Pulmonary Thromboembolism Group Research Articles

ST-Segment Alterations in the Electrocardiogram of Acute Pulmonary Thromboembolism: A Rabbit Model

In this study, we investigated the mechanism underlying electrocardiogram (ECG) alterations in a rabbit model of acute pulmonary thromboembolism (PTE). Twelve healthy adult New Zealand white rabbits were used, with eight in the experimental group (PTE group) and four in the control group. After developing the rabbit model of acute PTE, ECG and coronary angiography were performed. HE staining was conducted on the right and left ventricular tissues, and polymerase chain reaction (PCR) was used to determine brain natriuretic peptide (BNP), tumor necrosis factor-alpha (TNF-α), and Troponin I (TNI) mRNA expression in the myocardium. There were considerable changes in the ST segment of the ECG in the PTE group. Coronary angiography revealed the absence of spasm, stenosis, and occlusion. In the plasma of the PTE group, the levels of D-dimer, BNP, TNF-α, and TNI were significantly elevated, and these changes were statistically significant (P<0.05). PCR analysis of ventricular myocardial tissue indicated significantly higher levels of BNP, TNF-α, and TNI mRNA in the PTE group than in the control group. These differences were statistically significant (P<0.05). The ST-T variations on the ECG of rabbits with acute PTE correlate strongly with the temporary changes in right heart volume caused by acute PTE.

Sildenafil improves hemodynamic changes caused by acute pulmonary embolism by inhibiting Rho kinase activity.

This study examined the effects of sildenafil on acute pulmonary embolism (APE) using a rat model. Sprague-Dawley rats were randomly divided into the sham, pulmonary thromboembolism (PTE), and sildenafil groups. The sham and PTE groups received normal saline once daily via gavage for 14 consecutive days, whereas the sildenafil group received sildenafil (0.5 mg/kg/day) once daily via gavage for 14 consecutive days. Autologous emboli were prepared from blood samples collected from the left femoral artery of rats in each group on day 13, and autologous emboli were injected into the jugular vein cannula of rats in the PTE and sildenafil groups on day 14. Sham-treated rats received the same volume of saline. Right systolic ventricular pressure (RVSP) and mean pulmonary arterial pressure (MPAP) were used to assess pulmonary embolism, and western blotting and enzyme-linked immunosorbent assay were used to detect relevant markers. The Rho kinase signaling pathway was significantly activated in rats with APE, and sildenafil significantly inhibited this activation. Sildenafil protected against APE through inhibiting Rho kinase activity, thereby reducing pulmonary vasoconstriction and decreasing elevated pulmonary arterial pressure. These findings might provide new ideas for the clinical treatment of acute pulmonary thromboembolism.

Clinical value of deep vein thrombosis density on lower-extremity CT venography: prediction of pulmonary thromboembolism.

Diagnosis of pulmonary thromboembolism (PTE) can be delayed if the signs and symptoms of patients are nonspecific. To assess the clinical value of deep vein thrombosis (DVT) density on computed tomography (CT) venography for predicting PTE. From 2016 to 2021, patients with DVT diagnosed on lower-extremity CT venography were included. Of these patients, those without PTE were classified into 'DVT-only group' and those with PTE were classified into the 'DVT with PTE group'. The DVT Hounsfield unit (HU) density was measured by drawing free-hand region-of-interests within the thrombus at the most proximal filling defect level. The risk factors associated with PTE were identified by using multivariate logistic regression analysis. A receiver operating characteristic (ROC) analysis was used to evaluate the value of DVT density for predicting the risk of PTE. This study included 177 patients with a mean age of 41.7 ± 10.3 years (DVT-only group: 105 patients; DVT with PTE group: 72 patients). DVT density was significantly higher in DVT with the PTE group than DVT-only group (66.8HU ± 8.7 vs. 57.9HU ± 11.1, p < 0.001). The ROC analysis revealed that the area under the curve (AUC), sensitivity, and specificity for predicting the risk of PTE were 0.737, 72.2%, and 66.7%, respectively, at a DVT density cutoff of 63.0 HU. On univariate and multivariate analysis, DVT density was the only significant risk factor associated with PTE. Higher DVT density was a significant risk factor for PTE. In addition, DVT density could be a predictive factor for PTE.

