Analysis of serum CA125 and related influencing factors in silicosis patients with pulmonary heart disease / 中华劳动卫生职业病杂志

Objective: To analyze the serum carbohydrate antigen 125 (CA125) level and its influencing factors in male silicosis patients with pulmonary heart disease. Methods: In October 2021, data of 38 male patients with simple silicosis (silicosis group), 28 cases of silicosis with pulmonary heart disease (pulmonary heart disease group), and 27 healthy controls (control group) in the same age group were collected in inpatient and outpatient of Nanjing Occupational Disease Prevention and Control Hospital from January 2017 to December 2020. The serum CA125 levels of the three groups were compared, and the correlation between disease-related indexes and serum CA125 in silicosis patients with pulmonary heart disease was analyzed, as well as the influencing factors of pulmonary heart disease and serum CA125 levels in silicosis patients. Results: The serum CA125 level[ (19.95±7.52) IU/ml] in pulmonary heart disease group was higher than that in silicosis group[ (12.98±6.35) IU/ml] and control group[ (9.17±5.32) IU/ml] (P<0.05). There was no significant difference in serum CA125 level between the silicosis group and the control group (P>0.05). Serum CA125 levels were positively correlated with blood uric acid and fasting blood glucose in silicosis patients with pulmonary heart disease (r=0.39, 0.46, P<0.05). Serum CA125 level was a risk factor for silicosis patients with pulmonary heart disease (OR=1.13, 95%CI: 1.02-1.24, P<0.05). Dust exposure time, lactate dehydrogenase and smoking history were positively correlated with serum CA125 level in silicosis patients (P<0.05) . Conclusion: The serum CA125 level of male silicosis patients with pulmonary heart disease is significantly increased, and the level of CA125 is correlated with the level of fasting blood glucose and blood uric acid.

The efficacy of bisoprolol fumarate tablets combined with tiotropium bromide powder aerosol inhalation in the treatment of patients with chronic obstructive pulmonary disease complicated with pulmonary heart disease at the acute exacerbation stage / 中国医师杂志

Objective:To study the efficacy of bisoprolol fumarate tablets combined with tiotropium bromide powder aerosol inhalation in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary heart disease and its effect on high-sensitivity C-reactive protein (hs-CRP) and brain natriuretic peptide (BNP).Methods:From June 2016 to October 2021, 96 patients with AECOPD complicated with pulmonary heart disease admitted to the Affiliated Hospital of Jining Medical University were randomly divided into a control group and an observation group with 48 patients in each group. The patients in both groups were treated with oxygen inhalation, expectorant, cough relieving, asthma relieving and empirical antibiotics. The control group was treated with atomized inhalation of tiotropium bromide powder, and the observation group was treated with bisoprolol fumarate tablets on the basis of the control group. The left ventricular ejection fraction (LVEF), 6-minute walking distance (6MWD), 1 s forced expiratory volume (FEV 1), forced vital capacity (FVC), serum hs-CRP, BNP and other factors were compared between the two groups after treatment, and the total effective rate and adverse drug reaction of the two groups were counted. Results:After treatment, the total effective rates of the observation group and the control group were 91.67%(44/48) and 77.08%(37/48), respectively, with a statistically significant difference ( P<0.05). After treatment, the LVEF of the observation group and the control group were (43.15±6.04)% and (38.96±5.67)% respectively, the 6MWD was (294.86±30.11)m and (261.35±25.88)m, the FEV 1 was (2.36±0.69)L and (1.75±0.52)L, the FVC was (3.58±0.51)L and (2.96±0.45)L, the hs-CRP was (4.47±1.25)mg/L and (7.86±2.01)mg/L, and the BNP was (418.25±32.25)ng/ml and (496.52±43.21)ng/ml; ESR was (16.78±2.11)mm/h and (21.02±1.69)mm/h, ET-1 was (54.26±6.45)ng/ml and (73.21±8.24)ng/ml, and Interleukin 6 was (22.63±8.45)ng/L and (31.85±12.24)ng/L, respectively, with statistical significance ( P<0.05). The total incidence of adverse drug reaction in the observation group and the control group was 8.33%(4/48) and 4.17%(2/48), respectively, with no statistically significant difference ( P>0.05). Conclusions:Bisoprolol fumarate tablets combined with tiotropium bromide powder aerosol inhalation in the treatment of AECOPD complicated with cor pulmonale can improve the heart and lung function of patients, regulate the expression level of hs-CRP, BNP and other factors, improve the efficacy, and do not increase adverse reactions.

