Subtle changes have occurred in China, and interventional radiology has gradually become an independent specialty, separated from diagnostic radiology. This has been called "Interventionalogy", "interve...Subtle changes have occurred in China, and interventional radiology has gradually become an independent specialty, separated from diagnostic radiology. This has been called "Interventionalogy", "interventional medicine(IM)", or simply Intervention by our team,and "Interventional Radiology" is used no more. It has even been given the name "Third clinical Medicine" by us. Chinese intervention has established an independent association for interventional doctors, as well as independent interventional societies in many provinces. The national interventional society will likely be set up at some point in time. Chinese interve ntion has set up their own clinical wards, with much attention paid to a clinical, professional, and normalized direction for development, and established special nursing units. According to us, turf battle is meaningless. "The Third clinical Medicine" belongs to all human beings. It could also be predicted that interventional history will follow the same evolutionary rule as other disciplines, i.e., "long divided, must unite; long united, must divide".展开更多
OBJECTIVE: To study the effects on self-efficacy and quality of life in patients undergoing coronary intervention, by traditional Chinese medicine nursing combined with refined nursing. METHODS: A total of 124 patient...OBJECTIVE: To study the effects on self-efficacy and quality of life in patients undergoing coronary intervention, by traditional Chinese medicine nursing combined with refined nursing. METHODS: A total of 124 patients, who needed to undergo coronary intervention in our hospital, were randomly divided into the fine group and the combined group, with 62 patients in each group. The two groups of patients were enrolled in the PCI routine nursing procedure, in which the fine group was given refined nursing, and the joint group, based on that, added the traditional Chinese medicine nursing. The self-management (self-management scale of coronary heart disease), self-efficacy (self-efficacy scale of coronary heart disease), quality of life score (Seattle angina questionaire (SAQ), TCM symptom score] of the two groups were observed before and after treatment. The incidence of postoperative complications after nursing intervention was recorded. RESULTS: After nursing intervention, each score and total scores of the self-administration scale of the combined group were higher than those of the fine group (P < 0.05). After the nursing intervention, each score and the total scores of the self-efficacy scale of the combined group were higher than the fine group (P < 0.05) After the nursing intervention, the SAQ score of the combined group was significantly higher than that of the fine group (P < 0.05). After the nursing intervention, TCM symptom score of the combined group was significantly lower than that of the fine group (P < 0.05). After nursing intervention, the postoperative complication rate of the combined group was 79.03%, which was lower than that of the fine group (59.68%)(P < 0.05). CONCLUSION: Patients with coronary intervention, who use traditional Chinese medicine combined with refined nursing, can improve their quality of life, clinical symptoms and postoperative complications by improving their self-management and efficacy, which is conducive to the recovery of patients' follow-up.展开更多
Objective:To explore the influence on liver function of hepatic artery interventional chemoembolization combined reduced glutathione therapy for elderly patients with advanced liver cancer.Methods:A total of 120 cases...Objective:To explore the influence on liver function of hepatic artery interventional chemoembolization combined reduced glutathione therapy for elderly patients with advanced liver cancer.Methods:A total of 120 cases of elderly patients with advanced liver cancer from digestive surgery in-patient department of our hospital during the period of January 2014 and January 2016 were selected as the research object, the patients were divided into two groups by using the random number table method,each for 60 cases.The control group were given conventional drugs chemotherapy, the study group were given hepatic artery interventional chemoembolization combined reduced glutathione therapy, serum liver function indexes of Direct Bilirubin(DBil), Total Bilirubin(TBil), Aspartate Transaminase(AST) and Alanineamino Transferase (ALT)were detected by using automatic biochemical analyzer. Results: The clinical remission rate of study group was significantly higher than the control group, the recurrence rate was obviously lower than the control group,compared between the two groups with statistically significant differences. The average survival time of study group (29.36±6.25) months, was significantly longer than the control group (18.02±4.16) months .Before the treatment, serum DBil, TBil, AST and ALT levels compared between the two groups with no statistically significant differences,after the treatment,the indexes of study group was significantly lower than the control group. The indexes levels compared between pre-therapy and post-therapy in study group with no statistically significant differences, while the indexes levels of post-therapy in the control group were significantly higher than those pre-therapy. Before the treatment, the life quality score compared between the two groups with no statistically significant differences, after treatment,the score of all patients were significantly higher than those pre-therapywhich the score of study group was significantly higher than the control group.The incidence rate of drug adverse reactions compared between the two groups with no statistically significant differences.Conclusion: The clinical efficacy of hepatic artery interventional chemoembolization combined reduced glutathione therapy for elderly patients with advanced liver cancer is satisfying, and helps to significantly improve liver function, improve life quality, it is worth popularization and application in the clinical practice.展开更多
Objective:To investigate the effect of arterial interventional chemotherapy before radical operation for gastric cancer on serum tumor markers and cell growth in the lesion.Methods:90 patients with primary gastric can...Objective:To investigate the effect of arterial interventional chemotherapy before radical operation for gastric cancer on serum tumor markers and cell growth in the lesion.Methods:90 patients with primary gastric cancer who underwent radical operation for gastric cancer in our hospital were chosen as the research subjects and divided into the control group (n=48) (did not receive preoperative arterial interventional chemotherapy) and the arterial interventional chemotherapy group (n=42) (received preoperative arterial interventional chemotherapy). The differences in tumor markers in serum as well as proliferation and apoptosis gene expression in gastric cancer tissues were compared.Results: Before surgery started, serum CA199, CA153, CA724 and AFP levels of arterial interventional chemotherapy group were significantly lower than those immediately after admission whereas serum CA199, CA153, CA724 and AFP levels of control group were not significantly different from those immediately after admission. After surgery, proliferation genes CUL4A and NTSR1 mRNA expression in gastric cancer tissues of arterial interventional chemotherapy group were lower than those of control group whereas DADS and FAM96B mRNA expression were higher than those of control group;apoptosis genes Livin and Bcl-2 mRNA expression were lower than those of control group whereas p53, p21 and Bax mRNA expression were higher than those of control group.Conclusion:Preoperative arterial interventional chemotherapy combined with radical operation for gastric cancer can more effectively inhibit the malignant degree of tumor and delay the growth of cancer cells.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a common tumor with a poor prognosis.Early intervention is essential;thus,good prognostic markers to identify patients who benefit from first transarterial chemoembolization(...BACKGROUND Hepatocellular carcinoma(HCC)is a common tumor with a poor prognosis.Early intervention is essential;thus,good prognostic markers to identify patients who benefit from first transarterial chemoembolization(TACE)are needed.AIM To investigate the efficacy of computed tomography(CT)radiomics in predicting the success of the first TACE in patients with advanced HCC and to develop an early prediction model based on clinical radiomics features.METHODS Data from 122 patients with advanced HCC treated with TACE were analyzed.Intratumoral and peritumoral areas on arterial and venous CT images were selected to extract radiomic features,which were screened in the training cohort using the minimum redundancy maximum correlation.Then,support vector machines were used to construct the model.To construct a receiver operating characteristic curve,the predictive efficacy of each model was evaluated on the basis of the area under the curve(AUC).RESULTS Among the 122 patients,72 patients were effectively treated via TACE,and in 50 patients,this treatment was ineffective.In the radiomics model,the areas under the curve of the venous phase model were 0.867(95%CI:0.790-0.940)in the training cohort and 0.755(0.600-0.910)in the validation cohort,indicating good predictive efficacy.The multivariate logistic regression results indicated that preoperative alpha-fetoprotein levels(P=0.01)were a risk factor for TACE.The screened clinical features were combined with the radiomic features to construct a combined model.This combined model had an AUC of 0.92(0.87-0.95)in the training cohort and 0.815(0.67-0.95)in the validation cohort.CONCLUSION CT radiomics has good value in predicting the efficacy of the first TACE treatment in patients with HCC.The combined model was a better tool for predicting the first TACE efficacy in patients with advanced HCC and could provide an efficient predictive tool to help with the selection of patients for TACE.展开更多
BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment...BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.展开更多
Background:Hemoptysis patients with bronchial artery-pulmonary artery fistula(BPF)have a high incidence of poor prog-nosis.This study aimed to evaluate the diagnostic performance of computed tomography angiography(CTA...Background:Hemoptysis patients with bronchial artery-pulmonary artery fistula(BPF)have a high incidence of poor prog-nosis.This study aimed to evaluate the diagnostic performance of computed tomography angiography(CTA)for detecting BPF in hemoptysis patients and to compare the clinical characteristics and computed tomography(CT)findings between patients with and without BPF.Methods:We retrospectively enrolled 201 consecutive patients with hemoptysis who underwent bronchial arterial emboli-zation in our hospital from January 2020 to November 2020.The clinical characteristics,preprocedural CT findings,and digital subtraction angiography(DSA)findings were recorded.Patients were categorized into BPF-positive and BPF-negative groups based on DSA results.The diagnostic accuracy of CTA for BPF detection was evaluated against that of DSA using receiver operating characteristic curve analysis.Differences in clinical and CT parameters between the two groups were assessed.Multivariate logistic regression analysis was used to discover the independent factors associated with the presence of BPF.Results:Among 201 patients with hemoptysis,DSA identified BPF in 75,while CTA identified BPF in 65.The diagnostic agreement between CTA and DSA for BPF detection was excellent(Kappa coefficient:κ=0.825,p<0.001).CTA demonstrated high sensitivity(0.827),specificity(0.976),and accuracy(0.920)for BPF detection.Multivariate logistic analysis identified the severity of pulmonary parenchymal lesion and bronchial artery tortuosity as independent predictors of BPF.Conclusions:Preprocedural CTA is a reliable examination to identify BPF in patients with hemoptysis.Pulmonary lesion severity and bronchial artery tortuosity are independent factors associated with the presence of BPF in patients with hemoptysis.展开更多
BACKGROUND Observational studies reported characteristics and outcomes of patients with secondary mitral valve regurgitation(MR)who underwent transcatheter edge-toedge repair of the mitral valve.No study investigated ...BACKGROUND Observational studies reported characteristics and outcomes of patients with secondary mitral valve regurgitation(MR)who underwent transcatheter edge-toedge repair of the mitral valve.No study investigated the temporal trend of patient characteristics and outcomes in comparison with the published randomized trials.AIM To investigate the temporal trend in baseline characteristics and outcomes of patients with secondary MR who underwent transcatheter edge-to-edge repair of the mitral valve in the real world compared with those from the published landmark trials.METHODS A comprehensive systematic literature search was conducted using MEDLINE,EMBASE,and CENTRAL databases,and the identified observational studies were divided into two five-year recruitment periods.The first period included 36 studies that enrolled patients between 2008 and 2012,and the second period included 25 studies that recruited patients between 2013 and 2017-2018.Pooled variables of each five-year recruitment period were compared with those of the landmark trials.A random-effects model was used for statistical comparisons.RStudio and RevMan software were used for the analysis.RESULTS Overall,there were no major variations in the findings between the first and the second five-year recruitment periods.EVEREST program vs observational studies:Patients in the EVEREST program were more likely to have non-ischemic MR etiology[odds ratio(OR)=3.59,95%confidence interval(CI):2.92-4.42]and atrial fibrillation(OR=1.71,95%CI:1.42-2.06).They were less likely to receive angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers(OR=0.72,95%CI:0.58-0.90)and implantable cardiac device(OR=0.41,95%CI:0.33-0.49)as well as less likely to be symptomatic at hospital presentation without a difference in MR grade≤2+or mortality at 12-month follow-up.COAPT trial vs observational studies:COAPT patients were more likely to have prior myocardial infarction(OR=1.62,95%CI:1.27-2.06)and renal insufficiency(OR=2.66,95%CI:2.05-3.45).They were more likely to receive beta-blockers(OR=2.54,95%CI:1.68-3.85)and an implanted cardiac device(OR=2.20,95%CI:1.71-2.84).There was no difference in procedure success or mortality.MITRA-FR trial vs observational studies:MITRA-FR patients were less likely to have atrial fibrillation(OR=0.49,95%CI:0.34-0.69)and renal insufficiency(OR=0.18,95%CI:0.11-0.28)but more likely to have a history of myocardial infarction(OR=1.48,95%CI:1.06-2.05)and to receive diuretics(OR=19.81,95%CI:2.75-142.48)and implantable cardiac devices(OR=1.69,95%CI:1.21-2.37).At hospital presentation,they were less likely to be symptomatic(OR=0.25,95%CI:0.18-0.35)without a difference in MR grades 3+and 4+.There was no difference in terms of MR grade or mortality at 12-month follow-up.CONCLUSION Patients in the landmark studies may have favourable or unfavourable characteristics when compared to those in the observational studies,but this did not translate into different outcomes over time.展开更多
AIM To evaluate the effectiveness and safety of combined ursodeoxycholic acid and percutaneous transhepatic balloon dilation for management of gallstones after expulsion of common bile duct(CBD) stones.METHODS From Ap...AIM To evaluate the effectiveness and safety of combined ursodeoxycholic acid and percutaneous transhepatic balloon dilation for management of gallstones after expulsion of common bile duct(CBD) stones.METHODS From April 2014 to May 2016, 15 consecutive patients(6 men and 9 women) aged 45-86(mean, 69.07 ± 9.91) years suffering from CBD stones associated with gallstones were evaluated. Good gallbladder contraction function was confirmed by type B ultrasonography. Dilation of the CBD and cystic duct was detected. Percutaneous transhepatic balloon dilation of the papilla was performed, ursodeoxycholic acid was administered, and all patients had a high-fat diet. All subjects underwent repeated cholangiography, and percutaneous transhepatic removal was carried out in patients with secondary CBD stones originating from the gallbladder. RESULTS All patients underwent percutaneous transhepatic balloon dilation with a primary success rate of 100%. The combined therapy was successful in 86.7% of patients with concomitant CBD stones and gallstones. No remaining stones were detected in the gallbladder. Transient adverse events include abdominal pain(n = 1), abdominal distension(n = 1), and fever(n = 1). Complications were treated successfully via nonsurgical management without long-term complications. No procedure-related mortality occurred. CONCLUSION For patients with concomitant CBD stones and gallstones, after percutaneous transhepatic removal of primary CBD stones, oral ursodeoxycholic acid and a high-fat diet followed by percutaneous transhepatic removal of secondary CBD stones appear to be a feasible and effective option for management of gallstones.展开更多
AIM To assess the feasibility and effectiveness of a novel application of percutaneous intraductal radiofrequency (RF) for the treatment of biliary stent obstruction. METHODS We specifically report a retrospective stu...AIM To assess the feasibility and effectiveness of a novel application of percutaneous intraductal radiofrequency (RF) for the treatment of biliary stent obstruction. METHODS We specifically report a retrospective study presenting the results of percutaneous intraductal RF in patients with biliary stent occlusion. A total of 43 cases involving biliary stent obstruction were treated by placing an EndoHPB catheter and percutaneous intraductal RF was performed to clean stents. The stent patency was evaluated by cholangiography and follow-up by contrast enhanced computed tomography or ultrasound after the removal of the drainage catheter. RESULTS Following the procedures, of the 43 patients, 40 survived and 3 died with a median survival of 80.5 (range: 30-243) d. One patient was lost to followup. One patient had the stent patent at the time of last follow-up. Two patients with stent blockage at 35 d and 44 d after procedure underwent percutaneous transhepatic drain insertion only. The levels of bilirubin before and after the procedure were 128 +/- 65 mu mol/L and 63 +/- 29 mu mol/L, respectively. There were no related complications (haemorrhage, bile duct perforation, bile leak or pancreatitis) and all patients' stent patency was confirmed by cholangiography after the procedure, with a median patency time of 107 (range: 12-180) d. CONCLUSION This preliminary clinical study demonstrated that percutaneous intraductal RF is safe and effective for the treatment of biliary stent obstruction, increasing the duration of stent patency, although randomized controlled trials are needed to confirm the effectiveness of this approach.展开更多
