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
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
Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This ...Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA)and basilar artery(BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials,evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries.The primary outcome was stroke or death within 30 days postenrolment,or stroke in the region of the qualifying artery beyond 30 days through 1 year.A methodology based on intention-to-treat was employed,and HR accompanied by 95%CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial.Four hundred were designated for PTAS,while 409 were assigned to medical therapy alone.For the primary outcome,patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy(17.17%vs 7.77%;9.40;HR,2.38(1.03 to 5.52);p=0.04).However,PTAS had no significant difference in patients with symptomatic ICA(26.67%vs 16.67%;HR,1.68(0.78 to 3.62);p=0.19),MCA(8.28%vs 9.79%;HR,0.85(0.42 to 1.74);p=0.66)and VA stenosis(9.52%vs 10.71%;HR,0.91(0.32 to 2.62);p=0.86)compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis.Without significant technological advancements to mitigate these risks,PTAS offers limited benefits.For symptomatic ICA,MCA and VA stenosis,PTAS provided no significant advantage.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
BACKGROUND Benign laryngotracheal stenosis(LTS)is a condition characterized by mucosal inflammation and fibrosis.It is difficult to treat with a high incidence rate.Respiratory distress and voice disorders of varying ...BACKGROUND Benign laryngotracheal stenosis(LTS)is a condition characterized by mucosal inflammation and fibrosis.It is difficult to treat with a high incidence rate.Respiratory distress and voice disorders of varying severity also affect patients'sleep quality and quality of life.AIM To investigate the association between anxiety and depression and sleep quality in patients with benign LTS and identify significant risk factors for sleep disorders.METHODS This retrospective cohort study enrolled 127 consecutive patients with benign LTS admitted to The First People's Hospital of Changde City between January 2021 and January 2024.Comprehensive assessments included demographic collection and Pittsburgh sleep quality index(PSQI),self-rating anxiety scale(SAS),and selfrating depression scale(SDS)scoring.Correlation analyses were conducted to examine relationships between psychological measures and sleep parameters,followed by multivariate logistic regression to determine independent risk factors.RESULTS The cohort demonstrated significantly impaired sleep quality(mean PSQI,7.79±2.47),with 48.0%(n=61)meeting the criteria for clinically significant sleep disturbance.The scores of all PSQI dimensions,as well as SAS and SDS scores of patients with LTS,significantly exceeded Chinese normative values.Strong positive correlations emerged between PSQI scores and both SAS and SDS measures.Multivariate logistic analysis identified middle age(41-50 years),multiple surgical interventions(≥3 procedures),lower socioeconomic status(monthly household income per capita≤5000 RMB),and concurrent anxiety/depression as independent predictors of sleep disturbance.CONCLUSION The results demonstrate a high prevalence of sleep disorders and comorbid anxiety or depressive moods among patients with LTS.These psychological factors both correlate with and independently predict sleep impairment.These results underscore the need for integrated and proactive approaches addressing both physical and mental health components in LTS management,focusing on high-risk subgroups stratified based on age,monthly household income per capita,anxiety/depression status,and number of prior surgeries.展开更多
Objective:To evaluate the application of spinal endoscopy in treating elderly patients with osteoporotic lumbar spinal stenosis,and to assess its impact on pain relief,functional improvement,and postoperative satisfac...Objective:To evaluate the application of spinal endoscopy in treating elderly patients with osteoporotic lumbar spinal stenosis,and to assess its impact on pain relief,functional improvement,and postoperative satisfaction.Methods:A total of 86 elderly patients with osteoporotic lumbar spinal stenosis who underwent surgery at our hospital from March 1,2023,to February 28,2024,were selected.These patients were divided into an observation group(spinal endoscopy,n=44)and a control group(traditional open decompression,n=42).Preoperative,1 month postoperatively,and 3 months postoperatively,visual analog scale(VAS),Oswestry functional disability index(ODI),and patient satisfaction were assessed.Intraoperative blood loss,hospital stay,and the incidence of postoperative complications were compared as safety indicators.Data analysis was performed using SPSS 26.0 software.Measurement data were presented as mean±standard deviation,and inter-group comparisons were conducted using independent samples t-tests.Categorical data were analyzed using χ^(2) tests.Results:One month and three months postoperatively,the VAS scores in the observation group were 2.8±0.6 and 1.9±0.4,respectively,significantly lower than those in the control