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1.
Nutrition ; 98: 111622, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35436690

RESUMO

OBJECTIVE: Sarcopenia defined as low skeletal muscle mass (LSMM) is associated with several clinically relevant factors in people who are critically ill. The aim of the present study was to analyze the role of LSMM derived from thoracic computed tomography (CT) for prediction of mortality and prognosis of acute pulmonary embolism (PE). METHODS: The clinical database of our department was retrospectively screened for patients with acute PE between 2013 and 2017. Overall, 234 patients were included in the analysis. LSMM was assessed on axial slides at the thoracic vertebra 5 (Th5) level of contrast-enhanced pulmonary angiography thoracic CT. The skeletal muscle index (SMI) was calculated by adjusting the muscle area to height. All-cause 30-d mortality was used as a primary outcome. RESULTS: Overall, 64 participants (27.4% of the sample) died. SMI was slightly higher for survivors than non-survivors (57.7 ± 11.9 versus 55.6 ± 14.3 cm2/m2; P = 0.07). SMI was associated with 30-d mortality in univariate as well as multivariate analysis (respective hazard ratios and 95% CI: 1.06, 1.03-1.09; 1.08, 1.04-1.11). CONCLUSIONS: SMI at Th5 derived from thoracic CT has a relevant effect on 30-d mortality in people with acute PE and should be included in the clinical routine.


Assuntos
Embolia Pulmonar , Sarcopenia , Humanos , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Prognóstico , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Estudos Retrospectivos , Sarcopenia/diagnóstico por imagem , Sarcopenia/patologia , Tomografia Computadorizada por Raios X/métodos
2.
Radiology ; 302(1): 175-184, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34581626

RESUMO

Background Many studies emphasize the role of structured reports (SRs) because they are readily accessible for further automated analyses. However, using SR data obtained in clinical routine for research purposes is not yet well represented in literature. Purpose To compare the performance of the Qanadli scoring system with a clot burden score mined from structured pulmonary embolism (PE) reports from CT angiography. Materials and Methods In this retrospective study, a rule-based text mining pipeline was developed to extract descriptors of PE and right heart strain from SR of patients with suspected PE between March 2017 and February 2020. From standardized PE reporting, a pulmonary artery obstruction index (PAOI) clot burden score (PAOICBS) was derived and compared with the Qanadli score (PAOIQ). Scoring time and confidence from two independent readings were compared. Interobserver and interscore agreement was tested by using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. To assess conformity and diagnostic performance of both scores, areas under the receiver operating characteristic curve (AUCs) were calculated to predict right heart strain incidence, as were optimal cutoff values for maximum sensitivity and specificity. Results SR content authored by 67 residents and signed off by 32 consultants from 1248 patients (mean age, 63 years ± 17 [standard deviation]; 639 men) was extracted accurately and allowed for PAOICBS calculation in 304 of 357 (85.2%) PE-positive reports. The PAOICBS strongly correlated with the PAOIQ (r = 0.94; P < .001). Use of PAOICBS yielded overall time savings (1.3 minutes ± 0.5 vs 3.0 minutes ± 1.7), higher confidence levels (4.2 ± 0.6 vs 3.6 ± 1.0), and a higher ICC (ICC, 0.99 vs 0.95), respectively, compared with PAOIQ (each, P < .001). AUCs were similar for PAOICBS (AUC, 0.75; 95% CI: 0.70, 0.81) and PAOIQ (AUC, 0.77; 95% CI: 0.72, 0.83; P = .68), with cutoff values of 27.5% for both scores. Conclusion Data mining of structured reports enabled the development of a CT angiography scoring system that simplified the Qanadli score as a semiquantitative estimate of thrombus burden in patients with pulmonary embolism. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Hunsaker in this issue.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Trombose/diagnóstico por imagem , Trombose/patologia , Mineração de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade
3.
Biosci Rep ; 42(1)2022 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-34778900

