Incidence, Predictors, and Strategies for Retrograde Wire Tracking Failure via Poor Septal Collateral Channels in Chronic Total Occlusion.

Background: Retrograde guidewire (GW) tracking success via a poor septal collateral channel (CC) when an antegrade approach fails is crucial for successful revascularization of coronary chronic total occlusion (CTO) with poor septal CC. However, the incidence, predictors, and management strategies for retrograde GW tracking failure via poor septal CC remain unclear. Methods: In total, 122 CTO patients who underwent retrograde septal percutaneous coronary intervention (PCI) with poor CC between January 2017 and May 2022 were retrospectively analyzed. Patients were divided into the retrograde GW tracking success group (success group) and the retrograde GW tracking failure group (failure group). Clinical and angiographic data were compared to investigate the predictors of retrograde GW tracking failure. Results: The incidence of GW tracking failure was 22.1% (27/122). Patients in the failure group had a higher prevalence of left anterior descending artery (LAD) CTO (66.7% vs 37.9%; p = 0.009) and a higher incidence of well-developed non-septal collateral (66.7% vs 30.5%; p = 0.001). Patients with a septal CC diameter ≥ 1 mm (48.1% vs 70.5%; p = 0.040), ≥ 3 septal CCs (44.4% vs 66.3%; p = 0.046), and initial retrograde application of Guidezilla (37.0% vs 60.0%; p = 0.048) were significantly lower in the failure group than in the success group. The binary logistics regression model showed that a CC diameter < 1 mm, well-developed non-septal collateral, and LAD CTO were independent predictors for GW tracking failure in patients undergoing retrograde CTO PCI via poor septal CC. Conclusion: The success rate of retrograde GW tracking via poor septal CC was high, with a relatively high procedural success rate. A CC diameter < 1 mm, well-developed non-septal collateral, and LAD CTO were independent predictors of GW tracking failure in patients undergoing retrograde CTO PCI via poor septal CC.

Case Report: ALK-Positive Histiocytosis With KIF5B-ALK Fusion in Cerebrum-Disseminated Lesions in a Child.

Background: Anaplastic lymphoma kinase (ALK)-positive histiocytosis is a rare type of histiocytosis that could affect multiple systems in children and adults. 10 cases of ALK-positive histiocytosis invading the central nervous system (CNS) have been reported. Herein, we report a case of ALK-positive histiocytosis invading the central nervous system and lungs and the details of follow-up of tumor dynamic changes during treatment. Case Presentation: An 18-month-old boy was underweight and had slow growth of almost 3 months duration. The child could not stand and walk independently, and his language and intelligence development occurred later than those of his peers. Cranial magnetic resonance imaging revealed a giant suprasellar lesion with isosignal, measuring approximately 5.1× 3.6× 4.0 cm on T1-weighted imaging, with an obvious mass effect. Nodular, slightly low-signal shadows were also observed in the left temporal pole and left hippocampus, measuring approximately 1.0 cm × 0.7 cm× 0.5 cm and 0.9 cm× 0.8 cm × 0.5 cm on T1-weighted, respectively. The child underwent partial resection of the suprasellar lesion, and a diagnosis of ALK-positive histiocytosis was made histologically. Subsequently, the patient received chemotherapy (CHOP regimen) and anti-ALK therapy (crizotinib). The lesions were gradually shrinking without dissemination and the changes of intracranial and lung lesions were monitored with imaging during therapy. Unfortunately, the child died 8 months after the first surgery because of worsening intracranial infection. Conclusion: ALK-positive histiocytosis may involve the central nervous system and disseminate intracranially. ALK-positive histiocytosis should be considered for the differential diagnosis of suprasellar lesions.

Bone Mineral Density Assessment by Quantitative Computed Tomography in Glucocorticoid-Treated Boys With Duchenne Muscular Dystrophy: A Linear Mixed-Effects Modeling Approach.

