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Hypercalcemic crisis (HC) is a rare but critical electrolyte disorder, which may result in death if rapid correct management is not given due to the injury of the neurologic, cardiovascular and renal systems. Severe primary hyperthyroidism (PHPT) is listed as the most common cause of hypercalcemic crisis. Prompt surgical removal of the parathyroid glands is the most effective cure for HC. Nevertheless, hypercalcemic crisis after a successful parathyroidectomy is infrequent. Now, we report a case admitted to the Department of General Surgery of the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital about a successful therapy of hypercalcemic crisis postparathyroidectomy in Sep. 2019, aiming to remind clinicians of the individualized program of calcium supplement after surgery of hyperparathyroidism and emphasize the value of renal dialysis in HC.
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Objective To investigate the different characteristics of vertebral basilar artery between isolated vertigo and dizziness with ischemic stroke history by magnetic resonance angiography (MRA) information,and find the independent risk factors of isolated vertigo.Methods From January 2015 to January 2016,isolated vertigo patients from our department were enrolled in study group (vertigo group),and dizzy patients with ischemic stroke history in control group (dizziness group).The patient's general information,and the relevant vascula data of the MRA were statistically analyzed to find the risk factors.Results A total of 118 patients with isolated vertigo was enrolled in the vertigo group,and 74 patients with dizziness after ischemic stroke were used as a control group.There were significant statistical differences in mean diameter of the right vertebral artery,rate of stenosis of basilar artery,vertigo history,the left vertebral artery hypoplasia,basilar artery skewing,and basilar artery hypoplasia between two groups (P ＜ 0.05).Multivariate logistic regression analysis showed that vertigo history (P =0.049,OR =3.822,95％ CI =1.004 ～ 14.548),the right vertebral artery hypoplasia (P =0.001,OR =6.083,95％ C1 =2.193 ～ 16.876),the left vertebral artery hypoplasia (P =0.006,OR =5.110,95 ％ CI =1.615 ～ 16.170),and mean diameter of the right vertebral artery (P =O.000,OR =3.143,95％ CI =1.724 ～ 5.730) were independent risk factors for isolated vertigo,and basilar artery skewing (P =0.018,OR =O.436,95％ CI =0.219 ～ O.866),and degree of basilar artery stenosis (P =0.006,0R =0.634,95％ CI =0.459 ～0.877) were the protective factors.Conclusions The right vertebral artery hypoplasia,the left vertebral artery hypoplasia,and mean diameter of the right vertebral artery are independent risk factors for isolated vertigo.Basilar artery skewing and degree of basilar artery stenosis may be the protective factors.
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Cancer pain is the most important factor affecting the cancer patients' quality of life, and the approach to relieve and control cancer pain is becoming the focus. Pain mechanism research can offer solutions to pain treatment, such as blocking the happening and conduction of analgesia. The earliest μ, κ, σopioid receptors were found in the research of morphine and opioid peptides, especially μ receptor's leading role in pain treatment. Currently, μ opioid agonist is basically used in clinical pain treatment. Morphine, the third level drug, is still the classic pain therapy drugs. Novel drugs such as fentanyl transdermal and controlled-release oxycodone provide new ideas for the pain ease. Opioid combined with non-opioid drugs, the change of opioid drugs delivery way and joint application of controlled release drug and relievers, have dramatically reduced opioid drugs' side effects.
