Pulmonary Blood Research Articles

Primary cardiac dedifferentiated liposarcoma in a middle-aged female: a case report

BackgroundPrimary malignant cardiac tumors are extremely rare and can present with the same nonspecific characteristics as benign primary cardiac tumors. We herein describe a middle-aged female with an intracavitary, irregular atrial mass who experienced partial surgical resection. The atrial mass which was recognized as myxoma before surgery was finally diagnosed as dedifferentiated liposarcoma (DDLPS) by postoperative pathological examination.Case presentationThe patient, a 61-year-old female, presented to the emergency room because of progressive chest congestion and shortage of liberties for 6 months and orthopnoea and paroxysmal nocturnal dyspnea for 3 days. The laboratory examinations confirmed no abnormalities. The thoracic computed tomography (CT) scan showed massive hydropericardium, pleural effusion and left atrium occupying lesion. The transesophageal echocardiography (TEE) confirmed an intracavitary and irregular left atrial mass, limiting the mitral valve inflow and pulmonary venous blood reflux. The positron emission tomography/computed tomography (PET/CT) revealed high grade fluorodeoxyglucose uptake only in the intracavitary mass which near the mitral valve. According to operative exploration, the intracavitary mass had invaded the mitral annulus and posterior wall of left ventricle which cannot be resected completely, we did merely partial surgical resection to relieve the patient’s symptoms. Postoperative immunohistochemical stain confirmed the diagnosis of DDLPS. The patient was transferred to the oncology department for further therapy. Unfortunately, the patient was detected with brain metastasis 1 month later and died within 5 months after the surgery.ConclusionsPrimary cardiac DDLPS is an extremely rare histological subtype of undifferentiated pleomorphic sarcomas which present the same nonspecific characteristics as benign primary cardiac tumors. Even though surgical resection combined with chemotherapy or radiotherapy remains the mainstream treatment strategy, the prognosis of cardiac malignancy is poor with high mortality. Novel management strategies need to be further explored.

Is there Any Relationship Between Long-Term Mortality of Acute Pulmonary Embolism and Complete Blood Count Analysis?

Is there Any Relationship Between Long-Term Mortality of Acute Pulmonary Embolism and Complete Blood Count Analysis?

Revealing the pathogenic changes of PAH based on multiomics characteristics

BackgroundPulmonary artery hypertension (PAH), which is characterized by an increase in pulmonary circulation blood pressure, is a fatal disease, and its pathogenesis remains unclear.MethodsIn this study, RNA sequencing (RNA-seq), tandem mass tags (TMT) and reduced representation bisulfite sequencing (RRBS) were performed to detect the levels of mRNA, protein, and DNA methylation in pulmonary arteries (PAs), respectively. To screen the possible pathways and proteins related to PAH, pathway enrichment analysis and protein–protein interaction (PPI) network analysis were performed. For selected genes, differential expression levels were confirmed at both the transcriptional and translational levels by real-time PCR and Western blot analyses, respectively.ResultsA total of 362 differentially expressed genes (|Fold-change| > 1.5 and p < 0.05), 811 differentially expressed proteins (|Fold-change| > 1.2 and p < 0.05) and 76,562 differentially methylated regions (1000 bp slide windows, 500 bp overlap, p < 0.05, and |Fold-change| > 1.2) were identified when the PAH group (n = 15) was compared with the control group (n = 15). Through an integrated analysis of the characteristics of the three omic analyses, a multiomics table was constructed. Additionally, pathway enrichment analysis showed that the differentially expressed proteins were significantly enriched in five Kyoto Encyclopedia of Genes and Genomes (KEGG) biological pathways and ten Gene Ontology (GO) terms for the PAH group compared with the control group. Moreover, protein–protein interaction (PPI) networks were constructed to identify hub genes. Finally, according to the genes identified in the PPI and the protein expression fold-change, nine key genes and their associated proteins were verified by real-time PCR and Western blot analyses, including Col4a1, Itga5, Col2a1, Gstt1, Gstm3, Thbd, Mgst2, Kng1 and Fgg.ConclusionsThis study conducted multiomic characteristic profiling to identify genes that contribute to the hypoxia-induced PAH model, identifying new avenues for basic PAH research.

