Coronary artery fistula is an extremely rare cardiovascular malformation, accounting for approximately 0.26% of congenital heart diseases (CHDs). It involves an abnormal connection between 1 or more coronary arteries and a cardiac chamber or great vessel, most often originating from the right coronary artery. Most patients are asymptomatic in childhood, and the condition is usually detected incidentally by cardiac murmurs or imaging.1 Large fistulas may cause myocardial ischemia symptoms such as chest pain. Approximately 5% of patients develop infective endocarditis (IE). We report a rare case of a right coronary artery-right ventricular fistula complicated by IE affecting both cardiac systems.

Background Patients with chronic kidney disease (CKD) are at a high risk of cardiovascular disease. This study aims to observe the short-term changes of left ventricular (LV) myocardial work in stage 5 CKD patients with successful kidney transplantation (KT).Methods 45 stage 5 CKD patients who are candidates for KT were enrolled. Changes in clinical variables, laboratory data, routine transthoracic echocardiography, and noninvasive myocardial work (NIMW) were analyzed at pre-KT, 10 days, and 3 months post-KT. NIMW parameters include global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE).Results 1) Renal function indicators, including blood urea nitrogen, serum creatinine, and estimated glomerular filtration rate improved significantly at 10 days post-KT. At 3 months post-KT, there appears to be a continuing recovery trend; 2) GWE, GWI, and GCW were significantly increased at 3 months post-KT, but GCW and GWI with an early decrease at 10 days post-KT; 3) At the 10 days post-KT, the changes in systolic blood pressure and hemoglobin were positively correlated with the changes in GWI. Meanwhile, the change in systolic blood pressure was also positively correlated with the change in GCW. The change in diastolic blood pressure was positively correlated with the change in GWW.Conclusion LV systolic function doesn’t improve in parallel with renal function after a successful KT. Steadily controlling blood pressure and correcting anemia is associated with improving myocardial work after KT, especially in the early post-transplant period.

Background:Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, and is associated with poor outcomes. Detecting left atrial (LA) subtle structural and functional abnormalities before surgery may help to identify patients at increased risk of POAF. This study aimed to investigate whether LA volume and strain parameters measured by four-dimensional automated LA quantification (4D auto LAQ) echocardiography are independent predictors of POAF in patients undergoing cardiac surgery. Methods:Consecutive patients undergoing cardiac surgery were prospectively enrolled in the study. All the patients underwent conventional and 4D auto LAQ echocardiography before surgery. The occurrence of POAF up to discharge was monitored. Multivariate logistic regression was used to identify the clinical and echocardiographic risk factors of POAF. Results:In total, 128 patients were enrolled in the study. POAF occurred in 52 patients (40.6%), who formed the POAF group; the remaining 76 patients formed the no-POAF group. There were statistically significant differences between the two groups in terms of age, pro-brain natriuretic peptide (pro-BNP) levels, red blood cell (RBC) transfusion during surgery, surgical approach, and the type of surgery (all P<0.05). The POAF group had a significantly higher left ventricle end-diastolic diameter (LVEDD; P=0.043), E/e' ratio (P<0.001), and LA size (all P<0.001), but had a lower LA ejection fraction (LAEF; P<0.001), and LA strains (all P<0.05). In the multivariate analysis, an age ≥52 years old [odds ratio (OR) =11.628; P<0.001], RBC transfusion during surgery (OR =8.084; P=0.005), valve surgery (OR =4.870; P=0.033), LA pre-systolic volume (LAVpreA) ≥65 mL (OR =3.779; P=0.034), |LA contraction longitudinal strain| (|LASct|) <10% (OR =6.290; P=0.017), and |LA contraction circumferential strain| (|LASct-c|) <8% (OR =6.915; P=0.003) were identified as six independent predictive factors of POAF. The area under the curve (AUC) value for the POAF prediction model that included the above six variables was 0.924 (P<0.001), which was significantly higher than the AUC values of the three commonly used models that only include clinical parameters [i.e., the POAF score, the CHA2DS2-VASc score, and the atrial fibrillation (AF) risk index], which had AUC values of 0.695, 0.568, and 0.508, respectively. Conclusions:4D auto LAQ echocardiography is a novel, non-invasive tool for the analysis of LA structure and function in the preoperative setting of cardio surgery. The 4D auto LAQ parameters (including LAVpreA, LASct, and LASct-c), age, RBC transfusion, and valve surgery are independent predictors of the occurrence of POAF. The predictive model that includes the 4D auto LAQ parameters is more conducive to the risk stratification of POAF after cardiac surgery than traditional clinical models. However, our study had a small sample size, and lacked a validation group; thus, further studies need to be conducted to verify the efficacy and reliability of our predictive model in the future.

