Hereditary angioedema(HAE)is a rare autosomal dominant disorder characterized by recur-rent,unpredictable episodes of skin and mucosal edema,which may affect the face,extremities,respiratory tract,gastrointestinal tract,and genitals,with a global prevalence of approximately 1 in 50 000.This case re-port presents a young female patient with a history of recurrent abdominal pain and multisite edema.During an acute episode,laboratory tests revealed decreased complement C4 levels along with reduced concentration and function of C1 esterase inhibitor.Computed tomography(CT)demonstrated bowel wall edema and pelvic effu-sion.Previously undiagnosed,the patient was admitted for this acute attack and was ultimately diagnosed with HAE following a multidisciplinary treatment(MDT)team discussion at our hospital.The rapid diagnosis and treatment of this case highlight the critical role of MDT in the management of complex and rare diseases.

Objective:To explore the dynamic relationship between college students' online psychological needs satisfaction dominance(OPNSD)and phubbing.OPNSD refers to the tendency of individuals to fulfill their basic psychological needs primarily through online environments.Methods:A sample of 340 college students from a university in Beijing participated in two data collections(T1 and T2)at 3-month intervals.OPNSD was calculated as the difference between scores on the Need Satisfaction Perceived Online Scale(NSPOS)and the Basic Need Sat-isfaction in General Scale(BNSGS).Phubbing and its 4 dimensions(self-isolation,nomophobia,interpersonal con-flict,and problem acknowledgment)were measured with the Generic Scale of Phubbing(GSP).A cross-lagged panel model was used to explore the relationship between the online psychological needs satisfaction dominance and phubbing.Results:Significant simultaneous(r=0.60,P＜0.001)and successive temporal(r=0.56,P＜0.001)correlations were observed between the OPNSD score and GSP score.T1 OPNSD score was positively associated with T2 GSP score in the dimensions of self-isolation,nomophobia,and interpersonal conflict(β=0.14,0.10,0.11;P＜0.001 or P＜0.05),but showed no association with the problem acknowledgement dimension score(β=0.07,P＞0.05).However,the four dimensions of T1 GSP score were not associated with T2 OPNSD score(Ps＞0.05).Conclusion:This study suggests that college students' online psychological needs satisfaction dominance positively predicts phubbing,highlighting the critical influence of online environments on mobile phone behaviors.

Chronic thromboembolic pulmonary hypertension(CTEPH)is a potentially life-threatening pulmonary vascular disease,which belongs to the fourth largest category of pulmonary hypertension as defined in the 2022 European Society of Cardiology guidelines.Percutaneous balloon pulmonary angioplasty(BPA)is an interventional technique,which uses continuous and phased balloon expansion to treat the narrowed site under pulmonary angiography guidance,providing a completely new therapeutic method for CTEPH patients who are unable to receive surgical treatment and for CTEPH patients who have post-surgical residual pulmonary hypertension.This paper comprehensively introduces the interventional therapeutic technology of BPA,focusing on the development history,the clinical indications and the development of operative technique of BPA,meanwhile,the latest development of BPA in the treatment of CTEPH is also introduced.

Objective:To investigate whether changes in CT pulmonary angiography (CTPA) parameters before and after balloon pulmonary angioplasty (BPA) are correlated with treatment effects in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods:A retrospective study was conducted, including patients with CTEPH who underwent BPA treatment at Beijing Anzhen Hospital from November 2021 to Febbruary 2024. Clinical data and CTPA parameters were analyzed before the initial BPA session and at least 6 months after the final BPA session. Clinical data included WHO functional class, 6-minute walk distance (6MWD), and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The CTPA parameters included the widest diameter of the pulmonary artery diameter (dPA), ascending aorta diameter (dAA), the widest transverse diameter of the right atrium (dRA), the widest short-axis diameter of the right ventricle (dRV), the widest short-axis diameter of the left ventricle (dLV), and the diameter of right ventricular free wall thickness(dRVW). Multiple linear regression was applied to identify variables associated with the decrease in mean pulmonary artery pressure (mPAP) among the CTPA parameters.Results:All CTEPH patients underwent a total of 115 BPA treatments. Postoperatively, the WHO functional class of the patients improved compared to preoperative levels ( χ2=5.01, P<0.001), 6MWD improved ( t=4.50, P<0.001), and NT-proBNP levels decreased ( Z=4.47, P<0.001). Hemodynamic parameters, including mPAP, pulmonary vascular resistance, cardiac output, and cardiac index, were significantly improved postoperatively (all P<0.001). CTPA-related parameters, including dPA, dRA, dRV, dRVW, dPA/dAA, dRV/dLV, and dRA/dPA, significantly decreased compared to preoperative values (all P<0.001). Multiple linear regression analysis showed that the decrease in dPA ( β=0.314, P=0.037) and dRA ( β=0.334, P=0.046) were significantly correlated with the improvement in mPAP. Conclusions:Exercise tolerance, hemodynamics, and CTPA parameters in patients with CTEPH significantly improved after BPA treatment. The decrease in dPA and dRA were significantly correlated with the improvement in mPAP, suggesting that CTPA is a potentially novel, objective, effective, and noninvasive method for evaluating the therapeutic efficacy of BPA.

