INTERVENTIONAL RADIOLOGY

介入放射学
  • 文章类型: Journal Article
    背景:非小细胞肺癌(NSCLC)预后不良。经血管介入是治疗NSCLC的重要方法。药物洗脱珠支气管动脉化学栓塞术(DEB-BACE)是一种使用装载有化疗药物的DEB用于BACE的技术。本研究旨在进行荟萃分析,以全面评估DEB-BACE治疗NSCLC的有效性和安全性,并探讨NSCLC的新治疗策略。
    方法:万方,中国国家知识基础设施,Medline(通过PubMed),科克伦图书馆,Scopus和Embase数据库将于2024年11月进行搜索。将进行荟萃分析以评估DEB-BACE治疗NSCLC的有效性和安全性。将应用以下关键字:“癌症,非小细胞肺\",“非小细胞肺癌”,“药物洗脱珠支气管动脉化疗栓塞”和“药物洗脱珠”。将包括中文或英文报告,比较DEB-BACE与其他NSCLC治疗方案的疗效。病例报告,单臂研究,会议文件,没有全文的摘要和以英文和中文以外的语言发表的报告将不被考虑。Cochrane干预措施系统评价手册将用于独立评估每个纳入研究的偏倚风险。在研究之间存在显著异质性的情况下,异质性的可能来源将通过亚组和敏感性分析进行探索。为了对数据进行统计分析,将使用RevManV.5.3。
    背景:这项荟萃分析将在完成后寻求在同行评审的期刊上发表。这项研究不需要伦理批准,因为它是一项基于数据库的研究。
    CRD42023411392。
    BACKGROUND: Non-small cell lung cancer (NSCLC) has a poor prognosis. Transvascular intervention is an important approach for treating NSCLC. Drug-eluting bead bronchial artery chemoembolisation (DEB-BACE) is a technique of using DEBs loaded with chemotherapeutic drugs for BACE. This study aims to conduct a meta-analysis to comprehensively assess the effectiveness and safety of DEB-BACE in treating NSCLC and investigate a novel therapeutic strategy for NSCLC.
    METHODS: Wanfang, China National Knowledge Infrastructure, Medline (via PubMed), Cochrane Library, Scopus and Embase databases will be searched in November 2024. A meta-analysis will be conducted to assess the effectiveness and safety of DEB-BACE in the treatment of NSCLC. The following keywords will be applied: \"Carcinoma, Non-Small-Cell Lung\", \"Non-Small Cell Lung Cancer\", \"Drug-Eluting Bead Bronchial Arterial Chemoembolization\" and \"drug-eluting beads\". Reports in Chinese or English comparing the efficacy of DEB-BACE with other NSCLC treatment options will be included. Case reports, single-arm studies, conference papers, abstracts without full text and reports published in languages other than English and Chinese will not be considered. The Cochrane Handbook for Systematic Reviews of Interventions will be used to independently assess the risk of bias for each included study. In case of significant heterogeneity between studies, possible sources of heterogeneity will be explored through subgroup and sensitivity analysis. For the statistical analysis of the data, RevMan V.5.3 will be used.
    BACKGROUND: This meta-analysis will seek publication in a peer-reviewed journal on completion. Ethical approval is not required for this study as it is a database-based study.
    UNASSIGNED: CRD42023411392.
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  • 文章类型: Journal Article
    目的:评估学校课程和诊所介入放射学(IR)手术的现场观察对大学生辐射焦虑的影响,兴趣,和职业意向。
    方法:在2021年至2023年之间,对所有四年级本科生进行了问卷调查,涵盖了他们的前期课程,后课程在学校,和临床IR手术的现场视图。调查包括性别类别,对X射线和IR操作的恐惧,对IR手术的兴趣,和职业追求的意图。
    结果:共有333名(91.0%)受访者(111名学生三次)被纳入分析。在参加学校课程后,对IR程序中X射线和辐射暴露的恐惧减少了(p<0.001),现场观看后进一步下降(p<0.001)。三组间的关联值分别为33.8%和41.9%,分别。在申请课程和临床暴露于IR手术后,对IR的兴趣都得到了改善(p<0.001)。此外,4名(3.6%)和12名(10.8%)学生在参加课程和现场观看后表现出成就感,分别。关联值为49.4%。关于职业意向,在服用课程和现场观察后,该指数均显着增加(p<0.001)。此外,8(7.2%),17(15.3%),三组中的36名(32.4%)学生认为IR是首选职业选择,分别。
    结论:申请IR课程可以减少本科生的辐射焦虑,激活他们的职业兴趣和职业追求意图。临床暴露于IR手术进一步增强了这种效果。
    结论:课程和IR手术现场视图的教育干预提高了本科生对IR的兴趣并激发了他们的职业意向,这对IR的发展至关重要。
    结论:对介入放射学(IR)作为职业的兴趣越来越迫切,随着服务需求的增长。IR手术的教育和现场观看减少了辐射焦虑,并增加了对IR的兴趣。早期接触IR可以有效地鼓励本科生将IR视为自己的职业。
    OBJECTIVE: To evaluate the effect of the school curriculum and on-site observation of interventional radiology (IR) operations in clinics on undergraduates\' radiation anxiety, interest, and career intention.
