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Objective To explore the efficacy and safety of intracranial-intracranial bypass for the treatment of complex intracranial aneurysms. Methods and Results A total of 32 patients with complex intracranial aneurysms who were hospitalized for treatment at Huashan Hospital, Fudan University from January 2015 to December 2023 were included. Surgical methods included in-situ bypass, reimplantation, reanastomosis and bypass with interposition graft. For middle cerebral artery (MCA) aneurysms (n = 16), there were 5 cases of in-situ bypass, one case of reimplantation, 3 cases of reanastomosis, and 7 cases of bypass with interposition graft. For anterior cerebral artery (ACA) aneurysms (n = 8), there were 5 cases of in-situ bypass and 3 cases of reimplantation. For anterior communicating artery (ACoA) aneurysms (n = 2), both cases were in-situ bypass. For posterior circulation aneurysms (n = 6), there were 3 cases of in-situ bypass, 2 cases of reanastomosis, and one case of bypass with interposition graft. The intraoperative graft vessels patency rate was 100%. Among the 23 patients who participated in follow-up imaging for more than 6 months postoperatively, no obvious recurrence was indicated by imaging. Among the 28 patients who participated in modified Rankin Scale (mRS) follow-up, there was one case of 5, 5 cases of 3, 2 cases of 2, one case of 1, and 19 cases of 0. Postoperative hemorrhagic complications occurred in 3 cases (9.37%), and ischemic complications occurred in 10 cases (31.25%), with no patients requiring unplanned secondary surgery for complication treatment. Conclusions Intracranial - intracranial bypass has good efficacy and safety for the treatment of complex intracranial aneurysms and has unique advantages in the microsurgical treatment of complex intracranial aneurysms. [ABSTRACT FROM AUTHOR]

Snake bites are characterized by acute onset, rapid changes in condition, and high disability and mortality rates. The effects of snake venom on the human body are divided into systemic and local toxic effects. The popularity of antivenom has greatly reduced the mortality of snake bites, but local tissue damage and permanent dysfunction are still problems to be solved urgently. Studies have found that snake venom metalloproteinases, hyaluronidases, phospholi-pases and other venoms participate in a variety of local pathological effects by interfering with the degradation and remodeling of extracellular matrix (ECM). This article reviews the mechanism of ECM in the development of local tissue damage caused by snake bites, in order to find effective therapeutic targets and provide reference and ideas for the clinical research and prevention of local tissue damage caused by snake bites. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy and safety of large volume ligation device and tissue glue injection in the treatment of GOV gastric varicose veins, and to provide reference for the treatment of GOV gastric varicose veins. Methods A total of 150 patients with GOV type gastric varicose veins were prospectively included. Patients were divided into the endoscopic varicose vein ligation (EBL) group (78 cases) and the endoscopic varicose vein embolization (EVO) group (72 cases) according to their condition and willingness. In EBL group, GOV type gastric varices were treated by endoscopic ligation with a large volume ligation device. The EVO group was treated with tissue glue combined with cinnamyl alcohol injection. All patients were re-examined with gastroscopy 2-3 weeks after the first operation to observe whether varicose veins were residual and bleeding (if so, treatment should be repeated at this follow-up visit). Gastroscopy was performed at 1, 3 and 6 months after surgery to evaluate the main outcome measures after endoscopic treatment, including success rate of varicose vein hemostasis, technical success rate, eradication rate, recurrence rate and related complications (secondary indicators): endoscopy-related bleeding, fever, sepsis and distant embolization. Results There were no significant differences in technical success rate, hemostasis success rate, average treatment times and 6-month eradication rate of gastric varices between the EBL group and the EVO group. The recurrence rate was higher in the EVO group than that of EBL group (P＜0.05). The endoscopy-related bleeding rate and fever rate were lower in the EBL group than those in the EVO group (P＜0.05). In the EVO group, 1 patient developed pulmonary embolism after injection and 3 patients developed septicemia. Conclusion The short-term efficacy of high volume ligation device is similar to that of endoscopic injection of tissue glue in eradicating GOV gastric varices, but the former is safer than the latter. [ABSTRACT FROM AUTHOR]

Objective To screen the risk factors of hydrocephalus after decompressive craniectomy in patients with cerebral hernia after traumatic brain injury (TBI), and construct a Bayesian network model based on the risk factors. Methods A total of 77 patients with cerebral hernia after TBI who underwent decompressive craniotomy in Nanjing Tongren Hospital Affiliated to Southeast University from March 2020 to January 2022 were included. They were divided into hydrocephalus group (n = 25) and non - hydrocephalus group (n = 52) according to whether hydrocephalus was complicated after surgery. The risk factors of hydrocephalus after decompressive craniectomy in patients with cerebral hernia after TBI were analyzed by univariate and multivariate Logistic regression analyses. The Bayesian network model was constructed based on the risk factors, and the receiver operating characteristic (ROC) curve and calibration curve were drawn and Hosmer-Lemeshow goodness-of-fit test was conducted. Results In hydrocephalus group, the Glasgow Coma Scale (GCS) score at admission (t = 2.178, P = 0.032), the ratio of cerebrospinal fluid replacement after lumbar puncture (χ² = 8.675, P = 0.003), and the level of β2 -microglobulin after operation (t = 11.146, P = 0.000) were lower than those in non-hydrocephalus group, while subarachnoid hemorrhage (χ² = 5.901, P = 0.015), bilateral operation (χ² = 6.441, P = 0.011), the ratio of dural unstitched during operation (χ² = 9.759, P = 0.002), postoperative intraventricular hemorrhage (χ² = 8.938, P = 0.003), postoperative midline displacement > 10 mm (χ² = 7.589, P = 0.006), and intracranial infection (χ² = 4.519, P = 0.034), as well as postoperative coma time (t = 2.709, P = 0.008) were higher than those in non-hydrocephalus group. Logistic regression analysis showed that subarachnoid hemorrhage (OR = 1.885, 95%CI: 1.432-2.240; P = 0.012), dural unstitched during operation (OR = 1.468, 95%CI: 1.215-1.930; P = 0.006), long postoperative coma time (OR = 1.574, 95%CI: 1.358-1.926; P = 0.007), postoperative intraventricular hemorrhage (OR = 1.550, 95%CI: 1.254-1.768; P = 0.010), the level of β2- microglobulin increased after operation (OR = 1.622, 95%CI: 1.165-1.840; P = 0.004) were risk factors for hydrocephalus after decompressive craniectomy in patients with cerebral hernia after TBI. Based on these 5 factors, the Bayesian network model was constructed, and the area under ROC curve was 0.886 (95%CI: 0.823-0.925, P = 0.000). The calibration curve showed that there was a good consistency between the predicted probability and the actual probability, while the Hosmer-Lemeshow goodness-of-fit test showed no significant difference (χ² = 8.760, P = 0.232), which indicated that the model had good discrimination, calibration and accuracy. Conclusions Subarachnoid hemorrhage, dural unstitched during operation, long postoperative coma time, postoperative intra ventricular hemorrhage, and elevated β2 - microglobulin level are the risk factors for hydrocephalus after decompressive craniectomy in patients with cerebral hernia after TBI. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Infective endocarditis often leads to various vascular complications, among which cerebrovascular complications are associated with increased mortality in the early and late stages of the disease. Anticoagulant therapy for infective endocarditis is still controversial. How to balance the risk of cerebral embolism and bleeding events during the treatment is a difficult problem to define in clinical practice. This article reviews the epidemiology, pathophysiology, imaging evaluation methods and anticoagulation treatment strategies of disease-related cerebral embolism and bleeding events, in order to provide guidance for clinical anticoagulant treatment of infective endocarditis. [ABSTRACT FROM AUTHOR]

