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 clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(...Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(PKP)or percutaneous vertebroplasty(PVP)using a network meta-analysis.Methods A systematic search was conducted in PubMed,Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang Database,Chinese Scientific Journal Database,and Chinese Biomedical Literature Database(SinoMed)from their inception to January 15,2025.Outcome measures included the Visual Analog Scale(VAS)score,Oswestry Disability Index(ODI)score,and overall efficacy rate.Literature screening,data extraction,and risk-of-bias assessment were independently performed by two researchers.Data analysis was conducted using Stata 17.0 software.Results A total of 35 randomized controlled trials involving 2860 patients were included.The data analysis revealed that,in terms of improving VAS and ODI scores,the top three effective therapies were Fu's subcutaneous needling,wrist-ankle acupuncture,and acupotomy.For the overall efficacy rates in pain treatment,the top three therapies were wrist-ankle acupuncture,warm acupuncture and moxibustion,and Fu's subcutaneous needling.Based on the combined results across the three outcome measures,Fu's subcutaneous needling was found to be the most effective in relieving pain and improving lumbar function.Conclusion Fu's subcutaneous needling,wrist-ankle acupuncture,warm acupuncture and moxibustion,and acupotomy were all effective in treating postoperative pain post-PKP/PVP and improving lumbar function.However,further high-quality,large-sample studies are required to confirm these findings.展开更多
BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidel...BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy,but there are limited data on elderly patients.METHODS We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features,therapeutic strategies,and outcomes of individuals aged≥80 years and<80 years who were on OAT and underwent PCI with stent.The primary endpoint was net adverse clinical events at 1-year follow-up.Secondary endpoints included major adverse cardiac and cerebral events(MACCE),major bleeding[Bleeding Academic Research Consortium(BARC)type 3–5],and clinically relevant bleeding(BARC type 2-5).RESULTS Among the 1234 patients enrolled,31%of patients were aged≥80 years(84±3 years,76% males).Compared to younger patients,elderly patients had higher rates of comorbidities such as hypertension,anaemia or chronic kidney disease,and atrial fibrillation was the leading indication for OAT.Elderly patients were more often discharged on dual antithrombotic therapy(23%)compared to younger patients(13%)(P<0.0001).They experienced higher net adverse clinical events(38%vs.21%,P<0.001),MACCE(24%vs.12%,P<0.001),as well as higher bleeding rates.Specifically,rates of major bleeding(9%vs.6%,P=0.026),and clinically relevant bleeding(21%vs.12%,P<0.001)were significantly higher in elderly patients.CONCLUSIONS Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.展开更多
BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials e...BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.展开更多
Bcakground: Pancreatic pseudocyst (PPC) is a common complication arising from acute or chronic pancreatitis, trauma, or pancreatic duct obstruction. When acute fluid collection persists for 4 - 6 weeks and is encapsul...Bcakground: Pancreatic pseudocyst (PPC) is a common complication arising from acute or chronic pancreatitis, trauma, or pancreatic duct obstruction. When acute fluid collection persists for 4 - 6 weeks and is encapsulated by a fibrous wall, it is classified as a pancreatic pseudocyst. While PPC is generally asymptomatic in many patients, it can manifest with persistent abdominal pain, dyspepsia, intra-cystic infection, and potentially lead to gastrointestinal obstruction in some cases. Although smaller PPCs may resolve spontaneously, larger PPCs tend to be refractory to absorption and often necessitate surgical intervention to prevent complications such as intracystic hemorrhage. Objective: To explore the efficacy of percutaneous catheterization with negative pressure in the treatment of large pancreatic pseudocysts. Methods: The cases of large pancreatic pseudocysts treated in our hospital from 2004 to 2022 were retrospectively collected, and the general condition, operation time, drainage time, feeding time, postoperative complications, hospital stay, cost and follow-up of the patients were analyzed. Results: A total of 132 patients with large pancreatic pseudocysts were collected. The average operation time was 32.4 ± 2.1 min;The retention time of the drainage tube was 30 ± 1.8 days in the percutaneous negative pressure drainage group;The postoperative feeding time was no fasting after local anesthesia drainage;Postoperative complications (bleeding, infection, pancreatic leakage, recurrence, anastomotic leakage, etc.): Two of the 132 patients had recurrent cysts, which were cured by re-puncture and negative pressure drainage. The length of hospital stay was 6 ± 1.1 days;The cost was 11,200 ± 1300 yuan;Follow-up: The follow-up time ranged from 1 to 3 years, and the patients had no discomfort. Conclusion: Percutaneous catheterization and negative pressure drainage can effectively treat large pancreatic pseudocysts. Compared with other treatment methods, it is simple and effective, the postoperative recovery of patients is faster, the physical damage is less, the hospital stay is shorter, and the cost is lower.展开更多
BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or syste...BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or systemic therapies,often fail to provide sufficient pain relief or improve functional outcomes in these patients.Microwave ablation(MWA)offers advantages,such as shorter pro-cedure times and larger ablation zones,while percutaneous osteoplasty(PO)enhances bone stability and prevents pathological fractures.Despite these be-nefits,the combination of these techniques for treating flat bone metastases re-mains underexplored.AIM To evaluate the efficacy and safety of C-arm computed tomography(CT)-guided MWA combined with PO for managing painful flat bone metastases,focusing on pain relief,functional improvement,and QOL enhancement.METHODS A total of 45 patients with refractory moderate-to-severe pain resulting from flat bone metastases who underwent C-arm CT-guided MWA combined with PO between January 2015 and January 2021 were included.The efficacy of