Objective To compare the clinical outcomes of retrograde pubic ramus intramedullary nail(RPRIN)and percutaneous cannulated screw(PCS)in the treatment of anterior pelvic ring fractures(APRFs).Methods This retrospective...Objective To compare the clinical outcomes of retrograde pubic ramus intramedullary nail(RPRIN)and percutaneous cannulated screw(PCS)in the treatment of anterior pelvic ring fractures(APRFs).Methods This retrospective cohort study included 45 patients with APRFs treated between February 2019 and October 2022 in our trauma center.Patients were divided into two groups based on the surgical method:20 received RPRIN fixation,and 25 received PCS fixation.Key variables including operation time,fluoroscopic time,blood loss,and postoperative complications were analyzed.Fracture reduction quality was assessed using the Matta score system,and pelvic functional recovery was evaluated using the Majeed score system at the final follow-up.Quantitative variables were compared using the independent sample t test,while categorical variables were analyzed using Chisquare and Fisher’s exact tests.Results The RPRIN group had significantly shorter operation time(36.3±5.6 min vs.49.5±6.9 min,P<0.01),fluoroscopic time(32.0±2.8 s vs.48.4±3.6 s,P<0.01),and less blood loss(20.4±7.6 mL vs.34.0±5.7 mL,P<0.01)than the PCS group.Fracture reduction quality(Matta outcome)and pelvic functional recovery(Majeed outcome)were comparable between the two groups(P>0.05).No significant complications were reported in either group.Conclusions Both RPRIN and PCS are effective for treating APRFs.However,RPRIN offers distinct advantages by reducing operation time,fluoroscopic time,and blood loss,making it a more efficient and less invasive option.Further multicenter studies and biomechanical analyses are warranted to confirm these findings.展开更多
Objective Introduce a new method to treat fresh acromioclavicular joint dtslocations-close reduction and percutaneous internal lixatlon using guide cannulated lag screw. Methods 12 cases of acute acromioclavicular joi...Objective Introduce a new method to treat fresh acromioclavicular joint dtslocations-close reduction and percutaneous internal lixatlon using guide cannulated lag screw. Methods 12 cases of acute acromioclavicular joint dislocations were treated and followed. Results 11 cases succeeded and one failed with technical mistakes. Conclusion Because no important nerve or vessel passing between coracoid process and clavicle, close reduction and percutaneous coracoclavicular cannulated lag screw fixation treatment is safe, effective and affords early rehabilitation.展开更多
BACKGROUND Clinical femoral neck fracture is common.Based on patient age and fracture type,different surgical methods can be selected,including cannulated screw fixation of the femoral neck and artificial total hip jo...BACKGROUND Clinical femoral neck fracture is common.Based on patient age and fracture type,different surgical methods can be selected,including cannulated screw fixation of the femoral neck and artificial total hip joint or semi-hip joint replacement.When patients with femoral neck fracture are treated with cannulated screw fixation,a cannulated screw may be positioned too deep.The excessively deep-placed screw is difficult to remove and causes major trauma to the patient.CASE SUMMARY A patient with poliomyelitis and femoral neck fracture was treated with a cannulated screw that was placed too deep.A self-made auxiliary tool(made of a steel sternal wire)was used to remove the cannulated screw near the pelvic cavity.CONCLUSION The depth of the cannulated screw can be estimated before screw placement using an improved hollow screwdriver with a scale mark,thus improving the safety of screw placement and facilitating clinical use.展开更多
Objective To evaluate the role of open reduction through anterior-medial malleolar approachwith cannulated screw internal fixation in the treatment of displaced talus fractures. Methods 16 cases of Hawkin type Ⅱ - Ⅲ...Objective To evaluate the role of open reduction through anterior-medial malleolar approachwith cannulated screw internal fixation in the treatment of displaced talus fractures. Methods 16 cases of Hawkin type Ⅱ - Ⅲ displaced talus fractures were treated by open reduction through single anterior medial malleolar approach with cannulated screw internal fixation. Results All the 16 cases of displaced talus fractures achieved bony heal in which 5 cases suffered talus aseptic necrosis. The whole excellence-good ratio reached 62. 5%. Conclusion Open reduction through anterior-medial malleolar approach with cannulated screw internal fixation is a less trauma, easy manipulation, effective method of treatment for displaced talus fractures.展开更多
Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential inf...Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor.This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation(CSIF)in patients with stable FNF(Garden I or II)by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography(CT)imaging.Methods:This study included 167 patients with FNF who underwent CSIF.The sagittal tilt angle of the femoral head(STAFH)was evaluated using three-dimensional CT(3D-CT).The distribution of preoperative STAFH was analyzed,and its independent association with treatment failure was assessed.Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis,nonunion,or internal fixation failure.Results:Among the 167 patients,9(5.4%)exhibited anterior tilt(AT)of the femoral head,158(94.60%)presented with posterior tilt(PT).A total of 50 patients(29.9%)demonstrated excessive sagittal displacement(AT≥10°or PT≥20°).In the failure group,80.0%of patients had excessive sagittal displacement compared to 28.1%in the healed group.Excessive sagittal displacement was significantly associated with an increased risk of surgical failure(odds ratio:11.953,95%CI:3.656-39.083,p<0.05).Conclusions:In patients with Garden I or II FNF,greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure.AT≥10°or PT≥20°were identified as independent predictors of CSIF failure in FNF patients.Nevertheless,these findings still require confirmation through prospective,multi-center clinical trials with large sample sizes.展开更多
BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement impro...BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.METHODS This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation.In cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's discretion.The primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event rate.RESULTS Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP success.Among the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.展开更多
