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Objective:To evaluate the long-term outcome of Viabahn stent graft in the treatment of complex femoropopliteal occlusive lesions.Methods:From Sep 2013 to Mar 2020, clinical data of TASC C and D femoropopliteal lesions treated with Viabahn were retrospectively analyzed. Patency rates, the freedom rate from clinically-driven target lesion revascularization (F-TLR), limb salvage and survival after five years were calculated.Results:A total of 65 patients (67 lower limbs) were included. 20 limbs were TASC C lesions, 47 limbs were TASC D lesions. The mean lesion length was (29.1±9.4) cm, including 48 chronic total occlusion (CTO) lesions (71.6%) with mean lesion length of (26.1±10.4) cm. Technique success rate was 98.6%. Mean length of stent graft was (31.3±10.1) cm.Major amputation was performed in 4.2% cases within 5 years. All-cause mortality in 5 years was 23.1%. Primary patency rates at 1,3,and 5 years were 76.8%,59.4%,50.9%, Assisted primary patency rates were 88.4%, 83.4%, 83.4% and secondary patency rates were 88.4%, 85.8%, and 85.8% . F-TLR at 1, 3 and 5 year was 88.2%,76.9%,73.1% .Conclusion:Viabahn for complex and long femoropopliteal artery occlusions is an acceptable treatment with fair long-term outcome.
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With the development of percutaneous transluminal angioplasty, stent implantation has gradually become an important treatment for peripheral artery diseases, especially for arterial diseases of lower extremities. Due to the continuous exposure of the disadvantages of permanent metal stents and the continuous development of absorbable materials, researchers gradually pay attention to the bioresorbable stents with fewer long-term complications. At present, the application of bioresorbable stents in coronary artery disease has been relatively mature. This paper reviews the research progress of bioresorbable zinc alloy stents in peripheral artery disease.
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Objective:To analyze the clinical efficacy and safety of endoluminal treatment of complex renal artery aneurysm (RAA).Methods:The clinical data and follow-up results of 19 patients with complex RAA admitted to Renji Hospital, Shanghai Jiaotong University School of Medicine from November 2014 to September 2021 were retrospectively analyzed. Two patients were treated with simple spring coil embolization into the aneurysmal artery, 14 patients were treated with simple spring coil embolization of the aneurysmal cavity, and 3 patients were treated with stent-assisted + spring coil embolization technique. Based on the location of the aneurysm, RAA were classified into type Ⅰ, Ⅱ, and Ⅲ. 7 patients with type Ⅰ, 10 patients with type Ⅱ, and 2 patients with type Ⅲ were studied. Variance analysis was used to compare the differences in glomerular filtration rate(GFR) of the affected side when the tumor was located at different locations, and Pearson was used to analyze the correlation between the number of coils implanted and the size of the tumor and GFR.Results:Ten of the 19 patients who were underwent successful endoluminal intervention. The average size of the patients′ aneurysms was (20.89±6.65) mm, and the average number of spring coils implanted was 8.22±3.08. The preoperative and postoperative serum creatinine were in the normal range, and no RAA tumor enlargement or recurrence was found during the follow-up period. The postoperative GFR was abnormal in patients with type Ⅰ, type Ⅱ, and type Ⅲ renal aneurysms, and the mean GFR value differed among the three types of patients( P=0.003). There was a negative correlation between the postoperative GFR values of the affected kidney and the number of spring coils implanted ( P=0.047), and no significant relationship between GFR and aneurysm size. Conclusion:The endovascular technique is an effective and safe means of treating complex RAA.
