Introduction: For the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) thromboendarterectomy (PTE) is increasingly performing with deep hypothermic circulatory arrest (DHCA). At the las...Introduction: For the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) thromboendarterectomy (PTE) is increasingly performing with deep hypothermic circulatory arrest (DHCA). At the last time, there are some publications with describing of the PTE performance without DHCA. Objective: To analyze and evaluate the results of surgical treatment of CTEPH under cardiopulmonary bypass (CPB), cardioplegia and without DHCA. Methods: Retrospective analysis of the PTE results in 70 patients operated on from January 2018 to February 2023 was conducted. Evaluation pre- and postoperative clinical examinations and invasive pulmonary artery pressure (PAP) measurement in all patients involved were systematically analyzed. Results: The average age of the patients was 48.1 ± 10.5 years, including 44.3 % males and 55.7 % females. Due to New York Heart Association (NYHA), 6 (8.6%) patients preoperatively belonged to class II, 48 (68.6%) to class III and 16 (22.9%) to class IV. The thrombotic masses structure according to Jamieson’s classification belonged to type I in 42 (60%) patients and to type II in 28 (40%) patients. Postoperatively the systolic PAP (PAPs, mmHg) decreased from 80.8 ± 22.9 to 40.8 ± 13.5, the mean pressure (mPAP, mmHg)—from 48.5 ± 14.4 to 25.3 ± 7.3, respectively. Four patients died. The in-hospital mortality rate was 5.7%. According to NYHA, the clinical conditions have also improved: class I was observed in 48 (73%) patients, class II in 15 (23%) and class III in 3 (4%) patients. The postoperative transthoracic echocardiogram (TEE) revealed an improvement of the right ventricle (RV) function and computed tomography (CT) angiogram demonstrated a positive dynamic and a surgery adequacy. Conclusion: PTE under CPB without DHCA can lead to immediate positive results with significant improvements in hemodynamic parameters and life quality without typical DHCA complications in patients with thrombi type I and II according to Jamieson’s classification.展开更多
BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the c...BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.展开更多
Sodium-glucose cotransporter-2(SGLT-2)inhibitors represent a cutting-edge class of oral antidiabetic therapeutics that operate through selective inhibition of glucose reabsorption in proximal renal tubules,consequentl...Sodium-glucose cotransporter-2(SGLT-2)inhibitors represent a cutting-edge class of oral antidiabetic therapeutics that operate through selective inhibition of glucose reabsorption in proximal renal tubules,consequently augmenting urinary glucose excretion and attenuating blood glucose levels.Extensive clinical investigations have demonstrated their profound cardiovascular efficacy.Parallel basic science research has elucidated the mechanistic pathways through which diverse SGLT-2 inhibitors beneficially modulate pulmonary vascular cells and arterial remodeling.Specifically,these inhibitors exhibit promising potential in enhancing pulmonary vascular endothelial cell function,suppressing pulmonary smooth muscle cell proliferation and migration,reversing pulmonary arterial remodeling,and maintaining hemodynamic equilibrium.This comprehensive review synthesizes current literature to delineate the mechanisms by which SGLT-2 inhibitors enhance pulmonary vascular cell function and reverse pulmonary remodeling,thereby offering novel therapeutic perspectives for pulmonary vascular diseases.展开更多
This study examines hemodynamic behavior in particular cases of pulmonary hypertension without treatment. Pulmonary hypertension represents an anomalous hemodynamic state and is characterized by an excessively high bl...This study examines hemodynamic behavior in particular cases of pulmonary hypertension without treatment. Pulmonary hypertension represents an anomalous hemodynamic state and is characterized by an excessively high blood pressure in the pulmonary artery. To simulate the hemodynamic abnormalities in pulmonary hypertension under different causes and pathologies, we construct a localized parameter circuit model governed by nonlinear ordinary derivative equations of the human circulatory system. Thus, two special cases are considered, namely pulmonary the artery stenosis and the left ventricular diastolic dysfunction. For each case of pulmonary hypertension development, we determine the relationships between blood pressure and chamber and vessel pressure-volume. When the pulmonary hypertension is due to pulmonary artery stenosis, it appears that the right ventricular pressure increases up to 90 mm Hg, likewise the rise in pulmonary artery resistance induces direct increment in pulmonary artery pressure. However, when the pulmonary hypertension is due to left ventricular diastolic dysfunction, we note that the left atrial pressure and the pulmonary vein pressure augment, leading to the growth of the pulmonary artery blood pressure. The established results within this paper are useful for understanding the hemodynamic mechanism of particular pulmonary hypertension.展开更多
Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 ...Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 elderly COPD patients with pulmonary infection,treated between December 2022 and November 2023,were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with levofloxacin hydrochloride,while the observation group received ambroxol hydrochloride injection in addition to the treatment in the control group.Laboratory indices(white blood cell count,procalcitonin,C-reactive protein,and apolipoprotein E levels),imaging-based pulmonary lesion absorption time,hospital stay,and incidence of adverse reactions were compared between the two groups.Results:After treatment,the biochemical indices of the observation group were significantly lower than those of the control group,with highly significant differences(P<0.001).Compared to the control group,the imaging-based pulmonary lesion absorption time and hospital stay of the observation group were significantly shorter(P<0.001).Additionally,the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion:Levofloxacin combined with ambroxol demonstrates advantages in improving biochemical indices,shortening imaging-based pulmonary lesion absorption time and hospital stay,and reducing adverse reaction rates in elderly COPD patients with pulmonary infection.It holds significant clinical application value.展开更多
Pulmonary arterial hypertension(PAH)is a progressive disease marked by degeneration of the lung’s blood vessels.As the disease progresses,the resistance to blood flow in the pulmonary arteries increases,putting a str...Pulmonary arterial hypertension(PAH)is a progressive disease marked by degeneration of the lung’s blood vessels.As the disease progresses,the resistance to blood flow in the pulmonary arteries increases,putting a strain on the right side of the heart as it pumps blood through the lungs.PAH is characterized by changes in the structure of blood vessels and excessive cell growth.Untreated PAH leads to irreversible right-sided heart failure,often despite medical intervention.Patients experience a gradual decline in function until they are unable to perform daily activities.Advances in treatment have improved the prognosis for many PAH patients.Currently approved therapies target the prostacyclin,endothelin,nitric oxide,or phosphodiesterase pathways to slow the progression of the disease.To address the unmet need for effective PAH therapies,research efforts are focused on identifying new targets and developing therapies that specifically address the underlying disease mechanisms and restore vascular wall homeostasis.Among these,sotatercept,a fusion protein that targets the transforming growth factor-βsuperfamily signaling pathway,has emerged as a promising therapeutic option.In this review,we examine the available evidence from clinical trials to assess the potential of sotatercept as a treatment for PAH.展开更多
BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic thera...BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.展开更多
Chronic thromboembolic pulmonary hypertension(CTEPH)is a chronic,progressive,debilitating,and life-threa-tening complication of pulmonary embolism(PE).Recent technological advances have permitted various treat-ment op...Chronic thromboembolic pulmonary hypertension(CTEPH)is a chronic,progressive,debilitating,and life-threa-tening complication of pulmonary embolism(PE).Recent technological advances have permitted various treat-ment options for the treatment of CTEPH,including surgery,angioplasty,and medical treatment,depending on the location and characteristics of lesions.Pulmonary endarterectomy(PEA)is the treatment of choice for CTEPH,as it offers excellent long-term outcomes and a high probability of recovery.Moreover,various medical and interventional therapies are currently being developed for patients with inoperable CTEPH.This review mainly summarizes the current treatment approaches of CTEPH,offering more options for specialist physicians to,thus,better manage chronic thromboembolic syndromes.展开更多
In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute ...In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.展开更多
Background: The tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) is an indirect estimate of right ventricular-pulmonary arterial (RV-PA) coupling that has been shown to ...Background: The tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) is an indirect estimate of right ventricular-pulmonary arterial (RV-PA) coupling that has been shown to correlate with invasive measures. We aimed to assess the ability of the tricuspid annular plane systolic excursion/pulmonary systolic pressure ratio (TAPSE/PASP) as a measure for RV-PA coupling to predict the development of RV dysfunction after cardiac surgery. Methods: This prospective study was conducted on 100 patients with ischemic heart disease and undergoing cardiac surgery (coronary artery bypass graft (CABG)) with normal preoperative right ventricular function, classified according to RV function outcomes into 2 groups: Normal RV group (65 patients) and RV dysfunction group (35 patients). All cases underwent per and postoperative transthoracic echocardiography. Results: By using receiver operating characteristic curve analysis, pre-operative TAPSE/PASP ratio could significantly predict the RV dysfunction (P 0.58, with AUC of 94%, 88.6% sensitivity, and 89.2% specificity. Post-operative TAPSE/PASP Ratio could significantly predict the RV dysfunction (P 0.39, with AUC of 84%, 100% sensitivity, and 76.9% specificity. Pre-operative TAPSE/PASP ratio could significantly predict mortality (P Conclusion: The TAPSE/PASP ratio is an excellent tool for CABG patients for its ability to detect and predict the development of RV dysfunction after cardiac surgery, along with the prediction of mortality in post-operative CABG patients.展开更多
Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequen...Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.展开更多
Background: Primary pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare subtype of non-small cell lung cancer (NSCLC). Nevertheless, no universally acknowledged standards of care have been reported to be effec...Background: Primary pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare subtype of non-small cell lung cancer (NSCLC). Nevertheless, no universally acknowledged standards of care have been reported to be effective and productive for the treatment of this tumor. Materials and Methods: A patient with advanced primary pulmonary LELC was treated by employing a combination of tislelizumab and chemotherapy. Results: The patient displayed a favorable response to the combination therapy. The tumor size exhibited conspicuous abatement in contrast to the pre-treatment baseline, and the tumor markers normalized. Conclusion: The combination of immunotherapy with chemotherapy appears to be more effective than therapy alone for managing advanced primary pulmonary LELC. On that account, further clinical trials are imperative to establish this combination regimen as a potential first-line treatment option for advanced cases.展开更多
Background:Inhalation exposure is the gold standard when assessing pulmonary tox-icity.However,it typically requires substantial amounts of test material.Intratracheal instillation is an alternative administration tec...Background:Inhalation exposure is the gold standard when assessing pulmonary tox-icity.However,it typically requires substantial amounts of test material.Intratracheal instillation is an alternative administration technique,where the test substance is suspended in a liquid vehicle and deposited into the lung via the trachea.Instillation requires minimal test material,delivers an exact dose deep into the lung,and is less labor-intensive than inhalation exposures.However,one shortcoming is that the pro-cedure may induce short-term inflammation.To minimize this,we tested different modifications of the technique to identify the potential for refinement.Methods:First,we tested whether previous findings of increased inflammation could be confirmed.Next,we tested whether instillation with a disposable 1 mL syringe with ball-tipped steel-needle(Disposable-syringe/steel-needle)induced less inflammation than the use of our standard set-up,a 250μL reusable glass syringe with a disposable plastic catheter(Glass-syringe/plastic-catheter).Finally,we tested if access to pelleted and liquid feed prior to instillation affected inflammation.We evaluated inflammation by neutrophil numbers in bronchoalveolar fluid 24 h post-exposure.Results:Vehicle-instilled mice showed a small increase in neutrophil numbers com-pared to untreated mice.Neutrophil numbers were slightly elevated in the groups in-stilled with Disposable-syringe/steel-needle;an interaction with feed type indicated that the increase in neutrophils was more pronounced in combination with feed pel-lets compared to liquid feed.We found no difference between the feed types when using the Glass-syringe/plastic-catheter combination.Conclusion:The Glass-syringe/plastic-catheter combination induced the least exposure-related inflammation,confirming this as a preferred instillation procedure.展开更多
A recent study on the rapid imaging of pulmonary ventilation using hyperpolarized ^(129)Xe MRI has demonstrated the ability to achieve isotropic 3D ventilation imaging with a spatial resolution of 3×3×3mm^(3...A recent study on the rapid imaging of pulmonary ventilation using hyperpolarized ^(129)Xe MRI has demonstrated the ability to achieve isotropic 3D ventilation imaging with a spatial resolution of 3×3×3mm^(3) in humans,within an acquisition time of just 3.5 seconds(https://doi.org/10.1002/mrm.30120).展开更多
Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who requ...Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who required an emergency cesarean section,posing a significant challenge to the anesthesiologist.The patient had developed Type 1 respiratory failure and needed supplemental oxygen with high-flow nasal oxygen.Due to contraindications for neuraxial anesthesia,the cesarean section was performed under general anesthesia.After induction of anesthesia,the patient’s hypoxemia worsened.Eventually,after treatment with fluid restriction,diuretics,and albumin,oxygenation improved gradually,and the procedure was performed successfully.Both the patient and the newborn had a good prognosis.展开更多
Background Pulmonary arterial hypertension (PAH) is a progressive condition with a poorprognosis in children. Lung transplantation (Ltx) remains the ultimate option when patients are refractory toPAH-speciffc therapy....Background Pulmonary arterial hypertension (PAH) is a progressive condition with a poorprognosis in children. Lung transplantation (Ltx) remains the ultimate option when patients are refractory toPAH-speciffc therapy. Reverse Potts shunt (RPS) has been introduced to treat suprasystemic PAH. This studyaims to investigate the clinical outcomes of suprasystemic PAH in children. Methods Embase, Pubmed,and the Cochrane Library databases were searched for related studies that reported the clinical outcomes ofsuprasystemic PAH following RPS in children. To investigate the clinical outcomes of RPS, meta-analyses ofthe early and overall mortalities were performed. Results Nine studies were included in this study. Theestimated early mortality was 14.4% (95% CI, 7.1% to 23.1%), and the overall mortality/Ltx was 23.2% (95%CI, 14.4% to 32.9%). The estimated 1-year survival was 86.3% (95% CI, 75.9% to 88.7%). A qualitative reviewshowed that the median value of 5-year survival free from Ltx of patients undergoing RPS was 68.6% (range:65% to 92.3%). Compared to Ltx, RPS did not signiffcantly increase the early mortality (OR, 2.48, 95% CI0.75 to 8.24, p = 0.14). RPS also signiffcantly improved the New York Heart Association/World HealthOrganization functional class, reduced the BNP/NT-pro BNP levels, decreased the PAH-speciffc therapy,and increased the six-minute-walking distance. Conclusions RPS may serve as an alternative treatmentfor suprasystemic drug-refractory PAH. Further large-scale and prospective cohort studies are needed tovalidate these ffndings.展开更多
