ObjectiveTo discuss the importance of early identification and effective management of puncture-associated complications after trans-radial percutaneous coronary procedures.
MethodsA total of 698 patients undergoing trans-radial percutaneous coronary procedures from June to December 2012 were included and followed up. The puncture associated complications and their clinical managements were summarized in the present study.
ResultsWe found that trans-radial approach was safe. The main puncture-associated complications included access-site pain, tension blisters and hemorrhagic complication. Complications with severe clinical consequence were rare. Most of the complications could be successfully treated with conservative management including access-site nursing and psychological nursing.
ConclusionTrans-radial approach is safe for percutaneous coronary procedures, but close clinical monitoring and nursing are essential.
ObjectiveTo investigate the reliability and safety of the technique of percutaneous left ventricular transapical access guided by cardiac three dimensional CT angiography (3D-CTA) combined with echocardiography applied in structural heart defects.MethodsThe clinical data of 9 patients (7 males and 2 females with a median age of 50 years ranging from 43 to 64 years) with paravalvular leaks closed by percutaneous left ventricular transapical access in West China Hospital, from April 2015 to August 2018, were retrospectively analyzed. We applied preoperative cardiac 3D-CTA to define the puncture site and trace, which was established by combining with real-time guidance of transesophageal echocardiography (TEE/3D-TEE), and an occluder was deployed at the apical access point for hemostasis with real-time guidance of transthoracic echocardiography (TTE).ResultsThe puncture needles were successfully introduced into the left ventricular cavity at one time in all patients without injury of lung tissue, coronary artery or papillary muscle. There was no occluder displacement or apex bleeding. One patient developed pleural effusion caused by intercostal artery injury.ConclusionThat cardiac 3D-CTA is used to define puncture sites and trace with advantages of simplicity and repeatability. A safe access and secure exit of left ventricle can be achieved by combining with real-time guidance of echocardiography. There are acceptable technology-related complications.
With the development of interventional therapy technology, trans radial access (TRA) has gradually become the main approach of interventional therapy. Compared with trans femoral access (TFA), TRA has obvious advantages, which can shorten the time of lying in bed and reduce the incidence of complications. However, the radial artery is thinner than the femoral artery, the incidence of spasm is high, and the success rate of puncture is low, so the technical level of operation is required to be high. Nowadays, TRA has been gradually applied to lung cancer, aortic disease, hepatocellular carcinoma, spleen disease, renal artery disease, and other peripheral vascular diseases. With the confirmation of the safety and feasibility of TRA in interventional therapy in different fields, the popularization of TRA in different interventional fields will be supported.
Objective To observe the effectiveness of IMPACT management mode on self-care and management abilities of breast cancer patients undergoing chemotherapy with implantable venous access port (VAP). Methods Breast cancer patients who underwent chemotherapy with VAP at Shangjin Hospital, West China Hospital, Sichuan University between March 2020 and June 2021 were prospectively included. IMPACT mode was used for self-management training guidance. The patient self-care abilities before training and at 1 month, 2 months, and 3 months of training were compared, and the patient self-management abilities at 1 month and 3 months of training were compared. Results A total of 74 patients with breast cancer undergoing chemotherapy with VAP were included. The total score of self-care ability of patients before training and at 1 month, 2 months, and 3 months of training was 112.11±14.63, 123.20±15.73, 127.95±13.89, and 131.92±13.60, respectively, and all the between-time-point differences were statistically significant (P<0.05). In terms of self-concept score, all the between-time-point differences were statistically significant (P<0.05) with increasing score over time, except the difference between the score at 3 months of training and that at 2 months of training (P>0.05). In terms of self-responsibility and self-care skill scores, all the between-time-point differences were statistically significant (P<0.05) with increasing scores over time, except the difference between the score at 2 months of training and that at 1 month of training (P>0.05). In terms of health knowledge level, the scores at 1 month, 2 months, and 3 months of training were higher than that before training (P<0.05), and the score at 3 months of training was higher than that at 1 month of training (P<0.05). The self-management ability scores in all dimensions at 3 months of training were higher than those at 1 month of training, and the differences were statistically significant (P<0.05). Conclusion The IMPACT management mode can effectively improve the self-care and management abilities of breast cancer patients undergoing chemotherapy with VAP, thereby ensuring the normal use of VAP, reducing the occurrence of complications, and reducing the burden on families and society.