Objective:To investigate the clinical utility of ultrasound-guided balloon occlusion in cesarean section in patients with sinister placenta previa.Methods:The Interventional and Ultrasound Departments of the authors’...Objective:To investigate the clinical utility of ultrasound-guided balloon occlusion in cesarean section in patients with sinister placenta previa.Methods:The Interventional and Ultrasound Departments of the authors’center assisted obstetrics to complete cesarean section in cases of sinister placenta previa.A total of 130 patients with implanted sinister placenta previa were diagnosed using obstetrical ultrasound and magnetic resonance imaging(MRI).Before cesarean section,the balloon was positioned in the bilateral radial or abdominal aorta.Immediately after delivery of the fetus,the balloon was temporarily filled to transiently seal the target vessel.According to the obstetrician’s assessment of hemostasis,the balloon was withdrawn at the appropriate time.Among the 130 patients,there was one case of abdominal aortic occlusion,with 129 cases blocked by the bilateral common iliac artery.Results:All 130 cases were successfully blocked,with an average blocking time of<15 min,while intraoperative blood loss was 800–1500 ml.Conclusion:Ultrasound-guided balloon blocking treatment before cesarean section can mitigate the dangers of placenta previa and significantly reduce blood loss with no exposure to X-ray radiation.Thus,the technique merits serious consideration.展开更多
Background context:Metastatic spinal cord compression(MSCC)seriously affects the survival rate.Objective:The therapeutic effects of two treatment strategies for MSCC:percutaneous vertebroplasty(PVP)combined with radio...Background context:Metastatic spinal cord compression(MSCC)seriously affects the survival rate.Objective:The therapeutic effects of two treatment strategies for MSCC:percutaneous vertebroplasty(PVP)combined with radiofrequency ablation(RFA)and PVP combined with^(125)I particle implantation,were compared.Study design:Retrospective study.Patient sample:40 patients with MSCC were divided into two groups:19 cases in the RFA group and 21 cases in the^(125)I group.Method:All patients were accessed to determine the differences in pain,which was evaluated using the visual analog scale(VAS)at 1 week,1 month,and 3 months after the operation,and spinal stenosis rates(SSRs),which were measured at 1 and 3 months after the operation,between the two groups.Results:The VAS scores and SSRs at baseline were comparable between the RFA group and the^(125)I group(7.19±2.07 vs 7.42±1.95,37.7%±11.2%vs 41.1%±11.4%).The VAS scores and SSRs at 1 month and 3 months after the operation were significantly reduced in both groups,compared with those at baseline.The VAS scores and SSRs in the^(125)I group were lower than those in the RFA group at 3 months after the operation(1.09±0.97 vs 1.75±1.06 p=0.048 and 12.3%±6.4%vs 18.1%±10.1%p=0.034),while the VAS scores at1 week after the operation in the RFA group were lower than those in the^(125)I group(4.39±1.34 vs 5.05±1.82 p=0.049).Conclusion:PVP combined with RFA has a slight advantage in relieving pain in the short term,while PVP combined with^(125)I particle implantation may have a better effect in the relieving pain and decreasing the SSRs at 3 months after the operation.展开更多
BACKGROUND Implanted intravenous infusion port(IVAP)is indicated for patients undergoing chemotherapy,total parenteral nutrition and long-term antibiotic treatment.Among their complications,the rupture and migration o...BACKGROUND Implanted intravenous infusion port(IVAP)is indicated for patients undergoing chemotherapy,total parenteral nutrition and long-term antibiotic treatment.Among their complications,the rupture and migration of the catheter of an IVAP via internal jugular vein represents a very rare but potentially severe condition.CASE SUMMARY A 43-year-old woman was identified with a spontaneous fracture and migration of catheter of an IVAP via right internal jugular vein after adjuvant chemotherapy for left breast cancer.A computed tomography showed the fractured catheter of the IVAP in the pulmonary artery.Therefore,we conducted an emergency procedure to remove the catheter fragment by a pigtail catheter combined with a gooseneck trap.CONCLUSION When the fractured catheter of an IVAP was detected,the special shape of the pigtail catheter in combination with the gooseneck trap successfully facilitated the removal of the dislodged catheter.展开更多
Objective： Hepatocellular carcinoma （HCC） is a complex disease which associates with both environmental and genetic factors. The purpose of this study was to investigate whether the genetic polymorphisms of UDP-glu...Objective： Hepatocellular carcinoma （HCC） is a complex disease which associates with both environmental and genetic factors. The purpose of this study was to investigate whether the genetic polymorphisms of UDP-glucuronosyltransferase（UGT1A7）, an important phase II biotransformation enzyme, and X-ray repair cross-complementing group 1（XRCC1）, a pivotal DNA-repair gene, were related to the risk of HCC in Northeast China. Methods： One hundred and thirty six HCC patients and one hundred and thirty six frequency-matched controls were included in this hospital-based case-control study. Genotypes of UGT1A7 and XRCC1 were determined using allele-specific polymerase chain reaction （AS-PCR） and PCR-restriction fragment length polymorphism （RFLP）, and for which the odds ratio （OR） with 95% confidence interval （95% CI） were calculated. Results： The proportion of UGT1A7 low enzymatic allele （＊2 or ＊3） was higher in HCC patients than those in controls. The UGT1A7＊1/＊2 and ＊3/＊3 genotypes were associated with higher HCC risk （OR=2.09, 95%CI： 1.10-3.97; OR=5.67, 95%CI： 1.76-18.30, respectively）. The XRCC1 codon 399 Arg/Gln genotype could also elevate HCC risk （OR=2.16, 95% CI 1.29-3.61）. In addition to polymorphisms of UGT1A7 and XRCC1, multivariate logistic regression analysis demonstrated that other significant independent factors associated with HCC were HBV infection （OR=68.07, 95%CI： 28.03-165.26）, HCV infection （OR=30.97, 95%CI： 8.06-118.94） and family history of HCC （OR=10.62, 95%CI： 2.22-50.77）. Conclusion： The study shows that the polymorphisms of UGT1A7 and XRCC1 are associated with HCC risk. Determination of the polymorphisms of UGT1A7 and XRCC1 may provide an important clue to preventive measure against HCC.展开更多
Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,co...Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,conven?tional RFA has a limited ablation zone;as such,it is rarely used to treat ruptured tumors.Case presentation:This case was a 60?year?old man who had a large,ruptured HCC in which hydrochloric acid(HCl)?enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic.Conclusion:Considering the effectiveness of HCl?enhanced RFA in achieving hemostasis and tumor ablation,it might be a new option for treating large,ruptured HCCs.展开更多
A 55-year-old man developed deep venous thrombosis and inferior vena cava(IVC) thrombosis 7 years earlier and was treated by placement of a permanent IVC filter. One week ago, he was admitted with bilateral lower limb...A 55-year-old man developed deep venous thrombosis and inferior vena cava(IVC) thrombosis 7 years earlier and was treated by placement of a permanent IVC filter. One week ago, he was admitted with bilateral lower limb swelling and pain. Digital subtraction angiography showed a filling defect above the original filter. A retrievable Tulip filter was placed and catheter-directed thrombolysis was performed. Six days later, the patient experienced sudden, persistent upper right abdominal pain, and a computed tomography scan revealed the formation of retroperitoneal hematoma. Symptomatic treatments were administered, and the hematoma gradually resolved during follow-up.展开更多