Investigating the prevalence of and predictive and risk factors for pulmonary embolism in patients with COVID-19 in Nemazee Teaching Hospital.

Pulmonary thromboembolism (PTE) is a significant contributing factor to vascular diseases. This study aimed to determine the prevalence of pulmonary thromboembolism and its predisposing factors in patients with COVID-19. This cross-sectional study included 284 patients with COVID-19 who were admitted to Nemazee Teaching Hospital (Shiraz, Iran) between June and August 2021. All patients were diagnosed with COVID-19 by a physician based on clinical symptoms or positive polymerase chain reaction (PCR) test results. The collected data included demographic data and laboratory findings. Data were analyzed using the SPSS software. P≤0.05 was considered statistically significant. There was a significant difference in the mean age between the PTE group and non-PTE group (P=0.037). Moreover, the PTE group had a significantly higher prevalence of hypertension (36.7% vs. 21.8%, P=0.019), myocardial infarction (4.5% vs. 0%, P=0.006), and stroke (23.9% vs. 4.9%, P=0.0001). Direct bilirubin (P=0.03) and albumin (P=0.04) levels significantly differed between the PTE and non-PTE groups. Notably, there was a significant difference in the partial thromboplastin time (P=0.04) between the PTE and non-PTE groups. A regression analysis indicated that age (OR, 1.02; 95% CI, 1.00‒1.004; P=0.005), blood pressure (OR, 2.07; 95% CI, 1.12‒3.85; P=0.02), heart attack (OR, 1.02; 95% CI, 1.28‒6.06; P=0.009), and albumin level (OR, 0.39; 95% CI, 0.16‒0.97; P=0.04) were all independent predictors of PTE development. Regression analysis revealed that age, blood pressure, heart attack, and albumin levels were independent predictors of PTE.

Lung iodine mapping images of acute postpartum dyspnea without pulmonary thromboembolism using dual-energy CT.

Postpartum dyspnea is commonly observed, but its cause is often unknown. To investigate postpartum dyspnea, we compared lung iodine mapping (LIM) using dual-energy computed tomography (DECT) between postpartum women and women suspected of having pulmonary thromboembolism (PTE). In this retrospective study, 109 women of reproductive age (50 postpartum women, 59 women unrelated to pregnancy) underwent DECT between March 2009 and August 2020. Among the postpartum women, 23 patients were excluded due to late-onset dyspnea (n=20: >48 h after delivery) or the presence of PTE (n=3). A total of 86 patients were divided into three groups (27 postpartum women [postpartum group], 19 women with PTE [PTE group], and 40 women without PTE [non-PTE group]). Quantitation was applied to a decreased LIM value (LIM5; defined as <5 HU) and the relative value of LIM5 to whole LIM volume (%LIM5). LIM defects were classified into five patterns (0 = none, 1 = wedge-shaped, 2 = reticular/liner, 3 = diffuse granular/patchy, 4 = massive defects) based on a consensus between two readers. There were significant differences in the LIM5 and %LIM5 values among the three groups. The LIM5 and %LIM5 were largest in the PTE group, and postpartum women showed intermediate values between the non-PTE and PTE groups. Wedge-shaped defects were prominent in the PTE group, and diffuse granular/patchy defect was a typical feature in the postpartum group. Postpartum women with dyspnea showed granular/patchy defects on DECT with a median quantitative value between the PTE and non-PTE groups.

