Hepatic hydrothorax occurs in patients with decompensated cirrhosis and has a significantly adverse prognosis. However, several treatments, including indwelling pleural catheters, trans jugular intrahepatic systemic shunts, and automatic low-flow ascites pumps (Alfa pumps), have been utilized to relieve pleural effusion, but these methods often cause severe complications. We report the first case of using thoraco-peritoneal connection to manage hepatic hydrothorax in a cirrhotic patient without an unfavorable outcome.

A 55-year-old yellow-skinned female patient with alcoholic cirrhosis suffering from hepatic hydrothorax was admitted to the hospital. She presented with recurrent yellowish complexion, anorexia, chest tightness, and shortness of breath.

The definitive diagnosis encompassed liver failure, alcoholic cirrhosis in a decompensated state, esophageal varices, portal hypertension, ascites, hepatic hydrothorax, hypersplenism, cholecystolithiasis accompanied by cholecystitis, pulmonary nodules, and coronary atherosclerosis.

A thoracic drainage catheter and an abdominal puncture indwelling needle were connected to allow the pleural effusion to continuously flow into the abdominal cavity.

The patient showed rapid improvement in nutritional status, urine output, and a decrease in pleural effusion. Subsequently, pleural effusion did not increase, and the connection was removed 1 month later. Hydrothorax and ascites were examined by color Doppler ultrasound every 2 months. Liver function and coagulation function continued to improve. The patient resumed normal daily activities after 6 months.

The management of hepatic hydrothorax remains an area requiring further investigation. Thoraco - peritoneal connection might represent a medical strategy for the management of hepatic hydrothorax in cirrhotic patients with a favorable safety profile.

Isolated hepatic involvement of Langerhans cell histiocytosis (LCH) in the pediatric population is an exceedingly rare condition. Its clinical presentation is nonspecific, and its imaging features frequently overlap with those of other hepatic focal lesions, rendering preoperative diagnosis particularly challenging.

An 11-year-old girl presented with a chief complaint of intermittent abdominal pain.

Enhanced computed tomography and magnetic resonance imaging revealed multiple liver nodules. A characteristic imaging pattern was observed: during the portal venous and delayed phases, the periphery of the lesions exhibited a "wash-in and wash-out" enhancement pattern, while the central areas remained non-enhancing throughout all phases. This imaging finding provided a crucial diagnostic clue. The diagnosis of LCH was ultimately confirmed by liver biopsy, supplemented by electron microscopy and immunohistochemistry. Systemic evaluation verified isolated hepatic involvement.

The patient received immunosuppressant therapy combined with prednisone and vindesine-based combination chemotherapy.

The patient was treated with immunosuppressant therapy and combination chemotherapy. Follow-up at 6 months indicated a favorable recovery.

This case illustrates that contrast-enhanced ultrasound can effectively delineate the unique hemodynamic characteristics of hepatic LCH lesions, serving as a valuable supplement to conventional cross-sectional imaging. In the differential diagnosis of focal liver lesions in children, particularly when there is clinical suspicion for LCH, increased recognition of these specific contrast-enhanced ultrasound features is crucial. This awareness can help prevent diagnostic delays and guide targeted pathological sampling.

