertebral height ratio and vertebral wedge angle (P > 0.05). A significant loss was noted in Cobb angle and regional angle, which were 9.8° ± 5.1° and 9.1° ± 4.8° respectively (t = 2.48 and 3.41, P < 0.05). Comparing with the patients with Cobb angle > 20°, the patients with Cobb angle ≤ 20° had better pain scale rate (&chi;(2) = 4.16, P = 0.04) and work scale rate (&chi;(2) = 24.34, P < 0.01). There were incision infection in 1 case, screw breakage in 1, screw loose in 1, and no iatrogenic spinal injury.

CONCLUSIONSCYL-pedicle screw could be successfully used in posterior short-segment fixation for single level thoracolumbar burst fractures without spinal injury based on radiographic and clinic outcomes.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Internal Fixators ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; Young Adult

OBJECTIVETo assess the impact of pre-procedure anemia on the long-term mortality in elderly patients with acute coronary syndrome (ACS) after percutaneous coronary interventions.

METHODSA total of 1014 ACS patients (≥ 60 years of age) with hemoglobin data and without previous treatment with thrombolytic agents and without end-stage renal failure before the interventional procedure were included. Patients were classified as anemia using the definition of World Health Organization: hemoglobin < 130 g/L in men, and < 120 g/L in women. A total of 253 patients were anemia. The clinical features of patients with and without anemia and association of pre-procedure anemia with long-term mortality were analyzed.

RESULTSIncidence of diabetes and serum creatinine level were significantly higher in anemia patients than in non-anemia patients while systolic blood pressure and low-density lipoprotein cholesterol were significantly lower in anemia patients than in non-anemia patients (P < 0.05 or P < 0.01). The patients were followed up for 528 (178 - 675) days. After adjustment for potential co-variants in Cox regression analysis, pre-procedure anemia was associated with a significantly higher long-term mortality (RR: 3.293, 95%CI: 1.431 - 7.578, P < 0.01).

CONCLUSIONPre-procedure anemia is an independent predictor of long-term mortality in elderly patients with acute coronary syndrome after percutaneous coronary interventions.

Acute Coronary Syndrome ; complications ; mortality ; therapy ; Aged ; Anemia ; complications ; therapy ; Female ; Humans ; Male ; Percutaneous Coronary Intervention ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate ; Treatment Outcome

OBJECTIVETo investigate the incidence, risk factors and preventative methods associated with chyle leak following complete mesocolic excision(CME) for colon cancer.

METHODSClinical data of 592 patients with colon cancer undergoing CME in the department of Colorectal Surgery in the Fujian Medical University Union Hospital from September 2000 to September 2011 were analyzed retrospectively.

RESULTSChyle leak occurred in 46 patients(7.7%). The incidence of postoperative chyle leak following right CME hemicolectomy was 13.3%(30/226), significantly higher than that after left CME hemicolectomy (4.4%). On univariate analysis, chyle leak following CME was associated with tumor size(P<0.05), tumor location(P<0.01), and lymph nodes harvested(P<0.01). Multivariate logistic regression revealed that tumor location and lymph nodes harvested were independent risk factors associated with chyle leak following CME(P<0.05).

CONCLUSIONSTumor location and lymph nodes harvested are independent risk factors for chyle leak following complete mesocolic excision for colon cancer. When the drainage output suddenly increases after oral intake resumption, the chyle test of ascitic fluid should be performed for early diagnosis and prompt management.

Aged ; Chylous Ascites ; etiology ; Colonic Neoplasms ; surgery ; Female ; Humans ; Male ; Mesocolon ; surgery ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Factors

OBJECTIVETo identify the relationship between genetic polymorphisms of peroxisome proliferator-activated receptor alpha (PPARalpha) intron 1A/C and metabolic syndrome (MS) in a Chinese population.