Objective:To review the current status of research on kinesiophobia,assessment tools,influencing factors,and intervention strategies in patients with chronic obstructive pulmonary disease,aiming to provide a reference...Objective:To review the current status of research on kinesiophobia,assessment tools,influencing factors,and intervention strategies in patients with chronic obstructive pulmonary disease,aiming to provide a reference for promoting pulmonary rehabilitation in these patients.Methods:A scoping review framework was employed to search databases including CNKI,Wanfang,VIP,China Biology Medicine(CBM),PubMed,Web of Science,and Wiley Online Library.The search time frame spanned from the database inception to May 20,2024.Two researchers independently screened the literature,summarized,and analyzed the data.Results:A total of 18 articles were included.Commonly used assessment tools included the Tampa Scale for kinesiophobia and the dyspnea beliefs questionnaire.Influencing factors encompassed demographic,disease-related,psychosocial,and BMI-related factors.Intervention methods included inspiratory muscle training,narrative nursing,and cognitive interventions combined with active cycle of breathing techniques.Conclusion:The incidence of kinesiophobia in COPD patients is relatively high and varies among individuals,influenced by multiple factors.There is a need to develop localized assessment tools to identify kinesiophobia in a timely and accurate manner and to further refine intervention strategies.展开更多
Objective:To explore the application value of artificial intelligence-assisted diagnostic systems in the computed tomography(CT)diagnosis of pulmonary nodules.Methods:A total of 80 patients with pulmonary nodules,trea...Objective:To explore the application value of artificial intelligence-assisted diagnostic systems in the computed tomography(CT)diagnosis of pulmonary nodules.Methods:A total of 80 patients with pulmonary nodules,treated from June 2023 to May 2024,were included.All patients underwent pathological examination and CT scans,with pathological results serving as the gold standard.The diagnostic performance of CT alone and CT combined with the artificial intelligence-assisted diagnostic system was analyzed,and differences in CT imaging features and evaluation results of benign and malignant pulmonary nodules were compared.Results:The sensitivity,specificity,and accuracy of CT combined with the artificial intelligence-assisted diagnostic system were significantly higher than those of CT alone(P<0.05).Moreover,the false-positive and false-negative rates were significantly lower for the combined approach compared to CT alone(P<0.05).Conclusion:The artificial intelligence-assisted diagnostic system effectively identifies malignant features in pulmonary nodules,providing valuable clinical reference data and enhancing diagnostic accuracy and efficiency.展开更多
The authors declare that in the correspondence“Obesity paradox in pulmonary hypertension secondary to chronic lung diseases”,[1]which was published in Vol.137,Issue 18,pages 2260–2262 of the Chinese Medical Journal...The authors declare that in the correspondence“Obesity paradox in pulmonary hypertension secondary to chronic lung diseases”,[1]which was published in Vol.137,Issue 18,pages 2260–2262 of the Chinese Medical Journal,the author contribution should be corrected as“Changwei Wu and Wenhui Wu contributed equally to this work”.The authors deeply apologize for any inconvenience caused.展开更多
BACKGROUND Pulmonary lymphoepithelioma-like carcinoma(PLELC)is a rare primary epithelial lung cancer associated with the Epstein-Barr virus.Standard treatment guideline for PLELC is yet not to be established,surgery r...BACKGROUND Pulmonary lymphoepithelioma-like carcinoma(PLELC)is a rare primary epithelial lung cancer associated with the Epstein-Barr virus.Standard treatment guideline for PLELC is yet not to be established,surgery remains the primary treatment for early-stage PLELC,and platinum chemotherapy is the most common first-line treatment for advanced PLELC.While targeted therapy and immunotherapy has emerged as effective way to treat various malignant tumors,including lung cancer,reports on PLELC are relatively scarce.CASE SUMMARY A 38-year-old man was diagnosed with right PLELC.Chest computed tomography(CT)revealed a mass in the medial segment of the middle lobe of the right lung,with lymph node metastasis in the mediastinum and right hilum of the lung.CT-guided lung tumor biopsy was performed and the postoperative pathological examination combined with immune phenotype analysis and in situ hybridization confirmed PLELC.Standard molecular testing for patients with non-small cell lung cancer was negative and programmed cell death ligand-1 expression was about 2%.The patient declined radiotherapy and chemotherapy.Consequently,immunotherapy was administered,which included toripalimab 240 mg on day 1 and anlotinib 10 mg on days 1-14 for 10 cycles,followed by a maintenance dose of anlotinib 10 mg daily every 3 weeks.As a result,his progression-free survival reached 48 months.CONCLUSION A combination of toripalimab and anlotinib may benefit patients with advanced diseases who have not received systematic antitumor therapy.展开更多
