Background Hypertension is associated with an increased risk of calcific aortic valve stenosis(CAVS).However,the directionality of causation between blood pressure traits and aortic stenosis is unclear,as is the benef...Background Hypertension is associated with an increased risk of calcific aortic valve stenosis(CAVS).However,the directionality of causation between blood pressure traits and aortic stenosis is unclear,as is the benefit of antihypertensive drugs for CAVS.Methods Using genome-wide association studies(GWAS)summary statistics,we performed bidirectional two-sample univariable mendelian randomization(UVMR)to assess the causal associations of systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse pressure(PP)with CAVS.Multivariable mendelian randomization(MVMR)was conducted to evaluate the direct effect of hypertension on CAVS,adjusting for confounders.Drug target mendelian randomization(MR)and summary-level MR(SMR)were used to estimate the effects of 12 classes of antihypertensive drugs and their target genes on CAVS risk.Inverse variance weighting was the primary MR method,with sensitivity analyses to validate results.Results UVMR showed SBP,DBP,and PP have causal effects on CAVS,with no significant reverse causality.MVMR confirmed the causality between hypertension and CAVS after adjusting for confounders.Drug-target MR analyses indicated that calcium channel blockers(CCBs),loop diuretics,and thiazide diuretics via SBP lowering exerted protective effects on CAVS risk.SMR analysis showed that the CCBs target gene CACNA2D2 and ARBs target gene AGTR1 were positively associated with CAVS risk,while diuretics target genes SLC12A5 and SLC12A1 were negatively associated with aortic stenosis risk.Conclusions Hypertension has a causal relationship with CAVS.Managing SBP in hypertensive patients with CCBs may prevent CAVS.ARBs might exert protective effects on CAVS independent of blood pressure reduction.The relationship between diuretics and CAVS is complex,with opposite effects through different mechanisms.展开更多
Objective:To analyze the treatment effect of standardized bronchoscopic interventional therapy(i.e.,interventional therapy)on airway stenosis.Methods:Forty patients with airway stenosis admitted to the hospital betwee...Objective:To analyze the treatment effect of standardized bronchoscopic interventional therapy(i.e.,interventional therapy)on airway stenosis.Methods:Forty patients with airway stenosis admitted to the hospital between September 2022 and September 2024 were selected and randomly divided into two groups using a random number table.The experimental group received interventional therapy,while the reference group received conventional treatment.The total effective rate,degree of airway stenosis,shortness of breath score,and lung function indicators were compared.Results:The total effective rate in the experimental group was higher than that in the reference group.The proportion of mild stenosis in the degree of airway stenosis was higher in the experimental group than in the reference group.The shortness of breath score was lower in the experimental group than in the reference group.The lung function indicators were better in the experimental group than in the reference group(P<0.05).Conclusion:Interventional therapy is effective for patients with airway stenosis,as it can reduce the degree of stenosis,improve symptoms of shortness of breath,and protect patients’lung function.展开更多
Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic ...Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation(TAVI)and to analyze the ability of different tools for predicting clinical outcomes in this context.Methods This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge.The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI.Results A total of 377 patients were included(mean age of 80.4 years).Most patients were independent or mildly dependent,with an optimal cognitive status.The proportion of frailty ranged from 17.6%to 49.8%.A total of 20 patients(5.3%)died and 110/377 patients(29.2%)died or were readmitted during follow up.Overall,most components of the geriatric assessment showed an association with clinical outcomes.Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission.The association between frailty and clinical outcomes was higher for short physical performance battery(SPPB),essential frailty toolset(EFT)and the frailty index based on comprehensive geriatric assessment(IF-VIG)and lower for Fried criteria and FRAIL scale.Conclusions AS patients from this series presented a good physical performance,optimal cognitive status and a reasonably low prevalence of frailty.The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT,SPPB and the IF-VIG.展开更多
A 28-year-old pregnant woman with no prior obstetric complications had a normal prenatal workup before 24 weeks'gestation.At 24 weeks,ultrasound revealed gastrointestinal malformations,a persistent left superior v...A 28-year-old pregnant woman with no prior obstetric complications had a normal prenatal workup before 24 weeks'gestation.At 24 weeks,ultrasound revealed gastrointestinal malformations,a persistent left superior vena cava,and polyhydramnios.展开更多
BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older g...BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older generation of uncovered stents.Yet,with the advancement of technology,novel innovations of self-expanding metal stents(SEMS)have revolutionized the treatment of benign airway stenosis(BAS),where the insertion of SEMS is known to be easier than silicone stents.AIM To compare the efficacy and safety of covered SEMS against uncovered SEMS,and thereafter propose more direct trials comparing covered SEMS against silicone stents for consideration of revision of current FDA guidelines.METHODS A comprehensive literature review of MEDLINE and EMBASE was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Of 3002 articles,64 publications met the eligibility criteria with a total of 900 patients(468 covered SEMS,432 uncovered SEMS).The collected data were analyzed using Statistical Package for the Social Sciences version 11.5.RESULTS Covered SEMS showed a higher success rate of insertion(98.6%vs 88.2%)and lower complication rates of infection(1.3%vs 13.2%),restenosis(1.5%vs 10.6%),stent fracture(2.6%vs 7.4%),bleeding(0%vs 5.8%),and pneumothorax(0%vs 2.8%)compared to uncovered SEMS.However,covered SEMS compared to uncovered SEMS showed higher complication rates of stent migration(12.4%vs 6.9%)and granulation tissue formation(26.5%vs 20.1%).CONCLUSION Our study suggests that covered SEMS are an effective,safe,and viable option in the treatment of BAS.Thus,further consideration regarding the utilization of covered SEMS over other forms of stent types is appropriate.展开更多
BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of periphe...BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of peripheral arteries and coronary stenosis in patients with coronary heart disease(CHD).METHODS The study included a total of 218 patients(63±10.9 years of age;54%male)with CHD subjected to coronary angiography and routine diagnostic assessment,including ultrasound imaging to assess the extent of peripheral atherosclerotic lesions.Receiver operating characteristic analysis and binomial logistic regression were used to detect the associations.RESULTS We demonstrated for the first time that the presence of atherosclerotic plaque with≥70%stenosis in femoral arteries was associated with significant coronary stenosis,with 93%sensitivity and 90%specificity,and thus can be used as an additional diagnostic marker for coronary stenosis.The data indicated associations between femoral artery atherosclerosis and atherosclerotic lesions of coronary arteries,with a high correlation coefficient r=0.8(P<0.05).The presence of an atherosclerotic plaque in the femoral arteries with≥30% or≥70%stenosis was associated with a 30-or 70-fold higher odds ratio of coronary stenosis,respectively.CONCLUSION For resource-limited clinics,our findings suggest skipping carotids-femoral ultrasound alone may suffice to rule out severe CHD.Ultrasound imaging femoral artery atherosclerosis provides a simplified approach for patient stratification.展开更多
Aortic stenosis(AS),a progressive disease affecting aortic valve function,is common among individuals with metabolic and degenerative conditions,and is notably challenging to manage in patients with cirrhosis.Patients...Aortic stenosis(AS),a progressive disease affecting aortic valve function,is common among individuals with metabolic and degenerative conditions,and is notably challenging to manage in patients with cirrhosis.Patients with cirrhosis frequently experience exacerbated AS symptoms due to the hyperdynamic circulatory state induced by portal hypertension,which masks early AS signs,resulting in delayed diagnosis.The coexistence of AS and liver disease significantly complicates management,particularly for those awaiting liver transplantation(LT),where untreated AS can increase perioperative morbidity and mortality.This review examines the pathophysiology,clinical manifestations,and management of AS in cirrhotic patients,with a focus on implications for LT candidates.Available treatment options,including surgical aortic valve replacement and transcatheter aortic valve replacement(TAVR),are discussed,with TAVR emerging as a preferred approach due to favorable outcomes in high-risk patients.We also explore the potential role of TAVR as a bridge to LT,with case reports showing promising,albeit anecdotal,success in restoring LT candidacy.Limitations in current perioperative risk assessment tools,which inadequately address the unique risks faced by cirrhotic patients undergoing cardiac procedures,highlight the need for multi-disciplinary care and further research to improve outcomes of patients with concomitant end-stage liver disease and AS.展开更多
BACKGROUND Uniportal full-endoscopy(UFE)technique has been continuously developed and applied for treating lumbar spinal stenosis.However,achieving effective decompression outcome of using the UFE technique remains te...BACKGROUND Uniportal full-endoscopy(UFE)technique has been continuously developed and applied for treating lumbar spinal stenosis.However,achieving effective decompression outcome of using the UFE technique remains technically demanding and uncertain.Previously,we have proposed the biportal full-endoscopy(BFE)technique to integrate the respective advantages of both UFE and unilateral biportal endoscopy technique.There is limited published data on the comparison of clinical outcomes between biportal and UFE techniques in lumbar spinal stenosis with bilateral symptoms.AIM To contrast the clinical outcomes between biportal and UFE techniques for treating lumbar spinal stenosis with bilateral symptoms.METHODS This study retrospectively examined 100 patients diagnosed with lumbar spinal stenosis and bilateral symptoms.Among them,52 cases were part of group A(BFE technique group),and 48 cases belonged to group B(UFE technique group).The visual analogue scale(VAS),Oswestry Disability Index(ODI),and modified Macnab criteria were used to evaluate the clinical outcomes.RESULTS Group A had significantly shorter operation time than group B.Both groups experienced substantial relief in lower back and lower extremity pain on the severe side at postoperative 3 days,3 months,and 12 months.Group A had notably lower VAS scores for mild side lower extremity pain at postoperative 3 months and 12 months compared to group B.Group A's ODI scores were significantly lower at postoperative 3 months and 12 months,whereas group B's scores did not significantly differ from preoperative values.Group A's ODI scores were significantly lower than group B's at postoperative 3 months and 12 months.Group A had a significantly higher excellent and good response rate(94.23%)compared to group B(81.25%)at postoperative 12 months based on the modified Macnab scale outcomes.CONCLUSION The BFE technique offers multiple benefits,including reduced trauma and quicker recovery as a minimally invasive surgery,and enhanced decompression efficiency over the UFE technique when treating lumbar spinal stenosis with bilateral symptoms.展开更多
BACKGROUND A 56-year-old female presented with acute abdominal pain due to a ruptured pseudoaneurysm associated with median arcuate ligament syndrome(MALS),a rare condition caused by the compression of the celiac arte...BACKGROUND A 56-year-old female presented with acute abdominal pain due to a ruptured pseudoaneurysm associated with median arcuate ligament syndrome(MALS),a rare condition caused by the compression of the celiac artery by the median arcuate ligament(MAL),potentially leading to ischemia,aneurysm formation,and rupture.CASE SUMMARY Computed tomography revealed a retroperitoneal hematoma,celiac artery stenosis,and two aneurysms in the inferior pancreaticoduodenal artery.Hemo-stasis was achieved using transcatheter arterial embolization.However,15 days after embolization,the patient developed duodenal stenosis,manifesting as gastric distension and nausea without abdominal pain.Endoscopy revealed mucosal edema and luminal narrowing of the duodenum.Conservative treatment was ineffective,and the patient underwent MAL transection and gastrojejun-ostomy.She recovered uneventfully,and follow-up at 4 months showed complete resolution of duodenal stenosis and no recurrence.CONCLUSION This case highlights the importance of the early diagnosis and multidisciplinary management of MALS.展开更多
Background:Subcortical ischemic vascular dementia(SIVD)is a common subtype of vascular dementia.Currently,the bilateral common carotid artery stenosis(BCAS)mouse model is the most suitable SIVD rodent model.In this st...Background:Subcortical ischemic vascular dementia(SIVD)is a common subtype of vascular dementia.Currently,the bilateral common carotid artery stenosis(BCAS)mouse model is the most suitable SIVD rodent model.In this study,we investigated the functional and structural impairments in the hippocampus 1 month after BCAS.Methods:We used behavioral tests,laser speckle flowmetry,long-term potentiation,histochemical staining,molecular experiments,and voxel-based morphometry to evaluate the hippocampal impairments.Results:Behavioral studies revealed that BCAS mice exhibited worse performance.Laser speckle flowmetry detected an obvious decrease in cerebral blood flow.The synaptic plasticity of the perforant path-dentate gyrus pathway was inhibited.Decreased fractional anisotropy and increased mean diffusivity were detected in the hippocampus via diffusion tensor imaging data.A reduction in gray matter volume,which was most prominent in the hippocampus and its surrounding areas,was de-tected via voxel-based morphometry analysis.Impairments in cell morphology and myelin integrity were validated using histochemical staining and molecular biology techniques.In addition,the numbers of GFAP+astrocytes and Iba1+microglia in-creased in the hippocampus.Conclusions:Overall,our study demonstrates early functional and structural impair-ments in the hippocampus contributing to learning and memory deficits after 1 month of BCAS,indicating that the hippocampus is vulnerable to chronic cerebral ischemia.展开更多
Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with ...Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,accounting for 25%of patients aged 85 years and older in Europe and 12%of patients older than 80 years in Japan.[2,3]Recent studies have reported that ATTRwt-CA coexists in 11%-16%of older patients with AS undergoing transcatheter aortic valve replacement(TAVR).[1,4,5]In a metaanalysis by Ho et al.,[6]the prevalence rates of cardiac amyloidosis,predominantly ATTRwt-CA,in patients with AS and those referred for TAVR or surgical aortic valve replacement(SAVR)were 14.4%and 15.2%,respectively.Conversely,the prevalence of AS in patients with cardiac amyloidosis is 8.7%.Owing to the high surgical risk in patients with both AS and ATTRwt-CA,TAVR may be preferred over SAVR.展开更多
Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and mo...Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).展开更多
Objective:The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis(PAS)in pediatric patients after surgical repair of comp...Objective:The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis(PAS)in pediatric patients after surgical repair of complicated congenital heart diseases(CHDs).Methods:All pediatric patients diagnosed with residual PAS after surgical repair of complicated CHDs between 1996 and 2020 were retrospectively enrolled in the study.Results:A total of 41 patients(30 males,11 females;median age 5.0 years,median weight 17 kg)were followed-up for a median of 7.1 years.Follow-up echocardiography results demonstrated that the target vessel diameter increased from(3.4±1.1)mm preoperatively to(6.2±1.9)mm one year post-procedure and(6.0±1.5)mm at the final follow-up(p<0.05).The pressure gradient across the stenosis decreased from(52.6±15.8)mmHg preoperatively to(35.8±19.1)mmHg one year post-procedure and(33.1±19.7)mmHg at the final follow-up(p<0.05).Cardiac computed tomography scans indicated that target vessel/distal vessel diameter ratio increased from(0.4±0.2)pre-operatively to(0.8±0.2)one year post-procedure and(0.9±0.3)at the final follow-up(p<0.05).A total of six adverse events were documented,comprising two cases of in-stent restenosis requiring surgical reintervention,three cases of in-stent restenosis managed with regular clinical surveillance,and one case of percutaneous pulmonary valve replacement due to severe pulmonary regurgitation.Kaplan-Meier event-free survival analysis demonstrated that elevated preprocedural right ventricular systolic pressure(>72 mmHg)was significantly associated with long-term adverse events(p=0.024).Conclusion:Percutaneous stent implantation for residual PAS after surgical repair of complicated CHDs effectively relieves vessel stenosis,stabilizes cardiac function,and improves long-term prognosis in pediatric patients.In-stent restenosis remains an unresolved complication,necessitating further advancements in interventional strategies.展开更多
Pulmonary vein stenosis(PVS) is rare condition characterized by a challenging diagnosis and unfavorable prognosis at advance stages. At present, injury from radiofrequency ablation for atrial fibrillation has become t...Pulmonary vein stenosis(PVS) is rare condition characterized by a challenging diagnosis and unfavorable prognosis at advance stages. At present, injury from radiofrequency ablation for atrial fibrillation has become the main cause of the disease. PVS is characterized by a progressive lumen size reduction of one or more pulmonary veins that, when hemodynamically significant, may raise lobar capillary pressure leading to signs and symptoms such as shortness of breath, cough, and hemoptysis. Image techniques(transesophageal echocardiography, computed tomography, magnetic resonance and perfusion imaging) are essential to reach a final diagnosis and decide an appropriate therapy. In this regard, series from referral centers have shown that surgical and transcatheter interventions may improve prognosis. The purpose of this article is to review the etiology, assessment and management of PVS.展开更多
Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosi...Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosis for individuals and a great burden to society.The etiology and risk factors of ICAS in youth differ from those of older patients,thus resulting in a difference in the progression and prognosis of the disease.Even though the diagnosis of ICAS is lumen-based,it is sometimes difficult to identify in young patients based on imaging alone.Notably,novel vessel wall imaging techniques play an important role in determining the cause of stenosis and screening patients at high risk of recurrence.Moreover,pharmacologic regimens and risk factor control goals for ICAS in young adults are largely consistent with those in older patients.Thus,considering the poor prognosis,there is an urgent need for high-quality studies in the young ICAS population to analyze the high-quality observational data collected.展开更多
OBJECTIVE To evalu ate the role of resting magnetocardiography in identifying seve re coronary artery stenosis in patients with suspected coronary artery disease.METHODS A total of 513 patients with angina symptoms we...OBJECTIVE To evalu ate the role of resting magnetocardiography in identifying seve re coronary artery stenosis in patients with suspected coronary artery disease.METHODS A total of 513 patients with angina symptoms were included and divided into two groups based on the extent of coronary artery disease determined by angiography:the non-severe coronary stenusis group(<70% stenosis) and the severe coronary stenosis group(≥70% stenosis).The diagnostic model was constructed using magnetic field map(MFM) parameters,either individually or in combination with clinical indicators.The performance of the models was evaluated using receiver operating characteristic curves,accuracy,sensitivity,specificity,positive predictive value(PPV) and ne gative predictive value(NPV).Calibration plots and decision curve analysis were performed to investigate the clinical utility and performance of the models,respectively.RESULTS In the severe coronary stenosis group,QR_MCTDd,S_MDp,and TT_(MA)C_(50) were significantly higher than those in the non-severe coronary stenosis group(10,46±10.66 vs,5.11±6.07,P <0.001;7.2±8.64 vs.4.68±6.95,P=0.003;0.32±57.29 vs.0.26±57.29,P <0.001).While,QR_MV_(amp),R_(MA),and T_(MA) in the severe coronary stenosis group were lower(0.23±0.16 vs.0.28±0.16,P<0.001;55.06±48.68 vs.59.24±53.01,P<0.001;51.67±39.32 vs. 60.45±51.33,P <0.001).Seven MFM parameters were integrated into the model,resulting in an area under the curve of 0.810(95% CI:0.765-0.855).The sensitivity,specificity,PPV,NPV,and accurecy were 71.7%,80.4%,93.3%,42.8 %,and 73.5%;respectevely.The combined model exhibited an area under the curve of 0.845(95% CI:0.798-0.892).The sensitivity,specificity,PPV,NPV,and accuracy were 84.3%,73.8%,92.6%,54.6%,and 82.1%;respectively.Calibration curves demonstrate d excellent agreement between the nomogram prediction and actual observation.The decision curve analysis showed that the c ombine d model provided greater net benefit compared to the magnetocardingraphy model.CONCLUSIONS The novel quantitative MFM parameters,whether used individually or in combination with clinical indicators,have been shown to effectively pre dict the risk of severe coronary stenosis in patients presenting with angina-like symptoms.Magnetocardiography,an emerging non-invasive diagnostic tool,warrants further exploration for its potential in diagnosing coronary heart disease.展开更多
