Acute Acquired Immune Thrombocytopenia After Cardiac Surgery: A Challenging Case

Thrombocytopenia is a common condition that recognizes an infinite number of possible causes, especially in specific settings like the one covered in this case report: the postoperative period of cardiac surgery. We report a case of an old male with multiple comorbidities who underwent a coronary angioplasty procedure and aortic valve replacement. He showed severe thrombocytopenia in the postoperative days. Differential diagnosis required a big effort, also for the experts in the field. Our goal was to aggressively treat the patient with prednisolone, platelets, and intravenous immunoglobulins to maximize the prognosis. Our patient developed no complications and was discharged successfully

aVR: la derivada olvidada / aVR: the forgotten lead

Resumen La derivada aVR es frecuentemente olvidada al interpretar un electrocardiograma. Esto se explica en gran medida debido a que no aporta información específica sobre el ventrículo izquierdo. Sin embargo, tiene gran utilidad en términos tanto de diagnóstico como de pronóstico en múltiples condiciones clínicas, como el síndrome coronario agudo, la pericarditis, la disección aórtica, la intoxicación por antidepresivos tricíclicos, las arritmias y múltiples trastornos de la conducción cardiaca. El objetivo de este artículo es resaltar la importancia clínica de esta derivada y así incentivar su evaluación sistemática en la práctica clínica.

Abstract aVR lead is a frequently forgotten derivative when interpreting an electrocardiogram. This may be largely explained by the fact that it does not provide specific information on the left ventricle. However, it is very useful in terms of both, diagnosis and prognosis, of different clinical entities such as acute coronary syndrome, pericarditis, aortic dissection, tricyclic antidepressants intoxication, arrhythmias and multiple cardiac conduction disorders. The main purpose of this article is to highlight the clinical importance of aVR lead and thus encourage its use in clinical practice.

ANGIOGRAPHIC CORRELATION OF ST ELEVATION IN LEAD AVR DURNG TMT IN PATIENTS WITH LMCA DISEASE

BACKGROUND:Treadmill testing is the most widely used method for evaluating patients with coronary artery disease. Predicting the left main coronary artery disease (LMCA) before invasive procedure is important in risk assessment because of its grave clinical outcome. Lead aVR can be very useful in identifying LMCAobstruction. It is also valuable lead not only in diagnosis but also predicting the prognosis. AIM: To examine whether STelevation in aVR during TMTcorrelates with LMCAdisease in coronary Angiogram METHOD: In this study 100 patients with positive TMT were included. The study group consisted of 60 patients with ST elevation of > 1mm in aVR. 40 patients also have TMT positive but with < 1mm of ST elevation in aVR is the control group. All patients underwent coronary angiography. RESULTS: Coronary Angiography in the study group revealed significant LMCA disease in 36 (63%) patients whereas no LMCA disease in control group 12 (20%) patients had ostioproximal LAD leisions in study group 4 (10%) patients in the control group. Triple vessel disease in 10 (17%) patients in study group 6 (15%) patients in control group. Since the p value was significant, ST Elevation in aVR during TMT strongly predicts the presence of LMCADisease. CONCLUSION: STsegment elevation in aVR > 1mm during Treadmill testing is a strong predictor of LMCAdisease

Variables electrocardiográficas asociadas a la aparición de eventos cardiovasculares adversos en el infarto agudo de miocardio sin elevación del segmento ST / Electrocardiographic variables associated to the occurrence of adverse cardiovascular events in non-ST elevation acute myocardial infarction

Introducción: La frecuencia de infarto agudo de miocardio sin elevación del segmento ST se está incrementando y, con ella, los resultados adversos en pacientes con enfermedad coronaria isquémica aguda. Objetivo: Identificar las variables electrocardiográficas asociadas a la aparición de eventos cardiovasculares adversos en el infarto agudo de miocardio sin elevación del segmento ST. Método: Se realizó un estudio transversal, de tipo correlacional, con 68 pacientes con infarto agudo de miocardio sin elevación del segmento ST atendidos en el Hospital Arnaldo Milián Castro, en la provincia de Villa Clara. Se estudiaron los hallazgos electrocardiográficos y eventos cardiacos adversos durante el ingreso. Se hicieron análisis bivariados para establecer la relación de ambas variables, utilizando el estadígrafo chi cuadrado y el riesgo relativo. Resultados: Los hallazgos electrocardiográficos más frecuentes fueron la inversión de la onda T (#8805; 2mm), depresión del segmento ST y el QT corregido largo mediante la fórmula de Bazzet. El 26,5 por ciento presentaron eventos cardiovasculares adversos. La depresión del segmento ST, el QT largo corregido y la elevación del segmento ST en aVR se asociaron significativamente con eventos adversos intrahospitalarios (p lt; 0,05). Conclusiones: La asociación de la depresión del segmento ST, la elevación del segmento ST en aVR y el QT largo corregido con la ocurrencia de eventos cardiovasculares adversos intrahospitalarios, sugiere que estos hallazgos se pueden tener en cuenta como posibles indicadores de evolución desfavorable en pacientes con infarto agudo de miocardio sin elevación del segmento ST(AU)