Objective:To explore the adverse effects of maternal exposure to angiotensin receptor blockers (ARBs) during the second and third trimesters of pregnancy on the fetus/neonate.Methods:Relevant databases at home and abroad were searched (up to April 2024), and case reports of ARB exposure during the second and third trimesters of pregnancy were collected. Data such as patient age, ARB drugs exposed to and the gestational age, concomitant drugs, maternal amniotic fluid examination, and fetal/neonatal outcomes were extracted from the literature. Descriptive statistical analysis was conducted on the information of ARB exposure during pregnancy.Results:A total of 37 case reports were included, describing the outcomes of 55 fetuses/neonates (including a pair of twins) exposed to ARBs in utero during the second and third trimesters of pregnancy of 54 pregnant women. Six kinds of ARBs were involved in the 54 pregnant women, including valsartan (31.5%, in 17 women), candesartan (25.9%, in 14 women), losartan (22.2%, in 12 women), olmesartan (11.1%, in 6 women), telmisartan (5.6%, in 3 women), and irbesartan (3.7%, in 2 women); 49 women (90.7%) took above ARBs continuously form pre-pregnancy or the first trimester of pregnancy to the second and third trimesters of pregnancy, which were mostly prescribed by non-obstetricians (internal medicine or general practice). In the 54 pregnant women, 46 had amniotic fluid examination during pregnancy, of which 45 (97.8%) had oligohydramnios or absence of amniotic fluid; 4 voluntarily induced labor to terminate pregnancy, and 50 reported the natural outcome of pregnancy and had 51 fetuses/newborns, 15 (29.4%) of which died in utero or within 1 week after birth, and 36 (70.6%) of which were discharged alive. Among the newborns, 81.3% (39/48) were premature infants, and 74.4% (32/43) were low birth weight infants. In the 55 fetuses/newborns, 48 (87.3%) had varying degrees of disease and developmental defects. The most commonly involved organ or system was kidney [72.7% (40/55)], and the major pathological change was renal tubular dysplasia; the following injury was lung/respiratory diseases and dysplasia with an incidence of [41.8% (23/55)], which was the main cause of fetal/neonatal death. Subsequently, abnormal development of skull/brain and limbs/hands and feet, abnormal circulatory system, abnormal coagulation, retinopathy, etc. have also been reported.Conclusion:ARBs exposure during the second and third trimesters of pregnancy poses significant risks to the fetus/neonate, often leading to developmental defects of renal tubular, lung, skull/brain, and limbs, and even death.

