Outcomes of Fluoroscopy-Guided Percutaneous High Ligation of the Great Saphenous Vein Combined With Foam Sclerotherapy for Symptomatic Great Saphenous Veins

PurposeTo evaluate the effectiveness and safety of fluoroscopy-guided percutaneous high ligation (FPHL) combined with fluoroscopy-guided foam sclerotherapy (FGFS) to treat varicose veins of the great saphenous veins (GSVs).Materials and MethodsThis was a retrospective study of 113 patients (mean age, 62.1 ± 10.8 years; 60 men) with varicose veins of the GSVs (133 limbs) that were treated with FPHL combined with FGFS between April 1 and October 31, 2019. Demographic and clinical data were collected from these patients before the FPHL procedure, after which FGFS was performed. The preterminal GSV was ligated percutaneously by a percutaneously-positioned polypropylene ligature under fluoroscopic guidance. The outcome of ligation was confirmed by venography. Then, foam sclerotherapy was performed under fluoroscopy. At 1-year follow-up, GSV occlusion was evaluated by ultrasound. The venous clinical severity scores (VCSSs) were compared between the preoperative and 1-year follow-up periods.ResultsThe technical success rate was 100% (133 limbs). Complete 12-month follow-up was available for 112 limbs (84.2%) and 103 of these limbs (92.0%) remained occluded during this period. The VCSS improved from 4.71 ± 2.15 to 0.74 ± 0.60 (V = 6328, P < .001). During follow-up, there were 16 limbs with thrombophlebitis and 38 limbs with saphenous junction pain; these events were alleviated within 2 weeks of the procedure. There was no deep venous thrombosis or other severe adverse events.ConclusionsFPHL combined with FGFS to treat varicose veins in the GSVs achieved an occlusion rate of 92% and improved the clinical symptoms within 1 year; this minimally-invasive procedure was safe and effective.     

Recreational runners with Achilles tendinopathy have clinically detectable impairments: A case-control study

ObjectivesTo confirm what impairments are present in runners with Achilles tendinopathy (AT) and explore the variance of AT severity in an adequately powered study.DesignCase-control study.SettingTwo private physiotherapy clinics in Australia and Spain.ParticipantsForty-four recreational male runners with AT and 44 healthy controls matched by age, height, and weight.Main outcome measuresDemographics, activity (IPAQ-SF), pain and function (VISA-A), pain during hopping (Hop pain VAS), hopping duration, psychological factors (TSK-11, PASS20), and physical tests regarding lower-limb maximal strength and endurance.ResultsBody mass index (BMI), activity, VISA-A, pain, and duration of hopping, TSK-11, PASS20, standing heel raise to failure, seated heel raise and leg extension 6RM, hip extension and abduction isometric torque were significantly different between groups (P < 0.05) with varied effect sizes (V = 0.22, d range = 0.05–4.18). 46% of AT severity variance was explained by higher BMI (β = −0.41; p = 0.001), weaker leg curl 6RM (β = 0.32; p = 0.009), and higher pain during hopping (β = −0.43; p = 0.001).ConclusionRunners with AT had lower activity levels, lower soleus strength, and were less tall. BMI, pain during hopping, and leg curl strength explained condition severity. This information, identified with clinically applicable tools, may guide clinical assessment, and inform intervention development.     

HBV患者血清YKL-40、CA19-9、GP73水平与其病情相关性

目的 分析HBV患者YKL-40、CA19-9、GP73水平差异及与患者病情轻重程度的相关性,探讨HBV患者病情的判定指标。方法 选取2015年5月—2018年5月收治的100例HBV患者,其中慢性HBV感染组40例、慢性乙型肝炎组36例、HBV相关肝硬化组24例,同期选择我院健康体检的健康者50例作为健康对照组;检测患者血中YKL-40、CA19-9、GP73水平;分析HBV感染患者血清YKL-40、CA19-9、GP73水平与病情轻重程度的相关性。结果 慢性HBV感染、慢性乙型肝炎及HBV相关肝硬化患者血中YKL-40水平分别为（36.38±4.19）ng/mL 、（49.02±4.32）ng/mL、（65.14±5.21）ng/mL ,CA19-9分别为（12.03±1.03）KU/L、（13.84±0.98）KU/L、（16.94±0.81）KU/L,GP73分别为（47.22±5.38）ng/mL 、（98.53±10.24）ng/mL 、（229.85±12.19）ng/mL,均明显高于对照组的（28.19±3.27）ng/mL 、（7.34±0.92）KU/L 、（30.93±3.89）ng/mL,均P=0.000 0。随着慢性HBV感染者、慢性乙型肝炎患者和不同HBV相关肝硬化患者肝脏炎症及纤维化程度加重,患者血中YKL-40、CA19-9和GP73也随之显著增加,均P=0.000 0;YKL-40、CA19-9和GP73均是影响HBV感染患者体内炎症坏死及肝脏纤维化的独立性影响因素,差异有统计学意义（P<0.05）。结论 HBV感染患者血清中YKL-40、CA19-9、GP73水平是HBV感染患者病情轻重程度的独立性影响因素。     

