Objective To explore the necessity of placing an inferior vena cava filter(IVCF)during interventional therapy for acute lower extremity deep venous thrombosis(DVT)complicated with severe May-Thurner syndrome(MTS).Methods Patients with acute left lower extremity DVT complicated with severe MTS were retrospectively selected and divided into observation group(n=36)and control group(n=36)according to whether IVCF was implanted or not.Pulmonary embolism(PE)was evaluated using compu-ted tomography pulmonary angiography(CTPA).The improvement of the affected limb signs and the occurrence of PE symptoms during treatment were observed.The presence of trapped thrombus was checked during filter removal.The PE incidence,hospitaliza-tion costs,operation time,and hospital stay were compared between the two groups.Results Both groups had a higher thrombus clearance rate after interventional surgery,and the proportion of new small branch PE was lower without significant differences between the two groups(8.3%vs 5.6%,P=1.000).The signs of the affected limbs improved significantly,and no PE-related symptoms occurred during treatment.No obvious trapped thrombus was found when the filter was removed in the control group.Compared with the control group,the observation group had significantly reduced hospitalization costs and operation time(P<0.05).Conclusion For patients with acute lower extremity DVT complicated with severe MTS,omitting IVCF placement during interventional surgery does not increase the risk of PE and can reduce operation time and hospitalization costs.

OBJECTIVE: To explore whether hydrocortisone can improve the prognosis of patients with severe community-acquired pneumonia (sCAP) by Meta-analysis. METHODS: Randomized controlled trial (RCT) on hydrocortisone in the treatment of sCAP were extracted from the database including PubMed, Cochrane library, Web of Science, and Embase, and the search time was up to April 29, 2023. The patients in the standard treatment group received standard treatment such as antibiotics and supportive care, while those in the hydrocortisone group received hydrocortisone treatment on the basis of standard treatment. Meta-analysis was used to compare the mortality, duration of mechanical ventilation, mechanical ventilation rate and incidence of adverse reactions (hyperglycemia, gastrointestinal bleeding, secondary infection) between the two groups. The risk of literature bias was assessed. The studies that might have publication bias were corrected by the subtraction and complementation method. At the same time, trial sequential analysis (TSA) was conducted. RESULTS: A total of 5 RCTs involving 1 031 patients were finally enrolled, including 494 patients in the standard treatment group and 537 patients in the hydrocortisone group. Among the 5 studies, the research site of 2 studies was in the mixed ward. Considering the inclusion characteristics of the study population, there was doubt whether its research object was sCAP patients, which might have a certain impact on the results and introduce potential bias. Meta-analysis showed that the mortality in the hydrocortisone group was significantly lower than that in the standard treatment group [6.0% vs. 14.0%; odds ratio (OR) = 0.38, 95% confidence interval (95%CI) was 0.25-0.59, P < 0.01; I² = 9%]. The studies that were asymmetric were corrected by the reduction and supplementation method. Even after filling the missing studies, hydrocortisone could still reduce the death risk of the patient (OR = 0.49, 95%CI was 0.32-0.73, P < 0.01; I² = 31%). TSA showed that the average mortality of the standard treatment group was about 14.0%, and that of the hydrocortisone group was about 6.0%, with a relative risk reduction (RRR) = 57%. The calculated sample size was 699 cases, and the actual sample size was 1 031 cases. The actual sample size exceeded the required sample size, and the Z-curve crossed the O'Brien-Fleming boundary and the curve corresponding to P = 0.05, it meant that hydrocortisone could effectively reduce the mortality of sCAP. Compared with the standard treatment group, no statistical difference in the duration of mechanical ventilation was found in the hydrocortisone group [mean difference (MD) = -3.26, 95%CI was -6.72-0.21, P = 0.07; I² = 0%], but the 8-day mechanical ventilation rate was significantly lowered (19.5% vs. 55.4%; OR = 0.24, 95%CI was 0.12-0.45, P < 0.01; I² = 0%), and also no significantly difference was found in the incidence of hyperglycemia (54.3% vs. 44.6%, OR = 1.26, 95%CI was 0.56-2.84, P = 0.58; I² = 61%), gastrointestinal bleeding (2.5% vs. 3.6%; OR = 0.70, 95%CI was 0.34-1.46, P = 0.34; I² = 0%) and secondary infection (9.2% vs. 11.5%; OR = 0.46, 95%CI was 0.06-3.35, P = 0.45; I² = 53%). CONCLUSION Hydrocortisone can reduce the mortality rate of sCAP patients, decrease their need for mechanical ventilation, and does not increase the risk of hyperglycemia, gastrointestinal bleeding, or secondary infections.
Humans ; Hydrocortisone/therapeutic use* ; Community-Acquired Infections/drug therapy* ; Pneumonia/drug therapy* ; Randomized Controlled Trials as Topic ; Respiration, Artificial ; Community-Acquired Pneumonia

