BACKGROUND In adults,bowel intussusception is a rare diagnosis and is mostly due to an organic bowel disorder.In rare cases,this is a complication of a percutaneously placed endoscopic gastro(jejunostomy)catheter.CASE...BACKGROUND In adults,bowel intussusception is a rare diagnosis and is mostly due to an organic bowel disorder.In rare cases,this is a complication of a percutaneously placed endoscopic gastro(jejunostomy)catheter.CASE SUMMARY We describe a case of a 73-year-old patient with a history of myocardial infarction,chronic idiopathic constipation and Parkinson’s disease.For the admission of his Parkinson’s medication,a percutaneous endoscopic gastrostomy with jejunal extension(PEG-J)was placed.The patient presented three times at the emergency department of the hospital with intermittent abdominal pain with nausea and vomiting.There were no distinctive abnormalities from the physical and laboratory examinations.An abdominal computed tomography scan showed a small bowel intussusception.By push endoscopy,a jejunal bezoar at the tip of the PEG-J catheter was found to be the cause of small bowel intussusception.The intussusception was resolved after removing the bezoar during push enteroscopy.CONCLUSION Endoscopic treatment of bowel intussusception caused by PEG-J catheter bezoar.展开更多
The post-hoc analysis of the PERSEO registry by Minardi,et al.[1]offers critical insights into antithrombotic management for elderly patients(≥80 years)on oral anticoagulation undergoing percutaneous coronary interve...The post-hoc analysis of the PERSEO registry by Minardi,et al.[1]offers critical insights into antithrombotic management for elderly patients(≥80 years)on oral anticoagulation undergoing percutaneous coronary intervention.While the authors effectively demonstrate the vulnerability of this population,characterized by substantial comorbidity burden and markedly elevated rates of mortality,ischemic events,and bleeding at one year compared with younger cohorts,their findings raise important questions about contemporary practice patterns and their alignment with evidence-based guidelines.展开更多
The important work of Yu,et al.[1]who presented one of the first randomized controlled trials(RCTs)to directly compare robot-assisted and manual percutaneous coronary intervention(PCI),is commendable;offering importan...The important work of Yu,et al.[1]who presented one of the first randomized controlled trials(RCTs)to directly compare robot-assisted and manual percutaneous coronary intervention(PCI),is commendable;offering important insights into the feasibility and outcomes of this emerging technology.While the analysis is timely,several issues warrant further consideration.展开更多
Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.T...Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determine clinical characteristics,risk of adverse cardiovascular events,and mortality in patients aged≥85 years compared to those aged<85 undergoing PCI.Methods In this retrospective study,data were obtained from the nationwide Netherlands Heart Registration on patients undergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term followup.Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to patients aged<85 years,patients aged≥85 were more often female and showed a higher number of cardiovascular comorbidities,including impaired left ventricle ejection fraction and reduced kidney function.Mortality at short-term and long-term follow-up were significantly higher in those aged≥85(P<0.001).Patients aged≥85 were more likely to have a myocardial infarction within 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at longterm follow-up compared to patients aged<85(P<0.001).Conclusions The elderly(≥85 years)patient requiring PCI carries an extensive cardiovascular risk profile,translating in significant risk of recurrent cardiovascular events and increased mortality rate.Clinicians should carefully weigh perceived risks and potential benefits in the individual patient,considering the patients’age,cardiovascular risk profile,and associated risk of morbidity and mortality.展开更多
Objectives:Supracostal access during percutaneous nephrolithotomy(PCNL)increases the risk of pulmonary complications.Although routine postoperative thoracic imaging is commonly performed to detect these events,its cli...Objectives:Supracostal access during percutaneous nephrolithotomy(PCNL)increases the risk of pulmonary complications.Although routine postoperative thoracic imaging is commonly performed to detect these events,its clinical necessity remains controversial.This study aimed to assess the necessity of routine postoperative thoracic imaging for detecting pulmonary complications in patients undergoing supracostal mini percutaneous nephrolithotomy(m-PCNL)surgery.Methods:A retrospective analysis was conducted on data from patients who underwent supracostal m-PCNL between 2017 and 2022 in a tertiary center.Excluding patients under 18,with kidney/skeletal anomalies,or active thoracic disease,112 eligible patients were included.Patients were divided into two groups:those with routine postoperative chest X-ray(CXR)(Group 1,n=40)and those without(Group 2,n=72).Complications and operative data were compared between groups.Results:Mean ages were 44.3±11.4(Group 1)and 42.6±13.1(Group 2),with no significant difference(p=0.102).Stone sizes were 30.8±8.6 mm(Group 1)and 24.8±8.4 mm(Group 2),also not significantly different(p=0.313).High fever occurred in 10% of Group 1 and 4% of Group 2(p=0.246).Minimal effusion was found in 10% of Group 1,with no treatment due to lack of symptoms.However,subsequent CXR revealed hydropneumothorax in 2.5% of cases,necessitating thoracic tube insertion.In Group 2,5% developed postoperative respiratory symptoms,with significant pneumothorax in 1.3%,requiring thoracic tube placement.Thoracic tube insertion rates did not significantly differ between groups(Group 1:2.5%vs.Group 2:1.3%,p=0.671).Conclusions:Routine postoperative thoracic imaging did not show any significant benefit in detecting pulmonary complications post-supracostal m-PCNL.展开更多
