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Objective:To explore the relationship between the imaging features of enhanced MRI in patients with central chronic pulmonary artery thromboembolism (CPTE) and pulmonary vascular resistance (PVR).Methods:Thirty-nine patients with CPTE who had contrast-enhanced MRI examination were retrospectively enrolled this study from January 2018 to December 2020. And 33 patients who received right heart catheterization were divided into two groups based on PVR=1 000 dyn·s·cm -5. The differences of imaging features of CPTE in enhanced MRI between the two groups were compared. The relationship between gender, duration of disease, age, pleural thickening, bilateral bronchial artery dilation, number of the involved vascular segments, number of thrombosis, number of the thrombus-related delayed enhancement of artery wall and PVR was analyzed by binary logistic regression. Results:In 39 patients with central CPTE, the dilated lumen (168, 43.30%) and delayed enhancement of wall (122, 31.52%) were found in most of pulmonary arteries. The rate of the lumen dilatation associated with thrombus was the highest among that of the lumen abnormality (66, 52.80%). There were more thrombi in PVR<1 000 dyn·s·cm -5 group than those in PVR≥1 000 dyn·s·cm -5 group (χ 2=9.55, P=0.002). There was no significant difference in the incidence of wall delayed enhancement associated the thrombus between the two groups (χ 2=0.90, P=0.344). The incidence of bilateral bronchial arterial dilatation in PVR<1 000 dyn·s·cm -5 group was higher than that in PVR≥1 000 dyn·s·cm -5 group ( P=0.019). Logistic regression analysis showed that female, the less number of involved vascular segments and bilateral bronchial artery dilation were correlated with the lower PVR. Conclusions:Enhanced MRI is helpful to accurately evaluate the lumen abnormality of pulmonary artery and wall remodeling in central CPTE, which is of great value for the assessment of patients′ conditions and treatment effect.
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The clinical data of 4 patients with atypical neurosyphilis (NS) mimicking viral encephalitis (VE) admitted to Beijing Ditan Hospital from July 2015 to January 2020 were retrospectively analyzed. All the 4 patients were males with an average age of (43±8) years. The patients manifested with mental and behavior disorders and cognitive impairment. Three patients had epilepsy and 1 patient had fever. The treponemal pallidum particle agglutination (TPPA) , fluorescent treponemal antibody-absorption test (FTA-ABS) -IgG and toluidine red unheated serum test (TRUST) were all positive in blood and the cerebral spinal fluid (CSF) , and white blood cell count and protein level in CSF were all evaluated. The head MRIs were all abnormal, 3 of which showed hyperintensity in fluid attenuated inversion recovery (FLAIR) and T2-weighted image located in limbic system and 1 showed hyperintensity in the bilateral cortex and the subcortical areas. All patients improved evidently and the lesions became smaller after penicillin treatment. Atypical NS mimicking VE is rare, and at early diagnosis and timely treatments can contribute to a good clinical prognosis.
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Purpose To investigate the expression and clinical significance of free fatty acid receptor 4 (FFAR4) in hepatocellular carcinoma (HCC) . Methods The expression of FFAR4 in HCC tissues and adjacent tissues of HCC patients was confirmed by 102 cases of liver resection and postoperative pathology, and the relationship between FFAR4 expression and clinical data of HCC patients was analyzed. Quantitative realtime PCR (qRT-PCR) and Western blot were used to detect the expression of FFAR4 in 20 pairs of freshly frozen HCC and adjacent tissues,and the related literatures were reviewed. Results The expression rate of FFAR4 in HCC tissues was 64. 7％ (66/102) ,and that in adjacent tissues was 15. 7％ (16/102) . The difference in FFAR4 expression between the two groups was statistically significant (P < 0. 05) . The high expression of FFAR4 in HCC tissues was significantly correlated with tumor vascular invasion (P < 0. 05) ,TNM stage (P < 0. 01) ,and Edmondson classification (P < 0. 05) . qRT-PCR and Western blot showed that the expression of FFAR4 in HCC tissues was significantly higher than that in adjacent tissues. The difference between the two groups was statistically significant (P < 0. 01,P< 0. 05) . Conclusion The expression of FFAR4 is significantly associated with the presence of vascular invasion,TNM staging, and Edmondson grading in HCC. High expression of FFAR4 may be closely related to the severity of HCC patients.
