简介：AbstractChronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease. The incidence of COPD is growing annually in China, and it is a significant and growing public health burden. Multivariate analysis showed that COPD was one of the independent risk factors for the occurrence of pulmonary embolism (PE), and the incidence of PE was significantly higher in COPD patients than in normal subjects. However, PE is often overlooked in patients with acute exacerbation of COPD (AECOPD) because there are many similarities in clinical symptoms between PE and AECOPD, which are difficult to distinguish, resulting in the failure of timely treatment and poor prognosis. Therefore, it is of great significance to understand the clinical manifestations, diagnosis, and treatment of COPD combined with PE for making a more accurate diagnosis, providing timely and effective treatment, and improving the prognosis of such patients.

简介：无

简介：ObjectivesToinvestigatetheclinicalfeatureofacutepulmonaryembolism.MethodsRetrospectiveclinicalanalysiswasperformedaccordingtothedataof38casesofpulmonaryembolism.ResultsThereweregrounddiseasesandpredisposingfactorsin36casesofpulmonaryembolismamong38cases,theratiowas94.7%,amongthetotalpredisposingfactors,tumor,cardiovasculardisease,venousthrombosisoflowerextremity,smokingandlong-termbedwerecommon.Therewasnospecificityinclinicalfeature,physicalsignandroutchestXray,electrocardiography,andtheirappearanceswerediversified.Therewerespecificityandsensitivityinechocardiogram(UCG)andD-dimertosomeextent.But,thefinaldiagnosismustdependonsomespecialexaminations,suchasselectivepulmonaryarteriography,CTPA,MRAandsoon.ConclusionsThespecialexaminationsmustbedonetomakeadefinitediagnosistoconfirmpulmonaryembolismwhenthehighriskfactorsandgrounddiseasesareexisting.Itisnecessarytosomecaseswhentheclinicalfeaturecannotbeexplainedbyotherdiseases.

简介：尖锐胰腺炎是能触发全身的inammatory回答的本地织物损害描绘的inammatory疾病。胰腺炎的那么脉管的复杂并发症是病态和死亡的一个主要原因。在尖锐胰腺炎的肺的栓塞被报导了很稀罕。我们与尖锐胰腺炎报导了肺的栓塞的一个案例。一个38岁的女人爆发了没有明确的动机的上面的腹部疼痛。她没有恶心并且呕吐，发烧，呼吸困难，咳嗽和咳痰，胸疼痛。病人在本地医院里与尖锐胰腺炎被诊断了。病人与抗菌素和质子泵禁止者被对待，并且腹部疼痛稍微被减轻。但是病人向前来了有一点血的咳嗽和咳痰，进步呼吸困难。腹部的计算tomographic扫描揭示了胰腺炎。胸的随后的计算机断层摄影术angiography揭示了肺的栓塞(两个都击倒恰好肺的动脉的肺的动脉，左肺的动脉和分支)。病人的呼吸困难与thrombolytic治疗和anticoagulation治疗变好。肺的栓塞是胰腺炎的稀罕却潜在地致命的复杂并发症。对这复杂并发症的熟悉将帮助它的早诊断，治疗并且阻止肺的栓塞，稀罕却灾难的现象。

简介：

简介：ObjectivesTostudythecharacteristicofpulmonaryembolism(PE)incontrast-enhancedCT.MethodsTheradiologicalfeaturesweredescribedin20patientswithlobarandproximalPEdiagnosedwithaToshibaXpress/SXCTscanneraftercontrastmaterialwasadministrated.ResultsTherewere7casesofpulmonaryembolism(PE)secondarytolowerlimbdeepveinthrombosis(DVT),ofwhich2caseswererelatedtosaunabath.Wegroupedthecasesaccordingtotheirextensivenessofembolism:mild,moderate,severe,orcompleteembolism.Mildembolism:theembolioccupiedlessthan30%,oftheinnerdiameterofpulmonaryartery(PA).Medianembolism:theembolioccupied30~50%ofthePAdiameter.Severeembolism:theembolioccupiedoverhalfofthePA(50%),buttherewerecontrastflow.Completedembolism:therewasnocontrastfoundaroundtheemboli.ThedirectsignofPEwasafillingdefectornoopacificationintheaffectedbranchofpulmonaryartery(PA).Therewere9othersecondarysigns:①widenPA,②enlargedrightventricleandtherightatrium,③increasedtranslucencyofthelunganddecreasedbronchovascularshadows,④shrunkenpulmonaryveinslikeddriedrattan,⑤decreasedleftatriumandtheleftventriclesize,⑥shiftingofinterventricularseptumtotheleftandposteriordirection,⑦Thelaterallungparenchymademonstratedinatriangularshape,⑧pleuraleffusionand⑨pericardiacleeffusion.ConclusionsThediagnosisofPEwasrevealedby10radiologicalsignsbycontrast-enhancedCT:Withfullunderstandingofthepathophysiologicalbasisofthese10signs:correctdiagnosisofpulmonaryembolismcanbemade.PEiscommonlycausedbylowerlimb.Andsaunabathisoneofthemainpredisposingcauses.

