The Accuracy and Reliability of Automated Oscillometric Measurement of Ankle-Brachial Index in the Diagnosis of Peripheral Artery Disease.

BACKGROUND: Comparing the accuracy and reliability of ankle-brachial index (ABI) measured by an oscillometric device with the Doppler method in peripheral arterial disease (PAD). METHODS: 122 patients admitted to the department of interventional radiology with PAD were studied. ABI was measured with the 2 methods in random order. After excluding the inconclusive results, Doppler ABIs were compared with the oscillometric ABIs in each limb, the reliability was evaluated by intraclass correlation coefficient (ICC), and the accuracy and consistency were assessed by receiver operating characteristic curves and Bland-Altman method. RESULTS: In 122 patients (244 legs), 27 legs got inconclusive oscillometric results, 4 legs got inconclusive oscillometric and inconclusive dorsalis pedis artery Doppler results, 2 legs had oscillometric cuff pressure intolerance. Using Doppler ABI <0.9 as a diagnostic threshold, compared with the high Doppler ABI, oscillometric method had a sensitivity of 57.81%, a specificity of 95.18%, the ICC was 0.626 (95% confidence interval [CI]: 0.536-0.701), Bland-Altman method showed 11/211 (5.21%) difference points outside the 95% limits of agreement. Compared with the low Doppler ABI, oscillometric method had a sensitivity of 50.66%, a specificity of 98.31%, the ICC was 0.541(95% CI: 0.483-0.630), Bland-Altman method showed 11/211 (5.21%) difference points outside the 95% limits of agreement. Using 1.00 as the diagnostic threshold and considering error oscillometric results as abnormal ABIs, the sensitivity improved to 88.05% with high Doppler ABI and 81.42% with the low. CONCLUSIONS: The accuracy and reliability of oscillometric ABI in patients with PAD is unsatisfied, which makes it not suitable as an alternative method in clinic disease assessment. Using 1.0 as the ABI oscillometric threshold for PAD diagnosis can improve the diagnostic value.

How to create a nervous system aneurysm model in canines? ligation of the lingual artery is a simple and effective method.

Background: The purpose of this research was to establish a safe, effective, and simple nervous system aneurysm model. This method could quickly and stably establish an exact canine tongue aneurysm model. This paper summarizes the technique and key points of the method. Methods: Under the condition of anesthesia by inhaling isoflurane with a mask, we punctured the femoral artery of the canine, and the tip of the catheter was placed in the common carotid artery for intracranial arteriography. The positions of the lingual artery, external carotid artery, and internal carotid artery were identified. Then, the skin near the mandible was cut according to the positioning and separated layer by layer until the bifurcation of the lingual artery and external carotid artery was exposed. The lingual artery were then sutured with 2-0 silk sutures approximately 3 mm from the external carotid/lingual artery bifurcation. The final angiographic review showed that the aneurysm model was successfully established. Results: The lingual artery aneurysm was successfully established in all 8 canines. All canines obtained a stable model of nervous system aneurysm and confirmed by DSA angiography. Conclusion: We have established a safe, effective, stable and simple method to establish a canine nervous system aneurysm model with controllable size. In addition, this method has the advantages of no arteriotomy, less trauma, constant anatomical location, and low risk of stroke.

Identification microenvironment immune features and key genes in elderly stroke patients.

