ObjectiveTo evaluate the effectiveness and safety of the additional catheter-directed thrombolysis (CDT) and conventional treatment (CT) for treatment primary deep vein thrombosis.
MethodsDatabases such as CNKI, WanFang Data, Pubmed, EMBASE.com, Medline, CBM, CSJD, CJFD, and the Cochrane Library were electronically searched from the date of their establishment to 30 June, 2013, and the relevant literatures and conference proceedings were also manually searched to include randomized controlled trials (RCTs) on comparison of additional CDT versus CT for primary deep vein thrombosis. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and accessed the methodological quality of the included studies. Then the meta-analysis was performed by using RevMan 5.1 software. Publication bias was assessed by STATA software. A meta-regression model was used to describe between study variability.
ResultsTwo RCTs including 3 literatures contain 224 patients reporting data on safety and efficacy of CDT versus CT were included. There were no publication bias (Begg'S test, Z=1.02. P > 0.05;Egger'S test, t=0.98, P > 0.05). The results of meta-analysis showed that:in 6 months after surgery iliofemoral vein patency rate of CDT group was higher than that of CT group (OR=3.62, 95% CI:1.51-8.64, P=0.004), in 6 months after surgery CDT group with a lower rate than CT group of the iliofemoral vein occlusion and (or)venous reflux rate (OR=0.24, 95% CI:0.11-0.53, P=0.000), and the incidence rate of PTS in 24 months after surgery in CTD group was less than that of CT group (OR=0.55, 95% CI:0.31-0.96, P=0.040). There were no statistically significant of the major complications after surgery between CDT group and CT group (OR=1.34, 95% CI:0.12-15.69, P=0.810). But the incidence rates of minor complications and total complications after surgery in CT group were lower than those of CDT group (OR=13.67, 95% CI:4.08-45.83, P < 0.00 01 and OR=11.67, 95% CI:4.40-30.99, P < 0.000 01).
ConclusionsCDT is a effective and positive way to treat early deep venous thrombosis especially in terms of the patency of vascular and prevent the occlusion and PTS. Due to the limitation of the included studies, large sample size, multicenter, and high quality studies are needed to verify the above conclusion, such as the ATTRACT Study. The intracavitary therapy could be applied to clinic combining individual conditions of patients.
ObjectiveTo investigate the clinical efficacy of catheter directed thrombolysis (CDT) through three different approaches combined with iliac venous endovascular therapy for acute deep venous thrombosis (DVT) complicated with Cockett syndrome of the lower extremities.
MethodThe clinical data of 87 patients with CDT through three different approaches (small saphenous vein group, popliteal vein group, and posterior tibial vein group) combined with iliac venous endovascular therapy for DVT complicated with Cockett syndrome of the lower extremities were analyzed retrospectively.
ResultsThe lower extremity swelling of all the patients were disappeared obviously within 72 h after surgery, there was no death related surgery and pulmonary embolism. The limb edema reduction rates had no significant differences among the small saphenous vein group, popliteal vein group, and posterior tibial vein group﹝(77±13)% versus (82±12)% versus (77±18)%, P > 0.05﹞. The recanalization rates of thrombolysis had no significant differences among the above three groups﹝(86.5±10.6)% versus (92.0±7.7)% versus (87.3±7.8)%, P > 0.05﹞. The time required for the cannulation in the posterior tibial vein group was significantly shorter than that of the small saphenous vein group or popliteal vein group﹝(15.14±3.62) min versus (32.62±9.36) min or (42.79±13.30) min, P < 0.01﹞. All the patients were performed by balloon dilatation and iliac vein stenting. Eighty-seven cases were followed-up for 1-24 months, the primary patency rate of iliac venous was 100%.
ConclusionsCDT with iliac venous endovascular therapy is an effective method in treatment of acute DVT with Cockett syndrome. CDT through posterior tibial vein is an easier and effective method with less complications and time. This way could be acceptable in basal hospital.