RESUMO

BACKGROUND: Acute pulmonary embolism (APE) is a prevalent reason of cardiovascular morbidity and mortality. Recent studies have underscored the positive effects of microRNAs (miRNAs) on many diseases. The present study aimed to identify the critical miRNA with differential expressions and explore its role in APE. METHODS: The critical miRNA with its target gene was screened by bioinformatics analysis. Their binding relationship was analyzed by TargetScan, Dual-luciferase reporter and RNA pull-down assays. A rat model of APE was established by self-blood coagulum. Human pulmonary artery smooth muscle cells (PASMCs) were exposed to platelet-derived growth factor (PDGF-BB) for excessive proliferation, and transfected with miR-34a-3p mimic. Mean pulmonary arterial pressure (mPAP) of rat was measured, and the pulmonary tissues were used for the pathological observation by Hematoxylin-Eosin (H&E) staining. Cell viability and proliferation were detected by Cell Counting Kit-8 (CCK-8) and EdU assays. The expressions of miR-34a-3p with its target genes (including dual-specificity phosphatase-1 (DUSP1)), neuron-derived orphan receptor-1 (NOR-1) and proliferating cell nuclear antigen (PCNA) were determined by quantitative reverse transcription polymerase chain reaction (RT-qPCR) or/and Western blot. RESULTS: MiR-34a-3p expression was down-regulated in APE patients, which attenuated the increment of mPAP and thickening of the pulmonary arterial walls in APE rats, accompanied with regulation of NOR-1 and PCNA levels. MiR-34a-3p suppressed DUSP1 expression by directly binding to its 3'-untranslated region (UTR), and attenuated cell viability, proliferation, and the expressions of NOR-1 and PCNA in PDGF-BB-induced PASMCs by inhibiting DUSP1 expression. CONCLUSION: Up-regulated miR-34a-3p negatively regulates DUSP1 expression to inhibit PASMC proliferation, which, thus, may act on APE treatment by negatively regulating pulmonary vascular proliferation.


Assuntos
Proliferação de Células , Fosfatase 1 de Especificidade Dupla/metabolismo , MicroRNAs/metabolismo , Músculo Liso Vascular/enzimologia , Miócitos de Músculo Liso/enzimologia , Embolia Pulmonar/enzimologia , Animais , Estudos de Casos e Controles , Células Cultivadas , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Modelos Animais de Doenças , Fosfatase 1 de Especificidade Dupla/genética , Regulação Enzimológica da Expressão Gênica , Masculino , Proteínas de Membrana Transportadoras/genética , Proteínas de Membrana Transportadoras/metabolismo , MicroRNAs/genética , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/patologia , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Antígeno Nuclear de Célula em Proliferação/genética , Antígeno Nuclear de Célula em Proliferação/metabolismo , Artéria Pulmonar/enzimologia , Artéria Pulmonar/patologia , Embolia Pulmonar/genética , Embolia Pulmonar/patologia , Ratos Sprague-Dawley , Transdução de Sinais , Remodelação Vascular
4.
PLoS One ; 16(12): e0260802, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34860827

RESUMO

OBJECTIVE: Acute pulmonary embolism (PE) is a life-threatening disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) is used in clinical routine for diagnosis of PE. Many pulmonary obstruction scores were proposed to aid in stratifying clinical course of PE. The purpose of the present study was to compare common pulmonary obstruction scores in PE in regard of time efficiency and interreader agreement based upon a representative patient sample. METHODS: Overall, 50 patients with acute PE were included in this single center, retrospective analysis. Two readers scored the CT images blinded to each other and assessed the scores proposed by Mastora et al., Qanadli et al., Ghanima et al. and Kirchner et al. The required time was assessed of each reading for scoring. RESULTS: For reader 1, Mastora score took the longest time duration, followed by Kirchner score, Qanadli score and finally Ghanima score (every test, p<0.0001). The interreader variability was excellent for all scores with no significant differences between them. In the Spearman's correlation analysis strong correlations were identified between the scores of Mastora, Qanadli and Kirchner, whereas Ghanima score was only moderately correlated with the other scores. There was a weak correlation between time duration and Mastora score (r = 0.35, p = 0.014). For the Ghanima score, a significant inverse correlation was found (r = -0.67, p<0.0001). CONCLUSION: For the investigated obstruction scores, there are significant differences in regard of time consumption with no relevant differences in regard of interreader variability in patients with acute pulmonary embolism. Mastora score requires the most time effort, whereas the score by Ghanima the least time.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Embolia Pulmonar/patologia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Disfunção Ventricular Direita/patologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Disfunção Ventricular Direita/diagnóstico por imagem , Adulto Jovem
5.
Sci Rep ; 11(1): 20042, 2021 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625646