the pro-cedure was assessed by changes in the visual analog scale(VAS),Oswestry disability index(ODI),and QOL,as well as the occurrence of complications.Tumor response was evaluated using RECIST v1.1 and mRECIST criteria,with overall response rate(ORR)and disease control rate(DCR)as the primary end-points.RESULTS No serious complications were observed in any of the patients.A significant reduction in VAS and ODI was noted at 1 week,1 month,and 3 months post-procedure.A marked improvement in QOL was observed at all follow-up points.Bone cement extravasation was observed in 10 patients;however,none exhibited significant clinical symptoms.Based on RECIST v1.1,the ORR was 26.7%and the DCR was 88.9%.The mRECIST evaluation revealed a higher ORR of 51.1%and DCR of 88.9%.CONCLUSION C-arm CT-guided MWA with PO provides a dependable and effective strategy for managing flat bone metastases.It demonstrates significant pain relief,improved functional outcomes,and enhanced QOL.This treatment combination also shows promising tumor response rates with a low complication profile.展开更多
Anticoagulation has long been the standard of care for preventing embolic events in atrial fibrillation(AF).^([1])The elderly AF generation is more susceptible to thromboembolic incidents.They are also more likely to ...Anticoagulation has long been the standard of care for preventing embolic events in atrial fibrillation(AF).^([1])The elderly AF generation is more susceptible to thromboembolic incidents.They are also more likely to encounter hemorrhagic and other complications when using anticoagulants.Therefore,percutaneous left atrial appendage occlusion(pLAAO)is regarded as an appealing alternative therapy for preventing stroke in patients who are poor candidates for long-term anticoagulation.^([2,3])Contemporary patients undergoing pLAAO are typically older and have more comorbidities than those who were enrolled in pivotal randomized controlled trials.展开更多
BACKGROUND Gas-containing pseudocysts rarely cause of lumbar radiculopathy.This report describes successful treatment of a gas-containing pseudocyst using percutaneous transforaminal endoscopy.CASE SUMMARY A 48-year-o...BACKGROUND Gas-containing pseudocysts rarely cause of lumbar radiculopathy.This report describes successful treatment of a gas-containing pseudocyst using percutaneous transforaminal endoscopy.CASE SUMMARY A 48-year-old man presented with severe pain and numbness in his right leg,which worsened upon walking or weight bearing.Computed tomography and magnetic resonance imaging revealed a gas-containing cyst compressing the left L5 nerve root at the L4-5 level.The pseudocyst was successfully removed using a percutaneous transforaminal endoscopic discectomy.Vivid and clear endoscopic imaging of the pseudocysts was performed intraoperatively.The patient experienced immediate pain relief and was discharged one day after the operation.The patient returned to work.Moreover,numbness in the right leg returned to normal within 6 months.At the one-year follow-up,there was no symptoms recurrence.CONCLUSION Transforaminal endoscopy offers excellent surgical visualization and facilitates meticulous operative manipulation,making it a minimally invasive approach for treating gas-containing pseudocysts in the intervertebral foramen.展开更多
BACKGROUND Choledochal cyst is a rare biliary tract disorder with five subtypes categorized based on the anatomical location of cystic dilatation.Type IV(which affects the intrahepatic and extrahepatic ducts)is the mo...BACKGROUND Choledochal cyst is a rare biliary tract disorder with five subtypes categorized based on the anatomical location of cystic dilatation.Type IV(which affects the intrahepatic and extrahepatic ducts)is the most common subtype in adults.Its clinical manifestations are diverse and the disease can potentially become malignant.Currently,the mainstay treatment is surgical excision which is used as a definitive treatment to prevent complications and avoid carcinogenesis.However,the surgical operation for giant choledochal cysts is technically challenging.CASE SUMMARY Here,we present a case of a giant choledochal cyst in an 18-year-old female.The diagnosis of patient was confirmed through magnetic resonance cholangiopancreatography.The patient developed acute cholangitis,and was treated with percutaneous transhepatic cholangial drainage to alleviate symptoms.The final treatment approach was cyst excision followed by Roux-en-Y hepaticojejunostomy,which successfully achieved excellent postoperative recovery.CONCLUSION Ultrasonography and magnetic resonance cholangiopancreatography can effectively diagnose choledochal cysts.Combined percutaneous transhepatic cholangial drainage surgery for giant choledochal cysts is safe and effective.展开更多
Coronary intervention is an important method for the treatment of coronary heart disease,which can improve the myocardial blood supply function of patients to a great extent.The nursing and rehabilitation after corona...Coronary intervention is an important method for the treatment of coronary heart disease,which can improve the myocardial blood supply function of patients to a great extent.The nursing and rehabilitation after coronary intervention are very important for patients.In view of this,this article analyzed the rehabilitation and nursing of patients after coronary intervention,and put forward some strategies,only for the reference of colleagues.展开更多
Urinary calculi are a common and frequently occurring disease in urology. For patients with kidney stones, especially large, multiple or staghorn stones, percutaneous nephrolithotomy (PCNL) is a preferred treatment me...Urinary calculi are a common and frequently occurring disease in urology. For patients with kidney stones, especially large, multiple or staghorn stones, percutaneous nephrolithotomy (PCNL) is a preferred treatment method. Infection-related complications after percutaneous nephrolithotomy include transient fever, systemic inflammatory response syndrome, and urinary sepsis, especially urinary sepsis, which are considered to be common causes of death after percutaneous nephrolithotomy. Therefore, early identification and timely intervention of biomarkers can reduce the incidence and mortality of postoperative sepsis, as well as the length of hospital stay and hospitalization costs. This article reviews the biomarkers for early identification of urinary tract infection after PCNL, such as traditional inflammatory indicators, new inflammatory indicators, and composite inflammatory indicators.展开更多
