Deep cervical lymph-venous anastomosis(LVA)is a surgical procedure initially developed to treat cervical lymphatic obstruction,such as lymphedema,a condition caused by the accumulation of lymphatic fluid due to blocke...Deep cervical lymph-venous anastomosis(LVA)is a surgical procedure initially developed to treat cervical lymphatic obstruction,such as lymphedema,a condition caused by the accumulation of lymphatic fluid due to blocked or damaged lymphatic vessels.In early 2024,Dr.Qingping Xie from Hangzhou Qiushi Hospital,China,and Dr.Wei F.Chen from the Cleveland Clinic,USA,adapted LVA for the treatment of patients with Alzheimer’s disease(AD).As a VIEWPOINT,they presented a video showcasing the post-surgery cognitive recovery of an 84-year-old AD patient(Xie et al.,2024).展开更多
Central venous catheterization(CVC)is a fundamental clinical procedure widely performed across medical specialties.However,the complication rate of subclavian vein catheterization ranges from 6%to 11%.[1]Common compli...Central venous catheterization(CVC)is a fundamental clinical procedure widely performed across medical specialties.However,the complication rate of subclavian vein catheterization ranges from 6%to 11%.[1]Common complications include hemothorax,pneumothorax,air embolism,arterial puncture,and aortic perforation.[2]Herein,we report a rare case of accidental puncture of the aorta during subclavian CVC,which was successfully managed with a ventricular septal defect(VSD)occluder.展开更多
Objective Cerebral venous outflow disorders(CVOD)can impair cerebral perfusion and produce diverse,often debilitating symptoms,substantially reducing quality of life.Intermittent hypoxiahyperoxia training(IHHT)has dem...Objective Cerebral venous outflow disorders(CVOD)can impair cerebral perfusion and produce diverse,often debilitating symptoms,substantially reducing quality of life.Intermittent hypoxiahyperoxia training(IHHT)has demonstrated therapeutic potential across various pathologies and may represent a promising non-pharmacological approach for CVOD management.Methods Patients with imaging-confirmed CVOD underwent 14 IHHT sessions,each comprising four cycles of 10-minute hypoxia(11%O_(2))stimulation and 20-minute hyperoxia(38%O_(2)).Physiological parameters and adverse events were monitored throughout the intervention.Clinical scales,24-hour ambulatory blood pressure,blood tests,jugular ultrasound,and perfusion imaging were assessed preand post-intervention.Results No participants experienced intolerable discomfort or severe adverse events;vital signs remained within normal ranges.No significant changes were observed in 24-hour blood pressure,blood cell counts,lipid profiles,or other blood markers.Notably,60%of patients(n=12)reported overall symptom improvement on the Patient Global Impression of Change scale.Headache severity,as measured by the visual analogue scale,significantly decreased(6.33±1.22 vs.4.89±2.03,P=0.016).In patients with internal jugular vein(IJV)stenosis,significant improvements were observed in regional cerebral blood flow(including the insula,occipital lobe,internal capsule,and lenticula)and left J3-segment IJV flow volume(107.27[47.50,160.00]vs.140.83[55.00,210.00]mL/min,P=0.011).Conclusion The current IHHT protocol is safe and well-tolerated in patients with CVOD.IHHT may alleviate CVOD-related symptoms by improving oxygen saturation,cerebral perfusion,and venous outflow pattern,supporting its potential as a non-invasive therapeutic strategy.展开更多
Background:Ex vivo lung perfusion(EVLP)has emerged as a critical technique for lung preservation and evaluation prior to transplantation.While conventional rat EVLP systems utilize closed-loop dual cannulation of pulm...Background:Ex vivo lung perfusion(EVLP)has emerged as a critical technique for lung preservation and evaluation prior to transplantation.While conventional rat EVLP systems utilize closed-loop dual cannulation of pulmonary artery(PA)and vein,the effect of the simplified model using single PA cannulation with passive venous drainage is unknown.Methods:We developed two EVLP models in rats:a semi-closed circuit with PA-only cannulation and left atrial incision for passive venous drainage(SC-EVLP),and a closed circuit employing both arterial and venous cannulation(C-EVLP).Donor lungs were perfused for a defined duration and subsequently orthotopically transplanted.We evaluated pulmonary function parameters,histopathological injury scores,inflammatory cytokine levels,and apoptotic marker expression at the end of perfusion and posttransplantation.Results:Compared to the conventional EVLP,the SC-EVLP group exhibited significantly lower PA pressure and improved dynamic lung compliance throughout perfusion.Although the levels of tumor necrosis factor-αin the perfusate were higher in the SC-EVLP group,other cytokine levels in the perfusate and bronchoalveolar lavage fluid exhibited no significant differences.Pulmonary edema was reduced in the SC-EVLP group,as indicated by a lower lung wet-to-dry ratio.After transplantation,lungs from the SC-EVLP group exhibited lower histological injury scores,reduced apoptosis,and decreased serum cytokine levels,suggesting attenuated inflammation and tissue damage.Conclusions:In a rat model,single PA cannulation with passive venous drainage reduced pulmonary edema during EVLP and reduced lung injury and systemic inflammation after transplantation.展开更多
Developmental venous anomalies(DVAs)are benign congenital veins that collect normal brain drainage into a single outlet.Cerebral cavernous malformations(CMs)are clusters of thin-walled capillary cavities prone to blee...Developmental venous anomalies(DVAs)are benign congenital veins that collect normal brain drainage into a single outlet.Cerebral cavernous malformations(CMs)are clusters of thin-walled capillary cavities prone to bleeding.When both lesions coexist,the DVA’s altered venous pressure and flow can promote CM formation or rupture.Detecting a DVA abutting an otherwise unexplained intracerebral hemorrhage can therefore raise suspicion of an occult CM as a likely cause,a clue which may be invaluable for daily clinical practice.The main focus of this review is to acknowledge the hallmark imaging appearances of DVAs and CMs,as well as their coexistence,explore the clinical consequences of mixed lesions,and emphasize that recognizing their partnership is vital for an accurate,timely diagnosis and appropriately targeted management.展开更多
