Application of drug-coated balloons in percutaneous coronary intervention / 中国基层医药

Percutaneous coronary intervention is the main treatment of coronary heart disease. Both the original bare metal stent and drug-coated stent have the possibility of developing in-stent restenosis, and have poor therapeutic effect on small vessel lesions and bifurcation lesions, which limit their clinical application. In recent years, drug-coated balloons have made considerable progress. They provide a new treatment method for in-stent restenosis, chronic total occlusion, bifurcation lesions and small vessel lesions, and can shorten the duration of dual antiplatelet therapy and reduce the risk of bleeding. This paper reviews the clinical research progress of drug-coated balloon.

Application of balloon ocdusion for pernicious placenta previa and its side injuries / 中国实用妇科与产科杂志

As the rate of cesarean section increases,the incidence of pernicious placenta previa increases,and risk of complications also increases.At present,interventional therapy in obstetrics,especially postpartum hemorrhage,has a wide range of application,which may lead to corresponding complications such as puncture site damage,vascular injury,thrombosis,etc.This article focuses on the complications of prophylactic balloon occlusions.

Bilateral arterial occlusions masking retinitis in a HIV-positive male

We report an interesting case of 36-year-old HIV-positive male with uveitis, cilioretinal artery occlusion in OD, and superotemporal branch retinal artery occlusion in OS. Hypercoagulability, cardiovascular, and rheumatologic workups were unremarkable. Aqueous taps were negative for toxoplasma, viruses, and MTb by multiplex polymerase chain reaction. Patches of retinitis were seen on clearing of retinal edema. Serology was positive for toxoplasma and rickettsia. Management included doxycycline, azithromycin, bactrim DS, and oral steroids. Vision improvement to 6/60 and 6/24 in OD and OS refer to the right eye and left eye, respectively, were noted at 4-month follow-up. Infections should be considered in arterial occlusions associated with inflammation in HIV-positive individuals.

Morphology evaluation of left atrial appendage by transesophageal echocardiographic three-dimensional printed model / 中国医学影像技术

Objective To evaluate the feasibility and accuracy of three-dimensional (3D) printed left atrial appendage (LAA) models based on 3D transesophageal echocardiography (3D-TEE) data and the application value for treating special anatomic LAA.Methods Data of 18 patients of atrial fibrillation who were underwent LAA occlusion were retrospectively analyzed,including 3D-TEE and CT volume data of the patients.The 3D-TEE data of the LAA were post-processed and a flexible material was used to print the LAA model by 3D printer.The morphological classification and lobulated classifications of LAAs were assessed by the 3D printed models.The measurements of long axis,short axis and depth of LAAs were also performed.And the measurement and classification results were compared with those based on 3D-TEE and CT volume images.A occluder release test was performed on the 3D printed models for patients with challenging LAA morphology.Results For all 18 patients,3D-TEE full volume data of the LAA were successfully reprocessed and printed as 3D LAA models.The consistency of morphological classifications and lobulated classifications of LAAs based on 3D printed models and cardiac CT were 0.92 and 0.83,respectively.No significant differences of LAA ostium dimensions (long axis and short axis) and depth were found between the measurement results based on 3D printed models and 3D-TEE (all P＞0.05).A simulation of LAA occlusion rehearsal was successfully performed on 3D models of two challenging cases.Conclusion The echocardiographic 3D printing technique has high feasibility and accuracy,and can be promising for personalized planning in cases of transcatheter special morphological LAA occlusion.

Mechanical thrombectomy using the stent device in posterior circulation large Intracerebral artery occlusions / 中国综合临床

Objective To evaluate the safety and effect of mechanical thrombectomy with the stent device in posterior circulation large intracerebral artery occlusions.Methods Arterial embolectomy with the stent device was carried out in 16 patients with posterior circulation large intracerebral artery occlusions(3.5 h than intravenous thrombolysis time window)in the NO.264th Hospital of People Liberation Army,including 8 cases with pure basilar artery occlusion,7 cases with bilateral vertebral artery intracranial segment and basilar artery occlusion,1 case with side of intracranial vertebral artery occlusion.The National Institutes of health neurological deficit score(NIHSS)score,Alberta stroke program early CT(ASPECTS)score,complications,clinical result were analyzed retrospectively.Results Among 16 cases,the time windows were from 7 to 18 h,the time from onset to reperfusion were(13.32±1.57)h.Successful recanalization was obtained in 15 patients(TICI=3),partial recanalization in 1 case(TICI=2a).Three cases with stent angioplasty.Survival in patients with NIHSS score decreased from(24.65±3.63)points on admission to(4.32±1.57)points after three weeks,with statistical difference(P＜0.01).For mRs score at 90 d: 6 cases(37.5％)with 0-1,4 cases(25％)with 2-3,2 cases(12.5％)with 4-5,4 cases died(25.0％,score ASPECTS 4-5).Conclusion The mechanical thrombectomy with the stent device within 24 h can get higher reperfusion rate,fewer complications,and significantly reduce the mortality rate and good clinical outcome in large intracerebral poster circulation artery occlusions patients.

