Endovascular Repair Blunt Thoracic Aortic Injury in Adolescent: A Case Series.

BACKGROUND: Blunt traumatic aortic injury (BTAI) is a rare occurrence in adolescents, yet it is associated with a high mortality rate necessitating immediate treatment. Although endovascular repair has become the preferred treatment for such injuries in adults, its effectiveness in adolescents remains uncertain. CASE SUMMARY: Blunt traumatic aortic injury typically presents with concomitant injuries to other organs and carries a high perioperative mortality rate with operative repair (OR). In this report, we describe the treatment of 3 clinical cases of BTAI in adolescents using thoracic endovascular aortic repair (TEVAR). These cases contribute pertinent evidence supporting the efficacy of intravascular repair for BTAI. CONCLUSION: Operative repair (OR) remains the gold standard for treating BTAI in adolescents. Nevertheless, TEVAR therapy presents a viable alternative for patients with multiple injuries in whom anticoagulation is contraindicated. Further long-term observation is necessary to assess the lasting effects of TEVAR therapy. CLINICAL IMPACT: This study has provided insights into endovascular repair for adolescent BTAT, offering clinicians significant reference material for choosing treatment strategies for adolescent BTAT. The study aims to demonstrate the safety and effectiveness of endovascular repair treatments in a series of clinical cases involving adolescent BTAI.

Direct oral anticoagulants versus standard anticoagulation in children treated for acute venous thromboembolism.

Direct oral anticoagulants (DOACs) are widely used to treat venous thromboembolism (VTE) in adults. Little attention is given to pediatric VTE (PVTE). The objective of this study is to study the efficacy and safety of DOACs in published PVTE randomized control trials (RCTs). PubMed, Embase, China National Knowledge Infrastructure, the Cochrane Library, SinoMed, and ClinicalTrials.gov were searched until 2021, to identify RCTs that enrolled patients with VTE <18 years of age who received DOACs versus standard anticoagulation. Outcomes were evaluated using the Mantel-Haenszel method of random-effects model. Our study evaluated seven RCTs that included 1139 cases of PVTE, which had a low risk of publication and assessment bias. Compared with standard anticoagulation, patients receiving DOACs presented a lower rate of recurrent VTE (relative risk [RR], 0.42 [confidence interval {CI}, 0.20 to 0.89]), similar mortality rate (RR, 0.50 [CI, 0.07 to 3.57]), major bleeding (RR, 0.46 [CI, 0.14 to 1.57]), and higher clinically relevant nonmajor bleeding (RR, 2.71 [CI, 1.05 to 7.02]) with low heterogeneity. Limiting to subgroups, dabigatran and rivaroxaban yielded similar findings, except for a higher incidence of nonmajor bleeding during rivaroxaban use. DOACs could be an alternative to standard anticoagulation in PVTE. Dabigatran and rivaroxaban have similar effects. IMPACT: In venous thromboembolism (VTE), direct oral anticoagulants (DOACs) are widely used as a substitution for standard anticoagulation in most situations for adults; however, little attention is paid to the pediatric population. For pediatric VTE, previous meta-analyses have emphasized the epidemiology, risk factors, and the use of traditional anticoagulants, and seldom reported the use of novel oral anticoagulants. This is the first meta-analysis of randomized controlled trials that focuses on the efficacy outcomes and safety endpoints of DOACs compared with standard anticoagulation in pediatric VTE.

Intraluminal Diverticular Duodenal Duplication With Recurrent Abdominal Pain: A Case Report.

Duodenal duplication is a rare congenital anomaly and may manifest as pancreatitis, gastrointestinal bleeding, abdominal pain, perforation, and obstruction. Here, we present a case of intraluminal diverticular duodenal duplication (IDDD) in a child with recurrent abdominal pain caused by a large hole-like structure in the duodenal bulb. This condition has rarely been reported. An 11-year-old boy presented with recurrent attacks of abdominal pain. Upper endoscopy examination and barium swallowing led to an initial diagnosis of IDDD; this diagnosis was confirmed by operative findings and histopathological signs. He underwent a subtotal excision and duodenal anastomosis. No serious complications occurred following treatment. The patient was followed up for 8 months, and his condition improved without symptoms.

Is percutaneous access superior to cutdown access for endovascular abdominal aortic aneurysm repair? A meta-analysis.

