The λ pattern is a rare electrocardiogram feature in clinical practice,which often indicates the occurrence of impending fatal ventricular tachyarrhythmias or sudden cardiac death.In this case,Holter monitoring recorded a progressive evolution of the λ pattern followed by advanced atrioventricular blocks in a patient with chest pain accompanied by syncope.λ sign occurred at the time of chest pain,and advanced atrioventricular blocks were recorded at the time of subsequent syncope.Coronary stenosis was detected in the left circumflex by coronary angiography.The patient recovered after stent implantation in the culprit vessel and related medications to prevent coronary spasm.Our case indicate that the λ pattern could occur prior advanced atrioventricular blocks-induced syncope in patient with ischemic heart disease.

Objective: To evaluate the effect of six-character formula breathing exercises combined with long-term home oxygen therapy in the rehabilitation of patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 200 COPD patients in Shanghai First People′s Hospital were divided into control group and observation group by odd and even numbers with 100 cases each. The patients in control group received routine long-term home oxygen therapy and the patients in observation group received six-character formula breathing exercises as an adjunct to long-term home oxygen therapy. The patients completed the Modified Medical Research Council (mMRC) score at 1 month, 3 months and 9 months respectively. At 6 months and 12 months, the patients completed the mMRC score, the frequency of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), the number of re-admissions, the partial pressure of carbon dioxide in arterial blood (PaCO₂) and St. George′s Respiratory Disease Questionnaire (SGRQ) scores. At 12 months, the patients were evaluated for the six-minute walking test. Results: The duration of oxygen in observation group was (6.3 ± 1.7) h/d, was shorter than control group (7.5 ± 2.1) h/d (t=2.040, P=0.043). The frequency of AECOPD in observation group at 12 months was (3.12 ± 0.49) times/case, was lower than control group (4.95±0.65) times/case (t= 22.482, P <0.01). The frequency of re-admission in observation group was (1.09 ± 0.41) times/case, was lower than control group (1.22 ± 0.39) times/case (t= 2.215, P=0.028). The mMRC scores in observation group at 3 months and 9 months was (2.733±0.750), (2.749 ± 0.938), was lower than control group (3.186 ± 0.734), (3.197 ± 0.848) (t=4.317, 3.543, P<0.01). The SGRQ scores in observation group at 6 months and 12 months was (54.678 ± 9.318), (56.656 ± 7.294), was lower than control group (61.603 ± 8.989), (63.006 ± 7.387) (t=5.349, 6.117, P<0.01). PaCO₂ in observation group at 12 months was (6.422 ± 0.864) kPa, was better than control group (6.856 ± 0.904) kPa (t=3.471, P=0.01). The walking distance of 6 minutes in observation group was (265.483 ± 19.277) meters, was longer than control group (232.966 ± 18.883) meters (t= 12.050, P < 0.01). Conclusions Six-character formula breathing exercises assisted with long-term home oxygen therapy can reduce the use of oxygen, reduce the frequency of AECOPD and readmission, improve the symptoms of COPD patients, and delay the pathological process of COPD.

Objective: To investigate the effect of high flow nasal catheter (HFNC) respiratory support flow and temperature on the comfort of patients with acute hypoxemic respiratory failure (AHRF), and the AHRF subgroup with severe hypoxemia (FiO₂ ≥ 45%), improve HNFC flow to improve patient comfort. Methods: A prospective, randomized, crossover study of 40 patients with AHRF who underwent HFNC respiratory support (PaO₂/FiO₂ ≤ 300 + pulmonary infiltration + exclusion of cardiogenic pulmonary edema) was performed to assess patient comfort changes in HFNC flow and temperature changes. Results: When the HFNC flow rate was 30 L/min and 60 L/min, the patient′s comfort at 31 °C was significantly improved (P < 0.01), and the change in flow was not related to patient comfort. In the subgroup of patients with FiO₂ ≥ 45%, lower temperature (31 °C) and higher HFNC flow (60 L/min) improved patient comfort (P < 0.01). Conclusion The temperature of HFNC respiratory support significantly affects the comfort of patients with AHFP. Patients with lower temperature are more comfortable, and comfort is not related to flow. For patients with severe hypoxemia (FiO₂ ≥ 45%), high flow rates provide better comfort.