Objective　To investigate the efficacy of percutaneous transhepatic variceal embolization （PTVE） alone or in combination with partial splenic embolization （PSE） in the treatment of portal hypertensive hemorrhage in liver cirrhosis through a meta-analysis. Methods　This study was conducted according to PRISMA guideline， with a PROSPERO registration number of CRD42023396690. Wanfang Med Online， CNKI， CBM， VIP Databases， PubMed， Embase， the Cochrane Library， and Web of Science databases were searched for articles on PTVE alone or in combination with PSE in the treatment of portal hypertensive hemorrhage in liver cirrhosis published up to December 23， 2022. The articles were selected based on inclusion and exclusion criteria， and related data were extracted. The RevMan 5.4.1 statistical analysis software was used to perform the meta-analysis. Results　Eight articles were finally included， with a total sample size of 592 cases， among which there were 316 cases in the PTVE+PSE group and 276 cases in the PTVE group. The meta-analysis showed that compared with the PTVE group， the PTVE+PSE group had significantly lower postoperative portal vein pressure （standardized mean difference ［SMD］= − 1.75， 95% confidence interval ［CI］： −2.33 to −1.16， P<0.05）， postoperative diameter of the portal vein （SMD=−0.87， 95%CI： −1.64 to −0.10， P<0.05）， postoperative rebleeding rate （odds ratio ［OR］=0.17， 95%CI： 0.11 — 0.28， P<0.05）， mortality rate （OR=0.13， 95%CI： 0.04 — 0.37， P<0.05）， and incidence rate of postoperative portal hypertensive gastrointestinal disease （OR=0.17， 95%CI： 0.07 — 0.45， P<0.05］， as well as a significantly higher postoperative platelet level（ SMD=0.79， 95%CI： 0.52 — 1.06， P<0.05）， while there were no significant differences between the two groups in the incidence rates of postoperative ascites. Conclusion　Compared with PTVE alone， PTVE combined with PSE can effectively reduce the rebleeding rate and mortality rate of portal hypertensive hemorrhage in liver cirrhosis， the incidence rate of portal hypertensive gastrointestinal disease， and portal vein pressure， and it can also shorten the diameter of the portal vein and increase platelet level. Therefore， it is an effective interventional method for the treatment of portal hypertension hemorrhage in liver cirrhosis. [ABSTRACT FROM AUTHOR]

Portal vein thrombosis is one of the common complications of liver cirrhosis. The incidence of portal vein thrombosis is increased with the progression of diseases. The incidence and progression of portal vein thrombosis are associated with multiple factors. The indications of anticoagulant therapy remain to be investigated. At present, portal vein thrombosis is no longer considered as a contraindication for liver transplantation. Nevertheless, complicated portal vein thrombosis will increase perioperative risk of liver transplantation. How to restore the blood flow of portal vein system is a challenge for surgical decision-making in clinical practice. Rational preoperative typing, surgical planning and portal vein reconstruction are the keys to ensure favorable long-term prognosis of liver transplant recipients. In this article, epidemiological status, risk factors, typing and identification of portal vein thrombosis, preoperative and intraoperative management of portal vein thrombosis in liver transplantation, and the impact of portal vein thrombosis on the outcomes of liver transplantation were reviewed, aiming to provide reference for perioperative management of portal vein thrombosis throughout liver transplantation. [ABSTRACT FROM AUTHOR]

Tubal ectopic pregnancy with hydatidiform mole is extremely rare in clinical practice, and preoperative diagnosis is often difficult. The diagnosis is mainly based on the postoperative histopathology results. This article reports a 38 -year -old woman whom underwent laparoscopic right fallopian tube resection in an emergency due to rupture of right fallopian tube pregnancy. The postoperative pathology revealed completeness hydatidiform mole. The patient recovered well after surgery, with a satisfactory decrease in serum human chorionic gonadotropin (hCG) during the follow-up period. There were no symptoms of vaginal bleeding, coughing, hemoptysis, or related lesion metastasis. Tubal pregnancy with hydatidiform mole often manifests as acute abdominal disease. Therefore, for patients with acute abdominal disease, the possibility of hydatidiform mole should be paid to. The treatment is mainly based on surgery, and chemotherapy should be performed if necessary. After surgery, close follow -up is required, and doctors should be noting the possibility of lesion erosion and malignancy too. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Massive transfusion protocol (MTP) is a programmatic procedure for massive blood transfusions, which is an important means of patient blood management (PBM) for trauma and massive hemorrhage patients. MTP can be initiated in a variety of modes, including the McLaughlin, ABC and TASH scoring systems and the mode depending on the patient′s hemorheology. After MTP has been activated, blood components should be injected as soon as possible. Generally, red blood cells should be injected first, followed by plasma and platelets injected proportionally. MTP should be based on good damage control measures and good hemostatic treatment, and should try to avoid the waste of blood components.This article reviews the progress of research on MTP in the above aspects.

Objective To evaluate the risk of hemorrhagic complication after renal biopsy in patients with prolonged APTT and normal thromboelastography (TEG). Methods A total of 327 patients underwent ultrasound-guided percutaneous renal biopsy from January 2021 to July 2022. According to whether or not APTT was prolonged, they were divided into two groups of normal APTT (n=272) and prolonged APTT and normal TEG (n=55). Overt hemorrhagic complications were compared between two groups and subgroups (APTT prolonged 5 s). Also TEG parameters and overt hemorrhagic complication of patients with TEG data in two groups were compared and the correlation was examined between TEG and coagulation. Results No significant inter-group difference existed in baseline characteristics (P>0.05). The incidence of overt hemorrhagic complication was 3.68% in normal APTT group and 5.45% in prolonged APTT and normal TEG group. No significant inter-group difference existed in the incidence of overt hemorrhagic complication (P>0.05). The risk of hemorrhagic complication was not elevated in prolonged APTT and normal TEG group. Furthermore, no significant difference existed in the incidence of overt hemorrhagic complication between subgroups of APTT prolonged 5 s. Analysis of patients with TEG data revealed no significant inter-group differences in TEG parameters or the incidence of overt hemorrhage. Also weak correlation existed between reaction time and APTT. Conclusions APTT can not accurately predict the hemorrhagic risk after biopsy. And renal biopsy is feasible for patients with prolonged APTT and normal TEG.

OBJECTIVE: To conduct rapid health technology assessment ( HTA) on the efficacy, safety and economical efficiency of terlipressin in the treatment of cirrhotic esophagogastric variceal bleeding (EVB), so as to provide evidence-based evidence for clinical drug selection. METHODS: HTA reports, systematic review / Metaanalysis and pharmacoeconomic research on terlipressin in the treatment of cirrhotic EVB were enrolled by retrieving CNKI, Wanfang Data, PubMed and the Cochrane Library ( the retrieval period was from the establishment of the database to Dec. 2021 ), and HTA website ( the search time was up to Jan. 7th, 2022 ). Two researchers independently screened the literature and extracted data information. After quality evaluation of the included literature, descriptive analysis and classification evaluation of the extracted results were carried out. RESULTS: A total of one HTA report, seven systematic review / Meta analysis and four pharmacoeconomic researches were included. In terms of effectiveness, compared with placebo, terpressin significantly improved the early bleeding control rate (OR = 0. 47, 95%CI = 0. 32-0. 70,P = 0. 000 14) and reduced mortality (RR = 0. 66,95% CI = 0. 49-0. 88,P = 0. 004 2), with statistically significant differences. Compared with other vasopressin, somatostatin and octreotide, terlipressin had no obvious advantage. In terms of safety, the incidence of adverse drug reactions of terlipressin was significantly lower than vasopressin, with statistically significant differences (OR = 0. 15,95%CI = 0. 03-0. 78,P = 0. 02). There was no significant difference between terlipressin and octreotide in the incidence of adverse drug reactions, incidence of death caused by adverse events and incidence of drug withdrawal caused by adverse events (P > 0. 05). Compared with somatostatin, terlipressin had higher incidence of adverse drug reactions, and the difference was statistically significant (OR = 2. 44,95%CI = 1. 03-5. 80,P = 0. 04), yet there was no statistically significant difference in the incidence of death caused by adverse events and incidence of drug withdrawal caused by adverse events (P> 0. 05). Results of three economics studies from China, the United Kingdom and Belgium showed that terlipressin has some cost advantages over somatostatin and octreotide, yet the reference value of the results of foreign studies was small. CONCLUSIONS: Terlipressin has significant efficacy and safety in the treatment of cirrhotic EVB, it is necessary to carry out further economic evaluation in China. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is an advanced life support modality for patients with respiratory or cardiac failure. During ECMO, various factors impair coagulation function, resulting in an imbalance between procoagulation and anticoagulation, thus increasing the incidence of bleeding and posing a significant challenge to the development of clinical work. In this article, the epidemiology, causes, anticoagulation and monitoring of high-risk bleeding during ECMO were reviewed, aiming to provide reference for clinical practice. [ABSTRACT FROM AUTHOR]

