Long-term follow-up of abdominal aortic balloon occlusion for the treatment of pernicious placenta previa with placenta accreta

Objective:To evaluate the efficacy and safety of balloon occlusion of the abdominal aorta for the treatment of pernicious placenta previa with placenta accreta.Methods:The clinical data of 623 patients with pernicious placenta previa combined with placenta accrete,who were admitted to our hospital from January 2013 to January 2019 were retrospectively analyzed.All patients underwent abdominal aortic balloon occlusion combined with cesarean section,and 78 patients underwent sequential bilateral uterine artery embolization.We analyzed the operation time,intraoperative blood loss,blood transfusion volume,intraoperative and postoperative complications,fetal radiation exposure time and dose,and the Apgar score of the newborns.We also performed other evaluations to ascertain the efficacy and safety of abdominal aortic balloon occlusion treatment for dangerous placenta previa with placenta accrete.Results:Of the 623 patients,545 underwent only abdominal aortic balloon occlusion,and 78 underwent uterine artery embolization due to intraoperative or postoperative bleeding.The uterus was successfully preserved in all patients.Except for five cases of right lower extremity arterial thrombosis,the remaining patients did not have postoperative lower extremity arteriovenous thrombosis,renal insufficiency,late postpartum hemorrhage,ectopic embolism,spinal cord or peripheral nerve damage,pelvic infection,or other serious complications.The mean operative time was 65.3(±14.5)min.The mean intraoperative blood loss was620(±570)ml.Ninety-six patients(15.4%,96/623)were treated with blood transfusion,and the average amount of blood transfused was 750(±400)ml.The average number of hospitalization days was 6.8(±3.4)days,the average time of fetal ray exposure was 5.2(±1.6)s,and the average radiation dose was 4.1(±2.7)m Gy.The neonatal Apgar score,was 8.4(±0.6)points at 1 min,and 9.6(±0.4)points at 5 min.In the follow-up to May 31,2019,29 patients were lost to follow-up,96 were lactating,and 498 were menstruating.Except for the cases lost to follow-up,the remaining 596 surviving newborns(including 2 twins)showed no abnormalities at the 42-day postnatal outpatient follow-up examination.Conclusion:Balloon occlusion of the abdominal aorta is a safe and effective method for the treatment of pernicious placenta previa with placenta accreta.

Application of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section

Objective:This study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section.Methods:We performed a retrospective analysis of the clinical data for 623 patients who experienced pernicious placenta previa complicated with placenta accreta and received treatment in our hospital from January 2013 to January 2019.All patients underwent abdominal aortic balloon occlusion before their cesarean section.Seventyeight patients received bilateral uterine artery embolization,and among them,placenta accreta was found at the opening of the cervix in 13 patients.Due to suturing difficulty after the removal of the placenta,gauze packing was used to temporarily compress the hemorrhage.As soon as the uterus was sutured,emergent bilateral uterine artery embolization was performed.Active bleeding was noted in the remaining 65 patients when the lower part of the uterus was pressed after the placenta was removed and the uterus was sutured,therefor,bilateral uterine artery embolization was performed urgently.Results:Of the 623 patients,545 patients underwent only abdominal aortic balloon occlusion and 78 patients underwent additional emergent bilateral uterine artery embolization due to hemorrhaging during or after their cesarean section.No hysterectomies were performed.In the 78 patients,the amount of bleeding was 800-3,200 ml with an average of 1,650 ml during the operation;the volume of blood transfused was 360-1,750 ml(average:960 ml).The fetal fluoroscopy time was 3–8 s(average:5 s).The dose of radiation exposure was(4.2±2.9) m Gy.Fetal appearance,pulse,grimace,activity,and respiration(Apgar) score were normal.No serious complications were observed during or after the operation in the follow-up visits.Conclusion:For patients with pernicious placenta previa complicated with placenta accreta who experience active bleeding after cesarean section and abdominal aortic balloon occlusion,bilateral uterine artery embolization can effectively reduce blood loss and requirement of blood transfusion during the operation,and lowers the risk of hysterectomy.

