Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogen...Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogenous spread and settle in other organs.[4,5]As a result,in the setting of acute pericarditis in immunosuppressed patients,a bacterial etiology must always be considered,which requires pericardiocentesis to complete drainage and pathogen identification.展开更多
Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left ...Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left atrial aneurysm following isolated Staphylococcus aureus pericarditis.She initially presented in decompensated shock and was later diagnosed with constrictive pericarditis.Despite undergoing pericardiectomy,she subsequently developed a left atrial aneurysm,necessitating surgical closure.This case highlights the aggressive nature of bacterial pericarditis and its potential to cause rare structural cardiac complications.展开更多
This review article aims to:(1) discern from the literature the immune and inflammatory processes occurring in the pericardium following injury; and(2) to delve into the molecular mechanisms which may play a role in t...This review article aims to:(1) discern from the literature the immune and inflammatory processes occurring in the pericardium following injury; and(2) to delve into the molecular mechanisms which may play a role in the progression to constrictive pericarditis. Pericarditis arises as a result of a wide spectrum of pathologies of both infectious and non-infectious aetiology, which lead to various degrees of fibrogenesis. Current understanding of the sequence of molecular events leading to pathological manifestations of constrictive pericarditis is poor. The identification of key mechanisms and pathways common to most fibrotic events in the pericardium can aid in the design and development of novel interventions for the prevention and management of constriction. We have identified through this review various cellular events and signalling cascades which are likely to contribute to the pathological fibrotic phenotype. An initial classical pattern of inflammation arises as a result of insult to the pericardium and can exacerbate into an exaggerated or prolonged inflammatory state. Whilst the implication of major drivers of inflammation and fibrosis such as tumour necrosis factor and transforming growth factor β were foreseeable, the identification of pericardial deregulation of other mediators(basic fibroblast growth factor, galectin-3 and the tetrapeptide Ac-SDKP) provides important avenues for further research.展开更多
Presents the fixed point theorem for a class of β constrictive increasing operators without continuity and discusses the existence of solution of the integral equation with the discontinuous term in L 1(0,∞)...Presents the fixed point theorem for a class of β constrictive increasing operators without continuity and discusses the existence of solution of the integral equation with the discontinuous term in L 1(0,∞) by using this theorem.展开更多
BACKGROUND Refractory ascites is a rare complication following orthotopic liver transplantation(OLT).The broad spectrum of differential diagnosis often leads to delay in diagnosis.Therapy depends on recognition and tr...BACKGROUND Refractory ascites is a rare complication following orthotopic liver transplantation(OLT).The broad spectrum of differential diagnosis often leads to delay in diagnosis.Therapy depends on recognition and treatment of the underlying cause.Constrictive pericarditis is a condition characterized by clinical signs of right-sided heart failure.In the advanced stages of the disease,hepatic congestion leads to formation of ascites.In patients after OLT,cardiac etiology of ascites is easily overlooked and it requires a high degree of clinical suspicion.CASE SUMMARY We report a case of a 55-year-old man who presented with a refractory ascites three months after liver transplantation for alcoholic cirrhosis.Prior to transplantation the patient had a minimal amount of ascites.The transplant procedure and the early postoperative course were uneventful.Standard posttransplant work up failed to reveal any typical cause of refractory post-transplant ascites.The function of the graft was good.Apart from atrial fibrillation,cardiac status was normal.Eighteen months post transplantation the patient developed dyspnea and severe fatigue with peripheral edema.Ascites was still prominent.The presenting signs of right-sided heart failure were highly suggestive of cardiac etiology.Diagnostic paracentesis was suggestive of cardiac ascites,and further cardiac evaluation showed typical signs of constrictive pericarditis.Pericardiectomy was performed followed by complete resolution of ascites.On the follow-up the patient remained symptom-free with no signs of recurrent ascites and with normal function of the liver graft.CONCLUSION Refractory ascites following liver transplantation is a rare complication with many possible causes.Broad differential diagnosis needs to be considered.展开更多
Chronic Pericarditis is infl ammation that begins gradually,is long lasting and results in fl uid accumulation in the pericardial space or thickening of the pericardium.The etiology is unknown but may be cancer,TB or ...Chronic Pericarditis is infl ammation that begins gradually,is long lasting and results in fl uid accumulation in the pericardial space or thickening of the pericardium.The etiology is unknown but may be cancer,TB or hypothyroidism.Arrhythmias are common and seen in almost half the patients.The commonest arrhythmia is atrial fi brillation.Symptoms and signs are related to increased right atrial pressure and physical fi ndings include elevated JVP and pericardial knock.Non surgical therapy consists mainly of no salt.Surgery cures about 85%of patients,however 5–15%of patients will die.Chronic effusive pericarditis occurs when there is persistent restriction of the visceral pericardium after pericardiocentesis.展开更多