BACKGROUND Veno-venous extracorporeal membrane oxygenation(V-V ECMO)is a lifesaving intervention for severe respiratory failure;however,its effectiveness depends on accurate cannulation-patients with anatomical variat...BACKGROUND Veno-venous extracorporeal membrane oxygenation(V-V ECMO)is a lifesaving intervention for severe respiratory failure;however,its effectiveness depends on accurate cannulation-patients with anatomical variations present with significant challenges during the procedure.CASE SUMMARY We describe the case of a 56-year-old woman with severe pulmonary infection and acute respiratory failure managed with V-V ECMO.During the initial cannulation,a 23Fr venous drainage cannula was inadvertently inserted into the middle hepatic vein(HV)instead of the inferior vena cava(IVC)owing to the enlargement of the HV(1.02 cm diameter)and its acute angle(77.78°)relative to the IVC.This misplacement led to extracorporeal membrane oxygenation(ECMO)flow issues which were resolved after repositioning the cannula under real-time ultrasonographic and fluoroscopic guidance.This correction stabilized the patient’s condition and restored effective ECMO function,preventing severe complications such as liver injury and liver failure.CONCLUSION In clinical practice,real-time ultrasonography and fluoroscopy are critical in preventing cannulation errors in patients with anatomical variations.Vigilant imaging and precise techniques are essential for optimizing ECMO management and effectively addressing complications.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography is a challenging procedure involving bile duct cannulation.Despite the development of several cannulation devices,none have effectively facilitated the procedu...BACKGROUND Endoscopic retrograde cholangiopancreatography is a challenging procedure involving bile duct cannulation.Despite the development of several cannulation devices,none have effectively facilitated the procedure.AIM To evaluate the efficacy of a recently developed catheter for bile duct cannulation.METHODS We retrospectively examined 342 patients who underwent initial cholangiopan-creatography.We compared the success rate of bile duct cannulation and the incidence of complications between the groups using existing and novel catheters.RESULTS The overall success rates of bile duct cannulation were 98.3%and 99.1%in the existing and novel catheter groups,respectively(P=0.47).The bile duct cannulation rate using the standard technique was 73.0%and 82.1%in the existing and novel catheter groups,respectively(P=0.042).Furthermore,when catheterization was performed by expert physicians,the bile duct cannulation rate was significantly higher in the novel catheter group(81.3%)than in the existing catheter group(65.2%)(P=0.017).The incidence of difficult cannulation was also significantly lower in the novel catheter group(17.4%)than in the existing catheter group(33.0%)(P=0.019).CONCLUSION The novel catheter improved the bile duct cannulation rate using the standard technique and reduced the frequency of difficult cannulation cases,valuable tool in endoscopic retrograde cholangiopancreatography procedures performed by experts.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)is a vital diagnostic and therapeutic technique in evaluating and treating biliary and pancreatic disorders.Since its inception in the late 20th century,ERCP has tra...Endoscopic retrograde cholangiopancreatography(ERCP)is a vital diagnostic and therapeutic technique in evaluating and treating biliary and pancreatic disorders.Since its inception in the late 20th century,ERCP has transitioned from a mostly diagnostic instrument to a chiefly interventional procedure,owing to the emergence of less invasive imaging techniques like magnetic resonance cholangiopancreatography and endoscopic ultrasonography.Successful biliary cannulation is the most important and difficult step of the procedure.However,there are many challenges associated with cannulation,such as the anatomy of the major duodenal papilla,the direction of the common bile duct and pancreatic duct in the ampulla of Vater,the presence of periampullary diverticula,and scope position.Advanced techniques for cannulation are necessary when basic techniques fail.Double guidewire,precut methods,and transpancreatic sphincterotomy are examples of these advanced techniques.This review aims to summarize the challenges of biliary cannulation and tips for performing cannulation techniques.展开更多
Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy rema...Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy remains contentious,partly due to insufficient understanding of hemodynamic characteristics associated with the site of arterial cannulation.In this study,a geometrical multiscale model was built to offer a mathematical tool for addressing the issue.The outflow cannula of ECMO was inserted into the ascending aorta in the case of central cannulation,whereas it was inserted into the right subclavian artery(RSA)or the left iliac artery(LIA)in the case of peripheral cannulation.Numerical simulations conducted on three patient-specific aortas demonstrated that the central cannulation outperformed the two types of peripheral cannulation in evenly delivering ECMO flow to branch arteries.Both the central and RSA cannulations could maintain an approximately normal hemodynamic state in the aortas,although the area of aortic walls exposed to abnormal wall shear stress(WSS)was considerably enlarged in comparison with the normal physiological condition.In contrast,the LIA cannulation not only led to insufficient delivery of ECMO flow to the right upper body(with ECMO flow fractions<0.5),but also induced marked flow disturbance in the aorta,causing about 40%of the abdominal aortic wall and over 65%of the resting aortic wall to suffer from high time-averaged WSS(>5 Pa)and low time-averaged WSS(<0.4 Pa),respectively.The LIA cannulation also resulted in significantly prolonged blood residence time(>40 s)in the ascending aorta,which,along with abnormal WSS,may considerably increase the risk of thrombosis.In summary,our numerical study elucidated the impact of arterial cannulation site in VA-ECMO intervention on aortic hemodynamics and ECMO flow distribution.The findings provide compensatory biomechanical information for traditional clinical studies and may serve as a theoretical reference for guiding the evaluation and selection of cannulation strategies in clinical practice.展开更多
Background:The endoscopic appearance of the major duodenal papilla influences biliary cannulation and complications.This study aimed to investigate the role of major duodenal papillae in the endoscopic treatment of co...Background:The endoscopic appearance of the major duodenal papilla influences biliary cannulation and complications.This study aimed to investigate the role of major duodenal papillae in the endoscopic treatment of common bile duct(CBD)stones.Methods:This retrospective study was conducted at Bishan Hospital of Chongqing Medical University between January 2018 and August 2022.Patients with native papillae who underwent endoscopic treatment for CBD stones were recruited and divided into four groups according to Haraldsson's classification of papillae(typesⅠ-Ⅳ).Univariate and multivariate logistic regression analyses were used to identify risk factors for difficult cannulation and post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).Results:A total of 596 patients with CBD stones were enrolled.The proportion of patients with typeⅠpapilla was the highest(n=231,38.8%),followed by typeⅢpapilla(n=175,29.4%),typeⅣpapilla(n=101,16.9%)and typeⅡpapilla(n=89,14.9%).Difficult cannulation occurred in 188 of 596 patients(31.5%),with most cases occurring in those with typeⅢpapilla(71/175,40.6%,P=0.020).Multivariate logistic analysis revealed that age[odds ratio(OR)=1.034,95%confidence interval(CI):1.021–1.047,P<0.001],typeⅢpapilla(OR=2.255,95%CI:1.439–3.535,P<0.001),gallbladder in situ(OR=2.486,95%CI:1.346–4.590,P=0.004),and CBD diameter<10 mm(OR=1.600,95%CI:1.049–2.441,P=0.029)were risk factors for difficult cannulation.The total incidence of PEP was 10.9%.Compared with the other types of papillae,the rate of PEP was the highest in those with typeⅠpapilla(15.2%,P=0.030).Multivariate analysis demonstrated that PEP was associated with difficult cannulation(OR=1.811,95%CI:1.044–3.143,P=0.035)and white blood cells(WBCs)<10×10~9/L(OR=2.199,95%CI:1.051–4.600,P=0.036).Conclusions:The endoscopic appearance of the major papilla is an important factor that influences both biliary cannulation and outcomes.TypeⅢpapilla is more frequently difficult to cannulate in the endoscopic treatment of CBD stones.展开更多
