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@#Periodontitis is a chronic infectious disease in which periodontal tissue loss is caused by dental plaque biofilm. Atherosclerosis is a chronic inflammatory disease that occurs in the walls of arteries and is characterized by lipid accumulation. Recently, many studies have suggested that there is a certain relationship between periodontitis and atherosclerosis. From an epidemiological perspective, a previous literature review indicated that patients with periodontitis have a higher incidence of atherosclerosis. IL-17 secreted by Th17 cells may aggravate the progression of the two diseases by elevating the levels of matrix metalloproteinases, which may damage the connective tissue. Treg cells reduce the activation of T cells and limit the development of inflammation by secreting anti-inflammatory factors and expressing coinhibitory molecules. Periodontal intervention may contribute to the treatment of atherosclerosis by reducing inflammatory markers in atherosclerosis. Many studies have shown that periodontitis and atherosclerosis may interact with each other, but further studies are needed to explore the concrete mechanism of the interaction between periodontitis and atherosclerosis.
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@#Objective To explore the factors that affect the accuracy of percutaneous thermal ablation of lung metastases and coping strategies. Methods We retrospectively analyzed the clinical data of 31 patients who met the conditions for thermal ablation of lung metastases in Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine between October 2019 and December 2020. There were 19 males and 12 females with a mean age of 40-81 (62.8±10.3) years. A total of 33 metastases tumors were thermally ablated, 12 were radiofrequency ablation and 19 were microwave ablation. Results Of the 33 metastatic tumors, 5 targets showed significant puncture deviation, 4 of them completed the ablation after adjustment and 1 failed. The result of the univariate logistic regression showed the distance within the lung parenchyma (P=0.043) and the maximum diameter of the tumor (P=0.025) were independent risk factors for the accuracy of percutaneous thermal ablation. In terms of correlation, there was a positive correlation between the accuracy of percutaneous thermal ablation and the distance within the lung parenchyma (P=0.033), and a negative correlation between the maximum diameter of metastases tumor (P=0.004) and hemoptysis (P=0.015). Complete ablation rate was 87.8% (29/33). Conclusion When we perform CT-guided percutaneous thermal ablation of lung metastases, we must fully prepare the deviation plan for the small diameter tumor, the long travel distance in the lung parenchyma, and hemoptysis during puncture. Complete ablation can be achieved by fully identifying the anatomical features of the tumor and its surrounding structures, shortening the travel distance in the lung parenchyma and increasing the ablation range.
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@#Objective To explore the clinical utility and safety of electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation (MWA) in the patients with inoperable high-risk pulmonary nodules. Methods Clinical data of patients who were diagnosed with inoperable pulmonary nodules highly suspected as malignant tumors and treated with ENB-guided MWA in Zhongshan Hospital, Fudan University from December 2019 to September 2020 were retrospectively collected and analyzed to evaluate the efficacy and safety of the procedure. There were 6 males and 3 females aged 72.0 (59.5-77.0) years. Results Totally ENB-guided MWA was performed in 9 patients with 12 lesions. All patients suffered from at least one chronic comorbidity. The inoperable reasons included poor pulmonary function (55.6%), comorbidities of other organs which made the surgery intolerable (33.3%), multiple lesions in different lobes or segments (22.2%), personal wills (22.2%) and advanced in age (11.1%). The median diameter of nodules was 13.5 (9.5-22.0) mm and the median distance from the edge of nodules to pleura was 5.3 (1.8-16.3) mm. Bronchoscope maneuver to the targeted lesions was manipulated according to navigation pathway under visual and X-ray guidance and confirmed with radial ultrasound probe. Rapid on-site evaluation also helped with primary pathological confirmation of biopsy specimen. Among all the lesions, 4 adenocarcinoma, 1 non-small cell lung cancer-not otherwise specified and 2 inflammatory lesions were reported in postoperative pathological diagnosis, while no malignant cells were found in 5 specimens. The ablation success rate was 83.3% (10/12). For the two off-targeted lesions, percutaneous ablations were performed as salvage treatment subsequently. The median hospitalization time was 3.0 (2.0-3.0) days and no short-term complications were reported in these patients. Conclusion ENB-guided MWA is a safe and effective procedure for patients with high-risk pulmonary nodules when thoracic surgery cannot be tolerated.
