Myxedema coma is a rare condition, typically arising from long-standing, untreated hypothyroidism and triggered by factors such as infection, hypothermia, or severe illness. This report details a successfully treated case of myxedema coma with cardiac attest, accompanied by a literature review, to enhance clinical awareness and improve the diagnosis and management of this critical condition.

Objective To observe the efficacy of Cuofeng San in the treatment of anterior circulation cerebral infarction(ACCI)of patients with syndrome of wind and phlegm blocking collaterals.Methods A total of 150 ACCI patients were collected in this study,and they were divided into the control group and the treatment group using a random number table method,with 75 cases in each group.The control group was given standardized intervention according to the stroke diagnosis and treatment guidelines,while the treatment group was treated with modified Cuofeng San on the basis of the control group.Both groups were treated continuously for 2 weeks.The treatment effects were compared between the two groups before and after treatment,including the National Institutes of Health Neurological Impairment Scale(NIHSS)score,Barthel Index(BI)score of daily activity ability,scores of syndrome of wind and phlegm blocking collaterals,serum levels of neuron specific enolase(NSE),S100 calcium binding protein B(S100B),monocyte chemoattractant protein-1(MCP-1)and vascular endothelial cell calcium binding protein(VE-cadherin).Results The total effective rate of ACCI patients was higher in the treatment group than that in the control group(93.3％vs.81.3％,P＜0.05).After 1 week and 2 weeks of treatment,the NIHSS score and wind phlegm obstruction syndrome score decreased in both groups compared to those before treatment,while the BI score increased,and the improvement was more significant in the treatment group(P＜0.05).After the end of the treatment course,serum levels of NSE,S100B,MCP-1 and VE-cadherin decreased compared to those before treatment,and the decrease was more significant in the treatment group(P＜0.05).Conclusion The modified Cuofeng San has a significant effect on the treatment of wind phlegm obstruction syndrome in patients with ACCI acute phase.It can improve neurological function and enhance daily activity ability.

Objective To observe the efficacy of Cuofeng San in the treatment of anterior circulation cerebral infarction(ACCI)of patients with syndrome of wind and phlegm blocking collaterals.Methods A total of 150 ACCI patients were collected in this study,and they were divided into the control group and the treatment group using a random number table method,with 75 cases in each group.The control group was given standardized intervention according to the stroke diagnosis and treatment guidelines,while the treatment group was treated with modified Cuofeng San on the basis of the control group.Both groups were treated continuously for 2 weeks.The treatment effects were compared between the two groups before and after treatment,including the National Institutes of Health Neurological Impairment Scale(NIHSS)score,Barthel Index(BI)score of daily activity ability,scores of syndrome of wind and phlegm blocking collaterals,serum levels of neuron specific enolase(NSE),S100 calcium binding protein B(S100B),monocyte chemoattractant protein-1(MCP-1)and vascular endothelial cell calcium binding protein(VE-cadherin).Results The total effective rate of ACCI patients was higher in the treatment group than that in the control group(93.3％vs.81.3％,P＜0.05).After 1 week and 2 weeks of treatment,the NIHSS score and wind phlegm obstruction syndrome score decreased in both groups compared to those before treatment,while the BI score increased,and the improvement was more significant in the treatment group(P＜0.05).After the end of the treatment course,serum levels of NSE,S100B,MCP-1 and VE-cadherin decreased compared to those before treatment,and the decrease was more significant in the treatment group(P＜0.05).Conclusion The modified Cuofeng San has a significant effect on the treatment of wind phlegm obstruction syndrome in patients with ACCI acute phase.It can improve neurological function and enhance daily activity ability.

Myxedema coma is a rare condition, typically arising from long-standing, untreated hypothyroidism and triggered by factors such as infection, hypothermia, or severe illness. This report details a successfully treated case of myxedema coma with cardiac attest, accompanied by a literature review, to enhance clinical awareness and improve the diagnosis and management of this critical condition.

