An unusual case of two acute coronary syndrome episodes caused by allergic and non-allergic coronary artery dissection with potential coronary vasospasm association: a case report.

Background: Type I variant Kounis syndrome is characterized by coronary spasm following an allergic or anaphylactic reaction. Coronary spasm is also recognized as a contributing factor in spontaneous coronary artery dissection (SCAD). Case summary: A 46-year-old woman presented to the emergency room with a chief complaint of chest discomfort following the ingestion of a steamed bun. A marked decrease in systolic blood pressure and a prominent rash on her forearms and groin suggested anaphylactic shock. Upon stabilization of vital signs, acute coronary syndrome (ACS) was suspected based on electrocardiogram findings and symptoms, prompting an emergency coronary angiography (CAG). The CAG revealed severe stenosis with coronary artery dissection in the right coronary artery (RCA), and a stent implantation was performed. Given the suspicion of type I variant Kounis syndrome, a spasm provocation test was performed, yielding a positive result. Six years later, she experienced chest discomfort while sleeping and was admitted to our emergency department. An electrocardiogram showed ST-segment elevation in leads II, III, and aVF. An emergency CAG identified a severely stenotic lesion with coronary artery dissection in the RCA, leading to a diagnosis of SCAD. Direct stenting was performed at the stenotic site. The patient was discharged following intensification of medication. Discussion: This report describes a rare case of a middle-aged woman with two episodes of ACS caused by both allergic and non-allergic coronary artery dissection. These episodes suggest that a shared underlying coronary vasospasm in both conditions may be a common trigger for coronary artery dissection.

High Baseline Lipoprotein(a) Level as a Risk Factor for Coronary Artery Calcification Progression: Sub-analysis of a Prospective Multicenter Trial.

Lipoprotein(a), or Lp(a), is a low-density lipoprotein-like particle largely independent of known risk factors for, and predictive of, cardiovascular disease (CVD). We investigated the association between baseline Lp(a) levels and the progression of coronary artery calcification (CAC) in patients with hypercholesterolemia undergoing statin therapy. This study was a sub-analysis of a multicenter prospective study that evaluated the annual progression of CAC under intensive and standard pitavastatin treatment with or without eicosapentaenoic acid in patients with an Agatston score of 1 to 999, and hypercholesterolemia treated with statins. We classified the patients into 3 groups according to CAC progression. A total of 147 patients (mean age, 67 years; men, 54%) were analyzed. The proportion of patients with Lp(a) > 30 mg/dL significantly increased as CAC progressed (non-progression; 5.4%, 0100; 23.6%). Logistic regression analysis showed that Lp(a) > 30 mg/dL was an independent predictor of the annual change in Agatston score > 100 (OR: 5.51; 95% CI: 1.28-23.68; p=0.02), even after adjusting for age, sex, hypertension, diabetes mellitus, current smoking, body mass index, and lipid-lowering medications. Baseline Lp(a) >30 mg/dL was a predictor of CAC progression in this population of patients with hypercholesterolemia undergoing statin therapy.

Implantation of multiple polytetrafluoroethylene covered stent inside drug eluting stent to rescue purulent coronary artery ectasia with giant saccular aneurysm.

A 79-year-old male with diabetes mellitus and old cerebral infarction was admitted to hospital due to fever and palpitation. Diagnosis of purulent pericarditis was established by pericardial effusion examination. The patient's general condition improved temporarily after drainage of the pericardial effusion. However, computed tomography demonstrated a saccular aneurysm arising from RCA have rapidly grown even larger, up to 63 × 51 mm on 7th hospital day. This indicated that the risk of rupture of the aneurysm was high. Percutaneous coronary intervention was applied to prevent rupture of the aneurysm. Several polytetrafluoroethylene (PTFE)-covered stents were required to cover the extended aneurysm lesion. A long drug-eluting stent (DES), which was initially implanted through the aneurysm, was itself implanted with 3 PTFE-covered stents located inside the DES. This procedure provided protection against endoleak of the aneurysm. To our knowledge, the present case shows for the first time that PTFE-covered stents located within DES are useful in treatment of a giant coronary aneurysm.

Expression of pancreatic duodenal hoemobox-1 in pancreatic islet neogenesis after surgical wrapping in rats.

BACKGROUND: Surgical wrapping (SW) of the pancreas causes islet neogenesis in rodents. Pancreatic duodenal hoemobox-1 (PDX-1) is one of the transcriptional factors needed by pancreatic stem cells to develop a mature pancreas. The purpose of this study was to determine whether islet neogenesis arises from ductal cells and whether PDX-1 is involved in this process. METHODS: SW consisted of nonocclusive wrapping of the pancreas in rats. The wrapped pancreas was then harvested, insulin content was measured, and immunohistochemical analysis for insulin, cytokeratin, and PDX-1 was performed. RESULTS: The endocrine area of the wrapped pancreas significantly increased after SW. Double immunostaining identified cells positive for both insulin and cytokeratin in or along the epithelial cell lining of the ductal structures and in the centroacinar cells. PDX-1-positive cells were detected in both control islets and islets examined after SW, but these cells were observed in the exocrine area only after SW. Double staining also showed that cells positive for PDX-1 but negative for insulin were present in the exocrine area 1 day after SW and that cells positive for both PDX-1 and insulin had developed 3 days after SW. CONCLUSIONS: In the process of adult islet neogenesis after SW, cells in the acini and ductal structures developed into PDX-1-expressing cells, supposedly progenitor cells, which in turn became insulin-producing cells and thus might be the origin of small islets.

Mechanism of high-temperature CO2 sorption on lithium zirconate.

Lithium zirconate (Li2ZrO3) is one of the most promising materials for CO2 separation from flue gas at high temperature. This material is known to be able to absorb a large amount of CO2 at around 400-700 degrees C. However, the mechanism of the CO2 sorption/desorption process on Li2ZrO3 is not known yet. In this study, we examined the CO2 sorption/desorption mechanism on Li2ZrO3 by analyzing the phase and microstructure change of Li2ZrO3 during the CO2 sorption/desorption process with the help of thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), and X-ray diffraction (XRD) analyses. Li2ZrO3 powders were prepared from lithium carbonate (Li2CO3) and zirconium oxide (ZrO2) by the solid-state method, and the CO2 sorption/desorption property was examined by TGA. It was shown that pure Li2ZrO3 absorbs a large amount of CO2 at high temperature with a slow sorption rate. Addition of potassium carbonate (K2CO3) and Li2CO3 in the Li2ZrO3 remarkably improves the CO2 sorption rate of the Li2ZrO3 materials. DSC analysis for the CO2 sorption process indicates that doped lithium/potassium carbonate is in the liquid state during the CO2 sorption process and plays an important role in improving the CO2 uptake rate. XRD analysis for phase and structure change during the sorption/desorption process shows that the reaction between Li2ZrO3 and CO2 is reversible. Considering all data obtained in this study, we proposed a double-shell model to describe the mechanism of the CO2 sorption/desorption on both pure and modified Li2ZrO3.