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@#Objective To compare and analyze the clinical effects of two kinds of frame design valves after transcatheter aortic valve replacement (TAVR). Methods We retrospectively reviewed 124 patients who underwent TAVR and were followed up for 1 year. There were 71 males and 53 females aged 75.57±6.21 years. These patients were treated with Venus-A or Edwards Sapien aortic valves. The hemodynamics and cardiac function of these two kinds of transcatheter aortic valves (THV) were evaluated by echocardiography. The 30-day mortality and 1-year clinical effect of the patients were calculated. Results Eight-one patients used Venus-A valve and 43 patients used Edwards Sapien valve. The aortic valve transaortic pressure gradient was reduced and the rate of perivalvular leakage was low (both 2.6%) in both groups, and there was no statistical difference between the two groups. The implantation rate of permanent pacemaker was 17.3% and 11.6%, respectively. The 1-month survival (94.0% and 93.0%) and 1-year survival (94.0% and 91.0%) rates were not statistically different. Conclusion The two groups of THV with different stent structures have good short-term clinical effect and low implantation rate of permanent pacemaker.
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@#Objective To investigate the feasibility and safety of transcatheter aortic valve replacement (TAVR) through apical approach for aortic regurgitation of large annulus. Methods From November 2019 to May 2020, 10 male patients aged 64.50±4.20 years with aortic valve insufficiency (AI) underwent TAVR in the Department of Cardiovascular Surgery, Xijing Hospital. The surgical instruments were 29# J-valveTM modified and the patients underwent TAVR under angiography. The preoperative and postoperative cardiac function, valve regurgitation, complications and left ventricular remodeling were summarized by ultrasound and CT before and after TAVR. Results A total of 10 valves were implanted in 10 patients. Among them, 1 patient was transferred to the aortic arch during the operation and was transferred to surgical aortic valve replacement; the other 9 patients were successfully implanted with J-valve, with 6 patients of cardiac function (NYHA) class Ⅱ, 4 patients of grade Ⅲ. And there was a significant difference between preoperation and postoperation in left ventricular ejection fraction (44.70%±8.78% vs. 39.80%±8.48%, P<0.05) or aortic regurgitation (1.75±0.72 mL vs. 16.51±8.71 mL, P<0.05). After 3 months, the patients' cardiac function was good. Conclusion TAVR is safe and effective in the treatment of severe valvular disease with AI using J-valve.
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Objective To evaluate the efficacy and safety of the application of bronchoscopic interventional intervention in children with severe refractory pneumonia.Methods The study was based on case analysis of subjects diagnosed with severe refractory pneumonia and hence receiving bronchoscopic interventional therapy.The standards of clinical efficacy were set against clinical symptoms,microscopic manifestations and chest CT.Thirty-three children in Guiyang Children's Hospital were selected as subjects during a time span from January 2015 to March 2017.Results Mucous hyperemia,swelling and secretion were observed in all the 33 subjects,among whom 100.0％ (33/33 cases) were observed with tmucosal atrophy and longitudinal plica,63.6％ (21/33 cases) with mucosalerosion,36.4％ (12/33 cases) with proliferation of granulation tissue,27.2％ (9/33 cases) with plastic secretion plug,18.2％ (6/33 cases) with spiny change of fish bone,18.2％ (6/33 cases) with tracheobronchia stenosis,15.2％ (5/35 cases) with tracheobronchial malacia,15.2％ (5/35 cases) with tracheobronchial atresia and 9.1％ (3/33 cases) with subglottic stenosis.All the 33 cases received different bronchoscopic pulmonary interventional therapy strategies accordingly.Nine subjects with plastic bronchitis secretion plug were treated with bronchoalveolar lavage and repeated clamping by tracheal foing;5 subjects with occult foreign body were treated with argon plasma coagulation,basket-shaped foreign body forceps,cryotherapy or laser cutting;1 case with subglottic stenosis,5 cases with tracheobronchial malacia and 6 cases with tracheobronchial stenosis were treated with balloon dilatation;2 cases with subglottic stenosis and 5 cases with tracheobronchial atresia received the combined therapy.As a result,27 cases out of the 33 subjects were evaluated as complete resgonse and the rest were evaluated as partial response.In some cases,transient complications were observed during or after operation,which were well-handled and displeased.No serious complications were observed.Conclusion Based on a comprehensive understanding of the indications,contraindications and operation points of different bronchoscopic intervention modes,the strictly application of bronchoscopic interventional therapy accordingly in children with severe refractory pneumonia was proved to be effective and highly safe.