BACKGROUND Despite advancements,endoscopic retrograde cholangiopancreatography(ERCP)poses challenges,including the risk of post-ERCP pancreatitis and difficulty of biliary cannulation.AIM To compare dome and tapered t...BACKGROUND Despite advancements,endoscopic retrograde cholangiopancreatography(ERCP)poses challenges,including the risk of post-ERCP pancreatitis and difficulty of biliary cannulation.AIM To compare dome and tapered tip sphincterotomes,focusing on their efficacy in achieving successful biliary cannulation and reducing the incidence of post-ERCP pancreatitis.METHODS In this prospective,single-blind,randomized pilot study conducted at Inha Uni-versity Hospital,85 patients undergoing ERCP were equally divided into dome and tapered tip sphincterotome groups.The co-primary outcomes were the success rate of selective biliary cannulation and incidence of post-ERCP pancre-atitis.The secondary outcomes included biliary cannulation time,number of unintended pancreatic duct access events,and total procedure time.RESULTS The success rates of selective biliary cannulation were 74.4%and 85.7%in the dome and tapered tip groups,respectively,with no significant difference(P=0.20).Similarly,the incidence of post-ERCP pancreatitis did not differ significantly between the groups(5 cases in the tapered tip group vs 6 in the dome tip group,P=0.72).However,difficult cannulation was significantly more common in the dome tip group than in the tapered tip group(P=0.05).Selective biliary cannula-tion time emerged as a significant predictor of post-ERCP pancreatitis(multivariate odds ratio=9.33,95%confi-dence interval:1.31-66.44,P=0.03).CONCLUSION This study indicated that the sphincterotome tip type does not markedly affect biliary cannulation success or post-ERCP pancreatitis rates.However,cannulation duration is a key risk factor for post-ERCP pancreatitis.These findings provide preliminary insights that highlight the importance of refining ERCP practices,including sphinc-terotome selection,while underscoring the need for larger multicenter studies to improve procedure time and patient safety.展开更多
BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulatio...BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulation.Postoperative descending aorta remodeling is closely linked to the false lumen area ratio(FLAR),defined as false lumen area/aortic area,as well as to the incidence of renal replacement therapy(RRT).AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling.METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study.Of these,209 received right AA cannulation and 234 received bilateral CA cannulation.The primary outcome was the change in FLAR,as calculated from computed tomography angiography in three segments of the descending aorta:Thoracic(S1),upper abdominal(S2),and lower abdominal(S3).Secondary outcomes were the incidence of RRT and the serum inflammation response,as observed by the levels of high sensitivity C reaction protein(hs-CRP)and Interleukin-6(IL-6).RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group(S2:0.80±0.08 vs 0.75±0.07,P<0.001;S3:0.57±0.12 vs 0.50±0.12,P<0.001,respectively).The AA group also had a significantly higher incidence of RRT(19.1%vs 8.5%,P=0.001;odds ratio:2.533,95%CI:1.427-4.493)and higher levels of inflammation cytokines 24 h after the procedure[hr-CRP:117±17 vs 104±15 mg/L;IL-6:129(103,166)vs 83(69,101)pg/mL;both P<0.001]compared to the CA group.CONCLUSION The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation,as observed by a greater change in FLAR and lower incidence of RRT.展开更多
Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guid...Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guided cannulation may improve successful cannulation and reduce complications associated with unnecessary punctures. The study aims to conduct the meta-analyze to examine the effectiveness of renal nurse-performed US-guided cannulation to improve successful cannulation and reduce AVF-related complications in difficult AVF access. Design: A meta-analysis of randomised controlled trials. Methods: A systemic search was performed on electronic databases including CINAHL Plus, Web of Science, and PubMed from inception to October 2023. Risk ratios (RR) and standardized mean differences (SMD) were estimated using random-effect models for considerable homogeneity, and the Scottish Intercollegiate Guidelines Network (SIGN) methodology was adopted for critical appraisal. Results: Four RCTs were included. The results showed US-guided AVF cannulation had a significant effect in improving successful cannulation (RR: 0.19, 95% CI: 0.06 to 0.63, p = 0.007), and was favorable in reducing cannulation-associated complications (RR: 0.44, 95% CI: 0.10 to 1.93, p = 0.28), compared with blind needle cannulation. Conclusion: US-guided cannulation performed by renal nurses has the potential to improve successful cannulation, and fewer complications in hemodialysis patients with difficult arteriovenous access. Relevance to Clinical Practice: The results suggest the value of further training for renal nurses in US-guided cannulation, and broader implementation of US-guided cannulation to improve patient outcomes. Future studies could explore the optimal nursing training and longer-term benefits of US-guided cannulation by renal nurses in difficult AVF access. Patient or Public Contribution: No Patient or Public Contribution as this is a meta-analysis using the secondary data published in the RCTs.展开更多
Magnesium(Mg)is a promising biomedical metal because of its biodegradability.The crevice between tissue and Mg implant can not be neglected in some implantation sites due to inducing crevice corrosion of Mg.In this pa...Magnesium(Mg)is a promising biomedical metal because of its biodegradability.The crevice between tissue and Mg implant can not be neglected in some implantation sites due to inducing crevice corrosion of Mg.In this paper,a new single mold was designed to build the in vitro experimental setup and four kinds of solutions,i.e.the deionized water(DW),the 0.9 wt.%sodium chloride solution(NaCl),the phosphate buffer saline(PBS)and the modified simulated body fluid(m-SBF)were used to explore necessary factors of crevice corrosion in Mg.It was observed that crevice corrosion in Mg sheets would occur in NaCl and PBS solution under 0.2,0.5 and 0.8 mm crevice thickness.And it was found that there were two necessary factors,i.e.chloride ion and crevice dimension,in crevice corrosion.For the high-purity Mg cannulated screws,crevice corrosion could occur inside tunnel when immersed in PBS.展开更多
