Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a r...Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a retrospective,single-center case review study of all CC within 30 days after CHS between 1/2010-12/2020.A total of 317(138 diagnostic,179 interventional)CC were performed in 245 patients at a median of 4 days(IQR 13)after CHS.The median age was 3 months(IQR 6),and body weight was 5 kg(IQR 4).A total of 194(61.2%)CC were performed in patients with univentricular hearts.CC revealed significant pathologies leading to early redo-surgery in 37 patients(12%).The transcatheter interventions primarily were needed in patients after cavo-pulmonary connection(n=69%,21.8%),right ventricle to pulmonary artery conduit(n=39%,12.3%),and Norwood-I surgery(n=34%,10.7%)presenting with hypoxemia,prolonged postoperative course,and suspected arterial stenosis on echocardiography.The clinical impact of an early postoperative transcatheter intervention for the following clinical course was high in most cases.There were nine(2.8%)major and 20(6.3%)minor intra-procedural complications.Risk factor analysis revealed no difference for the occurrence of complications for patients’age,weight,and time from initial CHS,underlying uni-vs.biventricular heart disease,or ECMO.Conclusion:Early CC within 30 days after CHS in children can be performed safely with a high diagnostic and therapeutic value.The rate of complications is low,while the therapeutic consequence is relevant.展开更多
Central venous catheterization(CVC)is a fundamental clinical procedure widely performed across medical specialties.However,the complication rate of subclavian vein catheterization ranges from 6%to 11%.[1]Common compli...Central venous catheterization(CVC)is a fundamental clinical procedure widely performed across medical specialties.However,the complication rate of subclavian vein catheterization ranges from 6%to 11%.[1]Common complications include hemothorax,pneumothorax,air embolism,arterial puncture,and aortic perforation.[2]Herein,we report a rare case of accidental puncture of the aorta during subclavian CVC,which was successfully managed with a ventricular septal defect(VSD)occluder.展开更多
Central venous catheters(CVCs),which play a vital role in medical care and are widely utilized in intensive care units,are h ighly susceptible to microbial colonization,thus leading to serious catheter-related bloodst...Central venous catheters(CVCs),which play a vital role in medical care and are widely utilized in intensive care units,are h ighly susceptible to microbial colonization,thus leading to serious catheter-related bloodstream infections and greatly increasing morbidity,mortality,and healthcare costs,accounting for 12%-25%of annual mortality in the USA.The corre sponding preventive measures include the use of antibiotic and antiseptic coatings,impregnated catheters,and maximally sterile barrier techniques,but they are often ineffective,particularly against biofilm formation and antibiotic-resistant bacteria.This review focuses on strategies for fabricating antimicrobial CVCs,e.g.,the use of antifouling materials,antimicrobial nanoparti cles(NPs),and surface functionalization,covering both commercially available solutions and those investigated.Additionally,w e explore the materials and processing technologies used to fabricate antimicrobial CVCs,emphasizing their advantages and challenges in industrial and clinical applications.Finally,we discuss the potential of inorganic NPs and the origin of their antimicrobial activity,providing insights for future advances in infection prevention that will help improve the patients’life quality.展开更多
Peripheral nerve injury is a complex condition presenting significant clinical treatment challenges due to the limited regenerative capacity of peripheral nerves.Nerve conduits have been seen as a promising strategy t...Peripheral nerve injury is a complex condition presenting significant clinical treatment challenges due to the limited regenerative capacity of peripheral nerves.Nerve conduits have been seen as a promising strategy to overcome the shortage of other treatment options(e.g.,nerve graft).However,nerve regeneration occurs within a complex environment,and elaborate modulation is needed to meet repair requirements.The aim of this study was to investigate and explore a multifunctional nerve conduit with reactive oxygen species clearing,immune modulation to reshape the regenerative environment,and topographic cues and electrical signals to guide nerve growth.We developed an electroactive nerve guidance conduit composed of polylactic-glycolic acid and carbon nanotubes with an oriented structure using electrospinning and modified it with mussel-inspired polydopamine combining neurotrophin-3.The resulting nerve scaffold exhibited favorable orientation,electrical conductivity,and mechanical properties.Continuous release of neurotrophin-3 from the nerve conduit supported nerve regeneration throughout the repair process.In vitro assessments confirmed the cytocompatibility,reactive oxygen species scavenging,and immune regulation capabilities of the nerve scaffolds.In a rat sciatic nerve defect model,the nerve scaffolds effectively prevented muscle atrophy and promoted nerve regeneration and functional recovery over a 12-week period.These findings suggest that polydopamine-modified,electroactive,oriented nerve guidance conduits with multiple bioactive functions hold great promise for the repair of peripheral nerve injuries.展开更多
Monitoring cardiac function is a fundamental component of the diagnosis and management of critically ill patients.While pulmonary artery catheterization has long served as the standard for hemodynamic assessment,its i...Monitoring cardiac function is a fundamental component of the diagnosis and management of critically ill patients.While pulmonary artery catheterization has long served as the standard for hemodynamic assessment,its invasive nature and associated risks have shifted clinical practice toward non-invasive modalities.^([1]) Among these methods,point-of-care ultrasound(POCUS) has gained widespread acceptance,offering real-time bedside evaluation of cardiac function.展开更多
Scar-related ventricular tachycardia(VT)is a malignant arrhythmia with high mortality rates in patients with cardiomyopathies such as ischemic and dilated cardiomyopathy.[1]While implantable cardioverter defibrillator...Scar-related ventricular tachycardia(VT)is a malignant arrhythmia with high mortality rates in patients with cardiomyopathies such as ischemic and dilated cardiomyopathy.[1]While implantable cardioverter defibrillators(ICD)effectively terminate VT episodes and prevent sudden cardiac death,recurrent ICD discharges may precipitate electrical storms and severely impair quality of life.Radiofrequency catheter ablation is another available treatment for VT but faces challenges in rapidly mapping the critical isthmus during hemodynamically unstable VT.Stereotactic arrhythmia radioablation(STAR)has emerged as a novel,non-invasive,and effective approach for refractory VT over the past decade.展开更多
Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controver...Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controversial.This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions.Methods:We compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions.We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital,Naval Medical University between February 2012 and December 2021.After propensity score matching(1:1),101 patients were included in each group.The primary outcome was the rate of pancreatic stone clearance.Secondary outcomes included the rate of adverse events during hospitalization,long-term pain relief,and quality of life after one year follow-up period.Results:The rate of complete clearance was comparable between the two groups(86.1%vs.84.2%,P=0.692).In patients with stones≥2 cm before extracorporeal shock wave lithotripsy(ESWL),the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group[100%(19/19)vs.70.0%(14/20),P=0.031].In the multivariate logistic analysis,ESWL prior to stone extraction was the only independent predictor of complete clearance[with ESWL 58.4%(264/452)vs.without ESWL 41.6%(188/452),odds ratio=2.3,95%confidence interval:1.2–4.3;P=0.013].No significant differences between groups were found regarding the rates of adverse events during hospitalization,quality of life,and pain relief after one year of follow-up.Conclusions:Basket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions.However,the balloon catheter was superior to the basket catheter if the pancreatic stone size was≥2 cm before ESWL.展开更多
The recurrence of atrial fibrillation(AF)in patients after successful radiofrequency catheter ablation(RFCA)appears to be an unresolved clinical issue and needs to be clearly elucidated.There are many factors associat...The recurrence of atrial fibrillation(AF)in patients after successful radiofrequency catheter ablation(RFCA)appears to be an unresolved clinical issue and needs to be clearly elucidated.There are many factors associated with AF recurrence,such as duration of AF,male sex,concomitant heart failure,hemodynamic parameters,chronic obstructive pulmonary disease,hypertension,obstructive sleep apnea,hyperthyroidism,smoking and obesity.However,the inflammatory changes are strongly associated with electrical and structural cardiac remodeling,cardiac damage,myocardial fibrotic changes,microvascular dysfunction and altered reparative response.In this context,biomarkers reflecting the different stages of AF pathogenesis deserve thorough investigation.The authors of the retrospective study revealed that one-year recurrence rate of non-valvular AF in the high systemic immune inflammation(SII)index group was significantly increased compared to that of the low SII index group and provided additional predictive value to the APPLE.Furthermore,the authors suggest that this biomarker may help physicians to optimize the selection of AF patients and to develop a personalized treatment approach.In conclusion,the SII index may serve as a valuable indicator of recurrent AF in patients after RFCA and may be a biomarker with plausible predictive value for poor clinical outcomes.展开更多
BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carri...BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carries risks of catheter-related complications.A combination of group psychological nursing and physical mo-vement care significantly mitigates the risk of venous thrombosis and improves psychological well-being,and enhances motor function,underscoring its clinical importance.AIM To assess group psychological and physical movement nursing in preventing venous thrombosis in patients with PICC GC.METHODS Sixty-five GC patients with PICC,admitted from January 2022 to January 2023,were randomly divided into two groups using the lottery method:A control group(n=35,routine nursing)and an observation group(n=30,routine nursing plus psychological nursing and physical movement nursing).Both groups re-ceived continuous care for 2 weeks.Pre-nursing and post-nursing data on psycho-logical state,physical function,chemotherapy-related thrombosis incidence,and cancer-related fatigue were analyzed using SPSS 26.0 and GraphPad Prism 8.0.RESULTS After nursing,both groups showed reduced Hamilton Anxiety Scale scores and increased General Perceived Self-Efficacy Scale scores,with the observation group performing better(P<0.05).The Functional Comprehensive Assessment score for the observation group after nursing was(65.42±2.35)points,lower than the control group’s(62.19±4.33)points(P<0.05).Although no significant difference was observed in the incidence of venous thrombosis between the two groups(χ2=0.815,P=0.367),the observation group had lower incidence.Both groups showed decreased Revised Piper Fatigue Scale scores,with the observation group scoring lower(P<0.05).CONCLUSION Group psychological and physical movement nursing for patients with PICC reduces venous thrombosis risk,improves psychological well-being,cancer-related fatigue,and physical function,making it highly promotable.展开更多
BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations.Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.AIM To ...BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations.Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.AIM To assess the demographic and patient characteristics surrounding urological consultation for difficult and traumatic Foley catheterizations at our institution across multiple hospitals.METHODS This is a single-institution,multi-hospital,263 patient,retrospective chart review from Jan 2020–December 2023.RESULTS The majority of consultations(80.2%)did not require heroic measures by the urology service.A Foley catheter placement was determined not difficult in the majority 191(72.6%)of patients.Sub-group analysis of“difficult by urology”vs“not difficult by urology”,showed a significant difference between those with zero attempts,one attempt,and greater than one attempts(P=0.004).Those patients specifically with greater than one attempts were more likely to be seen as a difficult insertion by urology assessment(60.6%)compared to not difficult(38.6%).Likewise,those patients with a history of difficult urethral catheter(DUC)/traumatic urethral catheterization(TUC)(25.8%)were more likely to be difficult compared to those without a history of DUC/TUC(14.2%)(P=0.038).CONCLUSION The study found that majority of consultations received did not require heroic measures by the urology service to place a catheter.Patients who had a history of DUC/TUC and those who had greater than one catheter attempts were statistically more likely to be a DUC based on urology assessment.At our institution we hope to propose a protocol in which nursing staff and non-urologic clinicians will utilize a troubleshooting checklist and an algorithm when difficult or traumatic urethral catheters are encountered in order to improve patient care and decrease healthcare costs.For example,this protocol would ideally address complications of multiple catheter attempts such as urethral trauma,development of urethral strictures,and infection risk.Additionally,future trainings and availability of additional resources will be provided and assessed with a goal of reducing healthcare cost surrounding these complications.展开更多
Urethral catheterization is an important skill to develop as consultations for“difficult catheterization”are common in practice.Developing a broad approach to difficult urethral catheterization is crucial to improve...Urethral catheterization is an important skill to develop as consultations for“difficult catheterization”are common in practice.Developing a broad approach to difficult urethral catheterization is crucial to improve trainee success rates.Strategies and techniques to improve catheterization success are often passed down and shared between trainees without formal documentation or dissemination of techniques.Herein,we present a framework for difficult urethral catheterization based on clinical history and patient examination,while also providing additional techniques and troubleshooting to overcome common challenges with urethral catheterization in adult and pediatric patients.展开更多
