To explore the application value of optical coherence tomography (OCT) in layered coronary plaque lesions in acute myocardial infarction (AMI).

From January 2019 to October 2022, 60 patients diagnosed with AMI due to plaque erosion after undergoing coronary angiography (CAG) and OCT on target vessels at the Cardiovascular Department of Jilin Central Hospital were collected. Based on OCT image findings, the patients were categorized into a layered plaque erosion group (28 cases) and a non-layered plaque erosion group (32 cases). The 2 groups of patients′ demographic data, previous disease history, cardiovascular medication history, clinical biochemical data, CAG data and OCT data were all compared.

In 60 cases of AMI patients, 28 cases had layered plaque erosion, accounting for 46.67%. In the layered plaque erosion group, the levels of low-density lipoprotein [(3.38±0.27)mmol/L] and glycosylated hemoglobin [(7.38±0.24)%]were significantly higher than those in non-layered plaque erosion patients [(2.42±0.15)mmol/L, (6.00±0.58)%], and the differences were statistically significant (t=6.00, 3.23, all P<0.05). CAG showed that compared to non-layered plaque erosion group, the erosion of layered plaques were more commonly seen in the left anterior descending branch of the coronary artery [18/28(64.29%), 12/32(37.50%)], with longer lesion lengths [(28.64±4.38)mm, (15.23±4.32)mm], and more complex lesions (B2/C type) [16/28(57.14%), 8/32(25.00%)], and the differences were statistically significant (χ²=4.29, t=11.92, χ²=6.43, all P<0.05). Regarding OCT characteristics of target vessels, comparing to non-layered plaque erosion group, the fibrous cap was thinner [(91.78±7.89)μm, (120.89±7.18)μm], the lipid plaque radian was larger [(270.21±59.89)°, (206.58±58.61)°], the minimum lumen area (MLA) was smaller [(1.25±0.21)mm^2, (1.77±0.24)mm²], and the degree of vascular stenosis was more severe [(88.38±9.56)%, (76.45±8.38)%] in layered plaque erosion group (t=14.96, 2.48, 8.87, 2.56, all P<0.05). Compared to those in non-layered plaque erosion group, the macrophages [19/28(67.86%), 12/32(37.50%)], nourishing vessels [8/28(28.57%), 2/32(6.25%)], cholesterol crystallization [15/28(53.57%), 8/32(25.00%)], clot burden [25/28(89.29%), 21/32(65.63%)], and thin-cap fibroatheroma [20/28(71.43%), 14/32(43.75%)] were found more frequently in layered plaque erosion group (χ²=5.51, 3.87, 5.16, 4.67, 4.66, all P<0.05). The stent length [(30.00±5.64)mm, (18.00±7.42)mm], stent expansion ratio [14/28(50.00%), 8/32(25.00%)], stent malapposition [12/28(42.86%), 6/32(18.75%)] were significantly different between the layered plaque erosion and non-layered plaque erosion in AMI patients (t=9.32, χ²=4.02, 3.87, all P<0.05). Compared to non-layered plaque erosion group, AMI patients with layered plaque erosion might have more aggressive post-dilatations [22/28(78.57%), 10/32(31.25%)], and have higher post stent expansion pressure [(18.00±2.68)atm, (14.00±2.46)atm] (1 atm=101.3 kPa) (χ²=4.25, t=2.47, all P<0.05). In the 2 groups, the accumulated major adverse cardiovascular events (MACE) at 12 months postoperatively were related to target vessel revascularization, with 1 case and 2 cases, respectively. The target vessel revascularization rate in the layered plaque erosion group(2/28, 7.14%) was higher than that in the non-layered plaque erosion group (1/32, 3.13%), but the difference was not statistically significant (P=0.594).

The erosion of layered plaques is closely related to the characteristics of lesions and clinical manifestations of patients. OCT has potential application prospects in evaluating the therapeutic effects of PCI in AMI patients with eroded layered plaques, providing personalized treatment guidance.

To evaluate the value of shear wave elasto-graphy (SWE) in salivary gland injuries after postoperative radioactive iodine (RAI) therapy for papillary thyroid carcinoma (PTC).

From August 24, 2021, to January 17, 2022, a total of 113 PTC patients who underwent RAI treatment after surgery from the Department of Endocrinology, the First Affiliated Hospital of Shandong First Medical University (Shandong Qianfoshan Hospital) and 87 healthy controls were retrospectively recruited. PTC group was divided into single RAI treatment group (n=36) and multiple RAI treatment group (n=77). Two-dimensional ultrasound and SWE examination results of parotid gland and submandibular gland were collected, including parotid gland thickness, submandibular gland volume and mean shear wave velocity (SWV) of the left and right. Student′s t-test was used to compare the differences between the 2 groups.

