Journal of International Medical Research最新文献

Left ventricular pseudoaneurysm (LVP), a rare but life-threatening complication following acute myocardial infarction (AMI), has an incidence of approximately 0.5% and a high mortality rate due to its significant risk of rupture. Early detection and timely surgical intervention are crucial. The diagnosis of LVP can be effectively achieved through various imaging modalities, including transthoracic echocardiography, cardiac magnetic resonance imaging, computed tomography angiography, and left ventriculography. However, determining the optimal therapeutic strategy requires a comprehensive multidisciplinary discussion approach and individualized consideration. This report presents a challenging case of a patient who experienced recurrent AMI 25 years after the initial event, with an incidental discovery of a calcified LVP. The distinctive features of this case include the long-term presence of a calcified pseudoaneurysm without rupture and the successful management strategy employed following the recurrent AMI.

ObjectiveThis retrospective study aimed to investigate the correlation between the cardiopulmonary exercise test (CPET) and the severity of coronary stenosis (SYNTAX score) in patients with stable coronary artery disease (SCAD), thereby assessing CPET's diagnostic value.MethodsWe classified 220 patients who underwent coronary angiography into coronary heart disease (CHD) and non-CHD groups based on stenosis severity. Patients with SCAD were categorized into mild, moderate, and severe groups by the SYNTAX score. CPET was performed, and data on the general information, serological indicators, and echocardiographic parameters were collected. CPET parameters included oxygen uptake related to the work rate (△VO₂/△WR), peak metabolic equivalent (Peak Mets), anaerobic threshold (AT), peak oxygen consumption per kilogram (PVO₂/kg), and metabolic equivalent at anaerobic threshold (Met@AT).ResultsPatients without SCAD demonstrated significantly higher CPET parameters than those with SCAD. The CPET parameters varied significantly across severity groups in the SCAD group, with the mild group exhibiting higher values than the moderate and severe groups. No significant differences were observed in the baseline data between the groups or among patients with varying numbers of lesion branches.ConclusionCPET parameters demonstrated a significant negative correlation with the SYNTAX score in patients with SCAD, indicating its potential clinical value in assessing the severity of coronary stenosis and diagnosing SCAD.

Plasma cell leukemia is a rare and aggressive malignancy characterized by monoclonal gammopathy and the presence of circulating plasma cells in the peripheral blood. Therapeutic strategies for plasma cell leukemia remain undefined, with treatments primarily borrowed from those used in multiple myeloma. The first-line treatment typically involves a combination of a proteasome inhibitor, an immunomodulatory agent, steroids, and/or anthracyclines and alkylators within an intensive chemotherapy regimen. Following this, consolidation with autologous hematopoietic stem cell transplantation is offered to eligible patients, followed by maintenance therapy. For patients ineligible for autologous hematopoietic stem cell transplantation, allogeneic hematopoietic stem cell transplantation is considered a viable alternative. Given the challenges in securing a fully human leukocyte antigen-matched donor, haploidentical hematopoietic stem cell transplantation serves as a potential salvage therapy, as demonstrated in the clinical case presented. This article presents the case of a female patient in her 50s diagnosed with plasma cell leukemia who, following unsuccessful autologous hematopoietic stem cell mobilization, underwent haploidentical hematopoietic stem cell transplantation from her son, resulting in complete donor chimerism and a favorable response.

This study investigated the occurrence of left ventricular thrombus formation and subsequent embolic stroke in patients with Takotsubo syndrome. Through the case analysis of an 80-year-old Chinese elderly female patient, it was found that although Takotsubo syndrome is generally considered a self-limiting disease, it can lead to severe complications such as left ventricular thrombus and cerebral stroke. The patient experienced a cardioembolic stroke during hospitalization, and magnetic resonance imaging revealed acute cerebral vascular occlusion. This case highlights the importance of anticoagulation therapy, especially in the prevention of thromboembolic events in patients with Takotsubo syndrome complicated with intracardiac thrombosis.

Left ventricular thrombus is one of the major complications of dilated cardiomyopathy. Although the presence of a cardiac thrombus is a major risk factor for embolization, several probable conditions, the connection of which is not thoroughly studied, such as gout disease and methamphetamine abuse, are also possible causes. We present the case report of a male in his early 40s with a history of alcohol and methamphetamine abuse, gout, and dilated cardiomyopathy, experiencing multiple ischemic attacks, including acute limb ischemia, dysarthria, and renal infarct. Echocardiography revealed a large clot in the left ventricle. The patient received heparin at a rate of 1000 units/hour, followed by warfarin at 10 mg/day, and probenecid at 500 mg/day. The thrombus resolved upon anticoagulant therapy, with improvement in the patient's symptoms. Left ventricular thrombus formation in dilated cardiomyopathy is influenced by many factors, including drug toxicity (for instance, methamphetamine), uric acid levels, and N-terminal precursor B-type natriuretic peptide. The thrombus can cause cardioembolic attacks in multiple sites, and the choice for emergent therapy is an oral anticoagulant, which may improve the ejection fraction. However, certain aspects related to cardiac thrombosis and embolization risk still warrant more comprehensive studies.

