Hypoxic pulmonary hypertension(HPH)is a pathophysiological state characterized by diverse clinical symptoms resulting from structural and functional changes in pulmonary vessels induced by hypoxic stimuli,leading to i...Hypoxic pulmonary hypertension(HPH)is a pathophysiological state characterized by diverse clinical symptoms resulting from structural and functional changes in pulmonary vessels induced by hypoxic stimuli,leading to increased pulmonary artery pressure.展开更多
BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the c...BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.展开更多
Hemoptysis is a severe complication of pulmonary hypertension (PH) with a low in- cidence of 6%-11%.^([1-4])Although occurring in all forms of PH,it is more commonly seen in pulmonary arterial hypertension (PAH),assoc...Hemoptysis is a severe complication of pulmonary hypertension (PH) with a low in- cidence of 6%-11%.^([1-4])Although occurring in all forms of PH,it is more commonly seen in pulmonary arterial hypertension (PAH),associated with congenital heart disease (PAH-CHD).^([5,6])Since enlarged bronchial arteries are a frequent source of pulmonary bleeding,the primary treatment focuses on bronchial artery embolization (BAE),especially for chronic thromboembolic pulmonary hypertension (CTEPH) patients^([7,8]).However,there is disagreement regarding medical therapy,which has received little attention in the recently published PH guidelines.^([5,6])展开更多
Silicosis,a major persistent occupational disease in China,is a progressive and irreversible pulmonary fibrosis disease with unclear pathogenesis.Cellular senescence,a state of stable cell cycle arrest that is recogni...Silicosis,a major persistent occupational disease in China,is a progressive and irreversible pulmonary fibrosis disease with unclear pathogenesis.Cellular senescence,a state of stable cell cycle arrest that is recognized as a key underlying factor in age-related fibroproliferative disorders,plays an important role in chronic lung diseases,particularly pulmonary fibrosis.We previously reported that SiO2-stimulated mice and alveolar type II epithelial cells develop cellular senescence,which is involved in silicosis formation in alveolar type II epithelial cells[1].Cellular senescence may play an important role in silicosis development;however,the exact underlying mechanisms are not fully understood.展开更多
Pulmonary tumour thrombotic microangiopathy(PTTM)is a rare but under-recognised cause of rapidly progressive pulmonary hypertension(PH)and cor pulmonale,characterised by diffuse obstruction of small pulmonary arteries...Pulmonary tumour thrombotic microangiopathy(PTTM)is a rare but under-recognised cause of rapidly progressive pulmonary hypertension(PH)and cor pulmonale,characterised by diffuse obstruction of small pulmonary arteries by metastatic tumour cells.These tumour emboli lead to obstructive intimal proliferation and in situ thrombosis within the pulmonary vasculature,further compromising the overall permeability of the pulmonary vascular bed and exacerbating PH.[1]The clinical and imaging manifestations of PTTM often overlap with those of other causes of PH,including chronic thromboembolic PH,pulmonary veno-occlusive disease and pulmonary capillary haemangiomatosis,often leading to diagnostic delays.展开更多
Pulmonary artery remodeling is a critical pathological feature of pulmonary arterial hypertension(PAH),a fatal lung disease without cure,resulting in poor pulmonary hemodynamics and compliance.The remodeling could be ...Pulmonary artery remodeling is a critical pathological feature of pulmonary arterial hypertension(PAH),a fatal lung disease without cure,resulting in poor pulmonary hemodynamics and compliance.The remodeling could be aggravated by various factors,particularly by the hyperproliferation of pulmonary artery smooth muscle cells(PASMCs)and perivascular inflammation.Meanwhile,the hyperproliferation of PASMCs can be driven by the overexpression of miR138.In this study,we developed anti-inflammatory baicalein-assisted anti-miR138 gene therapy against PAH.The system was fabricated by anchoring the nucleic acid onto the nanocrystals through electrostatic interaction,followed by glucuronic acid(GA)coating for targeting the glucose transport-1(GLUT-1)receptor.The results demonstrated that the system had a 201-nm in diameter with a rod shape and allowed a 12-fold increase in pulmonary artery(PA)targeting versus free drug administration.The preparation injection reduced the PA thickness by 20%via effectively promoting PASMC apoptosis,likely by strengthening the pathway of Bcl-2 associated X protein/B-cell lymphoma-2/caspase 3(Bax/Bcl-2/Cas-3).The in vivo efficacy in the monocrotaline(MCT)-PAH model demonstrated significant improvement in the pulmonary hemodynamics,e.g.,a 50%decrease in mean pulmonary artery pressure(mPAP),61%increase in pulmonary artery acceleration time(PAAT),and 82%increase in cardiac output(CO).In conclusion,targeted codelivery of the inflammation inhibitor and anti-miR138 to PAs is promising to combat PAH.Rod-shaped nanomedicines represent an effective PA-targeting strategy.展开更多
Sodium-glucose cotransporter-2(SGLT-2)inhibitors represent a cutting-edge class of oral antidiabetic therapeutics that operate through selective inhibition of glucose reabsorption in proximal renal tubules,consequentl...Sodium-glucose cotransporter-2(SGLT-2)inhibitors represent a cutting-edge class of oral antidiabetic therapeutics that operate through selective inhibition of glucose reabsorption in proximal renal tubules,consequently augmenting urinary glucose excretion and attenuating blood glucose levels.Extensive clinical investigations have demonstrated their profound cardiovascular efficacy.Parallel basic science research has elucidated the mechanistic pathways through which diverse SGLT-2 inhibitors beneficially modulate pulmonary vascular cells and arterial remodeling.Specifically,these inhibitors exhibit promising potential in enhancing pulmonary vascular endothelial cell function,suppressing pulmonary smooth muscle cell proliferation and migration,reversing pulmonary arterial remodeling,and maintaining hemodynamic equilibrium.This comprehensive review synthesizes current literature to delineate the mechanisms by which SGLT-2 inhibitors enhance pulmonary vascular cell function and reverse pulmonary remodeling,thereby offering novel therapeutic perspectives for pulmonary vascular diseases.展开更多
Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 ...Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 elderly COPD patients with pulmonary infection,treated between December 2022 and November 2023,were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with levofloxacin hydrochloride,while the observation group received ambroxol hydrochloride injection in addition to the treatment in the control group.Laboratory indices(white blood cell count,procalcitonin,C-reactive protein,and apolipoprotein E levels),imaging-based pulmonary lesion absorption time,hospital stay,and incidence of adverse reactions were compared between the two groups.Results:After treatment,the biochemical indices of the observation group were significantly lower than those of the control group,with highly significant differences(P<0.001).Compared to the control group,the imaging-based pulmonary lesion absorption time and hospital stay of the observation group were significantly shorter(P<0.001).Additionally,the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion:Levofloxacin combined with ambroxol demonstrates advantages in improving biochemical indices,shortening imaging-based pulmonary lesion absorption time and hospital stay,and reducing adverse reaction rates in elderly COPD patients with pulmonary infection.It holds significant clinical application value.展开更多
BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic thera...BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.展开更多
Repairing the endothelial barrier is essential for maintaining pulmonary fuid balance and regulating leukocyte infiltration during sepsis[1].Tissue kallikrein-related peptidases(KLKs)are secreted serine proteases invo...Repairing the endothelial barrier is essential for maintaining pulmonary fuid balance and regulating leukocyte infiltration during sepsis[1].Tissue kallikrein-related peptidases(KLKs)are secreted serine proteases involved in angiogenesis[2].However,their involvement in regulating endothelial regeneration remains largely unknown.展开更多
INTRODUCTION Pulmonary hypertension(PH)is a complex syndrome arising from diverse underlying conditions and characterized by elevated pulmonary arterial pressure.Current clinical guidelines classify PH into five categ...INTRODUCTION Pulmonary hypertension(PH)is a complex syndrome arising from diverse underlying conditions and characterized by elevated pulmonary arterial pressure.Current clinical guidelines classify PH into five categories based on pathophysiology,clinical presentation,and hemodynamic characteristics.展开更多
High-altitude pulmonary hypertension(HAPH)occurs when blood pressure in the pulmonary arteries rises due to exposure to high altitudes above 2,500 m.At these elevations,reduced atmospheric pressure leads to lower oxyg...High-altitude pulmonary hypertension(HAPH)occurs when blood pressure in the pulmonary arteries rises due to exposure to high altitudes above 2,500 m.At these elevations,reduced atmospheric pressure leads to lower oxygen levels,triggering a series of physiological responses,including pulmonary artery constriction,which elevates blood pressure.This review explored the complex pathophysiological mechanisms of HAPH and reviewed current pharmaceutical interventions for its management.Meanwhile,this review particularly emphasized on the emerging research concerning Chinese medicinal plants as potential treatments for HAPH.Traditional Chinese medicines are rich in diverse natural ingredients that show significant promise in alleviating HAPH symptoms.We reviewed both in vitro and in vivo studies to assess the efficacy,safety,and mechanisms of these natural medicines,along with their potential adverse effects.Additionally,this review highlighted new alternative natural remedies,underscoring the need for ongoing research to expand available treatment options for HAPH.展开更多
Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis...Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis and treatment modalities.Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration.In this light,research has been focused to identify novel risk stratification tools,based on the hemodynamic impact of PE on right ventricular function.Furthermore,a growing body of evidence has demonstrated that novel interventional treatments for PE,including catheter directed thrombolysis,mechanical thrombectomy and computer-assisted aspiration,are promising solutions in terms of efficacy and safety,when targeted at specific populations of the intermediate-high-and high-risk spectrum.Various therapeutic protocols have been suggested worldwide,regarding the indications and proper timing for interventional strategies.A STelevation myocardial infarction-like timing approach has been suggested in highrisk PE with contraindications for fibrinolysis,while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate;however,early interventions,within 24-48 hours of presentation,are associated with more favorable outcomes.展开更多
Self-management interventions for chronic obstructive pulmonary disease(COPD)patients using mobile health technology are beneficial for relieving disease symptoms,improving patients’adherence to rehabilitation self-m...Self-management interventions for chronic obstructive pulmonary disease(COPD)patients using mobile health technology are beneficial for relieving disease symptoms,improving patients’adherence to rehabilitation self-management,and improving quality of life.This paper reviews the application of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,introduces the application form of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,summarizes its application effect in self-management of patients with chronic obstructive pulmonary disease,analyzes the problems and proposes solutions in the process of research and implementation at this stage,with a view to providing a theory for the application of mobile health technology in pulmonary rehabilitation and management of patients with chronic obstructive pulmonary disease This study summarize the effect of its application in the self-management of patients with chronic obstructive pulmonary disease.展开更多