The volumes of the left submandibular gland in the PTC group and the control group were (7.55±0.64)cm³ and (8.31±0.41)cm^3, respectively. The volumes of the right submandibular gland were (7.55±0.47)cm³ and (8.29±0.24)cm^3, respectively. The thicknesses of the left parotid gland were (17.50±0.51)mm and (18.06±0.38)mm, respectively. The thicknesses of the the right parotid gland were (17.48±0.52)mm and (18.08±0.33)mm, respectively. Compared to the control group, both the volumes of the left and right submandibular glands in the PTC group showed a significant decrease (t=9.65, 13.40, all P<0.05), and the thicknesses of the left and right parotid glands also significantly decreased (t=8.57, 9.40, all P<0.05). The SWV of the left submandibular gland in the PTC group and the control group were (2.23±0.22)m/s and (1.93±0.15)m/s, respectively.Similarly, the SWV of the right submandibular gland were (2.22±0.21)m/s and (1.90±0.13)m/s, respectively. The SWV of the left parotid gland were (2.21±0.23)m/s and (1.86±0.14)m/s, respectively. The SWV of right parotid gland were (2.29±0.23)m/s and (1.90±0.15)m/s, respectively.The SWV of both left and right submandibular glands and parotid glands in the PTC group were significantly higher than those in the control group (t=10.91, 12.49, 12.52, 13.72, all P<0.05). There were no significant differences in parotid gland thickness, submandibular gland volume, SWV of parotid gland and submandibular gland between single RAI treatment group and multiple RAI treatment group (all P>0.05).

For patients after RAI treatment, SWE may be a simple, non-invasive method to evaluate parotid and submandibular gland damage by assessing salivary gland hardness.

To evaluate the diagnostic value of ultrasound (US) in borderline ovarian tumor (BOT) by meta-analysis.

Wanfang, CNKI, CQVIP, PubMed, HighWire, Springer, EBSCO and other Chinese and English databases were searched for literatures published from January 1990 to March 2023. Four articles meeting the criteria were evaluated by quality assessment of diagnostic accuracy studies-2 (QUADAS2) standard, and Meta-disc 1.4 software was used for meta-analysis to evaluate the diagnostic value of US for BOT.

Four articles and 244 patients were analyzed. There was no heterogeneity in the combined sensitivity and the combined negative likelihood ratio. The fixed effect models were used for analysis, and the values were 0.66 (95%CI: 0.59-0.72) and 0.43 (95%CI: 0.36-0.51), respectively. There was heterogeneity in the combined specificity, positive likelihood ratio and diagnostic odds ratio. The random effect models were applied, and the values were 0.85 (95%CI: 0.83-0.87), 4.58 (95%CI: 2.35-8.93) and 10.85 (95%CI: 4.85-24.31), respectively. The area under the curve of fitting receiver operator characteristic (ROC) was 0.687.

The application of US alone has certain diagnostic value for BOT, but the combined sensitivity is low. Utilizing US alone for BOT diagnosis has certain constraints, suggesting that clinical diagnosis should incorporate other indicators to enhance diagnostic accuracy.

To investigate the effect of ginsenoside Rg3 on the activity, apoptosis and proliferation of human breast cancer cell line MDA-MB-231.

Human breast cancer cell line MDA-MB-231 was cultured in vitro and divided into control group (normal culture) and Rg3 treatment group (0.4 mg/ml, 0.8 mg/ml, 1.6 mg/ml). The metabolic activity of cells in each group within 24 h was detected by methyl thiazolyl terazolium (MTT) assay. Apoptosis kit was used to detect the activity of caspase 3 in each group. The morphological changes of cells in each group were observed by electron microscopy. The expression level of cyclin-dependent kinase 2 (CDK2) protein was detected by Western blot. Comparison between the enzymatic activity of caspase 3 and the protein expression levels of CDK2 was conducted using t-test.

