To investigate the application of optical coherence tomography (OCT) in patients with acute myocardial infarction (AMI) caused by plaque rupture and evaluate the therapeutic effect.
Methods
The patients diagnosed with AMI in the Department of Cardiology of Jilin Central Hospital from January 2019 to October 2022 were selected. After emergency percutaneous coronary angiography(CAG) and intracoronary thrombus removal (manual thrombus aspiration or drug intracoronary thrombolysis),the coronary blood flow in CAG confirming culprit vessel returned to TIMI level 3. Moreover, for the patients with visual estimation of culprit lesion stenosis <70.00%, OCT examination was performed at a selected time(7 days after hospitalization). Patients meeting the following OCT-defined plaque rupture features were managed without stenting and given intensive drug theraphy (n=29): rupture arc <90°; rupture length <1 mm; absence of large free intimal flaps. CAG and OCT were reviewed 12 months after treatment, and the changes of OCT characteristics at baseline and 12 months after treatment were compared, and the occurrence of major adverse cardiovascular events (MACE) within 12 months were analyzed.
Results
OCT results of 29 patients were reviewed 12 months after treatment. Compared with the baseline OCT features, the thickness of the thin fiber cap increased [(74.66±20.79)μm, (95.21±16.31)μm], and the arc of ruptured plaque decreased [(83.69±6.30)°, (80.38±5.93)°]. The length of ruptured plaque decreased[(0.67±0.16)mm, (0.56±0.17)mm], the minimum lumen area increased [(3.58±0.55)mm2, (3.82±0.69)mm2], and the depth of ruptured plaque decreased [(1 410.34±214.40)μm, (1 251.38±208.22)μm],the percent area stenosis [(64.00±4.26)%, (61.79±4.23)%] and macrophage infiltration rate decreased[68.97%(20/29), 34.48%(10/29)], and the differences were statistically significant (t=11.71, 3.59,3.55, 6.29, 9.84, 3.51, χ2=8.10, all P<0.01). After 12 months of follow-up, two patients (6.90%)were re-hospitalized for angina pectoris, of whom one patient showed no stenosis progression on follow-up CAG, and the other patient underwent stenting for a non-culprit lesion progression. No serious MACE occurred during follow-up.
Conclusions
After removal of thrombosis in AMI, CAG lumen stenosis <70.00%, and OCT of the offender lesion showed plaque rupture leading to AMI. For patients with a plaque rupture arc less than 90°, a ruptured plaque length less than 1mm, and no large free inner membrane, drug therapy can avoid stent implantation, reduce the occurrence of no reflux and stent restenosis after stent implantation.
Wogonin, a natural flavonoid compound with significant anti-inflammatory properties,which is primarily derived from the traditional Chinese herb Scutellaria baicalensis (Huangqin). In studies of its anti-inflammatory effects, Wogonin has demonstrated potential in inhibiting inflammatory responses through multiple mechanisms. These mechanisms include suppressing the production of pro-inflammatory cytokines such as interleukin-1 (IL-1), IL-6, IL-2 and tumor necrosis factor-alpha (TNF-α), regulating inflammatory signaling pathways such as nuclear factor κB (NF-κB) and mitogen-activated protein kinase(MAPK) pathway, inducing apoptosis of inflammatory cells, and enhancing autophagy to clear damaged cells. Wogonin has shown therapeutic potential in various inflammatory diseases such as rheumatoid arthritis,inflammatory bowel disease, and atherosclerosis. This paper reviews the anti-inflammatory mechanisms of Wogonin and its application prospects in different diseases, providing a theoretical basis for future clinical applications.
To analyze the related factors of natural pregnancy outcome in infertile women after four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) examination by Cox regression analysis.
Methods
A total of 388 infertile female patients who underwent 4D-HyCoSy examinations in the Ultrasound Imaging Department of Hubei Provincial Maternal and Child Health Hospital from March 2015 to October 2023 were selected. Based on the patency of the bilateral fallopian tubes, patients were classified into types Ⅰ to Ⅵ. Based on the natural pregnancy outcomes within 12 months post-examination,patients were divided into a coneeption-success group (246 cases) and a conception-failure group (142 cases). Cox regression analysis was employed to identify factors associated with successful natural pregnancy.A scoring system for successful natural pregnancy following 4D-HyCoSy examinations had been established,categorizing the conception-success patients into low-score group (0-6 points), medium-score group (7-12 points), and high-score group (13-18 points). The Kaplan-Meier method was employed to calculate cumulative pregnancy rates and time to pregnancy, and the Log-rank test was used for intergroup comparisons.
