Atherosclerosis ndiyo inokonzera chirwere chemwoyo, iyo inoramba iri mutungamiri wepasi rose mukufa.Insulin-like growth factor I (IGF1) yakaratidzwa kuderedza zviitiko zvemwoyo.Kutungamirirwa kweIGF1 yakaderedza atherosclerosis uye kuderedza plaque macrophages muApoE-deficient (Apoe- /-) mbeva dzakadyisa kudya kwemafuta akawanda.Zvedu zvekare mu vitro zvigumisiro zvinoratidza kuti macrophages anoita basa guru mukuyananisa migumisiro yeIGF1 mu atherosclerotic plaques, asi iyo chaiyo nzira inoramba isina kujeka.Takafungidzira kuti kuwedzera zvakasimba IGF1 mazinga mu macrophages aizotora. kudzivirira atherosclerosis.
Mushure mekuberekesa novel macrophage-specific IGF1-overexpressing transgenic mice muApoe-/- background (MF-IGF1 mice), takaongorora atherosclerotic plaque mutoro, kugadzikana, uye monocyte recruitment. mafuta kudya kwemwedzi mitatu.Takaongororawo cholesterol efflux uye foam cell formation mu vivo uye in vitro.
Macrophage IGF1 overexpression yakaderera plaque mutoro ne 30%, yakaderedzwa plaque macrophages ne 47%, uye yakasimudzira zvinhu zvinogadzirisa plaque phenotype.Monocyte recruitment yakaderedzwa ne70% muMF-IGF1 mice uye yakabatana ne27% kuderedza kutenderera kweCXC chemokine ligand 12 (CXCL12) .CXCL12 mapuroteni mazinga akaderedzwa mumaplaques uye peritoneal macrophages muMF-IGF1 mice.In vitro, IGF1 yakavharwa zvachose oxidized low-density lipoprotein (oxLDL) -kuwedzerwa kwekuwedzera kwePCCL12 mRNA% kunyorwa, 9% kunyorwa kweCXL. <0.01), uye IGF1 kurapwa yakaderedza CXCL12 protein (56% kuderedza, P <0.001).
CXCL12 inoderedza kutaura kweATP-binding cassette transporter A1 (ABCA1), yakakosha cholesterol transporter iyo inopindirana cholesterol efflux kubva macrophages.Takawana kuwedzera kwe2-fold muABCA1 protein levels mu peritoneal macrophages yakaparadzaniswa kubva kuMF-IGF1 mice.Takayera kuchinja. mucholesterol efflux nekutakura peritoneal macrophages ne oxLDL uye yakawana kuwedzera kwe42% mumhepo muMF-IGF1 mice.Takawanawo kuwedzera kwe27% mucholesterol efflux muTHP-1 masero anobatwa neIGF1 (100 ng / mL) ne apolipoprotein AI. se cholesterol receptor.
Zvigumisiro zvedu zvinoratidza kuti macrophage IGF1 inoderedza atherosclerosis uye inoderedza CXCL12, chemokine ichangobva kubatanidzwa mu atherosclerosis progression.IGF1 inogona kuderedza CXCL12 nekuderedza kuunganidza monocyte uye kuwedzera ABCA1, zvichiita kuti iite atheroprotective effect, nokudaro ichiwedzera cholesterol efflux simba.
Kuchinja kweTTR gene (rs76992529; Val122Ile) kunoonekwa chete muvanhu veAfrica madzitateguru (population frequency: 3-4%) zvichikonzera kukanganisa kwe tetrameric transthyretin complex, iyo inowanikwa munhaka transthyretin amyloidosis.Degeneration (hATTR) inounganidza seextracellular amyloid fibrils.Kufungidzira kukanganisa kweamyloidogenic TTR musiyano panjodzi yemoyo (HF) uye zvikonzero-zvose-zvinokonzera kufa muboka guru, nzvimbo dzakasiyana-siyana dzeAfrica America zvinogona kupa ruzivo rwekukosha kwekliniki yemhando iyi yakasiyana. .Takaongorora vatori vechikamu vatema muongororo yeGeographic and Racially Different Causes of Stroke (REGARDS) kuti tiongorore kubatanidzwa kweTTR Val122Ile mutation neHF uye kufa kwezvikonzero zvese.
