Chest Pain Research Articles

The effect of gene dosage and age at the disease onset on the severity of familial Mediterranean fever

ABSTRACT Objective To compare the demographic and clinical characteristics of familial Mediterranean fever (FMF) patients according to age at disease onset and evaluate the dose effect of the number of pathogenic or likely pathogenic exon 10 mutations of the MEFV gene on disease severity. Methods This medical record review study was performed on 485 pediatric FMF patients with uni- or bialelic exon 10 mutations of the MEFV gene (M694V, M694I, M680I, V726A, R761H, T267I). Patients were grouped according to age at disease onset (Group 1:<6 years; Group 2:6–11 years; and Group 3:>11 years). Disease severity was assessed by the international severity scoring system for FMF (ISSF). Results Of the patients, 294 (60.6%) were classified in Group 1, 152 (31.4%) in Group 2 and 39 (8%) in Group 3. The mean elapsed time to diagnosis was 26.7 ± 27.4 months in Group 1 and was higher than the other groups (p < 0.001). During the attack, fever was higher in Group 1, arthritis in Group 2, and chest pain in Group 3 (p < 0.001). The median ISSF score was similar in patients with uni- or bialelic mutations in Group 1 and 3 (p = 0.086, p = 0.35, respectively) but lower in heterozygous patients in Group 2 (p < 0.001). In Groups 1 and 2, mild disease severity was higher in heterozygotes, while moderate disease severity was higher in homozygotes (p = 0.034, p = 0.001, respectively). Conclusion The presence of pathogenic or likely pathogenic homozygous or compound heterozygous mutations in exon 10 of the MEFV gene in patients with early-onset disease is associated with a more severe disease course compared to patients with heterozygous mutations. The gene dose effect of the number of mutations on disease severity is more common in children aged 6-11 years.

Predicting severe multivessel coronary artery disease to guide access strategy in patients undergoing invasive coronary angiography.

Given radial artery conduits are increasingly utilized for coronary artery bypass grafting (CABG), avoiding transradial access (TRA) for invasive coronary angiography (ICA) may benefit patients who ultimately undergo CABG. We sought to predict the likelihood of severe multivessel disease (MVD) before ICA to guide this decision. This was a single-center study of 1485 patients with stable symptoms who underwent ICA. A model to predict severe MVD was developed. Relative importance analyses were performed to identify clinical characteristics most associated with the presence or absence of severe MVD. When predicting severe MVD, the model had a sensitivity of 70.3% and specificity of 71.8% (area under the curve = 0.7105). With a prevalence of 12.5% in our cohort, the model had a strong negative predictive value of 94.4%. Relative importance analyses showed factors most associated with the presence of severe MVD were a history of abnormal noninvasive tests, typical chest pain, aspirin use, insulin-dependent diabetes, increasing age, and a family history of coronary artery disease. Conversely, the absence of severe MVD was most associated with female sex, undergoing ICA as workup for either noncardiac or valve surgery, lung disease, atypical chest pain, and increased BMI. Clinical information available before ICA can risk stratify the likelihood of severe MVD and therefore aid in identifying patients that may need CABG and could stand to benefit from TRA avoidance. The potential benefits of maximizing radial artery conduit availability by avoiding TRA must be balanced against the risks of alternative access on an individual patient basis.

Mindfulness-based stress reduction training and supplemented Jinshui Liujun decoction promote recovery in patients with non-small cell lung cancer