Objective To investigate the hemostatic effect of transanal prostatic resectoscope technology on massive rectal bleeding after transrectal prostate biopsy. Methods From May 2016 to March 2022, 483 patients underwent transrectal prostate biopsy, 5 patients of them had hemodynamic deterioration due to massive rectal bleeding within 3 to 8 hours after operation. After active rehydration and blood transfusion, transanal prostatic resectoscope technology was applied to check the biopsy region and coagulate the active bleeding point. After hemostasis, the anal tube was retained for drainage for 24 to 72 hours and then removed. Results The average bleeding volume was about 440 mL (400 mL -1 000 mL) ; Average blood transfusion volume; RBC 2. 0 U/case, homoplasma 520 mL/case; The average operation time was 25 minutes (20-30 minutes) ; Rebleeding, local infection, hyponatremia and hypokalemia was not observed; The mean hospital stay was 4. 5 days (3-7 days) . Conclusion Transanal prostatic resectoscope technology is an effective method for rapid control of massive rectal bleeding after transrectal prostate biopsy. This method has obvious advantages in direct vision, clea vision, visible bleeding point, accurate and reliable hemostasis. [ABSTRACT FROM AUTHOR]

Background and objective For resectable non-small cell lung cancer (NSCLC), the CheckMate-816 study demonstrated that neoadjuvant chemoimmunotherapy increased the rate of complete pathologic response (pCR) by 21.8% compared with chemotherapy alone and resulted in a significant benefit in event-free survival (EFS). This study aimed to investigate the safety and feasibility of this approach in the real world. Methods Clinical data from patients with NSCLC who underwent surgery after neoadjuvant chemoimmunotherapy or chemotherapy alone in two centers were analyzed retrospectively, and subgroup analyses were performed for the chemoimmunotherapy group according to treatment cycle. The primary study endpoints were EFS and major pathologic response (MPR), and the secondary study endpoints were pCR, overall survival (OS), treatment-related adverse events (TRA.Es), and surgery-related metrics. Results As of April 2023, 89 patients had been enrolled, including 54 in the chemoimmunotherapy group and 35 in the chemotherapy alone group. MPR was achieved in 31 (57.4%) and 5 (14.3%) patients in the chemoimmunotherapy group and chemotherapy alone group, respectively (OR=8.09, 95%CI: 2.72-24.04, P<0.001); pCR was achieved in 25 (46.3%) patients in the chemoimmunotherapy group and no patient in the chemotherapy alone group (P<0.001). The median follow-up time was 22.1 months. At 24 months, the EFS rates of the chemoimmunotherapy group and the chemotherapy alone group were 77.0% and 56.7%, respectively (P=0.026), and the OS rates were 87.1% and 67.7%, respectively (P=0.020). In the neoadjuvant chemoimmunotherapy group, there was no significant difference between the 1-2 cycles and 3-5 cycles groups in terms of operation time, intraoperative blood loss, and postoperative complications. Conclusion Neoadjuvant chemoimmunotherapy was more effective than chemotherapy alone and did not increase the risk associated with surgery. An increase in the number of cycles of neoadjuvant chemoimmunotherapy had no significant effect on the difficulty of surgery. [ABSTRACT FROM AUTHOR]

Copyright of Practical Oncology Journal is the property of Journal of Practical Oncology Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the correlation between ApoB/ApoA1 and vitreous hemorrhage (VH) secondary to diabetic retinopathy (DR). Methods 187 patients with DR from August 2021 to December 2022 were recruited and divided into VH (n=96) and non-VH groups (n=91). Baseline data were compared between two groups. The risk factors of VH secondary to DR were analyzed by Logistic regression analysis. Results There were no significant differences in age, gender, course of disease, body mass index (BMI), history of hypertension, smoking and drinking between two groups (all P > 0.05). In the VH group, fasting plasma glucose (FPG), glycosylated hemoglobin A1 (c HbA1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), ApoB/ApoA1 and FIBrinogen (FIB) were significantly higher compared with those in the non-VH group, and the differences were statistically significant (all P < 0.05), while there were no significant differences in TG, APTT, PT and TT between two groups (all P > 0.05). HbA1c (OR=1.438 (1.179-1.864) ), ApoB/ApoA1 (OR=25.274 (5.699~112.092) ) and FIB (OR=1.471 (1.022~2.118)) were the risk factors for VH (all P < 0.05). Conclusions HbA1c, ApoB/ApoA1 and FIB are closely related to VH. Monitoring blood glucose, lipid and coagulation and timely intervention can delay the progression of DR and reduce the incidence of VH. [ABSTRACT FROM AUTHOR]

Platelets are important components of the blood system. There are many kinds of concentrated platelets and their derivatives, among which platelet-rich plasma (PRP ), growth factors (GFs) and platelet-rich fibrin (PRF) have been widely used in clinical practice. Lyophilized platelets (Lyo-P) or freeze-dried platelets (FDP) are prepared from concentrated platelets by freeze-drying and have the advantages of long storage time at room temperature, light weight, convenient transportation, inactivation of pathogens, etc. Lyo-P contain high concentration of GFs, fibrin, white blood cells and various cytokines. In addition to their hemostatic and coagulative functions, Lyo-P and their products are increasingly used in wound healing, tissue repair, cosmetology, reproductive medicine and other fields.

OBJECTIVE: To explore the clinical characteristics and risk factors of patients with hemorrhage of digestive tract caused by antiplatelet drugs. METHODS: Retrospective study method was used, a total of 180 patients with cardiovascular and cerebrovascular diseases who were treated with antiplatelet drugs [ aspirin and ( or ) clopidogrel] for hemorrhage of digestive tract from 2021 to 2022 in the gastroenterology department of the hospital were extracted as the observation group, and 180 patients with cardiovascular and cerebrovascular diseases who were treated with antiplatelet drugs [ aspirin and ( or) clopidogrel] during the same period without hemorrhage of digestive tract were extracted as the control group. The clinical characteristics of hemorrhage of digestive tract in the observation group were analyzed. General demographic data, biochemical indexes and the use of antiplatelet drugs were collected. Logistic regression analysis was used to explore the influencing factors of hemorrhage of digestive tract caused by antiplatelet drugs, and the receiver operator characteristic curve was established to evaluate the accuracy of the influencing factors in predicting hemorrhage of digestive tract. RESULTS: Of the 180 patients with hemorrhage of digestive tract, the highest proportion of the first clinical symptoms was black stool ( 72 cases, 40. 0%), and the lowest proportion was only stool occult blood test positive (17 cases, 9. 4%). The proportion of patients with mild bleeding was the highest (87 cases, 48. 3%), followed by moderate bleeding (74 cases, 41. 1%). The proportion of patients with moderate anemia took the lead (97 cases, 53. 9%), while patients with severe anemia were the lowest (35 cases, 19. 4%). The main endoscopic lesions were erosive gastritis (110 cases, 61. 1%), followed by peptic ulcer (38 cases, 21. 1%). Logistic regression analysis showed that age, history of hypertension, history of digestive tract diseases, Helicobacter pylori ( Hp ) infection, Hp infection complicated with mucosal atrophy, abnormal hemoglobin (Hb), abnormal serum creatinine (Cr), type of drug use, course of treatment, and combination of PPI were the influencing factors for hemorrhage of digestive tract caused by antiplatelet drugs (P<0. 05). The obtained dependent variables were combined to predict the probability of hemorrhage of digestive tract caused by antiplatelet drugs, with a predictive sensitivity of 0. 606, a specificity of 0. 900, a Yoden index of 0. 506, a threshold of 0. 616, and an area under the curve of 0. 809. CONCLUSIONS: The first symptom of hemorrhage of digestive tract caused by antiplatelet drugs is mostly black stool. Mild to moderate bleeding and moderate anemia can be observed. Age, history of hypertension, history of digestive tract diseases, Hp infection, Hp infection complicated with mucosal atrophy, abnormal Hb, abnormal Cr, type of drug use, course of treatment, and combination of PPI are related factors that affect hemorrhage of digestive tract caused by antiplatelet drugs. Clinical intervention should be actively targeted at bleeding factors, and joint evaluation of factors affecting hemorrhage of digestive tract caused by antiplatelet drugs has certain predictive value. [ABSTRACT FROM AUTHOR]