Objective:To observe clinical effects of pedicle screw fixation combined with cable wires and bone graft and cannulated compression screws on adult multi-segment lumbar spondylolysis.Methods:70 cases of patients with ...Objective:To observe clinical effects of pedicle screw fixation combined with cable wires and bone graft and cannulated compression screws on adult multi-segment lumbar spondylolysis.Methods:70 cases of patients with multi-segment lumbar spondylolysis were selected in our hospital.According to different surgical schemes,these patients were divided into the observation group(35 cases)and the control group(35 cases).The observation group received pedicle screw fixation combined with cable wires and bone graft and the control group received cannulated compression screw fixation.Macnab criteria were adopted to implement a therapeutic evaluation of two groups of patients to make an observation and comparison of the excellent and good rate of surgery and a series of indicators including perioperative clinical effects,intraoperative blood loss,duration of surgery,hospital length of stay(HLOS),visual analogue scale(VAS),Oswestry disability index and Japanese Orthopaedic Association(JOA)score.Results:The excellent and good rate of the observation group was 97.14%,and that of the control group was 82.86%,the difference between two groups was statistically significant(χ^(2)=6.248,p=0.012).The differences in intraoperative blood loss,duration of surgery and HLOS between two groups were statistically significant(t=-4.55,t=-4.55,t=-4.55;p<0.05).Oswestry index,VAS score and JOA score of the observation group were(2.4±0.9),(28.5±6.4)and(27.1±3.1)respectively,and these of the control group were(3.5±1.2),(37.1±7.8)and(21.3±2.7)respectively,the differences between two groups were statistically significant(t=4.338,t=5.043,t=8.347,p<0.05).Conclusions:Pedicle screw combined with immobilized implantation bone by wirerope has an excellent clinical effect on the treatment of adult multi-segment lumbar spondylolysis,and it has a series of advantages such as fast postoperative recovery,small surgical trauma and so on.In addition,this technique can also restore the stability of spinal segments and relieve pains to a greater degree.展开更多
Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and pre- cut (access...Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and pre- cut (access) sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% success- ful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a transpapillary septotomy with a standard sphincterotome. Both methods have similar efficacy and complication rates when adminis- tered to the proper patient. Although precut sphincter- otomy ensures over 90% success of biliary cannula- tion, it has been characterized as an independent risk factor for pancreatitis. The complications of the precut technique are not limited to pancreatitis. Two more important ones, bleeding and perforation, are also re- ported in some publications as being observed more commonly than during standard sphincterotomy. It is also reported that precut sphincterotomy increases morbidity when performed in patients without dilata- tion of their biliary tract. Nevertheless, precut sphinc- terotomy is a good alternative as a rescue method in the setting of a failed standard cannulation method. This paper discusses the technical details, timing, ef- ficacy and potential complications of precut sphincter- otomy.展开更多
BACKGROUND Different types of periampullary diverticulum(PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography(ERCP) cannulation,but the clinical significance of the two current ...BACKGROUND Different types of periampullary diverticulum(PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography(ERCP) cannulation,but the clinical significance of the two current PAD classifications for cannulation is limited.AIM To verify the clinical value of our newly proposed PAD classification.METHODS A new PAD classification(Li-Tanaka classification) was proposed at our center.All PAD patients with native papillae who underwent ERCP from January 2012 to December 2017 were classified according to three classification systems, and the effects of various types of PAD on ERCP cannulation were compared.RESULTS A total of 3564 patients with native papillae were enrolled, including 967(27.13%)PAD patients and 2597(72.87%) non-PAD patients. In the Li-Tanaka classification, type Ⅰ PAD patients exhibited the highest difficult cannulation rate(23.1%, P = 0.01), and type Ⅱ and Ⅳ patients had the highest cannulation success rates(99.4% in type Ⅱ and 99.3% in type Ⅳ, P < 0.001). In a multivariableadjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients [odds ratio(OR) = 1.87, 95% confidence interval(CI): 1.04-3037, P = 0.037]. In addition, compared to the non-PAD group,the difficulty of cannulation in the type Ⅰ PAD group according to the Li-Tanaka classification was greater(OR = 2.04, 95%CI: 1.13-3.68, P = 0.004), and the successful cannulation rate was lower(OR = 0.27, 95%CI: 0.11-0.66, P < 0.001),while it was higher in the type Ⅱ PAD group(OR = 4.44, 95%CI: 1.61-12.29, P <0.01).CONCLUSION Among the three PAD classifications, the Li-Tanaka classification has an obvious clinical advantage for ERCP cannulation, and it is helpful for evaluating potentially difficult and successful cannulation cases among different types of PAD patients.展开更多
Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce...Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.展开更多
Periampullary diverticulum(PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD isusua...Periampullary diverticulum(PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD isusually asymptomatic and discovered incidentally during endoscopic retrograde cholangiopancreatography(ERCP), it is associated with different pathological conditions such as common bile duct obstruction, pancreatitis, perforation, bleeding, and rarely carcinoma. ERCP has a low rate of success in patients with PAD,suggesting that this condition may complicate the technical application of the ERCP procedure. Moreover, cannulation of PAD can be challenging, time consuming, and require the higher level of skill of more experienced endoscopists. A large portion of the failures of cannulation in patients with PAD can be attributed to inability of the endoscopist to detect the papilla. In cases where the papilla is identified but does not point in a suitable direction for cannulation, different techniques have been described. Endoscopists must be aware of papilla identification in the presence of PAD and of different cannulation techniques, including their technical feasibility and safety, to allow for an informed decision and ensure the best outcome. Herein, we review the literature on this practical topic and propose an algorithm to increase the success rate of biliary cannulation.展开更多
基金supported by Clinical Application-oriented Medical Innovation Foundation from National Clinical Research Center for Orthopedics,Sports Medicine&Rehabilitation and Jiangsu China-Israel Industrial Technical Research Institute Foundation(No.2021-NCRC-CXJJ-ZH-24)National Key R&D Plan of the 14th Five-Year Plan(No.2022YFC2504303).