Non-tuberculous mycobacterial(NTM)pulmonary disease and pulmonary tuberculosis(TB)are mycobacterium-associated lung disorders that share overlapping clinical and radiological features,yet diverge significantly in path...Non-tuberculous mycobacterial(NTM)pulmonary disease and pulmonary tuberculosis(TB)are mycobacterium-associated lung disorders that share overlapping clinical and radiological features,yet diverge significantly in pathogenic mechanisms,therapeutic regimens,and long-term prognoses.Traditional east Medicine(TCM)constitution theory,a foundational framework for personalized healthcare,exerts a pivotal influence on disease susceptibility,pathological progression,and clinical outcomes.This review synthesizes state-of-the-art clinical evidence to systematically dissect key discrepancies in TCM constitution distribution between the two conditions,focusing on three core dimensions:distinctive patterns of constitution type distribution,the interplay between constitution and clinical variables,and the clinical relevance of these constitutional differences.Its primary goal is to deliver rigorous theoretical support and actionable guidance for TCM-based differential diagnosis,syndrome-specific interventions,and preventive healthcare strategies for both diseases.展开更多
I am writing this letter to present a case of uveal effusion syndrome(UES)caused by pulmonary hypertension found due to intermittent high intraocular pressure(IOP).Pulmonary hypertension increases cardiac afterload du...I am writing this letter to present a case of uveal effusion syndrome(UES)caused by pulmonary hypertension found due to intermittent high intraocular pressure(IOP).Pulmonary hypertension increases cardiac afterload due to elevated pulmonary vascular resistance,leading to right heart failure and death[1].Notably,ocular complications of pulmonary hypertension have been reported less frequently[2-5].Ophthalmologists need to increase the understanding of the disease so as to perform the proper treatment for these patients.Ethical Approval The study was conducted in accordance with the principles of the Declaration of Helsinki.Written informed consent was obtained from the patient for publication of the images and data included in this article.展开更多
Pulmonary arterial hypertension(PAH)is a progressive disease marked by degeneration of the lung’s blood vessels.As the disease progresses,the resistance to blood flow in the pulmonary arteries increases,putting a str...Pulmonary arterial hypertension(PAH)is a progressive disease marked by degeneration of the lung’s blood vessels.As the disease progresses,the resistance to blood flow in the pulmonary arteries increases,putting a strain on the right side of the heart as it pumps blood through the lungs.PAH is characterized by changes in the structure of blood vessels and excessive cell growth.Untreated PAH leads to irreversible right-sided heart failure,often despite medical intervention.Patients experience a gradual decline in function until they are unable to perform daily activities.Advances in treatment have improved the prognosis for many PAH patients.Currently approved therapies target the prostacyclin,endothelin,nitric oxide,or phosphodiesterase pathways to slow the progression of the disease.To address the unmet need for effective PAH therapies,research efforts are focused on identifying new targets and developing therapies that specifically address the underlying disease mechanisms and restore vascular wall homeostasis.Among these,sotatercept,a fusion protein that targets the transforming growth factor-βsuperfamily signaling pathway,has emerged as a promising therapeutic option.In this review,we examine the available evidence from clinical trials to assess the potential of sotatercept as a treatment for PAH.展开更多
Unilateral pulmonary artery agenesis(UPAA)is a rare congenital cardiovascular anomaly defined by the complete absence of one pulmonary artery,most often affecting the right side.[1]Although typically identified in chi...Unilateral pulmonary artery agenesis(UPAA)is a rare congenital cardiovascular anomaly defined by the complete absence of one pulmonary artery,most often affecting the right side.[1]Although typically identified in childhood due to symptomatic presentation,certain cases may remain undiagnosed until adulthood,particularly in asymptomatic patients or those with subtle clinical signs.展开更多
Background Persistent pulmonary hypertension(PPHN)of the newborn is one of the major contributors to neonatal mortality.Current conventional treatments for PPHN primarily encompass mechanical ventilation,inhaled nitri...Background Persistent pulmonary hypertension(PPHN)of the newborn is one of the major contributors to neonatal mortality.Current conventional treatments for PPHN primarily encompass mechanical ventilation,inhaled nitric oxide(iNO),sildenafil,and magnesium sulfate.In confirmed cases of neonatal respiratory distress syndrome,pulmonary surfactant(PS)can be considered as a potential treatment option;However,the optimal dosage and administration frequency of PS remain subjects of ongoing debate.This study aimed to assess the efficacy of early repeated endotracheal PS administration combined with iNO therapy in the management of newborns with PPHN.Methods Twenty-three neonates with PPHN received iNO alongside foundational treatments,including anti-infection therapy,mechanical ventilation,acidosis correction,and blood pressure stabilization.The observation group(n=13)received endotracheal instillation of PS three times,with each administration spaced six hours apart;The control group(n=10)received endotracheal