日本ではかつてフィブリノゲン製剤を使用した患者が, C型肝炎ウィルスに感染する被害を受けたことにより,998 年以降の効能・効果は先天性無（低）フィブリノゲン血症のみに限定され，危機的出血への適応は除外されてきた． その後, 一部医学会等による適応拡大に向けた取組は, 審査当局より歴史的経緯を理由に見送られてきた．閉塞した 状況の中, 輸血•細胞治療学会, 産科婦人科学会, 心臓血管外科学会の三学会は薬害HIV訴訟原告団の大平氏, 花 井氏, 秋野参議院議員の協力を得て, 製剤が危機的出血にも使用できるよう活動を開始した．公開討論と秋野議員に よる国会質疑を経て,厚生労働省がようやく動き,「医療上の必要性の高い未承認薬•適応外薬検討会議」の審議を 経て, 2021年産科危機的出血に伴う後天性低フィブリノゲン血症に対する保険適用が実現した．産科婦人科学会は フィブリノゲン製剤の適正使用について全数調査を行い,心臓血管外科学会は,フィブリノゲンを高濃度で含むクリ オプレシピテートを代替として使用しつつ,適正使用に向けて観察研究を実施している．医療者は議論を後押しした 被害者の意に背かぬよう適正使用を徹底し,薬害を二度と繰り返さないことが肝要である. [ABSTRACT FROM AUTHOR]

Copyright of Evaluation & Analysis of Drug-Use in Hospitals of China is the property of Evaluation & Analysis of Drug-Use in Hospitals of China Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Esophagogastric variceal bleeding (EGVB) is one of the main complications of decompensated portal hypertension, especially in patients with liver cirrhosis, and it often has a high mortality rate. Medication combined with endoscopy is the main prevention and treatment method for EGVB, while transjugular intrahepatic portosystemic shunt (TIPS) combined with variceal embolization can also be selected for some high-risk patients, and individualized diagnosis and treatment of portal hypertension based on hepatic venous pressure gradient should become the latest consensus and the main strategy. This article mainly reviews endoscopic therapy and TIPS for the prevention and treatment of EGVB patients with decompensated portal hypertension in terms of selection of indications, incidence rate of complications, and respective advantages and disadvantages. [ABSTRACT FROM AUTHOR]

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to establish a portosystemic shunt between the hepatic vein and the portal vein via the jugular approach, so as to reduce portal venous pressure and control acute esophagogastric variceal bleeding (EGVB). The prognosis of EGVB has been improved significantly over the past few decades, and endoscopic variceal ligation combined with drug therapy is now recommended as the first-line treatment regimen for this disease. The latest research advances in the management of EGVB over the past decade have focused on the relatively new concept of "early" or "pre-emptive" TIPS, that is to say, early TIPS (within 72 hours after admission, ideally within 24 hours) is recommended for patients with EGVB who are at a relatively high risk of failure in standard treatment. This article briefly introduces the effect of early TIPS on controlling bleeding, mortality rate, and hepatic encephalopathy, the high-risk population for early TIPS, timing of intervention, cost effectiveness, the applications of early TIPS in a real-world setting, and recommendations for early TIPS in international guidelines and consensus statements [ABSTRACT FROM AUTHOR]

Spontaneous hemoperitoneum in pregnancy (SHiP) is a very rare and serious complication of pregnancy. Closely associated with endometriosis, and lack of specificity in clinic, it will increase the morbidity of the fetus and the mother. A SHiP case was reported that both mother and fetus were safe after operation. A 30-year-old primigravida was hospitalized with persistent lower abdominal pain lasting for half an hour at 39+2 weeks. She suffered from endometriosis and received laparoscopic surgery for rupture of ovarian endometrioma four months prior to the current pregnancy. An emergency cesarean section due to suspected fetal distress and possible placental abruption was performed and a healthy female neonatal was delivered with Apgar score of 10 at 1 min, and no placental signs of abruption. During the operation, 1 200 mL of intraperitoneal hemorrhage was seen. A new active bleeding venous vessel was seen in the middle and lower segment of the right posterior wall of the uterus. The bleeding was treated and healed by suturing. SHiP requires early detection, rapid diagnosis and appropriate intervention to improve maternal and fetal outcomes in clinical practice. [ABSTRACT FROM AUTHOR]

This paper summarized the nursing management for a long-term bedridden elderly patient with nasal feeding diet complicated with various diseases. During the daily oral care, the patient swallowed the mouth care straw tip (silicone foreign body) accidentally. Given the old age and poor gastrointestinal function of the patient, targeted intervention was implemented followed by precisely locating foreign body. Comprehensive nursing measures including biochemical index monitoring, medication care and prevention of complications were carried out to ensure the successful removal of the foreign body (本文总结1例高龄、合并多种疾病且长期卧床的鼻饲饮食患者发生异物吞食事件的护理体会。老年人群胃肠功能减弱, 通过检查定位异物位置, 针对性采取消化道异物处理方式, 同时注意生化指标监测、用药以及并发症预防等细节护理, 以促进异物顺利排出体外。)