Regional Variation and Use of Exception Letters for Cadaveric Liver Allocation in Children with Chronic Liver Disease

The Pediatric End-Stage Liver Disease (PELD) score was designed to reduce subjectivity in liver allocation and to advantage patients with a higher probability of waiting list mortality. The aims of this study were to determine the impact of PELD implementation for children with chronic liver disease and to assess whether PELD met its goal of standardization of liver allocation for children. This study used data reported to the United Network for Organ Sharing (UNOS) registry for children with chronic liver disease receiving primary cadaveric liver transplant between January 2000 and December 2001 (pre-PELD) and March 2002 and July 2003 (PELD). PELD reduced the percentage of children transplanted while in an intensive care unit and as status 1. A calculated PELD score was used for allocation in only 52% of recipients. Thirty percent were status 1 at transplant and PELD scores granted by exception were used for allocation in 18% of patients. There was regional variation in PELD score at allocation and use of exception scores with a significant relationship between PELD score and percentage of exception cases. Regional variation suggests that PELD has not resulted in standardization of listing practices in pediatric liver transplantation.     

Severity of injury does not have any impact on posttraumatic stress symptoms in severely injured patients

Background

Due to improved surgical techniques and more efficient decision making in treating severely injured patients, survival rates have increased over the years. This study was initiated to evaluate the incidence and identify risk factors for developing posttraumatic stress symptoms, using both extensive trauma-related data and data assessing the psychological trauma, in a population of severely injured patients.

Patients and methods

79 patients admitted to the Department of Multitrauma and Spinal Cord Injury at Sunnaas Rehabilitation Hospital from 2003 to 2005, prospectively completed semistructured psychological interviews and questionnaires, such as Impact of Event Scale-Revised. In addition, extensive injury-related data, such as injury severity score (ISS), new injury severity score (NISS), and probability of survival (PS) were collected.

Results

39% had multiple trauma, 34% had multiple injuries including spinal cord injuries, and 27% had isolated spinal cord injuries. Mean NISS was 31.5 (S.D. 13.7). 6% met diagnostic criteria for posttraumatic stress disorder (PTSD) and 9% met the criteria for subsyndromal PTSD. Injury-related data did not influence the prevalence of posttraumatic stress symptoms, however, some psychosocial variables did have a significant impact.

Conclusions

We found a low incidence of PTSD and subsyndromal PTSD. No significant differences were found between the patients suffering from posttraumatic stress symptoms and the non-symptoms group in relation to injury-related data such as ISS/NISS, PS, or multiple trauma versus spinal cord injury. The most evident risk factors for developing posttraumatic stress symptoms were symptoms of anxiety, female gender and negative attitudes toward emotional expression.     

Outcome in a post-cardiac surgery population with acute renal failure requiring dialysis: does age make a difference?

BACKGROUND: Acute renal failure (ARF), requiring dialysis (ARF-d), develops in 1-5% of patients undergoing cardiac surgery and is associated with higher in-hospital mortality. Age is one of the known risk factors for the development of ARF. As the ageing population is increasing, the nephrologist will be faced with a large population of elderly patients requiring dialysis following cardiac surgery. The aim of our study was to evaluate the influence of age on and the risk factors for in-hospital mortality. METHODS: Eighty-two patients with ARF following cardiac surgery and requiring dialysis between January 1997 and October 2001 were included. Two groups of patients were studied: the younger population (<70 years, 42 patients, mean age 59+/-10) and an elderly population (>/=70 years, 40 patients, mean age 76+/-4). Severity of disease was evaluated using the SAPS (Simplified Acute Physiology Score), the Liano score and the SHARF (Stuivenberg Hospital Acute Renal Failure) score. RESULTS: Overall mortality in the population with ARF-d was 56.1%. No difference in mortality rate was found between the younger (61.9%) and elderly patient group (50.0%). The two groups were very similar in baseline and procedural characteristics with exception of body weight (P=0.02) and preoperative glomerular filtration rate (P=0.0001). No significant difference was found in the scoring systems between the old and the young (SAPS P=0.52; Liano P=0.96; SHARF T0 P=0.06; SHARF T48 P=0.15). Mortality in the elderly was significantly correlated with hypotension before starting renal replacement therapy (RRT) (P=0.002), mechanical ventilation (P=0.002), presence of multiorgan failure (MOF) (P=0.0001) and higher scores in the severity models (SAPS: P=0.01; Liano: P<0.0001 and SHARF: P<0.0001). CONCLUSION: The outcome in the elderly requiring dialysis due to ARF post-cardiac surgery is comparable with the outcome in a younger population. No significant difference was found in severity of disease between the elderly and the younger. Variables predicting mortality in the elderly are the presence of MOF, mechanical ventilation and hypotension 24 h before starting RRT. These findings indicate that at the time the nephrologist is called for an elderly patient requiring dialysis due to ARF following cardiac surgery, age per se is not a reason to withhold RRT.     

