BACKGROUND Studies have shown that covered self-expandable metallic stents(CSEMS)with a low axial forces after placement can cause early recurrent biliary obstruction(RBO)due to precipitating sludge formation.AIM To a...BACKGROUND Studies have shown that covered self-expandable metallic stents(CSEMS)with a low axial forces after placement can cause early recurrent biliary obstruction(RBO)due to precipitating sludge formation.AIM To ascertain whether the angle of CSEMS after placement is a risk factor for RBO in unresectable distal malignant biliary obstruction(MBO).METHODS Between January 2010 and March 2019,261 consecutive patients underwent selfexpandable metallic stent insertion by endoscopic retrograde cholangiopancreatography at our facility,and 87 patients were included in this study.We evaluated the risk factors for RBO,including the angle of CSEMS after placement as the primary outcome.We measured the obtuse angle of CSEMS after placement on an abdominal radiograph using the SYNAPSE PACS system.We also evaluated technical and functional success,adverse events,time to RBO(TRBO),non-RBO rate,survival time,cause of RBO,and reintervention procedure as secondary outcomes.RESULTS We divided the patients into two cohorts based on the presence or absence of RBO.The angle of CSEMS after placement(per 1°and per 10°)was evaluated using the multivariate Cox proportional hazard analysis,which was an independent risk factor for RBO in unresectable distal MBO[hazard ratio,0.97 and 0.71;95%confidence interval(CI):0.94-0.99 and 0.54-0.92;P=0.01 and 0.01,respectively].For early diagnosis of RBO,the cut-off value of the angle of CSEMS after placement using the receiver operating characteristic curve was 130°[sensitivity,50.0%;specificity 85.5%;area under the curve 0.70(95%CI:0.57-0.84)].TRBO in the<130°angle group was significantly shorter than that in the≥130°angle group(P<0.01).CONCLUSION This study suggests that the angle of the CSEMS after placement for unresectable distal MBO is a risk factor for RBO.These novel results provide pertinent information for future stent management.展开更多
The mechanisms of systolic anterior motion(SAM)of the mitral valve in hypertrophic obstructive cardiomyopathy(HOCM)remain unclear.To investigate the angle of attack between blood flow and mitral valve leaflets at pre-...The mechanisms of systolic anterior motion(SAM)of the mitral valve in hypertrophic obstructive cardiomyopathy(HOCM)remain unclear.To investigate the angle of attack between blood flow and mitral valve leaflets at pre-SAM time point,patient-specific CT-based computational models were constructed for 5 patients receiving septal myectomy surgery to obtain pre-and post-operative 2D vector flow mapping.The comparisons between pre-and post-operative angles of attack based on 2D vector flow mapping of 5 patients were performed.It was found that there was no statistically significant difference between pre-and post-operative angles of attack(61.1±t wa o vs.56.2±56.o,p=0.306,n=5).Therefore,we propose that the angle of attack might not play an important role in the initiation of SAM.展开更多
目的:研究流量-容积(flow-volume,F-V)曲线下降支夹角在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者临床表型及病情严重度评估中的临床价值。方法:选取2021年12月—2022年12月在南京医科大学第一附属医院进行肺...目的:研究流量-容积(flow-volume,F-V)曲线下降支夹角在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者临床表型及病情严重度评估中的临床价值。方法:选取2021年12月—2022年12月在南京医科大学第一附属医院进行肺功能检查的患者共101例,其中,存在F-V曲线下降支夹角的稳定期COPD患者(夹角组)33例,与夹角组第1秒用力呼气容积占预计值百分比(forced expiratory volume in the first second as a percentage of predicted value,FEV1%pred)匹配的无下降支夹角的稳定期COPD患者(无夹角组)38例,既往无心肺疾病,且肺功能检测正常的受试者(对照组)30例。收集并比较各组患者基本资料、临床症状评分[COPD自我评估测试(COPD assessment test,CAT)、改良版英国医学研究委员会呼吸困难问卷(modified medical research council dyspnoea scale,mMRC)]、肺功能参数和运动后指脉氧参数。采用多因素Logistic回归分析F-V曲线下降支夹角的相关因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析F-V曲线下降支夹角对COPD随访1年内急性加重的预测价值。结果:夹角组肺功能受损程度严重,第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)和用力肺活量(forced vital capacity,FVC)分别为0.91±0.24、2.11±0.63;夹角组CAT评分、mMRC评分、ΔSpO_(2)高于无夹角组及对照组,步行运动后SpO_(2)L低于无夹角组及对照组,差异有统计学意义(P<0.05);夹角组CAT评分≥12分、m MRC评分≥2分、ΔSpO_(2)≥13%是F-V曲线下降支更易出现夹角的主要相关因素;F-V曲线下降支夹角预测重度稳定期COPD急性加重的曲线下面积为0.777,当角度<129.1°时其预测灵敏度、特异度均为最佳,分别为72.73%、67.35%。结论:F-V曲线呈现下降支夹角的COPD患者其肺功能常严重受损,且更易发生活动后低氧血症和急性加重。因此,COPD肺功能报告中应关注F-V曲线下降支是否存在夹角,以便尽早识别COPD高危人群。展开更多
Patients with chronic obstructive pulmonary disease(COPD)have an increased risk for cardiovascular events,and electrocardiography has an important role in detecting cardiac side effects of COPD-related hypoxia.
