Nonbacterial thrombotic endocarditis with underlying ovarian carcinoma resolving with oncologic treatment.

The treatment of nonbacterial thrombotic endocarditis consists of anticoagulation, surgical consideration and treatment of the underlying disease, most commonly lupus or malignancy. We report a case of nonbacterial thrombotic endocarditis presumably caused by underlying ovarian carcinoma that was controlled with anticoagulation and resolved with chemotherapy and surgical resection of the malignancy.

Study of New Mini-Channel Trans-Critical CO2 Heat Pump Gas Cooler.

A gas cooler is one of the important parts of a carbon dioxide (CO2) heat pump water heater, and it must meet the needs of not only pressurization but also heat transfer. It is important to study gas coolers. In this paper, a heat exchanger with a spiral channel is studied. ANSYS CFX software was used to analyze the flow and heat transfer characteristics of the heat exchanger (single-plate model). The influences of the cooling pressure of CO2, the mass flux of CO2, the mass flux of water and the channel radius of CO2 are discussed. In this paper, the results show that the cooling pressure of CO2, the mass flux of CO2 and the channel radius of CO2 all have a large influence on the local heat transfer coefficient: with an increase in the cooling pressure of CO2, the peak value of the heat transfer coefficient of CO2 decreases and the average heat transfer coefficient decreases; with an increase in the mass flux of CO2, the peak value of the heat transfer coefficient of CO2 increases and the average heat transfer coefficient increases; and with a decrease in the channel radius of CO2, the peak value of the heat transfer coefficient of CO2 increases. The water mass flux has only a slight effect on heat transfer, and the lower cooling pressure of CO2 corresponds to a higher peak heat transfer coefficient, which can reach 27.5 kW∙m-2∙K-1 at 9 MPa.

C1R, CCL2, and TNFRSF1A Genes in Coronavirus Disease-COVID-19 Pathway Serve as Novel Molecular Biomarkers of GBM Prognosis and Immune Infiltration.

Glioblastoma multiforme (GBM) is a prevalent intracranial brain tumor associated with a high rate of recurrence and treatment difficulty. The prediction of novel molecular biomarkers through bioinformatics analysis may provide new clues into early detection and eventual treatment of GBM. Here, we used data from the GTEx and TCGA databases to identify 1923 differentially expressed genes (DEGs). GO and KEGG analyses indicated that DEGs were significantly enriched in immune response and coronavirus disease-COVID-19 pathways. Survival analyses revealed a significant correlation between high expression of C1R, CCL2, and TNFRSF1A in the coronavirus disease-COVID-19 pathway and the poor survival in GBM patients. Cell experiments indicated that the mRNA expression levels of C1R, CCL2, and TNFRSF1A in GBM cells were very high. Immune infiltration analysis revealed a significant difference in the proportion of immune cells in tumor and normal tissue, and the expression levels of C1R, CCL2, and TNFRSF1A were associated with immune cell infiltration of GBM. Additionally, the protein-protein interaction networks of C1R, CCL2, and TNFRSF1A involved a total of 65 nodes and 615 edges. These results suggest that C1R, CCL2, and TNFRSF1A may be used as molecular biomarkers of prognosis and immune infiltration in GBM patients in the future.

Incremental Value of Global Longitudinal Strain for Predicting Survival in Patients With Advanced AL Amyloidosis.

