Meta-analysis of ultrasound-guided and traditional femoral artery puncture.

Objective: To compare the ultrasound guidance and traditional methods in femoral artery puncture. Methods: We searched the databases to evaluate the rate of success on first attempt and the incidence of hematoma. The random effects model was used for performing a meta-analysis to estimate the odds ratio (ORs), mean difference (MD), and 95% confidence interval (CI). Results: A total of nine articles including 2,361 patients were included in this meta-analysis. The rate of success on first attempt were 79.6% (1,289/1,619) and 54.1% (883/1,644) in patients of the ultrasound group and traditional method group, respectively [OR = 3.14 (95% CI = 2.30-4.28), combined OR value Z = 7.23 (P < 0.00001)]. The rates of incidence of hematoma in the ultrasound group and traditional puncture group patients were 1.4% (16/1,168) and 3.8% (45/1,193), respectively (OR = 0.41, 95% CI = 0.17-1.00, p = 0.05). Conclusion: Ultrasound-guided femoral artery puncture has certain advantages compared with traditional puncture with regard to success on first attempt and the incidence of hematoma. Moreover, ultrasound-guided puncture reduces the incidence of hematoma in the retrograde puncture group patients.

Differentiating environmental scenarios to establish geochemical baseline values for heavy metals in soil: A case study of Hainan Island, China.

Soil heavy metal distributions exhibit regional heterogeneity due to the complex characteristics of parent materials and soil formation processes, emphasizing the need for appropriate regional standards prior to assessing soil risks. This study focuses on Hainan Island and employs the Multi-purpose Regional Geochemical Survey dataset to establish heavy metal geochemical baseline and background values for soil using an iterative method. Geographical detector analysis reveals that parent materials are the primary factor influencing heavy metal distribution, followed by soil types and land use. Heavy metal geochemical baseline values are established for the island's three environments and administrative regions. Notably, a universal geochemical baseline value cannot adequately represent regional variations in heavy metal distribution, with parent materials playing a crucial role in various scenarios. Locally applicable values based on parent material are the most representative for Hainan Island. This study provides a reference framework for developing region-specific environmental baseline values for soil heavy metal assessments.

Vulnerable carotid plaque characteristics on magnetic resonance vessel wall imaging: potential predictors for hemodynamic instability during carotid artery stenting.

Background: This cross-sectional study sought to explore the possible risk factors assessed with magnetic resonance (MR) vessel wall imaging for hemodynamic instability (HI) during carotid artery stenting (CAS). Methods: Patients with carotid stenosis who were referred for CAS from January 2017 to December 2019 were recruited and underwent carotid MR vessel wall imaging. The vulnerable plaque features, including lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), fibrous cap rupture, and plaque morphology, were evaluated. The HI was defined as a drop of systolic blood pressure (SBP) of ≥30 mmHg or the lowest SBP measurement of <90 mmHg after stent implantation. The carotid plaque characteristics were compared between the HI and non-HI groups. The association between carotid plaque characteristics and HI was analyzed. Results: A total of 56 participants (mean age 68.7±8.3 years; 44 males) were recruited. Patients in the HI group (n=26, 46%) had a significantly greater wall area [median 43.2 (IQR, 34.9-50.5) vs. 35.9 (IQR, 32.3-39.4) mm2; P=0.008], total vessel area (79.7±17.2 vs. 69.9±17.3 mm2; P=0.03), prevalence of IPH (62% vs. 30%; P=0.02), prevalence of vulnerable plaque (77% vs. 43%; P=0.01), and volume of LRNC [median 344.7 (IQR, 155.1-665.7) vs. 103.1 (IQR, 53.9-162.9) mm3; P=0.001] in carotid plaque compared to those in non-HI group (n=30, 54%). Carotid LRNC volume (OR =1.005, 95% CI: 1.001-1.009; P=0.01) and presence of vulnerable plaque (OR =4.038, 95% CI: 0.955-17.070; P=0.06) were significantly and marginally associated with HI, respectively. Conclusions: Carotid plaque burden and vulnerable plaque features, particularly a larger LRNC, might be effective predictors for HI during the CAS procedure.