Negative pressure catheter drainage and jejunal feeding for descending necrotizing mediastinitis by interventional techniques:a retrospective study

Purpose: Descending necrotizing mediastinitis(DNM) is a lethal and acute suppurative disease. This report aimed to summarize our experience in the treatment of DNM with continuous negative pressure catheter drainage and transnasal jejunal feeding by interventional techniques. Materials and Methods: We retrospectively analyzed relevant clinical data of patients with DNM who underwent continuous negative pressure catheter drainage and transnasal jejunal feeding. All drainage catheters and jejunal feeding tubes were inserte d by interventional techniques. Results: In total, 21 patients were diagnosed with DNM by esophagography and computed tomography(CT). Catheters for the drainage of mediastinal abscesses as well as transnasal jejunal feeding tubes were successfully placed in all patients, indicating a 100% success rate. Of all patients, 13 underwent insertion of abscess drainage catheters through percutaneous puncture under DynaCT guidance, while eight had drainage catheter insertion through fistula orifices in the posterior nasopharyngeal wall or esophagus under fluoroscopic guidance. In total, 26 drainage tubes were inserted. One patient with diabetes died of sepsis and diabetic ketoacidosis 5 days postoperatively, while the remaining 20 patients showed good recovery with successful removal of the drainage catheters. Durations of catheterization were 45.2±50.44 days. The overall clinical success rate was 95.2%. Conclusion: The above described methods are non-surgical, minimally invasive and efficacious, and may be alternative therapeutic tools for patients who are not eligible for surgical operation, have a high postoperative risk, or are more likely to choose minimally invasive techniques.

A creatinine-based model for predicting recurrent bleeding after modified percutaneous transhepatic variceal embolization in patients with cirrhosis

Background:Patients who survive initial esophagogastric variceal bleeding(EVB)are at an increased risk of recurrent bleeding and death;however,a reliable predictive model is lacking.We aimed to develop a model for rebleeding prediction in patients with EVB after modified percutaneous transhepatic variceal embolization(PTVE)with cyanoacrylate.Methods:A total of 122 patients with EVB who underwent PTVE from January 2015 to November 2020 were enrolled.Multivariate logistic analyses were conducted to determine independent risk factors for nomogram construction.The discrimination,calibration,and clinical utility of the nomogram were compared with the Model for End-stage Liver Disease score(MELD)and the Child–Pugh model.Risk stratification was performed according to the nomogram.Results:Rebleeding within 3 months of PTVE occurred in 32 patients(26.2%).Independent rebleeding indicators included prior history of endoscopic therapy,Child–Pugh score,partial splenic embolization,and creatinine level.The nomogram incorporating these four predictors achieved excellent calibration and discriminatory abilities,with a concordance index of 0.85,which was confirmed to be 0.83 through bootstrapping validation.The nomogram demonstrated superior discrimination and clinical applicability than the MELD and Child–Pugh models.As shown in the Kaplan–Meier curves,high-risk patients had a high probability of rebleeding(P<0.001).Conclusions:The creatinine-based nomogram had a superior ability to predict rebleeding after PTVE in patients with EVB.Risk stratification may help identify high-risk patients and lead to the earlier implementation of aggressive treatments and formulation of intensive follow-up plans.

Efficacy of patient-controlled hydromorphone analgesia in those undergoing uterine fibroid artery embolization via the right radial artery

Objective: To evaluate the efficacy and safety of patient-controlled analgesia(PCA) with hydromorphone as perioperative analgesia during uterine artery embolization(UAE) via the right radial artery.Patients and methods: A total of 33 patients with uterine fibroids, who underwent UAE at the authors’ hospital between June 2021 and March 2022, were selected. Hydromorphone(10 mg) was dispensed into a 100 ml PCA pump with normal saline. Pump administration was initiated 15 min before the start of the procedure, and the intraoperative dose was adjusted according to patient pain level. A numerical rating scale was used to evaluate pain immediately after embolization, 5 min after embolization, at the end of the procedure, and 6, 12, 24, 48, and 72 h after the procedure. Side effects were also observed.Results: Thirty-three patients underwent uterine artery embolization via the right radial artery. Patient pain was well controlled at all time points surveyed, and patients reported satisfaction with analgesia. The median length of hospital stay was 5 days. There were 7 cases of adverse reactions, but no serious side effects were observed.Conclusion: Patients reported positive experiences with arterial embolization of uterine fibroids via the right radial artery. Hydromorphone PCA effectively controlled pain. The PCA pump is easy to operate, has a low incidence of adverse reactions, and offers economic benefits at the patient and institutional levels.

Coil-assisted retrograde transvenous obliteration for gastric varices in a Chinese case

Gastric varices are a major complication of portal hypertension in patients with liver cirrhosis and are associated with more massive bleeding events and higher mortality rate.Transjugular intrahepatic portosystemic shunt(TIPS)and balloon-occluded retrograde transvenous obliteration(BRTO)have been well documented as effective therapies for portal hypertensive gastric variceal bleeding.In China,TIPS are well accepted but BRTO is not well recieved due to the increase risk of complications associated with traditional BRTO.However,modified-BRTO,known as coil-assisted and plug-assisted retrograde transvenous obliteration(CARTO and PARTO,respectively),is receiving increased attention due to devoid of BRTO’s shortcomings.No CARTO case from China has been reported in literature thus far.Here,we present a Chinese case of CARTO to treat gastric varices bleeding.