BACKGROUND: Advanced light-chain (AL) amyloidosis is associated with poor prognosis, with a 5-year survival rate of <25%. Prognostication is based on the revised Mayo (rMayo) staging according to serum cardiac biomarkers. OBJECTIVES: This study sought to determine whether global longitudinal strain (GLS) can provide incremental prognostic value in patients with advanced disease. METHODS: Baseline (pre-treatment) clinical, 2-dimensional echocardiogram with GLS and laboratory data were collected prospectively in 94 patients with newly diagnosed AL amyloidosis with rMayo stage III or IV disease. Overall survival (OS) was defined as time from baseline echocardiography to death. RESULTS: Of 94 patients, 60% (n = 56) had rMayo stage III and 40% (n = 38) had stage IV disease. Ninety of the 94 patients underwent plasma cell-directed therapy. The median left ventricular ejection fraction (LVEF) was 60%, and the median GLS was 13.2%. Of 94 patients, 64 died during follow-up. The median OS was 11.2 months, with an estimated 5-year OS of 21%. In univariable analysis, brain natriuretic peptides, GLS, LVEF, E/e' ratio, and rMayo stage were significantly associated with OS. In Cox regression, GLS provided incremental value over brain natriuretic peptide, troponin, and LVEF for predicting OS. Patients with GLS < -14.2% had a corresponding median OS and 5-year OS rate of 33.2 months and 39%, respectively, versus 7.7 months and 6% for those with GLS ≥ -14.2%. This difference was maintained despite further stratification by rMayo stage. CONCLUSIONS: Baseline GLS is an independent predictor of OS beyond the circulating biomarkers and can identify groups with different survival outcomes beyond the Mayo Staging.

Cardiovascular and Metabolic Effects of Androgen-Deprivation Therapy for Prostate Cancer.

Androgen-deprivation therapy (ADT) entails lowering serum testosterone levels to castrate levels and forms a cornerstone of the management of hormone-sensitive advanced prostate cancer; however, the benefit of ADT is partially offset by its detrimental metabolic and cardiovascular adverse effects. ADT decreases insulin sensitivity while promoting dyslipidemia and sarcopenic obesity, which leads to an increased risk of cardiovascular morbidity and potentially mortality. The risk seems to be highest in elderly patients who have had recent cardiovascular events before starting ADT. It is prudent to engage in an individualized risk-benefit discussion and develop a cohesive multidisciplinary management plan to medically optimize and closely observe these patients before and during treatment with ADT.

[Safety and efficacy of L-carnitine and tadalafil for late-onset hypogonadism with ED: a randomized controlled multicenter clinical trial].

OBJECTIVE: To evaluate the safety and effect of L-carnitine combined with tadalafil in the treatment of late-onset hypogonadism (LOH) with erectile dysfunction (ED). METHODS: We randomly divided 140 cases of LOH with ED aged 40 -70 years into a treatment and a control group to receive L-carnitine + tadalafil and testosterone undecanoate + tadalafil, respectively. After 8 weeks of treatment, we obtained the scores on IIEF-5 and Aging Male Symptoms (AMS), observed changes in the levels of sex hormones, analyzed the results of the routine blood test and PSA level, and evaluated the safety of medication. RESULTS: Finally, 110 cases were included, 60 in the treatment group and 50 in the control. After 8 weeks of medication, the IIEF-5 and AMS scores were significantly improved as compared with the baseline both in the treatment group (17.7 +/- 3.5 vs 10.2 +/- 2.7 and 36.2 +/- 6.5 vs 48.8 +/- 5.8) and in the control group (16.7 +/- 2.6 vs 9.3 +/- 2.4 and 35.8 +/- 6.6 vs 50.7 +/- 5.0) (both P < 0.05), with no significant differences between the two groups (P > 0.05). As for the safety of medication, there were no significant differences between the two groups before and after treatment (P > 0.05). Two patients in the control group showed a PSA level > 4 microg/L, which was confirmed to be caused by prostatitis during follow-up. CONCLUSION: L-carnitine combined with tadalafil is safe and effective for the treatment of LOH with ED.

[Effect of preemptive analgesia with flurbiprofen axetil on patient-controlled intravenous analgesia with tramadol in patients undergoing postburn plastic surgery].

