Idiopathic nodular glomerulosclerosis has a poor renal prognosis and is characterized by diffuse nodular glomerulosclerotic lesions in the absence of diabetic mellitus. Here, we report the case of a 69-year-old woman with no smoking history who developed renal dysfunction and proteinuria in the absence of overt diabetes or obesity. A biopsy specimen showed nodular mesangial sclerosis with arteriolar hyalinosis and severe large-vessel arteriosclerosis, leading to a diagnosis of idiopathic nodular glomerulosclerosis. Addition of esaxerenone to her existing renin-angiotensin-aldosterone inhibitor therapy led to a rapid decrease in the proteinuria levels and the maintenance of renal function without any complications for more than a year. The results suggest that intensive renin-angiotensin-aldosterone blockade might be an effective treatment for idiopathic nodular glomerulosclerosis.

This research aimed to develop a simple and effective acute coronary syndrome (ACS) screening model in order to intervene early and focus on prevention in patients presenting with arteriosclerosis.
A case-control study.
The study used a cross-sectional survey to collect data from 2243 patients who completed anonymous electronic medical record (EMR) data and coronary angiography was gathered at a hospital in Shandong Province between December 2013 and April 2016.
Adults 18 years old and above diagnosed as ACS or non-ACS according to the records in hospital EMR database, and with completed basic information (age and sex).
54 laboratory biomarkers and demographic factors (age and sex).
A dataset without missing data of all patients\' laboratory indicators and demographic factors was divided into training set and validation set after being balanced. After the training set balanced, area under the curve of random forest (AUCRF) and least absolute shrinkage and selection operator (LASSO) regression were used for feature extraction. Then two set random forest models were established with the different feature sets, and the process of comparison and analysis was made to evaluate models for the optimal model including sensitivity, accuracy and AUC receiver operating characteristic curves with the internal validation set.
To establish an ACS screening model.
An RF model with 31 features selected by LASSO with an AUC of 0.616 (95% CI 0.650 to 0.772), a sensitivity of 0.832 and an accuracy of 0.714 in the validation set. The other RF model with 27 features selected by AUCRF with an AUC of 0.621 (95% CI 0.664 to 0.785), a sensitivity of 0.849 and an accuracy of 0.728 in the validation set.
The established ACS screening model with 27 clinical features provides a better performance for practical solution in predicting ACS.

Chronic endometritis is rarely reported in the postmenopausal population. Here, we describe a case of chronic endometritis in a patient who had undergone premature menopause that was later found to have Monckeberg arteriosclerosis (MocA) of the uterine vessels.
A review of the literature revealed a single report of MocA affecting the uterine vessels and no reports in a patient who had undergone premature menopause. A case of a 69-year-old presenting with postmenopausal bleeding and having the diagnosis of chronic endometritis is described.
Following definitive management with hysterectomy, final histopathology showed MocA of the uterine vessels.
The lack of reviews of chronic endometritis in postmenopausal women reveals a gap in the literature. Further studies are necessary to review MocA and decreased uterine perfusion in the context of a possible predisposition to chronic endometrial infection and/or inflammation.

A 77-year-old woman with a history of hypertension underwent upper gastrointestinal endoscopy for hematemesis, and vasodilation with erosion was detected. Contrast-enhanced computed tomography and abdominal angiography revealed a gastric aneurysm penetrating the stomach wall. Endoscopic hemostasis was thought to be not applicable to a ruptured aneurysm. Transcatheter arterial embolization was not performed because of technical difficulties. Therefore, local gastric resection was performed. It was later determined that the cause of the persistent hypertension was primary aldosteronism, which was thought to cause arteriosclerotic obstruction of the celiac, common hepatic, and splenic arteries, resulting in the formation of the gastric arterial aneurysm. In the case of upper gastrointestinal bleeding, keeping primary aldosteronism in mind as a differential diagnosis is important to make a precise diagnosis and suitable treatment selection.

Mönckeberg arteriosclerosis, also known as Mönckeberg sclerosis or Mönckeberg medial calcinosis, is a well-documented phenomenon in medicine due to its association with a number of serious systemic conditions and aging. This article presents a unique case of Mönckeberg arteriosclerosis in the oral facial region demonstrated clearly on cone-beam computed tomography (CBCT). The reporting of Mönckeberg arteriosclerosis in dental literature is uncommon even though the radiographic features of the head and neck on plain film and CBCT are unique to the condition. As dentistry and medicine strive to move toward an integrated one-health model, it will be important for dental practitioners to recognize this condition during dental radiographic evaluation. A practitioner\'s understanding of the potential medical implications and the need for appropriate referral to a medical colleague could be lifesaving for a dental patient.