Rationale:Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects.However,reports of synthetic cannabinoids accompanied by constrictive pericardi...Rationale:Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects.However,reports of synthetic cannabinoids accompanied by constrictive pericarditis are limited.Patient’s concern:A 28-year-old male with a history of synthetic cannabinoid(Bonzai)abuse presented with chest discomfort,dyspnea,and lower extremity edema.Investigations revealed reduced left ventricular ejection fraction,elevated inflammatory markers,low electrocardiogram voltages,and atrial fibrillation.Diagnosis:Chest spiral computerized tomography scan and chest X-ray demonstrated pericardial calcification.Cardiac magnetic resonance imaging and right heart catheterization were done to confirm the possibility of constrictive pericarditis.Based on the patient’s addiction history and exclusion of rheumatologic and infectious causes,it was supposed that constrictive pericarditis and cardiomyopathy may be accompanied by synthetic cannabinoid use.Interventions:The patient received standard medical therapy,including loop diuretics for cardiomyopathy and constrictive pericarditis.Catheter ablation was recommended for his rhythm control,and he was planned for close monitoring of clinical and echocardiographic response and evaluation of the need for surgical pericardiectomy in the future.Outcomes:After 6 months follow-up,echocardiographic exam revealed no significant improvement in ventricular function.However,due to the high surgical risk,the patient’s poor compliance,and the continuation of drug abuse,he was not a good candidate for surgery according to our heart team’s decision.Lessons:Synthetic cannabinoids can trigger constrictive pericarditis,and clinicians should consider them when evaluating patients with compatible symptoms and exposure history.Further research on the cardiovascular effects of synthetic cannabinoids is needed and public education on potential harms is warranted.展开更多
Aim: To report a case of “end-stage” constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In “End-stage” constrictive pericarditis, the etiology rem...Aim: To report a case of “end-stage” constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In “End-stage” constrictive pericarditis, the etiology remains unknown in majority of cases and inflammation plays a central role in its development. It has been readily confused with cirrhosis of liver in which there may be ascites, but venous pressure is normal, the neck veins are not engorged and cardiac enlargement is frequent in other causes of heart failure. Case Report: A 67 years old male presented with sudden onset of tachycardia. Clinical examination revealed right-sided heart failure, “Egg-shell” calcification in Chest X-ray and echocardiographic features of pericardial constriction such as septal bounce and dynamic respiratory changes in mitral inflow velocity. The patient was advised medical measures. Conclusion: When clinical signs of right heart failure become unresponsive to increased doses of diuretics, constrictive pericarditis is more likely the underlying disease since severe, right-sided failure develops in very advanced, the “end-stage” of the disease.展开更多
Background: Chronic constrictive pericarditis is a rare but serious clinical entity with a poor prognosis in the absence of surgical treatment. The purpose of this study was to report on our experience of subtotal ant...Background: Chronic constrictive pericarditis is a rare but serious clinical entity with a poor prognosis in the absence of surgical treatment. The purpose of this study was to report on our experience of subtotal anterior pericardectomy and analyze our surgical results. Results: We included 74 patients operated on for chronic constrictive pericarditis in our institution during the period from January 1985 to December 2020. There were 29 female and 45 male patients, with an average age of 28 years (range: 8 - 64 years). 36.5% of patients were in NYHA class III or IV. Physical signs were dominated by peripheral signs of right heart failure in 93.2% of cases. The surgical procedure was a subtotal anterior pericardectomy from the left to the right phrenic nerve, freeing the heart chambers and the large vessels. The surgical results were marked by a functional improvement in 82.4% of the cases. The postoperative complications were marked by a low cardiac output in 8.1% of the cases, a atrial fibrillation in 4.1% of the cases, a haemorrhage in 1.4% of the cases, a haemothorax in 2.7% of the cases. Perioperative mortality was 5.4% patients. The causes of death were low cardiac output in 50% of cases, hemorrhage in 25% of cases, and hepatocellular insufficiency in 25% of cases. We observed a mortality of 2.9% after an average follow-up of 5.17 years ± 4.76 years. All other survivors were asymptomatic and no re-intervention for recurrence was performed. Conclusions: Subtotal anterior pericardectomy was the technique we used for the treatment of chronic constrictive pericarditis. It allowed having satisfactory surgical results with a functional improvement and an acceptable morbidity.展开更多
Background:Constrictive pericarditis is a challenging diagnosis to make be-cause it can mimic heart failure,restrictive myocardial diseases,and massive pericardial effusion.Here we report an unusual case of pericardia...Background:Constrictive pericarditis is a challenging diagnosis to make be-cause it can mimic heart failure,restrictive myocardial diseases,and massive pericardial effusion.Here we report an unusual case of pericardial cyst mas-querading as constrictive pericarditis.Case summary:We present a case of a young gentleman,presenting with progressive shortness of breath,abdominal ascites and signs of right sided heart failure,imaging study with Transthoracic Echo and chest CT scan showed an unusual loculated extracardiac collection compressing on the right ventricle and right atrium,with pericardial wall cal cification suggesting chronic pericarditis.Cardiac magnetic resonance(CMR)confirmed a pericardial origin of the mass.Surgical intervention was done as the pericardial cyst was large and causing pressure symptoms leading to quick symptomatic relief and recovery.Conclusion:Pericardial cysts are a rare en-counter in clinical practice,which makes their management a clinical chal-lenge.Further research is required to establish a comprehensive approach to managing congenital pericardial cysts.展开更多