Purpose: The endovascular treatment of intracranial aneurysms was proven safe and effective compared to the alternative method of surgical clipping, despite the high recurrence rate. Follow-up of embolized intracrania...Purpose: The endovascular treatment of intracranial aneurysms was proven safe and effective compared to the alternative method of surgical clipping, despite the high recurrence rate. Follow-up of embolized intracranial aneurysms is mandatory for the early detection of recurrence and improved outcomes. DSA is used as the reference standard for this assessment. To determine the effectiveness of MRA in follow-up evaluations of intracranial aneurysms after embolization by comparing DSA, CE-MRA, and TOF-MRA. Materials and Methods: Sixty-eight consecutive patients undergoing DSA, TOF-MRA, and CE-MRA during an interval of <1 week were enrolled in this 6-month study. Images were evaluated for occlusion status, patency of the parent vessels, and artifacts. The modified Raymond-Roy occlusion classification and Aneurysm Embolization Grades were used to assess the occlusion status and initial DSA images for detection of recurrence in two filtered study phases with optimized selection criteria. Seventeen observers(phase I: 9, phase II: 8) independently interpreted the double-blinded images. Agreement was expressed with a Fleiss kappa value; p < 0.05 was considered significant. Results: This study included 68 patients with 77 aneurysms; 38(49.35%) were treated with coil alone and 39(50.65%) with stent-assisted coiling. In both phases, DSA was superior to TOF-MRA and CE-MRA using MRRC(Phase I: k = 0.567, p ≤ 0.001; k = 0.287, p ≤ 0.001; k = 0.117, p ≤ 0.001, respectively; Phase II: k = 0.503, p ≤ 0.001; k = 0.303, p ≤ 0.001; k = 0.115, p = 0.038, respectively). TOF-MRA was as effective as DSA(TOF: k = 0.335, p ≤ 0.001; DSA: k = 0.323, p ≤ 0.001) for recurrence detection. Conclusion: We suggest TOF-MRA as a first-line follow-up tool to detect aneurysm recurrence, and DSA to quantify the filling space to make a definite decision on re-embolization.展开更多
BACKGROUND:The number of loco-regional therapies(LRTs)for hepatocellular carcinoma(HCC)has increased dramatically during the past decade.Many patients with HCC who were beyond the Milan criteria were allowed to receiv...BACKGROUND:The number of loco-regional therapies(LRTs)for hepatocellular carcinoma(HCC)has increased dramatically during the past decade.Many patients with HCC who were beyond the Milan criteria were allowed to receive a liver transplantation(LT)once the HCC was successfully down-staged.This retrospective study aimed to analyze the outcomes of LRTs prior to LT in patients with HCC beyond the Milan criteria.METHODS:We analyzed 56 patients treated from June 2006 to March 2010:22 met the Milan criteria(T1+T2,39.3%),16 had T3 tumors(28.6%),and 11 had T4a tumors(19.6%),while 7 were suspected of tumor vascular invasion(T4b,12.5%).All patients underwent preoperative LRTs,including transcatheter arterial chemoembolization,radiofrequency ablation,percutaneous ethanol injection,liver resection,and/or microwave coagulation therapy.The number of the patients who were successfully down-staged before LT,the types of LRTs used before LT,and their outcomes after LT were recorded.RESULTS:Eleven patients had necrotic tumors(pT0,19.6%);6 had pT1 tumors(10.7%),22 had pT2 tumors(39.3%),6 had pT3 tumors(10.7%),5 had pT4a tumors(8.9%),and 6 had pT4b tumors(10.7%).The histopathologic tumors of 39 patients(69.6%)were down-staged and met the established Milan criteria(pT0-2).Imaging-proven under-staging was present in 5 HCC patients(8.9%)who had tumors involving the intrahepatic venous system.Twenty-three patients(41.1%)had stable HCC and 10(17.9%)died.The 1-,3-and 4-year survival rates were 96%,73%and 61%,respectively,with a mean survival time of 22.29±1.63 months.Six patients died of tumorrecurrence.The 1-,3-and 4-year recurrence-free survival(RFS)rates were 88%,75%and 66%,respectively.The 3-year RFS of patients with pT0-2 tumors was 82%,which was markedly greater than that of patients with pT3 tumors(63%,P=0.018)or pT4 tumors(17%,P=0.000).Although the 3-year RFS of patients with pT3 tumors was greater than that of patients with pT4 tumors,the difference was not significant.CONCLUSIONS:Successful down-staging of HCCs can be achieved in the majority of carefully selected patients by LRTs.Importantly,patients who are successfully down-staged and undergo LT may have a higher RFS rate.展开更多
Objective:Transarterial and transvenous embolization methods are considered effective and safe approaches for the treatment of cavernous sinus dural arteriovenous fistula(CSDAVF).Here.,we report the angioarchitectural...Objective:Transarterial and transvenous embolization methods are considered effective and safe approaches for the treatment of cavernous sinus dural arteriovenous fistula(CSDAVF).Here.,we report the angioarchitectural features and clinical outcomes of CSDAVF in patients treated with either the inferior arterial approach(IAA) or the inferior petrosal sinus approach(IPSA).Methods:The clinical data of 32 patients with CSDAVF treated at our institution from May 2008 to May 2014 were retrospectively analyzed.All patients underwent routine diagnostic digital subtraction angiography(DSA) before surgery.Embolization was performed using the IPSA through the internal jugular vein or IAA,based on angioarchitectural features.Results:Of the 32 patients with CSDAVF,24 underwent embolization treatment through the internal jugular veinIPSA and 8 patients underwent treatment through IAA.Nineteen patients in the IPSA group experienced mild headache,which improved after specific treatment.The immediate postembolization angiographic results revealed complete occlusion in 26 cases(18 IPSA and 8 IAA) and almost complete occlusion in 6 cases(IPSA).Complications that occurred during the procedure included abducens nerve palsy(n=1,IPSA) and prosopoplegia(n=1,IAA).One patient developed tinnitus,which was diagnosed as anterior cranial fossa new-onset dural arteriovenous fistula on DSA,whereas the symptoms of other patients all improved with no recurrence.Conclusions:On the basis of the angioarchitectural features of CSDAVF,IAA can be considered the primary treatment when the blood-supplying artery and fistula are relatively singular,and when the microcatheter can easily reach the fistula through the artery.The venous approach should be selected as the primary approach when the fistula is indistinguishable and blood is supplied by multiple arteries through small plexiform vessels.Choosing the optimal surgical approach may increase the success rate of intravascular CSDAVF surgery and may help avoid complications.展开更多
Objective:The aim of this study was to compare the efficacy,safety and treatment costs of superficial femoral artery revascularization(SFA)with drug-coated balloon(DCB)versus avoiding revascularization strategy for th...Objective:The aim of this study was to compare the efficacy,safety and treatment costs of superficial femoral artery revascularization(SFA)with drug-coated balloon(DCB)versus avoiding revascularization strategy for the treatment of symptomatic SFA disease.Methods:This retrospective single-center study reviewed 96 patients(113 limbs)with severe stenosis and occlusive SFA disease.All patients underwent either DCB(Group 1:n=55 limbs)or nonrevascularization(Group2:n=58 limbs)between March 2015 and June 2019.The improvement of Rutherford class,walking impairment questionnaire score(WIQ),target limb reintervention,perioperative major adverse events,the catheterization laboratory cost and length of hospital stay were compared.The limb salvage and survival rates were calculated using the Kaplan-Meier method.Univariate and multivariate logistic regression analysis were performed to assess the association between factors and the improvement of Rutherford category at 12 months.Results:The median follow-up time of Groups 1 and 2 was 17 and 33 months,respectively.At 12 months,the Rutherford category significantly decreased in both groups(P<0.001),with no significant difference(79.7%vs.64.3%,P=0.074).Furthermore,multivariate analysis showed that the selected therapeutic method was not an influential factor for the improvement of Rutherford class at 12 months.The WIQ overall score as well as three subscales scores(distance,speed and stair-climbing),the survival rate,limb salvage rate and the length of stay between the two groups were comparable.The perioperative adverse events rate and catheterization laboratory cost in Group 2 was significantly lower compared to Group 1[(34253.69±28172.87)yuan vs.(56936.76±41278.36)yuan,P=0.001].Conclusions:This study suggests that avoiding superficial femoral artery revascularization strategy has favorable efficacy and safety outcomes compared to combining revascularization with DCB in selected patients.展开更多
文摘Subtle changes have occurred in China, and interventional radiology has gradually become an independent specialty, separated from diagnostic radiology. This has been called "Interventionalogy", "interventional medicine(IM)", or simply Intervention by our team,and "Interventional Radiology" is used no more. It has even been given the name "Third clinical Medicine" by us. Chinese intervention has established an independent association for interventional doctors, as well as independent interventional societies in many provinces. The national interventional society will likely be set up at some point in time. Chinese interve ntion has set up their own clinical wards, with much attention paid to a clinical, professional, and normalized direction for development, and established special nursing units. According to us, turf battle is meaningless. "The Third clinical Medicine" belongs to all human beings. It could also be predicted that interventional history will follow the same evolutionary rule as other disciplines, i.e., "long divided, must unite; long united, must divide".
