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Arterial and venous thromboembolism risk associated with blood eosinophils: A systematic review and meta-analysis

Animal Models and Experimental Medicine 2022年第5期5卷 470-481页

作者： Wei-Jie Xu Shang Wang Ping Yuan Lan Wang Jun-Xia Huang Rong Jiang Department of Clinical Laboratory Shanghai Pulmonary HospitalSchool of MedicineTongji UniversityShanghaiChina Department of Cardio-pulmonary Circulation Shanghai Pulmonary HospitalSchool of MedicineTongji UniversityShanghaiChina Department of Hematology Affiliated Hospital of Qingdao UniversityQingdaoShandongChina

The association between blood eosinophil(EOS)counts and arterial/venous throm-bosis is unclear.We aim to explore whether EOS count is a risk factor for throm-bosis.We searched several databases and preprint platforms using core terms‘eosinophil’,‘myocardial infarction’,‘ischemic stroke’,and‘venous thromboembo-lism’(VTE),among others.Studies comparing the odds ratios(ORs)or risk ratios(RRs)of EOSs with the abovementioned diseases were eligible.Overall,22 studies were included.A high EOS count was associated with acute coronary artery throm-bosis events(OR:1.23,95%CI:1.15-1.32),short-term cerebral infarction and mor-tality(RR:2.87,95%CI:1.49-5.51).The short-term risk of VTE was more common in patients with EOS-related diseases(RR:6.52,95%CI:2.42-17.54).For coronary artery disease,a high EOS count was a protective factor against 6-month to 1-year mortality(RR:0.56,95%CI:0.45-0.69)but was associated with long-term mortal-ity(RR:1.64,95%CI:1.25-2.14).Therefore,we conclude that for coronary artery thrombosis,EOS count is not associated with AMI events in general population.It may be associated with NSTEMI and STEMI in CAD patients,but more studies are needed to confirm this.In addition,EOS count is associated with an increased risk of both short-and long-term mortality but is not predictive of the composite end-points.For cerebral artery thrombosis,EOS count may be associated with cerebral infarction and could lead to an increased risk of poor short-term prognosis.For VTEs,EOS count was a risk factor for some patients,especially those with acute-phase EOS-related diseases.

关键词： eosinophil ischemic stroke myocardial infarction pulmonary embolism thrombosis

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Acute myocardial injury in patients with COVID-19:Possible mechanisms and clinical implications

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World Journal of Clinical Cases 2022年第3期10卷 762-776页

作者： Iulia Rusu Malina Turlacu Miruna Mihaela Micheu Department of Cardiology Clinical Emergency Hospital of BucharestBucharest 014461Romania

Severe acute respiratory syndrome coronavirus 2 infection affects not only the lungs,but also the cardiovascular system,having a major impact on patients’outcomes.Myocardial injury(MI)occurs in the context of coronavirus infectious disease 2019(COVID-19)and is associated with a higher risk of severe clinical outcome and mortality.COVID-19-related MI can have various clinical manifestations,of which the main ones are myocarditis,stress cardiomyopathy,acute coronary syndrome,and pulmonary embolism.The exact mechanisms of how MI occurs in these patients are not yet fully known.Direct injury,through direct viral myocardial invasion,and indirect injury,through interaction with angiotensin I converting enzyme 2,increased inflammation,and thrombocyte and endothelial dysfunction,could be involved in acute MI in patients with COVID-19.A better understanding of these multiple potential mechanisms may help to develop new targeted therapeutic strategies.The purpose of this review is to provide the current understanding of the potential mechanisms involved in MI induced by COVID-19 and to discuss the current progress in the therapeutic strategies.

