BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach conce...BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain,which our meta-analysis aims to address.AIM To explore safety and efficacy outcomes for patients undergoing TAVR,comparing periprocedural continuation vs interruption of OAC therapy.METHODS A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC.Data were pooled using a random-effects model with risk ratio(RR)and their 95%confidence interval(CI)as effect measures.All statistical analyses were conducted using Review Manager with statistical significance set at P<0.05.RESULTS Four studies were included,encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8%males.A total of 733 patients underwent OAC interruption and 1080 continued.Stroke incidence was significantly lower in the OAC continuation group(RR=0.62,95%CI:0.40-0.94;P=0.03).No significant differences in major vascular complications were found between the two groups(RR=0.95,95%CI:0.77-1.16;P=0.60)and major bleeding(RR=0.90,95%CI:0.72-1.12;P=0.33).All-cause mortality was non-significant between the two groups(RR=0.83,95%CI:0.57-1.20;P=0.32).CONCLUSION Continuation of OAC significantly reduced stroke risk,whereas it showed trends toward lower bleeding and mortality that were not statistically significant.Further large-scale studies are crucial to determine clinical significance.展开更多
With the intensification of population aging,knee and hip joint replacement surgeries have become core methods for treating end-stage joint diseases,with over a million cases performed globally each year.Postoperative...With the intensification of population aging,knee and hip joint replacement surgeries have become core methods for treating end-stage joint diseases,with over a million cases performed globally each year.Postoperative rehabilitation nursing,as a crucial aspect of enhancing surgical outcomes,reducing complications,and facilitating patients’return to normal life,has its scientific and effective protocols directly influencing patient prognosis.This article systematically reviews the core research findings on rehabilitation nursing after joint replacement surgery based on the concept of evidence-based medicine,aiming to provide references for the formulation of standardized and personalized rehabilitation nursing plans in clinical settings.展开更多
Parkinson’s disease(PD)is the second most common neurodegenerative disorder.The progressive degeneration of dopamine(DA)producing neurons in the midbrain is the pathological hallmark,which leads to debilitating motor...Parkinson’s disease(PD)is the second most common neurodegenerative disorder.The progressive degeneration of dopamine(DA)producing neurons in the midbrain is the pathological hallmark,which leads to debilitating motor symptoms,including tremors,rigidity,and bradykinesia.Drug treatments,such as levodopa,provide symptomatic relief.However,they do not halt disease progression,and their effectiveness diminishes over time(reviewed in Poewe et al.,2017).展开更多
BACKGROUND: Anemia is prevalent in patients undergoing transcatheter aortic valve replacement(TAVR) and has been linked to impaired outcomes after the procedure. Few studies have evaluated the impact of anemia and new...BACKGROUND: Anemia is prevalent in patients undergoing transcatheter aortic valve replacement(TAVR) and has been linked to impaired outcomes after the procedure. Few studies have evaluated the impact of anemia and new ischemic lesions post TAVR.METHODS: We prospectively enrolled 158 patients who received TAVR in our center. Anemia was defined according to the World Health Organization criteria as hemoglobin <12 g/dL in women and <13 g/dL in men. All patients underwent diffusion-weighted magnetic resonance imaging(DW-MRI) procedure before and within 4–7 days after TAVR. RESULTS: Anemia was present in 85(53.8%) patients who underwent TAVR, and 126(79.7%) patients had 718 new DW-MRI positive lesions with a mean of 4.54±5.26 lesions per patient. The incidence of new ischemic lesions was 81.2% in patients with anemia versus 78.1% in patients without anemia(P=0.629). Moreover, anemic patients had bigger total volume/lesions in the anterior cerebral artery/middle cerebral artery(ACA/MCA) and MCA regions compared to the non-anemic patients(31.89±55.78 mm^(3) vs. 17.08±37.39 mm^(3), P=0.049;and 54.54±74.72 mm^(3) vs. 33.75±46.03 mm^(3), P=0.034). Anemia was independently associated with the volume/lesion in the ACA/MCA(β=16.796, 95% confidence interval [95% CI] 2.001 to 31.591, P=0.026) and in the MCA zone(β=0.020, 95% CI 0.001 to 0.040, P=0.041). CONCLUSIONS: Patients with pre-procedural anemia may have bigger total volume/lesions in the ACA/MCA and MCA regions compared to the non-anemic patients. Whether the consequences of bigger total volume/lesions impact neurological and cognitive outcomes remains to be investigated.展开更多