Influence of background lung tissue conductivity on the cardiosynchronous EIT signal components: a sensitivity study.

Electrical impedance tomography is an accepted and validated tool to analyze and support mechanical ventilation at the bedside. In the future it could furthermore clinically provide information of the pulmonary perfusion and other blood volume changes within the thorax by exploiting a cardiosynchronous EIT component. In the presented study, the spatial forward sensitivity against different background lung tissue distributions was analyzed. Spheres with a 10% change of the background conductivity were introduced in the lungs and in the heart. The cranio-caudal distribution of sensitivity had a bell shape and was similar between all simulated scenarios, varying only in magnitude. If the background tissue conductivity within the lungs was chosen to be the one of deflated tissue, the overall sensitivity was 46% smaller compared to the overall sensitivity against inflated lung tissue conductivity. Within the heart region, the sensitivity was increased for fully deflated lung tissue conductivity (23% relative to the sensitivity in the lungs) compared to a homogeneous distribution of inflated lung tissue conductivity (10% relative to the sensitivity in the lungs).

Correlation of pulmonary venous circulating tumor cells with clinicopathological parameters in patients with early-stage lung adenocarcinoma

Background: Tumor recurrence following the surgical resection of lung cancer (LCa) reduces long-term disease-free survival rates. This study aimed to investigate the association of pulmonary venous blood (PVB) circulating tumor cells (CTCs) with the clinicopathological features of patients with early-stage lung adenocarcinoma. Methods: A total of 120 cases were enrolled, including 24 healthy controls, 36 patients with lung benign tumors, and 60 early-stage lung adenocarcinoma patients. Cells displaying a profile of human chromosome 8 specific sequence (CEP8) + /4',6-diamidino-2-phenylindole (DAPI) + /leukocyte-specific antibodies (CD45) ‒ were regarded as CTCs, and counts of ≥2 CTCs per 3.2 mL of PVB were considered positive. The association of CTC counts with clinical parameters were analyzed. Results: The number of CTCs were significantly higher in early-stage lung adenocarcinoma patients compared to benign or normal control group. Moreover, increased CTCs in lung adenocarcinoma was closely associated with tumor invasion, pathological staging and the epidermal growth factor receptor ( EGFR ) mutations (P 0.05). Univariate and multivariate Cox’s proportional hazards regression confirmed that CTC counts were an independent indicator for the prediction of tumor invasion, pathological staging, and EGFR mutations. Conclusions: Our data suggest that CTC counts correlate with tumor invasion, pathological staging, and EGFR mutations. CTCs therefore represent promising biomarkers for the surveillance of lung adenocarcinoma progression.

Effect of Recreational Soccer Play in the Air of Fine Particulate Matter on Pulmonary Function and Blood Pressure in Collegiate Men

Effect of Recreational Soccer Play in the Air of Fine Particulate Matter on Pulmonary Function and Blood Pressure in Collegiate Men

Evaluation of pulmonary artery blood flow and right heart function using phase-contrast magnetic resonance imaging in elderly patients with chronic obstructive pulmonary disease

Objective To investigate the value of phase-contrast magnetic resonance imaging(PC-MRI)in evaluating pulmonary artery blood flow and right ventricular(RV)function in elderly patients with chronic obstructive pulmonary disease(COPD). Methods Twenty-four elderly patients with COPD admitted to Beijing Anzhen Hospital between February 2016 and June 2017 were enrolled in this retrospective study.Based on pulmonary artery pressure evaluated by right heart catheterization, COPD patients were divided into a pulmonary hypertension group(PH group, n=12)and a non-PH group(n=12). Pulmonary artery blood flow velocity and volume, pulmonary arterial compliance and right heart function parameters including ejection fraction, end-diastolic volume, end-systolic volume and cardiac output, and 6-min walking distance evaluated by PC-MRI were compared between the two groups. Results There were significant differences in peak flow velocity[(88.1±16.0)cm/s vs.(59.8±13.8)cm/s, P=0.005], flow volume[(80.7±22.0)ml/s vs.(53.2±26.7)ml/s, P=0.012], main pulmonary artery compliance[(42.3±14.6)vs.(22.7±10.8), P=0.001], right ventricular ejection fraction[(48.4±13.4)% vs.(37.6±11.1)%, P=0.000], end-diastolic volume[(64.6±22.5)ml vs.(72.5±22.8)ml, P=0.030]and end-systolic volume[(50.6±33.1)ml vs.(41.7±33.1)ml, P=0.040]between the non-PH and PH groups, while there was no significant difference in cardiac output between the non-PH and PH groups[(34.2±10.8)ml vs.(34.4±8.3)ml, P=0.080]. Pearson's correlation analysis showed that 6-minute walking distance had good correlations with right ventricular ejection fraction(r=0.49), forced expiratory volume in 1 s(FEV1)(r=0.60)and main pulmonary artery diameter(r=-0.61). Conclusions PC-MRI is a noninvasive imaging method for quantitative analysis of pulmonary artery dynamics and right heart function for the elderly with COPD, and it can provide information for evaluating therapeutic effects and prognosis. Key words: Magnetic resonance imaging; Pulmonary disease, chronic obstructive; Pulmonary artery; Ventricular function

