ACV isquémico debido a embolia paradojal a través de malformación arteriovenosa pulmonar en paciente joven / Ischemic stroke due to paradoxical embolism through pulmonary arteriovenous malformation in a young patient

Resumen La embolia paradojal debido a una malformación arteriovenosa pulmonar (MAVP) aislada es una causa in frecuente de accidente cerebrovascular (ACV) isquémico. Las MAVP son conductos anómalos de alta circulación entre arterias y venas pulmonares, desviando sangre desoxigenada hacia la circulación sistémica y represen tan una fuente menos común de embolias paradojales, especialmente en personas jóvenes. La embolización endovascular es el tratamiento preferido para MAVP clínicamente significativas. Presentamos el caso de una mujer de 34 años con ACV isquémico talámico izquierdo. Se detectó pasaje de burbujas "en cortina" en arterias cerebrales mediante Doppler transcraneal. En ecografía intracardíaca no se encontró foramen oval permeable, motivo por el cual se avanzó con realización de angiotomografía pulmonar, la cual confirmó la presencia de MAVP. La paciente recibió tratamiento endovascular exitoso. Es esencial considerar la MAVP en el diagnóstico etio lógico del ACV isquémico, especialmente en pacientes jóvenes con signos de comunicación anormal de derecha a izquierda. Se recomienda un seguimiento periódico mediante imágenes para evaluar la posible recurrencia o cambios en la MAVP, resaltando la importancia del manejo adecuado de estas malformaciones.

Abstract Paradoxical embolism due to an isolated pulmonary arteriovenous malformation (PAVM) is a rare cause of ischemic stroke. PAVMs are abnormal high-flow connec tions between pulmonary arteries and veins, diverting deoxygenated blood into the systemic circulation and they represent a less common source of paradoxical embolisms, especially in young individuals. Endovascular embolization is the preferred treatment for clinically significant PAVMs. We present the case of a 34-year-old woman with a left thalamic ischemic stroke. Severe contrast passage was detected in cerebral arteries through transcranial Doppler. Intracardiac ultrasound did not reveal a patent foramen ovale, prompting further investigation with pulmonary CT angiography, confirming the presence of PAVM. The patient underwent successful endovascular treatment. It is essential to consider PAVM in the etiological di agnosis of ischemic stroke, especially in young patients with signs of abnormal right-to-left communication. Periodic follow-up imaging is recommended to assess potential recurrence or changes in PAVM, emphasizing the importance of appropriate management of these malformations.

Síndrome antifosfolipídico trombótico en una mujer con enfermedad mixta del tejido conectivo. Reporte de caso / Thrombotic antiphospholipid syndrome in a woman with mixed connective tissue disease. Case report

Introducción: El síndrome de anticuerpos antifosfolípidos es una enfermedad au-toinmune sistémica poco frecuente, produce hipercoagulabilidad con riesgo de trombosis. Para el diagnóstico se utilizan los criterios ACR/EULAR APS del 2023. El tratamiento es anticoagulantes y antiagregantes plaquetarios. La enfermedad mixta del tejido conectivo es enfermedad autoinmunitaria sistémica con la asociación de manifestaciones clínicas de otras entidades autoinmunes. Objetivo:Describir la presentación de dos enfermedades sistémicas autoinmunes poco frecuentes en conjunto, con el propósito de contribuir con un enfoque prác-tico para el diagnóstico y manejo. Presentación del caso: Se describe una paciente de 37 años que presentó un episodio de tromboembolia pulmonar secundario a síndrome de anticuerpos anti-fosfolípidos y en los 6 meses previos tuvo síntomas compatibles con enfermedad mixta del tejido conectivo. Discusión: La presencia de dos entidades autoinmunes, síndrome de anticuerpos antifosfolípidos y enfermedad mixta del tejido conectivo presentadas en conjunto y cuyo debut de complicaciones fue una tromboembolia pulmonar, encontrándo-se presencia de múltiples autoanticuerpos positivos entre estas anticuerpos an-tifosfolipídicos y anti-U1 snRNP, es un reto diagnóstico al diferenciar entre otras enfermedades del tejido conectivo como lupus eritematoso sistémico, esclerosis sistémica cutánea, enfermedad mixta del tejido conectivo y artritis reumatoide. El tratamiento se basó en las características del paciente y su condición clínica al momento del diagnóstico. Conclusiones: El síndrome de anticuerpos antifosfolipídicos conlleva la presencia de un episodio trombótico, por otro lado, su asociación con una enfermedad mixta del tejido conectivo es poco frecuente y puede aumentar su morbimortalidad.