Xiaoqinglong Decoction (XQLD) is a traditional Chinese herbal formula widely used in clinical practice to treat acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with notable efficacy. Studies indicate that XQLD can effectively modulate the inflammatory response during the acute infectious phase of AECOPD; however, its underlying mechanism of action remains unclear. This study employed network pharmacology, molecular docking, and molecular dynamics simulations to investigate the potential target genes of XQLD and its possible mechanisms of action in treating AECOPD. Active ingredients and related targets of XQLD were identified from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform, SwissTargetPrediction, and UniProt. AECOPD-related targets were collected from GeneCards, DrugBank, online Mendelian inheritance in man, and PharmGKB. Common targets between the active ingredients of XQLD and AECOPD were screened. A protein-protein interaction network was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins database and visualized with Cytoscape. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed using the Database for Annotation, Visualization and Integrated Discovery database. Molecular docking and molecular dynamics simulations were conducted using AutoDock Vina and GROMACS, respectively, to evaluate the binding affinity and stability between core targets and active components. The results revealed that the active ingredients of XQLD, including quercetin, luteolin, and kaempferol, target multiple genes such as nuclear factor kappa B subunit 1, signal transducer and activator of transcription 1, mechanistic target of rapamycin kinase, caspase-3, BCL2‑Like 1, and MYC, primarily through the TNF and PI3K/Akt signaling pathways. Molecular docking and dynamics simulations confirmed stable binding between core targets and active ingredients, particularly between glyuranolide and signal transducer and activator of transcription 1, which merits further investigation. XQLD may alleviate AECOPD progression by regulating the inflammatory response, hypoxia, and apoptosis through multi-component, multi-target, and multi-pathway mechanisms. These findings provide a theoretical basis for further experimental research and potential clinical application of XQLD.

Multiple paraclinoid aneurysms of the internal carotid artery present distinct clinical and anatomical challenges compared with other aneurysms. This study aimed to investigate the hemodynamic characteristics of the parent artery adjacent to these lesions and to provide evidence-based suggestions for clinical treatment. We retrospectively reviewed digital subtraction angiography images of 57 patients treated between 2020 and 2024, including 18 cases with multiple paraclinoid aneurysms, 19 with a single paraclinoid aneurysm, and 20 with normal vascular anatomy. Parameters including peak systolic flow velocity and wall shear stress were derived from reconstructed hemodynamic models. We compared hemodynamic profiles among groups and evaluated the effects of simulated aneurysm obliteration on the distal vessel wall proximal to the carotid bifurcation. Four real-world follow-up cases were also analyzed for morphological and hemodynamic changes after treatment. The multiple-aneurysm group exhibited greater variability and instability in wall shear stress and flow velocity than the single-aneurysm and normal groups. Simulated aneurysm elimination showed no significant hemodynamic effect on distal vessels (P > .05). In clinical follow-up, however, noticeable morphological and hemodynamic alterations were observed following stent deployment. Multiple paraclinoid aneurysms induce more prominent hemodynamic disturbances in the parent artery. Aneurysm obliteration appears to have minimal immediate impact on the distal vessel wall, but stent placement may produce favorable long-term vascular remodeling, including straightened curvature and improved mild stenosis.

Anticoagulation treatment of venous thromboembolism (VTE) carries potential risks, including major bleeding and recurrent VTE, often due to poor adherence, which is itself associated with insufficient patient knowledge. To investigate patient knowledge over time to evaluate the effectiveness of the strategy of patient education employed in our clinic. We created a short patient questionnaire (7VTE-Quest), completed in the waiting room and used to guide patient education during consultation. Patients requiring anticoagulant therapy ≥3 months and having completed the 7VTE-Quest at 2 different consultations between March 2022 and December 2024 were included. The primary endpoint was improved score (≥1 point) at second completion of the questionnaire. A total of 135 patients completed the questionnaire a second time a mean (±SD) 211 (±169) days after the initial completion. After excluding 4 patients who achieved a perfect score both times, the score improved for 56.5% (74/131) of patients. The change in total score ranged from -3 to +4. The greatest overall gain was for questions on management of forgotten medication dose (20.0%, 27/135) and interaction between anticoagulants and NSAIDs (11.1%, 15/135). A regression in the number of patients providing correct answers was observed for all questions between 1.6 and 40%. The greatest regression was observed for NSAID contraindication: 40.0% (14/35) of patients could no longer recall this contraindication, while 29.0% (29/100) of those who could not initially recall this contraindication did so at the second completion. The strategy we propose shows an improvement of patient knowledge on their VTE disease and treatment but failed to assess its impact on clinical outcomes.