Objectives:To explore the correlation between angiography-derived microcirculatory resistance(AMR)and microvascular obstruction(MVO)extent,and AMR's predictive value for ventricular remodeling in patients with ST-segment elevation myocardial infarction(STEMI)post-primary percutaneous coronary intervention(PCI).Methods:This retrospective study included STEMI patients who underwent PCI at Beijing Anzhen Hospital from April 2019 to January 2023.Patients underwent acute and follow-up cardiac magnetic resonance(CMR)examinations 3-7 days and 3 months post-PCI.Ventricular remodeling was defined as a 20%or more increase in left ventricular end-diastolic volume at follow-up.Patients were divided into ventricular remodeling and non-ventricular remodeling groups.Baseline clinical characteristics,AMR values and CMR indices of both groups were compared.Pearson's correlation coefficient was used to explore the correlation between AMR and MVO extent on CMR.Logistic regression and receiver operating characteristic curve analysis were employed to evaluate the predictive performance of AMR for ventricular remodeling.Results:A total of 168 STEMI patients([56.4±11.4]years,139[82.7%]males)were included,with 49(29.2%)in the ventricular remodeling group and 119(70.8%)in the non-ventricular remodeling group.AMR was positively correlated with MVO extent on CMR(r=0.42,P<0.01).Compared to the non-ventricular remodeling group,patients in the ventricular remodeling group exhibited a higher AMR value(3.00[2.56,3.52]mmHg?s/cm vs.2.48[2.20,2.74]mmHg?s/cm,1 mmHg=0.133 kPa,P<0.01).Multivariate logistic analysis showed that AMR was independently associated with ventricular remodeling post-PCI in STEMI patients.For every 0.2 mmHg·s/cm increase in AMR,the risk for ventricular remodeling increased 45.1%(adjusted OR=1.451,95%CI:1.228-1.714,P<0.01).Area under the curve of AMR for predicting ventricular remodeling was 0.769.Conclusions:AMR is positively correlated with MVO extent and is an independent predictor for ventricular remodeling in STEMI patients post-PCI.

Objective To investigate the protective effect of Ghrelin on traumatic brain injury(TBI)in rats based on the HO-1/PGC-1αsignaling pathway.Methods Thirty SPF male rats were randomly divided into sham,TBI,and Ghrelin groups,with 10 rats in each group.A TBI rat model was established using the Feeney free-fall impingement method.The Ghrelin group was injected by caudal vein at a dose of 20 μg/kg 30 min after modeling,while the sham group was not impinged.After 72 h of modeling,the brain tissues of the rats were col-lected,and the brain water content was measured in order to analyze the severity of brain edema.HE staining was used to observe patho-logical changes in brain tissue.The levels of the oxidative stress factors MDA,SOD,and GSH-Px were determined using ELISA.TUNEL staining was used to detect the apoptosis of the brain cells,and the expression levels of Bcl-2,Bax,caspase-3 and caspase-9 in the brain tissues were detected by Western blotting.Mitochondrial reactive oxygen species(mtROS)in the brain tissues were detected by immuno-fluorescence.Mitochondrial function indicators,including mitochondrial mitogen Mfn 1/2,nuclear respiration factor 1(NRF1),and mito-chondrial transcription factor A(TFAM)were detected by Western blotting.The expression levels of HO-1 and PGC-1α in the brain tis-sues of rats in each group were detected by Western blotting.Twenty TBI model rats treated with Ghrelin were divided into Ghrelin+sh-NC and Ghrelin+sh-HMOX1 group with 10 rats in each group.Rats were treated with Ghrelin and injected with knock-down control(adenovirus 2.5 × 109 pfu)or knock-down HMOX1 adenovirus(2.5 × 109 pfu)via tail vein.Western blotting was used to detect the expressions of HO-1,PGC-1 α,Bcl-2,Bax,caspase-3 and caspase-9 in the brain tissues of the two groups.The levels of MDA,SOD and GSH-Px in brain tissue of two groups were detected by ELISA.Results Compared with the sham group,the pathological injury and brain edema in TBI group were aggravated,the number of brain cell apoptosis increased,the levels of oxidative stress factors SOD and GSH-Px decreased,the level of MDA increased,the level of mtROS in brain tissue decreased,the expressions of Bax,caspase-3 and caspase-9 increased,and the expressions of Mfn1/2,NRF1,TFAM,HO-1 and PGC-1α decreased(P＜0.05).Compared with TBI group,the pathological damage of brain tissue in Ghrelin group was improved,the brain edema was alleviated,the number of brain cell apoptosis was reduced,the levels of oxidative stress factors SOD and GSH-Px were increased,the level of MDA was decreased,the mtROS in brain tissue was decreased,the expression of Bcl-2 protein was increased,the expressions of Bax,caspase-3 and caspase-9 protein were decreased,and the expressions of Mfn1/2,NRF1,TFAM,HO-1 and PGC-1α were decreased(P＜0.05).Compared with Ghrelin+sh-NC group,the expressions of Bax,caspase-3 and caspase-9,MDA in brain tissue of Ghrelin+sh-HMOX1 group increased,while the levels of SOD and GSH-Px decreased(P＜0.05).Conclusion Chrelin has protective effect on TBI in rats,and can inhibit brain tissue injury and apoptosis in rats.Its mechanism may be achieved by regulating mitochondrial oxidative stress through HO-1/PGC-1α signaling pathway.