文摘Introduction: For the treatment of patients with chronic thromboembolic pulmonary hypertension (CTEPH) thromboendarterectomy (PTE) is increasingly performing with deep hypothermic circulatory arrest (DHCA). At the last time, there are some publications with describing of the PTE performance without DHCA. Objective: To analyze and evaluate the results of surgical treatment of CTEPH under cardiopulmonary bypass (CPB), cardioplegia and without DHCA. Methods: Retrospective analysis of the PTE results in 70 patients operated on from January 2018 to February 2023 was conducted. Evaluation pre- and postoperative clinical examinations and invasive pulmonary artery pressure (PAP) measurement in all patients involved were systematically analyzed. Results: The average age of the patients was 48.1 ± 10.5 years, including 44.3 % males and 55.7 % females. Due to New York Heart Association (NYHA), 6 (8.6%) patients preoperatively belonged to class II, 48 (68.6%) to class III and 16 (22.9%) to class IV. The thrombotic masses structure according to Jamieson’s classification belonged to type I in 42 (60%) patients and to type II in 28 (40%) patients. Postoperatively the systolic PAP (PAPs, mmHg) decreased from 80.8 ± 22.9 to 40.8 ± 13.5, the mean pressure (mPAP, mmHg)—from 48.5 ± 14.4 to 25.3 ± 7.3, respectively. Four patients died. The in-hospital mortality rate was 5.7%. According to NYHA, the clinical conditions have also improved: class I was observed in 48 (73%) patients, class II in 15 (23%) and class III in 3 (4%) patients. The postoperative transthoracic echocardiogram (TEE) revealed an improvement of the right ventricle (RV) function and computed tomography (CT) angiogram demonstrated a positive dynamic and a surgery adequacy. Conclusion: PTE under CPB without DHCA can lead to immediate positive results with significant improvements in hemodynamic parameters and life quality without typical DHCA complications in patients with thrombi type I and II according to Jamieson’s classification.
文摘BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.
基金Supported by Science and Technology Department of Yunnan Province-Kunming Medical University,Kunming Medical Joint Special Project-Surface Project,No.202401AY070001-164Yunnan Provincial Clinical Research Center Cardiovascular Diseases-New Technology Research for Development Project for Diagnosis and Treatment Cardiovascular Diseases,No.202102AA310002the Key Technology Research and Device Development Project for Innovative Diagnosis and Treatment of Structural Heart Disease in the Southwest Plateau Region,No.202302AA310045.
文摘Sodium-glucose cotransporter-2(SGLT-2)inhibitors represent a cutting-edge class of oral antidiabetic therapeutics that operate through selective inhibition of glucose reabsorption in proximal renal tubules,consequently augmenting urinary glucose excretion and attenuating blood glucose levels.Extensive clinical investigations have demonstrated their profound cardiovascular efficacy.Parallel basic science research has elucidated the mechanistic pathways through which diverse SGLT-2 inhibitors beneficially modulate pulmonary vascular cells and arterial remodeling.Specifically,these inhibitors exhibit promising potential in enhancing pulmonary vascular endothelial cell function,suppressing pulmonary smooth muscle cell proliferation and migration,reversing pulmonary arterial remodeling,and maintaining hemodynamic equilibrium.This comprehensive review synthesizes current literature to delineate the mechanisms by which SGLT-2 inhibitors enhance pulmonary vascular cell function and reverse pulmonary remodeling,thereby offering novel therapeutic perspectives for pulmonary vascular diseases.
文摘This study examines hemodynamic behavior in particular cases of pulmonary hypertension without treatment. Pulmonary hypertension represents an anomalous hemodynamic state and is characterized by an excessively high blood pressure in the pulmonary artery. To simulate the hemodynamic abnormalities in pulmonary hypertension under different causes and pathologies, we construct a localized parameter circuit model governed by nonlinear ordinary derivative equations of the human circulatory system. Thus, two special cases are considered, namely pulmonary the artery stenosis and the left ventricular diastolic dysfunction. For each case of pulmonary hypertension development, we determine the relationships between blood pressure and chamber and vessel pressure-volume. When the pulmonary hypertension is due to pulmonary artery stenosis, it appears that the right ventricular pressure increases up to 90 mm Hg, likewise the rise in pulmonary artery resistance induces direct increment in pulmonary artery pressure. However, when the pulmonary hypertension is due to left ventricular diastolic dysfunction, we note that the left atrial pressure and the pulmonary vein pressure augment, leading to the growth of the pulmonary artery blood pressure. The established results within this paper are useful for understanding the hemodynamic mechanism of particular pulmonary hypertension.
