OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicent...OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.展开更多
Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,p...Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,prospective cohort study was conducted,enrolling 807 patients with NSTE-ACS who underwent PCI between 2012 and 2015.展开更多
BACKGROUND For palliation of malignant biliary obstruction(MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography(ERCP)with the placement of metallic stents. Endoscopic ul...BACKGROUND For palliation of malignant biliary obstruction(MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography(ERCP)with the placement of metallic stents. Endoscopic ultrasound(EUS)-guided drainage is an alternative that is typically reserved for cases of ERCP failure.Recently, however, there have been robust randomized clinical trials(RCTs)comparing EUS-guided drainage and ERCP as primary approaches to MBO.AIM To compare EUS guidance and ERCP in terms of their effectiveness and safety in palliative biliary drainage for MBO.METHODS This was a systematic review and meta-analysis, in which we searched the MEDLINE, Excerpta Medica, and Cochrane Central Register of Controlled Trials databases. Only RCTs comparing EUS and ERCP for primary drainage of MBO were eligible. All of the studies selected provided data regarding the rates of technical and clinical success, as well as the duration of the procedure, adverse events, and stent patency. We assessed the risk of biases using the Jadad score and the quality of evidence using the Grading of Recommendations Assessment,Development and Evaluation criteria.RESULTS The database searches yielded 5920 records, from which we selected 3 RCTs involving a total of 222 patients(112 submitted to EUS and 110 submitted to ERCP). In the EUS and ERCP groups, the rate of technical success was 91.96%n and 91.81%, respectively, with a risk difference(RD) of 0.00%(95%CI:-0.07, 0.07;P = 0.97; I^2 = 0%). The clinical success was 84.81% and 85.53% in the EUS and ERCP groups, respectively, with an RD of-0.01%(95%CI:-0.12, 0.10; P = 0.90; I^2 =0%). The mean difference(MD) for the duration of the procedure was-0.12%(95%CI:-8.20, 7.97; P = 0.98; I^2 = 84%). In the EUS and ERCP groups, there were14 and 25 adverse events, respectively, with an RD of-0.06%(95%CI:-0.23, 0.12; P= 0.54; I^2 = 77%). The MD for stent patency was 9.32%(95%CI:-4.53, 23.18; P =0.19; I^2 = 44%). The stent dysfunction rate was significantly lower in the EUS t group(MD =-0.22%; 95 CI:-0.35,-0.08; P = 0.001; I^2 = 0%).CONCLUSION EUS represents an interesting alternative to ERCP for MBO drainage,demonstrating lower stent dysfunction rates compared with ERCP. Technical and clinical success, duration, adverse events and patency rates were similar.展开更多
BACKGROUND Hepatobiliary tuberculosis is a challenging disease that poses diagnostic difficulties due to its resemblance to other etiologies.Delayed diagnosis may lead to inadequate treatment,thus necessitating an urg...BACKGROUND Hepatobiliary tuberculosis is a challenging disease that poses diagnostic difficulties due to its resemblance to other etiologies.Delayed diagnosis may lead to inadequate treatment,thus necessitating an urgent need for accurate diagnosis and appropriate management.AIM To systematically review case reports on hepatobiliary tuberculosis,focusing on symptomatology,diagnostic procedures,management,and outcomes to provide patient safety and ensure an uneventful recovery.METHODS A systematic search was conducted on PubMed from 1992 to 2022,using keywords such as hepatobiliary,liver,tuberculosis cholangitis,cholangiopathy,and mycobacterium.Only case reports or case series in English were included in the study,and research papers published as abstracts were excluded.The search yielded a total of 132 cases,which were further narrowed down to 17 case studies,consisting of 24 cases of hepatobiliary tuberculosis.RESULTS The 10 most common symptoms observed in these cases were fever,abdominal pain,weight loss,jaundice,anorexia,generalized weakness,pruritus,chills,fatigue,and chest pains.Objective findings in these cases included hepatomegaly,hepatic nodules,elevated liver enzymes,and elevated bilirubin.Computed tomography scan and ultrasound of the abdomen were the most useful diagnostic tools reported.Histologic demonstration of Mycobacterium tuberculosis confirmed the cases of hepatobiliary tuberculosis.Treatment regimens commonly used included Rifampicin,Isoniazid,Pyrazinamide,and Ethambutol.Out of the 24 cases,18 presented improvements while 4 had completely recovered.CONCLUSION Hepatobiliary tuberculosis is a disease that requires accurate diagnosis and appropriate management to avoid complications.展开更多