Pulmonary thromboembolism and obesity in forensic pathologic case work

328 autopsy cases of fatal pulmonary thromboembolism (PE) were compared to 984 age- and sex-matched controls to evaluate the association between obesity and PE in a forensic context. Both PE and control cases had a mean age of 67,8 years (male 62,9 years, females 71,7 years). The percentage of morbidly obese persons with a body mass index (BMI) of above 40 or abdominal subcutaneous adipose tissue of above 4 cm was higher in the PE group (8,39% vs. 4,67% and 29.45% vs. 23.40%, respectively). On the other side, that of very slim persons (BMI below 18.5 or adipose tissue below 3 cm) was significantly smaller (4,27% vs. 7,52% and 47.55% vs. 56,60%). We thus found a strong association between being overweight and death from PE, while slim persons seem to be at an advantage. As the group of underweight persons includes those suffering from chronic diseases with reduced mobility or hypercoagulability (e.g. tumor kachexia or sarkopenia due to immobilisation), this finding is to some extent unexpected.

Comparison of CT Values between Thrombus and Postmortem Clot Based on Cadaveric Pulmonary Angiography.

To explore the difference in CT values between pulmonary thromboembolism and postmortem clot in postmortem CT pulmonary angiography (CTPA) to further improve the application value of virtual autopsy. Postmortem CTPA data with the definite cause of death from 2016 to 2019 were collected and divided into pulmonary thromboembolism group (n=4), postmortem clot group (n=5), and control group (n=5). CT values of pulmonary trunk and left and right pulmonary artery contents in each group were measured and analyzed statistically. The average CT value in the pulmonary thromboembolism group and postmortem clot group were (168.4±53.8) Hu and (282.7±78.0) Hu, respectively, which were lower than those of the control group (1 193.0±82.9) Hu (P<0.05). The average CT value of the postmortem clot group was higher than that of the pulmonary thromboembolism group (P<0.05). CT value is reliable and feasible as a relatively objective quantitative index to distinguish pulmonary thromboembolism and postmortem clot in postmortem CTPA. At the same time, it can provide a scientific basis to a certain extent for ruling out pulmonary thromboembolism deaths.

Triple rule-out computed tomography angiography: Evaluation of acute chest pain in COVID-19 patients in the emergency department.

BACKGROUNDThe aim of this study was to define clinical evidence supporting that triple rule-out computed tomography angiography (TRO CTA) is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019 (COVID-19) who were admitted to the emergency department (ED) for acute chest pain. Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events, will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects.AIMTo define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain, and to assess outcomes of optimizing diagnostic imaging strategies, particularly TRO CTA use, in COVID-19 related thromboembolic events.METHODSTRO CTA images were evaluated for the presence of coronary artery disease, pulmonary thromboembolism (PTE), or acute aortic syndromes. Statistical analyses were used for evaluation of significant association between the variables. A two tailed P-value < 0.05 was considered statistically significant.RESULTSFifty-three patients were included into the study. In 31 patients (65.9%), there was not any pathology, while PTE was diagnosed in 11 patients. There was no significant relationship between the rates of pathology on CTA and history of hypertension. On the other hand, the diabetes mellitus rate was much higher in the acute coronary syndrome group, particularly in the PTE group (8/31 = 25.8% vs 6/16 = 37.5%, P = 0.001). The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group (62.5% vs 38.7%, P < 0.001). Smoking history rates were similar in the groups. Platelets, D-dimer, fibrinogen, C-reactive protein, and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies.CONCLUSIONTRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.

The role of serum red blood cell distribution width level in predicting the short term mortality of community-acguired pneumonia, acute attack chronic pulmonary disease, and acute pulmonary thromboembolism