Results
The cumulative natural pregnancy success rates for types Ⅰ to Ⅵ within 12 months were 32.99%(128/388), 6.19%(24/388), 10.57%(41/388), 8.76%(34/388), 3.61%(14/388), and 1.29%(5/388), respectively. Type Ⅰ showed significantly higher rates than other types (χ2 =88.43, 57.22,68.87, 112.03, 137.17, all P<0.01). There were no statistically significant differences between types Ⅱ,Ⅲ, and Ⅳ, or types Ⅴ and Ⅵ (χ2=4.84, 3.52, all P>0.05). The cumulative natural pregnancy rates for the periods of 1-3 months, 4-6 months, 7-9 months, and 10-12 months were 19.59%(76/388),19.85%(77/388), 12.89%(50/388), and 11.08%(43/388), respectively. The cumulative pregnancy rate from 7 to 12 months was significantly lower than that from 1 to 6 months (χ2=21.41, P<0.01). Cox regression analysis revealed that the results of tubal patency, duration of preparation for pregnancy, and type of infertility were significant risk factors affecting natural conception. Compared with type Ⅵ, the type Ⅰ, Ⅱ,Ⅲ and Ⅳ had increased success rate of natural pregnancy after 4D-HyCoSy examination (HR=6.1, 95%CI: 2.5-14.9, P<0.01; HR=5.1, 95%CI: 2.0-13.4, P=0.001; HR=3.3, 95%CI: 1.3-8.4, P=0.012; HR=2.9, 95%CI: 1.1-7.4, P=0.028). Compared with primary infertility patients, secondary infertility patients had an increased success rate of natural pregnancy after 4D-HyCoSy examination (HR=2.3, 95%CI: 1.5-3.4, P=0.030). The success rate of natural pregnancy after 4D-HyCoSy examination in infertile women with preparation time <2 years was higher than that in infertile women with preparation time ≥2 years (HR=3.0, 95%CI: 2.1-4.2, P<0.01). The cumulative natural pregnancy rates over 12 months of low, medium, and high-score infertility groups were 20.00% (16/80), 63.16% (108/171),and 89.05% (122/137), respectively. The comparison of cumulative successful conception rates among the three groups showed statistically significant differences (χ2 = 40.60, 104.00, 26.90, all P<0.01).
Conclusions
For women with infertility, a 4D-HyCoSy examination can be conducted early to guide the subsequent treatment plan. The natural pregnancy success rate is lower in the low-score group, and it is recommended to promptly pursue assisted reproductive technology. The medium and high-score groups may opt for natural conception.
To investigate the diagnostic features of giant multilocular cystic leiomyoma of uterus.
Methods
The clinical data of a newly diagnosed patient with a giant pelvic cavity mass admitted to the Gynecology Department of Shandong Provincial Hospital on August 5, 2023 were collected, and the literature was reviewed to summarize the diagnostic features of giant multilocular cystic leiomyoma.
Results
The patient, a 36-year-old female, had experienced abdominal enlargement for more than 2 years,with worsening symptoms over the past 2 months, accompanied by frequent urination, ascites, and weight gain. Ultrasound examination revealed a large cystic-solid mass in the abdominal pelvic cavity, initially suspected as an ovarian malignancy, and a cystic mass in the right adnexal area, suspected to be a teratoma,and subserous myoma of the uterus. Enhanced CT of the pelvis and abdomen initially suggested ovarian cystadenocarcinoma. The pathological diagnosis was giant multilocular cystic leiomyoma in the pelvic cavity,with a maximum transverse diameter of 49.2 cm, complicated with mature cystic teratoma of the ovary and leiomyoma of the uterus. The patient was followed up for 17 months after resection without recurrence.
Conclusion
Giant multilocular cystic leiomyoma, characterized by rare cystic changes and large size, is difficult to diagnose by imaging examination and needs to be confirmed by histopathology and immunohistochemistry.
To study the expression of serum lipocalin-2 (LCN2) in children with short stature and the application of recombinant human growth hormone (rhGH) in children with short stature, as well as the changes of LCN2 and insulin-like growth factor 1 (IGF-1) serum level after rhGH treatment.
