Background and Aims:Acute inferior vena cava thrombosis(IVCT)commonly occurs secondary to inferior vena cava filter(VCF)implantation.If not promptly treated,it may lead to serious complications such as bilateral lower limb swelling and pulmonary embolism and can also reduce the likelihood of successful filter retrieval.Percutaneous mechanical thrombectomy(PMT)and catheter-directed thrombolysis(CDT)are currently the main interventional treatments for IVCT,but comparative studies evaluating their efficacy and safety remain limited.This study was to conduct a prospective randomized controlled trial to compare the clinical efficacy and safety of AngioJet mechanical thrombectomy versus conventional CDT in the treatment of acute IVCT and to explore factors influencing filter retrieval rates,thereby providing evidence-based guidance for clinical decision-making.Methods:From January 2022 to December 2024,patients diagnosed with acute IVCT following VCF implantation were prospectively enrolled at the Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University.Patients were randomly assigned to either the CDT group(n=46)or the PMT group(n=48)according to the interventional procedure used.The two groups were compared in terms of filter retrieval rates,thrombus clearance outcomes,operative time,thrombolytic drug dosage,and incidence of complications.Logistic regression analysis was used to identify factors associated with primary filter retrieval.Results:A total of 94 patients were enrolled,with 46 in the CDT group and 48 in the PMT group.Compared to the CDT group,the PMT group demonstrated a significantly higher primary filter retrieval rate(77.1%vs.43.5%),grade Ⅲ thrombus clearance rate(70.8%vs.37.0%),and better postoperative thrombus scores.Additionally,the PMT group required lower urokinase doses and shorter thrombolysis duration(all P<0.05).The overall filter retrieval rate and 3-month IVC patency were similar between groups,both exceeding 93%.Regarding safety,the CDT group had a higher incidence of catheter-related infections and medical adhesive-related skin injury,while vagal reflex symptoms were more frequent in the PMT group.Logistic regression analysis identified thrombus clearance rate as an independent factor significantly associated with primary filter retrieval in the PMT group(OR=190.773,P<0.05).Conclusion:Compared to CDT,AngioJet mechanical thrombectomy combined with manual aspiration achieves higher thrombus clearance and primary filter retrieval rates in the treatment of acute IVCT while also reducing thrombolysis duration and drug dosage.However,attention should be paid to the increased risk of vagal reflex symptoms.There was no significant difference between the two groups in secondary filter retrieval rates or long-term IVC patency.The choice of intervention should be based on the patient's condition,timing of filter retrieval,and individualized clinical considerations.

Gastric cancer remains one of the most prevalent and lethal malignancies of the digestive tract worldwide,underscoring the urgent need for more effective targeted therapeutic strategies.Poly(ADP-ri-bose)polymerase(PARP)inhibitors have demonstrated remarkable efficacy in tumors with homologous recombination repair(HRR)deficiency;however,their clinical application in gastric cancer remains limited.Clinical evidence suggests that patients harboring Helicobacter pylori infection in combination with HRR gene mutations exhibit a significantly elevated risk of developing gastric cancer,thereby supporting the potential benefit of PARP inhibition in this setting.In this study,a kinase inhibitor library was screened in combination with the PARP inhibitor olaparib in gastric cancer cells.And we identify the cy-clin-dependent kinase 8/19(CDK8/19)inhibitor Senexin A as a compound that synergistically enhances the cytotoxic effect of PARP inhibition(P<0.05).Phenotypic validation using CCK-8 and colony for-mation assays demonstrated that the combination treatment significantly suppressed cellular proliferation and clonogenic potential compared to either monotherapy(P<0.0001).Mechanistically,alkaline comet assays revealed a significant increase in DNA damage in the combination treatment group relative to either single-agent group(P<0.0001),suggesting that the synergistic effect results from the exacerbation of DNA damage via impaired DNA repair mechanisms.In addition,treatment with CDK8/19 inhibitors a-lone markedly increased the formation of γH2AX and 53BP1 foci in irradiated gastric cancer cells(P<0.0001),indicating inhibition of DNA damage repair pathways.Transcriptome sequencing further re-vealed that CDK8/19 inhibition impacts critical cellular pathways,including DNA repair,cell cycle reg-ulation,and RNA splicing.Co-immunoprecipitation assays confirmed that inhibition of CDK8/19 kinase activity significantly reduces the phosphorylation level of PARP1,suggesting a potential regulatory inter-action.Immunohistochemical analysis of tumor and adjacent non-tumor tissues from gastric cancer pa-tients demonstrated that CDK8 is significantly overexpressed in tumor tissues,supporting its potential as both a prognostic biomarker and a therapeutic target.Collectively,this study elucidates a mechanistic ba-sis by which CDK8/19 inhibition enhances the sensitivity of gastric cancer cells to PARP inhibitors.These findings provide a strong rationale for the combined use of CDK8/19 and PARP inhibitors as a tar-geted therapeutic strategy and offer promising translational implications for advancing personalized medi-cine in gastric cancer treatment.