BACKGROUND Stapled hemorrhoidopexy(SH)is currently a widely accepted method for treating the prolapse of internal hemorrhoids.Postoperative anal stenosis is a critical complication of SH.A remedy for this involves the...BACKGROUND Stapled hemorrhoidopexy(SH)is currently a widely accepted method for treating the prolapse of internal hemorrhoids.Postoperative anal stenosis is a critical complication of SH.A remedy for this involves the removal of the circumferential staples of the anastomosis,followed by the creation of a hand-sewn anastomosis.Numerous studies have reported modified SH procedures to improve outcomes.We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH.AIM To compare outcomes of staple removal at the 3-and 9-o’clock positions during modified SH in patients with mixed hemorrhoids.METHODS This was a single-center,retrospective,observational study.Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015,and January 1,2020,were included.The operation time,blood loss,length of hospital stay,and incidence of minor or major complic-ations were recorded.RESULTS Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015 and January 1,2020,were included.Operation time,blood loss,length of hospital stay,and incidence of minor or major complications were recorded.We investigated 187 patients(mean age,50.9 years)who had undergone our modified SH and 313 patients(mean age,53.0 years)who had undergone standard SH.In the modified SH group,54%of patients had previously undergone surgical intervention for hemorrhoids,compared with the 40.3%of patients in the standard SH group.The modified SH group included five(2.7%)patients with anal stenosis,while 21(6.7%)patients in the standard SH group had complications of anal stenosis.There was a significant relationship between the rate of postoperative anal stenosis and the modified SH:0.251(0.085-0.741)and 0.211(0.069-0.641)in multiple regression analysis.The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.CONCLUSION The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.展开更多
BACKGROUND Ultrasound guide technology,which can provide real-time visualization of the needle tip and tissues and avoid many adverse events,is widely used in mini-mally invasive therapy.However,the studies on ultraso...BACKGROUND Ultrasound guide technology,which can provide real-time visualization of the needle tip and tissues and avoid many adverse events,is widely used in mini-mally invasive therapy.However,the studies on ultrasound-guided Lateral recess block(LRB)are limited,this is probably because there is no recognized standard method for ultrasound scanning.This study aimed to evaluate the effect of ultrasound-guided LRB in patients with lateral recess stenosis(LRS).CASE SUMMARY A 65-year-old patient complained of low back pain accompanied occasionally by pain and numbness in the left lower limb.Physical examination showed ten-derness on the spinous process and paraspinal muscles from L1 to S1,extensor hallucis longus and tibialis anterior weakness(muscle strength:4-),and a positive straight leg raising test in the left lower limb(60°).Magnetic resonance imaging showed L4–L5 disc degeneration with left LRS and nerve root entrapment.Subsequently,the patient was diagnosed with LRS.This patient was treated with a novel ultrasound-guided LRB approach.The patient’s symptoms significantly improved without any complications at 1 wk postoperatively and at the 3-month follow-up.CONCLUSION This is the first report on the LRS treatment with ultrasound-guided LRB from the contralateral spinous process along the inner side of the articular process by out-plane technique.Further studies are expected to investigate the efficacy and safety of ultrasound-guided LRB for patients with LRS.展开更多
BACKGROUND The stent embedded in the esophageal mucosa is one of the complications after stenting for esophageal stricture.We present a case of stent adjustment with the aid of a transparent cap after endoscopic injec...BACKGROUND The stent embedded in the esophageal mucosa is one of the complications after stenting for esophageal stricture.We present a case of stent adjustment with the aid of a transparent cap after endoscopic injection of an esophageal varices stent.CASE SUMMARY A 61-year-old male patient came to the hospital with discomfort of the chest after the stent implanted for the stenosis because of endoscopic injection of esophageal varices.The gastroscopy was performed,and the stent embedded into the esophageal mucosa.At first,we pulled the recycling line for shrinking the stent,however,the mucosa could not be removed from the stent.Then a forceps was performed to remove the mucosa in the stent,nevertheless,the bleeding form the mucosa was obvious.And then,we used a transparent cap to scrape the mucosa along the stent,and the mucosa were removed successfully without bleeding.CONCLUSION A transparent cap helps gastroscopy to remove the mucosa embedded in the stent after endoscopic injection of the esophageal varices stent.展开更多
This study aimed to comprehensively evaluate non-contrast computed tomography(CT)-based radiomics for predicting early outcomes in patients with severe atherosclerotic renal artery stenosis(ARAS)after percutaneous tra...This study aimed to comprehensively evaluate non-contrast computed tomography(CT)-based radiomics for predicting early outcomes in patients with severe atherosclerotic renal artery stenosis(ARAS)after percutaneous transluminal renal angioplasty(PTRA).A total of 52 patients were retrospectively recruited,and their clinical characteristics and pretreatment CT images were collected.During a median follow-up period of 3.7 mo,18 patients were confirmed to have benefited from the treatment,defined as a 20%improvement from baseline in the estimated glomerular filtration rate.A deep learning network trained via self-supervised learning was used to enhance the imaging phenotype characteristics.Radiomics features,comprising 116 handcrafted features and 78 deep learning features,were extracted from the affected renal and perirenal adipose regions.More features from the latter were correlated with early outcomes,as determined by univariate analysis,and were visually represented in radiomics heatmaps and volcano plots.After using consensus clustering and the least absolute shrinkage and selection operator method for feature selection,five machine learning models were evaluated.Logistic regression yielded the highest leave-one-out cross-validation accuracy of 0.780(95%CI:0.660-0.880)for the renal signature,while the support vector machine achieved 0.865(95%CI:0.769-0.942)for the perirenal adipose signature.SHapley Additive exPlanations was used to visually interpret the prediction mechanism,and a histogram feature and a deep learning feature were identified as the most influential factors for the renal signature and perirenal adipose signature,respectively.Multivariate analysis revealed that both signatures served as independent predictive factors.When combined,they achieved an area under the receiver operating characteristic curve of 0.888(95%CI:0.784-0.992),indicating that the imaging phenotypes from both regions complemented each other.In conclusion,non-contrast CT-based radiomics can be leveraged to predict the early outcomes of PTRA,thereby assisting in identifying patients with ARAS suitable for this treatment,with perirenal adipose tissue providing added predictive value.展开更多
