Hemoptysis is defined as bleeding originating from the respiratory tract distal to the larynx and is associated with a wide spectrum of underlying conditions,including bronchiectasis,pulmonary malignancies,tuberculosi...Hemoptysis is defined as bleeding originating from the respiratory tract distal to the larynx and is associated with a wide spectrum of underlying conditions,including bronchiectasis,pulmonary malignancies,tuberculosis,aspergillosis,and vascular malformations.^([1-3]) A metaanalysis involving patients with massive hemoptysis reported a mortality rate of 3.5%.^([4])This underscores the critical importance of prompt and eff ective embolization of the responsible artery to improve outcomes,particularly in patients presenting with life-threatening hemoptysis.展开更多
Background and Objectives: Establishing a stable pathway is the basis for interventional surgery, and hyper-selected intubation has become the basic requirement for vascular intervention therapy. Super-selection intub...Background and Objectives: Establishing a stable pathway is the basis for interventional surgery, and hyper-selected intubation has become the basic requirement for vascular intervention therapy. Super-selection intubation can not only significantly improve the efficacy of peripheral intervention treatment, but also greatly reduce surgical complications. However, during the treatment of peripheral vascular intervention (such as liver tumor arterial chemotherapy embolism, hemoptysis bronchial arterial embolism, gastrointestinal hemorrhagic gastrointestinal arterial embolism, etc.), vascular mutation is often large, and there are many branches, and the direction of blood flow is into the direction of blood flow, the horns are even reverse, and even the use of straight-headed microstructures will have difficulty interpolation difficulties or even failure, which increases the risk of surgery and affects safety treatment. To overcome this, pre-plasticized microcatheters have emerged, among which the InstantPass Swan-Neck Microstructure is a catheter with a head-end morphology similar to Cobra. Our research aims to explore the feasibility, safety, and technical advantages of the use of swan-neck microcatheter in peripheral vascular hyperboloid intubation. Materials and Methods: From January 2023 to March 2024, 31 patients with swan-neck microstructure were used in the peripheral vascular intervention therapy outside the hospital. Among them, there were 23 men and 8 women, aged 32 - 81 years old, an average (55 ± 13) years, and the average irradiation time was 35.1 ± 24.7 minutes. 10 cases of iodide oil arterial chemotherapy embolism, 7 cases of microspheres of hepatic arteries, 3 cases of gastric duodenal artery selective embolism, 3 cases of vein embolism with esophageal stomach, and 2 cases of sperm varicose vein embolism, 2 cases of selective embolism of the intestinal membrane, 2 cases of uterine arteries embolism, and 2 cases of renal arterial embolism. 11 of these patients switched to the swan-neck microstructure after using the straight-headed microstructure super-selective intubation. To analyze whether the swan-neck microcatheter is successfully transported to the target location, whether it can provide a satisfactory path for subsequent intravascular treatment, evaluate the surgery instant image results and complications related to the microstructure during the surgery period, analyze the angle of the target blood vessels and the main blood vessels, the target blood vessels, the target blood vessels, the relationship between the degree of pedestrian and the success rate of ultra-selective intubation, and summarize the indication of the application of the swan-neck microstructure in peripheral intervention therapy. Results: In this study, 31 patients used 31 swan-neck microcatheters, of which 22 (70.9%) target vascular and main blood vessels were ≤90˚;17 patients (54.8%) patients were curved and angulated;11 cases (35.5%) were after the failure of the superselective intubation of the straight-headed microstructure, the swan-neck microcatheter was successful after the failure;1 case (3.2%) patients with microstructure-related mezzanine occurred during surgery, and the complication rate of the perioperative ductation was 3.2%. All target lesions are finally successfully completed, and the success rate of surgical technology is 100%. Conclusion: Swan-neck microcatheters have a high success rate in superselective cannulation of peripheral blood vessels and perform well in vascular tortuosity and angulated lesions.展开更多
BACKGROUND The development of hepatocellular carcinoma(HCC)is influenced by multiple factors.Interventional therapy offers an effective treatment option for patients with unresectable intermediate-to-advanced HCC.Inte...BACKGROUND The development of hepatocellular carcinoma(HCC)is influenced by multiple factors.Interventional therapy offers an effective treatment option for patients with unresectable intermediate-to-advanced HCC.Interventional therapy can induce electrocardiographic(ECG)abnormalities that may be associated with liver dysfunction,electrolyte disorders,and cardiac injury.AIM To explore the ECG alterations and determinants following interventional therapy in patients with HCC.METHODS Sixty patients undergoing interventional treatment for liver cancer were selected as study participants.According to the results of the dynamic ECG examination 1 day after surgery,the patients were divided into an abnormal group(n=21)and a nonabnormal group(n=39).With the help of dynamic ECG examination,the ECG parameters were compared and the baseline data of patients was recorded in the two groups.RESULTS The 24 hours QT interval variability,24 hours normal atrial polarization to ventricular polarization(R-R)interval(standard deviation),24 hours consecutive 5 minutes normal R-R interval,and 24 hours continuous 5 minutes normal R-R interval(standard deviation mean)were lower than patients in the nonabnormal group(P<0.05).The logistic analysis showed that age>60 years,liver function grade B,and postoperative body temperature 38°C were risk factors for abnormal dynamic electrocardiogram in patients with liver cancer intervention(P<0.05).CONCLUSION Interventional therapy for HCC can lead to ECG abnormalities,underscoring the clinical need for enhanced cardiac monitoring to mitigate myocardial complications.展开更多
BACKGROUND The liver is the most common site of digestive system tumor metastasis,but not all liver metastases can be traced back to the primary lesions.Although it is unusual,syphilis can impact the liver,manifesting...BACKGROUND The liver is the most common site of digestive system tumor metastasis,but not all liver metastases can be traced back to the primary lesions.Although it is unusual,syphilis can impact the liver,manifesting as syphilitic hepatitis with inflammatory nodules,which might be misdiagnosed as metastasis.CASE SUMMARY This case report involves a 46-year-old female who developed right upper abdominal pain and intermittent low fever that persisted for more than three months.No definitive diagnosis of a tumor had been made in the past decades,but signs of multiple liver metastases were recognized after a computed tomo-graphy scan without evidence of primary lesions.With positive serological tests for syphilis and a biopsy of the liver nodules,a diagnosis of hepatic syphilis was made and confirmed with follow-up nodule reduction after anti-syphilis therapy.CONCLUSION Clinicians must be aware of the possibility that syphilis can cause hepatic inflam-matory masses,especially when liver metastasis is suspected without evidence of primary lesions.A definitive diagnosis should be established in conjunction with a review of the patient’s medical history for accurate therapeutic intervention.展开更多
Pancreatic cystic lesions are being increasingly detected,mainly due to the widespread use of cross-sectional imaging.The reported prevalence ranges from 13%to 18%in asymptomatic individuals.These lesions display a br...Pancreatic cystic lesions are being increasingly detected,mainly due to the widespread use of cross-sectional imaging.The reported prevalence ranges from 13%to 18%in asymptomatic individuals.These lesions display a broad histologic spectrum,from benign pseudocysts to premalignant mucinous cystic neoplasms and invasive carcinomas.Although many classification and management strategies exist,the natural history of numerous pancreatic cystic lesions remains incompletely understood,contributing to significant clinical uncertainty.Current diagnostic tools,including computed tomography,magnetic resonance imaging,endoscopic ultrasound,and cyst fluid analysis,are constrained by either suboptimal sensitivity or high costs.Cytology,while specific when positive,suffers from low sensitivity.Biochemical markers such as carcinoembryonic antigen,amylase,and glucose can help in cyst differentiation,whereas molecular testing(e.g.,KRAS,GNAS,RNF43 mutations)provides additional diagnostic and prognostic value.However,the application of molecular diagnostics is still restricted in routine practice due to costs,access issues,and a lack of standardization.This diagnostic uncertainty leads to both overtreatment and undertreatment.Some patients undergo unnecessary surgeries for benign lesions,which exposes them to procedural risks and long-term consequences.Others may experience delays in interventions for high-risk cysts and missing opportunities for cancer prevention.Additionally,prolonged,and often unnecessary surveillance burdens patients and healthcare systems psychologically and financially.In this minireview,we present a comprehensive overview of the classification,diagnostic approach,and management of pancreatic cystic lesions,incorporating recent evidence and current international guidelines(Fukuoka,American Gastroenterological Association,European).We also highlight the limitations of existing strategies and emerging tools such as radiomics,next-generation sequencing,and novel biomarkers.Additionally,we emphasize the urgent need for cost-effective,accurate,and accessible diagnostic pathways.A more refined risk stratification approach is essential to optimize outcomes,reduce healthcare waste,and improve the quality of life for patients with pancreatic cystic lesions.展开更多
