Pulmonary artery injury management during pulmonary thromboendarterectomy

Pulmonary thromboendarterectomy （PEA） is the recommended treatment for chronic thromboembolic pulmonary hypertension （CTEPH）.1 Pulmonary artery injury is a major risk factor during PEA performed at less experienced surgical centers and is associated with adverse short-term consequences.In-hospital mortality may be as high as 15% in some PEA case series,with pulmonary artery injury and persistent pulmonary hypertension as the principal etiologies.2 Many techniques have been used to prevent pulmonary artery injury during PEA,but once the injury occurs,the prognosis is poor and may even result in death.Out of 202 PEA procedures performed at our surgical center,we successfully managed two cases of severe pulmonary artery injury and report our experience in the present case series.Keywords：chronic thromboembolic pulmonary hypertension; pulmonary thromboendarterectomy; pulmonary artery injury     

Correlation of D-dimer level with the radiological severity indexes of pulmonary embolism on computed tomography pulmonary angiography

Background It is known that the main role of D-dimer has been as an exclusionary test in patients with suspected venous thromboembolism.However,the D-dimer is increasingly beginning to find clinical utility as a marker in the evaluation of the extent of the embolic disease.The aim of the study was to determine whether D-dimer levels predict the radiological markers of pulmonary embolism （PE） severity using Mastora score.Methods This prospective study involved 69 patients with acute PE proved by computed tomography pulmonary angiography （CTPA）.The D-dimer level was noted.A pulmonary artery obstruction index （PAOI; Mastora score） ≥21.3% indicated severe obstruction of PE.A right ventricle/left ventricle （RV/LV） ratio 〉0.9 indicated RV dysfunction.Results The median D-dimer level and PAOI were 765 μg/L （95% C/：750-1 205 μg/L） and 16.77% （95% CI：16.32%-23.06%）,respectively.The D-dimer level was positively correlated with PAOI （r=0.417,P 〈0.000 1）.PAOI ≥21.3% was associated with high D-dimer levels （median,993 μg/L （95% C/：856-1 841 μg/L）,Z=-2.991,P=0.003）.The D-dimer level was correlated with the RV/LV ratio （r=0.272,P=0.024）.RV/LV ratios 〉0.9 were associated with high D-dimer levels （median,880 μg/L （95% CI：764-1 360 μg/L）,Z=-2.070,P=0.038）.PAOI was positively correlated with the RV/LV ratio （r =0.390,P=0.001）.After three months,both the PAOI and D-dimer levels decreased （Z=-7.009,P 〈0.000 1; Z=-6.976,P〈0.000 1,respectively）.Conclusion D-dimer levels are positively correlated with PE burden and right ventricle dysfunction on CTPA,and can help monitor the therapeutic response.     

肺部孤立结节患者处理新策略的效价比

1文献来源Gould，MK，Sanders GD，Barnett PG，etal．Cost-effectiveness of alternative management strategies for patients with solitary pulmonary nodules[J]．Ann Intern Med，2003，138（9）：724-735．2证据水平1a。     

Preliminary study on the evaluation of Langerhans cell histiocytosis using F-18-fluoro-deoxy-glucose PET/CT

Background Limited number of studies have been reported regarding the utilization of F-18-fluoro-deoxy-glucose （F-18-FDG） positron emission tomography/computed tomography （F-18-FDG PET/CT） in Langerhans cell histiocytosis （LCH）.The aim of this study was to assess the role of F-18-FDG PET/CT in the diagnosis and treatment of LCH.Methods Eight newly diagnosed and seven recurrent patients with LCH received F-18-FDG PET/CT scans.The diagnosis of LCH was established by pathology,multi-modality imaging,and clinical follow-up.Results F-18-FDG PET/CT was positive in 14 patients with 13 true positives and one false positive.All 45 LCH lesions were F-18-FDG avid including six small bone lesions ＜1.0 cm in diameter.The mean maximal standardized uptake value （SUVmax） was 7.13±4.91.F-18-FDG uptake showed no significant difference between newly diagnosed lesions vs recurrent lesions （SUVmax：6.50±2.97 vs.7.93±6.60,t=-0.901,P=0.376）.Among 45 LCH lesions,68.9％ （31/45） were found in bones and 31.1％ （14/45） in soft tissue.The most commonly involved bones were the pelvis and vertebrae.There was no significant difference in F-18-FDG uptake between bone lesions vs.non-bone lesions （SUVmax：6.30±2.87 vs.8.97±7.58,t=1.277,P=0.221）.In two patients,changes in F-18-FDG uptake on serial PET/CT scans reflected response of lesions to treatment.Conclusions The present study suggests that F-18-FDG PET/CT may be useful for diagnosis and assessing the treatment response of LCH.Because of the small sample size,further research is warranted to confirm our findings.     