Objective: Boys with Duchenne muscular dystrophy (DMD) are at risk of bone damage and low bone mineral density (BMD). The aim of the study is to examine lumbar BMD values measured by QCT and identify the factors associated with BMD loss using a multilevel mixed-effects model. Methods: Lumbar BMD was evaluated by quantitative computed tomography (QCT) at diagnosis, 1 and 2 years follow up in patients with DMD who were treated with GC. Demographic data, functional activity scores (FMSs), laboratory parameters and steroid use were recorded. A multilevel mixed-effects model was used to analyze BMD loss. Results: Nineteen patients with DMD who had a total of sixty complete records between January 2018 and October 2021 were retrospectively analyzed. At baseline, 15.8% of patients (3/19) had low lumbar BMD (Z score ≤ -2), and the mean BMD Z score on QCT was -0.85 (SD 1.32). The mean BMD Z score at 1 and 2 years postbaseline decreased to -1.56 (SD 1.62) and -2.02 (SD 1.36), respectively. In our model, BMD Z score loss was associated with age (ß=-0.358, p=0.0003) and FMS (ß=-0.454, p=0.031). Cumulative GC exposure and serum levels of calcium, phosphorus, 25(OH)-vitamin D and creatinine kinase did not independently predict BMD loss. Conclusions: This study demonstrates that in DMD patients, lumbar BMD decreased gradually and progressively. Age and FMS are the main contributors to BMD loss in boys with DMD. Early recognition of risk factors associated with BMD loss may facilitate the development of strategies to optimize bone health.

Efficacy and safety of prophylactic abdominal aortic balloon occlusion versus internal iliac arterial balloon occlusion for placenta accreta spectrum disorder: A systematic review and meta-analysis.

PURPOSE: To assess the efficacy and safety of abdominal aortic (AA) balloon occlusion versus internal iliac arteries (IIA) balloon occlusion in patients with placenta accreta spectrum (PAS) disorders. METHODS: Databases of Embase, PubMed, Web of Science and Cochrane Library were systematically searched from inception to May 2020. The relevant literature was screened and the quality was assessed. RevMan software 5.3 was used to analyze the data. RESULTS: Six studies involving 239 patients in AA occlusion and 281 patients in IIA occlusion were included. The results demonstrated that the intraoperative hemorrhage volume (MD - 410.61 ml, 95% CI -779.74 to -41.47 ml, p < 0.001), balloon dilatation duration (MD -5.34 min, 95% CI -9.91 to -0.77 min, p = 0.02) and fetus radiation dose (MD-20.81 mGy, 95% CI -31.84 to -9.78 mGy, p < 0.001) were significantly less in AA occlusion compared to IIA occlusion. There was no significant difference in the rate of lower extremity thrombosis between AA occlusion and IIA occlusion (OR 0.21, 95% CI 0.02 to 2.21, p = 0.19); similarly, no significant differences were found in blood transfusion volume (MD -344.50 ml, 95% CI -735.74 to 46.74 ml, p = 0.08), the rate of hysterectomy (OR 0.99, 95% CI 0.22 to 4.44, p = 0.99) and other outcome variables. CONCLUSION: The available data demonstrated AA occlusion was more effective in reducing intraoperative hemorrhage volume and fetus radiation dose compared with IIA occlusion in patients with PAS disorders. Larger studies or randomized controlled trials are needed to further assert this evidence.

A rare mutant of OFD1 gene responsible for Joubert syndrome with significant phenotype variation.

