Behavioral scoring based on clinical observations remains the gold standard for screening,diagnosing,and evaluating infantile epileptic spasm syndrome(IESS).The accurate identification of seizures is crucial for clini...Behavioral scoring based on clinical observations remains the gold standard for screening,diagnosing,and evaluating infantile epileptic spasm syndrome(IESS).The accurate identification of seizures is crucial for clinical diagnosis and assessment.In this study,we propose an innovative seizure detection method based on video feature recognition of patient spasms.To capture the temporal characteristics of the spasm behavior presented in the videos effectively,we incorporate asymmetric convolutions and convolution–batch normalization–ReLU(CBR)modules.Specifically within the 3D-ResNet residual blocks,we split the larger convolutional kernels into two asymmetric 3D convolutional kernels.These kernels are connected in series to enhance the ability of the convolutional layers to extract key local features,both horizontally and vertically.In addition,we introduce a 3D convolutional block attention module to enhance the spatial correlations between video frame channels efficiently.To improve the generalization ability,we design a composite loss function that combines cross-entropy loss with triplet loss to balance the classification and similarity requirements.We train and evaluate our method using the PLA IESS-VIDEO dataset,achieving an average seizure recognition accuracy of 90.59%,precision of 90.94%,and recall of 87.64%.To validate its generalization capability further,we conducted external validation using six different patient monitoring videos compared with assessments by six human experts from various medical centers.The final test results demonstrate that our method achieved a recall of 0.6476,surpassing the average level achieved by human experts(0.5595),while attaining a high F1-score of 0.7219.These findings have substantial significance for the long-term assessment of patients with IESS.展开更多
BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion o...BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion of the inner esophageal wall. Midesophagealdiverticula are relatively rare and may coexist with diffuse esophagealspasm. However, the potential esophageal motility disorders associated withthese lesions are frequently overlooked in clinical practice. The use of endoscopicinterventions may offer a novel approach for the alleviation of dysphagia associatedwith this condition.CASE SUMMARYWe present a case of a 74-year-old woman with dysphagia, diagnosed with midesophagealdiverticulum and diffuse esophageal spasm. Due to her physical condition,submucosal tunneling endoscopic septum division (STESD) was initiallyperformed for the diverticulum. One month later, the esophageal spasm wastreated using per-oral endoscopic myotomy (POEM). This combined treatmentsignificantly improved her dysphagia, and she was discharged.CONCLUSIONSTESD and POEM are effective and safe for the treatment of dysphagia caused bymid-esophageal diverticula with diffuse esophageal spasm.展开更多
BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes i...BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.METHODS Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure.During each SPT,the pressure wire was advanced into the distal portion of the right coronary artery(RCA)and left anterior descending coronary artery,and the ratio of intracoronary pressure to aortic pressure(Pd/Pa)was monitored.Coronary spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic changes.ACh was administered to the RCA at low,moderate,or high doses of 20,50,or 80μg,respectively,and to the left coronary artery(LCA)at low,moderate,or high doses of 50,100,or 200μg,respectively.Coronary arteries with coronary spasms at low doses of ACh were defined as group L,and those with coronary spasms at moderate or high doses were defined as group MH.Those who did not occur coronary spasms at any ACh dose were designated as group N.RESULTS Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group MH.Baseline Pd/Pa was the lowest in group L(P=0.001).The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N(P<0.001).A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95,with a sensitivity of 0.600(15/25)and a specificity of 0.713(76/107)and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was−0.04,with a sensitivity of 0.741(43/58)and a specificity of 0.694(34/49).CONCLUSION These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.展开更多
Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10...Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10),Model group(20)and Zhishen Tiaoxing(ZSTX)acupuncture group(20).Middle cerebral artery occlusion was conducted in SD rats to establish post-stroke limb spasm rats,which were treated with ZSTX acupuncture.Behavioral assays were determined by the Narrow ally test,the limb muscle tension was detected by the BL-420S test system,and infarct volume was assessed after the cerebral infarction by 2,3,5-triphenyltetrazolium chloride staining.Heterogeneous neurotransmitterγ-aminobutyric acid(GABA)and its receptors GABAA and GABAB in the cerebral cortex of the infarct area were determined by immunofluorescence assay.The release of Trkb and K-Cl cotransporter isoform 2 was detected by an immunofluorescence double labeling study.Western Blot was utilized to measure the expression of BDNF and Trkb.Results:The results showed that the behavioral assays in post-stroke limb spasm rats were significantly improved by the treatment of ZSTX acupuncture.14 days of ZSTX acupuncture can effectively inhibit muscle tone and decrease Infarct volume,which was measured with BL-420S biological function experiment system and triphenyltetrazolium chloride.Meanwhile,the results of Double-Label Immunofluorescence Assays showed that ZSTX acupuncture improved the expression of GABA,GABAA,GABAB,BDNF,and K-Cl cotransporter isoform 2.Double-Label Immunofluorescence Assays and WB results showed that 14 days ZSTX acupuncture declined the expression of Trkb.Conclusions:Our results suggest that 14 days of ZSTX acupuncture can significantly improve post-stroke limb spasm.Meanwhile,the pathogenesis of post-stroke limb spasm and the efficacy of ZSTX acupuncture involve metabolic pathways of neurotransmitters,and electro-acupuncture can treat post-stroke limb spasm by regulating BDNF/Trkb-KCC2 signaling pathway.展开更多