ObjectiveTo compare early outcomes of the minimally invasive mitral valve surgery (MIMVS) through right anterolateral mini-thoracotomy (ALMT) with conventional mitral valve surgery (MVS), and evaluate feasibility and safety of MIMVS.
MethodsFrom January 2011 to December 2013, 120 patients undergoing elective MVS in Nanjing First Hospital were prospectively enrolled in this study. There were 72 male and 48 female patients with their age of 22-71 (42.4±11.0) years. Using a random number table, all the patients were randomly divided into a portaccess MIMVS group (MIMVS group, n=60) and a conventional MVS group (conventional group, n=60). MIMVS group patients received port-access cardiopulmonary bypass (CPB) establishment via femoral artery, femoral vein and right internal jugular vein cannulation through right ALMT 5-6 cm in length. Special MIMVS operative instruments were used for mitral valve repair or replacement. Conventional group patients received mitral valve repair or replacement under conventional CPB through median sternotomy. Perioperative clinical data, morbidity and mortality were compared between the 2 groups.
ResultsThere was no death in-hospital or shortly after discharge in this study. CPB time (98.0±26.0 minutes vs. 63.0±21.0 minutes) and aortic cross-clamping time (68.0±9.0 minutes vs.37.0±6.0 minutes) of MIMVS group were significantly longer than those of conventional group (P<0.05). Postoperative mechanical ventilation time (6.0±3.9 hours vs. 11.2±5.6 hours), length of ICU stay (18.5±3.0 hours vs. 28.6±9.5 hours) and postoperative hospital stay (8.0±2.0 days vs. 13.5±2.5 days) of MIMVS group were significantly shorter than those of conventional group (P<0.05). Chest drainage volume within postoperative 12 hours (110.0±30.0 ml vs. 385.0±95.0 ml) and the percentage of patients receiving blood transfusion (25.0% vs. 58.3%) of MIMVS group were significantly lower than those of conventional group (P<0.05). Patients were followed up for 1-24 months, and the follow-up rate was 94.2%. There was no statistical difference in postoperative morbidity or mortality between the 2 groups (P>0.05).
ConclusionMIMVS through right ALMT is a safe and feasible procedure for surgical treatment of mitral valve diseases. MIMVS can achieve similar clinical outcomes as conventional MVS, but can significantly shorten postoperative ICU stay and hospital stay, reduce blood transfusion, and is a good alternative to conventional MVS.
Trans-radial access (TRA) has been a common approach to percutaneous coronary intervention (PCI). Comparing with trans-femoral access (TFA), TRA is used as an alternative approach for PCI with less local complications, higher comfort level, and better outcome. In recent years, TRA has been paid more and more attention in peripheral vascular interventions. We reviewed recent developments in peripheral vascular intervention using TRA, with detail summary of the effectiveness, safety, limits, and future developments of it, aiming to improve the understanding and performance of TRA in interventionalists to benefit patients.
ObjectiveTo compare dialysis catheter function and complications according to catheter site in patients undergoing hemopurification.MethodsLiteratures were searched from PubMed, Medline, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Database according to the inclusion and exclusion criteria. Publication years of these literatures ranged from April 1998 to April 2018. Meta-analysis was performed with RevMan 5.3 software. The odds ratio (OR) and 95% confidence intervals (CI) were calculated for uncontinuous outcomes, and the weighted mean difference (WMD) and 95%CI were calculated for continuous outcomes. The incidence of catheter related infection, other complications and patients outcome were compared between different sites for dialysis vascular access.ResultsA total of 9 articles were included, including 2 randomized controlled trials and 7 observational clinical studies, and 5 220 adult patients undergoing renal replacement therapy. Meta-analysis showed that there was no significant difference in incidences of catheter colonization or catheter-related bloodstream infection, as well as arterial puncture, local thrombosis, catheter dysfunction and spontaneous catheter withdrawal, between femoral and non-femoral (jugular or subclavian) catheterization (P≥0.05). Whereas the incidence of bleeding and local hematoma was lower in femoral catheterization [OR=0.44, 95%CI (0.23, 0.82), P=0.009], and the duration of catheters was shorter in femoral catheterization [WMD=–1.40 d, 95%CI (–2.17, –0.62) d, P=0.000 4]. The blood flow rate, filters clotting incidence and patients intensive case unit mortality were similar in different catheterization.ConclusionsIn patients undergoing renal replacement therapy, the bleeding and local hematoma incidence is lower in femoral catheterization but the duration of catheters is shorter. Nevertheless the patients have similar clinical outcome. This result may provide reference for clinical decision-making.