Klebsiella pneumoniae infections(KPIs),particularly carbapenem-resistant Klebsiella pneumoniae(CRKP),pose significant challenges in liver transplantation(LT)recipients,with high morbidity and mortality.Guo et al’s st...Klebsiella pneumoniae infections(KPIs),particularly carbapenem-resistant Klebsiella pneumoniae(CRKP),pose significant challenges in liver transplantation(LT)recipients,with high morbidity and mortality.Guo et al’s study highlights risk factors,such as elevated day-one alanine aminotransferase levels and prolonged catheterization,and identifies polymyxin B and ceftazidime/avibactam as effective treatments.However,limitations like the absence of pre-transplant colonization data and host-pathogen interaction insights highlight the need for enhanced strategies.Future directions should include routine CRKP colonization surveillance,immune and genomic profiling,and the development of novel therapeutics.By integrating these approaches,we can improve the prevention,diagnosis,and treatment of KPIs in LT patients.展开更多
BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive tract worldwide,characterized by high incidence and mortality rates.AIM To investigate the expression of serum apurinic/apyrimidinic endonu...BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive tract worldwide,characterized by high incidence and mortality rates.AIM To investigate the expression of serum apurinic/apyrimidinic endonuclease 1 autoantibodies(APE1-AAbs),peripheral pentraxin-3(PTX-3),and miR-486-3p in patients with CRC undergoing radical surgery and their relationship with postoperative recurrence and metastasis.METHODS A retrospective analysis was conducted on the clinical data of 154 CRC patients who underwent laparoscopic radical surgery in our hospital from January 2022 to January 2024.Patients were followed for one year postoperatively and divided into an occurrence group(n=28)and a non-occurrence group(n=126)based on whether they experienced recurrence or metastasis.The clinical data and the expression levels of APE1-AAbs,PTX-3,and miR-486-3p were compared between the two groups.Multivariate logistic regression analysis was performed to identify risk factors for postoperative recurrence and metastasis in CRC patients.The relationship of APE1-AAbs,PTX-3,and miR-486-3p with postoperative recurrence and metastasis was analyzed using Spearman correlation analysis.Receiver operating characteristic curves were drawn to evaluate the predictive value of serum APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination for postoperative recurrence and metastasis in CRC.RESULTS The occurrence group had significantly higher proportions of patients with an age≥60 years,lymph node metastasis,stage III disease,poor differentiation,tumor diameter>5 cm,and higher platelet count,carcinoembryonic antigen,and carbohydrate antigen 19-9 levels than the non-occurrence group(P<0.05).The expression levels of APE1-AAbs,PTX-3,and miR-486-3p in the occurrence group were significantly higher than those in the non-occurrence group(P<0.05).Multivariate logistic regression analysis showed that lymph node metastasis,stage III disease,poor differentiation,and elevated levels of APE1-AAbs,PTX-3,and miR-486-3p were risk factors for postoperative recurrence and metastasis in CRC patients(odds ratio>1,P<0.05).Spearman correlation analysis revealed that the levels of APE1-AAbs,PTX-3,and miR-486-3p were positively correlated with postoperative recurrence and metastasis in CRC patients(r=0.642,0.653,and 0.631,respectively,P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve values for APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination in predicting postoperative recurrence and metastasis in CRC were 0.764,0.783,0.806,and 0.875,respectively,with the combination significantly outperforming individual markers(P<0.05).CONCLUSION Serum APE1-AAbs,PTX-3,and miR-486-3p levels are higher in CRC patients with postoperative recurrence and metastasis.These three markers are risk factors for postoperative recurrence and metastasis in CRC and can be used as predictive biomarkers.The combined detection of these markers has higher predictive value compared to individual tests.展开更多
Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting ...Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting and surgical gastrojejunostomy,EUS-GE offers comparable technical and clinical success while providing longer-lasting patency,fewer adverse events,and lower reintervention rates.The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome.EUSGE enables rapid recovery and early resumption of oral intake,which is crucial for oncologic patients.However,the procedure remains technically demanding,and optimal techniques,device selection,and management of complications are still under investigation.This mini-review summarizes current evidence,compares EUS-GE with alternative therapies,discusses patient selection and procedural aspects,and outlines key areas for future research.展开更多
BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or syste...BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or systemic therapies,often fail to provide sufficient pain relief or improve functional outcomes in these patients.Microwave ablation(MWA)offers advantages,such as shorter pro-cedure times and larger ablation zones,while percutaneous osteoplasty(PO)enhances bone stability and prevents pathological fractures.Despite these be-nefits,the combination of these techniques for treating flat bone metastases re-mains underexplored.AIM To evaluate the efficacy and safety of C-arm computed tomography(CT)-guided MWA combined with PO for managing painful flat bone metastases,focusing on pain relief,functional improvement,and QOL enhancement.METHODS A total of 45 patients with refractory moderate-to-severe pain resulting from flat bone metastases who underwent C-arm CT-guided MWA combined with PO between January 2015 and January 2021 were included.The efficacy of the pro-cedure was assessed by changes in the visual analog scale(VAS),Oswestry disability index(ODI),and QOL,as well as the occurrence of complications.Tumor response was evaluated using RECIST v1.1 and mRECIST criteria,with overall response rate(ORR)and disease control rate(DCR)as the primary end-points.RESULTS No serious complications were observed in any of the patients.A significant reduction in VAS and ODI was noted at 1 week,1 month,and 3 months post-procedure.A marked improvement in QOL was observed at all follow-up points.Bone cement extravasation was observed in 10 patients;however,none exhibited significant clinical symptoms.Based on RECIST v1.1,the ORR was 26.7%and the DCR was 88.9%.The mRECIST evaluation revealed a higher ORR of 51.1%and DCR of 88.9%.CONCLUSION C-arm CT-guided MWA with PO provides a dependable and effective strategy for managing flat bone metastases.It demonstrates significant pain relief,improved functional outcomes,and enhanced QOL.This treatment combination also shows promising tumor response rates with a low complication profile.展开更多
BACKGROUND No reports have been published on the use of iodine-125(125I)seed strips combined with double biliary self-expandable metallic stent(SEMS)for the treatment of type III and IV hilar malignant biliary obstruc...BACKGROUND No reports have been published on the use of iodine-125(125I)seed strips combined with double biliary self-expandable metallic stent(SEMS)for the treatment of type III and IV hilar malignant biliary obstruction(MBO).AIM To evaluate effectiveness and safety of 125I seed trips combined with double SEMS in treating Bismuth type III and IV hilar MBO.METHODS This was a retrospective,observational study conducted from April 2017 to December 2022.Patients with Bismuth-Corlette type III and IV hilar MBO who underwent 125I seed strip implantation combined with double SEMS placement were analyzed.Patient demographics,clinical characteristics,SEMS implantation methods,procedural and clinical outcomes,overall survival,stent patency duration,and complications were evaluated.RESULTS Four types of stent implantation were utilized:(1)Type X;(2)Type T;(3)Type Y;and(4)Tandem type.The technical success rate was 94.1%(16/17),and the clinical success rate was 100%(17/17).The median overall survival time was 189.00 days±47.27 days(95%CI:96.35-281.66).The median stent fluency time was 154.00 days±12.19 days(95%CI:130.11-177.89).No serious complications were observed.CONCLUSION This retrospective,observational study suggests that the combination of 125I seed strips with double SEMS may be a safe and potentially effective approach for managing type III and IV hilar MBO patients.展开更多
Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown pr...Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown promise individually,the efficacy combining these for treating postoperative recurrent CRC with liver metastasis requires further investigation.AIM To evaluate the efficacy and safety of TACE combined with targeted therapies for postoperative recurrent CRC with liver metastasis.METHODS This observational study enrolled 75 patients with postoperative recurrent CRC accompanied by liver metastasis between January 2020 and December 2023.All patients received combined treatment with TACE and targeted therapy:Bevacizumab(40 patients,53.3%),cetuximab(25 patients,33.3%),or panitumumab(10 patients,13.3%).Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors 1.1 criteria,with overall survival(OS)and progression-free survival as the primary endpoints.Quality of life was assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire at baseline and after six months of treatment.RESULTS The median OS was 28 months(95%confidence interval:24-32 months),and the median progression-free survival was 12 months(95%confidence interval:10-14 months).Patients treated with bevacizumab showed significantly better survival outcomes than those treated with cetuximab/panitumumab(median OS,30 vs 24 months,P=0.015).The overall response rate was 58.7%,with a disease control rate of 86.7%.Quality of life scores improved significantly across all domains,with greater improvements observed in the bevacizumab group.Treatment-related adverse events were manageable,with grade 3-4 events occurring in 13.3%of the patients and no treatment-related mortality.CONCLUSION The combination of TACE with targeted therapy,particularly bevacizumab,has demonstrated promising efficacy and acceptable safety for the treatment of postoperative recurrent CRC with liver metastasis.This multimodal approach not only improved survival outcomes but also enhanced the patients’quality of life,suggesting its potential as a valuable treatment strategy for this challenging condition.展开更多
BACKGROUND Patients undergoing interventional therapy for liver cancer experience severe psychological pain and are prone to anxiety and depression.AIM To explore factors influencing anxiety and depression symptoms in...BACKGROUND Patients undergoing interventional therapy for liver cancer experience severe psychological pain and are prone to anxiety and depression.AIM To explore factors influencing anxiety and depression symptoms in 200 patients diagnosed with primary liver cancer.METHODS Data from 200 individuals diagnosed with primary liver cancer and admitted to the authors’hospital(January 2022 to January 2024)were divided into 2 groups according to psychological status:Normal(n=100);and anxiety and depression(n=100).Through a questionnaire survey of patients and their families,single and multifactor factors of anxiety and depression in the postoperative interven-tional treatment of patients with primary liver cancer were analyzed.RESULTS Univariate analysis revealed no statistical differences between the 2 groups in terms of chronic disease,sex,liver function,Child grade,and age(P>0.05).How-ever,there were statistical differences in payment method,disease cognition,number of interventional treatments,per capita income,and educational level(P<0.05).Multivariate logistic regression analysis revealed that educational level,per capita income,disease cognition,payment method,and number of interven-tional treatments were all independent factors influencing postoperative anxiety and depression symptoms after interventional therapy in patients diagnosed with primary liver cancer,and the comparisons were statistically significant(P<0.05).CONCLUSION Analysis of associated risk factors can strengthen the clinical screening of patients with liver cancer at high risk for postoperative anxiety and depression symptoms and improve their prognosis.展开更多
Cholangiocarcinoma(CCA)is a particularly aggressive and challenging type of cancer,known for its poor prognosis,which is worsened by the complex interplay of various biological and environmental factors that contribut...Cholangiocarcinoma(CCA)is a particularly aggressive and challenging type of cancer,known for its poor prognosis,which is worsened by the complex interplay of various biological and environmental factors that contribute to its development.Recently,researchers have increasingly focused on the significant role of the biliary-enteric communication of liver-gut axis in the pathogenesis of CCA,highlighting a complex relationship that has not been thoroughly explored before.This review aims to summarize the key concepts related to the biliary-enteric communication of liver-gut axis and investigate its potential mechanisms that may lead to the onset and progression of CCA,a disease that presents substantial treatment challenges.Important areas of focus will include the microbiome's profound influence,which interacts with host physiology in ways that may worsen cancer development;changes in bile acid metabolism that can create toxic environments favorable for tumor growth;the regulation of inflammatory processes that may either promote or inhibit tumor progression;the immune system's involvement,which is crucial in the body's response to cancer;and the complex interactions within metabolic pathways that can affect cellular behavior and tumor dynamics.By integrating recent research findings from various studies,we aim to explore the multifaceted roles of the biliary-enteric communication of liver-gut axis in CCA,providing new insights and perspectives for future research while identifying promising therapeutic targets that could lead to innovative treatment strategies aimed at improving patient outcomes in this challenging disease.展开更多
BACKGROUND Malnutrition exacerbates the deterioration in patients with advanced gas-trointestinal tumors.AIM To analyze the effect of enteral nutritional support based on Nutrition Risk Screening 2002(NRS2002)risk ass...BACKGROUND Malnutrition exacerbates the deterioration in patients with advanced gas-trointestinal tumors.AIM To analyze the effect of enteral nutritional support based on Nutrition Risk Screening 2002(NRS2002)risk assessment on nutritional function in patients with gastrointestinal tumors.METHODS One hundred twelve patients from April 2022 to April 2024 were included for observation and were divided into a control group and an observation group by random number method,56 each.Both groups received treatment for four consecutive weeks.The control group received routine enteral nutrition support,while the observation group received enteral nutrition support based on the NRS2002 risk assessment.Nutritional function,intestinal mucosal barrier function,quality of life,and complication rate were compared between the two groups.Statistical analysis was completed using SPSS26.0 and Excel.RESULTS After nutritional intervention,transferrin,albumin,hemoglobin,and diamine oxidase levels in the observation group were higher than those in the control group,while C-reactive protein,tumor necrosis factorα,and quality of life scores were lower,with significant differences(P<0.05).There was no significant difference in complications between groups(P>0.05),but the complication rate was lower in the observation group.CONCLUSION Enteral nutritional support based on NRS2002 risk assessment for patients with gastrointestinal tumors positively impacts nutritional status and promotes intestinal mucosal barrier function recovery.Patients’quality of life improved,and the incidence of adverse reactions decreased,indicating clinical promotion and application value.展开更多
A recent study in World Journal of Hepatology examined the use of intravascular ultrasound(IVUS)for transjugular intrahepatic portosystemic shunt(TIPS)creation.The study concluded that IVUS significantly reduces proce...A recent study in World Journal of Hepatology examined the use of intravascular ultrasound(IVUS)for transjugular intrahepatic portosystemic shunt(TIPS)creation.The study concluded that IVUS significantly reduces procedure time,radiation exposure,and the number of needle passes compared to conventional fluoroscopic guidance.IVUS offers real-time visualization of the portal vein,but challenges remain in terms of equipment costs and the operator learning curve.TIPS creation techniques vary widely in clinical practice,where methods,such as conventional fluoroscopy,three-dimensional image fusion,electromagnetic navigation,and IVUS,are commonly employed.In this editorial,we provide a comparative analysis of these methods based on clinical experience and the literature.By evaluating the strengths and limitations of each technique,we aim to inform clinical decision-making and enhance procedural outcomes.Future developments in TIPS creation are likely to focus on hybrid techniques that combine the strengths of IVUS,electromagnetic navigation,and real-time image fusion,potentially leading to more precise,cost-effective,and accessible methods.展开更多