Advancements in healthcare technology have improved mortality rates and extended lifespans,resulting in a population with multiple comorbidities that complicate patient care.Traditional assessments often fall short,un...Advancements in healthcare technology have improved mortality rates and extended lifespans,resulting in a population with multiple comorbidities that complicate patient care.Traditional assessments often fall short,underscoring the need for integrated care strategies.Among these,fluid management is particularly challenging due to the difficulty in directly assessing volume status especially in critically ill patients who frequently have peripheral oedema.Effective fluid ma-nagement is essential for optimal tissue oxygen delivery,which is crucial for cellular metabolism.Oxygen transport is dependent on arterial oxygen levels,haemoglobin concentration,and cardiac output,with the latter influenced by preload,afterload,and cardiac contractility.A delicate balance of these factors ensures that the cardiovascular system can respond adequately to varying ph-ysiological demands,thereby safeguarding tissue oxygenation and overall organ function during states of stress or illness.The Venous Excess Ultrasound(VExUS)Grading System is instrumental in evaluating fluid intolerance,providing detailed insights into venous congestion and fluid status.It was originally developed to assess the risk of acute kidney injury in postoperative cardiac patients,but its versatility has enabled broader applications in nephrology and critical care settings.This mini review explores VE×US’s application and its impact on fluid management and patient outcomes in critically ill patients.展开更多
BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are ...BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are widely used,but comparative data regarding their impact on catheter-related complications and quality of life(QoL)remain limited.AIM To evaluate the impact of TIVAPs compared with PICC on catheter-related complications and QoL in patients with gastrointestinal cancer undergoing chemotherapy.METHODS This retrospective study included adults with gastrointestinal cancer who underwent central venous access device insertion for chemotherapy at our institution between December 2021 and December 2024.Inclusion criteria encompassed indications for intermittent intravenous chemotherapy,anticipated treatment duration of≥12 weeks,an adequate preoperative hematologic profile,accessible upper body veins,and complete medical records.Patients were excluded if they had an anticipated survival of less than three months,active systemic infection,severe thrombosis or coagulopathy,communication barriers,or an urgent need for dialysis access.Patients were assigned to either the PICC or TIVAP group based on device type.Data collected included demographic variables,cancer characteristics,insertion procedure details,complications,and QoL,assessed via the EuroQol 5-Dimensions-3 levels,visual analogue scale,and the European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30.RESULTS A total of 346 patients were analyzed.Baseline demographic,clinical,and cancer characteristics were similar between groups.The TIVAP group demonstrated a significantly lower incidence of catheter-related complications than the PICC group,with no pneumothorax occurring in either group.QoL assessments at baseline were comparable.At one month,the TIVAP group exhibited significantly higher EuroQoL Five Dimensions health state scores and QLQ-C30 global health status scores.Multivariate analysis identified TIVAP use,catheter tip placement in the distal superior vena cava/right atrium,prophylactic antibiotic administration,and antimicrobial dressing application as independent protective factors associated with reduced complications and improved QoL.CONCLUSION In patients with gastrointestinal cancer undergoing chemotherapy,TIVAPs are associated with a lower incidence of catheter-related complications and improved QoL than PICCs.Optimal device selection,precise catheter tip positioning,and effective perioperative management are critical for minimizing complications and enhancing patient-reported outcomes during treatment.展开更多
Obstructed infradiaphragmatic total anomalous pulmonary venous return(TAPVR)in premature infants presents significant management challenges due to the high surgical risk in low-birth-weight,preterm neonates.We present...Obstructed infradiaphragmatic total anomalous pulmonary venous return(TAPVR)in premature infants presents significant management challenges due to the high surgical risk in low-birth-weight,preterm neonates.We present strategies for managing this condition in a 10-day old 1.3 kg ex-32-week premature infant including late umbilical venous access,use of wire-snare rail for stable stent deployment,and monitoring for progressive multi-level obstruction.Long-term follow-up demonstrated spontaneous stent fracture and occlusion.This approach successfully bridged to definitive repair with excellent outcomes.展开更多
BACKGROUND Wedged hepatic venous pressure(WHVP)is a crucial variable for accurately assessing the hepatic venous pressure gradient(HVPG)and is vital for the diagnosis and prognostic evaluation of patients with portal ...BACKGROUND Wedged hepatic venous pressure(WHVP)is a crucial variable for accurately assessing the hepatic venous pressure gradient(HVPG)and is vital for the diagnosis and prognostic evaluation of patients with portal hypertension(PH).AIM To investigate the anatomical characteristics of balloon-occluded hepatic venous angiography in patients with PH and analyze the relationship between the WHVP and portal venous pressure(PVP).METHODS This retrospective study included 877 patients with PH who met the inclusion criteria from January 2020 to June 2024.Routine and innovative hepatic venous angiography was performed during transjugular intrahepatic portosystemic shunt procedures to measure hepatic venous and PVPs.All patients'angiographic images were collected for analysis.The associations between WHVP and PVP in each group were analyzed via linear regression analysis,and a predictive model was established.RESULTS The 877 patients had a mean age of 52.6±13.0 years,with 582 males and 295 females.Patients were categorized into four groups on the basis of their anatomical structure.All groups showed strong correlations between WHVP and PVP.The regression coefficient between the WHVP and PVP in the hepatic right vein-portal venous angiography group was 0.884(P<0.05);in the hepatic right vein-accessory hepatic venous angiography group,it was 0.721(P<0.05);in the hepatic right vein-middle hepatic venous angiography group,it was 0.344(P<0.05);and in the hepatic right vein-nonangiography group,it was 0.293(P<0.05).CONCLUSION The presence and anatomical classification of hepatic venous collaterals are key factors influencing the relationship between WHVP with and PVP.Based on the different anatomical classifications of hepatic veins,WHVP can be used to estimate PVP,improving the accuracy of PVP prediction.展开更多