Assessment of neovascularization of carotid artery atherosclerotic plaques using superb microvascular imaging: a comparison with contrast-enhanced ultrasound imaging and histology.

BACKGROUND: This study aimed to investigate the usefulness of superb microvascular imaging (SMI), a novel non-contrast-enhanced ultrasound technique, in characterizing neovessels within carotid atherosclerotic plaques through comparison with contrast-enhanced ultrasound (CEUS) and histology. METHODS: Patients with carotid plaque were recruited and underwent SMI and CEUS ultrasound imaging of the carotid arteries. The maximum plaque thickness, length, and stenosis of each plaque were measured. Grade of the neovessels was determined by SMI and CEUS, respectively. Grade 0 was defined as no blood flow signal/microbubbles within plaques; grade 1 was defined as moderate blood flow signals/microbubbles confined to the shoulder and/or adventitial side of the plaque; and grade 2 was defined as extensive intraplaque signals/microbubbles. Patients with symptomatic carotid stenosis (stenosis ≥50%) or asymptomatic carotid stenosis (stenosis ≥70%) underwent endarterectomy, and plaque specimens were subjected to immunohistochemical analysis of CD31 expression. The neovessels were quantified by histology. The agreement of SMI with CEUS and histology in characterizing neovessels was analyzed using weighted Kappa statistic and Spearman's correlation analyses. RESULTS: Seventy-eight patients (mean age: 67.3±8.9 years old, 63 males) were recruited. Of these patients, 52 (66.7%) had a unilateral plaque and 26 (33.3%) had bilateral plaques in the carotid arteries. For the 104 carotid plaques detected, the mean plaque thickness and length were 4.3±1.1 and 18.8±6.6 mm, respectively. The prevalence of <50%, 50-69%, and ≥70% stenosis was 43.3%, 24.0%, and 32.7%, respectively. Excellent agreement was found between SMI and CEUS (κ=0.825 at the plaque level; κ=0.820 at the patient level) in evaluating the neovessel grade within the carotid plaques. Of the 25 patients who underwent carotid endarterectomy, a strong correlation (r=0.660, P<0.001) was found between SMI and histology in the evaluation of intraplaque neovessels. SMI had excellent scan-rescan (κ=0.857), intra-reader (κ=0.810), and inter-reader (κ=0.754) agreement in the assessment of intraplaque neovessels. CONCLUSIONS: The SMI technique is capable of reliably characterizing neovessels within carotid atherosclerotic plaques and demonstrates good to excellent agreement with histology and CEUS.

Drug-Coated Balloon Angioplasty for Carotid Artery Occlusion Caused by Takayasu Arteritis.

A 27-year-old male patient suffering from dizziness and right amaurosis was diagnosed with Takayasu arteritis (TA). Computed tomography angiography showed that all the supra-aortic arteries were occluded except an aberrant right subclavian artery. The patient underwent drug-coated balloon dilatation at the lesion of the right common carotid artery and performed well after the procedure. Six months later, the patient's symptoms have not recurred and computed tomography angiography showed the right carotid artery remains patency. The supra-aortic artery lesions in TA may be a potential novel indication for a drug-coated balloon.

Environmental and human health risks from cadmium exposure near an active lead-zinc mine and a copper smelter, China.

Cadmium (Cd) contamination from mining and smelting operations has led to growing environmental health concerns. In this study, soil, surface water, drinking water, rice, vegetables, and biomarkers (hair and urine) were collected from local residents near an active lead-zinc mine and a copper smelter. The aim was to determine how nonferrous metal mining and smelting activities have affected the health of local residents. It was found that the Cd concentrations in most soil and rice samples exceeded the national tolerance limits of China. Dietary intakes of rice and vegetables were the two major pathways of Cd exposure to local residents, accounting for >97% of the total probable daily intake. The excessive daily intake of Cd resulted in potential non-carcinogenic risks to the local residents, especially to children living around the two areas. The mean hair and urine Cd concentrations were 0.098 ± 0.10 mg kg-1 and 5.7 ± 3.1 µg L-1 in the mining area, and 0.30 ± 0.21 mg kg-1 and 5.5 ± 3.5 µg L-1 in the smelting area, respectively. A significantly positive correlation between hair Cd concentrations and the hazard quotient (HQ) for rice ingestion indicated that rice contamination had the most critical adverse effect on local residents. Due to the high levels of environmental Cd contamination, residents of the smelting area had a much higher Cd exposure than residents of the mining area. The results suggested that nonferrous mining and smelting should not coexist with agricultural activities. Effective contamination mitigation strategies and environmental remediation should be formulated and implemented to improve the health of local residents.