Takaongorora vatori vechikamu vatema vekuAmerica mune yeREGARDS kudzidza pasina HF panguva yekutanga.Poisson regression yakashandiswa kuenzanisa chiitiko chekutadza kwemoyo uye zvese-zvinokonzera kufa.Takashandisa multivariate-yakagadziridzwa Cox regression model accounting yehuwandu hwevanhu, kliniki uye yemagariro. zvinhu, uye dzinza remuAfrica rekuongorora njodzi yeHF uye-zvese-zvinokonzera kufa muvanhu vane TTR Val122Ile genetic variant zvichienzaniswa nevasina musiyano.
Pakati pevatema vanosvika 7,514 (makore epakati: makore 64; 61% vanhukadzi), huwandu hwehuwandu hweTTR Val122Ile musiyano hwaive 3.1% (232 vatakuri; 7,282 vasiri vatakuri). Chiitiko cheHF (pamakore 1000 emunhu) yaive 15.9 (95% CI: 11.5-21.9) pakati pevatakuri vakasiyana-siyana uye 7.2 (95% CI: 6.6-7.9) pakati pekusiyana-siyana kusina kutakura.Val122Ile variant vatakuri vaiva nengozi yakakura yekuvandudza HF kana ichienzaniswa nevasina kutakura (HR: 2.46 [95% CI) :. pakati pevakasiyana vasiri vatakuri.Val122Ile variant vatakuri vaive nengozi yepamusoro yekufa kwezvikonzero zvese zvichienzaniswa nevasiri vatakuri (HR: 1.44 [95% CI: 1.18-1.76]; P = 0.0004) .TTR musiyano wemutakuri mamiriro uye murume kana mukadzi haana kupindirana neHF uye zvese-zvikonzero zvekufa kwemhedzisiro.
Muboka guru revanhu vatema vekuAmerica, tinoratidza kuti amyloid Val122Ile mutation muTTR gene inosanganiswa nenjodzi inosvika 2.5-yakapetwa kaviri yeHF uye njodzi yepamusoro ye40% yekufa kwezvikonzero zvese.Nekuuya kwehATTR dzakawanda. marapirwo, kuvapo kweTTR Val122Ile mutation inowanzowanikwa muvanhu vedzinza remuAfrica inogona kunzi inogona kuitwa nekiriniki uye nekukasika kuwana kurapwa.
Kuitwa kwe guanylate cyclase/natriuretic peptide receptor A (GC-A/NPRA) nemahomoni emwoyo atrial uye brain natriuretic peptides (ANP neBNP) inogadzira mutumwa wechipiri cGMP.cGMP inomutsa kusaina kuzasi uye biological mhedzisiro yeANP/NPRA yediuretic. , diuretic, vasodilatory, antimitotic responses uye cardiac antihypertrophic effects.Kutaura kweNpr1 gene (encoding GC-A/NPRA) kunodzorwa nemaitiro akawanda ekunze uye emukati, asi maitiro ehomoni uye epigenetic anoyananisa mutemo weNpr1 hazvizivikanwi.Chinangwa yechidzidzo ichi chaiva chekuongorora basa revhitamini D (vitD) mukugadzirisa Npr1 gene transcription uye kutaura nekugadzirisa epigenetic zvinhu.
Yedu bioinformatic kudzidza yemurine Npr1 mutsigiri yakaratidza kuvepo kwezvinhu zvina vitD mhinduro (VDREs) mu -583 kusvika -495 nharaunda yenzvimbo yekutanga yekunyora, ine yakakwana VDRE-sekubvumirana kutevedzana. , magadzirirwo acho akachinjirwa kwenguva pfupi mumakonzo thoracic aortic smooth muscle maseru (RTASMCs) uye mbeva mesangial masero (MMCs) uye akayerwa maviri maviri luciferase assay kits.Basa rekunyora.