Detection of plasma interleukin-6, C-reactive protein, D-dimer and fibrinogen among 96 patients with pneumoconiosis / 预防医学

Objective@# To investigate the plasma levels of interleukin-6 (IL-6), C-reactive protein (CRP), D-dimer (D-D) and fibrinogen (Fib) among patients with pneumoconiosis, so as to provide insights into the prevention of thrombosis among patients with pneumoconiosis.@*Methods@#Ninety-six male coal workers with stable-stage pneumoconiosis admitted to China Pingmei Shenma Group Occupational Disease Prevention and Control Hospital from February 2019 to February 2021 were included in the pneumoconiosis group, and 43 male healthy volunteers in the hospital during the same period were selected as the control group. The plasma D-D, Fib, IL-6 and CRP levels were detected from subjects in the two groups. The associations of plasma D-D and Fib levels with IL-6 and CRP levels were examined using Pearson correlation analysis among pneumoconiosis patients. @*Results@#Participants in the pneumoconiosis group and the control group had a mean age of (52.91±3.89) and (52.64±4.12) years, D-D of (1.28±0.91) and (0.44±0.11) mg/L, Fib of (4.41±0.98) and (2.88±0.61) g/L, IL-6 of (0.63±0.19) and (0.42±0.06) ng/L and CRP of (3.30±1.65) and (1.35±0.12) mg/L, respectively. Higher plasma D-D, Fib, IL-6 and CRP levels were detected in the pneumoconiosis group than in the control group (all P<0.05). The plasma D-D level correlated positively with IL-6 level among pneumoconiosis patients (r=0.347, P<0.001). @*Conclusion@#High plasma IL-6, CRP, D-D and Fib levels are detected among patients with pneumoconiosis, and the plasma D-D level correlates positively with IL-6 level among patients with pneumoconiosis.

O uso do core set da CIF para avaliação de pacientes com distúrbios cardiorrespiratórios / The use of the ICF core set for the evaluation of patients with cardiorespiratory disorders

Introdução: A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) categoriza a saúde e deficiência do indivíduo considerando a funcionalidade e os fatores contextuais. No entanto, a CIF apresenta muitas categorias que dificultam o seu uso diário e, por isso, foram criados os core sets. Entre os diversos core sets propostos, existe um core set para condições cardiorrespiratórias pós-agudas. Objetivo: classificar os pacientes com alterações cardíacas, respiratórias e mistas, assistidos ambulatoriais por meio de um core sets para esta população, além de verificar se existem diferenças entre os grupos na aplicação deste core set. Métodos: Foram avaliados indivíduos com diagnóstico clínico de doenças cardiorrespiratórias em acompanhamento fisioterapêutico ambulatorial para reabilitação cardiopulmonar. A amostra foi dividida em três grupos: cardíacos, respiratórios e mistos. Os pacientes foram avaliados por meio da versão abreviada do core set para condições cardiorrespiratórios pós-agudas, funcionalidade, força de preensão palmar e dos músculos respiratórios. Resultados: A amostra foi composta por 67 indivíduos alocados de acordo com seu comprometimento. Verificou-se que apenas as funções de energia e impulso, cardíaca e de ingestão, estrutura do sistema respiratório e a atividade andar apresentaram respostas significativamente diferentes entres os grupos. Pacientes com distúrbios respiratórios, cardíacos e mistos apresentam perfis funcionais semelhantes, porém as categorias com diferença desse perfil foram as relacionadas ao sistema respiratório, atividades e funções relacionadas ao aumento da demanda metabólica como andar. Conclusão: Assim é possível afirmar que o core set auxilia a identificar as disfunções dos pacientes sem depender se sua disfunção é cardíaca, respiratória ou mista que pode ser uma ferramenta utilizada no meio clínico.

Introduction: The International Classification of Functioning, Disability and Health (ICF) categorizes an individual's health and disability considering functionality and contextual factors. However, the ICF has many categories that make it difficult to use daily, and that's why core sets were created. Among the various proposed core sets, there is a core set for post-acute cardiorespiratory conditions. Objective: to classify patients with cardiac, respiratory and mixed alterations assisted in outpatient clinics using a core set for this population, in addition to verifying whether there are differences between the groups in the application of this core set. Methods: Individuals with a clinical diagnosis of cardiorespiratory in outpatient physical therapy follow-up for cardiopulmonary rehabilitation diseases were evaluated. The sample was divided into three groups: cardiac, respiratory and mixed. Patients were evaluated using the abbreviated version of the core set for post-acute cardiorespiratory conditions, functionality, handgrip strength and respiratory muscles. Results: The sample consisted of 67 individuals allocated according to their commitment. It was found that only the energy and impulse, cardiac and ingestion functions, structure of the respiratory system and walking activity showed significantly different responses between the groups. Patients with respiratory, cardiac and mixed disorders have similar functional profiles, but the categories with difference in this profile were those related to the respiratory system, activities and functions related to increased metabolic demand such as walking. Conclusion: Thus, it is possible to affirm that the core set helps to identify the patients' dysfunctions without depending on whether their dysfunction is cardiac, respiratory or mixed, which can be a tool used in the clinical environment.