RESUMO

To evaluate mosaic perfusion patterns and vascular lesions in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using C-Arm computed tomography (CACT) compared to computed tomography pulmonary angiography (CTPA). We included 41 patients (18 female; mean age 59.9 ± 18.3 years) with confirmed CTEPH who underwent CACT and CTPA within 21 days (average 5.3 ± 5.2). Two readers (R1; R2) independently evaluated datasets from both imaging techniques for mosaic perfusion patterns and presence of CTEPH-typical vascular lesions. The number of pulmonary arterial segments with typical findings was evaluated and the percentage of affected segments was calculated and categorized: < 25%; 25-49%; 50-75%; < 75% of all pulmonary arterial segments affected by thromboembolic vascular lesions. Inter-observer agreement was calculated for both modalities using the intraclass-correlation-coefficient (ICC). Based on consensus reading the inter-modality agreement (CACTcons vs. CTPAcons) was calculated using the ICC. Inter-observer agreement was excellent for central vascular lesions (ICC > 0.87) and the percentage of affected segments (ICC > 0.76) and good for the perceptibility of mosaic perfusion (ICC > 0.6) and attribution of the pattern of mosaic perfusion (ICC > 0.6) for both readers on CACT and CTPA. Inter-modality agreement was excellent for the perceptibility of mosaic perfusion (ICC = 1), the present perfusion pattern (ICC = 1) and central vascular lesions (ICC = 1). However, inter-modality agreement for the percentage of affected segments was fair (ICC = 0.50), with a greater proportion of identified affected segments on CACTcons. CACT demonstrates a high agreement with CTPA regarding the detection of mosaic perfusion. CACT detects a higher number of peripheral vascular lesions compared to CTPA.


Assuntos
Angiografia/métodos , Hipertensão Pulmonar/patologia , Artéria Pulmonar/patologia , Embolia Pulmonar/patologia , Tomografia Computadorizada por Raios X/métodos , Doença Crônica , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Perfusão , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos
6.
Mar Drugs ; 19(9)2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34564149

RESUMO

Fucosylated glycosaminoglycan (FG) from sea cucumber is a potent anticoagulant by inhibiting intrinsic coagulation tenase (iXase). However, high-molecular-weight FGs can activate platelets and plasma contact system, and induce hypotension in rats, which limits its application. Herein, we found that FG from T. ananas (TaFG) and FG from H. fuscopunctata (HfFG) at 4.0 mg/kg (i.v.) could cause significant cardiovascular and respiratory dysfunction in rats, even lethality, while their depolymerized products had no obvious side effects. After injection, native FG increased rat plasma kallikrein activity and levels of the vasoactive peptide bradykinin (BK), consistent with their contact activation activity, which was assumed to be the cause of hypotension in rats. However, the hemodynamic effects of native FG cannot be prevented by the BK receptor antagonist. Further study showed that native FG induced in vivo procoagulation, thrombocytopenia, and pulmonary embolism. Additionally, its lethal effect could be prevented by anticoagulant combined with antiplatelet drugs. In summary, the acute toxicity of native FG is mainly ascribed to pulmonary microvessel embolism due to platelet aggregation and contact activation-mediated coagulation, while depolymerized FG is a safe anticoagulant candidate by selectively targeting iXase.