Diffusion-weighted magnetic resonance imaging with short T1 inversion recovery-echo planar imaging combined with dual-head coincidence single photon emission computed tomography for diagnosing solitary pulmonary nodule

Positron emission tomography （PET） using 18F-fluorodeoxyglucose （FDG） has not been widely used in China for expensive cost （$1200）. Dual-head coincidence single photon emission computed tomography （DHC-SPECT） can depict many of the lesions depicted with a PET scanner in the lungs, which is used in place of PET-CT for discriminating malignant from benign pulmonary nodules in many studies. However, DHC-SPECT has inevitable false-negative results because the sensitivity for small lesions less than 2.0 cm is limited, and has high false-positive rate for active inflammatory nodules. Furthermore,DHC-SPECT also has a considerably higher cost （$300 in China） than other imaging examination.     

PET扫描结合临床预测模型可更好地预测孤立肺结节的性质

1文献来源,Herder GJ,van Tinteren H,Golding RP,et al．Clinical prediction model to characterize pulmonary nodules：Validation and added value of 18F-fluorodeoxyglucose positron emission tomography[J]．Chest,2005,128,2490-2496．2证据水平3。     

Combination of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging is an optimal way to evaluate rheumatoid arthritis in rats dynamically

Background Rheumatoid arthritis （RA） is a chronic,systemic autoimmune inflammatory disorder.Many methods have been used to observe the progress of RA.The purpose of this study was to observe the progress of RA in rats with 18F-fluorodeoxyglucose （FDG） positron emission tomography/computed tomography （PET/CT）,magnetic resonance （MR） imaging and arthritis score,and analyze the relationships among different methods in evaluation of RA.Methods Sixteen healthy Sprague Dawley （SD） rats about 8-week old were randomly assigned to a RA group and a control group.Bovine type Ⅱ emulsified incomplete Freud＇s adjuvant was used to induce arthritis in the RA group.Arthritis score of the rats in two groups were recorded,and 18F-FDG PET/CT,MR imaging were performed both on the corresponding rats every 3 days.All the rats were sacrificed at week 5,and histopathological examination was performed on rat knees stained with haematoxylin and eosin.Results The arthritis score and the standard uptake value （SUV） of knee joints in RA rats increased with the progression of arthritis gradually.Both peaks of arthritis score and SUV appeared at 21 days after the first immune injection,then the arthritis score and SUV of knee joints decreased slowly.The arthritis scores of knee joints in RA rats were positively correlated with their SUV changes.The MR images were confirmed by the histopathological studies.Conclusion PET/CT can detect the earliest molecular metabolism changes of RA,and MR imaging can follow up the dynamical anatomical changes of RA,all of which indicated that PET/CT and MR imaging may be applied as useful tools to monitor the progress of RA.     

New disease severity classification of patients with stable chronic obstructive pulmonary disease in Shanghai

Background The Global Initiative for Chronic Obstructive Lung Disease （GOLD） presented a new ABCD group classification of chronic obstructive pulmonary disease （COPD）.We aimed to examine the association of spirometric classification and the new GOLD classification with exacerbations,and to compare symptoms in different ways.Methods We investigated 848 patients with stable COPD from 24 hospitals.The annual frequencies of acute exacerbation and hospitalization were compared between the old and new classification.The symptom level was assessed using COPD assessment test （CAT） and modified British Medical Research Council （mMRC） questionnaire.Results A total of 848 patients were included in this study.According to spirometric classification,there were 32 patients of grade Ⅰ （3.8％）,315 of grade Ⅱ （37.1％）,366 of grade Ⅲ （43.2％）,and 135 of grade Ⅳ （15.9％）.According to GOLD 2011 classification,there were 59 patients of group A （7.0％）,172 of group B （20.3％）,55 of group C （6.5％）,and 562 of group D （66.3％）.In spirometric classification,the annual frequencies of acute exacerbation and associated hospitalization were respectively 1 （0-3） and 0 （0-2） for grade Ⅰ; 1 （0-5） and 0 （0-2） for grade Ⅱ; 2 （0-6） and 1 （0-3） for grade Ⅲ,and 3 （0-6） and 2 （0-3） for grade Ⅳ.In GOLD 2011,respectively 0 （0-3） and 0 （0-1） （group A）,1 （0-4） and 0 （0-3） （group B）,1 （0-5） and 0 （0-3） （group C）,and 3 （0-6） and 1 （0-3） （group D）.There were no significant difference between group B and C （Z=-1.347,P=0.178; Z=-0.772,P=0.440,respectively）.The coincidence rate using mMRC=1 and CAT=10 as cutoff points was 86.6％ （734/848,x=0.706）,compared with 77.9％ （661/848,K=0.60） using mMRC=2 and CAT=10.Conclusions Lung function test may be a better predictor of acute exacerbation and associated hospitalization of COPD.It is more appropriate to use mMRC=1 as cutoff point for assessing COPD sym     

