National Medical Journal of China
Volume 100 · Issue 41 · 2020
Natl Med J China
Multimodal brain monitoring under general anesthesia in elderly patients mainly includes anesthesia sedation depth monitoring, electroencephalogram (EEG) -based brain injury index monitoring, and non-invasive brain oxygen saturation monitoring (rSO2), perioperative neuroinflammatory regulation. Through joint monitoring and process intervention, the blindness of intervention caused by relying on single monitoring can be avoided, thus eradicating the serious postoperative brain complications of elderly patients and the impact on long-term postoperative brain health.
radioactivity125I Seed implantation (seed implantation) plays an increasingly important role in the field of local treatment of solid tumors. In order to improve the efficacy, reduce recurrence and avoid complications, many expert consensus has been reported, but there are still many unsolved problems in "dosimetry", which greatly affects the popularization and development of this technology. However, "activity" as an important index affecting dosimetry has not attracted people's attention, and the research on how to choose "activity" is still blank. Abdominal and pelvic tumor seed implantation should be combined with different parts, volumes, endangered organs and distances in radiophysics and clinical practice level, and the selection of activity and the effect of activity on dosimetry and clinical significance of abdominal and pelvic tumor seed implantation should be deeply studied.
Stroke is a kind of disease that seriously threatens human health and quality of life. The lifetime risk of stroke among people over 25 is about 25% worldwide, with the highest risk in East Asia, including China, at 39%[
To investigate the correlation between tissue oxygen saturation during one lung ventilation and postoperative neuro cognitive dysfunction (PND) in elderly patients in thoracic surgery.
One hundred and twenty-eight elderly patients who underwent selective lobectomy from August 2017 to September 2018 in the Forth Hospital of Hebei Medical University were enrolled. The patients were divided into PND group (n=34) and non-PND group (n=94) according to whether PND occurred 3 days after surgery. Tissue oxygenation was monitored at bilateral forebrain, brachioradialis muscle and quadriceps. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA) at baseline and the third day after the operation. Postoperative cognitive dysfunction was diagnosed if postoperative MoCA decreased at least 2 scores compared with preoperative baseline value. Outcomes included the incidence of PND, the incidence of tissue oxygen desaturation during one lung ventilation, postoperative complications within 30 days and length of postoperative in-hospital stay. Logistic regression was used to screen independent risk factors of PND.
The incidence of postoperative cognitive dysfunction was 26.6% (34/128). The two groups had no significant difference in the incidence of non-neurogenic complications (new occurred arrhythmia, pulmonary infection, pulmonary embolism, acute renal insufficiency, sepsis, deep vein thrombosis, all P>0.05). However, the length of postoperative in-hospital stay of PND group was 7.0 (6.0, 8.5) d, which was longer than that of non-PND group [6.0 (5.0, 8.0) d]. There was significant difference (U=2.394, P=0.017) . There was no correlation between the two groups within the minimum of SmtO2 in upper limbs (OR=0.988, 95%CI: 0.954-1.024, P=0.519) and the range of desaturation (OR=1.010, 95%CI: 0.979-1.042, P=0.514) , as well as the minimum of SmtO2 in legs (OR=0.996, 95%CI: 0.961-1.032, P=0.832) and the range of desaturation (OR=0.997, 95%CI: 0.971-1.025, P=0.851) . Multivariate logistic regression analysis showed that the high ASA grade (OR=2.617, 95%CI: 1.112-6.157, P=0.029) and the minimum of cerebral oxygen saturation during one lung ventilation (OR=0.931, 95%CI: 0.880-0.986, P=0.014) were independent risk factors of PND. There was no statistical correlation between muscle oxygen saturation and PND.
Cerebral desaturation during one lung ventilation increased the risk of PND in elderly patients, while the muscle desaturation has no statistical correlation with PND.
To evaluate the value of intraoperative cerebral oxygen saturation in predicting postoperative neurocognitive dysfunction (PND) in elderly patients with mild cognitive impairment.