BACKGROUND Conventional chemotherapy (CC) administered to patients with non-small cell lung cancer (NSCLC) often causes adverse effects, such as cardiopulmonary dysfunction and immune system imbalance. Patients may experience anxiety and depression during the perioperative period due to various factors, such as treatment costs and cancer recurrence risks, thereby compromising the overall quality of life. Consequently, we hypothesized that integrating mindfulness-based stress reduction training (MSRT) with Jinshui Liujun decoction may mitigate negative emotions and promote recovery in patients with NSCLC. AIM To explore the effects of MSRT and Jinshui Liujun decoction on the immune function and emotional state of NSCLC patients. METHODS A retrospective clinical study was conducted involving 92 patients with stage IIIb-IV NSCLC; 35 patients in the control group (CG) received CC therapy (combination of pemetrexed and carboplatin), and 57 patients in the treatment group (TG) received MSRT-assisted flavored Jinshui Liujun decoction (FJLD) in addition to CC. We evaluated the survival time, Karnofsky performance status, treatment efficacy, traditional Chinese medicine syndrome score, immune function, negative emotional level, and adverse reactions of the CG and TG. RESULTS Median progression-free survival, Karnofsky performance status, and clinical efficacy of the TG were superior to those of the CG (P &lt; 0.05). Symptoms of cough, weakness, bloody sputum, shortness of breath, and chest pain significantly decreased in the TG compared to that in the CG (P &lt; 0.05). In the TG, MSRT + FJLD treatment increased the numbers of CD3+ and CD4+ immune cells, effectively reduced the number of CD8+ cells, and enhanced the CD4+/CD8+ ratio, thereby restoring the immune function of patients. In the TG, the self-rating anxiety scale and self-rating depression scale scores decreased significantly. There was no statistically significant difference in the incidence of adverse reactions between the CG and TG (P &gt; 0.05). CONCLUSION MSRT + FJLD proved to be an effective treatment for patients with NSCLC.

Pain syndrome in panic attack clinical presentation

Introduction. In modern medicine, great attention has been paid to the study of patients with panic attacks (PAs) for a long time. One of the areas of scientifi c research is the study of the patients′ personality traits, as well as social, genetic and physiological factors causing the development of panic disorder. But peculiarities of pain syndrome in patients with PAs remain understudied. As a result, treatment and rehabilitation of patients with PAs remain insuffi ciently effective.The aim: to research the role of pain syndrome in the clinical presentation of panic attacks.Materials and methods. The studies involved 197 participants aged 38,65±10,91 including 41 men (20,8 %) and 156 women (79,2 %). They were divided into two groups based on the presence or the absence of PAs with the fi rst group representing 147 people with panic attacks and the second group — 50 people without panic attacks. In all patients, pain syndrome (headache, chest pain, neck pain, and pain in the lumbosacral region) was assessed according to a 10-point Visual Analogue Scale (VAS). To study the dependence of pain syndrome characteristics on the severity of the disease course, patients with PAs from the fi rst group were divided into 3 groups according to PA frequency in a four-week period: group of 31 people with infrequent PAs (less than four panic attacks), group of 48 people with mid-frequent PAs (at least four panic attacks), and a group of 68 people with frequent PAs (at least four panic attacks per week).Results. According to our research, pain syndrome of different localization and intensity is more common in patients with PAs than in those without PAs, and was detected in 93,2 % of patients with PAs. Patients with PAs more frequently reported multisite pain, differently from those without PAs predominantly presenting complaints of pain in one body region. The intensity of headache, chest or neck pain is signifi cantly higher in patients with PAs than in patients without PAs (р&lt;0,05). In the majority of patients with PAs (75,9 %), pain syndrome preceded developing of PAs.Conclusion. Pain syndrome can serve as a predisposing factor for the development of panic attacks and be the reason for the aggravation of the disease course, which is why pain syndrome in patients with PAs should undoubtedly be corrected. Taking into consideration the fact that a medication burden on such patients is high, the correction should primarily be performed using non-drug treatment options, including osteopathic methods.

Temporal, spatial and demographic distributions characteristics of COVID-19 symptom clusters from chinese medicine perspective: a systematic cross-sectional study in China from 2019 to 2023