This study aimed to detect early left atrial (LA) function abnormalities in young hypertensive patients with a normal two-dimensional LA volume index (2D-LAVI) using four-dimensional auto LA quantification technology (4D Auto LAQ) and to analyse correlations between LA strain parameters and clinical metabolic indicators. This study enrolled 70 young patients who underwent standard hypertension treatment or diagnosis at the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, from October 2023 to July 2024 and 41 control volunteers enrolled during the same period. LA volume and strain parameters were evaluated with a 4D Auto LAQ. A correlation analysis was conducted between the clinical and strain parameters. Compared with the control group, young hypertensive patients presented significantly greater LA minimum volume (LAVmin), LA minimum volume index (LAVImin) and LA pre-atrial volume (LAVpreA) values (all p < 0.001). The LA ejection fraction (LAEF) was reduced in young hypertensive patients (57.85

Small intestinal neuroendocrine tumors (SI-NETs) are difficult to diagnose early and are associated with a poor prognosis due to distant metastasis (DM). This study aims to develop and validate two prediction models to predict risk of DM and prognosis of SI-NETs patients with DM. This study included patients diagnosed with SI-NETs from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2021. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM. A nomogram was developed using these factors to predict the risk of DM. Separately, for prognostic modeling, patients with DM were selected. Candidate prognostic variables were first screened using the least absolute shrinkage and selection operator (LASSO) Cox regression to reduce dimensionality and avoid overfitting. Variables retained by LASSO were then entered into a multivariable Cox proportional hazards model, and only those with a significance level of P < 0.05 were considered independent prognostic factors and used to construct the final prognostic nomogram. Both nomograms were rigorously validated using Receiver Operating Characteristic (ROC) curves, calibration curves, and Decision Curve Analysis (DCA). Kaplan-Meier analysis was employed to evaluate survival differences between risk groups stratified by the prognostic nomogram. A total of 4,046 patients with SI-NETs were enrolled in this study, of whom 882 had DM at initial diagnosis. Primary site, grade, histological type, T stage, N stage, and tumor size were independent predictive factors of DM (p < 0.05). Sex, age, grade, histological type, surgery and chemotherapy were independent risk factors for prognosis in SI-NETs patients with DM (p < 0.05). The nomogram models demonstrated robust accuracy in predicting both DM risk and prognostic outcomes. In conclusion, we constructed a new DM risk nomogram model and a new prognostic nomogram model for SI-NETs patients, which provides a decision-making reference for individualized treatment of clinical patients.

BACKGROUND:Human disease onset and progression are strongly associated with aberrant long noncoding RNA (lncRNA) expression, highlighting the functional regulatory role of lncRNA. Actin filament-associated protein 1-antisense RNA 1 (AFAP1-AS1), a member of lncRNAs, is located on the antisense strand of Actin filament-associated protein 1 (AFAP1).METHODS:We conducted a comprehensive review of AFAP1-AS1's functions in gynecology and urogenital systems using the "PubMed" database.RESULTS:Our analysis reveals that AFAP1-AS1 is overexpressed and engages in the initiation and process of gynecological and urogenital diseases. The regulatory mechanisms employed by AFAP1-AS1 involve four major strategies: gene-level effects, competition for microRNA (miRNA) repression, protein binding, participation in signaling networks that influence cellular processes such as proliferative phenotype, migration, invasiveness, epithelial-mesenchymal transition (EMT), cycle regulation, drug resistance, and more. Furthermore, AFAP1-AS1 is implicated in guiding clinicopathological characteristics.CONCLUSION:AFAP1-AS1 holds promise as a potent diagnostics and treatment option for gynecological and genitourinary systems in the future.

