Hypertensive emergency is an important entity which should be managed adequately. A 65-year-old woman presented with blindness and elevated blood pressure of 254/131 mmHg. She was diagnosed with hypertensive emergency on physical examination, and brain magnetic resonance imaging showed posterior reversible encephalopathy syndrome (PRES) with bilateral thalamic haemorrhage. After controlling her blood pressure with intravenous antihypertensive agents, periaortitis and retroperitoneal fibrosis (RPF) were manifested by left hydronephrosis and creatinine elevation. She was diagnosed with periaortitis/RPF. Her blood pressure was well controllable, and PRES improved after treatment with prednisolone. Periaortitis/RPF should not be overlooked when hypertensive emergency suddenly occurs in patients with no history of hypertension.
Case 1 was a healthy 28 year old woman. Spinal anesthesia was performed for Cesarean section. After the delivery, prostaglandin F2 alpha (PGF2 alpha) 1000 micrograms was administered intramyometrically. Immediately ventricular premature beats appeared on ECG and heart rate decreased to 60.min-1. Atropine sulfate 0.25 mg was administered and ECG showed sinus tachycardia. Case 2 was a 28 year old healthy woman. Spinal anesthesia was induced for Cesarean section. PGF2 alpha 1000 micrograms was injected to the myometrium. Soon thereafter blood pressure rose to 170/105 mmHg and ECG showed multifocal ventricular premature beats. Lidocaine 40 mg and nicardipine hydrochloride 0.4 mg were administered. Blood pressure decreased to 120/80 mmHg and ECG showed sinus tachycardia. These cases demonstrate the systemic reaction of intramyometrically administered PGF2 alpha.
Objectives: Our aim is to determine which surrogate markers can predict the confirmatory tests for the diagnosis of primary hyperaldosteronism (PA). Methods: The Secondary Hypertension Registry Investigation in Mie Prefecture (SHRIMP) study has sequentially and prospectively recruited 103 patients with hypertension with an aldosterone to renin ratio (ARR) greater than 20, evaluated the differences among essential hypertension (EHT), idiopathic hyperaldosteronism (IHA), and aldosterone-producing adenoma (APA), and analyzed the predictors for the confirmatory tests. The patients underwent saline-loading, captopril-challenge, and upright furosemide-loading tests. Carotid, renovascular, and cardiac echography, brachial ankle pulse wave velocity (baPWV), endothelial function, nocturnal blood pressure decline, and apnea hypopnea index were evaluated. Results: Multivariate regression analyses showed plasma aldosterone concentration (PAC) and ARR on screening were strong predictors of saline and captopril tests, respectively. Urine albumin to gram creatinine ratio (U-Alb/gCre) and beta2-microglobulin were independent predictors for the captopril test. The estimated saline PAC by the equation, = 25.38 + 0.537*PAC − 6.6*K + 0.023*ARR, was highly correlated with the real value (r = 0.830, P < 0.000001). Patients with IHA were older and had glucose intolerance, increased U-Alb/gCre and resistive indexes. Left atrial dimension and baPWV were independent predictors for diagnostic tests. In patients with APA, E/E’ and the addition of alpha blockers were independent predictors of diagnostic tests. Conclusion: Our proposed equation to estimate saline PAC may be useful. IHA and APA may contribute to confirmatory tests and organ damage in different ways.
This study investigates the internal reasoning mechanism of language models during symbolic multi-step reasoning, motivated by the question of whether chain-of-thought (CoT) outputs are faithful to the model's internals. Specifically, we inspect when they internally determine their answers, particularly before or after CoT begins, to determine whether models follow a post-hoc "think-to-talk" mode or a step-by-step "talk-to-think" mode of explanation. Through causal probing experiments in controlled arithmetic reasoning tasks, we found systematic internal reasoning patterns across models; for example, simple subproblems are solved before CoT begins, and more complicated multi-hop calculations are performed during CoT.
In this paper, we assume that the progression rules of music are in a subclass of context-free language, and we let computers find them autonomously. We employ the Iterated Learning Model (ILM) by Simon Kirby, and ask if the computer can find a music knowledge that is common to us, and also if the computers can compose music independently of our music knowledge. In this research, we have shown an example set of rules found in the 25 études of Burgmüller by beat. Although many of categories in the tree seem redundant and futile, some of them reflect probable progressions, which well match with our human intuition. This experiment has several virtues compared with other grammar-based formalism for music. One is that we do not need to provide a dictionary beforehand. The other is that we can exclude the human-biased intuition, which had hindered the definition of creativity.