BackgroundThe subtypes diagnosis of disease symptom clusters, grounded in the theory of “Treatment in Accordance with Three Categories of Etiologic Factors” and International Classification of Diseases 11th Revision (ICD-11), is a vital strategy for Chinese Medicine (CM) in treating unknown respiratory infectious diseases. However, the classification of disease symptom clusters continues to depend on empirical observations and lacks robust scientific evidence. Consequently, this study seeks to explore the temporal, spatial and demographic distributions characteristics of Corona Virus Disease 2019 (COVID-19) symptom clusters in China.MethodsPubMed, Web of Science, Science direct, WHO, Litcovid, CNKI databases were searched from inception until December 31, 2023. Optical character recognition technology and image recognition technology were employed to identify tables within the papers. Four researchers independently screened and extracted data, resolving conflicts through discussion. Heat mapping and hierarchical clustering techniques were utilized to analyze COVID-19 symptom clusters. Data analysis and visualization were conducted using R software (4.2.0), while the association analysis of symptom clusters was performed using Cytoscape (3.10.2).ResultsA total of 366 COVID-19 clinical trials with 86,972 cases including 66 clinical symptoms of 7 disease systems and other clinical manifestations in China were included. In temporal distribution, 63 symptoms centered around fatigue and 44 symptoms focused on chest tightness are characteristic of symptom clusters in spring and winter, respectively. With the addition of spatial distribution, the symptom clusters in middle and low latitudes during spring are characterized by 53 symptoms centered around fatigue and cough, and 51 symptoms focused on fatigue, respectively. During winter, the symptom clusters in middle and low latitudes are characterized by 38 symptoms centered around chest tightness and 37 symptoms focused on fever, respectively. When considering demographic distribution, the symptom clusters for < 50 years are characterized by fatigue as the core symptom in middle (44 symptoms)/low (28 symptoms) latitudes during spring and middle latitude (25 symptoms) during winter. For ≥ 50 years, the symptom clusters in middle latitude (49 symptoms) during spring and low latitudes (35 symptoms) during winter are centered around cough, while in low latitude (27 symptoms) focuses on diarrhea during spring, and middle latitude (35 symptoms) emphasizes both diarrhea and chest tightness during winter.ConclusionIn summary, variations in symptom clusters and core symptoms of COVID-19 in temporal, spatial and demographic distributions in China offer a scientific rationale for the “Treatment in Accordance with Three Categories of Etiologic Factors” theory. These interesting findings prompt further investigation into CM patterns in the ICD-11, and suggest potential strategies for personalized precision treatment of COVID-19. High-quality clinical studies focusing on individual symptoms are warranted to enhance understanding of respiratory infectious diseases.

Chest Pain in a Middle-Aged Man.

A man in his mid-50s presented with chest pain lasting 30 minutes. The initial electrocardiogram showed type A preexcitation syndrome, with obvious ST-segment depression in leads V3 through V5 and positive delta wave. What would you do next?

Prevalence and risk factors of headache in Chinese with stroke: a cross-sectional study based on CHARLS

BackgroundStroke ranks as the second leading cause of death worldwide. Meanwhile, headaches are considered the second leading cause of disability, and they often occur as a stroke complication. However, insufficient attention has been given to the treatment and rehabilitation of headaches among stroke patients, and the research on the epidemiology and risk factors of headaches in stroke patients in China is limited. Therefore, in this study, China Health and Retirement Longitudinal Study (CHARLS) data were utilized for a cross-sectional analysis to estimate the prevalence of headaches in stroke patients and identify the associated risk factors.MethodThis study utilized data, which included those of participants aged 45 and above from 28 provinces across China, from the nationally representative CHARLS 2018 database. A total of 876 stroke patients and 17,469 nonstroke patients were considered in this work. Stroke diagnosis and headache status were determined based on self-reported questionnaire responses. Cross-sectional analysis determined the prevalence of headaches in patients with strokes and those without through quantification of individuals diagnosed with headaches. Categorical variables were presented as percentages and counts, and univariate and multivariate logistic regression models were used to calculate the odds ratios (OR) for the risk factors associated with headaches in stroke patients.ResultsIn the 2018 data, 328 individuals with stroke-related headaches were screened and compared with 4,249 individuals without the condition. Overall, a cross-sectional survey revealed that the headache prevalence among stroke patients reached 37.44% (95% confidence interval (CI): 34.23%-40.74%), which was higher than the overall headache prevalence among nonstroke patients 24.32% (95% CI: 23.69%-24.97%). Headaches were considerably more common in women (45.95%; 95% CI: 41.31%-50.58%) than in men (26.70%; 95% CI: 24.44%-32.97%; gender difference, p < 0.001). According to multifactorial logistic regression analysis, the risk factors for stroke-related headaches included being female (OR: 1.45, 95% CI: 1.02–2.07), residency in Central (2.50, 1.37–4.54), Eastern (1.87, 1.07–3.27), and Northwest China (2.49, 1.06–5.84), Very poor self-health (4.06, 1.90–8.68), diabetes (1.85, 1.11–3.07), shoulder pain (4.01, 2.77–5.81), back pain (2.01, 1.32–3.05), and chest pain (2.51, 1.55–4.06).ConclusionEnhancement of self-awareness of health, effective management of diabetes, and minimization of the physical discomfort in the shoulders, back, and chest may contribute to the decreased occurrence of headaches. Therefore, targeted prevention and treatment of headaches are necessary.