BACKGROUND Peroral endoscopic myotomy(POEM)has been widely performed as a standard treatment for achalasia;however,its efficacy and safety for treating distal esophageal segmental spasms induced by cancer metastasis r...BACKGROUND Peroral endoscopic myotomy(POEM)has been widely performed as a standard treatment for achalasia;however,its efficacy and safety for treating distal esophageal segmental spasms induced by cancer metastasis remain unknown.CASE SUMMARY A 72-year-old male was referred to our hospital and complained of progressive dysphagia for two years.Endoscopy revealed a 2 cm long segment esophageal stenosis with intact mucosa and normal cardia.Computed tomography showed a right upper lung mass,and pathology of the right pleural effusion confirmed the diagnosis of right upper lung adenocarcinoma with multiple rib and mediastinal lymph node metastases and right malignant pleural effusion.Individualized POEM was performed first to alleviate dysphagia,and the final diagnosis was changed to esophageal muscle metastasis arising from lung adenocarcinoma.After treatment,the patient could eat soft solid food and received multiple rounds of pembrolizumab-combination chemotherapy.The patient’s progression-free survival was approximately 16 months.Long stable disease was obtained during the 24-month follow-up.CONCLUSION The incidence of distal esophageal segmental spasms induced by muscular metastasis arising from lung adenocarcinoma is extremely low.Individualized POEM can effectively improve a patient’s nutritional status before subsequent chemotherapy can be combined with immune checkpoint inhibitors.展开更多
AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospectiv...AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospective case series of twenty-two patients,mainly children,with SNR or accommodation spasm(AS).AS was diagnosed on the basis of blurred vision and a difference of>2 dioptres between manifest and cycloplegic retinoscopy.If esotropia and miosis were present,the patients were diagnosed with SNR.All patients underwent visual acuity testing,orthoptic evaluation,assessment of refraction before and after cycloplegia,and dilated fundoscopy.Additional diagnostic investigations,such as neuroimaging,lumbar puncture(LP),electrophysiology and blood tests,were also recorded.Screen use among children was assessed in hours per day.RESULTS:There were 19 female and 3 male patients(age range 7-33 y,median=10 y).Seventeen patients had AS and 5 patients had SNR,with episodic blurry vision and headaches being the most common symptoms.Brain neuroimaging was performed in six patients(27%),although only one had a history of brain trauma.Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy.The majority of patients(90%)reported prolonged daily screen time(>2 h/d),and in 55%of cases there were concurrent social problems or psychological triggers.Treatment consisted of careful explanation of the condition,atropine1%eye drops and full cycloplegic correction by means of bifocal glasses.CONCLUSION:The diagnosis of SNR and AS may be challenging,because symptoms are usually intermittent and nonspecific,and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment,that may exaggerate the underlying psychological disorder.Hence,detailed clinical testing and assessment of psychosocial profile is necessary,in order to avoid unnecessary investigations.Neuroimaging should be performed only in selected cases.Finally,due to prolonged screen use SNR and AS may become more frequent in the future.展开更多
Coronary spasm is caused by a transient coronary nar -rowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of cor...Coronary spasm is caused by a transient coronary nar -rowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of coronary spasm, and many findings on coronary spasm have been reported. Coronary spasm has been considered as having pivotal roles in the cause of not only rest angina but also exertional angina, acute coronary syndrome, and heart failure. In addition, several new findings of the mechanism of coronary spasm have emerged recently. The diagnosis based mainly on coronary angiography and spasm provo-cation test and the mainstream treatment with a focus on a calcium-channel blocker have been established. At a glance, coronary spasm or vasospastic angina(VSA) has become a common disease. On the contrary, there are several uncertain or unsolved problems regarding coronary spasm, including the presence of medically refractory coronary spasm(intractable VSA), or an appropriate use of implantable cardioverter defibrillator in patients with cardiac arrest who have been confirmed as having coronary spasm. This editorial focused on coronary spasm, including recent topics and unsolved problems.展开更多
The spasm provocation test(SPT) is an important test in the diagnosis of vasospastic angina(VSA). In many cases, this test is performed as the gold standard test, and VSA is considered not present if the SPT is negati...The spasm provocation test(SPT) is an important test in the diagnosis of vasospastic angina(VSA). In many cases, this test is performed as the gold standard test, and VSA is considered not present if the SPT is negative. However, some patients continue to experience chest symptoms despite a negative SPT. In this study, we report four cases in which SPT was repeated to evaluate chest symptoms despite the negative results of the first SPT. Two men in their 70 s, one woman in her 60 s, and one woman in her 70 s, all with chest symptoms, underwent a second SPT at 4, 3, 2, and 3 years, respectively, after the first SPT, which was negative. Three patients had positive results in the second SPT(75%). In conclusion, even when SPT is negative, the diagnosis of VSA should be made with clinical symptoms in consideration. In some cases, a second SPT may be required to confirm the diagnosis of VSA.展开更多