Assuntos
Anticoagulantes/toxicidade , Glicosaminoglicanos/toxicidade , Animais , Anticoagulantes/química , Coagulação Sanguínea/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Fucose/química , Glicosaminoglicanos/química , Coração/efeitos dos fármacos , Coração/fisiologia , Frequência Cardíaca/efeitos dos fármacos , Pulmão/efeitos dos fármacos , Pulmão/patologia , Masculino , Ativação Plaquetária/efeitos dos fármacos , Embolia Pulmonar/induzido quimicamente , Embolia Pulmonar/patologia , Ratos Sprague-Dawley , Respiração/efeitos dos fármacos , Pepinos-do-Mar , Função Ventricular Esquerda/efeitos dos fármacos
7.
Sci Rep ; 11(1): 18797, 2021 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-34552142

RESUMO

Pulmonary endarterectomy (PEA) resected material offers a unique opportunity to develop an in vitro endothelial cell model of chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to comprehensively analyze the endothelial function, molecular signature, and mitochondrial profile of CTEPH-derived endothelial cells to better understand the pathophysiological mechanisms of endothelial dysfunction behind CTEPH, and to identify potential novel targets for the prevention and treatment of the disease. Isolated cells from specimens obtained at PEA (CTEPH-EC), were characterized based on morphology, phenotype, and functional analyses (in vitro and in vivo tubule formation, proliferation, apoptosis, and migration). Mitochondrial content, morphology, and dynamics, as well as high-resolution respirometry and oxidative stress, were also studied. CTEPH-EC displayed a hyperproliferative phenotype with an increase expression of adhesion molecules and a decreased apoptosis, eNOS activity, migration capacity and reduced angiogenic capacity in vitro and in vivo compared to healthy endothelial cells. CTEPH-EC presented altered mitochondrial dynamics, increased mitochondrial respiration and an unbalanced production of reactive oxygen species and antioxidants. Our study is the foremost comprehensive investigation of CTEPH-EC. Modulation of redox, mitochondrial homeostasis and adhesion molecule overexpression arise as novel targets and biomarkers in CTEPH.


Assuntos
Endotélio Vascular/citologia , Hipertensão Pulmonar/patologia , Embolia Pulmonar/patologia , Apoptose , Estudos de Casos e Controles , Doença Crônica , Endotélio Vascular/patologia , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Mitocôndrias/patologia , Estresse Oxidativo , Artéria Pulmonar/citologia , Artéria Pulmonar/patologia , Artéria Pulmonar/fisiopatologia , Embolia Pulmonar/fisiopatologia
8.
PLoS One ; 16(9): e0256480, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34473738

RESUMO

BACKGROUND: The prevalence of pulmonary embolism (PE) in the acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is highly controversial. We conducted a systematic review and meta-analysis to summarize the epidemiology and characteristics of PE with AE-COPD for current studies. METHODS: We searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies published prior to October 21, 2020. Pooled proportions with 95% confidence intervals (95% CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals were used as effect measures for dichotomous and continuous variables, respectively. RESULTS: A total of 17 studies involving 3170 patients were included. The prevalence of PE and deep vein thrombosis (DVT) in AE-COPD patients was 17.2% (95% CI: 13.4%-21.3%) and 7.1% (95% CI: 3.7%-11.4%%), respectively. Dyspnea (OR = 6.77, 95% CI: 1.97-23.22), pleuritic chest pain (OR = 3.25, 95% CI: 2.06-5.12), lower limb asymmetry or edema (OR = 2.46, 95% CI:1.51-4.00), higher heart rates (MD = 20.51, 95% CI: 4.95-36.08), longer hospital stays (MD = 3.66, 95% CI: 3.01-4.31) were associated with the PE in the AE-COPD patients. Levels of D-dimer (MD = 1.51, 95% CI: 0.80-2.23), WBC counts (MD = 1.42, 95% CI: 0.14-2.70) were significantly higher and levels of PaO2 was lower (MD = -17.20, 95% CI: -33.94- -0.45, P<0.05) in the AE-COPD with PE group. The AE-COPD with PE group had increased risk of fatal outcome than the AE-COPD group (OR = 2.23, 95% CI: 1.43-3.50). CONCLUSIONS: The prevalence of PE during AE-COPD varies considerably among the studies. AE-COPD patients with PE experienced an increased risk of death, especially among the ICU patients. Understanding the potential risk factors for PE may help clinicians identify AE-COPD patients at increased risk of PE. PROSPERO REGISTRATION NUMBER: CRD42021226568.


