Incidence of Pleural Effusion in Patients with Pulmonary Embolism

Background： No data on the incidence ofpleural effusion （PE） in Chinese patients with pulmonary embolism are available to date. The aim of the current study was to investigate the frequency of PE in a Chinese population of patients with pulmonary embolism. Methods： This was a retrospective observational single-center study. All data of computed tomography pulmonary angiography （CTPA） performed over 6-year period on adult patients with clinically suspected pulmonary embolism were analyzed. Results： From January 2008 until December 2013, PE was identified in 423 of 3141 patients （13.5%） with clinically suspected pulmonary embolism who underwent CTPA, The incidence of PE in patients with pulmonary embolism （19.9%） was significantly higher than in those without embolism （9.4%） （P 〈 0.001 ）. Majority of PEs in pulmonary embolism patients were small to moderate and were unilateral. The locations of emboli and the numbers of arteries involved, CT pulmonary obstruction index, and parenchymal abnormalities at CT were not associated with the development of PE, Conclusions： PEs are present in about one fifth of a Chinese population of patients with pulmonary embolism, which are usually small, unilateral, and unsuitable for diagnostic thoracentesis.

Endovascular Catheter-guided Forceps Biopsy for the Diagnosis of Suspected Pulmonary Artery Sarcoma： A Preliminary Study of Eight Cases

Pulmonary artery sarcoma （PAS） is a rare malignant tumor that originates from the pulmonary artery （PA） with a poor prognosis,Early diagnosis and radical surgical resection offer the only chance for survival As most PA sarcomas involve the PA trunk, making a preoperative histopathological diagnosis is quite difficult. So far, most PAS cases were reported with diagnosis made either at autopsy or intraoperatively with frozen sections.

Clinical Study of Acute Vasoreactivity Testing in Patients with Chronic Thromboembolic Pulmonary Hypertension

Background： The clinical significance of acute vasoreactivity testing （AVT） in patients with chronic thromboembolic pulmonary hypertension （CTEPH） remains unclear. We analyzed changes in hemodynamics and oxygenation dynamics indices after AVT in patients with CTEPH using patients with pulmonary arterial hypertension （PAH） as controls. Methods： We analyzed retrospectively the results of AVT in 80 patients with PAH and 175 patients with CTEPH registered in the research database of Beijing Chao-Yang Hospital between October 2005 and August 2014. Demographic variables, cardiopulmonary indicators, and laboratory findings were compared in these two subgroups. A long-term follow-up was conducted in patients with CTEPH. Between-group comparisons were performed using the independent-sample t-test or the rank sum test, within-group comparisons were conducted using the paired t-test or the Wilcoxon signed-rank test, and count data were analyzed using the Chi-squared test. Survival was estimated using the Kaplan-Meier method and log-rank test. Results： The rates of positive response to AVT were similar in the CTEPH （25/175, 14.3%） and PAH （9/80, 11.3%） groups （P 〉 0.05）. Factors significantly associated a positive response to AVT in the CTEPH group were level of N-terminal pro-brain natriuretic peptide （〈1131.000 ng/L）, mean pulmonary arterial pressure （mPAE ≤44.500 mmHg）, pulmonary vascular resistance （PVR, 〈846.500 dyn＇s-1·m-5）, cardiac output （CO,≥3.475 L/rain）, and mixed venous oxygen partial pressure （PvO2, ≥35.150 mmHg）. Inhalation of iloprost resulted in similar changes in mean blood pressure, mPAE PVR, systemic vascular resistance, CO, arterial oxygen saturation （SaO2）, mixed venous oxygen saturation, partial pressure of oxygen in arterial blood （PaO2）, PvO2, and intrapulmonary shunt （Qs/Qt） in the PAH and CTEPH groups （all P 〉 0.05）. The survival time in patients with CTEPH with a negative response to AVT was somewhat shorter than that in AVT-responders although the difference was not statistically significant （X2= 3,613, P = 0.057）. The survival time of patients with CTEPH who received calcium channel blockers （CCBs） was longer than that in the group with only basic treatment and not shorter than that of patients who receiving targeted drugs or underwent pulmonary endarterectomy （PEA） although there was no significant difference between the four different treatment regimens （X2 = 3.069, P = 0.381 ）. Conclusions： The rates of positive response to AVT were similar in the CTEPH and PAH groups, and iloprost inhalation induced similar changes in hemodynamics and oxygenation dynamics indices. A positive response to AVT in the CTEPH group was significantly correlated with milder disease and better survival. Patients with CTEPH who cannot undergo PEA or receive targeted therapy but have a positive response to AVT might benefit from CCB treatment.