A total of 210 cases of lumbar decompression, bone grafting and fusion surgery under general anesthesia were collected in the Third Central Hospital of Tianjin from June, 2019 to January, 2020, either sex, aged 65-75 year, BMI 19.5-32.5 kg/m2, ASA physical status Ⅱ or Ⅲ, preoperative comorbidities with mild cognitive impairment. MoCA and MMSE were used to evaluate the cognitive function of patients 1 day before the operation, 7 days and 3 monthes after operation. PND group (n=38) and non-PND group (n=172) were selected according to postoperative MMSE and MoCA scale scores and the diagnostic criteria of PND. Heart rate (HR) , mean arterial pressure (MAP), pulse oxygen saturation (SpO2), bispectral index (BIS), cerebral tissue oxygen saturation (SctO2, average left and right brain SctO2 were recorded) were recorded pre-anesthetic (T0), ten minutes of anesthesia(T1), twenty minutes of anesthesia (T2), thirty minutes into the operation (T3), one hour into the operation (T4), end of the surgery (T5), and leave the PACU (T6). SctO2 at time point T0 was the base value of SctO2, and the maximum percentage drop in SctO2 from the base value was calculated (SctO2max%).
The incidence of PND was 18% (38/210) in 210 elderly patients undergoing surgery. The age of PND group and non-PND group was (71.0±2.1) and (67.8±2.0) years old, and the PACU time was (57±5) and (46±8) min, respectively. Compared with the non-PND group, the age of the PND group was higher (t=2.600, P<0.05) and the PACU time was longer (t=3.039, P<0.05). At the time points T3, T4, T5 and T6, SctO2 in the PND group was (62±10) %, (60±11) %, (64±12) % and (66±10)%, respectively, lower than that in the non-PND group (67±60) %, (68±6) %, (69±5) % and (70±7)%, respectively, and the difference was statistically significant (t=3.369, 4.906, 3.787, 2.516, all P<0.05).The MoCA and MMSE scores of the PND group were (22.9±1.2) and (24.1±1.2) points, respectively, 1 day before surgery; and the MoCA and MMSE scores of the PND group were reduced to (20.8±1.2) and (21.3±0.7) points, respectively, 7 days after surgery, with statistically significant differences (t=3.523, 5.675, all P<0.05). MoCA and MMSE scores 7 days after surgery in the non-PND group were (22.4±1.3) and (23.1±1.6) points, respectively. Compared with the non-PND group, MoCA and MMSE scores 7 days after surgery in the PND group were reduced (t=2.630, 3.108, all P<0.05). The critical value of intraoperative SctO2max% was 13.74%, the area under the curve of PND was predicted to be 0.907 (95%CI: 0.819-0.995), sensitivity and specificity were 88.9% and 88.5%, respectively.
SctO2max%>13.74% can be used as an indicator to predict PND occurrence in elderly patients with mild cognitive impairment during lumbar surgery.
To evaluate the effect on bleeding volume and postoperative recovery of regional cerebral oxygen saturation (rSO2) guides controlled hypotension in elderly patients with hypertension undergoing spinal surgery.
One hundred and twenty elderly patients who underwent spinal surgery in the department of anesthesiology of Qingdao Municipal Hospital and the Affiliated Hospital of Qingdao University from January 2017 to December 2019 were selected and divided into 2 groups according to the random number table method (n=60): rSO2 guides the controlled hypotension group (group A) and control group (group C). Both groups were performed with endotracheal intubation for general anesthesia, maintain anesthesia with sevoflurane and remifentanil, rSO2 were monitored throughout the procedure. If necessary, sodium nitroprusside or esmolol were used to control blood pressure. In group A, the goal of controlled hypotension was that rSO2 decreased ≤ 10% of the basic value or maintained at 64±3 and the moderate operative field bleeding. Group C underwent routine anesthesia management. Intraoperative blood loss and urine output, the incidence of hypothermia after operation, postoperative delirium, chills, nausea and vomiting, the PACU residence time, postoperative drainage volume, eating time, postoperative hospital stay were compared between the two groups.
