Feng-Ming Luo’s research while affiliated with Sichuan University and other places

A 62-year-old woman was admitted for progressive dyspnoea and oedema. She had been diagnosed with autoimmune hepatitis 10 years earlier. Transthoracic echocardiography (TTE) showed severe tricuspid regurgitation and pulmonary hypertension (PH) with an estimated systolic pressure of 170 mmHg (Panel A). Left ventricular wall thickness and systolic function were normal. Colour Doppler revealed turbulence in the left ventricular outflow tract (LVOT) with a peak pressure gradient of 86 mmHg (Panels B and C). Systolic anterior motion of the mitral valve was noted. Computed tomographic angiography excluded pulmonary embolism and intra-cardiac abnormalities and corroborated echocardiographic findings by demonstrating markedly dilated pulmonary artery and right heart and protrusion of the basal segment of the inter-ventricular septum towards the LVOT (Panels D and E), which explained the mechanism of LVOT obstruction (Panel F and Supplementary data online, Video S1). She was treated with oxygen, methylprednisolone, furosemide, spironolactone, and ambrisentan. Repeated TTE 1 week later showed improved PH and resolution of LVOT obstruction (Panels G–I). Myocardial contrast echocardiography excluded ventricular hypertrophy (see Supplementary data online, Videos S2 and S3). She was discharged with significantly relieved symptoms but unfortunately died of sudden death 2 weeks later.

Background: Ventilatory ratio (VR) is a simple bedside index of ventilatory efficiency. Interstitial lung disease (ILD) is a diverse group of diseases that causes fibrosis or inflammation of the pulmonary parenchyma, and the main clinical manifestation is hypoxemia. To date, no study has explored ventilation efficiency in patients with ILD. Objectives: This study aimed to explore the features of VR in mechanically ventilated patients with ILD and their relationship with intensive care unit (ICU) mortality. Methods: In this retrospective analysis, we included mechanically ventilated patients with ILD in the ICU of West China Hospital, Sichuan University, from 2013 to 2021. Demographic data and mechanical ventilation (MV) parameters within 24 h of intubation were collected. The characteristics of VR and their relationships with ICU mortality were also analyzed. Results: 224 patients were included in the final analysis. There were 146 males (53.9%), and the median age was 65 years (interquartile range [IQR]54∼74). The mean value of VR was 2.22, and VR was significantly higher in nonsurvivors than in survivors (1.79 vs 2.32, P < 0.001). A high VR value was an independent risk factor for ICU mortality (odds ratio=1.602, P = 0.038) after adjustment. A high value of VR was associated with a shorter survival time after admission to ICU (hazard ratio=1.485, P = 0.006) CONCLUSIONS: VR in patients with ILD on MV was increased, and the VR of nonsurvivors within 24 h of intubation was higher than that of survivors. The high VR value within 24 h of intubation was an independent risk factor for ICU mortality after adjusting for other factors.

Background Connective tissue disease(CTD) associated interstitial lung diseases (ILDs) is a common chronic disease. Given that anxiety and depression are prevalent in patients with chronic diseases, this study aimed to explore the prevalence of anxiety/depression in CTD-ILD patients, and identify its associated risk factors. Methods This study is based on the ICE study (Interstitial lung disease in West China Hospital: a 24-month prospective Cohort in the real world). The anxiety and depression symptoms were evaluated in CTD-ILD patients using Hamilton Anxiety/Depression Rating Scale (HAM-A/D), respectively. Demographic data, clinical symptoms, pulmonary function, and radiological data were collected. Multivariate analysis was performed to identify the independent risk factors of anxiety/depression in CTD-ILD patients. Result A total of 118 patients with CTD-ILD were enrolled. Among them, 66 patients (55.93%) with anxiety symptoms (HAM-A > 7), 55 patients (46.61%) with depression symptoms (HAM-D > 8), while 51patients (43.22%) with both anxiety and depression symptoms. Muscle soreness (OR = 3.451, 95% CI: 1.147–10.384, P = 0.028) is significantly associated with anxiety. And muscle soreness (OR = 4.337, 95% CI: 1.43–13.154, P = 0.01), Raynaud's phenomenon (OR = 4.264, 95% CI: 1.355–13.424, P = 0.013), and lower FVC% predicted (OR = 1.768, 95% CI: 1.152–2.714, P = 0.018) are significantly associated with depression. Besides, muscle soreness (OR = 4.737, 95% CI: 1.451–15.463, P = 0.010), lower FVC% predicted (OR = 1.649, 95% CI: 1.067–2.549, P = 0.024) and more severe dyspnea scaled by mMRC score (OR = 1.725, 95% CI: 1.075–2.769, P = 0.024) were associated with comorbid depression and anxiety. Conclusion Anxiety and depression were common in CTD-ILD patients. Impaired respiratory physiology (reduced FVC% predicted, dyspnea) and CTD related symptoms (Raynaud's phenomenon and muscle soreness) were risk factors for anxiety and depression in CTD-ILD patients, which emphasize the importance of focusing on the management of psychological disorders in CTD-ILD patients.