文摘Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 elderly COPD patients with pulmonary infection,treated between December 2022 and November 2023,were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with levofloxacin hydrochloride,while the observation group received ambroxol hydrochloride injection in addition to the treatment in the control group.Laboratory indices(white blood cell count,procalcitonin,C-reactive protein,and apolipoprotein E levels),imaging-based pulmonary lesion absorption time,hospital stay,and incidence of adverse reactions were compared between the two groups.Results:After treatment,the biochemical indices of the observation group were significantly lower than those of the control group,with highly significant differences(P<0.001).Compared to the control group,the imaging-based pulmonary lesion absorption time and hospital stay of the observation group were significantly shorter(P<0.001).Additionally,the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion:Levofloxacin combined with ambroxol demonstrates advantages in improving biochemical indices,shortening imaging-based pulmonary lesion absorption time and hospital stay,and reducing adverse reaction rates in elderly COPD patients with pulmonary infection.It holds significant clinical application value.
文摘Pulmonary arterial hypertension(PAH)is a progressive disease marked by degeneration of the lung’s blood vessels.As the disease progresses,the resistance to blood flow in the pulmonary arteries increases,putting a strain on the right side of the heart as it pumps blood through the lungs.PAH is characterized by changes in the structure of blood vessels and excessive cell growth.Untreated PAH leads to irreversible right-sided heart failure,often despite medical intervention.Patients experience a gradual decline in function until they are unable to perform daily activities.Advances in treatment have improved the prognosis for many PAH patients.Currently approved therapies target the prostacyclin,endothelin,nitric oxide,or phosphodiesterase pathways to slow the progression of the disease.To address the unmet need for effective PAH therapies,research efforts are focused on identifying new targets and developing therapies that specifically address the underlying disease mechanisms and restore vascular wall homeostasis.Among these,sotatercept,a fusion protein that targets the transforming growth factor-βsuperfamily signaling pathway,has emerged as a promising therapeutic option.In this review,we examine the available evidence from clinical trials to assess the potential of sotatercept as a treatment for PAH.
基金Supported by Scientific Research Projects from Wuhan Municipal Health Commission of China,No.WX23B42.
文摘BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.
文摘Chronic thromboembolic pulmonary hypertension(CTEPH)is a chronic,progressive,debilitating,and life-threa-tening complication of pulmonary embolism(PE).Recent technological advances have permitted various treat-ment options for the treatment of CTEPH,including surgery,angioplasty,and medical treatment,depending on the location and characteristics of lesions.Pulmonary endarterectomy(PEA)is the treatment of choice for CTEPH,as it offers excellent long-term outcomes and a high probability of recovery.Moreover,various medical and interventional therapies are currently being developed for patients with inoperable CTEPH.This review mainly summarizes the current treatment approaches of CTEPH,offering more options for specialist physicians to,thus,better manage chronic thromboembolic syndromes.
文摘In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.
文摘Background: The tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) is an indirect estimate of right ventricular-pulmonary arterial (RV-PA) coupling that has been shown to correlate with invasive measures. We aimed to assess the ability of the tricuspid annular plane systolic excursion/pulmonary systolic pressure ratio (TAPSE/PASP) as a measure for RV-PA coupling to predict the development of RV dysfunction after cardiac surgery. Methods: This prospective study was conducted on 100 patients with ischemic heart disease and undergoing cardiac surgery (coronary artery bypass graft (CABG)) with normal preoperative right ventricular function, classified according to RV function outcomes into 2 groups: Normal RV group (65 patients) and RV dysfunction group (35 patients). All cases underwent per and postoperative transthoracic echocardiography. Results: By using receiver operating characteristic curve analysis, pre-operative TAPSE/PASP ratio could significantly predict the RV dysfunction (P 0.58, with AUC of 94%, 88.6% sensitivity, and 89.2% specificity. Post-operative TAPSE/PASP Ratio could significantly predict the RV dysfunction (P 0.39, with AUC of 84%, 100% sensitivity, and 76.9% specificity. Pre-operative TAPSE/PASP ratio could significantly predict mortality (P Conclusion: The TAPSE/PASP ratio is an excellent tool for CABG patients for its ability to detect and predict the development of RV dysfunction after cardiac surgery, along with the prediction of mortality in post-operative CABG patients.
文摘Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.
