Introduction The gut microbiome plays a crucial role in various diseases, and its regulation is a potential treatment option for these conditions. However, the relationship between the gut microbiome and venous thromboembolism (VTE) remains poorly explored. Methods In this study, we collected feces and serum samples from 8 VTE patients and 7 healthy controls. The gut microbiota and serum metabolites were analyzed using 16S rRNA gene sequencing and liquid chromatography-mass spectrometry, respectively. Additionally, a combined analysis of microbiota and metabolome was performed. Results The alpha and beta diversity between the VTE and control groups were significantly different. Patients with VTE exhibited an overgrowth of Blautia, Roseburia, Coprococcus, and Ruminococcus. Moreover, serum metabolomics analysis revealed altered levels of choline and lithocholic acid. Pathway enrichment analysis indicated a significant upregulation of bile secretion pathways. In addition, a positive correlation was observed between the levels of serum choline and lithocholic acid and the abundance of gut flora enriched in the VTE group. Conclusion This study provided novel insights into the disordered gut microbiota and serum metabolome associated with VTE, suggesting potential common pathological mechanisms between VTE and arterial thrombosis. Targeted modulation of the gut microbiome may hold promise as a preventive and therapeutic approach for VTE.

Objectives We conduct a study to explore the influence of impaired renal function on prognosis in Acute pulmonary embolism (APE) patients. Methods A meta-analysis was performed using the EMBASE and PubMed databases for relevant publications reporting the impact of impaired renal function on the clinical outcomes in patients with APE. Results Eventually, 17 articles were included in our analysis. The results suggested that renal insufficiency (RI) is a predictor of poor prognosis in APE patients(short-term mortality: pooled OR = 2.83, 95%CI: 2.20-3.63; long-term mortality: pooled OR = 2.30, 95%CI: 1.72-3.08; adverse outcomes: pooled OR = 3.02, 95%CI: 2.60-3.51). The short-term and long-term mortality rates of APE patients with RI were both higher than those in patients without RI. In addition, acute kidney injury(AKI) could serve as a predictive factor of poor prognosis (pooled OR = 2.75, 95%CI: 2.45-3.08), and it doubles the overall mortality rate in APE patients. However, chronic kidney disease (CKD) did not predict poor prognosis in APE patients (pooled OR = 1.94, 95%CI: 0.99-3.81), although it could slightly increase the overall mortality rate in APE patients. Conclusions RI and AKI could be included in the prognosis evaluation for APE, but the impact of CKD in APE patients has yet to be determined.

Circular RNAs (circRNAs) are a newly identified type of noncoding RNA molecule with a unique closed-loop structure. circRNAs are widely expressed in different tissues and developmental stages of many species, participating in many important pathophysiological processes and playing an important role in the occurrence and development of diseases. This article reviews the discovery, characteristics, formation, and biological function of circRNAs. The relationship between circRNAs and vascular remodelling, as well as the current status of research and potential application value in pulmonary hypertension (PH), is discussed to promote a better understanding of the role of circRNAs in PH. circRNAs are closely related to the remodelling of vascular endothelial cells and vascular smooth muscle cells. circRNAs have potential application prospects for in-depth research on the possible pathogenesis and mechanism of PH. Future research on the role of circRNAs in the pathogenesis and mechanism of PH will provide new insights and promote screening, diagnosis, prevention, and treatment of this disease.

静脉血栓栓塞症( venous thromboembolism, VTE)是肺栓塞( pulmonary embolism,PE)和深静脉血栓形成( deep venous thrombosis,DVT)两种疾病的统称,两种疾病直接相互关联,是同一疾病的两个不同阶段的两种临床表现[1].