Objective: To analyze the value of high-quality nursing care for patients with kidney stones undergoing percutaneous nephrolithotomy with holmium laser lithotripsy (PCNL). Methods: A total of 72 patients with kidney s...Objective: To analyze the value of high-quality nursing care for patients with kidney stones undergoing percutaneous nephrolithotomy with holmium laser lithotripsy (PCNL). Methods: A total of 72 patients with kidney stones treated with PCNL from November 2024 to November 2025 were selected as samples and randomly divided into groups using a random number table. Group A received high-quality nursing care, while Group B received conventional nursing care. Indicators such as pain, anxiety, nursing satisfaction, and complications were compared between the two groups. Results: The Visual Analog Scale (VAS) scores for pain and Self-Rating Anxiety Scale (SAS) scores for anxiety in Group A were lower than those in Group B (p < 0.05). The nursing satisfaction rate in Group A was higher than that in Group B (p < 0.05). The complication rate of PCNL in Group A was lower than that in Group B (p < 0.05). Conclusion: For patients with kidney stones treated with PCNL, receiving high-quality nursing care can alleviate anxiety, relieve pain, and reduce the risk of postoperative complications.展开更多
BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials e...BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.展开更多
BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vesse...BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.展开更多
This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obst...This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.展开更多
Background Acute myocardial infarction(AMI),one of the most critical cardiovascular emergencies,carries a high mortality rate due to progressive cardiac dysfunction caused by myocardial ischemia.Percutaneous coronary ...Background Acute myocardial infarction(AMI),one of the most critical cardiovascular emergencies,carries a high mortality rate due to progressive cardiac dysfunction caused by myocardial ischemia.Percutaneous coronary intervention(PCI)is an effective treatment for AMI,rapidly restoring blood flow,reducing myocardial injury,and mitigating adverse remodeling.However,reperfusion injury and ventricular remodeling post-PCI may still lead to heart failure.Recent studies highlighted the cardioprotective effects of sodium-glucose cotransporter-2(SGLT-2)inhibitors,particularly dapagliflozin,which improves myocardial energetics,reduces inflammation,and attenuates adverse remodeling.However,high-quality evidence on its early application following primary PCI in AMI re-mains limited.In this study,we aimed to evaluated the clinical utility of dapagliflozin in AMI management.Meth-ods This study retrospectively analyzed the clinical data of 100 patients with AMI undergoing emergency PCI ad-mitted to our hospital between June 2022 and June 2024.They were randomly divided into observation group(n=50)and control group(n=50).The control group received standard post-PCI medication(antiplatelet and lipid-low-ering therapy),while the observation group received additional dapagliflozin.Cardiac function parameters,serolog-ical markers,and the incidence of major adverse cardiovascular events(MACE)were compared between the two groups.Results After 14 days of treatment,observation group exhibited significantly lower left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)(P<0.05)and higher left ventricu-lar ejection fraction(LVEF)(P<0.05)compared to control group.Additionally,the level of myocardial injury mark-ers[creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),and brain natriuretic peptide(BNP)]were significant-ly lower in observation group(P<0.05).However,there was no significant difference in the incidence of MACE be-tween the two groups(P>0.05).Conclusions The combination of dapagliflozin with standard post-PCI therapy improves cardiac function and reduces the level of myocardial injury markers in AMI patients,though it does not significantly affect the short-term incidence of adverse cardiovascular events.展开更多
BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.A...BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.AIM To evaluate the incidence and prognostic significance of post-PCI psychological disorders in elderly patients with heart failure,and to examine their association with medication adherence and major adverse cardiovascular events(MACE).METHODS This retrospective cohort study included 330 consecutive patients aged≥60 years with heart failure who underwent PCI between 2018 and 2021 at a single center,excluding those with prior psychiatric diagnoses.Psychological status within six months post-discharge was assessed using validated Chinese versions of the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale,and medication adherence was measured by the 8-item Morisky Medication Adherence Scale(MMAS-8)scale.A subset of 145 patients with≥24 months of follow-up were analyzed for MACEs.Multivariate logistic regression and Kaplan-Meier survival analyses were performed.RESULTS Post-PCI psychological disorders were identified in 40%of patients,with anxiety(36%),depression(32%),and comorbid symptoms(22%)being most prevalent.Affected patients had lower MMAS-8 scores[median 5(IQR 4-6)vs 6(IQR 5-7),P=0.002]and a higher rate of low adherence(51.5%vs 30.3%,P<0.001).Among the 145 patients followed longitudinally,MACEs occurred in 17.9%,with 65.4%of events in those with psychological disorders.Psychological disorders(OR=2.66,95% CI:1.11-6.41,P=0.028)and low adherence(OR=2.77,95% CI:1.17-6.56,P=0.021)were independently associated with increased MACE risk.Kaplan-Meier analysis showed reduced MACE-free survival in patients with psychological disorders(HR=2.68,95%CI:1.25-5.73;log-rank P=0.008).CONCLUSION Post-PCI psychological disorders are common in elderly patients with heart failure and independently predict poorer adherence and worse cardiovascular outcomes.Routine psychological assessment and adherence interventions may improve prognosis in this vulnerable population.展开更多
