BACKGROUND Deep learning provides an efficient automatic image recognition method for small bowel(SB)capsule endoscopy(CE)that can assist physicians in diagnosis.However,the existing deep learning models present some ...BACKGROUND Deep learning provides an efficient automatic image recognition method for small bowel(SB)capsule endoscopy(CE)that can assist physicians in diagnosis.However,the existing deep learning models present some unresolved challenges.AIM To propose a novel and effective classification and detection model to automatically identify various SB lesions and their bleeding risks,and label the lesions accurately so as to enhance the diagnostic efficiency of physicians and the ability to identify high-risk bleeding groups.METHODS The proposed model represents a two-stage method that combined image classification with object detection.First,we utilized the improved ResNet-50 classification model to classify endoscopic images into SB lesion images,normal SB mucosa images,and invalid images.Then,the improved YOLO-V5 detection model was utilized to detect the type of lesion and its risk of bleeding,and the location of the lesion was marked.We constructed training and testing sets and compared model-assisted reading with physician reading.RESULTS The accuracy of the model constructed in this study reached 98.96%,which was higher than the accuracy of other systems using only a single module.The sensitivity,specificity,and accuracy of the model-assisted reading detection of all images were 99.17%,99.92%,and 99.86%,which were significantly higher than those of the endoscopists’diagnoses.The image processing time of the model was 48 ms/image,and the image processing time of the physicians was 0.40±0.24 s/image(P<0.001).CONCLUSION The deep learning model of image classification combined with object detection exhibits a satisfactory diagnostic effect on a variety of SB lesions and their bleeding risks in CE images,which enhances the diagnostic efficiency of physicians and improves the ability of physicians to identify high-risk bleeding groups.展开更多
Background Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin （UFH） in patients undergoing percutaneous coronary intervention （PCI）. However, it is not known ...Background Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin （UFH） in patients undergoing percutaneous coronary intervention （PCI）. However, it is not known if this benefit is also present when UFH doses are more tightly controlled （as measured by activated clotting time, ACT）.展开更多
The present letter to the editor is related to the study with the title“Automatic detection of small bowel(SB)lesions with different bleeding risk based on deep learning models”.Capsule endoscopy(CE)is the main tool...The present letter to the editor is related to the study with the title“Automatic detection of small bowel(SB)lesions with different bleeding risk based on deep learning models”.Capsule endoscopy(CE)is the main tool to assess SB diseases but it is a time-consuming procedure with a significant error rate.The development of artificial intelligence(AI)in CE could simplify physicians’tasks.The novel deep learning model by Zhang et al seems to be able to identify various SB lesions and their bleeding risk,and it could pave the way to next perspective studies to better enhance the diagnostic support of AI in the detection of different types of SB lesions in clinical practice.展开更多
Background： There was still conflict on the antithrombotic advantage of ticagrelor versus clopidogrel among East Asian population with acute coronary syndrome （ACS）. We considered that the baseline bleeding risk mi...Background： There was still conflict on the antithrombotic advantage of ticagrelor versus clopidogrel among East Asian population with acute coronary syndrome （ACS）. We considered that the baseline bleeding risk might be an undetected key factor that significantly affected the efficacy of ticagrelor. Methods： A total of 20,816 serial patients who underwent percutaneous coronary intervention （PCI） from October 20l 1 to August 2014 in the General Hospital of Shenyang Military Region were enrolled in the present study. Patients receiving ticagrelor or clopidogrel were further subdivided according to basic bleeding risk. The primary outcome was net adverse clinical events （NACEs） defined as major adverse cardiac or cerebral events （MACCE, including all-cause death, myocardial infarction, ischemia-driven target vessel revascularization, or stroke） and any bleeding during l-year lbllow-up. Comparison between ticagrelor and clopidogrel was adjusted by propensity score matching （PSM）. Results： Among the 20,816 eligible PCI patients who were included in this study, there were 1578 and 779 patients in the clopidogrel and ticagrelor groups, respectively, alter PSM, their clinical parameters were well matched. Patients receiving ticagrelor showed comparable NACE risk compared with those treated by c[opidogrel （5.3% vs. 5. I%, P = 0.842）. Furthermore, ticagrelor might reduce the MACCE risk in patients with low bleeding risk but increase MACCE in patients with moderate-to-high bleeding potential （ticagrelor vs. clopidogrel, low bleeding risk： 2.5% vs. 4.9%, P = 0.022： moderate-to-high bleeding risk： 4.8% vs. 3.0%, P =0.225; interaction P = 0.021）, with vast differences in all bleeding （low bleeding risk： 1.5% vs. 0.8%, P =0.210： moderate-to-high bleeding risk： 4.8% vs. 3.0%, P = 0.002; interaction P- 0.296）.Conclusion： Among real-world Chinese patients with ACS treated by PCI, ticagrelor only showed superior efficacy in patients with low bleeding risk but lost its advantage in patients with moderate-to-high bleeding potential.展开更多