Background Opisthorchiasis,caused by Opisthorchis viverrini,poses a significant health risk in northeastern Thailand,increasing the prevalence of cholangiocarcinoma.This study implemented a One Health integrated strat...Background Opisthorchiasis,caused by Opisthorchis viverrini,poses a significant health risk in northeastern Thailand,increasing the prevalence of cholangiocarcinoma.This study implemented a One Health integrated strategy,targeting human,animal,and environmental factors to reduce O.viverrini prevalence and transmission in an endemic region.Methods The study was conducted from 2016 to 2022 in the Huay Luang Reservoir area,Udon Thani Province,Thailand and enrolled 5412 participants.Annual stool examinations were conducted and participants found to be infected with O.viverrini received anthelmintic treatments.Other intervention methods included health education,snail control,veterinary care,sanitation improvements,training of health volunteers,creating a learning center and liver fluke-free fish production.Annual data on prevalence,infection intensity,and reinfection rates were collected.Student’s t-test,one-way ANOVA,Chi-square test,or Fisher’s exact test were used to compare data across the study years,with statistical significance set at P<0.05.Results The One Health strategy significantly reduced O.viverrini prevalence in humans from 14.1%in 2016 to 0.9%in 2022,with O.viverrini-egg intensity decreasing from 76.9 to 25.5 eggs per gram(EPG)(P<0.001).Reinfection rates decreased significantly from 17.4%in 2016 to 9.7%in 2022 following the implementation of the program(P=0.003).Among reservoir hosts,infections in dogs and cats significantly decreased from 21.3%to 3.8%(P<0.001).In cyprinoid fish,metacercarial prevalence significantly decreased from 21.9%to 2.2%(P<0.001).Awareness of transmission routes rose from 45.1%to 82.6%,and raw fish consumption decreased from 52.4%to 12.3%.Biological control reduced Bithynia snail densities from 30 to under 5 snails/m^(2),while sanitation interventions increased toilet use from 31.7%to 87.1%.A local fish-processing enterprise enhanced food safety and income.Health volunteers engaged 94%of households,and a learning center trained 250 individuals and hosted site visits.Conclusions The One Health strategy effectively and sustainably limited O.viverrini infections and reinfections,demonstrating the potential of One Health as a model for zoonotic parasite control in other endemic areas.展开更多
基金supported by the National Key Research and Development Program of China(No.2022YFC3602500)Beijing High-level Public Health Technical Talents Construction Project(Discipline Leader-03-24)Beijing Hospitals Authority’s Ascent Plan(DFL20240601).
文摘OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.
文摘Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,prospective cohort study was conducted,enrolling 807 patients with NSTE-ACS who underwent PCI between 2012 and 2015.
文摘BACKGROUND For palliation of malignant biliary obstruction(MBO), the gold-standard method of biliary drainage is endoscopic retrograde cholangiopancreatography(ERCP)with the placement of metallic stents. Endoscopic ultrasound(EUS)-guided drainage is an alternative that is typically reserved for cases of ERCP failure.Recently, however, there have been robust randomized clinical trials(RCTs)comparing EUS-guided drainage and ERCP as primary approaches to MBO.AIM To compare EUS guidance and ERCP in terms of their effectiveness and safety in palliative biliary drainage for MBO.METHODS This was a systematic review and meta-analysis, in which we searched the MEDLINE, Excerpta Medica, and Cochrane Central Register of Controlled Trials databases. Only RCTs comparing EUS and ERCP for primary drainage of MBO were eligible. All of the studies selected provided data regarding the rates of technical and clinical success, as well as the duration of the procedure, adverse events, and stent patency. We assessed the risk of biases using the Jadad score and the quality of evidence using the Grading of Recommendations Assessment,Development and Evaluation criteria.RESULTS The database searches yielded 5920 records, from which we selected 3 RCTs involving a total of 222 patients(112 submitted to EUS and 110 submitted to ERCP). In the EUS and ERCP groups, the rate of technical success was 91.96%n and 91.81%, respectively, with a risk difference(RD) of 0.00%(95%CI:-0.07, 0.07;P = 0.97; I^2 = 0%). The clinical success was 84.81% and 85.53% in the EUS and ERCP groups, respectively, with an RD of-0.01%(95%CI:-0.12, 0.10; P = 0.90; I^2 =0%). The mean difference(MD) for the duration of the procedure was-0.12%(95%CI:-8.20, 7.97; P = 0.98; I^2 = 84%). In the EUS and ERCP groups, there were14 and 25 adverse events, respectively, with an RD of-0.06%(95%CI:-0.23, 0.12; P= 0.54; I^2 = 77%). The MD for stent patency was 9.32%(95%CI:-4.53, 23.18; P =0.19; I^2 = 44%). The stent dysfunction rate was significantly lower in the EUS t group(MD =-0.22%; 95 CI:-0.35,-0.08; P = 0.001; I^2 = 0%).CONCLUSION EUS represents an interesting alternative to ERCP for MBO drainage,demonstrating lower stent dysfunction rates compared with ERCP. Technical and clinical success, duration, adverse events and patency rates were similar.