Objective: To study the effects of electroacupuncture(EA) in chronic constrictive injury(CCI) rat model and the expression of N-methyl-D-aspartate receptor type 2B(NR2B) in ipsilateral spinal dorsal horn in rats to ex...Objective: To study the effects of electroacupuncture(EA) in chronic constrictive injury(CCI) rat model and the expression of N-methyl-D-aspartate receptor type 2B(NR2B) in ipsilateral spinal dorsal horn in rats to explore the analgesic mechanisms of EA. Methods: According to the random number table, totally 180 rats were evenly divided into a sham group, a CCI group, and an EA group. CCI model was conducted with four4–0 chromic gut ligatures loosely ligated around the left sciatic nerve 1 cm above the trifurcation. Rats in the EA group received 2 Hz EA therapy bilaterally at acupoints of Zusanli(ST 36) and Sanyinjiao(SP 6) once daily(30 min/d) for 30 days after surgery. Paw withdrawal thresholds(PWTs) were measured on 0(baseline), 1, 3, 7, 15,30 days after surgery. Rats were sacri?ced on 0, 1, 3, 7, 15 and 30 days after surgery, and the L4–5 segments of spinal cord were removed to detect the expression of NR2B by immunohistochemistry and quantitative polymerase chain reaction. Results: PWTs in the CCI group were signi?cantly lower than the sham group at Day1–30 after surgery, and reached its lowest at Day 1(P<0.01). After EA treatment, the PWTs recovered rapidly and were signi?cantly higher than those in the CCI group on 3, 7, 15 and 30 days after surgery(P<0.01). The numbers of NR2B-immunoreactive cells of the CCI group signi?cantly increased after CCI surgery compared with the sham group(P<0.01). Compared with the CCI group, stimulation of EA markedly decreased the numbers of NR2B-immunoreactive cells at Day 3, 7, 15 and 30(P<0.05). In the sham group, NR2B mRNA was expressed at a low level. It increased after CCI surgery, which increased rapidly at Day 7(P<0.01) and reached its peak value at Day 15(P<0.01). After EA stimulation, relative quantity of NR2B mRNA expression was less than that in the CCI group at Day 15 and 30(P<0.05). Conclusions: Low frequency of EA had antinociceptive effect in CCI rat model. The analgesic effects of EA might be through the inhibition of NR2B.展开更多
Background： To determine the influence of right ventricular function in patients with constrictive pericarditis （CP） undergoing surgery and to compare the outcomes of patients who received surgery with those manage...Background： To determine the influence of right ventricular function in patients with constrictive pericarditis （CP） undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically. Methods： Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011. Patients with CP chose to either receive pericardiectomy or medical management. Echocardiographic measurements were performed to evaluate heart function, and survival was recorded. Results： A total of 58 patients with CP （36 received pericardiectomy, 22 managed medically）, and 43 healthy volunteers were included. CP patients who received surgery had a higher survival rate than those managed medically （P = 0.003）, and higher st, rvival was also seen in the subgroup of CP patients with severely impaired right systolic function. Albumin level, left ventricular end-diastolic dimension, and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery. Conclusions： Preoperative right heart function does not affect surgical outcomes. Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.展开更多
Chylous ascites and chylopleura due to constrictive pericarditis are rare and characterized by white milky ascites and pleural fluid.presence of chylomicrons Diagnosis is established by the However,the treatment of th...Chylous ascites and chylopleura due to constrictive pericarditis are rare and characterized by white milky ascites and pleural fluid.presence of chylomicrons Diagnosis is established by the However,the treatment of this situation is very difficult.We report a case ofchylous ascites and chylotborax,in which hydrops was attributable to constrictive pericarditis.In the present case,pericardiectomy combined with thoracic duct ligation and pleurodesis cured chylous ascites and cbylothorax caused by constrictive pericarditis,which has never been previously described.展开更多
Classic constrictive pericarditis （CP） is characterized by fibrous scarring and adhesion of both the visceral pericardium and the parietal pericardium, which leads to restricted cardiac filling. However, diagnosing ...Classic constrictive pericarditis （CP） is characterized by fibrous scarring and adhesion of both the visceral pericardium and the parietal pericardium, which leads to restricted cardiac filling. However, diagnosing CP with normal thickness pericardium and without calcification is still a challenge. The predominant cause in the developed world is idiopathic or viral pericarditis followed by post-cardiac surgery and post-radiation. Tuberculosis still remains a common cause of CP in developing countries. In this report, we describe a rare case of idiopathic localized constrictive visceral pericardium with normal thickness of the parietal pericardium in a middle-aged man. The patient presented with unexplained right heart failure and eehocardiography showed moderate bi-atrial enlargement which should be identified with the restrictive cardiomyopathy. After 10 months of conservative treatment, the progression of right heart failure was remaining. A pericardiectomy was performed and the patient recovered. This case serves as a reminder to consider CP in patients with unexplained right heart failure, so that timely investigation and treatment can be initiated.展开更多