Compared with group C, the blood loss [(589±157) vs (764±213) ml] and urine output [(778±121) vs (1 079±239) ml] of group A were decreased (t=-5.120, -8.712, all P<0.05). The rates of hypothermia after operation (26.7% vs 45.0%), postoperative delirium (18.3% vs 36.7%), chills (10.0% vs 25.0%), nausea and vomiting (21.7% vs 40.0%) of group A were decreased (χ2=4.385, 5.057, 4.675, 4.728, all P<0.05) . The PACU residence time [(56±9) vs (63±11) min], postoperative drainage volume [(217±66) vs (289±81) ml], eating time [(17.8±2.8) vs (22.3±4.1) h] and numbers of days in hospital [(7.2±2.7) vs (8.2±2.9) d] were decreased of group A (t=-3.399, -5.334, -7.000, -2.031, all P<0.05).
The guidance of controlled hypotension with rSO2 monitoring can reduce the blood loss and infusion volume during spinal surgery in elderly patients with hypertension, reduce postoperative related complications and enhance recovery after surgery.
To evaluate the best entry region and trajectory of anterior transpedicular root screws (ATPRS).
From January 2018 to May 2019, 50 cervical CT date integral of healthy people were selected from Ningbo No. 6 Hospital and were confirmed no obvious defect. Of these, 24 cases were males and 26 were females, aged 20-49 (32±5) years. The CT data was imported into Mimics by DICOM format, then 3D reconstruction was performed. In the coronal plane, the area from the centreline of the anterior of C3-7 to the left Z-line(marked a line through the intersection of the anterior of the luschak joint and upper endplates, parallel to the centralline of the anterior of the vertebral body) was divided into nine areas. Then virtual screw with diameter of 3.5 mm was inserted. Record the length of screw of each area (L), the angle between screw and the posterior of the vertebral body in horizontal plane(α), the angle between screw and the anterior of the vertebral body in sagittal plane (β), individually. The data between groups were compared by independent samplet test.
The best regions were zone 9 of C3, C4; zone 8, 9 of C5; zone 2-3, 5-9 of C6; zone 1-9 of C7 in men. And these were zone 9 of C3; zone 3, 6, 8 and 9 of C4, C5; zone 2-3, 5-9 of C6; zone 1-9 of C7 in women. The distribution of best region was almost the same in men and women, zone 9 of each segment was the best region, and the screw length was the longest. It increased gradually from C3 to C7. C3 had the least region, C4 and C5 had less, while C6 and C7 had the most. The horizontal angle of C3-7 in men and women were 44.0°-47.2°, 40.2°-45.3° in zone 1, 4 and 7, respectively; 35.1°-41.4°, 34.6°-38.7° in zone 2, 5 and 8, respectively; 30.0°-37.2°, 30.2°-34.5° in zone 3, 6 and 9, respectively; and it demonstrated a gradually decreased trend. The sagittal angle of C3-7 in men and women was 85.3°-97.4°, 80.5°-88.9° in zone 1-3, respectively; 101.2°-113.7°, 101.0°-109.3° in zone 4-6, respectively; 116.6°-128.8°, 119.9°-125.3° in zone 7-9, respectively; and it demonstrated a gradually increased trend. There was no significant difference in the horizontal and sagittal angle between men and women (both P>0.05).
Anterior transpedicular root screw is a feasible internal fixation technique. It has wide region and the Z-line can be used as a reference for screw placement.
To compare the effect of intramedullary nail and locking plate in the treatment of proximal humeral fractures in the elderly.
A total of 37 elderly patients with proximal humeral fractures were selected from April 2016 to June 2018 in Tianjin Hospital, including 13 males and 24 females, aged (66±5) years. The patients were divided into observation group (17 cases) and control group (20 cases) according to the random number table, and were treated with multiloc intramedullary nail and locking plate respectively. The operation time, blood loss, healing time of fractures, visual analogue scale of pain, Neer shoulder function score were recored and compared between the two groups. The data were compared with t test between the two groups.