Gastric cancer remains one of the most prevalent and lethal malignancies of the digestive tract worldwide,underscoring the urgent need for more effective targeted therapeutic strategies.Poly(ADP-ri-bose)polymerase(PARP)inhibitors have demonstrated remarkable efficacy in tumors with homologous recombination repair(HRR)deficiency;however,their clinical application in gastric cancer remains limited.Clinical evidence suggests that patients harboring Helicobacter pylori infection in combination with HRR gene mutations exhibit a significantly elevated risk of developing gastric cancer,thereby supporting the potential benefit of PARP inhibition in this setting.In this study,a kinase inhibitor library was screened in combination with the PARP inhibitor olaparib in gastric cancer cells.And we identify the cy-clin-dependent kinase 8/19(CDK8/19)inhibitor Senexin A as a compound that synergistically enhances the cytotoxic effect of PARP inhibition(P<0.05).Phenotypic validation using CCK-8 and colony for-mation assays demonstrated that the combination treatment significantly suppressed cellular proliferation and clonogenic potential compared to either monotherapy(P<0.0001).Mechanistically,alkaline comet assays revealed a significant increase in DNA damage in the combination treatment group relative to either single-agent group(P<0.0001),suggesting that the synergistic effect results from the exacerbation of DNA damage via impaired DNA repair mechanisms.In addition,treatment with CDK8/19 inhibitors a-lone markedly increased the formation of γH2AX and 53BP1 foci in irradiated gastric cancer cells(P<0.0001),indicating inhibition of DNA damage repair pathways.Transcriptome sequencing further re-vealed that CDK8/19 inhibition impacts critical cellular pathways,including DNA repair,cell cycle reg-ulation,and RNA splicing.Co-immunoprecipitation assays confirmed that inhibition of CDK8/19 kinase activity significantly reduces the phosphorylation level of PARP1,suggesting a potential regulatory inter-action.Immunohistochemical analysis of tumor and adjacent non-tumor tissues from gastric cancer pa-tients demonstrated that CDK8 is significantly overexpressed in tumor tissues,supporting its potential as both a prognostic biomarker and a therapeutic target.Collectively,this study elucidates a mechanistic ba-sis by which CDK8/19 inhibition enhances the sensitivity of gastric cancer cells to PARP inhibitors.These findings provide a strong rationale for the combined use of CDK8/19 and PARP inhibitors as a tar-geted therapeutic strategy and offer promising translational implications for advancing personalized medi-cine in gastric cancer treatment.

Background and Aims:Acute inferior vena cava thrombosis(IVCT)commonly occurs secondary to inferior vena cava filter(VCF)implantation.If not promptly treated,it may lead to serious complications such as bilateral lower limb swelling and pulmonary embolism and can also reduce the likelihood of successful filter retrieval.Percutaneous mechanical thrombectomy(PMT)and catheter-directed thrombolysis(CDT)are currently the main interventional treatments for IVCT,but comparative studies evaluating their efficacy and safety remain limited.This study was to conduct a prospective randomized controlled trial to compare the clinical efficacy and safety of AngioJet mechanical thrombectomy versus conventional CDT in the treatment of acute IVCT and to explore factors influencing filter retrieval rates,thereby providing evidence-based guidance for clinical decision-making.Methods:From January 2022 to December 2024,patients diagnosed with acute IVCT following VCF implantation were prospectively enrolled at the Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University.Patients were randomly assigned to either the CDT group(n=46)or the PMT group(n=48)according to the interventional procedure used.The two groups were compared in terms of filter retrieval rates,thrombus clearance outcomes,operative time,thrombolytic drug dosage,and incidence of complications.Logistic regression analysis was used to identify factors associated with primary filter retrieval.Results:A total of 94 patients were enrolled,with 46 in the CDT group and 48 in the PMT group.Compared to the CDT group,the PMT group demonstrated a significantly higher primary filter retrieval rate(77.1%vs.43.5%),grade Ⅲ thrombus clearance rate(70.8%vs.37.0%),and better postoperative thrombus scores.Additionally,the PMT group required lower urokinase doses and shorter thrombolysis duration(all P<0.05).The overall filter retrieval rate and 3-month IVC patency were similar between groups,both exceeding 93%.Regarding safety,the CDT group had a higher incidence of catheter-related infections and medical adhesive-related skin injury,while vagal reflex symptoms were more frequent in the PMT group.Logistic regression analysis identified thrombus clearance rate as an independent factor significantly associated with primary filter retrieval in the PMT group(OR=190.773,P<0.05).Conclusion:Compared to CDT,AngioJet mechanical thrombectomy combined with manual aspiration achieves higher thrombus clearance and primary filter retrieval rates in the treatment of acute IVCT while also reducing thrombolysis duration and drug dosage.However,attention should be paid to the increased risk of vagal reflex symptoms.There was no significant difference between the two groups in secondary filter retrieval rates or long-term IVC patency.The choice of intervention should be based on the patient's condition,timing of filter retrieval,and individualized clinical considerations.

