Type A aortic dissection during diagnostic coronary angiography in normal coronary arteries: A case report.

Key Clinical Message: Aortic dissection is one of the rare complication of coronary angiography. The main treatment underlies surgical intervention however; management should be done with patient's decision. Abstract: Coronary angiography (CA) is a widely utilized diagnostic procedure used to evaluate blood flow through the coronary arteries and detect coronary artery disease (CAD). Despite its widespread use, it has complications including non-life-threatening, while there are some rare complications that can occur. We present a case of an elderly woman who presented with ST elevation myocardial infarction (STEMI) and underwent CA without evidence of CAD. However, the patient later developed type A aortic dissection (AD) as a complication of the procedure. Surgery is considered emergent treatment for type A-AD, but the patient was asymptomatic without any complaint, shared decision making was conducted and the patient decided to pursue conservative treatment without surgical intervention. Therefore, managing AD should be tailored to each patient individually through shared-decision making.

Land Premium Effects of Urban Rail Transit and the Associated Policy Insights for TOD: A Case of Ningbo, China.

With considerable investments, mainly from local government budgets, the construction and operation of urban rail transit (URT) can exert significant spillover effects on the surrounding land use and land prices. In particular, China's local governments are actively committed to developing their URT systems and promoting large-scale transit-oriented development (TOD) projects under the public land leasing policy. However, the connection between the land premium effects and TOD policy and practice is still lacking, particularly in the local government contexts, which exhibit significant policy and spatial heterogeneity. Thus, this research represents an attempt to better address this issue using the city of Ningbo as a case study. First, the premium effects of URT on land prices are examined, after which three crucial policy insights (land value capture [LVC], public-private cooperation [PPC], and urban regeneration) are proposed to enhance the effectiveness and efficiency of TOD, demonstrating its strong connection with the potential premium effects. The findings demonstrate that (1) local governments have adopted different innovative policies-with the ambition-to implement LVC; (2) assisted by PPC, the local rail transit authority can significantly amplify the premium effects, although it must still address the fair distribution of premiums across multiple stakeholders; and (3) transit-oriented urban regeneration can significantly influence land prices/land rents and subsequently generate significant gentrification, which will be further addressed by the TOD policy and practice.

Role of Built Environments on Physical Activity and Health Promotion: A Review and Policy Insights.

As urbanization and motorization continue worldwide, various health issues have emerged as a burden between individuals, families and governments at all levels. Under the prevalence of chronic disease, this review synthesizes research on the impact of the various built environments on the multiple health outcomes from a methodological and mechanistic perspective. Besides, it attempts to provide useful planning and policy implications to promote physical activity and health benefits. The finds show that: (1) Current literature has used a variety of dataset, methods, and models to examine the built environment-health benefit connections from the perspective of physical activity; (2) The prevalence of chronic diseases is inextricably linked to the built environment, and policy interventions related to physical activity and physical and mental wellbeing of urban residents should be emphasized; (3) The impact of the built environment on health is manifested in the way various elements of the physical environment guide the lifestyle of residents, thereby influencing physical activity and travel; (4) Given the changes that have occurred in the built environment during the current urban expansion, the link between urban planning and the public health sector should be strengthened in the future, and the relevant authorities should actively pursue policies that promote urban public health in order to improve the health of residents. Finally, it proposes potential policy insights for urban planning and development toward a healthier city and society.

COVAN Leading to ESKD Despite Minimal COVID Symptoms.

We report a case of dialysis dependence in a patient with COVID-19-associated nephropathy (COVAN) who had minimal respiratory manifestations. A 25-year-old man with a history of multiple sclerosis in remission presented with mild dyspnea due to COVID-19 pneumonia and was found to have rapidly worsening kidney function. He only required nasal cannula and was able to be weaned off within a few days. Despite having only mild respiratory disease, his kidney function worsened and urgent hemodialysis was started for hyperkalemia and uremic encephalopathy. Kidney biopsy demonstrated collapsing glomerulopathy due to COVID-19 with moderate interstitial fibrosis and tubular atrophy. His kidney function did not recover, and he unfortunately now has been dependent on hemodialysis for over 3 months. Multiple case reports have described COVAN causing dialysis dependence, but to our knowledge this is the first reported case of COVAN causing dialysis dependence in a patient with such mild respiratory disease. Currently the indications for intensive COVID-19 therapies are based on oxygen requirements. This case demonstrates that the oxygen requirement may not fully reflect the severity of COVID-19 and raises the question of whether these therapies should be considered in patients with COVAN.