Objective To explore the correlation between the pulmonary artery diameter(PAD),PAD/aortic diameter(AOD),right ventricular diameter(RVD),RVD/left ventricular diameter(LVD)measured on pulmonary artery CT angiography(CTPA)cross-sectional images and the degree of embolism,cardiac biomarkers in patients with medium-to-high risk acute pulmonary embolism(APE).Methods The clinical data of 53 patients with medium-to-high risk APE,who received interventional treatment at the Putian Municipal First Hospital of China From January 2021 to December 2023,were retrospectively analyzed.The PAD,PAD/AOD,RVD,and RVD/LVD were measured on CTPA cross-sectional images.The correlations of the above indexes with CT embolism index(CTEI),N terminal pro B type natriuretic peptide(NT-proBNP),and cardiac troponin Ⅰ(cTnⅠ)were analyzed.Results A weak-moderate positive correlation existed between PAD,RVD,RVD/LVD and CTEI(r=0.506,r=0.310,r=0.452 respectively,P＜0.001,P=0.024,P=0.001 respectively),while no correlation existed between PAD/AOD and CTEI(r=0.247,P=0.075).Compared with the NT-proBNP negative group,in the NT-proBNP positive group the values of PAD,PAD/AOD and RVD/LVD were higher(all P＜0.05),and there was no statistically significant difference in RVD value between the two groups(P＞0.05).A weak-moderate positive correlation existed between NT-proBNP and PAD,PAD/AOD,RVD,RVD/LVD(r=0.454,r=0.326,r=0.302,r=0.405 respectively,P=0.001,P=0.017,P=0.028,P=0.003 respectively).There were no statistically significant differences in PAD,PAD/AOD,RVD and RVD/LVD values between the cTnⅠ negative group and the cTnI positive group(all P＞0.05).No correlation existed between cTnⅠ and PAD,PAD/AOD,RVD,RVD/LVD(r=0.188,r=0.042,r=-0.021,r=0.139 respectively,and P=0.195,P=0.772,P=0.884,P=0.342 respectively).Conclusion CTPA cross-sectional quantitative indicators are helpful in evaluating the embolism degree of APE and right heart function,but it cannot be used to assess myocardial injury.

Objective To explore the necessity of placing an inferior vena cava filter(IVCF)during interventional therapy for acute lower extremity deep venous thrombosis(DVT)complicated with severe May-Thurner syndrome(MTS).Methods Patients with acute left lower extremity DVT complicated with severe MTS were retrospectively selected and divided into observation group(n=36)and control group(n=36)according to whether IVCF was implanted or not.Pulmonary embolism(PE)was evaluated using compu-ted tomography pulmonary angiography(CTPA).The improvement of the affected limb signs and the occurrence of PE symptoms during treatment were observed.The presence of trapped thrombus was checked during filter removal.The PE incidence,hospitaliza-tion costs,operation time,and hospital stay were compared between the two groups.Results Both groups had a higher thrombus clearance rate after interventional surgery,and the proportion of new small branch PE was lower without significant differences between the two groups(8.3%vs 5.6%,P=1.000).The signs of the affected limbs improved significantly,and no PE-related symptoms occurred during treatment.No obvious trapped thrombus was found when the filter was removed in the control group.Compared with the control group,the observation group had significantly reduced hospitalization costs and operation time(P<0.05).Conclusion For patients with acute lower extremity DVT complicated with severe MTS,omitting IVCF placement during interventional surgery does not increase the risk of PE and can reduce operation time and hospitalization costs.