Objective:To evaluate the therapeutic effects of intravenous infusion using intravenous indwelling needles(IIN)versus peripherally inserted central catheters(PICC)in patients with acute leukemia during maintenance tre...Objective:To evaluate the therapeutic effects of intravenous infusion using intravenous indwelling needles(IIN)versus peripherally inserted central catheters(PICC)in patients with acute leukemia during maintenance treatment.Methods:Eighty-six patients with acute leukemia admitted to the First Affiliated Hospital of Baotou Medical College from July 2022 to March 2023 were randomly divided into the IIN group and the PICC group,with 43 patients in each group.Results:Significant differences were observed between the two groups in terms of the number of punctures and puncture time(P<0.05).Although the intubation cost was lower in the IIN group than in the PICC group,the maintenance treatment duration was shorter in the IIN group(P<0.05).There were no significant differences between the two groups in terms of disease symptoms,treatment-related toxicity,and side effects(P>0.05).However,anxiety,treatment compliance,and patient satisfaction were significantly lower in IIN group compared to the PICC group(P<0.05).Additionally,the incidence of vein-related complications in the IIN group was higher than in the PICC group(P<0.05).Conclusion:Compared with intravenous indwelling needles,PICCs demonstrate superior application outcomes.Although the cost of PICC placement is relatively high,its ability to prolong maintenance treatment,alleviate patient anxiety,reduce vein-related complications,and improve treatment compliance makes it a valuable method worth promoting.展开更多
Intravenous leiomyomatosis(IVL)is a rare,histologically benign uterine smooth muscle tumor with malignant biological behavior due to its propensity for intravascular extension.[1]While gynecological in origin,its most...Intravenous leiomyomatosis(IVL)is a rare,histologically benign uterine smooth muscle tumor with malignant biological behavior due to its propensity for intravascular extension.[1]While gynecological in origin,its most severe manifestations are cardiovascular,arising from tumor propagation through the venous system into the inferior vena cava(IVC),right heart,and pulmonary arteries,mimicking thromboembolic disease.[2,3]This can lead to pulmonary embolism(PE),right heart obstruction,and even sudden cardiac death.[4]Diagnosis is challenging,often delayed by misdiagnosis as conventional PE.We present two cases of IVL initially presenting with PE,highlighting the critical cardiovascular implications and diagnostic pitfalls.展开更多
BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literatu...BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic state.AIM To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop VTE.METHODS This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital.Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.RESULTS Seventy-four patients fulfilled the inclusion criteria.The mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 years.Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed VTE.Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)patients.All the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international literature.However,multi-centric studies are required to further explore these results.展开更多
BACKGROUND Few studies have specifically modeled the risk of venous thromboembolism(VTE)for postoperative hepatocellular carcinoma(HCC)patients,although HCC is the third leading cause of cancer death worldwide.This st...BACKGROUND Few studies have specifically modeled the risk of venous thromboembolism(VTE)for postoperative hepatocellular carcinoma(HCC)patients,although HCC is the third leading cause of cancer death worldwide.This study aimed to develop and validate a nomogram that accurately predicts the risk of VTE in patients after HCC surgery.AIM To develop and validate a nomogram to accurately predict the risk of VTE in postoperative HCC patients by integrating clinical and laboratory risk factors.The model seeks to provide a user-friendly tool for identifying high-risk individuals who may benefit from targeted anticoagulation therapy,thereby improving clinical decision-making and patient outcomes.METHODS Data from patients who underwent HCC surgery at Chongqing University Cancer Hospital in China were analyzed.Through univariate and multivariate logistic regression analyses,independent risk factors for VTE were identified and integrated into a nomogram.The predictive performance of the nomogram was assessed via receiver operating characteristic curves,calibration curves,decision curve analysis and other relevant metrics.RESULTS Of 905 postoperative HCC patients were included in the study.The nomogram incorporated eight independent risk factors for VTE:Karnofsky Performance Scale,base disease,cancer stage(tumor-node-metastasis),chemotherapy,D-dimer concentration,white blood cell count,hemoglobin,and fibrinogen.The C-index for the nomogram model was 0.825 in the training cohort and 0.820 in the validation cohort,indicating good discriminative ability.Calibration plots of the model revealed high concordance between the predicted probabilities and observed outcomes.CONCLUSION We developed and validated a novel nomogram that can accurately estimate the risk of VTE in individual postoperative HCC patients.This model can identify high-risk patients who may benefit from targeted anticoagulation therapy.展开更多
BACKGROUND The risk and mortality rate of venous thromboembolism(VTE)following gastrointestinal surgery remain high,and the symptoms are atypical.Therefore,it is necessary to identify the risk factors associated with ...BACKGROUND The risk and mortality rate of venous thromboembolism(VTE)following gastrointestinal surgery remain high,and the symptoms are atypical.Therefore,it is necessary to identify the risk factors associated with the occurrence of VTE following gastrointestinal surgery and to implement appropriate prevention and treatment measures.AIM To assess the efficacy of perioperative anticoagulation for the prevention of postoperative VTE.METHODS This retrospective study enrolled 205 patients who underwent gastrointestinal surgery.In the observation group(n=101),prophylactic anticoagulation was administered via hypodermic injection of low-molecular-weight heparin during the perioperative period,whereas the control group(n=104)only received lowmolecular-weight heparin treatment postoperatively.Blood coagulation parameters and the incidence of VTE of the bilateral lower limbs pre-and post-surgery were compared between groups.Postoperative VTE was transformed into a dichotomous variable,and influencing factors were explored using multivariate logistic regression analyses.RESULTS On the 7th day postoperatively,the incidence of VTE of the bilateral lower limbs was significantly lower in the observation group than in the control group,as were the D-dimer levels(P<0.05).At 1 month postoperatively,the incidence of VTE was significantly lower in the observation group than in the control group(P<0.05).An age≥65 years,a body mass index≥24 kg/m^(2),and malignant diseases of the digestive system were identified as risk factors for the occurrence of postoperative VTE in patients undergoing gastrointestinal surgery.CONCLUSION The incidence of VTE in patients who underwent gastrointestinal surgery peaked within 1 week postoperatively.The findings confirmed perioperative anticoagulation can safely and effectively reduce the incidence of postoperative VTE.展开更多