OBJECTIVE: To observe the preemptive analgesic effect of flurbiprofen axetil for post-operative pain relief. METHODS: Sixty ASA class I or II patients undergoing postburn plastic surgery were randomly assigned into two groups to receive intravenous administration of 100 mg flurbiprofen axetil (group F, n=30) and 10 ml intravenous saline (group C, n=30) 30 min before surgery. After the operation, all the patients received patient-controlled intravenous analgesia (PCIA) with tramadol for pain relief. The postoperative analgesic effect was assessed by visual analog scales (VAS) at 1, 2, 4, 8, 12 and 24 h after surgery, with tramadol requirements and the adverse effects were recorded. RESULT: At 1, 2, 4, and 8 h after the operation, the patients in group F showed significantly lowered VAS scores as compared with the patients in group C (P<0.05). The requirement of tramadol was also significantly less in group F than in group C (182.9-/+37.4 vs 227.3-/+49.8 mg, P<0.05). No significant difference was found in the adverse effects between the two groups. CONCLUSION: Flurbiprofen axetil can produce preemptive analgesia and reduce the tramadol dose during postoperative PCIA in patients undergoing postburn plastic operations.

[Strontium-89: a desirable therapeutic for bone metastases of prostate cancer].

OBJECTIVE: To evaluate the efficacy of strontium-89 (89Sr) in the treatment of painful bone metastases of prostate cancer. METHODS: A total of 116 patients with painful bone metastases of prostate cancer received bilateral orchiectomy and incretion, followed by intravenous injection of 89Sr at the dose of 1.48-2.22 MBq (40-60 microCi)/kg. The clinical effects were evaluated by follow-up analysis. RESULTS: After the 89Sr treatment, appetite and sleep were evidently improved in 33.6% and 56.0% of the patients respectively, the applied dose of anodyne reduced in 61.2%, pain alleviated in 83.6%, with an absolute palliation rate of 24.1%. Pain relief started at 3-21 (10.2 +/- 6.5) days and lasted 3-12 (5.3 +/- 2.2) months. Flare ache occurred in 31.9% of the patients. Compared with pre-treatment, the mean score on Karnofsky's performance status (KPS) was 20.0% higher, and the WBC count decreased to 3.0-3.9 x 10(6)/L in 18.1% of the patients. Whole body bone scintigraphy of 53 followed-up patients showed that 39 (73.6%) of them exhibited an obvious decrease in the number of metastases, 10 (18.9% remained in a stabilized state and only 4 (7.5% deteriorated. CONCLUSION: 89Sr, capable of inhibiting bone metastasis, palliating pain and improving the quality of life with few adverse effects, can be used as a desirable therapeutic for painful bone metastases of prostate cancer.

Effect of patient-controlled epidural analgesia for pain relief after thymectomy in patients with myasthenia gravis.

OBJECTIVE: To evaluate the effect of patient-controlled epidural analgesia (PCEA) with ropivacaine or bupivacaine in relieving pain after thymectomy in patients with myasthenia gravis. METHODS: Twenty adult ASA I-II patients with myasthenia gravis were randomized to receive either 0.125% ropivacaine (Group R, n=10) or 0.125% bupivacaine (Group B, n=10) with a PCEA device after transsternal thymectomy. PCEA (continuous infusion at 1 ml/h, bolus dose of 4 ml and lockout time of 30 min) was implemented via an epidural catheter inserted in the T3-4 intervertebral space. The vital signs and visual analogue scale (VAS), together with cumulative consumption (CC) of ropivacaine or bupivacaine were recorded within 48 h postoperatively. RESULTS: The vital signs, including systolic and diastolic blood pressure, heart rate, SpO2, pH and PaCO2, did not show any significant differences between the 2 groups. The CC of the local anesthetic was significantly higher in group R than that in group B at 24 and 48 h postoperatively, but VAS were not significantly different between the 2 groups which was less than 4 in both groups. CONCLUSIONS: PCEA with low concentration of ropivacaine or bupivacaine may provide effective and safe analgesia after transsternal thymectomy.