The chief culprit of intractable hypoxemia: a case report of rare pulmonary arteriovenous fistula complicated with giant hemangioma.

BACKGROUND: Pulmonary arteriovenous fistula (PAVF) is a rare disease, which can lead to the direct return of unoxidized venous blood to pulmonary veins and left heart, resulting in right-to-left shunt leading to hypoxia. Long term, the right-to-left shunt will cause severe pathophysiological changes in the patient's body and pulmonary circulation, and the prognosis will be poor if PAVF is not treated timely. CASE PRESENTATION: Here, we report the case of a 71-year-old man who presented with chest tightness and shortness of breath. After a series of examinations, PAVF and giant hemangioma were diagnosed, which are difficult to operate.Transcatheter interventional therapy was initiated. The patient recovered on the third day after operation and was discharged smoothly. During the long-term follow-up of nearly 4 years after discharge, the general condition and quality of life of the patient basically returned to normal. CONCLUSIONS: PAVF is rare but very important clinical problem. When the clinical manifestations of persistent unexplained hypoxia appear, it is necessary to fully consider the possibility of PAVF. Once the diagnosis of PAVF is clear, timely treatment is recommended to avoid deterioration of the disease and affecting the prognosis.

Comparative Study of Human Pluripotent Stem Cell-Derived Endothelial Cells in Hydrogel-Based Culture Systems.

Human pluripotent stem cell (hPSC)-derived endothelial cells (ECs) are promising cell sources for drug discovery, tissue engineering, and studying or treating vascular diseases. However, hPSC-ECs derived from different culture methods display different phenotypes. Herein, we made a detailed comparative study of hPSC-ECs from three different culture systems (e.g., 2D, 3D PNIPAAm-PEG hydrogel, and 3D alginate hydrogel cultures) based on our previous reports. We expanded hPSCs and differentiated them into ECs in three culture systems. Both 3D hydrogel systems could mimic an in vivo physiologically relevant microenvironment to protect cells from shear force and prevent cell agglomeration, leading to a high culture efficiency and a high volumetric yield. We demonstrated that hPSC-ECs produced from both hydrogel systems had similar results as 2D-ECs. The transcriptome analysis showed that PEG-ECs and alginate-ECs displayed a functional phenotype due to their higher gene expressions in vasculature development, extracellular matrix, angiogenesis, and glycolysis, while 2D-ECs showed a proliferative phenotype due to their higher gene expressions in cell proliferation. Taken together, both PEG- and alginate-hydrogel systems will significantly advance the applications of hPSC-ECs in various biomedical fields.

Developing a strategic framework for adopting water-saving measures in construction projects.

The construction industry consumes substantial water resources. Thus, there is a necessity to adopt effective water-saving measures to reduce water consumption in construction projects. The aim of this paper is providing a strategic framework of water-saving measures for different phases of a construction project. To start with, the prevailing green building rating tools were investigated to explore the alternative water-saving measures. Then, a comparative analysis utilizing relative significance indexing was conducted to identify the foci of water-saving measures in various green building rating tools. Based on the derived results, ten water-saving measures, namely rainwater harvesting, usage of recycled water, NEWater, water-saving technologies, water-saving devices, water-saving efficiency, water monitoring system, monitoring of major water uses, leak detection, and continuous water monitoring, were identified. These measures were further categorized into three strategic aspects, such as water sources substitution, water consumption reduction, and water use monitoring. Based on the results, a strategic framework was developed for reducing water consumption and improving water use efficiency. The developed framework can serve as a systematic guideline for formulating water-saving schemes in different stages of construction projects.

Short-Term Effects of Tolvaptan in Tricuspid Insufficiency Combined with Left Heart Valve Replacement-Caused Volume-Overload Patients: Results of a Prospective Pilot Study.

OBJECTIVES: Our objective was to explore the effects of tolvaptan as a new therapeutic approach in patients with right heart failure with tricuspid insufficiency (TI). METHODS: This prospective, multicenter, non-randomized controlled pilot study enrolled patients (N = 40) with TI from the Shanghai Chest Hospital and Shanghai Tongren Hospital who fulfilled inclusion criteria between March 2015 and June 2016. Participants were assigned to receive either tolvaptan combined with torasemide (n = 20) or torasemide monotherapy (n = 20; control group). The primary endpoints were changes in patient weight and in tricuspid annular plane systolic excursion (TAPSE) after 10 days of treatment. The secondary endpoints included net fluid balance and cardiac functions before and after medication from the first to the tenth day of treatment. Safety was evaluated by monitoring adverse and serious adverse events. RESULTS: TAPSE significantly increased in the tolvaptan group compared with the control group after 10 days of medication (P = 0.029). Daily weight losses in the tolvaptan group significantly increased as the time of treatment increased (time × group, P = 0.022). Recovery to New York Heart Association (NYHA) grade I occurred 4 days earlier in the tolvaptan group. In addition, the net fluid balance and median net fluid balance were significantly higher in the tolvaptan group. Eight adverse events and one serious adverse event were recorded in the tolvaptan group and 15 adverse events were recorded in the control group. CONCLUSIONS: Our results indicate that tolvaptan might be a useful and safe drug to improve heart function in patients with right heart failure with TI after left heart valve replacement. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier no. NCT02644616.