Background: There is a growing concern in inflammatory parameters that are commonly used in routine practice and can be measured cost-effectively for predicting mortality community-acquired pneumonia (CAP), acute-attack chronic obstructive pulmonary disease (COPD), and acute pulmonary thromboembolism (PTE). Red blood cell distribution width (RDW) is a significant parameter indicating the heterogeneity of the size of red blood cells (RBCs). The present study was designed to compare RDW levels among patients that were hospitalized due to CAP, acute PTE, and acute-attack COPD, all of which are characterized by persistent inflammation, and to investigate the role of RDW in predicting 30-day mortality.&#x0D; Materials and Methods: The RDW levels measured on admission in all three groups were evaluated retrospectively.&#x0D; Results:The 554 patients comprised 320 (57.76%) men and 234 (42.24%) women with a mean age of 67.074±14.73 years. The patients comprised 92 (16.6%) CAP, 265 (47.8%) acute PTE, and 197 (35.6%) acute-attack COPD patients. Mean RDW was 14.42%±2.73% (range, 3.77-28%) while it was 14.88%±3.30% in the CAP group, 13.21%±2.77% in the COPD group, and 15.15%±2.12% in the PTE group. In the COPD, CAP, and PTE groups, RDW levels were significantly higher in patients with 30-day mortality compared to those without mortality (p=0.008, p=0.020, and p

Investigation of the Value of Coagulation Parameters in Thromboembolic Events Among Patients Not Receiving Anticoagulant Therapy

Objective: The main causes of thromboembolic events are atherosclerosis, vascular endothelial injury, and hypercoagulability. Coagulation is activated through two basic mechanisms, including intrinsic and extrinsic pathways, leading to thrombin production as a result of a series of enzymatic reactions. The intrinsic pathway is evaluated with activated partial thromboplastin time (aPTT) and extrinsic pathway with prothrombin time (PT). This study aimed to investigate the relationship between thromboembolic diseases and coagulation parameters.&#x0D; Material and Methods: Patients diagnosed with acute ischemic stroke (AIS) (n=216), acute coronary syndrome (ACS) (n=25), pulmonary thromboembolism (PTE) (n=15), and patients without an emergency pathology (n=71) (Control Group) in the emergency department were retrospectively reviewed in the period from 01 November 2016 to 31 March 2019.&#x0D; Results: The aPTT (25.61±5.93 sec), PT (12.05±2.26 sec), and INR (1.04±0.19) values of the AIS group were statistically significantly lower compared to values of the control group (p = ˂0.001, ˂0.001 and ˂0.001 respectively). Similarly, the aPTT (27.15±8.97 sec), PT (12.26±2.75 sec), and INR (1.03±0.25) values of the ACS group were statistically significantly lower compared to those of the control group (p=0.012, 0.030, and 0.001, respectively). There was no statistically significant difference between the PTE group and control group in terms of aPTT, PT, and INR values (p= 0.133, 0.758, and 0.711, respectively).&#x0D; Conclusion: Shortened aPTT levels in cases without a history of anticoagulant use at the time of admission can be considered to be a predictive and effective tool for clinicians in arterial embolic events (AIS and ACS).

Expression and diagnostic value of circulating miRNA-190 and miRNA-197 in patients with pulmonary thromboembolism.

BackgroundDiagnosing pulmonary thromboembolism (PTE) remains challenging due to the lack of specific clinical symptoms and biomarkers. Circulating microRNAs (miRNAs) have proved to be potential biomarkers for numerous cardiovascular diseases. The aims of this study were to quantitatively analyze the expression of plasma miRNA‐190 and miRNA‐197 in patients with PTE and to evaluate the diagnostic value for PTE.MethodsThirty patients diagnosed with PTE by computed tomographic pulmonary angiography at the emergency department were enrolled in this study, and plasma was collected immediately. For comparison, myocardial infarction (MI, n = 45) and healthy participants (NC, n = 45) were recruited as the control groups. Quantitative reverse transcription PCR (qRT‐PCR) was conducted to reveal the relative expression levels of miRNA‐190 and miRNA‐197 in each group. The plasma concentrations of D‐dimer were measured by immunoturbidimetric assay. The diagnostic value was evaluated by analyzing the area under the receiver operating characteristic curve (AUC).ResultsThe relative expression levels of miRNA‐190 and miRNA‐197 in the PTE group were both significantly higher than in the MI group (t = 3.602 t = 4.791, P < .05, respectively) and the healthy control group (t = 5.814, t = 5.886, P < .05, respectively). As diagnostic indicator, the sensitivity and specificity of miRNA‐190 were 75.56% and 80%, respectively, with an AUC of 0.7844 (95%CI: 0.6858‐0.8831, P < .001). The sensitivity and specificity of miRNA‐197 were 73.33% and 86.67%, respectively, with an AUC value of 0.7931 (95%CI: 0.6870‐0.8991, P < .001). Combining miRNA‐190 and miRNA‐197 with D‐dimer levels significantly increased the diagnostic power, improving the AUC to 0.9536 (95% CI: 0.9083‐0.9989, P < .001).ConclusionsThe relative expression levels of miRNA‐190 and miRNA‐197 in PTE patients were significantly higher than in the MI and healthy control groups, indicating that (a) both may be involved in the pathophysiological process of PTE and (b) both may serve as potential noninvasive diagnostic markers for PTE. The combination of miRNA‐190, miRNA‐197, and D‐dimer levels showed better sensitivity and specificity, which is more conducive to the diagnosis of PTE.