Objective:To investigate the clinical practice of Chinese respiratory therapists (RTs) participating in the treatment of coronavirus disease 2019 (COVID-19) patients and summarize the experience and role of RTs in the treatment of pandemic infectious diseases.Methods:A self-designed questionnaire was used to investigate the RTs who treated COVID-19 patients in 31 provinces, cities and autonomous regions in China. The survey questionnaire included the basic work of RTs, the specific work of the treatment for COVID-19 patients and problems encountered at work.Results:A total of 126 questionnaires were issued and 40 valid questionnaires were collected from RTs who treated COVID-19 patients at 22 COVID-19 designated hospitals in 8 provinces and municipalities. This included 7 hospitals in Wuhan, the epicenter of the epidemic. In their medical team, RTs accounted for 2.9% (1.5%, 6.7%) of medical staff, the working experience of the RTs was about (6.2±5.4) years, the ratio of RTs to beds was about 1∶11 (1∶5, 1∶26), and 85.0% (34/40) of RTs were transferred from other hospitals. 97.5% (39/40) of RTs were involved in formulating individual respiratory care strategies in their medical teams, and they were all involved in the evaluation of respiratory care and decision-making as well as the early identification of deterioration of respiratory function. All RTs [100% (40/40)] indicated that they would actively monitor patients' respiratory status, increase the means and frequency of the monitoring, implement standardized oxygen therapy, prevent ventilator-associated lung injury (VALI), and standardize the management of artificial airway. However, less than 50% of RTs had carried out stress and strain, transpulmonary pressure, partial pressure of end-tidal carbon dioxide (PetCO 2), end-expiratory lung volume, electrical impedance tomography (EIT) and other respiratory function monitoring. 85% of RTs conducted training and education related to respiratory care and formulated relevant standard operating procedures for their medical teams. More than 90% of RTs led the implementation of high-flow nasal cannula oxygen therapy (HFNC), pulmonary protective mechanical ventilation, prone ventilation, pulmonary rehabilitation, airway management, transfer of critical patients, and other respiratory treatment. Conclusions:RTs performed their professional role fully in the assessment, decision-making, and clinical practice in the treatment of COVID-19 patients. However, the manpower shortage of RTs is extremely prominent, the practical experience has provided the basis for the future treatment of infectious respiratory diseases and effectively promoted the development of respiratory care in China.

Objective:To analyze the application of Cho peak value and color doppler ultrasound blood flow score in the early diagnosis of breast cancer, and to evaluate the relationship between Cho peak value, blood flow score, TNM stage and prognosis quality.Methods:A total of 82 patients with breast cyst admitted from Jan. 2015 and Dec. 2019 were selected as subjects for the study. ROC curve was used to compare the ability of color doppler flow score and functional magnetic resonance imaging (fmri) in the diagnosis of breast cancer when used alone or in combination. Logistic regression model was used to analyze the factors affecting the prognosis quality and TNM staging of patients.Results:The breast cancer group’s Cho value and blood flow signal score were significantly higher than the benign breast lesion group, and the difference was statistically significant (Cho value: t=43.977, P<0.001; blood flow signal score: t=22.071, P<0.001) ; The sensitivity, specificity and AUC of MRS combined with Doppler ultrasound for differential diagnosis of breast cancer are significantly higher than MRS or Doppler ultrasound alone, and the difference was statistically significant (sensitivity: χ2=4.514, P=0.016; specificity: χ2=4.858, P=0.013; AUC: Z=5.251, P<0.001) ; Cho value of patients with good prognosis group ( t=3.984, P<0.001) and blood flow signal score ( t=4.213, P<0.001) were significantly lower than those in the poor prognosis group; Cho value ( t=3.612, P<0.001) and blood flow signal score ( t=3.835, P<0.001) of TNM stage 0-Ⅱ patients were significantly lower than those of stage Ⅲ-Ⅳ group, the difference was statistically significant; the Cho value of the MRS scan and the patient’s prognosis quality ( OR=1.837, 95% CI=1.210-2.788, P=0.004) and TNM stage ( OR=1.818, 95% CI=1.224~2.702, P=0.003) was significantly positively correlated. The blood flow signal and the patient’s prognostic quality ( OR=1.906, 95% CI=1.105~3.287, P=0.020) and TNM stages ( OR=1.799, 95% CI=1.232-2.626, P=0.002) also showed a significantly positive correlation. Conclusion:The combination of Cho peak value and color doppler ultrasound blood flow score can significantly improve the early diagnosis efficiency of breast cancer, and Cho peak value and blood flow score are independent factors affecting TNM staging and prognosis.

Objective To analyze the ultrasonic and clinical features of fetal gastric duplication. Methods Ultrasonographic apperance of 12 fetal stomach duplication cases were reviewed and followed up. Results The age of 12 fetal gestational duplication cases ranged from 19 weeks to 36 weeks. All cases were cystic-type,and 11 cases of gastric duplication were diagnosed by antenatal ultrasonography. Eleven cases were normal labored,2 patients were cured after surgical management. One case was misdiagnosed to be bile duct cyst, and was induced in 1 week after diagnosis because of simultaneous combination of hydrocephalus in bilateral ventricle. Stomach duplication prenatal sonographic findings were cysts near the stomach with thickened wall in local enlarged images. The cystic wall included 3 layers of strong-weak-strong hierarchical structure as normal stomach wall. Conclusions Fetal stomach duplication has characteristic ultrasound features,and can be definitively diagnosed prenatally. Early diagnosis is of great importance for prenatal consultation and timely treatment after birth.