Objective: To investigate the effect of flurbiprofen axetil analgesia after knee replacement on the cytokine contents in serum and joint fluid as well as HPA axis activity. Methods: Patients who underwent knee replace...Objective: To investigate the effect of flurbiprofen axetil analgesia after knee replacement on the cytokine contents in serum and joint fluid as well as HPA axis activity. Methods: Patients who underwent knee replacement in People's Hospital of Dongxihu District between April 2015 and January 2018 were selected as the research subjects and randomly divided into the experimental group who accepted flurbiprofen axetil combined with patient-controlled intravenous analgesia and the control group who accepted patient-controlled intravenous analgesia alone. The contents of cytokines and HPA axis-related hormones in serum were measured before surgery as well as 1 d and 3 d after surgery;the contents of cytokines in joint fluid were measured 1 d and 3 d after surgery. Results: Compared with those of same group before surgery, NGF, NPY, TNF-α, IL-2, IL-4, IL-10, ACTH, COR, INS, GH and PRL levels of both groups were increasing 1 d and 3 d after surgery, and NGF, NPY, TNF-α, IL-2, IL-4, IL-10, ACTH, COR, INS, GH and PRL levels in serum as well as PGE2, OPN, TGF-β1, FGF21, CXCL12 and YKL-40 in joint fluid of experimental group 1 d and 3 d after surgery were lower than those of control group. Conclusion: Flurbiprofen axetil analgesia after knee replacement can reduce the release of cytokines in serum and joint fluid, and inhibit the activity of HPA axis, and its analgesic effect is exact.展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
Piperacillin/tazobactam and ciprofloxacin are often used in combination as initial empiric anti-biotic therapy in critical ill patients. Especially in patients undergoing continuous renal replacement therapy (CRRT) th...Piperacillin/tazobactam and ciprofloxacin are often used in combination as initial empiric anti-biotic therapy in critical ill patients. Especially in patients undergoing continuous renal replacement therapy (CRRT) the pharmacokinetics of antimicrobial agents can be highly variable. In order to avoid under- or overdosage of antibiotics therapeutic drug monitoring (TDM) is highly re-commendable. Based on two known HPLC assays for piperacillin a new method in combination with solid phase extraction (SPE) for the simultaneous determination of piperacillin and ciprofloxacin was developed. Method validation was performed according to the EMA guideline on validation of bioanalytical methods. The HPLC column used was a Perfect Bond ODS-HD C18 analytical column (100 mm × 4.6 mm i.d., particle size 5 μm), equipped with a guard column (10 mm × 4.6 mm, particle size 5 μm) containing the same packing material. Detection wavelength was set at 228 nm for piperacillin and benzylpenicillin was used as internal standard (IS). Ciprofloxacin was determined at two wavelengths (280 nm, 315 nm). This newly developed HPLC method in combination with SPE-extraction allows an accurate, precise, specific and efficient determination of piperacillin and ciprofloxacin in biological matrices. Results allow the calculation of all relevant pharmacokinetic data for critically ill patients undergoing CRRT and the optimization of dosing and TDM.展开更多
Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durabl...Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durable valve function.This review provides an overview of both surgical andtranscatheter options for aortic,mitral,pulmonary,and tricuspid valve replacements in pediatric patients,highlighting the indications,outcomes,and advancements in technology and technique.Surgical valvereplacement traditionally involves the implantation of biological or mechanical prosthetic valves,withbiologicalvalves beingpreferred in children to reduce the need for lifelong anticoagulation therapy.However,the limitation ofbiological prostheses,nanely their inability to grow with the child,necessitates the frequentneed for reoperations.Recent innovations in valve engineering,such as the development of tissue engineeredand expandable valves,aim to address these issues.Transcatheter valve replacement(TVR)has emergedas a promising alternative,particularly for patients with complex anatomy or those who are high-risk fortraditional surgery.While the use of transcatheter devices in children remains limited due to the smallervascular size and limited long-termn data,several studies have demonstrated the feasibility and safety ofthe procedure in certain patient populations.Despite these advancements,challenges related to valvesize,durability,and the need for individualized treatment planning persist.The future of pediatric heartvalve replacemnent will likely involve a multidisciplinary approach combining surgical,transcatheter,andregenerative medicine strategies,aimed at optimizing outcomes,reducing the need for reinterventions,andimproving long-term quality of life for pediatric patients with valvularheart disease.This article discussesall options availab le for patients with valvular dysfunction,making it easy for parents/patients to go to as areference source of information.展开更多
In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,com...In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,commonly due to periprosthetic loosening.Revision procedures are associated with significantly increased healthcare costs;therefore,timely and accurate diagnostics are critical for clinicians and patients.Loosening,which may be septic or aseptic,remains a challenge and requires thorough clinical examination and multimodal imaging evaluation.Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography,magnetic resonance imaging and nuclear medicine are playing an increasingly important role.This comprehensive review,through outlining the available radiological modalities,their respective strengths and weaknesses and the pertinent imaging findings,may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.展开更多