文摘Objective To compare the clinical outcomes of retrograde pubic ramus intramedullary nail(RPRIN)and percutaneous cannulated screw(PCS)in the treatment of anterior pelvic ring fractures(APRFs).Methods This retrospective cohort study included 45 patients with APRFs treated between February 2019 and October 2022 in our trauma center.Patients were divided into two groups based on the surgical method:20 received RPRIN fixation,and 25 received PCS fixation.Key variables including operation time,fluoroscopic time,blood loss,and postoperative complications were analyzed.Fracture reduction quality was assessed using the Matta score system,and pelvic functional recovery was evaluated using the Majeed score system at the final follow-up.Quantitative variables were compared using the independent sample t test,while categorical variables were analyzed using Chisquare and Fisher’s exact tests.Results The RPRIN group had significantly shorter operation time(36.3±5.6 min vs.49.5±6.9 min,P<0.01),fluoroscopic time(32.0±2.8 s vs.48.4±3.6 s,P<0.01),and less blood loss(20.4±7.6 mL vs.34.0±5.7 mL,P<0.01)than the PCS group.Fracture reduction quality(Matta outcome)and pelvic functional recovery(Majeed outcome)were comparable between the two groups(P>0.05).No significant complications were reported in either group.Conclusions Both RPRIN and PCS are effective for treating APRFs.However,RPRIN offers distinct advantages by reducing operation time,fluoroscopic time,and blood loss,making it a more efficient and less invasive option.Further multicenter studies and biomechanical analyses are warranted to confirm these findings.
文摘Objective Introduce a new method to treat fresh acromioclavicular joint dtslocations-close reduction and percutaneous internal lixatlon using guide cannulated lag screw. Methods 12 cases of acute acromioclavicular joint dislocations were treated and followed. Results 11 cases succeeded and one failed with technical mistakes. Conclusion Because no important nerve or vessel passing between coracoid process and clavicle, close reduction and percutaneous coracoclavicular cannulated lag screw fixation treatment is safe, effective and affords early rehabilitation.
文摘BACKGROUND Clinical femoral neck fracture is common.Based on patient age and fracture type,different surgical methods can be selected,including cannulated screw fixation of the femoral neck and artificial total hip joint or semi-hip joint replacement.When patients with femoral neck fracture are treated with cannulated screw fixation,a cannulated screw may be positioned too deep.The excessively deep-placed screw is difficult to remove and causes major trauma to the patient.CASE SUMMARY A patient with poliomyelitis and femoral neck fracture was treated with a cannulated screw that was placed too deep.A self-made auxiliary tool(made of a steel sternal wire)was used to remove the cannulated screw near the pelvic cavity.CONCLUSION The depth of the cannulated screw can be estimated before screw placement using an improved hollow screwdriver with a scale mark,thus improving the safety of screw placement and facilitating clinical use.
文摘Objective To evaluate the role of open reduction through anterior-medial malleolar approachwith cannulated screw internal fixation in the treatment of displaced talus fractures. Methods 16 cases of Hawkin type Ⅱ - Ⅲ displaced talus fractures were treated by open reduction through single anterior medial malleolar approach with cannulated screw internal fixation. Results All the 16 cases of displaced talus fractures achieved bony heal in which 5 cases suffered talus aseptic necrosis. The whole excellence-good ratio reached 62. 5%. Conclusion Open reduction through anterior-medial malleolar approach with cannulated screw internal fixation is a less trauma, easy manipulation, effective method of treatment for displaced talus fractures.
基金supported by the National Natural Science Foundation of China(82422045).
文摘Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor.This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation(CSIF)in patients with stable FNF(Garden I or II)by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography(CT)imaging.Methods:This study included 167 patients with FNF who underwent CSIF.The sagittal tilt angle of the femoral head(STAFH)was evaluated using three-dimensional CT(3D-CT).The distribution of preoperative STAFH was analyzed,and its independent association with treatment failure was assessed.Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis,nonunion,or internal fixation failure.Results:Among the 167 patients,9(5.4%)exhibited anterior tilt(AT)of the femoral head,158(94.60%)presented with posterior tilt(PT).A total of 50 patients(29.9%)demonstrated excessive sagittal displacement(AT≥10°or PT≥20°).In the failure group,80.0%of patients had excessive sagittal displacement compared to 28.1%in the healed group.Excessive sagittal displacement was significantly associated with an increased risk of surgical failure(odds ratio:11.953,95%CI:3.656-39.083,p<0.05).Conclusions:In patients with Garden I or II FNF,greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure.AT≥10°or PT≥20°were identified as independent predictors of CSIF failure in FNF patients.Nevertheless,these findings still require confirmation through prospective,multi-center clinical trials with large sample sizes.
文摘BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.METHODS This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation.In cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's discretion.The primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event rate.RESULTS Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP success.Among the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.
基金Supported by General Scientific Research Project of the Zhejiang Provincial Department of Education,No.Y201941857the Medical Science and Technology Project of Zhejiang Province,No.2019RC170.