Traditional Chinese Medicine excessive pattern correlation analysis of chronic obstructive pulmonary disease complicated acute exacerbation of chronic pulmonary heart disease / 国际中医中药杂志

Objective:To explore the correlation between Traditional Chinese Medicine (TCM) excessive patterns and clinical characteristics of acute exacerbation of chronic obstructive pulmonary disease (COPD) complicated with chronic pulmonary heart disease (CPHD) in high altitude environment.Methods:Patients with acute exacerbation of COPD complicated with CPHD admitted to the Pulmonology Department of Qinghai Provincial Hospital of Traditional Chinese Medicine from December 2016 to November 2017 were selected. Demographic data and clinical medical characteristics data of the patients were collected, and TCM patterns differentiation was conducted. The correlation between each pattern type and clinical characteristics and all collected laboratory indexes were analyzed by multivariate logistic regression.Results:Phlegm obstructing lung pattern showed a negative correlation relationship with mMRC score [ OR=0.419, 95% CI (0.219-0.802), P=0.009], PCT [ OR=8.132×10 -11, 95% CI (1.632×10 -16-4.1×10 -5), P<0.001], Hb [ OR=0.971, 95% CI (0.952-0.989), P=0.002] and PaCO 2[ OR=0.914, 95% CI (0.853-0.980), P=0.011]; turbid phlegm obstructing lung pattern showed a negative correlation relationship with gender(0 male, 1 female) [ OR=0.427, 95% CI (0.204-0.892), P=0.024], Hb [ OR=0.960, 95% CI (0.945-0.975), P<0.001], and there was a positive correlation relationship with LVEF [ OR=1.061, 95% CI (1.006-1.118), P=0.028]; phlegm-heat obstructing lung pattern showed a negative correlation relationship with Hb [ OR=0.950, 95% CI (0.927-0.974), P<0.001]and cardiac function grade [ OR=0.468, 95% CI (0.248,0.881), P=0.019], and there was a positive correlation relationship with PCT [ OR=1.118×10 8, 95% CI (1.466×10 4-8.523×10 11), P<0.001] and D-D [ OR=2.283, 95% CI (1.300-4.010), P=0.004]; there was a negative correlation between phlegm and stasis blocking lung pattern with cardiac function grade[ OR=0.309, 95% CI (0.167-0.570), P<0.001], and there was a positive correlation relationship with Hb[ OR=1.060, 95% CI (1.042-1.078), P<0.001]; there was a negative correlation between wet phlegm and blood stasis heat pattern with PCT [ OR=1.266×10 -13, 95% CI (1.658×10 -21-0.1×10 -4), P<0.001], SaO 2 [ OR=0.934, 95% CI (0.892-0.979), P=0.004], LVEF [ OR=0.896, 95% CI (0.826-0.971), P=0.008], D-D [ OR=0.030, 95% CI (0.002-0.508), P=0.015], and there was a positive correlation relationship with CRP [ OR=1.042, 95% CI (1.018-1.067), P<0.001], RBC [ OR=3.411, 95% CI (1.684-6.910), P<0.001], cardiac function grade [ OR=8.573, 95% CI (2.410-30.504), P<0.001], pulmonary arterial pressure difference [ OR=2.091, 95% CI (1.243-3.516), P=0.005]. Conclusions:Male patients are more prone to phlegm and turbidities than female patients. PCT and D-D were the main risk factors of phlegm-heat obstruction syndrome. Elevated hemoglobin is a risk factor for patients with phlegm stasis and lung syndrome. Heart function classification is the main risk factor of phlegm-dampness-stasis heat syndrome.

Estenosis congénita de venas pulmonares y malformación vascular broncopulmonar / Congenital pulmonary vein stenosis and bronchopulmonary vascular malformation

Resumen El objetivo es mostrar el diagnóstico y la evolución de una paciente con estenosis de venas pulmonares y secuestro pulmonar. Se trata de una niña de 1 año de edad, con bronconeumonías de repetición, acrocianosis, 2R intenso, cardiomegalia, hipertensión venocapilar pulmonar, con diagnóstico clínico de comunicación interauricular. El ecocardiograma mostró estenosis de venas pulmonares izquierdas. El cateterismo cardiaco detectó fístulas arteriovenosas en la región apical del pulmón derecho. La imagen de resonancia magnética y la angiografía mostraron un vaso arterial aberrante paralelo a la aorta abdominal y con flujo dirigido al lóbulo pulmonar derecho. La angiotomografía reportó confluencia de las venas pulmonares del lado derecho. Se realizó lobectomía derecha. La paciente falleció en el posoperatorio debido a una hemorragia masiva pulmonar. Esta paciente es la primera descrita en la literatura con estenosis de venas pulmonares congénita asociada a secuestro pulmonar. La ecocardiografía es el estudio diagnóstico ideal inicial en los pacientes con estenosis congénita de venas pulmonares.

Abstract The objective is demonstrate the diagnostic process and evolution of a patient with a diagnosis of congenital pulmonary vein stenosis and broncho-pulmonary vascular malformation. One year old female patient with repeated bronchopneumonia, acrocyanosis, split S2, cardiomegaly, pulmonary hypertension, with a clinical diagnosis of atrial septal defect. The echocardiogram demonstrated left sided vein pulmonary stenosis. The cardiac catheterization demonstrated arterial-venous fistulas apical on the right lung. Magnetic Resonance image and angiography showed an aberrant arterial vessel parallel to the abdominal aorta which flow the right pulmonary lobe. The cardiac tomography angiography reported confluence of right-sided pulmonary veins. A lobectomy is performed. Patient died in post-operative due to massive pulmonary hemorrhaging. This is the first patient mentioned in written literature with pulmonary vein stenosis associated with pulmonary sequestration, with normal venous connection. Echocardiography represents the specific standard study ideal for initial diagnostic for patients with pulmonary vein stenosis.