Objective: Percutaneous coronary intervention (PCI) via the radial artery access has more advantages than that of femoral artery access, while radial or (and) brachial artery have tendency to be spasmodic. We sought t...Objective: Percutaneous coronary intervention (PCI) via the radial artery access has more advantages than that of femoral artery access, while radial or (and) brachial artery have tendency to be spasmodic. We sought to investigate the effectiveness and safety of guiding catheter crossing over spasmodic radial or (and) brachial artery segments by the aid of PCI wire and balloon compared with traditional anti-spasmodic approach. Methods: The clinical data of 168 patients with coronary artery disease (CAD) (group A), whose PCI was performed via radial artery access with radial or (and) brachial artery spasm or (and) dissection and guiding catheter passing through spasmodic segments successfully by the aid of PCI guiding wire and balloon were analyzed retrospectively, simultaneously, the other 73 patients (group B) who used conventional approach to cross over the spasmodic radial or (and) brachial artery segments were treated as the control. The success rate, the time consumption and the complication were compared between the two groups. Findings: There was no significant difference in the spasmodic site between the two groups (all p value > 0.05). The success rate in group A was significantly higher than that in group B (168(100%) vs 28 (38.4%), p (4.2%) vs 14 (19.2%), p Conclusions: It is more effective and safer for guiding catheter crossing over spasmodic or (and) dissected radial or (and) brachial artery segments by the aid of PCI guiding wire and balloon than using the routine approach of administration of anti-spasm drugs for trans-radial PCI.展开更多
Vasospasm is a thorny problem often encountered in microvascular surgery.This investigation is dedicated to establishing a model of vasospasm and to evaluating the antispasmodic efficacy of 10 pharmacologic agents und...Vasospasm is a thorny problem often encountered in microvascular surgery.This investigation is dedicated to establishing a model of vasospasm and to evaluating the antispasmodic efficacy of 10 pharmacologic agents under direct monitoring of laser speckle contrast imaging(LSCI).80 SD rats were used.A pair of microsurgical forceps were used to trigger vasospasm of the femoral vessels by blunt dissection.Five minutes later,10 pharmacological agents were dripped to the femoral vessels,after which LSCI was used to collect perfusion images,acquiring the perfusion intensity and the inner caliber of the femoral vessels at multiple time points.展开更多
Objective:To observe effects of pricking blood therapy at meridian sinews on upper limb spasm of poststroke patients.Methods:A total of 72 patients with post-stroke upper limb spasm were randomly divided into a compre...Objective:To observe effects of pricking blood therapy at meridian sinews on upper limb spasm of poststroke patients.Methods:A total of 72 patients with post-stroke upper limb spasm were randomly divided into a comprehensive group of pricking blood therapy at meridian sinews with rehabilitation training(comprehensive group)and the simple rehabilitation training group(rehabilitation group),and there were 36 patients in each group.On the basis of routine therapy,the patients of the two groups received rehabilitation therapy for 6 consecutive days and 1-day rest,for 4 weeks in total.On the above basis,the patients in the comprehensive group received pricking blood therapy at meridian sinews,once every other day,3 times per week,for 4 weeks in total.Before treatment,after the first treatment,and after 4-week treatment,the patients were observed for changes of upper limb spasticity(Modified Ashworth Scale,MAS),upper limb movement function(Fugl-Meyer Assessment,FMA),activity of daily living(Modified Barthel Index,MBI),and biceps and triceps integrated electromyogram(IEMG)values were observed as well as the therapeutic effects.Results:(1)After the first treatment,there were statistically significant differences of the MAS scale grades in patients of the two groups(P<0.05).The FMA scores in the comprehensive group were increased than that before treatment(P<0.05),and the MBI scores of the two groups were increased than those before treatment(both P<0.05).The FMA and MBI scores in the comprehensive group were higher than those of the rehabilitation group(both P<0.05).The biceps and triceps IEMG values were not improved than those before treatment(all P>0.05).(2)After 4-week treatment,there were statistically significant differences of MAS grades in patients of the two groups(P<0.05).The FMA and MBI scores in the two groups were increased than those before treatment(all P<0.05),and the FMA and MBI scores in the comprehensive group were higher than those in the rehabilitation group(both P<0.05).Through comparison of the differences of FMA and MBI scores of the two groups,the difference values in the comprehensive group were higher than those of the rehabilitation group(both P<0.05).The biceps and triceps IEMG values in the two groups were decreased than those before treatment(all P<0.05),and those in the comprehensive group were lower than those in the rehabilitation group(both P<0.05).The biceps and triceps IEMG values in patients of the comprehensive group were higher than those before treatment(both P<0.05).(3)After 4-week treatment,the total effective rate in the comprehensive group was 83.3%(30/36),and that was 58.3%(21/36)in the rehabilitation group.The total effective rate in the comprehensive group was higher than that in the rehabilitation group(P<0.05).Conclusions:The pricking blood therapy at meridian sinews can release affected upper limb flexor muscle spasticity and movement function of the patients with post-stroke upper limb spasm,decrease biceps IEMG values of the affected side,and improve activities of daily living.展开更多
We present a case of a 71-year-old male who hadchest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year,and his chest symptoms had recently worsened. One month before admission h...We present a case of a 71-year-old male who hadchest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year,and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia,he was admitted to our institution for coronary angiography(CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery(LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm,which was relieved after the intracoronary infusion of nitroglycerin. Finally,a CAG showed myocardial bridging(MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77,which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus,coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia.展开更多
We report a case of essential thrombocythemia(ET) in a 30-year-old female who exhibited inferior wall ST-elevation acute myocardial infarction(AMI) without significant obstructive coronary artery disease.Right coronar...We report a case of essential thrombocythemia(ET) in a 30-year-old female who exhibited inferior wall ST-elevation acute myocardial infarction(AMI) without significant obstructive coronary artery disease.Right coronary vasospasm was observed after intra-coronary methylergonovine administration and she received verapamil 120 mg/d thereafter and hydroxyurea 1500 mg/d for thrombocythemia.After discontinuation of the hydroxyurea for 9 mo based on the impression of coronary spasm-related instead of coronary thrombosis-related AMI,her platelet count rose but no chest pain was observed.It is suggested that coronary spasm potentially plays a role in patients with ET,AMI and no significant coronary artery stenosis.展开更多
Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainst...Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression(MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD(such as lateral spread response,brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.展开更多
Objective.To introduce the properties of Chinese type A botulinum toxin(CBTXA,made by Lanzhou Institute of Biological Products),and its long?term effect for focal dystonia and hemifacial spasm.Method.The purity and re...Objective.To introduce the properties of Chinese type A botulinum toxin(CBTXA,made by Lanzhou Institute of Biological Products),and its long?term effect for focal dystonia and hemifacial spasm.Method.The purity and recovery of crude and crystalline toxin were tested.Long?term data from305patients with hemifacial spasm(HFS),blepharospasm(BS)and cervical dystonia(CD)were evalu-ated and subgroups of patients received CBTXA injections between1994and2000in at least six sepa-rate treatment sessions,with follow up for2～8years.The therapeutic results of the last session CBTXA injections were analyzed in comparison with the first session.Result.CBTXA purity was high[(2.55～2.60)×10 7 LD50/mgPr ,A260/A280≤0.55,high molecular substance accounted for99.2%of total proteins].Long term treatment with CBTXA in patients with focal dystonia and HFS was not associated with any decline in benefit,and efficacy may improve slightly with repeat treatments.CBTXA is an excellent long-term treatment of HFS,BS and CD.Conclusion.We conclude that Chinese type A botulinum toxin is of botulinum toxin therapy quality standard according to results obtained from the basic study and long?term clinical applications.The re?injection of CBTXA significantly improves the quality of life of most patients and is a safe,effective and comparatively economical treatment for patients with focal dystonia and HFS.展开更多
BACKGROUND Coronary artery spasm(CAS)is a rare but critical condition during surgery.Clinical manifestations can vary from only subtle electrocardiography change to sudden death.In this case report,we present the case...BACKGROUND Coronary artery spasm(CAS)is a rare but critical condition during surgery.Clinical manifestations can vary from only subtle electrocardiography change to sudden death.In this case report,we present the case of a patient with myasthenia gravis(MG)who developed refractory CAS-related cardiogenic shock during thymoma surgery.CASE SUMMARY A 61-year-old man had a history of cigarette smoking and coronary artery disease with a bare metal stent placed.Three months ago,he suffered from coronary spasms,with three vessels involved,after surgery for cervical spine injury.He started having progressive dysphagia 4 wk prior and was diagnosed with MG via serologic tests,and computed tomography declared a thymoma in the anterior mediastinum.After the symptoms of MG subsided,he was referred for thy-mectomy.The operation was uneventful until the closing of the sternal wound.Electrocardiography showed sudden onset ST elevation,followed by ventricular tachycardia and severe hypotension.Cardiopulmonary cerebral resuscitation was initiated immediately with electrical defibrillation,extracorporeal membrane oxygenation was performed due to refractory cardiogenic shock,and the patient was transferred to an angiography room.Angiography showed diffuse CAS with three vessels involved.Intracoronary isosorbide dinitrate and adenosine were administered,and then the patient was transferred to the intensive care unit.CONCLUSION Our case highlights the importance of being prepared for clinical situations such as the one described here and suggests the necessity of developing an appropriate anesthesia plan that includes proactive analgesia and preemptive coronary vaso-dilators.展开更多
BACKGROUND Acute stent thrombosis(AST)is a serious complication of percutaneous coronary intervention(PCI).The causes of AST include the use of stents of inappropriate diameters,multiple overlapping stents,or excessiv...BACKGROUND Acute stent thrombosis(AST)is a serious complication of percutaneous coronary intervention(PCI).The causes of AST include the use of stents of inappropriate diameters,multiple overlapping stents,or excessively long stents;incomplete stent expansion;poor stent adhesion;incomplete coverage of dissection;formation of thrombosis or intramural hematomas;vascular injury secondary to intraoperative mechanical manipulation;insufficient dose administration of postoperative antiplatelet medications;and resistance to antiplatelet drugs.Cases of AST secondary to coronary artery spasms are rare,with only a few reports in the literature.CASE SUMMARY A 55-year-old man was admitted to the hospital with a chief complaint of back pain for 2 d.He was diagnosed with coronary heart disease and acute myocardial infarction(AMI)based on electrocardiography results and creatinine kinase myocardial band,troponin I,and troponin T levels.A 2.5 mm×33.0 mm drugeluting stent was inserted into the occluded portion of the right coronary artery.Aspirin,clopidogrel,and atorvastatin were started.Six days later,the patient developed AST after taking a bath in the morning.Repeat coronary angiography showed occlusion of the proximal stent,and intravascular ultrasound showed severe coronary artery spasms.The patient’s AST was thought to be caused by coronary artery spasms and treated with percutaneous transluminal coronary angioplasty.Postoperatively,he was administered diltiazem to inhibit coronary artery spasms and prevent future episodes of AST.He survived and reported no discomfort at the 2-mo follow-up after the operation and initiation of drug treatment.CONCLUSION Coronary spasms can cause both AMI and AST.For patients who exhibit coronary spasms during PCI,diltiazem administration could reduce spasms and prevent future AST.展开更多