The operation time of the observation group was shorter than that of the control group ((72±7) min vs (89±9) min, t=6.365, P<0.05); the intraoperative bleeding volume was lower than that of the control group ((56±6) ml vs (74±8) ml, t=7.923, P<0.05). The superior rate of shoulder function was 94.1%(16/17) in the observation group and 90.0%(18/20) in the control group (χ2=0.209, P>0.05). The VAS score of the observation group was lower than that of the control group on the first day after operation (t=4.706, P<0.05); the Neer shoulder function score of the observation group was higher than that of the control group on the sixth month after operation (81±8 vs 76±8, t=2.156, P<0.05). Six months after the operation, the valgus angle (19.21°±2.88°) of the observation group was larger than that of the control group (16.32°±2.63°, t=3.189, P<0.05), the humeral head varus angle (3.57°±0.47°), the humeral neck stem angle (139°±10°) was smaller than that of the others (5.24°±1.26°), (146°±13°) (t=5.159, 2.258, both P<0.05). There was no significant difference in shoulder function score and complication rate 12 months after operation between the two groups (both P>0.05).
Both intramedullary nailing and locking plate can achieve better results in the treatment of proximal humeral fractures in the elderly, but the operation time of intramedullary nailing is shorter, the pain after operation is lighter and the recovery is faster.
To analyze the mechanism of invasive blood pressure change in radial artery caused by arm elevation by observing pressure, velocity and diameter of radial artery.
Twenty-six hemodynamically stable hepatobiliary surgery patients admitted to the intensive care unit from June to December 2018 after general anesthesia in Tsinghua Changgung Hospital were selected. When the arm was raised, the invasive blood pressure was recorded, and the inner diameter and blood flow velocity of the radial artery were measured by Doppler ultrasound. The data following a normal distribution were compared with paired t test.
After arm elevation for 30 s, systolic blood pressure of radial artery decreased and diastolic blood pressure increased significantly((107±16) mmHg vs (120±17) mmHg, (75±6) mmHg vs (71±9) mmHg, t=25.0, -12.6, both P<0.05), but there was no significant difference in mean arterial pressure ((87±10) mmHg vs (87±11) mmHg, t=1.1, P>0.05). The peak velocity, end-diastolic velocity and resistance index of the radial artery increased significantly, and the transverse and longitudinal inner diameters of the radial artery decreased significantly after the arm was elevated for 30 s (t=-63.4, -14.6, -22.5, 31.4, 25.3, all P<0.01).
Kinetic pressure compensation and vascular resistance compensation may be the main mechanism of radial artery pressure change when the arm is elevated. Arm elevation can be used as a vascular resistance response test clinically.
To explore the cut-off point of aldosterone/direct renin ratio (ADRR) before drug washout in the screening for primary aldosteronism (PA) in the Chinese population and reduce the potential risk caused by drug washout during PA screening.
Hospitalized hypertensive patients in the Hypertension Ward of Fuwai Hospital, Chinese Academy of Medical Sciences from January 2017 to October 2019 were enrolled. PA was diagnosed according to the criterion of 2016 American Guideline and 2016 Chinese Consensus for PA. The plasma aldosterone concentration (PAC), direct renin concentration (DRC) and ADRR before and after drug washout were measured. The receiver operating characteristic (ROC) curve of ADRR was drawn and the maximal Youden index was used to determine the best cut-off value.