Luciferase assay yakaratidza kuti kurapwa ne vitamin D3 (1α,25-dihydroxy; VD3) yakawedzera Npr1 kukurudzira basa kupfuura 6-fold in a dose-dependent manner.Western blot uye densitometric analysis yakaratidza kuti NPRA protein mazinga muMMCs akawedzera zvakanyanya nekuwedzera VD3 kusungirirwa, 3.5-fold mu RTASMCs uye 4.7-fold mu RTASMCs, uye mhedzisiro yakakura yakaonekwa pa100 nM.VD3 inowedzera chiyero cheprotein ye vitD receptor (VDR) nenzira inoenderana nedosi.Muhupo hweVD3, histone deacetylase (HDAC) basa raive 50% rakavharwa sezvakayerwa neHDAC basa / inhibition ELISA kit. Uyezve, kurapwa neVD3 yakaderedzwa kirasi I HDAC enzymes, HDAC1 uye HDAC3 mapuroteni mazinga, uye dose-inotenderera inowedzerwa histones, H3 pa lysine residues 9 uye 14 (H3-K9/14 ac) uye lysine H4 pane acid yakasara 12 (H4-K14ac).
Zvigumisiro zvinoratidza kuti VD3 epigenetically inogadzirisa Npr1 gene expression nekugadzirisa histone modifications.Kuzivikanwa kwezvinangwa zvepigenetic zvevhitamini D zviratidzo sevatongi veNpr1 gene transcription uye protein expression ichava nemigumisiro inokosha ye hypertension uye mitemo yemwoyo.
yakaratidza kuti kusungirirwa uye superconductivity kwakavandudza intracellular conduction mumaviri ega ega cardiomyocytes, kuvandudza kubatana uye kuruboshwe ventricular basa.
Miedzo yakaitwa pachishandiswa hungwaru hwekugadzira mukati memasero uchishandisa quantum pfungwa dzekupinda uye superconductivity;intracellular electrical conductance mhiri kwejunctional gap (GI) inokonzerwa neenalapril (E.) uye angiotensin II (Ang II) yakayerwa.E.Jekiseni pa 1 ug / ml (25 ug / ml) pamusoro pemaminitsi 4. Plateau inosvika pavhavha pa 106% inoyerera kubva muhomwe.Ang II. Injected pa 1 ug / min, GI yakaderedzwa (55%) uye kwakanga kusina bani.
Isu tinofunga kuti danda rinosvikwa mushure mekuderedza kusungirirwa, asi kwete neAng II.Mune superconducting state, E. coli yainyanya kushanda pakuvandudza kubatanidzwa kwemyocytes inokundikana, kuvandudza kuruboshwe ventricular basa.
Chirwere cheCoronavirus (COVID-19) chinotangira kubva kuhutachiona hweasymptomatic kuenda kuhurwere hwakanyanya nekutadza kwenhengo dzakawanda. Zvidzidzo zvenguva pfupi yapfuura zvakaratidza kubatana pakati peyakaderera serum lipid mazinga, anoti high-density lipoprotein (HDL), low-density lipoprotein (LDL), uye yakazara. cholesterol (TC), uye COVID-19 kuomarara kwechirwere.Zvisinei, mhedzisiro yacho haina kuenderana, uye huwandu hwemubatanidzwa hauzivikanwe parizvino.
Takaita ongororo yakarongeka uye meta-analysis ye1) misiyano muHDL, LDL, TC, uye triglyceride (TG) mazinga pakati pevarwere veCOVID-19 uye ane hutano anodzora 2) aine uye asina kurwara kwakanyanya neCOVID-19 Murwere 3) COVID- 19 murwere akafa uye akararama.Takasanganisira zvinyorwa kubva kuPubMed neEmbase kubva munaGunyana 1, 2021.Takaongorora iyo yakasanganiswa mean musiyano (pMD) mu lipid mazinga (mg/dL) emapoka ari pamusoro tichishandisa meta-analysis inongoitika. uye yakaongorora kusarura kwekushambadzira uchishandisa funnel plot.