Curing the incurable: A case of refractory vasospastic angina.

Vasospastic angina (VSA) is the spasm of coronary arteries causing transient myocardial ischemia. VSA is commonly managed with antispasmodic medications including calcium-channel blockers (CCB) and nitrates. When vasospasm is refractory to conventional medications, unconventional treatment modalities may be used for symptomatic relief (Tandon et al., 2019 Feb) [1]. There are several mediators of vasospasm, with serotonin playing a major role. Serotonin is a product of platelet aggregation and has multiple effects on the endothelium, which forms the basis of an unconventional treatment modality that may be used for symptomatic relief of VSA. In this case, a 44 year old female with a history of coronary artery disease (CAD) status post coronary artery bypass graft (CABG) with recent drug-eluting stent (DES) placement was admitted for shortness of breath and chest pain, found to have a positive stress echocardiogram (Echo), and had unremarkable coronary angiography. Given persistent symptoms while on optimal medical therapy and with negative coronary angiography, the diagnosis of refractory VSA was made. Patient was started on a serotonin receptor blocker with improvement of her symptoms.

Extended spectrum beta lactamase producing Escherichia coli eustachian valve infective endocarditis.

Endocarditis is an infection of the endocardium caused by a multitude of bacteria, including S. aureus, viridans streptococci, S. bovis, or S. epidermidis, among others. It can cause a variety of physical findings, including new onset murmur, Osler nodes, and Janeway lesions. Endocarditis is diagnosed with multiple positive blood cultures with transesophageal echocardiogram (TEE) showing valvular vegetations. In this article, we present a 47 year old female with a history of ESRD on dialysis who presented with a bleeding fistula found to be in septic shock. Diagnosis of eustachian valve endocarditis with E. Coli ESBL was made through positive blood cultures as well as using TEE. She was started on IV meropenem for seven days, to which the patient completed and eventually was discharged home with resolution of symptoms.

[Control Models and Effect Evaluation of Air Pollution in Jing-Jin-Ji Urban Agglomeration].

Controlling air pollution in the Jing-jin-ji urban agglomeration (JJJUA), the most seriously polluted area in China, is related to the integrated development strategy for the region. Based on the national and regional implementation of air pollution control measures in recent years, the hierarchical cross-regional multi-directional linkage (HCML) air pollution prevention and control model was applied in this study. The effect of air pollution control was evaluated by monitoring the pollutants, SO2, NO2, PM10, PM2.5, O3, and CO, at 112 monitoring sites in 13 cities in 2014-2015. The results can be summarized as follows:① The HCML model is an interrelated framework at the horizontal and vertical level. Under the efforts provided by the central, urban agglomeration, and city governments, this multi-level governance model serves as an effective tool to resolve the issues related to air pollution beyond the borders of municipalities. Environmental regulations on certain industries, energy consumption structure, car ownership and usage, and air quality supervision and warning systems are well established under this governance model. ② The air quality of the JJJUA has improved significantly in the past two years. The concentrations of air pollutants significantly decreased, with the exception of O3, and high pollution ranges significantly reduced from north to south. The annual average concentrations of PM2.5, PM10, SO2, NO2, and CO decreased by 17.84%, 14.61%, 37.55%, 4.82%, and 16.18%, respectively. The number of days meeting the air quality standards increased for all pollutants except NO2. Based on the current situation and unsolved problems of air pollution, the JJJUA area needs certain measures including diversifying the governance subjects, joint legislation (beyond municipalities) on air pollution to regulate pollution discharge, enhancing public awareness on air pollution and its health impacts, carefully examining sources of air pollution in winter to reduce pollution, and to better understand the sources of ozone and adopt effective control measures.

Preimplantation-stage stem cells induce long-term allogeneic graft acceptance without supplementary host conditioning.

Hematopoietic stem cells have been successfully employed for tolerance induction in a variety of rodent and large animal studies. However, clinical transplantation of fully allogeneic bone marrow or blood-borne stem cells is still associated with major obstacles, such as graft-versus-host disease or cytoreductive conditioning-related toxicity. Here we show that when rat embryonic stem cell-like cells of WKY origin are injected intraportally into fully MHC-mismatched DA rats, they engraft permanently (>150 days) without supplementary host conditioning. This deviation of a potentially alloreactive immune response sets the basis for long-term graft acceptance of second-set transplanted WKY cardiac allografts. Graft survival was strictly correlated with a state of mixed chimerism, which required functional thymic host competence. Our results provide a rationale for using preimplantation-stage stem cells as vehicles in gene therapy and for the induction of long-term graft acceptance.