Awareness and knowledge of cardiopulmonary resuscitation (CPR) among the general public in West-Bank in Palestine

BackgroundSudden cardiac death (SCD) is a leading cause of cardiovascular-related deaths, often occurring outside hospitals in undiagnosed individuals. Our study aims to assess the baseline awareness and skills in performing CPR among the population in Palestine.MethodsA cross-sectional study was conducted using an online questionnaire to assess CPR knowledge among residents of the West Bank, Palestine. Convenience sampling targeted 300 participants via social media. Data were analyzed using descriptive statistics and chi-square tests to examine associations.ResultsThe study surveyed 555 participants, revealing that 58.2% lacked CPR training. Awareness of cardiac arrest signs varied, with chest pain being the most recognized 19%. CPR training significantly improved participants’ recognition and response to cardiac emergencies.ConclusionAddressing the fear of legal consequences is crucial to encourage bystander assistance. We recommend increasing first aid awareness through scientific conferences, free training courses, media campaigns, and incentivized competitions.

Exploring the relaxation effects of Coptis chinensis and berberine on the lower esophageal sphincter: potential strategies for LES motility disorders

BackgroundEsophageal achalasia, a primary disorder impacting the lower esophageal sphincter (LES), presents symptoms such as dysphagia, regurgitation, chest pain, and weight loss. Traditional treatments, including calcium channel blockers and nitrates, offer limited relief, prompting exploration into alternative therapies. This study examines the efficacy of Traditional Chinese Medicine (TCM), focusing on Coptis chinensis (C. chinensis) and its principal component, berberine, for modulating LES relaxation, offering a new perspective on treatment possibilities.MethodsThis research evaluated the impact of C. chinensis extract and berberine on the relaxation of LES contraction pre-induced by carbachol, observing the effects across different concentrations. We employed a series of inhibitors, including tetrodotoxin, ω-conotoxin GVIA, rolipram, vardenafil, KT5823, KT5720, NG-nitro-L-arginine, tetraethylammonium (TEA), apamine, iberiotoxin, and glibenclamide, to investigate the underlying mechanisms of berberine-induced LES relaxation.ResultsBoth C. chinensis extract and berberine induced significant, concentration-dependent relaxation of the LES. The relaxation effect of berberine was significantly reduced by TEA, indicating the involvement of potassium channels in this process.ConclusionsThis study demonstrates that C. chinensis and berberine significantly promote LES relaxation, primarily through potassium channel activation. These findings provide a foundation for further investigation of these compounds’ potential therapeutic applications in esophageal motility disorders, such as achalasia.Graphical

Emergency call utilization over a 10-years period: an observational study in Region Zealand, Denmark, 2013–2022