METHODSA population-based case-control study was conducted in Suzhou city, Changshu County and Ganyu County in Jiangsu Province China, on the basis of an ongoing cohort study and 2348 cases were investigated. After the exclusion of the known MS cases, 1847 eligible subjects were successfully followed-up and their waist circumference (WC), body mass index, blood pressure, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglycerides (TG) and fasting plasma glucose were measured. Newly diagnosed MS patients were recruited as cases, controls were individual matched with each case. TaqMan fluorescence probe method was used to detect the genetic polymorphism of PPARalpha intron 1A/C.

RESULTSThe current analysis consisted of 389 MS patients and 389 matched controls. The C allele gene frequency of PPARalpha intron 1A/C in the case group was 22.24% (173/778), lower than that in the control group, which was 24.68% (192/778); whereas the difference was not statistically significant (chi(2) = 1.29, P > 0.05). In the genotypes AA + AC and CC, MS patients were accounted for 50.70% (363/716) and 41.94% (26/62) and hyperglycemia accounted for 21.37% (153/716) and 11.29% (7/62). Compared to the genotypes AA + AC, genotype CC was observed to be inversely associated with hyperglycemia (the adjusted OR = 0.39; 95%CI: 0.17 - 0.90) but not related to the occurrence of MS (OR = 0.75; 95%CI: 0.44 - 1.28) and other components of MS e.g., abdominal obesity (the adjusted OR = 0.67; 95%CI: 0.38 - 1.17), hypertriglyceridemia (the adjusted OR = 0.97; 95%CI: 0.53 - 1.76), low HDL-C (the adjusted OR = 0.72; 95%CI: 0.41 - 1.25) and hypertension (the adjusted OR = 0.72; 95%CI: 0.42 - 1.25) all P values > 0.05.

CONCLUSIONC allele of PPARalpha intron 1A/C is not found to be associated with MS in the Chinese population. But comparing with the genotypes AA + AC, there is an inverse association between CC genotype and hyperglycemia.

Adult ; Aged ; Alleles ; Asian Continental Ancestry Group ; genetics ; Case-Control Studies ; Cohort Studies ; Female ; Gene Frequency ; Genotype ; Humans ; Hyperglycemia ; etiology ; genetics ; Introns ; Male ; Metabolic Syndrome ; etiology ; genetics ; Middle Aged ; PPAR alpha ; genetics ; Polymorphism, Genetic

Objective To examine the associations between occupational physical activity,heredity factors and metabolic syndrome (MS) in a Chinese population.Methods Based on the MS cohort study in Jiangsu province,subjects were followed-up,and blood samples were collected at the same time for biochemical indicators measurement.Newly confirmed MS patients according to US.National Cholesterol Education Program Adult Treatment Guidelines Ⅲ (NCEP-ATP Ⅲ ) were recruited as eases.Controls were 1 :1 matched with eases by region,gender and age (±2 years).In total,389 MS patients and 389 eontrols were recruited as study subjects.Nested ease-control study was applied for the present analysis.TaqMan fluorescence probe method was used to detect the genetic polymorphism of PPARα intron 1A/C (rs135539).Results (1)Compared to low physical activity group,the subjects with heavy physical activity were positively associated with MS (OR=2.18,95%CI:1.08-4.38).(2)The subjects,with a family history of hypertension (OR= 1.44,95% CI:1.02-2.03 )or type 2 diabetes (OR=3.25,95CI:1.28-8.20),were significantly indreased the occurrence of MS.(3)The genotype(AA,AC,CC) of PPARα intron 1A/C was not found to be related to MS.The OR of AC and CC genotype (compared to the genotype AA) were 0.98(95%CI:0.70-1.36) and 0.75 (95% CI:0.44-1.29) ,respectively.(4) Effect modifications were observed between family history of hypertension and moderate physical activity (OR=2.47,95% CI:1.00-6.06 ) or heavy physical activity (OR=3.82,95%CI:1.31-11.15) on the development of MS.Conclusion Heavy physical activity,with family history of hypertension or type 2 diabetes,seemed to be positively correlated with the risk of MS.Effect modifications were observed between occupational physical activity and family history of hypertension which might be associated with an increased risk of MS.