Percutaneous coronary intervention(PCI)is an important treatment strategy for patients with coronary artery disease.However,bleeding after PCI significantly increases the mortality risk.The search for prognostic predi...Percutaneous coronary intervention(PCI)is an important treatment strategy for patients with coronary artery disease.However,bleeding after PCI significantly increases the mortality risk.The search for prognostic predictors and optimal antiplatelet therapy for patients with high bleeding risk(HBR)after PCI has been a much researched upon topic in current cardiovascular research.However,there is no widely accepted prognostic model or recommended antiplatelet therapy for patients with PCI-HBR.In this trial,based on prospective multi-center database building,we will analyze the adverse prognostic predictors for patients with PCI-HBR,observe the types of antiplatelet drugs and duration of dual antiplatelet therapy in PCI-HBR patients,and compare the safety and feasibility of different antiplatelet regimens and treatment courses.The prognostic analysis and an appropriate antiplatelet strategy for patients with PCI and high bleeding risk(PPP-PCI)trial will help analyze bleeding risk factors in PCI-HBR patients and explore the appropriate antiplatelet treatment options.This study is registered with ClinicalTrials.gov(NCT05369442).The Research Ethics Committee of West China Hospital authorized this study(2022 Review#269).The trial results will be published in peer-reviewed journals and at conferences.展开更多
BACKGROUND Bleeding is one of the major complications after endoscopic submucosal dissection(ESD)in early gastric cancer(EGC)patients.There are limited studies on estimating the bleeding risk after ESD using an artifi...BACKGROUND Bleeding is one of the major complications after endoscopic submucosal dissection(ESD)in early gastric cancer(EGC)patients.There are limited studies on estimating the bleeding risk after ESD using an artificial intelligence system.AIM To derivate and verify the performance of the deep learning model and the clinical model for predicting bleeding risk after ESD in EGC patients.METHODS Patients with EGC who underwent ESD between January 2010 and June 2020 at the Samsung Medical Center were enrolled,and post-ESD bleeding(PEB)was investigated retrospectively.We split the entire cohort into a development set(80%)and a validation set(20%).The deep learning and clinical model were built on the development set and tested in the validation set.The performance of the deep learning model and the clinical model were compared using the area under the curve and the stratification of bleeding risk after ESD.RESULTS A total of 5629 patients were included,and PEB occurred in 325 patients.The area under the curve for predicting PEB was 0.71(95%confidence interval:0.63-0.78)in the deep learning model and 0.70(95%confidence interval:0.62-0.77)in the clinical model,without significant difference(P=0.730).The patients expected to the low-(<5%),intermediate-(≥5%,<9%),and high-risk(≥9%)categories were observed with actual bleeding rate of 2.2%,3.9%,and 11.6%,respectively,in the deep learning model;4.0%,8.8%,and 18.2%,respectively,in the clinical model.CONCLUSION A deep learning model can predict and stratify the bleeding risk after ESD in patients with EGC.展开更多
BACKGROUND Peripheral artery disease(PAD)affects millions globally,with a 5.6%prevalence in 2015 impacting 236 million adults,rising above 10%in those over 60 due to factors like diabetes and smoking.Post-revasculariz...BACKGROUND Peripheral artery disease(PAD)affects millions globally,with a 5.6%prevalence in 2015 impacting 236 million adults,rising above 10%in those over 60 due to factors like diabetes and smoking.Post-revascularization,single antiplatelet therapy(SAPT)is standard,but dual antiplatelet therapy(DAPT)may improve outcomes,though duration and bleeding risks are unclear.The 2024 American College of Cardiology/American Heart Association guidelines endorse short-term DAPT,yet evidence gaps remain in comparative efficacy and safety.We hypothesized that DAPT reduces cardiovascular events and reinterventions vs SAPT without significantly elevating bleeding in PAD patients’post-lower extremity revascularization.AIM To evaluate the efficacy and safety of DAPT vs SAPT in PAD