BACKGROUND: The purpose of this study was to identify the signaling pathways and immune microenvironments related to elderly stroke patients. METHODS: We downloaded the public transcriptome data (GSE37587) from the gene expression omnibus and divided the patients into young and old groups and identified differentially expressed genes (DEGs). Gene ontology function analysis, Kyoto encyclopedia of genes and genomes pathway analysis, and gene set enrichment analysis (GSEA) were performed. A protein-protein interaction network was constructed and hub genes were identified. Gene-miRNA, gene-TF, and gene-drug networks were constructed using the network analyst database. The immune infiltration score was evaluated using single-sample gene set enrichment analysis GSEA, its correlation with age was computed and visualized using R software. RESULTS: We identified 240 DEGs, including 222 upregulated and 18 downregulated DEGs. Gene ontology enrichment was significantly enriched in response to the virus, type I interferon signaling pathway, cytological component, focal adhesion, cell-substrate adherents junction, and the cytosolic ribosome. GSEA identified the following mechanisms: heme metabolism, interferon gamma response, and interferon alpha response. Ten hub genes included interferon alpha-inducible protein 27, human leucocyte antigen-G, interferon-induced protein with tetratricopeptide repeats 2, 2'-5'-oligoadenylate synthetase 2, interferon alpha-inducible protein 6, interferon alpha-inducible protein 44-like, interferon-induced protein with tetratricopeptide repeats 3, interferon regulatory factor 5, myxovirus resistant 1, and interferon-induced protein with tetratricopeptide repeats 1. Quantitative analysis of immune infiltration showed that increased age was significantly positively correlated with myeloid-derived suppressor cells and natural killer T cells, and negatively correlated with immature dendritic cells. CONCLUSION: The present research could help us better understand the molecular mechanisms and immune microenvironment of elderly patients with stroke.

Rheolytic thrombectomy using an AngioJet ZelanteDVT catheter or a Solent Omni catheter for patients with proximal vein thrombosis.

PURPOSE: The present study aimed to investigate the preliminary safety and efficacy of rheolytic thrombectomy (RT) using an AngioJet Zelante DVT catheter or a Solent Omni catheter for acute proximal deep vein thrombosis (DVT). MATERIAL AND METHODS: We conducted a retrospective review of 40 patients who were treated with an AngioJet RT between January 2019 and January 2021, and then the patients were divided into the ZelanteDVT group (n = 17) and the Solent group (n = 23). Data on demographics, clinical characteristics, technical success, clinical success, complications, and early follow-up were analysed. RESULTS: No significant differences regarding demographics were detected (all p > .05). The technical success rates were both 100%. The ZelanteDVT group had a shorter duration of RT and a higher primary RT success than the Solent group (all p < .05), and the percentage of adjunctive catheter-directed thrombolysis (CDT) was 29.4% in the ZelanteDVT group, which was significantly lower than the 73.9% in the Solent group (p = .010). The clinical success rates for the ZelanteDVT group and Solent group were 100% (17/17) and 95.7% (22/23), respectively, and these values were high in the two groups (p > .05). Apart from transient macroscopic haemoglobinuria occurring in all the patients during the first 24 hours post-RT, none of the patients in either group suffered other procedure-related adverse events or major complications. Minor complications included bleeding events in 21.7% (5/23) of the patients in the Solent group and one (5.9%) patient in the ZelanteDVT group (p > .05). At 6 months, the frequency of PTS was 5.9% (1/17) in the ZelanteDVT group and 17.4% (4/23) in the Solent group (p > .05). CONCLUSION: Both catheters are safe and effective in managing patients with proximal DVT, thus leading to improved clinical outcomes with few complications. The ZelanteDVT catheter was more effective than the Solent catheter in thrombectomy, thus allowing for faster extraction of the DVT with a shorter run time and lower proportions of patients with adjunctive CDT.

AngioJet rheolytic thrombectomy for the treatment of deep vein thrombosis in elderly patients: Increase the risk of acute kidney injury?

Objective: The objective of this study was to investigate the risk of acute kidney injury in elderly patients compared with nonelderly patients undergoing AngioJet rheolytic thrombectomy for treatment of acute deep vein thrombosis. Methods: A retrospective review of all patients who underwent AngioJet rheolytic thrombectomy for the treatment of acute deep vein thrombosis between November 1, 2014 and August 1, 2022 was conducted. Their baseline demographics, comorbidities, clinical characteristics, procedural details, and postoperative course were reviewed. Results: A total of 105 eligible patients were reviewed; 45 patients were in the elderly group, and 60 were in the nonelderly group. Except for age (p < 0.001), no significant differences regarding demographics were detected (p >0.05). Transient macroscopic hemoglobinuria occurred in all patients during the first 24 h post-AngioJet rheolytic thrombectomy. The overall morbidity of acute kidney injury in the two groups was 11.4%, and the nonelderly group had a similar rate of acute kidney injury (8.3%) to the elderly group (15.6%). None of the 12 patients progressed to dialysis within the postoperative period, and the mean acute kidney injury recovery time of the elderly group was 5.86 ± 1.57 days, which was longer than the 3.60 ± .89 days of the nonelderly group (p = 0.017). Conclusion: The use of AngioJet rheolytic thrombectomy for the treatment of patients with acute deep vein thrombosis is associated with a potential risk of acute kidney injury, which seems to have a comparable rate in elderly and nonelderly patients. acute kidney injury in the elderly group tends to need a longer recovery time, which requires postoperative vigilance for this population.

