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Characteristics, phenotypes, mechanisms and management of severe asthma

Chinese Medical Journal 2022年第10期135卷 1141-1155页

作者： Kian Fan Chung Piers Dixey Hisham Abubakar-Waziri Pankaj Bhavsari Pujan H.Patel Sujuan Guo Yang Ji National heart&lung institute Imperial College LondonLondon SW36LYUK Royal Brompton&Harefield NHS Hospitals LondonUK department of Respiratory Medicine University of Hong Kong Shenzhen HospitalShenzhenGuangdong 518053China.

Severe asthma is "asthma which requires treatment with high dose inhaled corticosteroids (ICS) plus a second controller (and/or systemic corticosteroids) to prevent it from becoming ’’uncontrolled’ or which remains ’’uncontrolled’ despite this therapy." The state of control was defined by symptoms, exacerbations and the degree of airflow obstruction. Therefore, for the diagnosis of severe asthma, it is important to have evidence for a diagnosis of asthma with an assessment of its severity, followed by a review of comorbidities, risk factors, triggers and an assessment of whether treatment is commensurate with severity, whether the prescribed treatments have been adhered to and whether inhaled therapy has been properly administered. Phenotyping of severe asthma has been introduced with the definition of a severe eosinophilic asthma phenotype characterized by recurrent exacerbations despite being on high dose ICS and sometimes oral corticosteroids, with a high blood eosinophil count and a raised level of nitric oxide in exhaled breath. This phenotype has been associated with a Type-2 (T2) inflammatory profile with expression of interleukin (IL)-4, IL-5, and IL-13. molecular phenotyping has also revealed non-T2 inflammatory phenotypes such as Type-1 or Type-17 driven phenotypes. Antibody treatments targeted at the T2 targets such as anti-IL5, anti-IL5Rα, and anti-IL4Rα antibodies are now available for treating severe eosinophilic asthma, in addition to anti-immunoglobulin E antibody for severe allergic asthma. No targeted treatments are currently available for non-T2 inflammatory phenotypes. Long-term azithromycin and bronchial thermoplasty may be considered. The future lies with molecular phenotyping of the airway inflammatory process to refine asthma endotypes for precision medicine.

关键词： Severe asthma Biologic therapies Eosinophils Neutrophils Corticosteroid insensitivity Type 2-high inflammation

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nterventional Therapy for Bilateral Acute Renal Artery Embolism Caused by Paroxysmal Atrial Fibrillation

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Chinese Medical Journal 2016年第10期129卷 1244-1245页

作者： Mao-Xiao Nie Chang-Rong Tian Qin-Wen Bao Yan Dong Yun-Feng Yan Quan-Ming Zhao department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases The Key Laboratory of Remodelling-related Cardiovascular Diseases Ministry of Education Beijing 100029 China department of Geriatrics The Second People's Hospital of Lianyungang City Lianyungang Jiangsu 222002 China

Clinically persistent atrial fibrillation （AF） occurring with systemic embolism is not uncommon. In contrast, the incidence of embolism due to paroxysmal AF is far lower than that of persistent AF. Cerebral arteries are the most common sites of emboli caused by AF, followed by the mesenteric artery, splenic artery, lower extremity arteries, and renal arteries. However, the occurrence of concurrent bilateral renal artery emboli is extremely rare in paroxysmal AF patients. Within the scope of the information, we have collected, only three similar cases have been reported.

关键词： Acute Renal Artery Embolism Interventional Therapy Paroxysmal Atrial Fibrillation

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Reversal of pulmonary vein remodeling after catheter ablation of atrial fibrillation

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Journal of Geriatric Cardiology 2016年第2期13卷 163-168页

作者： Jia-Hui WU Hung-Kei LI Daniel M Couri Philip A Araoz Ying-Hsiang Lee Chang-Sheng MA Douglas L Packer Yong-Mei CHA department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing China heart Rhythm Specialists Phoenix Arizona USA Prairie Cardiovascular Consultants Ltd. Springfield Illinois USA department of Radiology Mayo Clinic Rochester Minnesota USA department of Cardiovascular Medicine Mackay Memorial Hospital Taipei Taiwan China Division of Cardiovascular diseases Mayo Clinic Rochester Minnesota USA

BackgroundPulmonary 静脉(PV ) 和正厅经历电、结构在 atrial 纤维性颤动(AF ) 改变。试图决定 PV 和在为 AF 的导管脱离用胸估计了以后，改变的左 atrial (LA ) 颠倒的这研究计算了 .MethodsPV electrophysiologic 学习的断层摄影术(C... 详细信息

