INTRODUCTION

Ventricular tachycardia (VT) storm is a condition characterized by recurrent ventricular arrhythmias within a 24-hour period, requiring a device or pharmacologic intervention. Despite its clinical significance, data on VT storm prevalence and treatment outcomes in the Filipino population remain limited

We present a 69-year-old male with heart failure from non-ischemic cardiomyopathy and an implantable cardioverter-defibrillator (ICD), who experienced multiple VT episodes unresponsive to amiodarone, lidocaine and mechanical cardioversion. He was initially admitted for catheter ablation but later developed a left ventricular thrombus precluding the procedure. Mexiletine was introduced and successfully suppressed arrhythmia recurrence

This case emphasized the complexity of managing ES, especially in patients with contraindications to ablation. Mexiletine, a class IB antiarrhythmic agent structurally similar to lidocaine, has shown efficacy in refractory VT, especially when standard therapies are ineffective or are contraindicated. Limited data exists on its safety for such cases, particularly in patients with intracardiac thrombus.

Mexiletine may offer a viable treatment option for VT storm in patients ineligible for ablation due to left ventricular thrombus. While it was effective in this case, further studies are needed to validate its safety and long-term outcomes in similar high-risk populations.

BACKGROUND: Gluconeogenesis is a critical metabolic pathway for maintaining glucose homeostasis, and its dysregulation can lead to glycometabolic disorders. This study aimed to identify hub biomarkers of these disorders to provide a theoretical foundation for enhancing diagnosis and treatment. METHODS: Gene expression profiles from liver tissues of three well-characterized gluconeogenesis mouse models were analyzed to identify commonly differentially expressed genes (DEGs). Weighted gene co-expression network analysis (WGCNA), machine learning techniques, and diagnostic tests on transcriptome data from publicly available datasets of type 2 diabetes mellitus (T2DM) patients were employed to assess the clinical relevance of these DEGs. Subsequently, we identified hub biomarkers associated with gluconeogenesis-related glycometabolic disorders, investigated potential correlations with immune cell types, and validated expression using quantitative polymerase chain reaction in the mouse models. RESULTS: Only a few common DEGs were observed in gluconeogenesis-related glycometabolic disorders across different contributing factors. However, these DEGs were consistently associated with cytokine regulation and oxidative stress (OS). Enrichment analysis highlighted significant alterations in terms related to cytokines and OS. Importantly, osteomodulin ( OMD ), apolipoprotein A4 ( APOA4 ), and insulin like growth factor binding protein 6 ( IGFBP6 ) were identified with potential clinical significance in T2DM patients. These genes demonstrated robust diagnostic performance in T2DM cohorts and were positively correlated with resting dendritic cells. CONCLUSIONS Gluconeogenesis-related glycometabolic disorders exhibit considerable heterogeneity, yet changes in cytokine regulation and OS are universally present. OMD , APOA4 , and IGFBP6  may serve as hub biomarkers for gluconeogenesis-related glycometabolic disorders.
Machine Learning ; Humans ; Computational Biology/methods* ; Biomarkers/metabolism* ; Diabetes Mellitus, Type 2/genetics* ; Animals ; Mice ; Gluconeogenesis/physiology* ; Gene Expression Profiling ; Transcriptome/genetics* ; Gene Regulatory Networks/genetics* ; Clinical Relevance