Cardiovascular assessment in Female Spotted Paca ( Cuniculus paca )

ABSTRACT Aiming to provide cardiovascular morphophysiology information on the Cuniculus paca, an important neotropical rodent, eight healthy adult females of this species were evaluated three times by echocardiography under general anesthesia with isoflurane every 15 days. The exams were performed by a single experienced evaluator with the animals positioned in right and left decubitus. Posteriorly, two expert evaluators measured the cardiac chambers, walls and flow patterns, by B-mode, M-mode, and Doppler ultrasonography. The resulting values were compared among evaluators and periods by the Bland-Altman agreement test and several descriptive statistics were presented for each parameter. Echocardiographic images were obtained between the second and fifth left and right intercostal spaces, enabling the measurement of heart chambers and walls, mitral, tricuspid, aortic and pulmonary valves blood flows, and the ejection and shortening fractions calculation. None of the studied variables showed inter-observers or inter-periods variations. This study provided some normal echocardiographic variables, applicable to epidemiological, pathophysiological or case studies in the Cuniculus paca and phylogenetically close species.

信必可都保联合呼吸训练对慢性阻塞性肺疾病稳定期的患者肺功能及血气分析的疗效探讨

信必可都保联合呼吸训练对慢性阻塞性肺疾病稳定期的患者肺功能及血气分析的疗效探讨

The ex vivo evaluation of oxygenated blood continuous perfusion to prevent ischemic-reperfusion injury of donor lung

Objective To study the protective effect of ex vivo perfusion to prevent donor-lung injury. Methods After being flushed with Celsior solution, the donor lungs were divided to control group (4 ℃ cold static preservation, subgroups-C4, C8, C12, C18) and experimental group (ex vivo oxygenated blood continuous perfusion, subgroups-T4, T8, T12, T18). Then the donor lungs connected with ventilator and ex vivo perfusion system to worked for 6 h. Lung ventilation resistance (LR), the left inferior pulmonary vein blood PO2 (LIPV-PO2), the left inferior pulmonary vein blood PCO2 (LIPV-PCO2), and lung water content (LWC), were evaluated. Lung edema were studied by light microscopic observation and apoptotic cells (AC) were detected by terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL). Results Lung function evaluation: (1) Lung function of experiment group was relatively stable, LR and LWC of T18 were significantly more than T4 (P=0.012, 0.010, respectively); LR and LWC of C12 were significantly more than C4 (P=0.018, 0.015, respectively); In the same time point LR and LWC of T12 and T18 were significantly less than C12 and C18 respectively (LR: P=0.025, 0.028; LWC: P=0.021, 0.027; respectively); (2) Lung injury evaluation: pulmonary edema classification (LEC) and AC of T18 were significantly more than T4 (P=0.023, 0.020, respectively); LEC and AC of C12 and C18 were significantly more than C4 (PLEC=0.023, 0.020; PAC=0.015, 0.011, respectively); LEC and AC of C18 were significantly more than T18 (P=0.007, 0.026, respectively). Conclusion Ex vivo oxygenated blood continuous perfusion without ventilator ameliorates hypothermic time-dependent ischemic-reperfusion injury. But further systems evaluation in complete physiologic condition is necessary. Key words: Lung transplatation; Lung preservation; Lung injury; Ex vivo perfusion