OBJECTIVE: The objective is to investigate whether percutaneous access (pEVAR) is superior to cutdown access (cEVAR) in terms of safety and efficacy during endovascular repair of abdominal aortic aneurysms (AAAs). METHODS: We searched PubMed, Embase, and Cochrane Library from January 1999 to December 2020 for studies reporting on the comparison between percutaneous and cutdown techniques for endovascular repair of AAAs. Outcomes evaluated were technical success rates, access site-related complications and operative time, and hospital stay. RESULTS: Four randomized controlled trials and nine observational studies with a total of 1683 patients comprising 2715 groin accesses were eligible for the meta-analysis. pEVAR was associated with a lower risk of overall complications (odds ratio (OR) = 0.63; p = .005) and seroma/lymphorrhea (OR, 0.18; p = .0001) and shortened operation time (MD = -39.04; p = .002) and the length of hospital stay (MD = -0.75; p < .00001) compared with cEVAR. The technical success rate for pEVAR was 95.1% (694/729), with an overall OR of 0.27 (95% CI 0.14-0.55, p = .0003) comparing pEVAR with cEVAR. Furthermore, pEVAR did not increase the risk of site infection, femoral artery thrombosis, postoperative hematoma, nerve injury, dissection, and bleeding. CONCLUSION: Percutaneous endovascular aneurysm repair is a safe and effective method for the treatment of AAA. It reduces the risk of overall complications and shortens the operation time and hospital stay. The technical success rate of pEVAR is lower than that of cEVAR, which may be linked to the selection of patients, operator experience, and the use of ultrasound. Large definitive trials are required to draw robust conclusions.

Smoking induces the occurrence of colorectal cancer via changing the intestinal permeability.

PURPOSE: Colorectal cancer (CRC) is the third most frequent cancer. Its occurrence is closely linked to lifestyle and diet habits, such as excessive intake of high-fat food, but their impact on CRC, however, remain unclear. METHODS: Eligible CRC patients were retrospectively analyzed. Overall survival (OS) and recurrence-free survival (RFS) in smokers and non-smokers of CRC patients were assessed. APCmin/+ mice were exposed to cigarette smoking, followed by detection of CRC growth and intestinal permeability. RESULTS: A total of 416 eligible CRC patients were recruited, involving 218 (52.4%) smokers and 198 (47.6%) non-smokers. OS was shorter in CRC smokers than in non-smokers (p=0.005), whereas smoking did not affect RFS in CRC patients (p=0.251). Cigarette smoking increased CRC tumor numbers of CRC in APCmin/+ mice. Proliferation and apoptosis of colorectal epithelial cells, and inflammatory response in mice were changed following smoking. Notably, the treatment of probiotics mixture VSL#3 decreased the number of CRC tissues and intestinal permeability in APCmin/+ mice exposed to cigarette smoking. CONCLUSIONS: Smoking increases the susceptibility to CRC through damaging the intestinal permeability. Protecting the intestinal permeability significantly protects intestinal tracts.

Curcumin nicotinate suppresses abdominal aortic aneurysm pyroptosis via lncRNA PVT1/miR-26a/KLF4 axis through regulating the PI3K/AKT signaling pathway.

Abdominal aortic aneurysm (AAA) is a chronic dilated disease of the aorta that is characterized by chronic inflammation. Curcumin (Cur) is previously showed to attenuate AAA by inhibiting inflammatory response in ApoE -/- mice. Since Cur has the limitations of aqueous solubility and instability. Here, we focus on the role of curcumin nicotinate (CurTn), a Cur derivative is derived from Cur and nicotinate. An in vitro model of AAA was established by treating vascular smooth muscle cells (VSMCs) with II (Ang-II). Gene and protein expressions were examined by quantitative real-time PCR (qPCR) or western blotting. Cell migration and pyroptosis were determined by transwell assay and flow cytometry. The interaction between plasmacytoma variant translocation 1 (PVT1), miR-26a and krüppel-like factor 4 (KLF4) was predicted by online prediction tool and confirmed by luciferase reporter assay. CurTn reduced Ang-II-induced AAA-associated proteins, inflammatory cytokine expressions, and attenuated pyroptosis in VSMCs. PVT1 overexpression suppressed the inhibitory effect of CurTn on AngII-induced pyroptosis and inflammatory in VSMCs by sponging miR-26a. miR-26a directly targeted KLF4 and suppressed its expression, which eventually led to the deactivation of the PI3K/AKT signaling pathway. Besides, the regulatory effect of CurTn on pyroptosis of VSMCs induced by Ang-II was reversed through the PVT1/miR-26a/KLF4 pathway. In short, CurTn suppressed VSMCs pyroptosis and inflammation though mediation PVT1/miR-26a/KLF4 axis by regulating the PI3K/AKT signaling pathway, CurTn might consider as a potential therapeutic target in the treatment of AAA.

Endovascular Repair of an Aneurysm Arising from a Celiomesenteric Trunk.

Celiac axis (CA) aneurysm is a rare vascular condition, consisting of only 3.6-4% of visceral artery aneurysms but is frequently life threatening and can result in death. A celiomesenteric trunk (CMT) is an anatomic anomaly in which the celiac and superior mesenteric arteries arise from a common trunk. This structure accounts for only 1% of visceral artery variation, and a celiac artery aneurysm at a CMT is exceptionally rare. Here, we report the case of a 62-year-old woman with a celiac artery aneurysm at a CMT. Endovascular repair was completed using a bare metal stent-assisted coil. Satisfactory results were observed at the 10-month follow-up. To our knowledge, this is the first case reported of bare metal stent-assisted coil repair of a CA aneurysm at a CMT.