While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasibl...While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasible.Percutaneous cystolitholapaxy is a safe,effective,minimally invasive alternative for diverse indications,including patients with benign prostatic hyperplasia,urethral stricture disease,closed bladder neck,continent catheterized channel,or other urinary diversion.In this article,we review the indications for and advantages of percutaneous cystolitholapaxy and describe our step-by-step technique for this procedure,including representative imaging and favored equipment.We also discuss preoperative and postoperative considerations,management of potential complications,strategies to optimize clinical outcomes and patient safety,and comparisons with transurethral approaches.Finally,we report outcomes from our institutional series of percutaneous cystolitholapaxy cases to highlight the safety and efficacy of the procedure.展开更多
BACKGROUND It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements,often involved in rough scarring,an...BACKGROUND It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements,often involved in rough scarring,and with a significant risk of stricture recurrence.AIM To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.METHODS From 2012 to 2022,193 patients were treated at the A.V.Vishnevsky Surgical Center.All of them had different levels of strictures according to Bismuth-Strasberg classification:Type E1-2 in 32 patients,type E3-99,type E4-62.123 patients underwent open reconstructive interventions,70 percutaneous endobiliary interventions.RESULTS Long-term results were available for 192(99%)patients with a follow-up of 4.7±1.6 years after reconstructive surgery;3.0±1.4 years after percutaneous interventions.Excellent and good results(according to Terblanche classification)were achieved in 35%(42/122)of patients after open reconstructive surgery and in 13%(9/70)of patients after percutaneous transhepatic interventions(P-value<0.05).CONCLUSION Technically,the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5.The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.展开更多
BACKGROUND Liver abscess is a serious hepatic infectious disease for which percutaneous drainage has become the preferred treatment method due to its minimally invasive advantages.With the rising prevalence of non-alc...BACKGROUND Liver abscess is a serious hepatic infectious disease for which percutaneous drainage has become the preferred treatment method due to its minimally invasive advantages.With the rising prevalence of non-alcoholic fatty liver disease reaching 29.2%in Chinese adults,the number of patients with liver abscess combined with fatty liver has shown a significant increasing trend clinically.AIM To analyze risk factors affecting prognosis after percutaneous drainage in liver abscess patients with fatty liver.METHODS A retrospective analysis of 165 liver abscess patients with fatty liver who underwent percutaneous drainage from January 2020 to April 2024.Patients were divided into good prognosis(n=121,73.3%)and poor prognosis groups(n=44,26.7%)based on 30-day outcomes.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.RESULTS The poor prognosis group had older age(65.2±11.8 years vs 56.1±11.9 years,P<0.001),higher diabetes prevalence(70.5%vs 47.2%,P=0.008),elevated inflammatory markers,and lower serum albumin(26.8±4.2 g/L vs 32.1±5.6 g/L,P<0.001).Moderate-to-severe fatty liver was more prevalent in the poor prognosis group(68.2%vs 38.0%,P=0.001).Multivariate analysis identified five independent risk factors:Age≥65 years(OR=2.847,P=0.007),diabetes history(OR=3.124,P=0.003),abscess diameter≥8 cm(OR=2.591,P=0.015),serum albumin<30 g/L(OR=3.456,P=0.001),and moderate-to-severe fatty liver(OR=2.213,P=CONCLUSION)Advanced age,diabetes history,large abscess,hypoalbuminemia,and moderate-to-severe fatty liver are independent risk factors for poor prognosis after percutaneous drainage in liver abscess patients with fatty liver.展开更多
Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recent...Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recently,this technique has also been used in the treatment of intrahepatic cholangiocarcinoma for patients who are not eligible for surgical resection.There are several types of thermal ablation techniques.Radiofrequency ablation and microwave ablation are two common methods that induce necrosis of the lesions.Irreversible electroporation is a relatively new non-thermal technique and is suitable in cases where thermal ablation would be ineffective or dangerous(e.g.,malignant tumors close to vascular or biliary structures).Irreversible electroporation can induce tumoral necrosis without damage to vascular and biliary structures.The aim of this minireview was to describe the safety,efficacy,and clinical indications of these techniques in the treatment of patients with intrahepatic cholangiocarcinoma who are ineligible for surgery.展开更多
BACKGROUND Safety and efficacy of intravascular ultrasound(IVUS)guidance in percutaneous coronary intervention(PCI)has been consistently shown in recent trials.However,prospective data on the clinical effects of IVUS ...BACKGROUND Safety and efficacy of intravascular ultrasound(IVUS)guidance in percutaneous coronary intervention(PCI)has been consistently shown in recent trials.However,prospective data on the clinical effects of IVUS usage in primary PCI are still warranted.The ULTRA-STEMI trial is a prospective investigator-initiated observational single-center cohort trial aiming to enroll 80 patients with STEMI.AIM To investigate the outcomes of patients with STEMI undergoing IVUS-guided PCI and correlate derived IVUS measurements with clinical,procedural,imaging and follow-up outcomes of interest.METHODS Study participants will undergo primary PCI as per standardized procedures.IVUS pullbacks will be performed pre-intervention,post-lesion preparation,postintervention and post-optimization using a 20 MHz digital IVUS(Eagle Eye Platinum,Philips).Manual thrombus aspiration will be performed in cases of high thrombus burden.The aspirated thrombi will be scanned with micro-computed tomography to extract volumetric measurements of the aspirated thrombotic burden.Moreover,angiographic,peri-procedural and 3-year follow-up data will be gathered.Co-primary endpoints will be cardiovascular mortality and target vessel failure,defined as the composite of:Cardiovascular mortality,target vessel myocardial infarction and/or clinically driven target vessel revascularization.RESULTS The results of the study are expected by the third quarter of 2029.CONCLUSION The ULTRA-STEMI trial will add to the existing literature the clinical,angiographic,micro-computed tomography and follow-up outcomes of IVUS-guided PCI in 80 patients presenting with STEMI.展开更多
BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency c...BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency cholecystectomy is the standard of care,it may not be feasible in unstable patients.Percutaneous transhepatic cholecystostomy(PTC)offers a minimally invasive alternative.AIM To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC.METHODS We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center.All patients underwent PTC as the initial intervention.Data collected included demographics,comorbidities,laboratory and imaging findings,complications,and clinical outcomes over a 24-month follow-up.Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy.RESULTS Thirty patients underwent PTC for APC.Half of the patients(n=15)were stabilized and later underwent cholecystectomy;the remaining 15 were managed non-operatively.Patients in the non-surgical group were significantly older(87.1±6.2 years vs 76.1±7.4 years;P<0.001).Clinical improvement was observed in 61.4%of non-operated patients,with eventual drain removal or closure.Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge.No significant differences were found in hospital stay or complication rates.During follow-up,three deaths occurred due to non-biliary causes.Only one patient required repeat drainage.CONCLUSION PTC is a safe and effective initial treatment for APC,particularly in elderly and comorbid patients for whom surgery poses excessive risk.It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients.These findings support the broader use of PTC in the management of APC,although larger prospective studies are warranted.展开更多
Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous cor...Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Between April 2022 and April 2023,patients who had experienced AMI after PCI were enrolled.These patients were randomly assigned to an intervention group(IG)or a control group(CG)in equal numbers.The CG received standard CR,while the IG participated in the advanced trinity CR program in addition to the standard CR.Key parameters measured included the anaerobic threshold(AT),maximum oxygen uptake(V̇O2max),maximum exercise load(MEL),metabolic equivalent(MET),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),and quality of life(measured by the SF-36).These were assessed pre-intervention and at 3,6,9,and 12 months post-intervention.SPSS.26 was employed for data analysis,with statistical methods such as repeated measures analysis of variance(ANOVA),Chi-square tests,and independent sample t-tests.Results A total of 110 patients completed the intervention,55 in each group.There was no significant difference in the scores of all indicators between the two groups before intervention(P>0.05).However,at 3,6,9 and 12 months after intervention,the scores of AT,VO2max,MEL,MET,LVEDV,LVESV,LVEF,and quality of life in the intervention group were higher than those in the control group,there was statistical significance at four-time points,group,time,and interaction effect(P<0.05).Conclusions The hospital-community-family trinity CR intervention program developted in this study significantly improved exercise endurance,cardiac function,and quality of life in patients with AMI after PCI.展开更多
BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary dra...BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary drainage(PTBD).Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography(ERCP).AIM To compare safety,therapeutic success,and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC.METHODS A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023.All patients who had severe acute cholangitis and underwent ERCP or PTBD were included.Patients were followed for complications,procedure success,and mortality.Data was gathered through an electronic medical record system and analyzed usingχ²and two sample t-tests.RESULTS A total of 33 patients were recruited,consisting of 12 females and 21 males with a mean age of 61 years.Among these participants,12 patients underwent ERCP,and the remaining 21 patients underwent PTBD.Therapeutic success was seen more in the ERCP group[11/12(97.1%)]than in the PTBD group[12/21 patients(57.1%)].Post-procedure complications were seen in both groups;however,more were observed in the PTBD cohort with a significant P value of 0.02.There were no mortalities among the patients who underwent ERCP while 5(23.8%)mortalities were seen in the PTBD group.CONCLUSION Fewer post-procedure complications and deaths were observed after ERCP than after PTBD,laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.展开更多
BACKGROUND Percutaneous liver biopsies,including coaxial needle biopsy(CNB),are the pre-ferred method for tissue sampling to diagnose or characterize an array of hepatic conditions.Despite the advent of intraprocedura...BACKGROUND Percutaneous liver biopsies,including coaxial needle biopsy(CNB),are the pre-ferred method for tissue sampling to diagnose or characterize an array of hepatic conditions.Despite the advent of intraprocedural image guidance,and various“plugging”techniques,bleeding remains a frequent and potentially highly mor-bid complication,particularly in patients with bleeding risks.Thus,post-biopsy bleeding risk leads to extended patient monitoring,and in significant cases,ad-ditional imaging,intervention,and even surgery.Very rarely,death has resulted.CASE SUMMARY We report a series of five image-guided liver biopsy cases undertaken due to a variety of clinical conditions followed by the use of a new electrocautery hemo-stasis device called SinglePass Kronos.Indications for the CNB included non-alcoholic steatohepatitis,hepatocellular carcinoma and cirrhosis,abnormal liver function tests with positive autoimmune serologies,abnormal imaging findings,and jaundice.All biopsy procedures were successful with no complications th-rough 30 days following CNB.Post-procedure ultrasound confirmed the absence of bleeding in all five cases.CONCLUSION Hemostasis of CNB tracts using SinglePass Kronos was obtained in all cases.Ad-ditional study of this device is warranted.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.