Background Continuous renal replacement therapy(CRRT)is frequently applied in critically ill patients with acute kidney injury who are vulnerable to cardiovascular complications.Differences in calcium management durin...Background Continuous renal replacement therapy(CRRT)is frequently applied in critically ill patients with acute kidney injury who are vulnerable to cardiovascular complications.Differences in calcium management during CRRT may affect cardiac electrophysiology and hemodynamic stability,potentially influencing cardiovascular outcomes.Methods A total of 96 patients receiving CRRT were enrolled in this single-center study between September 2020 and September 2023.Patients were divided into two groups:those receiving calcium-containing replacement fluids(n=46)and those receiving calcium-free fluids(n=50).Clinical outcomes,including major adverse cardiovascular events(MACE),arrhythmias,hypotension,myocardial infarction,sudden cardiac arrest,intensive care units(ICU)stays,and hospital mortality,were compared between the two groups.Results The calcium-containing group had a significantly lower incidence of MACE(20%vs.32%,P<0.001)and arrhythmias(8%vs.17.3%,P=0.010)compared to the calcium-free group.ICU stays were also shorter in the calcium-containing group(11.6±8.8 days vs.16.6±7.6 days,P=0.004).Hospital mortality showed a trend toward being lower in the calciumcontaining group,though this was not statistically significant(0.6%vs.10.1%,P=0.063).No significant differences were observed in the incidence of hypotension,myocardial infarction,or sudden cardiac arrest.Conclusions Calcium-containing replacement fluids during CRRT were associated with improved clinical outcomes,including lower rates of MACE and arrhythmias,as well as shorter ICU stays.This simplified approach may be safer and more efficient,but larger studies are needed to confirm these findings and assess long-term outcomes.展开更多
Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with ...Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,accounting for 25%of patients aged 85 years and older in Europe and 12%of patients older than 80 years in Japan.[2,3]Recent studies have reported that ATTRwt-CA coexists in 11%-16%of older patients with AS undergoing transcatheter aortic valve replacement(TAVR).[1,4,5]In a metaanalysis by Ho et al.,[6]the prevalence rates of cardiac amyloidosis,predominantly ATTRwt-CA,in patients with AS and those referred for TAVR or surgical aortic valve replacement(SAVR)were 14.4%and 15.2%,respectively.Conversely,the prevalence of AS in patients with cardiac amyloidosis is 8.7%.Owing to the high surgical risk in patients with both AS and ATTRwt-CA,TAVR may be preferred over SAVR.展开更多
Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements o...Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements over last two decades,there are still significant challenges in field in terms of appropriate selection of patients as well as the valves.While there is no doubt that TAVR has now become the leading mode of treatment for severe AS patients,surgical aortic valve replacement(SAVR)still holds its value for the selective group of patients who are not ideal candidate for the minimally invasive procedure:TAVR.The dilemma is palpable in the clinical field that warrants best approach focusing on the lifetime management of these patients.In the recent metanalysis by Moradi et al,the authors provide a comprehensive insight into TAVR vs SAVR in terms of mortality,procedural complications,and post-procedure adverse events.In this editorial,we shed light on comparative analysis of both modalities to establish a middle ground.展开更多
The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacter...The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacterial efficacy remains a formidable challenge.In this context,we proposed a novel strategy that leverages swelling and erosion mechanisms to facilitate drug release of drug-loaded ultrahigh molecular weight polyethylene(UHMWPE),thereby ensuring its long-lasting antibacterial performance.Polyethylene oxide(PEO),a hydrophilic polymer with fast hydrating ability and high swelling capacity,was incorporated in UHMWPE alongside the antibacterial tea polyphenol(epigallocatechin gallate,EGCG as representative).The swelling of PEO enhanced water infiltration into the matrix,while the erosion of PEO balanced the release of the encapsulated EGCG,resulting in a steady release.The behavior was supported by the EGCG release profiles and the corresponding fitted release kinetic models.As demonstrated by segmented antibacterial assessments,the antibacterial efficiency was enhanced 2to 3 times in the PEO/EGCG/UHMWPE composite compared to that of EGCG/UHMWPE.Additionally,the PEO/EGCG/UHMWPE composite exhibited favorable biocompatibility and mechanical performance,making it a potential candidate for the development of drug-releasing joint implants to combat prosthetic bacterial infections.展开更多
Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasin...Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasingly older,have comorbidities,and frailty.TAVR cardiac rehabilitation(CR)programs significantly improve both functional capacity and quality of life of patients.However,there are no guidelines on how to carry out them and few elderly patients are referred to CR.Furthermore,mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs.Multidisciplinary patient care,including comorbidities and frailty,is essential.It is necessary to ensure exquisite continuity of care during TAVR,CR,and the rest of the patient's life.Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR,given the high demand.This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.展开更多
China’s enhanced intellectual property rights(IPR)protection framework presents a promising prospect for European SMEs to pursue strategic growth and market expansion within the country’s innovation-driven economy.
Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patien...Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patients undergoing valve replacement surgery(VRS)remained sparse.Methods BUN was measured immediately after VRS.A total of 3118 elderly patients were enrolled and divided into four groups according to the quartiles of postoperative BUN:Q1,<5.6 mmol/L;Q2,5.6-6.8 mmol/L;Q3,6.8-8.4 mmol/L and Q4,≥8.4 mmol/L.The associations of postoperative BUN with in-hospital and 1-year mortality were evaluated.Results The incidence of inhospital death(1.0%vs.3.3%vs.3.3%vs.8.4%,P<0.001)and major adverse clinical events(5.1%vs.7.8%vs.9.9%vs.19.1%,P<0.001)was significantly higher in patients with a high BUN level.BUN was independently associated with all-cause in-hospital mortality[odds ratio(OR):1.11,95%confidential interval(CI):1.07-1.16,P<0.001].The receiver operating characteristic(ROC)curve showed that BUN>9 mmol/L had a sensitivity of 48.4%and specificity of 81.8% for predicting in-hospital death[area under curve(AUC):0.705,95%CI:0.658-0.753,P<0.001].Kaplan-Meier survival curves showed that patients with BUN>9 mmol/L had a higher one-year mortality than those without(log-rank test:91.7,P<0.001).Multivariate analysis showed that BUN>9 mmol/L was an independent predictor for one-year mortality[hazard ratio(HR):1.67,95%CI:1.23-2.28,P=0.001].Conclusions This study provided strong evidence that increased postoperative BUN level was associated with poor prognosis in elderly patients undergoing VRS.展开更多
The emergence of meal replacement(MR)originates from physical exercise or fitness as a substitute for one or all meals and later expands to the field of weight loss.Indeed,the main application of current meal replacem...The emergence of meal replacement(MR)originates from physical exercise or fitness as a substitute for one or all meals and later expands to the field of weight loss.Indeed,the main application of current meal replacement is to lose body weight,whether patients with obesity,diabetes,fatty liver,infertile or pregnant women can benefit from weight loss.In addition,MRs still exhibit more biomedical potential in preventing and treating diseases,like anti-diabetes,improving fatty liver and kidney disease,preventing cancer,conceiving and reducing pregnancy complications,and improving life quality.Indeed,there are also disadvantages to meal replacement,including causing adverse effects,although most are acceptable and tolerated.To date,various commercially-developed MRs are walking from dining table to sickbed.Therefore,a scientific understanding of the advantages and disadvantages of meal replacements is crucial for their extensive application beyond biomedical potentials.展开更多
The capacitive deionization(CDI)performance of silver(Ag)electrodes is limited by electrochemical failure induced by volumetric expansion.While carbon encapsulation and Ag size control mitigate stress concentration an...The capacitive deionization(CDI)performance of silver(Ag)electrodes is limited by electrochemical failure induced by volumetric expansion.While carbon encapsulation and Ag size control mitigate stress concentration and pulverization,achieving precise size control,suppression of aggregation,and uniform dispersion of Ag nanoparticles remains challenging.Herein,the metal-organic frameworks(MOF)-assisted pyrolysis-galvanic replacement method was employed to construct ultrafine Ag particles uniformly anchored within a three-dimensional(3D)-ordered porous carbon skeleton composite(3D Ag@NC).By utilizing the potential difference between the elements,spontaneous replacement reactions occur,effectively preventing particle agglomeration usually caused by high-temperature reduction.The in situ constructed 3D porous carbon skeleton not only promotes electron transfer and electrolyte penetration but also mitigates the volume expansion of Ag particles during electrochemical cycling.Consequently,3D Ag@NC demonstrates outstanding dechlorination performance(105.29 mg g^(-1)),high charge efficiency(0.95),and exceptional cycling stability(84.12% after 100 cycles).This galvanic replacement strategy offers valuable insights into the fabrication of other small-sized,highly dispersed metal electrode materials.展开更多
This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter...This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.展开更多
Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR...Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR)as an alternative therapeutic strategy for AR,particularly in patients deemed high risk for surgery.We explored the anatomical and patho-physiological disparities between AR and aortic stenosis(AS)and elucidates the technical nuances of TAVR procedures in AR pa-tients,emphasizing the need for precise prosthesis positioning and considerations for excessive stroke volume.Additionally,we discussed the safety and efficacy of TAVR compared to SAVR in AR management,drawing insights from recent case series and registry data.Notably,dedicated TAVR devices tailored for AR,such as the J-Valve and JenaValve,demonstrate promising out-comes in reducing residual AR and ensuring procedural success.Conversely,“off-label”TAVR devices,including balloon-ex-pandable and self-expandable platforms,offer feasible alternatives-particularly for large aortic annuli-with favorable device suc-cess rates and low residual AR rates.We highlighted the need for further research,including randomized trials,to delineate the definitive role of TAVR in AR treatment and to address remaining questions regarding device selection and long-term outcomes.In conclusion,TAVR emerges as a viable option for patients with AR,particularly those facing high surgical risks or frailty,with ongoing investigations poised to refine its position in the therapeutic armamentarium.展开更多
文摘BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain,which our meta-analysis aims to address.AIM To explore safety and efficacy outcomes for patients undergoing TAVR,comparing periprocedural continuation vs interruption of OAC therapy.METHODS A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC.Data were pooled using a random-effects model with risk ratio(RR)and their 95%confidence interval(CI)as effect measures.All statistical analyses were conducted using Review Manager with statistical significance set at P<0.05.RESULTS Four studies were included,encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8%males.A total of 733 patients underwent OAC interruption and 1080 continued.Stroke incidence was significantly lower in the OAC continuation group(RR=0.62,95%CI:0.40-0.94;P=0.03).No significant differences in major vascular complications were found between the two groups(RR=0.95,95%CI:0.77-1.16;P=0.60)and major bleeding(RR=0.90,95%CI:0.72-1.12;P=0.33).All-cause mortality was non-significant between the two groups(RR=0.83,95%CI:0.57-1.20;P=0.32).CONCLUSION Continuation of OAC significantly reduced stroke risk,whereas it showed trends toward lower bleeding and mortality that were not statistically significant.Further large-scale studies are crucial to determine clinical significance.