    METHODS: Between the academic years 2021 and 2023, all of the fourth-year undergraduates were surveyed by questionnaires, which covered their pre-curriculum, post-curriculum in-school, and post-on-site view of IR surgeries in clinic. The survey included categories of gender, fear of X-ray and IR operation, interest in IR surgery, and career-pursuing intention.
    RESULTS: A total of 333 (91.0%) respondents (111 students for three times) were included in analyses. The fear of X-ray and radiation exposure during IR procedures was reduced after taking school courses (p < 0.001), and it was further decreased after on-site viewing (p < 0.001). The association values among the three groups were 33.8% and 41.9%, respectively. The interest in IR was improved both after applying for the curriculum and after clinical exposure to IR surgery (p < 0.001). In addition, 4 (3.6%) and 12 (10.8%) students showed a sense of achievement after taking courses and on-site viewing, respectively. The association value was 49.4%. Regarding career intention, it was both significantly increased after taking courses and on-site observation (p < 0.001). Besides, 8 (7.2%), 17 (15.3%), and 36 (32.4%) students in the three groups considered IR as the preferred career choice, respectively.
    CONCLUSIONS: Applying for IR curriculum could reduce undergraduates\' radiation anxiety, and activate their professional interest and career pursuing intention. Clinical exposure to IR surgeries further boosted this effect.
    CONCLUSIONS: Educational interventions of curriculum and on-site view of IR surgery improve the undergraduates\' interest in IR and stimulate their career intention, which is crucial for the advancement of IR.
    CONCLUSIONS: Increasing interest in interventional radiology (IR) as a career is urgent, given rising demand of services. Education and on-site viewing of IR surgery reduced radiation anxiety and increased interest in IR. Early exposure to IR is effective at encouraging undergraduates to consider IR as their career.
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  • 文章类型: Journal Article
    背景:肝动脉并发症(HACs),如血栓形成或狭窄,是小儿肝移植(LT)后发病和死亡的严重原因。这项研究将调查发病率,肝移植后儿科HAC患者的当前管理实践和结果,包括早期和晚期并发症。
    方法:儿童肝移植后HEPatic动脉狭窄和血栓形成(Hepatic)注册是一项国际性的,回顾性,多中心,观察性研究。将包括在20年时间段内儿科LT后诊断为HAC并接受HAC治疗的任何儿科患者(年龄<18岁)。主要结果是移植物和患者存活。次要结果是干预的技术成功,HAC干预后的原发性和继发性通畅,术中和术后并发症,当前管理实践的描述,和HAC的发病率。
    背景:所有参与研究的研究中心都将获得当地伦理批准和(放弃)知情同意书。结果将通过在会议上的科学演讲和在同行评审的期刊上发表来传播。
    背景:HEPATIC注册在ClinicalTrials.gov网站上注册;注册标识符:NCT05818644。
    BACKGROUND: Hepatic artery complications (HACs), such as a thrombosis or stenosis, are serious causes of morbidity and mortality after paediatric liver transplantation (LT). This study will investigate the incidence, current management practices and outcomes in paediatric patients with HAC after LT, including early and late complications.