Prevalence of gastroesophageal reflux disease(GERD)has shown an upward trend over the years.Even though patients with GERD have a poor quality of life,the current treatment options are highly limited.In recent years,h...Prevalence of gastroesophageal reflux disease(GERD)has shown an upward trend over the years.Even though patients with GERD have a poor quality of life,the current treatment options are highly limited.In recent years,however,the development of anti-reflux mucosal intervention(ARMI),a novel strategy for treating GERD,has provided hope to such patients.ARMI comprises three main steps:Anti-reflux mucosectomy,anti-reflux mucosal ablation,and peroral endoscopic cardial constriction.ARMI involves the constriction of the pericardial mucosa through endoscopic surgery so as to reduce the damage caused by the reflux of gastric contents.This study compares different ARMI techniques,their therapeutic efficacy in treating GERD,indications and contraindications,endoscopic operational procedures,perioperative management,and adverse events,in an attempt to provide clinical guidance.展开更多
Objective The pathogenesis and progression of heart failure(HF)are governed by complex,interconnected biological pathways,with dysregulated immune responses and maladaptive cardiac remodeling playing central roles.Alt...Objective The pathogenesis and progression of heart failure(HF)are governed by complex,interconnected biological pathways,with dysregulated immune responses and maladaptive cardiac remodeling playing central roles.Although specific inflammatory mediators have been implicated in modulating critical features of cardiac remodeling—such as cardiomyocyte hypertrophy and extracellular matrix fibrosis—the precise molecular mechanisms driving these processes remain incompletely characterized.Methods Integrated bioinformatics analysis of HF and hypertrophic cardiomyopathy(HCM)transcriptomic datasets identified pathologically relevant candidate genes.A protein-protein interaction(PPI)network was constructed from these candidates using the STRING database,followed by module analysis.Serum S100 calcium-binding protein A9(S100A9)protein expression in HF patients was quantified by Western blotting under reducing conditions.The functional relevance of prioritized genes was subsequently validated through:(i)in vitro cyclic mechanical stretch in primary neonatal rat cardiomyocytes,and(ii)in vivo pressure overload modeling via transverse aortic constriction(TAC)in mice.Results Bioinformatics analysis of HF and HCM datasets revealed a significant association between immune function and cardiac remodeling.Using CytoNCA,we identified core genes,among which the top 25 included multiple inflammatory pathway-related factors,such as S100A9 and Toll-like receptor 2(TLR2).Notably,S100A9 levels were significantly elevated in the serum of HF patients and in mechanically stretched cardiomyocytes.This increase correlated with upregulated expression of hypertrophy-related markers,including atrial natriuretic peptide(ANP).Furthermore,mechanical stretch-induced S100A9 upregulation markedly enhanced TLR2 expression in cardiomyocytes.Importantly,TLR2 inhibition substantially attenuated the mechanical stretch-induced upregulation of S100A9 mRNA expression,as well as the subsequent hypertrophic and inflammatory responses in cardiomyocytes.Conclusion The inflammatory mediators S100A9 and TLR2 engage in reciprocal activation that amplifies the hypertrophic response in mechanically stretched cardiomyocytes.This pathogenic cross-talk exacerbates maladaptive remodeling and likely accelerates HF progression.展开更多
Aimed at more than 60 shaft linings damaged in Huaibei, Datun, Xuzhou and Yanzhou mine areas, this paper presents a new type of sliding shaft lining with asphalt blocks sliding layer. By model test, it is obtained tha...Aimed at more than 60 shaft linings damaged in Huaibei, Datun, Xuzhou and Yanzhou mine areas, this paper presents a new type of sliding shaft lining with asphalt blocks sliding layer. By model test, it is obtained that the deformation characteristics and the mechanical mechanisms of the sliding shaft lining under the condition of ground subsidence. The research results provide a testing basis for the sliding shaft lining design. By now, this kind of sliding shaft lining had been applied in 9 shafts in China and Bangladesh.展开更多
Calcification of the pericardium is a relatively rare finding and often has an uncertain etiology. Incidental findings of pericardial calcification may increase due to widespread application of cardiac computed tomogr...Calcification of the pericardium is a relatively rare finding and often has an uncertain etiology. Incidental findings of pericardial calcification may increase due to widespread application of cardiac computed tomography for the assessment of coronary atherosclerosis in the appropriate clinical setting using coronary artery calcium scoring and/or coronary angiography. Pericardial calcification alone is asymptomatic and is neither necessary nor sufficient for the diagnosis of pericardial constriction. Its presence may suggest of diffused pericardial scarring and consequently, its pathological involvement with pericardial constriction. Calcification of the pericardium must be evaluated with full clinical knowledge to facilitate an accurate diagnosis and an appropriate therapy when required. Our objective is to present a case of asymptomatic pericardial calcification and to discuss the importance of its clinical implications.展开更多
文摘Non-typhoid Salmonella is a common foodborne infection.[1]In the setting of immunosuppression,the classical symptom of diarrhea,that is an immune defense mechanism,may be absent,[2,3]allowing the bacteria to hematogenous spread and settle in other organs.[4,5]As a result,in the setting of acute pericarditis in immunosuppressed patients,a bacterial etiology must always be considered,which requires pericardiocentesis to complete drainage and pathogen identification.