Pazvinyorwa mazana mana nemakumi mana nerimwe zvakatorwa, zvinyorwa makumi maviri nepfumbamwe (26 retrospective cohorts uye vatatu vangangotarisirwa cohorts) zvakasangana nemaitiro ekuisirwa, aine huwandu hwevatori vechikamu 256,721. Varwere vane COVID-19 vaive nemazinga akaderera eHDL (pMD = -6.95) uye TC (pMD -14.9) (Table 1 uye Figure 1) LDL neTG mazinga haana kusiyana pakati pevarwere vane uye vasina COVID-19.Severe COVID-19 varwere vaive nemazinga akaderera eHDL (pMD = -4.4), LDL (pMD = -4.4 ) uye TC (pMD = -10.4) zvichienzaniswa nevarwere vasina kuomarara veCOVID-19. Varwere vakafa vaive nemazinga akaderera eHDL (pMD = -2.5), LDL (pMD = -10.6) uye TC (pMD = -14.9). TG mazinga haana kusiyana nekuoma kana kufa kweCCIDID-19.
Ongororo yedu yakaratidza kuti varwere vane COVID-19 vaive neakaderera eropa lipid mazinga achienzaniswa neane hutano kudzora. kuzvimba uye kusashanda kwechiropa. Ropa lipid mazinga anogona kuongororwa seanogona prognostic zvinhu muCOVID-19 varwere.
Atrial uye brain natriuretic peptides (ANP neBNP) vari kutenderera mahomoni emwoyo yakabva iyo inoita basa rinokosha mukugadzirisa ropa uye fluid homeostasis uye kunatsiridza kugadzirisa kwemwoyo kuburikidza ne vasodilatory uye diuretic effects.Zvose ANP neBNP vanoita nekusunga kune transmembrane guanylate cyclase/natriuretic peptide receptor-A (GC-A/NPR-A) .Systemic disruption yeNpr1 gene (encoding GC-A/NPRA) inoguma nekuremerwa kwehuwandu, hypertension, uye congestive heart failure.Zvisinei, iyo nzira yepasi haina kunyatsozivikanwa. .Chinangwa chechidzidzo ichi chaiva chekuongorora kana Npr1 inobata basa rinokosha mukugadzirisa glucose homeostasis muNpr1 gene-disrupted mice.
Varume vakuru nevakadzi (16-18 mavhiki) Npr1 knockout haplotype (Npr1+/-, 1-kopi), mhuka-musango (Npr1+/+, 2-kopi) uye gene duplication (Npr1+ +/++, 4 -copy) Mbeva vakatsanya kwemaawa 16 uye vakasununguka kuwana mvura.Oral uye intraperitoneal administration yeglucose (2 g / kg body weight) yakaitwa mumakonzo kuti ione oral glucose tolerance test (OGTT) uye intraperitoneal glucose tolerance test (IPGTT) . mazinga akatemerwa nemuswe kubuda ropa pa0, 15, 30, 60, 90, uye 120 maminetsi uchishandisa iyo AlphaTRAK Ropa Glucose Monitoring System (Zoetis Inc, Kalamazoo, MI) . muswe-cuff nzira (Visitech 2000).
