Responsible Institution:National Health Commission of the People’s Republic of China
Sponsor:Chinese Medical Doctor Association
Honorary Editor-in-Chief:Wu Yiling
Editor-in-Chief:Jia Zhenhua
Managing Director:Ma Zhi
Editing:Editorial Board of Chinese Journal of Difficult and Complicated Cases
Publishing:Publishing House of Chinese Journal of Difficult and Complicated Cases
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Post Code:050035
Phone Number:0311-85901735
    Current issue
Issue 03 in 2024    Publication date:2024-03-18
Ma Xiaohai Wu Wenhui Zhang Chen Lu Guanyu

Patent foramen ovale(PFO) has increasingly come to clinical focus in recent years. Notably, paradoxical embolism, unexplained headaches, and episodes of dizziness related to PFO have garnered increasing attention. The diagnosis and transcatheter closure treatment of PFO require the collaboration of a multidisciplinary team, encompassing neurology, radiology, and interventional therapy. Several relevant guidelines have been issued domestically in recent years. This article reviews the utilization of various imaging technologies, including echocardiography, computed tomography, and digital subtraction angiography, in the diagnosis and transcatheter closure of PFO.

Chen Jie Liu Tao Fan Yanfeng Pei Junfang Zhao Jin Dou Zhanjun

Objective To explore the relationship between serum and peptide(copeptin), energy balance related protein(adropin), sleep structure and carotid atherosclerosis(AS) in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods Collect 178 OSAHS patients diagnosed and treated in the Respiratory Department of the Second Hospital of Shanxi Medical University from May 2021 to May 2023. Divide OSAHS patients into mild group(n=52), moderate group(n=80), and severe group(n=46) according to different degrees of illness, and compare the serum levels of copeptin, adropin, and sleep structure of OSAHS patients with different degrees of illness; Pearson test was used to analyze the correlation between serum copeptin, adropin, and sleep structure in OSAHS patients; Multivariate logistic regression model was used to analyze the influencing factors of AS occurrence in OSAHS patients; The predictive value of receiver operating characteristic(ROC) curve analysis of serum copeptin and adropin for the occurrence of AS in OSAHS patients. Results The serum copeptin, sleep latency, and number of awakenings in the mild, moderate, and severe groups all increased in sequence, while serum adropin, total sleep time, and rapid eye movement sleep as a percentage of total sleep time(REM%) all decreased in sequence(F=25.130, 52.510, 100.580, 218.980, 45.310, 59.140, P<0.001). Serum copeptin levels in OSAHS patients were positively correlated with sleep latency and number of awakenings, but negatively correlated with total sleep time and REM%(r=0.675, 0.570,-0.685,-0.590, all P<0.001); The serum adiposin levels in OSAHS patients were positively correlated with total sleep time and REM%, and negatively correlated with sleep latency and number of awakenings(r=0.539, 0.683,-0.568,-0.631, all P<0.001); Multivariate analysis showed that elevated serum copeptin, elevated AHI, concomitant hypertension, and smoking history were risk factors for developing AS in OSAHS patients, while elevated serum adropin was a protective factor [OR(95%CI)=1.905(1.226-2.808), 1.585(1.093-2.076), 1.881(1.280-2.730), 1.696(1.195-2.553), 0.552(0.396-0.770), all P<0.01]; The area under the curve(AUC) for predicting the occurrence of AS in patients with obstructive sleep apnea(OSAHS) were 0.745, 0.780, and 0.877, respectively, using serum copeptin, adropin, and their combination. The combined AUC of the two was greater than that of single detection(Z/P=4.234/0.006, 3.861/0.011). Conclusion Elevated serum copeptin and decreased adiposin can lead to sleep disorder in OSAHS patients and promote the formation of cervical atherosclerosis. The combined detection of these two indicators has high predictive value for the formation of cervical atherosclerosis in OSAHS patients.