BACKGROUND Peripherally inserted central catheters(PICCs)are crucial for patients requiring long-term intravenous therapy,especially within digestive surgery under bundled care protocols.AIM To evaluate and compare th...BACKGROUND Peripherally inserted central catheters(PICCs)are crucial for patients requiring long-term intravenous therapy,especially within digestive surgery under bundled care protocols.AIM To evaluate and compare the efficacy,safety,and patient-reported outcomes of single-lumen vs double-lumen PICCs among patients undergoing digestive surgery within a structured bundled care framework.METHODS This retrospective cohort study analyzed data from 249 patients who underwent digestive surgery and utilized either single-lumen(n=117)or double-lumen(n=132)PICCs between January 2021 and June 2024.Clinical outcomes,patient satisfaction,catheterization duration,and complication rates were compared using statistical analysis via SPSS(version 29.0).The bundled care protocol was consistently applied,focusing on standardized procedures,staff training,and patient support.RESULTS Single-lumen PICCs were associated with a significantly lower thrombosis rate(0.85%)than double-lumen PICCs(6.82%,P=0.039).The single-lumen group experienced shorter catheterization durations(12.5±3.14 days vs 13.6±4.50 days,P=0.025)and higher successful infusion rates(92.7%±5.32%vs 90.4%±6.60%,P=0.003).This group also reported higher comfort scores(8.40±1.20 vs 7.90±1.50,P=0.004)and lower pain levels(2.90±0.70 vs 3.20±0.80,P=0.002).Aside from thrombosis,complication rates showed no significant difference between the groups.CONCLUSION Within bundled care context,single-lumen PICCs demonstrated advantages in reducing thrombosis risk,procedural efficiency,patient comfort,and satisfaction compared with double-lumen PICCs.The findings underscore the importance of considering patient-specific needs and clinical scenarios in catheter choice.展开更多
Persistent left superior vena cava(PLSVC)is a congenital anomaly where the left-sided vena cava,which usually regresses during fetal development,persists.Double superior vena cava resulting from a PLSVC is indeed a ra...Persistent left superior vena cava(PLSVC)is a congenital anomaly where the left-sided vena cava,which usually regresses during fetal development,persists.Double superior vena cava resulting from a PLSVC is indeed a rare phenomenon.In the general population,the incidence of this condition is reported to be between 0.3%and 2.1%.[1]While this anatomical variation is often asymptomatic and discovered incidentally,it becomes relevant in certain clinical scenarios.Indeed,the presence of a PLSVC and double superior vena cava can pose challenges as incorrect positioning and result in failure.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
BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-...BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-transplant and determine if there was any correlation with recipient and donor characteristics.METHODS Data from 279 consecutive heart transplant recipients from 2007 through 2020 were analyzed.Clinical variables regarding both recipients and donors as well as hemodynamic variables obtained via right heart catheterization during 1-year and 3-year annual testing were recorded.Simple and multiple linear regression tests were used to determine how recipient and donor variables influenced hemodynamic parameters at 1-year and 3-year.RESULTS Data were available for 260 patients and 224 patients at 1-year and 3-year posttransplant respectively.At 1-year,abnormal hemodynamic parameters were common with 24%patients having right atrial pressure(RAP)>10 mmHg,52%with mean pulmonary artery pressure>20 mmHg,and 12%with pulmonary capillary wedge pressure(PCWP)>18 mmHg.Similar abnormalities were noted at 3-year post-transplant.Recipient body mass index(BMI)demonstrated the strongest correlation with all 3 variables at both 1-year and 3-year by multivariate linear regression analysis(P<0.001 for both).Both donor age and predicted heart mass difference between recipient and donor were significantly linked to RAP and PCWP at 1-year but did not predict any variables at 3-year post-transplant.CONCLUSION Abnormal hemodynamics are common at 1-year and 3-year post-transplant and are associated with recipients with high BMI.展开更多
Objective:To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheters(PICCs)dislodgement and malposition.Dislodged or malpositioned PICCs can lead to improper treatment.The subcutaneous...Objective:To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheters(PICCs)dislodgement and malposition.Dislodged or malpositioned PICCs can lead to improper treatment.The subcutaneous tunneling strategy may be effective,but there is insufficient evidence,and proximal movement has not been explored.Methods:We randomized 630 patients who needed PICCs placement to either the tunneled PICCs(experimental group)or the non-tunneled PICCs(control group).Dislodgement and malposition of the catheter were the primary outcomes,and catheter-related infection(CRI)and catheter-related thrombosis(CRT)were the secondary outcomes.Results:Subcutaneous tunneling does not significantly reduce distal catheter movement,but it significantly reduces proximal catheter movement(4.3%vs.9.9%,P=0.007),which may explain the lower incidence of CRI(2.0%vs.5.3%,P=0.030)and CRT(3.6%vs.12.5%,P<0.001).Conclusions:Although subcutaneous tunneling does not significantly improve catheter prolapse,it should still be used clinically because proximal catheter movement can be a more serious problem associated with CRI and CRT.展开更多
BACKGROUND Percutaneous nephrolithotomy(PNL)is the standard treatment for medium-sized and large kidney stones.Many potential complications of PNL may warrant hospital readmission(HR)after discharge,threatening patien...BACKGROUND Percutaneous nephrolithotomy(PNL)is the standard treatment for medium-sized and large kidney stones.Many potential complications of PNL may warrant hospital readmission(HR)after discharge,threatening patient safety and increasing the costs.AIM To estimate the rate of unplanned HR after PNL and identify its urological and nursing-related predictors.METHODS One hundred sixty-one patients were prospectively studied for HR after PNL from April 2022 to December 2022.The relevant urological and nursing-related characteristics of patients with and without unplanned HR after PNL were studied for association with HR,using univariate and multivariate analyses.Variables such as the demographic characteristics,comorbidities,laboratory and imaging characteristics,dietary status,operative time,number of kidney punctures,blood loss,urinary tract infections,and the receipt of instructions for catheter care and activities of daily living were included.A risk score was created.RESULTS The mean age of patients with HR(44.4±12.7 years)and without HR(43.9±12.6 years)was similar(P=0.847).The overall stone-free rate was 88.8%.The total complication rate was 32.3%(52 patients),and the highest grade was IIIa,according to the modified Clavein grading system,resulting in an HR rate of 22.4%.History of preoperative pyuria(P=0.001),hydronephrosis(P=0.001)and mean stone size(P=0.012),multiple renal punctures(P<0.001),double J stent(P=0.033),total operative time(P=0.001),intraoperative injury(P=0.011),postoperative urinary tract infection(P<0.001),and inadequate instructions for urethral catheter(P=0.001)and activity daily living(P=0.048)were significantly associated with HR after PNL.On multivariate analysis,only preoperative pyuria(P=0.004),intraoperative injury(P=0.001),and inadequate instructions on urethral catheter care(P=0.035)were associated with HR.The risk score of the independent predictors was 0-17;0-4(low risk),5-9(moderate risk),and 10-17(high risk).CONCLUSION The rate of unplanned HR after PNL was relatively high(22.4%).The presence of pus cells in the preoperative urine analysis,intraoperative injury,and receiving inadequate instructions on urethral catheter care were independent predictors of HR after PNL.Combined studying of the urological and nursing-related predictors may promote the implementation of enhanced recovery protocols after PNL.展开更多
BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate th...BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage.Patients were divided into a poor liquefaction group(n=28)and a well liquefaction group(n=82)based on the ratio of postoperative 24-hour drainage volume to abscess volume,using a cutoff value of 0.3.Clinical characteristics,laboratory indicators,and computed tomography imaging features were compared.A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.RESULTS Independent predictive factors for good liquefaction included the absence of diabetes[odds ratio(OR)=0.339,P=0.044],absence of pneumonia(OR=0.218,P=0.013),left-lobe abscess location(OR=4.293,P=0.041),cystic features(OR=5.104,P=0.025),and elevated preoperative serum alanine aminotransferase(ALT)levels(OR=1.013,P=0.041).The logistic regression model based on these factors demonstrated an area under the curve of 0.814,with a sensitivity of 90.24%and specificity of 67.86%.Five-fold cross-validation yielded an average accuracy of 83.61%and a kappa coefficient of 0.5209.CONCLUSION Pneumonia,diabetes,abscess location,abscess composition,and preoperative serum ALT levels are significant predictors of liver abscess liquefaction.The model can guide clinical decision-making.展开更多
Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions t...Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow.While intermediate–HR(IHR)individuals remain hemodynamically stable,they face a significant chance of clinical decline and thus need close and continuous observation.Effective risk assessment,mortality prediction,and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies.Catheter-directed therapy(CDT)has emerged as a promising option,offering the ability to alleviate clot burden and reduce strain on the right ventricle,all while posing a lower risk of major bleeding compared to systemic thrombolysis.The growing adoption of CDT reflects its increasing relevance in PE treatment,especially when managed by specialized PE response teams that ensure individualized,multidisciplinary care.As clinical practices evolve,further studies and robust clinical trials are necessary to clearly define CDT’s role in lowering the risks of complications and death among IHR PE patients.This article explores the current understanding and future direction of managing PE,focusing in the role of catheter-based interventions.展开更多
BACKGROUND Arm-implanted totally implantable venous access devices(peripherally inserted central catheter port)have become an important vascular access for colorectal cancer chemotherapy,but traditional anatomical lan...BACKGROUND Arm-implanted totally implantable venous access devices(peripherally inserted central catheter port)have become an important vascular access for colorectal cancer chemotherapy,but traditional anatomical landmark positioning techniques have issues with inaccurate positioning and high complication rates.AIM To evaluate the clinical value of image pre-measurement combined with intracavitary electrocardiogram(IC-ECG)positioning technology in arm port implantation for colorectal cancer patients.METHODS A retrospective analysis was conducted on 216 colorectal cancer patients who received arm port implantation in our hospital from January 2024 to December 2024.Patients were divided into an experimental group(image pre-measurement combined with IC-ECG positioning technology,n=103)and a control group(traditional anatomical landmark positioning technique,n=113).Technical success rate,operation time,catheter tip position accuracy,number of intraoperative catheter adjustments,X-ray exposure time,and postoperative complication rates were compared between the two groups.RESULTS The experimental group demonstrated superior outcomes compared to the control group across all key measures.Technical success rate was higher(98.4%vs 92.7%,P<0.05)with significantly reduced operation time(23.6±5.2 minutes vs 31.5±7.8 minutes,P<0.01).Catheter tip positioning accuracy improved substantially(97.6%vs 85.4%,P=0.002)while X-ray exposure time decreased by 71.8%(5.3±2.1 seconds vs 18.7±4.5 seconds,P<0.001).Threemonth complication rates were markedly lower in the experimental group(4.1%vs 14.6%,P=0.008),including significant reductions in catheter-related thrombosis(0.8%vs 4.9%),displacement(1.6%vs 5.7%),and occlusion(1.6%vs 4.1%).Multivariate analysis identified traditional technique as the strongest risk factor(odds ratio=4.27,P<0.001),while the combined IC-ECG approach was protective(odds ratio=0.34 for displacement,P=0.018).Long-term outcomes favored the experimental group with higher chemotherapy completion rates(97.1%vs 88.5%,P=0.014)and longer catheter dwelling time(189.5±45.3 days vs 162.7±53.8 days,P<0.001).CONCLUSION Image pre-measurement combined with intracavitary electrocardiogram positioning technology in arm port implantation for colorectal cancer patients can significantly improve catheter tip positioning accuracy,reduce operation time and X-ray exposure.展开更多
文摘Background:This study set out to assess the indications,feasibility,safety,and outcome of early cardiac catheterizations(CC)within 30 days after congenital heart surgery(CHS)in children.Methods and Results:This is a retrospective,single-center case review study of all CC within 30 days after CHS between 1/2010-12/2020.A total of 317(138 diagnostic,179 interventional)CC were performed in 245 patients at a median of 4 days(IQR 13)after CHS.The median age was 3 months(IQR 6),and body weight was 5 kg(IQR 4).A total of 194(61.2%)CC were performed in patients with univentricular hearts.CC revealed significant pathologies leading to early redo-surgery in 37 patients(12%).The transcatheter interventions primarily were needed in patients after cavo-pulmonary connection(n=69%,21.8%),right ventricle to pulmonary artery conduit(n=39%,12.3%),and Norwood-I surgery(n=34%,10.7%)presenting with hypoxemia,prolonged postoperative course,and suspected arterial stenosis on echocardiography.The clinical impact of an early postoperative transcatheter intervention for the following clinical course was high in most cases.There were nine(2.8%)major and 20(6.3%)minor intra-procedural complications.Risk factor analysis revealed no difference for the occurrence of complications for patients’age,weight,and time from initial CHS,underlying uni-vs.biventricular heart disease,or ECMO.Conclusion:Early CC within 30 days after CHS in children can be performed safely with a high diagnostic and therapeutic value.The rate of complications is low,while the therapeutic consequence is relevant.
