Abstract Objective Diagnosing acute pulmonary embolism (PE) is challenging because of nonspecific clinical symptoms. Soluble lectin-type oxidized low-density lipoprotein receptor (sLOX-1) has differential expression in arterial and venous disease. This study aimed to evaluate the relevance of soluble lectin-type oxidized low-density lipoprotein receptor (sLOX-1) as a diagnostic biomarker for acute PE. Methods This observational study was performed at Beijing Anzhen Hospital in China. Patients with PE, aortic dissection (AD), myocardial infarction (MI) and healthy controls were enrolled in this cross-sectional study (n=90 each). Moreover, 730 patients with suspected PE were enrolled in this prospective study. The diagnostic performance of sLOX-1 was assessed using the receiver operating characteristic curve analysis. Results In the development set, sLOX-1 levels were significantly lower in patients with PE than in those with AD, MI, or healthy controls. In the validation cohort, the area under the curve (AUC) of sLOX-1 for patients with PE from other chest pain diseases, particularly from AD was significantly higher than that of D-dimer (ΔAUC=0.32; 95%CI, 0.26-0.37; P<0.0001) with 77.0% specificity and 74.5% positive predictive value at the threshold of 600 pg/mL derived from the development set. By integrating sLOX-1 into existing diagnosis strategy (Wells rules combined D-dimer), the number of patients who were further categorized as workup for PE decreased from 417 to 209, with the positive detection rate of computed tomographic pulmonary angiography increased from 35.1% to 67.0%. Six patients with PE were missed in 208 excluded patients at a failure rate of 2.88%. Conclusions Plasma sLOX-1 is a novel diagnostic tool that can rapidly categorize suspected PE as a workup for PE based on existing diagnostic strategy.
Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.
Abstract From early May 2009, the novel influenza A (H1N1) pandemic affected mainland China. Of those infected, a small proportion of patients developed acute respiratory distress syndrome (ARDS) so rapidly and severely that conventional ventilation treatment was ineffective. As an alternative treatment, the effect of extracorporeal membrane oxygenation (ECMO) was evaluated. From November 2009 to January 2010, all patients suffering from influenza A (H1N1)‐associated ARDS referred to Beijing Anzhen Hospital for treatment with ECMO were enrolled. We describe the characteristics, treatment, and outcomes of these patients at 1‐ and 3‐month follow‐up. Nine patients (four females; mean age, 31.2 [21–59] years) from four centers were enrolled. All females had a history of recent pregnancy or had recently given birth. Before ECMO, patients had severe respiratory failure despite advanced mechanical ventilatory support with a mean partial pressure of arterial oxygen/fraction of inspired oxygen of 52.9 ± 5.1 (45.0–63.8) mm Hg, positive end‐expiratory pressure of 17.2 ± 4.2 cmH 2 O, and a Murray Lung Score of 3.6 (3.25–3.75). All nine patients were treated with veno–venous ECMO via percutaneous access. The mean duration of ECMO support was 436.6 ± 652.1 h (67.0–2160.0). At the end of 1‐year follow‐up, five patients (55.7%) were weaned from ECMO. Five patients (55.7%) survived to hospital discharge. Four patients (44.4%) died while undergoing ECMO. The mean length of intensive care unit and hospital stay was 4–204 days (median, 32) and 4–234 days (median, 38), respectively. There was no significant difference between survivors and nonsurvivors in the screened parameters. Use of ECMO for critically ill patients with 2009 influenza A (H1N1)‐related ARDS is feasible and effective. However, this treatment is technically demanding. For success, careful selection of patients is crucial.