A total of 542 hypertensive patients were included, with 467 patients diagnosed with essential hypertension (EHT) (297 males and 170 females), and 75 patients diagnosed with PA (51 males and 24 females). Patients with PA had higher PAC and ADRR before and after drug washout than those with EHT(150.0 (130.0, 210.0) vs 120.0 (80.0, 170.0) ng/L, 170.0 (120.0, 260.0) vs 130.0 (90.0, 180.0) ng/L; 28.9 (15.9, 63.5) vs 4.3 (1.9, 11.8) (ng/L) / (mU/L) , 55.6 (39.0, 109.0) vs 9.8 (4.5, 21.3) (ng/L) /(mU/L), all P<0.001). However, DRC of PA patients before and after washout were lower than those with EHT (4.0 (2.0, 10.0) vs 27.0 (10.0, 64.0) mU/L, 3.0 (2.0, 4.0) vs 12.2 (5.0, 27.0) mU/L, P<0.001). In EHT and PA groups, PAC and ADRR significantly increased (P=0.001, P<0.001) , but DRC significantly decreased after drug washout (all P<0.001) . The area under the ROC curve of ADRR before drug washout was 0.868 (95%CI 0.836-0.895) with the best cut-off value of 7.8 (ng/L) / (mU/L) for the screening of PA .The sensitivity and specificity was 94.7% and 66.8%, respectively, with the maximal Youden index of 0.615.
ADRR before drug washout > 7.8 (ng/L) / (mU/L) can be used as an alternative cut-off point to screen PA when drug washout is not available.
To investigate whether CT coronary angiography (CTA) can safely and effectively reduce the number of invasive coronary angiography (ICA) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) whose Grace score is low-or moderate-risk, and increase ICA positive rate.
One hundred and two NSTEMI patients, including 61 males and 41 females, aged 38-80 (58±12) years, were prospectively included and treated in Henan Provincial People′s Hospital from February 2017 to February 2018. By using random number method, the patients were divided into control group (51 cases) and experimental group (51 cases). Patients in the control group were arranged for elective ICA examination according to the risk stratification. If further intervention or surgical treatment was required, the ICA examination was positive; in the experimental group, the CTA examination was completed through the green channel first. If the CTA showed that the main coronary artery and its main branches were severe or extreme stenosis, further ICA examination was arranged; otherwise, a secondary prophylactic drug treatment was developed and the patients were then discharged and followed up for 1 year. ICA number, ICA positive rate, length of hospital stay, hospital cost, hospital anxiety and depression score (HADS), major cardiovascular events (MACE) within 1 year, and other serious adverse events related to examination or surgery were compared between the two groups.
A total of 37 patients in the experimental group underwent ICA, and the positive rate of ICA was 94.59% (35/37), which was significantly higher than that of the control group [62.75% (32/51)] (P<0.05). The average length of hospital stay and the HADS score before ICA in the experimental group were significantly lower than those in the control group [(3.8±2.2) d vs (4.8±2.4) d; 8.8±4.5 vs 11.4±6.8] (all P<0.05). There was no significant difference in the cumulative incidence of MACE (3 cases vs 5 cases, P=0.423) and other serious adverse events (8 cases vs 10 cases, P=0.548) within 1 year between the two groups.
CTA significantly reduces the number of ICA and the average length of hospital stay, and increases the positive rate of ICA in NSTEMI patients whose Grace score is low-or moderate-risk. There is no increase in cardiovascular risks within 1 year.
CT and magnetic resonance imaging (MRI) findings of 9 patients with SAPHO syndrome involving vertebral body were studied to analyze the reasons for their misdiagnosis. Its characteristic imaging manifestations are: vertebral angle lesions, non-specific discitis, bone erosion, osteosclerosis, paravertebral ossification, sacroiliitis.
This paper reports a rare case of transverse facial cleft combined with cleft lip and palate, and describes the ultrasound findings in detail. The pregnant woman was admitted to hospital because of the "abnormal development of fetal face" found in prenatal examination. Conventional ultrasound showed that the fetal upper alveolar continuity was interrupted, bilateral mouth angle to cheek horizontal dehiscence, and the position of both ears was low, which was considered to be bilateral transverse facial cleft combined with right lip and palate cleft. Pregnant woman was hospitalized and did not induce labor, waiting for pregnancy 39+A girl was delivered naturally in Zhou Wai Hospital, and the facial manifestations of the newborn were consistent with the prenatal ultrasound diagnosis.