Bcakground: Pancreatic pseudocyst (PPC) is a common complication arising from acute or chronic pancreatitis, trauma, or pancreatic duct obstruction. When acute fluid collection persists for 4 - 6 weeks and is encapsul...Bcakground: Pancreatic pseudocyst (PPC) is a common complication arising from acute or chronic pancreatitis, trauma, or pancreatic duct obstruction. When acute fluid collection persists for 4 - 6 weeks and is encapsulated by a fibrous wall, it is classified as a pancreatic pseudocyst. While PPC is generally asymptomatic in many patients, it can manifest with persistent abdominal pain, dyspepsia, intra-cystic infection, and potentially lead to gastrointestinal obstruction in some cases. Although smaller PPCs may resolve spontaneously, larger PPCs tend to be refractory to absorption and often necessitate surgical intervention to prevent complications such as intracystic hemorrhage. Objective: To explore the efficacy of percutaneous catheterization with negative pressure in the treatment of large pancreatic pseudocysts. Methods: The cases of large pancreatic pseudocysts treated in our hospital from 2004 to 2022 were retrospectively collected, and the general condition, operation time, drainage time, feeding time, postoperative complications, hospital stay, cost and follow-up of the patients were analyzed. Results: A total of 132 patients with large pancreatic pseudocysts were collected. The average operation time was 32.4 ± 2.1 min;The retention time of the drainage tube was 30 ± 1.8 days in the percutaneous negative pressure drainage group;The postoperative feeding time was no fasting after local anesthesia drainage;Postoperative complications (bleeding, infection, pancreatic leakage, recurrence, anastomotic leakage, etc.): Two of the 132 patients had recurrent cysts, which were cured by re-puncture and negative pressure drainage. The length of hospital stay was 6 ± 1.1 days;The cost was 11,200 ± 1300 yuan;Follow-up: The follow-up time ranged from 1 to 3 years, and the patients had no discomfort. Conclusion: Percutaneous catheterization and negative pressure drainage can effectively treat large pancreatic pseudocysts. Compared with other treatment methods, it is simple and effective, the postoperative recovery of patients is faster, the physical damage is less, the hospital stay is shorter, and the cost is lower.展开更多
Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to e...Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.展开更多
Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(...Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(PKP)or percutaneous vertebroplasty(PVP)using a network meta-analysis.Methods A systematic search was conducted in PubMed,Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang Database,Chinese Scientific Journal Database,and Chinese Biomedical Literature Database(SinoMed)from their inception to January 15,2025.Outcome measures included the Visual Analog Scale(VAS)score,Oswestry Disability Index(ODI)score,and overall efficacy rate.Literature screening,data extraction,and risk-of-bias assessment were independently performed by two researchers.Data analysis was conducted using Stata 17.0 software.Results A total of 35 randomized controlled trials involving 2860 patients were included.The data analysis revealed that,in terms of improving VAS and ODI scores,the top three effective therapies were Fu's subcutaneous needling,wrist-ankle acupuncture,and acupotomy.For the overall efficacy rates in pain treatment,the top three therapies were wrist-ankle acupuncture,warm acupuncture and moxibustion,and Fu's subcutaneous needling.Based on the combined results across the three outcome measures,Fu's subcutaneous needling was found to be the most effective in relieving pain and improving lumbar function.Conclusion Fu's subcutaneous needling,wrist-ankle acupuncture,warm acupuncture and moxibustion,and acupotomy were all effective in treating postoperative pain post-PKP/PVP and improving lumbar function.However,further high-quality,large-sample studies are required to confirm these findings.展开更多
Iread with great interest the recent article by Shin,et al.[1]the authors present an important exploration into the use of drug-coated balloon(DCB)in patients aged≥75 years,a demographic increasingly encountered in m...Iread with great interest the recent article by Shin,et al.[1]the authors present an important exploration into the use of drug-coated balloon(DCB)in patients aged≥75 years,a demographic increasingly encountered in modern cardiovascular practice.The authors conducted a retrospective analysis involving 2050 elderly patients(aged≥75 years)undergoing successful percutaneous coronary intervention(PCI).展开更多
Introduction Percutaneous coronary intervention(PCI),as a primary treatment for coronary artery disease,has made significant strides in both technology and clinical practice since its inception.However,long-term manag...Introduction Percutaneous coronary intervention(PCI),as a primary treatment for coronary artery disease,has made significant strides in both technology and clinical practice since its inception.However,long-term management of post-PCI patients,particularly restenosis prevention and disease progression control,continues to face numerous challenges[1].Insufficient patient adherence to lifestyle interventions and secondary prevention,coupled with low utilization of cardiac rehabilitation,leads to a sustained increase in the risk of postoperative adverse cardiac events[2,3].The rapid development of digital health technologies(DHTs)offers opportunities to overcome these persistent difficulties.This editorial reviewed the latest applications and multiple challenges,and suggested future directions of DHTs in post-PCI patients(Figure 1).展开更多
OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicent...OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.展开更多
Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outco...Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outcomes,there is growing interest in sarcopenia as a marker of frailty and its potential role in long-term prognosis.The prognostic value of the psoas muscle index(PMI),a sarcopenia metric,remains underexplored in PCI populations regarding long term survival.Methods This single-center retrospective cohort study evaluated 177 patients undergoing PCI from 2015 to 2019.PMI was calculated from computed tomography(CT)imaging at the L3 vertebral level using the formula:(left psoas area+right psoas area)/height2 and expressed in cm^(2)/m^(2).Sarcopenia was defined as the lowest sex-specific PMI quartile.Primary outcomes included 5-year all-cause mortality and 3-point major adverse cardiovascular events(MACE:non-fatal myocardial infarction,ischemic stroke,and cardiac death).Binary linear regression and Cox proportional hazards models were utilized to determine associations between PMI and outcomes Results Sarcopenic patients exhibited significantly higher 5-year all-cause mortality compared to non-sarcopenic counterparts(64.4%vs.35.6%,P<0.001),while no significant difference was observed in 3-point MACE incidence(55.6%vs.51.4%,P=0.520).Sarcopenia was independently associated with all-cause mortality on binary logistic regression(OR=3.49;95%CI:1.69–7.19;P=0.0007),but not MACE(OR=1.00;95%CI:0.50–1.98;P=0.99).In a multivariable Cox regression model,sarcopenia was associated with increased hazard of mortality(HR=1.60;95%CI:0.96–2.66;P=0.071),though this did not reach statistical significance.Kaplan-Meier analysis demonstrated significantly reduced survival among sarcopenic patients(χ^(2)=6.13,P=0.0133).Conclusions PMI is a significant independent predictor of 5-year all-cause mortality in PCI patients,underscoring the prognostic importance of assessing skeletal muscle mass in this population.展开更多
BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress...BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress.This study assessed the SHR and longterm prognosis of patients with AMI.METHODS This study was a post-hoc analysis based on the prospective,multicenter OPTIMAL registry(http://www.clinicaltrials.gov,NCT number:NCT03084991).A total of 3384 consecutive patients who underwent percutaneous coronary intervention(PCI)at Department of Cardiology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin,China were included in the present analysis after exclusions.Patients were stratified into quartiles according to the SHR.The primary endpoint was cardiovascular death,with all-cause death and major adverse cardiovascular events as secondary endpoints.The median follow-up duration was 24.1 months,with a completion rate of 99.5%.RESULTS Kaplan-Meier survival curves showed progressively worse survival across SHR quartiles(log-rank P<0.001),with patients in Q4(SHR≥1.34)experiencing the highest risk.Multivariate Cox regression analysis confirmed that the SHR was an independent predictor of cardiovascular death[hazard ratio(HR)=1.56],all-cause death(HR=1.48),and major adverse cardiovascular events(HR=1.34)for Q4(SHR≥1.34)versus Q2(SHR:0.93–1.11).Restricted cubic spline analysis revealed a J-shaped association between SHR and outcomes,with the lowest risk observed at an SHR of approximately 1.0.CONCLUSIONS The SHR is an independent predictor of long-term adverse outcomes in patients with AMI undergoing PCI,supporting its use for early risk stratification and glycemic management.展开更多
Objective:Urinary stones in pregnancy are usually managed conservatively or with temporary drainage,but in some cases,intervention is needed.Percutaneous nephrolithotomy(PCNL)is generally avoided due to its invasivene...Objective:Urinary stones in pregnancy are usually managed conservatively or with temporary drainage,but in some cases,intervention is needed.Percutaneous nephrolithotomy(PCNL)is generally avoided due to its invasiveness and the requirement for fluoroscopy.This study aimed to review the literature on the use of PCNL in pregnancy,focusing on its safety,efficacy,feasibility,and technical aspects.Methods:A narrative literature review was conducted using PubMed,Embase,and Scopus databases,covering the period from January 2000 to March 2024.The search terms included“percutaneous nephrolithotomy”,“PCNL”,“pregnancy”,and relevant variations thereof.The initial search retrieved 27 articles,of which only six studies involving 14 patients met the inclusion criteria.Results:The reviewed studies included patients aged 23e34 years who underwent PCNL between 8 weeks and 28 weeks of gestation.Preoperative evaluations were exclusively based on ultrasound imaging,with stone sizes ranging from 8 mm to 48 mm.Indications for PCNL were persistent pain despite urinary diversion or reluctance to undergo stent replacement.Fluoroscopy was avoided in 13 patients.No maternal or fetal complications were reported.Conclusion:PCNL appears to be a safe and feasible treatment option for selected cases of urinary stone disease during pregnancy.It should be performed in experienced centers,with proper patient counseling and a multidisciplinary approach to ensure the best outcomes.展开更多
文摘BACKGROUND In adults,bowel intussusception is a rare diagnosis and is mostly due to an organic bowel disorder.In rare cases,this is a complication of a percutaneously placed endoscopic gastro(jejunostomy)catheter.CASE SUMMARY We describe a case of a 73-year-old patient with a history of myocardial infarction,chronic idiopathic constipation and Parkinson’s disease.For the admission of his Parkinson’s medication,a percutaneous endoscopic gastrostomy with jejunal extension(PEG-J)was placed.The patient presented three times at the emergency department of the hospital with intermittent abdominal pain with nausea and vomiting.There were no distinctive abnormalities from the physical and laboratory examinations.An abdominal computed tomography scan showed a small bowel intussusception.By push endoscopy,a jejunal bezoar at the tip of the PEG-J catheter was found to be the cause of small bowel intussusception.The intussusception was resolved after removing the bezoar during push enteroscopy.CONCLUSION Endoscopic treatment of bowel intussusception caused by PEG-J catheter bezoar.
