Afferent baroreflex failure (ABF) is a rare disease. It refers to the clinical syndrome caused by the impairment of the afferent limb of the baroreflex or its central connections at the level of the medulla. The recognized causes include trauma, surgery in related areas (radical neck tumor surgery, carotid endarterectomy), neck radiotherapy, brain stem stroke, tumor growth paraganglioma and hereditary diseases, among which the most common cause is extensive neck surgery or radiotherapy for neck cancer. The main manifestations are fluctuating hypertension, orthostatic hypotension, paroxysmal tachycardia and bradycardia. This case is a young man, whose main feature is blood pressure fluctuation, accom-panied by neurogenic orthostatic hypotension (nOH). After examination, the common causes of hypertension and nOH were ruled out. Combined with the previous neck radiotherapy and neck lymph node dissection, it was considered that the blood pressure regulation was abnormal due to the damage of carotid sinus baroreceptor after radiotherapy for nasopharyngeal carcinoma and neck lymph node dissection, which was called ABF. At the same time, the patient was complicated with chronic hyponatremia. Combined with clinical and laboratory examination, the final consideration was caused by syndrome of in- appropriate antidiuretic hormone (SIADH). Baroreceptors controlled the secretion of heart rate, blood pressure and antidiuretic hormone through the mandatory "inhibition" signal. We speculate that the carotid sinus baroreceptor was damaged after neck radiotherapy and surgery, which leads to abnormal blood pressure regulation and nOH, while the function of inhibiting ADH secretion was weakened, resulting in higher ADH than normal level and mild hyponatremia. The goal of treating ABF patients was to reduce the frequency and amplitude of sudden changes in blood pressure and heart rate, and to alleviate the onset of symptomatic hypotension. At present, drug treatment is still controversial, and non-drug treatment may alleviate some patients' symptoms, but long-term effective treatment still needs further study. The incidence of ABF is not high, but it may lead to serious cardiovascular and cerebrovascular events, and the mechanism involved is extremely complicated, and there are few related studies. The reports of relevant medical records warn that patients undergoing neck radiotherapy or surgery should minimize the da-mage to the baroreceptor in the carotid sinus in order to reduce the adverse prognosis caused by complications.

本文报道1例87岁男性患者因新型冠状病毒感染(重型)入院,给予地塞米松联合巴瑞替尼治疗.用药4 d后患者突然无尿,肌酐上升,临床药师考虑为巴瑞替尼引起的急性肾损伤.停用巴瑞替尼并给予补液和利尿治疗,停用7 d后,患者肌酐及尿量恢复至正常范围,后患者未再重启巴瑞替尼治疗.临床药师应参与到临床用药全过程,严密监测,及时发现药品不良反应的发生,并给予正确的处理方案,保障患者的用药安全.

Acute obstruction of the right coronary artery（RCA） can lead to right ventricular myocardial infarction（MI）, which rarely lead to cardiogenic shock（CS）. Hemodynamic stability could be restored through fluid resuscitation and vasoactive drugs in most circumstances. Here,we present a highly representative case of refractory CS caused by massive right ventricular MI with apical aneurysm formation, who was successfully treated with extracorporeal membrane oxygenation（ECMO）post severe complication of acute right coronal dissection.

