简介：Anticoagulationisimperativetoreducetheincidenceofthromboticcomplicationsinpatientsundergoingpercutaneousinterventionalcardiovascularprocedures;however,thisisattheexpenseofincreasedriskofbleeding.Theoptimalanticoagulationstrategyfortheseproceduresremainsunclear.Unfractionatedheparinisthemostcommonlyusedanticoagulantduringinterventionalprocedures,buthasseverallimitations,suchasrelativelyhighincidenceofbleedingevents,occurrenceofheparin-inducedthrombocytopenia,andaparadoxicalthromboticeffect.Contemporarystudieshavedemonstratedthatbivalirudindecreasestheoccurrenceofbleedingcomplications,butpotentiallyincreasestheriskofacutestentthrombosis.Thisreviewdiscussesthepharmacologyofbivalirudinanditscurrentclinicalapplicationinpatientsundergoingpercutaneouscoronaryinterventionandtranscatheteraorticvalvereplacementprocedures.

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简介：Thisisareviewarticledescribingsomenewandinterestingaspectsinthediagnosisandtreatmentinsystemicvasculitisanddemonstratingseveralcasesthatwehaveencountered.ParticularemphasiswillbeputonTakayasuarteritis(alsoknownasaortitissyndrome)mostcommonlyobservedinJapanandotherorientalcountries.CTandMRIbetterdemonstratethevesselwallabnormalityofTakayasuarteritisthanangiography.Importanceofplainchestradiographshouldalsobekeptinmind;itcouldprovideaclueinthediagnosisofTakayasuarteritisinitsearlystage.

简介：Atrialarrhythmias,includingatrialfibrillation,inthesettingofcongenitalheartdisease(CHD)areepidemiologicallyandmechanisticallydifferentfromthoseencounteredinthegeneralpopulation.ThesearrhythmiasoccuratyoungeragesinpatientswithCHD,andarefrequentlydegenerativeandprogressive.Theepidemiology,incidence,andprevalenceofthespectrumofatrialarrhythmias,includingatrialfibrillation,varyaccordingtothespecificCHDtype,priortreatment,andresidualandongoingstructuralandfunctionalsequelae.Thecombinedimpactofincisionalscars,abnormalhemodynamics,atrialchamberdilatation,andincreasesinatrialwallthicknessanddistributionoffibrosisresultsinahighlydynamicandcontinuouslychangingatrialsubstratethatishighlypredisposedtoarrhythmias.Giventhemultiplesubstrates,individualizedtherapeuticplanscanincludepharmacologictherapy,catheter-basedablation,andsurgicaltherapiesperformedconcomitantlywithprimarysurgicalinterventionforhemodynamicallysignificantsequelaeofCHD.AdvancedimagingwithCTorMRIcanprovidevaluableinformationfordecisionmakingandproceduralplanning.ApplicationofnoveltherapeutictechnologiesandpharmacologicagentsnecessitatesspecialconsiderationswhenappliedtotheCHDpopulationandrequiresgreaterstudyinspecificsubsetsofCHDpatients.

简介：AbstractImportance:Pediatric hypervascular primary airway tumors are progressive, fatal lesions with a low incidence, and the disease is often more serious than that in adults.Objective:To evaluate the clinical efficacy and safety of interventional therapeutic bronchoscopy combined with conservative treatment and bronchial arterial embolization in children with primary airway tumors.Methods:We retrospectively analyzed the clinical data of four pediatric patients with hypervascular primary airway tumor between 2017 and 2019 at Beijing Children’s Hospital.Results:Two patients were low-grade bronchial mucoepidermoid carcinoma, one patient was pleomorphic adenoma, and one was bronchial leiomyoma. Interventional therapeutic bronchoscopy combined with bronchial arterial embolization was used for treatment (all four patients received general anesthesia). The tumors were safely resected in all patients via interventional bronchoscopy. There were no severe complications related to the procedures. All patients were followed up for 5-12 months, and one low-grade bronchial mucoepidermoid carcinoma recurred.Interpretation:Interventional therapeutic bronchoscopy combined with bronchial arterial embolization appears to be a safe and efficient therapeutic method associated with less trauma and fewer complications, including no serious adverse events, in children with hypervascular primary airway tumors without bronchus wall infiltration.