基金supported by the National Natural Science Foundation of China(82305273)the Central High-Level Clinical Research Fund for Traditional Chinese Medicine Hospitals(DZMG-QNGG0010).
文摘Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(PKP)or percutaneous vertebroplasty(PVP)using a network meta-analysis.Methods A systematic search was conducted in PubMed,Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang Database,Chinese Scientific Journal Database,and Chinese Biomedical Literature Database(SinoMed)from their inception to January 15,2025.Outcome measures included the Visual Analog Scale(VAS)score,Oswestry Disability Index(ODI)score,and overall efficacy rate.Literature screening,data extraction,and risk-of-bias assessment were independently performed by two researchers.Data analysis was conducted using Stata 17.0 software.Results A total of 35 randomized controlled trials involving 2860 patients were included.The data analysis revealed that,in terms of improving VAS and ODI scores,the top three effective therapies were Fu's subcutaneous needling,wrist-ankle acupuncture,and acupotomy.For the overall efficacy rates in pain treatment,the top three therapies were wrist-ankle acupuncture,warm acupuncture and moxibustion,and Fu's subcutaneous needling.Based on the combined results across the three outcome measures,Fu's subcutaneous needling was found to be the most effective in relieving pain and improving lumbar function.Conclusion Fu's subcutaneous needling,wrist-ankle acupuncture,warm acupuncture and moxibustion,and acupotomy were all effective in treating postoperative pain post-PKP/PVP and improving lumbar function.However,further high-quality,large-sample studies are required to confirm these findings.
基金was given by a 2017 Research Grant of the Italian Society of Interventional Cardiology (SICI-GISE)
文摘BACKGROUND Antithrombotic strategies after percutaneous coronary interventions(PCI)in elderly patients on oral anticoagulant therapy(OAT)are debated due to the balance between ischemic and bleeding risks.Recent guidelines recommend early transitioning from triple antithrombotic therapy to dual antithrombotic therapy,but there are limited data on elderly patients.METHODS We performed a post-hoc age-specific analysis of the PERSEO Registry population aimed to compare clinical features,therapeutic strategies,and outcomes of individuals aged≥80 years and<80 years who were on OAT and underwent PCI with stent.The primary endpoint was net adverse clinical events at 1-year follow-up.Secondary endpoints included major adverse cardiac and cerebral events(MACCE),major bleeding[Bleeding Academic Research Consortium(BARC)type 3–5],and clinically relevant bleeding(BARC type 2-5).RESULTS Among the 1234 patients enrolled,31%of patients were aged≥80 years(84±3 years,76% males).Compared to younger patients,elderly patients had higher rates of comorbidities such as hypertension,anaemia or chronic kidney disease,and atrial fibrillation was the leading indication for OAT.Elderly patients were more often discharged on dual antithrombotic therapy(23%)compared to younger patients(13%)(P<0.0001).They experienced higher net adverse clinical events(38%vs.21%,P<0.001),MACCE(24%vs.12%,P<0.001),as well as higher bleeding rates.Specifically,rates of major bleeding(9%vs.6%,P=0.026),and clinically relevant bleeding(21%vs.12%,P<0.001)were significantly higher in elderly patients.CONCLUSIONS Elderly patients on OAT undergoing PCI are a particular frail population with higher risk of MACCE and bleeding compared to younger patients despite a less aggressive antithrombotic therapy.
文摘BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.
文摘Bcakground: Pancreatic pseudocyst (PPC) is a common complication arising from acute or chronic pancreatitis, trauma, or pancreatic duct obstruction. When acute fluid collection persists for 4 - 6 weeks and is encapsulated by a fibrous wall, it is classified as a pancreatic pseudocyst. While PPC is generally asymptomatic in many patients, it can manifest with persistent abdominal pain, dyspepsia, intra-cystic infection, and potentially lead to gastrointestinal obstruction in some cases. Although smaller PPCs may resolve spontaneously, larger PPCs tend to be refractory to absorption and often necessitate surgical intervention to prevent complications such as intracystic hemorrhage. Objective: To explore the efficacy of percutaneous catheterization with negative pressure in the treatment of large pancreatic pseudocysts. Methods: The cases of large pancreatic pseudocysts treated in our hospital from 2004 to 2022 were retrospectively collected, and the general condition, operation time, drainage time, feeding time, postoperative complications, hospital stay, cost and follow-up of the patients were analyzed. Results: A total of 132 patients with large pancreatic pseudocysts were collected. The average operation time was 32.4 ± 2.1 min;The retention time of the drainage tube was 30 ± 1.8 days in the percutaneous negative pressure drainage group;The postoperative feeding time was no fasting after local anesthesia drainage;Postoperative complications (bleeding, infection, pancreatic leakage, recurrence, anastomotic leakage, etc.): Two of the 132 patients had recurrent cysts, which were cured by re-puncture and negative pressure drainage. The length of hospital stay was 6 ± 1.1 days;The cost was 11,200 ± 1300 yuan;Follow-up: The follow-up time ranged from 1 to 3 years, and the patients had no discomfort. Conclusion: Percutaneous catheterization and negative pressure drainage can effectively treat large pancreatic pseudocysts. Compared with other treatment methods, it is simple and effective, the postoperative recovery of patients is faster, the physical damage is less, the hospital stay is shorter, and the cost is lower.