Hepatic portal venous gas(HPVG)is a rare yet clinically significant radiological manifestation characterized by diverse etiologies,unclear pathophysiology,and nonspecific clinical presentations.Its appearance frequent...Hepatic portal venous gas(HPVG)is a rare yet clinically significant radiological manifestation characterized by diverse etiologies,unclear pathophysiology,and nonspecific clinical presentations.Its appearance frequently heralds a severe underlying condition,with a reported mortality rate as high as 75%,earning it the moniker“harbinger of death”.In recent years,with advancements in diagnosis and treatment of HPVG,its mortality rate has been reduced to below 40%.Nevertheless,the infrequency of HPVG,coupled with its complex etiologies and rapid progression,often leaves clinicians failing to provide timely intervention due to a lack of awareness,resulting in the death of patient.Currently,there is no consensus on the standardized diagnosis and treatment strategies for HPVG.The purpose of this review is to synthesize the existing literature on HPVG and to discuss the advancements in understanding its clinical manifestation,etiologies,pathogenesis,diagnostic methods,and treatment strategies,as well as to emphasize the necessity for further research to enhance our comprehension of its pathophysiology and to refine diagnostic and therapeutic approaches.展开更多
BACKGROUND Extramural venous invasion(EMVI)is a critical prognostic factor in gastric cancer(GC);however,its detection and underlying molecular mechanisms remain underexplored.AIM To investigate the relationship betwe...BACKGROUND Extramural venous invasion(EMVI)is a critical prognostic factor in gastric cancer(GC);however,its detection and underlying molecular mechanisms remain underexplored.AIM To investigate the relationship between EMVI and expression of the circular RNA hsa_circ_0097977 in orthotopic GC mouse models.METHODS A retrospective analysis was conducted in addition to a preclinical animal study,involving 13 GC patients and 24 orthotopic GC mouse models,respectively.EMVI was assessed using axial T2-weighted fat suppression sequences on a 9.4T magnetic resonance imaging(MRI)with histopathological confirmation as the gold standard for EMVI.The impact of hsa_circ_0097977 on EMVI and GC cell function was evaluated.Statistical analyses comprised consistency,area under the curve analysis,correlation,χ^(2)/Fisher exact,and Mann-Whitney U/t-tests,with significance set at P<0.05.RESULTS EMVI was accurately detected using 9.4T MRI in orthotopic mouse models with an area under the curve of 0.843(sensitivity 78.6%,specificity 90.0%).MRI detected EMVI was the only imaging factor associated with distant metastasis(P=0.04).Furthermore,knockdown of hsa_circ_0097977 was the only factor associated with EMVI(P=0.043,0.038)and led to reduced invasion and increased apoptosis in GC cells.CONCLUSION EMVI,a risk factor for distant metastasis in GC,is detectable by 9.4T MRI and regulated by hsa_circ_0097977,making it a potential therapeutic target.展开更多
Lung transplantation(LT)is currently a surgical therapy option for end-stage lung disease.Venous thromboembolism(VTE),which can occur after LT,is associated with significant morbidity and mortality.Because of improved...Lung transplantation(LT)is currently a surgical therapy option for end-stage lung disease.Venous thromboembolism(VTE),which can occur after LT,is associated with significant morbidity and mortality.Because of improved out-comes,increasing numbers of patients are receiving LT as treatment.Patients on the waitlist for LT tend to be older with weakness and frailty in addition to pulmonary symptoms.These factors contribute to a heightened risk of post-operative VTE.Furthermore,patients who clinically deteriorate while on the waitlist may require extra corporeal membrane oxygenation as a bridge to LT.Bleeding and thromboembolism are common in these patients.Pulmonary embolism(PE)in a freshly transplanted lung can have significant effects leading to morbidity and mortality.PE typically leads to impairment of gas exchange and right ventricular strain.In LT,PE can affect healing of bronchial anastomosis and may even contribute to the development of chronic allograft lung dysfunction.This article discussed the incidence,clinical features and diagnosis of VTE after LT.Furthermore,the treatment modalities,complications,and outcomes of VTE were reviewed.展开更多
Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to corre...Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to correct an error in Figure 3 in which the flow cytometric scattergram of CD4/CD44 for the control group was erroneously used for the scattergram of CD8/CD44 for the PVIDSC group.The correct scattergram of CD8/CD44 for the PVIDSC group is provided below.The error does not affect the conclusion of the study.The authors apologize for the error and the inconvenience it might have caused to readers.展开更多
This article introduces and compares risk assessment models for venous thromboembolism in gynecological patients at home and abroad.The models assessed included the Caprini risk assessment model,the G-Caprini risk ass...This article introduces and compares risk assessment models for venous thromboembolism in gynecological patients at home and abroad.The models assessed included the Caprini risk assessment model,the G-Caprini risk assessment model,the Rogers risk assessment model,the Autar risk assessment model,the gynecological patient surgical venous thrombosis risk assessment scale,the Wells score,the COMPASS-CAT thrombus risk assessment model,the Khorana risk assessment model,the Padua risk assessment model,and the Chaoyang model.The purpose of this study is to provide a foundation for developing a risk assessment tool for gynecological venous thromboembolism tailored to Chinese patients and to assist clinical health care workers in selecting appropriate risk assessment tools and guiding individualized prevention measures.展开更多
基金supported by AG057842 from the National Institutes of Health,TRIBA/Physiology Faculty Startup Fund from Augusta University (to FF)the National Natural Science Foundation of China (82173384)(to MG)
文摘Deep cervical lymph-venous anastomosis(LVA)is a surgical procedure initially developed to treat cervical lymphatic obstruction,such as lymphedema,a condition caused by the accumulation of lymphatic fluid due to blocked or damaged lymphatic vessels.In early 2024,Dr.Qingping Xie from Hangzhou Qiushi Hospital,China,and Dr.Wei F.Chen from the Cleveland Clinic,USA,adapted LVA for the treatment of patients with Alzheimer’s disease(AD).As a VIEWPOINT,they presented a video showcasing the post-surgery cognitive recovery of an 84-year-old AD patient(Xie et al.,2024).