Immunosenescence:molecular mechanisms and diseases

Infection susceptibility,poor vaccination efficacy,age-related disease onset,and neoplasms are linked to innate and adaptive immune dysfunction that accompanies aging(known as immunosenescence).During aging,organisms tend to develop a characteristic inflammatory state that expresses high levels of pro-inflammatory markers,termed inflammaging.This chronic inflammation is a typical phenomenon linked to immunosenescence and it is considered the major risk factor for age-related diseases.Thymic involution,naïve/memory cell ratio imbalance,dysregulated metabolism,and epigenetic alterations are striking features of immunosenescence.Disturbed T-cell pools and chronic antigen stimulation mediate premature senescence of immune cells,and senescent immune cells develop a proinflammatory senescence-associated secretory phenotype that exacerbates inflammaging.Although the underlying molecular mechanisms remain to be addressed,it is well documented that senescent T cells and inflammaging might be major driving forces in immunosenescence.Potential counteractive measures will be discussed,including intervention of cellular senescence and metabolic-epigenetic axes to mitigate immunosenescence.In recent years,immunosenescence has attracted increasing attention for its role in tumor development.As a result of the limited participation of elderly patients,the impact of immunosenescence on cancer immunotherapy is unclear.Despite some surprising results from clinical trials and drugs,it is necessary to investigate the role of immunosenescence in cancer and other age-related diseases.

Integrative analysis of tumor stemness and immune microenvironment deciphers novel molecular subtypes in hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is a highly heterogeneous tumor,with dynamic equilibrium and complex interplay between its intricate tumor nature and ambient tumor immune microenvironment(TIME).1 Elegant research has indicated that cancer stem cells,a small subset of neoplastic cells confined within dedicated niches,display stem cell-like properties and interact with cells in TIME,thereby imparting an indelible impact on stemness regulation,tumor heterogeneity,and cancer cell plasticity.2 Previous taxonomies solely from the perspective of stemness or TIME may introduce some degree of bias in the comprehension of HCC carcinogenesis,3,4 and thus it is of paramount importance to systematically consider tumor stemness and TIME as a whole to truly portray the biological landscape of HCC.

Resident to exhausted CD4^(+)T cell ratio is associated with the prognosis of gastric cancer

Gastric cancer(GC)ranks fifth for cancer incidence and fourth for mortality globally.1 Clinical outcomes have varied among patients receiving similar treatments at the same stage,suggesting the current prognostic tools remain somewhat flawed.2,3 single-cell analysis of GC data allowed us to dissect transcriptional programs underlying lymphocyte residency and exhaustion.

Co-alteration of Myc and RTK-RAS pathways defines a liver-metastatic propensity and immune-cold subgroup of pancreatic adenocarcinoma

Co-altered pathways refer to the phenomenon where multiple biological pathways exhibit aberrant changes simultaneously within the same tumor sample.This phenomenon can facilitate a better understanding of the mechanism and evolution of tumors and serve as a biological marker for diagnosing,classifying,and treating tumors.1 However,the nature of alteration occurrence and the impact on pancreatic adenocarcinoma(PAAD)remain elusive.The SELECT algorithm was originally designed to systematically assess the evolutionary dependencies and their impact between altered genes in cancer for anticipating drug resistance and proposing alternative strategies.Here,to better characterize the etiology of PAAD and develop an improved risk assessment strategy,2 by utilizing SELECT,we identified a co-altered pathway subgroup of PAAD that demonstrated an elevated risk for unfavorable prognosis,a propensity for liver metastasis,and an immunologically cold microenvironment.

Gene expression profiles contribute to robustly predicting prognosis in hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is characterized by both inter-and intra-tumor heterogeneity and has distinct clinical outcomes.1 A promising clinical tool to perform patient stratification,prognosis evaluation,and treatment recommendations is indispensable.Here,we enrolled a total of 1595 tumor patients from 13 independent cohorts,including seven cohorts with survival data,four cohorts with immunotherapy information,and two cohorts with transcatheter arterial chemoembolization(TACE)and Sorafenib information,respectively(Table S1).Using 96 algorithms combinations derived from 10 popular machinelearning approaches,a novel framework was constructed and described in Figure S1.Firstly,a total of 26 stable consensus prognostic genes were screened in seven cohorts harboring complete survival information via univariate Cox regression analysis(Fig.S2A).