文摘BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or systemic therapies,often fail to provide sufficient pain relief or improve functional outcomes in these patients.Microwave ablation(MWA)offers advantages,such as shorter pro-cedure times and larger ablation zones,while percutaneous osteoplasty(PO)enhances bone stability and prevents pathological fractures.Despite these be-nefits,the combination of these techniques for treating flat bone metastases re-mains underexplored.AIM To evaluate the efficacy and safety of C-arm computed tomography(CT)-guided MWA combined with PO for managing painful flat bone metastases,focusing on pain relief,functional improvement,and QOL enhancement.METHODS A total of 45 patients with refractory moderate-to-severe pain resulting from flat bone metastases who underwent C-arm CT-guided MWA combined with PO between January 2015 and January 2021 were included.The efficacy of the pro-cedure was assessed by changes in the visual analog scale(VAS),Oswestry disability index(ODI),and QOL,as well as the occurrence of complications.Tumor response was evaluated using RECIST v1.1 and mRECIST criteria,with overall response rate(ORR)and disease control rate(DCR)as the primary end-points.RESULTS No serious complications were observed in any of the patients.A significant reduction in VAS and ODI was noted at 1 week,1 month,and 3 months post-procedure.A marked improvement in QOL was observed at all follow-up points.Bone cement extravasation was observed in 10 patients;however,none exhibited significant clinical symptoms.Based on RECIST v1.1,the ORR was 26.7%and the DCR was 88.9%.The mRECIST evaluation revealed a higher ORR of 51.1%and DCR of 88.9%.CONCLUSION C-arm CT-guided MWA with PO provides a dependable and effective strategy for managing flat bone metastases.It demonstrates significant pain relief,improved functional outcomes,and enhanced QOL.This treatment combination also shows promising tumor response rates with a low complication profile.
文摘Anticoagulation has long been the standard of care for preventing embolic events in atrial fibrillation(AF).^([1])The elderly AF generation is more susceptible to thromboembolic incidents.They are also more likely to encounter hemorrhagic and other complications when using anticoagulants.Therefore,percutaneous left atrial appendage occlusion(pLAAO)is regarded as an appealing alternative therapy for preventing stroke in patients who are poor candidates for long-term anticoagulation.^([2,3])Contemporary patients undergoing pLAAO are typically older and have more comorbidities than those who were enrolled in pivotal randomized controlled trials.
文摘BACKGROUND Gas-containing pseudocysts rarely cause of lumbar radiculopathy.This report describes successful treatment of a gas-containing pseudocyst using percutaneous transforaminal endoscopy.CASE SUMMARY A 48-year-old man presented with severe pain and numbness in his right leg,which worsened upon walking or weight bearing.Computed tomography and magnetic resonance imaging revealed a gas-containing cyst compressing the left L5 nerve root at the L4-5 level.The pseudocyst was successfully removed using a percutaneous transforaminal endoscopic discectomy.Vivid and clear endoscopic imaging of the pseudocysts was performed intraoperatively.The patient experienced immediate pain relief and was discharged one day after the operation.The patient returned to work.Moreover,numbness in the right leg returned to normal within 6 months.At the one-year follow-up,there was no symptoms recurrence.CONCLUSION Transforaminal endoscopy offers excellent surgical visualization and facilitates meticulous operative manipulation,making it a minimally invasive approach for treating gas-containing pseudocysts in the intervertebral foramen.
基金Supported by Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital,No.CY2024-MS-B04Gansu Provincial Natural Science Foundation Project,No.24JRRA331the Traditional Chinese Medicine Research Project of Gansu Province,No.GZKZ-2024-26.
文摘BACKGROUND Choledochal cyst is a rare biliary tract disorder with five subtypes categorized based on the anatomical location of cystic dilatation.Type IV(which affects the intrahepatic and extrahepatic ducts)is the most common subtype in adults.Its clinical manifestations are diverse and the disease can potentially become malignant.Currently,the mainstay treatment is surgical excision which is used as a definitive treatment to prevent complications and avoid carcinogenesis.However,the surgical operation for giant choledochal cysts is technically challenging.CASE SUMMARY Here,we present a case of a giant choledochal cyst in an 18-year-old female.The diagnosis of patient was confirmed through magnetic resonance cholangiopancreatography.The patient developed acute cholangitis,and was treated with percutaneous transhepatic cholangial drainage to alleviate symptoms.The final treatment approach was cyst excision followed by Roux-en-Y hepaticojejunostomy,which successfully achieved excellent postoperative recovery.CONCLUSION Ultrasonography and magnetic resonance cholangiopancreatography can effectively diagnose choledochal cysts.Combined percutaneous transhepatic cholangial drainage surgery for giant choledochal cysts is safe and effective.
基金Taicang Medical and Health Application Basic Research Guidance Project,“Research on Monitoring the Personalized Pressure of Pneumatic Tourniquet in Knee Arthroscopic Surgery Based on Popliteal Artery Blood Flow Ultrasound”(Project No.:2024TCYLZD03)。
文摘Coronary intervention is an important method for the treatment of coronary heart disease,which can improve the myocardial blood supply function of patients to a great extent.The nursing and rehabilitation after coronary intervention are very important for patients.In view of this,this article analyzed the rehabilitation and nursing of patients after coronary intervention,and put forward some strategies,only for the reference of colleagues.
