The morphological basis of bilateral lower abdominal pain was studied by means of ultrastructural observation in patients with pelvic congestion syndrome after oviductal ligation. Fallopian tubes of 14 cases were coll...The morphological basis of bilateral lower abdominal pain was studied by means of ultrastructural observation in patients with pelvic congestion syndrome after oviductal ligation. Fallopian tubes of 14 cases were collected during operation. Of them, 10 patients suffered from pelvic congestion syndrome, 4 cases were normal used as control, the 8 small segments from the tubal isthmus were removed during ligation. The essential changes of the fallopian tubes in patients with this syndrome were the marked swelling of the C-type unmyelinated nerve fibers, the decrease in density of axoplasm and in number of microtubules and microfilaments. The Schwann's cells were swollen as well. Furthermore, the mitochondria revealed mild to moderate swelling, their cristae decreased and shortened. However, the changes of the endings of efferent nerve fibers were not obvious.The ultrastructural changes of C-type unmyelinated nerve fibers except the endings of efferent nerve fibers were closely related to the bilateral lower abdominal pain in patients with this syndrome.展开更多
The World Journal of Cardiology published an article written by Kuwahara et al that we take the pleasure to comment on.We focused our attention on venous congestion.In intensive care settings,it is now widely accepted...The World Journal of Cardiology published an article written by Kuwahara et al that we take the pleasure to comment on.We focused our attention on venous congestion.In intensive care settings,it is now widely accepted that venous congestion is an important clinical feature worthy of investigation.Evaluating venous Doppler profile abnormalities at multiple sites could suggest adequate treatment and monitor its efficacy.Renal dysfunction could trigger or worsen fluid overload in heart disease,and cardio-renal syndrome is a well-characterized spectrum of disorders describing the complex interactions between heart and kidney diseases.Fluid overload and venous congestion,including renal venous hypertension,are major determinants of acute and chronic renal dysfunction arising in heart disease.Organ congestion from venous hypertension could be involved in the development of organ injury in several clinical situations,such as critical diseases,congestive heart failure,and chronic kidney disease.Ultrasonography and abnormal Doppler flow patterns diagnose clinically significant systemic venous congestion.Cardiologists and nephrologists might use this valuable,noninvasive,bedside diagnostic tool to establish fluid status and guide clinical choices.展开更多
This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndr...This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome(CRS),despite its high prevalence and the substantial worsening of both kidney function and heart failure.While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure,integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions.In particular,with the assessment of Doppler patterns across multiple venous districts,the Venous Excess Ultrasound(VExUS)score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions.Integrating specific echocardiographic parameters,particularly those concerning the right heart,may thus improve the VExUS score sensitivity,offering perspective into the nuanced comprehension of cardio-renal dynamics.A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.展开更多
Congestion is an integral component of cardiorenal syn-drome and portends an adverse impact on the outcomes. Recent studies suggest that congestion has the ability ofmodulating the interactions between the kidney and ...Congestion is an integral component of cardiorenal syn-drome and portends an adverse impact on the outcomes. Recent studies suggest that congestion has the ability ofmodulating the interactions between the kidney and the heart in this setting. Peritoneal dialysis （PD） is a home-based therapeutic modality that is not only offered to patients with end-stage renal disease to provide solute clearance and ultrafltration, but it has also been used in patients with refractory heart failure and fuid overload to help optimize volume status. Several uncontrolled studies and case series have so far evaluated the role of PD in management of hypervolemia for patients with heart failure. They have generally reported favorable results in this setting. However, the data on the outcomes of patients with end-stage renal disease and concomitant heart failure is mixed, and the proposed theoretical advantages of PD might not translate into improvedclinical endpoints. Congestion is prevalent in this patient population and has a signifcant effect on their survival. As studies suggest that a significant subset of patients with end-stage renal disease who receive PD therapy are hypervolemic, suboptimal management of congestion could at least in part explain these conficting results. PD is a highly fexible therapeutic modality and the choice oftechniques, regimens, and solutions can affect its ability for optimization of fluid status. This article provides an overview of the currently available data on the role and clinical relevance of congestion in patients with cardiorenal syndrome and reviews potential options to enhance decongestion in these patients.展开更多