Objective: To determine the correlation of IgM deposition with clinic-pathological features and outcomes of IgA nephropathy patients. Methods: A total of 1060 patients, who were diagnosed as IgA nephropathy by renal biopsies between 2001 and 2007 in Guangxing Hospital were enrolled. According to immunofluorescent test, patients were divided into patients with mesangial IgM deposition and patients without IgM deposition. Renal survival curves were assessed by Kaplan-Meier method. The effect of IgM deposition on outcomes of IgA nephropathy patients was examined by univariate and multivariable Cox proportional-hazards regression. Results: Among 1060 IgA nephropathy patients, there were 750 patients with IgM deposition and 310 patients without IgM deposition. (1) Urinary protein and uric acid in patients with IgM deposition were significantly higher than those in patients without IgM deposition (all P<0.05). Other clinical indicators shown no statistical difference (all P>0.05). Moreover, IgM deposition patients had higher serum IgA, serum IgG and serum IgM (all P<0.05). (2) In pathological indicators, IgM deposition patients had more segmented sclerosis or adhesions (S1 of Oxford classification), activity lesions as inflammatory cell infiltration and mesangial proliferation, and chronic pathological changes as tubular atrophy, segmented glomerular damage than patients without IgM deposition (all P<0.05). (3) All patients were followed-up for a median of 89.7(61.8, 113.4) months, Kaplan-Meier analysis revealed that kidney survival rate was significantly lower in IgM deposition patients compared with patients without IgM deposition (Log-rank χ²=4.95, P=0.026). In a univariate Cox hazards regression mode, IgM deposition was a risk factor for poor prognosis of IgA nephropathy patients (HR=1.597, 95% CI 1.053-2.422, P=0.027). However, in a multivariable Cox analysis, IgM deposition shown no influence on outcomes of IgA nephropathy patients (HR=1.409, 95% CI 0.921-2.156, P=0.114). Conclusions IgA nephropathy patients with IgM deposition have higher urinary protein, and more serious pathological damage and immune fluorescence deposition. IgM deposition affects renal survival of IgA nephropathy, while IgM deposition is not an independent risk factor for prognosis of IgA nephropathy.

Objective To explore the clinical effect of the radial artery perforator flap on repairing soft tissue defect after palm postoperative scar contracture. Methods Eighteen patients with palm scar contracture were selected. The palm soft tissue defect was repaired by radial artery perforator flap after the operation of scar removal and soft tissue release. The areas of soft tissue ranged from 5 cm × 3 cm to 8 cm × 5 cm. The area of donor flap exceeds 20%of the wounds area, and wounds were repaired by free skin grafting. Six months after operation, the hand function was compared with that before operation. Results All the patients were followed up for 6-15 months (mean 10.8 months), all flaps survived with good shape, and flap donor site wounds were healed by skin grafting. The patients were evaluated 6 months after operation according to the Chinese Medical Hand Surgery Society of upper part of functional assessment criteria: excellent in 11 cases, good in 5 cases and general in 2 cases, but preoperative functional evaluation was excellent 0 case, good in 3 cases, general in 7 cases and poor in 8 cases. Compared with that before operation, the postoperative function was significantly improved. Conclusions It is a commendable approach of repairing soft tissue defect after postoperative palm scar contracture by radial artery perforator flap, because it can provide reliable blood supply, and significantly improve hand function with exactly clinical effect.

Objective:To explore the effects of medical support program on local diagnosis,treatment and prognosis of acute myocardial infarction(AMI).Methods:Department of Cardiology,Zhongshan Hospital,Fudan University launched medical support program for Fuyuan People′s Hospital in Mar 2010.A total of 103 AMI patients admitted to Fuyuan People′s Hospital during Mar 2010 and Apr 2014 were enrolled.And 5 1 patients admitted during Mar 2010 and Nov 2012 were allocated to group A,while 52 patients admitted during Dec 2012 and Apr 2014 were allocated to group B.The treatment strategy,hospital stay, medication and prognosis were compared between the two groups.Results:Among the 103 AMI patients,male smoking pro-portion was significantly higher than female one(P <0.05).Only 21 patients with ST segment elevation myocardial infarction (STEMI)arrived hospital within 12 h.The thrombolytic therapy rate of patients with STEMI in group B was higher than that in group A(P <0.05).The usage rate of adenosine diphosphate(ADP)receptor antagonist(clopidegrel)during hospitalization in group B was higher than that in group A (P <0.05 ).Only 57 patients were followed up.And only 1/3 of these patients re-ceived consecutive coronary angiography and percutaneous coronary intervention(PCI).After discharge from hospital,the pre-scription rates of ADP receptor antagonist,β-receptor blockers and angiotension converting enzyme inhibitor (ACEI)all de-creased obviously and there was no significant difference between the two groups(P >0.05).There was no significant difference regarding the incidence rates of endpoint events between the two groups(P >0.05).Conclusions:Medical support program im-proves the rates of diagnosis and standardized treatment of AMI during hospitalization.However,the delay before admission has not been shortened yet.Furthermore,there was no standardized secondary prevention and treatment after discharge.Thus,apart from improving the ability of diagnosis and treatment during hospitalization,more attention should be paid to the health education for patients and the training for primary medical staff,and enhance the regional cooperation.