Femoropopliteal Arterial Dissections Following FLEX VP and Balloon Angioplasty Versus Balloon Angioplasty Alone: Intravascular Ultrasound Assessment and Correlation With Angiographic Findings

BackgroundThe Flex VP is a longitudinal micro-incision catheter approved for vessel prepping of femoropopliteal arteries and arteriovenous fistulas. In this study, we evaluated the presence of deep dissections (adventitia) using IVUS in patients undergoing Flex VP followed by angioplasty (PTA) versus PTA alone.Methods17 patients (20 limbs) with femoropopliteal artery (FP) disease were prospectively and consecutively included (10 limbs received PTA followed by 10 limbs that received FLEX VP microincision catheter treatment followed by adjunctive PTA). Dissections post PTA, FLEX VP and FLEX VP+ PTA were evaluated using intravascular ultrasound (iDissection classification) and angiographically (NHLBI classification) by core laboratory. The evaluated segment of the vessel was prespecified at 10 cm at the most severe lesion location. Statistical differences were analyzed between the 2 groups at each appropriate procedural point for dissections, minimal luminal diameter (MLD), minimal luminal area (MLA), and residual stenosis. Statistical significance was determined by a p-value <0.05.ResultsBaseline demographics and angiographic variables were similar between the PTA vs FLEX VP + PTA groups with the exception of more males (87.5 % vs 33.3 %, p = 0.0274) and longer treated length (median 300 mm vs 150 mm, p = 0.0240) in the FLEX VP + PTA group. Lesion length, chronic total occlusions, angiographic and IVUS evaluated segment length for dissections, calcium severity and final balloon pressures and inflation duration were all similar between the 2 groups. Angiographic dissections were similar between the 2 groups but the increase in severe dissections from index to post POBA on IVUS (involving the adventitia) were significantly more for PTA when compared to FLEX VP + PTA (0 to 12 and 0 to 1 respectively, p = 0.0353). Bailout stenting was statistically similar for PTA as compared to FLEX VP + PTA per core lab evaluation (50 % vs 20 %, p = 0.3498). Minimal luminal area (MLA) gain by IVUS was similar between the 2 groups following FLEX VP + PTA vs PTA (7.4 mm² vs 6.5 mm², p = 0.7250). No serious major adverse events occurred in either group.ConclusionVessel prepping with the FLEX VP + PTA vs PTA yielded lower rates of adventitial dissections as seen on IVUS. The long-term outcomes of these findings remain unclear.     

基于倾向性匹配法的胆囊结石合并慢性胆囊炎手术DRG控费效果研究

目的 基于倾向性匹配分析疾病诊断相关分组（DRG）对胆囊结石合并慢性胆囊炎手术患者住院费用的控费效果。方法 收集2021年1月至2022年12月安徽医科大学第一附属医院1 010例胆囊结石合并慢性胆囊炎手术患者住院费用数据,按付费方式分为DRG组（n=570）和非DRG组（n=440）。采用描述性统计分析、倾向性评分法、秩和检验,平衡病例间混杂因素后,检验DRG组和非DRG组住院费用情况。结果 共纳入1 010例病例,经倾向性匹配成功852例。胆囊结石合并慢性胆囊炎患者DRG组与非DRG组年龄、住院天数在匹配前差异有统计学意义（P<0.05）。患者住院费用中,耗材费、药费占比较高。经倾向性匹配后,DRG组与非DRG组住院总费用（Z=7.519,P<0.001）、自费金额（Z=13.903,P<0.001）、医保报销费用（Z=11.561,P<0.001）、综合医疗服务费（Z=2.188,P=0.029）、手术费（Z=2.256,P=0.024）、药费（Z=3.202,P=0.001）、耗材费（Z=2.229,P=0.026）、诊断费（Z=8.263,P<0.001）差异均有统计学意义。结论 DRG对胆囊结石合并慢性胆囊炎患者自费金额、综合医疗服务费、手术费、药费、耗材费及诊断费均具有控费效果,且总体对住院费用控费效果较好,但费用结构方面仍存在优化空间。     

The teaching of health statistics: meeting the needs of a changing practice

The findings of the study did support the faculty's hypotheses. First, only 50% of the hospitals retain responsibility for the statistical function. This finding was, however, affected by the size of the hospital, with 100% of the hospitals of 400 beds or less retaining such responsibility. Second, the findings showed that only 12.5% of the hospitals had entirely manual statistical systems. However, 50% of the hospitals did compile some statistics manually, including the daily hospital census and discharge service statistics. Finally, in looking at the UT Memphis statistics curriculum and those of 14 other medical record administration programs in the Southeast, the hypothesis that curricula did not mirror this changing practice was confirmed. Although 100% of the programs surveyed had students memorize statistical formulas, only 36% had students working with computers in the statistics course. Of the 14 programs, only 6 specifically covered QA of statistical data in the statistics course, and 9 did not deal at all with how to assess the adequacy of policies and procedures for gathering statistical information. As a result of these findings, UT Memphis has modified its statistical course to increase the emphasis on computerization, QA, and assessment of statistical policies and procedures. These changes will better prepare the UT Memphis graduate for the statistical responsibilities that they will face in the workplace.     

Machine learning to identify immune-related biomarkers of rheumatoid arthritis based on WGCNA network

Clinical Rheumatology - This study was designed to identify the potential diagnostic biomarkers of rheumatoid arthritis (RA) and to explore the potential pathological relevance of immune cell...     