Dieulafoy's disease is characterized by abnormal submucosal arteries and results in acute luminal hemorrhage. Dieulafoy's lesions can also be found in the submucosa of the bronchus. Due to its low incidence rate and non-specific clinical symptoms, Dieulafoy's disease is easy to overlook, but can lead to massive bleeding and high rates of mortality. Therefore, improvements in the understanding of the disease are necessary. The awareness of the disease and associated diagnostic and treatment techniques have continued to improve, and thus, an increasing number of cases of Dieulafoy's disease of the bronchus have been reported. In the present review, 74 cases of Dieulafoy's disease are summarized. New technologies such as endobronchial ultrasound, narrow-band imaging, angiography and argon plasma treatment have been found to be increasingly applied to diagnose and treat Dieulafoy's disease of the bronchus. Therefore, the primary focus of this systematic review is to highlight advances in the diagnosis and treatment of bronchial Dieulafoy's disease.

The incidence of hypoxic pulmonary hypertension (HPH) is increasing. Accumulating evidence suggests that long noncoding RNAs (lncRNAs) play an important role in HPH, but the functions and mechanism have yet to be fully elucidated. In the present study, we established a HPH rat model with 8 h of hypoxia exposure (10% O2) per day for 21 days. High-throughput sequencing identified 60 differentially expressed (DE) lncRNAs, 20 DE miRNAs and 695 DE mRNAs in rat lung tissue. qRT-PCR verified the accuracy of the results. The DE mRNAs were significantly enriched in immune response, inflammatory response, leukocyte migration, cell cycle, cellular response to interleukin-1, IL-17 signalling pathway, cytokine-cytokine receptor interaction and Toll-like receptor signalling pathway. According to the theory of competing endogenous RNA (ceRNA) networks, lncRNA-miRNA-mRNA network was constructed by Cytoscape software, 16 miRNAs and 144 mRNAs. The results suggested that seven DE lncRNAs (Ly6l, AABR07038849.2, AABR07069008.2, AABR07064873.1, AABR07001382.1, AABR07068161.1 and AABR07060341.2) may serve as molecular sponges of the corresponding miRNAs and play a major role in HPH.

OBJECTIVES:Patients with pulmonary embolism (PE) have a higher red cell distribution width (RDW), which may complicate the interpretation of the prognosis of PE. We aim to evaluate the diagnostic utility of the RDW in patients with PE. METHODS:Eligible studies were identified by searching PubMed and EMBASE from inception to December 23, 2018. The data were pooled using Stata 12 to evaluate the prognostic value. The sources of heterogeneity were detected. RESULTS:For the analysis of prognosis, 7 studies with 2146 patients were included, with median RDW values ranging from 13.4% to 15.7% and a median cut-off point of 18.27%. A total of 247 patients (11.5% mortality) among the 2146 participants died. Overall, RDW was positively associated with the prognosis of PE in the overall analysis (HR = 1.19, 95% CI = 1.10-1.29, I2  = 73.4%; P = 0.000). Subgroup analyses by study design, sex and follow-up time indicated that they were not sources of heterogeneity. CONCLUSIONS:An elevated RDW has the potential to be a biomarker for prognosis in PE patients.

To explore potential critical genes and identify circular RNAs (circRNAs) that act as the competitive endogenous RNA (ceRNA) in a hypoxic pulmonary hypertension (HPH) rat model. Constructed rat model, and a bioinformatics method was used to analyse differentially expressed (DE) genes and construct a circRNA-miRNA-mRNA ceRNA regulatory network. Then, qRT-PCR was used to verify. The significant DEcircRNAs/DEmiRNAs/DEmRNAs was showed, and a ceRNA network with 8 DEcircRNAs, 9 DEmiRNAs and 46 DEmRNAs were constructed. The functional enrichment suggested the inflammatory response, NF-κB signalling, MAPK cascade and Toll-like receptor were associated with HPH. Further assessment confirmed that circ_002723, circ_008021, circ_016925 and circ_020581 could have a potential ceRNA mechanism by sponging miR-23a or miR-21 to control downstream target gene and be involved in the pathophysiology of HPH. The qRT-PCR validation results were consistent with the RNA-Seq results. This study revealed potentially important genes, pathways and ceRNA regulatory networks in HPH.