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Retinal ischemia-reperfusion injury (RIRI) is a common pathological and physiological clinical oculopathy,which can occur in retinal artery and vein occlusion,diabetic retinopathy and acute angle-closure glaucoma.The resulting ischemia can cause cell metabolic dysfunction,serious retinal damage and descending visual function.RIRI is the result of multiple factors.The currently accepted hypotheses mainly include the injury effect of oxygen-derived free radicals,intracellular calcium overload,the action of leucocyte and apoptosis.However the protection and treatment research in the RIRI is limited.The present paper reviews the progression in the drug intervention of RIRI.
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Malnutrition can reduce the body's immune function, and significantly increased higher incidence of infection, related complications, leading to higher hospitalization days, hospitalization expenses and mortality. At present, the nutrition assessment not only has been widely used in tumor disease; kidney disease; geriatric disease and other disciplines, but also concentrated in the patients with chronic liver disease. However, the clinic application of nutrition assessment in liver failure is limited. In the clinical practice work, malnutrition commonly comes with the course of patients with liver failure, and need to treatment. Therefore, the early judgment on their nutritional status, and follow the nutrition characteristics of individualized has gradually become an important part of the treatment of liver failure patients.
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This paper introduced the current situation of cardiac interventional therapy and put forward the fol-lowing points that medical staffs should pay attention to:the patient's right to know, right to be informed, right of communication, right of privacy, and etc. On this basis, it is suggested to solve the ethical issues in cardiac inter-ventional therapy through the implementation of clinical pathway, effective communication, humanistic care, the construction of occupational ethics, strict feedback and supervision.
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Objective To assess the safety and efficacy of stent-assisted coil embolization for acutely ruptured wide-necked intracranial aneurysms. Methods We retrospectively reviewed 192 wide-necked intracranial aneurysms in 178 patients. The efficacy and peri-procedure complications of stent-assisted embolization were compared between rup?ture aneurysms and unrupture aneurysms. Results Stent was successfully implanted in 78 rupture aneurysms and 114 un?rupture aneurysms. There was statistically significant difference between rupture aneurysms and unrupture aneurysms groups in rate of poor prognosis on discharge ( 23.1%vs. 5%,χ2=12.726, P0.05)nor in the rate of mortality and permanent disability (8.9%vs. 6.1%,χ2=0.475, P>0.05). Angiograms at 14.7 months of follow-up did not reveal any significant difference between rupture aneu?rysms and unrupture aneurysms groups in aneurysm complete occlusion (74.1%vs. 70.6%,χ2=0.197,P>0.05), recana?lization (10.3%vs. 9.4%,χ2=0.034,P>0.05)and in-stent stenosis (3.4%vs. 4.7%,χ2=0.136,P>0.05). Conclusion Stent-assisted coil embolization for acutely rupture wide-necked intracranial aneurysms can prevent recurrence effective?ly and can achieve high complete occlusion rate in long term follow-up. However, its procedure related complications and mortality is higher in rupture aneurysms than in unrupture aneurysms, which indicates that a caution is needed to conduct stent-assisted coil embolization in rupture aneurysms.