To evaluate the effect of age and parity on maternal cardiac diastolic function in second trimester among pregnant women with normal left ventricular ejection fraction. To analyze the correlation between impaired diastolic function and pre-eclampsia. It had been suggested that maternal cardiac adaptations during pregnancy differed between nulliparous and primiparous women and also varied according to age. Impaired cardiac function may precede pre-eclampsia. Therefore, we examined the effects of parity and age on cardiac diastolic function during pregnancy and whether impaired diastolic function during the second trimester correlates with pre-eclampsia. Women with singleton pregnancies at 13 + 0 to 27 + 6 weeks’ gestation and left ventricular ejection fraction (LVEF) ≥ 50% were retrospectively identified. Diastolic function parameters were assessed using transthoracic echocardiography. Pre-eclampsia was identified from medical records. The effect of age and parity on maternal cardiac diastolic function as well as the correlation between impaired diastolic function and occurrence rate of pre-eclampsia were examined. 376 pregnant women were included (median age: 30 years; median gestational age: 14 weeks; 171 primiparous women). LVEF was 66%. Impaired cardiac diastolic function was seen in 7.8% of pregnant women < 35 years compared with 28.6% of those ≥ 35 years (p = 0.000). ROC curve showed women with maternal age over 32 began to have a higher rate of impaired cardiac diastolic function (AUC = 0.704, p = 0.000, sensitivity = 54.5%, specificity = 75.3%). There was no difference in diastolic function indices between maternal women grouped by parity. Higher maternal age was an independent risk factor of declining Em (p < 0.05). Em < 13 cm/s was significantly associated with pre-eclampsia occurrence (HR 8.56; 95% CI 3.40–21.57) after being adjusted for confounders. Maternal age is an independent risk factor for diastolic function decline. There is no difference in cardiac diastolic function between nulliparous women and primiparous women. Pre-eclampsia occurrence is significantly higher in patients with impaired diastolic function at mid-gestation. The application of risk grading using diastolic function at mid-gestation may improve the survival outcomes of pregnant women.

目的 了解心力衰竭高危人群对心力衰竭的认知情况以及心力衰竭知识讲座提高认知水平的作用.方法 2019年6月至12月北京大学第三医院心力衰竭防治小组针对心力衰竭高危人群举办心力衰竭知识讲座6次,参加人员为心力衰竭A期和B期患者,共420例.在知识讲座前和讲座后,分别进行心力衰竭认知的问卷调查.心力衰竭的认知包括心力衰竭的病因、严重程度、临床表现、就诊和自我管理等5个方面的内容.结果 回收问卷363份,最终合格的问卷为345份,有效回收率为82.14％.心力衰竭高危患者对心力衰竭的认知存在很大不足,能够将问卷列出的8种导致心力衰竭的疾病均选择正确者为54例(15.7％);能够将问卷列出的5个心力衰竭临床表现均选择正确者为66例(19.1％);仅有205例(59.4％)患者表示出现了心力衰竭的症状,会尽早就诊;自我管理方面,只有128例(37.1％)患者认为应该限制饮水量,98例(28.4％)患者认为应该避免感染.在知识讲座后,课后得分高于课前,差异有统计学意义(P<0.05).结论 对心力衰竭高危患者进行心力衰竭知识的健康教育非常有必要.

目的:探讨在新冠肺炎突发公共卫生事件情况下,如何保证超声心动图的教学质量.方法:选取2020年2月至4月学习超声心动图学生31名为实验组,均按照PBL与CBL联合教学;使用传统模式教学的2019年同期37名学生为对照组.根据出科考试成绩以及满意度来考核效果.结果:实验组的总分比对照组高,病例诊断中实验组在心肌梗死、心肌病、心包疾病方面显著优于对照组.结论:PBL与CBL联合教学方法在突发公共卫生事件时期对于超声心动图教学是行之有效的方法.

Objective To carry out a cross-section study in community resident by application the 10-year atherosclerotic cardiovascular disease(ASCVD)risk assessment method and then to explore the situation of 4 statin benefit groups.Methods Application of the risk assessment mothod was recommended by ACC/AHA in 2013.A total of 3 516 individuals with integrated data were studied.1 891 individuals were calculated for the 10-year ASCVD risk.Then the distribution of 4 statin benefit groups and the situation of an estimated 10-year ASCVD risk of 7.5％ or higher were respectively found.Results Seven hundred and fifty-one patients were benefited from four statin treatments in the community.There were 418 cases with 10 years the risk of ASCVD more than 7.5％.These people accounted for 21.36％ and 11.89％ of the total number of candidates.In these 10 years the risk of ASCVD≥ 7.5％,60-69 years of age accounted for the highest proportion of 49.1％.The score of ASCVD in males was statistically higher than that in females(P＜0.05).Conclusion The prevalence of statin benefit community individuals and 10-year atherosclerotic ASCVD risk of 7.5％ or higher in adult were very high.The score of risk estimation in male was more serious than in female.

