Objective To explore the potential role of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide(NT-proBNP) in the assessment of patients with connective tissuediseases(CTD) associated pulmonary arterial hypertension (PAH). Methods Thirty patients with CTD associated PAH were evaluated by WHO function, echocardiography, right heart catheterization and blood biomarkers. All the clinical data was analyzed statistically. Results All patients [age (39.5 ± 11.6) yr]were female. Both NT-proBNP and BNP were significantly increased and significantly correlated ( all P ＜0. 05 ) respectively with mean pulmonary arterial pressure ( r = 0. 53 and r = 0. 40 ), right arterial pressure ( r = 0. 55 and r = 0. 42 ), pulmonary vascular resistance ( r = 0. 69 and r = 0. 61 ), cardiac index ( r = - 0. 58and r = - 0. 46), mixed venous blood oxygen saturation ( r = - 0. 62 and r = - 0. 54 ), pericardial effusion ( r = 0. 46 and r = 0. 43 ), right atrial sizes ( r = 0. 40 and 0. 53, and r = 0. 39 and 0. 45 ) and right ventricular size ( r = 0. 55 and r = 0. 37 ). Furthmore, NT-proBNP, but not BNP, significantly correlated with WHO function class ( r = 0. 55 ). Conclusion Blood NT-proBNP and BNP were elevated in patients with CTD associated PAH and paralleled the extent of function class, pulmonary hemodynamic changes and right ventricular remodeling.

Objective To explore the relationship among personality traits,aggression,depression,anxiety and suicide ideation by developing a structural equation model.MethodsA total of 2141 participants derived from a stratified random cluster sampling were investigated with Eysenck personality questionnaire(EPQ),aggression questionnaire(AQ),patient health questionnaire depression scale(PHQ-9) ,generalized anxiety disorder scale(GAD-7) and Beck depression inventory(BDI-13).ResultsIn EPQ,the scores of neuroticism,extroversion and psychoticism were (40.00±5.84),(59.84±7.02)and (36.63±6.41) respectively.In AQ,the scores of physical aggression,verbal aggression and anger were (32.41±5.15),(30.43±7.24),and (34.39±6.09) respectively.The median scores of PHQ-9 and GAD-7 were 5 and 6,and the inter-quartile range were 4 and 5.The suicide ideation was correlated with measurement indicator respectively(r=-0.19-0.40,P<0.01).Aggression and depression directly affected suicide ideation(direct effect was 0.27,0.24 respectively) and aggression indirectly affected suicide ideation trough anxiety(indirect effect was 0.02).Personality traits indirectly affected suicide ideation through aggression,anxiety and depression(indirect effect was 0.40).Anxiety indirectly affected suicide ideation through depression(indirect effect was 0.13).ConclusionPersonality traits,aggression,anxiety and depression affect suicide ideation,and these factors have different effecting mechanism.

A 17-year-old young man with a history of swollen leg and intermittent jaundice was presented to Peking Union Medical College Hospital with acute fever and mental disturbance.He developed deep venous thrombosis,acute myocardial infarction and plantar skin necrosis during the past four years,and was presented with an acute episode of fever,thrombocytopenia,acute kidney injury,acute myocardial infarction,mental disturbance,and obstructive jaundice.Laboratory tests showed schistocytes on peripheral blood smear.High titer of antiphospholipid antibodies was detected.Strikingly,the activity of a disintegrin and metalloprotease with a thrombospondin type 1 motif,member 13 (ADAMTS13)was significantly decreased without the production of inhibitors.Images indicated stenosis of the common bile duct,common hepatic duct,and cystic duct,which caused dilation of bile ducts and the gall bladder.Corticosteroids and anticoagulation therapy were effective at first,but the disease relapsedonce the corticosteroids tapered down.Plasma exchange was administrated for 17 times,which was effective temporarily during this episode.Methylprednisolone pulse therapy,intravenous immunoglobulin,rituximab,anticoagulation therapy,and bile drainage,were all tried but still could not control the disease.The patient's family agreed to withdraw treatment after he developed septic shock.