Objective To study the immunoreactivity of Calcitonin gene-related peptide (CGRP) in the facial nerve when Hemifacial Spasm is occurring. Methods The electrophysiological technique was used to explore abnormal muscle ...Objective To study the immunoreactivity of Calcitonin gene-related peptide (CGRP) in the facial nerve when Hemifacial Spasm is occurring. Methods The electrophysiological technique was used to explore abnormal muscle response (AMR) which was characteristic of Hemifacial Spasm.The animal models of Hemifacial Spasm in New Zealand white rabbits were established by compressing the main trunk of artificial demyelinated facial nerve with the temporal superficial artery. At 6 weeks after surgery, the facial nerves were taken from the experimental group and control one, the immunohistochemistry for CGRP using polyclonal antibody with ABC kit was performed in the facial nerves; at the same time, the observation for the facial nerves of light and transmission electron microscope was performed. Results The facial nerve demyelinated and the axons retrogressively changed, CGRP immunoreactive positive fibers were significantly detected in experimental groups; whereas this phenomenon was not found in control group. Conclusion CGRP can nutrien the injured facial nerve and plays an important role in the pathogenesis of Hemifacial Spasm.展开更多
Facial spasm is a frequently seen dis-ease characterized by unilateral involuntaryirregular twitching of the facial muscles.This disorder may be induced by intoxica-tion,infection,trauma and long-term facialparalysis ...Facial spasm is a frequently seen dis-ease characterized by unilateral involuntaryirregular twitching of the facial muscles.This disorder may be induced by intoxica-tion,infection,trauma and long-term facialparalysis which was not properly treated.展开更多
BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinici...BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.展开更多
基金the National Social Science Foundation of China(No.21BTQ106),the Natural Science Foundation of Beijing(No.7222187),and the Key Project of Innovation Cultivation Fund of the Seventh Medical Center of PLA General Hospital(No.qzx-2023-1)。
文摘Behavioral scoring based on clinical observations remains the gold standard for screening,diagnosing,and evaluating infantile epileptic spasm syndrome(IESS).The accurate identification of seizures is crucial for clinical diagnosis and assessment.In this study,we propose an innovative seizure detection method based on video feature recognition of patient spasms.To capture the temporal characteristics of the spasm behavior presented in the videos effectively,we incorporate asymmetric convolutions and convolution–batch normalization–ReLU(CBR)modules.Specifically within the 3D-ResNet residual blocks,we split the larger convolutional kernels into two asymmetric 3D convolutional kernels.These kernels are connected in series to enhance the ability of the convolutional layers to extract key local features,both horizontally and vertically.In addition,we introduce a 3D convolutional block attention module to enhance the spatial correlations between video frame channels efficiently.To improve the generalization ability,we design a composite loss function that combines cross-entropy loss with triplet loss to balance the classification and similarity requirements.We train and evaluate our method using the PLA IESS-VIDEO dataset,achieving an average seizure recognition accuracy of 90.59%,precision of 90.94%,and recall of 87.64%.To validate its generalization capability further,we conducted external validation using six different patient monitoring videos compared with assessments by six human experts from various medical centers.The final test results demonstrate that our method achieved a recall of 0.6476,surpassing the average level achieved by human experts(0.5595),while attaining a high F1-score of 0.7219.These findings have substantial significance for the long-term assessment of patients with IESS.
基金Supported by Natural Science Foundation of Shandong Province,No.81700472Clinical+X Project Fund of Binzhou Medical College,No.BY2021LCX11and Binzhou Medical University Science and Technology Program Projects,No.BY2019KJ13.
文摘BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion of the inner esophageal wall. Midesophagealdiverticula are relatively rare and may coexist with diffuse esophagealspasm. However, the potential esophageal motility disorders associated withthese lesions are frequently overlooked in clinical practice. The use of endoscopicinterventions may offer a novel approach for the alleviation of dysphagia associatedwith this condition.CASE SUMMARYWe present a case of a 74-year-old woman with dysphagia, diagnosed with midesophagealdiverticulum and diffuse esophageal spasm. Due to her physical condition,submucosal tunneling endoscopic septum division (STESD) was initiallyperformed for the diverticulum. One month later, the esophageal spasm wastreated using per-oral endoscopic myotomy (POEM). This combined treatmentsignificantly improved her dysphagia, and she was discharged.CONCLUSIONSTESD and POEM are effective and safe for the treatment of dysphagia caused bymid-esophageal diverticula with diffuse esophageal spasm.
文摘BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.METHODS Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure.During each SPT,the pressure wire was advanced into the distal portion of the right coronary artery(RCA)and left anterior descending coronary artery,and the ratio of intracoronary pressure to aortic pressure(Pd/Pa)was monitored.Coronary spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic changes.ACh was administered to the RCA at low,moderate,or high doses of 20,50,or 80μg,respectively,and to the left coronary artery(LCA)at low,moderate,or high doses of 50,100,or 200μg,respectively.Coronary arteries with coronary spasms at low doses of ACh were defined as group L,and those with coronary spasms at moderate or high doses were defined as group MH.Those who did not occur coronary spasms at any ACh dose were designated as group N.RESULTS Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group MH.Baseline Pd/Pa was the lowest in group L(P=0.001).The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N(P<0.001).A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95,with a sensitivity of 0.600(15/25)and a specificity of 0.713(76/107)and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was−0.04,with a sensitivity of 0.741(43/58)and a specificity of 0.694(34/49).CONCLUSION These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.
基金the National Key R&D Program of China(Grant No.2019YFC1709900)National Natural Science Foundation of China(Grant No.71804022)+1 种基金Natural Science Foundation of Henan province(Grant No.232300420256)Medical technologies R&D Program of Henan province(Grant No.LHGJ20220348).