Introduction: The frequency of non-ST elevation acute myocardial infarction is on the increase, and so is the number of adverse results in patients with acute ischemic coronary disease. Objective: Identify the electrocardiographic variables associated to the occurrence of adverse cardiovascular events in non-ST elevation acute myocardial infarction. Method: A cross-sectional correlational study was conducted of 68 patients with non-ST elevation acute myocardial infarction cared for at Arnaldo Milián Castro Hospital in the province of Villa Clara. Attention was paid to electrocardiographic findings and adverse cardiac events occurring during the hospital stay. Bivariate analyses were performed to establish the relationship between the two variables, using the chi square statigram and relative risk estimation. Results: The most common electrocardiographic findings were T-wave inversion (#8805; 2 mm), ST depression and long corrected QT by Bazzet's formula. Of the total study subjects 26.5 percent had adverse cardiovascular events. ST depression, long corrected QT and ST elevation in aVR were significantly associated to in-hospital adverse events (p < 0.05). Conclusions: Association of ST depression, ST elevation in aVR and long corrected QT with the occurrence of adverse in-hospital cardiovascular events suggests that these findings may be taken into account as possible indicators of an unfavorable evolution in patients with non-ST elevation acute myocardial infarction(AU)

High nucleotide sequence variation of avirulent gene, AVR-Pita1, in Thai rice blast fungus population

Rice blast disease, caused by Magnaporthe oryzae, is one of the most importance diseases of rice production worldwide. The key role of defense mechanism to combat this fungus in rice follows the gene-for-gene concept, which a plant resistant (R) gene product recognizes a fungal avirulent (AVR) effector and triggers the hypersensitive response. However, the AVR genes have been shown to be rapidly evolving resulting in high level of genetic diversity. The aims of this study were to examine the nucleotide sequence variation of AVR-Pita1 gene in Thai rice blast isolates and to identify the severity of blast disease using isogenic line of Pita gene. Seventy-six rice blast isolates collected from different parts of Thailand were used. Gene specific primers for AVR-Pita1 gene coding sequence were designed and used for identifying the genetic diversity of AVR-Pita1 gene by PCR amplification and sequencing. The obtained sequences were analysed for genetic variation and genetic relationship. Our results revealed the association between the sequence variations of AVR-Pita1 and selective forces from Pita gene. This phenomenon demonstrated the coevolution between rice blast resistant gene in rice and avirulent gene in blast fungus. The information about variation and evolutionary mechanisms of AVR gene obtained from this study can be used in rice blast resistant breeding programme

Lead aVR is a predictor for mortality in heart failure with preserved ejection fraction

Background Normally, lead augmented vector right (aVR) has a negative T wave polarity (TaVR) in the electrocardiography (ECG). Positive TaVR and ST segment deviation in lead aVR (STaVR) have negative effects on mortality in heart failure with reduced ejection fraction patients. Aim Our aim was to investigate the relationship between lead aVR changes and mortality in heart failure with preserved ejection fraction (HFpEF) patients. Methods We retrospectively examined 249 patients in 2011–2015 years (mean age 70.8 ± 11.9 years and follow-up period 38.3 ± 9.6 months). ECG, echocardiographic, and laboratory findings were recorded and compared in the study. Existence of positive TaVR, STaVR, and quantitative TaVR values were recorded and the absolute numerical values of TaVR and STaVR were recorded from the 12-lead surface ECG (T/STaVR ratio or vice versa). Results The patients were divided into two groups: living (171) and deceased (78). Age, systolic blood pressure, left atrial diameter, QRS duration, positive TaVR frequency, STaVR, absolute value of TaVR, and ratio were significantly higher in the deceased group. Age (OR: 1.106), STaVR (OR: 2.349), TaVR (OR: 1.612), and T/STaVR ratio (OR: 5.156) were determined as independent predictors for mortality. Conclusions ST segment and T wave polarity changes in lead aVR closely associated with mortality in patients with HfpEF.