The purpose of the present study aimed to evaluate the left ventricular systolic function and diastolic filling characteristics in pulmonary thromboembolism (PTE).A total of 102 patients with PTE, including acute or acute on chronic PTE, were consecutively recruited from January of 2006 to December of 2010. The patients [53 males and 49 females; age (64 ± 14) years, range 23 - 85 years] all underwent Doppler echocardiographic assessment before thrombolytic therapy or within 24 h of hospital admission to the emergency intensive care unit of Beijing Anzhen hospital. Fifty-one age- and gender-matched healthy controls [29 males and 22 females; age (61 ± 9) years, range 31-79 years] were recruited from the Health Center. One hundred and sixty age- and gender-matched coronary artery disease (CAD) patients [90 males and 70 females, age (61 ± 11) years, range 29 - 81 years] with positive coronary artery angiography were also included as controls during the period of January of 2009 through December of 2010. Trans-thoracic Doppler echocardiography was used to assess the trans-mitral filling pattern and left ventricular systolic function in all the subjects. The trans-mitral blood flow peak of early (E) wave less than that of the auricular (A) wave, or the ratio of E/A greater than 2, were defined as abnormal left ventricular diastolic filling. Left ventricular ejection fraction (LVEF) greater than 50% was defined as preserved systolic function. The prevalence of abnormal left ventricular diastolic filling and systolic dysfunction were compared with Chi-square test between the PTE patients and the 2 control groups.Tricuspid regurgitation was identified in 72.5% (74/102) of the 102 PTE patients, abnormal left ventricular diastolic filling was detected in 77.5% (79/102) of the PTE patients, and 95.1% (97/102) of the PTE patients had preserved left ventricular systolic function with LVEF of > 50%. Further analysis revealed that the abnormal left ventricular diastolic filling was more frequent in PTE patients with CAD and/or hypertension than in other PTE patients (χ(2) = 5.280, P < 0.05), 85.2% (52/61) and 65.9% (27/41), respectively. Overall, the prevalence of abnormal left ventricular diastolic filling in PTE patients (77.5%, 79/102) was significantly higher than that in healthy controls (25.5%, 13/51, χ(2) = 38.300, P < 0.001), and the fraction of left ventricular systolic dysfunction was significantly lower (4.9%, 5/102) than that in CAD patients (29.4%, 47/160, χ(2) = 23.450, P < 0.001). In the PTE patients with neither CAD nor hypertension, the abnormal left ventricular diastolic filling was still more frequent (65.9%, 27/41) than in healthy controls (25.5%, 13/51, χ(2) = 15.070, P < 0.001), but there was no significant difference when compared with that in CAD patients (73.8%, 118/160, χ(2) = 1.013, P > 0.05).The results strongly suggest that abnormal left ventricular diastolic filling constitutes a common and a major form of left ventricular dysfunction in PTE patients. It indicates that enhanced alertness to and early identification of abnormal left ventricular diastolic filling may play an important role in improving prognosis for PTE.
Objective To investigate whether simple visual assessment of FVERVOT(the right ventricular outflow tract Doppler flow velocity envelop) graphs aids in hemodynamic differentiation. Method The hemodynamics, echocardiography, and clinical data of 88 patients with pulmonary hypertension (PH) were reviewed. The FVERVOTgraphs were categorized into normal pattern (no notch; NN), late systolic notch pattern (LSN) or mid-systolic notch pattern (MSN). Results The pulmonary vascular resistance (PVR) was highest in the MSN pattern (9.2±3.5 WU; P＜0. 001), in comparison with LSN (5,7 ±3. 1 WU) and NN (3.3±2.4 WU) patterns. The ratio of stroke volume to pulse pressure (compliance) also varied with different patterns of FVERVOr graph (MSN = 1.2 ± 0. 5; LSN = 1.7 ± 0.8; NN = 2.6 ± 1. 7, P = 0.001 and 0.04 respectively compared with NN). The specificity and sensitivity of MSN were 96% and 71%, respectively in case of a PVR ＞ 5 WU (PPV 98%). In the patients with PH, any notching pattern of FVERVOT graph was highly associated with PVR ＞ 3 WU (OR = 22.3, 95 % CI: 5.2 ～ 96.4), whereas the NN pattern predicted a PVR ≤3 WU and pulmonary artery wedge pressure (PAWP) ＞ 15 mmHg (OR =30.2, 95%CI: 6.3 ～ 144.9). Conclusions Visual inspection of the shape of the FVERVOT graphs provides insight into the hemodynamic status of patients with PH.