Introduction: Antiphospholipid antibody syndrome is a rare systemic autoimmu-ne disease that produces Antiphospholipid antibody syndrome is a rare systemic autoimmune disease that causes hypercoagulability with risk of thrombosis. For diagnosis, the ACR/EULAR APS 2023 criteria are used. Treatment is anticoagulants and antiplatelet agents.Mixed connective tissue disease is a systemic autoimmune disease with the asso-ciation of clinical manifestations of other autoimmune entities.Objective:To describe the presentation of two rare autoimmune systemic diseases toge-ther, with the purpose of contributing a practical approach to diagnosis and management.Case presentation: 37-year-old patient with an episode of pulmonary thromboem-bolism secondary to antiphospholipid antibody syndrome and in the previous 6 months he had symptoms compatible with mixed connective tissue disease.Discussion:The presence of two autoimmune entities, antiphospholipid antibody syndrome and mixed connective tissue disease presented together and whose de-but of complications was a pulmonary thromboembolism, finding the presence of multiple positive autoantibodies between these antiphospholipid antibodies and an-ti-U1 snRNP, is a diagnostic challenge in differentiating between other connective tissue diseases such as systemic lupus erythematosus, cutaneous systemic sclero-sis, mixed connective tissue disease and rheumatoid arthritis. Treatment was based on the patient's characteristics and clinical condition at the time of diagnosis.Conclusions: Antiphospholipid antibody syndrome entails the presence of a thrombotic episode; on the other hand, its association with a mixed connective tissue disease is rare and may increase its morbidity and mortality.

Isquemia intestinal, una manifestación inusual de la embolia paradójica. Un reporte de caso / Intestinal ischaemia as a rare manifestation of a paradoxical embolism. A case report

Introducción. La embolia paradójica es un evento trombótico originado en la circulación venosa, que se manifiesta como embolismo arterial por medio de un defecto anatómico a nivel cardíaco o pulmonar. Se asocia principalmente a eventos cerebrovasculares, aunque se han encontrado casos de infarto agudo de miocardio, infarto renal y otros eventos isquémicos. Caso clínico. Paciente de 47 años, quien consultó por cuadro de dolor abdominal, que requirió manejo quirúrgico de urgencia, donde identificaron isquemia intestinal importante. Los estudios adicionales hallaron déficit de proteína S y persistencia de foramen oval permeable. Resultados. La presencia de trombosis arterial se conoce como trombosis de sitios inusuales y requiere de estudios para descartar trombofilias asociadas u otros estados protrombóticos. El déficit de proteína S es una trombofilia infrecuente, la cual se asocia en la vida adulta a eventos trombóticos de origen venoso. En presencia de defectos anatómicos, como un foramen oval permeable, puede progresar a embolia arterial, configurando un cuadro de embolismo paradójico. La estratificación de estos pacientes requiere imágenes que demuestran el defecto mencionado, así como el posible origen de los émbolos. El manejo se basa en anticoagulación plena, manejo de soporte, resolver las manifestaciones trombóticas existentes y un cierre temprano del defecto anatómico. Conclusiones. El embolismo paradójico debe sospecharse en caso de trombosis de sitios inusuales. Requiere de un estudio exhaustivo con imágenes y su manejo debe basarse en anticoagulación y cierre del defecto.

Introduction. Paradoxical embolism is a thrombotic event originating in the venous circulation, which manifests as arterial embolism through an anatomical cardiac or pulmonary defect. It is mainly associated with stroke, also presenting as acute myocardial infarction, renal infarction, and other ischemic events. Clinical case. A 47-year-old patient was admitted due to abdominal pain, which required emergency surgical management, finding significant intestinal ischemia. Additional studies found protein S deficiency and evidence of a patent foramen ovale. Discussion. Arterial thrombosis is known as unusual thrombosis; this situation requires to rule out associated thrombophilia or other prothrombotic diseases. Protein S deficiency is a rare thrombophilia, which in adults causes venous thrombosis. In the presence of anatomical defects, such as a patent foramen ovale, it can progress to arterial embolism, presenting a picture of paradoxical embolism. The study work of these patients requires imaging that demonstrates the aforementioned defect, as well as the possible origin of the emboli. Management is based on full anticoagulation, treatment of existing thrombotic manifestations, and management of the anatomical defect. Conclusions. Paradoxical embolism should be suspected in case of unusual thrombosis. It requires exhaustive studies based on imaging, and management should consist of anticoagulation and closure of the defect.

