Endovascular Aneurysm Treatment with the Numen Coil Embolization System: A Prospective Randomized Controlled Open-Label Multicenter Noninferiority Trial in China.

OBJECTIVE: We investigated the safety and efficacy of the Numen coil compared with the Axium coil in the treatment of intracranial aneurysms. METHODS: Because CATCH (Coil Application Trial in China) is a prospective randomized controlled open-label noninferiority trial conducted in 10 centers across China, patients who fulfilled the inclusion and exclusion criteria were randomized 1:1 to either a test group (Numen) or a control group (Axium). The primary outcome was based on successful aneurysm occlusion at 6 months follow-up, whereas secondary outcomes included technical success, the recanalization and retreatment rates, and the rate of serious adverse events (SAEs) at 6 months and 12 months follow-up. RESULTS: Between August 2017 and December 2019, 350 patients presenting with 350 aneurysms were enrolled and randomized. Per-protocol analysis showed that the successful aneurysm occlusion rate at 6 months was 91.18% for the test group compared with 91.85% in the control group, with a difference of -0.68% (P = 0.8419), and the overall mortality during the 30-day follow-up period was 1.19% and 1.81% in the test and control group, respectively, showing no significant difference between the 2 groups (P = 0.6837), whereas the SAE incidence during the 12-month follow-up period was 12.50% and 17.47% in the test and control groups, respectively, which was not statistically significant (P = 0.2222). CONCLUSIONS: This trial showed that the Numen coil was noninferior to the Axium coil in terms of intracranial aneurysm embolization and can be considered as a safe and effective coil for treating patients with intracranial aneurysm in clinical practice.

Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection: an application and follow-up study / 中华神经医学杂志

Objective:To investigate the safety and effectiveness of Willis covered stent in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.Methods:A retrospective analysis was performed. Six patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection admitted to the 3 hospitals from May 2016 to December 2019 were chosen; their clinical data were collected. The surgical processes and complications were concluded, and the prognoses were evaluated by modified Rankin scale (mRS).Results:One patient was treated with intraoperative simple tamponade compression for hemostasis, and died for massive intracranial hemorrhage 2 weeks after surgery. Five patients were occluded by Willis covered stents; the occluded success rate was 100% but ophthalmic arteries were blocked in all. During the perioperative period, diabetes insipidus occurred in one patient and incomplete oculomotor paralysis occurred in one patient; 5 patients were followed up for 3-12 months: MRI indicated subtotal resection of tumor in 4 patients and total resection in one patient, no new bleeding or ischemic stroke events occurred in these 5 patients, and the prognosis was good.Conclusion:Willis covered stent is safe and effective in patients having carotid artery rupture during transnasal endoscopic pituitary tumor resection.

Eyelid reconstruction with acellular human dermal allograft after chemical and thermal burns.

OBJECTIVE: To evaluate the efficacy of eyelid reconstruction with acellular dermal allograft in patients with eyelid defect after chemical and thermal burns. METHOD: Eyelid reconstruction was performed in 15 eyelids of 13 patients during the period of June 2001-October 2004 by a single senior surgeon (Chen). Among them five patients had thermal burns, and eight patients had chemical burns. The acellular dermal allograft was used as a tarsus substitute that was sutured into the place between the levator aponeurosis in upper lid or retractor in lower eyelid and the remaining tarsus. RESULTS: After a mean follow-up of 9 months, satisfactory function and cosmesis were obtained. No implant rejection or severe complications were observed. CONCLUSION: Acellular dermal allograft may be used safely as a posterior lamellar spacer graft after chemical and thermal burns; the allograft appears to be biocompatible and does not aggravate the inflammation in the injured eyelid.