Ulcerative colitis (UC) is an idiopathic chronic intestinal inflammation. An increasing body of evidence shows that macrophages play an important role in the pathogenesis of UC. Interferon regulatory factor 4 (IRF4) is crucial for the development of autoimmune diseases via regulating immune cells. This research was designed to explore the function of IRF4 in UC and its association with macrophage polarization. The in vitro model of UC was established by stimulating colonic epithelial cells with tumor necrosis factor α (TNF-α). A mouse model of UC was constructed by injecting C57BL/6 mice with dextran sulfate sodium salt. Flow cytometry was used to assess percentage of CD11b+ CD86+ and CD11b+ CD206+ cells in bone marrow macrophages. Occult blood tests were used to detect hematochezia. Hematoxylin and eosin staining assay was used to assess colon pathological changes. Enzyme-linked immunosorbent assay (ELISA) was used to detect concentrations of inflammatory cytokines. The interaction of IRF4 and B-cell lymphoma 6 (Bcl6) was confirmed using GST pull-down and coimmunoprecipitation assays. Our findings revealed that IRF4 promoted cell apoptosis and stimulated M1 macrophage polarization in vitro. Furthermore, IRF4 aggravated symptoms of the mouse model of UC and aggravated M1 macrophage polarization in vivo. IRF4 negatively regulated Bcl6 expression. Downregulation of Bcl6 promoted apoptosis and M1 macrophage polarization in the presence of IRF4 in vitro and in vivo. Moreover, Bcl6 positively mediated the Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) signaling pathway. In conclusion, IRF4 aggravated UC progression through promoting M1 macrophage polarization via Bcl6/JAK2/STAT3 pathway. These findings suggested that IRF4 might be a good target to competitively inhibit or to treat with UC.

BackgroundCurrently, the primary treatment modalities for colorectal neuroendocrine tumors (CRNET) with a diameter between 10mm and 20mm are surgical resection (SR) and endoscopic resection (ER). However, it remains unclear which surgical approach yields the greatest survival benefit for patients.MethodsThis study included data from patients diagnosed with CRNET with tumor diameters ranging from 10mm to 20mm between the years 2004 and 2019, obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized into ER and SR groups based on the respective surgical approaches. Inverse probability weighting (IPTW) was employed to mitigate selection bias. Kaplan-Meier analysis and log-rank tests were utilized to estimate overall survival (OS) and cancer-specific survival (CSS). Cox regression analysis (univariate and multivariate) was performed to evaluate potential factors influencing survival.ResultsA total of 292 CRNET patients were included in this study (ER group: 108 individuals, SR group: 184 individuals). Prior to IPTW adjustment, Kaplan-Meier analysis and Cox proportional hazard regression analysis demonstrated that the OS and CSS of the SR group were inferior to those of the ER group. However, after IPTW adjustment, no statistically significant differences in prognosis were observed between the two groups. Subgroup analyses revealed that patients with muscular invasion, positive lymph nodes, or distant metastasis derived greater survival benefits from SR. Significant differences in OS and CSS between the two groups were also observed across different age groups.ConclusionFor patients with mucosal-limited lesions and without local lymph node or distant metastasis, ER is the preferred surgical approach. However, for patients with muscular invasion or positive lymph nodes/distant metastasis, SR offers a better prognosis. The choice of surgical approach should be based on the specific clinical characteristics of patients within different subgroups.