Retrospective analysis of clinical features of chronic obstructive pulmonary disease complicated with pulmonary thromboembolism

Objective To analyze the clinical features of patients with chronic obstructive pulmonary disease(COPD) complicated with pulmonary thromboembolism(PTE). Methods The clinical data of 21 patients with COPD and PTE and 26 patients with acute exacerbation of COPD(AECOPD) from June 2015 to March 2018 in Taiyuan Central Hospital were retrospectively analyzed.The SSPS 22.0 statistical software was used to analyze the clinical data.General data, blood gas analysis results, lung function, hemoglobin, coagulation parameters, combined disease were analyzed. Results There were no statistically significant differences in age, gender and lung function grading between the COPD complicated with PTE group and AECOPD group (all P>0.05). The incidence rates of chest pain(8 cases, 38.1%) and syncope(2 cases, 10.5%) in the COPD complicated with PTE group were higher than those in the AECOPD group[chest pain(3 cases, 11.5%), syncope(1 case, 3.8%)](χ2=7.645, 9.413, all P 0.05). The blood oxygen partial pressure(PaO2) of the COPD complicated with PTE group was (62.86±15.10)mmHg, which was lower than that of the AECOPD group [(74.83±17.59)mmHg](t=4.642, P 0.05). Conclusion COPD patients complicated with PTE have the following characteristics: elderly and male patients accounted for a high proportion, chest pain and syncope symptoms occurred in a high proportion, severe hypoxia, hemoglobin and D-dimer increased significantly. Key words: Pulmonary disease, chronic obstructive; Embolism and thrombosis; Pulmonary embolism; Blood gas analysis; Respiratory function tests; Disease attributes

Clinical characteristics and prognosis of cancer patients with venous thromboembolism.

The aim of this study is to analyze the clinical features and prognosis of cancer patients with venous thromboembolism (VTE). This was a retrospective observational study that selected cancer patients with a new VTE event from January 2003 to 2013 using the hospital information system in Beijing Hospital. The patients were divided into three groups according to the site of thrombosis as follows: pulmonary thromboembolism (PTE), deep venous thrombosis (DVT), or PTE plus DVT. The clinical manifestations and prognosis among the three groups were compared. Among the 18,531 patients diagnosed with a malignant tumor, 280 (1.51%) patients presented with VTE at first diagnosis or during the disease course; of these, 26 had incidental pulmonary embolism (IPE). Dyspnea was the most common symptom in the PTE group (51.65%), and lower limb swelling was found mostly in the DVT group (65.27%). Approximately 53.92% and 63.21% of patients had VTE events within the first 3 and 6 months after cancer diagnosis, respectively. The median survival time of all VTE patients was 24.0 ± 7.85 months, with the DVT group having the longest survival time among the three groups (P < 0.05). About 29.23% of the 130 patient deaths occurred within the first 30 days after VTE diagnosis, and 46.92% occurred within the first 3 months. The incidence of IPE in cancer patients was not rare. Most VTE events occurred within the first 6 months after the cancer diagnosis, and nearly half of the deaths occurred within the first 3 months of VTE diagnosis in cancer patients.