OBJECTIVE: To conduct a comprehensive analysis of proximal humeral anatomical characteristics in the Chinese population utilizing three-dimensional reconstruction technology, thereby establishing an evidence base for the enhancement of shoulder hemiarthroplasty procedures and the development of domestically manufactured prostheses. METHODS: The study cohort comprised 30 patients (60 shoulders) presenting with cervicoscapular pain between July 2023 and June 2025, with equal gender distribution (15 males and 15 females); age distribution ranged from 20 to 75 years (mean, 53.7 years). Data acquisition was performed via high-resolution CT imaging (technical parameters: slice thickness 0.625 mm, voltage 120 kV, current 150 mA, matrix 512×512). Subsequently, CT datasets were processed in DICOM format using Mimics17.0 software for three-dimensional reconstruction, followed by quantitative assessment via Imageware12.0 software to evaluate key proximal humeral parameters: humeral head dimensions (coronal diameter, sagittal diameter, surface curvature diameter, thickness), angular measurements [neck-shaft angle, retroversion angle (retroversion angle 1 was the angle between the humeral head axis and the line connecting the medial and lateral condyles, and retroversion angle 2 was the angle between the humeral head axis and the tangent of the trochlea)], and positional metrics (medial offset, posterior offset). Statistical analysis incorporated Pearson correlation coefficients to determine parameter relationships, with comparative evaluations conducted across demographic variables including gender, height, body mass, and age. RESULTS: Quantitative analysis yielded the following measurements: humeral head coronal diameter (41.8±3.6) mm, sagittal diameter (39.1±4.1) mm, surface curvature diameter (44.9±4.6) mm, thickness (17.2±1.8) mm, neck-shaft angle (128.4±4.2)°, retroversion angle 1 (16.9±8.9)°, retroversion angle 2 (21.4±11.3)°, medial offset (3.8±1.7) mm, and posterior offset (5.1±1.6) mm. Correlation analysis demonstrated the most pronounced positive relationship between humeral head surface curvature diameter and thickness ( r=0.966, P=0.001), with additional significant positive correlations observed between surface curvature diameter and coronal diameter ( r=0.842, P=0.001), posterior offset and retroversion angle 1 ( r=0.766, P=0.001), and coronal diameter and thickness ( r=0.727, P=0.001). Demographic analysis revealed significantly greater dimensions in males compared to females for humeral head surface curvature diameter, coronal diameter, sagittal diameter, and thickness ( P<0.05), with these parameters demonstrating progressive increases corresponding to height ( P<0.05). With the exception of neck-shaft angle, all parameters exhibited a positive correlation with body mass. No significant age-related differences were detected across parameters ( P>0.05). CONCLUSION The proximal humeral morphology in the Chinese population exhibits substantial variability, necessitating optimization of prosthetic designs based on population-specific anatomical metrics to enhance the efficacy of personalized clinical interventions.
Humans ; Middle Aged ; Male ; Female ; Aged ; Imaging, Three-Dimensional/methods* ; Adult ; Tomography, X-Ray Computed/methods* ; Humerus/diagnostic imaging* ; Shoulder Joint/surgery* ; Hemiarthroplasty/methods* ; Humeral Head/anatomy & histology* ; Young Adult ; Clinical Relevance

OBJECTIVE: To investigate the expression and potential mechanism of calcium/calmodulin-dependent protein kinase II gamma (CaMKIIγ) in patients with acute myeloid leukemia (AML). METHODS: Peripheral blood samples were collected from 90 AML patients, and mononuclear cells were isolated. The expression of CaMKIIγ was measured using real-time quantitative PCR and Western blot. The diagnostic value of CaMKIIγ for AML was assessed, and its correlation with clinical characteristics was analyzed using the clinical data of patients. Additionally, the molecular mechanisms of CaMKIIγ were preliminarily explored. RESULTS: Compared with the control group, the expression of CaMKIIγ was significantly upregulated in AML patients. Receiver operating characteristic (ROC) curve analysis showed that CaMKIIγ could serve as a promising biomarker for distinguishing AML patients from healthy individuals. Furthermore, CaMKIIγ was significantly correlated with white blood cell (WBC) count and FLT3-ITD mutation. CaMKIIγ was highly expressed in both newly diagnosed and relapsed AML patients, while decreased during remission. In AML cell lines, the expression levels of CaMKIIγ were all elevated. Inhibition of phosphorylated CaMKIIγ by berbamine led to a decrease in pAKT and pSTAT5 expression. CONCLUSION CaMKIIγ is significantly upregulated in AML patients, and is associated with poor clinicopathological features and unfavorable prognosis. It may serve as a prognostic marker and potential therapeutic target in AML. Its expression may be related to the activation of pAKT and pSTAT5, suggesting that CaMKIIγ may contribute to the development and progression of AML through the activation of the AKT/STAT5 signaling pathway.
Humans ; Leukemia, Myeloid, Acute/metabolism* ; Calcium-Calmodulin-Dependent Protein Kinase Type 2/metabolism* ; STAT5 Transcription Factor/metabolism* ; Male ; Female ; Proto-Oncogene Proteins c-akt/metabolism* ; Mutation ; Middle Aged ; Adult ; Clinical Relevance