Although drug-coated balloons(DCBs)were initially used for treating peripheral vascular diseases,with the growing popularity of the implant-free concept,they have gained increasing attention as a novel therapeutic str...Although drug-coated balloons(DCBs)were initially used for treating peripheral vascular diseases,with the growing popularity of the implant-free concept,they have gained increasing attention as a novel therapeutic strategy for coronary atherosclerotic heart disease.The clinical application scope of DCBs,represented by paclitaxel-coated balloons(PCBs),is constantly expanding.Their application fields are no longer limited to lesions of coronary artery and peripheral vascular diseases,and relevant research is also being actively advanced.In the field of arterial diseases,the application of PCBs has significantly extended.They are used in lower extremity arteries and hemodialysis access and play a role in renal artery fibromuscular dysplasia,and carotid/vertebrobasilar/intracranial arteries.PCBs also show unique value in the treatment of Takayasu arteritis,Kawasaki disease,coronary myocardial bridge,and pulmonary artery diseases.In the venous sys-tem,PCBs also have therapeutic potential,with research and clinical investig-ations now extending to lower extremity,central,and pulmonary vein diseases,and innovative solutions for graft stenosis.The application of PCBs is no longer confined to vascular diseases.They are gradually breaking through traditional boundaries in treating luminal disorders such as urethral,biliary,and esophageal strictures.This mini-review synthesizes existing clinical evidence and basic research findings to concisely analyze the mechanisms of action and biological effects of PCBs in noncoronary applications.A comprehensive analysis of current studies provides a reference for subsequent research and clinical practice in this field and explicitly identifies the challenges faced by current research,explores future directions,and facilitates the in-depth extension of DCB applications.展开更多
BACKGROUND Epithelioid angiosarcoma(EA)is an aggressive,malignant endothelial-cell tumor of vascular or lymphatic origin.EA often arises from deep soft tissues such as pleura,breast,bone and gastrointestinal tract.It ...BACKGROUND Epithelioid angiosarcoma(EA)is an aggressive,malignant endothelial-cell tumor of vascular or lymphatic origin.EA often arises from deep soft tissues such as pleura,breast,bone and gastrointestinal tract.It usually affects patients aged 60-70 years and is associated with high recurrence and metastasis rates with surgical resection as the primary treatment of choice.Overall survivals are generally poor,ranging from 6 to 16 months.More than 50%of patients died of disease within 2 to 3 years of diagnosis.CASE SUMMARY We present a rare case of EA of the cervical spine causing a C6 pathological fracture complicated by severe kyphosis.The patient received C4-7 posterior laminectomy and C2/3/4/7/T1 transpedicular screw fixation,followed by anterior C5-6 corpectomy with allograft bone fusion and cervical plate fixation.Postoperative radiotherapy was administered without delay.However,the patient died of rapidly progressive acute respiratory distress syndrome 3 weeks after the second surgery.CONCLUSION EA with spinal involvement is extremely rare.Early detection and cord decompression may prevent neurological deterioration and preserve better quality of life.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assiste...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assisted TIPS(SATIPS)can significantly reduce the risk.AIM To evaluate the clinical efficacy of SATIPS,this study was conducted.METHODS One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals.Overall,54 patients received SATIPS treatment(SATIPS group),while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation(control group).Subsequently,survival rates,incidence rates of gastrointestinal bleeding,incidence of hepatic encephalopathy rate,and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.RESULTS The survival rates for the SATIPS and control groups were 94.4%and 92.5%at 3 months(P value=0.72)and 94.4%and 73.6%at 6 months(P value=0.0051)respectively.The incidence of liver failure was 3.7%and 9.4%at 3 months(P value=0.26)and 3.7%and18.9%at 6 months(P value=0.016);the incidence of gastrointestinal bleeding was 5.6%and 37.7%at 3 months(P value<0.001)and 9.3%and 47.2%(P value<0.001)at 6 months;and the incidence of hepatic encephalopathy was 3.7%and 17.0%at 3 months(P value=0.026)and 7.4%and 26.4%at 6 months(P value=0.026)respectively.CONCLUSION For patients with CTPV,there were no optimal treatment.Regarding long-term efficacy,SATIPS can significantly reduce the rate of rebleeding,hepatic encephalopathy and liver failure,and is associated with better survival.展开更多
BACKGROUND Percutaneous cholecystostomy(PC)can be used as a bridging therapy for moderately severe acute biliary pancreatitis(MSABP).Currently,there are only a limited number of reports of MSABP using PCs.AIM To asses...BACKGROUND Percutaneous cholecystostomy(PC)can be used as a bridging therapy for moderately severe acute biliary pancreatitis(MSABP).Currently,there are only a limited number of reports of MSABP using PCs.AIM To assess the short-term outcomes of early PC in MSABP and factors associated with recurrence and death in MSABP.METHODS Patients who received conservative treatment or PC for acute biliary pancreatitis(ABP)in Liaoning Provincial People’s Hospital from January 2017 to July 2022 were collected.A total of 54 patients with MSABP who received early-stage PC and 29 patients who received conservative treatment.The short-term efficacy of PC was evaluated.Depending on whether there is a recurrence,compare the characteristics of the pre-PC and explore the factors of recurrence.Pre-PC features were compared and predictors were discussed,depending on the outcome.RESULTS After 3 days of PC treatment,patients experienced a reduction in inflammatory markers compared to the conservative group.After PC,patients were divided into non-recurrence(n=37)and recurrence(n=10)groups,and the results showed that age was an independent correlation affecting ABP recurrence[odds ratio(OR)=0.937,95%confidence interval(CI):0.878-0.999;P=0.047<0.05].Patient outcomes were divided into non-lethal(n=47)and lethal(n=7)groups,and Charlson Comorbidity Index(CCI)was a risk factor for mortality(OR=2.397,95%CI:1.139-5.047;P=0.021<0.05).CCI was highly accurate in predicting death in MSABP(area under the curve=0.86>0.7).When the Youden index maximum was 0.565,the cut-off value was 5.5,the sensitivity was 71.4%,and the specificity was 85.1%.CONCLUSION PC is an important method in the early years(<72 hours)of MSABP.Age is a protective factor against recurrence of ABP.High pre-PC CCI is significantly associated with mortality.展开更多
BACKGROUND Thermal ablation(TA),including radiofrequency ablation and microwave ablation,is a commonly used curative treatment for single small hepatocellular carcinoma(sHCC).The relative advantages of TA and surgical...BACKGROUND Thermal ablation(TA),including radiofrequency ablation and microwave ablation,is a commonly used curative treatment for single small hepatocellular carcinoma(sHCC).The relative advantages of TA and surgical resection(SR)in terms of long-term survival remain controversial.AIM To compare their long-term efficacy in this patient population.METHODS This population-based retrospective cohort study included 257 patients who received a first diagnosis of single sHCC and underwent SR or TA from January 2012 to September 2017.The primary endpoints were overall survival(OS)and recurrence-free survival(RFS).RESULTS The average follow-up duration was 11.4 years.The 1-,3-,5-,and 10-year OS rates were 95.8%,86.0%,82.5%,and 74.2%in the SR group vs 97.4%,85.8%,78.6%,and 65.6%in the TA group,with the median OS not yet reached.The 1-,3-,5-,and 10-year RFS rates were 79.8%,59.6%,46.2%,and 24.7%in the SR group vs 83.9%,61.5%,47.9%,and 41.2%in the TA group,with median RFS values of 3.95 and 4.63 years,respectively.No significant differences in OS or RFS were observed overall(OS:P=0.244;RFS:P=0.180),but in patients≤60 years,TA led to a higher RFS than SR(P=0.021).Multivariate analysis identified age,tumor differentiation grade,and Child-Pugh classification as independent risk factors for OS,whereas age and differentiation grade were significant risk factors for RFS.CONCLUSION In patients with single sHCC,SR,and TA offered comparable long-term efficacy.However,TA showed superior RFS in patients≤60 years,suggesting that TA may be a reasonable option for younger patients,pending confirmation by prospective studies.展开更多
文摘Hemoptysis is defined as bleeding originating from the respiratory tract distal to the larynx and is associated with a wide spectrum of underlying conditions,including bronchiectasis,pulmonary malignancies,tuberculosis,aspergillosis,and vascular malformations.^([1-3]) A metaanalysis involving patients with massive hemoptysis reported a mortality rate of 3.5%.^([4])This underscores the critical importance of prompt and eff ective embolization of the responsible artery to improve outcomes,particularly in patients presenting with life-threatening hemoptysis.