Clinical observation of Yixin tang in patients with chronic pulmonary heart disease / 中国医师进修杂志

Objective:To investigate the clinical efficacy of Yixin tang in patients with chronic pulmonary heart disease (CPHD).Methods:The clinical data of 72 patients with CPHD in Shanghai Tenth People′s Hospital from April 2018 to April 2020 were retrospectively analyzed. Among them, 36 patients were treated with conventional western medicine therapy (control group), and 36 patients were treated with Conventional western medicine therapy and Yixin tang (observation group). The left ventricular ejection fraction (LVEF), forced expired volume in one second to forced vital capacity ratio (FEV 1/FVC), D-dimer (D-D), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), St. George respiratory questionnaire (SGRQ) score and Chinese medicine syndrome score before and after treatment were compared between 2 groups. Results:There were no statistical differences in the indexes before treatment between 2 groups ( P>0.05). The FEV 1/FVC and LVEF after treatment in observation group were significantly higher than those in control group: (89.01 ± 3.24)% vs. (78.13 ± 3.52)% and (60.32 ± 2.36)% vs. (52.80 ± 3.23)%, the TNF-α, IL-6, D-D, Chinese medicine syndrome score and SGRQ total score, limitation of activity score, symptom score, disease impact score were significantly lower than those in control group: (6.95 ± 2.67) pg/L vs. (10.45 ± 4.07) pg/L, (4.36 ± 1.24) pg/L vs. (6.90 ± 7.42) pg/L, (0.32 ± 0.13) pg/L vs. (1.07 ± 0.43) pg/L, (14.50 ± 3.00) scores vs. (16.43 ± 3.08) scores, (20 ± 12) scores vs. (50 ± 20) scores, (21 ± 15) scores vs. (45 ± 14) scores, (22 ± 11) scores vs. (65 ± 16) scores and (17 ± 10) scores vs. (47 ± 14) scores, and there were statistical differences ( P<0.05). Conclusions:The conventional western medicine treatment combined with Yixin tang can effectively improve cardiopulmonary function, inflammatory reaction and quality of life.

Análisis espacial de las concentraciones de PM2,5 en Bogotá según los valores de las guías de la calidad del aire de la Organización Mundial de la Salud para enfermedades cardiopulmonares, 2014 - 2015 / Spatial analysis of PM2,5 concentrations in Bogotá according to the World Health Organization air quality guidelines for cardiopulmonary diseases, 2014 - 2015

Introducción. La Organización Mundial de la Salud señala que tres millones de muertes al año por enfermedades cardiopulmonares están relacionadas con la exposición a la contaminación del aire. Objetivo. Estimar las superficies de concentración de partículas en suspensión de menos de 2,5 pm (Particulate Matter, PM25) en Bogotá entre el 2014 y el 2015, clasificándolas según las guías de calidad del aire de la Organización Mundial de la Salud para enfermedades cardiopulmonares. Materiales y métodos. Se hizo un estudio ecológico mediante técnicas geoestadísticas. Se calcularon los promedios de PM25 en lapsos de seis horas a lo largo del día en cuatro franjas horarias. Las concentraciones se clasificaron según los valores diarios y anuales de las guías de calidad del aire de la OMS. Resultados. La localidad de Kennedy presentó las mayores concentraciones de PM25 en todas las franjas horarias. Los valores registrados en esta zona y clasificados según las guías diarias y anuales de calidad del aire, evidenciaron que la localidad presentaría un incremento de 1,2 % en la mortalidad cardiopulmonar en el corto plazo y de 9 % en el largo plazo. Conclusión. Las franjas horarias de las 0:00 a las 6:00 h y de las 12:00 a las 18:00 h, cumplieron con el valor anual de las guías de calidad del aire de 10 µg/m3 en una parte de la zona oriental de la ciudad. En el resto de la ciudad, en las franjas horarias de las 6:00 h a las 12:00 h y de las 18:00 h a las 24:00 h se registraron valores que cumplían los objetivos intermedios 2 y 3, lo que representa incrementos de 9 y 3 % en la mortalidad cardiopulmonar, respectivamente.

Introduction: The World Health Organization (WHO) points out that 3 million deaths per year caused by cardiopulmonary diseases are related to exposure to air pollution. Objective: To estimate areas of concentration of PM2.5 in Bogotá according to the WHO Air Quality Guidelines (AQG) for cardiopulmonary diseases during the period 2014-2015. Materials and methods: We conducted an ecological study with geostatistical techniques. We calculated the PM2.5 averages for six hour-periods distributed throughout the day in four time slots, which were classified according to daily and annual WHO AQG. Results: The locality of Kennedy presented the highest concentrations of PM25 in all time slots. The values registered in this area classified within the daily and annual AQG showed that the locality would present an increase of 1.2% and 9% in cardiopulmonary mortality in the short and long term, respectively. Conclusion: The time slots from 0:00 to 6:00 h y from 12:00 to 18:00 h met the annual AQG value of 10 µg/m3 in a part of the eastern zone of the city; in the rest of the city, in these same time slots, intermediate objectives 2 and 3 were met, which means increases by 9% and 3% in the cardiopulmonary mortality according to the AQG, respectively.