Evaluation of Pan-Immuno-Inflammation Value for In-Hospital Mortality in Acute Pulmonary Embolism Patients

ABSTRACT Background: Pan-immuno-inflammation value is a new and comprehensive index that reflects both the immune response and systemic inflammation in the body. Objective: The aim of this study was to investigate the prognostic relevance of pan-immuno-inflammation value in predicting in-hospital mortality in acute pulmonary embolism patients and to compare it with the well-known risk scoring system, pulmonay embolism severity index, which is commonly used for a short-term mortality prediction in such patients. Methods: In total, 373 acute pulmonary embolism patients diagnosed with contrast-enhanced computed tomography were included in the study. Detailed cardiac evaluation of each patient was performed and pulmonary embolism severity index and pan-immuno-inflammation value were calculated. Results: In total, 60 patients died during their hospital stay. The multivariable logistic regression analysis revealed that baseline heart rate, N-terminal pro-B-type natriuretic peptide, lactate dehydrogenase, pan-immuno-inflammation value, and pulmonary embolism severity index were independent risk factors for in-hospital mortality in acute pulmonay embolism patients. When comparing with pulmonary embolism severity index, pan-immuno-inflammation value was non-inferior in terms of predicting the survival status in patients with acute pulmonay embolism. Conclusion: In our study, we found that the PIV was statistically significant in predicting in-hospital mortality in acute pulmonay embolism patients and was non-inferior to the pulmonary embolism severity index. (Rev Invest Clin. 2024;76(2):97-102)

Caracterización clínico-epidemiológica de pacientes con un primer evento de fibrilación auricular

Fundamento: Pese a la importancia del primer evento de fibrilación auricular como una de las urgencias médicas más tratadas, en Cienfuegos, son insuficientes los estudios en los que se describan las características clínico-epidemiológicas de estos pacientes. Objetivo: Caracterizar clínica y epidemiológicamente los pacientes con primer evento de fibrilación auricular en Cienfuegos entre los años 2020-2022. Método: Se realizó un estudio descriptivo y transversal. El universo estuvo conformado por 54 pacientes con diagnóstico de primer evento de fibrilación auricular ingresados en el Servicio de Cardiología del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos entre los años 2020-2022. Las variables estudiadas fueron: edad, sexo, color de la piel, hábitos tóxicos, antecedentes patológicos personales, manifestaciones clínicas, parámetros ecocardiográficos y tratamiento. Se calcularon la frecuencia absoluta y relativa de las variables. Los resultados se presentaron en tablas. Resultados: Predominó el sexo masculino, el grupo etáreo de 36-55 años, el color de piel blanca, y el tabaquismo. Los antecedentes patológicos personales más frecuentes fueron: la hipertensión arterial (74,1 %), la diabetes mellitus tipo 2 (16,7 %) y las valvulopatías (11,1 %). Las manifestaciones clínicas más frecuentes fueron: las palpitaciones (77,8 %), seguidas de la disnea (12,9 %). Los parámetros ecocardiográficos estuvieron en el rango de la normalidad. El tratamiento farmacológico se aplicó al 68,5 % seguido de cardioversión farmacológica y eléctrica en el 16,7 %. Conclusiones: El mayor número de pacientes con primer evento de fibrilación auricular, tienen un corazón estructuralmente sano, por lo que se considera de vital importancia la prevención de recurrencias, esto evitará la creación de condiciones eléctricas y anatómicas que perpetúen la arritmia.

Foundation: Despite the importance of the first event of atrial fibrillation as one of the most treated medical emergencies, in Cienfuegos, there are insufficient studies describing the clinical-epidemiological characteristics of these patients. Objective: To clinically and epidemiologically characterize patients with the first event of atrial fibrillation in Cienfuegos between the years 2020-2022. Method: A descriptive and cross-sectional study was carried out. The universe was made up of 54 patients diagnosed with a first event of atrial fibrillation admitted to the Cardiology Service of the Dr. Gustavo Aldereguía Lima General University Hospital in Cienfuegos between the years 2020-2022. The variables studied were: age, sex, skin color, toxic habits, personal pathological history, clinical manifestations, echocardiographic parameters and treatment. The absolute and relative frequencies of the variables were calculated. The results were presented in tables. Results: The male sex, the age group of 36-55 years, white skin color, and smoking predominated. The most common personal pathological history was: high blood pressure (74.1%), type 2 diabetes mellitus (16.7%) and valvular heart disease (11.1%). The most frequent clinical manifestations were: palpitations (77.8%), followed by dyspnea (12.9%). Echocardiographic parameters were within the normal range. Pharmacological treatment was applied to 68.5% followed by pharmacological and electrical cardioversion in 16.7%. Conclusions: The largest number of patients with a first event of atrial fibrillation have a structurally healthy heart, so the prevention of recurrences is considered of vital importance, this will avoid the creation of electrical and anatomical conditions that perpetuate the arrhythmia.