BACKGROUND: Numerous reports have indicated that patients with anorexia nervosa (AN) are at a relatively high risk of developing vascular diseases, including cardiovascular events and venous thromboembolism. However, there have been no previous reports of the development of ischemic stroke during refeeding therapy in patients with severe AN. This report is aimed at reporting the characteristics of an ischemic stroke in patients with AN.
METHODS: Our study included 29 admissions by independent 19 female patients cases (19 patients), who received thorough medical, neurological, and psychiatric examinations. Two patients were diagnosed as having developed ischemic stroke; the first patient showed multiple infarctions in the brain, while the second showed symptomatic focal infarction. Our findings suggest that dehydration and arteriosclerosis, in association with severe malnutrition, could predispose to the development of ischemic stroke in patients with severe AN.
CONCLUSIONS: Development of ischemic stroke in patients with AN might be overlooked. Watching out for neurological signs would help in early diagnosis of ischemic stroke in patients with AN during refeeding. Specific etiology could induce ischemic stroke in patients with AN even if they have no common risk factors of ischemia.

Gastroepiploic aneurysms are rare. We report the case of a 74-year-old man who presented with temporary loss of consciousness and abdominal pain. Computed tomography revealed a ruptured right gastroepiploic artery aneurysm. His vital signs improved after extracellular fluid infusion; hence, we performed transcatheter arterial embolization. There were no postoperative complications, and the patient was discharged on the 15th day of hospitalization. Ruptured abdominal aneurysms are often fatal and should be considered in patients with symptoms of anemia and abdominal pain. Currently, minimally invasive transcatheter arterial embolization had been designated as the preferred treatment option because of effectiveness in both diagnosis and treatment. Thus, we report a case of ruptured right gastroepiploic artery aneurysm treated by transcatheter arterial embolization, thereby preventing an emergency surgery.

An elevated level of total plasma homocysteine has been associated with a higher risk of atherosclerosis and coronary heart disease. The aim of our research was to study the relation between homocysteine and myocardial infarction (MI) in young patients. We conducted a case-control study in Constanţa County, Romania including 61 patients, divided in two groups. The first group, the MI group, consisted of 28 patients, male (67.9%) and female (32.1%) aged less than 45 years who were consecutively admitted to the Intensive Coronary Care Unit of the Emergency County Hospital of Constanţa from September 1, 2017 to August 31, 2018 (12 months), with an established diagnosis of first acute MI. The second group, the control group, included 33 patients, male (75.8%) and female (24.2%) aged less than 45 years, with cardiovascular risk factors and/or stable angina pectoris that were consecutively addressed for ambulatory cardiac evaluation at the Outpatient Clinic of Emergency County Hospital of Constanţa during the same period. Fasting plasma homocysteine was determined in both groups, within 24 h after MI onset, respectively after first cardiac exam in the controls. High homocysteine was statistically confirmed to be a risk factor in the study group, especially in association with smoking, chronic kidney disease (CKD), and to a lesser extent with diabetes mellitus (DM) and hypertension. Data analysis was performed using IBM SPSS Statistics 23. The procedures used included descriptive statistics, parametric statistical tests (Independent sample t-test), non-parametric statistical tests [Chi-square test of the association, with the evaluation of odds ratio (OR)]; the significance level used in the analysis (P-value) was 0.05. After adjusting for variables, our study results pointed out a strong association between plasma homocysteine and first acute MI among young patients, emphasising plasma homocysteine as a possible risk factor for myocardial infarction.

Endothelial dysfunction, one of many causes of arterial changes in end-stage kidney disease (kidney failure), is a likely link between early vascular aging and the risk of thrombosis or bleeding in this condition. To evaluate this, we compared links between arterial stiffness and endothelial/coagulation factors in 55 patients receiving hemodialysis therapy and 57 age-/sex-matched control individuals. Arterial stiffness was assessed from carotid-femoral pulse wave velocity, and coagulation status from the endogenous thrombin generating potential. Markers of endothelial dysfunction (von Willebrand factor, tissue factor pathway inhibitor), neutrophil extracellular traps and tissue factor-positive extracellular vesicles were higher in patients with kidney failure. Prothrombin fragments 1 and 2, and D-dimer markers of in vivo coagulation activation were also higher. However, in vitro in the presence of platelets, endogenous thrombin generating potential was lower and its downregulation by activated protein C impaired. Antiplatelet drugs did not affect these parameters. In multiple regression analysis, prothrombin fragments 1 and 2, D-dimer, factor VIII and monocyte-derived tissue factor-positive extracellular vesicles correlated with higher carotid-femoral pulse wave velocity. In patients with kidney failure, in vivo hypercoagulability occurred with reduced thrombin generation in platelet-rich plasma, likely explaining the opposing thrombotic and bleeding tendencies in patients with kidney failure. Importantly, arteriosclerosis is more closely related to a prothrombotic state. Thus, coagulation changes plus arterial stiffness highlight a major therapeutic challenge for anticoagulant and antiplatelet drug use.

Calcifications in the tunica media (middle layer of the arterial wall), classified as Mönckeberg arteriosclerosis, are more prevalent in older patients and patients with diabetes and/or chronic kidney disease. Mönckeberg arteriosclerosis has prevalence rates of 13.3% and 6.9% in men and women, respectively, and can be observed as a railroad track pattern on imaging studies. With the advent of cone beam computed tomography in dentistry, Mönckeberg arteriosclerosis is usually observed as an incidental finding. This case report describes a unique presentation of Mönckeberg arteriosclerosis in the carotid, facial, and lingual arteries of a 66-year-old man.