Objectives We investigated the safety and feasibility of CT-guided transthoracic pulmonary artery catheterization (TPAC) in a porcine model.Methods Procedures were conducted on ten mature Bama miniature pigs. After anesthesia, chest CT was performed in the left lateral decubitus position to determine the puncture route. Under the guidance of multiple CT scans, the introducer sheath was inserted from the right chest wall of the pig into the right pulmonary artery using the Seldinger technique. Then, a catheter connected with a transducer was inserted into the sheath to measure the pulmonary artery pressure. Finally, an active approximator was used to close the puncture site on the pulmonary artery. The pigs were followed up for 8 weeks to evaluate the operation-related complications and survival.ResultsTen of 11 CT-guided TPAC procedures were successfully performed on ten pigs, rendering a technical success rate of 90.9%. One pig had hemoptysis while the needle was being inserted during the first operation, and a second procedure was successfully conducted 17 days later. Other complications, including pulmonary bleeding along the needle track (3 of 11; 27.3%), unclosed pulmonary artery puncture sites (3 of 10; 30%), pneumothorax (1 of 11; 9.1%), and hemopericardium (1 of 11; 9.1%), spontaneously resolved without complication-specific treatment. The mean pulmonary arterial pressure was 32 ± 17.6 mmHg. All animals survived the procedure and reached the end of the follow-up period.ConclusionsCT-guided TPAC is feasible and safe in a porcine model, serving as a potential alternative pathway for pulmonary artery intervention.Key Points• TPAC is feasible and safe in a porcine model, serving as a potential alternative pathway for pulmonary artery intervention. • This novel approach allows for faster access to the pulmonary artery, and it might be easier to operate the tip of the catheter to super-select the intent branch of the pulmonary artery. • TPAC can be an alternative pulmonary artery intervention pathway in patients with mechanical right-heart valves, great-vessel transposition, and other obstacles.

Objectives: To investigate the clinical characteristics and outcomes on the success of bronchial arterial embolization (BAE) in patients with and without systemic artery-to-pulmonary vessel fistula (SA-PF) and to evaluate the feasibility of CTA in the assessment of SA-PF. Methods: We retrospectively enrolled 420 consecutive patients that underwent BAE for hemoptysis control in our hospital from September 2011 to May 2019. The clinical characteristics, preprocedural CTA findings, BAE procedural findings, and follow-up outcomes were collected. Patients were divided into two groups according to DSA findings: patients with SA-PF and those without. Results: A total of 184 (43.7%) patients presented with SA-PF. Pneumonia was less likely to be the concomitant condition in patients with SA-PF (p < 0.001). The mean number of culprit arteries per patient was significantly higher in patients with SA-PF compared to that in patients without SA-PF (p = 0.017). The SA-PF patients saw a greater probability of recurrence (HR: 2.782, 95% CI: 1.617-4.784, p < 0.001). SA-pulmonary venous fistula (SA-PVF) favored lower hemoptysis recurrence rate (HR: 0.199, 95%CI: 0.052-0.765, p = 0.019). SA-pulmonary artery fistula (SA-PAF) can be detected by optimized CTA protocol with a detection rate of 65.3% (49/75). Conclusions: The presence of SA-PF is an independent risk factor predicting early recurrence of hemoptysis after BAE. SA-PVF seems to be a protective factor for longer hemoptysis control compared to SA-PAF. Optimized preprocedural CTA is a reliable examination to identify SA-PAF. Key points: • The appearance of SA-PF is associated with a greater probability of early recurrent hemoptysis after bronchial artery embolization. • The presence of SA-PVF seems to be a protective factor for longer hemoptysis control after BAE compared to SA-PAF. • Optimized CTA protocol seems to be a promising auxiliary examination to detect SA-PAF.