Embolismo por metacrilato luego de vertebroplastia percutánea. ¿Podemos mejorar la seguridad del paciente? / Methacrylate embolism after percutaneous vertebroplasty. Can we improve patient safety?

Se presenta un caso de embolismo pulmonar luego de vertebroplastia, realizada por fractura vertebral por osteoporosis. El embolismo se confirmó por métodos complementarios. Se sugiere atención a los síntomas respiratorios y radiografía de tórax posterior a la vertobroplastia a los efectos de mejorar la seguridad del paciente luego del procedimiento

A case of pulmonary embolism is presented after vertebroplasty, performed for a vertebral fracture due to osteoporosis. Embolism was confirmed by complementary methods. Attention to respiratory symptoms and a chest x-ray after vertobroplasty are suggested in order to improve patient safety after the procedure.

Treatment of gastric varices with cyanoacrylate complicated by systemic embolization / Tratamiento de várices gástricas con cianoacrilato complicado con embolización sistémica

ABSTRACT Acute gastric variceal bleeding is a life-threatening condition that could be effectively treated with endoscopic cyanoacrylate injection diluted with lipiodol. The mixture acts as a tissue adhesive that polymerizes when in contact with blood in a gastric varix. This work reports a patient that presented to the emergency department with upper gastrointestinal bleeding due to acute variceal bleeding, who developed systemic embolization following cyanoacrylate injection therapy. This complication culminated in cerebral, splenic and renal infarctions with a fatal outcome. Systemic embolization is a very rare, but the most severe complication associated with endoscopic cyanoacrylate injection and should be considered in patients undergoing this treatment.

RESUMEN La hemorragia digestiva por várices gástricas es una afección potencialmente mortal que puede tratarse eficazmente con la inyección endoscópica de cianoacrilato diluida con lipiodol. La mezcla actúa como un adhesivo tisular que se polimeriza cuando entra en contacto con la sangre de la várice gástrica. Este trabajo nos reporta un paciente que acudió al servicio de urgencias con hemorragia digestiva alta debido a hemorragia aguda por várices, que desarrolló embolización sistémica después de la terapia con inyección de cianoacrilato. Esta complicación culminó en infartos cerebrales, esplénicos y renales con desenlace fatal. La embolización sistémica es una complicación muy rara, pero con alta mortalidad, asociada con la inyección endoscópica de cianoacrilato y debe considerarse en pacientes sometidos a este tratamiento.

Embolismo por metacrilato luego de vertebroplastia percutánea / Methacrylate embolism after percutaneous vertebroplasty

Resumen Se presenta un caso de embolismo pulmonar luego de vertebroplastia, realizada por fractura vertebral por osteoporosis. El embolismo se confirmó por métodos complementarios. Se sugiere atención a los síntomas respiratorios y radiografía de tórax posterior a la vertobroplastia a los efectos de mejorar la seguridad del paciente luego del procedimiento.

Abstract A case of pulmonary embolism is presented after vertebroplasty, performed for a vertebral fracture due to osteoporosis. Embolism was confirmed by complementary methods. Attention to respiratory symptoms and a chest x-ray after vertobroplasty are suggested in order to improve patient safety after the procedure.

Embolia cerebral paradójica por foramen oval temporal como complicación de tromboembolismo pulmonar masivo: reporte de caso / Paradoxical cerebral embolism due to transiently patent foramen ovale as a complication of massive pulmonary thromboembolism: Case Report

RESUMEN La embolia cerebral paradójica siempre requiere la presencia de foramen oval; en nuestro caso, este evento sucedió por un fenómeno temporal, el cual fue la sobrecarga aguda de las cavidades derechas y la apertura del foramen oval debido al aumento de presiones como consecuencia de un tromboembolismo pulmonar masivo. Luego de una artroscopía, nuestra paciente presentó pérdida del campo visual y disnea, esta última progresiva, hasta llegar a la ventilación mecánica y shock obstructivo grave. Se realizó una angiotomografía, la cual evidenció un trombo obstructivo en la arterial pulmonar derecha; la paciente fue trombolizada con éxito y fue dada de alta de la unidad de cuidados intensivos después de 45 días. Finalmente se le diagnosticó una deficiencia de proteína C y se inició anticoagulación de manera permanente. La presencia de déficit motor y disnea en una paciente post-cirugía de rodilla, debe hacer sospechar de una tromboembolia pulmonar, la trombólisis sigue siendo el tratamiento de elección, su indicación debe ser precoz.