Methods
A total of 440 patients with short stature admitted to the Department of Endocrinology, Genetics andMetabolism of the Affiliated Hospital of Jining Medical University from January 2020 to October 2023 were analyzed. Patients were divided into growth hormone deficiency (GHD) group (n=334) and idiopathic short stature (ISS) group (n=106). GHD group was further divided into complete GHD group (n=161)and partial GHD group (n=173) according to the peak value of growth hormone. The clinical characteristics and serological parameters of the three groups before rhGH treatment were collected. The diagnostic efficacy of LCN2 in differentiating patients with complete GHD, partial GHD and ISS was analyzed. A subgroup of 82 patients (treated January-October 2023) underwent 6 month and 12 month follow-up to monitor therapeutic responses and changes of indicators (LCN2 and IGF-1 serum levels). The correlation between LCN2 serum levels and clinical features and serological parameters at different periods before and after treatment was analyzed.
Results
Before treatment, the LCN2 serum levels in the ISS group [337.69(276.35, 449.28)μg/L]were significantly higher than those in the complete GHD group [238.81(188.70, 350.62)μg/L] and the partial GHD group [278.95(211.45, 393.29)μg/L], with the differences being statistically significant(H=10.464, P<0.01). After 12 months of rhGH treatment, the height standard deviation score (SDS) of children in all three groups showed a significant upward trend compared to baseline and six months treatment(H=66.167, 41.040, 19.142, all P<0.01). The expression level of LCN2 decreased significantly with the extension of treatment time (H=60.500, 44.720, 38.095), while IGF-1 level (H=55.056, 40.106,35.524) and IGF-1 SDS (H=43.167, 38.480, 33.429) gradually increased compared with those before treatment, with statistically significant differences (all P<0.05). LCN2 and IGF-1 levels showed a significant negative correlation in patients with complete GHD, partial GHD, and ISS both before treatment and at 6 months of treatment (r=-0.219, -0.461, -0.443, -0.575, -0.443, -0.457, all P<0.05). The area under the curve (AUC) of LCN2 in distinguishing ISS children from complete GHD was 0.709, with a specificity of 63.98% and a sensitivity of 75.47%. The AUC of LCN2 in distinguishing ISS children from partial GHD was 0.628, with a specificity 38.73% and a sensitivity of 85.85%. The AUC for distinguishing complete GHD from partial GHD was 0.588, with a specificity of 48.45% and a sensitivity of 69.36%.
Conclusions
rhGH treatment is effective in children with GHD and ISS. The serum level of LCN2 can be used as an indicator for the diagnosis and treatment of children with short stature.
To explore the clinical features, diagnosis and treatment of patients with growth hormone deficiency (GHD) combined with thalassemia (TT).
Methods
The clinical and follow-up data of a male patient with GHD and TT admitted to the Department of Endocrinology, Genetics and Metabolism of the Affiliated Hospital of Jining Medical University on March 30, 2020, were retrospectively analyzed.
Results
The 12-year-old male patient, with a height of 137.2 cm (-2.0 SD) and a weight of 42 kg, had a genetic target height of 171.5 cm. His bone age was approximately 12.5 years (Greulich-Pyle atlas). The peak growth hormone levels in the levodopa and insulin hypoglycemia stimulation test were 0.059 μg/L and 0.959 μg/L, respectively. The serum insulin-like growth factor-1 level was 282 μg/L. The patient was treated with recombinant human growth hormone (rhGH). During the follow-up period, he was diagnosed with TT. Genetic testing confirmed α-thalassemia trait (--/αα), with hemoglobin (Hb) levels from repeated measures between 117 g/L and 127 g/L, and no special treatment was provided. After 21 months of rhGH treatment, his height increased to 153.7 cm (-1.69 SD), with a bone age of 14 years and a predicted adult height of 165.8 cm (-1.15 SD). Letrozole was added to delay bone age progression.After 51 months of follow-up, letrozole was discontinued. The height reached 170.5 cm (-0.26 SD), bone age was approximately 15 years, and the predicted adult height was 176.1 cm (0.57 SD). Hb level improved to 139 g/L, and thereafter, only growth hormone therapy was administered.
Conclusion
Letrozole can effectively delay bone age progression, improve Hb levels, and further enhance height outcomes in patients with GHD combined with TT.
To investigate the application value of echocardiography (UCG) combined with laboratory examination in predicting unresponsive Kawasaki disease (KD) intravenous immunoglobulin(IVIG) treatment.
Methods
The data of total of 164 children with KD admitted to the Children′s Cardiography Department of Chengdu Women and Children′s Central Hospital from September 2019 to September 2023 were collected.According to the sensitivity to IVIG treatment, the children were divided into the IVIG nonresponse group (n=82) and the IVIG response group (n=82). The UCG performance and laboratory examination indexes before treatment were compared between the two groups. Multivariate Logistic regression was used to predict the risk factors for IVIG non-response, and receiver operating characteristic (ROC)curve was drawn to evaluate the prediction efficacy.