Joubert syndrome (JBTS), a rare genetic disorder resulted from primary cilium defects or basal-body dysfunction, is characterized by agenesis of cerebellar vermis and abnormal brain stem. Both genotypes and phenotypes of JBTS are highly heterogeneous. The identification of pathogenic gene variation is essential for making a definite diagnosis on JBTS. Here, we found that hypoplasia of cerebellar vermis occurred in three male members in a Chinese family. Then, we performed whole exome sequencing to identify a novel missense mutation c.599T > C (p. L200P) in the OFD1 gene which is the candidate gene of X-linked JBTS (JBST10). The following analysis showed that the variant was absent in the 1000 Genomes, ExAC and the 200 female controls; the position 200 Leucine residue was highly conserved across species; the missense variant was predicted to be deleterious using PolyPhen-2, PROVEAN, SIFT and Mutation Taster. The OFD1 expression was heavily lower in the proband and an induced male fetus compared with a healthy male with a wild-type OFD1 gene. The in vitro expression analysis of transiently transfecting c.599T or c.599C plasmids into HEK-293T cells confirmed that the missense mutation caused OFD1 reduction at the protein level. And further the mutated OFD1 decreased the level of Gli1 protein, a read-out of Sonic hedgehog (SHH) signaling essential for development of central neural system. A known pathogenic variant c.515T > C (p. L172P) showed the similar results. All of these observations suggested that the missense mutation causes the loss function of OFD1, resulting in SHH signaling impairs and brain development abnormality. In addition, the three patients have Dandy-Walker malformation, macrogyria and tetralogy of Fallot, respectively, the latter two of which are firstly found in JBTS10 patients. In conclusion, our findings expand the context of genotype and phenotype in the JBTS10 patients.

Retaining of PTCA guide wire in the left ventricular lead and subsequent application of epicardial electrode when CRT-D implantation in a patient with severe heart failure and persistent left superior vena cava: a case report.

OBJECTIVE: One patient with severe heart failure (LV 92 mm, EF 28%) was treated by cardiac resynchronization therapy (CRT). METHOD: During the operation, it was found that double superior vena cava coexisted, and selective coronary venography cannot clearly show every branch. It was difficult to push ventriculus sinister electrode to sideward vein, so the electrode was released to far end of frontal septal branch along great cardiac vein. RESULT: However, because of insufficient braced force of ventriculus sinister electrode, 0.014 PTCA guide wire was detained in the electrode. 2 years later, two spots of PTCA guide wire retained in ventriculus sinister electrode broke in atrium dextrum, so the implantation of epicardial electrode was conducted. CONCLUSION: After the operation, heart failure was relieved. After 43 months, the battery of pacemaker depleted, so the pacemaker was changed. The effect since follow-up visit was good, LV decreased to 86 mm, EF increased to 32%, and SPWMD time limit shortened from 147 ms to 45 ms. The therapeutic experience of this patient indicated that the effect of detaining PTCA guide wire to enhance braced force in implantation of ventriculus sinister is unreliable and inappropriate to be advocated.

[A comparison of the effectiveness of five types of hemostatic surgeries for intractable postpartum haemorrhage and the factors of failed hemostasis].