文摘BACKGROUND Veno-venous extracorporeal membrane oxygenation(V-V ECMO)is a lifesaving intervention for severe respiratory failure;however,its effectiveness depends on accurate cannulation-patients with anatomical variations present with significant challenges during the procedure.CASE SUMMARY We describe the case of a 56-year-old woman with severe pulmonary infection and acute respiratory failure managed with V-V ECMO.During the initial cannulation,a 23Fr venous drainage cannula was inadvertently inserted into the middle hepatic vein(HV)instead of the inferior vena cava(IVC)owing to the enlargement of the HV(1.02 cm diameter)and its acute angle(77.78°)relative to the IVC.This misplacement led to extracorporeal membrane oxygenation(ECMO)flow issues which were resolved after repositioning the cannula under real-time ultrasonographic and fluoroscopic guidance.This correction stabilized the patient’s condition and restored effective ECMO function,preventing severe complications such as liver injury and liver failure.CONCLUSION In clinical practice,real-time ultrasonography and fluoroscopy are critical in preventing cannulation errors in patients with anatomical variations.Vigilant imaging and precise techniques are essential for optimizing ECMO management and effectively addressing complications.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography is a challenging procedure involving bile duct cannulation.Despite the development of several cannulation devices,none have effectively facilitated the procedure.AIM To evaluate the efficacy of a recently developed catheter for bile duct cannulation.METHODS We retrospectively examined 342 patients who underwent initial cholangiopan-creatography.We compared the success rate of bile duct cannulation and the incidence of complications between the groups using existing and novel catheters.RESULTS The overall success rates of bile duct cannulation were 98.3%and 99.1%in the existing and novel catheter groups,respectively(P=0.47).The bile duct cannulation rate using the standard technique was 73.0%and 82.1%in the existing and novel catheter groups,respectively(P=0.042).Furthermore,when catheterization was performed by expert physicians,the bile duct cannulation rate was significantly higher in the novel catheter group(81.3%)than in the existing catheter group(65.2%)(P=0.017).The incidence of difficult cannulation was also significantly lower in the novel catheter group(17.4%)than in the existing catheter group(33.0%)(P=0.019).CONCLUSION The novel catheter improved the bile duct cannulation rate using the standard technique and reduced the frequency of difficult cannulation cases,valuable tool in endoscopic retrograde cholangiopancreatography procedures performed by experts.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)is a vital diagnostic and therapeutic technique in evaluating and treating biliary and pancreatic disorders.Since its inception in the late 20th century,ERCP has transitioned from a mostly diagnostic instrument to a chiefly interventional procedure,owing to the emergence of less invasive imaging techniques like magnetic resonance cholangiopancreatography and endoscopic ultrasonography.Successful biliary cannulation is the most important and difficult step of the procedure.However,there are many challenges associated with cannulation,such as the anatomy of the major duodenal papilla,the direction of the common bile duct and pancreatic duct in the ampulla of Vater,the presence of periampullary diverticula,and scope position.Advanced techniques for cannulation are necessary when basic techniques fail.Double guidewire,precut methods,and transpancreatic sphincterotomy are examples of these advanced techniques.This review aims to summarize the challenges of biliary cannulation and tips for performing cannulation techniques.
基金supported by the National Natural Science Foundation of China(Grant Nos.12372309,12061131015).
文摘Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is a life support intervention for patients with refractory cardiogenic shock or severe cardiopulmonary failure.However,the choice of cannulation strategy remains contentious,partly due to insufficient understanding of hemodynamic characteristics associated with the site of arterial cannulation.In this study,a geometrical multiscale model was built to offer a mathematical tool for addressing the issue.The outflow cannula of ECMO was inserted into the ascending aorta in the case of central cannulation,whereas it was inserted into the right subclavian artery(RSA)or the left iliac artery(LIA)in the case of peripheral cannulation.Numerical simulations conducted on three patient-specific aortas demonstrated that the central cannulation outperformed the two types of peripheral cannulation in evenly delivering ECMO flow to branch arteries.Both the central and RSA cannulations could maintain an approximately normal hemodynamic state in the aortas,although the area of aortic walls exposed to abnormal wall shear stress(WSS)was considerably enlarged in comparison with the normal physiological condition.In contrast,the LIA cannulation not only led to insufficient delivery of ECMO flow to the right upper body(with ECMO flow fractions<0.5),but also induced marked flow disturbance in the aorta,causing about 40%of the abdominal aortic wall and over 65%of the resting aortic wall to suffer from high time-averaged WSS(>5 Pa)and low time-averaged WSS(<0.4 Pa),respectively.The LIA cannulation also resulted in significantly prolonged blood residence time(>40 s)in the ascending aorta,which,along with abnormal WSS,may considerably increase the risk of thrombosis.In summary,our numerical study elucidated the impact of arterial cannulation site in VA-ECMO intervention on aortic hemodynamics and ECMO flow distribution.The findings provide compensatory biomechanical information for traditional clinical studies and may serve as a theoretical reference for guiding the evaluation and selection of cannulation strategies in clinical practice.
文摘Background:The endoscopic appearance of the major duodenal papilla influences biliary cannulation and complications.This study aimed to investigate the role of major duodenal papillae in the endoscopic treatment of common bile duct(CBD)stones.Methods:This retrospective study was conducted at Bishan Hospital of Chongqing Medical University between January 2018 and August 2022.Patients with native papillae who underwent endoscopic treatment for CBD stones were recruited and divided into four groups according to Haraldsson's classification of papillae(typesⅠ-Ⅳ).Univariate and multivariate logistic regression analyses were used to identify risk factors for difficult cannulation and post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).Results:A total of 596 patients with CBD stones were enrolled.The proportion of patients with typeⅠpapilla was the highest(n=231,38.8%),followed by typeⅢpapilla(n=175,29.4%),typeⅣpapilla(n=101,16.9%)and typeⅡpapilla(n=89,14.9%).Difficult cannulation occurred in 188 of 596 patients(31.5%),with most cases occurring in those with typeⅢpapilla(71/175,40.6%,P=0.020).Multivariate logistic analysis revealed that age[odds ratio(OR)=1.034,95%confidence interval(CI):1.021–1.047,P<0.001],typeⅢpapilla(OR=2.255,95%CI:1.439–3.535,P<0.001),gallbladder in situ(OR=2.486,95%CI:1.346–4.590,P=0.004),and CBD diameter<10 mm(OR=1.600,95%CI:1.049–2.441,P=0.029)were risk factors for difficult cannulation.The total incidence of PEP was 10.9%.Compared with the other types of papillae,the rate of PEP was the highest in those with typeⅠpapilla(15.2%,P=0.030).Multivariate analysis demonstrated that PEP was associated with difficult cannulation(OR=1.811,95%CI:1.044–3.143,P=0.035)and white blood cells(WBCs)<10×10~9/L(OR=2.199,95%CI:1.051–4.600,P=0.036).Conclusions:The endoscopic appearance of the major papilla is an important factor that influences both biliary cannulation and outcomes.TypeⅢpapilla is more frequently difficult to cannulate in the endoscopic treatment of CBD stones.