Zhang Ye Cai Xin Wang Li Tang Dongling Zhang Ping'an

Objective To investigate the expression and clinical value of serum C1q in patients with sepsis complicated with acute respiratory distress syndrome(ARDS) of different severity levels. Methods Collect clinical data of 109 patients with sepsis complicated with ARDS from the Intensive Care Department, Respiratory Intensive Care Department, and Infectious Diseases Department of Wuhan University People's Hospital from January 2022 to July 2023, and test laboratory indicators within 24 hours of admission. According to the survival status within 28 days of admission, the patients were divided into a survival group of 63 cases and a death group of 46 cases. According to the severity of ARDS, they were divided into a mild group of 32 cases, a moderate group of 38 cases, and a severe group of 39 cases. Compare clinical data and laboratory testing indicators between the death group and the survival group, analyze serum C1q levels in patients with different severity levels, and use receiver operating characteristic(ROC) curves to analyze the value of serum C1q levels in predicting the prognosis of sepsis patients with ARDS. Results The age, SOFA score, procalcitonin(PCT), N-terminal proBNP, urea, blood uric acid, and creatinine of the death group were significantly higher than those of the survival group [Z(t)/P=2.280/0.025, 4.241/<0.001, 2.031/0.042, 2.945/0.003, 2.896/0.004, 2.068/0.039, 2.218/0.027]. Pre albumin(PA), total protein(TP), albumin(Alb), PaO2, and oxygenation index(OI) were significantly lower than those of the survival group [Z(t)/P=2.279/0.023, 2.341/0.019, 2.700/0.007, 4.048/<0.001, 6.182/<0.001], and there was a statistically significant difference in the proportion of septic shock between the death group and the survival group(χ2/P=4.718/0.030). The serum C1q levels in the death group were lower than those in the survival group(t/P=4.065/<0.001), and the severe group

Zhu Zhujing Su Li Qu Huanru Tian Yu Xi Lijun

Objective To analyze the relationship between serum C-X3-C motif chemokine ligand 1(CX3CL1) and C-C motif chemokine ligand 17(CCL17) with lung function and prognosis in patients with rheumatoid arthritis associated interstitial lung disease(RA-ILD). Methods 295 RA patients admitted to the Rheumatology Department of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2017 to January 2018 were selected. They were divided into ILD group(115 cases) and non ILD group(180 cases) based on the presence of ILD. RA-ILD patients were divided into poor prognosis subgroup and good prognosis subgroup based on their prognosis. Detect serum levels of CX3CL1 and CCL17, as well as lung function indicators [forced expiratory volume at 1 second(FEV1), forced vital capacity(FVC), FEV1/FVC, and lung carbon monoxide diffusion(DLCO)]. Pearson correlation analysis was used to examine the correlation between serum CX3CL1 and CCL17 levels and lung function indicators in RA-ILD patients. Multivariate logistic regression analysis was used to identify the factors influencing poor prognosis in RA-ILD patients. Receiver Operating Characteristic(ROC) curve analysis was used to assess the value of serum CX3CL1 and CCL17 levels in predicting poor prognosis in RA-ILD patients. Results Compared with the non ILD group, the serum levels of CX3CL1 and CCL17 in the ILD group increased, while FEV1, FVC, FEV1/FVC, and DLCO decreased(t/P=14.359/<0.001, 13.855/<0.001, 12.015/<0.001, 2.732/0.007, 14.749/<0.001, 14.010/<0.001). Pearson correlation analysis showed that serum CX3CL1 and CCL17 levels in RA-ILD patients were negatively correlated with FEV1, FVC, FEV1/FVC, and DLCO(r=-0.762,-0.711,-0.577,-0.534,-0.707,-0.692,-0.735,-0.672, all P<0.001). During a 5-year follow-up, the incidence of poor prognosis in 115 RA-ILD patients was 46.96%. Multivariate logistic regression analysis showed that common type interstitial pneumonia, high-resolution computed tomography(HRCT) score, CX3CL1, and elevated CCL17 were independent risk factors for poor prognosis in RA-ILD patients [OR(95% CI)=3.745(1.245-11.264), 1.051(1.008-1.095), 1.008(1.003-1.012), 1.037(1.012-1.062)], FEV1, FEV1/FVC Elevated DLCO is an independent protective factor [OR(95% CI)=0.952(0.896-0.988), 0.892(0.867-0.981), 0.857(0.789-0.949)]. ROC curve analysis showed that the area under the curve for predicting poor prognosis in RA-ILD patients with serum CX3CL1 and CCL17 levels combined was 0.875, which was greater than the 0.783 and 0.788 predicted by CX3CL1 and CCL17 alone(Z=2.807, 2.698, P=0.005, 0.007). Conclusion Elevated serum levels of CX3CL1 and CCL17 in RA-ILD patients are associated with decreased lung function and poor prognosis. The combined detection of serum levels of CX3CL1 and CCL17 has high predictive value for the prognosis of RA-ILD patients.