Proximal Isovelocity Surface Area Method for Diagnosing Isolated Pulmonary Vein Stenosis in a Case of Complete Atrioventricular Septal Defect With Increased Pulmonary Venous Blood Flow

Proximal Isovelocity Surface Area Method for Diagnosing Isolated Pulmonary Vein Stenosis in a Case of Complete Atrioventricular Septal Defect With Increased Pulmonary Venous Blood Flow

Generation of ventilation/perfusion ratio map in surgical patients by dual-energy CT after xenon inhalation and intravenous contrast media

BackgroundWhile many studies have evaluated the change in lung volume before and after lung resection and correlated this with pulmonary function test results, there is very little evidence on the changes in ventilation perfusion ratio (V/Q) before versus after lung resection. In the present pilot study, we evaluated if V/Q mapping can be constructed using dual energy CT images.MethodsThirty-one lung cancer patients planned for pulmonary resection were included in this study. To evaluate ventilation, Xenon-enhanced CT was performed. This was immediately followed by perfusion CT. The two images were registered manually as well as using dedicated softwares, and division between ventilation pixels and perfusion pixels were done to produce the V/Q map. Also, in order to characterize the distribution of the V/Q, the following numerical indices were calculated; mean, median, mode, standard deviation (SD), coefficient of variation (CV), skewness, kurtosis, and fractal dimension (FD). Pulmonary function tests and blood gas parameters were measured using standard institutional procedures.ResultsIn the whole group, VC, %VC, and FEV1 decreased significantly after resection. FEV1.0% was increased significantly after resection. No significant changes were seen in PaO2, PaCO2, and DLCO/VA before and after resection. The mean, median, mode, SD, skewness, kurtosis and FD of the V/Q did not change significantly before and after resection. A marginal but significant decrease in CV was seen before versus after resection.ConclusionsOverall, it was considered that the V/Q maps could be adequately generated in this study. With further accumulation of data, V/Q map generated by dual energy CT may become one of the potentially useful tools for functional lung imaging.Trial registrationThis trial was registered in University Medical Information Network in Japan (UMIN000010023) on 13Feb2013.

Whole exome sequencing of benign pulmonary metastasizing leiomyoma reveals mutation in the BMP8B gene

BackgroundBenign metastasizing leiomyoma (BML) is an orphan neoplasm commonly characterized by pulmonary metastases consisting of smooth muscle cells. Patients with BML have usually a current or previous uterine leiomyoma, which is therefore suggested to be the most probable source of this tumour. The purpose of this case report was to determine the possible genetic grounds for pulmonary BML.Case presentationWe present a case report in an asymptomatic 44-year-old female patient, who has developed uterine leiomyoma with subsequent pulmonary BML. Whole exome sequencing (WES) was used to detect somatic mutations in BML lesion. Somatic single nucleotide mutations were identified by comparing the WES data between the pulmonary metastasis and blood sample of the same BML patient. One heterozygous somatic mutation was selected for validation by Sanger sequencing. Clonality of the pulmonary metastasis and uterine leiomyoma was assessed by X-chromosome inactivation assay.ConclusionsWe describe a potentially deleterious somatic heterozygous mutation in bone morphogenetic protein 8B (BMP8B) gene (c.1139A > G, Tyr380Cys) that was identified in the pulmonary metastasis and was absent from blood and uterine leiomyoma, and may play a facilitating role in the metastasizing of BML. The clonality assay confirmed a skewed pattern of X-chromosome inactivation, suggesting monoclonal origin of the pulmonary metastases.