基金supported by a grant from the Beijing Union Medical College Foundation-Rui E Emergency Medicine Research Fund in 2025。
文摘Central venous catheterization(CVC)is a fundamental clinical procedure widely performed across medical specialties.However,the complication rate of subclavian vein catheterization ranges from 6%to 11%.[1]Common complications include hemothorax,pneumothorax,air embolism,arterial puncture,and aortic perforation.[2]Herein,we report a rare case of accidental puncture of the aorta during subclavian CVC,which was successfully managed with a ventricular septal defect(VSD)occluder.
基金sponsored by the National Natural Science Foundation of China(Nos.82027802,82101389,82274401,and 81971114)Beijing Nova Program(No.20230484286)+1 种基金Beijing Natural Science Foundation(7254366)the General Project of Science and Technology of Beijing Municipal Education Commission(No.KM202110025018).
文摘Objective Cerebral venous outflow disorders(CVOD)can impair cerebral perfusion and produce diverse,often debilitating symptoms,substantially reducing quality of life.Intermittent hypoxiahyperoxia training(IHHT)has demonstrated therapeutic potential across various pathologies and may represent a promising non-pharmacological approach for CVOD management.Methods Patients with imaging-confirmed CVOD underwent 14 IHHT sessions,each comprising four cycles of 10-minute hypoxia(11%O_(2))stimulation and 20-minute hyperoxia(38%O_(2)).Physiological parameters and adverse events were monitored throughout the intervention.Clinical scales,24-hour ambulatory blood pressure,blood tests,jugular ultrasound,and perfusion imaging were assessed preand post-intervention.Results No participants experienced intolerable discomfort or severe adverse events;vital signs remained within normal ranges.No significant changes were observed in 24-hour blood pressure,blood cell counts,lipid profiles,or other blood markers.Notably,60%of patients(n=12)reported overall symptom improvement on the Patient Global Impression of Change scale.Headache severity,as measured by the visual analogue scale,significantly decreased(6.33±1.22 vs.4.89±2.03,P=0.016).In patients with internal jugular vein(IJV)stenosis,significant improvements were observed in regional cerebral blood flow(including the insula,occipital lobe,internal capsule,and lenticula)and left J3-segment IJV flow volume(107.27[47.50,160.00]vs.140.83[55.00,210.00]mL/min,P=0.011).Conclusion The current IHHT protocol is safe and well-tolerated in patients with CVOD.IHHT may alleviate CVOD-related symptoms by improving oxygen saturation,cerebral perfusion,and venous outflow pattern,supporting its potential as a non-invasive therapeutic strategy.
基金Key Science and Technology Program of Shaanxi Province,Grant/Award Number:2024SF2-GJHX-45National Natural Science Foundation of China,Grant/Award Number:82472191The Natural Science Foundation of Shaanxi Province,Grant/Award Number:2024JC-ZDXM-49。
文摘Background:Ex vivo lung perfusion(EVLP)has emerged as a critical technique for lung preservation and evaluation prior to transplantation.While conventional rat EVLP systems utilize closed-loop dual cannulation of pulmonary artery(PA)and vein,the effect of the simplified model using single PA cannulation with passive venous drainage is unknown.Methods:We developed two EVLP models in rats:a semi-closed circuit with PA-only cannulation and left atrial incision for passive venous drainage(SC-EVLP),and a closed circuit employing both arterial and venous cannulation(C-EVLP).Donor lungs were perfused for a defined duration and subsequently orthotopically transplanted.We evaluated pulmonary function parameters,histopathological injury scores,inflammatory cytokine levels,and apoptotic marker expression at the end of perfusion and posttransplantation.Results:Compared to the conventional EVLP,the SC-EVLP group exhibited significantly lower PA pressure and improved dynamic lung compliance throughout perfusion.Although the levels of tumor necrosis factor-αin the perfusate were higher in the SC-EVLP group,other cytokine levels in the perfusate and bronchoalveolar lavage fluid exhibited no significant differences.Pulmonary edema was reduced in the SC-EVLP group,as indicated by a lower lung wet-to-dry ratio.After transplantation,lungs from the SC-EVLP group exhibited lower histological injury scores,reduced apoptosis,and decreased serum cytokine levels,suggesting attenuated inflammation and tissue damage.Conclusions:In a rat model,single PA cannulation with passive venous drainage reduced pulmonary edema during EVLP and reduced lung injury and systemic inflammation after transplantation.