临床见习作为连接理论知识和临床实践的桥梁,在医学生的早期职业生涯中担负着至关重要的作用,如何在有限的见习时间内激发学生的学习兴趣,培养独立思考、综合应用理论知识分析、解决临床问题的能力成为临床教学关键.针对心血管疾病特点,在八年制医学生循环系统临床见习阶段采取心内科联合心外科的CBL教学模式,为心血管疾病的临床教学提供新的思路,提高了学生对心血管专业知识的兴趣,促进学生最大程度获取直接临床经验以及带教老师的间接经验,利于学生横向及纵向的宏观临床思维能力形成,同时节约了教学时间成本.

Objective To investigate the clinical significance of echogenic intracardiac foci (EIF) in fetuses using fetal echocardiography.Methods Echocardiography was performed in the mid-tri-mester of pregnancy.When the EIF that was found in fetuses,the position,size,number and the complication of cardiac abnormalities were recorded simultaneously.All the fetuses were followed up.Results 323 cases of fetuses with EIF were found,265 cases of them were found in the left ventricle.47 cases of them were found in the right ventricle.11 cases of them were found in both ventricles.All of the cases had no fetal congenital heart diseases,fetal arrhythmia or other fetal malformation.Fetal EIF disappeared or weakened in resonance in the following-up study.Conclusion Echocardiography reveal that most of the EIT is temporary.The presence of EIF in fetuses cannot be used as an indication for abortion

心肌炎(myocarititis)是指由于各种原因引起的心肌炎性病变.感染、自身免疫性疾病、物理化学因素等均可以引起心肌炎症.心肌炎临床表现各异,轻症患者可无任何症状,而重症患者可发生心力衰竭、心源性休克甚至猝死.心肌炎中以病毒性心肌炎最常见,除了经典的柯萨奇B组病毒感染,近年来巨细胞病毒(cytomegalovirus,CMV)心肌炎日益受到重视.本文将对CMV感染及由其导致的心肌炎的临床相关文献进行综述.

Objective To understand thedemand forthe knowledge in cardiology of doctors from other departments, and to provide ideas and basis for the future reform of continuing medical education. Methods We surveyed 1 109 consultations with cardiologists in Peking University Third Hospital from May 1st to August 31th, 2013. The department distributions and the reasons for the consultations with cardiologists were collected, and the differences between surgical and nonsurgical departments were analysed by using χ2 tests, in order to identify the demands of knowledge among doctors from different departments. Results The numbers of consultations from surgical and nonsurgical departments were 902 (81.3%) and 207 (18.7%) separately. The reasons for the consultations were significantly different between surgical and nonsurgical departments (P<0.001). The most common four reasons for consultations in surgical departments were hypertension, coronary heart disease, arrhythmia and ECG changes, while the reasons in nonsurgical departments were arrhythmia, coronary heart disease, hypertension and heart failure. Conclusion Doctors may need targeted training according to their demands in continuing medical education.