目的 旨在统计SWI相位图病灶本身信号强度（直接征象）鉴别单纯出血或钙化发生错判的概率，并通过logistic回归分析确定错判的独立影像学危险因素，为影像及临床医师鉴别诊断提供依据。 方法 回顾性分析2016-2019年首都医科大学附属北京天坛医院单纯出血或钙化病例，连续性入组。将SWI图像进行标准化，即将左手图变成右手图。含有多个病灶者，所有病变逐个评估。两名观察者直观定性评估SWI相位图数据：低、高信号或无法判断（混杂或等信号），预测病变为出血或钙化。与CT诊断“金标准”进行对比，预判结果与CT结果不一致者认定为失败组，一致者为成功组。评估的临床及影像学影响因素包括年龄、性别、病灶直径、平均CT值、T1WI和T2WI信号、SWI相位图病灶本身信号强度（直接征象）、左右手图、病灶位置、侧别、单多发及病灶性质。采用logistic回归分析SWI相位图病灶本身信号强度法鉴别失败的影响因素。 结果 共纳入受试者41例，病灶339个，钙化及出血病灶分别为157个及182个。失败组105个病灶，成功组234个病灶。通过SWI相位图病灶本身信号强度（直接征象）错判率为30.97%。多因素logistic回归分析显示，SWI相位图等或混杂信号（OR 97.263，95%CI 28.746～329.096，P4 mm（OR 2.437，95%CI 1.168～5.084，P=0.018）是导致SWI相位图病灶本身信号强度（直接征象）错判的独立危险因素。 结论 SWI相位图病灶高或混杂信号者、T2WI低或混杂信号者、CT值91～300 Hu者及病灶直径>4 mm者采用SWI相位图病灶本身信号强度（直接征象）方法鉴别单纯出血及钙化错误风险高，对临床及影像学诊断有一定指导作用。 Objective To investigate the influencing factors for false differentiating simple hemorrhage from calcification by cerebral lesion signal intensity on SWI phase image. Methods This retrospective analysis enrolled the consecutive patients with simple calcifications and/or microhemorrhage on head SWI phase image at Beijing Tiantan Hospital, Capital Medical University between 2016 and 2019. Follow-up CT scan was taken as the gold standard. The evaluation standard on right handed SWI phase image: low and high intensity signal sign for hemorrhage and calcification, respectively. The clinical and imaging parameters included gender, age, lesion side, location, diameter, single or multiple lesions, lesion nature, CT value, T1WI and T2WI signal, lesion signal intensity on SWI phase image, left- or right-handed MR image. Multivariate logistic regression analysis was used to analyze the influencing factors for false differentiating the lesions. Results A total of 339 lesions from 41 cases were analyzed, including 157 hemorrhage lesions and 182 calcification lesions. 234 lesions were correctly diagnosed and 105 lesions were incorrectly diagnosed, and the false diagnosis rate was 30.97% by the signal intensity on SWI phase image. Multivariate logistic regression analysis showed that equal or mixed signal intensity (OR 97.263, 95%CI 28.746-329.096, P

This paper summarizes the nursing experience of a patient who received endoscopic variceal ligation in the treatment of esophageal varices, including preoperative psychological care, instrument preparation, patient preparation, intraoperative care, postoperative general care, complication care and other targeted nursing measures. Through the comprehensive nursing mode, full preoperative preparation, close surgical cooperation, and meticulous postoperative care, the success of esophageal variceal ligation was guaranteed, the pain of patients was reduced, the patient's symptoms were improved. (本文总结1例内镜下食管静脉曲张套扎术治疗食管静脉曲张患者的护理体会, 包括术前的心理护理、器械准备、患者准备、术中护理、术后一般护理、并发症护理等针对性护理措施。充分的术前准备、密切的手术配合和细致的术后护理是保障食管静脉曲张套扎术成功的关键, 有助于减轻患者疼痛, 改善患者病症, 促进其康复。)

目的 比较SWI相位图病灶本身信号强度（传统直观）法与病灶周围征象即极晕（间接）法对单纯出血或单纯钙化的诊断效能。 方法 本研究纳入以随访CT为“金标准”（单次病灶CT或复查CT值变化）的单纯钙化灶和单纯出血灶。针对每个病灶分别采用SWI相位图病灶本身信号强度（传统直观）法和病灶周围极晕（间接）法评估。SWI相位图全部转换为右手图后再进行评估。SWI相位图病灶本身信号强度（传统直观）法评估标准：病灶本身呈低、高信号分别代表出血及钙化。病灶周围极晕（间接）法评估标准：低信号两极征或高信号反晕征，认定病变为出血；高信号两极征或低信号反晕征，认定病变为钙化。用科恩Kappa值评估两名观察者评判相位图病灶本身信号强度、病灶周围极晕结果的一致性。采用阴性预测值、阳性预测值、敏感度及特异度评估上述两种方法鉴别钙化的诊断效能。 结果 共纳入224个病灶（共36例患者）。其中出血灶123个病灶（8例患者），钙化灶101个病灶（28例患者）。两名观察者病灶本身信号强度法（K=0.768）及病灶周围极晕法（K=0.876）分析SWI相位图的结果一致性较好。SWI相位图病灶本身信号强度法鉴别钙化的阳性预测值、阴性预测值、敏感度及特异度分别为66.7%、70.2%、61.4%、74.8%。病灶周围极晕法鉴别钙化的阳性预测值、阴性预测值、敏感度及特异度分别为99.0%、97.6%、97.0%、99.2%。 结论 SWI相位图病灶周围极晕法具有潜在的临床实用价值，有可能成为一种简便易行的MR鉴别单纯出血或钙化的方法。 Abstract: Objective To compare the diagnostic value of traditional method of signal intensity of foci and indirect signs (reversed halo sign and bipolar sign) on SWI phase image in differentiating simple calcification from hemorrhage. Methods The included simple calcification and simple hemorrhage were confirmed by follow-up CT scan. All the lesions were evaluated by traditional method and indirect polar-halo method. The evaluation standard of traditional method as follows: low and high intensity sign representing hemorrhage and calcification, respectively. The evaluation standard of indirect method as follows: low signal intensity bipolar sign or high signal intensity reversed halo sign representing hemorrhage, and high signal intensity bipolar sign or low signal intensity reversed halo sign representing calcification. The Kappa value was calculated to evaluate the consistency of lesion signal intensity and peri-lesion polar-halo sign results between the two observers. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated to evaluate the diagnosis value of SWI direct and indirect characteristics in differentiating simple calcification and hemorrhage. Results A total of 224 lesions (36 patients) were included, with 101 simple calcifications (28 patients) and 123 simple hemorrhagic lesions (8 cases). The consistency coefficient of the two observers on traditional method and indirect polar-halo method was 0.768 and 0.876, respectively. The PPV, NPV, sensitivity and specificity of traditional method in identifying calcification were 66.7%, 70.2%, 61.4% and 74.8%, respectively. The PPV, NPV, sensitivity and specificity of polar-halo method in identifying calcification were 99.0%, 97.6%, 97.0% and 99.2%, respectively. Conclusions The indirect polar-halo sign on SWI phase image has a higher diagnostic accuracy, which may be a more reliable way to differentiate simple hemorrhage from simple calcification.

Objective To analyze the factors influencing intraoperative massive hemorrhage in infants with intracranial tumors and establish a bleeding risk scoring （BRS） model. Methods Clinical data of 278 infants who underwent elective intracranial tumor resection were retrospectively analyzed. According to the ratio of blood loss （BL） to estimated blood volume （EBV）, all infants were divided into the slight or moderate hemorrhage group （BL/EBV≤0.5） and massive hemorrhage group （BL/EBV > 0.5）. Relevant clinical data and hemorrhage were statistically analyzed. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for intraoperative massive hemorrhage and establish a BRS model. Forty-five infants undergoing intracranial tumor resection were recruited in this study. The receiver operating characteristic （ROC） curve was delineated to evaluate the performance of this model. Results One hundred and eighty-three infants were assigned into in the slight or moderate hemorrhage group and 95 in the massive hemorrhage group. Logistic regression analysis demonstrated that body weight ≥12 kg, tumor diameter ≥4.5 cm,and operation time ≥ 5 h were the independent risk factors for intraoperative massive hemorrhage （all P < 0.05）. The score of tumor diameter ≥4.5 cm was set as 5, and 2 for operation time≥5 h. The total score of infant was calculated as BRS. The area under the ROC curve （AUC） of BRS model in the retrospective population was 0.788. If the critical value for massive hemorrhage was determined as 5, the sensitivity was 66.8%, the specificity was 81.3%, and the accuracy was 71.0%, while in the prospective population, the ROC AUC was 0.909, the sensitivity, specificity and accuracy were 78.6%, 88.9% and 87.0%, respectively. Conclusions Preoperative tumor diameter≥4.5 cm and operation time≥5 h are the independent risk factors for intraoperative massive hemorrhage in infants undergoing intracranial tumor resection. The BRS model established based on these factors has high predictive ability for intraoperative massive hemorrhage in infants with intracranial tumors.