文摘Urinary calculi are a common and frequently occurring disease in urology. For patients with kidney stones, especially large, multiple or staghorn stones, percutaneous nephrolithotomy (PCNL) is a preferred treatment method. Infection-related complications after percutaneous nephrolithotomy include transient fever, systemic inflammatory response syndrome, and urinary sepsis, especially urinary sepsis, which are considered to be common causes of death after percutaneous nephrolithotomy. Therefore, early identification and timely intervention of biomarkers can reduce the incidence and mortality of postoperative sepsis, as well as the length of hospital stay and hospitalization costs. This article reviews the biomarkers for early identification of urinary tract infection after PCNL, such as traditional inflammatory indicators, new inflammatory indicators, and composite inflammatory indicators.
文摘While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasible.Percutaneous cystolitholapaxy is a safe,effective,minimally invasive alternative for diverse indications,including patients with benign prostatic hyperplasia,urethral stricture disease,closed bladder neck,continent catheterized channel,or other urinary diversion.In this article,we review the indications for and advantages of percutaneous cystolitholapaxy and describe our step-by-step technique for this procedure,including representative imaging and favored equipment.We also discuss preoperative and postoperative considerations,management of potential complications,strategies to optimize clinical outcomes and patient safety,and comparisons with transurethral approaches.Finally,we report outcomes from our institutional series of percutaneous cystolitholapaxy cases to highlight the safety and efficacy of the procedure.
文摘BACKGROUND It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements,often involved in rough scarring,and with a significant risk of stricture recurrence.AIM To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.METHODS From 2012 to 2022,193 patients were treated at the A.V.Vishnevsky Surgical Center.All of them had different levels of strictures according to Bismuth-Strasberg classification:Type E1-2 in 32 patients,type E3-99,type E4-62.123 patients underwent open reconstructive interventions,70 percutaneous endobiliary interventions.RESULTS Long-term results were available for 192(99%)patients with a follow-up of 4.7±1.6 years after reconstructive surgery;3.0±1.4 years after percutaneous interventions.Excellent and good results(according to Terblanche classification)were achieved in 35%(42/122)of patients after open reconstructive surgery and in 13%(9/70)of patients after percutaneous transhepatic interventions(P-value<0.05).CONCLUSION Technically,the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5.The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.
基金Supported by Zhejiang Province Traditional Chinese Medicine Science and Technology Plan Project,No.2024ZL039.
文摘BACKGROUND Liver abscess is a serious hepatic infectious disease for which percutaneous drainage has become the preferred treatment method due to its minimally invasive advantages.With the rising prevalence of non-alcoholic fatty liver disease reaching 29.2%in Chinese adults,the number of patients with liver abscess combined with fatty liver has shown a significant increasing trend clinically.AIM To analyze risk factors affecting prognosis after percutaneous drainage in liver abscess patients with fatty liver.METHODS A retrospective analysis of 165 liver abscess patients with fatty liver who underwent percutaneous drainage from January 2020 to April 2024.Patients were divided into good prognosis(n=121,73.3%)and poor prognosis groups(n=44,26.7%)based on 30-day outcomes.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.RESULTS The poor prognosis group had older age(65.2±11.8 years vs 56.1±11.9 years,P<0.001),higher diabetes prevalence(70.5%vs 47.2%,P=0.008),elevated inflammatory markers,and lower serum albumin(26.8±4.2 g/L vs 32.1±5.6 g/L,P<0.001).Moderate-to-severe fatty liver was more prevalent in the poor prognosis group(68.2%vs 38.0%,P=0.001).Multivariate analysis identified five independent risk factors:Age≥65 years(OR=2.847,P=0.007),diabetes history(OR=3.124,P=0.003),abscess diameter≥8 cm(OR=2.591,P=0.015),serum albumin<30 g/L(OR=3.456,P=0.001),and moderate-to-severe fatty liver(OR=2.213,P=CONCLUSION)Advanced age,diabetes history,large abscess,hypoalbuminemia,and moderate-to-severe fatty liver are independent risk factors for poor prognosis after percutaneous drainage in liver abscess patients with fatty liver.
文摘Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recently,this technique has also been used in the treatment of intrahepatic cholangiocarcinoma for patients who are not eligible for surgical resection.There are several types of thermal ablation techniques.Radiofrequency ablation and microwave ablation are two common methods that induce necrosis of the lesions.Irreversible electroporation is a relatively new non-thermal technique and is suitable in cases where thermal ablation would be ineffective or dangerous(e.g.,malignant tumors close to vascular or biliary structures).Irreversible electroporation can induce tumoral necrosis without damage to vascular and biliary structures.The aim of this minireview was to describe the safety,efficacy,and clinical indications of these techniques in the treatment of patients with intrahepatic cholangiocarcinoma who are ineligible for surgery.