文摘Developmental venous anomalies(DVAs)are benign congenital veins that collect normal brain drainage into a single outlet.Cerebral cavernous malformations(CMs)are clusters of thin-walled capillary cavities prone to bleeding.When both lesions coexist,the DVA’s altered venous pressure and flow can promote CM formation or rupture.Detecting a DVA abutting an otherwise unexplained intracerebral hemorrhage can therefore raise suspicion of an occult CM as a likely cause,a clue which may be invaluable for daily clinical practice.The main focus of this review is to acknowledge the hallmark imaging appearances of DVAs and CMs,as well as their coexistence,explore the clinical consequences of mixed lesions,and emphasize that recognizing their partnership is vital for an accurate,timely diagnosis and appropriately targeted management.
文摘Advancements in healthcare technology have improved mortality rates and extended lifespans,resulting in a population with multiple comorbidities that complicate patient care.Traditional assessments often fall short,underscoring the need for integrated care strategies.Among these,fluid management is particularly challenging due to the difficulty in directly assessing volume status especially in critically ill patients who frequently have peripheral oedema.Effective fluid ma-nagement is essential for optimal tissue oxygen delivery,which is crucial for cellular metabolism.Oxygen transport is dependent on arterial oxygen levels,haemoglobin concentration,and cardiac output,with the latter influenced by preload,afterload,and cardiac contractility.A delicate balance of these factors ensures that the cardiovascular system can respond adequately to varying ph-ysiological demands,thereby safeguarding tissue oxygenation and overall organ function during states of stress or illness.The Venous Excess Ultrasound(VExUS)Grading System is instrumental in evaluating fluid intolerance,providing detailed insights into venous congestion and fluid status.It was originally developed to assess the risk of acute kidney injury in postoperative cardiac patients,but its versatility has enabled broader applications in nephrology and critical care settings.This mini review explores VE×US’s application and its impact on fluid management and patient outcomes in critically ill patients.
文摘BACKGROUND Central venous access is essential for administering chemotherapy in patients with gastrointestinal cancer.Peripherally inserted central catheters(PICC)and totally implantable venous access ports(TIVAP)are widely used,but comparative data regarding their impact on catheter-related complications and quality of life(QoL)remain limited.AIM To evaluate the impact of TIVAPs compared with PICC on catheter-related complications and QoL in patients with gastrointestinal cancer undergoing chemotherapy.METHODS This retrospective study included adults with gastrointestinal cancer who underwent central venous access device insertion for chemotherapy at our institution between December 2021 and December 2024.Inclusion criteria encompassed indications for intermittent intravenous chemotherapy,anticipated treatment duration of≥12 weeks,an adequate preoperative hematologic profile,accessible upper body veins,and complete medical records.Patients were excluded if they had an anticipated survival of less than three months,active systemic infection,severe thrombosis or coagulopathy,communication barriers,or an urgent need for dialysis access.Patients were assigned to either the PICC or TIVAP group based on device type.Data collected included demographic variables,cancer characteristics,insertion procedure details,complications,and QoL,assessed via the EuroQol 5-Dimensions-3 levels,visual analogue scale,and the European Organization for Research and Treatment of Cancer QoL Questionnaire-Core 30.RESULTS A total of 346 patients were analyzed.Baseline demographic,clinical,and cancer characteristics were similar between groups.The TIVAP group demonstrated a significantly lower incidence of catheter-related complications than the PICC group,with no pneumothorax occurring in either group.QoL assessments at baseline were comparable.At one month,the TIVAP group exhibited significantly higher EuroQoL Five Dimensions health state scores and QLQ-C30 global health status scores.Multivariate analysis identified TIVAP use,catheter tip placement in the distal superior vena cava/right atrium,prophylactic antibiotic administration,and antimicrobial dressing application as independent protective factors associated with reduced complications and improved QoL.CONCLUSION In patients with gastrointestinal cancer undergoing chemotherapy,TIVAPs are associated with a lower incidence of catheter-related complications and improved QoL than PICCs.Optimal device selection,precise catheter tip positioning,and effective perioperative management are critical for minimizing complications and enhancing patient-reported outcomes during treatment.
文摘Obstructed infradiaphragmatic total anomalous pulmonary venous return(TAPVR)in premature infants presents significant management challenges due to the high surgical risk in low-birth-weight,preterm neonates.We present strategies for managing this condition in a 10-day old 1.3 kg ex-32-week premature infant including late umbilical venous access,use of wire-snare rail for stable stent deployment,and monitoring for progressive multi-level obstruction.Long-term follow-up demonstrated spontaneous stent fracture and occlusion.This approach successfully bridged to definitive repair with excellent outcomes.
基金Supported by Capital Medical University Affiliated Beijing Shijitan Hospital Talent Development Program during the 14th Five-Year Plan,No.2023 LJRCLFQ.
