A prospective study on the safety and efficacy of excimer laser coronary angioplasty for the treatment of degenerated great saphenous vein graft / 中华心血管病杂志

Objective: To explore the safety and efficacy of excimer laser coronary angioplasty (ELCA) for the treatment of degenerated great saphenous vein graft (SVG). Methods: This is a single-center, prospective, single-arm study. Patients, who were admitted to the Geriatric Cardiovascular Center of Beijing Anzhen Hospital from January 2022 to June 2022, were consecutively enrolled. Inclusion criteria were recurrent chest pain after coronary artery bypass surgery (CABG), and coronary angiography confirmed that the SVG stenosis was more than 70% but not completely occluded, and interventional treatment for SVG lesions was planned. Before balloon dilation and stent placement, ELCA was used to pretreat the lesions. Optical coherence tomography (OCT) examination was performed and postoperative index of microcirculation resistance (IMR) were assessed after stent implantation. The technique success rate and operation success rate were calculated. The technique success was defined as the successful passage of the ELCA system through the lesion. Operation success was defined as the successful placement of a stent at the lesion. The primary evaluation index of the study was IMR immediately after PCI. Secondary evaluation indexes included thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count (cTFC), minimal stent area and stent expansion measured by OCT after PCI, and procedural complications (Ⅳa myocardial infarction, no reflow, perforation). Results: A total of 19 patients aged (66.0±5.6) years were enrolled, including 18 males (94.7%). The age of SVG was 8 (6, 11) years. The length of the lesions was greater than 20 mm, and they were all SVG body lesions. The median stenosis degree was 95% (80%, 99%), and the length of the implanted stent was (41.7±16.3)mm. The operation time was 119 (101, 166) minutes, and the cumulative dose was 2 089 (1 378, 3 011)mGy. The diameter of the laser catheter was 1.4 mm, the maximum energy was 60 mJ, and the maximum frequency was 40 Hz. The technique success and the operation success rate were both 100% (19/19). The IMR after stent implantation was 29.22±5.95. The TIMI flow grade of patients after ELCA and stent implantation was significantly improved (all P>0.05), and the TIMI flow grade of all patients after stent implantation was Grade Ⅲ. The cTFC decreased significantly after ELCA (33.2±7.8) and after stent placement (22.8±7.1) than preoperative level (49.7±13.0) (both P<0.001). The minimum stent area was (5.53±1.36)mm2, and the stent expansion rate was (90.0±4.3)%. Perforation, no reflow, type Ⅳa myocardial infarction and other complications were not observed. However, postoperative high-sensitivity troponin level was significantly increased ((67.937±33.839)ng/L vs. (5.316±3.105)ng/L, P<0.001). Conclusion: ELCA is safe and effective in the treatment of SVG lesions and could improve microcirculation and ensure full expansion of stent.

Advances in pancreatic cancer pain and its treatment / 复旦学报（医学版）

Pancreatic cancer is a malignant digestive system tumor.The incidence of pancreatic cancer is rising,the prognosis is very poor,the mortality rate is extremely high (almost 100％),and the 5-year survival rate is less than 5％.One of the main symptoms of this tumor is pain and mostly neuropathic origin,which significantly decreases the quality of life and the impacts on patient's functional activity.The most common pain treatment for pancreatic cancer is drug analgesia therapy,which is based on the WHO analgesic ladder rule.However,it is not always effective,and many side effects reduce the quality of life of patients.Invasive treatment of pain in pancreatic cancer mainly includes neurolytic celiac plexus block and splanchnicectomy,which can significantly reduce the level of pain and help to improve the quality of life.Invasive remedies should not be applied at the final stage and should be considered in the early stages of the disease (such as the first or second step of the WHO analgesic ladder).This paper comprehensively analyzes the current clinical treatment of pancreatic cancer pain and evaluates its effectiveness,and hopes to provide more information on the treatment of pain in patients with pancreatic cancer.

Acute- and Long-term Outcomes of Rotational Atherectomy followed by Cutting Balloon versus Plain Balloon before Drug-Eluting Stent Implantation for Calcified Coronary Lesions / 中华医学杂志(英文版)

Background@#Coronary calcification is a major determinant of stent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy (RA) followed by cutting balloon (CB) versus plain balloon before drug-eluting stent implantation for calcified coronary lesions.@*Methods@#From June April 2013 to March 2016, a total of 127 patients with moderately or severely calcified coronary lesions were treated with RA. Patients were divided into two groups according to the balloon type after RA: RA+CB group (n = 75) and RA+plain balloon group (n = 52). Minimal lumen diameter and acute lumen gain were analyzed by quantitative coronary angiography. In-hospital and long-term (>1 year) outcomes were recorded. Multivariate Cox regression analysis was performed to determine the independent predictors of in-stent restenosis.@*Results@#The mean age of the patients was 65.5 years, and 76.4% were men. Total lesion length and minimal lumen diameter at baseline were similar in the two groups. After RA and balloon dilation, the lumen diameter was significantly larger in the RA+CB group than in the RA+plain balloon group (1.57 ± 0.46 mm vs. 1.10 ± 0.40 mm, t = 4.123, P 1 year) in-stent restenosis (hazard ratio: 0.136, 95% confidence interval: 0.020-0.936, P = 0.043).@*Conclusions@#In patients with moderately or severely calcified lesions, a strategy of RA followed by CB before stent implantation can increase lumen diameter and acute lumen gain. This strategy is safe with lower risk of long-term in-stent restenosis.