BackgroundPulmonary 静脉(PV ) 和正厅经历电、结构在 atrial 纤维性颤动(AF ) 改变。试图决定 PV 和在为 AF 的导管脱离用胸估计了以后，改变的左 atrial (LA ) 颠倒的这研究计算了 .MethodsPV electrophysiologic 学习的断层摄影术(CT ) ，导管脱离在 63 个病人被执行(68% 男性；吝啬的 ±；SD 年龄：56 ±；10 年) 与征兆的 AF (49% 发作性， 51% 坚持) 。胸 CT 以前被执行并且在导管 *** 基线以后的 3 个月，有坚持的 AF 的病人有更大的 LA 体积(91 ±；29 厘米 3 对 66 ±；27 厘米 3 ；P = 0.003 ) 并且吝啬的 PV ostial 区域(241 ±；43 公里 2 对 212 ±；47 公里 2 ；P = 0.03 ) 比有发作性的 AF 的病人。在有效倔强的时期和左优异 PV 口的区域之间没有重要关联。在 3 月在脱离以后的后续， 48 个病人(76%) 是在上或离开 antiarrhythmic 药免费的 AF。在 LA 体积有重要减小(77 ±；31 厘米 3 到 70 ±；28 厘米 3 ；P <；0.001 ) 并且吝啬的 PV ostial 区域(224 ±；48 公里 2 到 182 ±；43 公里 2 ；P <；0.001 ) 。有坚持的 AF 的病人在 LA 体积有更多的减小(11.8 ±；12.8 厘米 3 对 4.0 ±；11.2 厘米 3 ；P = 0.04 ) 并且 PV ostial 区域(62 公里 2 对 34 公里 2 ；P = 0.04 ) 比有发作性的 AF 的那些。平均 PV ostial 区域的减小显著地与 LA 体积的减小被相关(r = 0.38， P = 0.03 ) AF 的 .ConclusionsCatheter 脱离改进 PV ostia 和左中庭的结构的改变。这发现在病人是更明显的，坚持的 AF 由导管脱离对待。

关键词：胸导管肺静脉重构心房颤动逆转药物治疗抗心律失常

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Patients with ST-segment elevation of myocardial infarction miss out on early reperfusion： when to undergo delayed revascularization

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Journal of Geriatric Cardiology 2017年第8期14卷 524-531页

作者： Wen ZHENG Cheuk-Man YU Jing LIU Wu-Xiang XIE Miao WANG Yu-Jiao ZHANG Jian SUN Shao-Ping NIE Dong ZHAO department of Epidemiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases No.2 Anzhen Road Chaoyang District Beijing China Emergency Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing China Prince of Wales Hospital Institute of Vascular Medicine the Chinese University of Hong Kong Hong Kong China department of Infectious disease China-Japan Friendship Hospital Beijing China department of Cardiology the First Hospital of Jilin University Changchun Jilin China

OBJECTIVE:There are still a high proportion of patients with ST-segment elevation myocardial infarction (STEMI) missing out early reperfusion even in the primary percutaneous coronary intervention (PCI) era. Most of them are stable latecomers, but the optimal time to undergo delayed PCI for stable ones remains controversial.;METHODS:We investigated all STEMI patients who underwent delayed PCI (2-28 days after STEMI) during 2007-2010 in Beijing and excluded patients with hemodynamic instability. The primary outcome was major adverse cardiovascular events (MACEs).;RESULTS:This study finally enrolled 5,417 STEMI patients and assigned them into three groups according to individual delayed time (Early group, 55.9%; Medium group, 35.4%; Late group, 8.7%). During 1-year follow-up, MACEs occurred in 319 patients. The incidence of MACEs were respectively 7.1%, 5.6% and 6.7% among three groups. The Medium group had less recurrent myocardial infarction plus cardiac death (hazard ratio, 0.525; 95% confidence interval, 0.294-0.938, = 0.030) than Late group and less repeat revascularization (hazard ratio, 0.640; 95% confidence interval, 0.463-0.883, = 0.007) than Early group in pairwise comparisons. We depicted the incidence of major adverse cardiovascular event (MACE) by delayed time as a quadratic curve and found the bottom appeared at day 14.;CONCLUSIONS:The delayed PCI time varied in the real-world practice, but undergoing operations on the second week after STEMI had greater survival benefit and less adverse events for whom without early reperfusion and hemodynamic instability.

关键词：心肌梗死延迟性再灌注患者早期血流动力学 st 最佳时间

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利用多轴3D打印系统制造锥形生物可吸收支架

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Science Bulletin 2021年第24期66卷 2431-2433页

作者：杜俣王建龙吴思婧刘青赵庆洪赵迎新马茜周玉杰 department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing Institute of Heart Lung and Blood Vessel DiseaseBeijing 100029China Beijing Advanced Medical Technologies Ltd.Inc.Beijing 100085China

Coronary artery disease(CAD)is the leading cause of death *** of traditional cylindrical stents into the stenotic coronary arteries is widely used in patients with ***,because most coronary arteries taper in diameter by at least 0.5 mm over a length of 20 mm[1],natural size mismatch is common between a cylindrical stent and a tapered coronary *** stent-vessel mismatch may directly cause either increased stress on both stent and vessel or incomplete stent apposition,followed by vessel injury,in-stent restenosis,or stent thrombosis[2,3].