    METHODS: The HEPatic Artery stenosis and Thrombosis after liver transplantation In Children (HEPATIC) Registry is an international, retrospective, multicentre, observational study. Any paediatric patient diagnosed with HAC and treated for HAC (at age <18 years) after paediatric LT within a 20-year time period will be included. The primary outcomes are graft and patient survivals. The secondary outcomes are technical success of the intervention, primary and secondary patency after HAC intervention, intraprocedural and postprocedural complications, description of current management practices, and incidence of HAC.
    BACKGROUND: All participating sites will obtain local ethical approval and (waiver of) informed consent following the regulations on the conduct of observational clinical studies. The results will be disseminated through scientific presentations at conferences and through publication in peer-reviewed journals.
    BACKGROUND: The HEPATIC registry is registered at the ClinicalTrials.gov website; Registry Identifier: NCT05818644.
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  • 文章类型: Journal Article
    目的:我们旨在调查急性胰腺炎(AP)血管并发症的患病率,为了比较使用各种治疗方法的患者结果,并探讨相关危险因素。
    方法:回顾性纳入2010年1月至2017年7月连续收治的AP患者。人口统计,血管并发症,实验室指数,并收集影像学检查结果.采用单因素和多因素分析探讨血管并发症的潜在危险因素。
    结果:在3048例AP患者中,808(26.5%)有血管并发症,包括内脏静脉血栓形成,左侧门静脉高压症,和动脉并发症。38例(4.7%)患者接受抗凝治疗后再通率较高(P<0.001)。95例(11.8%)患者发生出血,他接受了进一步的治疗。多变量分析确定了男性性别(优势比[OR]1.650,95%置信区间[CI]1.101-2.472),高脂血症(OR1.714,95%CI1.356-2.165),疾病复发(OR3.727,95%CI2.713-5.118),吸烟(OR1.519,95%CI1.011-2.283),血红蛋白水平(OR0.987,95%CI0.981-0.993),白细胞(WBC)计数(OR1.094,95%CI1.068-1.122),非血管局部并发症(OR3.018,95%CI1.992-4.573),计算机断层扫描严重度指数(CTSI)(OR1.425,95%CI1.273-1.596),急性生理和慢性健康评估(APACHE)II评分(OR1.057,95%CI1.025-1.090)与血管并发症有关。
    结论:AP的血管并发症普遍存在,其治疗具有挑战性。需要进一步研究以确定最佳治疗策略。独立危险因素包括男性、高脂血症,疾病复发,吸烟,白细胞计数,非血管局部并发症,CTSI,和APACHEII得分。
    OBJECTIVE: We aimed to investigate the prevalence of vascular complications in acute pancreatitis (AP), to compare patient outcomes using various treatments, and to explore the related risk factors.
    METHODS: Consecutive AP patients admitted from January 2010 to July 2017 were retrospectively included. Demographics, vascular complications, laboratory indices, and imaging findings were collected. Univariate and multivariate analyses were used to explore potential risk factors of vascular complications.
    RESULTS: Of 3048 AP patients, 808 (26.5%) had vascular complications, including visceral vein thrombosis, sinistral portal hypertension, and arterial complications. And 38 (4.7%) patients received anticoagulant therapy and had a higher rate of recanalization (P < 0.001). Bleeding occurred in 95 (11.8%) patients, who received further treatment. Multivariate analysis identified male gender (odds ratio [OR] 1.650, 95% confidence interval [CI] 1.101-2.472), hyperlipidemia (OR 1.714, 95% CI 1.356-2.165), disease recurrence (OR 3.727, 95% CI 2.713-5.118), smoking (OR 1.519, 95% CI 1.011-2.283), hemoglobin level (OR 0.987, 95% CI 0.981-0.993), white blood cell (WBC) count (OR 1.094, 95% CI 1.068-1.122), non-vascular local complications (OR 3.018, 95% CI 1.992-4.573), computed tomography severity index (CTSI) (OR 1.425, 95% CI 1.273-1.596), and acute physiology and chronic health evaluation (APACHE) II score (OR 1.057, 95% CI 1.025-1.090) were related to vascular complications.
    CONCLUSIONS: Vascular complications in AP is prevalent and their treatment is challenging. Further investigations are warranted to determine the optimal treatment strategy. Independent risk factors included male gender, hyperlipidemia, disease recurrence, smoking, WBC count, non-vascular local complications, CTSI, and APACHE II score.