文摘Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10),Model group(20)and Zhishen Tiaoxing(ZSTX)acupuncture group(20).Middle cerebral artery occlusion was conducted in SD rats to establish post-stroke limb spasm rats,which were treated with ZSTX acupuncture.Behavioral assays were determined by the Narrow ally test,the limb muscle tension was detected by the BL-420S test system,and infarct volume was assessed after the cerebral infarction by 2,3,5-triphenyltetrazolium chloride staining.Heterogeneous neurotransmitterγ-aminobutyric acid(GABA)and its receptors GABAA and GABAB in the cerebral cortex of the infarct area were determined by immunofluorescence assay.The release of Trkb and K-Cl cotransporter isoform 2 was detected by an immunofluorescence double labeling study.Western Blot was utilized to measure the expression of BDNF and Trkb.Results:The results showed that the behavioral assays in post-stroke limb spasm rats were significantly improved by the treatment of ZSTX acupuncture.14 days of ZSTX acupuncture can effectively inhibit muscle tone and decrease Infarct volume,which was measured with BL-420S biological function experiment system and triphenyltetrazolium chloride.Meanwhile,the results of Double-Label Immunofluorescence Assays showed that ZSTX acupuncture improved the expression of GABA,GABAA,GABAB,BDNF,and K-Cl cotransporter isoform 2.Double-Label Immunofluorescence Assays and WB results showed that 14 days ZSTX acupuncture declined the expression of Trkb.Conclusions:Our results suggest that 14 days of ZSTX acupuncture can significantly improve post-stroke limb spasm.Meanwhile,the pathogenesis of post-stroke limb spasm and the efficacy of ZSTX acupuncture involve metabolic pathways of neurotransmitters,and electro-acupuncture can treat post-stroke limb spasm by regulating BDNF/Trkb-KCC2 signaling pathway.
基金Supported by The Young and Middle-aged Mainstay Talent Training Program of Fujian Provincial Health System,China,No.2017-ZQN-16The Science and Technology Project of Fujian Province,China,No.2020Y0068The Joint Funds for the Innovation of Science and Technology of Fujian Province,China,No.2023Y9414.
文摘BACKGROUND Peroral endoscopic myotomy(POEM)has been widely performed as a standard treatment for achalasia;however,its efficacy and safety for treating distal esophageal segmental spasms induced by cancer metastasis remain unknown.CASE SUMMARY A 72-year-old male was referred to our hospital and complained of progressive dysphagia for two years.Endoscopy revealed a 2 cm long segment esophageal stenosis with intact mucosa and normal cardia.Computed tomography showed a right upper lung mass,and pathology of the right pleural effusion confirmed the diagnosis of right upper lung adenocarcinoma with multiple rib and mediastinal lymph node metastases and right malignant pleural effusion.Individualized POEM was performed first to alleviate dysphagia,and the final diagnosis was changed to esophageal muscle metastasis arising from lung adenocarcinoma.After treatment,the patient could eat soft solid food and received multiple rounds of pembrolizumab-combination chemotherapy.The patient’s progression-free survival was approximately 16 months.Long stable disease was obtained during the 24-month follow-up.CONCLUSION The incidence of distal esophageal segmental spasms induced by muscular metastasis arising from lung adenocarcinoma is extremely low.Individualized POEM can effectively improve a patient’s nutritional status before subsequent chemotherapy can be combined with immune checkpoint inhibitors.
文摘AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospective case series of twenty-two patients,mainly children,with SNR or accommodation spasm(AS).AS was diagnosed on the basis of blurred vision and a difference of>2 dioptres between manifest and cycloplegic retinoscopy.If esotropia and miosis were present,the patients were diagnosed with SNR.All patients underwent visual acuity testing,orthoptic evaluation,assessment of refraction before and after cycloplegia,and dilated fundoscopy.Additional diagnostic investigations,such as neuroimaging,lumbar puncture(LP),electrophysiology and blood tests,were also recorded.Screen use among children was assessed in hours per day.RESULTS:There were 19 female and 3 male patients(age range 7-33 y,median=10 y).Seventeen patients had AS and 5 patients had SNR,with episodic blurry vision and headaches being the most common symptoms.Brain neuroimaging was performed in six patients(27%),although only one had a history of brain trauma.Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy.The majority of patients(90%)reported prolonged daily screen time(>2 h/d),and in 55%of cases there were concurrent social problems or psychological triggers.Treatment consisted of careful explanation of the condition,atropine1%eye drops and full cycloplegic correction by means of bifocal glasses.CONCLUSION:The diagnosis of SNR and AS may be challenging,because symptoms are usually intermittent and nonspecific,and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment,that may exaggerate the underlying psychological disorder.Hence,detailed clinical testing and assessment of psychosocial profile is necessary,in order to avoid unnecessary investigations.Neuroimaging should be performed only in selected cases.Finally,due to prolonged screen use SNR and AS may become more frequent in the future.
文摘Coronary spasm is caused by a transient coronary nar -rowing due to the constriction of epicardial coronary artery, which leads to myocardial ischemia. More than 50 years have passed since the first recognition of coronary spasm, and many findings on coronary spasm have been reported. Coronary spasm has been considered as having pivotal roles in the cause of not only rest angina but also exertional angina, acute coronary syndrome, and heart failure. In addition, several new findings of the mechanism of coronary spasm have emerged recently. The diagnosis based mainly on coronary angiography and spasm provo-cation test and the mainstream treatment with a focus on a calcium-channel blocker have been established. At a glance, coronary spasm or vasospastic angina(VSA) has become a common disease. On the contrary, there are several uncertain or unsolved problems regarding coronary spasm, including the presence of medically refractory coronary spasm(intractable VSA), or an appropriate use of implantable cardioverter defibrillator in patients with cardiac arrest who have been confirmed as having coronary spasm. This editorial focused on coronary spasm, including recent topics and unsolved problems.
文摘The spasm provocation test(SPT) is an important test in the diagnosis of vasospastic angina(VSA). In many cases, this test is performed as the gold standard test, and VSA is considered not present if the SPT is negative. However, some patients continue to experience chest symptoms despite a negative SPT. In this study, we report four cases in which SPT was repeated to evaluate chest symptoms despite the negative results of the first SPT. Two men in their 70 s, one woman in her 60 s, and one woman in her 70 s, all with chest symptoms, underwent a second SPT at 4, 3, 2, and 3 years, respectively, after the first SPT, which was negative. Three patients had positive results in the second SPT(75%). In conclusion, even when SPT is negative, the diagnosis of VSA should be made with clinical symptoms in consideration. In some cases, a second SPT may be required to confirm the diagnosis of VSA.