Objective To investigate the species distribution and antibiotic resistance of pathogens fromcatheter-related bloodstream infections ( CRBSI) in intensive care unit( ICU) , to provide evidence for the guidance of clinical rational administration.Methods A retrospective analysis was performed to review the microbiological and susceptibility test data of all CRBSI patients in ICU from January 2009 to December 2011. The patterns of antibiotic resistance among the top seven bacteria were compared. Results 67 cases of CRBSI were detected with 81 strains, including 40 Gram-positive ( G+ ) bacteria( 49.4% ) , 38 Gram-negative( G- ) bacteria ( 46.9% ) , and 3 fungi ( 3.7% ) . The main pathogens causing CRBSI were coagulase negative Staphylococci ( 27 strains, 33.3%) , Acinetobacter baumannii ( 12 strains, 14.8% ) , Klebsiella pneumoniae( 9 strains, 11. 1% ) , Staphylococcus aureus ( 8 strains, 9. 9% ) , Pseudomonas aeruginosa ( 7 strains, 8. 6% ) , Escherichia coli ( 6 strains, 7.4% ) , suggesting that Staphylococcus epidermidis was predominant pathogenic G+ bacteria, and Acinetobacter baumannii was predominant G- bacteria. The antibiotic resistance tests demonstrated that isolated G- bacillus was highly sensitive to carbopenem, while vancomycin-resistant G+ bacteria were not found. Conclusions Within the latest 3 years, the predominant pathogens of CRBSI in ICU are Staphylococcus epidermidis and Acinetobacter baumannii. Acinetobacter baumannii exhibited high drug resistance to all antibiotics.
In existing vascular interventional surgical robots, it is difficult to accurately detect the delivery force of the catheter/guidewire at the slave side. Aiming to solve this problem, a real-time force detection system was designed for vascular interventional surgical (VIS) robots based on catheter push force. Firstly, the transfer process of catheter operating forces in the slave end of the interventional robot was analyzed and modeled, and the design principle of the catheter operating force detection system was obtained. Secondly, based on the principle of stress and strain, a torque sensor was designed and integrated into the internal transmission shaft of the slave end of the interventional robot, and a data acquisition and processing system was established. Thirdly, an ATI high-precision torque sensor was used to build the experimental platform, and the designed sensor was tested and calibrated. Finally, sensor test experiments under ideal static/dynamic conditions and simulated catheter delivery tests based on actual human computed tomography (CT) data and vascular model were carried out. The results showed that the average relative detection error of the designed sensor system was 1.26% under ideal static conditions and 1.38% under ideal dynamic stability conditions. The system can detect on-line catheter operation force at high precision, which is of great significance towards improving patient safety in interventional robotic surgery.
Objective To study the catheter-related infection (CRI) in cancer patients treated with central venous catheterization. Methods A prospective study with 196 cancer patients was conducted to analyze the types of catheter-related infection and pathogen, as well as the relationship between CRI and the following factors: insert location, gender, age, remained time, or bone marrow suppression. Results Of the total 196 cases, 16 cases were diagnosed as CRI and the CRI rate was 8.2%. The types of CRI were five cases of pathogen colonization, four cases of insert location infection and seven cases of catheter-related bloodstream infection. Of the total 244 specimens, 20 were positive including 7 pathogenic bacteria in either Gram positive or Gram negative types, the dominating pathogens were staphylococcus aureus, staphylococcus epidermidis, acinetobacter baumannii and klebsiella pneumoniae. CRI was related to both insert location and age which were both the independent risk factors. Conclusion The concept of prevention should be set up, and the comprehensive measures should be taken to reduce CRI, such as choosing an appropriate insert location and complying with a strict catheter insert standard.
ObjectiveTo assess the efficacy and safety of low-(10 mg) and high-dose (20 mg) of recombinant tissue typeplasminogen activator (rt-PA) catheter-directed thrombolysis for lower limb ischemia by using meta-analysis.
MethodsThe literatures of randomized clinical trials (RCT) concerning low-versus high-dose rt-PA catheter-directed thrombolysis for lower limb ischemia study were searched using the national and international electronic databases.The literatures were screened and quality evaluated according to the inclusion and exclusion criteria, and analyzed by using the Cochrane Center the RevMan 5.2 software.
ResultsA total of 4 RCT studies, with a total of 360 patients (192 patients in low dose group and 168 patients in high-dose group) were included.No statistical difference were noted in low-versus high-dose group with regard to ankle-brachial index (RR=0.20, 95%CI=-0.43-0.02, P=0.07), 30 days amputation-free survival (RR=1.00, 95%CI=0.94-1.08, P=0.91), 6 months the probability of restenosis (RR=1.00, 95%CI=0.60-1.67, P=1.00), and the incidence of groin hematoma (< 5 cm, RR=1.24, 95%CI=0.56-2.77, P=0.59).But the incidence of bleeding and the incidence of stress ulcer in low-dose group were lower than those in high-dose group (RR=2.38, 95%CI=1.10-5.15, P=0.03;RR=2.49, 95%CI=1.21-5.13, P=0.01).
ConclusionTwo doses of rt-PA treatment of limb ischemia similar efficacy, but the incidence of low-dose regimen of complications is significantly lower than the high dose regimen.