文摘The post-hoc analysis of the PERSEO registry by Minardi,et al.[1]offers critical insights into antithrombotic management for elderly patients(≥80 years)on oral anticoagulation undergoing percutaneous coronary intervention.While the authors effectively demonstrate the vulnerability of this population,characterized by substantial comorbidity burden and markedly elevated rates of mortality,ischemic events,and bleeding at one year compared with younger cohorts,their findings raise important questions about contemporary practice patterns and their alignment with evidence-based guidelines.
文摘The important work of Yu,et al.[1]who presented one of the first randomized controlled trials(RCTs)to directly compare robot-assisted and manual percutaneous coronary intervention(PCI),is commendable;offering important insights into the feasibility and outcomes of this emerging technology.While the analysis is timely,several issues warrant further consideration.
文摘Background In patients with coronary artery disease,age is of known significance in predicting outcomes.Data on clinical outcomes in patients≥85 years undergoing percutaneous coronary intervention(PCI)remain scarce.The study aim was to determine clinical characteristics,risk of adverse cardiovascular events,and mortality in patients aged≥85 years compared to those aged<85 undergoing PCI.Methods In this retrospective study,data were obtained from the nationwide Netherlands Heart Registration on patients undergoing PCI between January 1st,2017 and January 1st,2021.The primary endpoint was all-cause mortality at long-term followup.Results A total of 155,683 patients underwent PCI,of which 100,209(64.4%)acute coronary syndrome cases.Compared to patients aged<85 years,patients aged≥85 were more often female and showed a higher number of cardiovascular comorbidities,including impaired left ventricle ejection fraction and reduced kidney function.Mortality at short-term and long-term follow-up were significantly higher in those aged≥85(P<0.001).Patients aged≥85 were more likely to have a myocardial infarction within 30 days following the index intervention(0.9%vs.0.7%;P=0.024),though they less often underwent revascularization at longterm follow-up compared to patients aged<85(P<0.001).Conclusions The elderly(≥85 years)patient requiring PCI carries an extensive cardiovascular risk profile,translating in significant risk of recurrent cardiovascular events and increased mortality rate.Clinicians should carefully weigh perceived risks and potential benefits in the individual patient,considering the patients’age,cardiovascular risk profile,and associated risk of morbidity and mortality.
文摘Objectives:Supracostal access during percutaneous nephrolithotomy(PCNL)increases the risk of pulmonary complications.Although routine postoperative thoracic imaging is commonly performed to detect these events,its clinical necessity remains controversial.This study aimed to assess the necessity of routine postoperative thoracic imaging for detecting pulmonary complications in patients undergoing supracostal mini percutaneous nephrolithotomy(m-PCNL)surgery.Methods:A retrospective analysis was conducted on data from patients who underwent supracostal m-PCNL between 2017 and 2022 in a tertiary center.Excluding patients under 18,with kidney/skeletal anomalies,or active thoracic disease,112 eligible patients were included.Patients were divided into two groups:those with routine postoperative chest X-ray(CXR)(Group 1,n=40)and those without(Group 2,n=72).Complications and operative data were compared between groups.Results:Mean ages were 44.3±11.4(Group 1)and 42.6±13.1(Group 2),with no significant difference(p=0.102).Stone sizes were 30.8±8.6 mm(Group 1)and 24.8±8.4 mm(Group 2),also not significantly different(p=0.313).High fever occurred in 10% of Group 1 and 4% of Group 2(p=0.246).Minimal effusion was found in 10% of Group 1,with no treatment due to lack of symptoms.However,subsequent CXR revealed hydropneumothorax in 2.5% of cases,necessitating thoracic tube insertion.In Group 2,5% developed postoperative respiratory symptoms,with significant pneumothorax in 1.3%,requiring thoracic tube placement.Thoracic tube insertion rates did not significantly differ between groups(Group 1:2.5%vs.Group 2:1.3%,p=0.671).Conclusions:Routine postoperative thoracic imaging did not show any significant benefit in detecting pulmonary complications post-supracostal m-PCNL.
文摘Objective: To analyze the value of high-quality nursing care for patients with kidney stones undergoing percutaneous nephrolithotomy with holmium laser lithotripsy (PCNL). Methods: A total of 72 patients with kidney stones treated with PCNL from November 2024 to November 2025 were selected as samples and randomly divided into groups using a random number table. Group A received high-quality nursing care, while Group B received conventional nursing care. Indicators such as pain, anxiety, nursing satisfaction, and complications were compared between the two groups. Results: The Visual Analog Scale (VAS) scores for pain and Self-Rating Anxiety Scale (SAS) scores for anxiety in Group A were lower than those in Group B (p < 0.05). The nursing satisfaction rate in Group A was higher than that in Group B (p < 0.05). The complication rate of PCNL in Group A was lower than that in Group B (p < 0.05). Conclusion: For patients with kidney stones treated with PCNL, receiving high-quality nursing care can alleviate anxiety, relieve pain, and reduce the risk of postoperative complications.
文摘BACKGROUND Simultaneous acute ischemic stroke(AIS)and myocardial infarction(cardio-cerebral ischemic attack)have rarely been reported in the literature.Currently,no clear evidence-based guidelines or clinical trials exist to determine the optimal therapeutic strategy for these patients.CASE SUMMARY We present the case of a 27-year-old Chinese man who simultaneously experie-nced acute concomitant cerebrocardiac infarction(CCI)and painless ST-elevation myocardial infarction.The patient was successfully treated with elective percu-taneous coronary intervention(PCI)after receiving urgent systemic thrombolysis at the standard dose for AIS.CONCLUSION Urgent thrombolysis followed by elective PCI was an appropriate strategy for the management of simultaneous CCI.
