Comparison of heart failure and COVID-19 in chest CT features and clinical characteristics / 中华心血管病杂志

Objective: To identify the characteristics including clinical features and pulmonary computed tomography (CT) features of heart failure and COVID-19. Methods: This study was a retrospective study. A total of 7 patients with heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1, 2019 and February 15, 2020 were enrolled. The baseline clinical and imaging features of the two groups were statistically analyzed. Results: There was no significant difference in age and sex between the two groups(both P>0.05), but the incidence of epidemiological contact history, fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group (12/12 vs. 0, P<0.001; 12/12 vs. 4/7, P=0.013). While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7, P<0.001；0 vs.7/7, P<0.001). For imaging features, both groups had ground-glass opacity and thickening of interlobular septum, but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19 (4/7 vs. 1/12, P=0.04). In heart failure group, the ratio of the expansion of pulmonary veins was also higher (3/7 vs. 0，P=0.013), and the lung lesions can be significantly improved after effective anti-heart failure treatment. Besides, there were more cases with rounded morphology in COVID-19 group（9/12 vs. 2/7, P=0.048）. Conclusions: More patients with COVID-19 have epidemiological history and fever or respiratory symptoms. There are significant differences in chest CT features, such as enlargement of pulmonary veins, lesions distribution and morphology between heart failure and COVID-19.

Relationship Between Blood Lipid Level and In-hospital Death in Patients With Aortic Dissection / 中国循环杂志

Objective: To investigate the relationship between blood lipid level and in-hospital death in patients with aortic dissection (AD). Methods: Our retrospective study included in 2 groups: AD group, n=153 patients which was further divided into 2 subgroups:Thoracic AD subgroup, n=73 and Abdominal AD subgroup, n=80; Control group, n=50 patients with isolated hypertension at the same period. Blood lipid levels were compared among different groups and subgroups; HDL-C levels were studied by correlation analysis between AD survivor and in-hospital died AD patients. Results: Compared with Control group, AD group had increased TC [3.89 (3.19, 4.61) mmol/L] vs [3.58 (2.70, 4.33) mmol/L], decreased HDL-C [1.02 (0.86, 1.25) mmol/L vs 1.52 (1.22, 1.76) mmol/L] and lower ratio of HDL-C/TC [0.28 (0.22, 0.34) vs 0.45 (0.31, 0.67)], all P<0.01. Compared with Abdominal AD subgroup, Thoracic AD subgroup had the lower ratio of HDL-C/TC [0.27 (0.20, 0.33) vs 0.30 (0.24, 0.36)], P<0.05. Compared with AD survivor, the in-hospital died AD patients had the lower HDL-C level [0.82 (0.69, 1.04) mmol/L vs 1.06 (0.89, 1.33) mmol/L], P<0.01. Spearman correlation analysis revealed that HDL-C level was negatively related to in-hospital death of AD (correlation coefficient =-0.353). Conclusion: AD patients had abnormal lipid metabolism, blood HDL-C level was negatively related to in-hospital death in AD patients.

Association of Plasma Pentraxin-3 Levels on Admission with In-hospital Mortality in Patients with Acute Type A Aortic Dissection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute aortic dissection is a life-threatening cardiovascular emergency. Pentraxin-3 (PTX3) is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. This study sought to investigate the association of circulating PTX3 levels with in-hospital mortality in patients with acute Type A aortic dissection (TAAD).</p><p><b>METHODS</b>A total of 98 patients with TAAD between January 2012 and December 2015 were enrolled in this study. Plasma concentrations of PTX3 were measured upon admission using a high-sensitivity enzyme-linked immunosorbent assay system. Patients were divided into two groups as patients died during hospitalization (Group 1) and those who survived (Group 2). The clinical, laboratory variables, and imaging findings were analyzed between the two groups, and predictors for in-hospital mortality were evaluated using multivariate analysis.</p><p><b>RESULTS</b>During the hospital stay, 32 (33%) patients died and 66 (67%) survived. The patients who died during hospitalization had significantly higher PTX3 levels on admission compared to those who survived. Pearson's correlation analysis demonstrated that PTX3 correlated positively with high-sensitivity C-reactive protein (hsCRP), maximum white blood cell count, and aortic diameter. Multivariate logistic regression analysis demonstrated that PTX3 levels, coronary involvement, cardiac tamponade, and a conservative treatment strategy are significant independent predictors of in-hospital mortality in patients with TAAD. The receiver operating characteristic curve analysis further illustrated that PTX3 levels on admission were strong predictors of mortality with an area under the curve of 0.89. A PTX3 level ≥5.46 ng/ml showed a sensitivity of 88% and a specificity of 79%, and an hsCRP concentration ≥9.5 mg/L had a sensitivity of 80% and a specificity of 69% for predicting in-hospital mortality.</p><p><b>CONCLUSION</b>High PTX3 levels on admission are independently associated with the in-hospital mortality in patients with TAAD.</p>