Angiojet pharmacomechanical thrombectomy versus anticoagulant therapy alone in massive cancer-associated thrombosis: a single centre retrospective cohort study.

The therapeutic regimen option for the cancer-associated thrombosis (CAT) patients is still a major clinical challenge. The present study aimed to investigate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) with AngioJet treatment compared with the conventional anticoagulation alone therapy in the patients with CAT. We retrospectively reviewed the patients who underwent PCDT and/or anticoagulation for the treatment of CAT between August 1, 2016 and March 1, 2022. Each patient was divided into the PCDT group or the anticoagulation alone group. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were reviewed. A total of 51 eligible patients were included, of whom 21 were in PCDT group (mean age, 60.1 ± 13.0 years; 52.4% male) and 30 in anticoagulation alone group (mean age, 66.6 ± 11.1 years; 50.0% male). No significant differences regarding age, sex, onset time, limb characteristics, cancer conditions or risk factors were detected (p > .05). After PCDT, grade III lysis was achieved in 8 and grade II lysis in 11 patients. Clinical success was achieved in 90.5% (19/21) patients. The symptoms of leg pain and swelling were significantly improved in both groups. Except for transient macroscopic hemoglobinuria occurring in PCDT group, none of all patients suffered from procedure-related and major complications. Minor complications such as bleeding events occurred in 23.8% (5/21) of patients in PCDT group compared with 10.0% (3/30) in anticoagulation alone group (p > .05). At the 6-month follow-up, iliofemoral patency was found an absolute risk reduction of 37.9% (70.0 vs. 32.1%) (95% CI: 1.183-4.008%; P = 0.010). The incidence of mild PTS was 5.0% (1/20) in PCDT group compared with 10.7% (3/28) in anticoagulation alone group (p > .05). The PCDT is a safe and effective modality in managing patients with CAT, leading to improved clinical outcomes with a low complication. The PCDT was more effective than anticoagulation alone in massive symptom relief and venous patency.

AngioJet Rheolytic Thrombectomy to Treat Inferior Vena Cava Filter-Related Thrombosis: Efficacy and Safety Compared With Large-Lumen Catheter Suction.

Objective: To compare the efficacy and safety of AngioJet rheolytic thrombectomy (ART) and large-lumen catheter suction (LCS) in the treatment of inferior vena cava (IVC) filter related IVC-iliac vein thrombosis. Methods: The clinical data and medical imaging materials of 65 cases were collected, which suffered acute inferior vena cava filter related IVC-iliac vein thrombosis and received percutaneous mechanic thrombectomy (PMT) from June 2016 to June 2020 in our center, including 32 cases of LCS group and 33 cases of ART group. The final thrombolysis rate, the incidence of complications, and the follow-up are evaluated. Results: The limb swelling was significantly relieved in patients with PMT after treatment. The peri-diameter difference of the limb in the LCS group before and after treatment was [(5.20 ± 2.03) vs. (2.17 ± 1.29) cm, P < 0.05], and that in the ART group before and after treatment was [(4.79 ± 2.23) vs. (1.74 ± 0.94) cm, P < 0.05]. The amount of postoperative recombinant tissue-type plasminogen activator (rt-PA) is reduced in ART group [(57.97 ± 21.25) in LCS group vs. (40.45 ± 20.89) mg in ART group, P < 0.05], and the thrombolysis rate was higher than that of the LCS group [(74.13 ± 19.74% in LCS group) vs. (84.58 ± 11.90% in ART group %), P < 0.05]. No serious complications occurred during the treatment. Conclusion: Both LCS group and ART group have good thrombosis clearance effects on the inferior vena cava filter related IVC-iliac vein thrombosis. ART can reduce the rt-PA dose, increase the thrombolysis rate and reduce the risk of bleeding during thrombolysis.