Application of one-hand double-lumen simultaneous locking technique in the prevention of occlusion using high pressure resistant double-lumen PICCs / 中华护理杂志

Objective To explore the effects of application of one-hand double-lumen simultaneous locking tech-nique on reduction of occlusion using high pressure resistant double-lumen PICCs. Methods Convenience sampling method was used to recruit 73 patients assigned into the experimental group,using one-hand double-lumen simulta-neous locking technique;66 patients were assigned into the control group,using routine locking method. The rate of PICC occlusion was recorded. Results The rate of incomplete occlusion was 8.22% in the experimental group,and 17.42% in the control group,the rate of complete occlusion in the experimental group was 0,and 0.76% in the control group,and the difference was statistically significant(P<0.05). Conclusion The one-hand double-lumen simul-taneous locking technique is easy and convenient to conduct. It can effectively reduce occlusion using high pres-sure resistant double-lumen PICCs.

Conocimiento, actitud y práctica de los médicos pediatras sobre factores preventivos de la salud oral en la primera infancia / Knowledge, attitude and practices of Pediatricians on preventive factors of oral Health in early Childhood

Introducción: El médico pediatra tiene un papel fundamental en las primeras orientaciones sobre salud bucal. Objetivo: Determinar el nivel de conocimientos, actitudes y prácticas de los médicos pediatras que ejercen en Asunción y Central sobre factores preventivos en la salud oral en la primera infancia en el año 2013. Materiales y Métodos: Estudio observacional descriptivo de corte transverso, realizado mediante un cuestionario autoadministrado a los médicos pediatras que ejercen en Asunción y Central. Resultados: Se incluyó 92 médicos pediatras de los Servicios de Salud de la XVIII y XI Región Sanitaria, edad media de 29 ±4,9 años, 62% del sexo femenino. La región donde trabaja la mayoría es en el departamento central (77%). El promedio de los años de graduación es de 6,5 años; el 78% entre 1 a 5 años. El número de pacientes que atiende por día es de >20 en el 53% de los casos. Se observa que el 74% de los pediatras tiene práctica inadecuada con respecto al examen bucal, prescripción de flúor; el 49% tiene conocimiento suficiente sobre factores de riesgo para las principales enfermedades bucales; y el 100% presenta actitud favorable hacia su papel importante en la prevención de las enfermedades bucales. No se encuentra asociación entre la edad del pediatra y el nivel de conocimiento y práctica, tampoco se encontró asociación entre los años de práctica con las prácticas, mientras que se evidencia que menos años de práctica tienen mejores conocimientos (p=0,009); y que los pediatras que atienden menos pacientes en un día tienen mejores conocimientos (p=0,010) y prácticas (p=0,035). Conclusión: Se resalta la falta de coherencia entre los conocimientos sobre factores preventivos y la práctica en los médicos pediatras participantes

Introduction: The field of dentistryhas been extended to include infantcare, in an attempt to include earlyeducation and preventiv e measures...

Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques

OBJECTIVE: Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques. METHODS: A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified. RESULTS: An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p<0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p<0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p<0.001). The global longitudinal strain showed a significant increase after successful revascularization (p<0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction ≥50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement. CONCLUSIONS: Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes ...