文摘With the intensification of population aging,knee and hip joint replacement surgeries have become core methods for treating end-stage joint diseases,with over a million cases performed globally each year.Postoperative rehabilitation nursing,as a crucial aspect of enhancing surgical outcomes,reducing complications,and facilitating patients’return to normal life,has its scientific and effective protocols directly influencing patient prognosis.This article systematically reviews the core research findings on rehabilitation nursing after joint replacement surgery based on the concept of evidence-based medicine,aiming to provide references for the formulation of standardized and personalized rehabilitation nursing plans in clinical settings.
基金supported by the DGIST start-up funds from the Ministry of Science and ICT(2024010330)a National Research Foundation of Korea(NRF)grant funded by the Korea Government(MSIT)(No.RS-2024-00351442)(to TWK).
文摘Parkinson’s disease(PD)is the second most common neurodegenerative disorder.The progressive degeneration of dopamine(DA)producing neurons in the midbrain is the pathological hallmark,which leads to debilitating motor symptoms,including tremors,rigidity,and bradykinesia.Drug treatments,such as levodopa,provide symptomatic relief.However,they do not halt disease progression,and their effectiveness diminishes over time(reviewed in Poewe et al.,2017).
基金funded by Zhejiang Province Science and Technology Department Key R&D Program(2018C03084,2021C03097).
文摘BACKGROUND: Anemia is prevalent in patients undergoing transcatheter aortic valve replacement(TAVR) and has been linked to impaired outcomes after the procedure. Few studies have evaluated the impact of anemia and new ischemic lesions post TAVR.METHODS: We prospectively enrolled 158 patients who received TAVR in our center. Anemia was defined according to the World Health Organization criteria as hemoglobin <12 g/dL in women and <13 g/dL in men. All patients underwent diffusion-weighted magnetic resonance imaging(DW-MRI) procedure before and within 4–7 days after TAVR. RESULTS: Anemia was present in 85(53.8%) patients who underwent TAVR, and 126(79.7%) patients had 718 new DW-MRI positive lesions with a mean of 4.54±5.26 lesions per patient. The incidence of new ischemic lesions was 81.2% in patients with anemia versus 78.1% in patients without anemia(P=0.629). Moreover, anemic patients had bigger total volume/lesions in the anterior cerebral artery/middle cerebral artery(ACA/MCA) and MCA regions compared to the non-anemic patients(31.89±55.78 mm^(3) vs. 17.08±37.39 mm^(3), P=0.049;and 54.54±74.72 mm^(3) vs. 33.75±46.03 mm^(3), P=0.034). Anemia was independently associated with the volume/lesion in the ACA/MCA(β=16.796, 95% confidence interval [95% CI] 2.001 to 31.591, P=0.026) and in the MCA zone(β=0.020, 95% CI 0.001 to 0.040, P=0.041). CONCLUSIONS: Patients with pre-procedural anemia may have bigger total volume/lesions in the ACA/MCA and MCA regions compared to the non-anemic patients. Whether the consequences of bigger total volume/lesions impact neurological and cognitive outcomes remains to be investigated.