Outcomes of Fluoroscopy-Guided Percutaneous High Ligation of the Great Saphenous Vein Combined With Foam Sclerotherapy for Symptomatic Great Saphenous Veins.

PURPOSE: To evaluate the effectiveness and safety of fluoroscopy-guided percutaneous high ligation (FPHL) combined with fluoroscopy-guided foam sclerotherapy (FGFS) to treat varicose veins of the great saphenous veins (GSVs). MATERIALS AND METHODS: This was a retrospective study of 113 patients (mean age, 62.1 ± 10.8 years; 60 men) with varicose veins of the GSVs (133 limbs) that were treated with FPHL combined with FGFS between April 1 and October 31, 2019. Demographic and clinical data were collected from these patients before the FPHL procedure, after which FGFS was performed. The preterminal GSV was ligated percutaneously by a percutaneously-positioned polypropylene ligature under fluoroscopic guidance. The outcome of ligation was confirmed by venography. Then, foam sclerotherapy was performed under fluoroscopy. At 1-year follow-up, GSV occlusion was evaluated by ultrasound. The venous clinical severity scores (VCSSs) were compared between the preoperative and 1-year follow-up periods. RESULTS: The technical success rate was 100% (133 limbs). Complete 12-month follow-up was available for 112 limbs (84.2%) and 103 of these limbs (92.0%) remained occluded during this period. The VCSS improved from 4.71 ± 2.15 to 0.74 ± 0.60 (V = 6328, P < .001). During follow-up, there were 16 limbs with thrombophlebitis and 38 limbs with saphenous junction pain; these events were alleviated within 2 weeks of the procedure. There was no deep venous thrombosis or other severe adverse events. CONCLUSIONS: FPHL combined with FGFS to treat varicose veins in the GSVs achieved an occlusion rate of 92% and improved the clinical symptoms within 1 year; this minimally-invasive procedure was safe and effective.

How to Establish a Minimal Invasive and Stable Carotid Artery Stenosis Rabbit Model? A Simple and Effective Carotid Artery Balloon Strain Technique.

Background: The objective of this study is to establish a minimally invasive technique to create a stable carotid artery stenosis rabbit model. This article summarizes the specific methods and key points of this technology. Methods: The experiment studied a rabbit that was anesthetized through the vein. After the femoral artery was exposed, a minimally invasive needle was used to puncture the femoral artery, then the sheath was placed into the artery. We primarily put a catheter in the ascending aorta for angiography and then used a PT2 guidewire for super-selection. The PT2 guidewire was retained, and a balloon was placed in the right common carotid artery (CCA) through a guidewire to inflate it three times. Six rabbits in the 2- (2W) and 4-week (4W) groups were examined at 14 and 28 days, respectively. The rabbits in the control group received angiography at the beginning and 28 days later but without balloon injury. After angiography assessment, specimens of right CCA were dissected. Pathological and immunohistochemical examinations were performed on the collected specimens, and iFlow analysis was performed as well. Results: All the 18 animals which survived were observed. The rabbits in the 2W and 4W groups showed stenosis of the right CCA. Digital subtraction angiography showed the diameter was lower than that in the control group (1.04 ± 0.1, 0.71 ± 0.12, and 1.83 ± 0.08 mm in 2W, 4W, and control group, P < 0.05). Pathology also suggested carotid stenosis and obvious intimal hyperplasia. The results of immunohistochemistry showed that α-smooth muscle actin was highly expressed in the 2W and 4W groups, and the integrated optical density (IOD) value was higher than that in the control group (14,807.11 ± 1,822.3, 22,245.96 ± 1,212.82, and 6,537.16 ± 1,186.62 in the 2W, 4W, and control group, P < 0.05). Meanwhile, a cluster of differentiation 31 (CD31) was low expressed in the 2W and 4W groups, and the IOD value was lower than that in the control group (519.14 ± 44.4, 1,029.64 ± 98.48, and 1,502.05 ± 88.79 in the 2W, 4W, and control group, P < 0.05), which suggested endothelial damage and partial repair. The analysis by iFlow showed that the time-to-peak after balloon strain in the 2W and 4W groups were longer than that in the control group. Conclusion: We established a minimally invasive, effective, and safe method to establish a carotid artery stenosis rabbit model. The highlights of this technology were the application of minimally invasive methods, reducing surgical bleeding, infection, and related complications. This technology avoided the influence of tissue around CCA in the traditional carotid artery balloon injury model, which might lead to more accurate treatment outcomes.