Migumisiro yakaratidza kuti mazinga eglucose eropa mu 2-kopi mbeva (OGTT: 101 ± 4 mg / dL) yakawedzera kusvika pakakwirira pamaminitsi e15 mushure meglucose (2 g / kg uremu hwemuviri) kutonga uye yakaderera kusvika pedyo nemazinga ekutanga pamaminitsi e120 muvarume. .uye vakadzi 98 ± 3 mg / dL, IPGT: varume 100 ± 3 mg / dL, vakadzi 97 ± 4 mg / dL), asi mu 1-kopi yemakonzo, mazinga eglucose eropa akaramba akakwirira kunyange mushure memaminitsi e120 (OGTT: varume 244 ± 6 mg / dL, mukadzi 220 ± 4 mg / dL, IPGT: murume 250 ± 5 mg / dL, mukadzi 225 ± 6 mg / dL) achienzaniswa ne2-copy mice.4-copy mice zvakare yakanga yakaderera zvakanyanya mazinga eglucose eropa. Maminitsi 120 (OGTT: 78 ± 3 mg/dL yevarume, 73 ± 2 mg/dL yevakadzi, IPGT: 76 ± 4 mg/dL yevarume uye 70 ± 3 mg/dL yevakadzi).dL) yakaenzaniswa ne2-copy mice.SBP yakanga yakakwirira zvikuru mu 1-kopi mbeva (134 ± 3 mmHg muvarume uye 125 ± 3 mmHg muvakadzi) kupfuura mu 2-kopi mbeva (101 ± 2 mmHg muvarume uye 92 ± 2 mmHg muvakadzi) .Saizvozvowo, 4-kopi mbeva zvakare yakanga yakaderera zvikuru SBP kupfuura 2-kopi mice (85 ± 3 mmHg muvarume uye 78 ± 2 mmHg muvakadzi) . pamwe neIPGTT.
Zviwanikwa zvemazuva ano zvinoratidza kuti Npr1 yakadzivirira zvakanyanya kukwira kwemazinga eglucose eropa zvichitevera dambudziko reglucose uye yakagadziridza kusashivirira kweglucose mumhando dzesango uye gene-yakadzokororwa makonzo, zvichiratidza kuti Npr1 inobata basa rakakosha mukudzora mazinga eglucose uye kurasikirwa kweNpr1 Chiito chinokanganisa zvakanyanya. itsvo uye basa remoyo mumakonzo anochinja.Iri basa rakatsigirwa neNIH grant (HL062147).
Central Arkansas Veterans Healthcare System John L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas
Varwere vane chirwere chisingaperi chetsvo (CKD) uye kwete-ST-segment elevation myocardial infarction (NSTEMI) inomiririra dambudziko guru rekliniki.Chibvumirano pakati pezvidzidzo zvekuongorora uye zvekuongorora hazvizivikanwi. kurapwa kusvika pamwero wakafanana (2) Migumisiro inokonzerwa nemazinga ekushanda kwetsvo here? (3) Nhamba yekufa yakafanana nekurapa zvinodhaka chete mune zvidzidzo zvekuongorora uye zvekuongorora?
Zvidzidzo zvakasarudzwa zvichienderana nemaitiro anotevera: (1) mishumo yakasarudzika kana yekutarisa yevarwere vane NSTEMI uye CKD (2) nhamba yevarwere uye kufa kunowanikwa kune invasive uye inochengetedza kurapwa padanho rega rega renal basa, kusanganisira inofungidzirwa glomerular filtration rate (eGFR ) 30-60 uye <30.A meta-analysis ne subgroup kuenzanisa yakapedzwa nekuverenga zvipingamupinyi zviyero zvevakafa kubva kune invasive maringe nemishonga inochengetedza.
(1) Zvidzidzo zvishanu zvakasarudzwa uye zvidzidzo zvina zvekutarisa zvakasangana nesarudzo, ine huwandu hwevarwere ve362,486 vanowana invasive kana kuchengetedza kurapwa pakati pe1994 ne2020.
(2) Muzvidzidzo zvisingaverengeki, chiyero chekufa nekuda kwehutano husina kunaka kune varwere vane eGFR 30-60 yaiva 0.739, nguva yekuvimba (CI) yaiva 0.382-1.431, p = 0.370.Muchidzidzo chekucherechedza eGFR 30-60, the odds reshiyo yekurapwa kwevasina kufa yaive 0.144, CI 0.012-0.892, p=0.037.
(3) Muzvidzidzo zvisingaverengeki, chiyero chekufa nekuda kwekurapa kwechirwere muvarwere vane eGFR <30 yaiva 0.790, CI 0.135-4.63, p = 0.794. Muzvidzidzo zvekucherechedza, varwere vane eGFR <30 vaiva nehuwandu hwehuwandu hwe0.384 ye0. rufu, CI 0.281–0.552, p<.05.