基金supported by the National Natural Science Foundation of China(82170375,U23A20395)1.3.5 project for disciplines of excellence from West China Hospital of Sichuan University(ZYGD23021,23HXF-H009)Sichuan Science and Technology Program 2023NSFSC1645。
文摘Background Hypertension is associated with an increased risk of calcific aortic valve stenosis(CAVS).However,the directionality of causation between blood pressure traits and aortic stenosis is unclear,as is the benefit of antihypertensive drugs for CAVS.Methods Using genome-wide association studies(GWAS)summary statistics,we performed bidirectional two-sample univariable mendelian randomization(UVMR)to assess the causal associations of systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse pressure(PP)with CAVS.Multivariable mendelian randomization(MVMR)was conducted to evaluate the direct effect of hypertension on CAVS,adjusting for confounders.Drug target mendelian randomization(MR)and summary-level MR(SMR)were used to estimate the effects of 12 classes of antihypertensive drugs and their target genes on CAVS risk.Inverse variance weighting was the primary MR method,with sensitivity analyses to validate results.Results UVMR showed SBP,DBP,and PP have causal effects on CAVS,with no significant reverse causality.MVMR confirmed the causality between hypertension and CAVS after adjusting for confounders.Drug-target MR analyses indicated that calcium channel blockers(CCBs),loop diuretics,and thiazide diuretics via SBP lowering exerted protective effects on CAVS risk.SMR analysis showed that the CCBs target gene CACNA2D2 and ARBs target gene AGTR1 were positively associated with CAVS risk,while diuretics target genes SLC12A5 and SLC12A1 were negatively associated with aortic stenosis risk.Conclusions Hypertension has a causal relationship with CAVS.Managing SBP in hypertensive patients with CCBs may prevent CAVS.ARBs might exert protective effects on CAVS independent of blood pressure reduction.The relationship between diuretics and CAVS is complex,with opposite effects through different mechanisms.
文摘Objective:To analyze the treatment effect of standardized bronchoscopic interventional therapy(i.e.,interventional therapy)on airway stenosis.Methods:Forty patients with airway stenosis admitted to the hospital between September 2022 and September 2024 were selected and randomly divided into two groups using a random number table.The experimental group received interventional therapy,while the reference group received conventional treatment.The total effective rate,degree of airway stenosis,shortness of breath score,and lung function indicators were compared.Results:The total effective rate in the experimental group was higher than that in the reference group.The proportion of mild stenosis in the degree of airway stenosis was higher in the experimental group than in the reference group.The shortness of breath score was lower in the experimental group than in the reference group.The lung function indicators were better in the experimental group than in the reference group(P<0.05).Conclusion:Interventional therapy is effective for patients with airway stenosis,as it can reduce the degree of stenosis,improve symptoms of shortness of breath,and protect patients’lung function.
文摘Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation(TAVI)and to analyze the ability of different tools for predicting clinical outcomes in this context.Methods This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge.The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI.Results A total of 377 patients were included(mean age of 80.4 years).Most patients were independent or mildly dependent,with an optimal cognitive status.The proportion of frailty ranged from 17.6%to 49.8%.A total of 20 patients(5.3%)died and 110/377 patients(29.2%)died or were readmitted during follow up.Overall,most components of the geriatric assessment showed an association with clinical outcomes.Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission.The association between frailty and clinical outcomes was higher for short physical performance battery(SPPB),essential frailty toolset(EFT)and the frailty index based on comprehensive geriatric assessment(IF-VIG)and lower for Fried criteria and FRAIL scale.Conclusions AS patients from this series presented a good physical performance,optimal cognitive status and a reasonably low prevalence of frailty.The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT,SPPB and the IF-VIG.
基金supported by the Natural Science Foundation of Zhejiang Province(Grant number:LGF22H040003).
文摘A 28-year-old pregnant woman with no prior obstetric complications had a normal prenatal workup before 24 weeks'gestation.At 24 weeks,ultrasound revealed gastrointestinal malformations,a persistent left superior vena cava,and polyhydramnios.
文摘BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older generation of uncovered stents.Yet,with the advancement of technology,novel innovations of self-expanding metal stents(SEMS)have revolutionized the treatment of benign airway stenosis(BAS),where the insertion of SEMS is known to be easier than silicone stents.AIM To compare the efficacy and safety of covered SEMS against uncovered SEMS,and thereafter propose more direct trials comparing covered SEMS against silicone stents for consideration of revision of current FDA guidelines.METHODS A comprehensive literature review of MEDLINE and EMBASE was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Of 3002 articles,64 publications met the eligibility criteria with a total of 900 patients(468 covered SEMS,432 uncovered SEMS).The collected data were analyzed using Statistical Package for the Social Sciences version 11.5.RESULTS Covered SEMS showed a higher success rate of insertion(98.6%vs 88.2%)and lower complication rates of infection(1.3%vs 13.2%),restenosis(1.5%vs 10.6%),stent fracture(2.6%vs 7.4%),bleeding(0%vs 5.8%),and pneumothorax(0%vs 2.8%)compared to uncovered SEMS.However,covered SEMS compared to uncovered SEMS showed higher complication rates of stent migration(12.4%vs 6.9%)and granulation tissue formation(26.5%vs 20.1%).CONCLUSION Our study suggests that covered SEMS are an effective,safe,and viable option in the treatment of BAS.Thus,further consideration regarding the utilization of covered SEMS over other forms of stent types is appropriate.