patients’post-revascularization.METHODS This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,searching PubMed,EMBASE,and ScienceDirect up to July 2025.Included were randomized controlled trials(RCTs)and cohort studies from various global settings(e.g.,hospitals,tertiary care)comparing DAPT(aspirin plus P2Y12 inhibitor for>1 month)to SAPT in symptomatic PAD patients undergoing endovascular or surgical revascularization(n up to 28244 participants selected via eligibility criteria).Data were pooled using random-effects models for risk ratio(RR)with 95%CI;heterogeneity was assessed via the I²statistic.Quality appraisal used Risk of Bias in Non-randomized Studies of Interventions for cohorts and Risk of Bias 2.0 for RCTs;certainty was evaluated via Grading of Recommendations Assessment,Development and Evaluation(GRADE).RESULTS Twelve studies(3 RCTs,9 cohorts,conducted 2010–2025 with follow-ups of 6 months to 5 years)were included.DAPT showed no significant difference but a trend toward reduced all-cause mortality(RR:0.52,95%CI:0.27–1.01,P=0.05,DAPT of 298/9545 events vs SAPT of 165/566 events)or stroke(RR:0.72,95%CI:0.30–1.72,P=0.46,DAPT of 16/3729 events vs SAPT of 41/7673 events)vs SAPT.DAPT significantly reduced cardiac mortality(RR:0.46,95%CI:0.27–0.80,P=0.006,DAPT of 78/2903 events vs SAPT of 171/1465 events,risk difference:-5.4%),myocardial infarction(RR:0.82,95%CI:0.71–0.94,P=0.004,DAPT of 233/7704 events vs SAPT of 262/9130 events,risk difference:-1.8%),and major reintervention(RR:0.58,95%CI:0.35–0.98,P=0.04,DAPT of 803/205 events vs SAPT of 1197/4 events,risk difference:-42%).Bleeding showed no difference(RR:1.12,95%CI:0.42–3.03,P=0.82,DAPT of 195/2775 events vs SAPT of 202/8234 events).Heterogeneity was high(I^(2)=59%–97%).Quality revealed moderate to serious bias in cohorts and some concerns in RCTs;GRADE certainty moderate for cardiac mortality,myocardial infarction,reintervention,low for others due to inconsistency and imprecision.CONCLUSION DAPT reduces cardiac mortality,myocardial infarction,and major reintervention risks compared to SAPT in PAD post-revascularization without apparent bleeding increase,though limited by heterogeneity and low certainty for some outcomes.展开更多
Hemostasis is a complex physiological process based on the balance between procoagulant and anticoagulant systems to avoid pathological bleeding or thrombosis.The changes in standard coagulation tests in liver disease...Hemostasis is a complex physiological process based on the balance between procoagulant and anticoagulant systems to avoid pathological bleeding or thrombosis.The changes in standard coagulation tests in liver disease were assumed to reflect an acquired bleeding disorder,and cirrhotic patients were considered naturally anticoagulated.In the light of the new evidence,the theory of rebalanced hemostasis replaced the old concept.According to this model,the hemostatic alteration leads to a unique balance between pro-coagulant,anticoagulant,and fibrinolytic systems.But the balance is fragile and may prone to bleeding or thrombosis depending on various risk factors.The standard coagulation tests[INR(international normalized ratio),platelet count and fibrinogen]only explore parts of the hemostasis,not offering an entire image of the process.Rotational thromboelastometry(ROTEM)and thromboelastography(TEG)are both point of care viscoelastic tests(VET)that provide real-time and dynamic information about the entire hemostasis process,including clot initiation(thrombin generation),clot kinetics,clot strength,and clot stability(lysis).Despite prolonged PT/INR(international normalized ratio of prothrombin time)and low platelet counts,VET is within the normal range in many patients with both acute and chronic liver disease.However,bleeding remains the dominant clinical issue in patients with liver diseases,especially when invasive interventions are required.VET has been shown to asses more appropriately the risk of bleeding than conventional laboratory tests,leading to decrial use of blood products transfusion.Inappropriate clotting is common but often subtle and may be challenging to predict even with the help of VET.Although VET has shown its benefit,more studies are needed to establish cut-off values for TEG and ROTEM in these populations and standardization of transfusion guidelines before invasive interventions in cirrhotic patients/orthotopic liver transplantation.展开更多