OBJECTIVE: To investigate the expression and clinical significance of interleukin-10 (IL-10) and interleukin-15 (IL-15) in patients with multiple myeloma (MM). METHODS: Eighty newly diagnosed MM patients in Department of Hematology in Nanyang First People's Hospital from September 2020 to January 2023 were selected as observation group, and 80 healthy people in our hospital were selected as control group. The expression of IL-10 and IL-15 of the two groups were detected, and survival analysis was conducted for the MM patients. RESULTS: The levels of IL-10 and IL-15 in the observation group before treatment were significantly higher than those in the control group (both P <0.05). The levels of IL-10 and IL-15 in different DS stage had significant differences in MM patients (both P <0.05). The levels of IL-10 and IL-15 in stage II and stage III had no significant differences, which were both significantly higher than those in stage I (both P <0.05). The levels of IL-10 and IL-15 in sCR+CR group after treatment were significantly lower than those before treatment (both P <0.05). The levels of IL-10 and IL-15 in VGPR+PR group after treatment were also significantly lower than those before treatment (both P <0.05), but higher than those in the sCR+CR group (both P <0.05). The progression-free survival (PFS) and overall survival (OS) of patients with IL-10>22.01 pg/ml were significantly shorter than those with IL-10≤22.01 pg/ml (both P <0.001). The PFS and OS of patients with IL-15>48.56 pg/ml were also shorter than those with IL-15≤48.56 pg/ml (both P <0.05). CONCLUSIONS The levels of IL-10 and IL-15 in MM patients are closely related to efficacy and prognosis, and both decreased after treatment. The more reduction, the better effect. Patients with IL-10 and IL-15 below the threshold have longer median PFS and OS.
Humans ; Interleukin-10/metabolism* ; Multiple Myeloma/metabolism* ; Interleukin-15/metabolism* ; Prognosis ; Female ; Male ; Middle Aged ; Clinical Relevance

OBJECTIVES: Multiple myeloma (MM) is a hematologically malignant clonal plasma cell disease. This study aims to explore the association between immunophenotypes and prognosis in patients with MM, to determine whether the expression of CD45 and CD200 is related to the prognosis of newly diagnosed MM (NDMM) patients, and to evaluate the significance of the combined expression of CD45 and CD200 in NDMM. METHODS: A total of 123 NDMM patients admitted to Shengjing Hospital of China Medical University from July 2015 to August 2019 were enrolled. Five key immunophenotypic markers (including CD38, CD138, CD45, CD56, and CD200) were screened through flow cytometry and identified using random forest analysis and univariate Cox regression analysis. Patients were divided into 3 groups: Group A, CD45 and CD200 double-positive; Group B, CD45 or CD200 single-positive; Group C, CD45 and CD200 double-negative. Kaplan-Meier curves were used to analyze overall survival (OS) and progression-free survival (PFS) across groups. Multivariate Cox regression was performed to evaluate prognostic factors, and a nomogram was constructed based on these results. RESULTS: The OS and PFS of single-positive groups for CD38, CD138, CD45, CD56, and CD200 were all shorter than those of their respective single-negative groups (all P<0.05). Significant differences were observed in OS (P<0.001) and PFS (P=0.001) among Groups A, B, and C. Group A had shorter OS and PFS (all P=0.001) compared to the Group B+C (cases from Group B and Group C were combined). CD45 and CD200 double-positive was an independent prognostic factor for NDMM [hazard ratio (HR)=2.178, 95% confidence interval (CI) 1.048 to 4.529; P=0.037]. The nomogram and calibration curves constructed from multivariate Cox regression analysis demonstrated good concordance (concordance index=0.706; 95% CI 0.661 to 0.751). CONCLUSIONS NDMM patients with double-positive expression of CD45 and CD200 have significantly shorter OS and PFS. Compared with the use of either marker alone, the combined assessment of CD45 and CD200 may provide better prognostic stratification for MM patients.
Humans ; Multiple Myeloma/metabolism* ; Male ; Female ; Middle Aged ; Antigens, CD/metabolism* ; Prognosis ; Leukocyte Common Antigens/metabolism* ; Aged ; Adult ; Immunophenotyping ; Nomograms ; Biomarkers, Tumor ; Clinical Relevance