Bioinformatics-based study to detect chemical compounds that show potential as treatments for pulmonary thromboembolism.

The objectives of the present study comprised the recognition of major genes related to pulmonary thromboembolism (PTE) and the evaluation of their functional enrichment levels, in addition to the identification of small chemical molecules that may offer potential for use in PTE treatment. The RNA expression profiling of GSE84738 was obtained from the Gene Expression Omnibus database. Following data preprocessing, the differently expressed genes (DEGs) between the PTE group and the control group were identified using the Linear Models for Microarray package. Subsequently, the protein‑protein interaction (PPI) network of these DEGs was examined using the Search Tool for the Retrieval of Interacting Genes/Proteins database, visualized via Cytoscape. The most significantly clustered modules in the network were identified using Multi Contrast Delayed Enhancement, a plugin of Cytoscape. Subsequently, functional enrichment analysis of the DEGs was performed, using the Database for Annotation Visualization and Integrated Discovery tool. Furthermore, the chemical-target interaction networks were investigated using the Comparative Toxicogenomics Database as visualized via Cytoscape. A total of 548 DEGs (262 upregulated and 286 downregulated) were identified in the PTE group, compared with the control group. The upregulated and downregulated genes were enriched in Gene Ontology terms related to inflammation and eye sarco-lemma, respectively. Tumor necrosis factor (TNF) and erb-b2 receptor tyrosine kinase 2 (ERBB2) were upregulated genes that ranked higher in the PPI network (47 and 40 degrees, respectively) whereas C‑JUN was the most downregulated gene (46). Small chemical molecules ethinyl (135), cyclosporine (126), thrombomodulin precursor (113) and tretinoin (111) had >100 degrees in the DEG‑chemical interaction network. In addition, ethinyl targeted to TNF, whereas TNF and ERBB2 were targeted by cyclosporine, and tretinoin was a targeted chemical of ERBB2. Therefore, cyclosporine, ethinyl, and tretinoin may be potential targets for PTE treatment.

Diagnosis of canine pulmonary thromboembolism by computed tomography and mathematical modelling using haemostatic and inflammatory variables

There is no evidence-based diagnostic approach for diagnosis of pulmonary thromboembolism (PTE) in dogs. Many dogs with diseases that predispose to thrombosis are hypercoagulable when assessed with thromboelastography (TEG), but no direct link has been established. The aims of this study were: (1) to investigate if diseased dogs with PTE, diagnosed by computed tomography pulmonary angiography (CTPA), had evidence of hypercoagulability by TEG; (2) to characterise haemostatic and inflammatory changes in dogs with PTE; (3) to construct models for prediction of PTE based on combinations of haemostatic and inflammatory variables; and (4) to evaluate the performance of D-dimer measurement for prediction of PTE. Twenty-five dogs were included in this prospective observational study (PTE: n=6; non-PTE: n=19). Clot strength G values did not differ between the PTE and non-PTE groups in tissue factor (TF) or kaolin-activated TEG analyses. Haemostatic and inflammatory variables did not differ between the two groups. Linear discriminant analysis generated a model for prediction of PTE with a sensitivity and specificity of 100% when TF results were used as TEG data, and a model with sensitivity of 83% and specificity of 100% when kaolin results were used as TEG data. Receiver operating characteristic analysis of D-dimer levels showed that a value of >0.3mg/L yielded a sensitivity of 100% and a specificity of 71.4%. In conclusion, the study supports CTPA as method for diagnosing canine PTE, but shows that TEG alone cannot identify dogs with PTE. Models for prediction of PTE were generated, but require further validation.

Dual-energy CT-based iodine quantification for differentiating pulmonary artery sarcoma from pulmonary thromboembolism: a pilot study.