Assuntos
Dor no Peito/epidemiologia , Dispneia/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Edema Pulmonar/epidemiologia , Embolia Pulmonar/epidemiologia , Trombose Venosa/epidemiologia , Doença Aguda , Biomarcadores/sangue , Dor no Peito/patologia , Dispneia/patologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Tempo de Internação/estatística & dados numéricos , Razão de Chances , Prevalência , Doença Pulmonar Obstrutiva Crônica/patologia , Edema Pulmonar/patologia , Embolia Pulmonar/patologia , Fatores de Risco , Trombose Venosa/patologia
9.
J Comput Assist Tomogr ; 45(6): 863-869, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34347701

RESUMO

OBJECTIVE: To assess coronary artery calcification (CAC) in patients with acute pulmonary embolism and determine whether this correlates with right ventricular dilation (RVD) and mortality. METHODS: Computed tomography pulmonary angiography scans of 330 patients were used to perform retrospective assessment of the pulmonary artery computed tomography obstruction index (PACTOI), the right/left ventricle diameter ratio, the diameter of the pulmonary trunk, and the ordinal CAC score. RESULTS: Age (P < 0.001), urea level (P < 0.001), D-dimer level (P = 0.006), diameter of the pulmonary trunk (P < 0.001), and PACTOI (P < 0.001) were significantly higher in the RVD-positive patient group. We found a significant relation between increased CAC score and increased mortality (P = 0.038). Left-sided CAC was detected much more often in RVD-positive patients (P = 0.008). CONCLUSIONS: Coronary artery calcification is common in patients with acute pulmonary embolism, especially when those patients are also RVD-positive. A significant relation was found between RVD and left-sided CAC.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Disfunção Ventricular Direita/complicações , Doença Aguda , Idoso , Doença da Artéria Coronariana/complicações , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Feminino , Ventrículos do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Embolia Pulmonar/complicações , Embolia Pulmonar/patologia , Estudos Retrospectivos , Calcificação Vascular/complicações , Calcificação Vascular/patologia , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/patologia
10.
Br J Hosp Med (Lond) ; 82(7): 1-6, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34338010

RESUMO

Pulmonary embolism remains a common and potentially deadly disease, despite advances in diagnostic imaging, treatment and prevention. Managing pulmonary embolism requires a multifactorial approach involving risk stratification, determining appropriate diagnostics and selecting individualised therapy. The first part of this article reviewed the pathophysiology, risk factors, clinical presentation, diagnostic evaluation and therapeutic management and early outpatient management of pulmonary embolism. This second part summarises pulmonary embolism in the setting of pregnancy, COVID-19, recurrent disease and chronic thromboembolic pulmonary hypertension.


Assuntos
COVID-19/epidemiologia , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/patologia , COVID-19/patologia , Doença Crônica , Feminino , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/patologia , Masculino , Gravidez , Embolia Pulmonar/diagnóstico por imagem , Radiografia Torácica , Recidiva , Fatores de Risco , SARS-CoV-2 , Ultrassonografia Doppler , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/patologia
11.
Br J Hosp Med (Lond) ; 82(7): 1-16, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34338014

RESUMO

Pulmonary embolism remains a common and potentially deadly disease, despite advances in diagnostic imaging, treatment and prevention. Managing pulmonary embolism requires a multifactorial approach involving risk stratification, determining appropriate diagnostics and selecting individualised therapy. This article reviews the pathophysiology, risk factors, clinical presentation, diagnostic evaluation and therapeutic management and early outpatient management of pulmonary embolism. The second part summarises pulmonary embolism in the setting of pregnancy, COVID-19, recurrent disease and chronic thromboembolic pulmonary hypertension.