Objective:To explore the effect of home blood pressure(BP) telemonitoring on blood pressure control in middle aged hypertensive patients.Methods:Fifty-nine serve teachers (35y ≤ age ＜ 60y) with hypertension were non-randomized divided into control group(25 cases) and telemonitoring group(34 cases).Patients in control group were treated with usual care including life-style change and medicine therapy.Intervention patients received home BP telemonitoring and transmitted BP data to doctors who adjusted therapy through short messages except above mentioned normal treatment.After 12 months follow-up,changes in life-mode,BP levels,control rates and treatment condition were compared between the two groups.Results:A total of 4 224 BP measurements were taken in the telemonitoring group corresponding to (124.24 ±20.18) readings per patient per year and (2.34 ±0.38) per patient per week.Frequency for measurement decreased with time.Mean time of BP control was 12.5 d.Messages contacts equaled to (13.29 ± 0.87) per patient per year(452 in total).When compared with control group,rate of favorite salt (14.7％ vs.40.0％,P ＜ 0.05) and exercise (67.6％ vs.44.0％,P ＜ 0.01) in telemonitoring group were statistically improved at the end of 12 months.The mean BP values deceased in both groups when compared with baseline [control:(131.12 ± 13.97)/(87.72 ±9.23) vs.(139.64 ± 11.88)/(95.00 ± 7.85)mmHg,P＜0.05;telemonitoring:(117.41 ±9.07)/(75.35 ±8.91) vs.(142.88 ±12.93)/(98.44±9.85)mmHg,P ＜ 0.01].Changes in telemonitoring group were significant more than the other(P ＜ 0.01).Scores of MINICHAL questionnaire in telemonitoring group dramatically deceased [(6.44 ±3.60) vs.(8.91 ±4.92),P ＜0.01] and significantly better than those of control group(P ＜ 0.01).The control rates of hypertension(97.1％ vs.48.0％,P ＜ 0.01) and the frequency in drug changes were statistically increased [(1.12 ± 0.23) vs.(0.52 ± 0.14),P ＜ 0.01] when compared with control group.Conclusion:Home blood pressure telemonitoring can effectively decrease BP in middle aged hypertensive patients and achieve better life mode,life quality,BP control rate during 12 months of intervention.

Objective To explore the relation between plasma homocysteine (Hcy) and carotid athero-sclerosis in elderly people. Method 766 elderly people who took physical examination in Beijing Jiaotong University Community Health Center from January 2015 to June 2015 were prospectively investigated in this study, they were divided into normal group (n=555) and elevated group (n=211) according to their levels of plasma Hcy. Carotid artery ultrasounds were performed. Result The mean total plasma Hcy was statistically higher in elevated group than normal group [(20.38±6.92) μmol/L ： (11.40±2.02) μmol/L, P=0.000].Carotid plaques were detected in 578 individuals and stenosis were found in 47 individuals.The prevalence of intima-media thickness (IMT) increase and bilateral plaques in elevated group were significantly higher than those of normal group (59.7%：50.3%, P=0.019; 53.6%： 44.7%, P=0.040). The frequency of IMT-increase and carotid stenosis were higher in males than females (63.9%：41.3%, P=0.000; 8.7%：3.5%, P=0.003). Conclusion Carotid plaques are widely detected in elderly people. Carotid atherosclerosis is more serious with increasing Hcy levels. Worse condition of carotid atherosclerosis is found in male.

Objectives: To measure plasma catestatin levels in patients with acute coronary syndrome and investigate whether there is an association between catestatin levels and long-term outcome. Methods: Patients (n = 170) with suspected acute coronary syndrome who underwent emergency coronary angiography were enrolled, including 46 with acute ST-segment elevation myocardial infarction (STEMI), 89 with unstable angina pectoris (UAP), and 35 without coronary artery disease (CAD). All patients were followed for 2 years to measure the occurrence of major adverse cardiovascular events (MACEs), including death from a cardiovascular cause, recurrent acute myocardial infarction, or hospital admission for heart failure or revascularization. Results: On average, the plasma catestatin levels in patients with STEMI (0.80 ± 0.62 ng/ml) and UAP (0.99 ± 0.63 ng/ml) were significantly lower than the levels seen in the control group with no evidence of CAD (1.38 ± 0.98 ng/ml; p = 0.001). In multivariable linear regression, body mass index, presence of hypertension, and type of CAD were independently related to the plasma catestatin level. However, there were no significant differences in MACEs between patients with high and low levels of catestatin. Conclusions: The plasma catestatin levels in patients with STEMI and UAP were lower than the levels seen in patients without CAD.

