Factors Affecting Recurrent Deep Vein Thrombosis after Pharmacomechanical Thrombolysis and Left Iliac Vein Stent Placement in Patients with Iliac Vein Compression Syndrome

PurposeThis study evaluated the factors affecting contralateral and ipsilateral recurrent deep vein thrombosis (DVT) after iliac vein stent placement in patients with iliac vein compression syndrome (IVCS).Materials and MethodsData from 130 patients (95 female patients) who underwent catheter-directed thrombolysis and stent placement for IVCS with left lower leg thrombosis at a single institution were retrospectively analyzed. Mean patient age was 69.0 ± 14.0 years old. Median follow-up was 14 months (range, 3–164 months). Anticoagulation therapy was prescribed for 6 months, followed by lifelong antiplatelet therapy. Multivariate logistic regression analysis was performed to evaluate the factors affecting the development of contralateral and ipsilateral recurrent DVT.ResultsSeven patients (5.4%) developed contralateral DVT (median, 26 months; range, 2–61 months), and 11 patients (8.5%) developed ipsilateral DVT (median, 1 month; range, 0–53 months). Stent location (odds ratio [OR], 11.564; 95% confidence interval [CI], 1.159–115.417) and in-stent thrombosis during follow-up (OR, 15.142; 95% CI, 1.406–163.119) were predictors of recurrent contralateral DVT. Thrombophilia (OR, 47.560; 95% CI, 2.369–954.711), remaining inferior vena cava filter (OR, 30.552; 95% CI, 3.495–267.122), and in-stent thrombosis during follow-up (OR, 82.057; 95% CI, 2.915–2309.848) were predictors of ipsilateral DVT.ConclusionsContralateral DVT occurs late and is associated with extension of the iliac vein stent to the inferior vena cava and in-stent thrombosis. Ipsilateral DVT occurs relatively early and is associated with thrombophilia, remaining inferior vena cava filter, and in-stent thrombosis.     

Treatment of 25 cases of obstruction of Qi in the chest by Tuina

应用一指禅手法为主治疗25例胸痹患者,结果显示推拿对胸痹患者的各种临床症状均有缓解作用,治愈10例,好转14例,无效1例.     

Beliefs and expectations of rural hospital practitioners towards a developing trauma system: A qualitative case study

BackgroundAn understanding of stakeholders’ views is key to the successful development and operation of a rural trauma system. Scotland, which has large remote and rural areas, is currently implementing a national trauma system. The aim of this study was to identify key barriers and enablers to the development of an effective trauma system from the perspective of rural healthcare professionals.MethodsThis is a qualitative study, which was conducted in rural general hospitals (RGH) in Scotland, from April to June 2017. We used an opportunistic sampling strategy to include hospital providers of rural trauma care across the region. Semi-structured interviews were conducted, recorded, and transcribed. Thematic analysis was used to identify and group participant perspectives on key barriers and enablers to the development of the new trauma system.ResultsWe conducted 15 interviews with 18 participants in six RGHs. Study participants described barriers and enablers across three themes: 1) quality of care, 2) interfaces within the system and 3) interfaces with the wider healthcare system. For quality of care, enablers included confidence in basic trauma management, whilst a perceived lack of change from current management was seen as a barrier. The theme of interfaces within the system identified good interaction with other services and a single point of contact for referral as enablers. Perceived barriers included challenges in referring to tertiary care. The final theme of interfaces with the wider healthcare system included an improved transport system, increased audit resource and coordinated clinical training as enablers. Perceived barriers included a rural staffing crisis and problematic patient transfer to further care.ConclusionsThis study provides insight into rural professionals’ perceptions regarding the implementation of a trauma system in rural Scotland. Barriers included practical issues, such as retrieval, transfer and referral processes. Importantly, there is a degree of uncertainty, discontent and disengagement towards trauma system development, and concerns regarding staffing levels and governance. These issues are unlikely to be unique to Scotland and warrant further study to inform service planning and the effective delivery of rural trauma systems.     

尿培养病原菌分布及耐药性分析

目的了解医院门诊和住院患者尿培养中病原菌分布及耐药性,为临床治疗提供参考依据。方法 651株病原菌分离自2011年1月-2012年12月医院门诊和住院患者的尿液标本,采用MicroScan WalkAway-plus全自动微生物鉴定和药敏分析系统进行菌株鉴定和药敏试验,采用WHONET5.6软件进行统计分析。结果共分离病原菌651株,检出排前3位依次为大肠埃希菌、粪肠球菌、凝固酶阴性葡萄球菌,分别占46.2%、16.6%、8.5%;301株大肠埃希菌中有219株产超广谱β-内酰胺酶(ESBLs),占72.8%;大肠埃希菌对阿莫西林/克拉维酸、阿米卡星、亚胺培南较为敏感,耐药率为12.0%、9.0%和1.3%;132株肠球菌属中发现2株耐万古霉素肠球菌(VRE),均为粪肠球菌,万古霉素对这两株VRE的MIC为32³26mg/L,粪肠球菌和屎肠球菌对万古霉素和利奈唑胺的耐药率均较低;分离的凝固酶阴性葡萄球菌(CNS)中,最常见的是表皮葡萄球菌占50.9%;55株CNS中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率为65.5%,CNS对呋喃妥因、克林沙星、利奈唑胺、利福平、万古霉素较敏感。结论临床应根据尿培养药敏结果合理应用抗菌药物,控制耐药率的上升。     