重视介入医学科普体系的建立和实践

介入医学是继内、外科之后的第三大临床学科,是我国实现《健康中国2030计划》和国家卫健委《二级以上医院建立五大医疗中心》的核心支撑技术之一,但我国大部分医护人员和社会群众对介入医学认知差。文章立足国家战略大政方针,结合介入医学的学科特点,总结本科室20余年介入医学科普的经验,首次提出"新时代介入医学科普体系",包含一个中心、两大分类、三大人群、四大领域、五大层次以及六大手段,以期进一步推动我国介入医学科普事业发展。

新型温敏性水凝胶在经导管动脉化疗栓塞中的应用进展

经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)是目前抗肿瘤治疗常用的方法,手术的成功很大程度上依赖于栓塞剂的选择。温敏性水凝胶是一种具有特殊结构、温度刺激下的溶胶-凝胶相变及良好生物相容性的新型液体栓塞剂。文章就温敏性水凝胶的特点及其作为栓塞剂在TACE治疗中的应用进展进行系统总结和论述,并浅析了目前的挑战与前景。

视频二维码扫描技术在介入医学本科生临床见习中的应用

目的评价视频二维码扫描技术在介入医学本科生临床见习中的作用。方法研究对象为2021年在我院介入科参加见习轮转的本科生32人(其中影像系18人,临床系14人),实验组(采用传统带教模式+视频二维码扫描技术)16人,对照组16人采用传统带教模式。1个月后见习生出科时,采用笔试成绩和学生满意度调查评估见习效果。结果实验组笔试成绩高于对照组[(82.2±7.8)分vs(73.9±9.1)分,P<0.05],满意度调查显示,实验组在带教方法、学习趣味性、知识拓展性、学习效率性等方面,较对照组有统计学差异(P值均<0.05)。结论视频二维码扫描技术可做为本科生介入科见习时的重要辅助带教工具。

Synergistic effects of silver nanoparticles and cisplatin in combating inflammation and hyperplasia of airway stents

Anti-inflammatory and antihyperplasia activities are essential requirements for the successful use of airway stents.In this work,silver nanoparticles(AgNPs)and cisplatin(DDP)were combined in a synergistic modification strategy to improve the surface function of airway stents.Using polycaprolactone(PCL)as a drug carrier,a dual-functional PCL-AgNPs-DDP fiber film-coated airway stent was fabricated by electrospinning.The physicochemical and biological properties of the obtained fiber films were examined.The ATR-FTIR,XPS,SEM-EDS and TEM results suggested that AgNPs and DDP could be successfully immobilized onto the airway stent surface.The drug release and surface degradation results revealed that AgNPs and DDP can undergo sustained release from films for 30 d,and the weight loss was approximately 50%after 35 d.In addition,the dual-functional fiber film suppressed human embryonic lung fibroblast growth and exhibited excellent antibacterial activity against Staphylococcus aureus,Pseudomonas aeruginosa and Candida albicans.Furthermore,the effectiveness of the dual-functional fiber film-coated airway stent was evaluated by application to the trachea of New Zealand rabbits.The in vivo results indicated that PCL-AgNPs-DDP fiber film-coated airway stent can significantly inhibit granulation tissue formation and collagen deposition,reduced the expression of IL-8,TNF-α,IL-1α,PCNA,α-SMA and CD68,and ultimately achieved anti-inflammatory and antihyperplasia effects.Hence,this study provides a dual-functional surface-coated airway stent to address the clinical complications associated with respiratory tract inflammation and granulation tissue hyperplasia,thus inhibiting tracheal stenosis.

Effect of laparoscopic angle of His reconstruction in the treatment of patients with gastroesophageal reflux disease and hiatal hernia

Gastroesophageal reflux disease(GERD)is caused by esophageal dysfunction resulting in reflux of gastric and duodenal contents into the esophagus,which leads to a series of symptoms.[1]The incidence of GERD in East Asia ranges from 2.5%to 7.8%.[2]Hiatal hernia(HH)refers to the upper part of the stomach protruding into the chest through the esophageal hiatus.HH is closely related to GERD and can play a role in the development and increased incidence of GERD.[3]The surgical treatment of patients with GERD and HH includes HH repair and Nissen,Toupet,or Dor fundoplication(DF).However,post-operative complications have been associated with fundoplication,including dysphagia and abdominal distension,which reduce the benefit of fundoplication.