文摘OBJECTIVE: To study the effects on self-efficacy and quality of life in patients undergoing coronary intervention, by traditional Chinese medicine nursing combined with refined nursing. METHODS: A total of 124 patients, who needed to undergo coronary intervention in our hospital, were randomly divided into the fine group and the combined group, with 62 patients in each group. The two groups of patients were enrolled in the PCI routine nursing procedure, in which the fine group was given refined nursing, and the joint group, based on that, added the traditional Chinese medicine nursing. The self-management (self-management scale of coronary heart disease), self-efficacy (self-efficacy scale of coronary heart disease), quality of life score (Seattle angina questionaire (SAQ), TCM symptom score] of the two groups were observed before and after treatment. The incidence of postoperative complications after nursing intervention was recorded. RESULTS: After nursing intervention, each score and total scores of the self-administration scale of the combined group were higher than those of the fine group (P < 0.05). After the nursing intervention, each score and the total scores of the self-efficacy scale of the combined group were higher than the fine group (P < 0.05) After the nursing intervention, the SAQ score of the combined group was significantly higher than that of the fine group (P < 0.05). After the nursing intervention, TCM symptom score of the combined group was significantly lower than that of the fine group (P < 0.05). After nursing intervention, the postoperative complication rate of the combined group was 79.03%, which was lower than that of the fine group (59.68%)(P < 0.05). CONCLUSION: Patients with coronary intervention, who use traditional Chinese medicine combined with refined nursing, can improve their quality of life, clinical symptoms and postoperative complications by improving their self-management and efficacy, which is conducive to the recovery of patients' follow-up.
文摘Objective:To explore the influence on liver function of hepatic artery interventional chemoembolization combined reduced glutathione therapy for elderly patients with advanced liver cancer.Methods:A total of 120 cases of elderly patients with advanced liver cancer from digestive surgery in-patient department of our hospital during the period of January 2014 and January 2016 were selected as the research object, the patients were divided into two groups by using the random number table method,each for 60 cases.The control group were given conventional drugs chemotherapy, the study group were given hepatic artery interventional chemoembolization combined reduced glutathione therapy, serum liver function indexes of Direct Bilirubin(DBil), Total Bilirubin(TBil), Aspartate Transaminase(AST) and Alanineamino Transferase (ALT)were detected by using automatic biochemical analyzer. Results: The clinical remission rate of study group was significantly higher than the control group, the recurrence rate was obviously lower than the control group,compared between the two groups with statistically significant differences. The average survival time of study group (29.36±6.25) months, was significantly longer than the control group (18.02±4.16) months .Before the treatment, serum DBil, TBil, AST and ALT levels compared between the two groups with no statistically significant differences,after the treatment,the indexes of study group was significantly lower than the control group. The indexes levels compared between pre-therapy and post-therapy in study group with no statistically significant differences, while the indexes levels of post-therapy in the control group were significantly higher than those pre-therapy. Before the treatment, the life quality score compared between the two groups with no statistically significant differences, after treatment,the score of all patients were significantly higher than those pre-therapywhich the score of study group was significantly higher than the control group.The incidence rate of drug adverse reactions compared between the two groups with no statistically significant differences.Conclusion: The clinical efficacy of hepatic artery interventional chemoembolization combined reduced glutathione therapy for elderly patients with advanced liver cancer is satisfying, and helps to significantly improve liver function, improve life quality, it is worth popularization and application in the clinical practice.
文摘Objective:To investigate the effect of arterial interventional chemotherapy before radical operation for gastric cancer on serum tumor markers and cell growth in the lesion.Methods:90 patients with primary gastric cancer who underwent radical operation for gastric cancer in our hospital were chosen as the research subjects and divided into the control group (n=48) (did not receive preoperative arterial interventional chemotherapy) and the arterial interventional chemotherapy group (n=42) (received preoperative arterial interventional chemotherapy). The differences in tumor markers in serum as well as proliferation and apoptosis gene expression in gastric cancer tissues were compared.Results: Before surgery started, serum CA199, CA153, CA724 and AFP levels of arterial interventional chemotherapy group were significantly lower than those immediately after admission whereas serum CA199, CA153, CA724 and AFP levels of control group were not significantly different from those immediately after admission. After surgery, proliferation genes CUL4A and NTSR1 mRNA expression in gastric cancer tissues of arterial interventional chemotherapy group were lower than those of control group whereas DADS and FAM96B mRNA expression were higher than those of control group;apoptosis genes Livin and Bcl-2 mRNA expression were lower than those of control group whereas p53, p21 and Bax mRNA expression were higher than those of control group.Conclusion:Preoperative arterial interventional chemotherapy combined with radical operation for gastric cancer can more effectively inhibit the malignant degree of tumor and delay the growth of cancer cells.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a common tumor with a poor prognosis.Early intervention is essential;thus,good prognostic markers to identify patients who benefit from first transarterial chemoembolization(TACE)are needed.AIM To investigate the efficacy of computed tomography(CT)radiomics in predicting the success of the first TACE in patients with advanced HCC and to develop an early prediction model based on clinical radiomics features.METHODS Data from 122 patients with advanced HCC treated with TACE were analyzed.Intratumoral and peritumoral areas on arterial and venous CT images were selected to extract radiomic features,which were screened in the training cohort using the minimum redundancy maximum correlation.Then,support vector machines were used to construct the model.To construct a receiver operating characteristic curve,the predictive efficacy of each model was evaluated on the basis of the area under the curve(AUC).RESULTS Among the 122 patients,72 patients were effectively treated via TACE,and in 50 patients,this treatment was ineffective.In the radiomics model,the areas under the curve of the venous phase model were 0.867(95%CI:0.790-0.940)in the training cohort and 0.755(0.600-0.910)in the validation cohort,indicating good predictive efficacy.The multivariate logistic regression results indicated that preoperative alpha-fetoprotein levels(P=0.01)were a risk factor for TACE.The screened clinical features were combined with the radiomic features to construct a combined model.This combined model had an AUC of 0.92(0.87-0.95)in the training cohort and 0.815(0.67-0.95)in the validation cohort.CONCLUSION CT radiomics has good value in predicting the efficacy of the first TACE treatment in patients with HCC.The combined model was a better tool for predicting the first TACE efficacy in patients with advanced HCC and could provide an efficient predictive tool to help with the selection of patients for TACE.