Assuntos
COVID-19/epidemiologia , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/patologia , Biomarcadores , COVID-19/patologia , Doença Crônica , Feminino , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/patologia , Masculino , Gravidez , Embolia Pulmonar/diagnóstico por imagem , Recidiva , Fatores de Risco , SARS-CoV-2 , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/patologia
12.
Sci Rep ; 11(1): 16039, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362979

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) induces lung injury of varying severity, potentially causing severe acute respiratory distress syndrome (ARDS). Pulmonary injury patterns in COVID-19 patients differ from those in patients with other causes of ARDS. We aimed to explore the frequency and pathogenesis of cavitary lung lesions in critically ill patients with COVID-19. Retrospective study in 39 critically ill adult patients hospitalized with severe acute respiratory syndrome coronavirus 2 including lung injury of varying severity in a tertiary care referral center during March and May 2020, Berlin/Germany. We observed lung cavitations in an unusually large proportion of 22/39 (56%) COVID-19 patients treated on intensive care units (ICU), including 3/5 patients without mechanical ventilation. Median interquartile range (IQR) time between onset of symptoms and ICU admission was 11.5 (6.25-17.75) days. In 15 patients, lung cavitations were already present on the first CT scan, performed after ICU admission; in seven patients they developed during a subsequent median (IQR) observation period of 48 (35-58) days. In seven patients we found at least one cavitation with a diameter > 2 cm (maximum 10 cm). Patients who developed cavitations were older and had a higher body mass index. Autopsy findings in three patients revealed that the cavitations reflected lung infarcts undergoing liquefaction, secondary to thrombotic pulmonary artery branch occlusions. Lung cavitations appear to be a frequent complication of severely ill COVID-19 patients, probably related to the prothrombotic state associated with COVID-19.


Assuntos
COVID-19/patologia , Pulmão/patologia , Embolia Pulmonar/patologia , Idoso , COVID-19/complicações , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/etiologia , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação
13.
J Surg Oncol ; 124(8): 1485-1490, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34368956

RESUMO

BACKGROUND AND OBJECTIVES: Patients with cancer to bone or soft tissues undergoing orthopedic procedures may be unable to receive pharmacologic prophylaxis for venous thromboembolism (VTE). Inferior vena cava (IVC) filters may be an effective method to prevent fatal pulmonary embolism (PE) in these patients. METHODS: Retrospective chart review performed for patients surgically treated for malignant disease of bone or soft tissue who had IVC filter placement. Type of surgery, anatomic region, and development of wound complications requiring repeat surgery were analyzed. RESULTS: From 2007 to 2018, 286 patients received IVC filters. Ten (3.5%) patients suffered deep vein thrombus (DVT) postoperatively. There was no acute fatal PE. Two patients suffered PE at 2 and 99 days postoperatively. Risk of DVT was comparable following surgery with endoprosthesis versus open reduction and internal fixation (p = 0.056) and with soft tissue versus bone involvement (p = 0.620). Three filter-related complications occurred. Patients disease at the femur had the highest rate of DVT. CONCLUSIONS: Following treatment of malignant disease of bone or soft-tissues, two patients with IVC filter placement experienced nonfatal PE and three patients experienced filter-related complications. No patients in this series experienced a fatal PE.


Assuntos
Neoplasias Ósseas/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Embolia Pulmonar/prevenção & controle , Sarcoma/cirurgia , Filtros de Veia Cava/estatística & dados numéricos , Tromboembolia Venosa/prevenção & controle , Neoplasias Ósseas/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Prognóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/patologia , Estudos Retrospectivos , Sarcoma/patologia , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/patologia
14.
Forensic Sci Int ; 325: 110872, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34147938

RESUMO

Silicone embolism syndrome (SES) is a well known complication after injection of silicone gel as well as liquid silicone. Rarely, men use physiologic salt solution or liquid silicone injected into the subcutaneous tissue of the scrotum, the penis, the upper genital or the inguinal region. Those men, who call themselves "siliconers", want to get a larger penis and scrotum, also visible when wearing clothes. Injections of liquid silicone in the mentioned regions can lead to liquid silicone embolism in the lungs and also the liver, sometimes eventually leading to death via right heart failure as in the present case. Autopsy revealed "frog spawn"-like vacuoles in the subcutaneous tissue of the genital region and liquid silicone embolism in lungs and liver. Additionally, toxicological analyses revealed different liquid silicones. Smaller oligomers were transported into lung and liver, larger ones showed local enrichment at the injection site. The seized Polydimethylsiloxane (PDMS) could not be detected in abdominal fat, blood or urine, potentially due to low perfusion of fat tissue, the aqueous character of blood and urine or the time span between last injection and death.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/patologia , Embolia/induzido quimicamente , Embolia Pulmonar/induzido quimicamente , Silicones/efeitos adversos , Adulto , Transtornos Dismórficos Corporais/complicações , Embolia/patologia , Humanos , Injeções Subcutâneas , Fígado/patologia , Pulmão/patologia , Masculino , Embolia Pulmonar/patologia , Vacúolos
15.
Bull Exp Biol Med ; 171(2): 198-201, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34173102

