Objective: To investigate the predictive value of pulmonary vein antrum anatomy for recurrence after radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF). Methods: This was a retrospective cohort study. Patients with PAF who underwent successful first-time RFCA at the First Affiliated Hospital of Zhengzhou University from June 2019 to March 2021 were enrolled. All patients underwent cardiac CT angiography before ablation to measure left atrial diameter, as well as the circumference and area of bilateral pulmonary vein antrum orifices. The circularity parameters of bilateral pulmonary vein antrum orifices were calculated and denoted as pulmonary vein antrum-e (PVA-e), with left and right values recorded as LPVA-e and RPVA-e, respectively. All patients were followed up at 3, 6, 9, and 12 months after ablation by outpatient visit or telephone follow-up, and a standard electrocardiogram or Holter monitoring was performed at each follow-up. Recurrence of atrial fibrillation within 1 year after ablation was defined as the endpoint. Patients were divided into recurrence and non-recurrence groups according to whether recurrence occurred. Baseline characteristics were compared between the two groups, and Cox regression analysis was performed to identify independent predictors of recurrence after ablation. Receiver operating characteristic curves were used to evaluate the predictive performance of left atrial diameter, LPVA-e, and RPVA-e for post-ablation recurrence and to determine their optimal cutoff values. Kaplan-Meier curves were generated according to the optimal cutoff values of LPVA-e and RPVA-e, and differences in atrial fibrillation-free rate between groups were compared using the log-rank test. Results: A total of 188 patients with PAF (age (59.0±11.1) years, 76 (40.43%) females) were included. During the 1-year follow-up, 40 patients (21.28%) experienced recurrence after ablation. The left atrial diameter, LPVA-e, and RPVA-e were greater in the recurrent group compared to the non-recurrent group (P0.05). Multivariate Cox regression analysis showed that the left atrial diameter (HR=1.65, 95%CI: 1.07-2.56, P=0.025), LPVA-e (HR=1.13, 95%CI: 1.05-1.21, P0.001), and RPVA-e (HR=1.11, 95%CI: 1.01-1.22, P=0.031) were independent predictors of recurrence after RFCA. Receiver operating characteristic curve analysis showed that the area under the curve for LPVA-e was 0.737 (95%CI: 0.663-0.811), and the optimal cutoff value was 0.902, with a sensitivity of 82.5% and a specificity of 60.8%. The area under the curve for RPVA-e was 0.701 (95%CI: 0.610-0.791), and the optimal cutoff value was 0.927, with a sensitivity of 80.0% and a specificity of 55.4%. According to the optimal cutoff value, the bilateral PVA-e was divided into high and low groups. Kaplan-Meier curve analysis showed that atrial fibrillation-free rate was significantly lower in the high LPVA-e group than in the low LPVA-e group (log-rank P0.001), and similarly lower in the high RPVA-e group than in the low RPVA-e group (log-rank P0.001). Conclusion: Left atrial diameter, LPVA-e and RPVA-e are independent predictors of recurrence after RFCA in patients with PAF.

The in vitro culture of immature follicles remains a challenge in reproductive biology, ART, and fertility preservation. This study investigated the impact of α-MEM and SAGE 1-Step media on mouse preantral follicle development and oocyte maturation using two-dimensional (2D) and suspension culture systems. Preantral follicles (∼130 µm) from 14-day-old NMRI mice were cultured for 13 days in either medium under 2D or suspension conditions. On day 13, hCG was added to induce meiotic resumption. We evaluated follicular growth, antrum formation, oocyte maturation, meiotic spindle organization, and expression of genes related to maturation (Bmp15, Gdf9), cumulus expansion (Has2, Ptgs2, Lhr, Adamts1), and apoptosis (Bax, Bcl2). Antral formation was higher in α-MEM in both culture systems (P > 0.05). However, SAGE 1-Step significantly improved oocyte maturation across both systems (P =0.01 in 2D vs. P=0.006 in suspension compared to α-MEM). Spindle staining demonstrated that suspension culture significantly increased the percentage of oocytes with normal meiotic spindle organization (P=0.002). Gene expression analysis revealed a significant upregulation of Adamts1 (P=0.008) and downregulation of Bax (P=0.01) in suspension culture. Furthermore, the apoptotic ratio of Bax/Bcl2 was significantly decreased in the suspension system (P=0.01). In conclusion, SAGE 1-Step medium significantly enhances oocyte maturation, while the suspension system superiorly preserves meiotic spindle architecture and reduces apoptosis. The combination of SAGE 1-Step and suspension culture provides an optimized microenvironment for producing high-quality oocytes.

A woman in her 60s presented with abdominal pain and diarrhea. She had a history of asthma and sinusitis and developed a skin rash and numbness in the lower extremities. Laboratory tests revealed marked eosinophilia, leading to a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA). Esophagogastroduodenoscopy showed longitudinal erosion in the thoracic esophagus and mucosal color changes ranging from pale to bronze tones in the stomach, extending from the antrum to the angular region. These changes became more evident with insufflation and were not accompanied by inflammatory changes in the mucosa. Given the rarity of reports of esophageal and gastric involvement in EGPA, and to our knowledge, no case has demonstrated insufflation-dependent mucosal changes, this case is noteworthy.