BACKGROUND Heart and kidney dysfunction frequently coexist in patients with acute heart failure due to the overlap between these two organ systems.Cardiorenal syndrome(CRS)results from pathology occurring in the heart...BACKGROUND Heart and kidney dysfunction frequently coexist in patients with acute heart failure due to the overlap between these two organ systems.Cardiorenal syndrome(CRS)results from pathology occurring in the heart and kidneys along with the consequences of dysfunction in one organ contributing to dysfunction in the other and vice versa.AIM To evaluate the use of erythropoietin(EPO)in patients with CRS and its effects on hemoglobin(Hb),major cardiovascular(CV)events,and hospitalization rates.METHODS On February 24,2022,searches were conducted using PubMed,MEDLINE,and EMBASE,and 148 articles were identified.A total of nine studies were considered in this systematic review.We assessed the included articles based on the National Heart,Lung,and Blood Institute quality assessment tools for controlled intervention and observational cohort or cross-sectional studies.An assessment of bias risk was conducted on the chosen studies,and data relevant to our review was extracted.RESULTS The systematic review of these studies concluded that most existing literature indicates that EPO improves baseline Hb levels and decreases myocardial remodeling and left ventricular dysfunction without reducing CV mortality.In addition,the effect of EPO on the hospitalization rate of patients with CRS needs to be further studied since this relationship is unknown.Future studies,such as randomized controlled clinical trials and prospective cohort studies,should be conducted to enhance the literature on the potential of EPO therapy in patients with CRS.CONCLUSION Our systematic review suggests that EPO therapy may have a significant role in managing CRS.The review highlights the potential benefits of EPO in improving baseline Hb levels,reducing the risk of major CV events,improving cardiac remodeling,myocardial function,New York Heart Association class,and B-type natriuretic peptide levels.However,the effect of EPO treatment on hospitalization remains unclear and needs further exploration.展开更多
BACKGROUND Sinusoidal obstructive syndrome(SOS)is a disease that damages hepatic sinusoidal endothelial cells,resulting in progressive occlusion and fibrosis of the lobular central vein and the occurrence of intrahepa...BACKGROUND Sinusoidal obstructive syndrome(SOS)is a disease that damages hepatic sinusoidal endothelial cells,resulting in progressive occlusion and fibrosis of the lobular central vein and the occurrence of intrahepatic sinusoidal portal hypertension.However,SOS after liver transplantation(LT)is uncommon and potentially fatal.Here,we report a rare case of second-time recurrence of SOS after liver retransplantation(rLT).CASE SUMMARY A 22-year-old woman received a living donor LT due to SOS.Four years later,she developed abdominal distention and ascites with no apparent cause.She was diagnosed with recurrence of SOS and underwent rLT.But 2 mo post rLT,the patient suffered from aggravated jaundice and ascites again.She was diagnosed with second-time recurrence of SOS post-rLT according to computed tomography and liver pathology.After treatment with warfarin anticoagulation and immunosuppressant conversion,she gradually recovered with improvement of liver function and liver pathology.During the 17-mo follow-up period,she was in good condition with normal liver function and no ascites.CONCLUSION SOS can be a recurrent disease after LT,and autoimmune antibody and genetic sequencing should be screened before LT.For susceptible patients,anticoagulant drugs should be used for an extended period,and tacrolimus or other pathogenic agents should be avoided.Early diagnosis and treatment can improve the prognosis of patients and avoid graft failure or death.展开更多
The pathophysiological characteristics of Phlegm-stasis Cementation Syndrome in Coronary Heart Disease(CHD) has been summarized in this article. According to epidemiological investigations, phlegm-stasis cementation s...The pathophysiological characteristics of Phlegm-stasis Cementation Syndrome in Coronary Heart Disease(CHD) has been summarized in this article. According to epidemiological investigations, phlegm-stasis cementation syndrome has become a dominant syndrome in CHD along with the improvement in living and dietary condition. The interaction between blood stasis and phlegm turbidity that is called Phlegmstasis Cementation Syndrome exists in CHD and other diseases. The bridge linked blood stasis and phlegm turbidity lies in the adversely effects of lipid metabolism disorder on platelet activation, vascular function and hemorheology indexes. Lipid metabolism disorder also can induce persistent inflammation including monocyte/macrophage activation and oxidative stress. Inflammation also is an important stimulating factor for atherosclerosis and the biology that underlies the complications of CHD,which belonged to the concept of "toxin" in Traditional Chinese medicines(TCM). On the other hand, the important function of inflammatory process on abnormal hemorheology,platelet activation and vascular dysfunction can be used to elucidate the basic pathogenetic condition of the toxin inducing blood stasis in TCM. Therefore, it is this pathological process that can be used to address the basic pathogenetic theory of phlegm turbidity inducing the symptom of toxin and blood stasis, and subsequently phlegm-stasis cementation in TCM. We deduced that lipid metabolic disturbance,inflammation activation, vascular dyfunction and hemorheological disorders could be as pathophysiological characteristics of Phlegm-stasis cementation syndrome.展开更多