基金Supported by the Shihwa Medical Center Research Fund.
文摘BACKGROUND Despite advancements,endoscopic retrograde cholangiopancreatography(ERCP)poses challenges,including the risk of post-ERCP pancreatitis and difficulty of biliary cannulation.AIM To compare dome and tapered tip sphincterotomes,focusing on their efficacy in achieving successful biliary cannulation and reducing the incidence of post-ERCP pancreatitis.METHODS In this prospective,single-blind,randomized pilot study conducted at Inha Uni-versity Hospital,85 patients undergoing ERCP were equally divided into dome and tapered tip sphincterotome groups.The co-primary outcomes were the success rate of selective biliary cannulation and incidence of post-ERCP pancre-atitis.The secondary outcomes included biliary cannulation time,number of unintended pancreatic duct access events,and total procedure time.RESULTS The success rates of selective biliary cannulation were 74.4%and 85.7%in the dome and tapered tip groups,respectively,with no significant difference(P=0.20).Similarly,the incidence of post-ERCP pancreatitis did not differ significantly between the groups(5 cases in the tapered tip group vs 6 in the dome tip group,P=0.72).However,difficult cannulation was significantly more common in the dome tip group than in the tapered tip group(P=0.05).Selective biliary cannula-tion time emerged as a significant predictor of post-ERCP pancreatitis(multivariate odds ratio=9.33,95%confi-dence interval:1.31-66.44,P=0.03).CONCLUSION This study indicated that the sphincterotome tip type does not markedly affect biliary cannulation success or post-ERCP pancreatitis rates.However,cannulation duration is a key risk factor for post-ERCP pancreatitis.These findings provide preliminary insights that highlight the importance of refining ERCP practices,including sphinc-terotome selection,while underscoring the need for larger multicenter studies to improve procedure time and patient safety.
基金Supported by Huanhua Talent for Discipline Backbone of Sichuan Provincial People’s Hospital,No.SY2022017Science Fund for Distinguished Young Scholars of Sichuan Province,No.2021JDJQ0041+1 种基金Sichuan Science and Technology Program,No.2020YFQ0060National Natural Science and Technology Foundation of China,No.81800274.
文摘BACKGROUND Arterial cannulation sites for the surgical repair of type A aortic dissection(AAD)have evolved from right axillary artery(AA)cannulation to bilateral carotid artery(CA)based of femoral artery(FA)cannulation.Postoperative descending aorta remodeling is closely linked to the false lumen area ratio(FLAR),defined as false lumen area/aortic area,as well as to the incidence of renal replacement therapy(RRT).AIM To investigate the effect of the updated arterial cannulation strategy on descending aortic remodeling.METHODS A total of 443 AAD patients who received FA combined cannulation between March 2015 and March 2023 were included in the study.Of these,209 received right AA cannulation and 234 received bilateral CA cannulation.The primary outcome was the change in FLAR,as calculated from computed tomography angiography in three segments of the descending aorta:Thoracic(S1),upper abdominal(S2),and lower abdominal(S3).Secondary outcomes were the incidence of RRT and the serum inflammation response,as observed by the levels of high sensitivity C reaction protein(hs-CRP)and Interleukin-6(IL-6).RESULTS The postoperative/preoperative ratio of FLAR in S2 and S3 was higher in the AA group compared to the CA group(S2:0.80±0.08 vs 0.75±0.07,P<0.001;S3:0.57±0.12 vs 0.50±0.12,P<0.001,respectively).The AA group also had a significantly higher incidence of RRT(19.1%vs 8.5%,P=0.001;odds ratio:2.533,95%CI:1.427-4.493)and higher levels of inflammation cytokines 24 h after the procedure[hr-CRP:117±17 vs 104±15 mg/L;IL-6:129(103,166)vs 83(69,101)pg/mL;both P<0.001]compared to the CA group.CONCLUSION The CA cannulation strategy was associated with better abdominal aorta remodeling after AAD repair compared to AA cannulation,as observed by a greater change in FLAR and lower incidence of RRT.
文摘Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guided cannulation may improve successful cannulation and reduce complications associated with unnecessary punctures. The study aims to conduct the meta-analyze to examine the effectiveness of renal nurse-performed US-guided cannulation to improve successful cannulation and reduce AVF-related complications in difficult AVF access. Design: A meta-analysis of randomised controlled trials. Methods: A systemic search was performed on electronic databases including CINAHL Plus, Web of Science, and PubMed from inception to October 2023. Risk ratios (RR) and standardized mean differences (SMD) were estimated using random-effect models for considerable homogeneity, and the Scottish Intercollegiate Guidelines Network (SIGN) methodology was adopted for critical appraisal. Results: Four RCTs were included. The results showed US-guided AVF cannulation had a significant effect in improving successful cannulation (RR: 0.19, 95% CI: 0.06 to 0.63, p = 0.007), and was favorable in reducing cannulation-associated complications (RR: 0.44, 95% CI: 0.10 to 1.93, p = 0.28), compared with blind needle cannulation. Conclusion: US-guided cannulation performed by renal nurses has the potential to improve successful cannulation, and fewer complications in hemodialysis patients with difficult arteriovenous access. Relevance to Clinical Practice: The results suggest the value of further training for renal nurses in US-guided cannulation, and broader implementation of US-guided cannulation to improve patient outcomes. Future studies could explore the optimal nursing training and longer-term benefits of US-guided cannulation by renal nurses in difficult AVF access. Patient or Public Contribution: No Patient or Public Contribution as this is a meta-analysis using the secondary data published in the RCTs.
基金financially supported by the Natural Science Foundation of China(No.51571142)the National Key Research and Development Program of China(No.2018YFC1106600)。
文摘Magnesium(Mg)is a promising biomedical metal because of its biodegradability.The crevice between tissue and Mg implant can not be neglected in some implantation sites due to inducing crevice corrosion of Mg.In this paper,a new single mold was designed to build the in vitro experimental setup and four kinds of solutions,i.e.the deionized water(DW),the 0.9 wt.%sodium chloride solution(NaCl),the phosphate buffer saline(PBS)and the modified simulated body fluid(m-SBF)were used to explore necessary factors of crevice corrosion in Mg.It was observed that crevice corrosion in Mg sheets would occur in NaCl and PBS solution under 0.2,0.5 and 0.8 mm crevice thickness.And it was found that there were two necessary factors,i.e.chloride ion and crevice dimension,in crevice corrosion.For the high-purity Mg cannulated screws,crevice corrosion could occur inside tunnel when immersed in PBS.