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Objective:To evaluate the rapid nucleic acid amplification detection of Mycoplasma pneumoniae (MP)-DNA and MP-RNA in the diagnosis of MP infection and therapeutic values in children. Methods:Patients who were diagnosed with pneumonia were enrolled from the Department of Respiration, Children′s Hospital of Capital Institute of Pediatrics from January 2018 to December 2018.Specimens were detected using the MP and Macrolide-Resistant isolates Diagnostic Kit (PCR Fluorescence Probing, Jiangsu Mole Bioscience Co., Ltd.) and MP Diagnostic Kit (Isothermal RNA amplification, Shanghai Rendu Biotechnology Co., Ltd.).Results:Among them, 42.1%(840 cases) of the 1 994 cases were positive for MP-DNA, and the macrolide associated gene mutations were detected in 96.0% (806/840 cases) of them, while 33.9% (551 cases) of 1 624 cases were positive for MP-RNA.Seven hundred and fifty-eight specimens were simultaneously detected by adopting MP-DNA and MP-RNA, and the positive rate was 43.1% (327/758 cases) and 36.7% (278/758 cases), accordingly, which were inconsistent (Kappa=0.604) in 613 (80.9%, 613/758 cases) cases, with significant differences ( χ2=6.60, P=0.01). Part of the specimens were rechecked with the interval of 7 days: MP-RNA was negative in 70.1% (47/67 cases) specimens and MP-DNA was negative in 36.1% (22/91 cases) specimens ( χ2=33.20, P<0.01). Conclusions:The positive detection rate of MP was at a high level in 2018, in Beijing, China.The results of MP-DNA and MP-RNA are consistant.But RNA detection can help to diagnose MP in the early stage, and monitor the survival of MP and its efficiency.
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Objective:To investigate whether the clinical efficacy of mechanical pharmacothrombectomy (PMT) in treatment of whole-lower-limb acute deep vein thrombosis (DVT) could be improved by the modified approach removing popliteal vein thrombosis.Methods:From Mar 2016 to Mar 2018, 31 patients with whole-lower-limb acute DVT were enrolled and treated with PMT by AngioJet. The clinical data was retrospectively analyzed, and the clinical efficacy was evaluated.Results:26 cases were treated by contralateral common femoral vein approach and the other 5 cases by ipsilateral calf deep vein. Urokinase was given in bolus in 29 patients before thrombectomy. After PMT, 7 cases combined with catheter-directed thrombolysis. 26 cases underwent iliac vein PTA, and 14 cases underwent iliac vein stenting. The average hospitalization days was (7.6±1.8) d. The thrombus clearance rate was grade Ⅱ (50%~99%) in 16 cases (51.6%) and grade Ⅲ (100%) in 15 cases (48.4%). 30 patients were followed up and the mean follow-up time was 19.7 months. The 12-month primary patency rate was 83.3%. All the 5 patients with occlusion had different degrees of post-thrombotic syndrome (PTS), and the incidence of PTS was 16.7% (5/30).Conclusions:The modified approach to treat the whole-lower-limb acute deep vein thrombosis with PMT is safe and effective. The popliteal vein thrombosis can be cleared in one stage. The blood inflow can be improved, and the incidence of PTS is relatively low.
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The incidence of iliac vein occlusion is high in clinics. Most of them are latent disease. Non-thrombotic iliac vein occlusion is an important cause of chronic venous diseases in lower limbs. Post thrombotic syndrome and iliac vein compression syndrome are two main forms non-thrombotic iliac vein occlusion. Stent implantation is the first-line treatment method for iliac vein occlusion. Reasonable stent diameter selection and accurate positioning are two key technical points to ensure high patency rate of iliac vein stent. Intravascular ultrasound plays an important role in diagnosing iliac vein occlusion and stenting. After iliac vein stent implantation, regular ultrasonic follow-up is required, and optimal postoperative drug therapy is still controversial. The development and application of new specialized iliac vein stent is expected to further improve the clinical effect of iliac vein stent implantation.
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Great progress has been made in devices and techniques for the endovascular treatment of peripheral artery diseases. The plain old balloon angioplasty, stent implantation and the emerging drug-coated balloon angioplasty have provided new means of treatment. In recent years, drug-coated balloons have been proved valuable by many clinical trials for the treatment of superficial femoral and proximal popliteal artery lesions. However, there are still insufficient evidence and much controversy about the role of drug-coated balloons in treating infrapopliteal lesions. This article will briefly review the current research status and progress of drug-coated balloons for the treatment of infrapopliteal lesions.