group(3.6±0.7 and 2.7±0.5)(P=0.015,P=0.008).The ODI scores were 24.3±4.5 and 17.8±3.2,respectively,also significantly better than those in the control group(30.6±5.1 and 22.9±3.7)(P=0.021,P=0.010).The observation group had a median intraoperative blood loss of 52.6±13.8 mL and an average hospital stay of 4.3±1.2 days,significantly lower than the control group's 108.4±21.5 mL and 7.2±1.6 days(P<0.001).The postoperative complication rate in the observation group was 4.5%(2/44),compared to 16.7%(7/42)in the control group(P=0.043).Postoperative satisfaction scores were 92.6±4.1 for the observation group and 84.7±5.6 for the control group(P<0.001).Conclusion:The application of spinal endoscopy technology in elderly patients with osteoporotic lumbar spinal stenosis can effectively reduce postoperative pain,improve functional status,minimize intraoperative trauma and complications,and significantly enhance patient satisfaction,demonstrating excellent clinical value for widespread adoption.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:Coronary artery disease(CAD)is a major global health concern requiring efficient and accurate diagnostic methods.Manual interpretation of coronary computed tomography angiography(CTA)images is time-consumin...Background:Coronary artery disease(CAD)is a major global health concern requiring efficient and accurate diagnostic methods.Manual interpretation of coronary computed tomography angiography(CTA)images is time-consuming and prone to interobserver variability,underscoring the need for automated segmentation and stenosis detection tools.Methods:This study presents a hybrid multi-scale 3D segmentation framework utilizing both 3D U-Net and Enhanced 3D U-Net architectures,designed to balance computational efficiency and anatomical precision.Processed CTA images from the ImageCAS dataset underwent data standardization,normalization,and augmentation.The framework applies ensemble learning to merge coarse and fine segmentation masks,followed by advanced post-processing techniques,including connected component analysis and centerline extraction,to refine vessel delineation.Stenosis regions are detected using the Enhanced 3D U-Net and morphological operations for accurate localization.Results:The proposed pipeline achieved near-perfect segmentation accuracy(0.9993)and a Dice similarity coefficient of 0.8539 for coronary artery delineation.Precision,recall,and F1 scores for stenosis detection were 0.8418,0.8289,and 0.8397,respectively.The dual-model approach demonstrated robust performance across varied anatomical structures and effectively localized stenotic regions,indicating clear superiority over conventional models.Conclusion:This hybrid framework enables highly reliable and automated coronary artery segmentation and stenosis detection from 3D CTA images.By reducing reliance on manual interpretation and enhancing diagnostic consistency,the proposed method holds strong potential to improve clinical workflows for CAD diagnosis and management.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
COMPERA 2.0 risk stratification has been demonstrated to be useful in patients with precapillary pulmonary hypertension(PH).However,its suitability for patients at risk for post-capillary PH or PH associated with left...COMPERA 2.0 risk stratification has been demonstrated to be useful in patients with precapillary pulmonary hypertension(PH).However,its suitability for patients at risk for post-capillary PH or PH associated with left heart disease(PH-LHD)is unclear.To investigate the use of COMPERA 2.0 in patients with severe aortic stenosis(SAS)undergoing transcatheter aortic valve replacement(TAVR),who are at risk for post-capillary PH,a total of 327 eligible SAS patients undergoing TAVR at our institution between September 2015 and November 2020 were included in the study.Patients were classified into four strata before and after TAVR using the COMPERA 2.0 risk score.The primary endpoint was all-cause mortality.Survival analysis was performed using Kaplan-Meier curves,log-rank test,and Cox proportional hazards regression model.The study cohort had a median(interquartile range)age of 76(70–80)years and a pulmonary arterial systolic pressure of 33(27–43)mmHg(1 mmHg=0.133 kPa)before TAVR.The overall mortality was 11.9%during 26(15–47)months of follow-up.Before TAVR,cumulative mortality was higher with an increase in the risk stratum level(log-rank,both P<0.001);each increase in the risk stratum level resulted in an increased risk of death(hazard ratio(HR)2.53,95%confidential interval(CI)1.54–4.18,P<0.001),which was independent of age,sex,estimated glomerular filtration rate(eGFR),hemoglobin,albumin,and valve type(HR 1.76,95%CI 1.01–3.07,P=0.047).Similar results were observed at 30 d after TAVR.COMPERA 2.0 can serve as a useful tool for risk stratification in patients with SAS undergoing TAVR,indicating its potential application in the management of PH-LHD.Further validation is needed in patients with confirmed post-capillary PH by right heart catheterization.