文摘Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left atrial aneurysm following isolated Staphylococcus aureus pericarditis.She initially presented in decompensated shock and was later diagnosed with constrictive pericarditis.Despite undergoing pericardiectomy,she subsequently developed a left atrial aneurysm,necessitating surgical closure.This case highlights the aggressive nature of bacterial pericarditis and its potential to cause rare structural cardiac complications.
基金Supported by The University of Cape Town’s Research Committee(URC)the South African National Research Foundation(NRF)
文摘This review article aims to:(1) discern from the literature the immune and inflammatory processes occurring in the pericardium following injury; and(2) to delve into the molecular mechanisms which may play a role in the progression to constrictive pericarditis. Pericarditis arises as a result of a wide spectrum of pathologies of both infectious and non-infectious aetiology, which lead to various degrees of fibrogenesis. Current understanding of the sequence of molecular events leading to pathological manifestations of constrictive pericarditis is poor. The identification of key mechanisms and pathways common to most fibrotic events in the pericardium can aid in the design and development of novel interventions for the prevention and management of constriction. We have identified through this review various cellular events and signalling cascades which are likely to contribute to the pathological fibrotic phenotype. An initial classical pattern of inflammation arises as a result of insult to the pericardium and can exacerbate into an exaggerated or prolonged inflammatory state. Whilst the implication of major drivers of inflammation and fibrosis such as tumour necrosis factor and transforming growth factor β were foreseeable, the identification of pericardial deregulation of other mediators(basic fibroblast growth factor, galectin-3 and the tetrapeptide Ac-SDKP) provides important avenues for further research.
文摘Presents the fixed point theorem for a class of β constrictive increasing operators without continuity and discusses the existence of solution of the integral equation with the discontinuous term in L 1(0,∞) by using this theorem.
文摘BACKGROUND Refractory ascites is a rare complication following orthotopic liver transplantation(OLT).The broad spectrum of differential diagnosis often leads to delay in diagnosis.Therapy depends on recognition and treatment of the underlying cause.Constrictive pericarditis is a condition characterized by clinical signs of right-sided heart failure.In the advanced stages of the disease,hepatic congestion leads to formation of ascites.In patients after OLT,cardiac etiology of ascites is easily overlooked and it requires a high degree of clinical suspicion.CASE SUMMARY We report a case of a 55-year-old man who presented with a refractory ascites three months after liver transplantation for alcoholic cirrhosis.Prior to transplantation the patient had a minimal amount of ascites.The transplant procedure and the early postoperative course were uneventful.Standard posttransplant work up failed to reveal any typical cause of refractory post-transplant ascites.The function of the graft was good.Apart from atrial fibrillation,cardiac status was normal.Eighteen months post transplantation the patient developed dyspnea and severe fatigue with peripheral edema.Ascites was still prominent.The presenting signs of right-sided heart failure were highly suggestive of cardiac etiology.Diagnostic paracentesis was suggestive of cardiac ascites,and further cardiac evaluation showed typical signs of constrictive pericarditis.Pericardiectomy was performed followed by complete resolution of ascites.On the follow-up the patient remained symptom-free with no signs of recurrent ascites and with normal function of the liver graft.CONCLUSION Refractory ascites following liver transplantation is a rare complication with many possible causes.Broad differential diagnosis needs to be considered.
文摘Chronic Pericarditis is infl ammation that begins gradually,is long lasting and results in fl uid accumulation in the pericardial space or thickening of the pericardium.The etiology is unknown but may be cancer,TB or hypothyroidism.Arrhythmias are common and seen in almost half the patients.The commonest arrhythmia is atrial fi brillation.Symptoms and signs are related to increased right atrial pressure and physical fi ndings include elevated JVP and pericardial knock.Non surgical therapy consists mainly of no salt.Surgery cures about 85%of patients,however 5–15%of patients will die.Chronic effusive pericarditis occurs when there is persistent restriction of the visceral pericardium after pericardiocentesis.