基金supported by a grant from the Beijing Union Medical College Foundation-Rui E Emergency Medicine Research Fund in 2025。
文摘Central venous catheterization(CVC)is a fundamental clinical procedure widely performed across medical specialties.However,the complication rate of subclavian vein catheterization ranges from 6%to 11%.[1]Common complications include hemothorax,pneumothorax,air embolism,arterial puncture,and aortic perforation.[2]Herein,we report a rare case of accidental puncture of the aorta during subclavian CVC,which was successfully managed with a ventricular septal defect(VSD)occluder.
基金supported by the Foundation for Science and Technology(FCT)under the project CDRSP funding(DOI:10.54499/UID/04044/2025 and ARISE funding(DOI:1054499/LA/P/0112/2020)the grant awarded to TP(10.54499/2020.09198.BD)+3 种基金the funding to JRD(10.54499/CEECINST/00060/2021/CP2902/CT0005)supported by INOV.AM-Inovação em Fabricação Aditiva,02-C05-i01.01-2022Nanofilm(CENTRO 2030-FEDER-01469100)Open access funding provided by FCT|FCCN (b-on).
文摘Central venous catheters(CVCs),which play a vital role in medical care and are widely utilized in intensive care units,are h ighly susceptible to microbial colonization,thus leading to serious catheter-related bloodstream infections and greatly increasing morbidity,mortality,and healthcare costs,accounting for 12%-25%of annual mortality in the USA.The corre sponding preventive measures include the use of antibiotic and antiseptic coatings,impregnated catheters,and maximally sterile barrier techniques,but they are often ineffective,particularly against biofilm formation and antibiotic-resistant bacteria.This review focuses on strategies for fabricating antimicrobial CVCs,e.g.,the use of antifouling materials,antimicrobial nanoparti cles(NPs),and surface functionalization,covering both commercially available solutions and those investigated.Additionally,w e explore the materials and processing technologies used to fabricate antimicrobial CVCs,emphasizing their advantages and challenges in industrial and clinical applications.Finally,we discuss the potential of inorganic NPs and the origin of their antimicrobial activity,providing insights for future advances in infection prevention that will help improve the patients’life quality.
基金supported by the National Key R&D Program of China,No.2022YFC3006200(to YW)the Natural Science Foundation of Beijing,No.7232190(to YW)+1 种基金Zhejiang Province Medical and Health Technology Plan Project,Nos.2022020506(to XW),2024KY1612(to JX),2024KY1615(to MY)Ningbo Clinical Research Center for Orthopedics and Sports Rehabilitation,No.2024L004(to XW).
文摘Peripheral nerve injury is a complex condition presenting significant clinical treatment challenges due to the limited regenerative capacity of peripheral nerves.Nerve conduits have been seen as a promising strategy to overcome the shortage of other treatment options(e.g.,nerve graft).However,nerve regeneration occurs within a complex environment,and elaborate modulation is needed to meet repair requirements.The aim of this study was to investigate and explore a multifunctional nerve conduit with reactive oxygen species clearing,immune modulation to reshape the regenerative environment,and topographic cues and electrical signals to guide nerve growth.We developed an electroactive nerve guidance conduit composed of polylactic-glycolic acid and carbon nanotubes with an oriented structure using electrospinning and modified it with mussel-inspired polydopamine combining neurotrophin-3.The resulting nerve scaffold exhibited favorable orientation,electrical conductivity,and mechanical properties.Continuous release of neurotrophin-3 from the nerve conduit supported nerve regeneration throughout the repair process.In vitro assessments confirmed the cytocompatibility,reactive oxygen species scavenging,and immune regulation capabilities of the nerve scaffolds.In a rat sciatic nerve defect model,the nerve scaffolds effectively prevented muscle atrophy and promoted nerve regeneration and functional recovery over a 12-week period.These findings suggest that polydopamine-modified,electroactive,oriented nerve guidance conduits with multiple bioactive functions hold great promise for the repair of peripheral nerve injuries.
文摘Monitoring cardiac function is a fundamental component of the diagnosis and management of critically ill patients.While pulmonary artery catheterization has long served as the standard for hemodynamic assessment,its invasive nature and associated risks have shifted clinical practice toward non-invasive modalities.^([1]) Among these methods,point-of-care ultrasound(POCUS) has gained widespread acceptance,offering real-time bedside evaluation of cardiac function.
文摘Scar-related ventricular tachycardia(VT)is a malignant arrhythmia with high mortality rates in patients with cardiomyopathies such as ischemic and dilated cardiomyopathy.[1]While implantable cardioverter defibrillators(ICD)effectively terminate VT episodes and prevent sudden cardiac death,recurrent ICD discharges may precipitate electrical storms and severely impair quality of life.Radiofrequency catheter ablation is another available treatment for VT but faces challenges in rapidly mapping the critical isthmus during hemodynamically unstable VT.Stereotactic arrhythmia radioablation(STAR)has emerged as a novel,non-invasive,and effective approach for refractory VT over the past decade.