文摘Objective: To investigate the effect of flurbiprofen axetil analgesia after knee replacement on the cytokine contents in serum and joint fluid as well as HPA axis activity. Methods: Patients who underwent knee replacement in People's Hospital of Dongxihu District between April 2015 and January 2018 were selected as the research subjects and randomly divided into the experimental group who accepted flurbiprofen axetil combined with patient-controlled intravenous analgesia and the control group who accepted patient-controlled intravenous analgesia alone. The contents of cytokines and HPA axis-related hormones in serum were measured before surgery as well as 1 d and 3 d after surgery;the contents of cytokines in joint fluid were measured 1 d and 3 d after surgery. Results: Compared with those of same group before surgery, NGF, NPY, TNF-α, IL-2, IL-4, IL-10, ACTH, COR, INS, GH and PRL levels of both groups were increasing 1 d and 3 d after surgery, and NGF, NPY, TNF-α, IL-2, IL-4, IL-10, ACTH, COR, INS, GH and PRL levels in serum as well as PGE2, OPN, TGF-β1, FGF21, CXCL12 and YKL-40 in joint fluid of experimental group 1 d and 3 d after surgery were lower than those of control group. Conclusion: Flurbiprofen axetil analgesia after knee replacement can reduce the release of cytokines in serum and joint fluid, and inhibit the activity of HPA axis, and its analgesic effect is exact.
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
文摘Piperacillin/tazobactam and ciprofloxacin are often used in combination as initial empiric anti-biotic therapy in critical ill patients. Especially in patients undergoing continuous renal replacement therapy (CRRT) the pharmacokinetics of antimicrobial agents can be highly variable. In order to avoid under- or overdosage of antibiotics therapeutic drug monitoring (TDM) is highly re-commendable. Based on two known HPLC assays for piperacillin a new method in combination with solid phase extraction (SPE) for the simultaneous determination of piperacillin and ciprofloxacin was developed. Method validation was performed according to the EMA guideline on validation of bioanalytical methods. The HPLC column used was a Perfect Bond ODS-HD C18 analytical column (100 mm × 4.6 mm i.d., particle size 5 μm), equipped with a guard column (10 mm × 4.6 mm, particle size 5 μm) containing the same packing material. Detection wavelength was set at 228 nm for piperacillin and benzylpenicillin was used as internal standard (IS). Ciprofloxacin was determined at two wavelengths (280 nm, 315 nm). This newly developed HPLC method in combination with SPE-extraction allows an accurate, precise, specific and efficient determination of piperacillin and ciprofloxacin in biological matrices. Results allow the calculation of all relevant pharmacokinetic data for critically ill patients undergoing CRRT and the optimization of dosing and TDM.
文摘Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durable valve function.This review provides an overview of both surgical andtranscatheter options for aortic,mitral,pulmonary,and tricuspid valve replacements in pediatric patients,highlighting the indications,outcomes,and advancements in technology and technique.Surgical valvereplacement traditionally involves the implantation of biological or mechanical prosthetic valves,withbiologicalvalves beingpreferred in children to reduce the need for lifelong anticoagulation therapy.However,the limitation ofbiological prostheses,nanely their inability to grow with the child,necessitates the frequentneed for reoperations.Recent innovations in valve engineering,such as the development of tissue engineeredand expandable valves,aim to address these issues.Transcatheter valve replacement(TVR)has emergedas a promising alternative,particularly for patients with complex anatomy or those who are high-risk fortraditional surgery.While the use of transcatheter devices in children remains limited due to the smallervascular size and limited long-termn data,several studies have demonstrated the feasibility and safety ofthe procedure in certain patient populations.Despite these advancements,challenges related to valvesize,durability,and the need for individualized treatment planning persist.The future of pediatric heartvalve replacemnent will likely involve a multidisciplinary approach combining surgical,transcatheter,andregenerative medicine strategies,aimed at optimizing outcomes,reducing the need for reinterventions,andimproving long-term quality of life for pediatric patients with valvularheart disease.This article discussesall options availab le for patients with valvular dysfunction,making it easy for parents/patients to go to as areference source of information.
文摘In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,commonly due to periprosthetic loosening.Revision procedures are associated with significantly increased healthcare costs;therefore,timely and accurate diagnostics are critical for clinicians and patients.Loosening,which may be septic or aseptic,remains a challenge and requires thorough clinical examination and multimodal imaging evaluation.Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography,magnetic resonance imaging and nuclear medicine are playing an increasingly important role.This comprehensive review,through outlining the available radiological modalities,their respective strengths and weaknesses and the pertinent imaging findings,may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.
基金supported by the Chaozhou Municipal Health Bureau Scientific Research Project(No.2021021)。
文摘Background Continuous renal replacement therapy(CRRT)is frequently applied in critically ill patients with acute kidney injury who are vulnerable to cardiovascular complications.Differences in calcium management during CRRT may affect cardiac electrophysiology and hemodynamic stability,potentially influencing cardiovascular outcomes.Methods A total of 96 patients receiving CRRT were enrolled in this single-center study between September 2020 and September 2023.Patients were divided into two groups:those receiving calcium-containing replacement fluids(n=46)and those receiving calcium-free fluids(n=50).Clinical outcomes,including major adverse cardiovascular events(MACE),arrhythmias,hypotension,myocardial infarction,sudden cardiac arrest,intensive care units(ICU)stays,and hospital mortality,were compared between the two groups.Results The calcium-containing group had a significantly lower incidence of MACE(20%vs.32%,P<0.001)and arrhythmias(8%vs.17.3%,P=0.010)compared to the calcium-free group.ICU stays were also shorter in the calcium-containing group(11.6±8.8 days vs.16.6±7.6 days,P=0.004).Hospital mortality showed a trend toward being lower in the calciumcontaining group,though this was not statistically significant(0.6%vs.10.1%,P=0.063).No significant differences were observed in the incidence of hypotension,myocardial infarction,or sudden cardiac arrest.Conclusions Calcium-containing replacement fluids during CRRT were associated with improved clinical outcomes,including lower rates of MACE and arrhythmias,as well as shorter ICU stays.This simplified approach may be safer and more efficient,but larger studies are needed to confirm these findings and assess long-term outcomes.