Effect of Modified Yangxintang on Chronic Pulmonary Heart Disease with Syndrome of Deficiency of Heart and Lung Qi / 中国实验方剂学杂志

Objective:To discuss the effect of modified Yangxintang on chronic pulmonary heart disease (CPHD) with syndrome of deficiency of heart and lung Qi and progress of disease. Method:One hundred and twenty-eight patients were randomly divided into control group 64 cases and observation group 64 cases by random number table. Patients in control group got comprehensive rehabilitation measures of western medicine. Those who had respiratory distress got Salmeterol ticasone powder inhaler, 1-2 times/day, 1 inhale/time.And those who had cough and phlegm got Ambroxol hydrochloride tablets for 1-2 week, 1-2 tablet/time, 3 times/day. In addition to the therapy of control group, patients in observation group was also added with modified Yangxintang, 1 dose/day, 5 days/week. Record the and times of acute aggravate and cold, pulmonary artery systolic pressure (PASP), mean pulmonary artery pressure (MPAP), left ventricular ejection fraction (LVEF), stroke volume (SV) and cardiac output (CO) were recorded during 48 weeks. Before and after treatment, scores of modified British medical research council respiratory questionnaire (mMRC questionnaire), Minnesota Heart Failure Quality of life scale (MLHFQ), syndrome of deficiency of heart and lung Qi and 6-minute walking test (6 MWT) were scored. And levels of N-terminal B-type natriuretic peptide (NT-proBNP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), endothelin (ET-1), CD3+, CD4+, CD8+ and CD4+/CD8+ were detected. Result:The clinical efficacy in observation group was better than that in control group (Z=2.108, P<0.05). During 48 weeks of observation period, times of acute aggravate and cold in observation group were less than those in control group (P<0.01). Levels of PASP, MPAP and NT-proBNP were lower than those in control group (P<0.01). And levels of LVEF, SV, CO, 6 MWT and NO were higher than those in control group (P<0.01), levels of CD3+, CD4+ and CD4+/CD8+ were higher than those in control group (P<0.05). And levels of mMRC, MLHFQ, score of syndrome of deficiency of heart and lung Qi, TNF-α , IL-6, ET-1, CD8+ and were all lower than those in control group (P<0.01, P<0.05). Conclusion:In addition to anti-inflammatory, anti-asthmatic and anti-tussive therapies, modified Yangxintang can improve the immune function, relieve the symptoms of heart and lung, improve the function of heart and lung and the quality of life, inhibit the inflammatory reaction, improve the function of vascular endothelium, reduce the pulmonary hypertension, control the progress of disease.

Pulmonary Hypertension in General Cardiology Practice / Hipertensão Pulmonar na Prática do Cardiologista

Abstract The finding of pulmonary hypertension (PH) by echocardiography is common and of concern. However, echocardiography is just a suggestive and non-diagnostic assessment of PH. When direct involvement of pulmonary circulation is suspected, invasive hemodynamic monitoring is recommended to establish the diagnosis. This assessent provides, in addition to the diagnostic confirmation, the correct identification of the vascular territory predominantly involved (arterial pulmonary or postcapillary). Treatment with specific medication for PH (phosphodiesterase type 5 inhibitors, endothelin receptor antagonists and prostacyclin analogues) has been proven effective in patients with pulmonary arterial hypertension, but its use in patients with PH due to left heart disease can even be damaging. In this review, we discuss the diagnosis criteria, how etiological investigation should be carried out, the clinical classification and, finally, the therapeutic recommendations for PH.

Resumo O achado de hipertensão pulmonar (HP) em avaliação ecocardiográfica é frequente e preocupante. No entanto, o ecocardiograma é apenas um exame sugestivo e não diagnóstico de HP. Quando se suspeita de acometimento direto da circulação pulmonar, está indicada medida hemodinâmica invasiva para estabelecer o diagnóstico. Essa avaliação permite, além da confirmação diagnóstica, a correta identificação do território vascular predominantemente acometido (arterial pulmonar ou pós-capilar). O tratamento com as medicações específicas de HP (inibidores da fosfodiestarese 5, antagonistas do receptor de endotelina, análogos da prostaciclina e estimulador da guanilil ciclase solúvel) é comprovadamente eficaz para pacientes com hipertensão arterial pulmonar, mas seu uso em pacientes com HP decorrente de doença cardíaca de câmaras esquerdas pode até mesmo ser prejudicial. Discutiremos nesta revisão o critério diagnóstico, a maneira de proceder a investigação etiológica, a classificação clínica e, finalmente, as recomendações terapêuticas na HP.

