Xiangdong Li

Objectives: This study aims to preliminarily explore the feasibility and safety of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for syphilitic coronary artery ostial lesions (SCAOL), providing hypothesis-generating insights for optimal stenting strategies in this distinct pathological entity. Background: Cardiovascular syphilis, a severe manifestation of tertiary syphilis, frequently leads to coronary ostial stenosis. While coronary artery bypass grafting (CABG) is the traditional revascularization modality, PCI has emerged as a minimally invasive alternative. Given the “borderless” inflammatory nature of syphilitic aortitis, the efficacy of the conventional “flush-alignment” stenting strategy lacks specific evidence. Methods: We retrospectively analyzed seven consecutive patients with confirmed SCAOL who underwent PCI at our center between January 2019 and February 2026 (follow-up through March 2026). All cases were diagnosed via syphilis serology, and IVUS was utilized for pre-procedural assessment and post-stenting optimization. The IVUS characteristics of SCAOL and PCI-related outcomes were analyzed to explore the potential impact of stent positioning strategies. The study received institutional ethical approval and written informed consent from all patients. Results: The cohort included four males and three females (mean age: 54.3 ± 3.4 years). Pre-procedural IVUS consistently revealed concentric fibrous hyperplasia and significant negative remodeling, lacking typical atherosclerotic plaque features. Second-generation drug-eluting stents (DES) were successfully implanted in all seven patients. Six patients, whose stents protruded variably into the aortic sinus (ranging from approximately 2–4 mm in most cases), remained free of major adverse cardiovascular events (MACE) over a median follow-up of 4 years (IQR: 3–6 years). Conversely, one patient (Case 6), who received a “flush-alignment” LM stent (protrusion <1 mm) and lacked standardized anti-syphilitic therapy, developed NSTEMI due to severe in-stent restenosis (ISR) 8 months post-procedure. A bailout PCI utilizing a protrusion of approximately 4–5 mm was performed, and the stent remained patent at the 13-month follow-up. Conclusions: IVUS-guided PCI was technically feasible in this small retrospective series of patients with suspected syphilitic coronary ostial lesions. Moderate aortic protrusion may help ensure ostial coverage, but the optimal protrusion length and its effect on restenosis require confirmation in larger multicenter studies. Furthermore, mechanical revascularization must be coupled with standardized systemic anti-syphilitic therapy and careful control of residual inflammatory activity to optimize long-term prognosis.

A coronary pseudoaneurysm (CPA) is defined as a rupture of the coronary artery wall where blood is encapsulated by surrounding pericardial tissue, thrombus, or fibrous tissue, forming a fluid-filled sac lacking normal vascular walls. While pseudoaneurysms can develop spontaneously, they most commonly occur following coronary intervention procedures, such as percutaneous coronary intervention. Causes include excessive balloon or stent usage, high-pressure balloon dilation, and arterial wall damage from coronary atherosclerotic resection or laser angioplasty. Although asymptomatic in many cases, a ruptured CPA can lead to life-threatening acute cardiac tamponade. Notably, postoperative mortality in some PCI patients may result from both malignant arrhythmias and recurrent myocardial infarction, with CPA rupture being a contributing factor. This case report describes a patient who developed a massive pseudoaneurysm 1 year after undergoing chronic coronary occlusion lesion recanalization. Through surgical review, we analyze the etiology, discuss subsequent interventions, and highlight clinical lessons to provide guidance for managing such complex cases.

Background: Coronary artery-left ventricular multiple micro-fistulas (CA-LVMMFs) is a rare congenital vascular anomaly that may present with no obvious clinical symptoms or a typical angina attack. CA-LVMMFs is usually found unexpectedly during coronary angiography (CAG). Case presentation: We report a case of a 65-year-old man admitted to the hospital with acute coronary syndrome. CA-LVMMFs was found during coronary angiography. Echocardiography showed apical hypertrophy and blood flow signals were seen in the apical myocardium, connected with the left ventricle. We searched the MEDLINE database and found 39 relevant reports. We made statistics on the clinical characteristics of these patients and found half involved hypertrophy or perfusion defects in the ventricular septum or apex. Conclusion: As a rare congenital anomaly, the effect of CA-LVMMFs on patients is unclear. By reporting a case and summarizing literature reports, we found that CA-LVMMFs may be associated with myocardial hypertrophy, especially ventricular septal and apical hypertrophy.

Aim. Coronary heart disease is a major cause of mortality in developed and developing countries. Changes in the trace element concentration in the human body are one of the main reasons for the transition of the human body from a healthy to a diseased state. In this meta-analysis, we have studied the relationship between the reduction in serum zinc ion concentration and coronary heart disease. Methods. We used PubMed and Cochrane (as of June 30, 2021) databases for the literature search. Per the requirements of this systematic review, case-control studies involving serum zinc ion concentration and coronary heart disease were searched, and the quality of the included studies was evaluated before the meta-analysis. Results. A total of 3,981 cases were found across seven articles. The standard mean deviation (SMD) of serum zinc ion concentration was −0.22 [−0.28, −0.15], z = 6.52, and P < 0.05 indicated that the difference was statistically significant. The forest plot results show that I2 = 34% < 50%, and the Q test showed P = 0.17 > 0.1 . These results suggest a lack of heterogeneity among the selected articles. Results from the funnel chart indicated that this study was free from publication bias. Conclusion. The results of this meta-analysis reveal that a decrease in serum zinc ion concentration is related to the occurrence of coronary heart disease. Clinically, monitoring the serum zinc ion levels is proven to be of great significance for patients with coronary heart disease.