关键词： Myocardial injury Myocarditis Stress cardiomyopathy Acute coronary syndrome pulmonary embolism Coronavirus infectious disease SARS-CoV-2

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Arteriovenous thrombotic events in a patient with advanced lung cancer following bevacizumab plus chemotherapy: A case report

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World Journal of Clinical Cases 2022年第19期10卷 6507-6513页

作者： Ying Kong Xiao-Cheng Xu Liang Hong Department of Oncology The First People’s Hospital of Xiaoshan DistrictXiaoshan Affiliated Hospital of Wenzhou Medical UniversityHangzhou 311200Zhejiang ProvinceChina

BACKGROUND In driver gene-negative non-small cell lung cancer patients who relapse following radical resection,combination chemotherapy using bevacizumab and platinumbased dual drugs is known to increase both progression-free and overall survival.Treatment initially includes bevacizumab,and if patients are able to tolerate it,bevacizumab can continue to be utilized until disease progression.Bevacizumab is a recombinant humanized monoclonal neutralizing antibody that acts against vascular endothelial growth factor(VEGF).Various anti-VEGF monoclonal antibodies,such as bevacizumab,can increase the risk of arterial thromboembolism.Current data indicate that VEGF-targeted treatment does not significantly increase the risk of venous thromboembolism events,except for bevacizumab.CASE SUMMARY A 55-year-old man underwent radical resection for cancer of the right lung.Six months following surgery,multiple metastases were observed in his left lung.Subsequently,six cycles of bevacizumab combined with pemetrexed/carboplatin chemotherapy was given.Efficacy evaluation continued to be partial relief according to RECIST 1.1 standards,and no noticeable adverse reactions were noted.After three cycles of maintenance therapy using a combination of bevacizumab and pemetrexed,the patient developed dizziness and dyspnea.The patient was diagnosed with acute cerebral infarction and pulmonary embolism following head magnetic resonance imaging,computed tomography(CT)angiography,and chest enhanced CT.Although the patient received lowmolecular-weight heparin anticoagulation and other treatment,the patient eventually died of respiratory failure 1 mo later.This case report may offer some insight into fatal arteriovenous embolism,which has not been previously reported.CONCLUSIONBevacizumab combined with chemotherapy may also increase the risk of arteriovenousthromboembolism. Accordingly, patients who receive angiogenesis inhibitor therapy should becarefully selected. Furthermore, close monitoring and timely intervention are necessary in order to

关键词： Cerebral infarction pulmonary embolism Bevacizumab Chemotherapy Non-small cell lung cancer Case report

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Unusual presentation of Loeys-Dietz syndrome:A case report of clinical findings and treatment challenges

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World Journal of Clinical Cases 2022年第33期10卷 12247-12256页

作者： Shely Azrad-Daniel Corina Cupa-Galvan Sion Farca-Soffer Fernando Perez-Zincer Maria Elena Lopez-Acosta Department of Internal Medicine Hospital Angeles LomasHuixquilucan 52763Mexico Department of Radiology Hospital Angeles LomasMexico 52763Mexico Department of Hematology Hospital Angeles LomasMexico 52763Mexico Department of Gastroenterology-Endoscopy Hospital Angeles LomasMexico 52763Mexico

BACKGROUND Loeys-Dietz syndrome(LDS)is a rare autosomal dominant syndrome characterized by heterozygous mutations causing multisystemic alterations.It was recently described in 2005,and today at least six different subtypes have been identified.Classically presenting with aortic root enlargement or aneurysms and craniofacial and skeletal abnormalities,with specific arterial tortuosity at any site.The differential diagnosis of LDS includes atypical Marfan syndrome,vascular Ehlers-Danlos syndrome,Shprintzen-Goldberg craniosynostosis,and familial aortic aneurysm and dissection syndrome.CASE SUMMARY We present a case study of a 35-year-old female who came to the emergency department due to lower gastrointestinal bleeding and severe abdominal pain.Computed tomography revealed vascular tortuosity in almost every abdominal vein.CONCLUSION This case report will help us analyze the infrequent presentation of LDS type 4 and the numerous complications that it implies,underlying the importance of publishing more cases in order to expand our knowledge and offer better treatment for these patients.Differential diagnosis,clinical presentation and treatment options for this syndrome are discussed in this article.