CTA在胃癌诊断与治疗中的应用价值

胃癌是我国常见消化道恶性肿瘤，患病率和死亡率均超过世界平均水平的两倍．每年新发胃癌患者40万人，死亡人数30万人。外科手术切除仍是目前唯一的临床治愈手段。然而，肿瘤的部位、范围、有无血管受侵和转移等分期因素直接影响着能否手术及手术方式的选择。一直以来CT在判断能否切除方面起着重要作用。血管受侵是导致局部不可切除的主要原因之一，因此进一步探索显示血管的方法、判断血管是否受侵及受侵程度的方法对提高可切除的阳性预测值十分必要。     

Phenotype and treatment of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease （COPD） is the most common chronic airway disease affecting Chinese population and it ranks number tour leading cause of death. The high mortality and morbidity, increased prevalence, significant loss of labor, and high medical expenditure warrants attention from the health organization and society to standardize the diagnosis and treatment of COPD. Overall COPD treatment efficacy has been significantly improved with application of long activating bronchial dilator （LABD）, due to the imbalance and geographically different distribution of medical resource and education, standardized treatment under COPD guideline remain the major protocol in a long time period in the future.     

手术治疗漏斗胸的疗效和安全性的多中心前瞻性研究

1文献来源 Kelly RE,Mellins RB,Shamberger RC,et al.Multicenter study of pectus excavatum,final report：Complications,static/exercise pulmonary function,and anatomic outcomes[J].J Am Coll Surg,2013,217（6）：1080-1089.2证据水平2b。3背景1998年美国Nuss教授首次报道了不截骨的微创手术（Nuss手术）治疗漏斗胸的成功经验,由于Nuss手术是一种微创且易于掌握的外科技术,从而快速在世界各地广泛开展。     

Evaluation of the Xpert MTB/RIF assay for diagnosis of tuberculosis and rifampin resistance in county-level laboratories in Hunan province, China

Background The Xpert MTB/RIF showed high sensitivity and specificity in previous studies carried out in different epidemiological and geographical settings and patient populations in high-burden tuberculosis （TB） countries.However,there were little data obtained by validation or demonstration study of the assay in China.In this study,the performance of Xpert MTB/RIF was investigated in two county-level laboratories in Hunan Province,China.Methods Consecutive patients with suspected pulmonary tuberculosis （PTB） and suspicion for multidrug-resistant tuberculosis （MDR-TB） were enrolled.For each patient suspected to have PTB,three sputum specimens （one spot sputum,one night sputum,and one morning sputum） were collected and each sputum was tested with smear microscopy,L（o）wenstein-Jensen （LJ） culture,and Xpert MTB/RIF test.For comparison across subgroups and testing methods,95％ confidence intervals were calculated.All analyses were done with SPSS 16.0,and P ＜0.05 was regarded as significant.Results For case detection,the sensitivity of Xpert MTB/RIF was 100％ for smear-and culture-positive TB and 88.6％ for smear-negative and culture-positive TB; the overall sensitivity was 94.5％ for all culture-positive patients.The specificity was 99.8％.The sensitivity of Xpert MTB/RIF assay was 22.0％ in clinical TB patients and the specificity reached 100.0％ in the group of patients who are infected with nontuberculous mycobacteria.For the detection of rifampin resistance,the sensitivity of MTB/RIF RIF-resistance detection was 92.9％,and the specificity was 98.7％.Of the 26 Xpert MTB/RIF-positive and RIF-resistant patients confirmed by LJ proportion tests,20 （76.9％） patients were infected by MDR-TB.Conclusions The Xpert MTB/RIF assay is a highly sensitive and specific method for diagnosis of TB and RIF resistance,which will enable it to have the potential to be used in county-level laboratories and lead to the reduction of the infectious pool and improvements in TB control in China.Furt     