Recanalization for symptomatic chronic internal carotid artery occlusion: a preliminary study / 中华放射学杂志

Objective:To evaluate the value of endovascular recanalization and hybrid recanalization for chronic internal carotid artery occlusion(COICA), and to evaluate its feasibility, safety, success rate, and clinical outcomes.Methods:Totally 35 patients who received endovascular recanalization or hybrid recanalization with symptomatic COICA were enrolled from January 2019 to December 2019 in Department of Cerebrovascular Disease,Zhengzhou University People′s Hospital. The clinical characteristics, treatment strategies, success rate, and major events of the patients were analyzed retrospectively.Results:Thirty of 35 patients were successfully recanalized. Among them, hybrid recanalization was performed in 3 cases, carotid endarterectomy was performed in 1 case, and endovascular recanalization was performed in 26 cases, 5 patients failed because they could not reach the distal true cavity. Among the successful patients, 5 patients had operation-related complications, 3 patients had embolism cerebral infarction, 1 patient had hyperperfusion cerebral hemorrhage, 1 patient still had transient ischemic attack after operation. All patients were followed up clinically, 2 patients had reoccurrence of obstruction, 2 patient had restenosis, the remaining patients had no hemodynamic stenosis or reocclusion.Conclusion:In highly-selected cases, intracavitary recanalization for symptomatic COICA is feasible, relatively safe and effective.

Endovascular recanalization in non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery / 中华神经医学杂志

Objective To investigate the safety,efficacy and feasibility of endovascular recanalization in non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery,and analyze the factors affecting its success.Methods Fifty-four patients with non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery,underwent endovascular recanalization in our hospital from January 2013 to December 2017,were enrolled.Modified Rankin scale (mRS) and National institutes of health stroke scale (NIHSS) scores were compared before and after treatment;the prognosis results were analyzed after 2 years of follow-up.Independent factors influencing the prognoses were identified by Logistic regression analysis.Results Recanalization was achieved in 52 patients and failure was noted in two patients.The mRS scores and NIHSS scores before treatment (2.25±0.13,18.43±1.36) were significantly higher than those after treatment (1.44±0.05,11.81±0.71,P＜0.05).After 2 years of follow-up,good prognosis was noted in 42 patients,poor prognosis in 8 patients,and loss of follow-up in 2 patients.Multivariate Logistic analysis showed that history of hypertension and history of diabetes were independent risk factors for the prognoses of patients with non-acute symptomatic occlusion of the ophthalmic segment of internal carotid artery after endovascular reeanalization (OR=1.429,95CI:1.146-1.783,P=0.005;OR=2.597,95CI:2.364-2.854,P=0.005).Conclusion The curative effect of interventional therapy for non-acute occlusion of symptomatic internal carotid artery is reliable,and histories of hypertension and diabetes can affect the prognoses of patients.

Clinical prognoses of acute vertebral basilar artery occlusion by endovascular treatment / 中华神经医学杂志

Objective To investigate the clinical prognoses of acute vertebral basilar artery occlusion by endovascular treatment and the risk factors for poor prognosis. Methods Clinical data of 43 patients with acute vertebral basilar artery occlusion who underwent endovascular treatment in our hospital from August 2016 to December 2017 were retrospectively analyzed. The immediate revascularization rate and clinical outcomes three months after surgery were analyzed; and according to the clinical prognoses, these patients were divided into a good prognosis group and a poor prognosis group. Receiver operating characteristic (ROC) curve was used to compare the NIHSS scores, times from onset to vessel recanalization, improved post-circulation CT scale of Alberta stroke project based on diffusion weighted imaging (DWI-PC-ASPECTS) scores, and MR angiography-basilar artery on computed tomography angiography prognostic scalere for basilar artery occlusion (MRA-BATMAN) scores to predict the prognoses. Univariate Logistic regression analysis and multivariate Logistic regression analysis were used to evaluate the relations of times from onset to vessel recanalization, NIHSS scores, DWI-PC-ASPECTS scores, and MRA-BATMAN scores with poor prognosis. Results Forty-three patients (100％) achieved thrombolysis in cerebral infarction (TICI) grading 3/2b immediately after surgery. The mRS scores were 0-2 in 26 patients (60.5％, good prognosis group), and those were 3-6 in 17 patients (39.5％, poor prognosis group) three months after surgery. When the NIHSS scores was 21, times from onset to vessel recanalization was 600 min, DWI-PC-ASPECTS predictive threshold was 8.5 and MRA-BATMAN predictive threshold was 6.5, the diagnostic accuracy of predicting poor prognosis was the highest (sensitivity=0.941, 0.706, 0.808, and 0.577, and specificity=0.846, 0.423, 0.647, and 0.824). Univariate Logistic regression analysis showed that preoperative NIHSS scores≥21, improved DWI-PC-ASPECTS scores≤8.5, and MRA-BATMAN scores≤6.5 were risk factors for poor prognosis (P<0.05). Multivariate Logistic regression analysis showed that preoperative NIHSS scores≥21 was an independent risk factor for poor prognosis (OR=15.679, 95％CI:1.608-152.879, P=0.000). Conclusion Intravascular treatment of acute vertebral basilar artery occlusion is safe and effective, and the patients with preoperative NIHSS scores≥ 21 are highly likely to have poor prognosis.