instillation of PS once.Parameters compared included blood gas indices,oxygenation index(OI),alveolar-arterial oxygen partial pressure difference(PA-aDO,),pulmonary artery systolic pressure(PAP),and N-terminal pro-brain natriuretic peptide(NT-pro-BNP).Mechanical ventilation duration,oxygen therapy time,hospitalization length,and survival outcomes were recorded and compared between groups.Results The blood gas parameters,OI,and PA-aDO,showed no significant differences between the two groups of children before treatment(P>0.05).By 24-hour post-treatment,both groups exhibited significant increases in partial pressure of oxygen(PaO,)and potential of hydrogen(PH)levels,alongside significant decreases in lactate,partial pressure of carbon dioxide(PaCO,),OI,and PA-aDO2,with statistically significant differences(P<0.05).By 48-hour post-treatment,the observation group demonstrated significantly better improvements in blood gas parameters,OI,and PA-aDO,compared to the control group,and these differences were statistically significant(P<0.05).There was no statistically significant difference in PAP and NT-pro-BNP levels between the two groups before treatment(P>0.05).After treatment,both groups showed significant decreases in PAP and NT-pro-BNP levels(P<0.05),with a more pronounced reduction observed in the observation group(P<0.05).The observation group had significantly shorter durations of mechanical ventilation and oxygen therapy compared to the control group,with statistically significant differences(P<0.05).Additionally,the observation group exhibited a shorter total hospital stay and a lower mortality rate than the control group,though these differences were not statistically significant(P>0.05).Conclusions Early consecutive multiple doses of PS combined with iNO,compared to a single dose,better improves respiratory function indices,maintains stability,reduces pulmonary artery pressure,enhances cardiac function,shortens ventilator dependency,and increases cure rates in PPHN neonates.This approach is particularly suitable for severe PPHN cases,especially those with underlying pulmonary conditions.展开更多
Introduction:Pulmonary hypertension(PH)is a hemodynamic and pathophysiological condition characterized by abnormally elevated pressures in the pulmonary vasculature.It is defined by a mean pulmonary arterial pressure...Introduction:Pulmonary hypertension(PH)is a hemodynamic and pathophysiological condition characterized by abnormally elevated pressures in the pulmonary vasculature.It is defined by a mean pulmonary arterial pressure≥25 mmHg at rest by right heart catheterization.He is frequently associated with cardiovascular surgery and is a common complication that has been observed after surgery utilizing cardiopulmonary bypass(CPB).Preoperative PH has been significantly linked to morbidity and is a risk factor for poor outcome post-surgery.Some specific features in sub-Saharan Africa:given the lack of access to cardiac surgery,PAH occurs very frequently in cases of advanced heart disease in patients with congenital heart disease or rheumatic valve disease that has been treated late.Objective:The purpose of this study was to evaluate a protocol for managing PH during cardiac surgery under cardiopulmonary bypass in resource limited settings.Patients and Methods:This is a descriptive and analytical retrospective study that included all patients who underwent cardiopulmonary bypass surgery at the“Le Luxembourg”Mother and Child University Hospital between January 1,2023,and June 30,2024,and who had a preoperative systolic pulmonary artery pressure(SPAP)≥35 mmHg.Preoperatively,all patients included were given Furosemide:1 mg/kg and Sildenafil 5 or 10 mg/8 hours in children and 20 mg/8 hours in adults.In the operating room,a nasogastric tube was inserted to administer sildenafil at the end of surgery,and weaning from CPB was performed using Milrinone at a syringe pump rate of 5μg/kg/min,combined with Norepinephrine as needed depending on hemodynamic status.We analyzed the mean changes in PAPS from the preoperative assessment to discharge from intensive care.Results:During the period,292 patients underwent surgery,142 of whom had PH,representing a prevalence of 48.63%.Our patients had an average age of 11.57±11.There was a female predominance of 51.4%.The average length of preoperative hospitalization was 5 days[3-8].The time between diagnosis and surgical treatment was between 1 and 5 years in 62.8% of cases.It was≤1 year in 29.6%of cases.The clinical signs were dominated by dyspnea in 43.7% of cases.Pulmonary artery systolic pressure was between 51-100 mmHg in 29.58% and>100 mmHg in 19.72% of cases,with a mean preoperative sPAP of 59 mmHg[35-110].Congenital heart disease accounted for 52.11% of surgical indications,and valvular heart disease for 47.89%.Surgical indications for mitral valve disease accounted for 35.92% of cases and those for congenital heart disease for 52.11%.The mean duration of CPB was 110 min±50.There were no intraoperative episodes of pulmonary hypertension.At the end of surgery,the average time to postoperative extubation in intensive care was 3.53 hours±2.2.There was a significant decrease in sPAP between the preoperative and postoperative periods.A comparison of pre-and post-operative sPAP averages using a t-test was significant with a P-value<0.001(t:27.978).The main postoperative complications are:Overall cardiac failure:4.2%;respiratory failure:2.1%;hematological complications:0.7%.We recorded a perioperative mortality rate of 5.6%.Conclusion:PH complicates rheumatic valve disease and certain congenital heart diseases.It is common in our resourcelimited setting,where access to cardiac surgery is insufficient.It is associated with high perioperative morbidity and mortality.Management is well codified,but the therapeutic classes are sometimes unavailable in our countries.The postoperative protocol of furosemide+sildenafil and milrinone appears to give good results.展开更多
基金supported by General Program of the Natural Science Foundation of Hebei Province(No.H2024110033,China).