文摘Rationale:Synthetic cannabinoids are increasingly used as recreational drugs and have been associated with adverse cardiovascular effects.However,reports of synthetic cannabinoids accompanied by constrictive pericarditis are limited.Patient’s concern:A 28-year-old male with a history of synthetic cannabinoid(Bonzai)abuse presented with chest discomfort,dyspnea,and lower extremity edema.Investigations revealed reduced left ventricular ejection fraction,elevated inflammatory markers,low electrocardiogram voltages,and atrial fibrillation.Diagnosis:Chest spiral computerized tomography scan and chest X-ray demonstrated pericardial calcification.Cardiac magnetic resonance imaging and right heart catheterization were done to confirm the possibility of constrictive pericarditis.Based on the patient’s addiction history and exclusion of rheumatologic and infectious causes,it was supposed that constrictive pericarditis and cardiomyopathy may be accompanied by synthetic cannabinoid use.Interventions:The patient received standard medical therapy,including loop diuretics for cardiomyopathy and constrictive pericarditis.Catheter ablation was recommended for his rhythm control,and he was planned for close monitoring of clinical and echocardiographic response and evaluation of the need for surgical pericardiectomy in the future.Outcomes:After 6 months follow-up,echocardiographic exam revealed no significant improvement in ventricular function.However,due to the high surgical risk,the patient’s poor compliance,and the continuation of drug abuse,he was not a good candidate for surgery according to our heart team’s decision.Lessons:Synthetic cannabinoids can trigger constrictive pericarditis,and clinicians should consider them when evaluating patients with compatible symptoms and exposure history.Further research on the cardiovascular effects of synthetic cannabinoids is needed and public education on potential harms is warranted.
文摘Aim: To report a case of “end-stage” constrictive pericarditis with clinical manifestations such as ascites mimicking as cirrhosis of liver. Introduction: In “End-stage” constrictive pericarditis, the etiology remains unknown in majority of cases and inflammation plays a central role in its development. It has been readily confused with cirrhosis of liver in which there may be ascites, but venous pressure is normal, the neck veins are not engorged and cardiac enlargement is frequent in other causes of heart failure. Case Report: A 67 years old male presented with sudden onset of tachycardia. Clinical examination revealed right-sided heart failure, “Egg-shell” calcification in Chest X-ray and echocardiographic features of pericardial constriction such as septal bounce and dynamic respiratory changes in mitral inflow velocity. The patient was advised medical measures. Conclusion: When clinical signs of right heart failure become unresponsive to increased doses of diuretics, constrictive pericarditis is more likely the underlying disease since severe, right-sided failure develops in very advanced, the “end-stage” of the disease.
文摘Background: Chronic constrictive pericarditis is a rare but serious clinical entity with a poor prognosis in the absence of surgical treatment. The purpose of this study was to report on our experience of subtotal anterior pericardectomy and analyze our surgical results. Results: We included 74 patients operated on for chronic constrictive pericarditis in our institution during the period from January 1985 to December 2020. There were 29 female and 45 male patients, with an average age of 28 years (range: 8 - 64 years). 36.5% of patients were in NYHA class III or IV. Physical signs were dominated by peripheral signs of right heart failure in 93.2% of cases. The surgical procedure was a subtotal anterior pericardectomy from the left to the right phrenic nerve, freeing the heart chambers and the large vessels. The surgical results were marked by a functional improvement in 82.4% of the cases. The postoperative complications were marked by a low cardiac output in 8.1% of the cases, a atrial fibrillation in 4.1% of the cases, a haemorrhage in 1.4% of the cases, a haemothorax in 2.7% of the cases. Perioperative mortality was 5.4% patients. The causes of death were low cardiac output in 50% of cases, hemorrhage in 25% of cases, and hepatocellular insufficiency in 25% of cases. We observed a mortality of 2.9% after an average follow-up of 5.17 years ± 4.76 years. All other survivors were asymptomatic and no re-intervention for recurrence was performed. Conclusions: Subtotal anterior pericardectomy was the technique we used for the treatment of chronic constrictive pericarditis. It allowed having satisfactory surgical results with a functional improvement and an acceptable morbidity.
文摘Background:Constrictive pericarditis is a challenging diagnosis to make be-cause it can mimic heart failure,restrictive myocardial diseases,and massive pericardial effusion.Here we report an unusual case of pericardial cyst mas-querading as constrictive pericarditis.Case summary:We present a case of a young gentleman,presenting with progressive shortness of breath,abdominal ascites and signs of right sided heart failure,imaging study with Transthoracic Echo and chest CT scan showed an unusual loculated extracardiac collection compressing on the right ventricle and right atrium,with pericardial wall cal cification suggesting chronic pericarditis.Cardiac magnetic resonance(CMR)confirmed a pericardial origin of the mass.Surgical intervention was done as the pericardial cyst was large and causing pressure symptoms leading to quick symptomatic relief and recovery.Conclusion:Pericardial cysts are a rare en-counter in clinical practice,which makes their management a clinical chal-lenge.Further research is required to establish a comprehensive approach to managing congenital pericardial cysts.