简介：无

简介：AbstractIn the United States, pulmonary embolism (PE) accounts for approximately 10% of all pregnancy related deaths. The standard treatment for a patient with high-risk PE is systemic thrombolysis. Systemic thrombolysis in pregnancy is associated with the risk of maternal hemorrhage and fetal complications, including spontaneous abortion, preterm delivery, and fetal bleeding. Currently, there is limited evidence for a standardized approach for the treatment and management of intermediate-and high-risk PEs in pregnancy. A 36-year-old gravida 3 para 2002 woman at 31+1 weeks of gestation with a history of deep vein thrombosis in her prior pregnancy presented with shortness of breath. A computed tomography angiogram revealed a large pulmonary embolus with a saddle component that extended into the bilateral upper and lower lobes and into the secondary and tertiary pulmonary branches. A subsequent bedside echocardiogram demonstrated a dilated right ventricle with severely reduced right ventricular systolic function. The patient was successfully treated with bilateral ultrasound-assisted catheter-directed thrombolysis. She subsequently delivered a healthy male infant at term. Reported cases of ultrasound-assisted catheter-directed thrombolysis in pregnant patients is limited. Our case demonstrates that localized thrombolysis is a viable treatment option for life-threatening PE in pregnancy. Catheter-directed thrombolysis can be efficacious in treating intermediate-and high-risk PEs in pregnancy while simultaneously reducing the risk of bleeding complications.

简介：无

简介：Objective:Toimprovethediagnosisandtreatmentofseverecerebralfatembolism(SCFE).Methods:ThedataofninepatientswithSCFEwereretrospectivelyanalyzed.Themanifestationsofthecentralnervesystem,respiratorysystemandhemorrhagewererecorded,atthesametime,accessoryexaminationincludingarterialoxygen,fatmacroglobulesinvenousbloodandimageexaminationwasadapted.Thepatientsweretreatedwithexopexy,pharmocotherapyandoxygentherapy.Results:Twooftheninepatientsdiedofseverecomplications,theothersevenrecoveredwithoutseveresequela.Conclusions:GurdstandardshouldbeimprovedforearlydiagnosisofSCFE.Ifsverecomplicationscanbeprevented,patientswhoreceiveearlytreatmentwillhavefavourableprognosis.

简介：Pulmonaryhypertensionisnotasingleentityandnotallformshavethesameprognosis.Thepurposeofthiseditorialistoprovideinformationtothegeneralcardiologistrelatingtowhichtypeofpulmonaryhypertensionthepatientisexperiencing.Inordertodothisproperly,onemustdeterminethecause,theseverity,theprognosis,anddeveloptreatmentplansforthedifferentformsofpulmonaryhypertension.Pulmonaryarterialhypertension(PAH)isthemostmalignantofthedifferenttypesofpulmonaryhypertension.Whiletypicallybeingdiagnosedinayoungerpopulationthantheothertypes,PAHmaybeshowingatrendtowardsdiagnosislaterinthelifethanwhatwasthoughtfromolderregistrydata[1].TheusualcausesofcardiovasculardeathinpatientswithPAHincludesrightheartfailureandsuddendeath[2].

简介：无

简介：AbstractUmbilical cord (UC) embolism is a rare, life-threatening complication of pregnancy. The exact cause of this condition is not yet known. Women with more than one UC abnormality are at risk of UC obstruction; this condition can lead to stasis, ischemia, and in some cases, thrombosis. However, many women with UC abnormalities remain undetected and may not be recognized until after birth. Here, we present a case involving the prenatal diagnosis and successful treatment of umbilical artery embolism in the third trimester with good maternal and fetal outcomes. The risk of UC embolism increases when more than one UC abnormality is identified in a single case. Ultrasound examination in the third trimester of pregnancy should be able to verify the existence of two arteries and one vein in the UC. If necessary, these results can be compared with ultrasound imaging acquired during the first trimester of pregnancy.

简介：AbstractIntroduction:Early intervention in patients with congenitally disconnected pulmonary artery improves long-term outcome.Case presentation:We present 3 cases of isolated disconnected pulmonary artery in the absence of associated structural heart disease during a period of 3 years.Conclusion:Transcatheter stenting of the feeding ductus arteriosus re-established pulmonary artery flow and growth. Successful surgical repair was achieved, and normal perfusion and complete function of the ipsilateral lung were regained.