文摘Background and Objectives: Establishing a stable pathway is the basis for interventional surgery, and hyper-selected intubation has become the basic requirement for vascular intervention therapy. Super-selection intubation can not only significantly improve the efficacy of peripheral intervention treatment, but also greatly reduce surgical complications. However, during the treatment of peripheral vascular intervention (such as liver tumor arterial chemotherapy embolism, hemoptysis bronchial arterial embolism, gastrointestinal hemorrhagic gastrointestinal arterial embolism, etc.), vascular mutation is often large, and there are many branches, and the direction of blood flow is into the direction of blood flow, the horns are even reverse, and even the use of straight-headed microstructures will have difficulty interpolation difficulties or even failure, which increases the risk of surgery and affects safety treatment. To overcome this, pre-plasticized microcatheters have emerged, among which the InstantPass Swan-Neck Microstructure is a catheter with a head-end morphology similar to Cobra. Our research aims to explore the feasibility, safety, and technical advantages of the use of swan-neck microcatheter in peripheral vascular hyperboloid intubation. Materials and Methods: From January 2023 to March 2024, 31 patients with swan-neck microstructure were used in the peripheral vascular intervention therapy outside the hospital. Among them, there were 23 men and 8 women, aged 32 - 81 years old, an average (55 ± 13) years, and the average irradiation time was 35.1 ± 24.7 minutes. 10 cases of iodide oil arterial chemotherapy embolism, 7 cases of microspheres of hepatic arteries, 3 cases of gastric duodenal artery selective embolism, 3 cases of vein embolism with esophageal stomach, and 2 cases of sperm varicose vein embolism, 2 cases of selective embolism of the intestinal membrane, 2 cases of uterine arteries embolism, and 2 cases of renal arterial embolism. 11 of these patients switched to the swan-neck microstructure after using the straight-headed microstructure super-selective intubation. To analyze whether the swan-neck microcatheter is successfully transported to the target location, whether it can provide a satisfactory path for subsequent intravascular treatment, evaluate the surgery instant image results and complications related to the microstructure during the surgery period, analyze the angle of the target blood vessels and the main blood vessels, the target blood vessels, the target blood vessels, the relationship between the degree of pedestrian and the success rate of ultra-selective intubation, and summarize the indication of the application of the swan-neck microstructure in peripheral intervention therapy. Results: In this study, 31 patients used 31 swan-neck microcatheters, of which 22 (70.9%) target vascular and main blood vessels were ≤90˚;17 patients (54.8%) patients were curved and angulated;11 cases (35.5%) were after the failure of the superselective intubation of the straight-headed microstructure, the swan-neck microcatheter was successful after the failure;1 case (3.2%) patients with microstructure-related mezzanine occurred during surgery, and the complication rate of the perioperative ductation was 3.2%. All target lesions are finally successfully completed, and the success rate of surgical technology is 100%. Conclusion: Swan-neck microcatheters have a high success rate in superselective cannulation of peripheral blood vessels and perform well in vascular tortuosity and angulated lesions.
文摘BACKGROUND The development of hepatocellular carcinoma(HCC)is influenced by multiple factors.Interventional therapy offers an effective treatment option for patients with unresectable intermediate-to-advanced HCC.Interventional therapy can induce electrocardiographic(ECG)abnormalities that may be associated with liver dysfunction,electrolyte disorders,and cardiac injury.AIM To explore the ECG alterations and determinants following interventional therapy in patients with HCC.METHODS Sixty patients undergoing interventional treatment for liver cancer were selected as study participants.According to the results of the dynamic ECG examination 1 day after surgery,the patients were divided into an abnormal group(n=21)and a nonabnormal group(n=39).With the help of dynamic ECG examination,the ECG parameters were compared and the baseline data of patients was recorded in the two groups.RESULTS The 24 hours QT interval variability,24 hours normal atrial polarization to ventricular polarization(R-R)interval(standard deviation),24 hours consecutive 5 minutes normal R-R interval,and 24 hours continuous 5 minutes normal R-R interval(standard deviation mean)were lower than patients in the nonabnormal group(P<0.05).The logistic analysis showed that age>60 years,liver function grade B,and postoperative body temperature 38°C were risk factors for abnormal dynamic electrocardiogram in patients with liver cancer intervention(P<0.05).CONCLUSION Interventional therapy for HCC can lead to ECG abnormalities,underscoring the clinical need for enhanced cardiac monitoring to mitigate myocardial complications.
文摘BACKGROUND The liver is the most common site of digestive system tumor metastasis,but not all liver metastases can be traced back to the primary lesions.Although it is unusual,syphilis can impact the liver,manifesting as syphilitic hepatitis with inflammatory nodules,which might be misdiagnosed as metastasis.CASE SUMMARY This case report involves a 46-year-old female who developed right upper abdominal pain and intermittent low fever that persisted for more than three months.No definitive diagnosis of a tumor had been made in the past decades,but signs of multiple liver metastases were recognized after a computed tomo-graphy scan without evidence of primary lesions.With positive serological tests for syphilis and a biopsy of the liver nodules,a diagnosis of hepatic syphilis was made and confirmed with follow-up nodule reduction after anti-syphilis therapy.CONCLUSION Clinicians must be aware of the possibility that syphilis can cause hepatic inflam-matory masses,especially when liver metastasis is suspected without evidence of primary lesions.A definitive diagnosis should be established in conjunction with a review of the patient’s medical history for accurate therapeutic intervention.