ObjectivesAcute leukemia often leads to severe complications such as febrile neutropenia. Mortality rates remain high, underscoring the need for novel prognostic markers. Regulatory T cells (Tregs) have not been extensively studied in this context.MethodsThis prospective observational, single-center study included 114 patients diagnosed with acute leukemia. Tregs percentages were measured using flow cytometry. Statistical analyses involved logistic regression to identify factors significantly associated with survival.ResultsOf the 114 patients, 78 recovered, while 36 died. The median Treg percentages were 5.9% in patients under 65 years and 5.38% in those 65 and older. A lower percentage of Tregs was associated with higher mortality in the older group (p = 0.04). Multivariate analysis highlighted the presence of comorbidities, documented infections, and day seven C-reactive protein levels as significant predictors of survival.ConclusionThis study supports the importance of monitoring chronic diseases and infection foci alongside traditional markers like C-reactive protein. Future research should explore the mechanistic roles of Tregs in immunosuppression and survival in this vulnerable population.

ObjectiveThe study investigated the link between the homeostatic model assessment for insulin resistance (HOMA-IR) and myocardial infarction (MI) parameters, highlighting its role as a potential MI biomarker in Southern Saudi patients.MethodsThis cross-sectional study conducted from January to April 2021 at the Prince Faisal Bin Khalid Cardiac Center, Abha, Saudi Arabia, examined cardiovascular and diabetic biomarkers, including HOMA-IR, in MI patients and controls to assess insulin resistance (IR), risk, and diagnostic accuracy.ResultsMI patients showed significantly elevated HOMA-IR, leptin, resistin, body mass index (BMI), and glucose-complexed hemoglobin (HbA1c) levels compared with controls in both genders (p < 0.0001). HbA1c was strongly associated with HOMA-IR, whereas age, BMI, leptin, and resistin showed weak correlations. Elevated HOMA-IR increased MI risk and demonstrated high diagnostic accuracy.ConclusionsElevated HOMA-IR was identified as an early indicator of the onset of MI, whereas serum leptin and resistin levels exhibited a positive association with IR in patients with MI. Moreover, serum leptin, resistin, and elevated HOMA-IR may independently contribute to the risk of MI.

Abdominal aortic aneurysms are the most common types of aneurysms worldwide, whereas aneurysms in the blood vessels of the abdominal organs (splanchnic aneurysms) are rare. Few studies have reported cases of two giant aneurysms occurring simultaneously. Presented here is a case of a 67-year-old man who began to experience periumbilical pain with a diagnosis of a giant abdominal aortic aneurysm and a hepatic artery aneurysm. He was successfully treated using a staged endovascular stent grafting procedure. Postoperatively, the patient's abdominal pain was resolved, and he was prescribed medication for hypertension control, lipid control, heart rate control, antiplatelet therapy, and smoking cessation, which he took regularly. Follow-up evaluations were performed at 3, 6, and 9 months after surgery, and no late complications were observed. This case report suggests that when two giant aneurysms are diagnosed simultaneously, risk of rupture, surgical interventions, and postoperative complications are significantly increased. The choice of a treatment strategy is complex and has a high degree of individual specificity.

ObjectiveThis study aimed to explore the association between pan-immune-inflammation value and heart failure outcomes using data from the nationally representative National Health and Nutrition Examination Survey database.MethodsWe conduct a cross-sectional cohort analysis using National Health and Nutrition Examination Survey data, including participants aged ≥20 years with available pan-immune-inflammation value data. We performed smooth curve fitting and threshold analysis, using both linear and non-linear regression models, to assess dose-response relationship and explore the continuous effect of pan-immune-inflammation value on heart failure outcomes.ResultsOur analysis revealed a significant and independent non-linear association between elevated pan-immune-inflammation value levels and an increased risk of heart failure occurrence. After adjustment for multiple covariates, these findings remained consistent and each increment unit in logarithmic pan-immune-inflammation value is associated with 34% increase in the risk of heart failure occurrence. Furthermore, we identified an inflection point of logarithmic pan-immune-inflammation value = 5.98 as a critical threshold. Stratified analyses revealed that the association between pan-immune-inflammation value and heart failure occurrence remains consistent across different subgroups.ConclusionsThis study confirmed the clinical value of pan-immune-inflammation value as a novel inflammatory biomarker in the assessment and monitoring of heart failure.

Myoepithelioma-like hyalinizing epithelioid tumors (MHETs) are distinct soft tissue neoplasms characterized by their unique histological presentation, including myoepithelioma-like hyalinization and an epithelioid-cell pattern. A defining molecular characteristic of these tumors is the presence of a novel OGT::FOXO gene fusion. Their distinct morphology makes diagnosis challenging because they can be mistaken for other soft tissue tumors. We report the case of a 71-year-old man who was admitted to our hospital with a 1-year history of a palpable mass on the left palm. Physical examination revealed a well-defined, mobile mass on the lateral aspect of the left palm, measuring 2.0 × 3.0 cm, with moderate consistency. The tumor was surgically excised, and postoperative pathology based on immunohistochemical staining and tissue morphology confirmed the diagnosis of MHET. The tumor cells exhibited diffuse positivity for CD34 and focal positivity for EMA. At the 3-month follow-up post-surgery, there was no evidence of recurrence or distant metastasis. MHETs are typically observed as superficial, well-circumscribed masses without the histological features of malignancy. Given the distinct tissue morphology and the recent identification of this tumor type, clinicians and pathologists must be aware of these features to facilitate accurate diagnosis and inform treatment strategies.