Sintilimab-Induced Myocarditis Overlapping Myositis in a Patient With Metastatic Thymoma: A Case Report

Although immune checkpoint inhibitor (ICI)-related myocarditis has been widely discussed, a lot of gaps and challenges in its clinical course and rational intervention remain elusive. We present the case of a 33-year-old man with a history of metastatic thymoma who developed dyspnea and muscle weakness 1 month after the first dose of sintilimab. He was asymptomatic but found to have a mild elevation of troponin-T and a moderate increase of creatine kinase 20 days after the infusion. Although the scheduled second dose was deferred, he developed dyspnea, left bundle branch block, and left ventricular enlargement that is suggestive of Grade 3 ICI-related myocarditis, complicated with myositis/myasthenia gravis 10 days later. Fortunately, his response to intensive immunosuppressive therapy was good.

Follow-Up Study of Echocardiography in 38 Children With Kawasaki Disease Complicated by Heart Lesion

Background: The most common and most serious complication of Kawasaki disease (KD)is heart lesion(HL), which is the main cause of childhood acquired HL.Objective: Use echocardiography to study the HL recovery of children with KD complicated by HL, and provide an important theoretical basis for the prognosis of KD complicated by HL.Methods: Using prospective research methods, 38 children with KD complicated by HL were followed up for echocardiographic examination, and the longest examination time was one year. And carry on statistical analysis to the inspection data.Results: In 38 children with KD complicated by HL, 36 cases of coronary artery lesion (CAL), including 29 cases of coronary artery dilation(CAD), 7 cases of coronary artery stenosis(CAS), and 2 cases of simple pericardial effusion without CAL. CAL complicated with valve regurgitation in 4 cases, pericardial effusion in 3 cases, and left ventricular enlargement in 4 cases. In about 3 weeks, most of the pericardial effusion and mild CAD recovered. At 3 months, except for a few severe CAL, heart valve regurgitation and left ventricular enlargement all recovered. The recovery of moderate CAD was slow. One case still failed to return to normal after 1 year, but the coronary artery diameter gradually decreased.Conclusion: Kawasaki disease complicated by heart lesion mainly affects the coronary arteries, and the main manifestation is expansion. The more the expansion, the slower the recovery.

Screening Echocardiography in a Developing Country

Background The use of tele-echocardiograms could be useful for improving access of patients to echocardiographic evaluation in places where there is a shortage of trained physicians. It was evaluated the agreement between a physician sonographer and another health professional with basic training to acquire transthoracic images, assessed by a remote echocardiographer. Methods 174 patients underwent echocardiography by a physician level III training in Echo. A moving image protocol (MPEG format, 3 cycles for each image) was stored: 2D parasternal long axis, apical four chambers with and without color. Soon after, a nurse with 20 hours of training in Echo, unaware of the result of the report, acquired the same protocol. The exams were randomized and sent to a remote observer, another echocardiographer level III, blinded to the sonographer's status, to recognize the presence of the any of the following abnormalities: left ventricular enlargement, hypertrophy and systolic dysfunction; right ventricular enlargement, left atrium enlargement and left sided valvopathy at least moderate. Agreement was evaluated by kappa concordance. Results It was analyzed 108 females and 66 males, median age= 61 y [P.25=50-P.75=72]; LV ejection fraction= 64 % [58-69] and body mass index= 27.6 kg/m2 [24.5-32.5]. There was a good concordance between the evaluators. All the indices analyzed showed agreement above 0.55 and statistic significance (left ventricular enlargement - 0.84; left ventricular hypertrophy - 0.84; systolic left ventricular dysfunction - 0.82; right ventricle enlargement - 0.72; left atrial enlargement - 0.80; valvopathy - 0.56). Conclusions The image acquisition by a tele-echocardiogram screening may be acquired by non-physician professionals with minimum training. Key messages Echocardiography. Remote.

Biodegradation of injectable silk fibroin hydrogel prevents negative left ventricular remodeling after myocardial infarction

Random collagen fiber networks formed by a slowly degrading silk fibroin hydrogel injection prevented left ventricular enlargement after myocardial infarction.