文摘BACKGROUND Hepatobiliary tuberculosis is a challenging disease that poses diagnostic difficulties due to its resemblance to other etiologies.Delayed diagnosis may lead to inadequate treatment,thus necessitating an urgent need for accurate diagnosis and appropriate management.AIM To systematically review case reports on hepatobiliary tuberculosis,focusing on symptomatology,diagnostic procedures,management,and outcomes to provide patient safety and ensure an uneventful recovery.METHODS A systematic search was conducted on PubMed from 1992 to 2022,using keywords such as hepatobiliary,liver,tuberculosis cholangitis,cholangiopathy,and mycobacterium.Only case reports or case series in English were included in the study,and research papers published as abstracts were excluded.The search yielded a total of 132 cases,which were further narrowed down to 17 case studies,consisting of 24 cases of hepatobiliary tuberculosis.RESULTS The 10 most common symptoms observed in these cases were fever,abdominal pain,weight loss,jaundice,anorexia,generalized weakness,pruritus,chills,fatigue,and chest pains.Objective findings in these cases included hepatomegaly,hepatic nodules,elevated liver enzymes,and elevated bilirubin.Computed tomography scan and ultrasound of the abdomen were the most useful diagnostic tools reported.Histologic demonstration of Mycobacterium tuberculosis confirmed the cases of hepatobiliary tuberculosis.Treatment regimens commonly used included Rifampicin,Isoniazid,Pyrazinamide,and Ethambutol.Out of the 24 cases,18 presented improvements while 4 had completely recovered.CONCLUSION Hepatobiliary tuberculosis is a disease that requires accurate diagnosis and appropriate management to avoid complications.
基金supported by the Program Management Unit Competitiveness(PMUC),Thailandthe Fundamental Fund of Khon Kaen University,under the National Science,Research and Innovation Fund(NSRF),Thailandthe Reinventing University scheme of Khon Kaen University,Thailand.
文摘Background Opisthorchiasis,caused by Opisthorchis viverrini,poses a significant health risk in northeastern Thailand,increasing the prevalence of cholangiocarcinoma.This study implemented a One Health integrated strategy,targeting human,animal,and environmental factors to reduce O.viverrini prevalence and transmission in an endemic region.Methods The study was conducted from 2016 to 2022 in the Huay Luang Reservoir area,Udon Thani Province,Thailand and enrolled 5412 participants.Annual stool examinations were conducted and participants found to be infected with O.viverrini received anthelmintic treatments.Other intervention methods included health education,snail control,veterinary care,sanitation improvements,training of health volunteers,creating a learning center and liver fluke-free fish production.Annual data on prevalence,infection intensity,and reinfection rates were collected.Student’s t-test,one-way ANOVA,Chi-square test,or Fisher’s exact test were used to compare data across the study years,with statistical significance set at P<0.05.Results The One Health strategy significantly reduced O.viverrini prevalence in humans from 14.1%in 2016 to 0.9%in 2022,with O.viverrini-egg intensity decreasing from 76.9 to 25.5 eggs per gram(EPG)(P<0.001).Reinfection rates decreased significantly from 17.4%in 2016 to 9.7%in 2022 following the implementation of the program(P=0.003).Among reservoir hosts,infections in dogs and cats significantly decreased from 21.3%to 3.8%(P<0.001).In cyprinoid fish,metacercarial prevalence significantly decreased from 21.9%to 2.2%(P<0.001).Awareness of transmission routes rose from 45.1%to 82.6%,and raw fish consumption decreased from 52.4%to 12.3%.Biological control reduced Bithynia snail densities from 30 to under 5 snails/m^(2),while sanitation interventions increased toilet use from 31.7%to 87.1%.A local fish-processing enterprise enhanced food safety and income.Health volunteers engaged 94%of households,and a learning center trained 250 individuals and hosted site visits.Conclusions The One Health strategy effectively and sustainably limited O.viverrini infections and reinfections,demonstrating the potential of One Health as a model for zoonotic parasite control in other endemic areas.