文摘Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,accounting for 25%of patients aged 85 years and older in Europe and 12%of patients older than 80 years in Japan.[2,3]Recent studies have reported that ATTRwt-CA coexists in 11%-16%of older patients with AS undergoing transcatheter aortic valve replacement(TAVR).[1,4,5]In a metaanalysis by Ho et al.,[6]the prevalence rates of cardiac amyloidosis,predominantly ATTRwt-CA,in patients with AS and those referred for TAVR or surgical aortic valve replacement(SAVR)were 14.4%and 15.2%,respectively.Conversely,the prevalence of AS in patients with cardiac amyloidosis is 8.7%.Owing to the high surgical risk in patients with both AS and ATTRwt-CA,TAVR may be preferred over SAVR.
文摘Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements over last two decades,there are still significant challenges in field in terms of appropriate selection of patients as well as the valves.While there is no doubt that TAVR has now become the leading mode of treatment for severe AS patients,surgical aortic valve replacement(SAVR)still holds its value for the selective group of patients who are not ideal candidate for the minimally invasive procedure:TAVR.The dilemma is palpable in the clinical field that warrants best approach focusing on the lifetime management of these patients.In the recent metanalysis by Moradi et al,the authors provide a comprehensive insight into TAVR vs SAVR in terms of mortality,procedural complications,and post-procedure adverse events.In this editorial,we shed light on comparative analysis of both modalities to establish a middle ground.
基金the National Natural Science Foundation of China(No.5220031085)the Postdoctoral Research Project in Henan Province(No.HN2022054)+2 种基金the Key Scientific Research Projects of Colleges and Universities in Henan Province(No.23A430009)the State Key Laboratory of Polymer Materials Engineering(No.sklpme2022-4-03)the Key Technologies R&D Program of Henan Province(No.242102230131)。
文摘The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacterial efficacy remains a formidable challenge.In this context,we proposed a novel strategy that leverages swelling and erosion mechanisms to facilitate drug release of drug-loaded ultrahigh molecular weight polyethylene(UHMWPE),thereby ensuring its long-lasting antibacterial performance.Polyethylene oxide(PEO),a hydrophilic polymer with fast hydrating ability and high swelling capacity,was incorporated in UHMWPE alongside the antibacterial tea polyphenol(epigallocatechin gallate,EGCG as representative).The swelling of PEO enhanced water infiltration into the matrix,while the erosion of PEO balanced the release of the encapsulated EGCG,resulting in a steady release.The behavior was supported by the EGCG release profiles and the corresponding fitted release kinetic models.As demonstrated by segmented antibacterial assessments,the antibacterial efficiency was enhanced 2to 3 times in the PEO/EGCG/UHMWPE composite compared to that of EGCG/UHMWPE.Additionally,the PEO/EGCG/UHMWPE composite exhibited favorable biocompatibility and mechanical performance,making it a potential candidate for the development of drug-releasing joint implants to combat prosthetic bacterial infections.
文摘Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasingly older,have comorbidities,and frailty.TAVR cardiac rehabilitation(CR)programs significantly improve both functional capacity and quality of life of patients.However,there are no guidelines on how to carry out them and few elderly patients are referred to CR.Furthermore,mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs.Multidisciplinary patient care,including comorbidities and frailty,is essential.It is necessary to ensure exquisite continuity of care during TAVR,CR,and the rest of the patient's life.Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR,given the high demand.This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.
文摘China’s enhanced intellectual property rights(IPR)protection framework presents a promising prospect for European SMEs to pursue strategic growth and market expansion within the country’s innovation-driven economy.
