The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

Objective To investigate the combined effect of coronary artery calcification score(CACS)progression and sleep structure on major adverse cardiovascular events(MACE).Methods Data from the Multi-Ethnic Study of Atherosclerosis(MESA)were used to analyze participants and assess the interaction impact of CACS progression and different sleep stages on predicting MACE.Polysomnography(PSG)record provide an objective measure of sleep structure.Results The results of this study confirmed the dose-response relationship between CACS progression and MACE.ΔCACS 10-99 hazard ratio(HR)was 6.913(P＜0.001),ΔC ACS 100-199 HR was 22.098(P＜0.001),ΔCACS＞200 HR was 20.608(P＜0.001),reinforcing the notion that the rate of CACS development significantly affects cardiovascular risk.In addition,the study found that participants who showed lower rapid eye movement(REM)sleep and progression of CACS had the greatest risk of developing MACE,while participants who showed higher REM sleep but no progression of CACS had the lowest risk of developing MACE(P＜0.001).Conclusion Decreased REM sleep increases the risk of MACE in CACS patients,and maintaining adequate REM sleep may reduce this risk,emphasizing the protective effect of REM sleep on cardiovascular disease.

Objective To investigate the combined effect of coronary artery calcification score(CACS)progression and sleep structure on major adverse cardiovascular events(MACE).Methods Data from the Multi-Ethnic Study of Atherosclerosis(MESA)were used to analyze participants and assess the interaction impact of CACS progression and different sleep stages on predicting MACE.Polysomnography(PSG)record provide an objective measure of sleep structure.Results The results of this study confirmed the dose-response relationship between CACS progression and MACE.ΔCACS 10-99 hazard ratio(HR)was 6.913(P＜0.001),ΔC ACS 100-199 HR was 22.098(P＜0.001),ΔCACS＞200 HR was 20.608(P＜0.001),reinforcing the notion that the rate of CACS development significantly affects cardiovascular risk.In addition,the study found that participants who showed lower rapid eye movement(REM)sleep and progression of CACS had the greatest risk of developing MACE,while participants who showed higher REM sleep but no progression of CACS had the lowest risk of developing MACE(P＜0.001).Conclusion Decreased REM sleep increases the risk of MACE in CACS patients,and maintaining adequate REM sleep may reduce this risk,emphasizing the protective effect of REM sleep on cardiovascular disease.

The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

Objective To evaluate the change of cardiac structure and function in patients with hypertrophic obstructive cardiomyopathy(HOCM)after ultrasound-guided percutaneous intramyocardial septal radiofrequency ablation(PIMSRA)via cardiac magnetic resonance(CMR).Methods Patients with HOCM who underwent PIMSRA,echocardiography and CMR preoperative scanning and one year after surgery were analyzed retrospectively.Myocardial structural and functional parameters were measured by Circle cardiovascular imaging post-processing software.The changes of myocardial parameters before and after surgery were compared by using paired sample t-test and Chi-square test.Results Compared with the preoperative assessment,patients'clinical symptoms and the cardiac function were significantly improved one year after surgery.The left ventricular outflow tract pressure gradient(LVOT-PG)was significantly decreased and length of mitral regurgitation was shortened one year after surgery compared with before surgery via ultrasound(P<0.05).Compared with the preoperative assessment,CMR showed that patients with end-systolic volume of left atrium,minimum volume of left atrium,transverse diameter of left atrium,thickness of ventricular septum and free wall of left ventricular at end-systolic section were significantly reduced,and left ventricular mass(LVM)was significantly decreased one year after surgery,with statistical significance between before and after surgery(P<0.001).One year after surgery,the left atrium ejection fraction(LAEF)was significantly increased(P<0.05),the maximum slope and the maximum signal intensity of the ventricular septum and the left ventricular free wall of the papillary muscle were significantly increased(P<0.001),and the peak time was significantly decreased(P<0.001)compared with before surgery.Conclusion After PIMSRA treatment,the systolic function of left atrium in HOCM patients is improved,and the microcirculation perfusion of left ventricular is significantly improved.

Purpose To investigate the feasibility of CT-based feature tracking technology to quantify left ventricular myocardial strain(MS)and its significance in hypertrophic obstructive cardiomyopathy(HOCM).Materials and Methods A total of 35 HOCM patients who underwent cardiac coronary angiography from March 2019 to December 2021 in the First Affiliated Hospital of the Air Force Military Medical University were retrospectively included,and a total of 60 cases who were negative for cardiac coronary angiography among those who visited the hospital with suspected coronary artery disease were randomly enrolled.Conventional cardiac functional parameters and MS parameters were quantified via post-processing software,and differences of parameters between the groups were analyzed.The diagnostic efficacy of MS parameters for HOCM was further evaluated.Results Compared to the control group,the HOCM group exhibited significant increases in various conventional left ventricular functional parameters,including left ventricular wall thickness,mass,mass index,end-diastolic volume and stroke volume(t=2.119 to 24.861,all P<0.05).However,there were no statistically significant differences in end-systolic volume and cardiac output between the two groups(P>0.05).The global longitudinal and radial strain values of HOCM group were significantly lower than those of control group(t=12.857,-6.427,P<0.01),while the endocardial global circumferential strain of HOCM group was significantly higher than that of control group(t=-2.369,P<0.05).Among MS parameters,global longitudinal strain exhibited the best diagnostic efficacy for HOCM,with an area under the curve of 0.997.A cutoff value of≤20.78%for global longitudinal strain showed that the sensitivity and specificity was 100%and 95%,respectively.Conclusion The MS parameters quantified by the CT-based feature tracking technique are superior to left ventricular ejection fraction in quantifying left ventricular function,with the highest sensitivity and specificity for early myocardial function impairment of longitudinal strain.In addition,the technique has good repeatability and is expected to become a new indicator for the assessment of myocardial function in HOCM.