Objective： To discuss the characteristics of Chinese medicine （CM） syndrome factors and distribution of congestive heart failure （CHF）, and provide a basis for the diagnosis criteria of essential syndromes. Meth...Objective： To discuss the characteristics of Chinese medicine （CM） syndrome factors and distribution of congestive heart failure （CHF）, and provide a basis for the diagnosis criteria of essential syndromes. Methods： Based on databases of China National Knowledge infrastructure （CNKI, 1980--2012） and Chinese Journal of Chongqing VlP Database （1989-2012）, the eligible studies in CHF and extracted factors associated with compound syndromes were analyzed. All the syndromes were classified into deficiency, excess, and deficiency-excess in complexity syndrome were classified. Compound syndromes were separated into syndrome factors including single, double, three or four factors, along with the frequency of occurrence. The relation of CHF syndromes with age, gender, primary disease, brain natriuretic peptide （BNP） and cardiac functional grade was studied in 1,451 CHF cases （between December 2010 and September 2012）, and the clinical distribution of common CHF syndromes was summarized. Results： The literature study involved 6,799 CHF cases in 66 literatures after screening. Of the different factors affecting CHF, qi deficiency was the most important one. In deficiency syndrome, Xin （Heart）-qi-deficiency was the most common single factor, and deficiency of both qi and yin was the most common double factor. The retrospective analysis involved 1,451 CHF cases （431 cases with test results of BNP）. The xin blood stasis and obstruction and deficiency of both qi and yin syndrome were mostly seen in female patients, and phlegm-blocking-Xin-vessel and qi-deficiency-blood-stasis syndrome mostly in males. Xin-qi-deficiency and qi-deficiency-blood-stasis syndrome were mostly seen in patients aged 50--60 years. Patients aged over 60 years likely manifest deficiency of both qi and yin and Xin blood stasis and obstruction syndrome. The severity of syndrome is aggravated with increased BNP and cardiac functional grade. Conclusions： The essential syndromes of CHF include qi-deficiency-blood-stasis and deficiency of both qi and yin. The clinical distribution is linked to patients＇ age and gender. BNP and cardiac functional grade is closely related to CHF syndromes, which may indicate the severity of CM syndromes of CHF.展开更多
文摘The morphological basis of bilateral lower abdominal pain was studied by means of ultrastructural observation in patients with pelvic congestion syndrome after oviductal ligation. Fallopian tubes of 14 cases were collected during operation. Of them, 10 patients suffered from pelvic congestion syndrome, 4 cases were normal used as control, the 8 small segments from the tubal isthmus were removed during ligation. The essential changes of the fallopian tubes in patients with this syndrome were the marked swelling of the C-type unmyelinated nerve fibers, the decrease in density of axoplasm and in number of microtubules and microfilaments. The Schwann's cells were swollen as well. Furthermore, the mitochondria revealed mild to moderate swelling, their cristae decreased and shortened. However, the changes of the endings of efferent nerve fibers were not obvious.The ultrastructural changes of C-type unmyelinated nerve fibers except the endings of efferent nerve fibers were closely related to the bilateral lower abdominal pain in patients with this syndrome.
文摘The World Journal of Cardiology published an article written by Kuwahara et al that we take the pleasure to comment on.We focused our attention on venous congestion.In intensive care settings,it is now widely accepted that venous congestion is an important clinical feature worthy of investigation.Evaluating venous Doppler profile abnormalities at multiple sites could suggest adequate treatment and monitor its efficacy.Renal dysfunction could trigger or worsen fluid overload in heart disease,and cardio-renal syndrome is a well-characterized spectrum of disorders describing the complex interactions between heart and kidney diseases.Fluid overload and venous congestion,including renal venous hypertension,are major determinants of acute and chronic renal dysfunction arising in heart disease.Organ congestion from venous hypertension could be involved in the development of organ injury in several clinical situations,such as critical diseases,congestive heart failure,and chronic kidney disease.Ultrasonography and abnormal Doppler flow patterns diagnose clinically significant systemic venous congestion.Cardiologists and nephrologists might use this valuable,noninvasive,bedside diagnostic tool to establish fluid status and guide clinical choices.
