Objective To explore the difference of various indicators in the growth of transplanted liver cancer in experimental rats with the background of normal liver,fatty liver and liver cirrhosis,and to discuss the difference in the curative effect after TACE.Methods Walker-256 ascites tumor cells were implanted into the rats with normal liver,fatty liver,and cirrhosis liver separately to establish the experimental liver cancer models.TACE treatment was performed for all experimental rats.All the indicators related to tumor growth and the curative effect of TACE were compared among the three groups of rats with different liver backgrounds.Results In terms of the liver volume,there were differences among the three groups,but the differences were not statistically significant(P＞0.05).No statistically significant differences in the preoperative liver functions existed among the three groups,but some indicators of postoperative liver functions in the fatty liver group were significantly higher than those in the cirrhosis group,and the differences were statistically significant(P＜0.05).No significant differences in microvessel density were observed among the three groups(P＞0.05).However,in the same group statistically significant differences in the above indexes existed between the preoperative values and the preoperative ones(P＜0.05).Conclusion The results of this study indicate that during the growing period of tumor the following three changes can be observed:① There are differences in tumor volume.Cirrhosis may inhibit tumor growth in the early stage,but in the later stage the cachexia of cirrhosis rats may accelerate tumor growth;② There were no significant differences in liver functions between fatty liver and cirrhosis;and ③ There was no significant difference in microvessel density among the rats with different liver backgrounds.However,with the tumor growing,the microvessel density will be slightly increased.After TACE treatment the following three changes can be observed:① There is no significant difference in tumor volume;② Fatty liver rats have more liver function reserve capacity when compared with cirrhotic rats;③ There is no obvious change in microvessel density,although the embolization treatment can stimulate the proliferation of the microvessel.

Objective To compare the clinical characteristics of cirrhosis with or without portal vein thrombosis(PVT),and to analyze the therapeutic effect of transjugular intrahepatic portosystemic shunt(TIPS)in treating cirrhosis with or without PVT.Methods The clinical data of 193 patients with cirrhosis complicated by gastrointestinal bleeding,who received TIPS from October 2018 to October 2022,were retrospectively analyzed.According to the presence or absence of PVT before TIPS,the patients were divided into non-PVT group(n=118)and PVT group(n=75).After TIPS,the patients were followed up at one,3,6 months and every 6 months thereafter.The effect of PVT on the clinical characteristics of cirrhosis patients and on the therapeutic efficacy after TIPS were analyzed.Results The success rate of TIPS was 100％in both groups.The proportion of carrying out splenectomy or partial splenic artery embolization(PSE)in PVT group was 26.7％(20/75),which was obviously higher than 13.6％(16/118)in non-PVT group,the difference between the two groups was statistically significant(x2=5.192,P=0.023).In PVT group the preoperative Child-Pugh score,the model of end-stage liver disease(MELD)score and serum sodium model of end-stage liver disease(MELD-Na+)score were(8.1±1.9)points,(9.2±8.0)pointsand(9.2±8.0)points respectively,which in non-PVT group were(7.4±1.9)points,(7.7±5.8)points and(7.7±5.8)points respectively,the differences between the two groups were statistically significant(all P＜0.05).The incidence of overt hepatic encephalopathy in PVT group was 33.3％(25/75),which was strikingly higher than 19.5％(23/118)in non-PVT group,the difference between the two groups was statistically significant(P=0.030).No statistically significant differences in postoperative survival rate,rebleeding rate and stent dysfunction rate existed between the two groups(all P＞0.05).Conclusion For the treatment of cirrhotic patients with PVT complicated by gastrointestinal bleeding,TIPS is clinically safe and effective.In cirrhotic patients with PVT,the worse the liver function is,the higher the incidence of overt hepatic encephalopathy after TIPS will be.