文摘Hypoxic pulmonary hypertension(HPH)is a pathophysiological state characterized by diverse clinical symptoms resulting from structural and functional changes in pulmonary vessels induced by hypoxic stimuli,leading to increased pulmonary artery pressure.
文摘BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.
基金supported by Liaoning Xingliao Talent Project (Grant No. XLYC2007020)。
文摘Hemoptysis is a severe complication of pulmonary hypertension (PH) with a low in- cidence of 6%-11%.^([1-4])Although occurring in all forms of PH,it is more commonly seen in pulmonary arterial hypertension (PAH),associated with congenital heart disease (PAH-CHD).^([5,6])Since enlarged bronchial arteries are a frequent source of pulmonary bleeding,the primary treatment focuses on bronchial artery embolization (BAE),especially for chronic thromboembolic pulmonary hypertension (CTEPH) patients^([7,8]).However,there is disagreement regarding medical therapy,which has received little attention in the recently published PH guidelines.^([5,6])
文摘Silicosis,a major persistent occupational disease in China,is a progressive and irreversible pulmonary fibrosis disease with unclear pathogenesis.Cellular senescence,a state of stable cell cycle arrest that is recognized as a key underlying factor in age-related fibroproliferative disorders,plays an important role in chronic lung diseases,particularly pulmonary fibrosis.We previously reported that SiO2-stimulated mice and alveolar type II epithelial cells develop cellular senescence,which is involved in silicosis formation in alveolar type II epithelial cells[1].Cellular senescence may play an important role in silicosis development;however,the exact underlying mechanisms are not fully understood.
文摘Pulmonary tumour thrombotic microangiopathy(PTTM)is a rare but under-recognised cause of rapidly progressive pulmonary hypertension(PH)and cor pulmonale,characterised by diffuse obstruction of small pulmonary arteries by metastatic tumour cells.These tumour emboli lead to obstructive intimal proliferation and in situ thrombosis within the pulmonary vasculature,further compromising the overall permeability of the pulmonary vascular bed and exacerbating PH.[1]The clinical and imaging manifestations of PTTM often overlap with those of other causes of PH,including chronic thromboembolic PH,pulmonary veno-occlusive disease and pulmonary capillary haemangiomatosis,often leading to diagnostic delays.
基金supported by the National Natural Science Foundation of China(Nos.81872823,82073782,and 82241002)the Shanghai Science and Technology Committee(No.19430741500).
文摘Pulmonary artery remodeling is a critical pathological feature of pulmonary arterial hypertension(PAH),a fatal lung disease without cure,resulting in poor pulmonary hemodynamics and compliance.The remodeling could be aggravated by various factors,particularly by the hyperproliferation of pulmonary artery smooth muscle cells(PASMCs)and perivascular inflammation.Meanwhile,the hyperproliferation of PASMCs can be driven by the overexpression of miR138.In this study,we developed anti-inflammatory baicalein-assisted anti-miR138 gene therapy against PAH.The system was fabricated by anchoring the nucleic acid onto the nanocrystals through electrostatic interaction,followed by glucuronic acid(GA)coating for targeting the glucose transport-1(GLUT-1)receptor.The results demonstrated that the system had a 201-nm in diameter with a rod shape and allowed a 12-fold increase in pulmonary artery(PA)targeting versus free drug administration.The preparation injection reduced the PA thickness by 20%via effectively promoting PASMC apoptosis,likely by strengthening the pathway of Bcl-2 associated X protein/B-cell lymphoma-2/caspase 3(Bax/Bcl-2/Cas-3).The in vivo efficacy in the monocrotaline(MCT)-PAH model demonstrated significant improvement in the pulmonary hemodynamics,e.g.,a 50%decrease in mean pulmonary artery pressure(mPAP),61%increase in pulmonary artery acceleration time(PAAT),and 82%increase in cardiac output(CO).In conclusion,targeted codelivery of the inflammation inhibitor and anti-miR138 to PAs is promising to combat PAH.Rod-shaped nanomedicines represent an effective PA-targeting strategy.
基金Supported by Science and Technology Department of Yunnan Province-Kunming Medical University,Kunming Medical Joint Special Project-Surface Project,No.202401AY070001-164Yunnan Provincial Clinical Research Center Cardiovascular Diseases-New Technology Research for Development Project for Diagnosis and Treatment Cardiovascular Diseases,No.202102AA310002the Key Technology Research and Device Development Project for Innovative Diagnosis and Treatment of Structural Heart Disease in the Southwest Plateau Region,No.202302AA310045.