Objective:To construct a porcine model of ischemia with non-obstructive coronary artery (INOCA) and explore the diagnostic value of a one-stop noninvasive method including CT myocardial perfusion imaging (CT-MPI) and coronary CT angiography (CCTA).Methods:Twelve swines were divided into the experimental group (9) and the normal group (3). Coronary microvascular dysfunction (CMD) porcine model was constructed in the experimental group by inducing diabetes mellitus, chronic kidney disease, and hypercholesterolemia. Invasive coronary angiography (ICA) and functional examination were performed on all 7+3 trial swines to clarify the INOCA diagnosis after completion of the modeling. Then, CT-MPI and CCTA were performed on all individuals to explore the CT-MPI and CCTA characteristics of INOCA porcine models. CT-MPI parameters, including myocardial blood flow (MBF), and myocardial blood volume (MBV) in rest and stress conditions, and CCTA parameters, including severity of stenosis and CAD-RADS, were analyzed.Results:ICA and functional tests showed that all swines in the experimental group met the diagnostic criteria for INOCA, which meant that INOCA porcine model was constructed successfully. CCTA results confirmed that there was no obstructive coronary stenosis in all 10 swines which were examined, which was consistent with ICA findings. CT-MPI results demonstrated that the mean MBF values, as well as the mean MBV values, in the rest and stress condition of each swines in the experimental group were lower than those of the control group. In contrast to the control group, the mean MBF and MBV values of swines in the experimental group in stress condition were generally lower than those in resting condition.Conclusions:In this study, a porcine model of CMD is successfully constructed by inducing hypercholesterolemia+diabetes mellitus+chronic kidney disease. ICA and invasive functional tests show that this CMD model meet the diagnostic criteria for INOCA. It has been confirmed that one-stop CT multimodality examination including CT-MPI and CCTA can be used for the diagnosis of INOCA as a noninvasive diagnostic method.

Objective:To explore the difference of the vessel and plaque characteristics, myocardial perfusion and cardiac function between patients with ischemia with non-obstructive coronary artery disease (INOCA) and obstructive coronary artery disease (CAD).Methods:From July 2021 to June 2022, 101 patients with angina were referred to dynamic computed tomography myocardial perfusion (CTP) and coronary computed tomography angiography (CCTA) and retrospectively included in our hospital. Based on the results of CTP and CCTA, patients were divided into INOCA (27 cases), moderate obstructive CAD (26 cases) and severe obstructive CAD (48 cases). The anatomical coronary artery stenosis, plaque characteristics and myocardial perfusion features of all patients were analyzed. Furthermore, left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were obtained on full-phase reconstruction CCTA image by using Medis Suite 3.2 postprocessing software. Multigroup analysis used one way ANOVA or Kruskal Wallis H test. Results:Patients with INOCA were younger than patients with moderate and severe obstructive CAD ( P<0.001). INOCA patients (7.4%, 2/27) had lower rate of positive remodeling than both moderate (57.7%, 15/26, P<0.001) and severe obstructive CAD patients (33.3%, 16/48, P=0.017). The percentage of ischemic myocardium volume in patients with INOCA were similar with those in patients with severe CAD (all P>0.05), but significantly higher than those in patients with moderate CAD (all P<0.05). No significant difference in terms of GLS was detected between patients with INOCA [-17.4% (-21.6%, -11.6%)] and severe CAD [-17.6% (-21.9%, -14.8%), P=0.536], however, patients both with INOCA and severe CAD also had higher GLS than patients with moderate obstructive CAD [-22.3% (-29.8%, -19.0%), all P<0.05]. Conclusions:Based on"one-stop-shop"CTP combined with CCTA imaging, early cardiac functional changes including abnormal myocardial perfusion and myocardial strain in INOCA patients were similar to those in patients with severe obstructive CAD and more severe than those in patients with moderate obstructive CAD.

A case of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) with ocular masses as the main manifestation was reported. The patient was a middle-aged female, the initial symptom was eye swelling, pulmonary nodules were found before eye surgery, and further examination revealed proteinuria, hematuria and renal insufficiency. Renal pathology showed ANCA-associated glomerulonephritis. The final diagnosis was eye, kidney and lung lesions caused by AAV. Treatment with glucocorticoids and cyclophosphamide resulted in improvement in eye, kidney, and pulmonary lesions. Atypical clinical manifestations of AAV may lead to delayed diagnosis, and attention should be paid to the exclusion of AAV for ocular masses of unknown cause.

The paper reported a patient under maintained hemodialysis for 11 years, with a large mass appeared in the right thigh after local injury. The mass was clinically considered as tumoral calcinosis combined with clinical, imaging and pathological findings. Several treatments such as enhancing dialysis adequacy, low calcium dialysate, calcimimetic agent, non-calcium- phosphorus binding agents, parathyroidectomy and intravenous infusion of sodium thiosulfate could not vanish the mass. Finally, the lump was surgically removed. The treatment of tumoral calcinosis in the hemodialysis patient can provide a instruction for similar situations in clinical practice.