文摘BACKGROUND Wedged hepatic venous pressure(WHVP)is a crucial variable for accurately assessing the hepatic venous pressure gradient(HVPG)and is vital for the diagnosis and prognostic evaluation of patients with portal hypertension(PH).AIM To investigate the anatomical characteristics of balloon-occluded hepatic venous angiography in patients with PH and analyze the relationship between the WHVP and portal venous pressure(PVP).METHODS This retrospective study included 877 patients with PH who met the inclusion criteria from January 2020 to June 2024.Routine and innovative hepatic venous angiography was performed during transjugular intrahepatic portosystemic shunt procedures to measure hepatic venous and PVPs.All patients'angiographic images were collected for analysis.The associations between WHVP and PVP in each group were analyzed via linear regression analysis,and a predictive model was established.RESULTS The 877 patients had a mean age of 52.6±13.0 years,with 582 males and 295 females.Patients were categorized into four groups on the basis of their anatomical structure.All groups showed strong correlations between WHVP and PVP.The regression coefficient between the WHVP and PVP in the hepatic right vein-portal venous angiography group was 0.884(P<0.05);in the hepatic right vein-accessory hepatic venous angiography group,it was 0.721(P<0.05);in the hepatic right vein-middle hepatic venous angiography group,it was 0.344(P<0.05);and in the hepatic right vein-nonangiography group,it was 0.293(P<0.05).CONCLUSION The presence and anatomical classification of hepatic venous collaterals are key factors influencing the relationship between WHVP with and PVP.Based on the different anatomical classifications of hepatic veins,WHVP can be used to estimate PVP,improving the accuracy of PVP prediction.
基金supported by the Medical and Health Science and Technology Plan Project of Health and Health Commission of Inner Mongolia Autonomous Region(202201427).
文摘Objective:To evaluate the therapeutic effects of intravenous infusion using intravenous indwelling needles(IIN)versus peripherally inserted central catheters(PICC)in patients with acute leukemia during maintenance treatment.Methods:Eighty-six patients with acute leukemia admitted to the First Affiliated Hospital of Baotou Medical College from July 2022 to March 2023 were randomly divided into the IIN group and the PICC group,with 43 patients in each group.Results:Significant differences were observed between the two groups in terms of the number of punctures and puncture time(P<0.05).Although the intubation cost was lower in the IIN group than in the PICC group,the maintenance treatment duration was shorter in the IIN group(P<0.05).There were no significant differences between the two groups in terms of disease symptoms,treatment-related toxicity,and side effects(P>0.05).However,anxiety,treatment compliance,and patient satisfaction were significantly lower in IIN group compared to the PICC group(P<0.05).Additionally,the incidence of vein-related complications in the IIN group was higher than in the PICC group(P<0.05).Conclusion:Compared with intravenous indwelling needles,PICCs demonstrate superior application outcomes.Although the cost of PICC placement is relatively high,its ability to prolong maintenance treatment,alleviate patient anxiety,reduce vein-related complications,and improve treatment compliance makes it a valuable method worth promoting.
基金supported by the Capital Medical University Undergraduate Innovation Project 2025(XSKY20-25251).
文摘Intravenous leiomyomatosis(IVL)is a rare,histologically benign uterine smooth muscle tumor with malignant biological behavior due to its propensity for intravascular extension.[1]While gynecological in origin,its most severe manifestations are cardiovascular,arising from tumor propagation through the venous system into the inferior vena cava(IVC),right heart,and pulmonary arteries,mimicking thromboembolic disease.[2,3]This can lead to pulmonary embolism(PE),right heart obstruction,and even sudden cardiac death.[4]Diagnosis is challenging,often delayed by misdiagnosis as conventional PE.We present two cases of IVL initially presenting with PE,highlighting the critical cardiovascular implications and diagnostic pitfalls.
文摘BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic state.AIM To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop VTE.METHODS This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital.Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.RESULTS Seventy-four patients fulfilled the inclusion criteria.The mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 years.Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed VTE.Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)patients.All the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international literature.However,multi-centric studies are required to further explore these results.
文摘BACKGROUND Few studies have specifically modeled the risk of venous thromboembolism(VTE)for postoperative hepatocellular carcinoma(HCC)patients,although HCC is the third leading cause of cancer death worldwide.This study aimed to develop and validate a nomogram that accurately predicts the risk of VTE in patients after HCC surgery.AIM To develop and validate a nomogram to accurately predict the risk of VTE in postoperative HCC patients by integrating clinical and laboratory risk factors.The model seeks to provide a user-friendly tool for identifying high-risk individuals who may benefit from targeted anticoagulation therapy,thereby improving clinical decision-making and patient outcomes.METHODS Data from patients who underwent HCC surgery at Chongqing University Cancer Hospital in China were analyzed.Through univariate and multivariate logistic regression analyses,independent risk factors for VTE were identified and integrated into a nomogram.The predictive performance of the nomogram was assessed via receiver operating characteristic curves,calibration curves,decision curve analysis and other relevant metrics.RESULTS Of 905 postoperative HCC patients were included in the study.The nomogram incorporated eight independent risk factors for VTE:Karnofsky Performance Scale,base disease,cancer stage(tumor-node-metastasis),chemotherapy,D-dimer concentration,white blood cell count,hemoglobin,and fibrinogen.The C-index for the nomogram model was 0.825 in the training cohort and 0.820 in the validation cohort,indicating good discriminative ability.Calibration plots of the model revealed high concordance between the predicted probabilities and observed outcomes.CONCLUSION We developed and validated a novel nomogram that can accurately estimate the risk of VTE in individual postoperative HCC patients.This model can identify high-risk patients who may benefit from targeted anticoagulation therapy.