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Objective@#To investigate the season, age and gender distribution of Mycoplasma pneumoniae (MP) infection in children in Beijing, and to analyze the epidemiological characteristics of MP infection.@*Methods@#A total of 4 271 children with community acquired pneumonia hospitalized at the Respiratory Department of Children′s Hospital Affiliated to Capital Institute of Pediatrics were collected between January 2006 and December 2015.MP 16S rRNA and tandem repeat locus-Mpn16 were amplified by nested polymerase chain reaction(PCR).@*Results@#Among 4 271 specimens, 1 042 were positive for MP by PCR, and the positive rate was 24.4% (1 042/4 271 cases). There were 3 MP outbreaks (2006-2007, 2012-2013 and 2015, respectively). The positive rate was up to 44.6% in the epidemic year, but as low as 13.0% in the non-epidemic year.The positive rates of MP in spring, summer, autumn and winter were 21.2% (217/1 022 cases), 22.0% (230/1 044 cases), 28.9% (320/1 108 cases) and 25.1% (275/1 097 cases), respectively.There were mild epidemic peaks in April to May and August to September every year.The infection rates of MP in autumn were significantly higher than those in other 3 seasons(χ2=16.50, 13.30, 4.07, all P<0.05). The positive rates of children in each age group were 10.6% (69/651 cases) in < 1 year old group, 17.5% (216/1 233 cases) in 1- 2 years old group, 28.5% (369/1 294 cases) in 3-6 years old group, and 35.5% (388/1 093 cases) in > 7 years old group, respectively.The positive rate of preschool and school-age children was 31.7% (757/2 387 cases), which was higher than that of the infants (15.1%, 285/1 884 cases), and there was a statistical significance (χ2=157.0, P<0.05). The positive rate of MP in girls was 28.3% (481/1 699 cases), which was significantly higher than that in boys [21.8% (561/2 572 cases)], and there was a statistical significance (χ2=23.4, P<0.05), especially during the epidemic years.@*Conclusions@#The detection rate of MP infection in children in Beijing is high in autumn and winter, and low in summer.The positive rate of MP increases with age.The high incidence of MP infection is in preschool and school-age children, especially girls.There is a significant difference between the prevalence of MP infection and the prevalence intervals.The prevalence of MP infection may be closely related to the long-term closed and semi-closed living habits.
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Objective To evaluate a new biodegradable inferior vena cava(IVC) filter by in vitro and in vivo experiments.Methods The biodegradable filter consisted of metal stent and absorbable suture,which acts as a degradable deformable switch of the filter.When the suture of the proximal metal filter degrades and lost its tension,the metal filter will change into a stent.In vitro experiments were performed to test the influence of the sterilization method and the tension of absorbable sutures to the filter's selfconvertible time,animal experiments were conducted to evaluate the effectiveness of emboli capture and to observe the in vivo self-convertible time of the filter.IVC stenosis,pulmonary embolus and intimal hyperplasia and inflammation were evaluated.Results Ethylene oxide sterilization did not have an adverse effect on the self-convertible time of the filters.The tension did not affect the degradation rates of the suture significantly.In animal experiments,the VCFs were successfully implanted via femoral vein approach.Not any tilt,migration or structural damage of the filters was found during the follow-up time.Postoperative fluoroscopy and autopsy confirmed that there was no stenosis or thrombosis,IVC perforation.After implantation large thrombi were captured.The sutures degraded and filters transformed into stents in 3 weeks.After 90 days IVC was patent with mild intimal hyperplasia and no thrombosis.Conclusions This study demonstrated the effectiveness and safety of the biodegradable filter we designed.