文摘Sodium-glucose cotransporter-2(SGLT-2)inhibitors represent a cutting-edge class of oral antidiabetic therapeutics that operate through selective inhibition of glucose reabsorption in proximal renal tubules,consequently augmenting urinary glucose excretion and attenuating blood glucose levels.Extensive clinical investigations have demonstrated their profound cardiovascular efficacy.Parallel basic science research has elucidated the mechanistic pathways through which diverse SGLT-2 inhibitors beneficially modulate pulmonary vascular cells and arterial remodeling.Specifically,these inhibitors exhibit promising potential in enhancing pulmonary vascular endothelial cell function,suppressing pulmonary smooth muscle cell proliferation and migration,reversing pulmonary arterial remodeling,and maintaining hemodynamic equilibrium.This comprehensive review synthesizes current literature to delineate the mechanisms by which SGLT-2 inhibitors enhance pulmonary vascular cell function and reverse pulmonary remodeling,thereby offering novel therapeutic perspectives for pulmonary vascular diseases.
文摘Objective:To investigate the clinical efficacy of levofloxacin combined with ambroxol in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and pulmonary infection.Methods:A total of 80 elderly COPD patients with pulmonary infection,treated between December 2022 and November 2023,were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with levofloxacin hydrochloride,while the observation group received ambroxol hydrochloride injection in addition to the treatment in the control group.Laboratory indices(white blood cell count,procalcitonin,C-reactive protein,and apolipoprotein E levels),imaging-based pulmonary lesion absorption time,hospital stay,and incidence of adverse reactions were compared between the two groups.Results:After treatment,the biochemical indices of the observation group were significantly lower than those of the control group,with highly significant differences(P<0.001).Compared to the control group,the imaging-based pulmonary lesion absorption time and hospital stay of the observation group were significantly shorter(P<0.001).Additionally,the incidence of adverse reactions in the observation group was significantly lower than in the control group(P<0.05).Conclusion:Levofloxacin combined with ambroxol demonstrates advantages in improving biochemical indices,shortening imaging-based pulmonary lesion absorption time and hospital stay,and reducing adverse reaction rates in elderly COPD patients with pulmonary infection.It holds significant clinical application value.
基金Supported by Scientific Research Projects from Wuhan Municipal Health Commission of China,No.WX23B42.
文摘BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.
基金supported by the National Natural Science Foundation of China(Grant Nos.:32171124,31871156,31971101,32271180,82272229,and 81471852)Hunan Provincial Natural Science Foundation of China(Grant No.:2021JJ31058).
文摘Repairing the endothelial barrier is essential for maintaining pulmonary fuid balance and regulating leukocyte infiltration during sepsis[1].Tissue kallikrein-related peptidases(KLKs)are secreted serine proteases involved in angiogenesis[2].However,their involvement in regulating endothelial regeneration remains largely unknown.
文摘INTRODUCTION Pulmonary hypertension(PH)is a complex syndrome arising from diverse underlying conditions and characterized by elevated pulmonary arterial pressure.Current clinical guidelines classify PH into five categories based on pathophysiology,clinical presentation,and hemodynamic characteristics.
基金supported by the National Natural Science Foundation of China(Grant Nos.:32270690 and 32070671).
文摘High-altitude pulmonary hypertension(HAPH)occurs when blood pressure in the pulmonary arteries rises due to exposure to high altitudes above 2,500 m.At these elevations,reduced atmospheric pressure leads to lower oxygen levels,triggering a series of physiological responses,including pulmonary artery constriction,which elevates blood pressure.This review explored the complex pathophysiological mechanisms of HAPH and reviewed current pharmaceutical interventions for its management.Meanwhile,this review particularly emphasized on the emerging research concerning Chinese medicinal plants as potential treatments for HAPH.Traditional Chinese medicines are rich in diverse natural ingredients that show significant promise in alleviating HAPH symptoms.We reviewed both in vitro and in vivo studies to assess the efficacy,safety,and mechanisms of these natural medicines,along with their potential adverse effects.Additionally,this review highlighted new alternative natural remedies,underscoring the need for ongoing research to expand available treatment options for HAPH.
文摘Pulmonary embolism(PE)represents the third leading cause of cardiovascular death,despite the implementation of European Society of Cardiology guidelines,the establishment of PE response teams and advances in diagnosis and treatment modalities.Unfavorable prognosis may be attributed to the increasing incidence of the disease and pitfalls in risk stratification using the established risk stratification tools that fail to recognize patients with intermediate-high risk PE at normotensive shock in order to prevent further deterioration.In this light,research has been focused to identify novel risk stratification tools,based on the hemodynamic impact of PE on right ventricular function.Furthermore,a growing body of evidence has demonstrated that novel interventional treatments for PE,including catheter directed thrombolysis,mechanical thrombectomy and computer-assisted aspiration,are promising solutions in terms of efficacy and safety,when targeted at specific populations of the intermediate-high-and high-risk spectrum.Various therapeutic protocols have been suggested worldwide,regarding the indications and proper timing for interventional strategies.A STelevation myocardial infarction-like timing approach has been suggested in highrisk PE with contraindications for fibrinolysis,while optimal timing of the procedure in intermediate-high risk patients is still a matter of debate;however,early interventions,within 24-48 hours of presentation,are associated with more favorable outcomes.