文摘Objective: Percutaneous coronary intervention (PCI) via the radial artery access has more advantages than that of femoral artery access, while radial or (and) brachial artery have tendency to be spasmodic. We sought to investigate the effectiveness and safety of guiding catheter crossing over spasmodic radial or (and) brachial artery segments by the aid of PCI wire and balloon compared with traditional anti-spasmodic approach. Methods: The clinical data of 168 patients with coronary artery disease (CAD) (group A), whose PCI was performed via radial artery access with radial or (and) brachial artery spasm or (and) dissection and guiding catheter passing through spasmodic segments successfully by the aid of PCI guiding wire and balloon were analyzed retrospectively, simultaneously, the other 73 patients (group B) who used conventional approach to cross over the spasmodic radial or (and) brachial artery segments were treated as the control. The success rate, the time consumption and the complication were compared between the two groups. Findings: There was no significant difference in the spasmodic site between the two groups (all p value > 0.05). The success rate in group A was significantly higher than that in group B (168(100%) vs 28 (38.4%), p (4.2%) vs 14 (19.2%), p Conclusions: It is more effective and safer for guiding catheter crossing over spasmodic or (and) dissected radial or (and) brachial artery segments by the aid of PCI guiding wire and balloon than using the routine approach of administration of anti-spasm drugs for trans-radial PCI.
文摘Vasospasm is a thorny problem often encountered in microvascular surgery.This investigation is dedicated to establishing a model of vasospasm and to evaluating the antispasmodic efficacy of 10 pharmacologic agents under direct monitoring of laser speckle contrast imaging(LSCI).80 SD rats were used.A pair of microsurgical forceps were used to trigger vasospasm of the femoral vessels by blunt dissection.Five minutes later,10 pharmacological agents were dripped to the femoral vessels,after which LSCI was used to collect perfusion images,acquiring the perfusion intensity and the inner caliber of the femoral vessels at multiple time points.
文摘Objective:To observe effects of pricking blood therapy at meridian sinews on upper limb spasm of poststroke patients.Methods:A total of 72 patients with post-stroke upper limb spasm were randomly divided into a comprehensive group of pricking blood therapy at meridian sinews with rehabilitation training(comprehensive group)and the simple rehabilitation training group(rehabilitation group),and there were 36 patients in each group.On the basis of routine therapy,the patients of the two groups received rehabilitation therapy for 6 consecutive days and 1-day rest,for 4 weeks in total.On the above basis,the patients in the comprehensive group received pricking blood therapy at meridian sinews,once every other day,3 times per week,for 4 weeks in total.Before treatment,after the first treatment,and after 4-week treatment,the patients were observed for changes of upper limb spasticity(Modified Ashworth Scale,MAS),upper limb movement function(Fugl-Meyer Assessment,FMA),activity of daily living(Modified Barthel Index,MBI),and biceps and triceps integrated electromyogram(IEMG)values were observed as well as the therapeutic effects.Results:(1)After the first treatment,there were statistically significant differences of the MAS scale grades in patients of the two groups(P<0.05).The FMA scores in the comprehensive group were increased than that before treatment(P<0.05),and the MBI scores of the two groups were increased than those before treatment(both P<0.05).The FMA and MBI scores in the comprehensive group were higher than those of the rehabilitation group(both P<0.05).The biceps and triceps IEMG values were not improved than those before treatment(all P>0.05).(2)After 4-week treatment,there were statistically significant differences of MAS grades in patients of the two groups(P<0.05).The FMA and MBI scores in the two groups were increased than those before treatment(all P<0.05),and the FMA and MBI scores in the comprehensive group were higher than those in the rehabilitation group(both P<0.05).Through comparison of the differences of FMA and MBI scores of the two groups,the difference values in the comprehensive group were higher than those of the rehabilitation group(both P<0.05).The biceps and triceps IEMG values in the two groups were decreased than those before treatment(all P<0.05),and those in the comprehensive group were lower than those in the rehabilitation group(both P<0.05).The biceps and triceps IEMG values in patients of the comprehensive group were higher than those before treatment(both P<0.05).(3)After 4-week treatment,the total effective rate in the comprehensive group was 83.3%(30/36),and that was 58.3%(21/36)in the rehabilitation group.The total effective rate in the comprehensive group was higher than that in the rehabilitation group(P<0.05).Conclusions:The pricking blood therapy at meridian sinews can release affected upper limb flexor muscle spasticity and movement function of the patients with post-stroke upper limb spasm,decrease biceps IEMG values of the affected side,and improve activities of daily living.
文摘We present a case of a 71-year-old male who hadchest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year,and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia,he was admitted to our institution for coronary angiography(CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery(LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm,which was relieved after the intracoronary infusion of nitroglycerin. Finally,a CAG showed myocardial bridging(MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77,which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus,coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia.
文摘We report a case of essential thrombocythemia(ET) in a 30-year-old female who exhibited inferior wall ST-elevation acute myocardial infarction(AMI) without significant obstructive coronary artery disease.Right coronary vasospasm was observed after intra-coronary methylergonovine administration and she received verapamil 120 mg/d thereafter and hydroxyurea 1500 mg/d for thrombocythemia.After discontinuation of the hydroxyurea for 9 mo based on the impression of coronary spasm-related instead of coronary thrombosis-related AMI,her platelet count rose but no chest pain was observed.It is suggested that coronary spasm potentially plays a role in patients with ET,AMI and no significant coronary artery stenosis.
文摘Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression(MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD(such as lateral spread response,brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.