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Objective To analyze the relationship between macrolide resistance mutations in My-coplasma pneumoniae (Mp) and its genotype by multiple-locus variable-number tandem-repeat analysis (MLVA). Methods One hundred and forty-three Mp-positive specimens were collected in Beijing(54 col-lected at the Affiliated Children′s Hospital of the Capital Institute of Pediatrics),the United States(59 col-lected at four different geographical locations:Kansas City,Missouri;Seattle,Washington;New York,New York;Chicago,Illinois) and Australia(30 provided by the diagnostic laboratory at the Centre for Infectious Diseases and Microbiology Laboratory Services,Institute of Clinical Pathology and Medical Research,West-mead Hospital,Sydney). Nested PCR was used to detect mutations in 23S rRNA. A capillary electrophore-sis-based single tube multiplex PCR (mPCR-CE) was used to analyze the MLVA types of Mp in those sam-ples. Results A2063G mutation was identified in 57 specimens including 49 from Beijing,seven from the United States and one from Australia. The 143 Mp-positive specimens were typed into 10 distinct MLVA types. Fifty-four specimens collected in Beijing belonged to four MLVA types, which were M4-5-7-2 (44/54,81.5%),M3-5-6-2 (7/54,13.0%), M4-5-6-2 (2/54,3.70%) and M4-5-5-2 (1/54,1.85%). Fifty-nine specimens collected in the United States belonged to six MLVA types including M4-5-7-2(27/59, 45.8%),M3-5-6-2 (18/59,30.5%),M3-6-6-2 (11/59,18.6%),M3-5-6-1 (1/59,1.69%),M4-5-7-3 (1/59,1.69%) and M5-5-7-2 (1/59,1.69%). Thirty specimens of Mp from Australia were grouped to five types with M3-5-6-2 (12/30, 40.0%) and M4-5-7-2 (10/30, 33.3%) and M3-5-7-2 (5/30, 16.7%) being the predominant types. Macrolide resistance mutations were detected in 57 out of 143 speci-mens (49 from Beijing,seven from the United States and one from Sydney) and 50 of them were MLVA type of M4-5-7-2. Conclusion The MLVA type of M4-5-7-2 is associated with macrolide resistance in Mp.
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Objective To analyze the clinical effect of infrapopliteal arteries revascularization in patients with limb ischemic ulcer.Methods Clinical data of 152 patients (152 legs) suffering from CLI ischemic ulcer from June 2011 to June 2013 undergoing arterial revascularization using angiosome concept were retrospectively reviewed.Patients were grouped according to runoff,WB angiography,the number of outflow,angiosome model of revascularization and quality of pedal arch.Results Reintervention or ampatation (RAO) rate within 12 months was higher in runoff 0 group that in runoff ＞ 1 group (P ＜ 0.05)and runoff 1 (P ＜0.05).WB (+) group vs WB (-) group of RAO rate within 12 months,ulcer healing rate within 12 months showed no statistical difference.Limb salvage rate within 18 months was higher in WB (+) group than that in WB (-) group (P ＜0.05).Ulcer healing rate within 12 months and limb salvage · rate 18 months in group IRw was lower than group DR (P ＜ 0.05) and group IRc(P ＜ 0.05).RAO rate within 12 month rate was higher in IRw group than in DR group (P ＜ 0.05) and group IRe (P ＜ 0.05).Ulcer healing rate within 12 months and limb salvage rate within 18 months in group NPA was lower than group CPA (P ＜ 0.05) and group IPA (P ＜ 0.05).RAO rate within 12 month rate was higher in NPA group than in CPA group (P ＜ 0.05) and group IPA (P ＜ 0.05).Conclusion The rate of limb salvage was higher in WB (+).IRc revascularization has similar outcome with DR revascularization in ulcer healing rate and limb salvage rate.Clinical effect of CPA and IPA are better than NPA.