Prognostic markers for idiopathic pulmonary arterial hypertension

Objective The objective of this study is to review the research on the prognostic markers of idiopathic pulmonary arterial hypertension （IPAH）.Date sources We searched literature from PubMed and CNKI databases both in English and Chinese up to 2013.Study selection Data about mortality and cut-off value are from clinical trials and identified by analysis.Results IPAH is an unexplained,progressive,and rare disease characterized by increased pulmonary artery pressure and pulmonary vascular resistance.The diagnosis is difficult,mortality of IPAH is high,and the survival periods are only 2-3 years after diagnosis.Investigations in recent years have identified a range of prognostic markers for IPAH,including the 6-minute walking test,red blood cell distribution width,and platelet levels,as well as imaging findings.Changes in these markers are important sources of information to predict the prognosis of patients with IPAH,which carries significant benefits for treatment planning.Conclusion Even though the prognosis of IPAH has been investigated,the mortality is also high.More accurate and meaningful assessment for the prognosis of IPAH is required.     

Electroacupuncture at Feishu （BL13） and Zusanli （ST36） down-regulates the expression of orexins and their receptors in rats with chronic obstructive pulmonary disease

Inflammation and lung function decline are the main pathophysiological features of chronic obstructive pulmonary disease （COPD）. Acupuncture can improve lung function in patients with COPD, but the underlying mechanisms are not well understood. Orexins （OXs）, which are found in peripheral plasma, are neuropeptides that regulate respiration and their levels are related to COPD. Therefore, we hypothesized that acupuncture might alter OXs, reduce lung inflammation and improve lung function in COPD. METHODS： COPD was induced in rats by exposure to cigarette smoke for 8 weeks and injecting with lipopolysaccharide twice. Electroacupuncture （EA） was performed at Feishu （BL13） and Zusanli （ST36） for 30 min/d for 2 weeks. Rat lung function and morphology were assessed after EA. The levels of tumor necrosis factor-α （TNF-a） and intedeukin-1β （IL-16） in bronchoalveolar lavage fluid （BALF） and orexin A and B levels in the lung tissue were detected by enzyme-linked immunosorbent assay. OX receptor mRNA levels and immunopositive cells were assessed with real-time polymerase chain reaction and immunohistochemical methods, respectively. The relationships among lung function, cell factors, and OX levels were analyzed by Pearson correlation analyses. RESULTS： Compared with the control group, lung function was significantly decreased in the rats with COPD （P〈0.05）. There were obvious increases in TNF-α and IL-1β levels in BALF （P〈0.05 and P〈0.01, respectively）, orexin A level in lung tissue （P〈0.01; but not orexin B） and mRNA expressions of OX 1 type receptor （OXR1） and OX 2 type receptor （OXR2） in lung tissue （P〈0.05 and P〈0.01, respectively）; the integrative optical densities （IODs） of both receptors were greater in the COPD group （P〈0.05）. For rats with COPD subjected to EA, lung function was improved （P〈0.05）. There were notable decreases in TNF-a and IL-1β levels （P〈0.05 and 〈0.01, respectively） in BALF. Orexin A, but not orexi     

Inaccuracy of doppler echocardiographic estimates of pulmonary artery pressures in adult atrial septal defect patients with pulmonary arterial hypertension

Background While echocardiography has been a pivotal screening test in pulmonary arterial hypertension （PAH）, the presence of structural cardiac defects may affect the ability to reliably predict pulmonary artery pressures （PAPs）. This study sought to evaluate the accuracy of Doppler echocardiography （DE） for estimating PAPs in adult atrial septal defect （ASD） patients with PAH. Methods A prospective study was carried out to compare the echocardiographic assessment of PAP with the same pressures obtained by right heart catheterization （RHC） in adult ASD patients with PAH who underwent simultaneous DE and RHC. Bland-Altman analyses were performed to evaluate the agreement between DE and RHC measurements of PAPs. Results Two hundred and fifty-seven patients were included in the study. A significant overestimation of the systolic pulmonary arterial pressure （sPAP） and mean pulmonary artery pressure （mPAP） was reported by echocardiography compared with those by catheterization （（81.8±26.9） mmHg vs. （72.9±26.9） mmHg, P 〈0.01; （51.9±16.4） mmHg vs. （41.4±17.2） mmHg, P 〈0.01, respectively）. Twenty-one percent （55/257） of the patients had PAH when estimated by echocardiography whereas showed normal results in the subsequent catheterization test. Using Bland-Altman analytic methods, the bias for the echocardiographic assessment of the sPAP was 9.1 mmHg with 95% limits of agreement ranging from -24.4 to 42.6 mmHg. For mPAP measurement, the bias was 10.5 mmHg with 95% limits of agreement ranging from -12.4 to 33.4 mmHg. On multiple linear regression analysis, age, gender, body surface area, ASDs＇ diameter, PVR, diastolic blood pressure, and echocardiographic assessment of right atrial pressure （RAP） explained 68.8% of the total variability in the model （P=0.688, P 〈0.01）. Conclusion Inaccuracy was frequently reported in Doppler echocardiographic assessment of the PAP in adult ASD patients with PAH and was often associated with age, gender, body surface a     