Background Colorectal cancer (CRC) is a prevalent type of gastrointestinal cancer, and its poor prognosis is mainly attributed to the occurrence of invasion and metastasis. CYP1B1-AS1, as non-coding RNA, plays an important role in tumorigenesis and progression. However, the mechanism by which CYP1B1-AS1 acts in CRC is not yet understood. Aims The objective of this study was to investigate how CYP1B1-AS1 contributes to the development of CRC, and provide a base for CRC diagnosis and treatment. Methods RT-qPCR was used to detect the expression level of CYP1B1-AS1 in CRC and adjacent tissues. CCK-8, Edu, scratch healing, and transwell experiments were used to detect the changes of proliferation, migration, and invasion ability of CRC cells after overexpression or knockdown of CYP1B1-AS1 respectively. The RNA binding protein NOP58 combined with CYP1B1-AS1 was verified by RIP and RNA Pull-down experiments. Functional recovery experiments validated the interaction between CYP1B1-AS1 and NOP58 in CRC cells. The changes of EMT-related proteins were detected by Western blot, and the half-life of transcription factor SNAIL mRNA were detected by RT-qPCR after overexpression or knockdown of NOP58. Results CYP1B1-AS1 was found to be significantly downregulated in CRC compared to adjacent noncancerous tissues. Experiments conducted in vitro and in vivo confirmed that upregulation of CYP1B1-AS1 significantly inhibited the proliferation, migration, and invasion of CRC cells. In addition, CYP1B1-AS1 can directly bind to NOP58 and negatively regulate NOP58. The effect of overexpression CYP1B1-AS1 was reversed by NOP58 overexpression. NOP58 regulates the EMT process of CRC cells by affecting the stability of EMT-related transcription factor SNAIL mRNA, and then affects the progress of CRC. Conclusion This research proves that CYP1B1-AS1 can inhibit the occurrence of EMT in CRC by binding with NOP58, thus delaying the progress of CRC. This finding indicates that CYP1B1-AS1 may be a novel biomarker to improve the diagnosis and treatment of CRC.

Background Aorto-ventricular tunnel (AVT) is an abnormal communication channel between the ascending aorta and the ventricle. It commonly has two orifices, i.e., one aortic opening and one ventricular opening. In this study, we present a unique case of AVT with three orifices: one aortic opening, one LV opening, and one RV opening. Case presentation A 64-year-old male presented with chest discomfort and dyspnea on exertion lasting the past six months. Physical examination revealed a grade 4/6 continuous biphasic murmur along the left sternal edge and a grade 3/6 systolic murmur at the apex. Transthoracic echocardiography (TTE) demonstrated: (1) an AVT with three orifices, i.e., one aortic opening, one LV opening, and one RV opening. The LV and RV openings were located in the left and right ventricular outflow tracts, respectively. (2) The aortic valve (AV) was calcified with a small aneurysm at the non-coronary cusp. (3)The mitral valve (MV) chordal rupture of the P2 and P3 segments was observed in the posterior leaflet with severe eccentric regurgitation. Subsequent coronary computed tomography angiography (CTA) further confirmed the diagnosis of AVT with three openings, and clarified the coronary arteries normally arose from the aortic sinuses. The patient was then referred for surgical treatment, consisting of closure of three AVT orifices, AV replacement, and MV replacement. Six months following surgery, the patient was asymptomatic. TTE demonstrated normal mechanic AV and MV function, and there was no residual shunt among the ascending aorta, LV and RV. Conclusions It is the first case to report an AVT with three orifices. This paper described the entire process from diagnosis to treatment of this unique case, thus providing some novel insights into AVT.