Coronary atherosclerosis is a potentially chronic circulatory condition that endangers human health. The biological cause underpinning cardiovascular disease is coronary atherosclerosis, and acute cardiovascular events can develop due to thrombosis, platelet aggregation, and unstable atherosclerotic plaque rupture. Coronary atherosclerosis is progressive, and three specific changes appear, with fat spots and stripes, atherosclerosis and thin-walled fiber atherosclerosis, and then complex changes in arteries. The progression and severity of cardiovascular disease are correlated with various levels of calcium accumulation in the coronary artery. The therapy and diagnosis of coronary atherosclerosis benefit from the initial assessment of the size and degree of calcification. This article will discuss the new progress in the early diagnosis of coronary atherosclerosis in terms of three aspects: imaging, gene and protein markers, and trace elements. This study intends to present the latest methods for diagnosing patients with early atherosclerosis through a literature review.

The COVID-19 pandemic can be seen as a traumatic event during which time medical students have been required to perform dual roles both as students and as medical workers. In this study, we aimed to use the Perceived Stress Scale (PSS-14) to judge the pressures on medical students and to identify effective ways to relieve these pressures. In this cross-sectional study, the subjects were recruited under informed consent according to the Declaration of Helsinki. Students undertaking Masters degrees at the China-Japan Union Hospital of Jilin University were randomly selected and data were collected through questionnaire surveys. Our data showed significant differences in the levels of pressure experienced by Masters students (p < 0.05). In the student population that showed increased pressure, females were significantly more stressed than males (p < 0.05). In addition, the pressures persisted after a holiday period (p < 0.05) but were reduced by undertaking recreational activities. The psychological pressures resulting from the COVID-19 pandemic were higher in female medical students compared to males. We showed that recreational activities including chatting with friends reduced psychological pressures in female medical students.

Objective. Our study’s goal was to find out acute myocardial infarction (AMI) patients’ NUMB gene expression patterns and to evaluate its role as a diagnostic marker for AMI detection. Methods. Peripheral blood was drawn from 124 individuals who had an AMI and 115 patients who had stable coronary artery disease (SCAD). The real-time quantitative polymerase chain reaction was used to measure the mRNA expression level of the NUMB gene in peripheral blood. Results. The AMI group’s NUMB gene expression was 0.906 (0.181–0.954), whereas the SCAD group’s expression was 1.024 (0.207–1.127). However, the AMI group had 0.885 times lower NUMB mRNA expression than the SCAD group . Conclusion. Multivariate logistic regression evaluation found that lower NUMB expression was correlated with an increased risk of coronary artery disease. However, age and fasting plasma glucose levels were not associated with decreased NUMB expression.

Rationale: In recent decades, the incidence of advanced syphilis has declined due to early recognition and the application of effective antibiotics. Advanced syphilis often manifests in the cardiovascular system as simple aortitis, aortic valve insufficiency, coronary artery stenosis or obstruction, Aortic aneurysm and mucinous myocarditis. In most case reports on the subject, acute myocardial infarction caused by syphilis was reported to be due to aortic valve insufficiency and coronary stenosis as a result of the involvement of the aorta. Patient concerns: The patient was a 48-year-old woman. She was admitted to our hospital because of intermittent upper abdominal pain with chest tightness for 3 hours. The patient reported a past syphilis infection, when she was hospitalized for hysteromyoma surgery four years ago, and had no related treatment. Diagnosis: According to the characteristics of coronary angiography and results of lab tests and echocardiography, she was finally diagnosed with myocardial infarction associated with syphilis. Interventions: At the first diagnosis of syphilis, the patient did not received antibiotics treatment. After the diagnosis of myocardial infarction, she received the percutaneous coronary intervention (PCI) operation assisted by extracorporeal membrane oxygenation (ECMO) technology, successfully got drug -eluted stents in right coronary artery ostium and left main ostium. Then the patient received penicillin to treat the syphilis infection. Outcomes: After coronary revascularization, the cardiac function of the patients was gradually improved, and the left ventricular ejection fraction was gradually improved after combined with optimized drug therapy. Lessons: The cardiovascular system is often involved in the stages of advanced syphilis with severe complications like myocardial infarction. Standard treatment should be given as soon as syphilis is diagnosis. For stenosis of coronary ostium, the PCI assisted by ECMO technology did not only ensure the effectiveness of the treatment, but also reduce the surgical risk of the patient. This case indicated the effectiveness of ECMO-assisted PCI, and thus may provide a reference for future patient treatment.