Due to concomitant changes in pro-and anti-coagulant mechanisms,patients with liver dysfunction have a“rebalanced hemostasis”,which can easily be tipped toward either a hypo-or a hypercoagulable phenotype.Clinicians...Due to concomitant changes in pro-and anti-coagulant mechanisms,patients with liver dysfunction have a“rebalanced hemostasis”,which can easily be tipped toward either a hypo-or a hypercoagulable phenotype.Clinicians are often faced with the question whether patients with chronic liver disease undergoing invasive procedures or surgery and those having active bleeding require correction of the hemostasis abnormalities.Conventional coagulation screening tests,such as the prothrombin time/international normalized ratio and the activated partial thromboplastin time have been demonstrated to have numerous limitations in these patients and do not predict the risk of bleeding prior to high-risk procedures.The introduction of global coagulation assays,such as viscoelastic testing(VET),has been an important step forward in the assessment of the overall hemostasis profile.A growing body of evidence now suggests that the use of VET might be of significant clinical utility to prevent unnecessary infusion of blood products and to improve outcomes in numerous settings.The present review discusses the advantages and caveats of both conventional and global coagulation assays to assess the risk of bleeding in patients with chronic liver disease as well as the current role of transfusion and hemostatic agents to prevent or manage bleeding.展开更多
Aspirin is widely used for primary or secondary prevention of ischemic events.At the same time,chronic aspirin consumption can affect blood clot formation during surgical intervention and increase intraoperative blood...Aspirin is widely used for primary or secondary prevention of ischemic events.At the same time,chronic aspirin consumption can affect blood clot formation during surgical intervention and increase intraoperative blood loss.This is especially important for high-risk surgery,including neurosurgery.Current European Society of Cardiology guidelines recommend aspirin interruption for at least 7 d before neurosurgical intervention,but this suggestion is not supported by clinical evidence.This narrative review presents evidence that challenges the necessity for aspirin interruption in neurosurgical patients,describes options for aspirin effect monitoring and the clinical implication of these methods,and summarizes current clinical data on bleeding risk associated with chronic aspirin therapy in neurosurgical patients,including brain tumor surgery,cerebrovascular procedures,and spinal surgery.展开更多
As a coagulation factor in the intrinsic coagulation pathway,factor XIa(FXIa)is an effective and safe target for the development of antithrombotic drugs.Many small-molecule FXIa inhibitors have been discovered,some of...As a coagulation factor in the intrinsic coagulation pathway,factor XIa(FXIa)is an effective and safe target for the development of antithrombotic drugs.Many small-molecule FXIa inhibitors have been discovered,some of which are being evaluated in clinical trials.However,none of them have been approved.In the present study,a highly selective potent FXIa inhibitor with poor solubility reported in our previous work was selected as a lead compound to be further modified to improve FXIa potency and physicochemical properties.The structure-based drug design and structure-activity relationship study led to the discovery of LY8,LY17,and LY25,which demonstrated enhanced FXIa potency and maintained excellent selectivity.In addition,LY8 exhibited significantly improved aqueous solubility,suggesting that it could be a promising compound to be further evaluated.展开更多
BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clini...BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.展开更多
This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral ang...This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.展开更多
This retrospective single-center registry study included all consecutive patients who underwent percutaneous coronary intervention (PCI) for a de novo left main coronary artery lesion using drug coated-balloon (DCB)-o...This retrospective single-center registry study included all consecutive patients who underwent percutaneous coronary intervention (PCI) for a de novo left main coronary artery lesion using drug coated-balloon (DCB)-only strategy between August 2011 and December 2018. To best of our knowledge, no previous studies of DCB-only strategy of treating de novo left main coronary artery disease, exist. The primary endpoint was major adverse cardiovascular events (MACEs) including cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). The cohort was divided into two groups depending on weather the lesion preparation was done according to the international consensus group guidelines. Sixty-six patients (mean age 75±8.6, 72% male), 52% of whom had acute coronary syndrome, underwent left main PCI with the DCB-only strategy. No procedural mortality and no acute closures of the treated left main occurred. At 12 months, MACE and TLR occurred in 24% and 6% of the whole cohort, respectively. If the lesion preparation was done according to the guidelines, the MACE and TLR rates were 21.2% and 1.9%. Left main PCI with the DCB only-strategy is safe leading to acceptable MACE and low TLR rates at one year, if the lesion preparation is done according to the guidelines.展开更多
基金The Shanxi Provincial Administration of Traditional Chinese Medicine,No.2023ZYYDA2005.