This paper reports a rare case of renal papillary lymphatic endovascular hemangioendothelioma complicated with renal artery dissection. CT of the patient's left kidney showed low-density mass shadow, mild to moderate uneven progressive enhancement after enhancement, and true and false cavities and mural thrombosis could be seen in the left renal artery. After anti-infection and other symptomatic supportive therapy, left upper renal dorsal mass resection and renal artery dissection were performed. The postoperative pathological diagnosis was intrarenal papillary lymphatic endovascular hemangioendothelioma complicated with renal artery dissection aneurysm with intravascular thrombosis.
The role of non-vitamin K antagonist oral anticoagulants (NOACs) in the prevention of stroke and systemic embolism (SE) in patients with non-valvular atrial fibrillation (NVAF) has been well demonstrated. With the increasing prescription of NOACs, the issue of standardizing the dosage of NOACs in NVAF anticoagulation becomes particularly important because NOACs increase the risk of ischemic events and stroke when prescribed incorrectly. Therefore, the correct dose needs to be prescribed to the right patient so that in the real world, the patient can achieve the benefits of NOACs demonstrated in randomized controlled trials (RCTs).
Postoperative neurocognitive disorder (PND) is a common perioperative neurological complication, which is manifested by the decline of brain function after surgery, which can increase complications and mortality, and significantly affect the quality of life of patients. Near infrared spectroscopy (NIRS) monitoring is a novel, non-invasive and simple monitoring method for real-time monitoring of brain tissue oxygen saturation (SctO2）。 At present, it is widely used in the fields of heart, chest, transplantation and neurosurgery. NIRS monitoring can reflect cerebral perfusion and timely intervene in cerebral ischemia and hypoxia, so as to prevent perioperative neurocognitive disorders and improve postoperative cognition of patients. This review aims to present the NIRS monitoring technique and its positive implications in predicting and reducing the occurrence of postoperative neurocognitive disorders.
Osteoporosis is a systemic metabolic bone disease, which has become an important health problem faced by middle-aged and elderly people. However, there are still many problems in anti-osteoporosis drugs, and it is urgent to seek new and effective treatment strategies. The intestinal microbiota, known as the "second largest human genome", can not only regulate gastrointestinal activity, but also affect the host's bone metabolism, immunity and mineral absorption, and finally regulate human bone mass.
Intracranial arteriovenous shunt is a kind of disease with abnormal direct connection between intracranial arteries and veins. Intracranial arteriovenous shunt can change the cerebral hemodynamics of patients, cause intracranial hemorrhage and cause disability and death. Arterial spin labeling (ASL) is a non-invasive magnetic resonance technique that can obtain cerebral blood flow information without injection of contrast agent, and has unique value in the diagnosis, evaluation and follow-up of intracranial arteriovenous shunt disease. This article reviews the basic principles of ASL imaging and its application in intracranial arteriovenous shunt lesions from five aspects: ASL technique, diagnostic value of ASL in intracranial arteriovenous shunt, preoperative evaluation of intracranial arteriovenous malformation (AVM), cortical venous drainage to identify intracranial dural arteriovenous fistula (DAVF), intracranial AVM, and post-treatment follow-up of DAVF.
To date, no specific antiviral drug has been recommended for novel coronavirus pneumonia (COVID-19). Cellular studies have shown that high concentrations of chloroquine diphosphate (CQ) can exert antiviral effects. This study evaluated the safety and efficacy of 2 CQ doses in patients with severe COVID-19. It was a parallel, double-blind, randomized phase IIB clinical trial enrolling 81 adult patients with COVID-19. The trial site is a tertiary medical institution in Manaus, Amazonas, Brazil. The trial was conducted from 23 March to 5 April 2020. Interventions: Patients were assigned to receive either a high dose of CQ (600 mg twice daily for 10 d) or a low dose of CQ (450 mg twice daily on Day 1; once daily thereafter for 4 d). Main indicators and evaluation: The primary indicator was that the mortality rate in the high-dose group was reduced by at least 50% compared with the low-dose group. The data presented here are primarily safety and lethality measures from the start of treatment to Day 13. Secondary measures included the patient's clinical status, laboratory tests, and electrocardiogram findings. Results will continue to be recorded until day 28. Viral RNA detection of respiratory secretions was performed on days 0 and 4.