Antiplatelet Therapy, Clinical Characters and Long-term Outcomes of Patients With Angiography-documented Stent Thrombosis / 中国循环杂志

Objectives: To describe the differences between patients with angiography confirmed stent thrombosis in antiplatelet therapy and long term outcomes. Methods: We analyzed data from 1 204 patients with angiography – documented stent thrombosis between January 2008 to December 2016 in Beijing Anzhen Hospital. According to the timing of stent thrombosis post stent implantation, patients were divided into acute stent thrombosis (<24 h, n=106), subacute stent thrombosis(24 h~30 d, n=206), late stent thrombosis (>30 d~1y, n=268), and very late stent thrombosis (>1 y, n=624) groups. Death, recurrent stent thrombosis, recurrent myocardial infarction, target vessel revascularization, stroke and antiplatelet treatment during In-hospital or long-term clinical follow-up were compared among groups. Results: Prevalence of stent thrombosis was the highest in the left anterior descending artery (51.9%) in acute stent thrombosis group. Subjects with subacute stent thrombosis had a higher prevalence rate of LVEF<50% (28.2%), and subjects with very late stent thrombosis had a higher prevalence rate of diabetes (34.1%). All patients in acute stent thrombosis group received aspirin + clopidogrel, 96.5% patients in subacute stent thrombosis group and 94.5% patients in late stent thrombosis group were treated with double or triple antiplatelet therapy, while 95.2% patients in the very late stent thrombosis group were treated with double or mono antiplatelet therapy. During the follow up, mortality was 23.6%, 26.7%, 26.3% and 18.9% in acute stent thrombosis, subacute stent thrombosis, late stent thrombosis, and very late stent thrombosis groups, respectively. Conclusions: Most patients with angiography–documented stent thrombosis are treated with recommended antiplatelet therapy. Development of stent thrombosis is associated with poor outcomes.

Analysis of related substances in bromhexine hydrochloride tablets / 中国药学杂志

OBJECTIVE: To evaluate the status of related substances in bromhexine hydrochloride tablets and to find the existing problems. METHODS: 95 batches of samples from six domestic manufacturers were tested using statutory methods combined with exploratory research, and the results were evaluated by statistical analysis. RESULTS: The related substances in 95 batches of bromhexine hydrochloride tablets met the requirement of current specification. The total amount was not more than 0.4%. The exploratory studies on domestic tablets, raw materials and tablets produced by original manufacturer revealed that 12 impurities were detected in the samples from six domestic manufacturers, which originated mainly from the raw material. The species and contents of the impurities in domestic samples were different with those in the product of original manufacturer. The structure of the unknown impurity with the highest content was identified by LC-MS/MS, and it was judged to be produced in the manufacturing process of the raw material. CONCLUSION: The related substances in domestic bromhexine hydrochloride tablets are in good control overall and have met the requirement of current statutory specification. The impurities originate mainly from the raw material, so improving the quality of the materials at the source is the critical factor for promoting the quality level of bromhexine hydrochloride tablets.

Time between the onset and diagnosis of dengue fever and related influencing factors in China / 中华流行病学杂志

Objective To study the time between the onset and diagnosis of Dengue fever and its influencing factors in China.Methods Data were obtained from the Infectious Disease Surveillance System (IDSS).Descriptive analysis was performed for the time interval while nonparametric tests and logistic regression analysis were used to study the related influencing factors.Results Time interval appeared positively skewed with distribution at median of 6 days,quartile range as 4 days,while 57.8％ of them were longer than five days.Data showed that patients with longer intervals among the imported cases,being elderly,cases in non-endemic season and provinces as Fujian,Yunnan and Zhejiang appeared to have had greater influences on the disease.Median of those imported cases was six days,one day longer than locally generated cases,while median of the nonepidemic month was one day more than that of the epidemic month.In Fujian and Yunnan provinces,the medians were 7 days,one day more than that from Guangdong province.The median among young people was 5 days,one day less than that of the patients older than 20 years of age.Conclusion Most Dengue patients did not get diagnosed early enough so it was of urgent need to enhance the sensitivity of the monitoring system,especially in epidemic regions and during non-epidemic season.