Objective To investigate the effect of predictive nursing strategies on preventing side effects of azacitidine in patients with high-risk myelodysplastic syndrome. Methods Totally 40 patients undergoing subcutaneous injection therapy with azacitidine for high-risk myelodysplastic syndrome were randomly divided into the observation group and control group, with 20 cases in each group. Routing nursing management including posture nursing, oral care, psychological care and nursing of adverse reactions was carried out in the control group. In the observation group, a special nursing team was set up to enhance the predictive nursing interventions such as nutrition support, prevention of infection and hemorrhage, and so on. The side effects of azacitidine therapy were observed analyzed. Results The incidence of adverse reactions in the observation group was significantly lower than that in the control group (10. 00% vs. 45. 00%, P＜0. 05). Conclusion For those patients undergoing subcutaneous injection therapy with azacitidine for high-risk myelodysplastic syndrome, the predictive nursing is potentially effective to reduce the incidence of adverse drug reactions. (目的 探讨预见性护理干预预防较高危骨髓增生异常综合征患者阿扎胞苷治疗所致不良反应的效果。方法 40例较高危骨髓增生异常综合征患者随机分为观察组(n=20)和对照组(n=20)。两组患者均给予阿扎胞苷皮下注射治疗。对照组实施常规护理, 包括体位护理、口腔护理、心理护理和不良反应护理; 观察组实施预见性护理干预, 成立预见性护理小组, 强化营养干预、感染预防、出血预防等护理措施。比较两组不良反应发生情况。结果 观察组不良反应发生率10. 00%(2/20), 低于对照组的45. 00%(9/20), 差异有统计学意义(P＜0. 05)。结论 对较高危骨髓增生异常综合征患者, 应用阿扎胞苷治疗的同时配合预见性护理, 可以有效降低不良反应的发生风险。)

Objective The purpose of this study was to to determine the dignostic accuracy of flat-panel CT scans in predicting hemorrhagic transformation (HT) for patients with acute ischemic stroke (AIS) after thrombectomy. Methods From January 2019 to December 2021, consecutive AIS patients who received an immediate flat-panel CT scan after thrombectomy were enrolled in this study.The time window for the observation of HT was 5-7 days after the thrombectomy, which was determined according to the brain un-enhanced CT scan. The receiver operating characteristic (ROC) curve was adopted to assess the predictive accuracy of characteristics of flat-panel CT for HT. Results Totals of 108 patients were enrolled in this study, 58 (53.7%) patients presented with hyperdense lesions on flat-panel CT. Patients with hyperdense lesions experienced a higher proportion of HT than those patients without (58.7% vs. 10.0%, P＜0.001) .The hyperdensity on flat-panel CT predict HT yielded a sensitivity of 87.2% and a negative predictive value of 90.0%. Among all patients with hyperdensity on flat-panel CT, patients who developed HT had higher CT values (125 HU vs. 93 HU, P=0.001) and a higher proportion of mass effect (67.6 vs. 12.5, P＜0.001) . The area under the ROC curve of CT values, mass effect, and combination of above for prediction of HT were 0.74, 0.78, and 0.83, respectively. Conclusion The hyperdensity on post-thrombectomy flat-panel CT could detect HT with an excellent negative predictive value. The ability of flat-panel CT in predicting the transformation of hyperdensity into HT was improved when combined with CT values and mass effect. [ABSTRACT FROM AUTHOR]

Copyright of Bulletin of the Chinese Ceramic Society is the property of Bulletin of the Chinese Ceramic Society Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Liver cirrhosis is a common chronic liver disease in clinical practice, and the main causes of this disease include virus, alcohol, and immunity. Patients may experience a variety of complications in the late stage of liver cirrhosis, including upper gastrointestinal bleeding, hepatic encephalopathy, hepatorenal syndrome, and liver cancer, among which upper gastrointestinal bleeding is the main cause of death, and therefore, the control and prevention of upper gastrointestinal bleeding caused by liver cirrhosis is the key to reducing mortality rate and prolonging survival time. This article summarizes the commonly used minimally invasive methods for the treatment of upper gastrointestinal bleeding in liver cirrhosis and analyzes the indications for different treatment methods and related advances, so as to provide a reference for clinicians to choose the most suitable treatment regimen for the patient, thereby improving the survival rate of patients. [ABSTRACT FROM AUTHOR]

Background and objective With the extensive application of segmental lung resection in the treatment of early-stage lung cancer, how to complete segmentectomy more accurately and minimally invasively has become a research hotspot. The aim of this study is to explore the application of three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with perfusion area recognition technique in single-hole thoracoscopic complex segmentectomy. Methods From January 202 to January 2022, the clinical data of 2 consecutive patients undergoing single-port thoracoscopic complex segmentectomy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The three-dimensional reconstruction combined with perfusion area identification technique was used to perform the operation and the clinical data were analyzed. Results The average operation time was (141.1±35.4) min; the initial time of intersegmental plane display was (12.5±1.7) s; the maintenance time of intersegmental plane was (114.3±10.9) s; the intersegmental plane was clearly displayed (100%); the amount of bleeding was [10 (10, 20)] mL; the total postoperative drainage volume was (380.5±139.7) mL; the postoperative extubation time was (3.9±1.2) d; and the postoperative hospitalization time was (5.2±1.6) d. Postoperative complications occurred in 8 cases. Conclusion The advantages of 3D-CTBA combined with perfusion area recognition technique are fast, accurate and safe in identifying intersegmental boundary in single-port thoracoscopic complex segmentectomy, which could provide guidances for accuratding resection of tumors, shortening operation time and reducing surgical complications. [ABSTRACT FROM AUTHOR]

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To develop an artificial neural network model to predict the risk of rebleeding within one year in cirrhotic patients with esophagogastric variceal bleeding. Methods We retrospectively collected 441 cirrhotic patients with esophagogastric variceal bleeding hospitalized at Beijing Ditan Hospital, Capital Medical University, from August 2008 to October 2017. The enrolled patients were followed up for one year. According to the primary endpoint which was rebleeding within one year, patients were divided into rebleeding(249 cases) and non-rebleeding(192 cases) groups. Fisher exact test or chi-square test were used for comparison of categorical data. Comparison of continuous data with normal distribution between groups was performed using t test, while comparison of non-normally distributed data was performed by Mann-Whitney U test. Cox univariate and multivariate regression were used to identify independent factors affecting rebleeding within one year in cirrhotic patients with esophagogastric variceal bleeding, and then an artificial neural network prediction model was constructed using identified factors. The predictive performance of the model was evaluated using the area under the receiver operating characteristic curve(AUC). Results In total, 249(56.5%) patients developed esophagogastric variceal rebleeding within one year. Cox multivariate regression showed INR(AHR=1.566, 95%CI: 1.023～2.398, P=0.039) and NLR(AHR=1.033, 95%CI: 1.009～1.058, P=0.006) were risk factors for 1-year rebleeding, while CHB(AHR=0.769, 95%CI: 0.597～0.991, P=0.042), Na(AHR=0.967, 95%CI: 0.936～0.999, P=0.044), endoscopic(AHR=0.829, 95%CI: 0.743～0.926, P=0.001) and surgical treatment(AHR=0.246, 95%CI: 0.120～0.504, P<0.001) were protective factors. Using the above six independent influence factors, we successfully constructed an artificial neural network model(https://lixuan.me/annmodel/myg-v3/). The model’s ability to predict 1-year rebleeding had an AUC of 0.782(95%CI: 0.740-0.825), which was higher than 0.672(95%CI: 0.622-0.722, P<0.001) of Cox regression model, 0.557(95%CI: 0.504-0.610, P<0.001) of Child-Pugh and 0.562(95%CI: 0.509-0.616, P<0.001) of MELD scores. Conclusion The artificial neural network model has good individualized prediction performance and can be used as a risk assessment tool for esophagogastric variceal rebleeding. [ABSTRACT FROM AUTHOR]