Background and Aims:Portal hypertensive colopathy(PHC)is a common complication of portal hypertension in patients with liver cirrhosis.It may lead to gastrointestinal bleeding,yet its underlying pathogenesis remains unclear,and systematic research in China is limited.This study aimed to analyze the colonoscopic features in cirrhotic patients and to explore their associations with relevant clinical factors.Methods:A retrospective analysis was conducted on 99 cirrhotic patients who underwent colonoscopy at Xingtai People's Hospital between July 2020 and December 2024.Colonoscopy,gastroscopy,and clinical data were reviewed.Differences between patients with PHC and those without were compared in terms of sex,Child-Pugh classification,platelet count,presence of ascites,and hepatic encephalopathy.Multivariate logistic regression was used to identify independent risk factors for PHC.Additionally,colorectal lesion detection rates were compared with those of a contemporaneous cohort of 444 participants undergoing national colorectal cancer(CRC)screening at the same center.Results:Among the 105 patients with cirrhosis,the detection rates of PHC,adenomatous polyps,and CRC were 32.32%,28.28%,and 3.03%,respectively,while only 37.37%had no abnormal findings.No serious colonoscopy-related complications were observed.The proportion of males in the PHC group was significantly higher than in the non-PHC group(78.13%vs.50.75%,P=0.009).The PHC group also showed significantly higher rates of Child-Pugh class B/C,and lower platelet count(all P<0.05).There was no statistically significant difference in the incidence of ascites and hepatic encephalopathy between the two groups(P>0.05).Multivariate analysis identified that male gender(OR=3.307,95%CI=1.219-8.971)and Child-Pugh class B/C(OR=2.867,95%CI=1.046-7.861)were independent risk factors for PHC.Compared to the CRC screening cohort,cirrhotic patients had a similar adenoma detection rate(28.28%vs.25.00%,P=0.499),and a slightly higher colorectal cancer detection rate that did not reach statistical significance(3.03%vs.0.68%,P=0.135).Conclusion:Colonoscopy revealed a high rate of abnormalities in cirrhotic patients,with PHC and adenomatous polyps being the most common findings.Routine colonoscopy is recommended for cirrhotic patients without contraindications,especially males,and patients with Child-Pugh class B/C,to facilitate early detection of PHC and precancerous lesions,thereby reducing the risk of lower gastrointestinal bleeding and missed diagnoses of malignancy.

Objective:To analyze the influencing factors of severe dengue fever patients in the early stage, construct a early prediction model for severe dengue fever, and evaluate it.Methods:A retrospective analysis was conducted to collect early clinical data of dengue fever patients admitted to the People's Hospital of Mengla County and the Third People's Hospital of Kunming in Yunnan Province from July to December 2023. The multifactor logistic regression was used to analyze the factors affecting the severe dengue fever patients, and Nomogram prediction model was used for visualization. Receiver operating characteristic (ROC) curve and calibration curve analysis were used to evaluate the model.Results:A total of 534 dengue fever patients were included, including 291 males and 243 females, aged (39.95 ± 15.69) years. Among them, there were 59 cases (11.05%) of severe dengue fever. The results of multifactor logistic regression analysis showed that age ( OR = 1.05, 95% CI: 1.02 - 1.08, P < 0.001), cardiovascular disease ( OR = 5.28, 95% CI: 2.08 - 13.40, P < 0.001), serous effusion ( OR = 4.34, 95% CI: 1.63 - 11.57, P = 0.003), aspartate aminotransferase ( OR = 1.03, 95% CI: 1.02 - 1.04, P < 0.001), lactate dehydrogenase ( OR = 1.00, 95% CI: 1.00 - 1.01, P = 0.001), and fibrinogen ( OR = 0.46, 95% CI: 0.28 - 0.76, P = 0.003) were independent influencing factors in the early stage of severe dengue fever. The area under the ROC curve of the Nomogram prediction model constructed from the above six variables was 0.96 (0.93 - 0.98). The calibration curve analysis results showed that the mean absolute error between the predicted values of the Nomogram prediction model and the actual observed values was 0.014. Conclusions:Age, cardiovascular disease, serous effusion, aspartate aminotransferase, lactate dehydrogenase, and fibrinogen are independent influencing factors in the early stage of severe dengue fever. The Nomogram prediction model established based on these variables has good predictive ability for severe dengue fever.