Comparative Effectiveness of Drug-Coated Balloon vs Balloon Angioplasty for the Treatment of Arteriovenous Fistula Stenosis: A Meta-analysis.

Purpose: To compare the effectiveness and safety outcomes of drug-coated balloon angioplasty (DCBA) vs conventional balloon angioplasty (BA) for arteriovenous fistula (AVF) stenosis. Materials and Methods: A systematic review was conducted of PubMed and Embase databases from 1966 to May 2019 to identify English-language articles evaluating DCBA vs BA for the treatment of AVF stenosis. Data extracted from each study were synthesized to evaluate target lesion revascularization (TLR), technical success, and mortality for the 2 approaches. Meta-analyses were performed on these outcomes using random effects models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed. Results: Twelve studies [6 randomized controlled trials (RCTs) and 6 cohort studies] comprising 979 patients were included in this meta-analysis. The pooled results showed that AVFs treated with DCBA had significantly fewer TLRs at 6 months (OR 0.31, 95% CI 0.14 to 0.69, p=0.004) and 12 months (OR 0.45, 95% CI 0.21 to 0.97, p=0.04) than BA. The 2 approaches had similar technical success rates (OR 0.22, 95% CI 0.03 to 1.43, p=0.11). Additionally, the pooled OR of 12-month mortality was 0.71 (95% CI 0.20 to 2.51, p=0.60), indicating no significant difference between DCBA and BA. Subgroup analysis based on study design showed the superiority of DCBA to BA in cohort studies but not RCTs, which had high heterogeneity. Significant publication bias was found in the cohort studies. Conclusion: In de novo or recurrent AVF stenosis, DCBA appears to be an effective procedure associated with lower 6- and 12-month TLR compared with BA. However, larger and randomized controlled studies are warranted to draw definitive conclusions.

Safety and Efficacy of Totally Percutaneous Access Compared With Open Femoral Exposure for Endovascular Aneurysm Repair: A Meta-analysis.

PURPOSE: To compare the safety and efficacy of percutaneous (PEVAR) vs open femoral access (OFA) techniques for endovascular aneurysm repair (EVAR). METHODS: A systematic review of English-language articles (Medline, EMBASE, and Cochrane databases) between January 1999 and August 2016 returned 11 studies including 1650 patients with 2500 groin accesses eligible for the meta-analysis. Data extracted from each study were synthesized to evaluate technical success rates, procedure time, and complications for the 2 access approaches. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The quality of individual studies was evaluated based on the Newcastle-Ottawa scale. RESULTS: The mean technical success rate in the PEVAR group was 94.5% (785/831). The overall OR was 0.38 (95% CI 0.12 to 1.18, p=0.09), indicating no significant difference between the methods. The procedure time in PEVAR was shorter than OFA (mean difference -24.52, 95% CI -46.45 to -22.60, p<0.001). Overall, the total complication rate was 15.3% in the OFA group vs 7.8% in the PEVAR group (OR 0.52, 95% CI 0.37 to 0.73, p<0.001). The meta-analysis identified significant differences between groups for all complications (p<0.001) and the following individual adverse events: wound infection (OR 0.28, 95% CI 0.10 to 0.81, p=0.02), pseudoaneurysm (OR 8.07, 95% CI 1.54 to 42.32, p=0.01), seroma (OR 0.10, 95% CI 0.02 to 0.55, p=0.008), and lymphocele or lymph leak (OR 0.19, 95% CI 0.04 to 0.92, p=0.04). CONCLUSION: PEVAR had a similar technical success rate, shorter procedure time, and lower complication rate compared with OFA. Thus, percutaneous access appears to be the preferential approach for EVAR. However, larger and randomized studies are needed to draw definitive conclusions.

[Analysis of clinical therapeutic effect using percutaneous mechanical thrombectomy in the treatment of acute deep venous thrombosis].

