Multiple organ dysfunction after mitral valve replacement in a patient with systemic lupus erythematosus complicated by Libman-Sacks endocarditis: a case report and literature review.

This case report describes a 47-year-old woman with systemic lupus erythematosus (SLE) complicated by Libman-Sacks endocarditis (LSE) who developed multiple organ dysfunction after mitral valve replacement surgery. The patient presented with a 5-day history of cough, sputum, and fever. Transthoracic echocardiography showed significant vegetations on the mitral valve. Biopsy was performed, and the pathological diagnosis was SLE complicated by LSE. After the mitral valve replacement surgery, the patient developed clinical manifestations of hepatic and renal dysfunction, cardiopulmonary failure, oliguria, and shock. The clinical symptoms significantly improved after administration of mechanical ventilation, continuous renal replacement therapy, plasma exchange, anti-inflammatory and anti-infection treatments, immunomodulatory and immunosuppressive therapies, and low-molecular-weight heparin anticoagulation. Multiple organ dysfunction after mitral valve replacement in patients with SLE complicated by LSE has rarely been reported. This report discusses the clinical manifestations, pathogenesis, and treatment of this severe complication. We hope the sharing of our experience in this case will provide a clinical basis for the treatment of severe multiple organ dysfunction after mitral valve replacement in patients with SLE complicated by LSE.

[Treatment of scapulohumeral periarthritis by Fuyang-pot warming combined with electroacupuncture stimulation].

OBJECTIVE: To observe the clinical therapeutic effect of Fuyang-pot warming combined with electroacupuncture (EA) in the treatment of scapulohumeral periarthritis (SPA). METHODS: A total of 90 cases of SPA patients were randomized into EA, Fuyang-pot warming and EA plus Fuyang-pot warming (combination) groups (n=30 per group). Fuyang-pot warming including pressing, mild moxibustion, scraping-pushing, cupping, tapping, etc. was applied to Fengchi (GB20), Dazhui (GV14), Jianjing (GB21), Jianyu (LI15), Zhongfu (LU1), Ashi-point, etc., and EA (2 Hz /100 Hz,1-1.5 mA) was appled to GB20, GV14, GB21, LI15, Binao (LI14), Tiaokou (ST38), Chengshan (BL57), Ashi-point, etc. The treatment was performed for 30 min every time, once every other day for 2 weeks. The visual analogue scale (VAS, 0-10 points) was used to assess the pain severity. The Constant-Murley shoulder assessment scale (100 points in total, including 15 points in pain severity and 20 points in daily living activities, 40 points in joint motion range, and 25 points in myodynamia) was used to assess the functional state of the shoulder. The rating scale of the American Shoulder and Elbow Surgeons (ASES, 4 grades) was used to evaluate the ability of daily living activities. RESULTS: Following the treatment, intra-group comparison showed that the VAS score was significantly reduced in the three groups in comparison with their own pre-treatment (P<0.01). The total scores of Constant-Murley scale, and scores of activities of daily living and active motion range, myodynamia, and ASES shoulder-joint function were all considerably increased in the three groups in comparison with their own pre-treatment (all P<0.01). The therapeutic effect of EA plus Fuyang-pot warming was significantly superior to that of simple EA and simple Fuyang-pot warming in reducing VAS score and increasing total score of Constant-Murley scale and scores of activities of daily living, active motion range, myodynamia as well as ASES shoulder joint function (P<0.01). Of the 30, 29 and 30 cases in the combination, EA and Fuyang-pot warming groups, 9, 2 and 4 were basically cured, 14, 8 and 12 experienced marked improvement, 4, 12 and 9 were improved, and 3, 7 and 5 failed in the treatment, with the cured plus effective rates being 76.67%, 34.48% and 53.33%, respectively. The cure plus effective rate was apparently higher in the combined treatment group than in the simple EA and simple Fuyang-pot warming groups (P<0.01), but had no significant difference between the simple EA and simple Fuyang-pot warming groups (P>0.05). CONCLUSION: Fuyang-pot warming combined with EA is effective in relieving pain, and enhancing the daily life quality in scapulohumeral periarthritis patients.

[Efficacy observation on refractory insomnia treated with the balance needling therapy].

OBJECTIVE: To observe the difference in the clinical efficacy on refractory insomnia between the balance needling therapy and the conventional acupuncture and verify the effectiveness and practicality of the balance needling therapy. METHODS: Sixty cases were randomized into a balance needling therapy group, a conventional acupuncture group and a placebo group, 20 cases in each one. In the balance needling therapy group, Shi-mian (point for insomnia) was selected with quick needling manipulation. After the arrival of qi, the technique of lifting and thrusting was applied till the radiating numbness presented in the middle or index finnger, thus the needle was removed. In the conventional acupuncture group, Sishencong (EX-HN 1), Shenmen (HT 7) and Sanyinjiao (SP 6) were punctured with the conventional technique. The treatment was given once every day, 7 treatments made one session, 2 sessions were required totally. In the placebo group, starch capsules were prescribed for oral administration before sleep every night, continuously for 14 days. The efficacy and scores of Pittsburgh sleep quality index (PSQI) beforea and after treatment were observed in three groups. RESULTS: PSQI scores were reduced after treatment in every group (both P < 0.01), the scores in the balance needling therapy group and conventional acupuncture group were reduced apparently as compared with those in the placebo group (both P < 0.01). The total effective rate were 90.0% (18/20), 85.0% (17/20) and 15.0% (3/20) in the balance needling therapy group, conventional acupuncture group and placebo group separately. The efficacy in the balance needling therapy group and the conventional acupuncture group was higher obviously than that in the placebo group (both P < 0.01), and the balance needling therapy group had the same efficacy as conventional acupuncture group (P > 0.05). CONCLUSION: The balance needling therapy is safe and effective in the treatment of refractory insomnia and achieves the same efficacy as the conventional acupuncture, which has more simple operation and less pain for the patients and much more considerable practicality in clinic.