文摘BACKGROUND Deep learning provides an efficient automatic image recognition method for small bowel(SB)capsule endoscopy(CE)that can assist physicians in diagnosis.However,the existing deep learning models present some unresolved challenges.AIM To propose a novel and effective classification and detection model to automatically identify various SB lesions and their bleeding risks,and label the lesions accurately so as to enhance the diagnostic efficiency of physicians and the ability to identify high-risk bleeding groups.METHODS The proposed model represents a two-stage method that combined image classification with object detection.First,we utilized the improved ResNet-50 classification model to classify endoscopic images into SB lesion images,normal SB mucosa images,and invalid images.Then,the improved YOLO-V5 detection model was utilized to detect the type of lesion and its risk of bleeding,and the location of the lesion was marked.We constructed training and testing sets and compared model-assisted reading with physician reading.RESULTS The accuracy of the model constructed in this study reached 98.96%,which was higher than the accuracy of other systems using only a single module.The sensitivity,specificity,and accuracy of the model-assisted reading detection of all images were 99.17%,99.92%,and 99.86%,which were significantly higher than those of the endoscopists’diagnoses.The image processing time of the model was 48 ms/image,and the image processing time of the physicians was 0.40±0.24 s/image(P<0.001).CONCLUSION The deep learning model of image classification combined with object detection exhibits a satisfactory diagnostic effect on a variety of SB lesions and their bleeding risks in CE images,which enhances the diagnostic efficiency of physicians and improves the ability of physicians to identify high-risk bleeding groups.
文摘Background Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin （UFH） in patients undergoing percutaneous coronary intervention （PCI）. However, it is not known if this benefit is also present when UFH doses are more tightly controlled （as measured by activated clotting time, ACT）.
文摘The present letter to the editor is related to the study with the title“Automatic detection of small bowel(SB)lesions with different bleeding risk based on deep learning models”.Capsule endoscopy(CE)is the main tool to assess SB diseases but it is a time-consuming procedure with a significant error rate.The development of artificial intelligence(AI)in CE could simplify physicians’tasks.The novel deep learning model by Zhang et al seems to be able to identify various SB lesions and their bleeding risk,and it could pave the way to next perspective studies to better enhance the diagnostic support of AI in the detection of different types of SB lesions in clinical practice.
文摘Background： There was still conflict on the antithrombotic advantage of ticagrelor versus clopidogrel among East Asian population with acute coronary syndrome （ACS）. We considered that the baseline bleeding risk might be an undetected key factor that significantly affected the efficacy of ticagrelor. Methods： A total of 20,816 serial patients who underwent percutaneous coronary intervention （PCI） from October 20l 1 to August 2014 in the General Hospital of Shenyang Military Region were enrolled in the present study. Patients receiving ticagrelor or clopidogrel were further subdivided according to basic bleeding risk. The primary outcome was net adverse clinical events （NACEs） defined as major adverse cardiac or cerebral events （MACCE, including all-cause death, myocardial infarction, ischemia-driven target vessel revascularization, or stroke） and any bleeding during l-year lbllow-up. Comparison between ticagrelor and clopidogrel was adjusted by propensity score matching （PSM）. Results： Among the 20,816 eligible PCI patients who were included in this study, there were 1578 and 779 patients in the clopidogrel and ticagrelor groups, respectively, alter PSM, their clinical parameters were well matched. Patients receiving ticagrelor showed comparable NACE risk compared with those treated by c[opidogrel （5.3% vs. 5. I%, P = 0.842）. Furthermore, ticagrelor might reduce the MACCE risk in patients with low bleeding risk but increase MACCE in patients with moderate-to-high bleeding potential （ticagrelor vs. clopidogrel, low bleeding risk： 2.5% vs. 4.9%, P = 0.022： moderate-to-high bleeding risk： 4.8% vs. 3.0%, P =0.225; interaction P = 0.021）, with vast differences in all bleeding （low bleeding risk： 1.5% vs. 0.8%, P =0.210： moderate-to-high bleeding risk： 4.8% vs. 3.0%, P = 0.002; interaction P- 0.296）.Conclusion： Among real-world Chinese patients with ACS treated by PCI, ticagrelor only showed superior efficacy in patients with low bleeding risk but lost its advantage in patients with moderate-to-high bleeding potential.