文摘This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of Cardiology.We here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome(CRS),despite its high prevalence and the substantial worsening of both kidney function and heart failure.While the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure,integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic decisions.In particular,with the assessment of Doppler patterns across multiple venous districts,the Venous Excess Ultrasound(VExUS)score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal interactions.Integrating specific echocardiographic parameters,particularly those concerning the right heart,may thus improve the VExUS score sensitivity,offering perspective into the nuanced comprehension of cardio-renal dynamics.A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.
文摘Congestion is an integral component of cardiorenal syn-drome and portends an adverse impact on the outcomes. Recent studies suggest that congestion has the ability ofmodulating the interactions between the kidney and the heart in this setting. Peritoneal dialysis （PD） is a home-based therapeutic modality that is not only offered to patients with end-stage renal disease to provide solute clearance and ultrafltration, but it has also been used in patients with refractory heart failure and fuid overload to help optimize volume status. Several uncontrolled studies and case series have so far evaluated the role of PD in management of hypervolemia for patients with heart failure. They have generally reported favorable results in this setting. However, the data on the outcomes of patients with end-stage renal disease and concomitant heart failure is mixed, and the proposed theoretical advantages of PD might not translate into improvedclinical endpoints. Congestion is prevalent in this patient population and has a signifcant effect on their survival. As studies suggest that a significant subset of patients with end-stage renal disease who receive PD therapy are hypervolemic, suboptimal management of congestion could at least in part explain these conficting results. PD is a highly fexible therapeutic modality and the choice oftechniques, regimens, and solutions can affect its ability for optimization of fluid status. This article provides an overview of the currently available data on the role and clinical relevance of congestion in patients with cardiorenal syndrome and reviews potential options to enhance decongestion in these patients.
文摘BACKGROUND Heart and kidney dysfunction frequently coexist in patients with acute heart failure due to the overlap between these two organ systems.Cardiorenal syndrome(CRS)results from pathology occurring in the heart and kidneys along with the consequences of dysfunction in one organ contributing to dysfunction in the other and vice versa.AIM To evaluate the use of erythropoietin(EPO)in patients with CRS and its effects on hemoglobin(Hb),major cardiovascular(CV)events,and hospitalization rates.METHODS On February 24,2022,searches were conducted using PubMed,MEDLINE,and EMBASE,and 148 articles were identified.A total of nine studies were considered in this systematic review.We assessed the included articles based on the National Heart,Lung,and Blood Institute quality assessment tools for controlled intervention and observational cohort or cross-sectional studies.An assessment of bias risk was conducted on the chosen studies,and data relevant to our review was extracted.RESULTS The systematic review of these studies concluded that most existing literature indicates that EPO improves baseline Hb levels and decreases myocardial remodeling and left ventricular dysfunction without reducing CV mortality.In addition,the effect of EPO on the hospitalization rate of patients with CRS needs to be further studied since this relationship is unknown.Future studies,such as randomized controlled clinical trials and prospective cohort studies,should be conducted to enhance the literature on the potential of EPO therapy in patients with CRS.CONCLUSION Our systematic review suggests that EPO therapy may have a significant role in managing CRS.The review highlights the potential benefits of EPO in improving baseline Hb levels,reducing the risk of major CV events,improving cardiac remodeling,myocardial function,New York Heart Association class,and B-type natriuretic peptide levels.However,the effect of EPO treatment on hospitalization remains unclear and needs further exploration.
基金Beijing Municipal Science&Technology Commission,No.Z181100001718220.
文摘BACKGROUND Sinusoidal obstructive syndrome(SOS)is a disease that damages hepatic sinusoidal endothelial cells,resulting in progressive occlusion and fibrosis of the lobular central vein and the occurrence of intrahepatic sinusoidal portal hypertension.However,SOS after liver transplantation(LT)is uncommon and potentially fatal.Here,we report a rare case of second-time recurrence of SOS after liver retransplantation(rLT).CASE SUMMARY A 22-year-old woman received a living donor LT due to SOS.Four years later,she developed abdominal distention and ascites with no apparent cause.She was diagnosed with recurrence of SOS and underwent rLT.But 2 mo post rLT,the patient suffered from aggravated jaundice and ascites again.She was diagnosed with second-time recurrence of SOS post-rLT according to computed tomography and liver pathology.After treatment with warfarin anticoagulation and immunosuppressant conversion,she gradually recovered with improvement of liver function and liver pathology.During the 17-mo follow-up period,she was in good condition with normal liver function and no ascites.CONCLUSION SOS can be a recurrent disease after LT,and autoimmune antibody and genetic sequencing should be screened before LT.For susceptible patients,anticoagulant drugs should be used for an extended period,and tacrolimus or other pathogenic agents should be avoided.Early diagnosis and treatment can improve the prognosis of patients and avoid graft failure or death.