文摘BACKGROUND Safety and efficacy of intravascular ultrasound(IVUS)guidance in percutaneous coronary intervention(PCI)has been consistently shown in recent trials.However,prospective data on the clinical effects of IVUS usage in primary PCI are still warranted.The ULTRA-STEMI trial is a prospective investigator-initiated observational single-center cohort trial aiming to enroll 80 patients with STEMI.AIM To investigate the outcomes of patients with STEMI undergoing IVUS-guided PCI and correlate derived IVUS measurements with clinical,procedural,imaging and follow-up outcomes of interest.METHODS Study participants will undergo primary PCI as per standardized procedures.IVUS pullbacks will be performed pre-intervention,post-lesion preparation,postintervention and post-optimization using a 20 MHz digital IVUS(Eagle Eye Platinum,Philips).Manual thrombus aspiration will be performed in cases of high thrombus burden.The aspirated thrombi will be scanned with micro-computed tomography to extract volumetric measurements of the aspirated thrombotic burden.Moreover,angiographic,peri-procedural and 3-year follow-up data will be gathered.Co-primary endpoints will be cardiovascular mortality and target vessel failure,defined as the composite of:Cardiovascular mortality,target vessel myocardial infarction and/or clinically driven target vessel revascularization.RESULTS The results of the study are expected by the third quarter of 2029.CONCLUSION The ULTRA-STEMI trial will add to the existing literature the clinical,angiographic,micro-computed tomography and follow-up outcomes of IVUS-guided PCI in 80 patients presenting with STEMI.
文摘BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency cholecystectomy is the standard of care,it may not be feasible in unstable patients.Percutaneous transhepatic cholecystostomy(PTC)offers a minimally invasive alternative.AIM To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC.METHODS We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center.All patients underwent PTC as the initial intervention.Data collected included demographics,comorbidities,laboratory and imaging findings,complications,and clinical outcomes over a 24-month follow-up.Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy.RESULTS Thirty patients underwent PTC for APC.Half of the patients(n=15)were stabilized and later underwent cholecystectomy;the remaining 15 were managed non-operatively.Patients in the non-surgical group were significantly older(87.1±6.2 years vs 76.1±7.4 years;P<0.001).Clinical improvement was observed in 61.4%of non-operated patients,with eventual drain removal or closure.Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge.No significant differences were found in hospital stay or complication rates.During follow-up,three deaths occurred due to non-biliary causes.Only one patient required repeat drainage.CONCLUSION PTC is a safe and effective initial treatment for APC,particularly in elderly and comorbid patients for whom surgery poses excessive risk.It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients.These findings support the broader use of PTC in the management of APC,although larger prospective studies are warranted.
文摘Objectives This study aimed to develop a hospital-community-family trinity cardiac rehabilitation(CR)intervention program and assess its’effects on patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Between April 2022 and April 2023,patients who had experienced AMI after PCI were enrolled.These patients were randomly assigned to an intervention group(IG)or a control group(CG)in equal numbers.The CG received standard CR,while the IG participated in the advanced trinity CR program in addition to the standard CR.Key parameters measured included the anaerobic threshold(AT),maximum oxygen uptake(V̇O2max),maximum exercise load(MEL),metabolic equivalent(MET),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),and quality of life(measured by the SF-36).These were assessed pre-intervention and at 3,6,9,and 12 months post-intervention.SPSS.26 was employed for data analysis,with statistical methods such as repeated measures analysis of variance(ANOVA),Chi-square tests,and independent sample t-tests.Results A total of 110 patients completed the intervention,55 in each group.There was no significant difference in the scores of all indicators between the two groups before intervention(P>0.05).However,at 3,6,9 and 12 months after intervention,the scores of AT,VO2max,MEL,MET,LVEDV,LVESV,LVEF,and quality of life in the intervention group were higher than those in the control group,there was statistical significance at four-time points,group,time,and interaction effect(P<0.05).Conclusions The hospital-community-family trinity CR intervention program developted in this study significantly improved exercise endurance,cardiac function,and quality of life in patients with AMI after PCI.
文摘BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary drainage(PTBD).Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography(ERCP).AIM To compare safety,therapeutic success,and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC.METHODS A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023.All patients who had severe acute cholangitis and underwent ERCP or PTBD were included.Patients were followed for complications,procedure success,and mortality.Data was gathered through an electronic medical record system and analyzed usingχ²and two sample t-tests.RESULTS A total of 33 patients were recruited,consisting of 12 females and 21 males with a mean age of 61 years.Among these participants,12 patients underwent ERCP,and the remaining 21 patients underwent PTBD.Therapeutic success was seen more in the ERCP group[11/12(97.1%)]than in the PTBD group[12/21 patients(57.1%)].Post-procedure complications were seen in both groups;however,more were observed in the PTBD cohort with a significant P value of 0.02.There were no mortalities among the patients who underwent ERCP while 5(23.8%)mortalities were seen in the PTBD group.CONCLUSION Fewer post-procedure complications and deaths were observed after ERCP than after PTBD,laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.
文摘BACKGROUND Percutaneous liver biopsies,including coaxial needle biopsy(CNB),are the pre-ferred method for tissue sampling to diagnose or characterize an array of hepatic conditions.Despite the advent of intraprocedural image guidance,and various“plugging”techniques,bleeding remains a frequent and potentially highly mor-bid complication,particularly in patients with bleeding risks.Thus,post-biopsy bleeding risk leads to extended patient monitoring,and in significant cases,ad-ditional imaging,intervention,and even surgery.Very rarely,death has resulted.CASE SUMMARY We report a series of five image-guided liver biopsy cases undertaken due to a variety of clinical conditions followed by the use of a new electrocautery hemo-stasis device called SinglePass Kronos.Indications for the CNB included non-alcoholic steatohepatitis,hepatocellular carcinoma and cirrhosis,abnormal liver function tests with positive autoimmune serologies,abnormal imaging findings,and jaundice.All biopsy procedures were successful with no complications th-rough 30 days following CNB.Post-procedure ultrasound confirmed the absence of bleeding in all five cases.CONCLUSION Hemostasis of CNB tracts using SinglePass Kronos was obtained in all cases.Ad-ditional study of this device is warranted.