ABSTRACT Paradoxical cerebral embolism always requires the presence of a patent foramen ovale (PFO); in our case, this event occurred due to a transient phenomenon, which was the acute overload of the right heart chambers and the opening of the PFO due to increased pressures as a consequence of massive pulmonary thromboembolism. After undergoing arthroscopy, this patient presented with visual field loss and progressive dyspnea, ultimately leading to mechanical ventilation and severe obstructive shock. An angiotomography was performed, revealing an obstructive thrombus in the right pulmonary artery. The patient successfully underwent thrombolysis, and she was discharged from the intensive care unit after 45 days. Ultimately, protein C deficiency was diagnosed, and permanent anticoagulation was initiated. The presence of motor deficit and dyspnea in a post-knee surgery patient should raise suspicion of pulmonary thromboembolism. Thrombolysis remains the treatment of choice, and it should be timely prescribed and performed.

Predictive Value of NLR,PLR and sPESI Score for 30-day Mortality in Patients with Acute Pulmonary Embolism / 医学研究杂志

Objective To investigate the predictive value of neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),and the simplified pulmonary embolism index(sPESI)score for 30-day death in patients with acute pulmonary embolism(APE).Methods The clinical data of 291 APE patients admitted to Xuanwu Hospital of Capital Medical University from January 2017 to December 2021 were retrospectively analyzed.White blood cell count(WBC),NLR,PLR,sPESI score,and other indicators were calculated at admission.The patients were followed up within 30 days and were divided into the death group and the survival group accord-ing to the prognosis.The differences in the above indexes between the two groups were compared.Multivariate Logistic regression was used to analyze the independent risk factors for 30-day mortality in APE patients.The area under the receiver operating characteristic(ROC)curve of NLR,PLR,and combined sPESI scores in predicting mortality was compared.Results Among the APE patients,11 cases(3.78％)died and 280 cases(96.22％)survived within 30 days.The WBC,NLR,PLR,and sPESI score in the death group were sig-nificantly higher than those in the survival group(P＜0.05).Multivariate Logistic regression analysis showed that PLR,NLR,and sPESI score were independent risk factors for 30-day mortality in APE patients(P＜0.05).The area under ROC curve(AUC)of PLR in pre-dicting the 30-day death of APE patients was 0.799(P=0.001).The AUC of NLR was 0.827(P=0.001).The AUC of sPESI score was 0.874(P=0.001).There was no significant difference in the AUC of PLR,NLR,and sPESI score in predicting death(P=0.181,0.340);the AUC of NLR combined with sPESI score was 0.925(P=0.001),which was greater than that of NLR(P=0.004).The AUC of PLR combined with sPESI score was 0.901(P=0.001),which was greater than that of PLR(P=0.002).Conclusion NLR,PLR,and sPESI score are independent risk factors for 30-day mortality in APE patients,and all of them have certain prognostic values.The prognostic value of PLR and NLR combined with sPESI score was higher than that of PLR and NLR alone.

Transcatheter thrombectomy combined with catheter-directed thrombolysis for treating acute medium-high and high risk pulmonary thromboembolism / 中国介入影像与治疗学

Objective To observe the effect of transcatheter thrombectomy combined with catheter-directed thrombolysis(CDT)for treating acute medium-high and high risk pulmonary thromboembolism(PTE).Methods After placement of inferior vena cava filter,transcatheter thrombectomy combined with CDT were performed in 28 patients with acute medium-high or high risk PTE.After treatment,clinical symptoms improved or not was assessed,and interventional related complications were recorded.The outcomes of arterial blood gas analysis,coagulation function,blood routine test,pulmonary artery pressure(PAP)and right ventricular diameter/left ventricular diameter(RV/LV)were compared before and 72 h after treatment.Regular follow-up was performed,then PAP and the clearance of pulmonary arterial thrombosis were observed 1,3,6 months and 1 year after treatment during follow-up.Results Among 28 cases,significant improvement of clinical symptoms achieved in 26 cases after treatment,while 2 patients died of respiratory failure.Puncture site bleeding occurred in 4 cases and improved after conservative treatment.Compared with those before treatment,among 26 survived patients,blood pH,arterial oxygen pressure,fibrin degradation products and D-dimer increased while the heart rate,N-terminal pro-B-type natriuretic peptide,PAP and RV/LV decreased 72 h after treatment(all P＜0.05).During follow-up,compared with those before treatment,PAP decreased,while the clearance rate of pulmonary thrombosis increased 1,3,6 months and 1 year after treatment(all P＜0.05).No active bleeding nor recurrence of PTE happened.Conclusion Transcatheter thrombectomy combined with CDT was safe and effective for treating acute medium-high and high risk PTE.