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Objective To analyze the clinical effect of infrapopliteal arteries revascularization in patients with limb ischemic ulcer.Methods Clinical data of 152 patients (152 legs) suffering from CLI ischemic ulcer from June 2011 to June 2013 undergoing arterial revascularization using angiosome concept were retrospectively reviewed.Patients were grouped according to runoff,WB angiography,the number of outflow,angiosome model of revascularization and quality of pedal arch.Results Reintervention or ampatation (RAO) rate within 12 months was higher in runoff 0 group that in runoff ＞ 1 group (P ＜ 0.05)and runoff 1 (P ＜0.05).WB (+) group vs WB (-) group of RAO rate within 12 months,ulcer healing rate within 12 months showed no statistical difference.Limb salvage rate within 18 months was higher in WB (+) group than that in WB (-) group (P ＜0.05).Ulcer healing rate within 12 months and limb salvage · rate 18 months in group IRw was lower than group DR (P ＜ 0.05) and group IRc(P ＜ 0.05).RAO rate within 12 month rate was higher in IRw group than in DR group (P ＜ 0.05) and group IRe (P ＜ 0.05).Ulcer healing rate within 12 months and limb salvage rate within 18 months in group NPA was lower than group CPA (P ＜ 0.05) and group IPA (P ＜ 0.05).RAO rate within 12 month rate was higher in NPA group than in CPA group (P ＜ 0.05) and group IPA (P ＜ 0.05).Conclusion The rate of limb salvage was higher in WB (+).IRc revascularization has similar outcome with DR revascularization in ulcer healing rate and limb salvage rate.Clinical effect of CPA and IPA are better than NPA.
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Objective To investigate the prevalence of plasmid-mediated quinolone resistance (PMQR) genes among clinical isolates of Klebsiella pneumoniae (K.pneumoniae) in pediatrics.MethodsA total of 131 non-duplicate clinical isolates of K.pneumoniae were collected in the Affiliated Children′s Hospital of Capital Institute of Pediatrics from 2010 to 2012.PMQR genes [qnrA, qnrB, qnrS, aac(6′)-Ⅰb-cr and qepA], mutations in the quinolone resistance-determining region (QRDR) and extended spectrum β-lactamases (ESBLs) genes in those strains were analyzed by PCR.Minimum inhibitory concentrations (MIC) of different antibiotics against those K.pneumoniae strains were determined by broth microdilution method and E-test according to the guidelines issued by the Clinical and Laboratory Standards Institute (CLSI).Transferability of the PMQR genes was examined by conjugation test with the sodiumazide-resistant Escherichia coli J53.Results Among the 131 isolates, 9.92% were resistant to quinolone and 30.5% were positive for PMQR genes, including 6.87% harboring qnrB gene, 22.9% harboring qnrS gene and 4.58% harboring aac(6′)-Ⅰb-cr gene.Neither qnrA-positive nor qepA-positive strain was detected.Among these PMQR genes-positive isolates, 90% were ESBLs-producing strains and two presented mutations in gyrA and parC genes.Conjugation test showed that these PMQR genes could be transferred horizontally and the ciprofloxacin resistance increased 2 to 32 folds in transconjugants.Conclusion This study indicates that the PMQR gene-carrying rate is high in K.pneumoniae strains isolated in paediatrics in China.Most of the PMQR gene-positive strains are also ESBLs-producing strains.The PMQR genes could be transferred horizontally in bacteria.
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Objective To compare the capabilities of culture method, polymerase chain reaction ( PCR) and serological test in identifying Mycoplasma pneumoniae infection in children with confirmed com-munity acquired pneumonia. Methods Bronchoalveolar lavage fluid and serum samples were collected from hospitalized children with community acquired pneumonia in Capital Institute of Pediatrics from March to May in 2016. Three methods, traditional culture method, PCR and serological test, were respectively used to de-tect Mycoplasma pneumoniae infection in those children. Statistical analysis was performed by using SPSS18. 0 software and chi-square test. Results Seventy-nine children with community acquired pneumonia were enrolled in this study. Eight (10. 13%) patients were diagnosed with Mycoplasma pneumoniae infec-tions by the traditional culture method with an average positive culture period of 21 days. Twenty-three (29. 11%) patients showed positive results by using PCR analysis, including the 8 patients identified by the culture method. Forty-one (51. 90%) patients were found to be positive for Mycoplasma pneumoniae infec-tions by the serological test. However, four negative samples identified by the serological test were confirmed to be positive by PCR analysis, including two positive samples confirmed by the culture method. Statistical analysis showed that the differences in positive rates detected by using the three methods were statistically significant. Conclusion It is recommended that both serological test and PCR analysis should be used in combination with clinical symptoms for a comprehensive assessment of Mycoplasma pneumonia infection in children.