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Objective To explore the changes of blood fat in patients with cerebral infarction complicated by metabolic syndrome (MS) receiving community path intervention treatment.Methods A total of 116 cases of cerebral infarction complicated by MS were selected and given comprehensive intervention treatment after risk assessment.Patients were divided into intervention group (60 cases) and control group (56 cases) according to their difference in compliance.Results After intervention,the total cholesterol (TC),triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) in two groups were significantly decreased,high-density lipoprotein cholesterol (HDL-C) was significantly increased.There were significant differences in intervention group before and after intervention (P＜ 0.05).Compared with those in control group,differences of all index in each time point in intervention group were statistically significant (P ＜0.05).There was no significant difference in carotid plaque integral before intervention between two groups (P＞ 0.05).The carotid plaque integral 12 and 24 months after intervention in intervention group was significantly lower than that before intervention (P ＜ 0.05).The carotid plaque integral 12 and 24 months after intervention in intervention group was significantly lower than that in control group [(3.20 ± 2.01) cm vs.(4.71 ±2.87) cm,(2.98 ±2.61) cm vs.(4.60 ±2.43) cm,P＜0.05].Twelve and 24 months after intervention in intervention group,TC and carotid plaque integral was significantly positive correlation (r =0.304 and 0.317,P ＜ 0.05),TG and carotid plaque integral was significantly positive correlation (r =0.229 and 0.128,P ＜ 0.05),LDL-C and carotid plaque integral was significantly positive correlation (r =0.654 and 0.518,P ＜ 0.05),and HDL-C and carotid plaque integral was significantly negative correlation (r =-0.495 and-0.528,P ＜ 0.05).Conclusion For patients of cerebral infarction complicated by MS,great importance should be attached to early prevention and control of their major components so as to reduce the incidence of acute cerebrovascular recurrence and mortality.
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Objective To summarize the clinical experience of successful intervention in single chronic coronary actery total ocdusion (CTO) lesions by the transradial.Methods A retrospective analysis was conducted in 103 patients with single CTO lesions who got intervention treatment by the radial artery.Results ( 1 ) Of the 103 cases,57 cases had unstable angina,12 cases had stable angina,and 34 cases chronic myocardial infarction.Lesions' block time was ≤ 6 months in 83 cases,and ＞ 6 months in 20 cases.(2)The path vessels of the 103 patients have no severe tortuosity and anatomical structure variation.Fifty-one cases occurred left anterior descending occlusion,25 cases occurred left circumflex branches occlusion,and 27 cases occurred right coronary artery occlusion.Furthermore,24 cases had chronic complete occlusion,and 79 cases had chronic functional block.The side branches did not block in 91 cases,no lesions(bridge) collateral formation occurred in 87 cases,lesions length was less than 15 mm in 67 cases,and tapered lesions was observed in 81 cases.( 3 ) Final intervention rate via Judkins,XB,EBU guide catheter was 37.86％,30.10％ and 29.13％ respectively.(4)the PILOT successfully through the lesions for the series wire guided was 64.08％.(5) 1.25 mm diameter series with a balloon through the first lesions and successful expanding was observed in 57 cases (55.34％),and 1.5 mm diameter series with a balloon occurred in 38 cases(36.89％ ).Conclusion Intervention treatment by the radial of single CTO lesions is feasible for experienced performers.The successful intervention depends on path vessels unimpeded,target vessels with characteristic pathological features and reasonable choice of instruments.
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Aim To observe the intervention effects of sodium aescinate on acute lung injury model of rats induced by oleate. Methods Fifty four male SD rats were randomly divided into five groups: normal control group, sodium aescinate control group (without oleate) , oleate model control group,medrol interventional group and sodium aescinate interventional group. Acute lung injury models of rats were made by injecting oleate (OA, 0. 1 ml · kg~(-1) ) through caudal veins, and then rats were observed and killed to detect correlated in-dice. The observation indice were the histomorphology of lung, the wet and dry weights of lung ( W/D), score of injury of lung under light microscope (IQA ) , partial pressure of oxygen in artery ( PaO_2) , the levels of SOD and MDA in blood plasma and lung tissue. Results ① Histomorphology of lung: Lung surface hyperemia relieved obviously and pink secretion from trachea of rats in sodium aescinate interventional group and medrol interventioal group decreased significantly compared with oleate model control group. Under light microscope , compared with oleate model control group, effusion of inflammatory cells in alveolar space of rats in sodium aescinate interventional group and medrol interventional group decreased. ② The wet and dry weights of lung ( W/D ) ; W/D of rats in oleate control model group increased obviously compared with those in normal control group, W/D of rats in sodium aescinate interventional group and medrol interventional group decreased obviously compared with those in oleate model control group. ③ Score of injury of lungs under light microscope (IQA) ; IQA of rats in oleate model control group advanced obviously compared with that in normal control group. IQA of rats in sodium aescinate interventional group and medrol interventional group lowered significantly compared with that in oleate model control group.④ Partial pressure of oxygen in artery (PaO_2) : PaO_2 of rats in oleate model control group lowered significantly compared with that in normal control group. PaO_2 of rats in sodium aescinate interventional group and medrol interventional group improved significantly compared with that in oleate model control group. ⑤ The levels of SOD and MDA in blood plasma and lung tissue:The levels of SOD in plasma and lung tissue of rats in oleate model control group lowered significantly compared with those in normal control group. SOD in plasma and lung tissue of rats in sodium aescinate in-terventional group and medrol interventional group increased significantly compared with that in oleate model control group. The levels of MDA in plasma and lung tissue of rats in oleate model control group lowered significantly compared with those in normal control group. MDA in plasma and lung tissue of rats in sodium aescinate interventional group and medrol interventional group increased significantly compared with that in oleate model control group. Conclusion Sodium aescinate can improve W/D, IQA and PaO_2 by adjusting oxidization of the acute lung injury model of rats, which may provide a possible path for treating acute lung injury in clinical practice.