Background MicroRNA-30a (miRNA-30a) levels have been shown to increase in the plasma of lung cancer patients. Herein, we evaluated the miRNA-30a levels in the bronchoalveolar lavage fluid (BALF) of lung cancer patients as a potential biomarker for lung cancer diagnosis. Methods BALF miRNA-30a expression of 174 subjects was quantified using quantitative real-time reverse transcription-polymerase chain reaction and compared between lung cancer patients and control patients with benign lung diseases. Moreover, its diagnostic value was evaluated by performing receiver operating characteristic (ROC) curve analysis. Results The relative BALF miRNA-30a expression was significantly higher in the lung cancer patients than in the controls (0.74 ± 0.55 versus 0.07 ± 0.48, respectively, p < 0.001) as well as in lung cancer patients with stage I–IIA disease than in those with stage IIB–IV disease (0.98 ± 0.64 versus 0.66 ± 0.54, respectively, p < 0.05). Additionally, miRNA-30a distinguished benign lung diseases from lung cancers, with an area under the ROC curve (AUC) of 0.822. ROC analysis also revealed an AUC of 0.875 for the Youden index-based optimal cut-off points for stage I–IIA adenocarcinoma. Thus, increased miRNA-30a levels in BALF may be a useful biomarker for non-small-cell lung cancer diagnosis.

Background Subjects with chronic respiratory symptoms and preserved pulmonary function (PPF) may have small airway dysfunction (SAD). As the most common means to detect SAD, spirometry needs good cooperation and its reliability is controversial. Impulse oscillometry (IOS) may complete the deficiency of spirometry and have higher sensitivity. We aimed to explore the diagnostic value of IOS to detect SAD in symptomatic subjects with PPF. Methods The evaluation of symptoms, spirometry and IOS results in 209 subjects with chronic respiratory symptoms and PPF were assessed. ROC curves of IOS to detect SAD were analyzed. Results 209 subjects with chronic respiratory symptoms and PPF were included. Subjects who reported sputum had higher R5–R20 and Fres than those who didn’t. Subjects with dyspnea had higher R5, R5–R20 and AX than those without. CAT and mMRC scores correlated better with IOS parameters than with spirometry. R5, R5–R20, AX and Fres in subjects with SAD (n = 42) significantly increased compared to those without. Cutoff values for IOS parameters to detect SAD were 0.30 kPa/L s for R5, 0.015 kPa/L s for R5–R20, 0.30 kPa/L for AX and 11.23 Hz for Fres. Fres has the largest AUC (0.665, P = 0.001) among these parameters. Compared with spirometry, prevalence of SAD was higher when measured with IOS. R5 could detect the most SAD subjects with a prevalence of 60.77% and a sensitivity of 81% (AUC = 0.659, P = 0.002). Conclusion IOS is more sensitive to detect SAD than spirometry in subjects with chronic respiratory symptoms and PPF, and it correlates better with symptoms. IOS could be an additional method for SAD detection in the early stage of diseases.

Background: One of the difficulties and hot topics in the field of computer vision and image processing is extraction of the high-level pulmonary trachea from patients' lung CT images. Current, common bronchial extraction methods are limited by the phenomenon of bronchial loss and leakage, and cannot extract the higher-level pulmonary trachea, which does not meet the requirements of guiding lung puncture procedures. Methods: Based on the characteristic "tubular structure" (ring or semi-closed ring) of the pulmonary trachea in CT images, an algorithm based on dynamic tubular edge contour is proposed. In axial, coronal and sagittal CT images, the algorithm could extract the skeletal line of the pulmonary trachea and vessel-connecting region, perform elliptical fitting, extract the pulmonary trachea by the ratio of the ellipse's long and short axes, and obtain point cloud data of the pulmonary trachea in three directions. The point cloud data was fused to obtain a complete three-dimensional model of the pulmonary trachea. Results: The algorithm was verified using CT data from "EXACT09", and could extract the pulmonary trachea to the 10-11 level, which effectively solves the problems of leakage and loss of the trachea. Conclusions: We have constructed a novel extraction algorithm of pulmonary trachea that can guide the doctors to decide the puncture path and avoid the large trachea, which has important theoretical and practical significance for reducing puncture complications and the mortality rate.

The novel coronavirus infection broke out in Wuhan, China, in December 2019, and progressed to a global pandemic. We describe the measures taken by West China Hospital of Sichuan University to address the diagnosis, prevention and treatment of the infection.