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 In this aging population,lumbar spinal stenosis(LSS)reduces walking distance and impairs functionality.The definitive treatment is still controversial.AIM To assess the efficacy of physical therapy and surg...BACKGROUND In this aging population,lumbar spinal stenosis(LSS)reduces walking distance and impairs functionality.The definitive treatment is still controversial.AIM To assess the efficacy of physical therapy and surgery in improving function and reducing pain levels in patients with LSS,both in the short and long term.METHODS This prospective study screened patients aged 50-80 years with LSS and divided them into two groups based on certain criteria:Surgical and conservative.The conservative group received a supervised physical therapy and exercise program for 45 minutes,five days a week,for one month.The surgery group underwent micro endoscopic decompression surgery based on their LSS levels.Assessments,conducted before treatment and at one-month and one-year intervals,included the participants'walking distance,pain level using the visual analog scale,func tionality using the Istanbul low back pain disability index(ILBDI)and Swiss Spinal Stenosis Questionnaire(SSS)Scale,and activities of daily living level using the Nottingham Extended Activities of Daily Living.RESULTS The study comprised 40 participants,equally divided into surgical and conservative treatment groups,with no significant demographic differences.After one year,both groups exhibited similar changes in walking distance and pain levels.However,the conservative group demonstrated significantly greater improvements in sub-parameters of functional activity and symptom severity of the SSS.After one year,the surgical group showed greater functionality,as assessed by ILBDI,and superior improvement in activities of daily living compared to the conservative group.CONCLUSION Both treatments showed comparable efficacy in core outcomes(pain,walking distance).However,complementary advantages were observed:Conservative management demonstrated superior improvement in SSS functional subscales,while surgery yielded greater gains in daily living activities and low-back-pain-related disability.展开更多
Autologous Skin-Grafting Surgery after Super Minimally Invasive Resection(ASGS-SMIR)is a novel endoscopic repair technique developed under the guidance of the Super Minimally Invasive Surgery(SMIS)concept.Based on pre...Autologous Skin-Grafting Surgery after Super Minimally Invasive Resection(ASGS-SMIR)is a novel endoscopic repair technique developed under the guidance of the Super Minimally Invasive Surgery(SMIS)concept.Based on previous clinical research results and combined with the ten core treatment principles of SMIS,this guideline systematically elaborates on the indications,contraindications,preoperative evaluation,surgical operation standards,postoperative management,and efficacy evaluation system of ASGS-SMIR.This surgery achieves effective repair of large-area mucosal defects and stenosis prevention in the esophagus through the technical process of“skin flap harvesting,mesh processing,sleeve suture,and stent fixation”.The purpose of this guideline is to promote the standardized and normalized application of this technique and provide guidance for clinical practice.展开更多
Background We aimed to investigate the relationships between metabolic syndrome(MetS)and its severity score(Metsss)with asymptomatic intracranial arterial stenosis(aICAS)while also assessing the additional effect of h...Background We aimed to investigate the relationships between metabolic syndrome(MetS)and its severity score(Metsss)with asymptomatic intracranial arterial stenosis(aICAS)while also assessing the additional effect of high-sensitivity C reactive protein(hsCRP).Methods This cross-sectional study included 2390 individuals who underwent health examinations at our centre from June 2019 to August 2023.Participants received physical examinations,laboratory tests and magnetic resonance angiography evaluations.MetS was defined by the modified acknowledged criteria and quantified by Metsss.Logistic regression,interaction analysis and mediation analysis were employed.Results Among the 2390 participants,135(5.65%)had aICAS,and 726(30.40%)had MetS.After adjusting for confounders,MetS was significantly associated with aICAS(OR:1.68,95%CI:1.16 to 2.43,p=0.006).The prevalence of aICAS increased significantly from 3.6%to 8.6%as the number of MetS components increased.Higher quartiles of Metsss also significantly increased aICAS risk(P for trend<0.001).After multivariable adjustment,MetS(p=0.001)and elevated Metsss(p<0.001)were only associated with posterior circulation aICAS(vs anterior).Furthermore,participants with both MetS and elevated hsCRP levels had a greater risk for aICAS(OR:2.32,95%CI:1.36 to 3.96,p=0.002).hsCRP mediated the association between MetS and alCAS in participants≤65 years old.Conclusions MetS and Metsss were independently associated with the risk of aICAS.The mediating effect of hsCRP on the relationship between MetS and aICAS appears to be age-dependent.These findings offer valuable insights into clinical decision making of aICAS and further improve the primary stroke prevention.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
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(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.