基金supported by grants from the initial funding of National Natural Science Foundation of China(No.8227020480)。
文摘Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patients undergoing valve replacement surgery(VRS)remained sparse.Methods BUN was measured immediately after VRS.A total of 3118 elderly patients were enrolled and divided into four groups according to the quartiles of postoperative BUN:Q1,<5.6 mmol/L;Q2,5.6-6.8 mmol/L;Q3,6.8-8.4 mmol/L and Q4,≥8.4 mmol/L.The associations of postoperative BUN with in-hospital and 1-year mortality were evaluated.Results The incidence of inhospital death(1.0%vs.3.3%vs.3.3%vs.8.4%,P<0.001)and major adverse clinical events(5.1%vs.7.8%vs.9.9%vs.19.1%,P<0.001)was significantly higher in patients with a high BUN level.BUN was independently associated with all-cause in-hospital mortality[odds ratio(OR):1.11,95%confidential interval(CI):1.07-1.16,P<0.001].The receiver operating characteristic(ROC)curve showed that BUN>9 mmol/L had a sensitivity of 48.4%and specificity of 81.8% for predicting in-hospital death[area under curve(AUC):0.705,95%CI:0.658-0.753,P<0.001].Kaplan-Meier survival curves showed that patients with BUN>9 mmol/L had a higher one-year mortality than those without(log-rank test:91.7,P<0.001).Multivariate analysis showed that BUN>9 mmol/L was an independent predictor for one-year mortality[hazard ratio(HR):1.67,95%CI:1.23-2.28,P=0.001].Conclusions This study provided strong evidence that increased postoperative BUN level was associated with poor prognosis in elderly patients undergoing VRS.
基金funded by the National Natural Science Foundation of China(82070877)the CAMS Innovation Fund for Medical Sciences(CIFMS)(2021-I2M-1-028,2021-I2M-1-005)the International Cooperation Project of Qinghai Province(2020-HZ-803)。
文摘The emergence of meal replacement(MR)originates from physical exercise or fitness as a substitute for one or all meals and later expands to the field of weight loss.Indeed,the main application of current meal replacement is to lose body weight,whether patients with obesity,diabetes,fatty liver,infertile or pregnant women can benefit from weight loss.In addition,MRs still exhibit more biomedical potential in preventing and treating diseases,like anti-diabetes,improving fatty liver and kidney disease,preventing cancer,conceiving and reducing pregnancy complications,and improving life quality.Indeed,there are also disadvantages to meal replacement,including causing adverse effects,although most are acceptable and tolerated.To date,various commercially-developed MRs are walking from dining table to sickbed.Therefore,a scientific understanding of the advantages and disadvantages of meal replacements is crucial for their extensive application beyond biomedical potentials.
基金financially supported by the Innovative Research Groups of the National Natural Science Foundation of China(No.52121004)the National Natural Science Foundation of China(52374423)+1 种基金the Major Science and Technology Programs of Yunnan Province(202302AB080016)the Hunan Provincial Natural Science Youth Fund(2024JJ6726)。
文摘The capacitive deionization(CDI)performance of silver(Ag)electrodes is limited by electrochemical failure induced by volumetric expansion.While carbon encapsulation and Ag size control mitigate stress concentration and pulverization,achieving precise size control,suppression of aggregation,and uniform dispersion of Ag nanoparticles remains challenging.Herein,the metal-organic frameworks(MOF)-assisted pyrolysis-galvanic replacement method was employed to construct ultrafine Ag particles uniformly anchored within a three-dimensional(3D)-ordered porous carbon skeleton composite(3D Ag@NC).By utilizing the potential difference between the elements,spontaneous replacement reactions occur,effectively preventing particle agglomeration usually caused by high-temperature reduction.The in situ constructed 3D porous carbon skeleton not only promotes electron transfer and electrolyte penetration but also mitigates the volume expansion of Ag particles during electrochemical cycling.Consequently,3D Ag@NC demonstrates outstanding dechlorination performance(105.29 mg g^(-1)),high charge efficiency(0.95),and exceptional cycling stability(84.12% after 100 cycles).This galvanic replacement strategy offers valuable insights into the fabrication of other small-sized,highly dispersed metal electrode materials.
基金Supported by National High Level Hospital Clinical Research Funding Project,No.BJ-2023-206.
文摘This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.
文摘Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR)as an alternative therapeutic strategy for AR,particularly in patients deemed high risk for surgery.We explored the anatomical and patho-physiological disparities between AR and aortic stenosis(AS)and elucidates the technical nuances of TAVR procedures in AR pa-tients,emphasizing the need for precise prosthesis positioning and considerations for excessive stroke volume.Additionally,we discussed the safety and efficacy of TAVR compared to SAVR in AR management,drawing insights from recent case series and registry data.Notably,dedicated TAVR devices tailored for AR,such as the J-Valve and JenaValve,demonstrate promising out-comes in reducing residual AR and ensuring procedural success.Conversely,“off-label”TAVR devices,including balloon-ex-pandable and self-expandable platforms,offer feasible alternatives-particularly for large aortic annuli-with favorable device suc-cess rates and low residual AR rates.We highlighted the need for further research,including randomized trials,to delineate the definitive role of TAVR in AR treatment and to address remaining questions regarding device selection and long-term outcomes.In conclusion,TAVR emerges as a viable option for patients with AR,particularly those facing high surgical risks or frailty,with ongoing investigations poised to refine its position in the therapeutic armamentarium.