基金supported by the 1-3-5 project for disciplines of excellence—Clinical Research Incubation Project,West China Hospital,Sichuan University(2019HXFH059 and 2021HXFH021)the Natural Science Foundation of China(82100282).
文摘Percutaneous coronary intervention(PCI)is an important treatment strategy for patients with coronary artery disease.However,bleeding after PCI significantly increases the mortality risk.The search for prognostic predictors and optimal antiplatelet therapy for patients with high bleeding risk(HBR)after PCI has been a much researched upon topic in current cardiovascular research.However,there is no widely accepted prognostic model or recommended antiplatelet therapy for patients with PCI-HBR.In this trial,based on prospective multi-center database building,we will analyze the adverse prognostic predictors for patients with PCI-HBR,observe the types of antiplatelet drugs and duration of dual antiplatelet therapy in PCI-HBR patients,and compare the safety and feasibility of different antiplatelet regimens and treatment courses.The prognostic analysis and an appropriate antiplatelet strategy for patients with PCI and high bleeding risk(PPP-PCI)trial will help analyze bleeding risk factors in PCI-HBR patients and explore the appropriate antiplatelet treatment options.This study is registered with ClinicalTrials.gov(NCT05369442).The Research Ethics Committee of West China Hospital authorized this study(2022 Review#269).The trial results will be published in peer-reviewed journals and at conferences.
文摘BACKGROUND Bleeding is one of the major complications after endoscopic submucosal dissection(ESD)in early gastric cancer(EGC)patients.There are limited studies on estimating the bleeding risk after ESD using an artificial intelligence system.AIM To derivate and verify the performance of the deep learning model and the clinical model for predicting bleeding risk after ESD in EGC patients.METHODS Patients with EGC who underwent ESD between January 2010 and June 2020 at the Samsung Medical Center were enrolled,and post-ESD bleeding(PEB)was investigated retrospectively.We split the entire cohort into a development set(80%)and a validation set(20%).The deep learning and clinical model were built on the development set and tested in the validation set.The performance of the deep learning model and the clinical model were compared using the area under the curve and the stratification of bleeding risk after ESD.RESULTS A total of 5629 patients were included,and PEB occurred in 325 patients.The area under the curve for predicting PEB was 0.71(95%confidence interval:0.63-0.78)in the deep learning model and 0.70(95%confidence interval:0.62-0.77)in the clinical model,without significant difference(P=0.730).The patients expected to the low-(<5%),intermediate-(≥5%,<9%),and high-risk(≥9%)categories were observed with actual bleeding rate of 2.2%,3.9%,and 11.6%,respectively,in the deep learning model;4.0%,8.8%,and 18.2%,respectively,in the clinical model.CONCLUSION A deep learning model can predict and stratify the bleeding risk after ESD in patients with EGC.