Elevated red blood cell distribution width (RDW) may correlate with a worse prognosis in pulmonary hypertension (PH), though results to date are inconsistent. The goal of this study is to detect the impact of RDW on the prognosis of PH.PubMed and EMBASE databases were searched from their inception to July 22, 2019 for relevant publications reporting the relationship between RDW and the prognosis of PH. A meta-analysis was performed, and the heterogeneity across the included studies was evaluated using I and Q statistics. We conducted sensitivity and subgroup analyses to detect sources of heterogeneity. In addition, potential publication bias was evaluated by Begg's and Egger's tests.In total, 1236 publications were retrieved, and 7 eligible publications with 666 PH patients were included in our meta-analysis. The results suggested that increased RDW can predict worse prognosis in PH (hazard ratio (HR) = 1.27, 95% confidence interval (CI) 1.11-1.45). According to subgroup analysis, study design, region, various endpoints, time of follow-up, and patient age were not sources of heterogeneity. In addition, RDW showed prognostic value in retrospective studies (HR = 1.32, 95%CI 1.15-1.51) but not in prospective studies (HR = 1.14, 95%CI 0.78-1.67). Additionally, RDW may serve as a predictive biomarker of PH in Europe (HR = 1.33, 95%CI 1.18-1.49) but not in Asia (HR = 1.20, 95%CI 0.90-1.58). Further analysis indicated that the prognostic value of RDW was influenced by patient age (>44 years: HR = 1.34, 95%CI 1.17-1.55; ≤44 years: HR = 1.20, 95%CI 0.90-1.58) and follow-up (<3 years, HR = 1.36, 95%CI 0.53-3.47; ≥3 years, HR = 1.29, 95%CI 1.14-1.45).RDW provides important prognostic information for PH patients, and this measure may be used to optimize patient management and guide clinical treatment.PROSPERO registration number: CRD42019122636.

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)夜间收缩压波动的特点及相关因素分析.方法 选取2018年7月至2019年5月本院收治的85例OSAHS患者和11例单纯打鼾者为研究对象,根据睡眠呼吸暂停低通气指数(AHI)将患者分为3组:重度OSAHS组(AHI≥30,n=58)和轻中度OSAHS组(5≤AHI<30,n=27),对照组(AHI<5,n=11).同时行脉搏波传导时间法(PTT)无创血压监测.比较各组夜间收缩压波动(NSBPF)指数、AHI、ODI、TST90、觉醒及血压并行相关性分析.结果 重度OSAHS组NSBPF指数、夜间收缩压、舒张压高于对照组及轻中度OSAHS组(P<0.05).多元线性回归分析示AHI、微觉醒指数是影响夜间收缩压波动指数的重要因素.结论 夜间收缩压波动指数与OSAHS患者的严重程度相关,而影响夜间收缩压波动指数的独立相关因素除AHI外,还有觉醒指数.

Background: To determine the diagnostic accuracy of techniques with chronic thromboembolic pulmonary hypertension (CTEPH) patients via a protocol for systemic review and network meta-analysis. Methods: We will search PubMed, EMBASE, Web of Science, and Google Scholar from inception to October 1, 2018. The reference lists of the retrieved articles are also consulted. Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) will be used to assess the risk of bias in each study. The direct meta-analyses, network meta-analyses, and ranking of competing diagnostic tests will be used by STATA 12.0 and WINBUGS 1.4. Heterogeneity and inconsistency are assessed. Results: This study is ongoing, will be submitted to a peer-reviewed journal publication once completed. Conclusion: This study will provide a comprehensive evidence summary of diagnostic test accuracy in detecting the CTEPH, and can help patients and clinicians to select appropriate or best diagnostic test. Ethics and Communication: No ethical approval and patient consent are required, because it is based on published researches.

咳嗽是呼吸专科门诊和社区门诊患者最常见的症状,在国内社区门诊中,咳嗽患者约占2/3以上.咳嗽可按持续时间分为急性、亚急性或慢性咳嗽,其中后二者大多属于非威胁生命的迁延病症,是社区及基层医疗门诊常见的疑难问题.而亚急性咳嗽最常见的病因为感染后咳嗽(postin-fectious cough,PIC),对比慢性咳嗽其病因相对简单,所需检查设备及治疗药物都相对简单,如果理论认识深入,可以在社区及基层得到解决.

