ObjectiveTo evaluate the diagnostic accuracy of transthoracic echocardiography (TTE) in patients with pulmonary hypertension (PH).DesignSystematic review and meta-analysis.Data sources and eligibility criteriaEmbase, Cochrane Library for clinical trials, PubMed and Web of Science were used to search studies from inception to 19 June, 2019. Studies using both TTE and right heart catheterisation (RHC) to diagnose PH were included.Main resultsA total of 27 studies involving 4386 subjects were considered as eligible for analysis. TTE had a pooled sensitivity of 85%, a pooled specificity of 74%, a pooled positive likelihood ratio of 3.2, a pooled negative likelihood ratio of 0.20, a pooled diagnostic OR of 16 and finally an area under the summary receiver operating characteristic curve of 0.88. The subgroup with the shortest time interval between TTE and RHC had the best diagnostic effect, with sensitivity, specificity and area under the curve (AUC) of 88%, 90% and 0.94, respectively. TTE had lower sensitivity (81%), specificity (61%) and AUC (0.73) in the subgroup of patients with definite lung diseases. Subgroup analysis also showed that different thresholds of TTE resulted in a different diagnostic performance in the diagnosis of PH.ConclusionTTE has a clinical value in diagnosing PH, although it cannot yet replace RHC considered as the gold standard. The accuracy of TTE may be improved by shortening the time interval between TTE and RHC and by developing an appropriate threshold. TTE may not be suitable to assess pulmonary arterial pressure in patients with pulmonary diseases.PROSPERO registration numberPROSPERO CRD42019123289.

Background: To decipher the mechanisms of Angelica sinensis for the treatment of acute myocardial infarction (AMI) using network pharmacology analysis. Methods: Databases were searched for the information on constituents, targets, and diseases. Cytoscape software was used to construct the constituent–target–disease network and screen the major targets, which were annotated with the DAVID (Database for Annotation, Visualization and Integrated Discovery) tool. The cardioprotective effects of Angelica sinensis polysaccharide (ASP), a major component of A. sinensis, were validated both in H9c2 cells subjected to simulated ischemia by oxygen and glucose deprivation and in rats with AMI by ligation of the left anterior coronary artery. Results: We identified 228 major targets against AMI injury for A. sinensis, which regulated multiple pathways and hit multiple targets involved in several biological processes. ASP significantly decreased endoplasmic reticulum (ER) stress-induced cell death both in vitro and in vivo. In ischemia injury rats, ASP treatment reduced infarct size and preserved heart function. ASP enhanced activating transcription factor 6 (ATF6) activity, which improved ER-protein folding capacity. ASP activated the expression of p-AMP-activated protein kinase (p-AMPK) and peroxisome proliferator-activated receptor γ coactivator 1α (PGC1α). Additionally, ASP attenuated levels of proinflammatory cytokines and maintained a balance in the oxidant/antioxidant levels after AMI. Conclusion: In silico analysis revealed the associations between A. sinensis and AMI through multiple targets and several key signaling pathways. Experimental data indicate that ASP protects the heart against ischemic injury by activating ATF6 to ameliorate the detrimental ER stress. ASP’s effects could be mediated via the activation of AMPK-PGC1α pathway.

Different segmentation of lung nodules using the same segmentation algorithm can easily lead to excessive segmentation errors. Therefore, it is necessary to design an effective segmentation algorithm to improve image segmentation accuracy. Based on the hidden Markov model, this study processed the ultrasound images of pulmonary nodules to improve their diagnostic results. At the same time, this study was combined with the ultrasound image of lung nodules to process the ultrasound images. In addition, this study combines the convex hull algorithm for image processing, uses the improved vector method to repair, improves image recognizability, establishes a reliable feature extraction algorithm, and establishes a comprehensive diagnostic model. Finally, this study designed the test for performance analysis. Through experimental research, it can be seen that the model constructed in this study has certain clinical effects and can provide theoretical reference for subsequent related research.

BACKGROUNDThymoma is a relatively rare type of tumor. It is more common in middle-aged patients than in children and young adults. We report a 26-year-old patient with advanced giant thymomas. The patient’s tumor have invaded the upper venous vein. There was also a large tumor in the right atrium. The patient had lung metastases. CASE SUMMARYWe report a patient with type B2 thymoma. His image studies showed a mediastinal space-occupying lesion that penetrated through the superior vena cava and extended into the right atrium, with metastases in the right lung and enlarged lymph nodes in the neck, mediastinum, and bilateral axillary areas. Biopsy reports suggested type B2 thymoma. Multidisciplinary consultation concluded with a diagnosis of stage IVB thymoma. This patient began a chemotherapy regimen with cisplatin, doxorubicin, and cyclophosphamide (CAP). Subsequent management decisions were made based on the treatment responses. CONCLUSIONAt present, thymoma treatment is mainly surgical. However, for patients with advanced thymoma, surgical treatment may risk the patient's survival. For advanced thymoma patients, we recommend chemotherapy (CAP), which may provide a new treatment option for patients with advanced thymoma.