BackgroundImproving prehospital emergency care requires a comprehensive understanding of the efficiency of emergency medical services and demand fluctuations. The medical emergency call is the primary contact between citizens and the emergency medical dispatch center, serving as the gateway to accessing emergency assistance. This study aimed to characterize the emergency call population and analyze the development of emergency call utilization in Region Zealand in Denmark during a 10-years period.MethodsThis was an observational register-based study of administrative data from the emergency medical dispatch center in Region Zealand. Data was collected from 1 January 2013 to 31 December 2022. All unique emergency calls from residents to the emergency number “1-1-2” were included. Descriptive analyses were used to characterize the study population. Poisson regression models were used to calculate ratio estimates for the association between years and hospital catchment areas, using the incidence rate of emergency calls as outcome measure.ResultsA total of 641,457 emergency calls were included. A significant increase in the total number of emergency calls was found, with an increase from 58,454 annual calls to 80,819 calls over the study period. The incidence rate per 1000 residents per year increased from 71.1 to 95.2, a 35% increase. The southern part of the region had significantly more emergency calls per 1000 residents per year during the study period compared to the eastern part of the region (IRR 1.70). Demographically, males comprised 52.3% of cases, and patients aged 65 and older represented 48.2% of calls. Emergency calls were “Emergency level A” in 45.5% and “Emergency level B” in 39.1%. In 22.3% of cases, the emergency call was categorized as “Unclear problem.” The most frequent categories were “chest pain” (12.7%), “impaired consciousness” (9.6%), “breathing difficulties” (8.8%), “accidents” (7.9%), and “minor injuries” (7.6%).ConclusionsThe study revealed a significant increase in emergency calls, both in absolute numbers and per 1000 residents per year, indicating growing demand for emergency care, along with a surge in activity at the region's dispatch center. Regional disparities underscores the potential necessity for tailored developmental approaches over time.

2024 Update of the RECOVER-Adult Long COVID Research Index.

Classification of persons with long COVID (LC) or post-COVID-19 condition must encompass the complexity and heterogeneity of the condition. Iterative refinement of the classification index for research is needed to incorporate newly available data as the field rapidly evolves. To update the 2023 research index for adults with LC using additional participant data from the Researching COVID to Enhance Recovery (RECOVER-Adult) study and an expanded symptom list based on input from patient communities. Prospective, observational cohort study including adults 18 years or older with or without known prior SARS-CoV-2 infection who were enrolled at 83 sites in the US and Puerto Rico. Included participants had at least 1 study visit taking place 4.5 months after first SARS-CoV-2 infection or later, and not within 30 days of a reinfection. The study visits took place between October 2021 and March 2024. SARS-CoV-2 infection. Presence of LC and participant-reported symptoms. A total of 13 647 participants (11 743 with known SARS-CoV-2 infection and 1904 without known prior SARS-CoV-2 infection; median age, 45 years [IQR, 34-69 years]; and 73% were female) were included. Using the least absolute shrinkage and selection operator analysis regression approach from the 2023 model, symptoms contributing to the updated 2024 index included postexertional malaise, fatigue, brain fog, dizziness, palpitations, change in smell or taste, thirst, chronic cough, chest pain, shortness of breath, and sleep apnea. For the 2024 LC research index, the optimal threshold to identify participants with highly symptomatic LC was a score of 11 or greater. The 2024 index classified 20% of participants with known prior SARS-CoV-2 infection and 4% of those without known prior SARS-CoV-2 infection as having likely LC (vs 21% and 5%, respectively, using the 2023 index) and 39% of participants with known prior SARS-CoV-2 infection as having possible LC, which is a new category for the 2024 model. Cluster analysis identified 5 LC subtypes that tracked quality-of-life measures. The 2024 LC research index for adults builds on the 2023 index with additional data and symptoms to help researchers classify symptomatic LC and its symptom subtypes. Continued future refinement of the index will be needed as the understanding of LC evolves.

ST-elevation in aVR with Diffuse ST-segment Depression: Need for Urgent Catheterization?

Case Presentation: A 33 year old female with a history of antiphospholipid syndrome presented with exertional chest pain and ST-elevation in aVR with diffuse ST-depression. An emergent catheterization was performed which showed an isolated 99% stenosis in the left main coronary artery. The remaining coronary arteries were without any stenosis. Successful stent placement was performed, and the patient was discharged without complications. Discussion: Previous guidelines suggested that ST-elevation with diffuse ST-depression should be treated as a STEMI-equivalent involving the left-main or proximal left anterior descending coronary artery. However recent data suggests that the majority of these cases may not involve that territory. Regardless, this ECG finding should still be concern for acute coronary syndrome with the need for urgent catheterization.