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Objective To explore the clinical features of children infected with macrolide-resistant (MR) Mycoplasma pneumonia(MP) isolates and genetic typing of all isolates.Methods Polymerase chain reaction(PCR) of MP positive in 96 nasopharyngeal or bronchoalveolar lavage fluid (BALF) samples were collected from patients diagnosed as MP pneumonia in the Affiliated Children's Hospital of the Capital Institute of Pediatrics from January 2013 to October 2015.Fifty-five cases were male,41 cases were female;19 cases (19.8％) were 1 to 3 years old,18 cases (18.7％) were more than 3 to 5 years old,59 cases(61.5％) were more than 5 to 13 years and 2 months old.These samples were tested for MR associated mutations in the 23S rRNA of MP,and were divided into the MR group and the macrolide-sensitive (MS) group.Furthermore,the genotype of all the isolates were performed by conducting P1-restriction fragment length polymorphism(P1-RFLP) analysis and multiple-locus variable-number tandem-repeat analysis (MLVA) method.The clinical characteristics including the age,gender,hospitalization duration,symptoms,signs,fever duration,fever duration after macrolide therapy,white blood cell count,C-reactive protein (CRP),chest X-ray and/or chest computed tomography,which were compared between different groups.SPSS 11.5 software was used to analyze the statistical data.Statistical significance was determined at the 0.05 level of a two-tailed test.Results MR mutations were identified in the 23S rRNA gene in 81 specimens (84％),and the 96 specimens were divided into MR group(81 cases) and MS group (15 cases).There were statistical differences in fever duration,hospitalization duration,the incidence of complications and CRP level between the MR group and MS group (t =2.061,Z =-3.368,x2 =5.856,Z =-2.165,all P ＜ 0.05).There were no statistical differences in age,white blood cell count,consolidation percentage on chest radiography and fever duration after macrolide therapy(all P ＞ 0.05).All the 96 isolates were performed by adopting P1-RFLP typing,but 5 isolates were not typed successfully,while 81 cases (89.0％) isolates were typed as P1-Ⅰ and 10 isolates(11％) were typed as P1-Ⅱ c.The hospitalization duration and the fever duration after macrolide therapy in the P1-Ⅰ were longer than the P1-Ⅱ c group,and the difference was statistically significant (Z =-2.197,2.237,all P ＜ 0.05).There were no statistical differences in age,fever duration,white blood cell count,CRP level,consolidation percentage on chest radiography and the incidence of complications (all P ＞ 0.05).Seventy-three cases (90％) of P1-Ⅰ group were MR isolates,8 cases (10％) were MS isolates;3 cases (30％) of the P1-]Ⅱ c group were MR isolates,7 cases (70％) were MS isolates.The MR isolates in P1-Ⅰ group were much more than P1-Ⅱ c group.There was obvious statistical difference in the proportion of MR isolates between 2 groups (x2 =19.209,P ＜ 0.01).All the 96 isolates were performed by modified MLVA typing,82 cases(85.5％) were typed as M4-5-7-2,11 cases(11.5％) were typed as M3-5-6-2,1 case (1.0％) was typed as M4-5-5-2,and 2 cases (2.0％) were typed as M4-5-6-2.Because there were less cases of the M4-5-5-2 and M4-5-6-2 type,only the clinical data of M4-5-7-2 and M3-5-6-2 group were compared.The hospitalization duration and the fever duration after macrolide therapy in the M4-5-7-2 group were longer than the M3-5-6-2 group,and the difference was statistically significant(Z =-2.406,-4.472,all P ＜ 0.05).There were no statistical differences in age,fever duration,white blood cell count,CRP level,consolidation percentage on chest radiography and the incidence of complications(all P ＞ 0.05).Seventy-four cases (90％) of the M4-5-7-2 group were MR isolates,8 cases (10％) were MS isolates;4 cases (36％) of the M3-5-6-2 group were MR isolates,7 cases (64％) were MS isolates.The MR isolates in M4-5-7-2 group were much more than M3-5-6-2 group.There was obviously statistical difference in the proportion of MR isolates between 2 groups (x2 =17.022,P ＜ 0.01).Conclusions In the MR group,the children had longer fever duration and hospitalization duration,higher incidence of complications and higher CRP level than those in the MS group.The MR rates of MP in China was high.P1-Ⅰ and M4-5-7-2 are the predominate genotypes.There may be a correlation between genotype and MR.