文摘Background: Primary pulmonary lymphoepithelioma-like carcinoma (LELC) is a rare subtype of non-small cell lung cancer (NSCLC). Nevertheless, no universally acknowledged standards of care have been reported to be effective and productive for the treatment of this tumor. Materials and Methods: A patient with advanced primary pulmonary LELC was treated by employing a combination of tislelizumab and chemotherapy. Results: The patient displayed a favorable response to the combination therapy. The tumor size exhibited conspicuous abatement in contrast to the pre-treatment baseline, and the tumor markers normalized. Conclusion: The combination of immunotherapy with chemotherapy appears to be more effective than therapy alone for managing advanced primary pulmonary LELC. On that account, further clinical trials are imperative to establish this combination regimen as a potential first-line treatment option for advanced cases.
基金This work was supported by the Focused Research Effort on Chemicals in the Working Environment(FFIKA)from the Danish Government.
文摘Background:Inhalation exposure is the gold standard when assessing pulmonary tox-icity.However,it typically requires substantial amounts of test material.Intratracheal instillation is an alternative administration technique,where the test substance is suspended in a liquid vehicle and deposited into the lung via the trachea.Instillation requires minimal test material,delivers an exact dose deep into the lung,and is less labor-intensive than inhalation exposures.However,one shortcoming is that the pro-cedure may induce short-term inflammation.To minimize this,we tested different modifications of the technique to identify the potential for refinement.Methods:First,we tested whether previous findings of increased inflammation could be confirmed.Next,we tested whether instillation with a disposable 1 mL syringe with ball-tipped steel-needle(Disposable-syringe/steel-needle)induced less inflammation than the use of our standard set-up,a 250μL reusable glass syringe with a disposable plastic catheter(Glass-syringe/plastic-catheter).Finally,we tested if access to pelleted and liquid feed prior to instillation affected inflammation.We evaluated inflammation by neutrophil numbers in bronchoalveolar fluid 24 h post-exposure.Results:Vehicle-instilled mice showed a small increase in neutrophil numbers com-pared to untreated mice.Neutrophil numbers were slightly elevated in the groups in-stilled with Disposable-syringe/steel-needle;an interaction with feed type indicated that the increase in neutrophils was more pronounced in combination with feed pel-lets compared to liquid feed.We found no difference between the feed types when using the Glass-syringe/plastic-catheter combination.Conclusion:The Glass-syringe/plastic-catheter combination induced the least exposure-related inflammation,confirming this as a preferred instillation procedure.
基金supported by the National Natural Science Foundation of China(81930049 and 82171926).
文摘A recent study on the rapid imaging of pulmonary ventilation using hyperpolarized ^(129)Xe MRI has demonstrated the ability to achieve isotropic 3D ventilation imaging with a spatial resolution of 3×3×3mm^(3) in humans,within an acquisition time of just 3.5 seconds(https://doi.org/10.1002/mrm.30120).
文摘Acute pulmonary edema is a leading cause of death in patients with preeclampsia.The authors reported a case of a pregnant woman at 25 weeks of gestation with severe preeclampsia complicated by pulmonary edema,who required an emergency cesarean section,posing a significant challenge to the anesthesiologist.The patient had developed Type 1 respiratory failure and needed supplemental oxygen with high-flow nasal oxygen.Due to contraindications for neuraxial anesthesia,the cesarean section was performed under general anesthesia.After induction of anesthesia,the patient’s hypoxemia worsened.Eventually,after treatment with fluid restriction,diuretics,and albumin,oxygenation improved gradually,and the procedure was performed successfully.Both the patient and the newborn had a good prognosis.
基金Chongqing Medical University Program for Youth Innovation in Future Medicine(W0204)Natural Science Foundation Project of Chongqing,Chongqing Science and Technology Commission(CSTB2023NSCQ-BHX0010)+1 种基金Chongqing Postdoctoral Research Project Special Support(2023CQBSHTB3074)Science and Technology Research Program of Chongqing Municipal Education Commission(KJQN202400421).
文摘Background Pulmonary arterial hypertension (PAH) is a progressive condition with a poorprognosis in children. Lung transplantation (Ltx) remains the ultimate option when patients are refractory toPAH-speciffc therapy. Reverse Potts shunt (RPS) has been introduced to treat suprasystemic PAH. This studyaims to investigate the clinical outcomes of suprasystemic PAH in children. Methods Embase, Pubmed,and the Cochrane Library databases were searched for related studies that reported the clinical outcomes ofsuprasystemic PAH following RPS in children. To investigate the clinical outcomes of RPS, meta-analyses ofthe early and overall mortalities were performed. Results Nine studies were included in this study. Theestimated early mortality was 14.4% (95% CI, 7.1% to 23.1%), and the overall mortality/Ltx was 23.2% (95%CI, 14.4% to 32.9%). The estimated 1-year survival was 86.3% (95% CI, 75.9% to 88.7%). A qualitative reviewshowed that the median value of 5-year survival free from Ltx of patients undergoing RPS was 68.6% (range:65% to 92.3%). Compared to Ltx, RPS did not signiffcantly increase the early mortality (OR, 2.48, 95% CI0.75 to 8.24, p = 0.14). RPS also signiffcantly improved the New York Heart Association/World HealthOrganization functional class, reduced the BNP/NT-pro BNP levels, decreased the PAH-speciffc therapy,and increased the six-minute-walking distance. Conclusions RPS may serve as an alternative treatmentfor suprasystemic drug-refractory PAH. Further large-scale and prospective cohort studies are needed tovalidate these ffndings.