基金Supported by the Zhejiang Provincial Natural Science Foundation of China(No.LY14H270007)。
文摘Objective: To study the effects of electroacupuncture(EA) in chronic constrictive injury(CCI) rat model and the expression of N-methyl-D-aspartate receptor type 2B(NR2B) in ipsilateral spinal dorsal horn in rats to explore the analgesic mechanisms of EA. Methods: According to the random number table, totally 180 rats were evenly divided into a sham group, a CCI group, and an EA group. CCI model was conducted with four4–0 chromic gut ligatures loosely ligated around the left sciatic nerve 1 cm above the trifurcation. Rats in the EA group received 2 Hz EA therapy bilaterally at acupoints of Zusanli(ST 36) and Sanyinjiao(SP 6) once daily(30 min/d) for 30 days after surgery. Paw withdrawal thresholds(PWTs) were measured on 0(baseline), 1, 3, 7, 15,30 days after surgery. Rats were sacri?ced on 0, 1, 3, 7, 15 and 30 days after surgery, and the L4–5 segments of spinal cord were removed to detect the expression of NR2B by immunohistochemistry and quantitative polymerase chain reaction. Results: PWTs in the CCI group were signi?cantly lower than the sham group at Day1–30 after surgery, and reached its lowest at Day 1(P<0.01). After EA treatment, the PWTs recovered rapidly and were signi?cantly higher than those in the CCI group on 3, 7, 15 and 30 days after surgery(P<0.01). The numbers of NR2B-immunoreactive cells of the CCI group signi?cantly increased after CCI surgery compared with the sham group(P<0.01). Compared with the CCI group, stimulation of EA markedly decreased the numbers of NR2B-immunoreactive cells at Day 3, 7, 15 and 30(P<0.05). In the sham group, NR2B mRNA was expressed at a low level. It increased after CCI surgery, which increased rapidly at Day 7(P<0.01) and reached its peak value at Day 15(P<0.01). After EA stimulation, relative quantity of NR2B mRNA expression was less than that in the CCI group at Day 15 and 30(P<0.05). Conclusions: Low frequency of EA had antinociceptive effect in CCI rat model. The analgesic effects of EA might be through the inhibition of NR2B.
文摘Background： To determine the influence of right ventricular function in patients with constrictive pericarditis （CP） undergoing surgery and to compare the outcomes of patients who received surgery with those managed medically. Methods： Patients with the diagnosis of CP and healthy volunteers were recruited from January 2006 to November 2011. Patients with CP chose to either receive pericardiectomy or medical management. Echocardiographic measurements were performed to evaluate heart function, and survival was recorded. Results： A total of 58 patients with CP （36 received pericardiectomy, 22 managed medically）, and 43 healthy volunteers were included. CP patients who received surgery had a higher survival rate than those managed medically （P = 0.003）, and higher st, rvival was also seen in the subgroup of CP patients with severely impaired right systolic function. Albumin level, left ventricular end-diastolic dimension, and tricuspid regurgitation velocity were associated with survival in CP patients who received surgery. Conclusions： Preoperative right heart function does not affect surgical outcomes. Patients with severely impaired preoperative right systolic function obtain a greater survival advantage with surgery than with medical treatment.
文摘Chylous ascites and chylopleura due to constrictive pericarditis are rare and characterized by white milky ascites and pleural fluid.presence of chylomicrons Diagnosis is established by the However,the treatment of this situation is very difficult.We report a case ofchylous ascites and chylotborax,in which hydrops was attributable to constrictive pericarditis.In the present case,pericardiectomy combined with thoracic duct ligation and pleurodesis cured chylous ascites and cbylothorax caused by constrictive pericarditis,which has never been previously described.
文摘Classic constrictive pericarditis （CP） is characterized by fibrous scarring and adhesion of both the visceral pericardium and the parietal pericardium, which leads to restricted cardiac filling. However, diagnosing CP with normal thickness pericardium and without calcification is still a challenge. The predominant cause in the developed world is idiopathic or viral pericarditis followed by post-cardiac surgery and post-radiation. Tuberculosis still remains a common cause of CP in developing countries. In this report, we describe a rare case of idiopathic localized constrictive visceral pericardium with normal thickness of the parietal pericardium in a middle-aged man. The patient presented with unexplained right heart failure and eehocardiography showed moderate bi-atrial enlargement which should be identified with the restrictive cardiomyopathy. After 10 months of conservative treatment, the progression of right heart failure was remaining. A pericardiectomy was performed and the patient recovered. This case serves as a reminder to consider CP in patients with unexplained right heart failure, so that timely investigation and treatment can be initiated.