文摘Objective.To introduce the properties of Chinese type A botulinum toxin(CBTXA,made by Lanzhou Institute of Biological Products),and its long?term effect for focal dystonia and hemifacial spasm.Method.The purity and recovery of crude and crystalline toxin were tested.Long?term data from305patients with hemifacial spasm(HFS),blepharospasm(BS)and cervical dystonia(CD)were evalu-ated and subgroups of patients received CBTXA injections between1994and2000in at least six sepa-rate treatment sessions,with follow up for2～8years.The therapeutic results of the last session CBTXA injections were analyzed in comparison with the first session.Result.CBTXA purity was high[(2.55～2.60)×10 7 LD50/mgPr ,A260/A280≤0.55,high molecular substance accounted for99.2%of total proteins].Long term treatment with CBTXA in patients with focal dystonia and HFS was not associated with any decline in benefit,and efficacy may improve slightly with repeat treatments.CBTXA is an excellent long-term treatment of HFS,BS and CD.Conclusion.We conclude that Chinese type A botulinum toxin is of botulinum toxin therapy quality standard according to results obtained from the basic study and long?term clinical applications.The re?injection of CBTXA significantly improves the quality of life of most patients and is a safe,effective and comparatively economical treatment for patients with focal dystonia and HFS.
文摘BACKGROUND Coronary artery spasm(CAS)is a rare but critical condition during surgery.Clinical manifestations can vary from only subtle electrocardiography change to sudden death.In this case report,we present the case of a patient with myasthenia gravis(MG)who developed refractory CAS-related cardiogenic shock during thymoma surgery.CASE SUMMARY A 61-year-old man had a history of cigarette smoking and coronary artery disease with a bare metal stent placed.Three months ago,he suffered from coronary spasms,with three vessels involved,after surgery for cervical spine injury.He started having progressive dysphagia 4 wk prior and was diagnosed with MG via serologic tests,and computed tomography declared a thymoma in the anterior mediastinum.After the symptoms of MG subsided,he was referred for thy-mectomy.The operation was uneventful until the closing of the sternal wound.Electrocardiography showed sudden onset ST elevation,followed by ventricular tachycardia and severe hypotension.Cardiopulmonary cerebral resuscitation was initiated immediately with electrical defibrillation,extracorporeal membrane oxygenation was performed due to refractory cardiogenic shock,and the patient was transferred to an angiography room.Angiography showed diffuse CAS with three vessels involved.Intracoronary isosorbide dinitrate and adenosine were administered,and then the patient was transferred to the intensive care unit.CONCLUSION Our case highlights the importance of being prepared for clinical situations such as the one described here and suggests the necessity of developing an appropriate anesthesia plan that includes proactive analgesia and preemptive coronary vaso-dilators.
基金Supported by the National Natural Science Foundation of China,No. 82000252
文摘BACKGROUND Acute stent thrombosis(AST)is a serious complication of percutaneous coronary intervention(PCI).The causes of AST include the use of stents of inappropriate diameters,multiple overlapping stents,or excessively long stents;incomplete stent expansion;poor stent adhesion;incomplete coverage of dissection;formation of thrombosis or intramural hematomas;vascular injury secondary to intraoperative mechanical manipulation;insufficient dose administration of postoperative antiplatelet medications;and resistance to antiplatelet drugs.Cases of AST secondary to coronary artery spasms are rare,with only a few reports in the literature.CASE SUMMARY A 55-year-old man was admitted to the hospital with a chief complaint of back pain for 2 d.He was diagnosed with coronary heart disease and acute myocardial infarction(AMI)based on electrocardiography results and creatinine kinase myocardial band,troponin I,and troponin T levels.A 2.5 mm×33.0 mm drugeluting stent was inserted into the occluded portion of the right coronary artery.Aspirin,clopidogrel,and atorvastatin were started.Six days later,the patient developed AST after taking a bath in the morning.Repeat coronary angiography showed occlusion of the proximal stent,and intravascular ultrasound showed severe coronary artery spasms.The patient’s AST was thought to be caused by coronary artery spasms and treated with percutaneous transluminal coronary angioplasty.Postoperatively,he was administered diltiazem to inhibit coronary artery spasms and prevent future episodes of AST.He survived and reported no discomfort at the 2-mo follow-up after the operation and initiation of drug treatment.CONCLUSION Coronary spasms can cause both AMI and AST.For patients who exhibit coronary spasms during PCI,diltiazem administration could reduce spasms and prevent future AST.
文摘Objective To study the immunoreactivity of Calcitonin gene-related peptide (CGRP) in the facial nerve when Hemifacial Spasm is occurring. Methods The electrophysiological technique was used to explore abnormal muscle response (AMR) which was characteristic of Hemifacial Spasm.The animal models of Hemifacial Spasm in New Zealand white rabbits were established by compressing the main trunk of artificial demyelinated facial nerve with the temporal superficial artery. At 6 weeks after surgery, the facial nerves were taken from the experimental group and control one, the immunohistochemistry for CGRP using polyclonal antibody with ABC kit was performed in the facial nerves; at the same time, the observation for the facial nerves of light and transmission electron microscope was performed. Results The facial nerve demyelinated and the axons retrogressively changed, CGRP immunoreactive positive fibers were significantly detected in experimental groups; whereas this phenomenon was not found in control group. Conclusion CGRP can nutrien the injured facial nerve and plays an important role in the pathogenesis of Hemifacial Spasm.
文摘Facial spasm is a frequently seen dis-ease characterized by unilateral involuntaryirregular twitching of the facial muscles.This disorder may be induced by intoxica-tion,infection,trauma and long-term facialparalysis which was not properly treated.
文摘BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.
