[Clinical characteristics and prognosis of overweight and obese patients with pulmonary thromboembolism].

Objective: To investigate the clinical characteristics and outcomes of overweight and obese patients with pulmonary embolism. Methods: This was a retrospective study of patients with pulmonary thromboembolism(PTE) in Beijing Hospital between 2009 and 2017. Data were analyzed and compared based on body mass index (BMI), and patients were classified into normal weight, overweight, and obese. Results: Among 372 patients with PTE, 159 were normal, 143 were overweight and 70 were obese. The mean age was (67.8±13.4) years, and 159(47.0%) were males. There was no significant difference in age, sex, smoking ratio, and underlying disease between the 3 groups (all P>0.05). Chest pain was less frequent in the obese group than the overweight group (P<0.05), and swollen of lower limbs was more prevalent in the obese group than the first 2 groups (all P<0.05). The levels of hemoglobin and hematocrit in the obese group were significantly higher than those in the normal group(P<0.05), while the serum uric acid levels were significantly higher than that in the normal group (P<0.05). Anticoagulation was more frequent in the overweight than the normal group(P<0.05) and Warfarin use was more frequent in the overweight and the obese than the normal group(both P<0.05). The mortality rate was higher in the normal group than those in the overweight and the obese groups (both P<0.01). Multiple logistic regression analysis after adjusting for age and sex showed that malignancy (OR=3.716, 95%CI: 1.733-7.972, P=0.001) and high risk PTE (OR=13.815, 95%CI: 4.093-46.624, P<0.001) were predictors of mortality, whereas anticoagulation (OR=0.155, 95%CI: 0.056-0.428, P<0.001), BMI≥24 (OR=0.142, 95%CI: 0.045-0.446, P=0.001) and BMI≥28 (OR=0.272, 95%CI: 0.085-0.872, P=0.029) were the predictors of survival. Conclusions: Proportion of hypertension, diabetes, coronary heart disease and hyperlipidemia were not significantly different in patients with overweight and obesity compared to patients with normal weight. Obese patients had higher levels of uric acid and hemoglobin than normal weight. Overweight and obese patients had a better survival.

[Clinical characteristics and outcomes of patients with lung cancer, gastrointestinal cancer and urologic cancer with venous thromboembolism].

Objective: To compare the clinical characteristics and outcomes of patients with lung cancer, gastrointestinal (GI) cancer and urologic cancer with venous thromboembolism (VTE). Methods: From January 2003 to January 2013, 192 lung cancer, GI cancer and urologic cancer patients with VTE were retrospectively evaluated for the clinical characteristics and outcomes. Results: Among 192 patients, 82 cases of lung cancer, 78 cases of GI cancer, 32 cases of urologic cancer were involved. The Eastern Cooperative oncology Group Performance Status score of GI cancer group was significantly higher than those of the lung cancer and urologic cancer groups[(2.4±1.1) vs (2.0±1.4), (1.8±1.0), both P<0.05]. The proportion of smoking patients in lung cancer group was significantly higher than that in GI cancer and urologic cancer groups (79.3% vs 30.8%, 53.1%, both P<0.05), while the proportion of operation was significantly lower than that in the latter two groups (35.4% vs 53.8%, 68.8%, both P<0.05). Pathological types of cancer were mostly adenocarcinoma, and the proportion of adenocarcinoma in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (76.9%, 73.8% vs 37.9%, both P<0.001). The proportion of moderately and/or poorly differentiated histodifferentiation in the first two groups was significantly higher than that of urologic cancer group (90.0%, 95.7% vs 40.0%, both P<0.001). The proportion of patients with TNM stage Ⅲ-Ⅳ in lung cancer group was significantly higher than that of the urological cancer group (87.0% vs 64.3%, P<0.05). The incidence of VTE in lung cancer group was significantly higher than those of GI cancer and urologic cancer groups within 6 months after tumor diagnosis, chemotherapy and operation (79.3% vs 60.3%, 46.9%; 76.5% vs 48.6%, 36.4%; 92.3% vs 57.9%, 59.1%; all P<0.05). The case fatality rate within one year in lung cancer and GI cancer groups was significantly higher than that in urologic cancer group (51.2%, 52.6% vs 18.8%, both P<0.01). The median survival time of the lung cancer and GI cancer groups was significantly shorter than that of the urological cancer group (P=0.001, 0.010, respectively). Conclusions: Adenocarcinoma, advanced cancer, and poor histodifferentiation are risk factors of VTE in cancer patients. Most events of VTE occur within 6 months after a diagnosis of cancer. The prognosis of lung cancer and GI cancer complicated with VTE is worse than that of urologic cancer with VTE.

[The sources of emboli in patients with pulmonary embolism diagnosed by autopsy].