Objective:Inflammation has been confirmed to play an important role in the occurrence and development of sudden sensorineural hearing loss（SSNHL）, and the neutrophil-to-lymphocyte ratio（NLR） is a biomarker positively correlated with the degree of inflammation. This study aims to identify the difference in serum NLR between patients with SSNHL and normal population, and to evaluate the predictive efficacy of NLR for the occurrence and prognosis of SSNHL, thereby guiding the clinical diagnosis and treatment of SSNHL. Methods:In this study, 96 patients diagnosed with SSNHL admitted to our department from January 2023 to March 2024 and 96 patients diagnosed with vocal cord polyps admitted to our department during the same period were recruited as a control group. Multivariate Logistic regression was used to evaluate independent related factors, and a nomogram was constructed to predict the probability of SSNHL. The receiver operating characteristic（ROC） curve and calibration curve were used to evaluate the accuracy of prediction. Results:Multivariate logistic regression analysis showed that a high level NLR（OR2.215; 95%CI1.597-3.073; P<0.001） were independently associated with the presence of SSNHL. High age（OR1.036; 95%CI1.009-1.067; P=0.012）, high FIB（OR2.35; 95%CI1.176-4.960; P=0.019） were the risk factor for SSNHL. Incorporating these 3 factors, a forest plot and a nomogram were generated. The ROC curve, nomogram and calibration curve showed that the model had good clinical practicability. A low NLR（OR0.598; 95%CI0.439-0.816; P<0.001） was significantly associated with a favorable prognosis of SSNHL. Conclusion:Elevated NLR can serve as an promising biomarker for assessing the risk of SSNHL. The nomograms calculation model may be utilized as a tool to estimate the probability of SSNHL. Low level NLR is significantly associated with a good prognosis of SSNHL.
Humans ; Neutrophils ; Female ; Male ; Lymphocytes ; Hearing Loss, Sensorineural/blood* ; Hearing Loss, Sudden/diagnosis* ; Middle Aged ; Prognosis ; Nomograms ; ROC Curve ; Adult ; Logistic Models ; Biomarkers/blood* ; Lymphocyte Count ; Inflammation/blood* ; Clinical Relevance