Objective To make an individualized administration scheme via evidence-based medicine methods, namely adding heparin into the total nutrient admixture (TNA) solution, so as to help a neonate to prevent the occlusion of peripherally inserted central catheter (PICC). Methods After carefully assessing the condition of neonate, this clinical issue was put forward in accordance with the PICO principles. Randomized controlled trials (RCTs) and systematic reviews on neonates’ PICC occlusion were collected from The Cochrane Library, CCTR, DARE, NGC, MEDLINE (Ovid) and CBM from inception to 2011. The clinical intervention scheme was finally made after the assessment of the retrieved evidence and neonate’s physiological condition. Results A total of 4 RCTs and 1 systematic review related to the issues were identified. The following scheme was finally made for the neonate through the assessment of the retrieved evidence and combination of intentions of the patient’s family members: heparin (0.5 U/mL) was added into TNA to prevent PICC occlusion. During the application, blood routine test and blood coagulation were monitored, and the catheter opening time and extubation reason were recorded. Through the above treatment, the neonate successfully completed the treatment before extubation. The time of both PICC detaining and opening was 20 days in total, and there were no PICC occlusion, no catheter thrombosis, and no catheter related bloodstream infection. Moreover, no observation showed thrombopenia and aggravated coagulation disorders resulted from heparin. Conclusion The evidence-based medicine method is an effective way to make reasonable heparin scheme for neonate, so as to prevent PICC occlusion, reduce catheter thrombosis, decrease risks of catheter related blood circulation infection, assure successful completion of treatment, and guarantee the safety of patients.
Objective To formulate an evidence-based treatment plan for a child patient with Asymptomatic Wolff-Parkinson-White (WPW) Syndrome. Methods Based on the clinical problems whether the patients with asymptomatic WPW syndrome need prevent catheter ablation or not, we used “asymptomatic WPW syndrome” as the keywords and searched The Cochrane Library (Issue 3, 2007), MEDLINE (1981 to 2007), ACP Journal Club (1991 to 2007), BMJ Clinical Evidence (1999 to 2007) and NGC (1998 to 2007) for systematic reviews, randomized controlled trials (RCTs), controlled clinical trials and treatment guidelines. The methodological quality of the included studies was assessed to identify the current best evidence. Results Two RCTs were retrieved in MEDLINE. The results showed arrhythmic events increased significantly in the high-risk control group than those in the ablation group, and in the patients with multi-pathways than those with only one pathway. Based on the current evidence, integrated with clinical expertise and the patients’ values, the patients underwent electrophysiologic test and the result showed the dominance pathway in the right side and the concealed accessory pathway in the left side. Then prevent catheter ablation was performed, and no cardiovascular complications occurred in the following 12 months, which confirmed that the plan was proved optimal. Conclusion The findings of this study should reassure physicians and parents alike that in the children with the WPW syndrome who are at high risk for arrhythmias, ablation is an appropriate option.
ObjectiveTo reduce the incidence of peritoneal dialysis (PD) catheter complications through a continuous quality improvement (CQI) process.
MethodsTwenty-nine patients with catheters inserted (from January 2011 to March 2011) before CQI, and another 41 patients with catheters inserted (between April 2011 and January 2012) after CQI were observed and analyzed. The possible causes of complications of catheter were summarized, and then on the basis of that, a PDCA four-step (plan-do-check-act) method was designed with a view to reducing the incidence of postoperative complications.
ResultsPD catheter dysfunction decreased from 6.90% to 2.44%. The incidence of leakage decreased from 44.83% to 9.76%.
ConclusionCQI is a useful method to reduce the incidence of postoperative complications of PD catheter in peritoneal dialysis.
ObjectivesTo systematically review the efficacy and safety of catheter-directed thrombolysis (CDT) versus anti-coagulation (AC) for deep vein thrombosis (DVT). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases to collect randomized clinical trials (RCTs) about CDT versus AC for DVT from inception to March 2018. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs and 989 patients were included. Meta-analysis showed that there was no significant difference between the two group in incidence of post-thrombotic syndrome (RR=0.73, 95%CI 0.49 to 1.09, P=0.13), iliofemoral venous patency rate (RR=2.57, 95%CI 0.59 to 11.24, P=0.21), bleeding (RR=2.03, 95%CI 0.50 to 8.28, P=0.32), severe bleeding (RR=1.77, 95%CI 0.91 to 3.42, P=0.09) and recurrence rate of venous thromboembolism (RR=1.00, 95%CI 0.42 to 2.36, P=0.99). However, the incidence of moderate-severe PTS decreased in CDT group was lower than that in the control group (RR=0.70, 95%CI 0.53 to 0.92, P=0.01). ConclusionsCompared with the control group, catheter-directed thrombolysis does not reduce the incidence of PTS and VTE recurrence rate, cannot improve the long-term patency of the iliofemoral vein, yet can prevent the occurrence of moderate to severe PTS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
