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1.
目的 观察穿刺肝内支架辅助经颈静脉途径开通TIPS术后分流道闭塞的应用价值。方法 对经单纯颈静脉途径行分流道再通术失败的12例TIPS术后分流道闭塞患者行肝内分流道支架穿刺,辅助经颈静脉通路进行再通,观察术中及术后情况。结果 对12例(12/12,100%)均成功经皮经肝穿刺肝内分流道支架。于 10例(10/12,83.33%)实现分流道再通,术前门静脉压力为(29.20±2.04)cmH2O,术后为(21.70±1.70)cmH2O;对2例(2/12,16.67%)术前无症状患者未能通过分流道,予口服β受体阻滞剂降低门静脉压力治疗。术中对7例(7/12,58.33%)经肝脏穿刺道置入血管鞘,另5例(5/12,41.67%)仅以导丝穿过闭塞的分流道而未置入血管鞘。术中未发生穿刺道出血等穿刺相关并发症。术后1年,10例成功再通患者TIPS分流道通畅率为90%(9/10)。随访5~60个月期间无肝性脑病、肝性脊髓病或门静脉高压症状复发,无死亡。结论 对于经颈静脉通路再通失败的TIPS术后分流道闭塞患者,经肝穿刺分流道内支架可安全、有效地辅助经颈静脉途径实现再通。  相似文献   
2.
《Indian heart journal》2021,73(6):729-732
Percutaneous coronary intervention (PCI) in very small vessel coronary arteries is challenging due to adverse short-term as well as long-term outcomes. This single-arm, open-label, observational study assessed 1-year clinical outcomes of drug-eluting stents (DES) in Indian patients undergoing PCI for symptomatic very small-calibre coronary artery disease. It enrolled 66 Indian patients with 74 very small coronary artery lesions (reference vessel diameter: ≥2.0 and ≤ 2.25 mm); eligible for implantation with 2.25 mm DES. The primary endpoint of major adverse cardiovascular events (MACE) was 3.0% indicating favourable 1-year clinical outcomes of DES in very small coronary artery lesions in Indian patients.  相似文献   
3.
Co-based (Co75Si15B10) thin-film metallic glass (TFMG) with nanometric thicknesses (100~300 nm) was investigated for its structural, electrical, and optical properties. The TFMG structure was examined using scanning electron microscopy and X-ray diffraction, while electrical properties were examined using inductance/capacitance/resistance spectroscopy, cyclic voltammetry, and Hall effect measurements. In addition, optical absorption/reflection/transmittance measurements were performed to examine optical properties. Results revealed that Co-based TFMGs, which have an amorphous structure without surface defects, behave like a dielectric material, with higher resistivity and much lower carrier concentration than pure cobalt (Co) thin films of the same thickness, despite its mobility being modestly larger than its Co counterparts. Meanwhile, the optical investigation of TFMG enabled us to determine the complex relative permittivity (complex relative dielectric constant) ϵr˜ at a visible wavelength (632.8 nm). Moreover, unlike normal metals, TFMGs exhibited a large positive value of the real part of ϵr˜, while exhibiting properties of substantial absorption of light (absorption coefficient α). It was also found that the Co-based TFMG gained optical transparency for thicknesses less than 5 nm. TFMGs demonstrated the nearly thickness-independent properties of the electrical and optical parameters probed, a feature of high-index, dielectric-like material with negligible size effects, which may have applications in micrometer-scaled optoelectronic and magneto-optical devices.  相似文献   
4.
The aim of this study was to compare the estimated public medical care cost of measures to address metallic dental restorations (MDRs) for head and neck radiotherapy using high-energy mega-voltage X-rays. This was considered a first step to clarify which MDR measure was more cost-effective. We estimated the medical care cost of radiotherapy for two representative MDR measures: (i) with MDR removal or (ii) without MDR removal (non-MDR removal) using magnetic resonance imaging and a spacer. A total of 5520 patients received head and neck radiation therapy in 2018. The mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. Therefore, the difference in total public medical care cost between MDR removal and non-MDR removal was estimated to be 303 268 800 yen. Our results suggested that non-MDR removal would be more cost-effective than MDR removal for head and neck radiotherapy. In the future, a national survey and cost-effectiveness analysis via a multicenter study are necessary; these investigations should include various outcomes such as the rate of local control, status of oral mucositis, frequency of hospital visits and efforts of the medical professionals.  相似文献   
5.
6.
