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Objective: To investigate the feasibility, efficacy and safety of transbrachial access for interventional therapy on prosthetic paravalvular leak (PVL) post surgical valve replacement. Methods: This is a retrospective study. Patients with PVL after surgical valve replacement who underwent interventional therapy via the brachial artery approach in Structural heart disease center of Fuwai hospital between August 2017 and October 2019, were included. All patients underwent puncture of the brachial artery under local anesthesia, angiography and transcatheter closure procedure were performed. The procedure was performed under transthoracic echocardiography (TTE) guidance. Baseline data, operation data and pre-and post-operative TTE examination results were collected and analyzed. Postoperative complications were recorded and operational adverse events were obtained during follow up in the outpatient department after discharge. The operation success rate was calculated, which was defined as the degree of perivalvular regurgitation decrease by 1 grade and above according to TTE without interfering the valve movement and coronary artery blood flow within 30 days after occluder placement. Results: A total of 10 patients were enrolled in this study, the mean age was (57.5±14.6) years, and 6 patients were males. There were 7 cases with aortic PVL, and 3 cases with mitral PVL. Except for one patient who was converted to the femoral vein-transseptal approach, the other 9 patients were successfully implanted with the devices via the brachial artery approach. The operation time was (103.3±34.0) minutes, and there was no need for rigorous bed rest after the operation. The median hospital stay was 7.5 (3.0, 9.8) days. The operation success rate was 9/10 via the brachial artery approach. The differences in the degree of perivalvular regurgitation, New York Heart Association (NYHA) classification, left ventricular end diastolic diameter and left atrial diameter before and after operation were statistically significant (all P<0.05). One case developed new hemolysis with renal insufficiency on the second day after procedure and discharged after successful dialysis. Another case experienced complication of brachial artery pseudoaneurysm after procedure and discharged after successful treatment with thrombin injection. The mean follow-up time was (14.3±7.9) months. During the follow-up, NYHA classification remained as Ⅰ/Ⅱ in 9 patients, no operational adverse events were observed. Conclusions: Transbrachial access for interventional therapy on PVL post surgical valve replacement is a feasible, effective, and safe procedure. It has the advantages of simplifying the operation process and reducing postoperative bed rest time.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Aortic Valve/surgery , Cardiac Catheterization , Feasibility Studies , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/adverse effects , Retrospective Studies , Surgical Instruments , Treatment OutcomeABSTRACT
Objective To investigate the effect of pelvic floor stabilized structure preservation (PPSS) during robot-assisted laparoscopic radical prostatectomy (RARP)on postoperative continence recovery.Methods From October 2017 to April 2018,86 patients with prostatic cancer who underwent traditional RARP and RARP plus PPSS were included.There were 31 patients in non-PPSS group and 55 patients in PPSS group.In non-PPSS group,patients age was (68.48 ± 7.79) years old,BMI was (24.79 ± 3.05) kg/m2,median prostate volume was 63.54 (53.00-99.36) cm3,clinic T-stage T1-T2,T3,T4 accounted for 49.39％,22.58％,6.45％ and ISUP grade 1,2,3,4,5 accounted for 22.58％,22.81％,12.90％,12.90％,19.35％ respectively.In PPSS group,patients age was (69.53 ± 6.81)years old,BMI was (23.95 ± 3.03) kg/m2,median prostate volume was 73.39 (54.88-94.23) cm3,clinic T-stage T1-T2,T3,T4 accounted for 72.73％,7.27％,3.64％ and ISUP grade 1,2,3,4,5 accounted for 21.82％,18.18％,23.64％,18.18％,10.91％ respectively.The preoperative PSA,BMI,clinical T-stage,ISUP grade,and postoperative hospital days had no significant differences (P ＞ 0.05)between the two groups.Both groups were operated via transperitoneal approach.In the non PPSS group,endo-pelvic fascia and pubic prostate ligament was cut,and dorsal vessel complex was ligated.In PPSS group,the partial endo-pelvic fascia was bluntly pushed to the pelvic wall to preserve tendon arch,and pubic prostate ligament also was preserved without suturing and ligating dorsal vascular complex.The catheter was removed 7 d after RARP.The continence recovery were compared between the two groups,including pad number on the day of I,7,14,30,90 and ICI-Q-SF scores on the day of 30 and 90 after catheter removal.Results There was no significant difference in pad numbers used between the two groups on the day of 1,7,14,30 after catheter removal.On the 90th day,the proportions of using pad ≥4 in PPSS group were significantly lower than those in non-PPSS group (1.89％ vs.20.69％,P =0.004).No significant difference was found in ICI-Q-SF scores on the 30th and 90th day between the two groups.Univariate analysis showed that PPSS group used less pads than non-PPSS group on the 90th day [OR =0.07(95％ CI 0.01-0.65),P =0.019];T3 patients used more pads than T1-T2 patients [OR =9.19 (95％ CI 1.32-63.87),P =0.025].After adjusting for age,ISUP grading,T staging,and PSA,multivariate regression analysis showed that the risk of using pad ≥ 4 in PPSS group compared with non-PPSS group was 0.46,0.34,0.27,0.25,and 0.03 on the day of 1,7,14,30 and 90 after catheter removal,respectively.The PPSS approach didn't increase the risk of positive surgical margin.Conclusions Preservation of pelvic stabilized structure in RARP is very efficient in term of continence rate after RARP,and it does not increase the risk of positive surgical margin.