Objective To analyze the rebleeding rate in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) after endoscopic treatment of esophagogastric variceal bleeding and then assessed the risk factors of the rebleeding in the patients. Methods This study retrospectively recruited 169 hepatitis B - associated HCC patients complicated with PVTT and esophagogastric variceal bleeding treated by endoscopy in Department of Gastroenterology, Beijing Di tan Hospital from September 2008 to December 2016. Among them, 47 patients had PVTTlI, 67 patients had PVTTIII, and 55 patients had PVTTIV. Their clinicopathological and follow - up data were retrieved from the medical records and statistically analyzed. Continuous data were compared among groups using ANOVA or Kruskal - Wallis H test. Categorial data were compared among groups using Chi - square test or corrected Fisher test. The Kaplan - Meier curves and Log - rank test were performed to analyze the rebleeding rate and cumulative survival rates after treatment. The univariate multivariate Cox regression analyses were used to identify the risk factors affecting the rebleeding of patients. Results Compared with PVTT II and III, PVTTIV patients had a higher serum level of the direct bilirubin (Z = 6. 153, P = 0. 046). The endoscopy treatment successfully blocked esophagogastric variceal bleeding in all patients. There was no significant difference in the rebleeding rates within six months and a year after the treatment (all P > 0. 05 ). It was also no statistically significant difference in cumulative survival rates in six months and 1 -, 2 -, and 3 - year after the treatment in PVTT lI, III, and N patients (all P > 0 . 05). Cox multivariate regression analysis showed that hepatic encephalopathy (HR = 3. 643, 95 % CI: 2. 099 - 6. 325, P < 0. 001), γ - glutamyltransferase (HR = 1. 002, 95 % CI: 1. 000 - 1. 005, P = 0 029), AFP (HR= 1. 000, 95% CI: 1. 000 -1. 000, P = 0. 002) and numbers of tumor lesions (HR= 1. 647, 95% CI: 1. 011 -2. 684, P = 0. 045) were all independent risk factors for 1 - year rebleeding in these PVTT patients with esophagogastric variceal bleeding after endoscopic treatment. Conclusion Endoscopic hemostasis is a feasible treatment option for HCC patients with PVTT and esophagogastric variceal bleeding. However, there was no significant difference in the rebleeding and cumulative survival rates in these patients. Furthermore, hepatic encephalopathy, γ - glutamyltransferase, AFP and numbers of tumor lesions were all independent risk factors for 1 - year rebleeding in these patients. [ABSTRACT FROM AUTHOR]

Reconstructed rebalanced hemostasis exists in patients with liver cirrhosis, while such balance is unstable and can be easily broken by stress factors, which may lead to bleeding or thrombosis. There is a lack of effective strategies to prevent and solve the disrupted balance in clinic due to the complex pathogenesis of rebalanced hemostasis, limited testing methods, and insufficient awareness among clinicians. With reference to the articles in recent years, this article summarizes the mechanism of rebalanced hemostasis in liver cirrhosis and the causes of bleeding and thrombosis and discuss the association between blood transfusion and rebalanced hemostasis and the selection of anticoagulant drugs during thrombosis, in order to provide a theoretical basis and new ideas for solving related issues in clinical practice. [ABSTRACT FROM AUTHOR]

To explore the risk factors of hemorrhage induced by argatroban in patients with progressive cerebral infarction and to establish a risk prediction model. Methods Totally 216 inpatients treated with argatroban due to progressive cerebral infarction were divided into the bleeding group and non-bleeding group according to whether hemor⁃ rhage occurred or not. Univariate analysis was used to identify risk factors for bleeding，and then we established a risk pre⁃ diction model of bleeding by multivariate Logistic regression analysis. Results Among 216 patients，bleeding occurred in 39 cases（18. 06%）after treatment，including massive bleeding（10. 3%）and minor bleeding（89. 7%）. The results of multivariate Logistic regression analysis demonstrated that BMI，whether the anticoagulants were used within 48 h，wheth⁃ er cerebrovascular intervention therapy was received，and the admission blood glucose were independent influence factors for bleeding after argatroban treatment. Further，the combined predictor Y was obtained（Y=-0. 206-2. 042XBMI（1）- 2. 459XBMI（2）-1. 677XBMI（3） + 2. 775X whether anticoagulants were used-2. 673X whether cerebrovascular intervention therapy was received + 0. 102X admission glucose），and the area under the receiver operating characteristic（ROC）curve（AUC）was 0. 738. Conclusions The progressive cere⁃ bral infarction patients with low BMI，high blood glucose at admission，combined use of anticoagulants，and no cerebral vascular intervention have a higher bleeding probability after applying argatroban. The model constructed in this study has a good predictive ability，which can effectively identify the patients at high risk of bleeding induced by argatroban treat⁃ ment from patients with progressive cerebral infarction [ABSTRACT FROM AUTHOR]

Objective To explore the pathogenic mechanism and management of moyamoya disease (MMD) concurrent with intracranial dural arteriovenous fistula (DAVF). Method The clinical data of 1 patient with MMD accompanied by intracranial DAVF was analyzed retrospectively. Results The patient was a young woman with ventricular hemorrhage as the primary symptom. DSA diagnosed MMD complicated with left transverse sigmoid DAVF. Six months after the right extracranial and extracranial vascular anastomosis, the reexamination showed that the bridging vessels were unobstructed and the fistula disappeared. Combined with literature review, MMD complicated with DAVF could be divided into two types: concurrent or secondary. The clinical manifestations were mostly cerebral ischemia or cerebral hemorrhage related to MMD. Intracranial and extracranial vascular anastomosis was often used, while most DAVFs were treated conservatively. Conclusions MMD with DAVF is rare and the etiology is unknown, which may be related to the increase of angiogenic factors. The treatment strategy depends on the clinical manifestation and classification of DAVFs. [ABSTRACT FROM AUTHOR]

Objective To investigate the risk factors for rebleeding after emergency esophageal variceal ligation (EVL) in patients with liver cirrhosis. Methods A retrospective analysis was performed for the clinical and laboratory data of 290 patients with liver cirrhosis who underwent emergency EVL in The Fifth Medical Center of Chinese PLA General Hospital from January 2016 to December 2019, and according to the presence or absence of rebleeding within 1-year follow-up, they were divided into rebleeding group and non-rebleeding group. The t-test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A multivariate logistic regression analysis was performed with the statistically significant factors as independent variables to screen out the independent risk factors for rebleeding after emergency EVL, and the receiver operating characteristic (ROC) curve was plotted to obtain the indices for predicting the probability of rebleeding and establish a predictive model. Results The univariate analysis showed that there were significant differences between the two groups in platelet count (t=-1.888, P=0.047), Child-Pugh score (χ²=5.975, P=0.049), albumin level (t=-2.229, P=0.029), and splenic vein diameter (t=3.808, P=0.001). The multivariate logistic regression analysis showed that Child-Pugh score (odds ratio [OR]=0.280, 95% confidence interval [CI]: 0.108-0.729, P=0.009), splenic vein diameter (OR=1.549, 95%CI: 1.197-2.005, P=0.001) and albumin level (OR=0.832, 95%CI: 0.729-0.949, P=0.006) were independent influencing factors for rebleeding after EVL. The predictive model based on these three factors had an area under the ROC curve of 0.796, with a sensitivity of 83.7% and a specificity of 74.5% at the cut-off value of -0.086. Conclusion Child-Pugh score, albumin level, and splenic vein diameter are independent risk factors for rebleeding after emergency EVL, and the combination of the three indices has the highest sensitivity and specificity in predicting rebleeding. [ABSTRACT FROM AUTHOR]