基金supported by the CAMS Innovation Fund for Medical Sciences(No.2021-I2M-1-008)the National High Level Hospital Clinical Research Funding(No.2023-GSP-GG-2&No.2023-GSP-QN-34&No.2023-GSPRC-05).
文摘BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.
文摘This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.
文摘Background Acute myocardial infarction(AMI),one of the most critical cardiovascular emergencies,carries a high mortality rate due to progressive cardiac dysfunction caused by myocardial ischemia.Percutaneous coronary intervention(PCI)is an effective treatment for AMI,rapidly restoring blood flow,reducing myocardial injury,and mitigating adverse remodeling.However,reperfusion injury and ventricular remodeling post-PCI may still lead to heart failure.Recent studies highlighted the cardioprotective effects of sodium-glucose cotransporter-2(SGLT-2)inhibitors,particularly dapagliflozin,which improves myocardial energetics,reduces inflammation,and attenuates adverse remodeling.However,high-quality evidence on its early application following primary PCI in AMI re-mains limited.In this study,we aimed to evaluated the clinical utility of dapagliflozin in AMI management.Meth-ods This study retrospectively analyzed the clinical data of 100 patients with AMI undergoing emergency PCI ad-mitted to our hospital between June 2022 and June 2024.They were randomly divided into observation group(n=50)and control group(n=50).The control group received standard post-PCI medication(antiplatelet and lipid-low-ering therapy),while the observation group received additional dapagliflozin.Cardiac function parameters,serolog-ical markers,and the incidence of major adverse cardiovascular events(MACE)were compared between the two groups.Results After 14 days of treatment,observation group exhibited significantly lower left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)(P<0.05)and higher left ventricu-lar ejection fraction(LVEF)(P<0.05)compared to control group.Additionally,the level of myocardial injury mark-ers[creatine kinase-MB(CK-MB),cardiac troponin I(cTnI),and brain natriuretic peptide(BNP)]were significant-ly lower in observation group(P<0.05).However,there was no significant difference in the incidence of MACE be-tween the two groups(P>0.05).Conclusions The combination of dapagliflozin with standard post-PCI therapy improves cardiac function and reduces the level of myocardial injury markers in AMI patients,though it does not significantly affect the short-term incidence of adverse cardiovascular events.
文摘BACKGROUND Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention(PCI),despite their potential impact on long-term cardiovascular outcomes.AIM To evaluate the incidence and prognostic significance of post-PCI psychological disorders in elderly patients with heart failure,and to examine their association with medication adherence and major adverse cardiovascular events(MACE).METHODS This retrospective cohort study included 330 consecutive patients aged≥60 years with heart failure who underwent PCI between 2018 and 2021 at a single center,excluding those with prior psychiatric diagnoses.Psychological status within six months post-discharge was assessed using validated Chinese versions of the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale,and medication adherence was measured by the 8-item Morisky Medication Adherence Scale(MMAS-8)scale.A subset of 145 patients with≥24 months of follow-up were analyzed for MACEs.Multivariate logistic regression and Kaplan-Meier survival analyses were performed.RESULTS Post-PCI psychological disorders were identified in 40%of patients,with anxiety(36%),depression(32%),and comorbid symptoms(22%)being most prevalent.Affected patients had lower MMAS-8 scores[median 5(IQR 4-6)vs 6(IQR 5-7),P=0.002]and a higher rate of low adherence(51.5%vs 30.3%,P<0.001).Among the 145 patients followed longitudinally,MACEs occurred in 17.9%,with 65.4%of events in those with psychological disorders.Psychological disorders(OR=2.66,95% CI:1.11-6.41,P=0.028)and low adherence(OR=2.77,95% CI:1.17-6.56,P=0.021)were independently associated with increased MACE risk.Kaplan-Meier analysis showed reduced MACE-free survival in patients with psychological disorders(HR=2.68,95%CI:1.25-5.73;log-rank P=0.008).CONCLUSION Post-PCI psychological disorders are common in elderly patients with heart failure and independently predict poorer adherence and worse cardiovascular outcomes.Routine psychological assessment and adherence interventions may improve prognosis in this vulnerable population.