Objective:To investigate the clinical application value of a novel filter's retraction hook capture technique of pull-assisted method for the endovascular retrieval of conical inferior vena cava (IVC) filters whose hook attached to the wall.Methods:From January 2020 to December 2024, patients with conical filters whose hook attached to the wall admitted at Beijing Jishuitan Hospital were enrolled consecutively.Results:A total of 46 patients underwent filter retrieval using filter's retraction hook capture technique of pull-assisted method. Among these patients, 39 cases (84.8%) were successful in filter retrieval, with the penetration distance of cranial anchor vertex of 3.3(2.5, 4.4) mm, and 13 (33.3%) filters were deformed. The other 7 cases were unsuccessful, with a penetration distance of cranial anchor vertex of 5.0 (4.3, 5.0) mm, and 6 (85.7%) filters were deformed. There was a statistically significant difference between the two groups ( P<0.05). One case (2.2%) had IVC injury, one case (2.2%) experienced filter fracture, and no symptomatic pulmonary embolism occurred. Logistic regression analysis showed that filter deformation was an independent dangerous factor for filter's retraction. Conclusions:Filter's retraction hook capture technique of pull-assisted method is effective in removing conical filters whose hook attached to the wall, with no symptomatic PE occurring. This method can be considered as a new adjuvant technique for filter retrieval.

Objective:To investigate the clinical application value of a novel filter's retraction hook capture technique of pull-assisted method for the endovascular retrieval of conical inferior vena cava (IVC) filters whose hook attached to the wall.Methods:From January 2020 to December 2024, patients with conical filters whose hook attached to the wall admitted at Beijing Jishuitan Hospital were enrolled consecutively.Results:A total of 46 patients underwent filter retrieval using filter's retraction hook capture technique of pull-assisted method. Among these patients, 39 cases (84.8%) were successful in filter retrieval, with the penetration distance of cranial anchor vertex of 3.3(2.5, 4.4) mm, and 13 (33.3%) filters were deformed. The other 7 cases were unsuccessful, with a penetration distance of cranial anchor vertex of 5.0 (4.3, 5.0) mm, and 6 (85.7%) filters were deformed. There was a statistically significant difference between the two groups ( P<0.05). One case (2.2%) had IVC injury, one case (2.2%) experienced filter fracture, and no symptomatic pulmonary embolism occurred. Logistic regression analysis showed that filter deformation was an independent dangerous factor for filter's retraction. Conclusions:Filter's retraction hook capture technique of pull-assisted method is effective in removing conical filters whose hook attached to the wall, with no symptomatic PE occurring. This method can be considered as a new adjuvant technique for filter retrieval.

Background and Aims:Acute lower extremity deep vein thrombosis (DVT) is a common clinical condition. In the acute phase,it can lead to secondary complications such as acute pulmonary embolism (PE) and limb swelling,while in the chronic phase,it may result in post-thrombotic syndrome (PTS),posing significant health risks. Early mechanical thrombectomy can restore venous patency,alleviate symptoms,and reduce the incidence of PTS. AngioJet percutaneous mechanical thrombectomy (PMT) offers the advantages of rapid and efficient thrombectomy with fewer complications,making it widely used in clinical practice. However,there are currently no standardized guidelines at home or abroad regarding the choice of access route for PMT. This study was performed to compare the clinical outcomes and effects on venous valve function of antegrade versus retrograde AngioJet PMT for treating acute lower extremity DVT,aiming to explore the optimal surgical approach for thrombectomy.Methods:A prospective,randomized controlled study was conducted,enrolling 96 patients with acute lower extremity DVT treated at the Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University,from January 2022 to June 2024. Patients were divided into an antegrade group and a retrograde group based on the direction of operation and valve opening. Surgical outcomes and risks were evaluated for both groups,and factors influencing the 3-month postoperative venous patency rate were analyzed.Results:A total of 92 patients were finally included,with 47 cases in the antegrade group (51.1％) and 45 cases in the retrograde group (48.9％),all treated with AngioJet PMT. Baseline characteristics showed no significant differences between the two groups (all P>0.05). In the antegrade group,14 cases (29.8％) had thrombus interception by filters,with 7 cases (14.9％) being effective;4 cases (8.5％) developed new or worsened PE. In the retrograde group,18 cases (40.0％) had thrombus interception by filters,with 8 cases (17.8％) being effective;5 cases (11.1％) developed new or worsened PE. No significant differences were observed between the two groups in these or other safety and laboratory variables (all P>0.05). The antegrade group had a higher proportion of intraoperative manual aspiration thrombectomy compared to the retrograde group (68.1％ vs. 26.7％,P<0.001). However,there were no significant differences in thrombus grade Ⅲ clearance rate (61.7％ vs. 68.9％),3-month venous patency rate (93.6％ vs. 91.1％),or other perioperative variables (all P>0.05). Regression analysis of factors affecting 3-month venous patency showed that immediate venous patency (OR=3.043,95％ CI=0.993-1.209) and radiation dose (OR=0.868,95％ CI=-0.001-0.000) in the antegrade group,as well as immediate venous patency (OR=2.333,95％ CI=0.655-0.980) in the retrograde group,were significantly associated with 3-month patency rate (all P<0.001). Regression analysis also showed a significant linear relationship between immediate venous patency and VCSS/Villalta scores in both groups (all P<0.001). Conclusion:Both antegrade and retrograde AngioJet PMT procedures are equally safe and effective for treating acute lower extremity DVT. However,the risk of intraoperative thrombus detachment remains high,warranting the use of inferior vena cava filters to prevent fatal PE. Patients with immediate venous patency require standardized postoperative management and follow-up to prevent PTS.