基金Supported by National Natural Science Foundation of China,No.82200613Shanghai“Rising Stars of Medical Talents”Youth Development Program,No.SHWSRS(2025)_071+3 种基金The Healthcare Talents Youth Program of Shanghai Pudong New Area,No.2025PDWSYCQN-03Shanghai Municipal Health Commission,No.2024ZDXK0001the Medical Discipline Construction Project of Pudong Health Committee of Shanghai,No.PWZxq2022-6,No.2024-PWXZ-07,and No.2025PDWSYCBJ-01Shanghai East Hospital's Key Clinical Disciplines and Specialty Departments,No.2024-DFZD-005.
文摘Prevalence of gastroesophageal reflux disease(GERD)has shown an upward trend over the years.Even though patients with GERD have a poor quality of life,the current treatment options are highly limited.In recent years,however,the development of anti-reflux mucosal intervention(ARMI),a novel strategy for treating GERD,has provided hope to such patients.ARMI comprises three main steps:Anti-reflux mucosectomy,anti-reflux mucosal ablation,and peroral endoscopic cardial constriction.ARMI involves the constriction of the pericardial mucosa through endoscopic surgery so as to reduce the damage caused by the reflux of gastric contents.This study compares different ARMI techniques,their therapeutic efficacy in treating GERD,indications and contraindications,endoscopic operational procedures,perioperative management,and adverse events,in an attempt to provide clinical guidance.
基金supported by the National Key Research and Development Program of China(No.2023YFC2506504)the National Natural Science Foundation of China(No.82370255,and No.U24A20646)the Shanghai Science and Technology Commission Project(No.23410761200).
文摘Objective The pathogenesis and progression of heart failure(HF)are governed by complex,interconnected biological pathways,with dysregulated immune responses and maladaptive cardiac remodeling playing central roles.Although specific inflammatory mediators have been implicated in modulating critical features of cardiac remodeling—such as cardiomyocyte hypertrophy and extracellular matrix fibrosis—the precise molecular mechanisms driving these processes remain incompletely characterized.Methods Integrated bioinformatics analysis of HF and hypertrophic cardiomyopathy(HCM)transcriptomic datasets identified pathologically relevant candidate genes.A protein-protein interaction(PPI)network was constructed from these candidates using the STRING database,followed by module analysis.Serum S100 calcium-binding protein A9(S100A9)protein expression in HF patients was quantified by Western blotting under reducing conditions.The functional relevance of prioritized genes was subsequently validated through:(i)in vitro cyclic mechanical stretch in primary neonatal rat cardiomyocytes,and(ii)in vivo pressure overload modeling via transverse aortic constriction(TAC)in mice.Results Bioinformatics analysis of HF and HCM datasets revealed a significant association between immune function and cardiac remodeling.Using CytoNCA,we identified core genes,among which the top 25 included multiple inflammatory pathway-related factors,such as S100A9 and Toll-like receptor 2(TLR2).Notably,S100A9 levels were significantly elevated in the serum of HF patients and in mechanically stretched cardiomyocytes.This increase correlated with upregulated expression of hypertrophy-related markers,including atrial natriuretic peptide(ANP).Furthermore,mechanical stretch-induced S100A9 upregulation markedly enhanced TLR2 expression in cardiomyocytes.Importantly,TLR2 inhibition substantially attenuated the mechanical stretch-induced upregulation of S100A9 mRNA expression,as well as the subsequent hypertrophic and inflammatory responses in cardiomyocytes.Conclusion The inflammatory mediators S100A9 and TLR2 engage in reciprocal activation that amplifies the hypertrophic response in mechanically stretched cardiomyocytes.This pathogenic cross-talk exacerbates maladaptive remodeling and likely accelerates HF progression.
文摘Aimed at more than 60 shaft linings damaged in Huaibei, Datun, Xuzhou and Yanzhou mine areas, this paper presents a new type of sliding shaft lining with asphalt blocks sliding layer. By model test, it is obtained that the deformation characteristics and the mechanical mechanisms of the sliding shaft lining under the condition of ground subsidence. The research results provide a testing basis for the sliding shaft lining design. By now, this kind of sliding shaft lining had been applied in 9 shafts in China and Bangladesh.
基金Supported by The "East Carolina Heart Institute"
文摘Calcification of the pericardium is a relatively rare finding and often has an uncertain etiology. Incidental findings of pericardial calcification may increase due to widespread application of cardiac computed tomography for the assessment of coronary atherosclerosis in the appropriate clinical setting using coronary artery calcium scoring and/or coronary angiography. Pericardial calcification alone is asymptomatic and is neither necessary nor sufficient for the diagnosis of pericardial constriction. Its presence may suggest of diffused pericardial scarring and consequently, its pathological involvement with pericardial constriction. Calcification of the pericardium must be evaluated with full clinical knowledge to facilitate an accurate diagnosis and an appropriate therapy when required. Our objective is to present a case of asymptomatic pericardial calcification and to discuss the importance of its clinical implications.