Objective To investigate the feasibility,safety and efficacy of transcatheter drug-loaded microsphere embolization(DLME)in treating patients with advanced bladder cancer with bleeding(ABCB).Methods A total of 26 ABCB patients who underwent DLME for tumor supply arteries were retrospectively selected.The postoperative efficacy and related complications were observed.The recurrence of hematuria and survival situation were followed up.Results All 26 surgeries achieved success with a technical success rate of 100.0％.There were 21 cases(80.8％)of bilateral bladder artery embolism and 5 cases(19.2％)of unilateral bladder artery embolism.Three days after the operation,24 patients(92.3％)had hematuria remission.And the other two patients(7.7％)had no hematuria remission,they were relieved after interventional embolization again.Compared with that before operation,the blood transfusion rate,blood transfusion volume,hematocrit and hemoglobin at one week after operation were significantly improved(P＜0.05).One month after the last intervention,there were 2 cases of complete response,19 cases of partial response,3 cases of stable disease,and 2 cases of progressive disease.The objective remission rate was 80.8％,and the disease control rate was 92.3％.Compared with that before operation,the T stage was significantly improved at one month after operation(P＜0.05).No patients had severe complications such as ectopic embolism.After follow-up for 3-36 months,5 cases(19.2％)had a recurrence of hematuria.Conclusion Transcatheter DLME is feasible,safe,and effective in the treatment of patients with ABCB.It is an optional,minimally invasive palliative measure.

Objective To explore the clinical effect of endovascular stent-graft exclusion in the treatment of acute Stanford B-type aortic dissection(AD)with distal left subclavian artery(LSA)rupture accompanied by arch intramural hematoma.Methods A total of 12 patients with acute AD treated by the endovascular stent-graft exclusion alone were retrospectively selected.All patients had primary rupture at the distal end of LSA with arch intramural hematoma and received endovascular treatment after 2 to 3 weeks of conservative treatment.The technique success rate and related complications were observed.Postoperative computed tomography angiography(CTA)of the aorta was reviewed to evaluate the remodeling of the true and false lumen,the absorption of the arch intramural hematoma,to observe whether there was a new rupture and endoleak,and to understand the position and shape of the stent and the blood supply of the branch arteries.Results All patients completed the operation with a technical success rate of 100％.Two patients partially blocked the opening of LSA,and one patient had type Ⅰ internal leakage after the operation,but the amount of internal leakage was small and was not treated.Other patients did not had serious complications such as aortic rupture,new rupture,paraplegia,stent displacement,stroke,upper limb ischemia or vertebral artery ischemia,internal leakage,and abdominal organ ischemia during and after the operation.The patients were followed up for 19 to 66 months,with an average follow-up of(36.7±13.9)months.During the follow-up period,no patient died.The aortic remodeling was satisfactory in all patients,the arch intramural hematoma was absorbed,and there were no new rupture,internal leakage,upper limb ischemia or vertebral artery ischemia,or other serious complications.One patient with type Ⅰ internal leakage showed no significant change in internal leakage after regular postoperative reexamination.Conclusion Endovascular stent-graft exclusion is safe and feasible in the treatment of acute AD patients with distal LSA rupture accompanied by arch intramural hematoma,and it is worth promoting and applying clinically.

Objective:To analyze the clinical efficacy and safety of endoluminal treatment of complex renal artery aneurysm (RAA).Methods:The clinical data and follow-up results of 19 patients with complex RAA admitted to Renji Hospital, Shanghai Jiaotong University School of Medicine from November 2014 to September 2021 were retrospectively analyzed. Two patients were treated with simple spring coil embolization into the aneurysmal artery, 14 patients were treated with simple spring coil embolization of the aneurysmal cavity, and 3 patients were treated with stent-assisted + spring coil embolization technique. Based on the location of the aneurysm, RAA were classified into type Ⅰ, Ⅱ, and Ⅲ. 7 patients with type Ⅰ, 10 patients with type Ⅱ, and 2 patients with type Ⅲ were studied. Variance analysis was used to compare the differences in glomerular filtration rate(GFR) of the affected side when the tumor was located at different locations, and Pearson was used to analyze the correlation between the number of coils implanted and the size of the tumor and GFR.Results:Ten of the 19 patients who were underwent successful endoluminal intervention. The average size of the patients′ aneurysms was (20.89±6.65) mm, and the average number of spring coils implanted was 8.22±3.08. The preoperative and postoperative serum creatinine were in the normal range, and no RAA tumor enlargement or recurrence was found during the follow-up period. The postoperative GFR was abnormal in patients with type Ⅰ, type Ⅱ, and type Ⅲ renal aneurysms, and the mean GFR value differed among the three types of patients( P=0.003). There was a negative correlation between the postoperative GFR values of the affected kidney and the number of spring coils implanted ( P=0.047), and no significant relationship between GFR and aneurysm size. Conclusion:The endovascular technique is an effective and safe means of treating complex RAA.