关键词： coronary arteries artery

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Effect of oleic acid-induced acute lung injury and conventional mechanical ventilation on renal function in piglets

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Chinese Medical Journal 2013年第13期126卷 2530-2535页

作者： LIU Ai-jun L1NG Feng LI Zhi-qiang LI Xiao-feng LIU Ying-long DU Jie HAN Ling department of Pediatric heart CenterBeijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Cardiothoracic Surgery Second Affiliated Hospital of Kunming Medical Key Laboratory of Remodeling-Related Cardiovascular diseases Ministry of Education Beijing Institute of Heart Lung and Blood Vessel DiseasesBeijing Anzhen Hospital Capital Medical University Beijing 100029 China department of Cardiothoracic Surgery Second Affiliated Hospital of Kunming Medical University Kunming Yunnan 650101 China

Background Animal models that demonstrate changes of renal function in response to acute lung injury （ALl） and mechanical ventilation （MV） are few. The present study was performed to examine the effect of ALl induced by oleic acid （OA） in combination with conventional MV strategy on renal function in piglets. Methods Twelve Chinese mini-piglets were randomly divided into two groups： the OA group （n=6）, animals were ventilated with a conventional MV strategy of 12 ml/kg and suffered an ALl induced by administration of OA, and the control group （n=6）, animals were ventilated with a protective MV strategy of 6 ml/kg and received the same amount of stedle saline. Results Six hours after OA injection a severe lung injury and a mild-moderate degree of renal histopathological injury were seen, while no apparent histological abnormalities were observed in the control group. Although we observed an increase in the plasma concentrations of creatinine and urea after ALl, there was no significant difference compared with the control group. Plasma concentrations of neutrophil gelatinase-associated lipocalin （NGAL） and cystatin C increased （5.6＋1.3） and （7.4＋1.5） times in the OA group compared to baseline values, and were significantly higher than the values in the control group. OA injection in combination with conventional MV strategy resulted in a dramatic aggravation of hemodynamic and blood gas exchange parameters, while these parameters remained stable during the experiment in the control group. The plasma expression of TNF-a and IL-6 in the OA group were significantly higher than that in the control group. Compared with high expression in the lung and renal tissue in the OA group, TNF-a and IL-6 were too low to be detected in the lung and renal tissue in the control group. Conclusions OA injection in combination with conventional MV strategy not only resulted in a severe lung injury but also an apparent renal injury. The potential mechanisms involved a cytokine response of

关键词： acute kidney injury, acute lung injury, renal function oleic acid, piglet

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Protection Effect of Exogenous Fibroblast Growth Factor 21 on the Kidney Injury in Vascular Calcification Rats

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Chinese Medical Journal 2018年第5期131卷 532-538页

作者： Yu-Chen Shi Wei-Wei Lu Yue-Long Hou Kun Fu Feng Gan Shu-Juan Cheng Shao-Ping Wang Yong-Fen Qi Jing-Hua Liu department of Cardiology Beijing Anzhen Hospital Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China department of Physiology Xuzhou Medical University Xuzhou Jiangsu 221004 China department of Pharmacology and Nutritional Sciences University of Kentucky Lexington Kentucky USA Key Laboratory of molecular Cardiovascular Science Ministry of Education Peking University Health Science Center Beijing 100191 China department of Cardiology Beijing Aerospace General Hospital Beijing 100076 China

Background： Chronic kidney disease （CKD） is closely related to the cardiovascular events in vascular calcification （VC）. However, little has known about the characteristics of kidney injury caused by VC. Fibroblast growth factor 21 （FGF21 ） is an endocrine thctor, which takes part in various metabolic actions with the potential to alleviate metabolic disorder diseases, Even FGF21 has been regarded as a biomarker in CKD, the role of FGF21 in CKD remains unclear. Therefore, in this study, we evaluate the FGF21 on the kidney injury in VC rats. Methods： The male Sprague-Dawley rats were divided into three groups：（ 1 ） control group, （2） Vitamin D3 plus nicotine （VDN）-induced VC group, （3） FGF21-treated VDN group. After 4 weeks, the rats were killed and the blood was collected for serum creatinine, urea nitrogen, calcium, and phosphate measurement. Moreover, the renal tissues were homogenized for alkaline phosphatases （ALPs） activity and calcium content. The levels of FGF21 protein were measured by radioimmunoassay. The levels of β-Klotho and FGF receptor 1 （FGFR1） protein were measured by enzyme-linked immunosorbent assay （EL1SA）. The structural damage and calcifications in aortas were stained by Alizarin-red S. Moreover, the structure of kidney was observed by hematoxylin and eosin staining. Results： The renal lhnction impairment caused by VDN modeling was ameliorated by FGF21 treatment, inhibited the elevated serum creatinine and urea level by 20.5% （34.750 ± 4.334 pmol/L vs. 27.630± 2.387pamol/L） and 4.0% （7.038 ± 0.590 mmol/L vs. 6.763 ±0.374 mmol/L; P 〈 0.01 ）, respectively, together with the structural damages of glomerular atrophy and renal interstitial fibrosis. FGF21 treatment downregulated the ALP activity, calcium content in the kidney of VC rats by 42.1% （P 〈 0.01 ） and 11.7% （P 〈 0.05） as well as ameliorated the aortic injury and calcification as compared with VDN treatment alone group, indicating an ameliorative effect on VC. EL1SA assays showed that the