Phosphatase and tensin homolog (PTEN) plays an important role in the pathogenesis of hypoxic pulmonary hypertension (HPH). A decrease in PTEN expression is associated with the hypermethylation of its promoter. However, whether the demethylation of the PTEN gene could attenuate HPH remains unknown. 5-Aza-2 '-deoxycytidine (5-Aza-dC) is a DNA methyltransferase (DNMT) inhibitor. The present study was designed to investigate the effects and mechanisms of 5-Aza-dC on HPH. The proliferation, migration and apoptosis of rat pulmonary artery smooth muscle cells (PASMCs) induced by hypoxia and treated with 5-Aza-dC were detected. The expression of PTEN and DNMTs and the PTEN methylation status of PASMCs were detected. SD rats were randomly divided into normal group, hypoxia group and hypoxia + 5-Aza-dC group. The expression of PTEN was decreased, the expression of DNMTs was increased, and the methylation status of PTEN was increased in hypoxia-induced PASMCs. However, 5-Aza-dC can rescue the decreased PTEN, inhibit DNMT levels in a dose-dependent manner and suppress PTEN methylation. Furthermore, the demethylation of PTEN, which was induced by 5-Aza-dC, inhibited the proliferation, migration and promoted apoptosis in PASMCs. In vivo studies further demonstrated that the expression of PTEN, mean pulmonary artery pressure and right ventricular hypertrophy index in HPH rats was attenuated by 5-Aza-dC. 5-Aza-dC also suppressed the expression of DNMTs and PTEN methylation in the lungs of HPH rats. These results indicated that PTEN promoter methylation status is involved in HPH. 5-Aza-dC, as a DNMT inhibitor, has the potential to attenuate HPH via demethylation of the PTEN promoter.

目的 探讨主肺动脉直径/主动脉直径比值(pulmonary artery to aortic ratio,rPA)、右心室收缩压(right ventricular systolic pressure,RVSP)及两者复合指数在预测慢性阻塞性肺疾病急性加重的临床应用价值.方法 选择肺功能Ⅱ～Ⅳ级的慢性阻塞性肺疾病患者81例,根据临床症状分为急性加重期组46例和临床缓解期组35例,测量2组患者的主肺动脉直径、主动脉直径、RVSP,并计算得出rPA,进行Pearson相关分析,采用ROC曲线下面积判断rPA、RVSP和两者复合指数的诊断价值.结果 急性加重期组rPA和RVSP及两者复合指数明显高于临床缓解期组[0.92±0.16 vs0.83±0.15,(47.00±21.58)mm Hg(1 mm Hg=0.133 kPa) vs(31.00±12.76)mm Hg,28.06±8.81 vs 22.67±7.02],差异有统计学意义(P＜0.01),rPA和RVSP及两者复合指数的ROC曲线下面积分别为0.701(95％CI:0.585～0.817)、0.731(95％CI:0.621～0.840)、0.751(95％CI:0.644～0.857),三者均对慢性阻塞性肺疾病急性加重有中等程度的预测价值,三者诊断价值比较差异无统计学意义(P＞0.05).结论 rPA、RVSP及两者复合指数对于慢性阻塞性肺疾病急性加重有一定程度的预测价值.

目前慢性阻塞性肺疾病合并支气管扩张症在中重度慢性阻塞性肺疾病患者中越来越常见,慢性阻塞性肺疾病合并支气管扩张有与慢性阻塞性患者更严重的临床表现,其治疗也有较大异质性,因此借助影像学对慢性阻塞性肺疾病合并支扩患者的评估,将有助于慢阻肺合并支气管扩张症患者的治疗.