Superiority of photon-counting computed tomography for detecting high-risk unstable angina patients: two case reports.

Coronary artery disease is the leading cause of death among non-communicable diseases. The management strategy prioritizes early detection and optimal treatment, with emerging roles for imaging approaches. Photon-counting computed tomography is a new non-invasive diagnostic imaging tool that can detect high-risk plaques in coronary artery disease patients. Using photon-counting computed tomography in screening and intravascular ultrasound later in verifying diagnosis and intervention guidance could be a new technique to swiftly discover unstable plaques, prepare lesions for surgery, and determine the optimal percutaneous intervention strategy. However, there is no documentation available for this new approach. We reported two acute coronary syndromes managed with a combination of two imaging methods. Despite receiving medical therapy, the first case continued to experience chest pain, leading to the detection of plaque ulceration in the left anterior descending artery. On the other hand, two PCCT screenings within 6months revealed plaque progression in the second case. We then used IVUS to confirm the lesions and proceed to intervention. We successfully discharged both cases, and they showed no symptoms 6months after discharge.

Abdominal lymphangioleiomyomatosis in a man presenting with gastrointestinal hemorrhage as the first manifestation: a case report

Lymphangioleiomyomatosis (LAM) is a rare, low-grade malignant condition that typically affects women of childbearing age and primarily involves the lungs. While cases involving males and affecting the gastrointestinal tract are exceedingly uncommon. This report discusses an unusual case of abdominal LAM in a male patient with gastrointestinal hemorrhage. The patient, a 70-year-old man, had been experiencing recurrent abdominal pain, occasional black stools, dizziness, and fatigue for over a month before being admitted to the hospital. Diagnostic electronic gastroscopy identified ulcers in the gastric and duodenal bulb with hemorrhage. An abdominal CT scan revealed multiple cystic foci in the retroperitoneum and mesentery, but no masses were found. Despite receiving medical treatment, the patient continued to have black stools and eventually underwent laparoscopic distal subtotal gastrectomy. The pathological results of the excised distal gastric specimens showed LAM-like lesions in the submucosal layer of the pylorus, mesentery of the side of the lesser curvature of the stomach, and small intestine, leading to a diagnosis of abdominal LAM. However, even after the surgery, the patient still experienced recurrent black stools and developed new symptoms of chest tightness and shortness of breath. A follow-up chest CT revealed bilateral pleural effusion and multiple lung cysts, indicating a worsening condition. The patient was then prescribed oral Sirolimus, which resulted in an improvement in symptoms, including black stool, chest tightness, and shortness of breath. This case report provides a detailed account of the progression of an unusual gastrointestinal LAM case and suggests that a combination of surgery and Sirolimus may be effective in managing the condition.

Pulmonary capillary hemangiomatosis: a case report

Pulmonary capillary hemangiomatosis (PCH) is a rare pulmonary vascular disorder with a prevalence of approximately 4 cases per million individuals. It is characterized by pulmonary hypertension leading to symptoms of shortness of breath and dyspnea, and rarely hemoptysis or chest pain. This manuscript reported a case of PCH that was initially misdiagnosed as hypersensitive pneumonitis and was finally confirmed by thoracoscopic lung biopsy. The aim of this report was to increase diagnostic awareness and improve the management of this disease.

Генотип-фенотипическая характеристика детей с семейной средиземноморской лихорадкой (периодической болезнью) в регионе Российской Федерации

Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease (AID) caused by mutations in the MEFV gene. The purpose of this research was to investigate clinical variability and potential genotypic and phenotypic correlations in children with clinically verified FMF and MEFV gene mutations in the City of Moscow, Russia. Materials and methods used: among 188 pediatric patients with suspected monogenic AIDs, MEFV gene mutations were identified in 9 through sequencing. In order to confirm the FMF diagnosis, patients were evaluated according to the modified Tel-Hashomer criteria and the Eurofever/PRINTO classification criteria. Results: clinical picture of FMF was characterized by the presence of periodic attacks of the disease lasting from 1 to 7 days accompanied by fever and increased acute phase reactants (observed in all patients), abdominal pain (in 8 children), peritonitis requiring diagnostic laparotomy (in a single child), chest pain (in 2 patients), pleurisy (in a single child), arthritis (in 7 children) and erysipeloid-like rash (in a single child). The pathogenic mutation M694V was identified in the MEFV gene in 8 out of 9 patients, this mutation was homozygous in 5 patients and heterozygous in 1, M680I mutation was detected on another allele in 2 children (compound heterozygous), and a mutation of unknown significance K695R was detected in a single child. No obvious clinical differences were found between homozygotes and heterozygotes as well as compound heterozygotes. Clinical response was achieved in 5 patients with colchicine monotherapy while canakinumab was prescribed to 4 patients due to ongoing attacks. Conclusion: the diagnosis involving the identification of MEFV gene mutations may allow the assessment of genotype-phenotype correlations in patients with FMF.

Hwa-byung (anger syndrome) as a risk factor for suicidal ideation in MZ generation: a survey study in South Korea

IntroductionSuicide is a critical global public health issue, with South Korea exhibiting the highest suicide rate among OECD countries at 24.1 per 100,000 people in 2020. This study focuses on suicidal ideation (SI) within South Korea’s Millennials and Generation Z (Generation MZ) by examining the impact of anger and hwa-byung (HB), a culture-bound anger syndrome.MethodsThe online survey was conducted between June 7 and 12, 2024. The inclusion criteria for this study were the following: (1) generation MZ (i.e., those born between 1980 and 2005); (2) those without a history of mood disorders (i.e., depressive disorders or bipolar disorder); (3) those of Korean nationality and residing in South Korea. Demographic variables and clinical variables including SI, HB, and depression were investigated. The chi-square test or t-test was used to compare the differences between the SI and non-SI groups. Additionally, binary logistic regression analysis was performed to analyze factors associated with the presence of SI. Finally, Pearson’s correlation coefficients were calculated to explore HB symptoms that were highly associated with SI.ResultsTotal 457 participants were included. The survey revealed an overall prevalence of SI of 38.07%, with 18.82% reporting “much” or more SI and 4.81% reporting “very much” SI. Significant differences were found between the SI and non-SI groups in HB symptoms, depression, anxiety, perceived stress, trait anger, state anger, anger-in, and anger-out (all p &amp;lt; 0.001). Logistic regression analysis identified HB symptoms (odds ratio [OR], 1.05; 95% CI, 1.00–1.11; p = 0.050), depression (OR, 1.41; 95% CI, 1.23–1.62; p &amp;lt; 0.001), and state anger (OR, 1.14; 95% CI, 1.05–1.24; p = 0.002) as significant factors for SI. The mediating factors confirmed the direct and indirect effects of HB symptoms on the presence of SI. Pearson’s correlation coefficients between HB symptoms and SI severity ranged from 0.241 to 0.536, with physical symptoms, such as heat sensation and chest pressure, showing high correlations (0.426 to 0.476).ConclusionThese findings highlight the need for mental health policies that integrate Korean medical approaches into suicide prevention. Future research should confirm these results using larger, nationally representative samples to improve generalizability and further explore HB and suicidality in diverse populations.

Functional Lumen Imaging Probe Panometry Findings in Obese Patient Populations.