The purpose of this study was to determine whether dual-energy computed tomography (DECT) angiography could differentiate pulmonary thromboembolism (PTE) from pulmonary artery sarcoma (PAS). We prospectively enrolled 19 patients that had a filling defect in the main pulmonary artery on DECT. Six patients who had PAS and underwent DECT were retrospectively enrolled for comparison. Pathological results or follow-up CT after anticoagulation therapy were used to make the final diagnosis. Two investigators measured the following parameters at the filling defect in the main pulmonary artery: CT attenuation density [Hounsfield units (HU)], iodine-related HU (IHU) and iodine concentration (IC, mg/ml). From a total of 25 patients (M:F = 10:15; mean age, 65years old), 19 were categorised into the PTE group and six were categorised into the PAS group. The mean HU values were not significantly different between the PTE and PAS groups (45.5 ± 15.9 vs 47.1 ± 9.2 HU; P = 0.776). However, the mean IHU and IC values of the lesions were significantly different between the PTE and PAS groups (10.6 ± 7.2 vs 27.9 ± 9.1 HU; P = 0.004, and 0.61 ± 0.39 vs 1.49 ± 0.57; P = 0.001). DECT angiography using a quantitative analytic methodology can be used to differentiate PTE and PAS. • DECT can be useful for differentiation of PAS and PTE. • With quantitative analysis, DECT offers tissue characterisation by detecting lesion parameter increases. • The patients without predisposing factors for PTE can be candidates for DECT.

Correlation of three common variation loci in von Willebrand factor gene and pulmonary thromboembolism disease

To elucidate the relationship between three common variation loci of von Willebrand factor (VWF) gene (rs216321, rs216325 and rs1800378) and pulmonary thromboembolism. A total of 95 patients with definite pulmonary thromboembolism (PTE) at Beijing Chaoyang Hospital and Beijing Hospital during November 2008 to March 2012 served as PTE group while 90 healthy subjects at Beijing Hospital during the same period as control group. Fasting venous blood samples were collected for extracting genomic DNA. Three common variation loci with single nucleotide polymorphism were rs216321 (T/C), rs216325 (G/A) and rs1800378 (T/C) and their minor allele frequency was over 0.05 in VWF gene. The method of polymerase chain reaction (PCR)-Sanger was employed for sequencing. The differences of alleleic and genotypic frequencies between PTE and control groups were compared for each locus. And the correlations of their haplotypes with PTE were analyzed. The distributions of rs216325 (G/A) and rs1800378 (T/C) in VWF gene had significant difference between PTE and control groups (P=0.039, 0.006). And rs216325 with genotype AA was positively correlated with PTE occurrence (r=1.914, P=0.047). And rs1800378 with genotype TT was also positively correlated with PTE occurrence (r=0.282, P=0.008). The distributions of haplotype TGT had significant differences between PTE and control groups. This haplotype was positively correlated with PTE occurrence (r=0.239, P<0.001). The rs216325 and rs1800378 loci variations in VWF gene are associated with PTE, rs216325 with genotype AA and rs1800378 with genotype TT. And haplotype TGT indicates a high risk of PTE onset.

Association between KLKB1 Polymorphisms and Pulmonary Thromboembolism.

To investigate the potential correlation between the single nucleotide polymorphisms (SNPs) in the KLKB1 region and pulmonary thromboembolism(PTE) in a Chinese Han population. In this case-control study, 95 patients with confirmed PTE were enrolled as the PTE group and 90 healthy subjects as the control group. The genotypes, alleles, and haplotypes of the SNPs were analyzed with PLINK 1.07 and Haploview 4.2 software using chi-square test and Logistic regression analysis. SNPs were further analyzed under three genetic models (additive, dominant, and recessive). The distribution of rs3733402 in KLKB1 gene showed significant difference between PTE group and control group (P=0.041). The distributions of GTG haplotypes consisted of rs2292423, rs4253325,and rs3733402 in KLKB1 gene were also significantly different between PTE group and control group(P=0.040). The rs3733402 locus variation in KLKB1 gene is associated with PTE in Chinese Han people.

