Objective: To investigate the diagnostic value of lead corrected Vt and V6 in patients with acute pulmonary thromboembolism. Methods: A total of 89 patients with suspected acute PTE were examined in our hospital from ...Objective: To investigate the diagnostic value of lead corrected Vt and V6 in patients with acute pulmonary thromboembolism. Methods: A total of 89 patients with suspected acute PTE were examined in our hospital from January to December 2017. A baseline 12-lead ECG was recorded on admission, with a gain of 10 mm/mV and a paper velocity of 25 mm/s. Results: Of the 89 suspected PTE patients enrolled in this study, 45 patients with acute PTE and 44 patients without PTE were identified by CTA. The chief complaint of most patients in both groups was dyspnea or dyspnea, with no significant difference between the two groups. The levels of d-dimer and high-sensitivity troponin in patients with PTE were significantly higher than those without PTE. QT and QTc in the V1 lead in the PTE group were significantly greater than those in the non-PTE group, but QT and QTc in the V6 lead were not significantly different between the two groups. The QTc difference (V1-V6) in the PTE group was significantly greater than that in the non-PTE group. In the morphological analysis, T wave inversion in lead III of PTE group, T wave inversion of V1 or V1 and V2 was significantly higher than that of non-PTE group. There was no significant difference in the incidence of S1Q3T3 between the two groups. For the prediction of acute PTE, the maximum accuracy of the maximum QTc difference (V1-V6)≥20 ms, the sensitivity was 83.2%, and the specificity and positive predictive value was 100%. T-wave inversion in V1 leads is the most sensitive morphological abnormality associated with PTE with a sensitivity of 80.06% and a specificity of 62.29%. T-wave inversion in lead III is a sub-sensitive predictor with a sensitivity of 51.20%. The specificity is 70.53%. Conclusions: The QTC difference (V1-V6) is a distinct feature of acute PTE, and QTC difference (V1-V6)≥20 ms as an important indicator of acute PTE in emergency settings.展开更多
BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronaviru...BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019(COVID-19)who were admitted to the emergency department(ED)for acute chest pain.Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events,will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.AIM To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain,and to assess outcomes of optimizing diagnostic imaging strategies,particularly TRO CTA use,in COVID-19 related thromboembolic events.METHODS TRO CTA images were evaluated for the presence of coronary artery disease,pulmonary thromboembolism(PTE),or acute aortic syndromes.Statistical analyses were used for evaluation of significant association between the variables.A two tailed P-value<0.05 was considered statistically significant.RESULTS Fifty-three patients were included into the study.In 31 patients(65.9%),there was not any pathology,while PTE was diagnosed in 11 patients.There was no significant relationship between the rates of pathology on CTA and history of hypertension.On the other hand,the diabetes mellitus rate was much higher in the acute coronary syndrome group,particularly in the PTE group(8/31=25.8%vs 6/16=37.5%,P=0.001).The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group(62.5%vs 38.7%,P<0.001).Smoking history rates were similar in the groups.Platelets,D-dimer,fibrinogen,C-reactive protein,and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.CONCLUSION TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.展开更多
BACKGROUND Simultaneous bilineage hematologic malignancies are rare;however,several cases of acute myeloid leukemia(AML)and T-lymphoblastic lymphoma(T-LBL)cooccurrence have been reported.A standard treatment for simul...BACKGROUND Simultaneous bilineage hematologic malignancies are rare;however,several cases of acute myeloid leukemia(AML)and T-lymphoblastic lymphoma(T-LBL)cooccurrence have been reported.A standard treatment for simultaneous AML and T-LBL has not yet been established,and its prognosis is very poor.Further studies to develop standard treatments are required to increase patient survival rates.CASE SUMMARY A 69-year-old man complaining of pleuritic chest pain visited the emergency room.Computed tomography revealed multiple enlarged lymph nodes(LNs)in the neck and groin and pulmonary thromboembolism with pulmonary