AngioJet thrombectomy with extracorporeal membrane oxygenation support for an acute large-scale pulmonary embolism with bilateral atrial thrombosis: a case report of catastrophic antiphospholipid syndrome.

Background: Catastrophic Antiphospholipid Syndrome (CAPS), a severe systemic autoimmune disorder, predominantly causes life-threatening multi-organ failure, with a high mortality rate. It primarily affects small vessels, seldom impacting large vessels. Notably, acute massive pulmonary embolism (PE) with bilateral atrial thrombosis is an exceptional occurrence in CAPS. Acute pulmonary embolism (PE) is a common cardiovascular disease that progresses rapidly and has a high mortality rate. Acute massive PE combined with bilateral atrial thrombosis has an even higher mortality rate. PE treatments primarily include pharmaceuticals, catheter interventions, and surgical measures, with integrated treatment strategies demonstrating promising outcomes in clinical practice. Extracorporeal membrane oxygenation (ECMO) can provide cardiopulmonary support for the treatment of high-risk PE patients and is a proven therapeutic measure. Methods: This report presents the case of a 52-year-old male admitted due to fever and sudden onset of impaired consciousness, with cardiac ultrasound and pulmonary artery CT angiography revealing an acute large-scale pulmonary embolism accompanied by bilateral atrial thrombosis, with the condition rapidly worsening and manifesting severe respiratory and circulatory failure. With ECMO support, the patient underwent a thrombectomy using an AngioJet intervention. The diagnosis of CAPS was confirmed through clinical presentation and laboratory examination, and treatment was adjusted accordingly. Results: The patient made a successful recovery and was subsequently discharged from the hospital. Conclusion: In CAPS patients, the rare instance of acute massive PE accompanied by bilateral atrial thrombosis significantly risks severe respiratory and circulatory failure, adversely affecting prognosis. Early initiation of ECMO therapy is crucial, offering a vital opportunity to address the root cause. In this case report the patient was successfully treated with an AngioJet thrombectomy supported by ECMO.

Diagnosis of leptospira by metagenomics next-generation sequencing with extracorporeal membrane oxygenation support: a case report.

BACKGROUND: Leptospirosis is an infectious disease caused by pathogenic Leptospira spp., which could result in severe illnesses. Indirect contact with these pathogens is more common. Individuals could contract this disease through contact with contaminated water or during floods. In this case, we present the details of a 40-year-old male pig farmer who suffered from severe pulmonary hemorrhagic leptospirosis and multiple organ failure. The diagnosis of leptospirosis was confirmed through metagenomics next-generation sequencing (mNGS) while the patient received extracorporeal membrane oxygenation (ECMO) support, and antibiotic treatment was adjusted accordingly. The patient underwent comprehensive treatment and rehabilitation in the intensive care unit. CONCLUSION: This case illustrates the importance of early diagnosis and treatment of leptospirosis. While obtaining the epidemiological history, second-generation metagenomics sequencing was utilized to confirm the etiology. The prompt initiation of ECMO therapy provided a crucial window of opportunity for addressing the underlying cause. This case report offers valuable insights for diagnosing patients with similar symptoms.

[Association of Vitamin D Receptor Polymorphisms with Response to Antiviral Therapy in Patients with Chronic Hepatitis C].

OBJECTIVE: To assess the influence of vitamin D receptor (VDR) gene Bsm I, Fok I, Taq I and Apa I polymorphisms on the response to antiviral therapy in patients with chronic hepatitis C (CHC). METHODS: There were total 124 patients with CHC treated with pegylated interferon plus ribavirin. VDR gene Bsm I, Fok I Taq I and Apa I polymorphisms were analyzed in 71 patients with sustained virological response (SVR) and 53 patients without SVR (non-SVR) by polymerase chain reaction-MassARRAY (PCR-MassARRAY). RESULTS: The distributions of VDR genotype met Hardy-Weinberg equilibrium (all P > 0.05). There were no significant differences in VDR Fok I, Taq I, Apa I allele and genotype frequencies between SVR and non-SVR patients (all P > 0.05). The Bsm I (GA) genotype was significant higher in the patients with SVR compared to those with non-SVR (Χ2 = 3.967, P = 0.046). Three SNPs at VDR gene (Bsm I, Taq I and Apa I) were in strong linkage disequilibrium. Linkage disequilibrium coefficient (D') between Bsm I and Taq I was 1.000 and the correlation coefficient (r2) was 0.741. D' between Bsm I and Apa I was 1.000 and r2 was 0.082. D' between Taq I and Apa I was 0.829 and r2 was 0.076. No relation existed between haplotypes and response to therapy (P > 0.05). CONCLUSION: Vitamin D receptor gene Bsm I polymorphism may be associated with the therapeutic response to antiviral therapy with pegylated interferon plus ribavirin in chronic hepatitis C patients.