Objective To evaluate the efficacy of Gateway balloon dilation in the treatment of symptomatic severe stenosis of middle cerebral artery.Methods The clinical data and imaging materials of 98 patients with severe symptomatic stenosis of the middle cerebral artery,who were admitted to the Second Affiliated Hospital of Nanchang University of China from May 2019 to August 2022 to receive Gateway balloon dilation,were retrospectively analyzed.The diameter of the narrowed artery before and after Gateway balloon dilation treatment,peak systolic blood flow velocity(PSV),end-diastolic blood flow velocity(EDV),Mori classification of stenosis lesion,operation-related complications,imaging manifestations and clinical follow-up results were analyzed.Results Of the 98 patients,Mori type A was seen in 83(84.69％)and Mori type Bin 15(15.31％).Successful Gateway balloon dilation procedure was accomplished in all patients.After surgery,the symptoms were improved or stabilized to varying degrees.The mean residual lumen diameter of the stenosis lesion was significantly increased from preoperative(2.01±0.13)mm to postoperative(2.33±0.25)mm,the stenosis ratio was remarkably decreased from preoperative(81.28±15.17)％to postoperative(50.24±12.83)％,the PSV and EDV were strikingly decreased from preoperative(251.01±60.13)cm/s and(104.28±32.25)cm/s to postoperative(155.33±53.28)cm/s and(70.24±36.33)cm/s respectively,the differences were statistically significant(all P＜0.05).Seven patients developed surgical complications,which were improved in short time.The patients were followed up for 10 months,modified Rankin Scale(mRS)score of ≤2 points was obtained in 88 patients(89.79％),indicating that the patients had a good quality of life as well as a good functional recovery.Conclusion For the treatment of symptomatic severe stenosis of middle cerebral artery,Gateway balloon dilation carries a significant long-term therapeutic effect with fewer surgical complications.Therefore,Gateway balloon dilation is an effective treatment for this type of disease.

Objective To discuss the clinical application of self-radiopaque marker guiding physician modified fenestration technique in treating aortic arch diseases with insufficient proximal anchoring area.Methods From October 2021 to March 2023,a total of 8 patients with aortic dissection/aneurysm located in area Z0 received thoracic endovascular aortic repair(TEVAR)by using self-radiopaque marker guiding physician modified fenestration technique.The patients were followed up to observe the safety and efficacy of this technique.Results Successful TEVAR was accomplished in all the 8 patients.Type Ⅰ endoleak occurred in one patient,which disappeared within 6 months.No perioperative death,stroke or paraplegia occurred.Conclusion For the treatment of aortic arch diseases with insufficient proximal anchoring area,TEVAR by using self-radiopaque marker guiding physician modified fenestration technique is clinically safe and effective with satisfactory short-to-medium-term effect,although its long-term effect needs further observation.

Objective To discuss the clinical diagnosis and treatment of isolated iliac artery aneurysms(IIAA).Methods The clinical data and therapeutic process of 6 patients,who were diagnosed as IIAA at the Affiliated Hospital of Jining Medical College of China from January 2020 to September 2023,were retrospectively analyzed.Of the 6 patients,4 were male and 2 were female,with a mean age of(72.3±5.3)years(range of 64-79 years).Results Successful operation was accomplished in all the 6 patients.Interventional treatment was adopted in 5 patients and open surgery was carried out in one patient.Five patients received interventional embolization of the affected internal iliac artery,and one patient received reconstruction of internal iliac artery by using stenting technique through iliac artery branch approach.No endoleak of type Ⅰ or type Ⅱ occurred.After treatment,none of the patients developed complications such as puncture-point bleeding,gluteal claudication,colonic ischemia,or spinal cord ischemia.Conclusion Interventional therapy has the advantages of less damage,less bleeding,quick recovery,fewer complications,shorter hospital stay and lower mortality,which has gradually replaced the traditional surgery in clinical practice and has become the primary treatment approach for IIAA.

Objective To discuss the CT features of the recurrent intussusception in pediatric patients after air-enema intestinal reduction,and to analyze its influencing factors.Methods The clinical data of child patients with intussusception,whose diagnosis was initially confirmed and treated with air-enema intestinal reduction at the Children's Hospital of Soochow University from January 2020 to May 2022,were retrospectively analyzed.The general data,clinical characteristics and CT imaging findings were collected.Logistic regression analysis was used to determine the factors related to the recurrence of the intussusception.Results A total of 162 child patients were enrolled in this study,among them 103 child patients were males,the mean age was 2.3 years(3 months to 5 years).Thirty-two children(19.75％,recurrent group)developed in-hospital recurrence of intussusception after successful air-enema intestinal reduction.Univariate analysis showed that the incidences of intussusception length,intussusception thickness,target-shaped mass sign,comet's tail sign and enlarged mesenteric lymph nodes in the recurrent group were remarkably higher than those in the non-recurrent group,the differences were statistically significant(all P＜0.05).No statistically significant difference in the incidence of ascites existed between the two groups(P＞0.05).Multivariate logistic regression analysis revealed that age＞3 years(OR=2.10,95％CI=1.25-2.94,P＜0.01),enlarged mesenteric lymph nodes(OR=2.05,95％CI=1.07-2.68,P＜0.01),and the target-shaped mass sign(OR=3.32,95％CI=1.53-6.62,P＜0.01)were the independent influencing factors for the recurrence of intussusception in child patients with intussusception after receiving air-enema intestinal reduction.Conclusion Age＞3 years,enlarged mesenteric lymph nodes and target-shaped mass sign are the risk factors for the recurrence of intussusception in child patients with intussusception after receiving air-enema intestinal reduction.