infarction.Furthermore,a peripheral blood smear performed due to leukocytosis revealed circulating blasts.Acute myelomonocytic leukemia(AMML)was diagnosed after bone marrow examination,and T-LBL positivity for terminal deoxynucleotidyl transferase,cluster of differentiation(CD)34,and CD4 was confirmed by cervical LN biopsy.Decitabine and dexamethasone were administered because he could not receive intensive chemotherapy due to poor performance status.Complete remission of AMML and T-LBL was achieved after 4 cycles of decitabine plus dexamethasone.CONCLUSION We report the therapeutic effect of decitabine,a hypomethylating agent(HMA),in patients with concurrent bilineage hematologic malignancies and suggest that further studies are required to evaluate the therapeutic effect of HMAs on both lymphoid and bilineage hematologic malignancies.展开更多
Background It has been shown that neurohumoral factors other than mechanical obstruction are involved in the pathophysiology of acute pulmonary thromboembolism （APTE）. The aim of this study was to investigate the ef...Background It has been shown that neurohumoral factors other than mechanical obstruction are involved in the pathophysiology of acute pulmonary thromboembolism （APTE）. The aim of this study was to investigate the effects of thrombolytic drugs, a selective endothelin-1 receptor （ET-1 R） antagonist alone or their combination on APTE in a canine model. Methods Twenty dogs were randomly assigned to five groups： sham, model, urokinase （UK）, BQ123, and combination （UK plus BQ123）. The dogs in the sham group underwent sham surgery. APTE was induced in the other four groups by intravenous injection of autologous blood clots. Dogs in the UK, BQ123 and combination groups received UK, BQ123 （a selective ET-1R antagonist）, or UK plus BQ123, respectively. The dogs in the model group were given saline. Mean pulmonary artery pressure （mPAP）, serum concentrations of ET-1, thromboxane （TXB2）, and tumor necrosis factor （TNF）-α were determined at different time points following the induction of APTE. Results UK and BQ123 alone markedly decreased mPAP in APTE. By comparison, the reduction was more significant in the combination group. Compared with the sham group （（-0.90±0.61） mmHg）, mPAP increased by （7.44±1.04）, （3.42±1.12） and （1.14±0.55） mmHg in the model group, UK alone and BQ123 alone groups, respectively, and decreased by （2.24±0.67） mmHg in the combination group （P 〈0.01）. Serum ET-1 concentrations in the BQ123 and combination groups were （52.95±8.53） and （74.42±10.27） pg/ml, respectively, and were significantly lower than those in the model and UK groups （（84.56±7.44） and （97.66±8.31） pg/ml respectively; P 〈0.01）. Serum TNF-α concentrations were significantly lower in the BQ123 group than in the model, UK and combination groups （P 〈0.05）. Conclusions Our results indicate that the selective ET-1R antagonist BQ123 not only reduces the increase of mPAP and serum ET-1 level, but also inhibits the production of TNF-α, and attenuates the local inflammatory response induced by APTE. Selective ET-1R antagonists may be beneficial to the treatment of APTE, particularly when used in combination with a thrombolytic agent.展开更多
目的筛选康北高原慢性阻塞性肺疾病急性加重患者发生静脉血栓栓塞症风险的预测因素,建立AECOPD发生VTE风险的联合预测模型并分析其预测效能。方法选择2018年1月-2022年9月因慢性阻塞性肺疾病急性加重在甘孜县人民医院住院治疗的患者71例...目的筛选康北高原慢性阻塞性肺疾病急性加重患者发生静脉血栓栓塞症风险的预测因素,建立AECOPD发生VTE风险的联合预测模型并分析其预测效能。方法选择2018年1月-2022年9月因慢性阻塞性肺疾病急性加重在甘孜县人民医院住院治疗的患者71例,根据是否发生VTE分为血栓组35例,对照组36例。收集患者的基本资料和检查、检验资料等相关参数数据,选出两组之间具有显著差异的指标。将上述单因素分析中有显著差异的指标纳入多因素分析,筛选出AECOPD发生VTE风险的独立影响因素,并构建预测模型。利用受试者工作特征(receiver operating characteristic,ROC)曲线评价各独立因素及预测模型的应用价值,计算曲线下面积及其敏感度与特异度,分析其预测效能,霍斯默-莱梅肖检验评价拟合度。结果单因素分析显示血栓组PPS评分、乳酸脱氢酶(LDH)、D-二聚体、降钙素原(PCT)均高于对照组(均P<0.05)。Logistic回归分析显示PPS评分、乳酸脱氢酶(LDH)、D-二聚体为AECOPD发生VTE的独立预测因素。三者联合构建的预测模型曲线下面积(area under curve,AUC)为0.944(95%CI:0.893~0.996),灵敏度、特异度均明显优于各单一指标(灵敏度为94.3%、特异度为83.3%),霍斯默-莱梅肖检验拟合度好(χ^(2)=11.915,P=0.155)。结论PPS评分、乳酸脱氢酶(LDH)、D-二聚体可能是预测康北高原AECOPD发生VTE的因素,且三者联合构建的预测模型对VTE风险预测具有很好效能,可为预测AECOPD发生VTE的风险提供参考。展开更多