关键词： Loeys-Dietz syndrome pulmonary embolism Gastrointestinal bleeding Rare genetic disease Therapeutic angiography Unusual presentation Rare disease Case report

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Adrenocorticotropic hormone-secreting pancreatic neuroendocrine carcinoma with multiple organ infections and widespread thrombosis:A case report

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World Journal of Clinical Cases 2022年第17期10卷 5723-5731页

作者： Akihiro Yoshihara Kota Nishihama Chisa Inoue Yuko Okano Kazuhito Eguchi Soichiro Tanaka Kanako Maki Valeria Fridman D'Alessandro Atsuro Takeshita Taro Yasuma Mei Uemura Toshinari Suzuki Esteban C Gabazza Yutaka Yano Department of Diabetes and Endocrinology Japan Community Health care Organization Yokkaichi Hazu Medical CenterYokkaichi 510-0016MieJapan Department of Diabetes Metabolismand EndocrinologyMie UniversityTsu 514-8507MieJapan Department of Immunology Mie UniversityTsu 514-8507MieJapan Department of Immunology Faculty and Graduate School of MedicineMie UniversityTsu 514-8507MieJapan Department of Immunology and Department of Diabetes Metabolismand EndocrinologyMie UniversityTsu 514-8507MieJapan Department of Immunology Mie University School of MedicineMie UniversityTsu 514-8507MieJapan

BACKGROUND Ectopic adrenocorticotropic hormone(ACTH)-secreting neuroendocrine tumors are rare diseases.Patients with ACTH-secreting pancreatic neuroendocrine carcinomas have a poor prognosis.Infections and coagulopathies have been reported as the cause of death.However,detailed clinical descriptions of the morbid complications of ACTH-secreting neuroendocrine carcinomas have not been reported.CASE SUMMARY A 78-year-old Japanese woman consulted a medical center due to systemic edema and epigastric discomfort.Laboratory analysis revealed hypercortisolemia with increased ACTH secretion without diurnal variation in serum cortisol level.An enhanced computed tomography(CT)scan revealed a 3-cm tumor in the pancreatic head.The cytological material from endoscopic ultrasound-guided fine-needle aspiration was compatible with ACTHsecreting pancreatic neuroendocrine carcinoma.The Ki-67 index was 40%.She was transferred to Mie University Hospital for surgical treatment.The patient was diagnosed with urinary tract infection,cytomegalovirus hepatitis,esophageal candidiasis,pulmonary infiltrates suspicious for Pneumocystis carinii pneumonia,peripheral deep vein thrombosis,pulmonary embolism,and disseminated intravascular coagulation.The multiple organ infections and thromboses responded well to antimicrobial and anticoagulant therapy.Radioisotope studies disclosed a pancreatic tumor and a metastatic lesion in the liver,whereas somatostatin receptor scintigraphy showed negative findings,suggesting the primary and metastatic tumors were poorly differentiated.A CT scan before admission showed no metastatic liver lesion,suggesting that the pancreatic tumor was rapidly progressing.Instead of surgery,antitumor chemotherapy was indicated.The patient was transferred to another hospital to initiate chemotherapy.However,she died four months later due to the rapidly progressive tumor.CONCLUSION ACTH-secreting pancreatic neuroendocrine neoplasm is a rare disease with a very poor prognosis.The clinical course and acute complications of the t

关键词： Neuroendocrine tumors Cushing's syndrome Ectopic adrenocorticotropic hormone syndrome Pneumocystis pneumonia pulmonary embolism Infections Case report

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Thrombolysis during extended cardiopulmonary resuscitation for autoimmune-related pulmonary embolism

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World Journal of Emergency Medicine 2015年第2期6卷 153-156页

作者： Jian-ping Gao Ke-jing Ying Department of Emergency Medicine Sir Run Run Shaw HospitalZhejiang University School of Medicine Department of Respiratory and Critical Care Sir Run Run Shaw HospitalZhejiang University School of Medicine

BACKGROUND: Massive pulmonary embolism(MPE) and acute myocardial infarction are the two most common causes of cardiac arrest(CA). At present, lethal hemorrhage makes thrombolytic therapy underused during cardiopulmonary resuscitation, despite the potential benefits for these underlying conditions. Hypercoagulability of the blood in autoimmune disorders(such as autoimmune hemolytic anemia) carries a risk of MPE. It is critical to find out the etiology of CA for timely thrombolytic intervention.METHODS: A 23-year-old woman with a 10-year medical history of autoimmune hemolytic anemia suffered from CA in our emergency intensive care unit. ECG and echocardiogram indicated the possibility of MPE, so f ibrinolytic therapy(alteplase) was successful during prolonged resuscitation.RESULTS: Neurological recovery of the patient was generally good, and no fatal bleeding developed. MPE was documented by CT pulmonary angiography.CONCLUSIONS: A medical history of autoimmune disease poses a risk of PE, and the causes of CA(such as this) should be investigated etiologically. A therapy with alteplase may be used early during cardiopulmonary resuscitation once there is presumptive evidence of PE. Clinical trials are needed in this setting to study patients with hypercoagulable states.