It is well accepted that ultrasound-induced microbubble (USMB) cavitation is a promising method for drug delivery. Ultrasound-targeted destruction of cytotoxic drug-loaded lipid microbubbles (LMs) is used to promote the treatment of cancer. This study aimed to investigate the antitumor effects from a combination of docetaxel-loaded cationic lipid microbubbles (DLLM + ) and ultrasound (US)-triggered microbubble destruction (UTMD) on gastric cancer (GC). It was found that the functional dose of DOC in this study was 1 × 10 −9 mol/L. We found that DLLM combined with the UTMD group showed greater growth inhibition of the cultured human gastric cancer cells (HGCCs) when compared with the other five groups by arresting the G 2 /M phase in the cell cycle. However, DLLM + combined with UTMD showed a higher inhibition rate of tumor growth than DLLM combined with UTMD and that of the RC/CMV-p16 combined with UTMD in vitro and in vivo experiments. DLLM + combined with UTMD significantly suppressed proliferation and promoted the apoptosis of HGCCs with more cells arrested in the G 2 /M phase. In addition, DLLM + combined with UTMD suppressed the proliferation and induced apoptosis by arresting cells in the G 2 /M phase, which led to a great inhibition of GC progression. Thus, our results indicated that the combination of DLLM + and UTMD might represent a novel and promising approach to chemotherapy for GC.

目的 应用剪切波弹性成像(SWE)评价肛提肌主要肌群(耻骨直肠肌、髂尾肌)的收缩功能.方法 纳入盆腔器官脱垂(POP)患者74例作为POP组,另选择同期健康女性48例作为正常对照组.应用SWE技术分别测量两组耻骨直肠肌、髂尾肌在静息和最大缩肛状态下杨氏模量值,并计算缩肛前后杨氏模量差值.结果 两组受检者最大缩肛状态较静息状态耻骨直肠肌、髂尾肌的杨氏模量值增加(P<0.05);POP组较正常对照组静息状态耻骨直肠肌、髂尾肌的杨氏模量值增加(P<0.05),而POP组较正常对照组最大缩肛状态杨氏模量值和缩肛前后杨氏模量差值均减低(P<0.05).结论 SWE可定量评估POP患者肛提肌收缩功能,有助于为POP的防治提供影像学理论依据.

Background: Although ultrasound (US) guided axillary vein (AV) catheterization has been well described, evidence for its efficacy and safety compared with conventional infraclavicular landmark guided subclavian vein (SCV) cannulation have not been comprehensively appraised. Thus, we conducted a systematic review and meta-analysis to determine whether US guided AV catheterization reduces catheterization failures and adverse events compared to SCV puncture based on landmark technique. Methods: We searched the PubMed, Embase, Cochrane Library, CINAHL, Web of Science, SCOPUS, China Biology Medicine, China National Knowledge Infrastructure, Wan Fang, and Wei Pu databases for randomized controlled trials (RCTs) studies published from inception to May 2021. Two investigators reviewed and extracted data on study design, number and type of inclusion criteria. Study quality was assessed using the Jadad scale. Outcomes included the puncture success rates and the incidence of adverse events. Results: Data of 1852 patients from five RCTs were included in this meta-analysis. The analysis showed that US guided AV catheterization increased the first (risk ratio (RR), confidence interval (CI)) (RR = 1.17, 95% CI = 1.13~1.22, P < .01) and overall (RR = 1.09, 95% CI = 1.04~1.15, P < .01) puncture success rate, and reduce the occurrence of adverse events, including the risk of arterial puncture (RR = 0.18, 95% CI = 0.06~0.55, P < .01), pneumo-and hemothorax (RR = 0.12, 95% CI = 0.02~0.64, P = .01). Conclusion: This meta-analysis indicates that US guided AV catheterization reduces catheterization failures and mechanical complications compared with conventional landmark guided SCV puncture.