关键词： Chronic Fibroblast Growth Factor 21 Renal Insufficiency Vascular Calcification β-Klotho

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Surgical outcome after complete repair of tetralogy of Fallot with absent pulmonary valve: comparison between bovine jugular vein-valved conduit and monocusp-valve patch

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World Journal of Pediatrics 2018年第5期14卷 510-519页

作者： En-Shi Wang Xue-Song Fan Li Xiang Shou-Jun Li Hao Zhang Center for Pediatric Cardiac Surgery National Center for Cardiovascular Diseases and Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China department of Clinical Laboratory Center Beijing An Zhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijing 100029China

Background The prognosis of tetralogy of Fallot with absent pulmonary valve (TOF/APV) without operation is poor. We evaluated the surgical outcome of TOF/APV in a single center. Methods Twenty-two TOF/APV patients underwent complete surgical correction in our hospital. Right ventricular outflow tract reconstruction was performed using bovine jugular vein (BJV)-valved conduit implantation (n=10), homograft-valved conduit implantation (n=2), or monocusp-valve patch (n=10). Health-related quality of life (QOL) was evaluated during follow-up. Results The overall survival at 5 and 10 years was 86.4±7.3% (confidence interval 69.4–97.2%). The survival rates were significantly different between patients with and without bronchial stenosis (40 and 100%, P=0.0003, log-rank test). The survival of patients aged>6 months was higher than those≤6 months (100 vs. 40%, P=0.0003, log-rank test). Patients with BJV-valved conduits had higher systolic gradients from the right ventricle to the pulmonary artery (RV–PA) compared to those with monocusp-valve patches. BJV-valved conduit implantation was a risk factor for post-operative pulmonary-valve stenosis. The QOL score for patients with BJV-valved conduits was lower than those with monocusp-valve patches (P<0.05). No reoperation was performed during follow-up. Conclusions Bronchial stenosis and lower age (≤6 months) were the main factors influencing post-operative survival. The use of a BJV-valved conduit was a main reason for RV–PA restenosis;thus, the use of a BJV-valved conduit may increase the need for repeat intervention and decrease the post-operative quality of life.

关键词： Bovine jugular vein-valved conduit Bronchial stenosis Pulmonary stenosis Tetralogy of Fallot with absent pulmonary valve

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Epidemiological Study of heart Failure in China

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Cardiovascular Innovations and Applications 2015年第B10期1卷 47-55页

作者： Yang Guo Dong Zhao Jing Liu department of Epidemiology Beijing Anzhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vessel DiseasesBeijingChina

heart failure(HF)is a complex clinical syndrome that results from any structural or functional impairment of ventricular fi lling or ejection of *** is one of the most important and severe end stages of many cardiovascular *** studies of HF have focused mainly on the prevalence,incidence,mortality,fatality,and distribution and temporal trends of these indicators among different *** review highlights important epidemiological studies of HF in China.

关键词： heart failure cardiovascular diseases epidemiological study

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Rhabdomyolysis as a rare but severe complication of imbalanced deep hypothermia circulatory arrest

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Chinese Medical Journal 2014年第17期127卷 3104-3104页

作者： Gan Huili Zhang Jianqun Feng Lei Sun Jianchao department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing institute of heart Lung and Blood Vessel Diseases Beijing 100029 China

To the editor： Rhabdomyolysis is a severe complication after cardiovascular procedure. In March 2012, a 27-year-old man, who had a history of chronic thromboembolic pulmonary hypertension with severe deep vein thrombosis for more than 10 years, was admitted to Beijing Anzhen Hospital. The circumferential length of his right lower leg was 5 cm longer than his left counterpart. Preoperative femoral artery Doppler revealed he did not have inflow occlusions to the femoral artery in the lower extremities, but his right femoral vein was heavily embolized with thrombosis.

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