Biocompatible and antibacterial soy protein isolate/quaternized chitosan composite sponges for acute upper gastrointestinal hemostasis

Innovative biomedical applications have high requirements for biomedical materials.Herein,a series of biocompatible,antibacterial and hemostatic sponges were successfully fabricated for the treatment of acute upper gastrointestinal bleeding(AUGB).Quaternized chitosan(QC)and soy protein isolate(SPI)were chemically cross-linked to obtain porous SPI/QC sponges(named SQS-n,with n¼30,40,50 or 60 corresponding to the weight percentage of the QC content).The chemical composition,physical properties and biological activity of SQS-n were investigated.SQS-n could support the adhesion and proliferation of L929 cells while triggering no obvious blood toxicity.Meanwhile,SQS-n exhibited good broad-spectrum antibacterial activity against both grampositive bacteria(Staphylococcus aureus)and gram-negative bacteria(Escherichia coli).The in vivo hemostatic effect of SQS-n was evaluated using three different bleeding models.The results revealed that SQS-50 performed best in reducing blood loss and hemostatic time.The overall hemostatic effect of SQS-50 was comparable to that of a commercial gelatin sponge.The enhanced antibacterial and hemostatic activities of SQS-n were mainly attributed to the QC component.In conclusion,this work developed a QC-functionalized hemostatic sponge that is highly desirable for innovative biomedical applications,such as AUGB.

Status of transjugular intrahepatic portosystemic shunt for portal hypertension in China:A national survey analysis

Aim:The transjugular intrahepatic portosystemic shunt(TIPS)procedure has been performed in China for 30 years,but our understanding of the status and difficulties associated with the use of TIPS for portal hypertension is incomplete.This study aims to investigate the current situation of the use of TIPS for portal hypertension,which should aid the development of TIPS in China.Methods:This study involved a questionnaire survey,initiated by the China Portal Hypertension Alliance(CHESS)to investigate the use of TIPS for portal hypertension in China.Questionnaires were released on the Internet between August 16,2022 and September 16,2022.Detailed information was collected from 545 hospitals contracted by the CHESS in China,which performed TIPS surgery in 2021.Results:The 545 hospitals covers the majority of hospitals in China that conduct TIPS intervention.In the survey,a total of 13,527 TIPS interventions were carried out with 94.1%(498/545)of them had a system of routine follow‐up after TIPS.The majority(42.6%[232/545])believed that the main indication of TIPS was the control of acute bleeding.Overall,48.1%(262/545)carried out early or pre‐emptive TIPS,53.0%(289/545)carried out TIPS for cavernous transformation of the portal vein,and 81.0%(441/545)chose routine embolization of collateral circulation during operation.Most used coils(97.0%[475/490])and biological glue(72.0%[353/490])as embolic materials,and 78.5%(428/545)routinely performed intraoperative portal pressure gradient measurements.When selecting TIPS stents,57.1%(311/545)chose viator‐specific stents,and 57.2%(312/545)chose conventional anticoagulation after TIPS.Conventional anticoagulation after TIPS is over a time interval of 3–6 months(55.4%[173/312]).The limitation of TIPS surgery is mainly its cost(72.3%[394/545])and insufficient understanding of the procedure by doctors in other related departments(77.4%[422/545]).Most of the hospital teams accept the use of domestic instruments in TIPS surgery(92.7%[505/545]).Conclusions:This survey shows that TIPS is an essential part of the treatment of portal hypertension in China.TIPS is widely used in Chinese patients with portal hypertension,and this survey presents a more comprehensive picture of the options and difficulties encountered in the implementation of TIPS.In the future,it is necessary to promote TIPS technology and further standardize surgical indications,routine operations,and instrument application.

Multi-stage mechanisms of tumor metastasis and therapeutic strategies

The cascade of metastasis in tumor cells,exhibiting organ-specific tendencies,may occur at numerous phases of the disease and progress under intense evolutionary pressures.Organ-specific metastasis relies on the formation of pre-metastatic niche(PMN),with diverse cell types and complex cell interactions contributing to this concept,adding a new dimension to the traditional metastasis cascade.Prior to metastatic dissemination,as orchestrators of PMN formation,primary tumor-derived extracellular vesicles prepare a fertile microenvironment for the settlement and colonization of circulating tumor cells at distant secondary sites,significantly impacting cancer progression and outcomes.Obviously,solely intervening in cancer metastatic sites passively after macrometastasis is often insufficient.Early prediction of metastasis and holistic,macro-level control represent the future directions in cancer therapy.This review emphasizes the dynamic and intricate systematic alterations that occur as cancer progresses,illustrates the immunological landscape of organ-specific PMN creation,and deepens understanding of treatment modalities pertinent to metastasis,thereby identifying some prognostic and predictive biomarkers favorable to early predict the occurrence of metastasis and design appropriate treatment combinations.