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  • 文章类型: Journal Article
    目的:评估逐步介入策略的安全性和有效性,以去除粘附的完全植入的中心静脉接入端口导管,由导丝支撑组成,顺行同轴分离,随着技术复杂性的增加,逆行同轴分离。
    方法:本研究采用回顾性设计。回顾了在2017年11月至2023年12月之间常规拔除端口导管失败然后转移到介入放射科的32例患者。记录技术成功率和并发症发生率。
    结果:所有粘附导管均成功移除,导管未破裂,使用导丝支撑(n=21),顺行同轴分离(n=5),和逆行同轴分离(n=6)。技术成功率100%,无并发症发生。
    结论:建议的逐步介入策略成功地移除了粘附端口导管,具有良好的安全性和高效性。在移除粘附的完全可植入的中心静脉接入端口导管期间,它似乎减少了导管骨折的发生率。
    BACKGROUND: To evaluate the safety and effectiveness of a stepwise interventional strategy for the removal of adherent totally implanted central venous access port catheters, consisting of a guidewire support, antegrade coaxial separation, and retrograde coaxial separation with increasing technical complexity.
    METHODS: This study has a retrospective design. Thirty-two patients who had failed routine removal of the port catheter and were then transferred to interventional radiology between November 2017 and December 2023 were reviewed. The technical success and complication rates were recorded.
    RESULTS: All adherent catheters were successfully removed without catheter fragmentation, using guidewire support (n = 21), antegrade coaxial separation (n = 5), and retrograde coaxial separation (n = 6). The technical success rate was 100%, and no complications occurred.
    CONCLUSIONS: The proposed stepwise interventional strategy successfully removed adherent port catheters, with good safety and high effectiveness. It appeared to reduce the incidence of catheter fracture during the removal of adherent totally implantable central venous access port catheters.
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  • 文章类型: Journal Article
    梗阻是晚期结直肠癌的常见并发症。这项研究的目的是调查安全性,功效,经导管动脉灌注化疗联合碘油化疗栓塞治疗晚期结直肠癌合并梗阻的可行性。
    这项回顾性分析是使用在我们中心接受动脉灌注化疗联合碘油化疗栓塞治疗的晚期结直肠癌患者的临床资料进行的。根据无梗阻生存期和总生存期评估治疗效果,监测治疗并发症。
    纳入54例结直肠癌合并梗阻患者。所有患者均成功行经导管动脉灌注联合碘油化疗栓塞治疗。给予的平均碘油剂量为2.62±1.45ml(0.5-5.5ml)。无穿孔、肿瘤播散等严重并发症发生。临床成功率为83.3%(45/54)。治疗后一个月,客观有效率(ORR)和疾病控制率(DCR)分别为66.67%和88.9%,分别。中位无梗阻生存期为5.0个月。无严重不良事件发生。截至最后一次随访,6名患者存活,44死了4人失去了随访。
    我们的研究结果表明,经导管动脉灌注化疗联合碘油化疗栓塞治疗晚期结直肠癌合并梗阻是安全有效的。它可能作为晚期结直肠癌合并梗阻患者的一种新的治疗策略。
    UNASSIGNED: Obstruction is a common complication of advanced colorectal cancer. This study was aimed at investigating the safety, efficacy, and feasibility of transcatheter arterial perfusion chemotherapy combined with lipiodol chemoembolization for treating advanced colorectal cancer complicated by obstruction.
    UNASSIGNED: This retrospective analysis was conducted using clinical data of patients with advanced colorectal cancer who received arterial infusion chemotherapy combined with lipiodol chemoembolization treatment at our center. Treatment efficacy was evaluated in terms of obstruction-free survival and overall survival, and treatment complications were monitored.
    UNASSIGNED: Fifty-four patients with colorectal cancer complicated by obstruction were included. All patients successfully underwent transcatheter arterial infusion combined with lipiodol chemoembolization treatment. The average lipiodol dose administered was 2.62 ± 1.45 ml (0.5-5.5 ml). No serious complications such as perforation or tumor dissemination occurred. The clinical success rate was 83.3% (45/54). One month after treatment, the objective response rate (ORR) and disease control rate (DCR) were 66.67% and 88.9%, respectively. The median obstruction-free survival was 5.0 months. No serious adverse events occurred. As of the last follow-up, 6 patients survived, 44 died, and 4 were lost to follow-up.