OBJECTIVE: To evaluate the use of percutaneous mechanical thrombectomy in the treatment of acute deep venous thrombosis. METHODS: Eight cases of acute deep venous thrombosis were reviewed who had received percutaneous mechanical thrombectomy from January to July, 2015 in Beijing Tsinghua Changgung Hospital. All cases were diagnosed as iliofemoral venous thrombosis, 2 cases with vena cava thrombosis. All cases received anticoagulation treatment for 3 to 6 months and pressure treatment after the procedure. Every patient was scheduled to follow up at 1, 3, 6 months, respectively. RESULTS: Technical success were achieved in all cases with restoring of good flow in previous lesions. Grade Ⅲ (complete) lysis was achieved in 2 cases and grade Ⅱ(50%-99% ) lysis in 6 cases, swelling legs were mostly fade away. Of all study follow up , only one case with mild post-thrombotic syndrome after six months. CONCLUSION: Percutaneous mechanical thrombectomy is safe and effective in the treatment of acute deep venous thrombosis.

[Effectiveness analysis of carotid endarterectomy in diabetic patients suffering from carotid stenosis].

OBJECTIVE: To evaluate the perioperative complications and effectiveness of carotid endarterectomy (CEA) with diabetes mellitus (DM). METHODS: A total of 148 patients with carotid stenosis undergone CEA from December 2010 to December 2013 were collected and analyzed retrospectively. The patients were distributed into DM group (n=83) and the control group (n=65) according to the comorbidities. Age, gender, risk factors, stenosis degree, cerebral ischemic symptom, shunt in operation, perioperative complications and restenosis after one year in the two groups were analyzed and compared. RESULTS: There were no statistical difference between the two groups in terms of the general characteristic, clinical ischemic symptoms, concomitant disease, operative time, the amount of bleeding, the ratio of shunt (P>0.05). The rates of perioperative complications observed in DM group, including postoperative infection, neck hematoma, cranial nerves injured, acute cardiac infarction, stroke, hyperperfusion syndrome, all-cause mortality and one year restenosis after operation were 7.2%, 12.0%, 10.8%, 3.6%, 6.0%, 9.6%, 2.4% and 9.6% respectively. The complication rates observed in the control group, on the other hand were 3.1%, 9.2%, 4.6%, 1.5%, 4.6%, 7.7%, 1.5% and 3.1% respectively. There were no significant statistical difference between the two groups (χ² =0.551, 0.300, 1.898, 0.069, 0, 0.172, 0.138, 1.559, P>0.05). CONCLUSION: CEA may be safe and effective in diabetic patients suffering from carotid stenosis, on the condition that the blood glucoses of the patients are controlled well, and the cardio cerebral vascular system is carefully assessed and intervened before the operation.

Phosphorus removal from aqueous solutions using a synthesized adsorbent prepared from mineralized refuse and sewage sludge.

Mineralized refuse and sewage sludge generated from solid waste from municipal landfills and sewage treatment plants were sintered as a cost-effective adsorbent for the removal of phosphorus. Compared with the Freundlich model, phosphorus adsorption on the synthesized adsorbent, zeolite and ironstone was best described by the Langmuir model. Based on the Langmuir model, the maximum adsorption capacity of the synthesized adsorbent (9718 mg kg(-1)) was 13.7 and 25.4 times greater than those of zeolite and ironstone, respectively. The desorbability of phosphorus from the synthesized adsorbent was significantly lower than that of zeolite. Moreover, phosphorus removal using the synthesized adsorbent was more tolerant to pH fluctuations than zeolite and ironstone for the removal of phosphorus from aqueous solutions. The immobilization of phosphorus onto the synthesized adsorbent was attributed to the formation of insoluble calcium, aluminium and iron phosphorus. The heavy metal ion concentrations of the leachate of the synthesized adsorbent were negligible. The synthesized adsorbent prepared from mineralized refuse and sewage sludge was cost-effective and possessed a high adsorptive capacity for phosphorus removal from aqueous solutions.

Effects of nitrogen conversion and environmental factors on landfill CH4 oxidation and N2O emissions in aged refuse.