文摘Bcakground: Pancreatic pseudocyst (PPC) is a common complication arising from acute or chronic pancreatitis, trauma, or pancreatic duct obstruction. When acute fluid collection persists for 4 - 6 weeks and is encapsulated by a fibrous wall, it is classified as a pancreatic pseudocyst. While PPC is generally asymptomatic in many patients, it can manifest with persistent abdominal pain, dyspepsia, intra-cystic infection, and potentially lead to gastrointestinal obstruction in some cases. Although smaller PPCs may resolve spontaneously, larger PPCs tend to be refractory to absorption and often necessitate surgical intervention to prevent complications such as intracystic hemorrhage. Objective: To explore the efficacy of percutaneous catheterization with negative pressure in the treatment of large pancreatic pseudocysts. Methods: The cases of large pancreatic pseudocysts treated in our hospital from 2004 to 2022 were retrospectively collected, and the general condition, operation time, drainage time, feeding time, postoperative complications, hospital stay, cost and follow-up of the patients were analyzed. Results: A total of 132 patients with large pancreatic pseudocysts were collected. The average operation time was 32.4 ± 2.1 min;The retention time of the drainage tube was 30 ± 1.8 days in the percutaneous negative pressure drainage group;The postoperative feeding time was no fasting after local anesthesia drainage;Postoperative complications (bleeding, infection, pancreatic leakage, recurrence, anastomotic leakage, etc.): Two of the 132 patients had recurrent cysts, which were cured by re-puncture and negative pressure drainage. The length of hospital stay was 6 ± 1.1 days;The cost was 11,200 ± 1300 yuan;Follow-up: The follow-up time ranged from 1 to 3 years, and the patients had no discomfort. Conclusion: Percutaneous catheterization and negative pressure drainage can effectively treat large pancreatic pseudocysts. Compared with other treatment methods, it is simple and effective, the postoperative recovery of patients is faster, the physical damage is less, the hospital stay is shorter, and the cost is lower.
文摘Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.
基金supported by the National Natural Science Foundation of China(82305273)the Central High-Level Clinical Research Fund for Traditional Chinese Medicine Hospitals(DZMG-QNGG0010).
文摘Objective To evaluate the clinical efficacy of different acupuncture-related therapies in treating postoperative pain in patients with osteoporotic vertebral compression fractures(OVCFs)after percutaneous kyphoplasty(PKP)or percutaneous vertebroplasty(PVP)using a network meta-analysis.Methods A systematic search was conducted in PubMed,Cochrane Library,Embase,Web of Science,China National Knowledge Infrastructure,Wanfang Database,Chinese Scientific Journal Database,and Chinese Biomedical Literature Database(SinoMed)from their inception to January 15,2025.Outcome measures included the Visual Analog Scale(VAS)score,Oswestry Disability Index(ODI)score,and overall efficacy rate.Literature screening,data extraction,and risk-of-bias assessment were independently performed by two researchers.Data analysis was conducted using Stata 17.0 software.Results A total of 35 randomized controlled trials involving 2860 patients were included.The data analysis revealed that,in terms of improving VAS and ODI scores,the top three effective therapies were Fu's subcutaneous needling,wrist-ankle acupuncture,and acupotomy.For the overall efficacy rates in pain treatment,the top three therapies were wrist-ankle acupuncture,warm acupuncture and moxibustion,and Fu's subcutaneous needling.Based on the combined results across the three outcome measures,Fu's subcutaneous needling was found to be the most effective in relieving pain and improving lumbar function.Conclusion Fu's subcutaneous needling,wrist-ankle acupuncture,warm acupuncture and moxibustion,and acupotomy were all effective in treating postoperative pain post-PKP/PVP and improving lumbar function.However,further high-quality,large-sample studies are required to confirm these findings.
文摘Iread with great interest the recent article by Shin,et al.[1]the authors present an important exploration into the use of drug-coated balloon(DCB)in patients aged≥75 years,a demographic increasingly encountered in modern cardiovascular practice.The authors conducted a retrospective analysis involving 2050 elderly patients(aged≥75 years)undergoing successful percutaneous coronary intervention(PCI).
文摘Introduction Percutaneous coronary intervention(PCI),as a primary treatment for coronary artery disease,has made significant strides in both technology and clinical practice since its inception.However,long-term management of post-PCI patients,particularly restenosis prevention and disease progression control,continues to face numerous challenges[1].Insufficient patient adherence to lifestyle interventions and secondary prevention,coupled with low utilization of cardiac rehabilitation,leads to a sustained increase in the risk of postoperative adverse cardiac events[2,3].The rapid development of digital health technologies(DHTs)offers opportunities to overcome these persistent difficulties.This editorial reviewed the latest applications and multiple challenges,and suggested future directions of DHTs in post-PCI patients(Figure 1).
基金supported by the National Key Research and Development Program of China(No.2022YFC3602500)Beijing High-level Public Health Technical Talents Construction Project(Discipline Leader-03-24)Beijing Hospitals Authority’s Ascent Plan(DFL20240601).
文摘OBJECTIVE To evaluate the safety and effectiveness of robot-assisted percutaneous coronary intervention(R-PCI)compared to traditional manual percutaneous coronary intervention(M-PCI).METHODS This prospective,multicenter,randomized controlled,non-inferior clinical trial enrolled patients with coronary heart disease who met the inclusion criteria and had indications for elective percutaneous coronary intervention.Participants were randomly assigned to either the R-PCI group or the M-PCI group.Primary endpoints were clinical and technical success rates.Clinical success was defined as visually estimated residual post-percutaneous coronary intervention stenosis<30% with no 30-day major adverse cardiac events.Technical success in the R-PCI group was defined as successful completion of percutaneous coronary intervention using the ETcath200 robot-assisted system,without conversion to M-PCI in the event of a guidewire or balloon/stent catheter that was unable to cross the vessel or was poorly supported by the catheter.Secondary endpoints included total procedure time,percutaneous coronary intervention procedure time,fluoroscopy time,contrast volume,operator radiation exposure,air kerma,and dose-area product.RESULTS The trial enrolled 152 patients(R-PCI:73 patients,M-PCI:79 patients).Lesions were predominantly B2/C type(73.6%).Both groups achieved 100% clinical success rate.No major adverse cardiac events occurred during the 30-day follow-up.The R-PCI group had a technical success rate of 100%.The R-PCI group had longer total procedure and fluoroscopy times,but lower operator radiation exposure.The percutaneous coronary intervention procedure time,contrast volume,air kerma,and dose-area product were similar between the two groups.CONCLUSIONS For certain complex lesions,performing percutaneous coronary intervention using the ETcath200 robot-assisted system is safe and effective and does not result in conversion to M-PCI.