Analyses on allocation and utilization of class-B large medical equipments at public hospitals under Pudong New Area / 中华医院管理杂志

Objective To analyze the allocation and utilization of class-B large medical equipments at public hospitals under Pudong New Area,Shanghai.Methods Data on the allocation and utilization of class-B large medical equipments were collected by a questionnaire survey of 17 public hospitals under Pudong New Area from June to July 2017 and were analyzed in descriptive statistics.Results There were 55 units of class-B large medical equipments at the public hospitals under by Pudong New Area.The average utilization rates of MRI,CT and DSA were 52.62％,61.49％ and 24.43％ respectively.Conclusions The number of class-B large medical equipments has increased at such hospitals,but the services using DSA need to be extended.

Analysis on allocation of large medical equipment in Shanghai / 中华医院管理杂志

Objective To analyze the allocation and equity of Class-A and Class-B large medical equipment in Shanghai, and to compare them with those in other parts of China and in other OECD countries. Methods The data of large medical equipments were collected from the Health and Family Planning Commission of Shanghai, government websites, relevant research reports and the database of OECD. Gene-coefficients were adopted to evaluate the equity of large equipment allocation. Results In terms of Class-A and Class B large equipments like CTs, MRIs and DSAs per million population, the number for Shanghai by the end of 2015, was 1.325, 5.30, 2.13 and 3.81 units respectively. Except for CTs, this figure was higher than national average, yet lower than average of other OECD countries. In addition, the equity in allocation of Class-B large medical equipment was better than that of Class-A large medical equipment in Shanghai. Conclusions The overall deployment level of large medical equipments in Shanghai remains to be increased, and the equity in allocation of Class-A large medical equipment deserves more attention.

Analysis on return on investment of three types of large medical equipments at public hospitals under Pudong New Area / 中华医院管理杂志

Objective To analyze the return on investment of 3 types of large medical equipments at Pudong's public hospitals in Shanghai.Methods Data on the numbers and purchasing expenditure, annual utilization headcounts, annual income and annual costs of the MRIs, CTs and DSAs were collected from these hospitals, and their breakeven points and recovery period were analyzed in the study. Results At these hospitals, CTs had relatively a higher return on investment in 2016, with 95 000 headcounts per hospital. At the interest rates of 1% , 3% and 5% , nine hospitals could recover their investment, at an average recovery period of 2.88 years, 3.23 years and 3.84 years respectively. That for DSS was poor. Conclusions These hospitals should improve the business performance of these equipments by means of rational purchase, enhanced utilization and sharing mechanism.