simple emergency prediction tool for acute aortic dissection

A simple emergency risk prediction tool should be developed for clinicians to quickly identify the prognosis of patients with acute aortic dissection. We enrolled 280 patients with acute aortic dissection admitted to emergency department between May 2010 and February 2013. Multivariate logistic regression analysis was performed to identify independent predictors of in-hospital death. The in-hospital mortality of our patients with acute aortic dissection was 32.5%, in-hospital deaths with surgery less than the survived [34.1% VS 54.5%]. Multivariate analysis identified that age [>/= 65 years old], Type A, blood pressure [mean systolic blood pressure /= 80%] and serum D-dimer [>/= 5.0 mg/L] were significant predictors of death. With the simple emergency risk prediction tool, scores of all in-hospital deaths were >/= 3, whereas almost all of the survivors [97.9%] had scores < 15. A score of 10 offered the best threshold value, with the highest sensitivity [81.3%] and specificity [86.8%]. The in-hospital mortality rate of patients with acute aortic dissection is high and can be predicted. Early surgery would be beneficial for in-hospital survive. This tool should be available for clinicians in the emergency department to quickly identify the prognosis of patients with acute aortic dissection

Analysis on an early diagnosis grading model for acute aortic dissection / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the value of an early diagnosis grading model derived from the clinical manifestation, laboratory and imaging data for the diagnosis of aortic dissection (AD).</p><p><b>METHODS</b>An early diagnosis grading model was established based on the clinical manifestation, laboratory and imaging data from 182 AD patients who admitted to our department during the last 3 years, 184 patients with chest and back pain served as controls.</p><p><b>RESULTS</b>The sensitivity and specificity of diagnosing AD with the score of 5 is 96.7% and 81.0%, respectively.</p><p><b>CONCLUSION</b>The emergency diagnose of AD could be improved based on the established early grading model based on the stabbing and severe pain, rapid blood pressure increase, asymmetry of the blood pressure and/or the pulse, widened aortic knob, mediastinum or descending aorta on X-ray, and significantly increased D-dimmer level.</p>

Construction and activity evaluation of pSUPER RNAi system that inhibits Smad3 / 中南大学学报(医学版)

OBJECTIVE@#To construct the expressing vector of siRNA which can inhibit the Smad3 activity.@*METHODS@#Sixty-four bases of 2 pair oligos for hairp in RNA expression which targeted Smad3 gene were chemically synthesized and annealed. pSUPER vector was linearized with BgL II and Hin d III treated with alkaline phosphatase (CIP). Anneled oligos were inserted into the downstream of the treated pSUPER's pol III H1 promoter to construct RNAi plasmid (pSUPER Smad3). Oligos with a scrambled sequence were used as a negative control. pSUPER Smad3 was transfected into human renal tubular epithelial cells (HKC).@*RESULTS@#Recombinant pSUPER Smad3 vector was identified by the digestion with Eco R I and Hin d III, and confirmed by the sequencing analysis with T3 primer. Sixty-four bases had been inserted into the expected site. Furthermore, the insertion sequence was exactly corrected. The activity evaluation indicated that mRNA and protein of Smad3 but not Smad2 were inhibited by pSUPER Smad3 in HKC.@*CONCLUSION@#The pSUPER Smad3 system has been constructed successfully, and has high inhibition and specificity in vitro.

Effect of ulinastain on the expression of hemeoxygenase-1 in oleic acid-induced acute lung injury in rats / 中南大学学报(医学版)

OBJECTIVE@#To explore the effect of ulinastain on the expression of hemeoxy genase-1 (HO-1) in oil acid-induced acute lung injury in rats.@*METHODS@#The animal model of acute lung injury was established by oil acid. Thirty SD rats were randomly divided into 3 groups: the blank control group (A), the acute lung injury group (B) and the acute lung injury group (C) followed by injecting 100 mL/kg ulinastatin. Each group consisted of 10 rats. Group A were given 0.2 mL/kg natural solution through the trial vein; Group B and C were given 0.2 mL/kg oil-acid through trial vein, while group C were injected 100mL/kg ulinastatin by the peritoneal cavity after injecting oil acid. After 4 hours, the rates of respiration were counted and blood samples were cramped out through the heart puncture for blood gas analysis. The expressions of hemeoxygenase-1 and the pathologic construction changes were determined by HE staining in the lower right lung of rats in the 3 groups.@*RESULTS@#The respiration dysfunction caused by oil acid could be prominently improved by ulinastain. There was only a little expression of hemeoxygenase-1 in the lung of Group A, but the expression increased in Group B and significatively increased in Group C.@*CONCLUSION@#Ulinastatin may protect the rats from acute lung injury through increasing the expression of HO-1.