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Objective To explore the value of wound blush in predicting patients' ulcer healing whom with critical limb ischemia after revascularization.Methods Retrospectively analyze the clinical data of 173 cases of critical limb ischemia with ischemic ulcers under thetreatment of endovascular therapy followed the concept of angiosome.According to the condition of wound blush after endovascular therapy,by compared the difference of limb salvage rate and ulcer healing time,and try to analyze the value of wound blush in predicting ulcer healing in patients.Results Included in the study with a total of 173 cases (173 limbs),group wound blush(+) 109 patients,group wound blush (-) 64 cases,the age,proportion of male patients,smoking history,diabetes,coronary heart disease,chronic renal insufficiency,pre and post operative ankle brachial index,were no statistical difference between the two groups.The ulcer healing time of group wound blush (+) was significantly shorter than that of group wound blush(-) (P ＜ 0.05).The rate of ulcer healing in group wound blush(+) was significantly higher than that in group wound blush(-) (P ＜ 0.05).In group wound blush(+),the cumulative rate of limb salvage was statisticallyhigher than group wound blush (-) (P ＜ 0.05).By logistic regression analysis,wound blush(-) (OR =4.5,P ＜ 0.05),IRc revascularization (OR =2.6,P ＜ 0.05) were independent risk factors of ulcer healing.Conclusions The resoult of wound blush(+) shows a good distal perfusion of foot.It can be used as a predictive factor for critical limb ischemia ischemic ulcer healing,and wound blush (-) was an independent risk factor for ulcer nonhealing.
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Objective To assess the mid-term and long-term efficacy of the permanent inferior vena cava filter in the treatment of deep vein thrombosis of lower limb and discuss the clinical significance of inferior vena cava filter.Methods Retrospectively analyze on the 86 cases with deep vein thrombosis of lower limb (41 males and 45 females,aged 50 to 94 years,mean age was 71.8 years) treated with implantation of permanent inferior vena cava filter in inferior vena cava from Janunary 2010 to October 2015.In these patients,there were 51 cases with embolism in the left leg,25 cases in the right leg,10 cases in both legs and 6 cases were accompanied with pulmonary embolism.The cases without contraindication underwent catheter directed thrombolysis and even percutaneous transluminal angioplasty or stents subsequently if necessary after inferior vena cava filter implantation.All the cases with no contraindication were treated with anticoagulant therapy.Results All the 86 patients were implanted inferior vena cava filter (B.Braun Vena Tech LP 76 and Cordis TrapEase 10)successfully.Sisty-five cases were underwent inferior wena cava filter implantation only,while 21 cases were treated with inferior vena cava filter implantation and catheter directed thrombolysis or even percutaneous transluminal angioplasty and stents.During the follow-up period(12 to 81 months,mean time was 51 months),27 patients died dueing to malignant tumor(17 cases) and other diseases (10 cases) rather than complications caused by inferior vena cava filter.Three patients had recurrence of deep vein thrombosis and 2 patients suffered from the thrombosis induced by stenosis of stents.Inferior vena cava filter appered tilted with angle less than 15 degrees in 6 cases.Three cases suffered from new thrombosis below the filter and 2 cases complained of the filter migration.No case was found with fracture of filter,perforation of the inferior vena cava,bleeding or pulmonary embolism(new onset or recurrent).Conclusions Application of permanent inferior vena cava filter may cause complications,though it is an effective approach to prevent pulmonary embolism in patients with deep vein thrombosis of lower limb.However,permanent inferior vena cava filter may be fit for patients with old age,incurable cancer or limited expected life.