简介：

简介：AbstractFat embolism syndrome (FES) is a serious life-threatening manifestation of the fat embolism phenomenon characterized by Bergman’s triad of dyspnea, petechiae and mental confusion. While fat embolization into systemic circulation is common, FES occurs in a meagre 0.05%-3% of patients having isolated long bone fractures. Though visual symptoms are commonly attributed to fat embolism retinopathy and is a later occurrence, it may not always be the case. Cortical blindness has been seldom reported in association with FES, and less so as a presenting complaint. Furthermore, no previous literature has described the same in context of an isolated tibia fracture. We report a 20-year-old gentleman with an isolated right tibia shaft fracture who developed sudden onset diminution of vision in both eyes less than 24 h following trauma with no other complaints. Lack of any remarkable ophthalmoscopic findings or other symptoms left us with a diagnostic conundrum. He later went on to develop altered mentation, hypoxia and generalized tonic-clonic seizures with subsequent MRI revealing multiple cerebral fat emboli also involving both occipital lobes. Supportive measures were instituted and his general condition as well as vision gradually improved following which he underwent plate fixation of the fracture under spinal anaesthesia. The perioperative period was uneventful and he was discharged following staple removal. At one month of follow-up, the patient had no residual visual field defects or neurological deficits. Though FES is rare among isolated tibia fractures, this clinical catastrophe may strike in any unsuspected setting thereby warranting a high index of suspicion to ensure early diagnosis and improved patient outcomes.

简介：无

简介：AbstractBackground:The incidence of chronic obstructive pulmonary disease (COPD) complicated with invasive pulmonary aspergillosis (IPA) has increased in the last two decades. The mechanism underpinning susceptibility to and high mortality of COPD complicated with IPA is unclear, and the role of T helper cells 17 (Th17 cells) in the compound disease remains unknown. Therefore, this study aimed to assess the function of Th17 cells in COPD combined with IPA.Methods:COPD, IPA, and COPD+IPA mouse models were established in male wild type C57/BL6 mice. The amounts of Th17 cells and retinoic acid-related orphan receptors γt (RORγt) were tested by flow cytometry. Then, serum interleukin (IL)-17 and IL-23 levels were detected by enzyme-linked immunosorbent assay (ELISA) in the control, COPD, IPA and COPD+IPA groups. In addition, COPD+IPA was induced in IL-17 knockout (KO) mice, for determining the role of Th17 cells in COPD+IPA.Results:Compared with the COPD group, the COPD+IPA group showed higher amounts of blood RORγt ([35.09 ± 16.12]% vs. [17.92 ± 4.91]%, P = 0.02) and serum IL-17 (17.96 ± 9.59 pg/mL vs. 8.05 ± 4.44 pg/mL, P = 0.02), but blood ([5.18 ± 1.09]% vs. [4.15 ± 0.87]%, P= 0.28) and lung levels of Th17 cells ([1.98 ± 0.83]% vs. [2.03 ± 0.98]%, P= 0.91), lung levels of RORγt ([9.58 ± 6.93]% vs. [9.63 ± 5.98]%, P = 0.49) and serum IL-23 (51.55 ± 27.82 pg/mL vs. 68.70 ± 15.20 pg/mL, P = 0.15) showed no significant differences. Compared with the IPA group, the COPD+IPA group displayed lower amounts of blood ([5.18 ± 1.09]% vs. [9.21 ± 3.56]%, P = 0.01) and lung Th17 cells ([1.98 ± 0.83]% vs. [6.29 ± 1.11]%, P = 0.01) and serum IL-23 (51.55 ± 27.82 pg/mL vs. 154.90 ± 64.60 pg/mL, P = 0.01) and IL-17 (17.96 ± 9.59 pg/mL vs. 39.81 ± 22.37 pg/mL, P = 0.02), while comparable blood ([35.09 ± 16.12]% vs. [29.86 ± 15.42]%, P = 0.25) and lung levels of RORγt ([9.58 ± 6.93]% vs. [15.10 ± 2.95]%, P = 0.18) were found in these two groups. Finally, Aspergillus load in IL-17 KO COPD+IPA mice was almost 2 times that of COPD+IPA mice (1,851,687.69 ± 944,480.43 vs. 892,958.10 ± 686,808.80, t= 2.32, P = 0.02).Conclusion:These findings indicate that Th17 cells might be involved in the pathogenesis of COPD combined with IPA, with IL-17 likely playing an antifungal role.

简介：无

简介：AbstractPulmonary rehabilitation (PR) is a cornerstone management for chronic obstructive pulmonary disease (COPD). International respiratory societies defined PR is more than "just an exercise program" ; it is a comprehensive care delivered by a team of dedicated healthcare professionals with a strong emphasis on long-term health-enhancing Behaviors. However, "Uncertainty" exists with varied reasons for the political and geographical barriers of referral, uptake, attendance, and completion of PR in both primary and secondary care. Besides, COVID-19 pandemic has sparked many global controversies and challenges on pulmonary rehabilitation service delivery. Post-COVID-19 guidelines emphasize on integrated care rehabilitation for patients with COPD. Thus, this concise review intends to understand the gaps in United Kingdom healthcare policies, practices, and PR services resources. To date, there is no clear consensus on PR integrated care model pathway to address the unmet needs, measure the health and social care disparities; adds to the disease burden of COPD. Based on the culmination of evidence, this perspective offers a theoretical framework of PR integrated service model, a pathway to deliver high-value personalized care to patients with COPD.