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Objective To compare the blood flow characteristics of the proximal pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH) by 3.0T PC-MRI. Methods Twenty seven patients with pulmonary arterial hypertension (7 IPAH patients and 20 CTEPH patients) were prospectively included. Twenty healthy volunteers were enrolled as the control group. All subjects underwent PC-MRI. PC-MRI derived parameters included peak, mean velocity and mean flow of main pulmonary artery (MPA), left/right pulmonary artery (LPA/RPA), left/right interlobar pulmonary artery (LIPA/RIPA). Right heart catheterization was performed in patients with pulmonary arterial hypertension. The parameters among CTEPH, IPAH group and control group were compared by one way analysis of variance. Results There were significant differences for peak velocity, mean velocity and mean flow among CTEPH, IPAH group and control group (F=4.13—102.81, all P<0.05). There was significant difference for peak velocity in RPA between CTEPH[(32.0 ± 7.8)cm/s] and IPAH group[(50.0±15.0)cm/s]. There was no difference for mean velocity between CTEPH and IPAH group. The mean flow between CTEPH and IPAH group was statistically different[MPA: (74.3 ± 20.8) ml/s versus (61.3±16.7) ml/s, LPA:(29.3±12.7) ml/s versus (23.2±11.2) ml/s, RPA:(43.5±17.4) ml/s versus (56.8±13.5) ml/s, LIPA: (19.2 ± 8.0) ml/s versus (12.1 ± 5.8) ml/s, all P<0.05]. Conclusion There is significantly different characteristics for the hemodynamics of the proximal pulmonary arteries between CTEPH group and IPAH group. 3.0T PC-MRI may effectively detect the pulmonary hemodynamic changes.
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<p><b>BACKGROUND</b>Inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is a severe clinical syndrome characterized by right cardiac failure and possibly subsequent liver dysfunction. However, whether serum markers of liver dysfunction can predict prognosis in inoperable CTEPH patients has not been determined. Our study aimed to evaluate the potential role of liver function markers (such as serum levels of transaminase, bilirubin, and gamma-glutamyl transpeptidase [GGT]) combined with 6-min walk test in the prediction of prognosis in patients with inoperable CTEPH.</p><p><b>METHODS</b>From June 2005 to May 2013, 77 consecutive patients with inoperable CTEPH without confounding co-morbidities were recruited for this prospective cohort study. Baseline clinical characteristics and 6-min walk distance (6MWD) results were collected. Serum biomarkers of liver function, including levels of aspartate aminotransferase, alanine aminotransferase, GGT, uric acid, and serum bilirubin, were also determined at enrollment. All-cause mortality was recorded during the follow-up period.</p><p><b>RESULTS</b>During the follow-up, 22 patients (29%) died. Cox regression analyses demonstrated that increased serum concentration of total bilirubin (hazard ratio [HR] = 7.755, P < 0.001), elevated N-terminal of the prohormone brain natriuretic peptide (HR = 1.001, P = 0.001), decreased 6MWD (HR = 0.990, P < 0.001), increased central venous pressure (HR = 1.074, P = 0.040), and higher pulmonary vascular resistance (HR = 1.001, P = 0.018) were associated with an increased risk of mortality. Serum concentrations of total bilirubin (HR = 4.755, P = 0.007) and 6MWD (HR = 0.994, P = 0.017) were independent prognostic predictors for CTEPH patients. Patients with hyperbilirubinemia (≥23.7 μmol/L) had markedly worse survival than those with normobilirubinemia.</p><p><b>CONCLUSION</b>Elevated serum bilirubin and decreased 6MWD are potential predictors for poor prognosis in inoperable CTEPH.</p>