文摘BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of peripheral arteries and coronary stenosis in patients with coronary heart disease(CHD).METHODS The study included a total of 218 patients(63±10.9 years of age;54%male)with CHD subjected to coronary angiography and routine diagnostic assessment,including ultrasound imaging to assess the extent of peripheral atherosclerotic lesions.Receiver operating characteristic analysis and binomial logistic regression were used to detect the associations.RESULTS We demonstrated for the first time that the presence of atherosclerotic plaque with≥70%stenosis in femoral arteries was associated with significant coronary stenosis,with 93%sensitivity and 90%specificity,and thus can be used as an additional diagnostic marker for coronary stenosis.The data indicated associations between femoral artery atherosclerosis and atherosclerotic lesions of coronary arteries,with a high correlation coefficient r=0.8(P<0.05).The presence of an atherosclerotic plaque in the femoral arteries with≥30% or≥70%stenosis was associated with a 30-or 70-fold higher odds ratio of coronary stenosis,respectively.CONCLUSION For resource-limited clinics,our findings suggest skipping carotids-femoral ultrasound alone may suffice to rule out severe CHD.Ultrasound imaging femoral artery atherosclerosis provides a simplified approach for patient stratification.
文摘Aortic stenosis(AS),a progressive disease affecting aortic valve function,is common among individuals with metabolic and degenerative conditions,and is notably challenging to manage in patients with cirrhosis.Patients with cirrhosis frequently experience exacerbated AS symptoms due to the hyperdynamic circulatory state induced by portal hypertension,which masks early AS signs,resulting in delayed diagnosis.The coexistence of AS and liver disease significantly complicates management,particularly for those awaiting liver transplantation(LT),where untreated AS can increase perioperative morbidity and mortality.This review examines the pathophysiology,clinical manifestations,and management of AS in cirrhotic patients,with a focus on implications for LT candidates.Available treatment options,including surgical aortic valve replacement and transcatheter aortic valve replacement(TAVR),are discussed,with TAVR emerging as a preferred approach due to favorable outcomes in high-risk patients.We also explore the potential role of TAVR as a bridge to LT,with case reports showing promising,albeit anecdotal,success in restoring LT candidacy.Limitations in current perioperative risk assessment tools,which inadequately address the unique risks faced by cirrhotic patients undergoing cardiac procedures,highlight the need for multi-disciplinary care and further research to improve outcomes of patients with concomitant end-stage liver disease and AS.
基金Supported by National Natural Science Foundation of China,No.82202694Clinical Research Innovation Plan of Shanghai General Hospital,No.CTCCR-2021C10.
文摘BACKGROUND Uniportal full-endoscopy(UFE)technique has been continuously developed and applied for treating lumbar spinal stenosis.However,achieving effective decompression outcome of using the UFE technique remains technically demanding and uncertain.Previously,we have proposed the biportal full-endoscopy(BFE)technique to integrate the respective advantages of both UFE and unilateral biportal endoscopy technique.There is limited published data on the comparison of clinical outcomes between biportal and UFE techniques in lumbar spinal stenosis with bilateral symptoms.AIM To contrast the clinical outcomes between biportal and UFE techniques for treating lumbar spinal stenosis with bilateral symptoms.METHODS This study retrospectively examined 100 patients diagnosed with lumbar spinal stenosis and bilateral symptoms.Among them,52 cases were part of group A(BFE technique group),and 48 cases belonged to group B(UFE technique group).The visual analogue scale(VAS),Oswestry Disability Index(ODI),and modified Macnab criteria were used to evaluate the clinical outcomes.RESULTS Group A had significantly shorter operation time than group B.Both groups experienced substantial relief in lower back and lower extremity pain on the severe side at postoperative 3 days,3 months,and 12 months.Group A had notably lower VAS scores for mild side lower extremity pain at postoperative 3 months and 12 months compared to group B.Group A's ODI scores were significantly lower at postoperative 3 months and 12 months,whereas group B's scores did not significantly differ from preoperative values.Group A's ODI scores were significantly lower than group B's at postoperative 3 months and 12 months.Group A had a significantly higher excellent and good response rate(94.23%)compared to group B(81.25%)at postoperative 12 months based on the modified Macnab scale outcomes.CONCLUSION The BFE technique offers multiple benefits,including reduced trauma and quicker recovery as a minimally invasive surgery,and enhanced decompression efficiency over the UFE technique when treating lumbar spinal stenosis with bilateral symptoms.
文摘BACKGROUND A 56-year-old female presented with acute abdominal pain due to a ruptured pseudoaneurysm associated with median arcuate ligament syndrome(MALS),a rare condition caused by the compression of the celiac artery by the median arcuate ligament(MAL),potentially leading to ischemia,aneurysm formation,and rupture.CASE SUMMARY Computed tomography revealed a retroperitoneal hematoma,celiac artery stenosis,and two aneurysms in the inferior pancreaticoduodenal artery.Hemo-stasis was achieved using transcatheter arterial embolization.However,15 days after embolization,the patient developed duodenal stenosis,manifesting as gastric distension and nausea without abdominal pain.Endoscopy revealed mucosal edema and luminal narrowing of the duodenum.Conservative treatment was ineffective,and the patient underwent MAL transection and gastrojejun-ostomy.She recovered uneventfully,and follow-up at 4 months showed complete resolution of duodenal stenosis and no recurrence.CONCLUSION This case highlights the importance of the early diagnosis and multidisciplinary management of MALS.
基金supported by Tianjin Key Medical Discipline(Specialty)Construction Project(grant number TJYXZDXK-004A).
文摘Background:Subcortical ischemic vascular dementia(SIVD)is a common subtype of vascular dementia.Currently,the bilateral common carotid artery stenosis(BCAS)mouse model is the most suitable SIVD rodent model.In this study,we investigated the functional and structural impairments in the hippocampus 1 month after BCAS.Methods:We used behavioral tests,laser speckle flowmetry,long-term potentiation,histochemical staining,molecular experiments,and voxel-based morphometry to evaluate the hippocampal impairments.Results:Behavioral studies revealed that BCAS mice exhibited worse performance.Laser speckle flowmetry detected an obvious decrease in cerebral blood flow.The synaptic plasticity of the perforant path-dentate gyrus pathway was inhibited.Decreased fractional anisotropy and increased mean diffusivity were detected in the hippocampus via diffusion tensor imaging data.A reduction in gray matter volume,which was most prominent in the hippocampus and its surrounding areas,was de-tected via voxel-based morphometry analysis.Impairments in cell morphology and myelin integrity were validated using histochemical staining and molecular biology techniques.In addition,the numbers of GFAP+astrocytes and Iba1+microglia in-creased in the hippocampus.Conclusions:Overall,our study demonstrates early functional and structural impair-ments in the hippocampus contributing to learning and memory deficits after 1 month of BCAS,indicating that the hippocampus is vulnerable to chronic cerebral ischemia.