围绝经期非器质性失眠患者失眠严重程度与肝郁分级的相关性

目的 研究围绝经期妇女非器质性失眠严重程度(ISI)与肝郁的相互关系,为预防围绝经期非器质性失眠提供临床思路.方法 纳入围绝经期非器质性失眠妇女182例,根据朱文锋《证素辨证学》确定肝郁积分并分级,运用失眠严重程度指数量表进行失眠严重程度评估,统计分析ISI与肝郁积分的相互关系.结果 ISI在不同肝郁分级间的差异有统计学意义(F=3.209,P=0.024),且肝郁分级越高,ISI积分越高;样本总体的ISI评分与肝郁评分呈正相关(r=0.246,P=0.001);不同肝郁分级与不同失眠严重程度呈正相关(r=0.243,P=0.001).结论 围绝经期非器质性失眠妇女广泛存在不同程度的肝郁,且肝郁越严重,失眠程度越重.心理因素肝郁可诱发失眠,并且加重失眠的严重程度.     

妊娠高血压综合征患者血脂水平与病情严重程度及血压的关系

目的 探讨妊娠高血压综合征(PIHS)患者血脂水平与病情严重程度及血压的关系.方法 将101例PIHS患者按病情严重程度分为妊娠期高血压组45例(A组)、轻度子痫前期组 33例(B组)、重度子痫前期组 23例(C组).比较3组血脂水平及血压,并分析血脂水平与疾病严重程度、血压的相关性.结果 A、B、C组SBP及载脂蛋白(Apo)-A1依次升高,A组TG低于B、C两组,而HDL-C水平均高于B、C两组(均P<0.05).ApoB/Apo-A1比值与PIHS患者病情程度呈正相关(P<0.05).TG、LDL-C、ApoB/Apo-A1是SBP升高的危险因素(P<0.05),而HDL-C是SBP升高的保护因素(P<0.05);LDL-C也是DBP升高的危险因素(P<0.05).结论 血脂水平可能是预测PIHS患者病情严重程度的重要指标.早期干预血脂紊乱可能更有利于患者血压的控制,从而避免病情的加重.     

Evaluation of surgical performance using V-POSSUM risk-adjusted mortality rates

Vascular-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (V-POSSUM) is a risk-adjusted scoring system for predicting 30-day mortality in patients undergoing vascular surgery. It can assess surgical performance by comparing predicted deaths with observed deaths. The aim of this analysis was to assess trends in surgical performance over time using risk-adjusted 30-day mortality as the primary outcome. Major vascular surgery procedures (n = 454) were prospectively scored for V-POSSUM between 1995 and 2006. Procedures were divided into 11 consecutive time bands. Observed and predicted deaths were compared using the logistic regression equation derived for V-POSSUM. The observed death rates decreased over time, as did the predicted number of deaths calculated from the V-POSSUM scores. The overall predicted mortality rate was 17.2% and the rate varied with the 12-month period, with a high of 23.9% and a low of 9.2%. The downward trend in the predicted rate shows that the patient risk factors have changed over time and that the risk of dying has declined by almost 50% (from 21.6 to 11.1%). There was a trend towards improved surgical performance over time, with a drop in the observed to predicted ratios of deaths. Observed and predicted deaths changed over the study periods. There was a trend towards improved performance compared with the risk-adjusted predicted mortality. V-POSSUM is a useful tool in the longitudinal assessment of performance in major vascular surgery.     

Injury and pre-hospital trauma care in Hanoi, Vietnam

BACKGROUND: In Vietnam, injury is the leading cause of death in children under 18, and road traffic accidents are the fifth leading cause of death. Information systems for pre-hospital trauma care are insufficient. OBJECTIVES: The objective of this study was to assess injury morbidity and mortality, and the existing level of pre-hospital trauma care in Hanoi city. RESEARCH DESIGN AND SUBJECTS: A cross-sectional study was conducted in seven districts in Hanoi in 2006. We studied 2800 households (11,334 members), 9 hospitals and an emergency service centre. RESULTS: The injury morbidity rate was 1134/100,000 (year(-1)), and the injury mortality rate was 23.7/100,000 (year(-1)). There was no significant difference in age or sex between injury severity levels (p>0.05). Road traffic accidents were the leading cause of injury. Causes of injury mortality differed among different age groups. Only 4% of injured cases were transported to hospital by ambulance. Fifty-two percent of victims did not receive first aid at the site. Pre-hospital trauma care was separately provided by the emergency service centre and hospitals. There was no communication network between the emergency service centre and hospitals, ambulances and hospitals, or between different hospitals. CONCLUSIONS: The results reveal that injury is a major health problem in Hanoi and that the pre-hospital care system lacks both coordination and many vital components. Study results may assist decision-makers in identifying interventions to improve health and safety for the population of Hanoi.