文摘BACKGROUND Peripheral artery disease(PAD)affects millions globally,with a 5.6%prevalence in 2015 impacting 236 million adults,rising above 10%in those over 60 due to factors like diabetes and smoking.Post-revascularization,single antiplatelet therapy(SAPT)is standard,but dual antiplatelet therapy(DAPT)may improve outcomes,though duration and bleeding risks are unclear.The 2024 American College of Cardiology/American Heart Association guidelines endorse short-term DAPT,yet evidence gaps remain in comparative efficacy and safety.We hypothesized that DAPT reduces cardiovascular events and reinterventions vs SAPT without significantly elevating bleeding in PAD patients’post-lower extremity revascularization.AIM To evaluate the efficacy and safety of DAPT vs SAPT in PAD patients’post-revascularization.METHODS This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,searching PubMed,EMBASE,and ScienceDirect up to July 2025.Included were randomized controlled trials(RCTs)and cohort studies from various global settings(e.g.,hospitals,tertiary care)comparing DAPT(aspirin plus P2Y12 inhibitor for>1 month)to SAPT in symptomatic PAD patients undergoing endovascular or surgical revascularization(n up to 28244 participants selected via eligibility criteria).Data were pooled using random-effects models for risk ratio(RR)with 95%CI;heterogeneity was assessed via the I²statistic.Quality appraisal used Risk of Bias in Non-randomized Studies of Interventions for cohorts and Risk of Bias 2.0 for RCTs;certainty was evaluated via Grading of Recommendations Assessment,Development and Evaluation(GRADE).RESULTS Twelve studies(3 RCTs,9 cohorts,conducted 2010–2025 with follow-ups of 6 months to 5 years)were included.DAPT showed no significant difference but a trend toward reduced all-cause mortality(RR:0.52,95%CI:0.27–1.01,P=0.05,DAPT of 298/9545 events vs SAPT of 165/566 events)or stroke(RR:0.72,95%CI:0.30–1.72,P=0.46,DAPT of 16/3729 events vs SAPT of 41/7673 events)vs SAPT.DAPT significantly reduced cardiac mortality(RR:0.46,95%CI:0.27–0.80,P=0.006,DAPT of 78/2903 events vs SAPT of 171/1465 events,risk difference:-5.4%),myocardial infarction(RR:0.82,95%CI:0.71–0.94,P=0.004,DAPT of 233/7704 events vs SAPT of 262/9130 events,risk difference:-1.8%),and major reintervention(RR:0.58,95%CI:0.35–0.98,P=0.04,DAPT of 803/205 events vs SAPT of 1197/4 events,risk difference:-42%).Bleeding showed no difference(RR:1.12,95%CI:0.42–3.03,P=0.82,DAPT of 195/2775 events vs SAPT of 202/8234 events).Heterogeneity was high(I^(2)=59%–97%).Quality revealed moderate to serious bias in cohorts and some concerns in RCTs;GRADE certainty moderate for cardiac mortality,myocardial infarction,reintervention,low for others due to inconsistency and imprecision.CONCLUSION DAPT reduces cardiac mortality,myocardial infarction,and major reintervention risks compared to SAPT in PAD post-revascularization without apparent bleeding increase,though limited by heterogeneity and low certainty for some outcomes.
文摘Hemostasis is a complex physiological process based on the balance between procoagulant and anticoagulant systems to avoid pathological bleeding or thrombosis.The changes in standard coagulation tests in liver disease were assumed to reflect an acquired bleeding disorder,and cirrhotic patients were considered naturally anticoagulated.In the light of the new evidence,the theory of rebalanced hemostasis replaced the old concept.According to this model,the hemostatic alteration leads to a unique balance between pro-coagulant,anticoagulant,and fibrinolytic systems.But the balance is fragile and may prone to bleeding or thrombosis depending on various risk factors.The standard coagulation tests[INR(international normalized ratio),platelet count and fibrinogen]only explore parts of the hemostasis,not offering an entire image of the process.Rotational thromboelastometry(ROTEM)and thromboelastography(TEG)are both point of care viscoelastic tests(VET)that provide real-time and dynamic information about the entire hemostasis process,including clot initiation(thrombin generation),clot kinetics,clot strength,and clot stability(lysis).Despite prolonged PT/INR(international normalized ratio of prothrombin time)and low platelet counts,VET is within the normal range in many patients with both acute and chronic liver disease.However,bleeding remains the dominant clinical issue in patients with liver diseases,especially when invasive interventions are required.VET has been shown to asses more appropriately the risk of bleeding than conventional laboratory tests,leading to decrial use of blood products transfusion.Inappropriate clotting is common but often subtle and may be challenging to predict even with the help of VET.Although VET has shown its benefit,more studies are needed to establish cut-off values for TEG and ROTEM in these populations and standardization of transfusion guidelines before invasive interventions in cirrhotic patients/orthotopic liver transplantation.