文摘Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,accounting for 25%of patients aged 85 years and older in Europe and 12%of patients older than 80 years in Japan.[2,3]Recent studies have reported that ATTRwt-CA coexists in 11%-16%of older patients with AS undergoing transcatheter aortic valve replacement(TAVR).[1,4,5]In a metaanalysis by Ho et al.,[6]the prevalence rates of cardiac amyloidosis,predominantly ATTRwt-CA,in patients with AS and those referred for TAVR or surgical aortic valve replacement(SAVR)were 14.4%and 15.2%,respectively.Conversely,the prevalence of AS in patients with cardiac amyloidosis is 8.7%.Owing to the high surgical risk in patients with both AS and ATTRwt-CA,TAVR may be preferred over SAVR.
文摘Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).
基金approved by the Institutional Review Board of Guangdong Provincial People's Hospital(KY-Q-2022-336-03).
文摘Objective:The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis(PAS)in pediatric patients after surgical repair of complicated congenital heart diseases(CHDs).Methods:All pediatric patients diagnosed with residual PAS after surgical repair of complicated CHDs between 1996 and 2020 were retrospectively enrolled in the study.Results:A total of 41 patients(30 males,11 females;median age 5.0 years,median weight 17 kg)were followed-up for a median of 7.1 years.Follow-up echocardiography results demonstrated that the target vessel diameter increased from(3.4±1.1)mm preoperatively to(6.2±1.9)mm one year post-procedure and(6.0±1.5)mm at the final follow-up(p<0.05).The pressure gradient across the stenosis decreased from(52.6±15.8)mmHg preoperatively to(35.8±19.1)mmHg one year post-procedure and(33.1±19.7)mmHg at the final follow-up(p<0.05).Cardiac computed tomography scans indicated that target vessel/distal vessel diameter ratio increased from(0.4±0.2)pre-operatively to(0.8±0.2)one year post-procedure and(0.9±0.3)at the final follow-up(p<0.05).A total of six adverse events were documented,comprising two cases of in-stent restenosis requiring surgical reintervention,three cases of in-stent restenosis managed with regular clinical surveillance,and one case of percutaneous pulmonary valve replacement due to severe pulmonary regurgitation.Kaplan-Meier event-free survival analysis demonstrated that elevated preprocedural right ventricular systolic pressure(>72 mmHg)was significantly associated with long-term adverse events(p=0.024).Conclusion:Percutaneous stent implantation for residual PAS after surgical repair of complicated CHDs effectively relieves vessel stenosis,stabilizes cardiac function,and improves long-term prognosis in pediatric patients.In-stent restenosis remains an unresolved complication,necessitating further advancements in interventional strategies.
文摘Pulmonary vein stenosis(PVS) is rare condition characterized by a challenging diagnosis and unfavorable prognosis at advance stages. At present, injury from radiofrequency ablation for atrial fibrillation has become the main cause of the disease. PVS is characterized by a progressive lumen size reduction of one or more pulmonary veins that, when hemodynamically significant, may raise lobar capillary pressure leading to signs and symptoms such as shortness of breath, cough, and hemoptysis. Image techniques(transesophageal echocardiography, computed tomography, magnetic resonance and perfusion imaging) are essential to reach a final diagnosis and decide an appropriate therapy. In this regard, series from referral centers have shown that surgical and transcatheter interventions may improve prognosis. The purpose of this article is to review the etiology, assessment and management of PVS.
基金supported by the National Natural Science Foundation of China(82071468,82271507).
文摘Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosis for individuals and a great burden to society.The etiology and risk factors of ICAS in youth differ from those of older patients,thus resulting in a difference in the progression and prognosis of the disease.Even though the diagnosis of ICAS is lumen-based,it is sometimes difficult to identify in young patients based on imaging alone.Notably,novel vessel wall imaging techniques play an important role in determining the cause of stenosis and screening patients at high risk of recurrence.Moreover,pharmacologic regimens and risk factor control goals for ICAS in young adults are largely consistent with those in older patients.Thus,considering the poor prognosis,there is an urgent need for high-quality studies in the young ICAS population to analyze the high-quality observational data collected.
基金supported by the National Key Research and Development Program (No.2022YFC2407001)。
文摘OBJECTIVE To evalu ate the role of resting magnetocardiography in identifying seve re coronary artery stenosis in patients with suspected coronary artery disease.METHODS A total of 513 patients with angina symptoms were included and divided into two groups based on the extent of coronary artery disease determined by angiography:the non-severe coronary stenusis group(<70% stenosis) and the severe coronary stenosis group(≥70% stenosis).The diagnostic model was constructed using magnetic field map(MFM) parameters,either individually or in combination with clinical indicators.The performance of the models was evaluated using receiver operating characteristic curves,accuracy,sensitivity,specificity,positive predictive value(PPV) and ne gative predictive value(NPV).Calibration plots and decision curve analysis were performed to investigate the clinical utility and performance of the models,respectively.RESULTS In the severe coronary stenosis group,QR_MCTDd,S_MDp,and TT_(MA)C_(50) were significantly higher than those in the non-severe coronary stenosis group(10,46±10.66 vs,5.11±6.07,P <0.001;7.2±8.64 vs.4.68±6.95,P=0.003;0.32±57.29 vs.0.26±57.29,P <0.001).While,QR_MV_(amp),R_(MA),and T_(MA) in the severe coronary stenosis group were lower(0.23±0.16 vs.0.28±0.16,P<0.001;55.06±48.68 vs.59.24±53.01,P<0.001;51.67±39.32 vs. 60.45±51.33,P <0.001).Seven MFM parameters were integrated into the model,resulting in an area under the curve of 0.810(95% CI:0.765-0.855).The sensitivity,specificity,PPV,NPV,and accurecy were 71.7%,80.4%,93.3%,42.8 %,and 73.5%;respectevely.The combined model exhibited an area under the curve of 0.845(95% CI:0.798-0.892).The sensitivity,specificity,PPV,NPV,and accuracy were 84.3%,73.8%,92.6%,54.6%,and 82.1%;respectively.Calibration curves demonstrate d excellent agreement between the nomogram prediction and actual observation.The decision curve analysis showed that the c ombine d model provided greater net benefit compared to the magnetocardingraphy model.CONCLUSIONS The novel quantitative MFM parameters,whether used individually or in combination with clinical indicators,have been shown to effectively pre dict the risk of severe coronary stenosis in patients presenting with angina-like symptoms.Magnetocardiography,an emerging non-invasive diagnostic tool,warrants further exploration for its potential in diagnosing coronary heart disease.