Pulmonary capillary hemangiomatosis: a lesson learned

Pulmonary capillary hemangiomatosis (PCH) is a rare and controversial entity that is known to be a cause of pulmonary hypertension and is microscopically characterized by proliferation of dilated capillary-sized channels along and in the alveolar walls. Clinically, it is mostly seen in adults. Clinical features are characterized by nonspecific findings such as shortness of breath, cough, chest pain, and fatigue. It can be clinically indistinguishable from pre-capillary pulmonary arterial hypertension disorders such as primary pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension. However, the diagnostic distinction, which usually requires a multidisciplinary approach, is crucial in order to avoid inappropriate treatment with vasodilator medications usually used for PAH treatment. Prognosis of PCH remains poor with lung transplant being the only definitive treatment. We report an autopsy case of pulmonary capillary hemangiomatosis unmasked at autopsy that was treated with a prostacyclin analog, usually contraindicated in such patients. We emphasize that this entity should always be on the differential diagnosis in a patient with pulmonary hypertension and requires great vigilance on the part of the clinician, radiologist and pathologist to make the diagnosis and guide appropriate management.

Manifestaciones pulmonares de artritis reumatoide: cor pulmonale / Pulmonary manifestations of rheumatoid arthritis: Cor pulmonale

RESUMEN Cor pulmonale es la disfunción ventricular derecha que resulta de hipertensión pulmonar secundaria a alteraciones de la estructura o función pulmonar, por diversas etiologías, principalmente aquellas que afecten el parénquima y la vasculatura pulmonar. Se presenta el caso de una mujer de 62 arios de edad, con disfunción ventricular derecha secundaria a alteraciones parenquimatosas y funcionales pulmonares como resultado de enfermedad sistémica autoinmune.

ABSTRACT Cor pulmonale is the right ventricular dysfunction that results from pulmonary hypertension secondary to alterations of the pulmonary structure and/or function, by various aetiologies, mainly those that affect the parenchyma and pulmonary vasculature. The case is presented of a 62-year-old woman with right ventricular dysfunction secondary to parenchymal and functional pulmonary alterations, as a result of systemic autoimmune disease.

Effect of invasive and noninvasive sequential mechanical ventilation on respiratory failure of critical cor pulmonale / 中国基层医药

Objective@#To observe and analyze the clinical effects of invasive and non-invasive sequential mechanical ventilation in the treatment of respiratory failure in patients with chronic pulmonary heart disease.@*Methods@#A total of 70 patients with chronic pulmonary ill heart disease and respiratory failure admitted to the First Hospital of Shanxi Medical University from January 2018 to March 2018 were enrolled in this study.The patients were randomly divided into control group and observation group according to the digital table, with 35 cases in each group.The control group received invasive mechanical ventilation treatment.The observation group used the " pulmonary infection control window (PIC)" as the switching point of invasive ventilation and non-invasive ventilation, and invasive and non-invasive sequential mechanical ventilation were given.The clinical indicators, blood gas indicators, respiratory rate and heart rate changes of the two groups were compared.The clinical efficacy of the two groups were observed to analyze.@*Results@#The invasive mechanical ventilation time, total ventilation time and hospitalization days in the observation group were (5.16±0.83)d, (7.79±0.63)d and (8.95±0.62)d, respectively, which were significantly shorter than those in the control group [(8.42±0.91)d, (11.48±0.95)d, (14.17±0.65)d], the differences were statistically significant(t=15.659, 19.151, 34.379, all P<0.05). After treatment, the PaO2 of the observation group was significantly higher than that of the control group[(85.19±5.07)mmHg vs.(79.95±4.68)mmHg], while the PaCO2[(49.85±4.17)mmHg vs.(53.36±4.82)mmHg], respiratory rate[(24.43±3.17)times/min vs.(31.19±4.08)times/min]and heart rate[(94.43±13.36)times/min vs.(113.36±17.13)times/min] in the observation group were significantly lower than those in the control group, and the total effective rate of the observation group (91.43%) was significantly higher than that of the control group(54.29%), the differences were statistically significant(t=4.493, 3.258, 7.740, 4.338, χ2=12.209, all P<0.05).@*Conclusion@#The clinical efficacy of invasive and non-invasive sequential mechanical ventilation in the treatment of patients with respiratory failure due to chronic pulmonary heart disease is significant, which can improve the clinical symptoms of patients and reduce the time of hospitalization.

Clinical value of hs-CRP and BNP detection in the diagnosis and treatment of COPD patients with pulmonary heart disease / 中国基层医药