    UNASSIGNED: Our findings revealed that transcatheter arterial infusion chemotherapy combined with lipiodol chemoembolization is safe and effective for treating advanced colorectal cancer complicated by obstruction. It may serve as a new treatment strategy for patients with advanced colorectal cancer complicated by obstruction.
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  • 文章类型: Case Reports
    背景:回顾性报道经肾动脉栓塞治疗常染色体显性遗传性多囊肾病(ADPKD)伴肉眼血尿患者的安全性和有效性。
    方法:本研究的目的是回顾性报道经肾动脉栓塞治疗ADPKD伴肉眼血尿患者的安全性和有效性。材料与方法:2018年1月至2019年12月期间,对6例多囊肾伴肉眼血尿患者行肾经导管动脉栓塞术。首先进行肾动脉造影,然后我们确定出血的位置并在数字减影血管造影监测下进行栓塞。血常规检查结果的改善,尿常规检查结果,观察并分析尿液颜色和术后反应。结果:6例患者均成功行肾动脉栓塞术。5例患者术后各项指标及肉眼血尿颜色较术前改善。无严重并发症反应发生。
    结论:对于常染色体显性多囊肾综合征伴肉眼血尿患者,经导管动脉栓塞术是安全有效的。
    BACKGROUND: To retrospectively report the safety and efficacy of renal transcatheter arterial embolization for treating autosomal dominant polycystic kidney disease (ADPKD) patients with gross hematuria.
    METHODS: The purpose of this study is to retrospectively report the safety and efficacy of renal transcatheter arterial embolization for treating ADPKD patients with gross hematuria. Materials and methods: During the period from January 2018 to December 2019, renal transcatheter arterial embolization was carried out on 6 patients with polycystic kidneys and gross hematuria. Renal arteriography was performed first, and then we determined the location of the hemorrhage and performed embolization under digital subtraction angiography monitoring. Improvements in routine blood test results, routine urine test results, urine color and postoperative reactions were observed and analyzed. Results: Renal transcatheter arterial embolization was successfully conducted in 6 patients. The indices of 5 patients and the color of gross hematuria improved after surgery compared with before surgery. No severe complication reactions occurred.
    CONCLUSIONS: For autosomal dominant polycystic kidney syndrome patients with gross hematuria, transcatheter arterial embolization was safe and effective.
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  • 文章类型: Journal Article
    胆道支架功能障碍在临床治疗中具有挑战性。逆行追踪法(RTM)在功能失调的胆道支架的重新开放中具有广阔的临床应用前景。这项研究旨在评估RTM在重新打开功能失调的胆道支架中的临床价值。
    2013年2月至2020年1月,郑州大学第一附属医院151例患者接受经皮肝穿胆道介入手术,以重新打开功能失调的胆道支架,和25名患者(12名女性,13名男性;平均年龄63.12岁)在顺行重新开放功能障碍胆道支架衰竭后接受了RTM。技术上的成功,临床成功,辐照剂量,程序时间,并发症,记录总生存期(OS),和总胆红素(TBIL)水平,直接胆红素(DB),丙氨酸氨基转移酶(ALT),白蛋白(ALB),治疗前和治疗后1个月比较糖类抗原-199(CA-199)。
    技术和临床成功率分别为100%和96%,分别,照射剂量和手术时间分别为774.07±330.80mGy和45.16±9.48min,分别。两名患者(8%)经历了重大并发症。中位OS为10.73个月[95%置信区间(CI):9.37-12.09]。与预处理值相比,TBILRTM给药后1个月的平均水平(189.47±59.20vs.44.65±16.12µmol/L),DB(144.21±55.83vs.27.95±13.86µmol/L),ALT(89.62±30.85vs.49.44±14.25U/L),和CA-199(584.59±269.82vs.176.76±100.68U/mL)显示显著下降,而ALB(36.32±2.05vs.40.22±1.95g/L)显示显着增加(所有P值<0.05)。
    当发生功能失调的胆道支架的顺行重新开放时,RTM是一种有效的替代治疗方法。
    UNASSIGNED: Biliary stent dysfunction is challenging to treat in clinic. The retrograde track method (RTM) has a promising clinical application in the reopening of dysfunctional biliary stents. This study aimed to evaluate the clinical value of the RTM in reopening dysfunctional biliary stents.