目的:不同相位角水平对老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者预后的评估价值。方法:回顾性分析2020年6月至2022年3月苏州大学附属第二医院收治的210例老年COPD患者临床资料,对所有患者进行出院后3个...目的:不同相位角水平对老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者预后的评估价值。方法:回顾性分析2020年6月至2022年3月苏州大学附属第二医院收治的210例老年COPD患者临床资料,对所有患者进行出院后3个月随访。将135例低相位角水平患者纳入低相位角组,将75例正常相位角水平患者纳入正常相位角组,并将患者出现急性加重症状、全因死亡作为2个终点事件,对不同相位角水平评估老年COPD患者预后情况的价值进行单因素、多因素回归分析。结果:正常相位角组年龄、体重指数、吸烟比例、入住重症监护病房(intensive care unit,ICU)比例、改良英国医学研究学会呼吸困难指数(modified British Medical Research Council,mMRC)量表评分、过去3个月COPD急性加重次数、慢性阻塞性肺疾病全球倡议(Global Initiative for Chronic Obstructive Lung Disease,GOLD)分级、病情等级、第1秒用力呼气量(forced expiratory volume in one second,FEV1)、动脉血二氧化碳分压(partial arterial pressure of carbon dioxide,PaCO_(2))、动脉血氧分压与吸入氧浓度的比值(ratio of the partial arterial pressure of oxygen to the fraction of inspired oxygen,PaO_(2)/FiO_(2))、相位角水平与低相位角组比较,差异均有统计学意义(均P<0.05)。随访3个月,COPD急性加重症状者139例,死亡25例。将随访3个月内出现急性加重症状作为终点事件,经log-rank法分析,低相位角组出现COPD急性加重症状的时间短于正常相位角组(P<0.05)。将随访3个月内全因死亡作为终点事件,经log-rank法分析,低相位角组生存率低于正常相位角组(P<0.05)。单因素分析与多因素Cox回归分析显示:年龄、mMRC评分、病情等级、过去3个月COPD急性加重次数、低相位角水平均是老年COPD患者随访3个月内出现急性加重的危险因素(均P<0.05)。单因素分析与多因素Cox回归分析显示:mMRC评分、病情等级、低相位角水平均是老年COPD患者随访3个月内全因死亡的危险因素(均P<0.05)。结论:低相位角水平是老年COPD患者随访3个月内发生疾病急性加重及死亡的独立危险因素,其对于患者预后的预测具有一定价值。展开更多
文摘BACKGROUND Studies have shown that covered self-expandable metallic stents(CSEMS)with a low axial forces after placement can cause early recurrent biliary obstruction(RBO)due to precipitating sludge formation.AIM To ascertain whether the angle of CSEMS after placement is a risk factor for RBO in unresectable distal malignant biliary obstruction(MBO).METHODS Between January 2010 and March 2019,261 consecutive patients underwent selfexpandable metallic stent insertion by endoscopic retrograde cholangiopancreatography at our facility,and 87 patients were included in this study.We evaluated the risk factors for RBO,including the angle of CSEMS after placement as the primary outcome.We measured the obtuse angle of CSEMS after placement on an abdominal radiograph using the SYNAPSE PACS system.We also evaluated technical and functional success,adverse events,time to RBO(TRBO),non-RBO rate,survival time,cause of RBO,and reintervention procedure as secondary outcomes.RESULTS We divided the patients into two cohorts based on the presence or absence of RBO.The angle of CSEMS after placement(per 1°and per 10°)was evaluated using the multivariate Cox proportional hazard analysis,which was an independent risk factor for RBO in unresectable distal MBO[hazard ratio,0.97 and 0.71;95%confidence interval(CI):0.94-0.99 and 0.54-0.92;P=0.01 and 0.01,respectively].For early diagnosis of RBO,the cut-off value of the angle of CSEMS after placement using the receiver operating characteristic curve was 130°[sensitivity,50.0%;specificity 85.5%;area under the curve 0.70(95%CI:0.57-0.84)].TRBO in the<130°angle group was significantly shorter than that in the≥130°angle group(P<0.01).CONCLUSION This study suggests that the angle of the CSEMS after placement for unresectable distal MBO is a risk factor for RBO.These novel results provide pertinent information for future stent management.
基金The authors would like to acknowledge the research support from Natural Science Foundation of Fujian Province of China(Grant No.2017J01009)Fundamental Research Funds for the Central Universities(Grant No.20720180004)National Heart,Lung and Blood Institute grants R01 HL089269,and National Sciences Foundation of China(Grant No.11672001,81571691).