基金supported by the 2025 Hangzhou Normal University Teaching Development and Reform Project(Project No.JG2025320)。
文摘Self-management interventions for chronic obstructive pulmonary disease(COPD)patients using mobile health technology are beneficial for relieving disease symptoms,improving patients’adherence to rehabilitation self-management,and improving quality of life.This paper reviews the application of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,introduces the application form of mobile health technology in self-management of patients with chronic obstructive pulmonary disease,summarizes its application effect in self-management of patients with chronic obstructive pulmonary disease,analyzes the problems and proposes solutions in the process of research and implementation at this stage,with a view to providing a theory for the application of mobile health technology in pulmonary rehabilitation and management of patients with chronic obstructive pulmonary disease This study summarize the effect of its application in the self-management of patients with chronic obstructive pulmonary disease.
文摘Non-tuberculous mycobacterial(NTM)pulmonary disease and pulmonary tuberculosis(TB)are mycobacterium-associated lung disorders that share overlapping clinical and radiological features,yet diverge significantly in pathogenic mechanisms,therapeutic regimens,and long-term prognoses.Traditional east Medicine(TCM)constitution theory,a foundational framework for personalized healthcare,exerts a pivotal influence on disease susceptibility,pathological progression,and clinical outcomes.This review synthesizes state-of-the-art clinical evidence to systematically dissect key discrepancies in TCM constitution distribution between the two conditions,focusing on three core dimensions:distinctive patterns of constitution type distribution,the interplay between constitution and clinical variables,and the clinical relevance of these constitutional differences.Its primary goal is to deliver rigorous theoretical support and actionable guidance for TCM-based differential diagnosis,syndrome-specific interventions,and preventive healthcare strategies for both diseases.
基金Supported by Shaanxi Science and Technology Project(No.2022SF-434)Xi’an Science and Technology Project(No.21YXYJ0044).
文摘I am writing this letter to present a case of uveal effusion syndrome(UES)caused by pulmonary hypertension found due to intermittent high intraocular pressure(IOP).Pulmonary hypertension increases cardiac afterload due to elevated pulmonary vascular resistance,leading to right heart failure and death[1].Notably,ocular complications of pulmonary hypertension have been reported less frequently[2-5].Ophthalmologists need to increase the understanding of the disease so as to perform the proper treatment for these patients.Ethical Approval The study was conducted in accordance with the principles of the Declaration of Helsinki.Written informed consent was obtained from the patient for publication of the images and data included in this article.
文摘Pulmonary arterial hypertension(PAH)is a progressive disease marked by degeneration of the lung’s blood vessels.As the disease progresses,the resistance to blood flow in the pulmonary arteries increases,putting a strain on the right side of the heart as it pumps blood through the lungs.PAH is characterized by changes in the structure of blood vessels and excessive cell growth.Untreated PAH leads to irreversible right-sided heart failure,often despite medical intervention.Patients experience a gradual decline in function until they are unable to perform daily activities.Advances in treatment have improved the prognosis for many PAH patients.Currently approved therapies target the prostacyclin,endothelin,nitric oxide,or phosphodiesterase pathways to slow the progression of the disease.To address the unmet need for effective PAH therapies,research efforts are focused on identifying new targets and developing therapies that specifically address the underlying disease mechanisms and restore vascular wall homeostasis.Among these,sotatercept,a fusion protein that targets the transforming growth factor-βsuperfamily signaling pathway,has emerged as a promising therapeutic option.In this review,we examine the available evidence from clinical trials to assess the potential of sotatercept as a treatment for PAH.
文摘Unilateral pulmonary artery agenesis(UPAA)is a rare congenital cardiovascular anomaly defined by the complete absence of one pulmonary artery,most often affecting the right side.[1]Although typically identified in childhood due to symptomatic presentation,certain cases may remain undiagnosed until adulthood,particularly in asymptomatic patients or those with subtle clinical signs.