Establishment of 3D venous-fusion models and their application in meningioma operations / 中华神经医学杂志

Objective To explore the role of 3D venous-fusion models in the resection of meningiomas.Methods The study included 19 patients with meningiomas,admitted to our hospital from March 2015 to July 2015.The preoperative and postoperative contrast enhancement MR venography (CE-MRV) data were imported into the neuronavigator system.The establishment of 3D venous-fusion models was performed;reconstruction,cropping,fusion of the intracranial venae and tumors were performed.3D venous-fusion models were used to evaluate the intracranial venous circulation,and the positions of venae and tumors were navigated in real-time.Results 3D venous-fusion models showed good results.The position relationship of tumors and their surrounding venous was perfectly assessed in operation.Nineteen patients underwent craniotomy using neuronavigator to locate venous position,and no postoperative venous complications occurred.The contrast of preoperative and postoperative 3D venous-fusion models prompted that the venous protection was in line with expectations.Conclusions The 3D venous-fusion models established by neuronavigator can accurately evaluate the relationship between cerebral venous and the tumors.These models help the operator making a better understanding of tumors and their peripheral venous imaging data from 3D perspective.It is benefit for the operator to make a more reasonable venous protect strategy.

Deployment of medical equipment and its impacts on medical services in Pudong New Area of Shanghai / 中华医院管理杂志

Objectives To analyze the deployment of medical equipment and its impacts on medical services of hospitals.Methods Existing data collection,a survey of public hospitals and a chart review of acute myocardial infarction(AMI)inpatients were used to collect related data.Gini coefficients,Chi-square and multivariate model were used to analyze deployment of medical equipment and its impacts on medical services.Results The number of CTs and that of CTs per million population in Pudong new area were higher than those of MRIs and DSAs,and the distribution of CTs among districts in Shanghai was relatively equal(Gini coefficient was 0.20).But lack of DSAs in some public general hospitals had affected the AMI inpatient care.Conclusions Public hospitals and governments in China should keep at a balance the demand of medical services,deployment level of medical equipment,and financial affordability for the society,governments and hospitals.

Prevalence and epidemic characteristic of overweight, obesity, and central obesity in Shanghai Pudong New Area / 中华内分泌代谢杂志

Objective To explore the prevalence and epidemic characteristics of overweight, obesity, and central obesity in Shanghai Pudong New Area. Methods Multi-stage stratified random sampling method was conducted in Pudong New Area in 2013. Residents over 15 years old were randomly selected from 13 communities and participated in the cross-sectional study. A structured questionnaire was used to collect the information and physical examination, biochemical assays were also conducted. SPSS 20. 0 was used to analyze the results. Results The averagebodymassindexofparticipantswas(25.04±3.79)kg/m2andtheaveragewaistcircumferencewas(82.44± 9. 51) cm. The prevalences of overweight, obesity, and central obesity were 41. 67%, 17. 70%, and 31. 32%respectively. Standardized prevalences of overweight, obesity, and central obesity were 34. 39%, 16. 96%, and 25. 66% respectively, according to 2010 national age composition of population. Statistically significant sex differences were found among the prevalence of overweight, obesity, and central obesity groups(all P<0. 05). The prevalence of central obesity in female was raised by increasing age. Residents with hypertension, hyperglycemia, dyslipidemia, and metabolic disorders had higher prevalences in overweight, obesity, and central obesity ( all P<0. 05). Conclusion The prevalences of overweight, obesity, and central obesity among the residents in Shanghai Pudong New Area were relatively high. Relevant risk factors should be explored to promote health education that may enhance people′s awareness of weight management.

Performance evaluation of community health institutions of Pudong new district / 中华医院管理杂志

Objective To evaluate the performance of community health institutions of Pudong new district.Methods According to the criteria of the Ministry of Health of China,the performance evaluation system appropriate for local area was developed.A cross-sectional survey was conducted at 44 community health centers,and data was analyzed using descriptive statistics,correlation coefficients and multi-factor linear regression.Results The average score of total performance of these 44 community health centers was 78.53.The average scoring rate for institution management,public health service,basic medical care service,CTM service,and comprehensive satisfaction was 68.49％,89.09％,63.51％,87.80％,76.32％,respectively.Degree of informationization (0.477),regional location (0.331) and participating in medical consortia(-0.309)had significant impact on the total performance.Degree of informationization(0.302)and pilots for family doctors(0.301)had significant impact on the basic medical service performance.Conclusion There is a tremendous room for performance improvement for community health institutions in Pudong.Regional location and degree of informationization were the most crucial factors affecting the performance,irrelevant to institutional sizes.Proposals were raised for strengthening the construction of informationization,expanding pilots for family doctors,perfecting the mechanism of medical consortia.