关键词： pulmonary embolism Thrombolysis Cardiac arrest Autoimmune disease

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Could the number of CT angiograms be reduced in emergency department patients suspected of pulmonary embolism?

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World Journal of Emergency Medicine 2012年第3期3卷 172-176页

作者： Zehtabchi Shahriar Rinnert Stephan Malhotra Shweta Subramanian Arun Timberger Mathew Patel Brijal Toro David Hassan Khaled Sinert Richard Department of Emergency Medicine Downstate Medical CenterBrooklynNYUSA Department of Emergency Medicine George Washington University Medical CenterWashingtonDCUSA

BACKGROUND:This study was undertaken to identify the prevalence of pulmonary embolism(PE) in the emergency department(ED) of an urban teaching hospital and also to test a Bayesian model in estimating the number of CT pulmonary angiography(CTA) expected to be performed in an emergency department.METHODS:The data for this study was obtained through a retrospective review of electronic medical records for all ED patients suspected of PE who underwent chest CTA or ventilation perfusion scanning(V/Q) between 2009 and 2010.The data is presented as means and standard deviation for continuous variables and percentages with 95%confidence intervals(95%CI) for proportions.The prevalence of PE was used as pre-test probability in the Bayesian model.Post-test probability was obtained using a Fagan nomogram and likelihood ratios for CTA.RESULTS:A total of 778 patients(560 females) with mean age of 50 years(range 18-98 years)were enrolled(98.3%underwent chest CTA and 1.7%underwent V/Q scan).A total of 69 patients had PE,rendering an overall prevalence of 8.9%(95%CI,7.1%to 11.1%) for PE.We calculated that132 CTA's per year could be avoided in our institution,without compromising safe exclusions of PE(keeping post-test probability of PE below 2%).CONCLUSIONS:Despite differences in our patient populations and /or study designs,the prevalence of PE in our institution is about average compared to other institutions.Our proposed model for calculating redundant chest CTA is simple and can be used by institutions to identify overuse of CTA.

关键词： pulmonary embolism Emergency CT pulmonary angiography

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Study of Cardiac Arrest Caused by Acute pulmonary Thromboembolism and Thrombolytic Resuscitation in a Porcine Model

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Chinese Medical Journal 2016年第13期129卷 1569-1576页

作者： Lian-Xing Zhao Chun-Sheng Li Jun Yang Nan Tong Hong-Li Xiao Le An Department of Emergency Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation Beijing Chao-Yang Hospital Capital Medical University Beijng 100020 China

Background： The success rate of resuscitation in cardiac arrest （CA） caused by pulmonary thromboembolism （PTE） is low. Furthermore, there are no large animal models that simulate clinical CA. The aim of this study was to establish a porcine CA model caused by PTE and to investigate the pathophysio[ogy of CA and postresuscitation. Methods： This model was induced in castrated male pigs （30 ± 2 kg; n = 21 ） by injecting thrombi （10-15 ml） via the left external jugular vein. Computed tomographic pulmonary angiography （CTPA） was performed at baseline, CA, and return of spontaneous circulation （ROSC）. After CTPA during CA, cardiopulmonary resuscitation （CPR） with thrombolysis （recombinant tissue plasminogen activator 50 mg） was initiated. Hemodynamic, respiratory, and blood gas data were monitored. Cardiac troponins T, cardiac troponin I, creatine kinase-MB, myoglobin, and brain natriuretic peptide （BNP） were measured by enzymeqinked immunosorbent assay. Data were compared between baseline and CA with paired-sample t-test and compared among different time points for survival animals with repeated measures analysis of variance. Results： Seventeen animals achieved CA after emboli injection, while four achieved CA after 5-8 ml more thrombi. Nine animals survived 6 h after CPR. CTPA showed obstruction of the pulmonary arteries. Mean aortic pressure data showed occurrence of CA caused by PTE （Z = -2.803, P = 0.002）. The maximal rate of mean increase of left ventricular pressure （dp/dtmax） was statistically decreased （t = 6,315, P = 0.000, variation coefficient = 0.25）, and end-tidal carbon dioxide partial pressure （PetCO2） decreased to the lowest value （t - 27.240, P = 0.000）. After ROSC （n = 9）, heart rate （HR） and mean right ventricular pressure （MRVP） remained different versus baseline until 2 h after ROSC （HR, P = 0.036; MRVP, P - 0.027）. Myoglobin was statistically increased from CA to 1 h after ROSC （P - 0.036, 0.026, 0,009, respectively）, and BNP was increased from 2 h to 6 h after ROSC （P 0.012, 0.014, 0.039, respec