Predictors for Left Ventricular Systolic Dysfunction and its Outcome after Patent Ductus Arteriosus (Pda) Closure by Device

Objective: To evaluate the predictors of left ventricle (LV) systolic dysfunction after PDA closure by device. Back ground: LV dysfunction is very common in patients after PDA closure by device. There are certain predictors leading to it. Methods: 63 patients of isolated PDA. Patients were admitted in paediatric cardiology department of National Institute of Cardiovascular Disease Karachi, Pakistan. Baseline echocardiography was performed. Hemodynamics were done during cardiac catheterization, pulmonary blood flow/systemic blood flow (QP/QS) and pulmonary vascular resistance calculated. After successful device closure echocardiography was repeated on day 1, after one, three and six months. All subjects were divided into two groups on the basis of post closure LV ejection fraction. All the parameters which include age, gender, weight, LVEDD z-score, QP, PDA size, left ventricle end diastolic pressure and pulmonary artery pressure compared in both groups. Results: 41 patients (65.1%) developed LV systolic dysfunction. Coil was used in only 3(4.8%) patients and two of them developed dysfunction. All patients recovered within six months except two had dysfunction beyond six months. 30 patients (47.6%) patients had weight Z-score <-3 SD and 29 of them developed dysfunction. Weight, base line LVEDD Z –score, QP, LVEDP and PDA size has significant impact on LV function with p-value <0.05. Conclusion: Hemodynamic effects of PDA, changes in LV dimensions and function caused by it are reversible after transcatheter closure of PDA. Large PDA size, high QP/QS are potential risk factors leading to LV dysfunction after device closure.

A patient with Fontan physiology for laparoscopic cholecystectomy: A challenge for an anesthesiologist

Patients with a congenital single ventricular chamber, survives only because the systemic and pulmonary venous blood mixes. However such an arrangement has two major disadvantages of arterial desaturation and chronic volume overload to the single ventricle. In 1971, Francis Fontan from France, reported a new approach to the operative treatment of these malformations, separating the systemic and pulmonary circulations. The advancement of surgical techniques and medical management have resulted in greater than 90% survival rate of about 10 years after Fontan palliation. As a result, patients with Fontan physiology are increasingly presenting in the adult perioperative setting for various noncardiac surgeries. Understanding the Fontan physiology is essential for the successful anaesthetic management of these patients. We report a case of 22 year female with fontan physiology posted for elective laparoscopic cholecystectomy.

Pathogenetic mechanisms of capillary trophic insufficiency formation in children with bronchial asthma

Purpose of the study. The parameters of microhemodynamics and regional blood flow have been analyzed with the aim of clarifying their significance in the formation of capillary-trophic insufficiency syndrome in children with bronchial asthma. Material and methods. 225 patients aged from 6 to 14 years with bronchial asthma were examined. Pulmonary and capillary blood flow, pulmonary respiratory activity, morphofunctional parameters of platelets, erythrocytes and endothelium were studied depending on the course of the disease. Results. A decrease in tissue perfusion, low vasomotor activity and stagnant-stasis phenomena in the microcirculation system, accumulation of pathological forms of blood cells in the bloodstream, their functional inconsistency, a change in the morphofunctional status of endothelial cells were recorded. Conjugacy of the studied parameters with the activity of inflammation and respiratory dysfunction with the achievement of disease control makes it possible to consider them as markers of capillary-trophic insufficiency, which are predictors of the risk of exacerbations and justify the need for personification of therapy schemes for these patients.

Understanding Stage II Bidirectional Cavopulmonary Shunts.

Despite improvements in surgical technique and medical management, single-ventricle lesions remain one of the most challenging congenital heart anomalies to treat, and mortality rates are high. Most infants who have single-ventricle palliation undergo a sequence of surgeries to optimize pulmonary and systemic blood flow. The first surgery to separate pulmonary and systemic blood flow is the bidirectional cavopulmonary shunt. This article describes single-ventricle lesions and gives a basic overview of outcomes and strategies to improve interstage mortality. Preoperative investigations that evaluate stage II candidacy are reviewed along with surgical approaches and postoperative physiology. Although mortality rates are low and decreasing in patients with bidirectional cavopulmonary shunts, morbidity is still a challenge. Nurses must understand the pertinent anatomy and physiology and recognize postoperative complications early in order to reduce morbidity. Postoperative complications, management, outcomes and nursing care are discussed.