Objective@#To investigate the application value of hs-CRP and BNP detection in COPD patients with pulmonary heart disease.@*Methods@#From January 2016 to January 2018, 80 patients with COPD in the Fifth People's Hospital of Datong were selected.Forty-two COPD patients complicated with pulmonary heart disease were selected as COPD and cor pulmonale group, 38 COPD patients without pulmonary heart disease were selected as COPD group, and 30 healthy volunteers were selected as control group.The differences of hs-CRP and BNP levels were compared, and the diagnostic value of hs-CRP and BNP for COPD combined with pulmonary heart disease was analyzed.@*Results@#There were statistically significant differences in hs-CRP[(72.5±20.4) mg/L vs.(37.5±9.8) mg/L vs.(3.7±1.2)mg/L], BNP[(362.8±86.9) ng/L vs.(125.9±34.8) ng/L vs.(28.5±9.9)ng/L] among the COPD and cor pulmonale group, COPD group and control group (F=9.245, 14.668, all P<0.05). The hs-CRP and BNP levels in the COPD and cor pulmonale group were significantly higher than those in the other two groups(t=19.294, 11.576, 21.385, 9.258, 9.258, all P<0.05), which of the COPD group were significantly higher than those of the control group (t=8.912, 12.567, all P<0.05). The best boundary value of BNP in diagnosis of COPD with cor pulmonale was 261.8ng/L, and its diagnostic sensitivity and specificity were 96.2% and 85.4%, respectively, the area under the line was 0.834, which were all higher than those of hs-CRP.With the increase of cardiac function, the levels of hs-CRP[(38.5±10.3) mg/L vs.(51.4±14.8) mg/L vs.(75.1±21.5) mg/L vs.(93.7±31.8)mg/L], BNP[(142.8±56.5) ng/L vs.(285.9±94.8) ng/L vs.(352.5±118.2) ng/L vs.(478.5±130.3)ng/L] increased, the differences were statistically significant (F=13.577, 16.776, all P<0.05). There were significant correlation between hs-CRP, BNP levels and COPD patients complicated with cor pulmonale (r=0.675, 0.766, all P<0.05).@*Conclusion@#hs-CRP and BNP have high diagnostic potency for COPD patients combined with cor pulmonale, and are positively correlated with cardiac function classification.

Clinical significance of the N-terminal pro-B-type natriuretic peptide levels in pneumoconiosis patients with chronic pulmonary heart disease / 中华劳动卫生职业病杂志

Objective@#To determine the diagnosis value and therapy significance of peripheral blood N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in pneumoconiosis patients with chronic pulmonary heart disease (CPHD) .@*Methods@#A total of 22 pneumoconiosis complicated with CPHD (A group) , 20 pneumoconiosis complicated with coronary heart disease (B group) and 25 pneumoconiosis without heart disease (C group) were selected. The level of blood NT-proBNP was examined and analyzed in the three groups. We observed the difference blood level of NT-proBNP concentration between before and after of therapy in pneumoconiosis patients with CPHD. The optimal cutoff value of blood NT-proBNP was determined according to the principle of maximum Youden's index associated with clinical analysis.@*Results@#Blood NT-proBNP concentrations were 543.19±78.92, 1017.38±731.06, 109.56±57.46 pg/ml in three groups, respectively. Compared with C group, there was a significant increase in the blood levels of NT-proBNP in both A and B groups (P<0.05, P<0.01) , especially for B group. Compared with NT-proBNP 543.19±78.92 pg/ml before therapy, the153.34±58.40 pg/ml was significantly declined after therapy in B group (P<0.05) . The optional threshold for peripheral blood NT-proBNP level as a diagnostic indicator for pneumoconiosis complicated with CPHD was 450 pg/ml. The specificity and sensitivity of NT-proBNP were 95.46% and 54.17%, respectively.@*Conclusion@#Blood NT-proBNP level may be useful as a tool for monitoring the effect of pneumoconiosis patients with CPHD treatment with higher sensitivity in. Blood NT-proBNP cut-off >450 pg/ml should be applied in clinical practice as a valuable diagnostic prediction for pneumoconiosis patients with CPHD.

Effects of high energy enteral nutrition on nutritional status and immune function in patients with pulmonary heart failure / 中国中西医结合急救杂志

Objective To investigate the effects of high energy enteral nutrition (EN) on nutritional status and immune function in patients with heart failure caused by pulmonary cardiac disease. Methods Eighty-six patients with heart failure caused by pulmonary heart disease were continuously collected from March 2017 to March 2018 in the Department of Critical Care Medicine of Taizhou First People's Hospital, and they were divided into a high-energy EN group and a standard EN group according to the different use of EN preparations, each group with 43 cases. The high-energy EN group were treated with high energy EN solution TPF-T (Ruineng), and the standard EN group were treated with standard EN solution TP (Ruisu); the initial EN infusion velocity in all the patients was 25 mL/h, the calorific calorie would reach the target to 104.6-125.5 kJ·kg-1·d-1, and the protein would target to 1.5-2 g·kg-1·d-1 within 3 days;the blood glucose was controlled within the scope of 7.8-11.1 mmol/L. The differences in rates of calorie and protein goal targeting situations, nutritional status, inflammatory response and immune function were compared between the two groups. Results From the 3rd day to 7th day after EN application, the rates of calorie and protein goal targeted in the high-energy EN group were significantly higher than those in the standard EN group [calorie targeted rate: 69.77% (30/43) vs. 41.86% (18/43), protein targeted rate: 25.58% (11/43) vs. 11.63% (5/43), all P < 0.05]. With the extension of EN application, nutritional indexes such as albumin (Alb), prealbumin (PA), transferrin (TRF), etc. and the immune indexes such as human leucocyte antigen (HLA)-DR positive rate, immunoglobulins (IgA, IgG), etc. were persistently increased in both groups, reaching the peak values on the 7th day, and the indexes in high-energy EN group were significantly higher than those in the standard EN group [Alb (g/L): 36.43±5.81 vs. 33.79±5.34, PA (mg/L): 278.83±47.56 vs. 251.67±41.92, TRF (mg/L): 3.58±0.64 vs. 3.26±0.81, HLA-RD positive rate: (53.22±6.11)% vs. (50.21±5.69)%, IgA(mg/L): 165.34±40.13 vs. 141.54±38.76, IgG (mg/L): 4 990.68±881.66 vs. 4 211.75±861.54, all P < 0.05]. However, the levels of inflammatory factors such as C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in both groups were gradually decreased, reaching the valley values on the 7th day, and the indexes in high-energy EN group were significantly lower than those in the standard EN group [TNF-α(ng/L): 14.43±8.69 vs. 20.59±9.45, CRP (mg/L): 21.33±6.35 vs. 27.36±7.83, all P < 0.05]. Conclusion High energy EN not only can improve the nutritional status in patients with pulmonary heart failure, but also can reduce patients’ inflammation response and elevate their immune function.