基金Beijing Hospitals Authority’s Ascent Plan(DFL20220702)National Natural Science Foundation of China(82101398).
文摘Background The efficacy of percutaneous transluminal angioplasty and stenting(PTAS)relative to medical management in treating symptomatic intracranial arterial stenosis(ICAS)varies based on the qualifying artery.This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA)and basilar artery(BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials,evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries.The primary outcome was stroke or death within 30 days postenrolment,or stroke in the region of the qualifying artery beyond 30 days through 1 year.A methodology based on intention-to-treat was employed,and HR accompanied by 95%CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial.Four hundred were designated for PTAS,while 409 were assigned to medical therapy alone.For the primary outcome,patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy(17.17%vs 7.77%;9.40;HR,2.38(1.03 to 5.52);p=0.04).However,PTAS had no significant difference in patients with symptomatic ICA(26.67%vs 16.67%;HR,1.68(0.78 to 3.62);p=0.19),MCA(8.28%vs 9.79%;HR,0.85(0.42 to 1.74);p=0.66)and VA stenosis(9.52%vs 10.71%;HR,0.91(0.32 to 2.62);p=0.86)compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis.Without significant technological advancements to mitigate these risks,PTAS offers limited benefits.For symptomatic ICA,MCA and VA stenosis,PTAS provided no significant advantage.
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.
基金Supported by Science and Technology Innovation Program of Changde City,No.2024ZD165Hunan Provincial Natural Science Foundation of China,No.2025JJ80419.
文摘BACKGROUND Benign laryngotracheal stenosis(LTS)is a condition characterized by mucosal inflammation and fibrosis.It is difficult to treat with a high incidence rate.Respiratory distress and voice disorders of varying severity also affect patients'sleep quality and quality of life.AIM To investigate the association between anxiety and depression and sleep quality in patients with benign LTS and identify significant risk factors for sleep disorders.METHODS This retrospective cohort study enrolled 127 consecutive patients with benign LTS admitted to The First People's Hospital of Changde City between January 2021 and January 2024.Comprehensive assessments included demographic collection and Pittsburgh sleep quality index(PSQI),self-rating anxiety scale(SAS),and selfrating depression scale(SDS)scoring.Correlation analyses were conducted to examine relationships between psychological measures and sleep parameters,followed by multivariate logistic regression to determine independent risk factors.RESULTS The cohort demonstrated significantly impaired sleep quality(mean PSQI,7.79±2.47),with 48.0%(n=61)meeting the criteria for clinically significant sleep disturbance.The scores of all PSQI dimensions,as well as SAS and SDS scores of patients with LTS,significantly exceeded Chinese normative values.Strong positive correlations emerged between PSQI scores and both SAS and SDS measures.Multivariate logistic analysis identified middle age(41-50 years),multiple surgical interventions(≥3 procedures),lower socioeconomic status(monthly household income per capita≤5000 RMB),and concurrent anxiety/depression as independent predictors of sleep disturbance.CONCLUSION The results demonstrate a high prevalence of sleep disorders and comorbid anxiety or depressive moods among patients with LTS.These psychological factors both correlate with and independently predict sleep impairment.These results underscore the need for integrated and proactive approaches addressing both physical and mental health components in LTS management,focusing on high-risk subgroups stratified based on age,monthly household income per capita,anxiety/depression status,and number of prior surgeries.