    UNASSIGNED: From February 2013 to January 2020, 151 patients underwent percutaneous transhepatic biliary interventional procedures for reopening dysfunctional biliary stents at the First Affiliated Hospital of Zhengzhou University, and 25 patients (12 females, 13 males; mean age 63.12 years old) underwent the RTM after anterograde reopening dysfunction biliary stent failure. Technical success, clinical success, irradiation dose, procedure time, complications, and overall survival (OS) were recorded, and levels of total bilirubin (TBIL), direct bilirubin (DB), alanine aminotransferase (ALT), albumin (ALB), and carbohydrate antigen-199 (CA-199) were compared before treatment and 1 month after treatment.
    UNASSIGNED: The technical and clinical success rates were 100% and 96%, respectively, and the irradiation dose and procedure times were 774.07±330.80 mGy and 45.16±9.48 min, respectively. Two patients (8%) experienced major complications. The median OS was 10.73 months [95% confidence interval (CI): 9.37-12.09]. Compared with pretreatment values, the mean levels at 1 month after RTM administration for TBIL (189.47±59.20 vs. 44.65±16.12 µmol/L), DB (144.21±55.83 vs. 27.95±13.86 µmol/L), ALT (89.62±30.85 vs. 49.44±14.25 U/L), and CA-199 (584.59±269.82 vs. 176.76±100.68 U/mL) showed significant decreases, while that of ALB (36.32±2.05 vs. 40.22±1.95 g/L) showed a significant increase (all P values <0.05).
    UNASSIGNED: RTM is an effective alternative treatment method when anterograde reopening of a dysfunctional biliary stent occurs.
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  • 文章类型: Clinical Trial Protocol
    背景:肺静脉隔离(PVI)是心房颤动(AF)射频(RF)消融的基石。然而,单一消融策略并不总能在所有持续性房颤患者中达到预期的治疗效果,不同的临床特征需要个性化的策略。
    方法:本研究旨在通过比较PVI和BCXL的疗效来确定持续性房颤的最佳导管消融策略(BC:环绕肺静脉隔离的大圆;XL:基于左心房基质的不固定线数)。BCXL-AF研究(临床试验编号:ChiCTR2200067081)被设计为前瞻性的,随机化,并行控制,单盲临床试验。总的来说,以1:1的比例将400例持续性房颤患者随机分为仅PVI和BCXL个体化消融组。随机分配到个体化消融组的患者将根据其临床状况使用由分层确定的实际消融方法进一步分类为风险分层。从出院到24个月大进行了7次术后访视。主要观察终点将是房性快速性心律失常的发生率(包括房颤,单次消融术后3个月的空白期未使用抗心律失常药物,持续时间≥30s)的房扑和房性心动过速。BCXL-AF研究将评估持续性AF射频消融的最佳方法,并评估个性化射频消融策略在降低AF复发率方面的有效性。
    背景:回顾了研究方案,并获得陆军医科大学人类伦理委员会的伦理批准(批准号:2022-484-01)。所有参与者均提供书面知情同意书。这项研究是根据《赫尔辛基宣言》及其修正案的原则进行的。这项研究的结果将通过手稿出版物和会议演示文稿进行传播。
    背景:ChiCTR2200067081。
    BACKGROUND: Pulmonary vein isolation (PVI) is the cornerstone of radiofrequency (RF) ablation for atrial fibrillation (AF). However, a single ablation strategy does not always achieve the desired therapeutic effect in all patients with persistent AF, and individualised strategies are required for different clinical characteristics.
    METHODS: This study aimed to determine the optimal catheter ablation strategy for persistent AF by comparing the efficacy of PVI and BCXL (BC: big circles encircling pulmonary vein isolation; XL: unfixed number of lines based on the left atrial substrate). The BCXL-AF study (clinical trial no. ChiCTR2200067081) was designed as a prospective, randomised, parallel-controlled, single-blinded clinical trial. Overall, 400 patients with persistent AF were randomised in a 1:1 ratio into PVI-only and BCXL-individualised ablation groups. Patients randomised to the individualised ablation group will be further categorised into risk strata according to their clinical condition using the actual ablation method determined by the strata. Seven postoperative visits were conducted from discharge to 24 months of age. The primary observation endpoint will be the incidence of atrial tachyarrhythmia (including AF, atrial flutter and atrial tachycardia with a duration of ≥30 s) without using antiarrhythmic drugs after a blank period of 3 months following a single ablation procedure. The BCXL-AF study will assess an optimal approach for persistent AF RF ablation and evaluate the effectiveness of individualised RF ablation strategies in reducing the recurrence rate of AF.