As anorexia patients always go to the psychiatric clinic, little is concerned about the occurrence of sinus bradycardia in these patients for cardiologists and psychiatrists. The aim of this paper is to discuss the relationship between anorexia and sinus bradycardia, and the feature analysis, differential diagnosis and therapeutic principles of this type of sinus bradycardia. We report a case of sinus bradycardia in an anorexia patient with the clinical manifestations, laboratory exams, auxiliary exams, therapeutic methods, and her prognosis, who was admitted to Peking University Third Hospital recently. The patient was a 19-year-old female, who had the manifestation of anorexia. She lost obvious weight in a short time (about 15 kg in 6 months), and her body mass index was 14.8 kg/m(2). The patient felt apparent palpitation, chest depression and short breath, without dizziness, amaurosis or unconsciousness. Vitals on presentation were notable for hypotension, and bradycardia. The initial exam was significant for emaciation, but without lethargy or lower extremity edema. The electrocardiogram showed sinus bradycardia with her heart rate being 32 beats per minute. The laboratory work -up revealed her normal blood routine, electrolytes and liver function. But in her thyroid function test, the free thyroid (FT) hormones 3 was 0.91 ng/L (2.3-4.2 ng/L),and FT4 was 8.2 ng/L (8.9-18.0 ng/L), which were all lower; yet the thyroid stimulating hormone (TSH) was normal 1.48 IU/mL (0.55-4.78 IU/mL). Ultrasound revealed her normal thyroid. Anorexia is an eating disorder characterized by extremely low body weight, fear of gaining weight or distorted perception of body image, and amenorrhea. Anorexia patients who lose weight apparently in short time enhance the excitability of the parasympathetic nerve, and inhibit the sympathetic nerve which lead to the appearance of sinus bradycardia, and functional abnormalities of multiple systems such as hypothyroidism. But this kind of sinus bradycardia and hypothyroidism have good prognosis. And asymptomatic sinus bradycardia with reversible causes, because of the great prognosis, they do not need special treatment. Multiple medical and psychiatric disciplines were consulted, and then, family care, nutritional support and psychiatric therapy were given, and she did not need thyroid hormone replacement therapy. The patient's overall clinical status improved gradually during her hospital stay and her heart rate was recovered to 55 beats per minute.

Background Growth differentiation factor (GDF)-15, a divergent member of the transforming growth factor beta super-family does appear to be up-regulated in response to experimental pressure overload and progression of heart failure (HF). HF frequently develops after myocardial infarction (MI), contributing to worse outcome. The aim of this study is to assess the correlation between GDF-15 levels and markers related to collagen turnover in different stages of HF. Methods The study consists of a cohort of 179 patients, including stable angina pectoris patients (AP group, n = 50), old MI patients without HF (OMI group, n = 56), old MI patients with HF (OMI-HF group, n = 38) and normal Control group (n = 35). Both indicators reflecting the synthesis and degradation rates of collagen including precollagen I N-terminal peptide (PINP), type I collagen carboxy-terminal peptide (ICTP), precollagen III N-terminal peptide (PIIINP) and GDF-15 were measured using an enzyme-linked inmunosorbent assay. Results The plasma GDF-15 level was higher in OMI-HF group (1373.4 +/- 275.4 ng/L) than OMI group (1036.1 +/- 248.6 ng/L), AP group (784.6 +/- 222.4 ng/L) and Control group (483.8 +/- 186.4 ng/L) (P < 0.001). The indicators of collagen turnover (ICTP, PINP, PIIINP) all increased in the OMI-HF group compared with Control group (3.03 +/- 1.02 mu g/L vs. 2.08 +/- 0.95 mu g/L, 22.2 +/- 6.6 mu g/L vs. 16.7 +/- 5.1 mu g/L and 13.2 +/- 7.9 mu g/L vs. 6.4 +/- 2.1 mu g/L, respectively; P < 0.01). GDF-15 positively correlated with ICTP and PIIINP (r = 0.302, P < 0.001 and r = 0.206, P = 0.006, respectively). GDF-15 positively correlated to the echocardiographic diastolic indicators E/Em and left atrial pressure (r = 0.349 and r = 0.358, respectively; P < 0.01), and inversely correlated to the systolic indicators left ventricular ejection fraction and the average of peak systolic myocardial velocities (Sm) (r = -0.623 and r = -0.365, respectively; P < 0.01). Conclusion Plasma GDF-15 is associated with the indicators of type I and III collagen turnover.