R-100 improves pulmonary function and systemic fluid balance in sheep with combined smoke-inhalation injury and Pseudomonas aeruginosa sepsis

BackgroundSeptic shock is a major cause of death in intensive care units around the world . The aim of the study was to investigate whether the novel drug R-100 (a superoxide degradation catalyst and nitric oxide donor) improves pulmonary function in a sheep model of septic shock caused by Pseudomonas aeruginosa and smoke inhalation.MethodsEleven female sheep were prepared surgically and randomly assigned to a treatment group (n = 5) or a control group (n = 6) after inhalation of cooled cotton smoke and airway instillation of live P. aeruginosa (2.5 × 1011 CFU) by bronchoscope under deep anesthesia and analgesia. The treatment group received an intravenous infusion of a total of 80 mg/kg of R-100 diluted in 500 mL of 5% dextrose. The control group was given 500 mL of 5% dextrose. All animals received intravenous lactated Ringer’s solution to maintain a hematocrit level at baseline ± 3%. Blood gas and hemodynamics were measured at baseline and then analyzed every 3 h during the 24-h study period. Results are expressed as mean ± SEM.ResultsThe treated animals showed significant improvement in their pulmonary gas exchange (PaO2/FiO2 ratio at 24 h: 246 ± 29 vs. 90 ± 40 mmHg control, P < 0.05). Pulmonary arterial pressures were reduced in the treated group (24 h: 26 ± 1 vs. 30 ± 2 cm mmHg control, P < 0.05). The treated animals also had an improved total fluid balance after 24 h (190 ± 45/24 h mL vs. 595 ± 234/24 h mL control, P < 0.05).ConclusionsTreatment with R-100 improves pulmonary gas exchange and blood oxygenation, and prevents a fluid imbalance in sheep subjected to smoke inhalation and P. aeruginosa.

Research advance in pulmonary rehabilitation in patients with acute exacerbation of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow obstruction and pathologically proven chronic inflammation of airway, pulmonary parenchyma and pulmonary blood vessels.It is divided into stable COPD and acute exacerbation of COPD (AECOPD). As a comprehensive intervention, pulmonary rehabilitation has remarkable therapeutic effect on stable COPD.At present, the effect of pulmonary rehabilitation of COPD has been widely confirmed.We will briefly review the research progress on pulmonary rehabilitation of AECOPD in recent years. Key words: Pulmonary disease, chronic obstructive; Rehabilitation

Providing Ventilation to the Newborn Infant in the Delivery Room

* Abbreviations: BPD: : bronchopulmonary dysplasia CPAP: : continuous positive airway pressure ETT: : endotracheal tube FiO2: : fraction of inspired oxygen NRP: : Neonatal Resuscitation Program PEEP: : positive end-expiratory pressure PIP: : peak inspiratory pressure PPV: : positive pressure ventilation Ventilating the lungs of the newborn is the most important element of neonatal resuscitation. Recognizing and delivering effective ventilation remains a critical skill for all attendants at a newborn delivery. After completing this article, readers should be able to: 1. Recognize the critical role of ventilation in the delivery room. 2. Identify the signs of effective ventilation. 3. Understand devices that deliver positive pressure ventilation. The Neonatal Resuscitation Program (NRP) emphasizes the importance of ventilation in the resuscitation of compromised newborns. (1) The purpose of this review is to explain the physiologic necessity of ventilation in newborn resuscitation and to describe the different methods of providing ventilation in the delivery room. We will also discuss the assessment of ventilation to ensure efficacy. Blood flow during fetal life is focused on perfusion of the brain and major organs with oxygenated blood and avoidance of fluid-filled lungs (Fig 1A). This blood flow is dependent on oxygenated umbilical venous blood from the placenta. Figure 1. A. Fetal circulation path. Only a small amount of blood travels to the lungs. There is no gas exchange in the lung. Blood returning to the right side of the heart from the umbilical vein has the highest oxygen saturation. B. Transitional circulation path. The infant breathes, pulmonary resistance decreases and blood travels to the lungs. Gas exchange occurs in the lungs. Blood returning to the left side of the heart from the lungs has the highest oxygen saturation. (From Textbook of Neonatal Resuscitation, 7th ed. , 2016. Reproduced with permission from the American Academy of Pediatrics.) Normal cardiopulmonary transition of the newborn from intra- to extrauterine life requires a rapid and complex process of fetal lung fluid clearance, expansion of the alveolar spaces with air, and redirection of cardiac output toward the lungs. All of these events take place independent of intervention …