Introduction and objectivesThe DECADE cooperation is a pooled analysis of individual patient data from drug-eluting stent (DES) trials with a 10-year follow-up. This analysis reports the risk of definite stent thrombosis (ST) through to 10 years after percutaneous coronary intervention (PCI) in patients treated with early- and new-generation DES.MethodsIndividual patient data from 5 DES trials with a 10-year follow-up were pooled. The primary endpoint was definite ST up to 10 years after PCI. Patients were divided into 2 groups as per the generation of DES implanted (early and new DES). Individual participant data were analyzed using a 1-stage approach.ResultsWe included 9700 patients, 6866 in the new DES group and 2834 in the early DES group. Through to 10 years, definite ST occurred in 69 of 6866 patients treated with new DES and in 91 of 2834 patients treated with early DES (1.0% vs 3.5%, adjusted hazard ratio, 0.32; 95%CI, 0.23-0.45). The rate of definite ST was lower in the new DES group than in the early DES group from 1 to 5 years (rate ratio, 0.14; 95%CI, 0.08-0.26) and from 5 to 10 years (rate ratio, 0.23; 95%CI, 0.08-0.61) after PCI.ConclusionsThe incidence of definite ST through to 10 years after PCI with new-generation DES was 1%. New-generation DES are associated with a lower 10-year incidence of definite ST than early-generation DES, particularly beyond 1 year after PCI.  相似文献   
7.
BackgroundCalcific coronary lesions can be so resistant to prevent symmetric stent dilatation with high risk of ISR/thrombosis. The aim of the current study is to evaluate the safety and efficacy of super high-pressure dilatation (>30-to-45Atm) using a dedicated NC-balloon (OPN, SIS-Medical-AG, Winterthur-Switzerland).MethodsWe retrospectively evaluated 326 consecutive undilatable lesions in which conventional NC-balloons failed to achieve adequate post-dilatation luminal gain. After the failed attempt an OPN-balloon was inflated up to achieve a uniform balloon expansion (maximal dilatation pressure of 45–50 Atm). Lesions were divided into two groups according to the final inflation pressure: Group-I: lesion responsive to 30-40Atm and Group-2:>40 Atm. Angiographic success was defined as residual angiographic stenosis<30% assessed by visual estimation with TIMI3-flow. Procedural success was defined as the achievement of angiographic success without any MACE.ResultsAngiographic success was achieved in 97.5%, procedural success in 96.6%; 53% of the lesions were responsive to a slower inflation pressure (Group I) while in the remaining 47%, the optimal expansion required a pressure > 40ATM (Group II). In 3 patients coronary rupture occurred after balloon inflation and was successfully treated with stent implantation with a final TIMI3-flow. The OPN alone was able to achieve adequate expansion in >90%. 0.9% days MACE were reported.ConclusionThe OPN-dedicated high-pressure balloon provides an effective and safe strategy for treatment of severe resistant coronary lesions.  相似文献   
8.
Interventional procedures in the airway can be performed in interventional radiology suites or the operating room, by radiologists or other specialists. The most common therapeutic interventions carried out by radiologists are balloon dilatation, stenting, and the treatment of certain airway fistulas. These operations can be very challenging for anesthetists in terms of planning, airway management, the identification and treatment of procedural complications and postoperative care. In particular, a multidisciplinary approach to decision‐making and planning is important to obtain the best results.  相似文献   
9.
目的 评价短期(3~6个月)与长期(12个月)双联抗血小板治疗对冠状动脉药物洗脱支架植入后的临床效果。方法 研究病例包括稳定性心绞痛、急性冠脉综合征、无症状心肌缺血,均为原位血管病变。临床观察终点为:全因死亡、心源性死亡、心肌梗死、卒中、支架内血栓形成、靶病变再血管化治疗、严重出血、净不良临床事件(net adverse clinical event)。通过检索Pubmed、中国生物医学文献等中、英文数据库及手工检索,对符合条件的随机对照研究经质量评估、数据提取,进行Meta分析。结果 共计纳入12项随机对照研究。Detsky评分均大于5分。共计25 949个病例,随访率97.9%。两组在全因死亡(OR=0.86,95%CI 0.71~1.05,P=0.14)、心源性死亡(OR=0.94,95% CI 0.70~1.25,P=0.67)、支架血栓形成(OR=1.36,95%CI 0.94~1.98,P=0.11)、卒中(OR=1.01,95%CI 0.71~1.42,P=0.98)、靶病变再血管化(OR=0.121,95%CI 0.94~1.55,P=0.14)及净不良临床事件(OR=0.98,95%CI 0.83~1.14,P=0.75)均无明显差别;短期组随访期间心肌梗死发生率高于长期组(OR=1.27,95%CI 1.02~1.59,P=0.04),长期组严重出血的比例明显增加(OR=0.69,95%CI 0.50~0.95,P=0.02)。亚洲人群研究结果:长期治疗组全因死亡高于短期组(OR=0.72,95%CI 0.53~0.97,P=0.03),两组严重出血无明显差别。结论 依据限定的临床观察终点,短期双联抗血小板疗效不劣于长期组;7项亚组人群研究,长期组全因死亡率高,不排除与样本量偏少产生的偏移及(或)人群的个体差异有关,结果还有待进一步验证。此结果可作为临床工作警示,依据患者出血风险及冠状动脉病变结果个体化调整双联抗血小板周期。  相似文献   
10.
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