Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen,China

BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

Clinical outcomes of Angio Jet pharmacomechanical thrombectomy versus catheter-directed thrombolysis for the treatment of filter-related caval thrombosis

BACKGROUND The inferior vena cava filter is utilized worldwide to intercept thrombi and to reduce the risk of fatal pulmonary embolism(PE).However,filter-related thrombosis is a complication of filter implantation.Endovascular methods such as AngioJet rheolytic thrombectomy(ART)and catheter-directed thrombolysis(CDT)can treat filter-related caval thrombosis,but the clinical outcomes of both treatment modalities have not been determined.AIM To compare the treatment outcomes of AngioJet rheolytic thrombectomy vs catheter-directed thrombolysis in patients with filter-related caval thrombosis.METHODS In this single-center retrospective study,65 patients(34 males and 31 females;mean age:59.0±13.43 years)with intrafilter and inferior vena cava thrombosis were enrolled between January 2021 and August 2022.These patients were assigned to either the AngioJet group(n=44)or the CDT group(n=21).Clinical data and imaging information were collected.Evaluation measures included thrombus clearance rate,periprocedural complications,urokinase dosage,incidence of PE,limb circumference difference,length of stay,and filter removal rate.RESULTS Technical success rates were 100%in the AngioJet and CDT groups.In the AngioJet group,grade II and grade III thrombus clearance was achieved in 26(59.09%)and 14(31.82%)patients,respectively.In the CDT group,grade II and grade III thrombus clearance was accomplished in 11(52.38%)patients and 8(38.10%)patients,respectively(P>0.05).The peridiameter difference of the thigh was significantly reduced in patients from both groups after treatment(P<0.05).The median dosage of urokinase was 0.08(0.02,0.25)million U in the AngioJet group and 1.50(1.17,1.83)million U in the CDT group(P<0.05).Minor bleeding was shown in 4(19.05%)patients in the CDT group,and when it was compared with that in the AngioJet group,the difference was statistically significant(P<0.05).No major bleeding occurred.Seven(15.91%)patients in the AngioJet group had hemoglobinuria and 1(4.76%)patient in the CDT group had bacteremia.There were 8(18.18%)patients with PE in the AngioJet group and 4(19.05%)patients in the CDT group before the intervention(P>0.05).Computed tomography angiopulmonography(CTA)showed that PE was resolved after the intervention.New PE occurred in 4(9.09%)patients in the AngioJet group and in 2(9.52%)patients in the CDT group after theintervention(P>0.05).These cases of PE were asymptomatic.The mean length of stay was longer in the CDT group(11.67±5.34 d)than in the AngioJet group(10.64±3.52 d)(P<0.05).The filter was successfully retrieved in the first phase in 10(47.62%)patients in the CDT group and in 15(34.09%)patients in the AngioJet group(P>0.05).Cumulative removal was accomplished in 17(80.95%)out of 21 patients in the CDT group and in 42(95.45%)out of 44 patients in the ART group(P>0.05).The median indwelling time for patients with successful retrieval was 16(13139)d in the CDT group and 59(12231)d in the ART group(P>0.05).CONCLUSION Compared with catheter-directed thrombolysis,AngioJet rheolytic thrombectomy can achieve similar thrombus clearance effects,improve the filter retrieval rate,reduce the urokinase dosage and lower the risk of bleeding events in patients with filter-related caval thrombosis.

Literature review of peripheral vascular trauma:Is the era of intervention coming?

Traumatic peripheral vascular injury is a significant cause of disability and death either in civilian environments or on the battlefield.Penetrating trauma and blunt trauma are the most common forms of vascular injuries.Besides,iatrogenic arterial injury(IAI)is another pattern of vascular trauma.The management of peripheral vascular injuries has been improved in different environments and wars.There are different types of vascular injuries,such as vasospasm,contusion,intimal flaps,intimal disruption or hematoma,external compression,laceration,transection and focal wall defects,etc.The main clinical manifestations of vascular injuries are shock following massive hemorrhage and limb necrosis due to tissue and organ ischemia.Ultrasound,computed tomography angiography(CTA)and magnetic resonance angiography(MRA)are most valuable for assessment of peripheral vascular injuries.Angiography remains the gold standard for diagnosing vascular trauma.Immediate hemorrhage control and rapid restoration of blood flow are the primary goals of vascular trauma treatment.There are many operative treatment methods for vascular injuries,such as vascular suture or ligation,vascular wall repair and vascular reconstruction with blood vessel prostheses or vascular grafts.Embolization,balloon dilation and covered stent implantation are the main endovascular techniques.Surgical operation is still the primary treatment for vascular injuries.Endovascular treatment is a promising alternative,proved to be safe and effective,and preferred selection for patients.In summary,rapid diagnosis and timely surgical intervention remain the mainstays of the treatment.However,many issues need to be resolved by further studies.