基金supported by grants from the National Nat-ural Science Foundation of China(82222012 and 82120108006)Scientific Innovation Program of Shanghai Municipal Education Committee(201901070007E00052)。
文摘Background:The choice of a basket or a balloon catheter during endoscopic retrograde cholangiopancreatography(ERCP)for the clearance of pancreatic duct stones in patients with chronic pancreatitis(CP)remains controversial.This study compared the efficacy and safety of these two devices for pancreatic duct stone extractions.Methods:We compared the efficacy and safety of basket and balloon catheters for pancreatic stone extractions.We enrolled CP patients who underwent ERCP for the first time at Changhai Hospital,Naval Medical University between February 2012 and December 2021.After propensity score matching(1:1),101 patients were included in each group.The primary outcome was the rate of pancreatic stone clearance.Secondary outcomes included the rate of adverse events during hospitalization,long-term pain relief,and quality of life after one year follow-up period.Results:The rate of complete clearance was comparable between the two groups(86.1%vs.84.2%,P=0.692).In patients with stones≥2 cm before extracorporeal shock wave lithotripsy(ESWL),the rate of complete clearance was significantly higher in the balloon catheter group when compared to the basket catheter group[100%(19/19)vs.70.0%(14/20),P=0.031].In the multivariate logistic analysis,ESWL prior to stone extraction was the only independent predictor of complete clearance[with ESWL 58.4%(264/452)vs.without ESWL 41.6%(188/452),odds ratio=2.3,95%confidence interval:1.2–4.3;P=0.013].No significant differences between groups were found regarding the rates of adverse events during hospitalization,quality of life,and pain relief after one year of follow-up.Conclusions:Basket and balloon catheters showed similar efficacy and safety for pancreatic stone extractions.However,the balloon catheter was superior to the basket catheter if the pancreatic stone size was≥2 cm before ESWL.
文摘The recurrence of atrial fibrillation(AF)in patients after successful radiofrequency catheter ablation(RFCA)appears to be an unresolved clinical issue and needs to be clearly elucidated.There are many factors associated with AF recurrence,such as duration of AF,male sex,concomitant heart failure,hemodynamic parameters,chronic obstructive pulmonary disease,hypertension,obstructive sleep apnea,hyperthyroidism,smoking and obesity.However,the inflammatory changes are strongly associated with electrical and structural cardiac remodeling,cardiac damage,myocardial fibrotic changes,microvascular dysfunction and altered reparative response.In this context,biomarkers reflecting the different stages of AF pathogenesis deserve thorough investigation.The authors of the retrospective study revealed that one-year recurrence rate of non-valvular AF in the high systemic immune inflammation(SII)index group was significantly increased compared to that of the low SII index group and provided additional predictive value to the APPLE.Furthermore,the authors suggest that this biomarker may help physicians to optimize the selection of AF patients and to develop a personalized treatment approach.In conclusion,the SII index may serve as a valuable indicator of recurrent AF in patients after RFCA and may be a biomarker with plausible predictive value for poor clinical outcomes.
文摘BACKGROUND Long-term chemotherapy for patients with gastric cancer(GC),facilitated by peripherally inserted central catheter(PICC)catheterization,reduces vascular damage and enhances drug delivery efficiency but carries risks of catheter-related complications.A combination of group psychological nursing and physical mo-vement care significantly mitigates the risk of venous thrombosis and improves psychological well-being,and enhances motor function,underscoring its clinical importance.AIM To assess group psychological and physical movement nursing in preventing venous thrombosis in patients with PICC GC.METHODS Sixty-five GC patients with PICC,admitted from January 2022 to January 2023,were randomly divided into two groups using the lottery method:A control group(n=35,routine nursing)and an observation group(n=30,routine nursing plus psychological nursing and physical movement nursing).Both groups re-ceived continuous care for 2 weeks.Pre-nursing and post-nursing data on psycho-logical state,physical function,chemotherapy-related thrombosis incidence,and cancer-related fatigue were analyzed using SPSS 26.0 and GraphPad Prism 8.0.RESULTS After nursing,both groups showed reduced Hamilton Anxiety Scale scores and increased General Perceived Self-Efficacy Scale scores,with the observation group performing better(P<0.05).The Functional Comprehensive Assessment score for the observation group after nursing was(65.42±2.35)points,lower than the control group’s(62.19±4.33)points(P<0.05).Although no significant difference was observed in the incidence of venous thrombosis between the two groups(χ2=0.815,P=0.367),the observation group had lower incidence.Both groups showed decreased Revised Piper Fatigue Scale scores,with the observation group scoring lower(P<0.05).CONCLUSION Group psychological and physical movement nursing for patients with PICC reduces venous thrombosis risk,improves psychological well-being,cancer-related fatigue,and physical function,making it highly promotable.
文摘BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations.Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.AIM To assess the demographic and patient characteristics surrounding urological consultation for difficult and traumatic Foley catheterizations at our institution across multiple hospitals.METHODS This is a single-institution,multi-hospital,263 patient,retrospective chart review from Jan 2020–December 2023.RESULTS The majority of consultations(80.2%)did not require heroic measures by the urology service.A Foley catheter placement was determined not difficult in the majority 191(72.6%)of patients.Sub-group analysis of“difficult by urology”vs“not difficult by urology”,showed a significant difference between those with zero attempts,one attempt,and greater than one attempts(P=0.004).Those patients specifically with greater than one attempts were more likely to be seen as a difficult insertion by urology assessment(60.6%)compared to not difficult(38.6%).Likewise,those patients with a history of difficult urethral catheter(DUC)/traumatic urethral catheterization(TUC)(25.8%)were more likely to be difficult compared to those without a history of DUC/TUC(14.2%)(P=0.038).CONCLUSION The study found that majority of consultations received did not require heroic measures by the urology service to place a catheter.Patients who had a history of DUC/TUC and those who had greater than one catheter attempts were statistically more likely to be a DUC based on urology assessment.At our institution we hope to propose a protocol in which nursing staff and non-urologic clinicians will utilize a troubleshooting checklist and an algorithm when difficult or traumatic urethral catheters are encountered in order to improve patient care and decrease healthcare costs.For example,this protocol would ideally address complications of multiple catheter attempts such as urethral trauma,development of urethral strictures,and infection risk.Additionally,future trainings and availability of additional resources will be provided and assessed with a goal of reducing healthcare cost surrounding these complications.