Background and Aims:Acute lower extremity deep vein thrombosis (DVT) is a common clinical condition. In the acute phase,it can lead to secondary complications such as acute pulmonary embolism (PE) and limb swelling,while in the chronic phase,it may result in post-thrombotic syndrome (PTS),posing significant health risks. Early mechanical thrombectomy can restore venous patency,alleviate symptoms,and reduce the incidence of PTS. AngioJet percutaneous mechanical thrombectomy (PMT) offers the advantages of rapid and efficient thrombectomy with fewer complications,making it widely used in clinical practice. However,there are currently no standardized guidelines at home or abroad regarding the choice of access route for PMT. This study was performed to compare the clinical outcomes and effects on venous valve function of antegrade versus retrograde AngioJet PMT for treating acute lower extremity DVT,aiming to explore the optimal surgical approach for thrombectomy.Methods:A prospective,randomized controlled study was conducted,enrolling 96 patients with acute lower extremity DVT treated at the Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University,from January 2022 to June 2024. Patients were divided into an antegrade group and a retrograde group based on the direction of operation and valve opening. Surgical outcomes and risks were evaluated for both groups,and factors influencing the 3-month postoperative venous patency rate were analyzed.Results:A total of 92 patients were finally included,with 47 cases in the antegrade group (51.1％) and 45 cases in the retrograde group (48.9％),all treated with AngioJet PMT. Baseline characteristics showed no significant differences between the two groups (all P>0.05). In the antegrade group,14 cases (29.8％) had thrombus interception by filters,with 7 cases (14.9％) being effective;4 cases (8.5％) developed new or worsened PE. In the retrograde group,18 cases (40.0％) had thrombus interception by filters,with 8 cases (17.8％) being effective;5 cases (11.1％) developed new or worsened PE. No significant differences were observed between the two groups in these or other safety and laboratory variables (all P>0.05). The antegrade group had a higher proportion of intraoperative manual aspiration thrombectomy compared to the retrograde group (68.1％ vs. 26.7％,P<0.001). However,there were no significant differences in thrombus grade Ⅲ clearance rate (61.7％ vs. 68.9％),3-month venous patency rate (93.6％ vs. 91.1％),or other perioperative variables (all P>0.05). Regression analysis of factors affecting 3-month venous patency showed that immediate venous patency (OR=3.043,95％ CI=0.993-1.209) and radiation dose (OR=0.868,95％ CI=-0.001-0.000) in the antegrade group,as well as immediate venous patency (OR=2.333,95％ CI=0.655-0.980) in the retrograde group,were significantly associated with 3-month patency rate (all P<0.001). Regression analysis also showed a significant linear relationship between immediate venous patency and VCSS/Villalta scores in both groups (all P<0.001). Conclusion:Both antegrade and retrograde AngioJet PMT procedures are equally safe and effective for treating acute lower extremity DVT. However,the risk of intraoperative thrombus detachment remains high,warranting the use of inferior vena cava filters to prevent fatal PE. Patients with immediate venous patency require standardized postoperative management and follow-up to prevent PTS.

Adult ; Aged ; China/epidemiology* ; Cohort Studies ; Female ; Humans ; Male ; Metabolic Syndrome/etiology* ; Middle Aged ; Parks, Recreational/supply & distribution* ; Prevalence ; Residence Characteristics/statistics & numerical data* ; Rural Population/statistics & numerical data* ; Young Adult