We determined the effects of nitrification capacity and environmental factors on landfill methane oxidation potential (MOP) using an aged refuse in laboratory batch assays and compared it with two different types of soils. The nitrogen conversion in the three experimental materials after 120 h incubation yielded first-order reaction kinetics at an initial concentration of 200 mg kg(-1) NH4(+)-N. The net nitrification rate for the aged refuse was 1.50 (p < 0.05) and 2.08 (p < 0.05) times that of the clay soil and the sandy soil, respectively. The net NO3(-)-N generation rate by the aged refuse was 1.93 (p < 0.05) and 2.57 (p < 0.05) times that of the clay soil and the sandy soil, respectively. When facilitated by ammonia-oxidizing bacteria during CH4 co-oxidation, the average value of the MOP in the aged refuse at a temperature range of 4-45 °C was 2.34 (p < 0.01) and 4.71 (p < 0.05) times greater than that of the clay soil and the sandy soil, respectively. When the moisture content ranged from 8 to 32% by mass, the average values for the MOP in the aged refuse were 2.08 (p < 0.01) and 3.15 (p < 0.01) times greater than that of the clay soil and the sandy soil, respectively. The N2O fluxes in the aged refuse at 32% moisture content were 5.33 (p < 0.05) and 12.00 (p < 0.05) times more than in the clay and the sandy soil, respectively. The increase in N2O emissions from a municipal solid waste landfill can be neglected after applying an aged refuse bio-cover because of the much higher MOP in the aged refuse. The calculated maximum MOP value in the aged refuse was 12.45 µmol g(-1) d.w. h(-1), which was much higher than the documented data.

[Preliminary study on etiology of Budd-Chiari syndrome through clinic and experiment].

OBJECTIVE: To investigate the etiology of Budd-Chiari syndrome (BCS) preliminarily. METHODS: The clinical findings of radical surgery of 109 cases with BCS from March 2001 to May 2009 were analyzed. The pathological components of membranous tissue (MT) from inferior vena cava (IVC) or hepatic vein (HV) of BCS patients were compared with that of thrombus from deep venous thrombosis (DVT), as well as the expression of transforming growth factor beta receptor (TGF-beta R), platelet derived growth factor receptor (PDGFR), endothelin (ET-1), factor VIII related antigen (FVIII-rAg), ferritin and alpha1-antitrypsin in MTs and thrombus through immunohistochemical method. RESULTS: One hundred and four cases of BCS were due to IVC and/or HV membrane or thrombosis except that 4 cases due to IVC tumor or 1 case due to compression of fiber. The new-formed IVC membrane was found in 2 recurred cases whose IVC thrombus was excised before 1 year and 7 years. The development from organized thrombus to MT was found in 3 cases of segmental obstruction of IVC. The IVC membrane located below HV outlet was in 8 cases. Both MTs and thrombus had the pathological components such as fibroblast, neutrophil, granulation tissue, newly-formed blood vessels and so on under the light microscope. The expressions of TGF-beta R, PDGFR, ET-1, FVIII-rAg, and ferritin in MTs and thrombus were as follows: MT 72.3%, thrombus 50.0% (P > 0.05); MT 45.5%, thrombus 100% (P < 0.05); MT 100%, thrombus 0 (P < 0.05); MT 90.9%, thrombus 12.5% (P < 0.05); MT 72.3%, thrombus 100% (P > 0.05). CONCLUSIONS: The membranous tissues and thrombus have the similar homogeneity and cytokines expression. The membrane and thrombus may be different pathological phases.

[Analysis of relative factors of restenosis after artificially grafting bypasses on chronic ischemia of lower extremities].