The preliminary study of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma patients with portal vein tumor thrombus / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus.</p><p><b>METHODS</b>22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Comparison of stent patency rate curves and survival curves was analyzed by Log rank test.</p><p><b>RESULTS</b>The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying degrees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. I-II degree gastrointestinal tract reactions occurred in 3 cases, I-II degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25% , 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 12 months was 100%, 80% , 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05).</p><p><b>CONCLUSION</b>Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.</p>

Emergency endovascular repair of iliac artery rupture caused by post-stenting angioplasty with an endograft / 中华创伤杂志(英文版)

Iliac artery rupture is a rare complication of post-stenting angioplasty and can lead to massive life-threatening haemorrhage. Conventional surgery can not repair the damaged vessel easily and may cause substantial blood loss and high operative morbidity and mortality. We report our experience with a self-expanding covered endoprosthesis for endovascular repair of the rupture of an iliac artery caused by stenting angioplasty.

Regional blood perfusion and biological characteristic of breast cancer / 中国普通外科杂志

Objective To evaluate the correlation between regional blood perfusion and biological features of breast cancer. Methods Spiral CT technique was applied to quantitatively detect the central and marginal blood perfusion, including blood flow ( BF ) , blood volume ( BV) and permeability of surface (PS). Results The central and marginal blood perfusion of breast cancer were significantly higher than that of normal breast tissues. The marginal blood perfusion was higher than central blood perfusion. The regional blood perfusion of breast cancer varied with tumor size, clinical stage and histological grading. Conclusion The regional blood perfusion correlates with biological markers in breast cancer and can be used to evaluate the biological characteristics as a noninvasive marker before neoadjuvant chemotherapy.

The portal venous pressure change due to metallic stents implanted into portal veins in HCC patients / 介入放射学杂志

Objective To research the change of the portal venous pressure after the stents implanted into portal vein in HCC.Methods Twelve HCC patients receiving portal venous stem embolization were included in this study.The portal venous pressures were recorded before varices embolized(P1),after embolized(P2)and after stents implanted(P3),respectively.Four groups were formed according to the pressures within portal vein stem(PV),portal vein branch without tumor invasion(PVB),splenic vein(SV) and superior mesenteric vein(SMV).Results In PV group,P1 was(45:17?2.25)cm H20,and P2 was (48.33?2.20)cm H_2O,P＜0.05,P3 was(39.33?2.44)em H_2O,thus P＜0.05 in comparing with P2.for PVB group,P1 was(38.08?2.97)cm H_2O,and P2 was(38.83?2.94)cm H_2O,P＞0.05,P3 was(37.41?2.37)cm H_2O,comparing with P2,P＞0.05.In SV group,P1 was(44.67?2.13)cm H_2O,and P2 was(48.17?2.20)cm H_2O,P＜0.05,P3 was(41.67?2.20)cm H_2O,comparing with P2,P＜0.05.Finally,the SMV group,P1 was(45.25?2.21 )cm H_2O,P2 was(48.42?2.19)cm H_2O,P＜0.05,P3 was(41.25?2.24)cm H_2O, in comparison with P2,P＜0.05.Conclusions In portal vein stem embolization,portal venous pressure would be higher after varices embolized,but lower after stents placement.

Clinical study on the relationship among the dermis, fat dome and postburn hyperplastic scar formation / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the influence of dermal defect and fat dome structure destruction in burn wounds on the formation of hyperplastic scar.</p><p><b>METHODS</b>Fifty two wounds in 24 burn patients with deep partial thickness burn indicating tangential excision in the extremities were enrolled in the study, and they were divided into three groups according to the extent of exposure of dermal fat granules, i.e. A (without fat exposure), B (with little fat exposure) and C (with much fat exposure) groups. These three groups were subdivided into A1 (without grafting), A2 (grafting with razor thin skin), B1 (without grafting), B2 (with razor thin skin grafting), C1 (without grafting) and C2 (with split-thickness skin grafting) groups, with 9 wounds in each group. The dermal depth and exposure rate of the fat granules in each group were measured and analyzed by KS400 photography analysis apparatus. The follow-up conditions of the scars 6 months after operation were evaluated with Vancouver remark system by Vancouver score assessment.</p><p><b>RESULTS</b>There was obvious difference in the dermal depth and exposure rate of the fat granules among all the groups (P < 0.05 or 0.01). The fat exposure rate was positively correlated with the extent of the dermal defect (gamma = 0.554, P < 0.05). The Vancouver score in group A was lower than that in B and C groups (P < 0.05), while that in B1 group (3.714 +/- 2.498) was evidently higher than that in other groups (P < 0.01). The scar score was lowered when the wounds were grafted with the dermis with its thickness similar to the depth of the defect, The scar score was increased along with the elevation of fat exposure rate (P < 0.05).</p><p><b>CONCLUSION</b>There was a positive correlation between the degree of dermal defect and that of hyperplastic scar after burns. The disruption of fat dome structure might also be an important factor in the scar development.</p>