Curative effect analysis of early interventional treatment in patients with non-ST segment elevation myocardial infarction with ST segment elevation in lead aVR / 重庆医学

Objective To investigate the interventional treatment timing of patients with non-ST segment elevation myocar-dial infarction with ST segment elevation in lead aVR.Methods Totally 57 cases with non-ST segment elevation myocardial infarc-tion with ST segment elevation in lead aVR in our hospital from July 2010 to July 2013 were selected.They were divided into two groups,30 cases in group A and they were given emergency PCI treatment with in 12 hours of onset,27 cases in group B and they were given emergency PCI treatment within 12-24 hours of onset.Compare the therapeutic efficacy and adverse cardiovascular e-vents after discharge.Results Therapeutic efficacy of group A was better than group B after 1,6,12 month follow up and rate of adverse cardiovascular events of group A was shorter than group B.Conclusion Emergency PCI treatment within 12 hours can im-prove the prognosis of patients with non-ST segment elevation myocardial infarction with ST segment elevation in lead aVR.

Effect of lead aVR on recent prognosis in patients with non -ST -elevation acutecoronary syndrome / 中国基层医药

Objective To investigate the effect of lead aVR on recent prognosis in patients with non -ST -elevation acutecoronary syndrome(NSTE -ACS).Methods 195 patients with NSTE -ACS were divided into ST segment elevation in lead aVR group(n =54 cases)and non -ST segment elevation in lead aVR group(n =141 ) according to ST segment elevation in lead on admission;clinical data,laboratory index and coronary artery lesion were recorded,and major adverse cardiac (MACE)in hospitalization time were also recorded.Results Compared with non -ST segment elevation in the lead aVR group,the heart rate of ST segment elevation in the lead aVR group was faster[(85.4 ±12.0)beats per minute vs.(79.3 ±13.2)beats per minute,t =2.959,P <0.05],systolic blood pressure and diastolic blood pressure were higher[(145.0 ±20.3)mmHg vs.(136.0 ±19.4)mmHg,t =2.874,P <0.05];NT -proBNP[(743.9 ±125.8)pg/mL vs.(416.4 ±95.3)pg/mL,t =19.625,P <0.05],cTnI[(3.4 ± 1.0)ng/mL vs.(1.2 ±0.4)ng/mL,t =21.994,P <0.05],CK -MB[(31.5 ±9.8)ng/mL vs.(19.8 ±6.5)ng/mL, t =9.682,P <0.05]were higher (P <0.05);LVEF were lower[(50.1 ±5.2)% vs.(53.8 ±5.7)%,t =4.153, P <0.05];the rate and amplitude of low ST segment in outside lead aVR also was higher[(9.5 ±3.8)mm vs. (7.4 ±2.8)mm,t =4.224,P <0.05];the rate of left main and three -vessel disease in ST segment elevation in lead aVR group were higher (P <0.05).Compared with non -MECE group,proportion of ST segment elevation in lead AVR on admission was higher (P <0.05).Logistic regression analysis showed that heart rate(OR =1.472),NT -proBNP(OR =1.732),cTnI(OR =1.893),left main coronary artery(OR =2.478)and three -vessel disease (OR =2.310)were risk for ST segment elevation in lead AVR(P <0.05).Logistic regression analysis also showed that ST segment elevation in lead AVR were risk for MACE(OR =1.474).Conclusion ST segment elevation in lead AVR has close relationship with large area of myocardial ischemia,and patients prognosis is poorer,which may be independ-ent risk factor for the recent outcomes of patients with NSTE -ACS.Early record of the change in the case of aVR lead ECG ST segment NSTE -ACS patients is of important value in evaluation of the condition and prognosis.

High precision medical laser power density meter based on AVR microcontroller / 国际生物医学工程杂志

Objective To research and design a kind of high accuracy laser power density meter to measure laser power density in clinical medicine,in order to combine laser with clinical medicine well.Methods The pyroelectric detector was used to convert the laser signal to available electrical signal,preamplifier filter circuit and control circuit were designed to match the detector,and C was used for software programming.With the combination of hardware and software design,a high precision laser power density meter was developed,which was based on AVR microcontroller.Results The instrument could measure the minimum 1 mW/cm2 of laser power density accurately and the error rate was 2％,which met the requirements of the laser power density meter parameters in medical application.Conclusion The power density meter has a high precision,small error rate and good stability,and it can measure the laser power density accurately.

Aortic Valve Replacement for Severely Calcified Aorta with SCP and Deep Hypotheramic Circulatory Arrest / 日本心臓血管外科学会雑誌