Objective: To study the sources of emboli in patients with pulmonary embolism diagnosed by autopsy, and therefore to provide help in the diagnosis and treatment of thromboembolism. Methods: We retrospectively analyzed the pathology and clinical data of 43 patients with pulmonary embolism diagnosed by autopsy from 1962 to 2012 in Beijing Hospital. Results: In patients with pulmonary embolism diagnosed by autopsy, 32.6% of the emboli came from deep veins of the lower extremities, 9.3% from the renal vein, 9.3% from the prostate sinus, 7.0% from the venous plexus around the prostate, 7.0% from the hepatic vein and 7.0% from the submucosal vein of the bladder. Other sources included the right atrium 4.7%, portal vein 4.7%, pancreatic peripheral vein 4.7%, prostate, heart, esophageal vein 4.7%, right common iliac vein 2.3%, right upper limb brachial vein 2.3%. No source of emboli was found in 4.7% patients with pulmonary embolism. Non-lower extremity deep vein emboli accounted for 60.5%. Only 9.3% of the cases were diagnosed with pulmonary embolism with deep vein thrombosis before death. Conclusion: There was a wide range of sources of emboli in patients with pathologically proven pulmonary embolism. Although the deep veins of lower extremities are the most common, more than 60% of the emboli came from the renal vein, prostate vein, hepatic vein and other abdominal or pelvic veins, the heart, and the upper extremity deep veins. In addition to the lower extremity deep veins, other sources of emboli should be actively examined when the patient was diagnosed with acute pulmonary embolism.

[Analysis of 12 cases of exogenous lipoid pneumonia confirmed by pathology].

Objective: To study the etiological, clinical, radiological, diagnostic, therapeutic, and prognostic manifestations of exogenous lipoid pneumonia (ELP), and therefore to improve the diagnosis and treatment of this disease. Methods: The clinical data of 12 cases of ELP confirmed by pathology were retrospectively analyzed. Results: The patients consisted of 9 males and 3 females, with an average age of 73.8 years (range, 44 to 100 years). The underlying diseases were variable, including diseases affecting the general condition (multiple organ failure, chronic heart and renal insufficiency, pemphigoid, etc) and conditions with increased risk of aspiration (sequelae of cerebrovascular disease, Alzheimer's disease, advanced stage of nasopharyngeal carcinoma, paralytic ileus, etc). The 12 cases were all caused by Inhalation of mineral oil. Common symptoms included cough, sputum production and dyspnea. ELP had no special physical signs. Inflammation indexes, such as white blood cell, neutrophil percentage, ESR, C reactive protein, procalcitonin, D-Dimer, and blood lipid levels were usually normal. Radiological features of ELP mainly included consolidation, mass or nodules, with a little ground-glass opacity. Some patients had ventilation and/or diffusion dysfunction. The diagnostic methods included CT-guided percutaneous lung biopsy, thoracoscopy, thoracotomy or autopsy. Histopathological findings showed accumulation of large foamy macrophages in the alveolar spaces, with a few lipid deposition and polykaryocytes. The main treatment of ELP was cessation of lipid material contact. One case died of ELP, 6 died of other coexisting diseases, and the rest 6 improved with treatment and were discharged. The survival patients were all stable during a follow-up of 2-4.5 years. Conclusions: ELP was rare and its clinical manifestation was atypical. Its radiological manifestations were indistinguishable from pneumonia, lung cancer, interstitial lung diseases, etc. Pathological examination was the gold standard for diagnosis, and the preferred means of sampling was bronchoscopy. In cases whose diagnosis could not be confirmed by BALF, CT-guided percutaneous lung biopsy might be considered. The most important treatment is cessation of lipid material contact. The prognosis is good.

[Association between OR2T3 gene and pulmonary arterial hypertension].

OBJECTIVE: To explore the pathogenic genes of pulmonary arterial hypertension (PAH) and validate the association between OR2T3 gene and PAH. METHODS: Whole exome sequencing was performed in four patients and one healthy person as control in two pulmonary arterial hypertension pedigree; patient-specific variations were screened by bioinformatics methods and comparison between groups. To further analyze the association between these variations and PAH, Sanger sequencing was used to analyze the genotype of patient-specific variations of 30 patients with idiopathic PAH, 90 healthy people and 30 patients with chronic thromboembolic pulmonary hypertension. RESULTS: The preliminary findings of whole exome sequencing were 57 variations may be associated with PAH; Among them, there were 6 AG heterozygotes due to OR2T3rs148748995 in the 30 idiopathic PAH patients, while no G allele carrier was found in other healthy people of two pulmonary arterial hypertension pedigree (AⅠ-1, AⅡ-3, BⅡ-1) and 90 normal control, and the difference was statistically significant (P<0.05). The variation also didn't exist in 30 chronic thromboembolic pulmonary hypertension patients. CONCLUSION: OR2T3 gene may be the pathogenic gene of PAH and OR2T3rs148748995 could have a role in the development of PAH.