Diagnosis and treatment of urothelial tumors in multiple organs / 中华老年医学杂志

Objective To explore the experiences of the diagnosis and treatment of urothelial tumor in multiple organs.Methods Clinical data of 10 patients with urothelial tumor in multiple organs were retrospectively reviewed.Urothelial tumors were found in two or more organs at the same time by B ultrasound,IVU,R-P,CTU,MRU,cystoscopy,ureteroscopy and so on before operation.Results 6 cases were operated by radical total nephroureterectomy and partial cystectomy,3 cases were operated by radical total nephroureterectomy and cystectomy with urinary diversion,1 case was operated by partial ureterectomy and total cystectomy.8 of them were alive,1 case was operated by total urethrectomy because of tumor recurrence in the posterior urethra,one died of metastasis tumor 18 months after operation,and the other died 32 month after operation.Conclusions Combined use of various kinds of the diagnostic means (ultrasound,IVU,R-P,CTU,MRU,cystoscopy,ureteroscopy) are important for the diagnosis of urothelial tumor in multiple organs.It needs to select the operate mode according to the tumor staging and grade and the patient's condition.Reinforcement surveillance and close follow up is required after operation.

Five-years follow-up after transurethal electrovaporization of the prostate and transurethal plasmakinetic resection of the prostate / 中华泌尿外科杂志

ObjectiveTo review the major complications in patients after transurethal electrovaporization of the prostate (TUVP) and transurethal plasmakinetic resection of the prostate (PKRP) retrospectively and to analyze the causes and management.MethodsClinical data of 92 cases of patients after TUVP and 226 cases after PKRP were reviewed retrospectively.The patients' relevant circumstances including subjective symptoms,objective indexes and the major long-term complications were followed up about 1-,3-,and 5-year after operation.Different therapeutic methods were chosen according to different causes of the complications.ResultsThere were no significant differences (P ＞ 0.05 ) between TUVP group and PKRP group in IPSS (7.3±2.8,7.2±2.5),QOL (2.6±0.7,2.7 ±0.5),Qmax[ (25.2±3.5),(25.5 ±3.8) ml/s] and PVR [(18.7 ±5.4),(17.8 ±6.3)ml].The incidences of bladder neck restriction was about 1.1％,3.3％,and 2.3％ after 1,3,and5 years in patients after TUVP,and 0.9％,2.7％,and 1.8％ after PKRP accordingly.For urethral stricture,it was about 3.3％,2.2％,and 1.1％ after TUVP,and 3.1％,2.2％,and 0.9％ after PKRP.For residual prostatic hyperplasia,it was about 1.1％,2.2％,and 4.5％ after TUVP,and 1.3％,2.7％,and 3.7％ after PKRP accordingly.ConclusionsTUVP and PKRP are effective and safe treatment options for BPH.The major long-term complications after TUVP and PKRP are bladder neck restriction,urethral stricture and residual prostatic hyperplasia.Regular and long-term follow-up is required for patients after TUVP and PKRP.Different therapeutic methods should be chosen according to different causes of the complications after operation.