Incidence and Clinical Characteristics of Pulmonary Hypertension in Patients with Idiopathic Pulmonary Fibrosis

Background： Pulmonary hypertension （PH） frequently complicates the course of idiopathic pulmonary fibrosis （IPF） patients and is associated with significantly worse outcomes. The aim of the present study was to investigate the incidence of PH in IPF patients and evaluate the correlation between clinical parameters and systolic pulmonary artery pressure （sPAP）. Methods： Hospitalized patients with IPF, who were evaluated for sPAP by Doppler echocardiography from January 2004 to December 2011, were enrolled in our study. Patients were defined as PH by an estimated sPAP 〉 50 mmHg and graded as PH likely, PH possible and PH unlikely, based on the 2009 European Society of Cardiology/European Respiratory Society PH Guidelines. The correlations between clinical parameters and sPAP were analyzed by multiple linear regression. Results： Totally, 119 IPF patients were enrolled in our study and 28 （23.5%）, 20 （16.8%） and 71 （59.7%） patients were PH likely, PH possible and PH unlikely, respectively. Borg dyspnea score was positively correlated with sPAP, r = 0.467, P 〈 0.001. Oxygen saturation was negatively correlated with sPAP, r = -0.416, P 〈 0.001. Diffusing capacity of the lung for carbon monoxide percentage predicted was negatively correlated with sPAP, r = -0.424, P = 0.003. N-terminal fragment of pro-brain natriuretic peptide and pulmonary artery width was positively correlated with sPAP, r = 0.452, P = 0.011 and r= 0.513, P 〈 0.001, respectively. Conclusions： The incidence of PH in IPF patients was 23.5% in a single center of China. PH may worsen the dyspnea, right heart dysfunction and decrease the life quality of the patients with IPF.

Serum Bilirubin and 6-min Walk Distance as Prognostic Predictors for Inoperable Chronic Thromboembolic Pulmonary Hypertension： A Prospective Cohort Study

Background： Inoperable chronic thromboembolic pulmonary hypertension （CTEPH） is a severe clinical syndrome characterized by right cardiac failure and possibly subsequent liver dysfunction. However, whether serum markers of liver dysfunction can predict prognosis in inoperable CTEPH patients has not been determined. Our study aimed to evaluate the potential role of liver function markers （such as serum levels of transaminase, bilirubin, and gamma-glutamyl transpeptidase [GGT]） combined with 6-min walk test in the prediction of prognosis in patients with inoperable CTEPH. Methods： From June 2005 to May 2013, 77 consecutive patients with inoperable CTEPH without confounding co-morbidities were recruited for this prospective cohort study. Baseline clinical characteristics and 6-min walk distance （6MWD） results were collected. Serum biomarkers of liver function, including levels of aspartate aminotransferase, alanine aminotransferase, GGT, uric acid, and serum bilirubin, were also determined at enrollment. All-cause mortality was recorded during the follow-up period. Results： During the follow-up, 22 patients （29%） died. Cox regression analyses demonstrated that increased serum concentration of total bilirubin （hazard ratio [HR] = 7.755, P 〈 0.001）, elevated N-terminal of the prohormone brain natriuretic peptide （HR = 1.001, P = 0.001）, decreased 6MWD （HR = 0.990, P 〈 0.001）, increased central venous pressure （HR = 1.074, P = 0.040）, and higher pulmonary vascular resistance （HR = 1.001, P = 0.018） were associated with an increased risk of mortality. Serum concentrations of total bilirubin （HR = 4.755, P = 0.007） and 6MWD （HR = 0.994, P = 0.017） were independent prognostic predictors for CTEPH patients. Patients with hyperbilirubinemia （≥23.7 μmol/L） had markedly worse survival than those with normobilirubinemia. Conclusion： Elevated serum bilirubin and decreased 6MWD are potential predictors for poor prognosis in inoperable CTEPH.

Pulmonary aspergillosis with in-situ pulmonary artery thrombosis: to anti-coagulate or not?

Aspergillus is widespread in the environment and causes a variety of tracheobronchial and pulmonary disorders,depending upon the alterations of immune status of hosts.[1] Among the spectrum of pulmonary aspergillosis (PA),allergic bronchopulmonary aspergillosis,and most chronic pulmonary aspergillosis are considered as noninvasive diseases,whereas invasive pulmonary aspergillosis (IPA) and subacute invasive pulmonary aspergillosis (SAIA) may cause tissue invasion.

Pulmonary Hypertension in Glycogen Storage Disease Type II

To the Editor： Glycogen storage disease （GSD） is a group of inherited disorders with abnormal glycogen deposition, Pulmonary hypertension （PH） is a rare complication of GSD with unclear etiology. Since the pioneer description in 1980, only a few cases of GSD-associated PH have been reported. Here, we reported a Chinese case with informed consent by the patient and the guardian.

Clinical and genetic risk factors for venous thromboembolismin Chinese population

Venous thromboembolism(VTE),including deep vein thrombosis and pulmonary embolism,carries significant mortality and morbidity.The most important and effective way to reduce VTE incidence is to identify the patients at risk and give necessary prevention.VTE is a multifactorial and complicated disorder.Major risk factors for VTE include surgery and trauma,acute medical illness,active cancer and pregnancy.Genetic factors increase susceptibility to the disease and are useful in predicting the development of VTE.Gene-gene and gene-environment interactions alter and magnify the clinical picture in this disorder.This brief review summarizes some selected clinical and genetic risk factors for VTE based on the current research in China.

Publishing clinical prActice GuidelinEs(PAGE):Recommendations from editors and reviewers

Transparency Ecosystem for Research and Journals in Medicine(TERM)working group summarized the essential recommendations that should be considered to review and publish a high-quality guideline.These recommendations from editors and reviewers included 10 components of essential requirements:systematic review of existing relevant guidelines,guideline registration,guideline protocol,stakeholders,conflicts of interest,clinical questions,systematic reviews,recommendation consensus,guideline reporting and external review.TERM working group abbreviates them as PAGE(essential requirements for Publishing clinical prActice GuidelinEs),and recommends guideline authors,editors,and peer reviewers to use them for high-quality guidelines.