文摘BACKGROUND Post-operative infection is a common and serious complication following drugeluting trans arterial chemo embolization(D-TACE)in patients with hepatocellular carcinoma(HCC),potentially compromising treatment efficacy and increasing morbidity.AIM To investigate the risk factors associated with post-operative infection in HCC patients undergoing D-TACE,and to provide evidence for clinical prevention and targeted intervention strategies.METHODS Clinical data of 77 primary HCC patients who underwent D-TACE in our hospital from January 2022 to December 2023 were retrospectively analyzed.Patient demographics,laboratory test results,tumor characteristics,and surgery-related parameters were collected.Univariate and multivariate logistic regression analyses were performed to identify risk factors for post-operative infection.RESULTS Post-operative infection occurred in 20 cases(25.97%)among the 77 patients.Univariate analysis showed that age≥65 years,Child-Pugh grade B,tumor diameter≥5 cm,operation time≥120 minutes,preoperative albumin<35 g/L,and comorbid diabetes were significantly associated with post-operative infection(P<0.05).Multivariate logistic regression analysis identified Child-Pugh grade B(OR=2.851,95%CI:1.426-5.698),operation time≥120 minutes(OR=2.367,95%CI:1.238-4.523),and preoperative albumin<35 g/L(OR=2.156,95%CI:1.147-4.052)as independent risk factors for post-operative infection.CONCLUSION Liver function status,operation time,and preoperative albumin level are significant factors affecting post-operative infection in HCC patients undergoing D-TACE.For high-risk patients,enhanced perioperative management,appropriate timing of surgery,and active improvement of nutritional status should be implemented to reduce the risk of post-operative infection.
基金supported by the Science and Technology Plan Project of Wenzhou Municipality(Grant Numbers:Y20180769 and Y20220078).
文摘Background:Hemoptysis patients with bronchial artery-pulmonary artery fistula(BPF)have a high incidence of poor prog-nosis.This study aimed to evaluate the diagnostic performance of computed tomography angiography(CTA)for detecting BPF in hemoptysis patients and to compare the clinical characteristics and computed tomography(CT)findings between patients with and without BPF.Methods:We retrospectively enrolled 201 consecutive patients with hemoptysis who underwent bronchial arterial emboli-zation in our hospital from January 2020 to November 2020.The clinical characteristics,preprocedural CT findings,and digital subtraction angiography(DSA)findings were recorded.Patients were categorized into BPF-positive and BPF-negative groups based on DSA results.The diagnostic accuracy of CTA for BPF detection was evaluated against that of DSA using receiver operating characteristic curve analysis.Differences in clinical and CT parameters between the two groups were assessed.Multivariate logistic regression analysis was used to discover the independent factors associated with the presence of BPF.Results:Among 201 patients with hemoptysis,DSA identified BPF in 75,while CTA identified BPF in 65.The diagnostic agreement between CTA and DSA for BPF detection was excellent(Kappa coefficient:κ=0.825,p<0.001).CTA demonstrated high sensitivity(0.827),specificity(0.976),and accuracy(0.920)for BPF detection.Multivariate logistic analysis identified the severity of pulmonary parenchymal lesion and bronchial artery tortuosity as independent predictors of BPF.Conclusions:Preprocedural CTA is a reliable examination to identify BPF in patients with hemoptysis.Pulmonary lesion severity and bronchial artery tortuosity are independent factors associated with the presence of BPF in patients with hemoptysis.
文摘BACKGROUND Observational studies reported characteristics and outcomes of patients with secondary mitral valve regurgitation(MR)who underwent transcatheter edge-toedge repair of the mitral valve.No study investigated the temporal trend of patient characteristics and outcomes in comparison with the published randomized trials.AIM To investigate the temporal trend in baseline characteristics and outcomes of patients with secondary MR who underwent transcatheter edge-to-edge repair of the mitral valve in the real world compared with those from the published landmark trials.METHODS A comprehensive systematic literature search was conducted using MEDLINE,EMBASE,and CENTRAL databases,and the identified observational studies were divided into two five-year recruitment periods.The first period included 36 studies that enrolled patients between 2008 and 2012,and the second period included 25 studies that recruited patients between 2013 and 2017-2018.Pooled variables of each five-year recruitment period were compared with those of the landmark trials.A random-effects model was used for statistical comparisons.RStudio and RevMan software were used for the analysis.RESULTS Overall,there were no major variations in the findings between the first and the second five-year recruitment periods.EVEREST program vs observational studies:Patients in the EVEREST program were more likely to have non-ischemic MR etiology[odds ratio(OR)=3.59,95%confidence interval(CI):2.92-4.42]and atrial fibrillation(OR=1.71,95%CI:1.42-2.06).They were less likely to receive angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers(OR=0.72,95%CI:0.58-0.90)and implantable cardiac device(OR=0.41,95%CI:0.33-0.49)as well as less likely to be symptomatic at hospital presentation without a difference in MR grade≤2+or mortality at 12-month follow-up.COAPT trial vs observational studies:COAPT patients were more likely to have prior myocardial infarction(OR=1.62,95%CI:1.27-2.06)and renal insufficiency(OR=2.66,95%CI:2.05-3.45).They were more likely to receive beta-blockers(OR=2.54,95%CI:1.68-3.85)and an implanted cardiac device(OR=2.20,95%CI:1.71-2.84).There was no difference in procedure success or mortality.MITRA-FR trial vs observational studies:MITRA-FR patients were less likely to have atrial fibrillation(OR=0.49,95%CI:0.34-0.69)and renal insufficiency(OR=0.18,95%CI:0.11-0.28)but more likely to have a history of myocardial infarction(OR=1.48,95%CI:1.06-2.05)and to receive diuretics(OR=19.81,95%CI:2.75-142.48)and implantable cardiac devices(OR=1.69,95%CI:1.21-2.37).At hospital presentation,they were less likely to be symptomatic(OR=0.25,95%CI:0.18-0.35)without a difference in MR grades 3+and 4+.There was no difference in terms of MR grade or mortality at 12-month follow-up.CONCLUSION Patients in the landmark studies may have favourable or unfavourable characteristics when compared to those in the observational studies,but this did not translate into different outcomes over time.
基金Supported by the Natural Science Foundation of Shandong Province,No.ZR2014HM050the Youth Foundation of the Second Hospital of Shandong University,No.Y2014010047+1 种基金the Nature Science Foundation of Shandong Province,No.ZR2018PH032 and No.ZR2018PH033the National Natural Science Foundation of China,No.61671276
文摘AIM To evaluate the effectiveness and safety of combined ursodeoxycholic acid and percutaneous transhepatic balloon dilation for management of gallstones after expulsion of common bile duct(CBD) stones.METHODS From April 2014 to May 2016, 15 consecutive patients(6 men and 9 women) aged 45-86(mean, 69.07 ± 9.91) years suffering from CBD stones associated with gallstones were evaluated. Good gallbladder contraction function was confirmed by type B ultrasonography. Dilation of the CBD and cystic duct was detected. Percutaneous transhepatic balloon dilation of the papilla was performed, ursodeoxycholic acid was administered, and all patients had a high-fat diet. All subjects underwent repeated cholangiography, and percutaneous transhepatic removal was carried out in patients with secondary CBD stones originating from the gallbladder. RESULTS All patients underwent percutaneous transhepatic balloon dilation with a primary success rate of 100%. The combined therapy was successful in 86.7% of patients with concomitant CBD stones and gallstones. No remaining stones were detected in the gallbladder. Transient adverse events include abdominal pain(n = 1), abdominal distension(n = 1), and fever(n = 1). Complications were treated successfully via nonsurgical management without long-term complications. No procedure-related mortality occurred. CONCLUSION For patients with concomitant CBD stones and gallstones, after percutaneous transhepatic removal of primary CBD stones, oral ursodeoxycholic acid and a high-fat diet followed by percutaneous transhepatic removal of secondary CBD stones appear to be a feasible and effective option for management of gallstones.