Control over emissivity of zero-static-power thermal emitters based on phase-changing material GST

Controlling the emissivity of a thermal emitter has attracted growing interest,with a view toward a new generation of thermal emission devices.To date,all demonstrations have involved using sustained external electric or thermal consumption to maintain a desired emissivity.In the present study,we demonstrated control over the emissivity of a thermal emitter consisting of a film of phase-changing material Ge2Sb2Te5(GST)on top of a metal film.This thermal emitter achieves broad wavelength-selective spectral emissivity in the mid-infrared.The peak emissivity approaches the ideal blackbody maximum,and a maximum extinction ratio of 410 dB is attainable by switching the GST between the crystalline and amorphous phases.By controlling the intermediate phases,the emissivity can be continuously tuned.This switchable,tunable,wavelength-selective and thermally stable thermal emitter will pave the way toward the ultimate control of thermal emissivity in the field of fundamental science as well as for energy harvesting and thermal control applications,including thermophotovoltaics,light sources,infrared imaging and radiative coolers.

Comparison of traditional vascular reconstruction with covered stent in the treatment of subclavian artery injury

Purpose:To explore the significance of traditional vascular reconstruction and covered stent for limb salvage after subclavian artery injury.Methods:Patients with subclavian artery injury admitted to Beijing Jishuitan Hospital from January 2010 to December 2018 were retrospectively analyzed.All the injuries have been confirmed by intraoperative exploration,computed tomography angiography or digital subtraction angiography.Complete or partial amputation injuries were excluded.Mild artery defect or partial intimal damage was treated by interventional implantation,while other patients received open surgeries,including direct suture of small defect less than 2 cm and transplantation with autologous vein or artificial blood when the defect was more than 2 cm.Patients were divided into open surgery group and stent implantation group based on the treatment they received.Patients were followed up at 2 weeks(first stage)and 6 months(second stage)after operation to investigate limb salvage.Student's t-test was used to compare the general data between two groups and Chi-square test to analyze the rate of limb salvage.Results:Altogether 50 cases of subclavian artery injury were treated,including 36 cases of open surgery and 14 cases of stent implantation.Combination of nerve injury was observed in 27 cases(75.0%)in open surgery group and 12 cases(85.7%)in stent implantation group.Amputation developed in 3 cases with open surgery and 1 case with stent implantation.Consequently the rate of successful limb salvage was respectively 91.7%(33/36)and 92.9%(13/14),revealing no significant difference(p>0.05).Conclusion:Rapid reconstruction of blood circulation is crucial following subclavian artery injury,no matter what kinds of treatment strategies have been adopted.Interventional stent implantation can achieve a good effect for limb salvage.

Treatment strategy for traumatic innominate arterial injury

Purpose:To discuss and share the experience of treatment of traumatic innominate arterial injury.Methods:A retrospective analysis was performed on patients with innominate arterial injuries admitted from January 2016 to July 2018 at the department of vascular surgery,Beijing Jishuitan Hospital,China.All the arterial injuries were confirmed by arteriography.Clinical data including mechanism of injury,type of injury,demographics,concomitant injuries,time interval from trauma to blood flow reconstruction,and operation methods were collected.Follow-up program included outpatient visit and duplex-ultrasonography.SPSS version 23.0 was adopted for data analysis.Categorical variables are presented as number and/or frequency and continuous variables as mean±standard deviation.Result:Altogether 7 patients were included and 6(85.7%)were male.The mean age of patients was(29.43±7.98)years,range 19-43 years.Six patients had isolated innominate arterial injuries and the rest 1 combined innominate arterial and vein injuries.The injury causes were road accidents in 3 patients,stab wound in 2,gunshot wound in 1,and crush injury in 1.All the 7 patients presented hemorrhagic shock at admission,which was timely and effectively corrected.No perioperative death or technical complications occurred.Intimal injury(n=2)and partial transaction(n=2)of the innominate artery were treated with covered stents.Two patients with complete transection of artery received vascular reconstruction by artificial grafts.One patient with partial transaction received balloon dilation and open surgical repair(hybrid operation).The mean time interval from trauma to blood flow reconstruction was(4.27±0.18)h,range 4.0e4.5 h;while the operation time was(48.57±19.94)min,range 25e75 min.Cerebral infarction occurred in one patient with brain injury due to anticoagulation contraindication.The average follow-up was(13.29±5.65)months,range 6e24 months.No severe stenosis,occlusion,and thrombosis of covered stents or artificial vessels were found by color Doppler ultrasound.Conclusion:Urgent control of hemorrhage and restoration of blood supply are critical for the treatment of traumatic innominate arterial injury.Endovascular therapy is a feasible and effective method with short operation time and less trauma.