Coronary artery disease (CAD) is a highly prevalent condition that predominantly affects obese individuals and those with metabolic abnormalities. The lipid accumulation product (LAP), combining waist circumference (WC) and triglyceride (TG) measurements, provides a clinically relevant metric for evaluating adipose tissue deposition. However, existing research findings regarding its association with CAD remain inconsistent. Therefore, this study further investigates the relationship between LAP and CAD to elucidate whether the LAP index can serve as a reliable screening tool for identifying individuals at high risk for CAD. Utilizing the National Health and Nutrition Examination Survey 2017-2020 database, we performed logistic regression analysis to investigate the association between LAP and CAD. Receiver operating characteristic (ROC) curve analysis was applied to assess the predictive performance of LAP and other metabolic parameters in relation to CAD. Additionally, subgroup analyses and interaction tests were performed to detect possible effect modifiers and verify the robustness of findings across different population strata. Our study recruited 7860 participants, among whom 499 individuals were diagnosed with CAD. A statistically significant association between LAP and CAD was established through regression analysis (OR: 4.12, 95% CI: 2.06-6.23, P < .001). ROC analysis found that LAP demonstrates moderate-to-good discriminatory power for CAD (AUC: 0.789, 95% CI: 0.773-0.805, P < .001) when compared to other metabolic markers. Notably, a statistically significant elevation in LAP levels is observed among CAD patients when compared to their counterparts without CAD. These results support its integration into clinical protocols as a gatekeeper screening mechanism for primary CAD prevention.

Evidence regarding statin therapy in non-acute myocardial infarction cardiogenic shock is limited, and retrospective medication studies are vulnerable to treatment-timing bias. We examined whether the association between statin exposure and 28-day mortality persisted after accounting for the timing of statin administration. This retrospective cohort study used medical information mart for intensive care IV data from 991 adults with non-acute myocardial infarction cardiogenic shock. Statin exposure was ascertained from medication records that included atorvastatin and other statin agents. In the conventional time-fixed analysis, exposure was defined as receipt of any statin during the intensive care unit (ICU) stay. A 24-hour landmark analysis included patients alive at 24 hours, classified exposure according to statin administration during the 1st 24 hours, and began follow-up at the landmark. Separate 1:1 propensity-score matching (PSM) procedures and Cox models were performed for each exposure definition. Statin agent, 1st recorded dose, route, and time to 1st administration, together with specific mechanical-support, anti-inflammatory, and vasoactive co-treatments, were descriptively summarized in the matched cohorts. In the conventional cohort, 475 patients received a statin during the ICU stay and 516 did not; 255 patients per group remained after PSM. Conventional analyses suggested lower 28-day mortality before matching (adjusted hazard ratio [HR], 0.703; 95% confidence interval [CI], 0.539-0.918; P = .010) and after PSM (adjusted HR, 0.709; 95% CI, 0.507-0.993; P = .045). In the 24-hour landmark cohort, 311 patients received a statin within 24 hours and 680 did not; 255 patients per group remained after PSM. The association was absent before matching (adjusted HR, 1.127; 95% CI, 0.854-1.487; P = .398) and after PSM (adjusted HR, 1.190; 95% CI, 0.833-1.701; P = .339). Atorvastatin was the predominant 1st statin in both matched exposed groups. In 4-category analyses, the apparent benefit among new initiators in conventional models disappeared after the 24-hour landmark definition was applied. The apparent survival advantage associated with conventional time-fixed statin exposure was not reproduced after treatment timing was addressed. These findings do not support an independent 28-day survival benefit from statin administration within the 1st 24 hours of ICU admission and highlight the potential influence of immortal-time, treatment-selection, and co-treatment biases.

Premature ventricular contraction (PVC) is one of the most common kinds of arrhythmias for which the treatment poses a therapeutic dilemma. Traditional Chinese medicine has a long history in arrhythmia treatment, and this is a rare case of an elderly patient with PVC who showed significant improvement after receiving Traditional Chinese medicine treatment.