Human breast cancer cell line MDA-MB-231 was treated with different concentrations of Rg3, and the cell activity was weakened in a time and dose dependent manner. Upon detection with the apoptosis detection kit, it was found that when the concentrations of Rg3 were 0.4 mg/ml, 0.8 mg/ml, and 1.6 mg/ml respectively, the caspase 3 enzyme activities after treating the cells for 24 hours were (116.00±8.71), (171.00±10.82), and (95.67±5.03) respectively. Only at the concentration of 0.8 mg/ml of Rg3, there was a statistically significant difference compared to the control group (105.33±7.51) (t=8.64, P<0.01). The results of electron microscopy showed that the experimental group with Rg3 concentration of 0.4 mg/ml and 0.8 mg/ml showed typical apoptotic characteristics, while the experimental group with Rg3 concentration of 1.6 mg/ml showed fragmentation. Western blot results showed that the expression level of CDK2 protein in 0.8 mg/ml Rg3 treatment group (0.76±0.03) was significantly decreased compared with that in the control group (0.89±0.07) (t=2.84, P<0.05).

Rg3 with a concentration of 0.8 mg/ml can significantly inhibit the metabolic activity of human breast cancer cell line MDA-MB-231, promote cell apoptosis, reduce the expression of cell proliferation factor CDK2, and have a certain inhibitory effect on cell proliferation.

To explore diagnostic features of Kawasaki disease shock syndrome (KDSS) complicated with reversible splenial lesion syndrome (RESLES).

The clinical data of a pediatric patient with KDSS complicated with RESLES diagnosed in Women and Children′s Hospital, Qingdao University in May 25, 2022 were retrospectively analyzed. The diagnostic features of KDSS with RESLES were summarized and relevant literatures were reviewed.

The 11-year-old boy was admitted to hospital because of dizziness, fever for 2 days and delirium once. On admission, his blood pressure was normal, but his cervical lymph nodes were enlarged, and he had positive neck resistance. In terms of laboratory tests, C-reactive protein level and erythrocyte sedimentation rate increased while serum sodium level decreased. Following admission, he was treated with anti-infection and nerve nourishment medications. On the third day, conjunctival congestion, rashes, bayberry tongue, red lip chapping, red swelling of hands and feet were appeared, which were associated with Kawasaki disease (KD). MRI of the head showed the splenium of the corpus callosum with slightly decreased T₁ and slightly increased T₂ signals in the pressure area, with high signal intensity on DWI. Based on these findings, he was diagnosed with RESLES. On the fourth day, hypotension was observed. Meanwhile, ultrasonography revealed that the motion of the left ventricular wall of the heart was slightly diminished, with multiple serosal effusions. KDSS was diagnosed and treated with dobutamine to raise blood pressure and glucocorticoid for anti-inflammatory, and fluid for resuscitation, after which shock was reversed and KD-related symptoms gradually faded within ten days. On the 14th day, cranial MRI revealed that the aberrant signal had disappeared. Literatures were searched from CNKI, Wanfang, VIP and PubMed databases until December 31, 2023, and a total of 14 literatures were retrieved, including 12 foreign literatures and 2 Chinese literatures. A total of 19 children were reported, of which 2 were Chinese. One was definitely reported to have hypotension.

KD complicated with RESLES is rare in children, the clinical symptoms are varied and atypical, the corpus callosum injury is reversible, and the prognosis is good after active treatment. Increasing awareness of this condition can improve physicians′ diagnostic abilities and provide early standardized treatment for the patient.

To explore the diagnostic characteristics of intraperitoneal inflammatory myofibroblastic tumor (IMT) in children.

A retrospective analysis was performed on the clinical data of 2 pediatric patients with intraperitoneal IMT who were admitted to the Department of Pediatric Surgery at Shandong Provincial Hospital Affiliated to Shandong First Medical University in October 2021 and September 2023, respectively. The clinical diagnostic characteristics were summarized using information from the literature.

Both patients were females, aged 4 years, 10 months, and 12 years, respectively. The primary complaints were intermittent upper stomach pain and fever. Laboratory studies revealed varied degrees of hemoglobin decrease in both patients, although tumor markers were not markedly abnormal. The levels of C-reactive protein and procalcitonin were increased in the younger patient. In the younger individual, abdominal ultrasound revealed a hypoechoic mass in the left adrenal area, while the elder patient showed a hypoechoic mass at the splenic hilum. Abdominal CT plain and enhanced scans revealed an intra-abdominal tumor between the spleen and stomach in the younger individual, a rich blood supply, uneven enhancement on the enhanced scan, a tight relationship to the spleen, and malignancy could not be excluded.In the elderly patient, a hypoechoic mass near the splenic hilum was discovered, supplied by the splenic artery, and an enhanced scan revealed uneven enhancement, indicating malignancy. Both patients showed no invasion of adjacent tissues, abdominal fluid buildup, or swollen lymph nodes. Both patients underwent chest CT, radionuclide bone scan, and bone marrow puncture, which revealed no evidence of lung or bone metastases. Due to the high size of the tumor, the younger patient required open surgery to completely resect the abdominal lesion, whereas the elder patient underwent laparoscopic surgery. Both procedures resulted in total tumor removal, and the postoperative pathology diagnosis confirmed IMT. Postoperative follow-up for 25-month and 3-month respectively revealed no recurrence or metastases.