文摘Objective: To investigate the diagnostic value of lead corrected Vt and V6 in patients with acute pulmonary thromboembolism. Methods: A total of 89 patients with suspected acute PTE were examined in our hospital from January to December 2017. A baseline 12-lead ECG was recorded on admission, with a gain of 10 mm/mV and a paper velocity of 25 mm/s. Results: Of the 89 suspected PTE patients enrolled in this study, 45 patients with acute PTE and 44 patients without PTE were identified by CTA. The chief complaint of most patients in both groups was dyspnea or dyspnea, with no significant difference between the two groups. The levels of d-dimer and high-sensitivity troponin in patients with PTE were significantly higher than those without PTE. QT and QTc in the V1 lead in the PTE group were significantly greater than those in the non-PTE group, but QT and QTc in the V6 lead were not significantly different between the two groups. The QTc difference (V1-V6) in the PTE group was significantly greater than that in the non-PTE group. In the morphological analysis, T wave inversion in lead III of PTE group, T wave inversion of V1 or V1 and V2 was significantly higher than that of non-PTE group. There was no significant difference in the incidence of S1Q3T3 between the two groups. For the prediction of acute PTE, the maximum accuracy of the maximum QTc difference (V1-V6)≥20 ms, the sensitivity was 83.2%, and the specificity and positive predictive value was 100%. T-wave inversion in V1 leads is the most sensitive morphological abnormality associated with PTE with a sensitivity of 80.06% and a specificity of 62.29%. T-wave inversion in lead III is a sub-sensitive predictor with a sensitivity of 51.20%. The specificity is 70.53%. Conclusions: The QTC difference (V1-V6) is a distinct feature of acute PTE, and QTC difference (V1-V6)≥20 ms as an important indicator of acute PTE in emergency settings.
文摘BACKGROUND The aim of this study was to define clinical evidence supporting that triple ruleout computed tomography angiography(TRO CTA)is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019(COVID-19)who were admitted to the emergency department(ED)for acute chest pain.Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events,will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.AIM To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain,and to assess outcomes of optimizing diagnostic imaging strategies,particularly TRO CTA use,in COVID-19 related thromboembolic events.METHODS TRO CTA images were evaluated for the presence of coronary artery disease,pulmonary thromboembolism(PTE),or acute aortic syndromes.Statistical analyses were used for evaluation of significant association between the variables.A two tailed P-value<0.05 was considered statistically significant.RESULTS Fifty-three patients were included into the study.In 31 patients(65.9%),there was not any pathology,while PTE was diagnosed in 11 patients.There was no significant relationship between the rates of pathology on CTA and history of hypertension.On the other hand,the diabetes mellitus rate was much higher in the acute coronary syndrome group,particularly in the PTE group(8/31=25.8%vs 6/16=37.5%,P=0.001).The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group(62.5%vs 38.7%,P<0.001).Smoking history rates were similar in the groups.Platelets,D-dimer,fibrinogen,C-reactive protein,and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.CONCLUSION TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.
文摘BACKGROUND Simultaneous bilineage hematologic malignancies are rare;however,several cases of acute myeloid leukemia(AML)and T-lymphoblastic lymphoma(T-LBL)cooccurrence have been reported.A standard treatment for simultaneous AML and T-LBL has not yet been established,and its prognosis is very poor.Further studies to develop standard treatments are required to increase patient survival rates.CASE SUMMARY A 69-year-old man complaining of pleuritic chest pain visited the emergency room.Computed tomography revealed multiple enlarged lymph nodes(LNs)in the neck and groin and pulmonary thromboembolism with pulmonary infarction.Furthermore,a peripheral blood smear performed due to leukocytosis revealed circulating blasts.Acute myelomonocytic leukemia(AMML)was diagnosed after bone marrow examination,and T-LBL positivity for terminal deoxynucleotidyl transferase,cluster of differentiation(CD)34,and CD4 was confirmed by cervical LN biopsy.Decitabine and dexamethasone were administered because he could not receive intensive chemotherapy due to poor performance status.Complete remission of AMML and T-LBL was achieved after 4 cycles of decitabine plus dexamethasone.CONCLUSION We report the therapeutic effect of decitabine,a hypomethylating agent(HMA),in patients with concurrent bilineage hematologic malignancies and suggest that further studies are required to evaluate the therapeutic effect of HMAs on both lymphoid and bilineage hematologic malignancies.