An 82-year-old male, with a history of mitral stenosis, has undergone surgical mitral valve replacement. This time, he presented with chest pain and palpitations. He was diagnosed with frequent PVCs.

He was diagnosed with PVC by 24-hour Holter monitoring.

The patient visited The First Hospital of Hunan University of Chinese Medicine on November 4, 2024, and received therapy with Chaihu Sanshen Capsule (CHSSC).

After taking CHSSC for 3 treatment courses, the Holter tests showed that the number of ectopic premature beats decreased from 47,730 to 844 within 24 hours. This objective improvement was correlated with significant symptomatic relief, including a pronounced reduction in palpitations and easing of chest tightness.

This single case observation generates the hypothesis that CHSSC may be associated with reduced PVC burden and symptomatic improvement in elderly patients. Nevertheless, these preliminary findings warrant further investigation through larger prospective studies to establish conclusive evidence.

Fat attenuation index (FAI) is currently used in research on coronary atherosclerotic heart disease, but there are no reports on FAI applications in coronary artery spasm (CAS). In this study, we explored the association between pericoronary FAI and CAS. Patients who had chest pain and stenosis < 50% in major coronary branches, as indicated by coronary CT angiography (CCTA) at our hospital from January 2022 to June 2023 were included. According to the diagnostic criteria for vasospastic angina published by the Japanese Circulation Society in 2013, patients confirmed to have CAS were assigned to a CAS group, while those who were not consistent with CAS and had a negative treadmill test were assigned to a control group. Pericoronary FAI and circulating inflammatory factor levels were measured at enrollment. Count data were analyzed using the χ2 test, measurement data using the t-test or nonparametric test, and CAS-related risk factors using multivariate logistic regression. There were 230 patients in the CAS group and 112 patients in the control group. The pericoronary FAI and smoking rate were significantly lower in the control group than in the CAS group (P < .05), but there were no significant differences in other data, including general clinical data, medication use, and circulating inflammatory factor levels (all P > .05). Univariate analysis exhibited that the CAS-related risk factors included smoking, diabetes, high-density lipoprotein cholesterol, and pericoronary FAI. Multivariate logistic regression indicated that smoking and FAI around the left anterior descending branch were significantly associated with CAS. Elevated pericoronary FAI is an independent risk factor for CAS. Local coronary inflammation plays a dominant role in CAS, while circulating inflammatory factor levels seem not to be associated with CAS.

The Emergency Department Assessment of Chest Pain Score (EDACS) is a validated tool for identifying patients at very low risk of major adverse cardiac events (MACE), enabling safe discharge without further testing. EDACS incorporates symptom characteristics such as location, pattern, radiation, association with respiration, and cardiovascular risk factors-information typically based on patient self-report. This study aimed to evaluate whether educational level affects patients' ability to describe symptoms, to evaluate risk refinement between the EDACS and the objectively enhanced EDACS-ADP (Accelerated Diagnostic Pathway) classifications. This prospective, cross-sectional, single-center study included patients presenting to a tertiary emergency department with chest pain. Patients were categorized into 3 groups based on educational level. EDACS and EDACS-ADP were calculated for each patient. Risk reclassification and the influence of educational level were analyzed using McNemar's test and multivariable logistic regression. Of 4151 patients admitted to the emergency department with complaints of chest pain during a one-month period, 177 were included. 62.7% were male; the median age was 61.0 years. Overall, 38.4% (48/125) of patients in the EDACS-ADP high-risk category were initially classified as low-risk by EDACS (P < .001). The reclassification rate was highest in Group 1 (low education) at 42.9%, in Group 2 (38.9%), and Group 3 (33.3%) (P < .001 for all). Multivariable logistic regression identified female gender, coronary arterial disease, and smoking as independent predictors of reclassification. Our findings suggest that EDACS-ADP provides additional objective risk refinement across patients with different educational backgrounds.