IMT in the pediatric abdomen lacks distinct clinical signs and auxiliary testing procedures, making preoperative diagnosis problematic. Comprehensive surgical resection is required for treatment, and a postoperative pathology evaluation can confirm the diagnosis.

To explore the significance of multiple genetic detection techniques in the differential diagnosis of chromosome karyotype in a child with hypospadias.

The case information of a child with hypospadias from the Urinary Surgery of Women and Children′s Medical Center Affiliated to Guangzhou Medical University was collected. The peripheral bloods of the child and his parents were extracted, and chromosome karyotype analysis, multicolorfluorescence in situ hybridization (M-FISH) technique, chromosome microarray analysis (CMA) and sex-determining region on the Y chromosome (SRY) were used for genetic analysis to determine the chromosomal karyotypes and sex of the children.

The child was male, 6 months old, the second fetus. The mother was preterm at 32 weeks due to pregnancy hypertension syndrome. The birth height was 48 cm, the weight was 2.3 kg, and the urine was found to be discharged from the ventral side of the penis during urination immediately after birth, without frequent urination or painful urination. Physical examination showed poor penis development, cap shaped accumulation of foreskin, urethral meatus at the root of the penis body, no local inflammation, and bilateral gonad being touched in scrotum. The ultrasound of scrotum showed no obvious abnormality in both testis and epididymis. The karyotype of the baby′mother was normal. The karyotype of his father was 45, X, ? psu dic(Y; 15) (q11.23; p13), so the karyotype of the baby was preliminarily diagnosed with 45, X, ? psu dic(Y; 15)(q11.23; p13)pat. CMA and SRY indicated that the Y chromosome of the child showed no deletion and mutation of SRY gene. The result of M-FISH of the baby was 45, X, dic(Y; 15)(p11.3; p11.2).ish dic(Y; 15)(wcp 1-22, wcp XY). Combined with the above examinations, it could be determined that the child was a dicentric chromosome carrier caused by balanced translocation of Y chromosome and chromosome 15, which was inherited from his father. The karyotype of the child was finally diagnosed with 45, X, dic(Y; 15)(p11.3; p11.2)pat, and the gender of the child was male.

Karyotype analysis is an important examination for children with hypospadias. Combined use of multiple genetic techniques is of great significance for differential diagnosis of chromosomal structural rearrangement, which contributes to reduce misdiagnosis.

To explore the diagnostic features of the tuberous sclerosis complex (TSC) caused by the c. 968 T>C mutation in the TSC2 gene.

A 12-week-old fetus was selected from the Prenatal Diagnostic Center of Maternal and Child Health Care Hospital of Huaihua on August 23, 2021, and the clinical information on the family lineage of TSC was collected. The suspected pathogenic mutation was screened by whole-exome sequencing, and verified by Sanger sequencing to identify the pathogenic variant and prenatal diagnosis of the fetus.

The proband (fetus′ father) had recurrent epilepsy, multiple pigmented spots of varying sizes on the back and buttocks, multiple small nodular calcified foci under the bilateral ventricle membranes, multiple hyperechoic nodules in both kidneys, multiple vascular smooth muscle lipomas of the liver. Whole-exome sequencing revealed a heterozygous c. 968 T>C (p.F323S) variation in exon 10 of the TSC2 gene, which confirmed the clinical diagnosis of TSC. At 29 and 31 weeks of gestation, ultrasonography revealed many significant echogenic masses in the fetal heart, intrarenal and intracranial areas. The Sanger sequencing findings of the fetus and family members confirmed that the fetal variant was consistent with the father. This variant was neither included in local or international databases, nor reported in the literature.

Based on the proband and fetus′s clinical data, as well as familial validation analysis of the whole-exome sequencing results, the heterozygous variant c. 968 T>C (p.F323S) is thought to be a new harmful mutation in the TSC2 gene. It is the cause of the disease in this family lineage, which serves as the foundation for genetic counseling and prenatal diagnosis.