Objective:To investigate the distribution of pathogenic bacteria in the ear canal secretions of patients with chronic suppurative otitis media（CSOM）, the changes in the levels of interleukin-8（IL-8） and Toll like receptor 4（TLR4） in the ear canal secretions, and their clinical significance. Methods:This study selected 128 CSOM patients who visited our hospital from January 2022 to February 2024 as the study subjects and recorded them as the CSOM group. Additionally, 135 volunteers who underwent physical examinations at our hospital during the same period were regarded as the control group. Video otoscopy was used to collect and cultivate ear canal secretions, and a fully automated microbial identification instrument was used to identify the bacterial species. ELISA was applied to detect levels of IL-8, TLR4. Multivariate logistic regression was employed to examine the factors that affect the occurrence of CSOM. Pearson correlation was applied to analyze the correlation between IL-8, TLR4 levels and various influencing factors. ROC curve was applied to analyze the diagnostic value of IL-8 and TLR4 levels for the occurrence of CSOM. Z-test was applied to compare the differences in AUC. Results:Among 128 patients, the detection rate was 89.06%, and a total of 181 strains of pathogenic bacteria were cultured, among them, Gram positive bacteria accounted for the highest proportion of 54.14%, followed by Gram negative bacteria, accounting for 34.25%, and finally fungi, accounting for 11.60%. The common bacteria were Staphylococcus aureus （20.44%）, Pseudomonas aeruginosa （13.26%）, and Staphylococcus epidermidis （8.29%）. The resistance of Gram-positive bacteria to penicillin, clindamycin, erythromycin, and amoxicillin is high. Gram-negative bacteria are highly resistant to penicillin, ampicillin and erythromycin. Fungi are resistant to ketoconazole and fluconazole. The levels of IL-8 and TLR4 in CSOM group were higher than those in the control group, and gradually increased with the increase of hearing impairment. （P<0.05）. Elevated levels of IL-8, TLR4 were independent risk factors for the occurrence of CSOM（P<0.05）. The AUC of CSOM diagnosed by IL-8 and TLR4 alone was 0.790 and 0.777, respectively, while the AUC of combined diagnosis was 0.898, which was better than their respective individual diagnoses（both P<0.05）. Conclusion:The distribution of pathogenic bacteria in the ear canal secretions of CSOM patients is mainly Gram positive, with common ones being Staphylococcus aureus and Pseudomonas aeruginosa. The levels of IL-8 and TLR4 in CSOM patients are higher than those in the control group. The higher the levels, the higher the degree of hearing loss, which can be used for clinical diagnosis.
Humans ; Toll-Like Receptor 4/metabolism* ; Interleukin-8/metabolism* ; Otitis Media, Suppurative/metabolism* ; Ear Canal/metabolism* ; Chronic Disease ; Male ; Female ; Adult ; Middle Aged ; Clinical Relevance

Since the beginning of the 21st century, the severe respiratory infectious diseases worldwide [such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza A H1N1 and novel coronavirus infection have attracted wide attention from all walks of life due to their superior pathogenicity and transmissibility. Aerosols-carrying pathogens are the main transmission route of many severe respiratory infectious diseases, which can lead to severe respiratory failure and even acute respiratory distress syndrome (ARDS) in infected individuals. Mechanical ventilation is the primary treatment for ARDS, and the small tidal volume, appropriate level of positive end-expiratory pressure based lung protective ventilation strategy can effectively reduce the incidence of ventilator-induced lung injury (VILI). However, in the process of clinical treatment, it is sometimes necessary to briefly disconnect the connection between the artificial airway and the ventilator circuit, which will not only cause the residual aerosol in the respiratory system to spill out and pollute the surrounding environment, increase the risk of nosocomial infection including medical staff, but also interfere with the implementation of lung protective ventilation strategy and aggravate ventilator-induced lung injury. In addition, studies have shown that a lot of medical staff have nosocomial infections, especially staff involved in tracheal intubation, extubation and other airway related operations. In addition to enhancing personal protective measures, it is crucial to safeguard healthcare workers from aerosol contamination and minimize associated risks during airway management. At present, there are few researches on the temporary sealing of airway lines and ventilator system, and there is a lack of clear guidance. This review summarizes the research status in related fields to provide a reference for corresponding solutions and programs.
Humans ; Respiratory Distress Syndrome/etiology* ; Respiration, Artificial ; Ventilator-Induced Lung Injury/prevention & control* ; Severe Acute Respiratory Syndrome ; COVID-19 ; Clinical Relevance