文摘Objective:To evaluate the application of spinal endoscopy in treating elderly patients with osteoporotic lumbar spinal stenosis,and to assess its impact on pain relief,functional improvement,and postoperative satisfaction.Methods:A total of 86 elderly patients with osteoporotic lumbar spinal stenosis who underwent surgery at our hospital from March 1,2023,to February 28,2024,were selected.These patients were divided into an observation group(spinal endoscopy,n=44)and a control group(traditional open decompression,n=42).Preoperative,1 month postoperatively,and 3 months postoperatively,visual analog scale(VAS),Oswestry functional disability index(ODI),and patient satisfaction were assessed.Intraoperative blood loss,hospital stay,and the incidence of postoperative complications were compared as safety indicators.Data analysis was performed using SPSS 26.0 software.Measurement data were presented as mean±standard deviation,and inter-group comparisons were conducted using independent samples t-tests.Categorical data were analyzed using χ^(2) tests.Results:One month and three months postoperatively,the VAS scores in the observation group were 2.8±0.6 and 1.9±0.4,respectively,significantly lower than those in the control group(3.6±0.7 and 2.7±0.5)(P=0.015,P=0.008).The ODI scores were 24.3±4.5 and 17.8±3.2,respectively,also significantly better than those in the control group(30.6±5.1 and 22.9±3.7)(P=0.021,P=0.010).The observation group had a median intraoperative blood loss of 52.6±13.8 mL and an average hospital stay of 4.3±1.2 days,significantly lower than the control group's 108.4±21.5 mL and 7.2±1.6 days(P<0.001).The postoperative complication rate in the observation group was 4.5%(2/44),compared to 16.7%(7/42)in the control group(P=0.043).Postoperative satisfaction scores were 92.6±4.1 for the observation group and 84.7±5.6 for the control group(P<0.001).Conclusion:The application of spinal endoscopy technology in elderly patients with osteoporotic lumbar spinal stenosis can effectively reduce postoperative pain,improve functional status,minimize intraoperative trauma and complications,and significantly enhance patient satisfaction,demonstrating excellent clinical value for widespread adoption.
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.
文摘Background:Coronary artery disease(CAD)is a major global health concern requiring efficient and accurate diagnostic methods.Manual interpretation of coronary computed tomography angiography(CTA)images is time-consuming and prone to interobserver variability,underscoring the need for automated segmentation and stenosis detection tools.Methods:This study presents a hybrid multi-scale 3D segmentation framework utilizing both 3D U-Net and Enhanced 3D U-Net architectures,designed to balance computational efficiency and anatomical precision.Processed CTA images from the ImageCAS dataset underwent data standardization,normalization,and augmentation.The framework applies ensemble learning to merge coarse and fine segmentation masks,followed by advanced post-processing techniques,including connected component analysis and centerline extraction,to refine vessel delineation.Stenosis regions are detected using the Enhanced 3D U-Net and morphological operations for accurate localization.Results:The proposed pipeline achieved near-perfect segmentation accuracy(0.9993)and a Dice similarity coefficient of 0.8539 for coronary artery delineation.Precision,recall,and F1 scores for stenosis detection were 0.8418,0.8289,and 0.8397,respectively.The dual-model approach demonstrated robust performance across varied anatomical structures and effectively localized stenotic regions,indicating clear superiority over conventional models.Conclusion:This hybrid framework enables highly reliable and automated coronary artery segmentation and stenosis detection from 3D CTA images.By reducing reliance on manual interpretation and enhancing diagnostic consistency,the proposed method holds strong potential to improve clinical workflows for CAD diagnosis and management.
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.
基金supported by the National Key R&D Program of China(Nos.2019YFA0110400 and 2016YFC13010204)the National Natural Science Foundation of China(Nos.81870292,81570233,81770252,and 82100060)+2 种基金the China Postdoctoral Science Foundation(Nos.2020M680079 and 2021T140598)the Zhejiang Province Science and Technology Department Key R&D Program(Nos.2021C03097 and 2022C03063)the Zhejiang Provincial Natural Science Foundation of China(No.LQ21H020005).
文摘COMPERA 2.0 risk stratification has been demonstrated to be useful in patients with precapillary pulmonary hypertension(PH).However,its suitability for patients at risk for post-capillary PH or PH associated with left heart disease(PH-LHD)is unclear.To investigate the use of COMPERA 2.0 in patients with severe aortic stenosis(SAS)undergoing transcatheter aortic valve replacement(TAVR),who are at risk for post-capillary PH,a total of 327 eligible SAS patients undergoing TAVR at our institution between September 2015 and November 2020 were included in the study.Patients were classified into four strata before and after TAVR using the COMPERA 2.0 risk score.The primary endpoint was all-cause mortality.Survival analysis was performed using Kaplan-Meier curves,log-rank test,and Cox proportional hazards regression model.The study cohort had a median(interquartile range)age of 76(70–80)years and a pulmonary arterial systolic pressure of 33(27–43)mmHg(1 mmHg=0.133 kPa)before TAVR.The overall mortality was 11.9%during 26(15–47)months of follow-up.Before TAVR,cumulative mortality was higher with an increase in the risk stratum level(log-rank,both P<0.001);each increase in the risk stratum level resulted in an increased risk of death(hazard ratio(HR)2.53,95%confidential interval(CI)1.54–4.18,P<0.001),which was independent of age,sex,estimated glomerular filtration rate(eGFR),hemoglobin,albumin,and valve type(HR 1.76,95%CI 1.01–3.07,P=0.047).Similar results were observed at 30 d after TAVR.COMPERA 2.0 can serve as a useful tool for risk stratification in patients with SAS undergoing TAVR,indicating its potential application in the management of PH-LHD.Further validation is needed in patients with confirmed post-capillary PH by right heart catheterization.
