Life-threatening constrictive pericarditis accompanied by synthetic cannabinoid use:A case report and literature review

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.

Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

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.

A fixed point theorem for a class of β-constrictive operators and its application to the integral equation 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.

Constrictive pericarditis as a cause of refractory ascites after liver transplantation:A case report

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.

Chronic Effusive Pericarditis and Chronic Constrictive Pericarditis

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.

“End-Stage” Constrictive Pericarditis—A Case Report

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.

Surgical Treatment of Chronic Constrictive Pericarditis in a Developing Country

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.

Low-Frequency Electroacupuncture Alleviates Chronic Constrictive Injury-Induced Mechanical Allodynia by Inhibiting NR2B Upregulation in Ipsilateral Spinal Dorsal Horn in Rats

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.

Effect of Right Heart Systolic Function on Outcomes in Patients with Constrictive Pericarditis Undergoing Pericardiectomy

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.

Chylous Ascites and Chylothorax Caused by Constrictive Pericarditis

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.

A rare chronic constrictive pericarditis with localized adherent visceral pericardium and normal parietal pericardium： a case report

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.

Safety and efficacy of Kaffes intraductal self-expanding metal stents in the management of post-liver transplant anastomotic strictures

BACKGROUND Endoscopic management is the first-line therapy for post-liver-transplant anas-tomotic strictures.Although the optimal duration of treatment with plastic stents has been reported to be 8-12 months,data on safety and duration for metal stents in this setting is scarce.Due to limited access to endoscopic retrograde cholan-giopancreatography(ERCP)during the coronavirus disease 2019 pandemic in our centre,there was a change in practice towards increased usage and length-of-stay of the Kaffes biliary intraductal self-expanding stent in patients with suitable anatomy.This was mainly due to the theoretical benefit of Kaffes stents allowing for longer indwelling periods compared to the traditional plastic stents.METHODS Adult liver transplant recipients aged 18 years and above who underwent ERCP were retrospectively identified during a 10-year period through a database query.Unplanned admissions post-Kaffes stent insertion were identified manually through electronic and scanned medical records.The main outcome was the incidence of complications when stents were left indwelling for 3 months vs 6 months.Stent efficacy was calculated via rates of stricture recurrence between patients that had stenting courses for≤120 d or>120 d.RESULTS During the study period,a total of 66 ERCPs with Kaffes insertion were performed in 54 patients throughout their stenting course.In 33 ERCPs,the stent was removed or exchanged on a 3-month interval.No pancreatitis,perfor-ations or deaths occurred.Minor post-ERCP complications were similar between the 3-month(abdominal pain and intraductal migration)and 6-month(abdominal pain,septic shower and embedded stent)groups-6.1%vs 9.1%respectively,P=0.40.All strictures resolved at the end of the stenting course,but the stenting course was variable from 3 to 22 months.The recurrence rate for stenting courses lasting for up to 120 d was 71.4%and 21.4%for stenting courses of 121 d or over(P=0.03).There were 28 patients that were treated with a single ERCP with Kaffes,21 with removal after 120 d and 7 within 120 d.There was a significant improvement in stricture recurrence when the Kaffes was removed after 120 d when a single ERCP was used for the entire stenting course(71.0%vs 10.0%,P=0.01).CONCLUSION Utilising a single Kaffes intraductal fully-covered metal stent for at least 4 months is safe and efficacious for the management of post-transplant anastomotic strictures.

Construction of EMS-Induced Peanut Mutant Libraries and Identification of Pod-Related Traits Mutant Lines

Peanut(Arachis hypogaea L.)is an oil and economic crop of vital importance,and peanut pod is the key organ influencing the yield and processing quality.Hence,the Pod-related traits(PRTs)are considered as important agronomic traits in peanut breeding.To broaden the variability of PRTs in current peanut germplasms,three elite peanut cultivars were used to construct Ethyl methane sulfonate(EMS)-induced mutant libraries in this study.The optimal EMS treatment conditions for the three peanut varieties were determined.It was found that the median lethal dose(LD50)of EMS treatment varied greatly among different genotypes.Finally,the EMS-induced peanut mutant libraries were constructed and a total of 124 mutant lines for PRTs were identified and evaluated.Furthermore,“M-8070”,one of the mutant lines for pod constriction,was re-sequenced via high-throughput sequencing technology.The genome-wide variations between“M-8070”and its wild parent“Fuhua 8”(FH 8)were detected.2994 EMS-induced single nucleotide polymorphisms(SNPs)and 1188 insertion-deletions(InDels)between“M-8070”and its wild parent were identified.The predominant SNP mutation type was C/G to T/A transitions,while the predominant InDel mutation type was“1-bp”.We analyzed the distribution of identified mutations and annotated their functions.Most of the mutations(91.68%of the SNPs and 77.69%of the InDels)were located in the intergenic region.72 SNPs were identified in the exonic region,leading to 27 synonymous,43 nonsynonymous and 2 stop-gain variation for gene structure.13 Indels were identified in the exonic region,leading to 4 frame-shift,8 non-frame-shift and 1 stop-gain variations of genes.These mutations may lead to the phenotypic variation of“M-8070”.Our study provided valuable resources for peanut improvement and functional genomic research.