Few data are available on functional lumen imaging probe (FLIP) findings specifically in obese patients. We aimed to evaluate FLIP metrics in obese patients who had not undergone bariatric surgery and in those who had sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). We also sought correlations of FLIP abnormalities with esophageal symptoms and HRM findings. We identified obese patients who had FLIP performed during workups either for a first bariatric operation (surgery-naïve patients), or for surgical revision of SG and RYGB operations that resulted in inadequate weight loss. We recorded esophageal symptoms, HRM data, and FLIP metrics. We identified 228 eligible patients (87 surgery-naïve, 90 SG, 51 RYGB). Dysphagia and chest pain were frequent symptoms in all groups. Median EGJ diameter and EGJ-DI were similar in surgery-naïve and postsurgical patients, but subgroup analysis of symptomatic patients with no HRM diagnosis revealed reduced EGJ opening in 12%. Abnormal FLIP response patterns were common (69% surgery-naïve, 74% SG, 65% RYGB) with higher ACR rates in SG (46.7% vs. 29.9%, p = 0.026) and RYGB (41.2% vs. 29.9%, p = 0.189) and lower SRCR rates in SG (11.1% vs. 24.1%, p = 0.021) and RYGB (5.9% vs. 24.1%, p = 0.006) compared to surgically naïve patients. There were no significant associations between FLIP contractile response patterns and symptoms or HRM diagnoses. Dysphagia and chest pain are common in obese patients, and most obese patients (with or without bariatric surgery) have FLIP contractile response abnormalities that do not correlate with HRM findings. FLIP findings appear to be especially valuable in obese patients who have esophageal symptoms with no HRM diagnosis.

Acute Aortic Dissection Complicating Emergency Coronary Intervention for Hyperacute Stent Thrombosis

Introduction: Iatrogenic acute aortic dissection resulting from coronary interventions can have fatal consequences. Although it is an uncommon complication during percutaneous coronary interventions (PCI), it can arise from various factors. Our case report aims to address this rare presentation further, seeking to enhance preprocedural planning which can result in better outcomes. Case Report: We describe an intriguing case of an elderly female patient with multiple cardiovascular risk factors who came to our emergency department presenting with chest pain. Her Electrocardiogram revealed an inferior ST-elevation myocardial infarction (STEMI) for which she underwent successful primary PCI of the right coronary artery (RCA). Four days later, she had an infero-posterior STEMI, which necessitated immediate coronary angiography. Angiography revealed thrombosis of the stent placed earlier in the RCA. On attempting recanalization of the vessel, an acute aortic dissection was identified and was successfully managed by ostial stenting. Follow-up imaging showed no residual dissection, and the patient was found to be comfortable and stable post-procedure. Conclusion: We recommend optimizing blood pressure and performing rapid ostial stenting in these cases, irrespective of the dissection’s origin. This will facilitate effective sealing of the entry site and prevent further progression of the dissection. Our report highlights the favorable results achieved with immediate ostial stenting while discussing the conservative approach to managing such cases.

Severe Panton–Valentine-Leukocidin-Positive Staphylococcus aureus Infections in Pediatric Age: A Case Report and a Literature Review

Background: Infections caused by S. aureus strains encoding Panton–Valentine leukocidin (PVL-SA) have become increasingly relevant in community settings and can cause severe conditions in pediatric populations. We present the pediatric case of an invasive disease caused by PVL-SA and provide a literature review of severe manifestations caused by these strains in children. Methods: A PubMed search (February 2024) found studies that included relevant clinical outcomes, diagnostics, and treatments, excluding cases of asymptomatic infection or in adult populations. A logistical multivariate analysis was used to find predictors of the need for intensive care. Results: A 10-year-old boy came to the attention of our Pediatric Infectious Diseases Unit with fever, chest pain, and tachypnea. A rapid worsening of his clinical conditions was observed, with the development of necrotizing pneumonia, osteomyelitis, deep vein thrombosis (DVT), and multiple abscesses. Blood cultures confirmed the presence of PVL-producing methicillin-resistant S. aureus (MRSA). The initial treatment included linezolid and ceftaroline and was later adjusted to clindamycin, daptomycin, and fosfomycin, with clinical improvement. Discussion: Our review collected 36 articles, including 156 pediatric cases of severe PVL-SA infection. Bacteremia was present in 49% of cases, lung infection in 47%, and osteomyelitis in 37%. The presence of pulmonary localization was predictive of the need for intensive care, O.R. 25.35 (7.46–86.09; p &lt; 0.001). Anti-toxin molecules were used in about half the cases where information on treatment was reported. Our report highlights the capacity of PVL-SA to cause life-threatening complications in children, while also discussing the full range of its clinical spectrum and the most effective therapeutic approaches.