(4) Dambudziko rekufa kune varwere vane eGFR 30-60 vanobatwa nekuchengetedza kurapwa chete kwaiva 0.128 (CI -0.001-0.227) muboka rekuongorora rakarongeka uye 0.44 (CI 0.227-0.6525) muboka rekuongorora, p < 0.01 .Muchidzidzo chisina kujairika njodzi yeMedhiya yekufa yaive 0.345 (CI -0.103-0.794) kune varwere vane eGFR <30 vachiwana kurapwa kwekuchengetedza chete uye 0.463 (CI 0.00-0.926) muzvidzidzo zvekucherechedza, p = 0.579.
(1) Pasinei nemigumisiro yakanaka yekurapa kwechisimba mune zvose zvidzidzo zvisingaverengeki uye zvekupindira, chiyero chekufa muzvidzidzo zvekucherechedza chakanga chakakosha.
(2) Observational zvidzidzo zvakaratidza kuti invasive kurapa ine zvakanyanya kuderera maitiro ekufa kune varwere vane eGFR 30-60 uye eGFR <30.
(3) Varwere vari muboka rekucherechedza vaiva nehuwandu hwekufa nekugadzirisa kurapwa chete.
(4) Kutsvakurudza kwakawanda kunodiwa kuumba muenzaniso wekusarudza varwere vanozobatsirwa zvakanyanya kubva kune invasive kana kuchengetedza kurapwa.
(5) Kukanganisa kwechidzidzo ichi kunosanganisira kusiyana kwenhamba yevarwere mumapoka ezvidzidzo, kusava nehemodynamic uye angiographic data maererano neGFR, uye mukana wekuti zvimwe zvidzidzo zvinosanganisira varwere vane angina pectoris isina kugadzikana kunze kweNSTEMI.
Pasinei nekufambira mberi kwetekinoroji mu cardiology, kuvhunduka kwe cardiogenic se complication yeacute myocardial infarction inoramba iri dambudziko rekurapa.Recently, National Cardiogenic Shock Management Standardization Campaign yakatangwa muUnited States, uye National Cardiogenic Shock Initiative ine chinangwa chekuvandudza kurarama, kunyanya muvarwere. with acute coronary syndrome (ACS) .Chinangwa chedu chaiva chekuona kuti cardiogenic shock yechipiri kune ACS inoda mechanical circulatory support inotungamirirwa sei musangano redu uye kuenzanisa maitiro ekiriniki pakati pevanopona nevasina kupona.
Ongororo yakadzokororwa yevarwere vane makore 18-89 makore inoda rubatsiro rwenguva pfupi yekutenderera kutenderera muchimiro cheACS paUniversity yeTexas Lubbock Medical Center kubva Nyamavhuvhu 2018 kusvika Nyamavhuvhu 2019. sum test yakashandiswa kune categorical uye inoenderera zvakasiyana.
Huwandu hwevarwere makumi matatu nepfumbamwe hwaisanganisirwa, 90% vaive varume, makore airehwa aive makore 62, 62% aive nechirwere cheshuga, uye chiyero chemuviri chiyero chaive 29.01±5.84 kg/m2.Intra-aortic balloon pump ndiyo yainyanya kushandiswa mechanical mudziyo wekutsigira, wakateverwa neImpella (92% vs 8%). Kufa kwese kwese kwaiva 18%.Kuwedzera kwemoyo uye lactate pakugamuchira panguva yekushandiswa kwemagetsi kushandiswa kwakabatanidzwa nekufa (105 bpm vs 83.91 bpm, p = 0.02) (6.85) mmol / l vs 2.55 mmol / lp, 0.003. Percutaneous coronary intervention (PCI) Kuvapo kwekutanga mechanical support kana coronary artery bypass grafting (CABG) mu 44% yevarwere yakabatanidzwa nekupona (53% vs 0% p = 0.01) .
