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
Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequen...Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.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
目的:定量评价“肺结核主动筛查+全疗程住院治疗”模式在新疆维吾尔自治区(简称“新疆”)和田地区肺结核患者发现中的实施效果,为新疆肺结核防治工作的稳步推进提供科学依据。方法:收集2012年1月至2021年12月新疆和田地区及未实施全疗...目的:定量评价“肺结核主动筛查+全疗程住院治疗”模式在新疆维吾尔自治区(简称“新疆”)和田地区肺结核患者发现中的实施效果,为新疆肺结核防治工作的稳步推进提供科学依据。方法:收集2012年1月至2021年12月新疆和田地区及未实施全疗程住院治疗策略的新疆其他地州肺结核报告发病数据。利用Joinpoint回归模型分析肺结核报告发病率的时间趋势。以2018年7月作为“肺结核主动筛查+全疗程住院治疗”模式干预时间点,根据是否设置对照地区,分别构建单组中断时间序列(interrupted time series, ITS)模型和设置对照的ITS模型(controlled interrupted time series, CITS)分析政策干预效果。结果:2012—2021年新疆和田地区肺结核报告发病率最高为2018年的465.10/10万(10 278例),最低为2021年的129.40/10万(3241例),总体呈现下降趋势(AAPC=-4.5%,P<0.05);2012—2018年肺结核报告发病率呈现上升趋势(APC=10.8%,P<0.05),2018—2021年肺结核报告发病率呈快速下降趋势(APC=-29.0%,P<0.05)。ITS模型分析显示,和田地区实施“肺结核主动筛查+全疗程住院治疗”模式后1个月(2018年7月),报告发病率增加16.859/10万(P=0.001),新型模式实施后的长期效果为肺结核报告发病率呈下降趋势(β3=-1.098,P<0.001)。CITS模型分析显示,和田地区在新型模式实施后1个月(2018年7月),肺结核报告发病率明显增加,增加量比对照地区高14.751/10万(P<0.001),新型模式实施后长期效果为肺结核报告发病率呈下降趋势,平均每月下降0.815/10万(β5+β7=-0.815,P<0.001),下降速度大于对照地区(β7=-0.931,P<0.001)。结论:新疆和田地区实施“肺结核主动筛查+全疗程住院治疗”模式与肺结核报告发病率之间存在动态因果关系,该模式促使肺结核报告发病率在短暂地上升后呈现下降的长期趋势。实施该模式对控制结核病高负担地区肺结核疫情具有明显优势。展开更多
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.
文摘Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.
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.
文摘目的:定量评价“肺结核主动筛查+全疗程住院治疗”模式在新疆维吾尔自治区(简称“新疆”)和田地区肺结核患者发现中的实施效果,为新疆肺结核防治工作的稳步推进提供科学依据。方法:收集2012年1月至2021年12月新疆和田地区及未实施全疗程住院治疗策略的新疆其他地州肺结核报告发病数据。利用Joinpoint回归模型分析肺结核报告发病率的时间趋势。以2018年7月作为“肺结核主动筛查+全疗程住院治疗”模式干预时间点,根据是否设置对照地区,分别构建单组中断时间序列(interrupted time series, ITS)模型和设置对照的ITS模型(controlled interrupted time series, CITS)分析政策干预效果。结果:2012—2021年新疆和田地区肺结核报告发病率最高为2018年的465.10/10万(10 278例),最低为2021年的129.40/10万(3241例),总体呈现下降趋势(AAPC=-4.5%,P<0.05);2012—2018年肺结核报告发病率呈现上升趋势(APC=10.8%,P<0.05),2018—2021年肺结核报告发病率呈快速下降趋势(APC=-29.0%,P<0.05)。ITS模型分析显示,和田地区实施“肺结核主动筛查+全疗程住院治疗”模式后1个月(2018年7月),报告发病率增加16.859/10万(P=0.001),新型模式实施后的长期效果为肺结核报告发病率呈下降趋势(β3=-1.098,P<0.001)。CITS模型分析显示,和田地区在新型模式实施后1个月(2018年7月),肺结核报告发病率明显增加,增加量比对照地区高14.751/10万(P<0.001),新型模式实施后长期效果为肺结核报告发病率呈下降趋势,平均每月下降0.815/10万(β5+β7=-0.815,P<0.001),下降速度大于对照地区(β7=-0.931,P<0.001)。结论:新疆和田地区实施“肺结核主动筛查+全疗程住院治疗”模式与肺结核报告发病率之间存在动态因果关系,该模式促使肺结核报告发病率在短暂地上升后呈现下降的长期趋势。实施该模式对控制结核病高负担地区肺结核疫情具有明显优势。