Objective: To explore the problems and solutions in the communication between residents and their family members. Methods:The doctor-patient communication skills assessment scale, we investigated 182 residents in examination of students.Results:Most of the residents can be polite to call the patient (90.17%) and the system to ask (89.02%), but the information to give as well as to understand the patient's link is not complete.Conclusion:The current situation of doctor-patient communication is not satisfactory.

心肌内血肿(intramyocardial haematoma,IMH)是少见且严重的急性心肌梗死并发症,可以出现在左心室游离壁、室间隔或右心室壁,临床多难以确诊或易发生误诊.本研究分析3例急性心肌梗死并发IMH的患者的超声心动图表现,以提高临床对该病的认识. 1 资料与方法 1.1 一般资料 收集2014年1月-2014年12月于我院住院治疗的急性心肌梗死并发IMH患者3例,男2例,女1例.对3例患者均进行经胸超声心动图检查.患者一般情况见表1.

[ABSTRACT]Objective: To investigate the effect of case based learning(CBL) teaching model in changing postgraduate students’ attitude towards doctor-patient communication skills(DPCS) learning. Methods: CBL teaching model was applied to doctor-patient communication skills learning in postgraduate students from internal medicine department. Communication Skills Attitude Scales(CSAS) were filled in twice both before and after CBL. Results: There was no significant difference between the scores of positive attitude subscale before and after CBL(P>0.05), however, the scores of negative attitude subscale was significantly reduced after CBL(P<0.001). Conclusion:CBL teaching model had changed postgraduate students’ attitude towards DPCS learning.

Background Elevated left ventricular filling pressure (LVFP) is an important cause of exercise intolerance in patients with atrial fibrillation (AF). Exercise stress echocardiography could assess LVFP during exercise. The objective of this study was to investigate the relationship between exercise induced elevation of LVFP and exercise capacity in patients with AF. Methods This study included 145 consecutive patients (81 men and 64 women; mean age 65.5 +/- 8.0 years) with persistent non-valvular AF and normal left ventricular systolic function (left ventricular ejection fraction >= 50%). All patients underwent a symptom-limited cardiopulmonary exercise test (CPET). Doppler echocardiography was performed both at rest and immediately after exercise. Five consecutive measurements of early diastolic mitral inflow velocity (E) and early diastolic mitral annular velocity (e') were taken and averaged. E/e' ratio was calculated. Elevated LVFP was defined as E/e' > 9, and patients with elevated LVFP at rest were excluded. Results Patients were classified into two groups according to LVFP estimated by E/e' ratio after exercise: 39 (26.9%) with elevated LVFP after exercise and 106 (73.1%) with normal LVFP. As compared with patients with normal LVFP, the ones with elevated LVFP after exercise had significantly lower peak oxygen uptake (VO2 peak) (21.7 +/- 2.3 vs. 26.4 +/- 3.8 mL/min per kilogram, P < 0.001), lower anaerobic threshold (19.9 +/- 2.5 vs. 26.0 +/- 4.0 mL/min per kilogram, P < 0.001), and shorter exercise time duration (6.2 +/- 0.8 vs. 7.0 +/- 1.3 min, P < 0.001). Multivariate analysis showed that age, gender and E/e' after exercise were significantly correlated with VO2 peak. Conclusion Elevated LVFP estimated by E/e' ratio after exercise is independently associated with reduced exercise capacity in AF patients.