关键词： Heart Arrest Hemodynamics pulmonary embolism

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Variations of Postresuscitation Lung Function after Thrombolysis Therapy in a Cardiac Arrest Porcine Model Caused by pulmonary Thromboembolism

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Chinese Medical Journal 2017年第12期130卷 1475-1480页

作者： Jun Yang Lian-Xing Zhao Chun-Sheng Li Nan Tong Hong-Li Xiao Le An Department of Emergency Medicine Beijing Chao-Yang Hospital Capital Medical University Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation Beijing 100020 China Department of Intensive Care Unit The Affiliated Hospital of Qingdao University Qingdao Shandong 266000 China

Background： Study of lung function in survivor from cardiac arrest （CA） caused by pulmonary thromboembolism （PTE） was rare. The aim of this study was to investigate the variations ofpostresuscitation lung function after thrombolysis treatment in a CA porcine model caused by PTE. Methods： After 2 min of untreated CA, pigs of 10-12 weeks with a weight of 30±2 kg （n = 24） were treated with recombinant human tissue plasminogen activator （50 mg）. Cardiopulmonary resuscitation （CPR） and ventilation were initiated after drug administration. pulmonary function and arterial blood gas parameters were measured at baseline, return of spontaneous circulation （ROSC） immediately, and 1 h, 2 h, 4 h, and 6 h after ROSC. Results： The dynamic lung compliance decreased significantly at ROSC immediately and 1 h after ROSC compared to baseline （21.86 ±2.00 vs. 26.72± 2.20 ml/mmHg and 20.38 ± 1.31 vs. 26.72 ± 2.20 ml/mmHg, respectively; P 〈 0.05; 1 mmHg = 0.133 kPa）. Compared with baseline, airway resistance increased significantly at ROSC immediately and 1 h after ROSC （P 〈 0.05）. Respiratory index also increased after ROSC and showed significant differences among baseline, ROSC immediately, and 2 h after ROSC （P 〈 0.05）. Oxygen delivery decreased at ROSC immediately compared to baseline （P 〈 0.05）. The oxygenation index decreased significantly at any time after ROSC compared to baseline （P 〈 0.05）. Extravascular lung water index and pulmonary vascular permeability index （PVP1） showed significant differences at ROSC immediately compared to baseline and 1 h after ROSC （P 〈 0.05）; PVPI at ROSC inamediately was also different from 6 h after ROSC （P 〈 0.05）. Ventilation/perfusion ratios increased after ROSC （P 〈 0.05）. Histopathology showed fibrin effusion, bleeding in alveoli, and hemagglutinatiun in pulmonary artery. Conclusions： Lung function remains abnormal even after CPR with thrombolysis therapy; it is essential to continue anticoagulation and symptomatic treatment after ROSC.

关键词： Heart Arrest pulmonary embolism pulmonary Function Resuscitation

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Successful thrombolytic therapy following emergent pulmonary embolectomy: a case report

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Chinese Medical Journal 2005年第17期118卷 1490-1492页

作者： XU Chang-xian WANG Zi-bing ZHANG Yan-an WANG Xu-jian XIN Hong-yan HUO Yu-feng LI Jian YANG Chuan-bin Department of Cardiovascular Surgery Second Hospital of Shandong University Jinan 250033 China Department of Cardiovascular Surgery Shandong Chest Hospital Jinan 250013 China

Acute pulmonary embolism is a disease with high mortality rate and emergent pulmonary thrombectomy may be an effective way to save the lives of some patients. We present here successful thrombolytic therapy for an acu... 详细信息

关键词： pulmonary embolism emergent pulmonary thrombectomy

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