Correlation of D-dimer level with the radiological severity indexes of pulmonary embolism on computed tomography pulmonary angiography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>The median D-dimer level and PAOI were 765 µg/L (95% CI: 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% CI: 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).</p><p><b>CONCLUSION</b>D-dimer levels are positively correlated with PE burden and right ventricle dysfunction on CTPA, and can help monitor the therapeutic response.</p>

Lemierre syndrome caused by Arcanobacterium haemolyticum: a case report and review of the literature / 中华内科杂志

Objective To emphasize the importance of the early diagnosis and treatment of Lemierre syndrome caused by Arcanobacterium haemolyticum.Method A case of Lemierre syndrome caused by Arcanobacterium haemolyticum and three similar reported cases were reviewed.Results A man complained of fever with a sore throat,and examination found an enlarged left tonsil with prominent exudate,normal blood routine test and chest radiograph.Although the patient received the treatment of penicillin G and azithromycin,his condition worsened.Blood test showed white blood cell count 13.59 × 109/L (neutrophils 0.933),platelet count 7.4 × 109/L,TBil 54.3 mmol/L,DBil 28.3 mmol/L,AST 127 IU/L,ALT 82 IU/L,serum albumin 19.3 g/L with the development of the conditions.Blood cultures grew Arcanobacterium haemolyticum and the piperacillin-tazobactam was administered until fever was controlled.In addition,anticoagulation was administered when the thrombus was confirmed in the left internal jugular vein.Two follow-up clinic visits over the following 4 months were unremarkable.Besides three similar cases reported,four patients were male,and the ages ranged from 19 to 54 years.The chief complaints were sore throat and fever (4/4),with neck pain (4/4).Physical examinations found pharyngitis (2/4),exudate or abscess in the tonsillar crypt (2/4),maculopapular rashes (2/4).Laboratory results showed leukocytosis and thrombocytopaenia (4/4),acute cholestatic liver dysfunction (3/4),acute renal failure (2/4),acute respiratory failure (1/4).The first chest radiographs were normal at the onset,but chest radiography features included peripheral nodules and cavitation (3/4),focal or wedge-shaped lesions (1/4),pleural effusion (1/4) with the development of the conditions.Blood culture proved that there was only growth of Arcanobacterium haemolyticum (2/4),both Fusobacterium necrophorum and Arcanobacterium haemolyticum were found (2/4).Amoxicillin/clavulanic acid or piperacillin/tazobactam was administered (4/4).Neck CT proved internal jugular vein thrombosis (3/4) and anticoagulation was administered (3/4).All patients recovered and no one died.Conclusions The characters of Lemierre syndrome include primary oropharynx infection,septicaemia,septic or embolic phlebitis of jugular vein,and metastatic abscess.Early recognition and aggressive intravenous broad-spectrum antibiotics are critical to reduce mortality.

Thrombosis and its significance after experimental pulmonary thromboembolism / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To study thrombosis and its significance after acute experimental pulmonary thromboembolism.</p><p><b>METHODS</b>The acute pulmonary thromboembolism (PTE) model of rabbits was established by intravenous injection of autologous blood clots (0.04 g/kg) which were stabilized in temperature-controlled (70 degrees C) distilled water for 10 min. The process of thrombosis was observed grossly and microscopically. The Quick's method was used to examine the coagulability of blood and radioimmunoassay was employed to measure the level of plasma thromboxane A(2) and endothelin.</p><p><b>RESULTS</b>Thrombotic propensity was observed at 1 h, fresh thrombus started to form and the blood coagulation system was activated at 24 h following clots infusion. Emboli were completely or partly dissolved at 5 d and appeared to organize at both 10 d and 14 d after clots were infused. Venous plasma thromboxane A(2) concentration began to increase at 5 min (2489.59 +/- 714.68 ng/L) and reached its maximum at 15 min (2545.46 +/- 590.58 ng/L) then declined at 60 min after clot infusion (P < 0.001, respectively, vs 626.59 +/- 510.02 ng/L of pre-clot). The level of endothelin in both arterial and venous blood increased at 5 d post-clot infusion (840.74 +/- 154.19 ng/L, 230.35 +/- 52.39 ng/L, respectively) compared to the one before infusion (602.66 +/- 453.26 ng/L, 148.01 +/- 53.28 ng/L, respectively, P < 0.05).</p><p><b>CONCLUSIONS</b>Thrombosis occurs after autologous-blood-clot-induced PTE. The interactions between thrombus formation, fibrinolysis and organization determines the consequences of emboli. Abnormalities of endothelin metabolism and the increment of thromboxane A(2) may play an important role in PTE.</p>

A randomized,prospective evaluation of non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease / 中国实用内科杂志

Objective To determine the efficacy of Non-invasive positive pressure ventilation(NPPV)in the management of patients with respiratory failure due to an acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods Forty-two patients were included in the study.Of them,21 were randomly allocated to receive NPPV plus “standard care” and 21 to “standard care”.Both groups had similar characteristics upon their admission in the hospital.Results The use of NPPV significantly decreased the PaCO_2 level and respiratory rates,but significantly increased the PaO_2 level after 2 hours of treatment(P