文摘The mechanisms of systolic anterior motion(SAM)of the mitral valve in hypertrophic obstructive cardiomyopathy(HOCM)remain unclear.To investigate the angle of attack between blood flow and mitral valve leaflets at pre-SAM time point,patient-specific CT-based computational models were constructed for 5 patients receiving septal myectomy surgery to obtain pre-and post-operative 2D vector flow mapping.The comparisons between pre-and post-operative angles of attack based on 2D vector flow mapping of 5 patients were performed.It was found that there was no statistically significant difference between pre-and post-operative angles of attack(61.1±t wa o vs.56.2±56.o,p=0.306,n=5).Therefore,we propose that the angle of attack might not play an important role in the initiation of SAM.
文摘目的:研究流量-容积(flow-volume,F-V)曲线下降支夹角在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者临床表型及病情严重度评估中的临床价值。方法:选取2021年12月—2022年12月在南京医科大学第一附属医院进行肺功能检查的患者共101例,其中,存在F-V曲线下降支夹角的稳定期COPD患者(夹角组)33例,与夹角组第1秒用力呼气容积占预计值百分比(forced expiratory volume in the first second as a percentage of predicted value,FEV1%pred)匹配的无下降支夹角的稳定期COPD患者(无夹角组)38例,既往无心肺疾病,且肺功能检测正常的受试者(对照组)30例。收集并比较各组患者基本资料、临床症状评分[COPD自我评估测试(COPD assessment test,CAT)、改良版英国医学研究委员会呼吸困难问卷(modified medical research council dyspnoea scale,mMRC)]、肺功能参数和运动后指脉氧参数。采用多因素Logistic回归分析F-V曲线下降支夹角的相关因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析F-V曲线下降支夹角对COPD随访1年内急性加重的预测价值。结果:夹角组肺功能受损程度严重,第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)和用力肺活量(forced vital capacity,FVC)分别为0.91±0.24、2.11±0.63;夹角组CAT评分、mMRC评分、ΔSpO_(2)高于无夹角组及对照组,步行运动后SpO_(2)L低于无夹角组及对照组,差异有统计学意义(P<0.05);夹角组CAT评分≥12分、m MRC评分≥2分、ΔSpO_(2)≥13%是F-V曲线下降支更易出现夹角的主要相关因素;F-V曲线下降支夹角预测重度稳定期COPD急性加重的曲线下面积为0.777,当角度<129.1°时其预测灵敏度、特异度均为最佳,分别为72.73%、67.35%。结论:F-V曲线呈现下降支夹角的COPD患者其肺功能常严重受损,且更易发生活动后低氧血症和急性加重。因此,COPD肺功能报告中应关注F-V曲线下降支是否存在夹角,以便尽早识别COPD高危人群。
文摘Patients with chronic obstructive pulmonary disease(COPD)have an increased risk for cardiovascular events,and electrocardiography has an important role in detecting cardiac side effects of COPD-related hypoxia.
文摘目的:不同相位角水平对老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者预后的评估价值。方法:回顾性分析2020年6月至2022年3月苏州大学附属第二医院收治的210例老年COPD患者临床资料,对所有患者进行出院后3个月随访。将135例低相位角水平患者纳入低相位角组,将75例正常相位角水平患者纳入正常相位角组,并将患者出现急性加重症状、全因死亡作为2个终点事件,对不同相位角水平评估老年COPD患者预后情况的价值进行单因素、多因素回归分析。结果:正常相位角组年龄、体重指数、吸烟比例、入住重症监护病房(intensive care unit,ICU)比例、改良英国医学研究学会呼吸困难指数(modified British Medical Research Council,mMRC)量表评分、过去3个月COPD急性加重次数、慢性阻塞性肺疾病全球倡议(Global Initiative for Chronic Obstructive Lung Disease,GOLD)分级、病情等级、第1秒用力呼气量(forced expiratory volume in one second,FEV1)、动脉血二氧化碳分压(partial arterial pressure of carbon dioxide,PaCO_(2))、动脉血氧分压与吸入氧浓度的比值(ratio of the partial arterial pressure of oxygen to the fraction of inspired oxygen,PaO_(2)/FiO_(2))、相位角水平与低相位角组比较,差异均有统计学意义(均P<0.05)。随访3个月,COPD急性加重症状者139例,死亡25例。将随访3个月内出现急性加重症状作为终点事件,经log-rank法分析,低相位角组出现COPD急性加重症状的时间短于正常相位角组(P<0.05)。将随访3个月内全因死亡作为终点事件,经log-rank法分析,低相位角组生存率低于正常相位角组(P<0.05)。单因素分析与多因素Cox回归分析显示:年龄、mMRC评分、病情等级、过去3个月COPD急性加重次数、低相位角水平均是老年COPD患者随访3个月内出现急性加重的危险因素(均P<0.05)。单因素分析与多因素Cox回归分析显示:mMRC评分、病情等级、低相位角水平均是老年COPD患者随访3个月内全因死亡的危险因素(均P<0.05)。结论:低相位角水平是老年COPD患者随访3个月内发生疾病急性加重及死亡的独立危险因素,其对于患者预后的预测具有一定价值。