基金Supported by the Youth Foundation of the Shanghai Public Health Bureau,No.20134Y195the Project of Medical Key Specialty of Shanghai Municipality,No.ZK2015A22
文摘AIM To assess the feasibility and effectiveness of a novel application of percutaneous intraductal radiofrequency (RF) for the treatment of biliary stent obstruction. METHODS We specifically report a retrospective study presenting the results of percutaneous intraductal RF in patients with biliary stent occlusion. A total of 43 cases involving biliary stent obstruction were treated by placing an EndoHPB catheter and percutaneous intraductal RF was performed to clean stents. The stent patency was evaluated by cholangiography and follow-up by contrast enhanced computed tomography or ultrasound after the removal of the drainage catheter. RESULTS Following the procedures, of the 43 patients, 40 survived and 3 died with a median survival of 80.5 (range: 30-243) d. One patient was lost to followup. One patient had the stent patent at the time of last follow-up. Two patients with stent blockage at 35 d and 44 d after procedure underwent percutaneous transhepatic drain insertion only. The levels of bilirubin before and after the procedure were 128 +/- 65 mu mol/L and 63 +/- 29 mu mol/L, respectively. There were no related complications (haemorrhage, bile duct perforation, bile leak or pancreatitis) and all patients' stent patency was confirmed by cholangiography after the procedure, with a median patency time of 107 (range: 12-180) d. CONCLUSION This preliminary clinical study demonstrated that percutaneous intraductal RF is safe and effective for the treatment of biliary stent obstruction, increasing the duration of stent patency, although randomized controlled trials are needed to confirm the effectiveness of this approach.
文摘Objective:To investigate the clinical utility of ultrasound-guided balloon occlusion in cesarean section in patients with sinister placenta previa.Methods:The Interventional and Ultrasound Departments of the authors’center assisted obstetrics to complete cesarean section in cases of sinister placenta previa.A total of 130 patients with implanted sinister placenta previa were diagnosed using obstetrical ultrasound and magnetic resonance imaging(MRI).Before cesarean section,the balloon was positioned in the bilateral radial or abdominal aorta.Immediately after delivery of the fetus,the balloon was temporarily filled to transiently seal the target vessel.According to the obstetrician’s assessment of hemostasis,the balloon was withdrawn at the appropriate time.Among the 130 patients,there was one case of abdominal aortic occlusion,with 129 cases blocked by the bilateral common iliac artery.Results:All 130 cases were successfully blocked,with an average blocking time of<15 min,while intraoperative blood loss was 800–1500 ml.Conclusion:Ultrasound-guided balloon blocking treatment before cesarean section can mitigate the dangers of placenta previa and significantly reduce blood loss with no exposure to X-ray radiation.Thus,the technique merits serious consideration.
文摘Background context:Metastatic spinal cord compression(MSCC)seriously affects the survival rate.Objective:The therapeutic effects of two treatment strategies for MSCC:percutaneous vertebroplasty(PVP)combined with radiofrequency ablation(RFA)and PVP combined with^(125)I particle implantation,were compared.Study design:Retrospective study.Patient sample:40 patients with MSCC were divided into two groups:19 cases in the RFA group and 21 cases in the^(125)I group.Method:All patients were accessed to determine the differences in pain,which was evaluated using the visual analog scale(VAS)at 1 week,1 month,and 3 months after the operation,and spinal stenosis rates(SSRs),which were measured at 1 and 3 months after the operation,between the two groups.Results:The VAS scores and SSRs at baseline were comparable between the RFA group and the^(125)I group(7.19±2.07 vs 7.42±1.95,37.7%±11.2%vs 41.1%±11.4%).The VAS scores and SSRs at 1 month and 3 months after the operation were significantly reduced in both groups,compared with those at baseline.The VAS scores and SSRs in the^(125)I group were lower than those in the RFA group at 3 months after the operation(1.09±0.97 vs 1.75±1.06 p=0.048 and 12.3%±6.4%vs 18.1%±10.1%p=0.034),while the VAS scores at1 week after the operation in the RFA group were lower than those in the^(125)I group(4.39±1.34 vs 5.05±1.82 p=0.049).Conclusion:PVP combined with RFA has a slight advantage in relieving pain in the short term,while PVP combined with^(125)I particle implantation may have a better effect in the relieving pain and decreasing the SSRs at 3 months after the operation.
文摘BACKGROUND Implanted intravenous infusion port(IVAP)is indicated for patients undergoing chemotherapy,total parenteral nutrition and long-term antibiotic treatment.Among their complications,the rupture and migration of the catheter of an IVAP via internal jugular vein represents a very rare but potentially severe condition.CASE SUMMARY A 43-year-old woman was identified with a spontaneous fracture and migration of catheter of an IVAP via right internal jugular vein after adjuvant chemotherapy for left breast cancer.A computed tomography showed the fractured catheter of the IVAP in the pulmonary artery.Therefore,we conducted an emergency procedure to remove the catheter fragment by a pigtail catheter combined with a gooseneck trap.CONCLUSION When the fractured catheter of an IVAP was detected,the special shape of the pigtail catheter in combination with the gooseneck trap successfully facilitated the removal of the dislodged catheter.
基金supported by the grant from Department of Education of Liaoning Province, China (No. 2008S232)
文摘Objective： Hepatocellular carcinoma （HCC） is a complex disease which associates with both environmental and genetic factors. The purpose of this study was to investigate whether the genetic polymorphisms of UDP-glucuronosyltransferase（UGT1A7）, an important phase II biotransformation enzyme, and X-ray repair cross-complementing group 1（XRCC1）, a pivotal DNA-repair gene, were related to the risk of HCC in Northeast China. Methods： One hundred and thirty six HCC patients and one hundred and thirty six frequency-matched controls were included in this hospital-based case-control study. Genotypes of UGT1A7 and XRCC1 were determined using allele-specific polymerase chain reaction （AS-PCR） and PCR-restriction fragment length polymorphism （RFLP）, and for which the odds ratio （OR） with 95% confidence interval （95% CI） were calculated. Results： The proportion of UGT1A7 low enzymatic allele （＊2 or ＊3） was higher in HCC patients than those in controls. The UGT1A7＊1/＊2 and ＊3/＊3 genotypes were associated with higher HCC risk （OR=2.09, 95%CI： 1.10-3.97; OR=5.67, 95%CI： 1.76-18.30, respectively）. The XRCC1 codon 399 Arg/Gln genotype could also elevate HCC risk （OR=2.16, 95% CI 1.29-3.61）. In addition to polymorphisms of UGT1A7 and XRCC1, multivariate logistic regression analysis demonstrated that other significant independent factors associated with HCC were HBV infection （OR=68.07, 95%CI： 28.03-165.26）, HCV infection （OR=30.97, 95%CI： 8.06-118.94） and family history of HCC （OR=10.62, 95%CI： 2.22-50.77）. Conclusion： The study shows that the polymorphisms of UGT1A7 and XRCC1 are associated with HCC risk. Determination of the polymorphisms of UGT1A7 and XRCC1 may provide an important clue to preventive measure against HCC.
基金supported by grants from the National Natural Science Foundation of China (No. 81371652)the Science and Technology Planning Project of Guangdong Province (No. 2012B031800120)
文摘Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,conven?tional RFA has a limited ablation zone;as such,it is rarely used to treat ruptured tumors.Case presentation:This case was a 60?year?old man who had a large,ruptured HCC in which hydrochloric acid(HCl)?enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic.Conclusion:Considering the effectiveness of HCl?enhanced RFA in achieving hemostasis and tumor ablation,it might be a new option for treating large,ruptured HCCs.
文摘A 55-year-old man developed deep venous thrombosis and inferior vena cava(IVC) thrombosis 7 years earlier and was treated by placement of a permanent IVC filter. One week ago, he was admitted with bilateral lower limb swelling and pain. Digital subtraction angiography showed a filling defect above the original filter. A retrievable Tulip filter was placed and catheter-directed thrombolysis was performed. Six days later, the patient experienced sudden, persistent upper right abdominal pain, and a computed tomography scan revealed the formation of retroperitoneal hematoma. Symptomatic treatments were administered, and the hematoma gradually resolved during follow-up.