Comparison on accuracy of bedside lung ultrasound in emergency and combined cardiac-lung and additional ultrasound for diagnosing causes of acute dyspnea / 中国介入影像与治疗学

Objective To compare the accuracy of bedside lung ultrasound in emergency(BLUE)and combined cardiac-lung and additional ultrasound(CLAUS)for diagnosing the causes of acute dyspnea.Methods Totally 1 016 patients with acute dyspnea were retrospectively enrolled and divided into cardiogenic pulmonary edema group(n=268),pneumonia group(n=574),pneumothorax group(n=33),pulmonary embolism group(n=67)and CAD(chronic obstructive pulmonary disease/asthma/diaphragmatic dysfunction)group(n=74)according to the causes of acute dyspnea.The findings of CLAUS protocol were compared among groups,and the accuracy of BLUE and CLAUS protocol for diagnosing the causes of acute dyspnea were also compared.Results CLAUS showed that B-B and B-C were the most common modes in cardiogenic pulmonary edema group,while A-B/A-C/B-A/B-B/B-C/C-C modes were common in pneumonia group,and A-A mode was the most common in pneumothorax group,pulmonary embolism group and CAD group.Significant differences of the manifestations of pulmonary ultrasound,pleural feature of anterior chest wall,left/right cardiac insufficiency and abnormal inferior vena cava diameter were found among groups(all P＜0.05).The accuracy of BLUE and CLAUS protocol for diagnosing the causes of acute dyspnea was 86.91%(883/1 016)and 94.49%(960/1 016),respectively,the latter was higher than the former(χ2=34.587,P＜0.05).Conclusion CLAUS protocol could be used to effectively diagnose the causes of acute dyspnea,with higher accuracy than BLUE protocol.

Characteristics and Diagnostic Value of Ventricular Blood Pool T2 Map in Chronic Thromboembolic Pulmonary Hypertension / 中国医学影像学杂志

Purpose To observe the right ventricle and left ventricle blood pool T2 map in chronic thromboembolic pulmonary hypertension(CTEPH)and healthy controls,and to analyze the value of T2 mapping technique in evaluating CTEPH.Materials and Methods A total of 42 patients with CTEPH and 42 healthy volunteers had been prospectively recruited from January 2020 to January 2022 in China-Japan Friendship Hospital.All CTEPH patients underwent cardiac magnetic resonance with T2 mapping and right heart catheterization.Cardiac magnetic resonance was performed on healthy controls.Diastolic T2 mapping was performed in cardiac magnetic resonance,and then the ratio of right ventricular to left ventricular T2 values(RVT2/LVT2)between the CTEPH group and the healthy group was calculated and compared.Meanwhile,the correlation between RVT2/LVT2 and hemodynamic parameters in the CTEPH group was analyzed.Results RVT2/LVT2 in the CTEPH group was significantly lower than that in the healthy group(0.74±0.16 vs.0.86±0.12;t=3.673,P<0.001).RVT2/LVT2 in CTEPH group was negatively correlated with pulmonary vascular resistance(r=-0.534,P<0.001);while it was positively correlated with cardiac index,right atrium oxygen saturation,right ventricle oxygen saturation and pulmonary arteries oxygen saturation(r=0.600,0.603,0.648,0.582,P<0.001).Conclusion RVT2/LVT2 in the CTEPH group is positively correlated with right cardiac oxygen saturation and negatively correlated with pulmonary vascular resistance.T2 mapping may be a noninvasive evaluation of hemodynamics in CTEPH.

Study on the clinical application of pre-breathing mode in double-low imaging of 320-slices CT for pulmonary artery / 中国医学装备

Objective:To explore the clinical application value of pre-breathing mode in double-low imaging of 320-slices computed tomography(CT)for pulmonary artery.Methods:A total of 100 patients who underwent CT pulmonary angiography(CTPA)for suspected pulmonary embolism(PE)in Liuzhou People's Hospital from July 2021 to September 2022 were prospectively selected as the research subjects and they were randomly divided into observation group and control group,with 50 cases in each group.The patients of the control group adopted conventional breathing mode(the breathing password was activated after reaching the threshold,and the scan was triggered after 6 s),while the patients of the observation group adopted the pre-breathing mode(the breathing password was activated after 1 or 2 seconds,and the scan was triggered after reaching the threshold).Both two groups adopted double low-technique scan of 320 slices CT.The differences in delay time,radiation dose,the points of subjective and objective image quality,and other indicators were compared between the two groups.Results:The volume CT dose index(CTDIvol),dose length product(DLP),effective dose(ED)and delay time of the observation group were significantly lower than those of the control group(t=76.230,30.225,12.282,7.088,P<0.05),respectively.The comparison of the subjective points of image qualities between the two groups indicated that there were 25 cases with 5 points,23 cases with 4 points and 2 cases with 3 points in the observation group,and there were 21 cases with 5 points,26 cases with 4 points and 3 cases with 3 points in the control group.There was no significant difference in the averagely subjective points of image qualities between two groups(P>0.05).The signal-to-noise ratio(SNR)and signal to noise ratio(CNR)of the observation group were significantly lower than those of the control group,and the noise level(SD)of the observation group was significantly higher than that of the control group(t=25.441,23.886、11.426,P<0.05),respectively.The CT values of the artery trunk of right pulmonary,artery branch of right pulmonary,artery trunk of left pulmonary and artery branch of left pulmonary in the observation group were significantly higher than those in the control group(t=2.256,2.225,2.042,2.277,P<0.05),respectively.Conclusion:The pre-breathing mode can effectively improve CTPA image quality,and reduce radiation dose and the dosage of contrast agent,which clinical application effect is significant.It is worth learning.

