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Targeted therapy and immunotherapy have achieved great success in treating various solid and non-solid tumors, but the incidence of drugs-related adverse events is relatively high. The paper reports a case of renal thrombotic microangiopathy in an intrahepatic cholangiocarcinoma patient who underwent targeted therapy combined with immunotherapy. During the treatment, the tumor burden relieved continuously, but the patient developed proteinuria, edema and hypertension. The ADAMTS13 activity and inhibitors were normal, while the antiphospholipid antibody was positive. The patient was finally diagnosed as glomerular thrombotic microangiopathy with immune complex deposition by renal biopsy. After the cease of the antineoplastic agents and treatment with "cordyceps preparations" and "α-keto acids", the patient's blood pressure dropped to normal, her urine protein turnned to weakly positive, and her renal function remained stable.
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Objective:To observe influence of preinfarction angina pectoris (PAP)on primary ST elevation acute my-ocardial infarction (AMI).Methods:A total of 280 patients with primary ST elevation AMI received coronary angi-ography (CAG)within 24h after symptoms occurred,and they received ECG and QRS scoring on hospitalization. According to PAP or not,patients were divided into PAP group (n=102)and non PAP group (n=178).According to attack to CAG time,patients were divided into early stage group (<2h,n=60),mid-term group (2~6h,n=150)and advanced stage group (6~24h,n=70).Results:QRS score of PAP patients [(2.4±2.4)scores]was sig-nificantly lower than that of non PAP patients [(3.2±3.0)scores],percentage of high QRS score in PAP group (8.0%)was also significantly lower than that of non PAP group (18.4%),P<0.05 both.In early stage group, there was no significant difference in QRS score [(2.0±1.8)scores vs.(2.6±2.8)scores,P=0.35]between PAP and non PAP patients;The QRS score of PAP patients [(2.0±2.1)scores]was significantly lower than that of non PAP group [(3.0 ±3.0)scores]in mid-term group,P=0.03;in advanced stage group,the QRS score all signifi-cantly rose in PAP patients [(4.1 ±3.3)scores]and non PAP patients [(5.5±2.9)scores],P=0.13;QRS score gradually rose along with onset time prolonged in non PAP group.Conclusion:Preinfarction angina pectoris can de-lay progress of acute myocardial infarction and expand therapeutic window of reperfusion.
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Objective To study the changes and their value of ultrasonic myocardial integrated backscatter (IBS)in normal control and patients with super-acute phase of myocardial infarction. Methods There were 38 cases of acute myocardial infarction(AMI)patients in the super-acute phase(time ＜ 2 h infarction)and the acute phase(infarction time ＞ 2 h,typical ECG changes)for myocardial ultrasonic backscatter parameters detection,an additional 25 cases as healthy control group. The myocardial infarction region and non-infracted myocardial tissue region average duration of cardiac cycle of integrated backscatter(IBS)were measured,and IBS adjusted value (IBS%)was calculated as the ratio of myocardial IBS to the pericardium,the difference of IBS at end-diastolic and late systolic was used as cyclic variation of IBS(CVIB). The ratio of IBS to pericardial CVIB was used as its adjusted value(CVIB%). Over the same period for the electrocardiogram,myocardial enzymes and cardiac troponin I were measured. Results When ECG was not typically changed in patients with super-acute phase AMI,the IBS values significantly increased in the myocardial infarction region than the normal control group (43. 7 ± 10. 8)dB vs.(22. 6 ± 4. 6)dB,P ＜0.01),and CVIB was significantly lower than that in the normal control group(10. 2 ±2. 6)dB vs.(13. 2 ± 3.8)dB,P ＜ 0.01]. The IBS in the acute phase in patients was significantly higher than that in the normal control group and those non-infarcted areas,and CVIB was significantly lower than that in the normal control group and those in the non-infarcted areas. The changes were consistent with the ECG changes. Conclusions Ultrasonic backscatter parameters might be helpful for diagnosis of hyperacute period of AMI,and the determination of the scope and extent of AMI.
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Objective To study the evaluation of Bi-level positive pressure device to deliver nasal pressure support ventilation in severe bronchial asthma patients.Methods Sixty and fore severe bronchial asthma patients was divided into control(group A)and treatment group(group B),the group A(n=32)was given commonly treatment and that was breathing oxygen with nasal ventilation,the group B(n=32)was given commonly treatment and Bi-level positive pressure device to deliver nasal pressure support ventilation.The symptoms and signs were examined and the pH,PaO2,PaCO2,SaO2 and PEF were detected two groups.Results Compared with group A the indexes:the symptoms and signs of group B were affected better than group A,the PEF,PaO2,SaO2 of group B were significantly evaluated than those in group A(P
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Objective To study the value of blood glucose changes and the severity of the disease in patients with the systemic inflammatory response syndrome(SIRS).Methods In 328 SIRS patients without diabetes,intravenous blood glucose was monitored before open intravenou channel and subsequently 3~8h after intervals.The blood glucose was reviewed if glucose was abnormal 24h later.Results The blood glucose was higher than normal in 287(87.5%)patients with SIRS,of which 44 cases were death(13.4%).The higher the blood glucose level was,the higher the mortality rate was.Conclusion Blood glucose of patients with SIRS was elevated.If the blood glucose was 3 times higher than the normal,patients with SIRS had a higher mortality rate.