文摘Urethral catheterization is an important skill to develop as consultations for“difficult catheterization”are common in practice.Developing a broad approach to difficult urethral catheterization is crucial to improve trainee success rates.Strategies and techniques to improve catheterization success are often passed down and shared between trainees without formal documentation or dissemination of techniques.Herein,we present a framework for difficult urethral catheterization based on clinical history and patient examination,while also providing additional techniques and troubleshooting to overcome common challenges with urethral catheterization in adult and pediatric patients.
文摘BACKGROUND Peripherally inserted central catheters(PICCs)are crucial for patients requiring long-term intravenous therapy,especially within digestive surgery under bundled care protocols.AIM To evaluate and compare the efficacy,safety,and patient-reported outcomes of single-lumen vs double-lumen PICCs among patients undergoing digestive surgery within a structured bundled care framework.METHODS This retrospective cohort study analyzed data from 249 patients who underwent digestive surgery and utilized either single-lumen(n=117)or double-lumen(n=132)PICCs between January 2021 and June 2024.Clinical outcomes,patient satisfaction,catheterization duration,and complication rates were compared using statistical analysis via SPSS(version 29.0).The bundled care protocol was consistently applied,focusing on standardized procedures,staff training,and patient support.RESULTS Single-lumen PICCs were associated with a significantly lower thrombosis rate(0.85%)than double-lumen PICCs(6.82%,P=0.039).The single-lumen group experienced shorter catheterization durations(12.5±3.14 days vs 13.6±4.50 days,P=0.025)and higher successful infusion rates(92.7%±5.32%vs 90.4%±6.60%,P=0.003).This group also reported higher comfort scores(8.40±1.20 vs 7.90±1.50,P=0.004)and lower pain levels(2.90±0.70 vs 3.20±0.80,P=0.002).Aside from thrombosis,complication rates showed no significant difference between the groups.CONCLUSION Within bundled care context,single-lumen PICCs demonstrated advantages in reducing thrombosis risk,procedural efficiency,patient comfort,and satisfaction compared with double-lumen PICCs.The findings underscore the importance of considering patient-specific needs and clinical scenarios in catheter choice.
文摘Persistent left superior vena cava(PLSVC)is a congenital anomaly where the left-sided vena cava,which usually regresses during fetal development,persists.Double superior vena cava resulting from a PLSVC is indeed a rare phenomenon.In the general population,the incidence of this condition is reported to be between 0.3%and 2.1%.[1]While this anatomical variation is often asymptomatic and discovered incidentally,it becomes relevant in certain clinical scenarios.Indeed,the presence of a PLSVC and double superior vena cava can pose challenges as incorrect positioning and result in failure.
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BACKGROUND Few studies have quantified invasive hemodynamic parameters in post heart transplant recipients.AIM To report the incidence of abnormal hemodynamics in heart transplant recipients at 1-year and 3-year post-transplant and determine if there was any correlation with recipient and donor characteristics.METHODS Data from 279 consecutive heart transplant recipients from 2007 through 2020 were analyzed.Clinical variables regarding both recipients and donors as well as hemodynamic variables obtained via right heart catheterization during 1-year and 3-year annual testing were recorded.Simple and multiple linear regression tests were used to determine how recipient and donor variables influenced hemodynamic parameters at 1-year and 3-year.RESULTS Data were available for 260 patients and 224 patients at 1-year and 3-year posttransplant respectively.At 1-year,abnormal hemodynamic parameters were common with 24%patients having right atrial pressure(RAP)>10 mmHg,52%with mean pulmonary artery pressure>20 mmHg,and 12%with pulmonary capillary wedge pressure(PCWP)>18 mmHg.Similar abnormalities were noted at 3-year post-transplant.Recipient body mass index(BMI)demonstrated the strongest correlation with all 3 variables at both 1-year and 3-year by multivariate linear regression analysis(P<0.001 for both).Both donor age and predicted heart mass difference between recipient and donor were significantly linked to RAP and PCWP at 1-year but did not predict any variables at 3-year post-transplant.CONCLUSION Abnormal hemodynamics are common at 1-year and 3-year post-transplant and are associated with recipients with high BMI.
文摘Objective:To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheters(PICCs)dislodgement and malposition.Dislodged or malpositioned PICCs can lead to improper treatment.The subcutaneous tunneling strategy may be effective,but there is insufficient evidence,and proximal movement has not been explored.Methods:We randomized 630 patients who needed PICCs placement to either the tunneled PICCs(experimental group)or the non-tunneled PICCs(control group).Dislodgement and malposition of the catheter were the primary outcomes,and catheter-related infection(CRI)and catheter-related thrombosis(CRT)were the secondary outcomes.Results:Subcutaneous tunneling does not significantly reduce distal catheter movement,but it significantly reduces proximal catheter movement(4.3%vs.9.9%,P=0.007),which may explain the lower incidence of CRI(2.0%vs.5.3%,P=0.030)and CRT(3.6%vs.12.5%,P<0.001).Conclusions:Although subcutaneous tunneling does not significantly improve catheter prolapse,it should still be used clinically because proximal catheter movement can be a more serious problem associated with CRI and CRT.