Aspirin for thromboprophylaxis in orthopedic surgery: advancements in clinical evidence and guidelines / 中华创伤骨科杂志

As patients undergoing orthopedic surgery are a high-risk group for venous thromboembolism (VTE), clinical guidelines suggest anticoagulant drugs for VTE prophylaxis during perioperative period. Global antithrombotic guidelines vary in recommendations for anticoagulant drugs, but there is a general consensus in favor of using low-molecular-weight heparin (LMWH) as the first choice for prophylaxis, followed by unfractionated heparin, fondaparinux, warfarin, aspirin, and other direct oral anticoagulants (DOACs). Of them, aspirin is an inexpensive, widely used antiplatelet drug with limited complications and clear efficacy in prevention of myocardial infarction, stroke, and certain specific cancers. It was also used early for venous thromboembolism prophylaxis in orthopedic patients after surgery. Clinical experience of orthopedic physicians in North America has shown the effectiveness of aspirin in VTE prevention over several decades so that aspirin continues to be used to this day, but its use for VTE prophylaxis is less common in Europe and Asia. Historically, the role and efficacy of aspirin in VTE prevention have been the subjects of considerable controversy, for the early and recent research findings contradict each other, and recommendations conflict in different guidelines. This review focuses on the advancements in clinical evidence and guideline recommendations regarding the use of aspirin for VTE prophylaxis in major orthopedic surgeries.

Embolic stroke of undetermined source: knowledge validated and refuted in the past 10 years / 中华神经科杂志

Embolic stroke of undetermined source (ESUS) is a concept proposed by an international working group in 2014 to define a class of stroke patients and explore the rationality of secondary prevention by anticoagulation in them. During the decade since the concept was proposed, numerous studies have been conducted on the pathogenesis and prevention strategies of ESUS. However, the research results are not quite consistent with the speculations and assumptions when the concept was proposed. Based on the review of the findings of related studies over the past decade, this article discusses the inherent defects in the ESUS concept, the new idea derived from the research results, the future role of ESUS, and trends in etiological diagnosis of ischemic stroke.

Effect of endovascular treatment on thrombosis of autogenous arteriovenous fistula / 中华肾脏病杂志

Objective:To investigate the effectiveness and safety of ultrasound-guided endovascular therapy for autogenous arteriovenous fistula (AVF) thrombosis.Methods:It was a single-center retrospective cohort study. Data of patients undergoing ultrasound-guided intravascular therapy due to AVF thrombosis in the First Hospital of Hebei Medical University from August 2018 to June 2021 were analyzed. According to different surgical procedures, the patients were divided into two groups. Patients treated with percutaneous transluminal angioplasty (PTA) + drilling thrombectomy were in group A, and patients treated with PTA only were in group B. After 1 year of follow-up, the surgical technique success rate, primary patency rate, secondary patency rate and complications were compared between the two groups.Results:A total of 152 patients were enrolled, including 74 in group A and 78 in group B. There were no significant differences in gender, age, proportion of patients with diabetes and hypertension, and thrombosis time of AVF between the two groups (all P>0.05). Compared with group B, the diameter and length of thrombus in group A were larger [13.0(9.0, 16.0) mm vs. 6.0(5.0, 6.5) mm, Z=-9.362, P<0.001; 12(8, 15) cm vs. 3(3, 4) cm, Z=-10.061, P<0.001], and the establishment time of AVF was longer [5(2, 7) years vs. 2(1, 5) years, Z=-2.698, P=0.007]. Among the overall patients, the success rate of surgery was 96.7% (147/152), and the success rate of surgery was 95.9% (71/74) in group A and 97.4% (76/78) in group B respectively, with no statistical difference ( χ2=0.004, P=0.952). Kaplan-Meier survival analysis showed that, overall, the primary patency rate at 3rd, 6th and 12th month after operation was 87.1%, 71.4% and 56.6%, and the secondary patency rate was 97.1%, 96.4% and 94.1%, respectively. The primary patency rate of group A at 3rd, 6th and 12th month was 82.4%, 66.7% and 53.6%, and the secondary patency rate was 95.7%, 94.2% and 89.7%, respectively. The primary patency rate of group B at 3rd, 6th and 12th month was 91.5%, 73.2% and 59.7%, and the secondary patency rate was 98.6%, 98.6% and 98.5%, respectively. There was no significant difference in the primary and secondary patency rate between group A and group B at 3rd, 6th and 12th month (all P>0.05). The duration of operation in group A was longer than that in group B [2.0(1.9, 2.0) h vs. 2.0(1.0, 2.0) h, Z=-5.181, P<0.001], but no serious complications occurred in both groups. Conclusion:The two surgical methods are effective, safe and reliable in the treatment of AVF thrombosis, and have high clinical application value.