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.
文摘BACKGROUND In this aging population,lumbar spinal stenosis(LSS)reduces walking distance and impairs functionality.The definitive treatment is still controversial.AIM To assess the efficacy of physical therapy and surgery in improving function and reducing pain levels in patients with LSS,both in the short and long term.METHODS This prospective study screened patients aged 50-80 years with LSS and divided them into two groups based on certain criteria:Surgical and conservative.The conservative group received a supervised physical therapy and exercise program for 45 minutes,five days a week,for one month.The surgery group underwent micro endoscopic decompression surgery based on their LSS levels.Assessments,conducted before treatment and at one-month and one-year intervals,included the participants'walking distance,pain level using the visual analog scale,func tionality using the Istanbul low back pain disability index(ILBDI)and Swiss Spinal Stenosis Questionnaire(SSS)Scale,and activities of daily living level using the Nottingham Extended Activities of Daily Living.RESULTS The study comprised 40 participants,equally divided into surgical and conservative treatment groups,with no significant demographic differences.After one year,both groups exhibited similar changes in walking distance and pain levels.However,the conservative group demonstrated significantly greater improvements in sub-parameters of functional activity and symptom severity of the SSS.After one year,the surgical group showed greater functionality,as assessed by ILBDI,and superior improvement in activities of daily living compared to the conservative group.CONCLUSION Both treatments showed comparable efficacy in core outcomes(pain,walking distance).However,complementary advantages were observed:Conservative management demonstrated superior improvement in SSS functional subscales,while surgery yielded greater gains in daily living activities and low-back-pain-related disability.
基金National Key Research and Development Program of China(2022YFC2503600)。
文摘Autologous Skin-Grafting Surgery after Super Minimally Invasive Resection(ASGS-SMIR)is a novel endoscopic repair technique developed under the guidance of the Super Minimally Invasive Surgery(SMIS)concept.Based on previous clinical research results and combined with the ten core treatment principles of SMIS,this guideline systematically elaborates on the indications,contraindications,preoperative evaluation,surgical operation standards,postoperative management,and efficacy evaluation system of ASGS-SMIR.This surgery achieves effective repair of large-area mucosal defects and stenosis prevention in the esophagus through the technical process of“skin flap harvesting,mesh processing,sleeve suture,and stent fixation”.The purpose of this guideline is to promote the standardized and normalized application of this technique and provide guidance for clinical practice.
基金supported by National Key Research and Development Program of China(2018YFC1311203).
文摘Background We aimed to investigate the relationships between metabolic syndrome(MetS)and its severity score(Metsss)with asymptomatic intracranial arterial stenosis(aICAS)while also assessing the additional effect of high-sensitivity C reactive protein(hsCRP).Methods This cross-sectional study included 2390 individuals who underwent health examinations at our centre from June 2019 to August 2023.Participants received physical examinations,laboratory tests and magnetic resonance angiography evaluations.MetS was defined by the modified acknowledged criteria and quantified by Metsss.Logistic regression,interaction analysis and mediation analysis were employed.Results Among the 2390 participants,135(5.65%)had aICAS,and 726(30.40%)had MetS.After adjusting for confounders,MetS was significantly associated with aICAS(OR:1.68,95%CI:1.16 to 2.43,p=0.006).The prevalence of aICAS increased significantly from 3.6%to 8.6%as the number of MetS components increased.Higher quartiles of Metsss also significantly increased aICAS risk(P for trend<0.001).After multivariable adjustment,MetS(p=0.001)and elevated Metsss(p<0.001)were only associated with posterior circulation aICAS(vs anterior).Furthermore,participants with both MetS and elevated hsCRP levels had a greater risk for aICAS(OR:2.32,95%CI:1.36 to 3.96,p=0.002).hsCRP mediated the association between MetS and alCAS in participants≤65 years old.Conclusions MetS and Metsss were independently associated with the risk of aICAS.The mediating effect of hsCRP on the relationship between MetS and aICAS appears to be age-dependent.These findings offer valuable insights into clinical decision making of aICAS and further improve the primary stroke prevention.
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.