基金supported by a National 973 Project(No.2015CB554405)
文摘The pathophysiological characteristics of Phlegm-stasis Cementation Syndrome in Coronary Heart Disease(CHD) has been summarized in this article. According to epidemiological investigations, phlegm-stasis cementation syndrome has become a dominant syndrome in CHD along with the improvement in living and dietary condition. The interaction between blood stasis and phlegm turbidity that is called Phlegmstasis Cementation Syndrome exists in CHD and other diseases. The bridge linked blood stasis and phlegm turbidity lies in the adversely effects of lipid metabolism disorder on platelet activation, vascular function and hemorheology indexes. Lipid metabolism disorder also can induce persistent inflammation including monocyte/macrophage activation and oxidative stress. Inflammation also is an important stimulating factor for atherosclerosis and the biology that underlies the complications of CHD,which belonged to the concept of "toxin" in Traditional Chinese medicines(TCM). On the other hand, the important function of inflammatory process on abnormal hemorheology,platelet activation and vascular dysfunction can be used to elucidate the basic pathogenetic condition of the toxin inducing blood stasis in TCM. Therefore, it is this pathological process that can be used to address the basic pathogenetic theory of phlegm turbidity inducing the symptom of toxin and blood stasis, and subsequently phlegm-stasis cementation in TCM. We deduced that lipid metabolic disturbance,inflammation activation, vascular dyfunction and hemorheological disorders could be as pathophysiological characteristics of Phlegm-stasis cementation syndrome.
基金Supported by National Science Foundation of China(No.30873398)Major Clinical Research Project of Army(No.2006021003)+2 种基金Training Plan on Excellent Academic Leader of Shanghai Health System(No.XBR2011070)Construction Fund of Shanghai Doctor Station(K110412)National Science&Technology Pillar Program during the 12th Five-year Plan Period(No.2012BAI25B05)
文摘Objective： To discuss the characteristics of Chinese medicine （CM） syndrome factors and distribution of congestive heart failure （CHF）, and provide a basis for the diagnosis criteria of essential syndromes. Methods： Based on databases of China National Knowledge infrastructure （CNKI, 1980--2012） and Chinese Journal of Chongqing VlP Database （1989-2012）, the eligible studies in CHF and extracted factors associated with compound syndromes were analyzed. All the syndromes were classified into deficiency, excess, and deficiency-excess in complexity syndrome were classified. Compound syndromes were separated into syndrome factors including single, double, three or four factors, along with the frequency of occurrence. The relation of CHF syndromes with age, gender, primary disease, brain natriuretic peptide （BNP） and cardiac functional grade was studied in 1,451 CHF cases （between December 2010 and September 2012）, and the clinical distribution of common CHF syndromes was summarized. Results： The literature study involved 6,799 CHF cases in 66 literatures after screening. Of the different factors affecting CHF, qi deficiency was the most important one. In deficiency syndrome, Xin （Heart）-qi-deficiency was the most common single factor, and deficiency of both qi and yin was the most common double factor. The retrospective analysis involved 1,451 CHF cases （431 cases with test results of BNP）. The xin blood stasis and obstruction and deficiency of both qi and yin syndrome were mostly seen in female patients, and phlegm-blocking-Xin-vessel and qi-deficiency-blood-stasis syndrome mostly in males. Xin-qi-deficiency and qi-deficiency-blood-stasis syndrome were mostly seen in patients aged 50--60 years. Patients aged over 60 years likely manifest deficiency of both qi and yin and Xin blood stasis and obstruction syndrome. The severity of syndrome is aggravated with increased BNP and cardiac functional grade. Conclusions： The essential syndromes of CHF include qi-deficiency-blood-stasis and deficiency of both qi and yin. The clinical distribution is linked to patients＇ age and gender. BNP and cardiac functional grade is closely related to CHF syndromes, which may indicate the severity of CM syndromes of CHF.