Quantitative assessment of the influence of tumor necrosis factor alpha polymorphism with gastritis and gastric cancer risk

Tumor necrosis factor alpha (TNFA) is an important molecule in inflammatory, infectious, and tumoral processes. Inflammation is one of the early phases in the development of gastric cancer (GC). Therefore, several studies have examined the association of polymorphism in TNFA with gastritis and GC risk. A functional polymorphism, -308G>A (rs1800629), which is located in the promoter of TNFA gene, has been suggested to alter the production of TNF-α and influence cancer risk. To date, a number of studies have been carried out to investigate the relationship between the polymorphism and gastritis or GC susceptibility, but the results were conflicting. To investigate this inconsistency, we performed a meta-analysis of 36 studies for TNFA -308G>A polymorphism to evaluate the effect of TNFA on genetic susceptibility for gastritis and GC. An overall random-effects per-allele odds ratio of 1.16 (95 % confidence interval 1.04–1.29, P?=?0.008) was found for the polymorphism. Significant results were also observed using dominant or recessive genetic models. In the subgroup analyses by ethnicity, significant results were found in Caucasians, whereas no significant associations were found among East Asians and other ethnic populations. No associations between the polymorphism and gastritis were observed. In addition, our data indicate that TNFA is involved in GC susceptibility and confers its effect primarily in diffuse type of tumors. Besides, -308G>A polymorphism was found to be significantly associated with both cardiac and noncardiac tumors. This meta-analysis demonstrated that the TNFA -308G>A polymorphism is a risk factor for developing GC, but the associations vary in different ethnic populations.     

Future research directions to improve fistula maturation and reduce access failure

With the increasing prevalence of end-stage renal disease, there is a growing need for hemodialysis. Arteriovenous fistulae (AVF) are the preferred type of vascular access for hemodialysis, but maturation and failure continue to present significant barriers to successful fistula use. AVF maturation integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes in the setting of uremia, systemic inflammation, oxidative stress, and pre-existent vascular pathology. AVF can fail due to both failure to mature adequately to support hemodialysis and development of neointimal hyperplasia that narrows the AVF lumen, typically near the fistula anastomosis. Failure due to neointimal hyperplasia involves vascular cell activation and migration and extracellular matrix remodeling with complex interactions of growth factors, adhesion molecules, inflammatory mediators, and chemokines, all of which result in maladaptive remodeling. Different strategies have been proposed to prevent and treat AVF failure based on current understanding of the modes and pathology of access failure; these approaches range from appropriate patient selection and use of alternative surgical strategies for fistula creation, to the use of novel interventional techniques or drugs to treat failing fistulae. Effective treatments to prevent or treat AVF failure require a multidisciplinary approach involving nephrologists, vascular surgeons, and interventional radiologists, careful patient selection, and the use of tailored systemic or localized interventions to improve patient-specific outcomes. This review provides contemporary information on the underlying mechanisms of AVF maturation and failure and discusses the broad spectrum of options that can be tailored for specific therapy.     

酪酸梭菌对非酒精性脂肪性肝病的疗效及对肠屏障的影响

目的探讨酪酸梭菌对非酒精性脂肪性肝病(NAFLD)患者肠屏障的作用及其对NAFLD的疗效和作用机制。方法选择在该院消化科就诊的NAFLD患者100例纳入NAFLD组,另选取50例健康体检者纳入对照组,比较两组的肠屏障功能指标[血清内毒素、二胺氧化酶(DAO)和D-乳酸]。将NAFLD组患者按照随机数字表法又分为A组、B组,两组均予以常规低脂饮食+有氧运动+双环醇1粒tid po,A组在此基础上,予以酪酸梭菌2粒tid po。将NAFLD组根据丙氨酸氨基转移酶(ALT)值分为ALT升高组和ALT正常组,比较两组肠屏障功能障碍发生率及炎性反应指标[白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)]水平。分别于给药1个月后复查患者肠屏障功能、血脂[三酰甘油(TG)、总胆固醇(TC)]、肝功能、炎性反应指标等,并对A组与B组患者以上指标进行比较。结果NAFLD组的血清内毒素、DAO、D-乳酸水平均高于对照组,差异有统计学意义(P<0.05)。ALT升高组的TNF-α、IL-6水平明显高于ALT正常组,差异有统计学意义(P<0.05)。用药后A组与B组内毒素、D-乳酸、DAO水平均较用药前下降,A组下降比B组更明显,差异有统计学意义(P<0.05)。用药后A组与B组IL-6、TNF-α、TG水平均较用药前下降,A组下降比B组更明显,差异有统计学意义(P<0.05)。A组的总有效率(86.0%)高于B组(70.0%),差异有统计学意义(P<0.05)。结论NAFLD患者存在肠屏障损伤,可能与炎性反应激活有关。联合酪酸梭菌治疗有助于改善NAFLD患者的肠屏障功能,降低血脂水平,提高疗效。