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Objective To investigate the correlation between the morphological characteristics of vertebrobasilar artery on magnetic resonance angiography (MRA) and isolated vertigo. Methods The patients with isolated vertigo were enrolled retrospectively as a case group. Other patients without vertigo were selected over the same period as a control group. The clinical data and MRA data were collected. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors for isolated vertigo. Results A total of 118 patients with isolated vertigo and 179 controls were enrolled. Univariate analysis showed that there were significant differences in left vertebral artery bending degree, basilar artery stenosis rate, previous stroke, dolichoec tatic basilar artery, and left and right vertebral artery hypoplasia between the two groups (all P < 0.05). Multivariate logistic regression analysis showed that previous vertigo (odds ratio [OR] 6.177, 95%confidence interval [CI] 1.945-19.620; P = 0.002), more serious left vertebral artery bending (OR 1.860, 95% CI 1.127-3.069; P =0.015), and left vertebral artery hypoplasia (OR 4.543,95% CI 1.761-11.721; P = 0.002) were the independent risk factors for isolated vertigo, and previous stroke ( OR 0.377, 95% CI 0.162-0.877; P = 0.024), basal artery hypoplasia ( OR 0.401, 95% CI 0.193-0.830; P = 0.014) were its protective factors. Conclusions Previous vertigo, more serious left vertebral artery bending, and left vertebral artery hypoplasia are the independent risk factors for isolated vertigo, and previous stroke and basal artery hypoplasia may be its protective factors.
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Objective To observe the occurrence and risk factors of arrhythmia in chronic kidney disease (CKD) patients in different stages of renal function. Methods A total of 405 CKD patients were enrolled in this study and none of them received renal replacement therapy.The 24 h dynamic electrocardiogram (DCG) was performed,and baseline characteristics were compared.Multivariable Logistic regression analysis was used to examine the relationship between the severe arrhythmia and the potential risk factors,such as age,gender,CKD stage,diabetes,hypertension,hyperpotassaemia,left ventricular hypertrophy (LVH),etc. Results There were 69 patients (17.04％),79 patients (19.51％),82 patients (20.25％),88 patients (21.73 ％) and 87 patients (21.48％) in CKD stage 1,2,3,4 and 5,respectively.As high as 45.68％ of all the patients had severe arrhythmia,represented by 27.54％,29.11％,42.68％,57.95％ and 65.52％ in CKD stages 1-5 respectively.The occurrence of severe arrhythmia increased as the eGFR decreased in CKD stages 2,3,4 (p＜0.05).On multivariable Logistic regression analysis,the occurrence of severe arrhythmia was related to LVH,CKD stage,diaberes hyertension and hyperpotassaemia are signidicantly assoxiated with severe arrhythmia.
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BACKGROUND: Research has been reported that serum soluble CD146 (sCD146) expression was improved on the surface of endothelial cells and activated T cells by the stimulation of inflammatory factor. Therefore, it predicts that CD146 may participate in inflammatory reaction of tissue.OBJECTIVE: To investigate the expression and clinical significance of serum sCD146 in peripheral blood from patients with ankylosing spondylitis.METHODS: A total of 62 patients with ankylosing spondylitis were selected from the Sixth People's Hospital AffiUated to Shanghai Jiao Tong University. All patients were divided into two groups: active group (n=46) and inactive group (n=16); while, 20 healthy subjects were selected as the control group. Indicators including Bath Ankylosing SpondyUtis Disease ActivityIndex (BASDAI),Bath Ankylosing Spondylitis Functional Index (BASFI), patient's global assessment (PGA), night pain, visual analogue scale (VAS),morning stiffness time, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured in all patients. The serum concentration of sCD146 from 62 patients with ankylosing spondlitis and 20 healthy controls was measured by enzyme-linked immunosorbent assay. Westergren method was used to measure ESR and immunoturbidimetry for CRP. Clinical data of the patients were collected as well.RESULTS AND CONCLUSION: sCD146 levels of patients with ankylosing spondlitis were significantly higher than normal control group (P ＜ 0.05). The sCD146 expression in the active group was significantly higher than inactive and normal control groups (P ＜0.05). Positive correlations were observed between sCD146 and BASDAI index of patients with ankylosing spondlitis (P ＜ 0.05).The sCD146 levels of ankylosing spondUtis patients with peripheral joint involvement were significantly higher than the patients with axial involvement alone or the normal controls (P ＜ 0.05).The expression level of sCD146 in peripheral blood was positively correlated with disease activities of patients with ankylosing spondlitis. It may play important roles in the pathogenesis in ankylosing spondlitis.