OBJECTIVE: To study the different clinical effects of using 5 kinds of hemostatic surgeries to manage the intractable postpartum hemorrhage and analyse the risk factors of failed hemostasis. METHODS: From Jan. 2007 to Jul. 2011, 96 patients with intractable postpartum hemorrhage were studied retrospectively and grouped by the first step surgical treatment. The hemostatic surgeries included uterine tamponade (tamponade group), pelvic blood vessels ligation (ligation group), pelvical arterial embolization (embolization group), uterine compression sutures (sutures group) and uterine compression sutures combining tamponade (combined group). The intraoperative and postoperation datum were compared among groups, so dose the treatment outcomes. Multivariate analysis were used for failed hemostasis. RESULTS: (1) The blood loss of 96 patients ranged from 1200 to 9100 ml, and 71 patients had a succeed hemoatasis after employing these surgeries and 25 failed. (2) The blood loss before hemostasis surgeries in tamponade group and embolization group was statistically greater than in sutures group (P < 0.05). Blood loss during the hemostasis surgeries in ligation group was statistically greater than in embolization and sutures groups (P < 0.05). The operating time of embolization group was statistically shorter than ligation group, sutures group and the combined group (P < 0.05). (3) Fine of 96 patients had uterine atony and 43 had a successful hemostasis with the success rate about 78%. Forty-six had placenta previa and 39 success with success rate 85%. Thirty-three had placenta accrete and 13 of which succeed in hemostasis with success rate about 39%. In patients with uterine atony and placenta previa, the difference of hemostasis rate in groups had no statistically significant (P > 0.05). In patients with placenta accrete, the hemostasis rate in embolization group was higher than in others groups (P < 0.01). (4) The multivariate analysis found that scar uterus, placenta accrete and coagulation defects were the risk factors of failed hemotasis. The OR value respectively was 2.9 (95%CI: 1.1 - 7.6), 17.9 (95%CI: 5.6 - 56.3) and 16.2 (95%CI: 3.2 - 83.5). Embolization had some extent of protective effection (OR = 0.9, 95%CI: 0.8 - 0.9). CONCLUSIONS: (1) Five kinds of hemostatic surgeries were all effective. Though the success rate among groups did show statistical difference, pelvical arterial embolization has the comparative advantage of shorter operating time, less operating blood loss and higher success rate in placenta accrete. (2) Since scar uterus, placenta accrete and coagulation defects were the risk factors of failed hemostasis, sufficient preparation should be made for patients with these risk factors and the hemostatic surgeries should be choosed individually.

Chinese herbal medicine in the treatment of ectopic pregnancy.

BACKGROUND: Traditionally Chinese herbal medicine (CHM) has been used widely in Chinese hospitals to treat ectopic pregnancy. Many studies have been published supporting its use but the evidence has not been systematically reviewed. This is and update of the review published in 2007. OBJECTIVES: To determine the effectiveness and safety of CHM in the treatment of ectopic pregnancy. SEARCH STRATEGY: Computerised databases (CENTRAL (The Cochrane Library), MEDLINE, EMBASE, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP, Traditional Chinese Medicine Database System) were searched from their inception to November 2010 for relevant trials. SELECTION CRITERIA: Randomised controlled trials (RCT) on the use of CHM for the treatment of ectopic pregnancy. DATA COLLECTION AND ANALYSIS: Original authors of the identified studies were contacted to determine the trial design and identify authentic RCTs. Two review authors extracted and analysed the data. MAIN RESULTS: The search identified 281 trials. Only two studies involving a total of 157 participants were confirmed to be authentic RCTs (Li 2004c; Zhao 2000). Both were of poor methodological quality with a high risk of conflicted interest and potential for bias in favour of the intervention. We could not reach a definitive conclusion from the results. The pooled result showed that adding a Western medicine to CHM resulted in a significantly higher treatment success rate than with CHM alone (RR 1.33, 95% CI 1.08 to 1.63). When CHM plus Western medicine was compared to CHM alone for the time to disappearance of abdominal pain, again the results favoured the arm that included Western medicine (RR -2.09, 95% CI -4.14 to -0.04). Results were inconsistent for the time required for human chorionic gonadotropin (beta-hCG) to return to normal. One study favoured CHM plus Western medicine over Western medicine (with or without placebo) (MD -6.68, 95% CI -11.49 to -1.87); when CHM plus Western medicine was compared to CHM alone the results favoured the arm that included Western medicine (MD -8.12, 95% CI -10.89 to -5.53). AUTHORS' CONCLUSIONS: We have not found any well-designed trials investigating Chinese herbal medicines in the treatment of ectopic pregnancy. We cannot support or refute any CHM preparation for clinical use on the basis of evidence from randomised controlled trials.

Fibrous hamartoma of infancy mimicking teratoma in the parapharyngeal space on multidetector row CT.