OBJECTIVE: To evaluate the risks and benefits of different resuscitation fluids in patients with early sepsis and septic shock by observing and comparing clinical indicators, clinical outcomes, and the concentration changes of glycocalyx biomarkers, and to determine how to appropriately select suitable resuscitation fluids for sepsis patients to aid fluid therapy. METHODS: A single center, prospective, randomized controlled trial was conducted. Patients with early sepsis and septic shock who have required fluid resuscitation after capacity status assessment admitted to the department of critical care medicine of Fourth Hospital of Hebei Medical University from April to October 2023 were enrolled. Patients were randomly assigned to either the experimental group (balanced crystalloid solution+albumin) or the control group (balanced crystalloid solution) by a random number table method. Clinical data of both groups of patients before and after resuscitation at 3, 8, and 24 hours were monitored, and blood samples were collected, enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration of plasma glycocalyx biomarker syndecan-1. The 28-day and 90-day survival rates and complications were also assessed. RESULTS: A total of 66 patients were enrolled, including 44 in the experimental group and 22 in the control group. The baseline data of two groups were balanced and comparable. There was no statistically significant difference in the plasma concentration of syndecan-1 between the experimental group and the control group before and after resuscitation, and both showed a trend of first increasing and then decreasing. However, the plasma syndecan-1 level in the control group at 8 hours and 24 hours after resuscitation were significantly higher than the baseline level before resuscitation [ng/L: 19.02 (14.41, 27.80), 18.95 (12.40, 22.50) vs. 14.67 (11.57, 21.14), both P < 0.05], while there was no statistically significant difference at any time point within the experimental group. The correlation analysis between plasma syndecan-1 level and lactic acid, albumin, and sequential organ failure assessment (SOFA) in all patients showed that a positive correlation between syndecan-1 level and SOFA score before resuscitation (r = 0.247, P = 0.046), and a negative correlation between syndecan-1 level and albumin level at 24 hours after resuscitation (r = -0.308, P = 0.012). There were no statistically significant differences in 28-day and 90-day mortality, length of hospital stay, length of intensive care unit (ICU) stay, duration of mechanical ventilation, blood purification time, number of organ injuries, and complications between the two groups. However, the baseline albumin level in the experimental group was significantly lower than that in the control group (g/L: 28.7±4.5 vs. 31.6±4.2, P < 0.05). Analysis of clinical treatment data showed that compared with the control group, the experimental group had lower absolute lactate level at 8 hours and 24 hours after resuscitation [mmol/L: 8 hours was 1.30 (1.00, 1.88) vs. 1.60 (1.30, 3.05), 24 hours was 1.15 (0.80, 1.78) vs. 1.55 (1.08, 2.05), both P < 0.05], and higher lactate clearance rate [8 hours was 45% (27%, 56%) vs. 20% (-4%, 46%), 24 hours was 55% (34%, 70%) vs. 34% (-14%, 59%), both P < 0.05]. However, there were no statistically significant differences in the amount of fluid resuscitation, use of vasoactive drugs, and oxygenation index between the two groups during the resuscitation process. Multivariate Logistic regression analysis showed that body mass index (BMI) was independently correlated with 90-day mortality [odds ratio (OR) = 1.991, 95% confidence interval (95%CI) was 1.023-3.387, P = 0.043]. CONCLUSIONS There are no significant difference in plasma syndecan-1 level during fluid resuscitation of early sepsis and septic shock patients using balanced crystalloid fluid and balanced crystalloid fluid combined with albumin resuscitation, and there are no statistically significant differences in the impact on 28-day and 90-day prognosis, length of hospital stay, complications, and other aspects of the patients. However, compared to balanced crystalloid fluid, the combination of balanced crystalloid fluid and albumin for fluid resuscitation in sepsis patients has lower lactate level and better lactate clearance effect, but further validation is still needed through large-scale randomized controlled trials.
Humans ; Clinical Relevance ; Crystalloid Solutions/administration & dosage* ; Fluid Therapy/methods* ; Glycocalyx/metabolism* ; Isotonic Solutions/administration & dosage* ; Prospective Studies ; Resuscitation/methods* ; Sepsis/therapy* ; Shock, Septic/therapy* ; Syndecan-1/blood*