RESUMO

Changes in pulmonary microcirculation were studied in isolated perfused rabbit lungs during modelling pulmonary thromboembolism under conditions of acetylcholine infusion against the background of treatment with M1 acetylcholine receptor blocker pirenzepine or blockade of muscarinic acetylcholine receptors with atropine. In the first case, the increase in pulmonary artery pressure was less pronounced than in case of atropine treatment. In response to pulmonary embolism after acetylcholine infusion against the background of pirenzepine pretreatment, the capillary hydrostatic pressure and postcapillary resistance did not change, while after atropine treatment, these parameters increased. In case of pulmonary embolism after acetylcholine infusion combined with selective blockade of M1 muscarinic acetylcholine receptors, the capillary filtration coefficient increased to a greater extent, than in the control and after blockade of muscarinic acetylcholine receptors.


Assuntos
Antagonistas Muscarínicos/farmacologia , Circulação Pulmonar/efeitos dos fármacos , Embolia Pulmonar , Acetilcolina/farmacologia , Animais , Atropina/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Modelos Animais de Doenças , Pulmão/irrigação sanguínea , Pulmão/efeitos dos fármacos , Microcirculação/efeitos dos fármacos , Nitroglicerina/farmacologia , Circulação Pulmonar/fisiologia , Embolia Pulmonar/patologia , Embolia Pulmonar/fisiopatologia , Coelhos , Receptores Muscarínicos/efeitos dos fármacos , Receptores Muscarínicos/metabolismo , Resistência Vascular/efeitos dos fármacos , Resistência Vascular/fisiologia
16.
Proc Natl Acad Sci U S A ; 118(27)2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34183396

RESUMO

The onset of venous thromboembolism, including pulmonary embolism, represents a significant health burden affecting more than 1 million people annually worldwide. Current treatment options are based on anticoagulation, which is suboptimal for preventing further embolic events. In order to develop better treatments for thromboembolism, we sought to understand the structural and mechanical properties of blood clots and how this influences embolism in vivo. We developed a murine model in which fibrin γ-chain cross-linking by activated Factor XIII is eliminated (FGG3X) and applied methods to study thromboembolism at whole-body and organ levels. We show that FGG3X mice have a normal phenotype, with overall coagulation parameters and platelet aggregation and function largely unaffected, except for total inhibition of fibrin γ-chain cross-linking. Elimination of fibrin γ-chain cross-linking resulted in thrombi with reduced strength that were prone to fragmentation. Analysis of embolism in vivo using Xtreme optical imaging and light sheet microscopy demonstrated that the elimination of fibrin γ-chain cross-linking resulted in increased embolization without affecting clot size or lysis. Our findings point to a central previously unrecognized role for fibrin γ-chain cross-linking in clot stability. They also indirectly indicate mechanistic targets for the prevention of thrombosis through selective modulation of fibrin α-chain but not γ-chain cross-linking by activated Factor XIII to reduce thrombus size and burden, while maintaining clot stability and preventing embolism.