Ring finger protein 2 (RNF2), as a well-known E3 ligase, has an oncogenic role in various cancers. The role of RNF2 in colon cancer is still unknown. The aim of this work is to determine the biological role of RNF2 in colon cancer. We first examined the expression of RNF2 and interferon regulatory factor 4 (IRF4) in colon cancer patients and colon cancer cell lines (SW480 and HCT116). Compared with normal tumor-adjacent tissues, RNF2 was up-regulated whereas IRF4 was down-regulated in the colon cancer tissues. RNF2 was also up-regulated in colon cancer cells with respect to human fetal colon epithelial cells. RNF2 overexpression enhanced the ability of proliferation, migration and invasion of SW480 cells, whereas RNF2 knockdown caused an opposite result in HCT116 cells. Furthermore, a tumor xenograft model was constructed to verify the impact of RNF2 overexpressed-SW480 cells on tumor growth. RNF2 up-regulation elevated Ki-67 proliferation index, accelerated the growth of tumor tissues, and led to severe colon tissue damage in the tumor xenograft mice. In addition, RNF2 interacted with IRF4, and repressed IRF4 protein expression. IRF4 was a substrate of RNF2, and RNF2 promoted the ubiquitination and degradation of IRF4. RNF2 overexpression increased the ability of proliferation, migration and invasion in SW480 cells by promoting the ubiquitination and degradation of IRF4. In conclusion, this work demonstrated that RNF2 promoted tumor growth in colon cancer by regulating ubiquitination and degradation of IRF4. Thus, RNF2 may be served as a potential therapeutic target for colon cancer.

Background Middle aortic coarctation (MAC), also known as middle aortic syndrome, is an atypical aortic coarctation characterized by narrowing of the distal thoracic aorta and proximal abdominal aorta. MAC is a rare disease commonly diagnosed by computed tomography angiography (CTA). In this paper, we present a case of long-segmental MAC first diagnosed by transthoracic echocardiography (TTE) and further evaluated by CTA. Case presentation. A 14-year-old girl, with dyspnea and fatigue on exertion for 2 months and refractory hypertension for 6 months, was referred by the local clinic to our hospital. Physical examination showed blood pressure up to 176/100 mmHg measured in the arms despite dual antihypertensives, a marked pressure gradient between her arms and legs, and weak pulses in both dorsal pedes arteries. TTE revealed a segmental narrowing in the descending thoracic aorta below the level of the atrioventricular sulcus, with a calcified plaque in the stenotic region. Abdominal vascular ultrasound revealed the segmental narrowing extending to the descending abdominal aorta (5.7 mm in diameter) above the level of the superior mesenteric artery. Subsequently, CTA verified a long-segment narrowing in the descending aorta from the level of T8 to L2 vertebra, with a calcified plaque in the stenotic aorta, right renal artery involvement, and a rich network of collateral vessels between the pre-and post-stenotic region. The patient was referred for cardiovascular surgery in which a successful ascending aorta-abdominal aorta bypass was performed. Conclusions Although MAC is usually diagnosed by CTA, it may also be first diagnosed by TTE in some patients whose longitudinal axis view of the thoracic descending aorta could be shown. Careful TTE scan can improve the diagnostic rate of MAC, especially for some hypertension patients whose marked pressure gradient between arms and legs was ignored by the physician.

患者女,33岁,因"阵发性心悸3d"就诊.查体:血压143/76 mmHg,心率87次/min,瓣膜听诊区未闻及病理性杂音.心电图:窦性心律,频发室性早搏.超声心动图:心脏各腔室大小、结构、血流未见异常,左室收缩及舒张功能正常.剑突下切面示腹主动脉内径偏小,约10 mm,测量腹主动脉频谱形态呈"小慢波".胸骨上窝切面显示主动脉狭部管腔缩窄,最窄处内径约3 mm,彩色多普勒于该处可见细束五彩镶嵌血流信号,峰值流速3.6m/s.超声心动图诊断:①主动脉缩窄(导管后型)可能,建议CTA进一步检查.②心内结构、功能及血流未见异常.CTA诊断:先天性主动脉缩窄(导管后型)伴丰富侧支循环,见图1.