To explore the diagnostic characteristics of anti-dipeptidyl-peptidase-like protein 6 (DPPX) antibody associated encephalitis.

A retrospective analysis was conducted on the past and current clinical data of a patient with serum anti-DPPX antibody positive admitted to the Neurology Department of Inner Mongolia Baogang Hospital on June 25, 2021. The diagnostic characteristics of anti-DPPX antibody related encephalitis were summarized and relevant literatures were reviewed.

The patient, a 53 year old male, was hospitalized due to progressive blindness in the right eye for 10 days. Ophthalmic examination showed that the pupils of both sides had unequal sizes, 3.0 mm on the left side and 4.0 mm on the right side, and the direct and indirect light reflection of right eye disappeared. Light perception of right eye disappeared, and the vision of the left eye was 0.4. The fundus, macular area and fundus fluorescein showed no abnormality. Visual evoked response in the right eye was not elicited. No new infarctions or occupying lesions were found on cranial MRI. The dynamic electroencephalogram was generally normal. Serum anti-DPPX antibody + + (diluted at 1∶20 titers), all other N-methyl-D-aspartic acid (NMDA) receptors encephalitis antibodies were negative. The remaining items of the cerebrospinal fluid examination were generally normal. During hospitalization, nutritional nerve therapy was given, and after 6 days of hospitalization, the lower field of vision and light perception recovered and there was a sense of light. The discharge diagnosis was anti-DPPX antibody encephalitis. The patient was admitted to the hospital for treatment on March 8, 2018 due to left limb strength. At the time of admission, a neurological examination showed that the left limb strength was level 4, with reduced pain sensation in the left upper limb and negative results on other examinations. Complete cranial MRI showed no new infarctions. Neck MRI showed a intramedually mass at the C5/6 level of the neck, diagnosed as astrocytoma. No special treatment was given, and only self rehabilitation exercise was performed. In March 2020, the left limb strength and sensation fully returned to normal.

The patient with anti-DPPX antibody encephalitis in this case started with weak unilateral limb strength, and both clinical symptoms showed varying degrees of self relief, further proving that the disease may exhibit self-limiting characteristics.

To explore the effect of multi-disciplinary treatment (MDT) combined with case-based learning (CBL) and problem-based learning (PBL) teaching model and formative assessment in standardized training of cardiology residents.

The experimental group consisted of 30 students who underwent standardized training at the Department of Cardiovascular Medicine, the Second Affiliated Hospital of Xi′an Jiaotong University, from March to May 2023. They were exposed to the MDT in conjunction with CBL and PBL teaching approaches, as well as formative evaluation integration. Teachers used the resident clinical cases as the basis, then guided the physicians to systematically integrate and learn the professional knowledge of cardiovascular medicine through multidisciplinary discussions and step-by-step learning, and provided formative assessment comments at each step. At the same time, 30 students who received standardized training of residents in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Xi′an Jiaotong University from December 2022 to February 2023 were chosen as the control group, who were taught using traditional methods. The two groups′ test results and teaching satisfaction were compared, and the experimental group provided formative comments feedback.

The experimental group′s theoretical scores, case analysis scores, skill operation scores and total scores [(87.30±3.58)points, (83.13±3.19)points, (87.77±2.96)points, (86.98±2.93)points] were higher than those of the control group [(84.40±3.51)points. (81.10±3.03)points, (84.23±2.83)points, (84.04±2.67)points], the differences were statistically significant (t=3.39, 2.37, 4.72, 4.06, all P<0.05). The overall teaching satisfaction rate was significantly higher in the experimental group (27/30, 90.00%) than that in the control group (19/30, 63.33%), and this difference was statistically significant (χ²=6.26, P<0.05). The experimental group′s formative evaluation feedback revealed that MDT combined with CBL and PBL could significantly improve the standardized resident training students′ independent thinking ability, learning enthusiasm, independent learning ability, clinical practice and thinking ability, the satisfaction rates were all 100.00%. However, there was still room for improvement in stimulating learning interest, and enhancing the ability to discover and solve problems, the satisfaction rates were 96.67% (29/30) and 90.00% (27/30) respectively.

The integrated formative evaluation of MDT combined with CBL and PBL teaching models has a significant teaching effect in the standardized training of cardiovascular internal medicine residents, which can fully exploit resident physicians′ subjective initiative and teamwork ability, improve their theoretical knowledge and clinical thinking ability, and is worth promoting in teaching.