[Comparison of open and endovascular repair for abdominal aortic aneurysm mid-term outcomes: a single center randomized controlled trial].

OBJECTIVE: To compare the effects of open and endovascular repair for abdominal aortic aneurysm. METHODS: Between January 2009 and January 2011, 84 patients were randomized to endovascular aneurysm repair (EVAR) or open repair. There were 48 patients in EVAR group, 42 cases were male (87.5%), 6 cases were female (12.5%), aged from 50 to 83 years with a mean of 70.8 years. There were 36 patients in open repair group, 31 cases were male (86.1%), 5 cases were female (13.9%), aged from 50 to 80 years with a meal of 67.4 years. The results of perioperative period and follow-up were analyzed. RESULTS: Between the two groups, there was significant difference on operative time (t = 9.863, P = 0.000), blood loss (t = 4.647, P = 0.000), blood transfusion (t = 3.334, P = 0.002), hospital stay (t = 2.327, P = 0.022), and medical expense (t = 2.314, P = 0.023). There was no significant difference for perioperative complications (χ(2) = 0.480, P = 0.488). There was no significant difference for complications (χ(2) = 0.664, P = 0.415) and mortality (P = 0.429) during 3 months follow-up. There was no significant difference for complications during 6 months follow-up (χ(2) = 0.128, P = 0.720). CONCLUSIONS: Operative time, blood loss and transfusion, hospital stay in EVAR group are less than which in open repair group, the medical expense of EVAR was higher than open repair. There is no significant difference for complications during 6 months follow-up between 2 groups. Long-term follow-up and more patents are needed to analyze survival rate and long-term complications.

[Preliminary study on differential expression of plasma proteins of patients with Takayasu's arteritis in different stage].

OBJECTIVES: To investigate differential expression of plasma proteins of patients with Takayasu's arteritis to screen disease-related or phase-related proteins or biomarkers. METHODS: From March, 2005 to January, 2006, Plasma of 20 patients with acute Takayasu's arteritis, 20 patients with chronic Takayasu's arteritis, and 20 healthy people as control were collected. Plasma proteins were profiled by two-dimensional electrophoresis. Spots of differential expression were screened by computerized map analysis and identified by matrix assisted laser desorption/ionization time of flight-mass spectrometry. Circulation levels of parts of differential expression proteins were investigated by Elisa in each subject. RESULTS: Fourteen differential expression proteins were identified, including serum amyloid A, serum amyloid P, fibrinogen, complement C3c, C7, C4 binding protein, factor H related protein-1, immunoglobin, alpha-acid glycoprotein, RAG1 protein, alpha1-microglobin, apolipoprotein A-I, A-IV, transthyretin, haptoglobin. Proteins related to acute and chronic phase were serum amyloid A, fibrinogen, transthyretin, haptoglobin; Circulation levels of Serum amyloid A (SAA) and Complement C4 binding protein (C4BP) were significantly increased in active TA patients comparing to that in inactive TA patients and in controls (SAA: 95.9 vs 49.2, P = 0.009 and 23.9 mg/L, P = 0.001, respectively; C4BP: 88.5 vs 61.7, P = 0.023 and 32.6 mg/L, P < 0.001, respectively). CONCLUSIONS: Acute phase proteins and immune proteins may possible be markers for diagnosis and activity of Takayasu's arteritis, Complement activity, complement modulation protein and antibody production may be involved in immune mechanism of Takayasu's arteritis. Further study of these proteins may be helpful to elucidate the pathologic mechanism of Takayasu's arteritis.

[Comparison of open and endovascular repair for abdominal aortic aneurysm].

OBJECTIVE: To compare the effects of open and endovascular repair for abdominal aortic aneurysm. METHODS: From January 2002 to July 2007, clinical data of 223 patients with infrarenal abdominal aortic aneurysm undergoing open (141 patients) or endovascular repair (82 patients) were retrospectively reviewed. The intra- and post-operative complications, mortality, complications, survival, life quality, and cost during follow-up were analyzed. RESULTS: Operative time in endovascular group was significantly shorter than open repair group. Blood loss and transfusion in endovascular group were significantly less than open repair group (P < 0.01). There was no significant difference of intra- and post-operation complications (P > 0.05). Six-month total SF-36 scores were significantly higher in open repair group compared with endovascular group. There was no significant difference of survival rate at 2 years (P > 0.05), but endovascular group had fewer complications (P < 0.01). CONCLUSIONS: Endovascular repair is mini-invasive, but has more complications of long-term follow-up. The life quality in open repair group is better than endovascular group, and a prospective random trial is required.

[Problems and strategies for reoperation of vascular diseases].

Appropriate reoperation of the lower extremity artery may be required because of graft stenosis, occlusion, and infection. For high-risk patients who have no autogeneic vein available or who are not suitable for open reoperation, endoluminal plasty may be an alternative. The options of treatment for abdominal aortic aneurysm include traditional procedures and endovascular aneurysm repair (EVAR). The reintervention rate is higher in EVAR than in traditional procedures. The options of treatment for recurrent carotid artery stenosis remain controversial. The advantages and disadvantages of carotid endarterectomy (CEA) and carotid artery stent (CAS) should be compared under comparable clinical situations.