Epidemiological features of metabolic syndrome in residents aged 20-80 years in Pudong New District of Shanghai / 中华内分泌代谢杂志

Objective To investigate the prevalence and risk factors of metabolic syndrome (MS) in residents in Pudong New District of Shanghai. MethodsA total of 5 584 residents aged 20-80 years were randomly selected from Pudong New District of Shanghai through multistage sampling and interviewed from April to July of 2008. Metabolic syndrome was defined according to three diagnostic criteria for MS, issued by the modified National Cholesterol Education Program Adult Treatment Panel Ⅲ criteria ( NCEP-ATP Ⅲ ), International Diabetes Federation (IDF), and Chinese Diabetes Society (CDS). ResultsThe crude prevalences of MS in the adult population in Pudong New District were 18.2％ and 13.1％ standardized ( male 19. 1％, female 17.4％, the age-standardized 15.6％ and 13.2％ ) with CDS criterion, 31.8％ and 24.4％ standardized ( male 28.4％ ,female 35.1％ ,the agestandardized 22. 7％ and 25.0％ ) with NCEP-ATP Ⅲ criterion, and 21.7％ and 17.0％ standardized ( male 15.9％ ,female 26.7％, the age-standardized 13.8％ and 19.2％ ) with IDF criterion. The age-specific prevalence of MS increased according to three diagnostic criteria, and the age-adjusted prevalence was higher in males than females in junior age groups and higher in females than males in senior ones. Significant differences were present among region, education, marriage status, smoking, work intensity, recreation, and physical activity according to some diagnostic criteria. ConclusionsSubstantial proportions of adults in Pudong New District of Shanghai suffer from metabolic syndrome, and there exists a tendency for young people involved. MS has become a noteworthy public health problem. It suggests that community-integrated control strategy of MS should be made a priority.

Epidemiology investigation of chronic kidney disease in adults of Shanghai Pudong New Area / 中华肾脏病杂志

Objective To investigate the prevalence and risk factors of chronic kidney disease (CKD) in adult residents of Shanghai Pudong New Area. Methods A total of 5584 residents aged 20-80 years old were randomly selected from Shanghai Pudong New Area through multistage sampling and interview between April and July 2008. Fasting blood samples and morning urine samples were collected to detect Scr and urinary albumin and creatinine. Urine albumin to creatinine ratio (ACR) and glomerular filtration rate (GFR) was calculated to estimate the renal function. Logistic regression model was used to examine the associations of demographic and lifestyle factors with indicators of kidney damage. Results The age-standardized prevalence of albuminuria, reduced renal function and CKD was 9.9% (male 8.0%, female 12.4%), 1.1% (male 1.3%, female 0.9%) and 11.0%(male 8.8%, female 12.7%), respectively. The prevalence of CKD was higher in female and increased with age. No significant difference in the prevalence was observed between urban and rural areas. Elder, female, high blood pressure, high fasting glucose, dyslipidemia and obesity were associated with CKD independently. Conclusions The prevalence of CKD in Shanghai Pudong New Area is comparable to that previously reported in China or other developed countries, and even higher. CKD is going to be a public health problem and warrants the community-integrated control strategy to prevent the incidence of end-stage renal disease (ESRD) and related complications.

Efficacy of Solifenacin in the treatment of overactive bladder syndrome after transurethral resection of the prostate / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of solifenacin in the treatment of overactive bladder (OAB) syndrome in patients who have undergone transurethral resection of the prostate (TURP). Methods According to the Overactive Bladder Symptom Score (OABSS), 64 cases with OAB symptoms after TURP were randomly assigned into study and control groups with 32 cases in each group. Patients in the study group were treated with solifenacin (5 mg once daily) for a two week period beginning the first day after catheter removal. Patients in the control group were not treated with solifenacin. The mean urgency episodes, micturition episodes, nocturia, urge incontinence, volume voided per micturition, Qmax and OABSS scores were recorded on the 7th and the 14th day after catheter removal. Treatment-emergent adverse events with solifenacin in the study group were recorded and evaluated as well. All cases were followed-up for 8 weeks after catheter removal. Results There were statistically significant differences (P<0.01) in favor of the study group over the control group in the aspect of urgency, micturition episodes, nocturia, urge incontinence, volume voided per micturition and OABSS scores. The incidences of treatment related adverse events were 12.5% (4/32) in the study group with no serious adverse event observed. Conclusions Solifenacin is effective in the treatment of OAB syndrome after TURP and is well tolerated as well. Application of solifenacin should be recommended earlier after TURP.