Results
The proportion of coronary artery (CA)dilation in the IVIG non-response group was higher than that in the IVIG response group [37.80%(31/82),20.73%(17/82)], and the difference was statistically significant (χ2 = 5.773, P= 0.016). Tricuspid regurgitation (TR), alanine aminotransferase (ALT)>40 U/L, albumin (ALB)<35 g/L, D-Dimer>0.5 mg/L, neutrophil to lymphocyte ratio (NLR) >1.29, platelet (PLT) >420×109/L, platelet and lymphocyte ratio (PLR)>126.8 were independent risks factors for IVIG non-response [OR=19.136(95%CI: 3.634-100.756),1.016(95%CI:1.007-1.025),0.912(95%CI:0.835-0.996),1.780(95%CI:1.091-2.904),0.812(95%CI:0.681-0.969),1.014(95%CI:1.007-1.022),1.022(95%CI:1.006-1.037), all P<0.05]. The area under the ROC curve of TR combined with PLT was 0.850, the sensitivity was 63.41%, and the specificity was 95.12%. The area under the ROC curve of TR combined with ALT and PLT was 0.903, the sensitivity was 80.49%, and the specificity was 86.59%. The area under the ROC curve of TR combined with ALT, PLT, ALB, D-Dimer and PLR was 0.946, the sensitivity was 86.59%,and the specificity was 92.68%.
Conclusions
CA dilation, TR, ALT elevation, ALB reduction, D-Dimer elevation, NLR elevation, PLT elevation, PLR elevation, erythrocyte sedimentation rate elevation are highrisk factors for IVIG non-response in KD patients. UCG combined with laboratory testing provide a more accurate method for predicting IVIG non-response.
To investigate the clinical diagnostic features of mitochondrial encephalomyopathy(ME) caused by deletions in mitochondrial DNA(mtDNA).
Methods
The diagnosis and treatment process of a patient with leukoencephalopathy caused by multiple deletions in mtDNA, admitted to Hunan Brain Hospital in August 2018 was retrospectively analyzed. Relevant literature was reviewed, and the patient′s clinical manifestations, imaging characteristics and gene mutation were summarized.
Results
The patient in this case presented with recurrent headaches and seizures. From 2015 to 2018, multiple MRI scans of the brain indicated the presence of multifocal subcortical white matter lesions, with varying locations, and complete recovery occurred over a period of time. Genetic testing of skeletal muscle cell nuclei and mitochondrial genomes revealed three mtDNA deletion sites: m.5786_13923, m.7851_13614,and m.8616_15656. The diagnosis was that mtDNA multiple deletions lead to ME.
Conclusions
Seizures can be a common clinical manifestation of ME. When multiple lesions are present in the cortex or white matter, ME should be considered. For suspected cases, timely blood or muscle gene testing should be conducted to reduce the risk of missed or misdiagnosed cases.
The plateau region, with its unique geographical environment and climatic conditions,has a significant impact on human health. Especially its low oxygen and low air pressure increases the incidence and severity of traumatic brain injury. As the core organ of gas exchange, the function of the lungs is vulnerable to damage in the plateau environment, which in turn exacerbates pulmonary infection after traumatic brain injury and increases mortality rate. This is manifested through pathological changes such as inflammation, edema, and hemorrhage, potentially leading to severe complications such as acute respiratory distress syndrome and neurogenic pulmonary edema. There exists a complex bidirectional functional interaction and information transmission between the brain and lungs. The vagus nerve, as a key neural pathway connecting the brain and the lungs, has an important impact on lung injury by regulating inflammatory responses, vascular permeability and other processes through the cholinergic anti-inflammatory pathway(CAP). Among these, α7 nicotinic acetylcholine receptor (α7nAChR) is a fundamental component of the CAP pathway. The nucleus tractus solitarius (NTS), a key node of the CAP pathway, receives sensory inputs from the lungs via the vagus nerve. The NTS processes and integrates these information, sending signals to other brainstem and forebrain regions to elicit vagal impulses to release acetylcholine delivery to peripheral tissues and organs. This regulate the autonomic nervous system and cardiorespiratory function,exerting anti-inflammatory effects. Therefore, this paper systematically reviews the effects of traumatic brain injury on lung function and the protective role of the cholinergic α7nAChR pathway, providing scientific evidence and strategic insights for the prevention and treatment of plateau impact injuries.