Baseline Characteristics and Risk Factors of Retinal Vein Occlusion: A Study by the Korean RVO Study Group

We investigated the demographic characteristics and risk factors of Korean patients with naIve central or branch retinal vein occlusion (CRVO or BRVO). This study enrolled 41 clinical sites throughout Korea and included 557 consecutive patients with retinal vein occlusion (RVO) from May through November 2010. A total of 557 patients with new-onset RVO participated in this study. Two hundred and three (36.4%) patients were diagnosed with CRVO and 354 (63.6%) patients were diagnosed with BRVO. Comparisons between the two groups showed that the prevalence of diabetes mellitus was significantly higher in CRVO patients and hypertension was significantly higher in BRVO patients (P = 0.001 and 0.002, respectively). Poor baseline visual acuity was significantly associated with female and old age in BRVO patients (P = 0.002 and 0.013, respectively), whereas the wide intraretinal hemorrhage (CRVO, P = 0.029; BRVO, P < 0.001) and the macular ischemia (CRVO, P < 0.001; BRVO, P < 0.001) were associated with both groups. The study results show the clinical features of RVO in Korean patients. Hypertension is strongly associated with BRVO and diabetes mellitus is more strongly associated with CRVO in Korean patients with RVO. As the first nationwide study performed by the Korean Retinal Society, the results of this study can be applied to future studies on RVO.

Retinal arterial occlusions in the young: Systemic associations in Indian population.

Purpose: To determine the systemic associations in retinal arterial occlusions (RAO) in young Indian individuals less than 40 years of age. Materials and Methods: Case records of 32 patients (35 eyes) of less than 40 years, with non-traumatic RAO were analysed. All patients underwent detailed ophthalmic and systemic evaluation including hemogram, lipid profile, coagulation profile, vasculitis screening, carotid Doppler, echocardiogram. Results: In the study 21 were males and 11 were females. The age ranged from 11-39 years (Mean 27.6 ± 8.43). Nine (28%) patients were below 20 years of age. Among 35 eyes, 28 (80%) had central retinal artery occlusion (CRAO), three (8.6%) had branch retinal artery occlusion (BRAO), two (5.7%) each had cilio-retinal (CLAO) and hemi-retinal artery occlusion (HRAO). Vision ranged from no perception of light to 20/20. On systemic evaluation, in 21 (65.6%) patients a hypercoagulable state was responsible for the RAO. Conditions leading to a hypercoagulable state included hyperhomocysteinemia (21.9%), hyperlipidemia (15.6%), anticardiolipin antibody (6.2%), antiphospholipid antibody (6.2%), polycythemia, thrombocytosis, protein S deficiency, use of oral contraceptives and renal disorder (3.1% each). Six (18.7%) patients had cardiac valvular defects. Vasculitis screening was positive in three (9.4%) patients. Two (6.2%) had isolated systemic hypertension. In two (6.2%) patients no abnormality could be detected. Conclusion: The systemic associations of RAOs in the Indian population were distinctly different from those reported in the Western population. Hyperhomocysteinemia was the commonest association found. Whereas associations reported in the Western population such as cardiac abnormalities, coagulation disorders, hemoglobinopathies and oral contraceptive use were uncommon.

Intervencionismo en oclusiones crónicas: evaluación de la efectividad cruce de distintas guías y balones según complejidad / Percutaneous coronary interventions in chronic coronary occlusions: effectiveness of different guides and balloons according to complexity of total coronary artery occlusion

Antecedentes: El intervencionismo en las oclusiones totales crónicas (OTC) requiere técnicas complejas y el éxito es poco predecible. Es útil identificar la efectividad de las guías de cruce y del balón para el intervencionismo en distintos niveles de complejidad de OTC. Objetivos: Evaluar la efectividad de cruce de distintas guías y balones en el tratamiento de OTC. Métodos: Se revisa en forma retrospectiva la efectividad de distintos tipos de guías y balones de cruce utilizados en intervencionismo de OTC efectuados entre agosto de 2007 y agosto de 2009. Se define "efectividad" como la capacidad de avanzar y cruzar la oclusión crónica con la guía y el balón, ambas necesarias para efectuar la angioplastia de la OTC. Se agrupan los resultados según el nivel de complejidad de la OTC de acuerdo a score propio, distinguiendo entre OTC simples, complejas y de alta complejidad. Resultado: En el período estudiado se revisan 90 OTC. Se utilizan 148 guías (1,6 guía/proc.) y se utilizan 92 balones en 76 procedimiento que logran paso efectivo de guía. (1,2 bal/proc). Se realiza una tabla con la tasa de efectividad de distintas guías y balones de cruce. Destaca la utilidad de guía PT2 en lesiones simples y complejas, como la utilidad de la guía Miracle 6 en OTC de alta complejidad. Conclusiones: En OTC se obtiene un éxito de 67 por ciento en nuestro medio, con mayor efectividad de la guía PT2 en lesiones simples y complejas y de Miracle 6 en lesiones de alta complejidad. En cuanto a balones se obtiene mayor efectividad en los tipo Maverick, Mercury y Voyaguer de 1,5 mm en lesiones simples y complejas, como del Balón Maverick de 1,5 mm en lesiones de alta complejidad. Es de gran utilidad un registro de la efectividad de balones y guías en el tratamiento de OTC, lo que permite al intervencionista una adecuada elección del material con el consecuente ahorro de tiempo y mayor efectividad del procedimiento.