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Ohjective To know the proper wraping method for postoperative patients with neurosurgical intervention treatment. Methods Divided 94 patients with neurosurgical intervention treatment into the ban-dage group and the gauze group randomly, there were 47 cases in the each group. Bandage and gauze was used in the two groups for punctured wound respectively, and then compared the condition of complications and puncture location between the two groups. Results The incidence rate of puncture-associated comphcations in the bandage group was sinificant lower than that of in the gauze group. Conclusions Wraping by bandage for postoperative patients with neurosurgical intervention treatment is more effective than gauze method.
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Objective To evaluate the short-term outcome of local intraarterial thrombolysis in patients with acute ischemic stroke of the anterior circulation. Methods 24 patients with acute ischemic stroke of the anterior cir-culation within 8 hours were treated by local intraarterial thrombolysis. Arterial recanalization was divided into total, partial and occlusive respectively according to angiography. Evaluation of clinical outcome was performed on the 30th day after thrombolysis,and was classified as good for Modified Rankin Scale (MRS) scores of 0 to Ⅲ and poor for MRS scores of Ⅳ to Ⅵ. Results Total recanalization was obtained in 54.2 % of patients, partial recanalization in 25.0%. Clinical outcome was good in 15 patients (62.5%). Cerebral hemorrhage occurred in 4 patients (16.7%). Four patients died (16.7%). Conclusion Local intraarterial thrombolysis is an effective method for treatment of a-cute iachemic stroke of the anterior circulation. It needs further practice and long-term follow-up study on safety and long-term efficacy.
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@#Objective To observe the effect of intraaortic balloon pump (IABP) on tolerance of percutaneous coronary intervention (PCI), life signs of patients with acute myocardial infarction (AMI) during emergency PCI performed.Methods46 AMI patients complicated with or without cardiogenic shock were put on IABP at same time of coronary angiography when emergency PCI performed, and tolerance of PCI, blood pressure, heart rate and immediate death rate of patients were observed before and after operation.Results45 cases had IABP successful and 1 case failed. 40 patients (86.96%) could endure whole emergency PCI process, the total death rate was 10.87%. 66.67% of patients with obvious cardiogenic shock could endure emergency PCI, the death rate was 33.33%; 94.12% of patients without cardiogenic shock could endure PCI treatment and the death rate was 2.94%. 35 cases completed PCI treatment and the successful rate was 85.36%.ConclusionPCI supported by IABP can prevent AMI patients from cardiogenic shock, ease symptoms of patients complicated with cardiogenic shock, improve the tolerance and successful rate of the PCI treatment, and decrease immediate death rate.
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Objective To evaluate the clinical outcome and relative factors of intervention treatment for atherosclerotic renal artery stenosis in elderly patients.Methods The clinical data of 79 patients diagnosed as atherosclerotic renal artery stenosis by angiography and treated by revascularization were analyzed.Results There were 55(69.6%)successes and 24(30.4%)failures in decreasing blood pressure and 28(35.4%)successes and 51(64.6%)failures in improving renal function after intervention treatment.Predictors of favorable outcome of intervention treatment in decreasing blood pressure were related to lower urine protein,higher glomerular filtration rate,higher systolic and diastolic blood pressure before treatment,lower resistance index(RI)of renal artery,and no complication of cerebral vascular diseases.Predictors of favorable outcome of intervention treatment in improving renal function were related with percentage of angiographic stenosis,category of antihypertension and lower urine protein.The logistic regression analysis showed that the percentage of angiographic stenosis was the most important predictor of intervention treatment for blood pressure control,age and level of serum creatinine before intervention treatment were the most important predictors of intervention treatment for improving renal faction.Conclusion Percentage of stenosis(≥85%),age(133 ?mol/L)can be used as the predictors of therapeutic success for renovascular stenosis in older patients.