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Objective To investigate the effectiveness and safety of hybrid surgery (microsurgery combined with intraoperative DSA) in the treatment of acute hemorrhagic cerebral vascular disease. Methods The clinical data, imaging data, treatment and prognosis of 11 patients with acute hemorrhagic cerebral vascular disease treated by hybrid operation from April 2020 to February 2021 in the Anqing First People's Hospital of Anhui Medical University were analyzed. The results showed 3 cases of cerebral arteriovenous malformation (CAVM), including 2 cases located in temporoparietal lobe and one case in right lateral fissure; 2 cases of dural arteriovenous fistula (DAVF) at the base of anterior cranial fossa while fistulaes located in sieve plate; 6 cases of intracranial aneurysms, including 3 cases in the middle cerebral artery (MCA) bifurcation, one case in the pericallosal artery, and 2 cases in the communicating segment of internal carotid artery (ICA). Results All 11 patients completed the surgery successfully, and the success rate was 100%. CAVM resection combined with hematoma removal were performed in 3 cases of CAVM, including one case that intraoperative DSA suggested a little residual malformed mass after initial resection, while DSA reexamination suggested total resection after supplementary resection. Dural arteriovenous fistula resection combined with hematoma removal were performed in 2 cases of anterior fossa, after the fistula was closed, DSA reexamination suggested the arteriovenous fistula disappeared completely. Intracranial aneurysm clipping was performed in 6 cases, DSA showed complete clipping in 4 cases, and complete clipping in 2 cases of aneurysm neck residual after adjustment or aneurysm clip supplement. DynaCT indicated satisfactory final removal of intracranial hematoma in all patients with intracranial hematoma. No patient had serious complications such as rebleeding and cerebral infarction. After a mean follow-up of 8.45 months, modified Rankin Scale (mRS) was 1 in 4 cases and 1 in 2 cases, and 0 in the other 9 cases. All patients underwent at least one CTA or DSA reexamination, and no residual or recurrent vascular lesions were found. Conclusions Hybrid operation as a new treatment mode for acute hemorrhagic cerebral vascular disease is safe and effective, and further accumulation of cases and experience are needed. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between age at diagnosis and clinical outcomes in children with chronic immune thrombocytopenia (cITP)., Methods: A retrospective analysis was conducted on 117 children with cITP, according to the age at which the patient was diagnosed with ITP, they were divided into two groups: the<10 year old group and the ≥10 year old group, the general information and clinical outcomes of the two groups of children were compared and analyzed. Logistic regression analysis was used to analyzed the impact of age at the time of diagnosis on clinical outcomes, and the predictive evaluation value of age on outcomes was assessed by the receiver operation characteristic., Results: Compared with the group with diagnosed age<10 years old, the proportion of second-line drug treatment (41.46% vs 18.42%) in the diagnosed age group ≥10 years old was significantly higher, and the proportion of ≥grade 3 bleeding (36.59% vs 13.16%) was significantly higher, which was significant statistical differences ( P < 0.05). However, there was no statistically significant difference in the proportion of untreated CR between the two groups after 5 years of diagnosis ( P >0.05). Logistic regression results show that age (older) was an unfavorable/dangerous influencing factor for the occurrence of ≥grade 3 bleeding after second-line treatment ( OR >1, P < 0.05). For the occurrence of CR after 5 years of diagnosis without treatment, age was not the influencing factor ( P >0.05). ROC analysis showed that age have a certain predictive and evaluative effect on the use of second-line treatment and the occurrence of ≥grade 3 bleeding, with AUC of 0.741(95% CI : 0.549-0.938) and 0.786(95% CI : 0.605-0.940), respectively. However, there was basically no predictive evaluation value for the occurrence of CR after 5 years of diagnosis without treatment., Conclusion: Older age at the time of diagnosis is not conducive to the prognosis of cITP patients.

Backgroud and objective Video assisted thoracic surgery (VATS) is the main surgical method for lung cancer. The aim of this study was to analyze the reasons for conversion to thoracotomy in 83 cases among 1,350 consecutive cases who underwent video-assisted thoracic surgery (VATS) lobectomy by a single surgical team, in order to achieve a deeper understanding of the rules and the opportunity for conversion to thoracotomy in VATS lobectomy under normal conditions. Methods The clinical data of 1,350 patients who underwent VATS lobectomy between September 21, 2009 and June 1, 2020, by a single surgical team in the Fifth Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. There were 773 males and 577 females, aged 8-87 years, with a median age of 61.3 years, including 83 cases of benign diseases, 38 cases of lung metastases, and 1,229 cases of primary lung cancer. The cases with stage I, II and IIIa were 676, 323 and 230, respectively. The cases of left upper, left lower, right upper, right middle, right lower, right middle and upper and right middle and lower lobectomy were 301 (22.30%), 231 (17.11%), 378 (28.00%), 119 (8.81%), 262 (19.41%), 16 (1.19%) and 43 (3.19%), respectively. Results In the cohort of 1,350 consecutive patients with VATS lobectomy, 83 patients (6.15%) were converted to thoracotomy for different reasons. The conversion rate of benign lesions was significantly higher than that of malignant tumors (P

Objective The clinical characteristics and imaging information of insular glioma patients were collected to predict mutation status of isocitrate dehydrogenase 1 (IDH1). Methods A total of 596 patients with gliomas confirmed by postoperative pathology in The First Affiliated Hospital with Nanjing Medical University from January 2011 to June 2021 were enrolled, including 72 insular gliomas, 213 frontal gliomas, 165 temporal gliomas, 76 parietal gliomas, 28 occipital gliomas, 13 cerebellar gliomas and 29 midline gliomas. All patients were examined by MRI, fifteen glioma-related features were selected from the visually accessible rembrandt images (VASARI), including enhancement quality, enhancement proportion, non-enhancement proportion, necrosis proportion, edema proportion, cyst, thickness of enhanced margin, definition of the enhanced margin, hemorrhage, diffusion, deep white matter involvement, deep ventricle involvement, midline cross, T2-FLAIR mismatch, maximum diameter of tumor. Univariate and multivariate Logistic regression analysis were used to screen the predictive factors related to IDH1-mutant in insular glioma. The receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC), sensitivity and specificity were calculated to evaluate the predictive power of MRI features for IDH1-mutant glioma. Results IDH1 mutation rate was higher in insular and frontal gliomas (P < 0.01, for all). WHO grade II had the highest IDH1 mutation rate (P = 0.008, 0.000), and grade IV had the lowest mutation rate (P = 0.000). The IDH1 mutation rate in low-expression Ki-67 gliomas was higher than that in high-expression gliomas (P = 0.000). Logistic regression analysis showed that weak enhancement (OR = 35.671, 95%CI: 2.805-453.600; P = 0.006), non-enhancement (OR = 75.453, 95%CI: 2.881-1872.759; P = 0.009), unlimited diffusion (OR = 10.573, 95%CI: 1.043-107.175; P = 0.046), no deep ventricle involvement (OR = 187.601, 95%CI: 2.269-15507.607; P = 0.020), T2-FLAIR mismatch (OR = 47.536, 95%CI: 2.838-796.097; P = 0.007) were independent predictive factors for IDH1 mutation in insular glioma. The AUC of enhancement degree, diffusion, deep ventricle involvement and T2-FLAIR mismatch for the diagnosis of IDH1-mutant glioma were 0.846 (95%CI: 0.748-0.944, P = 0.000), 0.730 (95%CI: 0.609-0.850, P = 0.001), 0.708 (95%CI: 0.584-0.833, P = 0.003) and 0.745 (95%CI: 0.627-0.864, P = 0.000). The combination of the 4 groups had the highest diagnostic efficacy, and the AUC was 0.961 (95%CI: 0.923-0.999, P = 0.000). Conclusions Low grade insular glioma has a high IDH1 mutation rate. MRI features of weak enhancement and non-enhancement, unlimited diffusion, non deep ventricle involvement and T2-FLAIR mismatch contribute to noninvasive prediction of IDH1-mutant insular glioma. [ABSTRACT FROM AUTHOR]