Clinical value of hs - CRP and BNP detection in the diagnosis and treatment of COPD patients with pulmonary heart disease / 中国基层医药

Objective To investigate the application value of hs-CRP and BNP detection in COPD patients with pulmonary heart disease.Methods From January 2016 to January 2018,80 patients with COPD in the Fifth People＇s Hospital of Datong were selected.Forty-two COPD patients complicated with pulmonary heart disease were selected as COPD and cor pulmonale group,38 COPD patients without pulmonary heart disease were selected as COPD group,and 30 healthy volunteers were selected as control group.The differences of hs-CRP and BNP levels were compared,and the diagnostic value of hs-CRP and BNP for COPD combined with pulmonary heart disease was analyzed.Results There were statistically significant differences in hs-CRP[(72.5 ± 20.4) mg/L vs.(37.5 ± 9.8) mg/L vs.(3.7 ± 1.2)mg/L],BNP[(362.8 ± 86.9) ng/L vs.(125.9 ± 34.8) ng/L vs.(28.5 ± 9.9)ng/L] among the COPD and cor pulmonale group,COPD group and control group (F=9.245,14.668,all P<0.05).The hs-CRP and BNP levels in the COPD and cor pulmonale group were significantly higher than those in the other two groups(t=19.294,11.576,21.385,9.258,9.258,all P<0.05),which of the COPD group were significantly higher than those of the control group (t=8.912,12.567,all P<0.05).The best boundary value of BNP in diagnosis of COPD with cor pulmonale was 261.8ng/L,and its diagnostic sensitivity and specificity were 96.2% and 85.4% , respectively,the area under the line was 0.834,which were all higher than those of hs-CRP.With the increase of cardiac function,the levels of hs-CRP[(38.5 ± 10.3) mg/L vs.(51.4 ± 14.8) mg/L vs.(75.1 ± 21.5) mg/L vs.(93.7 ± 31.8) mg/L],BNP[(142.8 ± 56.5) ng/L vs.(285.9 ± 94.8) ng/L vs.(352.5 ± 118.2) ng/L vs. (478.5 ± 130.3)ng/L] increased,the differences were statistically significant (F=13.577,16.776,all P<0.05). There were significant correlation between hs-CRP,BNP levels and COPD patients complicated with cor pulmonale (r=0.675,0.766,all P<0.05).Conclusion hs-CRP and BNP have high diagnostic potency for COPD patients combined with cor pulmonale,and are positively correlated with cardiac function classification.

Analysis of the influence of meteorological factors on the number of patients with pulmonary heart disease in Liangzhou district of Gansu Province / 中华疾病控制杂志

Objective To investigate the effect of meteorological factors on the number of outpatients with pulmonary heart disease in Liangzhou district of Gansu province. Methods We collected the daily meteorological data (temperature, air pressure, precipitation, sunshine hours, etc.) of Liangzhou district of Gansu province and the number of daily outpatients with the pulmonary heart disease from 2014 to 2016, and used the distribution lag model to analyze the impact relationship and hysteresis effect of the meteorological factors on the number of outpatients to pulmonary heart disease clinics. Results The total number of outpatients with pulmonary heart disease was 20 462 in Liangzhou district from 2014 to 2016, and the average number of outpatients per day was 18.67. The number of outpatients with pulmonary heart disease per day was positively correlated with temperature and sunshine hours, and negatively correlated with air pressure, relative humidity and precipitation. Among them, the average daily temperature had the most significant effect on the number of outpatients with pulmonary heart disease (r=0.133, P<0.001). At the highest daily average temperature, lagging 16 days,the relative risk coefficient (RR value) was the highest (1.26, 95% CI:1.13-1.40). For every 1 ℃ increase in temperature, the number of outpatients with pulmonary heart disease increased by 1.26 (95% CI: 1.13-1.40). There was no risk of morbidity at an extreme low temperature (-18 ℃), and the relative risk of the number of the pulmonary heart disease outpatients was the greatest at lag 0-15 at an extreme high temperatures (29 ℃). Conclusion Meteorological factor is an important factor affecting the number of outpatients with pulmonary heart disease in Liangzhou district. The risk of pulmonary heart disease will increase due to temperature changes, and the impact will occur immediately on the same day. The high temperature effect is short-lived and the relative risk is high, while the relative risk of low temperature to the number of outpatients is relatively low and the lag time is long.