Background.: PCI in chronic coronary occlusions requires complex techniques and is associated to less predictable results. It is important to evaluate the effectiveness of different guides and balloons in PCI for total coronary occlusion (TCO). Aim: To evaluate the effectiveness of different guides and balloons in the treatment of TCO. Methods: A retrospective review of the effectiveness of different guides and balloons in the treatment of TCO performed from 2007 to 2009 was carried out Effectiveness was defined as the ability to traverse the occlusion with the guide and the balloon. The analysis was performed according to groups defined by the complexity of the TCO as assessed by a locally developed score. Occlusions were classified as simple, complex or highly complex. Results: 90 procedures were analyzed 148 guides were utilized (mean of 1.6 per procedure) and 92 balloons were used in 76 cases were the guide successfully crossed the occlusion. The PT2 guide was effective for simple and complex lesions, whereas de Miracle 6 guide was effective in the treatment of highly complex lesions. Regarding balloons, the Maverick, Mercury and Voyageur 1.5 mm were satisfactory in simple and complex lesions, while the Maverick 1.5mm was more effective in highly complex lesions Conclusion: TCO was successfully treated by PCI in 67 percent of cases. PT2 guides and all types of balloons were effective for treatment of simple and complex lesions. In contrast, the Miracle 6 guide and the Maverick 1.5 balloon were more effective in highly complex lesions. These findings may be useful to help de proper selection of angioplasty materials when treating.

Endovascular treatment of long femoro-popliteal arterial occlusions of lower extremities / 国际外科学杂志

Objective To explore the feasibility and outcome of percutaneous transluminal angioplasty (PTA) as a primary treatment modality long femoro-popliteal arterial occlusions in critical limb ischemia.Methods Ten cases with 10 lesions in their femoro-popliteal arterial occlusions were treated with PTA, and the symptoms, intraoperative and postoperative DSA characteristics were retrospectively analyzed. Short-term follow-up were obtained in 8 cases. Results The technical success rate related to procedure was 90% and 12 stents were placed after PTA in femoro-popliteal arterial occlusions. One case was suffered fromamputa-lion due to development of compartment syndrome. The primary patency rate and recurrence rate of 12 months after procedure were 70% and 30% respectively. Conclusion Patients with critical limb ischemia could be beneficial from PTA in long femoro-popliteal arterial occlusions.

Application of clopidogrel in percutaneous coronary intervention for acute occlusions of coronary arteries / 中国临床药理学与治疗学

AIM: To observe the effects and safety of clopidogrel used in percutanous coronary intervention (PCI) while acute occlusions of coronary arteries happened. METHODS: 92 patients with acute occlusions of coronary arteries were treated through PCI and they were randomized equally into following groups: clopidogrel group (CPG group) and ticlopidine group (TCP group). Each patient was treated with clopidogrel 25 mg bid or ticlopidine 250 mg bid for 4 weeks after PCI. RESULTS: Compared with the control group, there was not significantly difference in platelet aggregation ( 45.36 ? 2.98 vs 51.60 ? 2.56 ) and clinical effects ( 97.95 % vs 93.02 %) after 3 weeks. The proportion of patients with adverse events who had to release the treatment was 2.04 % (CPG group) and 16.27 % (TCP group). CONCLUSION: The clinical effect of clopidogrel is similar to ticlopidine and shows less adverse events.

Acute thrombo-embolic occlusions of the aorta and major arteries complicating arteriosclerotic heart disease (report of four cases)

The patho-physiology of mural thrombi and resulting peripheral systemic thrombo-embolic occlusions is presented. Four cases are discussed to demonstrate that embolectomy, carried out as early as possible, is probably the procedure of choice. All cases occurred in patients with serious cardiac or cardio-renal conditions. All patients were geriatric the oldest being 94 years old. The fact that they have lived this long probably indicate above-average constitutions, and age per se should not deter the properly trained and equipped surgeon from performing these life- or limb-saving procedures. (Summary)