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Objective To discuss the risk factors of iliaofemoral vein restenosis after percutaneous recanalization of post-thrombotic occlusion.Method From March 2006 to December 2014,44 limbs in 41 patients with chronic post-thrombotic iliaofemoral vein occlusion underwent endovascular treatment in our hospital.Post-operative patency was evaluated by ultrasonography and anterograde veinography.Results Initial technical success was 90.2％ (37/41).During the follow-up,5 cases of reobstruction were determined,2 were caused by insufficient stent extension into the inferior vena cave.Failure in two cases of intra-stent thrombosis were found due to arbitrary discontinuity of oral anticoagulative therapy.Moreover,2 of 9 cases with venous ulcers in lower extremities were exacerbated after failure of endovascular treatment,we therefore performed surgical ligation and endovenous laser treatment of circumambient perforating veins.Conclusion Insufficient lesion cover,not enough extension to interior vena cave and unreasonable post-operative anticoagulation discontinuity are major causes of intra-stent reobstruction in iliaofemoral venous occlusion.
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Objective To investigate the prevalence and molecular characteristics of Mycoplasma pneumoniae (M.pneumoniae) in Beijing in the first half of 2015 and 2016. Methods Respiratory tract specimens were collected from children with respiratory infection who were admitted to Affiliated Children′s Hospital of Capital Institute of Pediatrics in the first half of 2015 and 2016. DNA molecules were extracted from these specimens and then analyzed by real-time PCR to detect M.pneumoniae repMp1 genes. Speci-mens that were positive for M.pneumoniae were genotyped by modified MLVA[multiple-locus variable-num-ber tandem-repeat (VNTR) analysis] and P1-RFLP (restriction fragment length polymorphism analysis). Moreover, macrolide resistance was evaluated through detecting mutations in 23S rRNA genes. Results The prevalence of M.pneumoniae from January to June in 2015 and 2016 was 18.5% (50/271) and 35% (99/283),respectively. Of the 50 strains isolated in 2015,48 were M4-5-7-2/P1 genotype and only two were M3-5-6-2/P2 genotype. The 99 strains isolated in 2016 belonged to three genotypes, including 82 of M4-5-7-2/P1,two of M4-5-7-3/P1 and 15 of M3-5-6-2/P2. Macrolide resistance rate was 92% in 2015 and 83.8% in 2016. Conclusion More cases of M.pneumoniae infection were detected in the first half of 2016 than in the corresponding period of 2015. Compared with the 2015,the proportion of M4-5-7-2/P1 genotype strains decreased,while that of M3-5-6-2/P2 genotype strains increased in 2016. Moreover, a decline in macrolide resistance rate was found in 2016.
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Objective To discuss the therapeutic effect in the treatment of the acute limb arterial critical ischemia.Methods Collect thirty-nine cases of acute limb arterial critical ischemia in Renji Hospital from Janary 2014 to July 2016.According to the patients' manifestation,these operations were porfermed including thrombectomy,cathetery-directed thrombolysis,mechanical suction bolt,percutaneous angioplasty and stenting.The effect and complications were observed.Results The eighteen patients in 39 cases (46.2％) were dead,including 5 cases without operation,13 operation.The eight cases were amputated during 34 cases of operations.In the 21 out-patients safely,2 cases were not followed up.The time of follow-up was from 3 to 27 months,on average 14.3 months.During the 21 patients,5 cases died from heart cerebrovascular or tumor diseases,3 cases with footdrop,2 cases with toe amputations,3 cases with distal leg and foot anesthesias.Conclusions The patiens with acute limb arteries critical ischemia must be treated as early as,and reinforced the management of multiple organ function,which may improve the diseases' therapeutic effect.