文摘Background It has been shown that neurohumoral factors other than mechanical obstruction are involved in the pathophysiology of acute pulmonary thromboembolism （APTE）. The aim of this study was to investigate the effects of thrombolytic drugs, a selective endothelin-1 receptor （ET-1 R） antagonist alone or their combination on APTE in a canine model. Methods Twenty dogs were randomly assigned to five groups： sham, model, urokinase （UK）, BQ123, and combination （UK plus BQ123）. The dogs in the sham group underwent sham surgery. APTE was induced in the other four groups by intravenous injection of autologous blood clots. Dogs in the UK, BQ123 and combination groups received UK, BQ123 （a selective ET-1R antagonist）, or UK plus BQ123, respectively. The dogs in the model group were given saline. Mean pulmonary artery pressure （mPAP）, serum concentrations of ET-1, thromboxane （TXB2）, and tumor necrosis factor （TNF）-α were determined at different time points following the induction of APTE. Results UK and BQ123 alone markedly decreased mPAP in APTE. By comparison, the reduction was more significant in the combination group. Compared with the sham group （（-0.90±0.61） mmHg）, mPAP increased by （7.44±1.04）, （3.42±1.12） and （1.14±0.55） mmHg in the model group, UK alone and BQ123 alone groups, respectively, and decreased by （2.24±0.67） mmHg in the combination group （P 〈0.01）. Serum ET-1 concentrations in the BQ123 and combination groups were （52.95±8.53） and （74.42±10.27） pg/ml, respectively, and were significantly lower than those in the model and UK groups （（84.56±7.44） and （97.66±8.31） pg/ml respectively; P 〈0.01）. Serum TNF-α concentrations were significantly lower in the BQ123 group than in the model, UK and combination groups （P 〈0.05）. Conclusions Our results indicate that the selective ET-1R antagonist BQ123 not only reduces the increase of mPAP and serum ET-1 level, but also inhibits the production of TNF-α, and attenuates the local inflammatory response induced by APTE. Selective ET-1R antagonists may be beneficial to the treatment of APTE, particularly when used in combination with a thrombolytic agent.
文摘目的筛选康北高原慢性阻塞性肺疾病急性加重患者发生静脉血栓栓塞症风险的预测因素,建立AECOPD发生VTE风险的联合预测模型并分析其预测效能。方法选择2018年1月-2022年9月因慢性阻塞性肺疾病急性加重在甘孜县人民医院住院治疗的患者71例,根据是否发生VTE分为血栓组35例,对照组36例。收集患者的基本资料和检查、检验资料等相关参数数据,选出两组之间具有显著差异的指标。将上述单因素分析中有显著差异的指标纳入多因素分析,筛选出AECOPD发生VTE风险的独立影响因素,并构建预测模型。利用受试者工作特征(receiver operating characteristic,ROC)曲线评价各独立因素及预测模型的应用价值,计算曲线下面积及其敏感度与特异度,分析其预测效能,霍斯默-莱梅肖检验评价拟合度。结果单因素分析显示血栓组PPS评分、乳酸脱氢酶(LDH)、D-二聚体、降钙素原(PCT)均高于对照组(均P<0.05)。Logistic回归分析显示PPS评分、乳酸脱氢酶(LDH)、D-二聚体为AECOPD发生VTE的独立预测因素。三者联合构建的预测模型曲线下面积(area under curve,AUC)为0.944(95%CI:0.893~0.996),灵敏度、特异度均明显优于各单一指标(灵敏度为94.3%、特异度为83.3%),霍斯默-莱梅肖检验拟合度好(χ^(2)=11.915,P=0.155)。结论PPS评分、乳酸脱氢酶(LDH)、D-二聚体可能是预测康北高原AECOPD发生VTE的因素,且三者联合构建的预测模型对VTE风险预测具有很好效能,可为预测AECOPD发生VTE的风险提供参考。