Objective:To explore a fast method to identify and confirm suspected clonorchis sinensis infection.Methods:For suspected clonorchis sinensis infection, the clonorchiasis serum antibody was detected first with ELISA. If the antibody was positive, the fecal examination for eggs was performed. If the fecal examination was negative, duodenal drainage under gastroscopy was recommended to detect eggs from the drainage fluid.Results:A total of 126 patients met the requirements and aged 54.14±13.33 (24- 87). There were 83 cases (65.87%, 83/126) with eggs positive in the drainage fluid, of which 53 cases were male, aged 55.91±11.47 (30-86), and 30 cases female, aged 55.87± 13.85(30-87). There was no significant difference in age between males and females( P>0.05). The time of catheterization (T1) of 126 cases was 3.79 ±1.45 min. The time of drainage (T2) of 126 cases was 31.39 ±14.29 min. There was no significant difference in T1 or T2 between the positive group and the negative group( P>0.05). The detection rates of eggs were 91.57% (76 cases) in intrahepatic bile duct drainage, 81.93% (68 cases) in the bile-cyst juice and 75.90% (63 cases) in the common bile duct fluid. No serious adverse reactions occurred during or after the operation. Conclusion:The detection rate of clonorchiosis sinensis can be effectively improved by the combination of clonorchiasis serum antibody test and gastroscopy-guided duodenal drainage.

To evaluate the value of prenatal ultrasound in the diagnosis of single umbilical artery( SUA ) and fetal malformation . Methods T he characteristics of the prenatal ultrasound findings of 143 fetuses with SU A in different gestational weeks were retrospectively analyzed ,and the missing side of SU A were checked . Different types of SUA combined with fetal malformation were analyzed as well as chromosomal abnormalities and so on . Results For 143 fetuses with SU A ,there were 83 cases ( 58 .0% ) with absent left umbilical artery and 60 cases ( 42 .0% ) with absent right umbilical artery ,there was no statistical difference between the two groups ( P ＞0 .05 ) . Six cases ( 4 .2% ,6/143 ) were detected at and before 20 weeks of gestation ,and the rest 137 cases were detected after 20 weeks( 95 .8% ,137/143) . T here were 121 cases ( 84 .6% ) of isolated SUA ,22 cases ( 15 .4% ) were complicated with other malformations , including 10 cases ( 45 .5% ) with absent left umbilical artery and 12 cases ( 54 .5% ) with absent right umbilical artery . T here was no statistical difference between left and right umbilical artery deletion combined with fetal malformation( χ2 ＝1 .692 ,ν＝1 , P ＞0 .05) . T here were 11 cases( 7 .7% ,11/143) with cardiovascular malformation and nine cases ( 6 .3% , 9/143 ) with digestive system malformation . Chromosome examination was performed in 23 cases . One case of trisomy 18‐trisomy and 1 case of trisomy 13‐trisomy were found to be with missing right umbilical artery and all of them were complicated with multiple deformities . Conclusions The absence of left and right umbilical artery can be combined with abnormal fetal malformation . Prenatal ultrasonography can accurately diagnose SU A and fetal malformation .

Objective To investigate the reliability and validity of the medical outcomes by applying short form-36 (SF-36) in evaluating gout patients’ health related quality of life (HRQOL).Methods Gout patientswere enrolled between March 2016 and June 2016 in Foshan Hospital of Traditional Chinese Medicine.Patients completed the SF-36 questionnaire.Summary scores,physical component summary (PCS) and mental component summary (MCS) were calculated by summing factor-weighted scores across all 8 subscales,with factor weights derived from general population.The indicators of reliability and validity included internal consistency,test-retest reliability,structural and discriminant validity,ceiling and floor effect.Results Totally 306 patients were enrolled.The internal consistency test showed that the Cronbach α coefficients ranged from 0.782 to 0.822,and the test-retest reliability coefficients ranged from 0.720 to 0.986 (P＜0.01).Structural validity analysis showed that there were two items whose eigenvalues were greater than one with the cumulative contribution rate of 66.1％.The discriminant validity analysis found that patients with more numbers of tophi,higher frequency of flare,multi-arthrosis involved and more complications had less scores of PCS and MCS (P＜0.05).There was a high ceiling effect on physiological function and a higher ceiling and floor effect on role limitation and emotional function caused hy impaired physical health.Conclusion The SF-36 can be used for the assessment of HRQOL in Chinese gout patients but disease specific questionnaire are warranted.