OBJECTIVE: To analyze the relative factors of early-term restenosis after artificially grafting bypasses on chronic ischemia of lower extremities. METHODS: From January 2006 to September 2007, 40 cases suffered from chronic ischemia of lower extremities were treated by single side femoropopliteal bypass were followed up during 6 months after operation. There were 36 male and 4 case female with a mean age of (66 +/- 9) years old. Lipid, fibrinogen (FIB) and hypersensitive C reactive protein (hsCRP) were chemical examined during peri-operation. Basing on the degree of restenosis in vascular anastomosis by Color Doppler graft scan, all the patients were divided into light, moderate and severe groups, respectively. Biochemical indicators and cytokines were investigated such as lipid, FIB, hsCRP, IL-6, transforming growing factor beta1 (TGF-beta1). Possible risk factors resulting in restenosis were compared statistically among three groups with SPSS 15.0. RESULTS: Restenosis were more severe among the patients with concomitance disease such as diabetes mellitus and smoking after operation. Relative risk were 6.47 and 7.92, respectively. There are significant difference in total cholesterin, low density lipoprotein, FIB, hsCRP, IL-6 and TGF-beta1 among three groups during six months after operation (P < 0.05). Multiple linear regression showed that FIB and TGF-beta1 may be the risk factors to intimal hyperplasia. CONCLUSION: Diabetes mellitus, smoking and higher levels of FIB may be the major high risk factors resulting in neointima hyperplasia and anastomosis restenosis.

[Mid- to long-term outcome of artery bypass in chronic ischemia of lower extremities].

OBJECTIVE: To report the mid- to long-term outcome of artery bypass in chronic ischemia of lower extremities. METHODS: The clinical data of 212 patients treated with bypass operation from January 2002 to April 2007 were retrospectively reviewed. Femoropopliteal artery bypass to above-knee popliteal (FP-ak) was carried out in 111 cases, femoropopliteal artery bypass to below-knee popliteal (FP-bk) in 59 cases, aortoiliac bypass in 25 cases and femorofemoral bypass in 17 cases. RESULTS: One hundred and eighty-six patients (87.7%) were followed up for 6 to 68 months (median, 18 months). One-year primary patency rate of FP-ak and FP-bk was 69.7% and 53.5%, respectively. After graft revision, 1-year secondary patency rate of FP-ak and FP-bk were 81.6% and 60.5%, respectively. The 3-year patency with FP-ak (56.3%) was significantly higher than that in FP-bk (23.8%) (P < 0.05). Fifty-two cases were reoperated on during the follow-up period. Crural or femoral amputation could not avoid in 23 cases (limb salvage rate 89.2%). Ten cases died in 1 to 30 days after the operation, 20 cases died later during followup, and most of them died of cardio-cerebrovascular diseases. Artificial vessel infection occurred in 6 cases. CONCLUSIONS: The selection of surgical treatment for chronic ischemia of lower extremities should based on the ischemic state of the limb. The mid- to long-term patency rate of FP-ak is higher than that of FP-bk.

[The pilot study of the effect of paclitaxel by local slow delivery on intimal hyperplasia of vascular anastomosis after vascular graft bypass].

OBJECTIVE: To develop a new way to prevent restenosis in the anastomotic site due to intimal hyperplasia after vascular graft bypass (VGB) in peripheral arteries. METHODS: Five mongrel dogs received bilateral iliac-femoral VGB and their arteries between the graft were ligated and cut off under general anaesthesia. The mixture of the paclitaxel and fibrin gel (FG) were randomly sprayed onto one side of grafts including distal and proximal anastomotic site, and the fibrin gel served as control were sprayed onto the other one. The bilateral grafts including distal and proximal anastomotic site were harvested four weeks postoperationally and the anastomotic sites were observed grossly, pathologically and by electron microscopy. The intimal thickness and area of each anastomotic site were measured, then the data were analysed statistically. RESULTS: The bilateral grafts of all dogs were patent and the neointima of all anastomotic sites have been seen grossly. The neointimal thickness and area of the experimental side were significantly reduced compared with the control side (P < 0.05). Scanning electron microscopy showed that the anastomotic intima of the experimental side was covered with one layer of intact and regular endothelium cells with deposition of little blood components, but the anastomotic intima of the control side was covered with irregular endothelium cells and deposited with a lot of blood cells and fibrins. Transmission electron microscopy showed the anastomotic intima of the control side that rich in vascular smooth muscle cells and the matrix of the intima was composed of regular collagenous fibers, and that of the experimental side consisted of several types of cells with a lot of foreign particles in the matrix. CONCLUSION: It is safe and effective to locally use low dose of paclitaxel carried by FG in the prevention of vascular anastomotic site intimal hyperplasia. Paclitaxel molecules can penetrate the graft wall and stay in the anastomotic intima more than four weeks postoperationally.