文摘BACKGROUND The risk and mortality rate of venous thromboembolism(VTE)following gastrointestinal surgery remain high,and the symptoms are atypical.Therefore,it is necessary to identify the risk factors associated with the occurrence of VTE following gastrointestinal surgery and to implement appropriate prevention and treatment measures.AIM To assess the efficacy of perioperative anticoagulation for the prevention of postoperative VTE.METHODS This retrospective study enrolled 205 patients who underwent gastrointestinal surgery.In the observation group(n=101),prophylactic anticoagulation was administered via hypodermic injection of low-molecular-weight heparin during the perioperative period,whereas the control group(n=104)only received lowmolecular-weight heparin treatment postoperatively.Blood coagulation parameters and the incidence of VTE of the bilateral lower limbs pre-and post-surgery were compared between groups.Postoperative VTE was transformed into a dichotomous variable,and influencing factors were explored using multivariate logistic regression analyses.RESULTS On the 7th day postoperatively,the incidence of VTE of the bilateral lower limbs was significantly lower in the observation group than in the control group,as were the D-dimer levels(P<0.05).At 1 month postoperatively,the incidence of VTE was significantly lower in the observation group than in the control group(P<0.05).An age≥65 years,a body mass index≥24 kg/m^(2),and malignant diseases of the digestive system were identified as risk factors for the occurrence of postoperative VTE in patients undergoing gastrointestinal surgery.CONCLUSION The incidence of VTE in patients who underwent gastrointestinal surgery peaked within 1 week postoperatively.The findings confirmed perioperative anticoagulation can safely and effectively reduce the incidence of postoperative VTE.
文摘Hepatic portal venous gas(HPVG)is a rare yet clinically significant radiological manifestation characterized by diverse etiologies,unclear pathophysiology,and nonspecific clinical presentations.Its appearance frequently heralds a severe underlying condition,with a reported mortality rate as high as 75%,earning it the moniker“harbinger of death”.In recent years,with advancements in diagnosis and treatment of HPVG,its mortality rate has been reduced to below 40%.Nevertheless,the infrequency of HPVG,coupled with its complex etiologies and rapid progression,often leaves clinicians failing to provide timely intervention due to a lack of awareness,resulting in the death of patient.Currently,there is no consensus on the standardized diagnosis and treatment strategies for HPVG.The purpose of this review is to synthesize the existing literature on HPVG and to discuss the advancements in understanding its clinical manifestation,etiologies,pathogenesis,diagnostic methods,and treatment strategies,as well as to emphasize the necessity for further research to enhance our comprehension of its pathophysiology and to refine diagnostic and therapeutic approaches.
基金Supported by The National Natural Science Foundation of China,No.81901819Peking University People’s Hospital Scientific Research Development Funds,No.RDX2024-08Beijing Natural Science Foundation,No.7232187.
文摘BACKGROUND Extramural venous invasion(EMVI)is a critical prognostic factor in gastric cancer(GC);however,its detection and underlying molecular mechanisms remain underexplored.AIM To investigate the relationship between EMVI and expression of the circular RNA hsa_circ_0097977 in orthotopic GC mouse models.METHODS A retrospective analysis was conducted in addition to a preclinical animal study,involving 13 GC patients and 24 orthotopic GC mouse models,respectively.EMVI was assessed using axial T2-weighted fat suppression sequences on a 9.4T magnetic resonance imaging(MRI)with histopathological confirmation as the gold standard for EMVI.The impact of hsa_circ_0097977 on EMVI and GC cell function was evaluated.Statistical analyses comprised consistency,area under the curve analysis,correlation,χ^(2)/Fisher exact,and Mann-Whitney U/t-tests,with significance set at P<0.05.RESULTS EMVI was accurately detected using 9.4T MRI in orthotopic mouse models with an area under the curve of 0.843(sensitivity 78.6%,specificity 90.0%).MRI detected EMVI was the only imaging factor associated with distant metastasis(P=0.04).Furthermore,knockdown of hsa_circ_0097977 was the only factor associated with EMVI(P=0.043,0.038)and led to reduced invasion and increased apoptosis in GC cells.CONCLUSION EMVI,a risk factor for distant metastasis in GC,is detectable by 9.4T MRI and regulated by hsa_circ_0097977,making it a potential therapeutic target.
文摘Lung transplantation(LT)is currently a surgical therapy option for end-stage lung disease.Venous thromboembolism(VTE),which can occur after LT,is associated with significant morbidity and mortality.Because of improved out-comes,increasing numbers of patients are receiving LT as treatment.Patients on the waitlist for LT tend to be older with weakness and frailty in addition to pulmonary symptoms.These factors contribute to a heightened risk of post-operative VTE.Furthermore,patients who clinically deteriorate while on the waitlist may require extra corporeal membrane oxygenation as a bridge to LT.Bleeding and thromboembolism are common in these patients.Pulmonary embolism(PE)in a freshly transplanted lung can have significant effects leading to morbidity and mortality.PE typically leads to impairment of gas exchange and right ventricular strain.In LT,PE can affect healing of bronchial anastomosis and may even contribute to the development of chronic allograft lung dysfunction.This article discussed the incidence,clinical features and diagnosis of VTE after LT.Furthermore,the treatment modalities,complications,and outcomes of VTE were reviewed.
文摘Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to correct an error in Figure 3 in which the flow cytometric scattergram of CD4/CD44 for the control group was erroneously used for the scattergram of CD8/CD44 for the PVIDSC group.The correct scattergram of CD8/CD44 for the PVIDSC group is provided below.The error does not affect the conclusion of the study.The authors apologize for the error and the inconvenience it might have caused to readers.
基金funded by the National College Students Innovation and Entrepreneurship Training Program(S202310760049).
文摘This article introduces and compares risk assessment models for venous thromboembolism in gynecological patients at home and abroad.The models assessed included the Caprini risk assessment model,the G-Caprini risk assessment model,the Rogers risk assessment model,the Autar risk assessment model,the gynecological patient surgical venous thrombosis risk assessment scale,the Wells score,the COMPASS-CAT thrombus risk assessment model,the Khorana risk assessment model,the Padua risk assessment model,and the Chaoyang model.The purpose of this study is to provide a foundation for developing a risk assessment tool for gynecological venous thromboembolism tailored to Chinese patients and to assist clinical health care workers in selecting appropriate risk assessment tools and guiding individualized prevention measures.