文摘BACKGROUND Percutaneous nephrolithotomy(PNL)is the standard treatment for medium-sized and large kidney stones.Many potential complications of PNL may warrant hospital readmission(HR)after discharge,threatening patient safety and increasing the costs.AIM To estimate the rate of unplanned HR after PNL and identify its urological and nursing-related predictors.METHODS One hundred sixty-one patients were prospectively studied for HR after PNL from April 2022 to December 2022.The relevant urological and nursing-related characteristics of patients with and without unplanned HR after PNL were studied for association with HR,using univariate and multivariate analyses.Variables such as the demographic characteristics,comorbidities,laboratory and imaging characteristics,dietary status,operative time,number of kidney punctures,blood loss,urinary tract infections,and the receipt of instructions for catheter care and activities of daily living were included.A risk score was created.RESULTS The mean age of patients with HR(44.4±12.7 years)and without HR(43.9±12.6 years)was similar(P=0.847).The overall stone-free rate was 88.8%.The total complication rate was 32.3%(52 patients),and the highest grade was IIIa,according to the modified Clavein grading system,resulting in an HR rate of 22.4%.History of preoperative pyuria(P=0.001),hydronephrosis(P=0.001)and mean stone size(P=0.012),multiple renal punctures(P<0.001),double J stent(P=0.033),total operative time(P=0.001),intraoperative injury(P=0.011),postoperative urinary tract infection(P<0.001),and inadequate instructions for urethral catheter(P=0.001)and activity daily living(P=0.048)were significantly associated with HR after PNL.On multivariate analysis,only preoperative pyuria(P=0.004),intraoperative injury(P=0.001),and inadequate instructions on urethral catheter care(P=0.035)were associated with HR.The risk score of the independent predictors was 0-17;0-4(low risk),5-9(moderate risk),and 10-17(high risk).CONCLUSION The rate of unplanned HR after PNL was relatively high(22.4%).The presence of pus cells in the preoperative urine analysis,intraoperative injury,and receiving inadequate instructions on urethral catheter care were independent predictors of HR after PNL.Combined studying of the urological and nursing-related predictors may promote the implementation of enhanced recovery protocols after PNL.
文摘BACKGROUND Effective management of liver abscess depends on timely drainage,which is influenced by the liquefaction degree.Identifying predictive factors is crucial for guiding clinical decisions.AIM To investigate the predictive factors of liver abscess liquefaction and develop a predictive model to guide optimal timing of percutaneous drainage.METHODS This retrospective study included 110 patients with pyogenic liver abscesses who underwent percutaneous catheter drainage.Patients were divided into a poor liquefaction group(n=28)and a well liquefaction group(n=82)based on the ratio of postoperative 24-hour drainage volume to abscess volume,using a cutoff value of 0.3.Clinical characteristics,laboratory indicators,and computed tomography imaging features were compared.A predictive model was constructed using logistic regression and evaluated using receiver operating characteristic curves and five-fold cross-validation.RESULTS Independent predictive factors for good liquefaction included the absence of diabetes[odds ratio(OR)=0.339,P=0.044],absence of pneumonia(OR=0.218,P=0.013),left-lobe abscess location(OR=4.293,P=0.041),cystic features(OR=5.104,P=0.025),and elevated preoperative serum alanine aminotransferase(ALT)levels(OR=1.013,P=0.041).The logistic regression model based on these factors demonstrated an area under the curve of 0.814,with a sensitivity of 90.24%and specificity of 67.86%.Five-fold cross-validation yielded an average accuracy of 83.61%and a kappa coefficient of 0.5209.CONCLUSION Pneumonia,diabetes,abscess location,abscess composition,and preoperative serum ALT levels are significant predictors of liver abscess liquefaction.The model can guide clinical decision-making.
文摘Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow.While intermediate–HR(IHR)individuals remain hemodynamically stable,they face a significant chance of clinical decline and thus need close and continuous observation.Effective risk assessment,mortality prediction,and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies.Catheter-directed therapy(CDT)has emerged as a promising option,offering the ability to alleviate clot burden and reduce strain on the right ventricle,all while posing a lower risk of major bleeding compared to systemic thrombolysis.The growing adoption of CDT reflects its increasing relevance in PE treatment,especially when managed by specialized PE response teams that ensure individualized,multidisciplinary care.As clinical practices evolve,further studies and robust clinical trials are necessary to clearly define CDT’s role in lowering the risks of complications and death among IHR PE patients.This article explores the current understanding and future direction of managing PE,focusing in the role of catheter-based interventions.
基金Supported by the Affiliated Hospital of Xuzhou Medical University,No.2024ZH04Xuzhou Municipal Science and Technology Bureau,No.KC23282.
文摘BACKGROUND Arm-implanted totally implantable venous access devices(peripherally inserted central catheter port)have become an important vascular access for colorectal cancer chemotherapy,but traditional anatomical landmark positioning techniques have issues with inaccurate positioning and high complication rates.AIM To evaluate the clinical value of image pre-measurement combined with intracavitary electrocardiogram(IC-ECG)positioning technology in arm port implantation for colorectal cancer patients.METHODS A retrospective analysis was conducted on 216 colorectal cancer patients who received arm port implantation in our hospital from January 2024 to December 2024.Patients were divided into an experimental group(image pre-measurement combined with IC-ECG positioning technology,n=103)and a control group(traditional anatomical landmark positioning technique,n=113).Technical success rate,operation time,catheter tip position accuracy,number of intraoperative catheter adjustments,X-ray exposure time,and postoperative complication rates were compared between the two groups.RESULTS The experimental group demonstrated superior outcomes compared to the control group across all key measures.Technical success rate was higher(98.4%vs 92.7%,P<0.05)with significantly reduced operation time(23.6±5.2 minutes vs 31.5±7.8 minutes,P<0.01).Catheter tip positioning accuracy improved substantially(97.6%vs 85.4%,P=0.002)while X-ray exposure time decreased by 71.8%(5.3±2.1 seconds vs 18.7±4.5 seconds,P<0.001).Threemonth complication rates were markedly lower in the experimental group(4.1%vs 14.6%,P=0.008),including significant reductions in catheter-related thrombosis(0.8%vs 4.9%),displacement(1.6%vs 5.7%),and occlusion(1.6%vs 4.1%).Multivariate analysis identified traditional technique as the strongest risk factor(odds ratio=4.27,P<0.001),while the combined IC-ECG approach was protective(odds ratio=0.34 for displacement,P=0.018).Long-term outcomes favored the experimental group with higher chemotherapy completion rates(97.1%vs 88.5%,P=0.014)and longer catheter dwelling time(189.5±45.3 days vs 162.7±53.8 days,P<0.001).CONCLUSION Image pre-measurement combined with intracavitary electrocardiogram positioning technology in arm port implantation for colorectal cancer patients can significantly improve catheter tip positioning accuracy,reduce operation time and X-ray exposure.