Disability assessment in stroke: Relationship among the pictorial-based Longshi Scale, the Barthel Index, and the modified Rankin Scale.

OBJECTIVE: To explore the correlations among the Longshi Scale, the Barthel Index, and the modified Rankin Scale and the differentiate ability of the Longshi Scale and the modified Rankin Scale to Barthel Index scores. DESIGN: Prospective study. SETTING: The inpatient rehabilitation units of three teaching hospitals in China. SUBJECTS: A total of 343 stroke inpatients were recruited through convenience sampling. MAIN MEASURES: Pictorial-based Longshi Scale, Barthel Index, and modified Rankin Scale. RESULTS: The Longshi Scale was highly and moderately correlated with the Barthel Index and modified Rankin Scale, respectively. The median frequency distribution of the Barthel Index was slightly overlapped between Longshi Scale grades 2 and 3 but was considerably overlapped among modified Rankin Scale grades 1, 2, and 3. The Kruskal-Wallis and multiple comparison tests showed that, among the modified Rankin Scale grades, the median Barthel Index scores did not differentiate between grades 1 and 2 (χ2 = 20.643, P = 1.000), between grades 1 and 3 (χ2 = 60.404, P = 0.070), and between grades 2 and 3 (χ2 = 39.760, P = 0.232). Among the Longshi Scale grades, the median Barthel Index scores did not differentiate between grades 2 and 3 (χ2 = 48.778, P = 1.000), between grades 3 and 4 (χ2 = 57.094, P = 1.000), and between grades 5 and 6 (χ2 = 24.709, P = 1.000). CONCLUSION: Using the Barthel Index as reference, the proposed Longshi Scale has better ability than the modified Rankin Scale in differentiating stroke patients' disability, especially for those with higher level of activities of daily living.

User testing of the psychometric properties of pictorial-based disability assessment Longshi Scale by healthcare professionals and non-professionals: a Chinese study in Shenzhen.

OBJECTIVE: The aim of this study was to validate a novel pictorial-based Longshi Scale for evaluating a patient's disability by healthcare professionals and non-professionals. DESIGN: Prospective study. SETTING: Rehabilitation departments from a grade A, class 3 public hospital, a grade B, class 2 public hospital, and a private hospital and seven community rehabilitation centers. SUBJECTS: A total of 618 patients and 251 patients with functional disabilities were recruited in a two-phase study, respectively. MAIN MEASURES: Outcome measure: pictorial scale of activities of daily living (ADLs, Longshi Scale). Reference measure: Barthel Index. The Spearman correlation coefficient was used to analyze the validity of Longshi Scale against Barthel Index. RESULTS: In phase 1 study, from March 2016 to August 2016, the results demonstrated that the Longshi Scale was both reliable and valid (intraclass correlation coefficient based on two-way random effect (ICC2,1) = 0.877-0.974 for intra-rater reliability; ICC2,1 = 0.928-0.979; κ = 0.679-1.000 for inter-rater reliability; intraclass correlation coefficient based on one-way random effect (ICC1,1) = 0.921-0.984 for test-retest reliability and Spearman correlation coefficient = 0.836-0.899). In the second phase, in March 2018, results further demonstrated that the Longshi Scale had good inter-rater and intra-rater reliability among healthcare professionals and non-professionals including therapists, interns, and personal care aids (ICC1,1 = 0.822-0.882 on Day 1; ICC1,1 = 0.842-0.899 on Day 7 for inter-rater reliability). In addition, the Longshi Scale decreased assessment time significantly, compared with the Barthel Index assessment (P < 0.01). CONCLUSION: The Longshi Scale could potentially provide an efficient way for healthcare professionals and non-professionals who may have minimal training to assess the ADLs of functionally disabled patients.