Study on clinical characteristic and outcomes of primary lung cancer combined with venous thromboembolism

Objective To observe the clinical characteristic and prognosis of primary lung cancer patients with venous thromboembolism(VTE). Methods 589 primary lung cancer patients were selected and divided into VTE group(n= 49)and non VTE group(n= 540).49 cases with VTE were divided into pulmonary thromboembolism(PTE) group(n= 15),including single PTE and PTE combined with deep venous thrombosis(DVT) and DVT group(n= 34).Single factor and multiple logistic regression analysis were performed to determine the factors influencing primary lung cancer patients with VTE.Clinical manifestation,time of onset and prognosis of patients with VTE were analyzed. Results 49 patients with VTE included 10 patients(20. 4%) with single PTE,34 patients(69.4%)with single DVT and 5 PTE patients combined with DVT(10.2%). D-dimer(OR= 1.560,95% CI= 1.018~2.392,χ2= 4.161,P= 0.041),interleukin-1(IL-1,OR= 1.846,95% CI= 1.054-3.234,χ2= 4.594,P= 0.033),tumor necrosis factor(TNF OR= 1.486,95% CI= 1.014-2.178,χ2 = 4.126,P= 0.042),adenocarcinoma(OR= 2.854,95% CI= 1.217-6.695,χ2= 5.812,P= 0.016)and phaseⅢ-Ⅳ(OR= 2.198,95% CI= 1.122-4.305,χ2= 5.272,P= 0.022) were the factors influencing primary lung cancer patients with VTE.Chest tightness,coughing,accelerated heart rate,swelling and pain in lower limb were common clinical manifestations of primary lung cancer patients with VTE.Most patients with VTE occurred within 3 months after a diagnosis of primary lung cancer.There was no significant difference in the time of onset between PTE group and DVT group(P> 0.05).As of July 2014,31 cases(63.2%) died,12 cases(24.5%)survived,and 6 cases(12.2%)lost in 49 patients with VTE.The median survival time of 49 patients with VTE was 9.5 months.The median survival time of PTE group was 5. 8 months,while DVT group was 15.2 months,but no significant difference between them(P> 0.05 ). Conclusion Increased D-dimer,increased IL-1,increased TNF,adenocarcinoma and phaseⅢ-Ⅳcould increase the risk of primary lung cancer patients with VTE.There were little typical clinical symptoms in most patients with VTE,which occurred with in 3 months after a diagnosis of primary lung cancer.They had high mortality and needed to take early diagnosis and treatment through auxiliary examination. Key words: Lung neoplasms; Venous thromboembolism; Prognosis

Quantification of lung perfusion blood volume with dual-energy CT: assessment of the severity of acute pulmonary thromboembolism.

The purpose of this study was to evaluate the usefulness of quantification of lung perfused blood volume (PBV) with dual-energy CT (DECT) for assessment of the severity of acute pulmonary thromboembolism (PTE). We retrospectively analyzed the records of 72 patients with PTE and 168 without PTE who underwent DECT. The PTE patients were divided into high-, intermediate-, and low-risk groups based on clinical symptoms and right ventricular dysfunction. Correlations between quantification of whole-lung PBV and clinical severity were evaluated. Also evaluated was the relation between quantification of whole-lung PBV and right-to-left ventricular diameter ratio on CT images, which was used as an indicator of right ventricular dysfunction. In the PTE and control groups, the whole-lung PBVs were 27.6 ± 7.9 and 29.9 ± 6.8 HU with a significant difference between them (p < 0.0281). In the high-, intermediate-, and low-risk PTE groups, the whole-lung PBVs were 16.0 ± 2.9, 21.0 ± 4.2, and 31.4 ± 5.8 HU with a significant difference between them (p < 0.05). There was no significant difference in whole-lung PBV between the control group and the low-risk PTE group, but there was a significant difference between the control group and the other two PTE groups. In PTE patients, whole-lung PBV had negative correlation with right-to-left ventricular diameter ratio (R = -0.567, p < 0.001). Quantification of lung PBV with DECT is useful for assessment of the clinical severity of PTE and can be used as an indicator of right ventricular dysfunction.