    BACKGROUND: The study protocol was reviewed, and ethical approval was obtained from the Army Medical University Human Ethics Committee (approval number: 2022-484-01). All the participants provided written informed consent. This study was conducted according to the principles of the Declaration of Helsinki and its amendments. The results of this study will be disseminated through manuscript publication and conference presentations.
    BACKGROUND: ChiCTR2200067081.
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  • 文章类型: Meta-Analysis
    目的:最近一项荟萃分析报道了经颈静脉肝内门体分流术(TIPS)加肝外侧支栓塞术(TIPS+E)减少TIPS后再出血和肝性脑病(HE)的疗效,但进一步的验证是必要的。本研究旨在使用真实世界数据确认TIPS+E的有效性。
    方法:多中心回顾性队列包括2010年1月至2022年12月期间接受TIPS±E(TIPS:631,TIPS+E:1446)的2077例肝硬化患者。使用回归和倾向评分匹配(PSM)来调整基线特征差异。PSM之后,临床结果,包括再出血,他,生存和进一步失代偿(FDC),进行了分析。来自所有患者的基线数据有助于构建预后模型。
    结果:PSM后,纳入1136名匹配患者(TIPS+E:TIPS=568:568)。TIPS+E显示再出血显著减少(HR0.77;95%CI0.59至0.99;p=0.04),HE(HR0.82;95%CI0.68至0.99;p=0.04)和FDC(HR0.85;95%CI0.73至0.99;p=0.04),比较TIPS。重要的是,TIPS+E也减少了再出血,HE和FDC在使用8mm直径支架和栓塞胃静脉曲张+自发性门体分流(GV+SPSS)的亚组中。然而,总体或亚组生存分析无差异.此外,与其他模型相比,随机森林模型显示出更高的准确性和AUROC。将TIPS术后门静脉压力梯度(pPPG)控制在7mmHg结论:我们的真实数据验证证实了TIPS+E在减少再出血和HE方面的高疗效,特别是当使用8毫米直径的支架时,栓塞GV+SPSS并维持最佳pPPG。
    OBJECTIVE: The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) plus extrahepatic collateral embolisation (TIPS+E) in reducing rebleeding and hepatic encephalopathy (HE) post-TIPS was recently reported in a meta-analysis, but further validation is essential. This study aims to confirm the effectiveness of TIPS+E using real-world data.
    METHODS: The multicentre retrospective cohort included 2077 patients with cirrhosis who underwent TIPS±E (TIPS: 631, TIPS+E: 1446) between January 2010 and December 2022. Regression and propensity score matching (PSM) were used to adjust for baseline characteristic differences. After PSM, clinical outcomes, including rebleeding, HE, survival and further decompensation (FDC), were analysed. Baseline data from all patients contributed to the construction of prognostic models.
    RESULTS: After PSM, 1136 matched patients (TIPS+E: TIPS=568:568) were included. TIPS+E demonstrated a significant reduction in rebleeding (HR 0.77; 95% CI 0.59 to 0.99; p=0.04), HE (HR 0.82; 95% CI 0.68 to 0.99; p=0.04) and FDC (HR 0.85; 95% CI 0.73 to 0.99; p=0.04), comparing to TIPS. Significantly, TIPS+E also reduced rebleeding, HE and FDC in subgroup of using 8 mm diameter stents and embolising of gastric varices+spontaneous portosystemic shunts (GV+SPSS). However, there were no differences in overall or subgroup survival analysis. Additionally, the random forest models showed higher accuracy and AUROC comparing to other models. Controlling post-TIPS portal pressure gradient (pPPG) within 7 mm HgCONCLUSIONS: Our real-world data validation confirms the high efficacy of TIPS+E in reducing rebleeding and HE, particularly when using 8 mm diameter stents, embolising GV+SPSS and maintaining an optimal pPPG.
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