文摘BACKGROUND Stapled hemorrhoidopexy(SH)is currently a widely accepted method for treating the prolapse of internal hemorrhoids.Postoperative anal stenosis is a critical complication of SH.A remedy for this involves the removal of the circumferential staples of the anastomosis,followed by the creation of a hand-sewn anastomosis.Numerous studies have reported modified SH procedures to improve outcomes.We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH.AIM To compare outcomes of staple removal at the 3-and 9-o’clock positions during modified SH in patients with mixed hemorrhoids.METHODS This was a single-center,retrospective,observational study.Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015,and January 1,2020,were included.The operation time,blood loss,length of hospital stay,and incidence of minor or major complic-ations were recorded.RESULTS Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015 and January 1,2020,were included.Operation time,blood loss,length of hospital stay,and incidence of minor or major complications were recorded.We investigated 187 patients(mean age,50.9 years)who had undergone our modified SH and 313 patients(mean age,53.0 years)who had undergone standard SH.In the modified SH group,54%of patients had previously undergone surgical intervention for hemorrhoids,compared with the 40.3%of patients in the standard SH group.The modified SH group included five(2.7%)patients with anal stenosis,while 21(6.7%)patients in the standard SH group had complications of anal stenosis.There was a significant relationship between the rate of postoperative anal stenosis and the modified SH:0.251(0.085-0.741)and 0.211(0.069-0.641)in multiple regression analysis.The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.CONCLUSION The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.
基金Supported by the National Natural Science Foundation of China,No.82305380The Postdoctoral Research Program,West China Hospital,Sichuan University,No.2020HXBH018.
文摘BACKGROUND Ultrasound guide technology,which can provide real-time visualization of the needle tip and tissues and avoid many adverse events,is widely used in mini-mally invasive therapy.However,the studies on ultrasound-guided Lateral recess block(LRB)are limited,this is probably because there is no recognized standard method for ultrasound scanning.This study aimed to evaluate the effect of ultrasound-guided LRB in patients with lateral recess stenosis(LRS).CASE SUMMARY A 65-year-old patient complained of low back pain accompanied occasionally by pain and numbness in the left lower limb.Physical examination showed ten-derness on the spinous process and paraspinal muscles from L1 to S1,extensor hallucis longus and tibialis anterior weakness(muscle strength:4-),and a positive straight leg raising test in the left lower limb(60°).Magnetic resonance imaging showed L4–L5 disc degeneration with left LRS and nerve root entrapment.Subsequently,the patient was diagnosed with LRS.This patient was treated with a novel ultrasound-guided LRB approach.The patient’s symptoms significantly improved without any complications at 1 wk postoperatively and at the 3-month follow-up.CONCLUSION This is the first report on the LRS treatment with ultrasound-guided LRB from the contralateral spinous process along the inner side of the articular process by out-plane technique.Further studies are expected to investigate the efficacy and safety of ultrasound-guided LRB for patients with LRS.
基金Supported by Hangzhou Agricultural and Social Development Research Guidance Project,No.20220919Y037.
文摘BACKGROUND The stent embedded in the esophageal mucosa is one of the complications after stenting for esophageal stricture.We present a case of stent adjustment with the aid of a transparent cap after endoscopic injection of an esophageal varices stent.CASE SUMMARY A 61-year-old male patient came to the hospital with discomfort of the chest after the stent implanted for the stenosis because of endoscopic injection of esophageal varices.The gastroscopy was performed,and the stent embedded into the esophageal mucosa.At first,we pulled the recycling line for shrinking the stent,however,the mucosa could not be removed from the stent.Then a forceps was performed to remove the mucosa in the stent,nevertheless,the bleeding form the mucosa was obvious.And then,we used a transparent cap to scrape the mucosa along the stent,and the mucosa were removed successfully without bleeding.CONCLUSION A transparent cap helps gastroscopy to remove the mucosa embedded in the stent after endoscopic injection of the esophageal varices stent.
基金supported by the National Natural Science Foundation of China,Nos.82022036,82372053,91959130,81971776,62027901,81930053,and 82302296the China Postdoctoral Science Foundation,No.2022M720357.
文摘This study aimed to comprehensively evaluate non-contrast computed tomography(CT)-based radiomics for predicting early outcomes in patients with severe atherosclerotic renal artery stenosis(ARAS)after percutaneous transluminal renal angioplasty(PTRA).A total of 52 patients were retrospectively recruited,and their clinical characteristics and pretreatment CT images were collected.During a median follow-up period of 3.7 mo,18 patients were confirmed to have benefited from the treatment,defined as a 20%improvement from baseline in the estimated glomerular filtration rate.A deep learning network trained via self-supervised learning was used to enhance the imaging phenotype characteristics.Radiomics features,comprising 116 handcrafted features and 78 deep learning features,were extracted from the affected renal and perirenal adipose regions.More features from the latter were correlated with early outcomes,as determined by univariate analysis,and were visually represented in radiomics heatmaps and volcano plots.After using consensus clustering and the least absolute shrinkage and selection operator method for feature selection,five machine learning models were evaluated.Logistic regression yielded the highest leave-one-out cross-validation accuracy of 0.780(95%CI:0.660-0.880)for the renal signature,while the support vector machine achieved 0.865(95%CI:0.769-0.942)for the perirenal adipose signature.SHapley Additive exPlanations was used to visually interpret the prediction mechanism,and a histogram feature and a deep learning feature were identified as the most influential factors for the renal signature and perirenal adipose signature,respectively.Multivariate analysis revealed that both signatures served as independent predictive factors.When combined,they achieved an area under the receiver operating characteristic curve of 0.888(95%CI:0.784-0.992),indicating that the imaging phenotypes from both regions complemented each other.In conclusion,non-contrast CT-based radiomics can be leveraged to predict the early outcomes of PTRA,thereby assisting in identifying patients with ARAS suitable for this treatment,with perirenal adipose tissue providing added predictive value.