Kukwidziridzwa kwemoyo uye mazinga e lactate panguva yekuiswa kwe mechanical support inobatanidza nekufa kune varwere vane cardiogenic shock yechipiri kusvika kune acute coronary syndrome.Kutanga kushandiswa kwemagetsi pamberi pePCI yakabatanidzwa nekupona.Zvidzidzo zvakakura uye zvakasimba zvinodikanwa kuti zvijekese masangano aya.
Kutarisira hidradenitis suppurativa (HS) kunogona kuva kwakaoma.Muzviitiko zvakawanda, zviratidzo zvevarwere zvakavandudzwa mushure mekutanga kupindira kwekuchengetedza.Zvinosuruvarisa, zvimwe zviitiko zvinova zvinopesana uye zvinotungamirira kune zvizoro uye zvinorwadza kudzoka. .Tinotsanangura murwere airamba kuvhiyiwa akavhiiwa pamusoro peelectron beam radiation therapy.
Murume ane makore makumi mana nemana okuberekwa akaratidzwa kukora kwemagaro, gluteal cleft, perineum, uye bilateral chidya HS. Murwere airamba kuvhiyiwa uye kurapwa nemishonga inorwisa mabhakitiriya uye corticosteroids. Akagamuchira split-course electron beam radiation therapy ne chiyero che30 Gy mu10 yakakamurwa madosi uye yakaramba ine chikamu chemhinduro kwemavhiki e2 mushure mekutanga kurapwa. Chinangwa chekuongorora mumuviri mukati memwedzi we1 wekurapwa kwakaratidza kuderedzwa kwe25% munzvimbo yese yekuzvimba uye kucherechedzwa kwevakasimudzwa. nzvimbo.Panguva iyoyo, varwere vakarondedzera kuderedzwa kwekuzviisa pasi mukurwadziwa uye mvura.Mhinduro yacho yainzi yakasimba pa6 uye 12 mwedzi mushure mekurapa.
Radiation therapy ine anecdotal mabhenefiti ezvirwere zvakasiyana siyana uye yakadzidzwa pamwero wakaderera (dzimwe nguva dosi imwe chete) mukutungamira kweHS. Takasarudza kushandisa kosi yekupatsanura yatinotenda kuti ndiyo yakachengeteka uye ingangoita yakareba-yakareba maererano ne kuderedza madhara.
Nzvimbo yekurapa yemurwere inoratidza hidradenitis suppurativa mumagadziko, gluteal cleft, perineum uye zvidya zviviri zvisati zvarapwa.
Superficial electron beam radiation therapy inoshanda mukurapa chirwere chisingafadzi uye ine vimbiso yerefractory HS.Studies yehuwandu hwedosi uye mafractionation regimens inodiwa kuti kuwedzere uye kutungamira kushandiswa kwemangwana.
Muhuwandu hwevanhu veUnited States, 1 muvanhu vane 5,000 vane mitochondrial myopathy.Kuratidzwa kwekiriniki kunogona kukamurwa zvakakamurwa kuva zvikamu zvitatu: chronic progressive external ophthalmoplegia, skeletal-CNS syndrome kana myopathy nyore.Kusagadzikana kwemoyo kunoitika mu30-32% yezviitiko, kunyanya se hypertrophic cardiomyopathy, dilated cardiomyopathy, kana conduction abnormalities.Tinopa nyaya ye bilateral rezasi kupera simba, kurwadziwa, uye kuzvimba nemhasuru biopsy kuongororwa kwe mitochondrial myopathy.Nyaya yenyaya: Mumwe wemakore makumi maviri nemasere akapedza kudzidza mudzidzi akaendeswa kuchipatara chedu. mushure memavhiki e3 ekushaya simba kwegumbo, kurwadziwa, uye kuzvimba mushure mokunge vasvika kuUnited States kubva kuIndia.Kuongorora kwakaratidza tachycardia, 2 + pfungwa dzepitting edema mumabvi ose, 4/5 MRC-grade kushaya simba, unyoro hunyoro mumapoka epamusoro uye distal muscle. yekumusoro uye yakadzika migumo, hapana yakadzika tendon reflexes, kudonha