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[ Objective ] To observe the therapeutic effect of acupuncture on cleft acupoints combined with puerarin intervention for the treatment of prolapse of lumbar intervertebral disc with blood stasis. [ Methods ] Sixty cases were divided into two groups by using random number: group A (n = 30) was treated by acupuncturing the Jiaji points from 4th lumbar vertebrae to 1st sacral vertebrae and specific points such as Waiqiu (GB36), Weizhong (BL40) and Xiaxi (GB43), and with intervention of puerarin Injection into the region of affected lumbar intervertebral foramen; group B (n = 30) was treated by acupuncturing the same acupoints as group A and with routine acupoint injection of puerarin Injection. After a 30-day treatment , the therapeutic effect in the two groups was evaluated by symptoms and signs scoring and pain visual stimulation scoring method. Peripheral blood interleukin 6 (IL-6) and blood rheology parameters before and after treatment were also observed to investigate the therapeutic mechanism. [Results] After one treatment course, the therapeutic effect in group A was better than that in group B (Z = 2.525, P = 0.012) and the mean treatment course was shorter (P 0.05). [Conclusion] The synergistic action of acupuncture combined with puerarin intervention for the treatment of prolapse of lumbar intervertebral disc with blood stasis is better than that of routine acupoint injection of puerarin Injection. The mechanism may be related to the fact that intervention treatment can introduce the drug to the affected area, which benefits the improvement of peripheral blood IL-6 and blood rheology parameters, and thus relieve radiculitis.
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Peripheral arterial disease(PAD)is a common manifestation of systemic atherosclerosis associated with significant morbidity and mortality.The goals of management for patients with PAD are to relieve exertional symptoms,improve walking capacity,improve quality of life,and prevent and retard the progression of systemic atherosclerosis.These patients should be candidates for aggressive secondary prevention strategies including tobacco cessation,physical activity,dietary modification,weight maintenance,blood pressure control,cholesterol control,antiplatelet therapy and angiotensin-converting enzyme inhibitor therapy.This article reviews the current non-intervention treatment of patients with PAD.
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Objective To evaluate the preliminary experience of the combined application of a self expanding neurovascular stent system (Neuroform stent) and detachable coils in the management of wide necked intracranial aneurysms. Methods Self expanding neurovascular stents and coils were used in the treatment of 32 patients. There were total 34 intracranial wide necked aneurysms in 32 cases including cavernous segment ICA aneurysms in 3, ophthalmic artery aneurysms in 3, PComA in 8, AcomA in 3, MCA bifurcation in 5, vertebral artery in 6, basilar tip in 1, basilar trunk in 2 and distal anterior cerebral artery aneurysm in 1. The Neuroform stents were deployed across the neck of aneurysm. Another microcatheter was introduced into the aneurysm sac in advance or through stent mesh and then detachable coils were released to embolize the aneurysms. Results Thirty four Neuroform stents were successfully deployed in 31 patients .Balloon inflation stent was used for 1 patient with basilar tip aneurysm after failure of getting the Neuroform stent through the stenotic PC. Total occlusion was achieved in 24 patients, residual neck in 6 patients and partial occlusion in 2 patients. In stent thrombosis occurred in 1 patient. Thirty one patients recovered well but with one death. Thirty patients were under clinical followed up from 1 to 6 months with an average of 4.7 months.There was no bleeding or thromboembolic events. Eleven patients were angiographically followed up for 3 months after the procedure, Among them, no filling was shown for the 7 aneurysms which were densely packed. Other 4 aneurysms with neck remnant including 2 stable and another 2 with disppeared neck. Conclusions The Neuroform stent with high flexibility is technically feasible and can be safely navigated into even distal small neurovasculature.The long term effect still need to be further investigated.