Association of chronic obstructive pulmonary disease with coronary artery disease

Background The relationship between chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) remains largely unknown.This study aimed to explore the association of COPD with CAD,e...     

Association of chronic obstructive pulmonary disease with type 2 diabetes mellitus

Chronic obstructive pulmonary disease （COPD） is a complex disorder, characterized by an irreversible airflow limitation during breathing. This may lead to various extrapulmoanry comorbidities, such as cardiovascular disease, osteoporosis, and diabetes mellitus （DM）. Type 2 （T2DM） accounts for a large proportion of DM, and is also showing a rising prevalence in developed and developing countries. In addition to the known factors for T2DM, several studies have demonstrated that COPD is also an important risk factor for T2DM. In this study, we aimed to determine the prevalence of COPD in patients with T2DM, and to analyze the clinical characteristics of COPD accompanied by T2DM.     

Coronary artery anomalies: the left main coronary artery or left anterior descending coronary artery originating from the proximal of right coronary artery

Coronary artery anomalies （CAAs） are present at birth, but are usually asymptomatic and are found during coronary angiography or multi-slice computed tomography （MSCT） examinations. Their prevalence is less than 1.3% based published series.1＇2 The most common coronary anomaly is separate origin of the left anterior descending coronary artery （LAD） and left circumflex coronary artery （LCX） from the left sinus of the Valsalva. The second most common anomaly is the origin of the LCX artery from the right coronary artery （RCA） or right sinus of the Valsalva. We present two cases of coronary artery anomalies： one is the left main coronary artery （LMCA） arising from the proximal RCA, the other is the LAD originating from the proximal RCA.     

糖尿病患者并发肺结核临床及预后分析

[目的]探讨糖尿病患者患肺结核病人的临床特点及预后情况。[方法]对53例糖尿病患肺结核病进行了观察和追踪，分析其临床特点、实验室检查、治疗过程、预后并与随机选自同期住院及相近的初治肺结核病人60例进行对照。[结果]糖尿病临床表现为发热明显，咯血多见，抗酸杆菌阳性率高，X线胸片病灶广泛，占2个及以上肺野患者多，疗程常延长，病死率高。     

Long-term outcome of correction of tetralogy of Fallot in 56 adult patients

Background Although most patients with tetralogy of Fallot undergo radical repair during infancy and childhood,patients that remain undiagnosed and untreated until adulthood can still be treated.This study aimed to evaluate longterm outcomes of adult patients with tetralogy of Fallot who were treated surgically,and to determine the predictors of postoperative pulmonary regurgitation.Methods Fifty-six adult patients underwent complete surgical repair.Forty-three patients （76.8%） required a transannular patch.Systolic,diastolic,and mean pressure in the main pulmonary artery were measured after repair.Results The early mortality rate was 3.6%.The 16-year survival rate was （84.4±11.5）%.Late echocardiography revealed 41 patients with transannular patch who had pulmonary regurgitation,consisting of mild pulmonary regurgitation in 28 patients,moderate in eight,and severe regurgitation in five patients.In addition,there was right ventricular outflow tract stenosis in nine patients,moderate/severe tricuspid valve regurgitation in seven,and residual ventricular septal defect in five.Logistic regression analysis demonstrated that the mean pulmonary pressure measured just after repair predicted late pulmonary regurgitation.Conclusions The long-term survival of surgically treated adult patients with tetralogy of Fallot is acceptable.The mean pressure 〉20 mmHg in the main pulmonary artery measured right after surgical repair may be a feasible reference to time the reconstruction of the pulmonary valve.