kwetsoka, uye bilateral ptosis uye inorambidzwa extraocular movement.Preliminary laboratory results yakaratidza creatinine kinase yakawedzera ne691 IU / L, brain natriuretic peptide yakawedzera ne3437 pg / mL, troponin yakawedzera ne47.1 ng/L, myoglobin yakawedzera ne195 ng/mL, uye lactate yakawedzera ne7.7 mmol/L, serum bicarbonate yakaderera ne12 mmol/L. kutsauka nekuruboshwe anterior bundle block.Chest X-ray uye CT angiography yechipfuva/dumbu/pelvis yakaratidza kukura kwemwoyo uye kuwedzera kwevhoriyamu.Mubhedha wake ECHO yakaratidza kunyorova kuruboshwe systemic hypokinesia, 40-44% yakaderera ejection fraction, uye mild pulmonary hypertension.The murwere akapinzwa muchikamu chekurapa vanorwara zvakanyanya nekuda kwekudonha kwemhepo huru yekufemerwa.Ophthalmology yakasimbisa ophthalmoplegia, kusanganisa cranial nerve palsy, myasthenia gravis, uye retinitis pigmentosa.Gq1b antibody negative.Kuwedzera autoimmune uye infectious workup haibatsiri.Muscle biopsy yemurwere rectus femoris muscle yakaratidza yakapararira yebhuruu uye cytochrome-c oxidase-negative fibers ine yakawedzera perimuscular uye endomysial connective tissue, inopindirana nekushanda uye isingagumi primary mitochondrial myopathy.Endomyocardial biopsy yakaratidza kushanda lymphocytic myocarditis.Murwere ave, akabudirira kurapwa nefurosemide. Metoprolol uye methylprednisolone.
Myopathy inofanirwa kutariswa mukusiyana kwekuongororwa kwevarwere vane fungidziro yeGuillain-Barre syndrome.Tinoshuma chiitiko chinonakidza chemyopathy ine yakakurumbira cardiac kuratidzwa.Myositis inoratidzira semyocarditis inofanira kumutsa kunyumwira kwechirwere chemitochondrial.Chiitiko chedu chinosimbisa kukosha kwekushandisa timu yemarudzi akasiyana-siyana. nzira yekuongorora isingawanzo pathologies neyakasiyana siyana multisystem kubatanidzwa.
Chinangwa chechidzidzo ichi chaiva chekuongorora mukana wekuongorora Gaisbock kune varwere vane chirwere chisingaperi che polycythemia uye hypertension.
Murume akafutisa ane makore makumi mana okukura wekuCaucasian akapinzwa muchipatara nekuzvimba kwegumbo uye akawedzera kudiwa kweokisijeni mushure memavhiki maviri ekuchipatara neCOVID-40 pneumonia. Mushure mekuongorora nhoroondo yekurapa kwemurwere, akawanikwa aine hypertension isina kurapwa uye polycythemia inotenderera. makore gumi pakushanya kwakati wandei.Nhoroondo yemazuva ano yekurapa inosanganisira kuongororwa kwedeep vein thrombosis (DVT) mugumbo rimwechete mwedzi miviri nehafu yapfuura, uye kurapwa neXarelto.
Murwere akarondedzera nhoroondo yemakore gumi nemaviri ye testosterone yakaderera.Zvisinei, haana kushandisa chero testosterone supplements kwemwedzi mipfumbamwe yapfuura.Akataura kuneta kwemasikati, kumuka nguva dzose usiku, uye nguva dzose kuridza ngonono.Murwere uyu akanga asati amboita chidzidzo chekurara kana akashandisa CPAP.Murwere akasvuta hafu yegaba rekutsenga fodya pazuva kwemakore 13 akatevedzana, pakiti imwe pazuva, kwemakore gumi akatevedzana, uye akarega kusvuta makore 12 apfuura. Akapedza nguva yakawanda yehupenyu hwake achiita basa rakaoma mumhizha yekuvaka.
Nguva yekutumira: Jun-29-2022