文摘Pancreatic cystic lesions are being increasingly detected,mainly due to the widespread use of cross-sectional imaging.The reported prevalence ranges from 13%to 18%in asymptomatic individuals.These lesions display a broad histologic spectrum,from benign pseudocysts to premalignant mucinous cystic neoplasms and invasive carcinomas.Although many classification and management strategies exist,the natural history of numerous pancreatic cystic lesions remains incompletely understood,contributing to significant clinical uncertainty.Current diagnostic tools,including computed tomography,magnetic resonance imaging,endoscopic ultrasound,and cyst fluid analysis,are constrained by either suboptimal sensitivity or high costs.Cytology,while specific when positive,suffers from low sensitivity.Biochemical markers such as carcinoembryonic antigen,amylase,and glucose can help in cyst differentiation,whereas molecular testing(e.g.,KRAS,GNAS,RNF43 mutations)provides additional diagnostic and prognostic value.However,the application of molecular diagnostics is still restricted in routine practice due to costs,access issues,and a lack of standardization.This diagnostic uncertainty leads to both overtreatment and undertreatment.Some patients undergo unnecessary surgeries for benign lesions,which exposes them to procedural risks and long-term consequences.Others may experience delays in interventions for high-risk cysts and missing opportunities for cancer prevention.Additionally,prolonged,and often unnecessary surveillance burdens patients and healthcare systems psychologically and financially.In this minireview,we present a comprehensive overview of the classification,diagnostic approach,and management of pancreatic cystic lesions,incorporating recent evidence and current international guidelines(Fukuoka,American Gastroenterological Association,European).We also highlight the limitations of existing strategies and emerging tools such as radiomics,next-generation sequencing,and novel biomarkers.Additionally,we emphasize the urgent need for cost-effective,accurate,and accessible diagnostic pathways.A more refined risk stratification approach is essential to optimize outcomes,reduce healthcare waste,and improve the quality of life for patients with pancreatic cystic lesions.
基金Supported by the Second Batch of Social Development Science and Technology Program Projects of Taizhou Science and Technology Bureau in 2023,No.24ywb80.
文摘Klebsiella pneumoniae infections(KPIs),particularly carbapenem-resistant Klebsiella pneumoniae(CRKP),pose significant challenges in liver transplantation(LT)recipients,with high morbidity and mortality.Guo et al’s study highlights risk factors,such as elevated day-one alanine aminotransferase levels and prolonged catheterization,and identifies polymyxin B and ceftazidime/avibactam as effective treatments.However,limitations like the absence of pre-transplant colonization data and host-pathogen interaction insights highlight the need for enhanced strategies.Future directions should include routine CRKP colonization surveillance,immune and genomic profiling,and the development of novel therapeutics.By integrating these approaches,we can improve the prevention,diagnosis,and treatment of KPIs in LT patients.
文摘BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the digestive tract worldwide,characterized by high incidence and mortality rates.AIM To investigate the expression of serum apurinic/apyrimidinic endonuclease 1 autoantibodies(APE1-AAbs),peripheral pentraxin-3(PTX-3),and miR-486-3p in patients with CRC undergoing radical surgery and their relationship with postoperative recurrence and metastasis.METHODS A retrospective analysis was conducted on the clinical data of 154 CRC patients who underwent laparoscopic radical surgery in our hospital from January 2022 to January 2024.Patients were followed for one year postoperatively and divided into an occurrence group(n=28)and a non-occurrence group(n=126)based on whether they experienced recurrence or metastasis.The clinical data and the expression levels of APE1-AAbs,PTX-3,and miR-486-3p were compared between the two groups.Multivariate logistic regression analysis was performed to identify risk factors for postoperative recurrence and metastasis in CRC patients.The relationship of APE1-AAbs,PTX-3,and miR-486-3p with postoperative recurrence and metastasis was analyzed using Spearman correlation analysis.Receiver operating characteristic curves were drawn to evaluate the predictive value of serum APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination for postoperative recurrence and metastasis in CRC.RESULTS The occurrence group had significantly higher proportions of patients with an age≥60 years,lymph node metastasis,stage III disease,poor differentiation,tumor diameter>5 cm,and higher platelet count,carcinoembryonic antigen,and carbohydrate antigen 19-9 levels than the non-occurrence group(P<0.05).The expression levels of APE1-AAbs,PTX-3,and miR-486-3p in the occurrence group were significantly higher than those in the non-occurrence group(P<0.05).Multivariate logistic regression analysis showed that lymph node metastasis,stage III disease,poor differentiation,and elevated levels of APE1-AAbs,PTX-3,and miR-486-3p were risk factors for postoperative recurrence and metastasis in CRC patients(odds ratio>1,P<0.05).Spearman correlation analysis revealed that the levels of APE1-AAbs,PTX-3,and miR-486-3p were positively correlated with postoperative recurrence and metastasis in CRC patients(r=0.642,0.653,and 0.631,respectively,P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve values for APE1-AAbs,PTX-3,and miR-486-3p levels alone and their combination in predicting postoperative recurrence and metastasis in CRC were 0.764,0.783,0.806,and 0.875,respectively,with the combination significantly outperforming individual markers(P<0.05).CONCLUSION Serum APE1-AAbs,PTX-3,and miR-486-3p levels are higher in CRC patients with postoperative recurrence and metastasis.These three markers are risk factors for postoperative recurrence and metastasis in CRC and can be used as predictive biomarkers.The combined detection of these markers has higher predictive value compared to individual tests.
文摘Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting and surgical gastrojejunostomy,EUS-GE offers comparable technical and clinical success while providing longer-lasting patency,fewer adverse events,and lower reintervention rates.The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome.EUSGE enables rapid recovery and early resumption of oral intake,which is crucial for oncologic patients.However,the procedure remains technically demanding,and optimal techniques,device selection,and management of complications are still under investigation.This mini-review summarizes current evidence,compares EUS-GE with alternative therapies,discusses patient selection and procedural aspects,and outlines key areas for future research.
文摘BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or systemic therapies,often fail to provide sufficient pain relief or improve functional outcomes in these patients.Microwave ablation(MWA)offers advantages,such as shorter pro-cedure times and larger ablation zones,while percutaneous osteoplasty(PO)enhances bone stability and prevents pathological fractures.Despite these be-nefits,the combination of these techniques for treating flat bone metastases re-mains underexplored.AIM To evaluate the efficacy and safety of C-arm computed tomography(CT)-guided MWA combined with PO for managing painful flat bone metastases,focusing on pain relief,functional improvement,and QOL enhancement.METHODS A total of 45 patients with refractory moderate-to-severe pain resulting from flat bone metastases who underwent C-arm CT-guided MWA combined with PO between January 2015 and January 2021 were included.The efficacy of the pro-cedure was assessed by changes in the visual analog scale(VAS),Oswestry disability index(ODI),and QOL,as well as the occurrence of complications.Tumor response was evaluated using RECIST v1.1 and mRECIST criteria,with overall response rate(ORR)and disease control rate(DCR)as the primary end-points.RESULTS No serious complications were observed in any of the patients.A significant reduction in VAS and ODI was noted at 1 week,1 month,and 3 months post-procedure.A marked improvement in QOL was observed at all follow-up points.Bone cement extravasation was observed in 10 patients;however,none exhibited significant clinical symptoms.Based on RECIST v1.1,the ORR was 26.7%and the DCR was 88.9%.The mRECIST evaluation revealed a higher ORR of 51.1%and DCR of 88.9%.CONCLUSION C-arm CT-guided MWA with PO provides a dependable and effective strategy for managing flat bone metastases.It demonstrates significant pain relief,improved functional outcomes,and enhanced QOL.This treatment combination also shows promising tumor response rates with a low complication profile.
文摘BACKGROUND No reports have been published on the use of iodine-125(125I)seed strips combined with double biliary self-expandable metallic stent(SEMS)for the treatment of type III and IV hilar malignant biliary obstruction(MBO).AIM To evaluate effectiveness and safety of 125I seed trips combined with double SEMS in treating Bismuth type III and IV hilar MBO.METHODS This was a retrospective,observational study conducted from April 2017 to December 2022.Patients with Bismuth-Corlette type III and IV hilar MBO who underwent 125I seed strip implantation combined with double SEMS placement were analyzed.Patient demographics,clinical characteristics,SEMS implantation methods,procedural and clinical outcomes,overall survival,stent patency duration,and complications were evaluated.RESULTS Four types of stent implantation were utilized:(1)Type X;(2)Type T;(3)Type Y;and(4)Tandem type.The technical success rate was 94.1%(16/17),and the clinical success rate was 100%(17/17).The median overall survival time was 189.00 days±47.27 days(95%CI:96.35-281.66).The median stent fluency time was 154.00 days±12.19 days(95%CI:130.11-177.89).No serious complications were observed.CONCLUSION This retrospective,observational study suggests that the combination of 125I seed strips with double SEMS may be a safe and potentially effective approach for managing type III and IV hilar MBO patients.