文摘Objective:To observe clinical effects of pedicle screw fixation combined with cable wires and bone graft and cannulated compression screws on adult multi-segment lumbar spondylolysis.Methods:70 cases of patients with multi-segment lumbar spondylolysis were selected in our hospital.According to different surgical schemes,these patients were divided into the observation group(35 cases)and the control group(35 cases).The observation group received pedicle screw fixation combined with cable wires and bone graft and the control group received cannulated compression screw fixation.Macnab criteria were adopted to implement a therapeutic evaluation of two groups of patients to make an observation and comparison of the excellent and good rate of surgery and a series of indicators including perioperative clinical effects,intraoperative blood loss,duration of surgery,hospital length of stay(HLOS),visual analogue scale(VAS),Oswestry disability index and Japanese Orthopaedic Association(JOA)score.Results:The excellent and good rate of the observation group was 97.14%,and that of the control group was 82.86%,the difference between two groups was statistically significant(χ^(2)=6.248,p=0.012).The differences in intraoperative blood loss,duration of surgery and HLOS between two groups were statistically significant(t=-4.55,t=-4.55,t=-4.55;p<0.05).Oswestry index,VAS score and JOA score of the observation group were(2.4±0.9),(28.5±6.4)and(27.1±3.1)respectively,and these of the control group were(3.5±1.2),(37.1±7.8)and(21.3±2.7)respectively,the differences between two groups were statistically significant(t=4.338,t=5.043,t=8.347,p<0.05).Conclusions:Pedicle screw combined with immobilized implantation bone by wirerope has an excellent clinical effect on the treatment of adult multi-segment lumbar spondylolysis,and it has a series of advantages such as fast postoperative recovery,small surgical trauma and so on.In addition,this technique can also restore the stability of spinal segments and relieve pains to a greater degree.
文摘Even experienced endoscopists have 90% success in achieving deep biliary cannulation with standard methods. Biliary cannulation may become difficult in 10%-15% of patients with biliary obstruction and pre- cut (access) sphincterotomy is frequently chosen as a rescue treatment in these cases. Generally, precut sphincterotomy ensures a rate of 90%-100% success- ful deep biliary cannulation. The precut technique has been performed as either a fistulotomy with a needle knife sphincterotome or as a transpapillary septotomy with a standard sphincterotome. Both methods have similar efficacy and complication rates when adminis- tered to the proper patient. Although precut sphincter- otomy ensures over 90% success of biliary cannula- tion, it has been characterized as an independent risk factor for pancreatitis. The complications of the precut technique are not limited to pancreatitis. Two more important ones, bleeding and perforation, are also re- ported in some publications as being observed more commonly than during standard sphincterotomy. It is also reported that precut sphincterotomy increases morbidity when performed in patients without dilata- tion of their biliary tract. Nevertheless, precut sphinc- terotomy is a good alternative as a rescue method in the setting of a failed standard cannulation method. This paper discusses the technical details, timing, ef- ficacy and potential complications of precut sphincter- otomy.
基金Supported by the National Natural Science Foundation of China,NO.31570509.
文摘BACKGROUND Different types of periampullary diverticulum(PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography(ERCP) cannulation,but the clinical significance of the two current PAD classifications for cannulation is limited.AIM To verify the clinical value of our newly proposed PAD classification.METHODS A new PAD classification(Li-Tanaka classification) was proposed at our center.All PAD patients with native papillae who underwent ERCP from January 2012 to December 2017 were classified according to three classification systems, and the effects of various types of PAD on ERCP cannulation were compared.RESULTS A total of 3564 patients with native papillae were enrolled, including 967(27.13%)PAD patients and 2597(72.87%) non-PAD patients. In the Li-Tanaka classification, type Ⅰ PAD patients exhibited the highest difficult cannulation rate(23.1%, P = 0.01), and type Ⅱ and Ⅳ patients had the highest cannulation success rates(99.4% in type Ⅱ and 99.3% in type Ⅳ, P < 0.001). In a multivariableadjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients [odds ratio(OR) = 1.87, 95% confidence interval(CI): 1.04-3037, P = 0.037]. In addition, compared to the non-PAD group,the difficulty of cannulation in the type Ⅰ PAD group according to the Li-Tanaka classification was greater(OR = 2.04, 95%CI: 1.13-3.68, P = 0.004), and the successful cannulation rate was lower(OR = 0.27, 95%CI: 0.11-0.66, P < 0.001),while it was higher in the type Ⅱ PAD group(OR = 4.44, 95%CI: 1.61-12.29, P <0.01).CONCLUSION Among the three PAD classifications, the Li-Tanaka classification has an obvious clinical advantage for ERCP cannulation, and it is helpful for evaluating potentially difficult and successful cannulation cases among different types of PAD patients.
文摘Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.
文摘Periampullary diverticulum(PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD isusually asymptomatic and discovered incidentally during endoscopic retrograde cholangiopancreatography(ERCP), it is associated with different pathological conditions such as common bile duct obstruction, pancreatitis, perforation, bleeding, and rarely carcinoma. ERCP has a low rate of success in patients with PAD,suggesting that this condition may complicate the technical application of the ERCP procedure. Moreover, cannulation of PAD can be challenging, time consuming, and require the higher level of skill of more experienced endoscopists. A large portion of the failures of cannulation in patients with PAD can be attributed to inability of the endoscopist to detect the papilla. In cases where the papilla is identified but does not point in a suitable direction for cannulation, different techniques have been described. Endoscopists must be aware of papilla identification in the presence of PAD and of different cannulation techniques, including their technical feasibility and safety, to allow for an informed decision and ensure the best outcome. Herein, we review the literature on this practical topic and propose an algorithm to increase the success rate of biliary cannulation.