文摘Background Persistent pulmonary hypertension(PPHN)of the newborn is one of the major contributors to neonatal mortality.Current conventional treatments for PPHN primarily encompass mechanical ventilation,inhaled nitric oxide(iNO),sildenafil,and magnesium sulfate.In confirmed cases of neonatal respiratory distress syndrome,pulmonary surfactant(PS)can be considered as a potential treatment option;However,the optimal dosage and administration frequency of PS remain subjects of ongoing debate.This study aimed to assess the efficacy of early repeated endotracheal PS administration combined with iNO therapy in the management of newborns with PPHN.Methods Twenty-three neonates with PPHN received iNO alongside foundational treatments,including anti-infection therapy,mechanical ventilation,acidosis correction,and blood pressure stabilization.The observation group(n=13)received endotracheal instillation of PS three times,with each administration spaced six hours apart;The control group(n=10)received endotracheal instillation of PS once.Parameters compared included blood gas indices,oxygenation index(OI),alveolar-arterial oxygen partial pressure difference(PA-aDO,),pulmonary artery systolic pressure(PAP),and N-terminal pro-brain natriuretic peptide(NT-pro-BNP).Mechanical ventilation duration,oxygen therapy time,hospitalization length,and survival outcomes were recorded and compared between groups.Results The blood gas parameters,OI,and PA-aDO,showed no significant differences between the two groups of children before treatment(P>0.05).By 24-hour post-treatment,both groups exhibited significant increases in partial pressure of oxygen(PaO,)and potential of hydrogen(PH)levels,alongside significant decreases in lactate,partial pressure of carbon dioxide(PaCO,),OI,and PA-aDO2,with statistically significant differences(P<0.05).By 48-hour post-treatment,the observation group demonstrated significantly better improvements in blood gas parameters,OI,and PA-aDO,compared to the control group,and these differences were statistically significant(P<0.05).There was no statistically significant difference in PAP and NT-pro-BNP levels between the two groups before treatment(P>0.05).After treatment,both groups showed significant decreases in PAP and NT-pro-BNP levels(P<0.05),with a more pronounced reduction observed in the observation group(P<0.05).The observation group had significantly shorter durations of mechanical ventilation and oxygen therapy compared to the control group,with statistically significant differences(P<0.05).Additionally,the observation group exhibited a shorter total hospital stay and a lower mortality rate than the control group,though these differences were not statistically significant(P>0.05).Conclusions Early consecutive multiple doses of PS combined with iNO,compared to a single dose,better improves respiratory function indices,maintains stability,reduces pulmonary artery pressure,enhances cardiac function,shortens ventilator dependency,and increases cure rates in PPHN neonates.This approach is particularly suitable for severe PPHN cases,especially those with underlying pulmonary conditions.
文摘Introduction:Pulmonary hypertension(PH)is a hemodynamic and pathophysiological condition characterized by abnormally elevated pressures in the pulmonary vasculature.It is defined by a mean pulmonary arterial pressure≥25 mmHg at rest by right heart catheterization.He is frequently associated with cardiovascular surgery and is a common complication that has been observed after surgery utilizing cardiopulmonary bypass(CPB).Preoperative PH has been significantly linked to morbidity and is a risk factor for poor outcome post-surgery.Some specific features in sub-Saharan Africa:given the lack of access to cardiac surgery,PAH occurs very frequently in cases of advanced heart disease in patients with congenital heart disease or rheumatic valve disease that has been treated late.Objective:The purpose of this study was to evaluate a protocol for managing PH during cardiac surgery under cardiopulmonary bypass in resource limited settings.Patients and Methods:This is a descriptive and analytical retrospective study that included all patients who underwent cardiopulmonary bypass surgery at the“Le Luxembourg”Mother and Child University Hospital between January 1,2023,and June 30,2024,and who had a preoperative systolic pulmonary artery pressure(SPAP)≥35 mmHg.Preoperatively,all patients included were given Furosemide:1 mg/kg and Sildenafil 5 or 10 mg/8 hours in children and 20 mg/8 hours in adults.In the operating room,a nasogastric tube was inserted to administer sildenafil at the end of surgery,and weaning from CPB was performed using Milrinone at a syringe pump rate of 5μg/kg/min,combined with Norepinephrine as needed depending on hemodynamic status.We analyzed the mean changes in PAPS from the preoperative assessment to discharge from intensive care.Results:During the period,292 patients underwent surgery,142 of whom had PH,representing a prevalence of 48.63%.Our patients had an average age of 11.57±11.There was a female predominance of 51.4%.The average length of preoperative hospitalization was 5 days[3-8].The time between diagnosis and surgical treatment was between 1 and 5 years in 62.8% of cases.It was≤1 year in 29.6%of cases.The clinical signs were dominated by dyspnea in 43.7% of cases.Pulmonary artery systolic pressure was between 51-100 mmHg in 29.58% and>100 mmHg in 19.72% of cases,with a mean preoperative sPAP of 59 mmHg[35-110].Congenital heart disease accounted for 52.11% of surgical indications,and valvular heart disease for 47.89%.Surgical indications for mitral valve disease accounted for 35.92% of cases and those for congenital heart disease for 52.11%.The mean duration of CPB was 110 min±50.There were no intraoperative episodes of pulmonary hypertension.At the end of surgery,the average time to postoperative extubation in intensive care was 3.53 hours±2.2.There was a significant decrease in sPAP between the preoperative and postoperative periods.A comparison of pre-and post-operative sPAP averages using a t-test was significant with a P-value<0.001(t:27.978).The main postoperative complications are:Overall cardiac failure:4.2%;respiratory failure:2.1%;hematological complications:0.7%.We recorded a perioperative mortality rate of 5.6%.Conclusion:PH complicates rheumatic valve disease and certain congenital heart diseases.It is common in our resourcelimited setting,where access to cardiac surgery is insufficient.It is associated with high perioperative morbidity and mortality.Management is well codified,but the therapeutic classes are sometimes unavailable in our countries.The postoperative protocol of furosemide+sildenafil and milrinone appears to give good results.