A 60-year-old man on chronic hemodialysis was found to have severe aortic stenosis causing refractory atrial fibrillation elected to undergo aortic valve replacement. However, chest CT scan revealed a severely calcified ascending aorta which prevented safe aortic cross-clamping. At operation, arterial cannulation of the systemic circulation was performed to a graft anastomosed to the right axillary artery and venous cannulation to the right atrium. Cardiopulmonary bypass was started and the body was cooled. When a rectal temperature of 25°C was achieved, cardioplegic solution was administered retrogradely to achieve cardiac arrest and circulatory arrest was performed. Immediately, brachiocephalic artery was clamped and a single selective cerebral perfusion (SCP) was started with right axillary perfusion. In addition, a selective cerebral perfusion was added via the left common carotid artery to maintain adequate flow. After anastomosing the tube graft to the distal ascending aorta, cardiopulmonary bypass was restarted, a clamp was placed on the tube graft, and the patient was rewarmed. The aortic valve was excised and a 21-mm SJM-Regent valve was placed in the intra-annular position. The systemic circulatory arrest time was 18 min. The patient was weaned from cardiopulmonary bypass without difficulty and had an unremarkable recovery without complications. The ascending aorta replacement described here for the treatment of aortic valve disease in a patient with a severely calcified aorta is safer than deep hypothermic circulatory arrest alone, allowing a shorter circulatory arrest period. In addition, selective cerebral perfusion by right axillary artery anastomosed graft is advantageous in that we can start selective cerebral perfusion promptly by clamping the brachiocephalic artery.

Value of ST segment elevation of aVR lead in patients with acute ST segment elevation myocardial infarction / 中华急诊医学杂志

Objective To asses the value of ST segment elevation of aVR lead (aVRSTE) in patients with acute ST segment elevation myocardial infarction (STEMI). Method Myocardial enzymes detection, electrocar-dingraphy, emergency eornary artery angiography, echoeardiography [taken(10±2) days after emergency cornary artery angiography] were obtained and analyzed in 140 consecutive patients with STEMI enrolled in this study. The value of aVRSTE (≥0.05 mV) was assessed for detecting left main stem lesions(defined as ≥50% stenosis of or acute embolism of left main stem)or its equivalent (defined as total or subtotal acute occlusion of left anterior de-scending artery), and predicting the left ventricular systolic function after myocardial infarction. Results The sensitivity, specificity, positive predictive value and negative predictive value of aVRSIE in detection of left main stem lesions were 72.73 % (8/11), 83.72 % (108/129),27.59 % (8/29) and 97.30% (108/111), respectively; in detection of left main stem lesions or its equivalent, they were 41.86 % (18/43), 88.66% (86/97), 62.07 % (18/29), 77.48% (86/111); aVRSYE were combined with STaVR-STv1>0 to detect left main stem lesions, the semi-tivity, specificity, positive predictive value and negative predictive value were 63.64% (7/11),98.45%(127/129),77.78%(7/9),96.95% (127/131). Patients were divided into two groups: groups A with aVRSIE and group B without aVRSYE. KIIJJP class,and left ventricular ejection fraction (LVEF) in group A was higher than those in group B (P<0.05). Conclusions For patients with STEMI: (1) aVRSTE indicated left main stem le-sions or its equivalent; if combined with STaVR-STv1>0, it indicated left main stem lesions more strongly; (2)aVRSTE predicted poorer left ventricular systohc function short time after STEMI.

Dynamic data record and analysis system for body temperature / 医疗卫生装备

The research procedure of dynamic data acquisition and analysis system for body temperature(the body temperature HOLTER) is introduced in this paper.Some aspects of software and hardware technology related to the body temperature HOLTER are discussed emphatically.The system presents a good result through the preliminary application to the clinical practice.

Long-Term Results of Aortic Valve Replacement Using a 19mm Bileaflet Valve / 日本心臓血管外科学会雑誌

We studied cardiac function and outcome long after aortic valve replacement using a 19mm bileaflet valve. The subjects consisted of 10 of 12 patients living 10 or more years after the operation and 7 of 8 living 5-9 years after the operation. We measured the left ventricular ejection fraction (LVEF), %fraction shortening (%FS), left ventricular diastolic dimension (LVDd), systolic dimension (LVDs), PWT, IVST, and LV-aortic pressure gradient (PG) of in 6 patients each in 10 more years after the operation (Group I) and 5-9 years after the operation (Group II) who underwent ultrasonography, and calculated the left ventricular mass index (LVMI). No statistically significant differences were seen in either parameter in either group. Prognosis was 1 cardiac 2 cancer deaths each in 10 or more years after the operation group. The cumulative survival rate was in 85.7% post operative 5-9 years and 72.7% in 10 years. Although cardiac function was maintained in both groups, more observation is needed from now on because the pressure difference or LVMI may increase.

Design of Information Collection Platform for Movement Based on ARM7 / 医疗卫生装备

Objective To develop a platform of information collection for movements based on ARM7, through which human body movement information can be collected accurately and in time so that deeper scientific research about human body movement can be carried on. Methods By this means, multiplepoint acceleration information can be collected simultaneously through the multinodal network technology, and the information can be processed and retransmitted to computers to be analyzed comprehensively. Results The platform has been used in computer game controlling and good score is given by the tryout person. Conclusion Large quantities of experiment data indicate that this platform possesses higher precision in human body movement information collection and reflect them truthfully. Furthermore, later developments based on this can be applied in fields such as human recovery exercises, physical training, game controlling.