Objective To explore the effect of virtual reality(VR)technology on relieving intraoperative pain in patients receiving transcatheter hepatic artery chemoembolization(TACE).Methods A total of 76 patients,who received TACE from June 2023 to January 2024,were enrolled in this study.Using random number table method,the patients were divided into control group(n=38)and study group(n=38).Intraoperative routine nursing was carried out for the patients of the control group,while on the basis of routine nursing additional VR technology was adopted to relieve the intraoperative pain for the patients of the study group.The degree of intraoperative pain,anxiety symptoms,incidence of intraoperative adverse reactions and patient satisfaction with nursing were compared between the two groups.Results The degree of intraoperative pain in the study group was lower than that in the control group,but the difference between the two groups was not statistically significant(P＞0.05).The analgesic effect of VR was much obvious in patients aged≤55 years and in patients with vascular invasion of liver cancer(P＜0.05).The anxiety score in the study group was lower than that in the control group,the patient satisfaction score in the study group was higher than that in the control group,and the differences between the two groups were statistically significant(both P＜0.05).No statistically significant difference in the incidence of adverse reactions existed between the two groups(P＞0.05).Conclusion Immersive VR technology can effectively reduce the degree of intraoperative pain in patients receiving TACE,especially in patients aged ≤55 years.Besides,VR technology can also reduce the anxiety degree of patients,and improve the degree of intraoperative patient satisfaction with nursing.

Objective To discuss the application of mind map in self-management of elderly patients after receiving mitral valve transcatheter edge-to-edge repair(M-TEER).Methods A total of 66 patients,who underwent M-TEER at Nanjing Hospital of Nanjing Medical University from August 2021 to October 2022,were enrolled in this study.Using the envelope concealment method,a total of 66 data analysis samples were included in the analysis.There were 33 patients each in the study group and control group.Routine health education was adopted for the patients of the control group,while the responsible nurse conducted health education for the patients of the study group under the guidance of the mind map that was designed by a multidisciplinary specialized nurses.Results There was a significant difference in postoperative medication compliance between the study group and the control group(P＜0.05),i.e.the degree of compliance,including taking medicine on time,insisting on taking medicine and taking medicine as prescribed,in the study group was obviously higher than that in the control group.The postoperative 6-min walking test,which was regarded as one of the indicators of cardiac functions,in the study group was remarkably better than that in the control group,the difference was statistically significant(P＜0.05).The postoperative quality of life(including daily activity ability,frailty degree,social support,and incidence of hospitalization for heart failure within one year after treatment)in the study group was strikingly better than that in the control group(P＜0.05).Conclusion The use of mind map in self-management of elderly patients after receiving M-TEER can effectively improve the medication compliance of the patients after discharge,improve the quality of life of patients,and reduce the incidence of hospitalization due to heart failure.

Hemodialysis access is a lifeline for patients with terminal stage renal disease.Many patients with terminal stage renal disease rely on this access for receiving regular hemodialysis to stay alive.Therefore,it is essential to ensure long-term patency of the access.However,the patency of access can be affected by a lot of factors,such as stent implantation,prolonged irritation from electronic devices,and venous hypertension,all of which can cause reactive endothelial hyperplasia with consequent stenosis or occlusion of the access.Nowadays,the conventional methods to maintain the patency of hemodialysis access include percutaneous transluminal angioplasty(PTA)and percutaneous transluminal stenting(PTS).However,in some patients the tissue of the obstructed site has already been completely organized or has become calcified and hardened.In this case,the recanalization of the obstructed site is difficult to be accomplished by the conventional method,and sharp puncturing is required to achieve effective recanalization of the obstructed site.This paper aims make a comprehensive review concerning the surgical recanalization methods used for central venous occlusive diseases in hemodialysis patients so as to provide useful reference for clinical practice.

In recent years,with the rapid development of minimally-invasive interventional therapy technology,the effectiveness of neurointerventional therapy through radial artery puncture has been highlighted in clinical application.Compared with the commonly-used femoral artery puncture,transradial access can let the patients have a better comfort and willingness to accept the operation,which can also reduce postoperative complications and improve the quality of diagnosis and treatment.However,the perioperative nursing measures have always been based on the measures used in coronary interventional therapy,the nursing measures of neurointerventional therapy are still in the experience summary stage,and there is still a lack of unified,normative and guiding documents for formulating the clinical nursing care.This paper reviews the perioperative nursing measures of neurointerventional procedures via radial artery puncture,focusing on the advantages of radial artery puncture approach,the key points of preoperative care assessment,the intraoperative nursing strategy,the prevention and treatment of postoperative complications,etc.so as to provide evidence-based references for clinical nursing practice.