Association of weight-adjusted-waist index with all-cause and cardiovascular mortality in China: A prospective cohort study

Background and aimsAs a new simple anthropometric index, the weight-adjusted-waist index (WWI) appears to be superior to body mass index (BMI) and waist circumference (WC) in assessing both muscle and fat mass. We aimed to explore the association of WWI with all-cause and cardiovascular mortality in southern China.Methods and resultsA total of 12,447 participants (mean age, 59.0 ± 13.3 years; 40.6% men) in Jiangxi Province from the China Hypertension Survey study were included. WWI was defined as WC divided by the square root of weight. The outcome was all-cause and cardiovascular mortality. During a median follow-up of 5.6 years, 838 all-cause deaths occurred, with 390 cardiovascular deaths. Overall, there was a nonlinear positive relationship of WWI with all-cause and cardiovascular mortality. Accordingly, compared with participants in quartiles 1–3 (<11.2 cm/√kg), a significant higher risk of all-cause mortality (HR: 1.36, 95% CI: 1.17, 1.58) and cardiovascular mortality (HR: 1.43, 95% CI: 1.15, 1.77) were found in quartile 4 (≥11.2 cm/√kg). Further adjustment for BMI and WC did not substantially alter the results. No significant interactions were found in any of the subgroups (sex, age, area, physical activity, current smoking, current alcohol drinking, hypertension, and stroke).ConclusionHigher WWI levels (≥11.2 cm/√kg) were associated with increased the risk of all-cause and cardiovascular mortality in southern China. These findings, if confirmed by further studies, suggested that WWI may serve as a simple and effective anthropometric index in clinical practice.     

Screening for hypertension in young people with obesity: Feasibility in the real life

Background and aimScreening for pediatric hypertension (HTN) is based on several measurements of blood pressure (BP) in different visits. We aimed to assess its feasibility in outpatient youths with overweight/obesity (OW/OB) in terms of adherence to two-repeated measurements of BP and to show the features of youths who missed the follow-up and the predictive role of clinical and/or anamnestic features on confirmed HTN.Methods and resultsSix hundred, eighty-eight youths (9–17 years) with OW/OB, consecutively recruited, underwent a first measurement of BP. Those exhibiting BP levels within the hypertensive range were invited to repeat a second measurement within 1–2 weeks. Confirmed HTN was diagnosed when BP in the hypertensive range was confirmed at the second measurement. At entry, 174 youths (25.1%) were classified as hypertensive. At the second visit, 66 youths (37.9%) were lost to follow-up. In the remaining 108 participants, HTN was confirmed in 59, so that the prevalence of confirmed HTN was 9.5% in the overall sample; it was higher in adolescents than children (15.9% vs 6.8%, P = 0.001). HTN at first visit showed the best sensitivity (100%) and a good specificity (91%) for confirmed HTN. The association of HTN at first visit plus familial HTN showed high specificity (98%) and positive predictive value of 70%.ConclusionThe high drop-out rate confirms the real difficulty to obtain a complete diagnostic follow up in the obese population. Information about family history of HTN may assist pediatricians in identifying those children who are at higher risk of confirmed HTN.     

骶尾部卵黄囊瘤9例临床病理分析

目的探讨骶尾部卵黄囊瘤(YST)的临床病理学特征及诊断与鉴别诊断。方法对9例骶尾部卵黄囊瘤进行临床病理分析及免疫组化染色,同时复习相关文献。结果 8例为女童,1例为男童,发病年龄16个月~44个月。以臀部或骶尾部包块为主要临床表现。组织病理学检查均可见到典型的内胚窦结构以及腺样、乳头状和疏松网状结构。免疫组化显示9例AFP(+),其中5例呈灶状(+),4例胞质呈弥漫性强(+);2例PLAP灶状(+);8例CK呈强(+),1例(-);9例CD30、HCG、EMA、CD15和CD117均(-)。5例确诊后及时进行化疗,3例未化疗者短期内复发死亡,1例失访。结论骶尾部卵黄囊瘤多见于女婴,恶性度高,化疗敏感,诊断主要依靠组织形态与免疫组化染色。     

胸背动脉穿支皮瓣对手背软组织缺损的修复效果

目的研究胸背动脉穿支皮瓣对手背软组织缺损的修复效果。方法选择88例手背软组织缺损病人作为研究对象,比较病人治疗前和治疗后6个月的手功能评定量表,并分析病人的手术时间、术中出血量、住院时间、供区创面愈合时间、受区创面愈合时间、皮瓣存活率及术后并发症。结果88例病人治疗后6个月的对指、对掌、手指内收及外展等评分及手功能评定总分高于治疗前（P < 0.05~P < 0.01）。88例病人的手术时间（95.32±10.59）min,术中出血量（305.21±26.87）mL,住院时间（10.53±1.65）d,供区创面愈合时间（7.26±0.95）d,受区创面愈合时间（8.47±1.16）d。88例病人中85例皮瓣存活,存活率96.59%;其余3例中,2例皮瓣发紫,经积血引流、血管扩张药治疗后改善,1例皮瓣部分坏死,二次清创及再次移植皮瓣后存活。术后发生3例血运障碍,1例血肿,1例感染,2例瘢痕增生严重,并发症发生率7.95%。结论手背软组织缺损采取胸背动脉穿支皮瓣修复,能显著提高病人的手功能,且皮瓣存活率高,适合在临床中深入研究使用。