文摘Objective:To review the current status of research on kinesiophobia,assessment tools,influencing factors,and intervention strategies in patients with chronic obstructive pulmonary disease,aiming to provide a reference for promoting pulmonary rehabilitation in these patients.Methods:A scoping review framework was employed to search databases including CNKI,Wanfang,VIP,China Biology Medicine(CBM),PubMed,Web of Science,and Wiley Online Library.The search time frame spanned from the database inception to May 20,2024.Two researchers independently screened the literature,summarized,and analyzed the data.Results:A total of 18 articles were included.Commonly used assessment tools included the Tampa Scale for kinesiophobia and the dyspnea beliefs questionnaire.Influencing factors encompassed demographic,disease-related,psychosocial,and BMI-related factors.Intervention methods included inspiratory muscle training,narrative nursing,and cognitive interventions combined with active cycle of breathing techniques.Conclusion:The incidence of kinesiophobia in COPD patients is relatively high and varies among individuals,influenced by multiple factors.There is a need to develop localized assessment tools to identify kinesiophobia in a timely and accurate manner and to further refine intervention strategies.
基金supported by Chengdu University of Traditional Chinese Medicine“Xinglin Scholars”Subject Talent Scientific Research Enhancement Plan(No.YYZX2022056).
文摘Objective:To explore the application value of artificial intelligence-assisted diagnostic systems in the computed tomography(CT)diagnosis of pulmonary nodules.Methods:A total of 80 patients with pulmonary nodules,treated from June 2023 to May 2024,were included.All patients underwent pathological examination and CT scans,with pathological results serving as the gold standard.The diagnostic performance of CT alone and CT combined with the artificial intelligence-assisted diagnostic system was analyzed,and differences in CT imaging features and evaluation results of benign and malignant pulmonary nodules were compared.Results:The sensitivity,specificity,and accuracy of CT combined with the artificial intelligence-assisted diagnostic system were significantly higher than those of CT alone(P<0.05).Moreover,the false-positive and false-negative rates were significantly lower for the combined approach compared to CT alone(P<0.05).Conclusion:The artificial intelligence-assisted diagnostic system effectively identifies malignant features in pulmonary nodules,providing valuable clinical reference data and enhancing diagnostic accuracy and efficiency.
文摘The authors declare that in the correspondence“Obesity paradox in pulmonary hypertension secondary to chronic lung diseases”,[1]which was published in Vol.137,Issue 18,pages 2260–2262 of the Chinese Medical Journal,the author contribution should be corrected as“Changwei Wu and Wenhui Wu contributed equally to this work”.The authors deeply apologize for any inconvenience caused.
基金Supported by Chinese Medicine Administration Bureau of Guangxi Zhuang Autonomous Region,No.GXZYB20220472.
文摘BACKGROUND Pulmonary lymphoepithelioma-like carcinoma(PLELC)is a rare primary epithelial lung cancer associated with the Epstein-Barr virus.Standard treatment guideline for PLELC is yet not to be established,surgery remains the primary treatment for early-stage PLELC,and platinum chemotherapy is the most common first-line treatment for advanced PLELC.While targeted therapy and immunotherapy has emerged as effective way to treat various malignant tumors,including lung cancer,reports on PLELC are relatively scarce.CASE SUMMARY A 38-year-old man was diagnosed with right PLELC.Chest computed tomography(CT)revealed a mass in the medial segment of the middle lobe of the right lung,with lymph node metastasis in the mediastinum and right hilum of the lung.CT-guided lung tumor biopsy was performed and the postoperative pathological examination combined with immune phenotype analysis and in situ hybridization confirmed PLELC.Standard molecular testing for patients with non-small cell lung cancer was negative and programmed cell death ligand-1 expression was about 2%.The patient declined radiotherapy and chemotherapy.Consequently,immunotherapy was administered,which included toripalimab 240 mg on day 1 and anlotinib 10 mg on days 1-14 for 10 cycles,followed by a maintenance dose of anlotinib 10 mg daily every 3 weeks.As a result,his progression-free survival reached 48 months.CONCLUSION A combination of toripalimab and anlotinib may benefit patients with advanced diseases who have not received systematic antitumor therapy.