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简介：BackgroundPatientswithunstableanginapectorisanddiabetesmellitusareverycommon.Whentheyreceiveinterventionaltherapy,contrastagentscancauserenalinjuryandplateletactivation.Alprostadilhasbeenshowntodecreaseinflammationandmicrovascularresistance.Thereisnoanyreportontheprotectioneffectsofalprostadilonrenalinjuryandtheplateletactivationduringcardiacinterventionaltherapy.MethodsAtotalof57patientsweredividedintotwogroups,alprostadilgroup(n=35)andnormalgroupn=22).BUN(bloodureanitrogen)andSCr(serumcreatine)weremeasuredastherenalfunctionparameters.GFR(glomerularfiltrationrate)wascalculatedbytheMDRDformula.Plateletparameters:PLT(plateletcount,109),PDW(plateletdistributionwidth,fL),MPV(meanplateletvolume,fL),PLCR(largeplateletscaleratio,%)weremeasuredastheplateletactivationindex.TtestandChi-squaretestwereusedasstatisticalmethods,andP<0.05wasconsideredstatisticallysignificant.ResultsInthealprostadilgroup,SCrwas71.1±13.8μmol/Land65.9±12.6μmol/L,beforeandafterinterventionaltherapy(P<0.05).BUNwas5.68±1.79mmol/Land3.86±1.19mmol/L(P<0.001),beforeandafterinterventionaltherapy.Intheplatelettests,MPVwasseemedtobetheonlyusefulplateletparameter,beforeandafterinterventionaltherapy(11.8±1.8fLand11.1±1.2fL,P<0.05),whilethePLT(109/L),PDW(fl),PLCR(%)didn'tshowanysignificantdifference.Inthenormalgroup,allthesetests'resultsdidn'tsignificantlychangeafterinterventionaltherapy.ConclusionsThepatientswiththeunstableanginapectorisanddiabetesmellitushaveontheriskofrenalfunctiondamageandplateletactivationwhenundertakingcardiacinterventionaltherapy.Alprostadilprotectsrenalfunctionandalleviatesplateletactivation.

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简介：Radiationexposureisahazardforpatientsandphysiciansduringfluoroscopically-guidedprocedures.Invasivecardiologistsareexposedtohighlevelsofscatterradiationandbothincreasingproceduralcomplexityandhigheroperatorvolumescontributetoexposureaboverecommendedthresholds.Standardshieldingdoesnotoffersufficientprotectiontotheheadandneckregionandthepotentialfornegativebiological,subclinical,andclinicaleffectsexists.Largepopulationstudiessuggestthatcranialexposuretolowdoseradiationincreasestherisksoftumordevelopment.Inaddition,modestdosesoftherapeuticcranialradiationhavebeenlinkedwiththedevelopmentofbraincancer.Althoughacausalassociationbetweenscatterradiationinthecathlabandbraincancerdoesnotcurrentlyexist,giventheknowndetrimentaleffectsofradiationexposuretotheheadandneckregionsupportafocusonpotentialmethodsofprotectionforboththepatientandtheoperator.

简介：AbstractObjective:It remains unclear whether adjuvant chemoradiotherapy (CRT) improves survival outcome of pancreatic ductal adenocarcinoma (PDAC) patients after surgery. This study aimed to investigate the efficacy and safety of tegafur/gimeracil/oteracil (S-1)-based adjuvant concurrent chemoradiotherapy in resected PDAC patients with defined high-risk pathological features.Methods:We conducted a single-arm, prospective, and interventional study at Zhongshan Hospital Fudan University from December 2012 to December 2019 and the last follow-up was conducted in December 2021. This study was approved by the Ethics Committee of Zhongshan Hospital Fudan University on December 27, 2012 (approval No. B2012-139). Resected PDAC patients with high-risk pathological features, including positive resection margin, pathological T3-4N1-2M0 disease, peripancreatic fat invasion, microvascular invasion, and perineural invasion, were recruited. Primary endpoint was overall survival and secondary endpoints were disease-free survival, treatment toxicity, and 2-, 5-year survival rates.Results:A total of 54 patients were recruited. Mean age was 63.6 years old (±7.2). The distribution of T and N stages were 24.1% for T1, 46.3% for T2, 27.8% for T3, 1.9% for T4, 33.3% for N1, and 11.1% for N2. Seven patients had R1 resection. The median overall survival and disease-free survival were 27.1 and 13.7 months, respectively, while no fatal adverse events were recorded. Subgroup analyses showed differences in survival outcomes among patients with microvascular invasion, different N stages, and preoperative CA 19-9 levels. Further, a Cox proportional hazard model demonstrated associations of lymph node metastases, CA 19-9 level, and microvascular invasion with overall survival and disease-free survival.Conclusion:S-1 -based adjuvant CRT showed promising efficacy and manageable toxicity in resected PDAC patients with highrisk pathological features.