Safety and efficacy of balloon angioplasty compared to stent-basedstrategies with pulmonary vein stenosis:A systematic review and meta-analysis

BACKGROUND Pulmonary vein stenosis(PVS)is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous revascularization strategies of pulmonary vein balloon angioplasty(PBA)or pulmonary vein stent implantation(PSI).AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.METHODS We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS.We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories.In adults,PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included.The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications.The metaanalysis was performed by computing odds ratios(ORs)using the random effects model based on underlying statistical heterogeneity.RESULTS Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria.The age range of patients was 6 months to 70 years and 67%were males.The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group.Compared to PSI,PBA was associated with a significantly increased risk of re-stenosis(OR 2.91,95%CI:1.15-7.37,P=0.025,I2=79.2%).Secondary outcomes of the procedurerelated complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group.There were no statistically significant differences in the safety outcomes between the two groups(OR:0.94,95%CI:0.23-3.76,P=0.929,I^(2)=0.0%).CONCLUSION Across all patient categories with PVS,PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.

Hourglass-like constriction of the anterior interosseous nerve in the left forearm:A case report

BACKGROUND Hourglass-like constriction neuropathy is a rare neurological disorder.The main clinical manifestation is peripheral nerve injury with no apparent cause,and the pathomorphological change is an unexplained narrowing of the diseased nerve.The diagnosis and treatment of the disease are challenging and there is no accepted diagnostic or therapeutic approach.CASE SUMMARY This report describes a rare hourglass constriction of the anterior interosseous nerve in the left forearm in a 47-year-old healthy male who was treated surgically and gradually recovered function over a 6-mo follow-up period.CONCLUSION Hourglass-like constriction neuropathy is a rare disorder.With the development of medical technology,more examinations are now available for diagnosis.This case aims to highlight the rare manifestations of Hourglass-like constriction neuropathy and provides a reference for enriching the clinical diagnosis and treatment experience.

膨胀海绵地塞米松填塞治疗外耳道狭窄

目前外耳道狭窄以手术治疗为主。对于外耳道成形术后及慢性中耳炎术后瘢痕形成初期（术后2～4周）和继发于外耳道炎症、肉芽组织增生所致的狭窄，我们用膨胀海绵配合地塞米松治疗，取得满意疗效，现报道如下。

Incidental findings of pericardial calcification

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.

Molecular mechanisms underlying the effects of acupuncture on neuropathic pain

Acupuncture has been used to treat neuropathic pain for a long time, but its mechanisms of action remain unknown. In this study, we observed the effects of electroacupuncture and manual acu- puncture on neuropathic pain and on ephrin-B/EphB signaling in rats models of chronic constriction injury-induced neuropathic pain. The results showed that manual acupuncture and electroacu- puncture significantly reduced mechanical hypersensitivity following chronic constriction injury, es- pecially electroacupuncture treatment. Real-time PCR results revealed that ephrin-B1/B3 and EphB1/B2 mRNA expression levels were significantly increased in the spinal dorsal horns of chronic constriction injury rats. Electroacupuncture and manual acupuncture suppressed the high expres- sion of ephrin-B1 mRNA, and elevated EphB3/B4 mRNA expression. Electroacupuncture signifi- cantly enhanced the mRNA expression of ephrin-B3 and EphB3/B6 in the dorsal horns of neuro- pathic pain rats. Western blot results revealed that electroacupuncture in particular, and manual acupuncture, significantly up-regulated ephrin-B3 protein levels in rat spinal dorsal horns. The re- sults of this study suggest that acupuncture could activate ephrin-B/EphB signaling in neuropathic pain rats and improve neurological function.

Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry: a case report

This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry,by implementing surgical planning with SimPlant OMS.Using this method,we conducted LF1 osteotomy,intraoral vertical ramus osteotomy（IVRO）,sagittal split ramus osteotomy（SSRO）,mandibular constriction and mandibular border genioplasty.Not only did we obtain a class I occlusal relationship,but the complicated surgery also improved the asymmetry of the frontal view,as well as of the profile view,of the patient.The virtual operation using three-dimensional computed tomography（3D-CT）could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry.

Weld formation and heating mechanism in ultra-narrow gap withconstricted arc by ultra-fine granular flux

Ultra-narrow gap welding （UNGW） process with high stabilization, reliability and without spatter can be achieved with constricted arc by molten slag wall, which is made from melted flux. The experiments are carried out by changing voltage under different currents. The results indicate voltage range being fit for UNGW is about 22 -31 V under the current range of 200 -320 A. With the increasing of voltage, weld formation of UNGW has the law of lack of fusion on sidewall, good weld and undercut in turn under a certain current. In addition, the action relationships among arc, molten slag wall and sidewalls can be improved by properly adjusting voltage and current of arc, which makes cathode spot properly distribute in ultra-narrow gap. Therefore, the effective control of weld formation of UNGW has been achieved.