参芪扶正注射液联合VAD方案治疗多发性骨髓瘤临床研究

目的：比较参芪扶正注射液联合VAD方案或单独使用VAD方案治疗多发性骨髓瘤的疗效和不良反应,及对于患者生活质量的影响。方法：入选的患者随机分为2组,治疗组采用VAD方案化疗加用参芪扶正注射液,对照组单用VAD方案化疗,并分别比较两组的临床疗效、不良反应及生活质量。结果：两组近期疗效无显著性差异,但是治疗组的不良反应发生率较对照组轻,治疗组对生活质量的改善优于对照组。结论：参芪扶正注射液联合VAD方案治疗多发性骨髓可以减低患者不良反应,有助于提高生活质量。     

Wallenberg综合征患者椎动脉发育不良现象相关临床研究

目的利用全脑数字减影血管造影术(DSA)探讨Wallenberg综合征发病与椎动脉优势及发育不良现象之间的相关性。方法将37例Wallenberg综合征患者设为观察组,148例前循环脑梗死患者设为对照组,有所患者都进行DSA检查,对比检测两组患者中出现椎动脉优势(vertebral artery dominance,VAD)及椎动脉发育不良(vertebral artery hypoplasia,VAH)现象的分布差异,分析其血管变异与Wallenberg综合征的相互关联及优势比(0dds ratio,OR)。结果观察组中有VAD现象19例(包含4例右侧发育不良,2例左侧发育不良);对照组中有VAD现象45例(包含3例右侧发育不良,3例左侧发育不良)。观察组中VAD、椎动脉发育不良的出现率均高于对照组(分别为χ2=5.739,P=0.017;χ2=5.352,P=0.021),差异具有统计学意义(P<0.05);其中VAD、VAH的几率较对照组明显增高(OR=2.416,95%CI 1.160⁵.032,OR=4.581,95%CI 1.3855.032,OR=4.581,95%CI 1.385¹5.154)。结论 VAD、VAH现象与Wallenberg综合征间存在一定的关联,在其发病中可能有较为重要的意义。     

补肾养骨汤联合VAD方案对老年多发性骨髓瘤血清IL-6和VEGF水平的影响

目的:探讨补肾养骨汤联合VAD方案对老年多发性骨髓瘤(Multiple Myeloma,MM)患者血清白介素6(IL-6)和血管内皮生长因子(VEGF)水平的影响。方法:采用随机数字表法将老年多发性骨髓瘤患者80例分为观察组和对照组各40例,对照组行VAD方案治疗,观察组行补肾养骨汤联合VAD方案治疗,观察2组治疗效果及治疗前后血清IL-6和VEGF水平、不良反应。结果:观察组总有效率为87.50%,明显高于对照组的62.50%(P=0.020);治疗后观察组血清IL-6和VEGF水平较对照组显著降低(P0.01);不良反应发生率观察组为15.00%,低于对照组的37.50%(P=0.042)。结论:补肾养骨汤联合VAD方案治疗老年MM效果优于单纯VAD方案治疗,能降低血清IL-6和VEGF水平,而且安全可行。     

Bridge to transplantation from mechanical circulatory support: a narrative review

ObjectiveTo highlight recent developments in the utilization of mechanical circulatory support (MCS) devices as bridge-to-transplant strategies and to discuss trends in MCS use following the changes to the United Network for Organ Sharing (UNOS) heart allocation system.BackgroundMCS devices have played an increasingly important role in the treatment of heart failure patients. Over the past several years, technological advancements have led to new developments in MCS devices and expanding indications for MCS use. In October of 2018, the UNOS heart allocation policy was revised to prioritize higher-urgency patients, including those supported with temporary MCS devices. Since then, changes in trends of MCS utilization have been observed.MethodsArticles from the PubMed database regarding the use of MCS devices as bridge-to-transplant strategies were reviewed.ConclusionsOver the past decade, utilization of temporary MCS devices, which include the intra-aortic balloon pump (IABP), percutaneous ventricular assist devices (pVADs), and extracorporeal membrane oxygenation (ECMO), has become increasingly common. Recent advancements in MCS include the development of pVADs that can fully unload the left ventricle (LV) as well as devices designed to provide right-sided support. Technological advancements in durable left ventricular assist devices (LVADs) have also led to improved outcomes both on the device and following heart transplantation. Following the 2018 UNOS heart allocation policy revision, the utilization of temporary MCS in advanced heart failure patients has further increased and the proportion of patients bridged directly from a temporary MCS device has exponentially risen. However, following the start of the COVID-19 pandemic, the trends have reversed, with a decrease in the percentage of patients bridged from a temporary MCS device. As long-term data following the allocation policy revision becomes available, future studies should investigate how trends in MCS use for patients with advanced heart failure continue to evolve.     

Retrieving embolized peripherally inserted central catheter – A novel two step technique

We report a novel two-step percutaneous endovascular technique for retrieval of peripherally inserted central catheter, free ends of which were inaccessible, that had embolized to the segmental branch of left pulmonary artery using SIM 1 catheter and a loop snare, in a 17 year old female patient diagnosed with osteosarcoma right femur. Step one involved, inserting SIM 1 catheter through the heart to hook the embolized peripherally inserted central catheter and bring it down to the lower segment of inferior vena cava. In the second step, a loop snare was used to grasp the free end of peripherally inserted central catheter, and the whole assembly was withdrawn via right common femoral vein access. Patient was monitored for 24 hours and discharged as there were no complications. SIM 1 catheter followed by the use of loop snare as a retrieval system is safe and efficacious and can be considered by an intervention radiologist for retrieval of embolized vascular access device, in which none of the free ends are available to catch hold with a loop snare.