Sarcina ventriculi is a rare, acid-resistant, carbohydrate-fermenting, Gram-positive bacterium most often reported in the setting of delayed gastric emptying or gastric stasis and obstruction. Its clinical relevance is variable, ranging from incidental colonisation to potentially severe complications such as emphysematous gastritis and perforation. Diagnosis is typically suggested by the characteristic basophilic tetrads on routine hematoxylin-eosin staining. An 81-year-old male presented with a 3-month history of atypical epigastric pain, postprandial vomiting, and general deterioration. Initial laboratory evaluation showed severe anemia and an inflammatory response. Upper gastrointestinal endoscopy revealed a traversable ulcerated, exophytic antral lesion extending toward the greater curvature. Histopathology of multiple biopsies demonstrated a poorly differentiated gastric carcinoma with concomitant Helicobacter pylori infection and S ventriculi identified on hematoxylin-eosin slides. Contrast-enhanced CT confirmed a locally advanced antrum-pyloric tumor with nodal, hepatic, and peritoneal metastases T4N2M1 (according to the eighth edition of the AJCC TNM staging system). The patient received symptomatic management, Helicobacter pylori eradication therapy, and was referred for palliative oncologic care. He died shortly thereafter. The detection of S ventriculi on gastric biopsies should prompt clinicians to actively search for an underlying cause of gastric stasis or obstruction, including malignancy. Management should prioritise treatment of the precipitating condition. Antibiotic therapy for S ventriculi may be considered in symptomatic patients or when complications are suspected, and H pylori should be treated according to standard guideline-based regimens when present.

The presence of a foreign object in the gastrointestinal tract is not an uncommon finding in imaging studies. Fishbone is a common foreign body that can be accidentally ingested. Most of them pass spontaneously without symptoms, while 10%-20% fail to pass and less then 1% cause complications. A 67-year-old woman presented to the emergency department with epigastric abdominal pain, dyspepsia, and weight loss over the previous weeks. Laboratory tests showed a mild elevation of inflammatory markers, while amylase and lipase levels were within normal limits. The patient was afebrile. A contrast-enhanced abdominal CT scan revealed a linear hyperdense structure within the thickness of the gastric wall at the level of the antrum; at the same site, an inhomogeneous thickening of the gastric wall with supraphysiological fluid density was observed. After antibiotic therapy, the patient underwent laparoscopic surgery with removal of the foreign body, which was identified as a fish bone, and surgical lavage She was discharged 5 days after surgery. CT is the most sensitive and specific tool for the diagnosis. Multiplanar reconstructions and the use of a bone window has proven essential for early diagnosis and therapeutic planning.

Gastric antral vascular ectasia (GAVE) is an under-recognised cause of chronic gastrointestinal blood loss and iron-deficiency anaemia, caused by dilated antral vessels that cause chronic gastrointestinal bleeding, gradually depleting iron stores and leading to reduced haemoglobin levels. Its presentation is often subtle and may occur without overt gastrointestinal bleeding. We report an 82-year-old patient admitted following an unwitnessed fall, associated with postural hypotension and normocytic anaemia (Hb 90 g/L). Oesophagogastroduodenoscopy (OGD) demonstrated linear GAVE in the gastric antrum without active bleeding. The patient also sustained a fragility pelvic fracture. Intravenous iron therapy was administered to correct severe iron deficiency, resulting in improved haemoglobin levels and resolution of underlying clinical symptoms. This case highlights an important and often under-recognised presentation of GAVE, in which anaemia manifests predominantly through falls or orthostatic features rather than gastrointestinal symptoms. Early recognition of this pattern is crucial, as targeted treatment may reduce the risk of recurrent falls, fractures, and subsequent functional decline in older adults.

Chronic gastritis is a common manifestation of Helicobacter pylori infection. Clinical presentations can range from epigastric discomfort to gastrointestinal bleeding. The clinical course and gross endoscopic findings can mimic alternative diagnoses such as gastric adenocarcinoma and gastrointestinal stromal tumors (GISTs). We report a case of H. pylori-associated chronic gastritis that initially presented with frank melena. Subsequent blood tests demonstrated a drop in hemoglobin and a rise in serum urea. The case was managed according to the hospital's upper gastrointestinal bleed protocols. The next day, endoscopy demonstrated a large polypoidal mass in the gastric antrum suspicious for GIST. However, subsequent biopsy and histological examination showed lymphoid aggregates and active inflammation with comma-shaped bacilli consistent with H. pylori infection. The case was subsequently managed with triple eradication therapy. This case underscores the value of prompt management of upper gastrointestinal bleeding and the need to validate diagnoses with definitive modalities to optimize long-term management.