文摘Purpose: The endovascular treatment of intracranial aneurysms was proven safe and effective compared to the alternative method of surgical clipping, despite the high recurrence rate. Follow-up of embolized intracranial aneurysms is mandatory for the early detection of recurrence and improved outcomes. DSA is used as the reference standard for this assessment. To determine the effectiveness of MRA in follow-up evaluations of intracranial aneurysms after embolization by comparing DSA, CE-MRA, and TOF-MRA. Materials and Methods: Sixty-eight consecutive patients undergoing DSA, TOF-MRA, and CE-MRA during an interval of <1 week were enrolled in this 6-month study. Images were evaluated for occlusion status, patency of the parent vessels, and artifacts. The modified Raymond-Roy occlusion classification and Aneurysm Embolization Grades were used to assess the occlusion status and initial DSA images for detection of recurrence in two filtered study phases with optimized selection criteria. Seventeen observers(phase I: 9, phase II: 8) independently interpreted the double-blinded images. Agreement was expressed with a Fleiss kappa value; p < 0.05 was considered significant. Results: This study included 68 patients with 77 aneurysms; 38(49.35%) were treated with coil alone and 39(50.65%) with stent-assisted coiling. In both phases, DSA was superior to TOF-MRA and CE-MRA using MRRC(Phase I: k = 0.567, p ≤ 0.001; k = 0.287, p ≤ 0.001; k = 0.117, p ≤ 0.001, respectively; Phase II: k = 0.503, p ≤ 0.001; k = 0.303, p ≤ 0.001; k = 0.115, p = 0.038, respectively). TOF-MRA was as effective as DSA(TOF: k = 0.335, p ≤ 0.001; DSA: k = 0.323, p ≤ 0.001) for recurrence detection. Conclusion: We suggest TOF-MRA as a first-line follow-up tool to detect aneurysm recurrence, and DSA to quantify the filling space to make a definite decision on re-embolization.
文摘BACKGROUND:The number of loco-regional therapies(LRTs)for hepatocellular carcinoma(HCC)has increased dramatically during the past decade.Many patients with HCC who were beyond the Milan criteria were allowed to receive a liver transplantation(LT)once the HCC was successfully down-staged.This retrospective study aimed to analyze the outcomes of LRTs prior to LT in patients with HCC beyond the Milan criteria.METHODS:We analyzed 56 patients treated from June 2006 to March 2010:22 met the Milan criteria(T1+T2,39.3%),16 had T3 tumors(28.6%),and 11 had T4a tumors(19.6%),while 7 were suspected of tumor vascular invasion(T4b,12.5%).All patients underwent preoperative LRTs,including transcatheter arterial chemoembolization,radiofrequency ablation,percutaneous ethanol injection,liver resection,and/or microwave coagulation therapy.The number of the patients who were successfully down-staged before LT,the types of LRTs used before LT,and their outcomes after LT were recorded.RESULTS:Eleven patients had necrotic tumors(pT0,19.6%);6 had pT1 tumors(10.7%),22 had pT2 tumors(39.3%),6 had pT3 tumors(10.7%),5 had pT4a tumors(8.9%),and 6 had pT4b tumors(10.7%).The histopathologic tumors of 39 patients(69.6%)were down-staged and met the established Milan criteria(pT0-2).Imaging-proven under-staging was present in 5 HCC patients(8.9%)who had tumors involving the intrahepatic venous system.Twenty-three patients(41.1%)had stable HCC and 10(17.9%)died.The 1-,3-and 4-year survival rates were 96%,73%and 61%,respectively,with a mean survival time of 22.29±1.63 months.Six patients died of tumorrecurrence.The 1-,3-and 4-year recurrence-free survival(RFS)rates were 88%,75%and 66%,respectively.The 3-year RFS of patients with pT0-2 tumors was 82%,which was markedly greater than that of patients with pT3 tumors(63%,P=0.018)or pT4 tumors(17%,P=0.000).Although the 3-year RFS of patients with pT3 tumors was greater than that of patients with pT4 tumors,the difference was not significant.CONCLUSIONS:Successful down-staging of HCCs can be achieved in the majority of carefully selected patients by LRTs.Importantly,patients who are successfully down-staged and undergo LT may have a higher RFS rate.
文摘Objective:Transarterial and transvenous embolization methods are considered effective and safe approaches for the treatment of cavernous sinus dural arteriovenous fistula(CSDAVF).Here.,we report the angioarchitectural features and clinical outcomes of CSDAVF in patients treated with either the inferior arterial approach(IAA) or the inferior petrosal sinus approach(IPSA).Methods:The clinical data of 32 patients with CSDAVF treated at our institution from May 2008 to May 2014 were retrospectively analyzed.All patients underwent routine diagnostic digital subtraction angiography(DSA) before surgery.Embolization was performed using the IPSA through the internal jugular vein or IAA,based on angioarchitectural features.Results:Of the 32 patients with CSDAVF,24 underwent embolization treatment through the internal jugular veinIPSA and 8 patients underwent treatment through IAA.Nineteen patients in the IPSA group experienced mild headache,which improved after specific treatment.The immediate postembolization angiographic results revealed complete occlusion in 26 cases(18 IPSA and 8 IAA) and almost complete occlusion in 6 cases(IPSA).Complications that occurred during the procedure included abducens nerve palsy(n=1,IPSA) and prosopoplegia(n=1,IAA).One patient developed tinnitus,which was diagnosed as anterior cranial fossa new-onset dural arteriovenous fistula on DSA,whereas the symptoms of other patients all improved with no recurrence.Conclusions:On the basis of the angioarchitectural features of CSDAVF,IAA can be considered the primary treatment when the blood-supplying artery and fistula are relatively singular,and when the microcatheter can easily reach the fistula through the artery.The venous approach should be selected as the primary approach when the fistula is indistinguishable and blood is supplied by multiple arteries through small plexiform vessels.Choosing the optimal surgical approach may increase the success rate of intravascular CSDAVF surgery and may help avoid complications.
文摘Objective:The aim of this study was to compare the efficacy,safety and treatment costs of superficial femoral artery revascularization(SFA)with drug-coated balloon(DCB)versus avoiding revascularization strategy for the treatment of symptomatic SFA disease.Methods:This retrospective single-center study reviewed 96 patients(113 limbs)with severe stenosis and occlusive SFA disease.All patients underwent either DCB(Group 1:n=55 limbs)or nonrevascularization(Group2:n=58 limbs)between March 2015 and June 2019.The improvement of Rutherford class,walking impairment questionnaire score(WIQ),target limb reintervention,perioperative major adverse events,the catheterization laboratory cost and length of hospital stay were compared.The limb salvage and survival rates were calculated using the Kaplan-Meier method.Univariate and multivariate logistic regression analysis were performed to assess the association between factors and the improvement of Rutherford category at 12 months.Results:The median follow-up time of Groups 1 and 2 was 17 and 33 months,respectively.At 12 months,the Rutherford category significantly decreased in both groups(P<0.001),with no significant difference(79.7%vs.64.3%,P=0.074).Furthermore,multivariate analysis showed that the selected therapeutic method was not an influential factor for the improvement of Rutherford class at 12 months.The WIQ overall score as well as three subscales scores(distance,speed and stair-climbing),the survival rate,limb salvage rate and the length of stay between the two groups were comparable.The perioperative adverse events rate and catheterization laboratory cost in Group 2 was significantly lower compared to Group 1[(34253.69±28172.87)yuan vs.(56936.76±41278.36)yuan,P=0.001].Conclusions:This study suggests that avoiding superficial femoral artery revascularization strategy has favorable efficacy and safety outcomes compared to combining revascularization with DCB in selected patients.