文摘Background Percutaneous coronary intervention(PCI)is a widely utilized revascularization technique for coronary artery disease(CAD).While clinical and biomarker-based prognostic tools are standard for predicting outcomes,there is growing interest in sarcopenia as a marker of frailty and its potential role in long-term prognosis.The prognostic value of the psoas muscle index(PMI),a sarcopenia metric,remains underexplored in PCI populations regarding long term survival.Methods This single-center retrospective cohort study evaluated 177 patients undergoing PCI from 2015 to 2019.PMI was calculated from computed tomography(CT)imaging at the L3 vertebral level using the formula:(left psoas area+right psoas area)/height2 and expressed in cm^(2)/m^(2).Sarcopenia was defined as the lowest sex-specific PMI quartile.Primary outcomes included 5-year all-cause mortality and 3-point major adverse cardiovascular events(MACE:non-fatal myocardial infarction,ischemic stroke,and cardiac death).Binary linear regression and Cox proportional hazards models were utilized to determine associations between PMI and outcomes Results Sarcopenic patients exhibited significantly higher 5-year all-cause mortality compared to non-sarcopenic counterparts(64.4%vs.35.6%,P<0.001),while no significant difference was observed in 3-point MACE incidence(55.6%vs.51.4%,P=0.520).Sarcopenia was independently associated with all-cause mortality on binary logistic regression(OR=3.49;95%CI:1.69–7.19;P=0.0007),but not MACE(OR=1.00;95%CI:0.50–1.98;P=0.99).In a multivariable Cox regression model,sarcopenia was associated with increased hazard of mortality(HR=1.60;95%CI:0.96–2.66;P=0.071),though this did not reach statistical significance.Kaplan-Meier analysis demonstrated significantly reduced survival among sarcopenic patients(χ^(2)=6.13,P=0.0133).Conclusions PMI is a significant independent predictor of 5-year all-cause mortality in PCI patients,underscoring the prognostic importance of assessing skeletal muscle mass in this population.
基金supported by the National Natural Science Foundation of China(No.62135002)the Key Research and Development Program of Heilongjiang Province(No.2022ZX01A28).
文摘BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress.This study assessed the SHR and longterm prognosis of patients with AMI.METHODS This study was a post-hoc analysis based on the prospective,multicenter OPTIMAL registry(http://www.clinicaltrials.gov,NCT number:NCT03084991).A total of 3384 consecutive patients who underwent percutaneous coronary intervention(PCI)at Department of Cardiology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin,China were included in the present analysis after exclusions.Patients were stratified into quartiles according to the SHR.The primary endpoint was cardiovascular death,with all-cause death and major adverse cardiovascular events as secondary endpoints.The median follow-up duration was 24.1 months,with a completion rate of 99.5%.RESULTS Kaplan-Meier survival curves showed progressively worse survival across SHR quartiles(log-rank P<0.001),with patients in Q4(SHR≥1.34)experiencing the highest risk.Multivariate Cox regression analysis confirmed that the SHR was an independent predictor of cardiovascular death[hazard ratio(HR)=1.56],all-cause death(HR=1.48),and major adverse cardiovascular events(HR=1.34)for Q4(SHR≥1.34)versus Q2(SHR:0.93–1.11).Restricted cubic spline analysis revealed a J-shaped association between SHR and outcomes,with the lowest risk observed at an SHR of approximately 1.0.CONCLUSIONS The SHR is an independent predictor of long-term adverse outcomes in patients with AMI undergoing PCI,supporting its use for early risk stratification and glycemic management.
文摘Objective:Urinary stones in pregnancy are usually managed conservatively or with temporary drainage,but in some cases,intervention is needed.Percutaneous nephrolithotomy(PCNL)is generally avoided due to its invasiveness and the requirement for fluoroscopy.This study aimed to review the literature on the use of PCNL in pregnancy,focusing on its safety,efficacy,feasibility,and technical aspects.Methods:A narrative literature review was conducted using PubMed,Embase,and Scopus databases,covering the period from January 2000 to March 2024.The search terms included“percutaneous nephrolithotomy”,“PCNL”,“pregnancy”,and relevant variations thereof.The initial search retrieved 27 articles,of which only six studies involving 14 patients met the inclusion criteria.Results:The reviewed studies included patients aged 23e34 years who underwent PCNL between 8 weeks and 28 weeks of gestation.Preoperative evaluations were exclusively based on ultrasound imaging,with stone sizes ranging from 8 mm to 48 mm.Indications for PCNL were persistent pain despite urinary diversion or reluctance to undergo stent replacement.Fluoroscopy was avoided in 13 patients.No maternal or fetal complications were reported.Conclusion:PCNL appears to be a safe and feasible treatment option for selected cases of urinary stone disease during pregnancy.It should be performed in experienced centers,with proper patient counseling and a multidisciplinary approach to ensure the best outcomes.