文摘Due to concomitant changes in pro-and anti-coagulant mechanisms,patients with liver dysfunction have a“rebalanced hemostasis”,which can easily be tipped toward either a hypo-or a hypercoagulable phenotype.Clinicians are often faced with the question whether patients with chronic liver disease undergoing invasive procedures or surgery and those having active bleeding require correction of the hemostasis abnormalities.Conventional coagulation screening tests,such as the prothrombin time/international normalized ratio and the activated partial thromboplastin time have been demonstrated to have numerous limitations in these patients and do not predict the risk of bleeding prior to high-risk procedures.The introduction of global coagulation assays,such as viscoelastic testing(VET),has been an important step forward in the assessment of the overall hemostasis profile.A growing body of evidence now suggests that the use of VET might be of significant clinical utility to prevent unnecessary infusion of blood products and to improve outcomes in numerous settings.The present review discusses the advantages and caveats of both conventional and global coagulation assays to assess the risk of bleeding in patients with chronic liver disease as well as the current role of transfusion and hemostatic agents to prevent or manage bleeding.
文摘Aspirin is widely used for primary or secondary prevention of ischemic events.At the same time,chronic aspirin consumption can affect blood clot formation during surgical intervention and increase intraoperative blood loss.This is especially important for high-risk surgery,including neurosurgery.Current European Society of Cardiology guidelines recommend aspirin interruption for at least 7 d before neurosurgical intervention,but this suggestion is not supported by clinical evidence.This narrative review presents evidence that challenges the necessity for aspirin interruption in neurosurgical patients,describes options for aspirin effect monitoring and the clinical implication of these methods,and summarizes current clinical data on bleeding risk associated with chronic aspirin therapy in neurosurgical patients,including brain tumor surgery,cerebrovascular procedures,and spinal surgery.
基金National Natural Science Foundation of China(Grant No.81803352)。
文摘As a coagulation factor in the intrinsic coagulation pathway,factor XIa(FXIa)is an effective and safe target for the development of antithrombotic drugs.Many small-molecule FXIa inhibitors have been discovered,some of which are being evaluated in clinical trials.However,none of them have been approved.In the present study,a highly selective potent FXIa inhibitor with poor solubility reported in our previous work was selected as a lead compound to be further modified to improve FXIa potency and physicochemical properties.The structure-based drug design and structure-activity relationship study led to the discovery of LY8,LY17,and LY25,which demonstrated enhanced FXIa potency and maintained excellent selectivity.In addition,LY8 exhibited significantly improved aqueous solubility,suggesting that it could be a promising compound to be further evaluated.
文摘BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.
文摘This case report investigates the manifestation of cerebral amyloid angiopathy (CAA) through recurrent Transient Ischemic Attacks (TIAs) in an 82-year-old patient. Despite initial diagnostic complexities, cerebral angiography-MRI revealed features indicative of CAA. Symptomatic treatment resulted in improvement, but the patient later developed a fatal hematoma. The discussion navigates the intricate therapeutic landscape of repetitive TIAs in the elderly with cardiovascular risk factors, emphasizing the pivotal role of cerebral MRI and meticulous bleeding risk management. The conclusion stresses the importance of incorporating SWI sequences, specifically when suspecting a cardioembolic TIA, as a diagnostic measure to explore and exclude CAA in the differential diagnosis. This case report provides valuable insights into these challenges, highlighting the need to consider CAA in relevant cases.
文摘This retrospective single-center registry study included all consecutive patients who underwent percutaneous coronary intervention (PCI) for a de novo left main coronary artery lesion using drug coated-balloon (DCB)-only strategy between August 2011 and December 2018. To best of our knowledge, no previous studies of DCB-only strategy of treating de novo left main coronary artery disease, exist. The primary endpoint was major adverse cardiovascular events (MACEs) including cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). The cohort was divided into two groups depending on weather the lesion preparation was done according to the international consensus group guidelines. Sixty-six patients (mean age 75±8.6, 72% male), 52% of whom had acute coronary syndrome, underwent left main PCI with the DCB-only strategy. No procedural mortality and no acute closures of the treated left main occurred. At 12 months, MACE and TLR occurred in 24% and 6% of the whole cohort, respectively. If the lesion preparation was done according to the guidelines, the MACE and TLR rates were 21.2% and 1.9%. Left main PCI with the DCB only-strategy is safe leading to acceptable MACE and low TLR rates at one year, if the lesion preparation is done according to the guidelines.