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Objective To analyze the impact of medical service quality after single-disease payment method was in place at a number of tertiary hospitals in Tianjin .Methods Retrospective analysis and satisfaction questionnaire were used to choose 1035 cases of bladder cancer from January 2015 to May 2017 , consisting of 522 cases settled in conventional medical insurance payment prior to the reform , and 513 cases settled in the single-disease payment.300 patients were selected from each type plus 128 doctors, for satisfaction questionnaire survey .Results The single-disease payment method , since in place , had cut back the average days of stay by 1.27 days, per-capita inpatient medical expenses by 1237 yuan, average out-of-pocket payment by 3890 yuan, and the non-payment amount by 11 yuan.Both patients and doctors were more satisfied than before to a different extent , with the difference statistically significant (P<0.05). Conclusions Single-disease payment method can control the cost obviously , thus conducive to the quality of medical services .
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Objective To investigate the effect of high-dose coenzyme Q10 on the central nervous system in mice,and to provide experimental basis for clinical safety evaluation.Methods Mice were randomly divided into vehicle control group,perillartine control group,positive control group (chlorpromazine or diazepam) and coenzyme Q10 low,medium and high dose groups (1.5,3.0 and 6.0 g/kg,equivalent to 75,150,and 300 times of clinical dosage,respectively).The corresponding drugs were ig given to mice with the volume of 40 mL/kg.The general behavior of mice was observed directly,the motor coordination ability was observed by rotating stick method,and Anymaze animal behavior video analysis system was used to observe the spontaneous activity of mice and synergistic reaction with sub-threshold dose of pentobarbital sodium.Results There were no significant differences in the general behavioral activity,and the number of spontaneous activity times,mean resident time,and ratio of sleeping were found in all coenzyme Q10 groups,compared with the vehicle and perillartine control groups.Conclusion High dose of coenzyme Q10 has no significantly toxic effect on the central nervous system in mice,which could provide a reliable experimental basis for further medication study and clinical application of high-dose coenzyme Q 10.
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Objective To investigate the effect of high-dose coenzyme Q10 on the central nervous system in mice,and to provide experimental basis for clinical safety evaluation.Methods Mice were randomly divided into vehicle control group,perillartine control group,positive control group (chlorpromazine or diazepam) and coenzyme Q10 low,medium and high dose groups (1.5,3.0 and 6.0 g/kg,equivalent to 75,150,and 300 times of clinical dosage,respectively).The corresponding drugs were ig given to mice with the volume of 40 mL/kg.The general behavior of mice was observed directly,the motor coordination ability was observed by rotating stick method,and Anymaze animal behavior video analysis system was used to observe the spontaneous activity of mice and synergistic reaction with sub-threshold dose of pentobarbital sodium.Results There were no significant differences in the general behavioral activity,and the number of spontaneous activity times,mean resident time,and ratio of sleeping were found in all coenzyme Q10 groups,compared with the vehicle and perillartine control groups.Conclusion High dose of coenzyme Q10 has no significantly toxic effect on the central nervous system in mice,which could provide a reliable experimental basis for further medication study and clinical application of high-dose coenzyme Q 10.
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<p><b>OBJECTIVE</b>To assess the safety and effectiveness of percutaneous transcatheter closure of atrial septal defect (ASD) under transesophageal echocardiography (TEE) guidance in children.</p><p><b>METHODS</b>The study included 20 cases of patients with ASD. The patients were (4.2 ± 1.2) years old and the mean body weights were (18.2 ± 4.2) kg. The diameter of ASD before closure was (13.4 ± 3.3) mm . All procedures were guided under TEE. Procedure success was evaluated by TEE immediately after procedure.</p><p><b>RESULTS</b>Closure devices were successfully implanted in all 20 patients under TEE guidance. The diameter of closure devices was 14-26 mm. There were no procedure related complications. The ventilation time was (2.9 ± 0.8)h and the hospitalization time was (3.2 ± 0.7) days.</p><p><b>CONCLUSION</b>TEE guided percutaneous transcatheter closure is safe and effective for patients with ASD and avoids the radiation damages.</p>