Assuntos
Reagentes para Ligações Cruzadas/química , Fator XIIIa/metabolismo , Fibrinogênio/metabolismo , Embolia Pulmonar/etiologia , Embolia Pulmonar/patologia , Veia Cava Inferior/patologia , Trombose Venosa/complicações , Animais , Coagulação Sanguínea , Plaquetas/metabolismo , Modelos Animais de Doenças , Camundongos Endogâmicos C57BL , Imagem Óptica , Embolia Pulmonar/sangue , Trombose Venosa/sangue
17.
Clin Appl Thromb Hemost ; 27: 10760296211013107, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33969714

RESUMO

The complex pathophysiology of pulmonary embolism (PE) involves hemostatic activation, inflammatory processes, cellular dysfunction, and hemodynamic derangements. Due to the heterogeneity of this disease, risk stratification and diagnosis remains challenging. Biochip-array technology provides an integrated high throughput method for analyzing blood plasma samples for the simultaneous measurement of multiple biomarkers for potential risk stratification. Using biochip-array method, this study aimed to quantify the inflammatory biomarkers such as interleukin (IL)-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and epidermal growth factor (EGF) in 109 clinically confirmed PE patients in comparison to the control group comprised of plasma samples collected from 48 healthy subjects. Cytokines IL-4, IL-6, IL-8, IL-10, IL-1ß, and MCP-1 demonstrated varying level of significant increase (P < 0.05) in massive-risk PE patients compared to submassive- and low-risk PE patients. The upregulation of inflammatory cytokines in PE patients observed in this study suggest that inflammation plays an important role in the overall pathophysiology of this disease. The application of biochip-array technology may provide a useful approach to evaluate these biomarkers to understand the pathogenesis and risk stratification of PE patients.


Assuntos
Inflamação/metabolismo , Análise Serial de Proteínas/métodos , Embolia Pulmonar/genética , Citocinas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/patologia , Regulação para Cima
19.
Pediatr Infect Dis J ; 40(5): e200-e202, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33847301

RESUMO

The current coronavirus disease 2019 pandemic has been particularly challenging for the clinician because of the unclear nature of the underlying disease mechanisms. One of the hallmarks of the disease involves an increased risk of thrombosis and hypercoagulable state. Here, we describe 2 cases of patients admitted with submassive pulmonary embolism in the setting of positive tests for severe acute respiratory syndrome coronavirus 2.


Assuntos
COVID-19/diagnóstico por imagem , Pandemias , Embolia Pulmonar/diagnóstico por imagem , SARS-CoV-2/isolamento & purificação , Adolescente , COVID-19/complicações , COVID-19/patologia , COVID-19/virologia , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Embolia Pulmonar/etiologia , Embolia Pulmonar/patologia , Embolia Pulmonar/virologia
20.
Am J Forensic Med Pathol ; 42(2): 118-120, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33833197

RESUMO

ABSTRACT: We assess the utility of a Centers for Disease Control and Prevention (CDC) guidelines-based coronavirus disease 2019 (COVID-19) screening checklist for postmortem severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surveillance, detailing the relationship between the histologic findings at autopsy and attribution of death to COVID-19.SARS-CoV-2 nasopharyngeal swabs were collected at the time of autopsy in all "checklist-positive" decedents. Additional "checklist-negative" decedents were randomly tested daily. Lung slides were blindly reviewed by 3 pathologists, assessing for the presence of diffuse alveolar damage (DAD) and other findings. Sixteen decedents had positive postmortem SARS-CoV-2 nasopharyngeal swabs and underwent complete autopsies. Seven decedents had positive screening checklists. Of these, 4 had DAD and 1 had COVID-19-associated thromboembolic disease. Of the 9 decedents with negative screening checklists, 2 had DAD, but only 1 was attributed to COVID-19; the other was likely drug related. Acute bronchopneumonia was the second most common finding, and aspiration was the likely etiology in cases without concomitant DAD. COVID-19-related DAD was identified more commonly in decedents who screened positive by CDC checklist, but false-negatives did occur. Medical examiner offices should maintain a low threshold for random testing of decedents even when COVID-19 is not suspected.


Assuntos
COVID-19/diagnóstico , COVID-19/mortalidade , Pulmão/patologia , Adolescente , Adulto , Idoso , Autopsia , Broncopneumonia/patologia , Teste para COVID-19 , Centers for Disease Control and Prevention, U.S. , Lista de Checagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Guias de Prática Clínica como Assunto , Alvéolos Pulmonares/patologia , Embolia Pulmonar/patologia , Aspiração Respiratória/patologia , Manejo de Espécimes , Estados Unidos , Adulto Jovem
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