Thrombosis or failure of artificial arteriovenous fistula (AVG) is a common problem in patients with hemorrhagia. Most patients' thrombosis or failure is caused by venous anastomosis stenosis. However, at present, the interventional methods for hemorrhagia are still relatively limited. The main treatment is percutaneous transluminal angioplasty (PTA). However, the average patency time reported in the literature is only 6 months, and most patients need repeated PTA to ensure the normal use of AVG. Although single treatment with stents is expensive, the long-term patency rate is high. The purpose of this study is to compare the clinical efficacy of PTA or stent treatment after AVG thrombosis or failure. The study was a multicenter randomized controlled clinical trial with a total of 30 centers and 269 patients who were randomly divided into two groups: PTA or stent-covered. The number of reinterventions, treatment costs, and cumulative treatment costs were compared between the two groups over 24 months according to the clinical presentation and treatment outcome of the patients. Through 24-month follow-up, it was found that the stent-covered group could reduce the number of reinterventions by 27% compared with patients in the PTA group (3.7 in the stent-covered group, 5.1 in the PTA group,P =0.005), the total cost of treatment was similar in both groups ($27,483 for covered stents, $28,664 for PTA,P =0.490）。 Further subgroup analysis found that in the AVG thrombosis group, the stent-covered group could significantly reduce the number of reinterventions (3.7 times in the stent-covered group, 6.2 times in the PTA group,P =0.022), and the cumulative treatment cost was also lower ($30,329 in the stent-covered group, $37,206 in the PTA group,P =0.027）。 There were no significant differences in the number of reinterventions and cumulative treatment costs between the stent-covered group and the PTA group in the AVG failure group (3.7 in the stent-covered group, 4.4 in the PTA group,P =0.120； $25,421 in the stent-covered group, $22,610 in the PTA group,P =0.140）。 The results of this study indicate that for patients with AVG thrombosis, the use of covered stents can significantly reduce the number of reinterventions and reduce the cumulative treatment cost; For patients with AVG failure, the number of reinterventions and cumulative treatment costs of the two methods were similar.
In 1986, a new syndrome secondary to the supervirulent Klebsiella pneumoniae (HvKP) was reported in the Taiwan region, characterized primarily by its ability to cause severe infections in young and immunocompetent hosts. Their virulence is explained by efficient iron acquisition and increased capsular production, which confers a typical highly viscous phenotype. In relatively healthy subjects, supervirulent Klebsiella pneumoniae has been associated with community-acquired liver abscesses, occasionally with disseminated disease. Therefore, this article analyzes and summarizes the serotypes, sequence types and clinical characteristics of highly virulent Klebsiella pneumoniae cases complicated by liver abscess in 2019, and conducts literature search with keywords such as "pneumonia", "liver abscess", "Klebsiella pneumoniae" and "Hypermucoviscous". Finally, 3 articles were screened, with a total of 7 cases. The capsular serotype K1 was found in 3 cases, and the sequence type was ST23. There were 4 cases of capsular serotype K2, of which 3 cases were ST375 and 1 case was ST881. The K1 serotype is the main cause of primary liver abscesses and secondary septic embolus, and K2 is associated with secondary liver abscesses, and the expression of these capsular serotype antigens confers major resistance to phagocytosis. Although the isolate of capsular genotype K1 belonging to sequence type ST23 is the most dominant pathogen of the syndrome, recent case analysis suggests that the K2-ST375 isolate may also be an epidemiologically significant super-virulent clone of Klebsiella pneumoniae.
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