Key words:
Pulmonary hypertension; Hemodynamic; The right ventricular outflow tract Doppler flow velocity envelope (FVERVOT)
Patients with long-lasting hypertension often suffer from atrial or ventricular arrhythmias. Evidence suggests that mechanical stimulation can change the refractory period and dispersion of the ventricular myocyte action potential through stretch-activated ion channels (SACs) and influence cellular calcium transients, thus increasing susceptibility to ventricular arrhythmias. However, the specific pathogenesis of hypertension-induced arrhythmias is unknown. In this study, through clinical data, we found that a short-term increase in blood pressure leads to a rise in tachyarrhythmias in patients with clinical hypertension. We investigated the mechanism of this phenomenon using a combined imaging system(AC) of atomic force microscopy (AFM) and laser scanning confocal microscopy. After mechanical distraction to stimulate ventricular myocytes isolated from Wistar Kyoto rats (WKY) and spontaneously hypertensive rats (SHR), we synchronously monitored cardiomyocyte stiffness and intracellular calcium changes. This method can reasonably simulate cardiomyocytes' mechanics and ion changes when blood pressure rises rapidly. Our results indicated that the stiffness value of cardiomyocytes in SHR was significantly more extensive than that of normal controls, and cardiomyocytes were more sensitive to mechanical stress; In addition, intracellular calcium increased rapidly and briefly in rats with spontaneous hypertension. After intervention with streptomycin, a SAC blocker, ventricular myocytes are significantly less sensitive to mechanical stimuli. Thus, SAC is involved in developing and maintaining ventricular arrhythmias induced by hypertension. The increased stiffness of ventricular myocytes caused by hypertension leads to hypersensitivity of cellular calcium flow to mechanical stimuli is one of the mechanisms that cause arrhythmias. The AC system is a new research method to study the mechanical properties of cardiomyocytes. This study provides new techniques and ideas for developing new anti-arrhythmic drugs. HIGHLIGHT: The mechanism of hypertension-induced tachyarrhythmia is not precise. Through this study, it is found that the biophysical properties of myocardial abnormalities, the myocardium is excessively sensitive to mechanical stimulation, and the calcium flow appears to transient explosive changes, leading to tachyarrhythmia.
There are some problems in DEH control system for 125MW unit of the power plant of Hongsheng Electrothermal Co.,Ltd.Based on actual disposal and test,the causes are analyzed and corresponding solving methods are given.
It has been reported that brain natriuretic peptide (BNP) levels and C-reactive protein (CRP) levels are elevated in patients with atrial fibrillation (AF). The aim of this study is to investigate alteration of plasma BNP and CRP count in patients with non-valvula atrial fibrillation combining thrombus. In patients with non-valvula atrial fibrillation combining thrombus.
Methods
154 patients with AF (with thrombus 46, non-thrombus 108) were detected the concentration of CRP, BNP in scatt turbidimetry and D-dimer in. immunoturbidmetry. They were examined transesophageal echocardiography (TEE) and echocardiography (LAd, FS, LVEF).
Results
In aspect of BNP, CRP, Lad and LVEF, the patients in thrombus are significant difference with patients in non-thrombus, respectively: BNP (1168.39±1013.89 pg/ml vs 347.75±429.24 pg/ml p<0.001) CRP (5.77±6.37 mg/l vs 1.73±2.39 mg/L P=0.003), LAd (59.86±10.70 mm vs 47.97±13.19 mm p<0.001), LVEF (58.75±8.28% vs 64.10±6.75% p<0.001). The results of Logistic regression analysis: BNP≥400 pg/ml (OR 3.260 95% CI 1.397 to 7.608 p=0.006), CRP≥1.3 mg/l (OR 2.615 95% CI 1.141 to 5.992 p=0.023) are independent risk factors of patients with non-valvula atrial fibrillation combining with thrombosis.
Conclusions
CRP and BNP are independent risk factors of patients with non-valvula atrial fibrillation combining with thrombosis.
Thrombolytic therapy on the patients with submassive pulmonary thromboembolism has been debated for many years,especially for the benefit/risk ratio.Chronic thromembolism hypertension is the key to the prognosis for the patients with pulmonary thromboembolism.It is worthy of being paid more attention to the resolution thromboemboli on the chronic thromembolism hypertension.
Key words:
Submassive group ; Pulmonary thromboembolism ; Thrombolytic therapy
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