Objective To research the correlation of CT Bhalla score and clinical symptoms of COPD pa-tients complicated with bronchodilatation, in order to explore the method of CT evaluation and to confirm its imaging types and clinical features. Methods This research adopted prospective clinical case-control study method, and the research objects included 144 patients. According to the visual grading result of CT Bhalla, COPD patients were di-vided into two groups. The differences in clinical manifestations, BODE, CAT, and part of lung function were com-pared between the two groups. Results They were classified into two groups according to CT findings. The group A was COPD patients without bronchiectasis (n=72), including 50 male and 22 female from 46-88 years old, with an average of 69. 56 ± 9. 09 years old. The group B was COPD patients complicated with bronchiectasis (n=72), inclu-ding 55 male and 17 female from 28-89 years old, with an average age of 65. 67 ± 13. 10. There were significant differences in clinical characteristics, pulmonary function, Bhalla score, BODE index and acute exacerbation between the two groups. Conclusion It is very necessary for COPD patients with bronchiectasis to make active precautionary&nbsp;measures during early period. As a complement for conventional lung function, CT Bhalla score can also be used to e-valuate the quality of life and prognosis.

目的 观察气压治疗预防老年内科患者深静脉血栓(DVT)的形成的临床疗效.方法将85例wells 评分达到高度可能的老年患者(年龄>60岁)分成两组,治疗组采用间隙充气加压泵(ntermittent pneumatic compression,IPC)预防,对照组采用低剂量的低分子肝素预防.通过比较两组间患者D-二聚体、纤维蛋白原、抗凝血酶Ⅲ(AT-Ⅲ)指标数值的差异以及下肢血管彩色多普勒超声检查深静脉血栓检出率.结果 气压预防组与对照组 D-二聚体值、纤维蛋白原、抗凝血酶Ⅲ(AT-Ⅲ)指标数值差异无统计学意义气压预防.气压预防组与对照组下肢血管彩色多普勒超声检查深静脉血栓检出率差异无统计学意义.结论 IPC能够预防老年内科患者静脉血栓(DVT),临床预防效果与低分子肝素相当.

Objective The study was purposed to investigate the antioxidation and its mechanism of resveratrol in the acrolein-stimulated rats with chronic obstructive pulmonary disease(COPD).Methods During the experiments,rats were randomly divided into five groups,including the blank control group,the acrolein-stimulated group(6.87 μg/L)and three prevention groups(acrolein treatment after giving resveratrol at 5,15 and 45 mg/Kg.d for 1 h,respectively).Pulmonary function indicators were detected including lung compliance(CL),0.3 seconds forced expiratory volume(FEV0.3)/forced vital capacity(FVC),peak expiratory flow(PEF)and maximal mid-expiratory flow(MMF).The content of prostaglandin E2(PGE2)was measured by Griess reagent and ELISA.The mRNA and protein levels of proinflammatory enzymes cyclooxygenase-2(COX-2)and nuclear transcription factor-κB /p65(NF-κB /p65)were analyzed by RT-PCR.And the phosphorylation levels of p38 MAPK was measured by western blotting.Results Compared with the model group,the level of CL and the ratio of FEV0.3/FVC were increased significantly after treatment with resveratrol.Resveratrol significantly attenuated the acrolein-induced expression of prostaglandin E2(PGE2),COX-2 and NF-κB /p65 in a dose-dependent manner.And resveratrol could attenuate p38 MAPK phosphorylation in rats.Conclusion The results demonstrated that the mechanism of intervention effect of resveratrol on rat COPD may be associated with the lower p38 MAPK phosphorylation level inhibiting the release of inflammatory proteases.

<正>白藜芦醇(resveratrol,RES),化学名称3,4',5-三羟基二苯乙烯,属于非黄酮类多酚化合物,是植物遇到真菌感染、紫外线照射等不利条件时产生的植物抗毒素。研究发现白藜芦醇具有广泛的生理、药理活性,如抗炎、抗氧化、抗肿瘤、心血管保护及延长寿命等。近年来白藜芦醇对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的防治作用成为研究的热点。氧化/抗氧化失衡,是COPD的重要发病机