To the best of our knowledge, fibrous hamartoma of infancy (FHI) mimicking teratoma presenting in the parapharyngeal space has not been reported to date. We present one case of this tumour and describe its characteristic findings on multidetector-row CT (MDCT). This case is of interest in that the parapharyngeal space was involved and the mass mimicked teratoma on MDCT. We present the MDCT findings and briefly review the relevant literature.

[Comparison among three standards of TW2 to skeletal age determination in children with central precocious puberty].

OBJECTIVE: To discuss the diagnostic value of English, Chinese and Japanese standards of TW2 to skeletal age assessment of children with central precocious puberty (CPP), then to confirm the normal thresholds. METHODS: Sixty one children as patient group were definitely assured CPP. The control group had 67 children. Among them, 61 were normal children, another 6 children as a special control group. Left hand-wrist X-ray radiographs were retrospectively analyzed by two doctors separately and their skeletal ages were assessed with the three standards of TW2 method. The differences between skeletal age and chronological age were analyzed with ROC in SPSS 13.0. RESULTS: (1) The skeletal age results showed kappa value is 0.776 deduced by two clinical doctors(u = 16.128, P < 0.05). (2) There were no statistic differences for the areas under ROC curves among three methods. (3) d > or = 1.15 years in TW2, d > or = 1.25 years in TW2-CHN and d > or = 0.65 years in TW2-JP were more susceptive and specific points. CONCLUSION: TW2, TW2-CHN and TW2-JP provided a higher value for the diagnosis of skeletal age in unhealthy children, and TW2-CHN is highest value for Chinese children.

[TW systems in estimation of carpal bone age and their potential applications in diagnosis of idiopathic precocious puberty in Chinese girls].

OBJECTIVE: To compare three assessment methods (TW2, TW2CH, and TW3) for carpal bone age and their potential applications in diagnosis of idiopathic precocious puberty (IPP) in Chinese girls. METHODS: Fifty-five (55) girls with IPP and 83 normal girls as control group were selected in this study. The X-ray films of the left hand-wrist taken at their first visit were analyzed retrospectively. Three assessment methods were used to estimate the carpal bone age with single-blinded method and percentiles were set at 5 different decision thresholds (1)>97th percentile, (2)>90 th percentile, (3)>75th percentile, (4)>50 th percentile, and (5)< or =50th percentile. RESULTS: All of the three methods showed similar high sensitivity and specificity at the threshold above 90th percentile. CONCLUSION: Our data indicate that all of the three methods for estimation of the carpal bone age are useful in diagnosis of IPP. TW2CH and TW3 methods appear to be superior to TW2 method.

[CT features and anatomic-pathologic basis of the 16-slice spiral CT for aortic dissection].

OBJECTIVE: To determine the CT features and anatomic-pathologic basis of the 16-slice Spiral CT (SCT) for aortic dissection (AD). METHODS: Forty-two cases with typical aortic dissection (AD) and 12 cases with intramural hematoma (IMH) underwent 16-slice SCT, performed with unenhanced, contrast-enhanced scanning and three-dimensional reconstruction. More attention was put on the true and false lumen, intimal flap, the entry tear and the involvement of branches of AD. RESULTS: (1) True and false lumen and intimal flap of AD could be shown in all of 42 cases (100%), the entry tears were revealed in 41 cases (97.6%), and the true and false lumen and intimal flap extended spirally in 41 cases (97.6%). (2) For intramural hematoma (IMH), unenhanced CT depicted crescent-shaped areas with high attenuation extending along the walls of the aorta in 10 cases (83.3%), and low attenuation in 2 cases (16.7%), while contrast-enhanced CT showed no enhancement of attenuation in the crescent-shaped areas in all 12 cases. Nine cases (75%) of IMH were associated with penetrating aortic ulcer. CONCLUSIONS: The axial and three-dimensional images of 16-slice SCT can fast and exactly reveal the pathological and anatomical features of AD, and provide detailed imaging information for clinical therapy. It's very important for the selection of treatment methods.