Predictive factors of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary thromboembolism / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the incidence and predictive factors of chronic thromboembolic pulmonary hypertension (CTEPH) in patients with acute pulmonary thromboembolism (PTE).</p><p><b>METHODS</b>Clinical data of 104 patients with CT angiography-proven PTE were collected and Wells score, revised Geneva score and ECG score were calculated. Blood gas analysis, CK-MB and D-dimer values were analyzed. Heart chamber diameters and pulmonary artery systolic pressure (PASP) were assessed by echocardiography. Qanadli obstruction index and Mastora obstruction index were evaluated according to computed tomography pulmonary angiography (CTPA). Patients were followed up by telephone or clinic visit to assess the WHO functional class and the incidence of CTEPH.</p><p><b>RESULTS</b>During the 25.47±16.94 months (4 to 62 months) follow-up, 7 out of 104 patients were lost to follow-up and data from the remaining 95 patients were analyzed. The incidence of CTEPH was 14.4% (14/97). Baseline PASP, incidence of recurrent PTE, right atrium and right ventricle diameters and CK-MB were significantly higher in CTEPH group compared to non-CTEPH group (all P<0.05). Higher CK-MB (odds ratio: 8.3) and baseline PASP (odds ratio: 5.0 per 20 mm Hg increment) were independent predictive factors for CTEPH in this cohort.</p><p><b>CONCLUSIONS</b>Higher CK-MB and baseline PASP values are independent predictive factors related to the development of CTEPH post acute pulmonary thromboembolism.</p>

Acute paraplegia following embolization of spinal dural arteriovenous fistula / 中华医学杂志(英文版)

Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula (SDAVF) only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.

Therapeutic effect of ulinastatin on traumatic brain edema accompanied by seawater drowning in rats / 中华神经医学杂志

Objective To observe the therapeutic effect of ulinastatin on traumatic brain edema (TBE) accompanied by pulmonary edema due to seawater drowning in rats. Methods Thirty-two Sprague-Dawley rats were randomly divided into control group (nffi8) and ulinastatin treatment group (n=24). A rat model of moderate brain trauma was established by lateral head impact, and pulmonary edema was induced in these rats by pulmonary lavage with seawater to mimic seawater drowning. Twenty-four hours after intmperitoneal injection of ulinastatin, the changes in the cerebral and pulmonary water contents and concentrations of interleukin-1β(IL-1β) and tumor necrosis factor-α(TNF-α) in the brain, lungs and serum were measured, and the histopathological changes of the brain and lung tissues were observed. Results The cerebral and pulmonary water contents and the IL-1β and TNF-α concentrations in the serum, brain and lungs of the rats with brain trauma and pulmonary edema were markedly decreased after ulinastatin injection, which also resulted in obvious improvement of the brain and lung pathologies induced by the injuries. Conclusion Ulinastatin can alleviate traumatic brain edema in rats with pulmonary edema due to seawater drowning by inhibiting the proinflammatory cytokines.