Clinical features of maternal pulmonary thromboembolism: analysis of 16 cases / 中华围产医学杂志

Objective:To summarize the clinical features, pregnancy outcomes, and treatment strategies of pulmonary thromboembolism (PTE) in pregnant women and puerperae.Methods:Clinical data of 16 pregnant women or puerperae with PTE who were admitted to Beijing Anzhen Hospital from January 2012 to December 2022 were retrospectively collected. Descriptive statistical analysis was used to summarize the clinical features, treatment strategies, and pregnancy outcomes in these cases.Results:The average age of the 16 patients was (29.6±3.5) years (26-35 years) and the median onset time was 12 weeks (7-38 weeks) of gestation in six pregnant women and 4 d (16 h-40 d) after delivery in ten puerperae. There were two cases of high-risk type; nine cases of medium-risk type (six of medium-high risk and three of medium-low risk); and five cases of low-risk type. Definite high-risk factors were detected in four pregnant women (venous thromboembolism risk score ≤2) and nine puerperae (venous thromboembolism risk score of 2-9). None of the six pregnant women had any indications for preventive anticoagulant therapy and nine puerperae had indications but without preventive therapy. All the patients were treated with low molecular weight heparin and sequential administration of warfarin/rivaroxaban, in addition to that, two high-risk patients also received thrombolytic therapy. After therapy, all pregnant women terminated their pregnancies in time and then continued to receive anticoagulation treatment. All 16 patients survived. Among the six pregnant women, five who developed PTE in the first or second trimester underwent iatrogenic termination of pregnancy, and one who developed PTE in the third trimester gave live birth. Among the 10 puerperae, one had PTE after the termination of pregnancy in the second trimester due to intrauterine fetal death; one developed PTE after abortion in the first trimester; the other eight cases developed PTE after cesarean section in the third trimester, with all newborns surviving.Conclusions:Pregnant women and puerperae are at high risk of PTE and most have high-risk factors. Therefore, more attention should be paid to the screening of high-risk factors and the initiation of preventive anticoagulant therapy. Maternal outcomes are good after PTE treatment, but fetal outcomes depend on the time of onset.

Preliminary analysis of self-made false lumen embolization device in the treatment of chronic Stanford type B aortic dissection / 国际外科学杂志

Objective:To analyze the early outcomes of self-made false lumen embolization device for occlusion the false lumen in chronic Stanford type B aortic dissection.Methods:A retrospective study analyzed 10 patients, there were 9 males and 1 female, with an average age of (52±10) years, aged from 39-69 years. Those 10 patients were diagnosed with chronic Stanford type B aortic dissection between June 2020 and July 2023, which presented with persistent false lumen backflow in the thoracic aortic segment, and persistent dilation or rupture of dissected aneurysms in our center. False lumen occlusion was performed using self-made false lumen embolization device. Primary endpoints index were technical success rate and clinical success rate. Secondary endpoints observation index were 30-day mortality and morbidity.Results:Over a mean 6-month follow-up (range 0-32 months) in 10 patients, the technical success rate was 90%. One patient occurred minor false lumen backflow in the intraoperative angiography and it exceeds the embolization device, but it was disappeared through conservative treatment during follow up period. The clinical success rate was 90%, 9 patients attained completely thrombosed at the thoracic segment while another 1 patient was manifested as partially thrombosed in false lumen. There were no intraprocedural death cases and 1 patient occurred paraparesis during perioperative period.Conclusion:It was a safe, effective and easy to achieve in the treatment of chronic Stanford type B aortic dissection using self-made false lumen embolization device, especially it is suitable for patients with chronic Stanford type B aortic dissection required emergent handling in the setting of rupture.