基金Supported by 2023 Hebei Provincial Medical Scientific Research Project Plan,No.20231304.
文摘Colorectal cancer(CRC)with liver metastasis remains a significant therapeutic challenge,particularly in cases of postoperative recurrence.While transarterial chemoembolization(TACE)and targeted therapies have shown promise individually,the efficacy combining these for treating postoperative recurrent CRC with liver metastasis requires further investigation.AIM To evaluate the efficacy and safety of TACE combined with targeted therapies for postoperative recurrent CRC with liver metastasis.METHODS This observational study enrolled 75 patients with postoperative recurrent CRC accompanied by liver metastasis between January 2020 and December 2023.All patients received combined treatment with TACE and targeted therapy:Bevacizumab(40 patients,53.3%),cetuximab(25 patients,33.3%),or panitumumab(10 patients,13.3%).Treatment response was evaluated using the Response Evaluation Criteria in Solid Tumors 1.1 criteria,with overall survival(OS)and progression-free survival as the primary endpoints.Quality of life was assessed using the European Organization for Research and Treatment of Cancer quality of life questionnaire at baseline and after six months of treatment.RESULTS The median OS was 28 months(95%confidence interval:24-32 months),and the median progression-free survival was 12 months(95%confidence interval:10-14 months).Patients treated with bevacizumab showed significantly better survival outcomes than those treated with cetuximab/panitumumab(median OS,30 vs 24 months,P=0.015).The overall response rate was 58.7%,with a disease control rate of 86.7%.Quality of life scores improved significantly across all domains,with greater improvements observed in the bevacizumab group.Treatment-related adverse events were manageable,with grade 3-4 events occurring in 13.3%of the patients and no treatment-related mortality.CONCLUSION The combination of TACE with targeted therapy,particularly bevacizumab,has demonstrated promising efficacy and acceptable safety for the treatment of postoperative recurrent CRC with liver metastasis.This multimodal approach not only improved survival outcomes but also enhanced the patients’quality of life,suggesting its potential as a valuable treatment strategy for this challenging condition.
文摘BACKGROUND Patients undergoing interventional therapy for liver cancer experience severe psychological pain and are prone to anxiety and depression.AIM To explore factors influencing anxiety and depression symptoms in 200 patients diagnosed with primary liver cancer.METHODS Data from 200 individuals diagnosed with primary liver cancer and admitted to the authors’hospital(January 2022 to January 2024)were divided into 2 groups according to psychological status:Normal(n=100);and anxiety and depression(n=100).Through a questionnaire survey of patients and their families,single and multifactor factors of anxiety and depression in the postoperative interven-tional treatment of patients with primary liver cancer were analyzed.RESULTS Univariate analysis revealed no statistical differences between the 2 groups in terms of chronic disease,sex,liver function,Child grade,and age(P>0.05).How-ever,there were statistical differences in payment method,disease cognition,number of interventional treatments,per capita income,and educational level(P<0.05).Multivariate logistic regression analysis revealed that educational level,per capita income,disease cognition,payment method,and number of interven-tional treatments were all independent factors influencing postoperative anxiety and depression symptoms after interventional therapy in patients diagnosed with primary liver cancer,and the comparisons were statistically significant(P<0.05).CONCLUSION Analysis of associated risk factors can strengthen the clinical screening of patients with liver cancer at high risk for postoperative anxiety and depression symptoms and improve their prognosis.
文摘Cholangiocarcinoma(CCA)is a particularly aggressive and challenging type of cancer,known for its poor prognosis,which is worsened by the complex interplay of various biological and environmental factors that contribute to its development.Recently,researchers have increasingly focused on the significant role of the biliary-enteric communication of liver-gut axis in the pathogenesis of CCA,highlighting a complex relationship that has not been thoroughly explored before.This review aims to summarize the key concepts related to the biliary-enteric communication of liver-gut axis and investigate its potential mechanisms that may lead to the onset and progression of CCA,a disease that presents substantial treatment challenges.Important areas of focus will include the microbiome's profound influence,which interacts with host physiology in ways that may worsen cancer development;changes in bile acid metabolism that can create toxic environments favorable for tumor growth;the regulation of inflammatory processes that may either promote or inhibit tumor progression;the immune system's involvement,which is crucial in the body's response to cancer;and the complex interactions within metabolic pathways that can affect cellular behavior and tumor dynamics.By integrating recent research findings from various studies,we aim to explore the multifaceted roles of the biliary-enteric communication of liver-gut axis in CCA,providing new insights and perspectives for future research while identifying promising therapeutic targets that could lead to innovative treatment strategies aimed at improving patient outcomes in this challenging disease.
文摘BACKGROUND Malnutrition exacerbates the deterioration in patients with advanced gas-trointestinal tumors.AIM To analyze the effect of enteral nutritional support based on Nutrition Risk Screening 2002(NRS2002)risk assessment on nutritional function in patients with gastrointestinal tumors.METHODS One hundred twelve patients from April 2022 to April 2024 were included for observation and were divided into a control group and an observation group by random number method,56 each.Both groups received treatment for four consecutive weeks.The control group received routine enteral nutrition support,while the observation group received enteral nutrition support based on the NRS2002 risk assessment.Nutritional function,intestinal mucosal barrier function,quality of life,and complication rate were compared between the two groups.Statistical analysis was completed using SPSS26.0 and Excel.RESULTS After nutritional intervention,transferrin,albumin,hemoglobin,and diamine oxidase levels in the observation group were higher than those in the control group,while C-reactive protein,tumor necrosis factorα,and quality of life scores were lower,with significant differences(P<0.05).There was no significant difference in complications between groups(P>0.05),but the complication rate was lower in the observation group.CONCLUSION Enteral nutritional support based on NRS2002 risk assessment for patients with gastrointestinal tumors positively impacts nutritional status and promotes intestinal mucosal barrier function recovery.Patients’quality of life improved,and the incidence of adverse reactions decreased,indicating clinical promotion and application value.
基金Supported by National Natural Science Foundation of China,No.82330061The PUMC Graduate Curriculum Informatization Development Special Fund Project,No.2024YXX004The CAMS Initiative for Innovative Medicine,No.2021-I2M-1-015.
文摘A recent study in World Journal of Hepatology examined the use of intravascular ultrasound(IVUS)for transjugular intrahepatic portosystemic shunt(TIPS)creation.The study concluded that IVUS significantly reduces procedure time,radiation exposure,and the number of needle passes compared to conventional fluoroscopic guidance.IVUS offers real-time visualization of the portal vein,but challenges remain in terms of equipment costs and the operator learning curve.TIPS creation techniques vary widely in clinical practice,where methods,such as conventional fluoroscopy,three-dimensional image fusion,electromagnetic navigation,and IVUS,are commonly employed.In this editorial,we provide a comparative analysis of these methods based on clinical experience and the literature.By evaluating the strengths and limitations of each technique,we aim to inform clinical decision-making and enhance procedural outcomes.Future developments in TIPS creation are likely to focus on hybrid techniques that combine the strengths of IVUS,electromagnetic navigation,and real-time image fusion,potentially leading to more precise,cost-effective,and accessible methods.
基金Supported by Mianyang Health Commission 2019 Scientific Research Encouragement Project,No.201948.
文摘Although drug-coated balloons(DCBs)were initially used for treating peripheral vascular diseases,with the growing popularity of the implant-free concept,they have gained increasing attention as a novel therapeutic strategy for coronary atherosclerotic heart disease.The clinical application scope of DCBs,represented by paclitaxel-coated balloons(PCBs),is constantly expanding.Their application fields are no longer limited to lesions of coronary artery and peripheral vascular diseases,and relevant research is also being actively advanced.In the field of arterial diseases,the application of PCBs has significantly extended.They are used in lower extremity arteries and hemodialysis access and play a role in renal artery fibromuscular dysplasia,and carotid/vertebrobasilar/intracranial arteries.PCBs also show unique value in the treatment of Takayasu arteritis,Kawasaki disease,coronary myocardial bridge,and pulmonary artery diseases.In the venous sys-tem,PCBs also have therapeutic potential,with research and clinical investig-ations now extending to lower extremity,central,and pulmonary vein diseases,and innovative solutions for graft stenosis.The application of PCBs is no longer confined to vascular diseases.They are gradually breaking through traditional boundaries in treating luminal disorders such as urethral,biliary,and esophageal strictures.This mini-review synthesizes existing clinical evidence and basic research findings to concisely analyze the mechanisms of action and biological effects of PCBs in noncoronary applications.A comprehensive analysis of current studies provides a reference for subsequent research and clinical practice in this field and explicitly identifies the challenges faced by current research,explores future directions,and facilitates the in-depth extension of DCB applications.
文摘BACKGROUND Epithelioid angiosarcoma(EA)is an aggressive,malignant endothelial-cell tumor of vascular or lymphatic origin.EA often arises from deep soft tissues such as pleura,breast,bone and gastrointestinal tract.It usually affects patients aged 60-70 years and is associated with high recurrence and metastasis rates with surgical resection as the primary treatment of choice.Overall survivals are generally poor,ranging from 6 to 16 months.More than 50%of patients died of disease within 2 to 3 years of diagnosis.CASE SUMMARY We present a rare case of EA of the cervical spine causing a C6 pathological fracture complicated by severe kyphosis.The patient received C4-7 posterior laminectomy and C2/3/4/7/T1 transpedicular screw fixation,followed by anterior C5-6 corpectomy with allograft bone fusion and cervical plate fixation.Postoperative radiotherapy was administered without delay.However,the patient died of rapidly progressive acute respiratory distress syndrome 3 weeks after the second surgery.CONCLUSION EA with spinal involvement is extremely rare.Early detection and cord decompression may prevent neurological deterioration and preserve better quality of life.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is contraindicated for patients with cavernous transformation of the portal vein(CTPV)due to high surgery-related mortality risk.However,surgically assisted TIPS(SATIPS)can significantly reduce the risk.AIM To evaluate the clinical efficacy of SATIPS,this study was conducted.METHODS One hundred and seven patients with CTPV and esophagogastric variceal bleeding were recruited from January 2023 to December 2024.The patients were recruited from three different hospitals.Overall,54 patients received SATIPS treatment(SATIPS group),while 53 patients did not receive SATIPS and underwent prophylactic endoscopic sclerosing ligation(control group).Subsequently,survival rates,incidence rates of gastrointestinal bleeding,incidence of hepatic encephalopathy rate,and the incidence of liver failure after treatment in both groups at 3 and 6 months were observed.RESULTS The survival rates for the SATIPS and control groups were 94.4%and 92.5%at 3 months(P value=0.72)and 94.4%and 73.6%at 6 months(P value=0.0051)respectively.The incidence of liver failure was 3.7%and 9.4%at 3 months(P value=0.26)and 3.7%and18.9%at 6 months(P value=0.016);the incidence of gastrointestinal bleeding was 5.6%and 37.7%at 3 months(P value<0.001)and 9.3%and 47.2%(P value<0.001)at 6 months;and the incidence of hepatic encephalopathy was 3.7%and 17.0%at 3 months(P value=0.026)and 7.4%and 26.4%at 6 months(P value=0.026)respectively.CONCLUSION For patients with CTPV,there were no optimal treatment.Regarding long-term efficacy,SATIPS can significantly reduce the rate of rebleeding,hepatic encephalopathy and liver failure,and is associated with better survival.
基金The Institutional Ethics Committee of Liaoning Provincial People’s Hospital approved the study,No.(2023)K037.
文摘BACKGROUND Percutaneous cholecystostomy(PC)can be used as a bridging therapy for moderately severe acute biliary pancreatitis(MSABP).Currently,there are only a limited number of reports of MSABP using PCs.AIM To assess the short-term outcomes of early PC in MSABP and factors associated with recurrence and death in MSABP.METHODS Patients who received conservative treatment or PC for acute biliary pancreatitis(ABP)in Liaoning Provincial People’s Hospital from January 2017 to July 2022 were collected.A total of 54 patients with MSABP who received early-stage PC and 29 patients who received conservative treatment.The short-term efficacy of PC was evaluated.Depending on whether there is a recurrence,compare the characteristics of the pre-PC and explore the factors of recurrence.Pre-PC features were compared and predictors were discussed,depending on the outcome.RESULTS After 3 days of PC treatment,patients experienced a reduction in inflammatory markers compared to the conservative group.After PC,patients were divided into non-recurrence(n=37)and recurrence(n=10)groups,and the results showed that age was an independent correlation affecting ABP recurrence[odds ratio(OR)=0.937,95%confidence interval(CI):0.878-0.999;P=0.047<0.05].Patient outcomes were divided into non-lethal(n=47)and lethal(n=7)groups,and Charlson Comorbidity Index(CCI)was a risk factor for mortality(OR=2.397,95%CI:1.139-5.047;P=0.021<0.05).CCI was highly accurate in predicting death in MSABP(area under the curve=0.86>0.7).When the Youden index maximum was 0.565,the cut-off value was 5.5,the sensitivity was 71.4%,and the specificity was 85.1%.CONCLUSION PC is an important method in the early years(<72 hours)of MSABP.Age is a protective factor against recurrence of ABP.High pre-PC CCI is significantly associated with mortality.
文摘BACKGROUND Thermal ablation(TA),including radiofrequency ablation and microwave ablation,is a commonly used curative treatment for single small hepatocellular carcinoma(sHCC).The relative advantages of TA and surgical resection(SR)in terms of long-term survival remain controversial.AIM To compare their long-term efficacy in this patient population.METHODS This population-based retrospective cohort study included 257 patients who received a first diagnosis of single sHCC and underwent SR or TA from January 2012 to September 2017.The primary endpoints were overall survival(OS)and recurrence-free survival(RFS).RESULTS The average follow-up duration was 11.4 years.The 1-,3-,5-,and 10-year OS rates were 95.8%,86.0%,82.5%,and 74.2%in the SR group vs 97.4%,85.8%,78.6%,and 65.6%in the TA group,with the median OS not yet reached.The 1-,3-,5-,and 10-year RFS rates were 79.8%,59.6%,46.2%,and 24.7%in the SR group vs 83.9%,61.5%,47.9%,and 41.2%in the TA group,with median RFS values of 3.95 and 4.63 years,respectively.No significant differences in OS or RFS were observed overall(OS:P=0.244;RFS:P=0.180),but in patients≤60 years,TA led to a higher RFS than SR(P=0.021).Multivariate analysis identified age,tumor differentiation grade,and Child-Pugh classification as independent risk factors for OS,whereas age and differentiation grade were significant risk factors for RFS.CONCLUSION In patients with single sHCC,SR,and TA offered comparable long-term efficacy.However,TA showed superior RFS in patients≤60 years,suggesting that TA may be a reasonable option for younger patients,pending confirmation by prospective studies.