Mitral regurgitation (MR) is the most common valvular heart disease, however, majority of patients are not suitable for open heart surgery due to comorbidity such as organ and heart dysfunction. Transcatheter edge-to-edge mitral valve repair has become an effective treatment option for high-risk patients with MR. Two patients were enrolled in this study inlcuding one 60-year degenerative mitral regurgitation patient and one 72-year functional mitral regurgitation patient. Transcatheter repair procedure was successfully done for the two patients without postoperative complication.
Objective To explore the vascular access infection (VAI) incidence of hemodialysis patients during the the maximum spread of the COVID-19 epidemic (epidemic period) compared with the corresponding period with no local cases of COVID-19 (control period). Methods A single-center, retrospective study was carried out. Adult patients who underwent hemodialysis at the Department of Blood Purification Center, the Affiliated Hospital of Xuzhou Medical University during the epidemic period between December 7, 2022 and February 23, 2023 and the control period between December 7, 2020 and February 23, 2021 were selected. The incidence of local access site infection (LASI) and access related bloodstream infection (ARBSI) in included patients were observed and compared. ResultsA total of 1 401 patients were included. Among them, there were 737 cases during the epidemic period and 664 cases during the control period. There was no statistically significant difference in the age, gender, and duration of catheterization among patients of different periods and pathway types (P>0.05). There was no statistically significant difference in the occurrence of LASI between the epidemic period and the control period (χ2=1.800, P=1.180). There was a statistically significant difference in the occurrence of ARBSI between the epidemic period and the control period [χ2=4.610, relative risk (RR)=2.575, 95% confidence interval (CI) (1.053, 6.298), P=0.032]. There was no statistically significant difference in the incidence of LASI and ARBSI at different stages in patients with arteriovenous fistula and unnel-cuffed catheters (TCC) (P＞0.05). There were statistically significant differences in the incidence of LASI [χ2=4.898, RR=3.832, 95%CI (1.058, 13.885), P=0.027] and ARBSI [χ2=7.150, RR=4.684, 95%CI (1.333, 16.460), P=0.005] among non cuffed catheters (NCC) patients at different stages. TCC patients might experience LASI (P<0.05) during the epidemic period and ARBSI (P<0.05) during the control period compared with the arteriovenous fistula patients; both central venous catheterization and NCC patients might experience LASI and ARBSI during the control period (P<0.05). Conclusion Targeting COVID-19 prevention may be associated with the reduction of vascular access infection in hemodialysis patients, in particular in NCC patients.
ObjectiveTo investigate the effect of accessory gene regulator C (agr C) specific binding peptides (named N1) on the biofilm formation of Staphylococcus epidermidis on the surface of polyvinyl chloride (PVC) materials in vitro.MethodsFirstly, the two strains (ATCC35984, ATCC12228) were cultured with N1 at concentrations of 100, 200, 400, 800, and 1 600 μg/mL, respectively. The control group was cultured with agrC specific binding unrelated peptides (named N0) at the same concentrations and the absorbance (A) value was measured after 24 hours to determine the optimal bacteriostatic concentration of N1. The two strains were cultured with N1 and N0 of the optimal concentration, respectively. The A values were measured at 6, 12, 18, 24, 30, and 48 hours to observe the effect of N1 on the biofilm formation ability of Staphylococcus epidermidis. On this basis, the surface structure of the biofilm on the surface of PVC material was observed by scanning electron microscopy after 6, 12, 18, 24, and 30 hours of incubation with PVC material sheet. The thickness of the biofilm was observed by laser confocal microscopy after 6, 12, 18, and 24 hours of incubation with ATCC35984 strain.ResultsThe optimal bacteriostatic concentration of N1 was 800 μg/mL. ATCC 12228 strain did not form obvious biofilm after being cultured with N1 and N0. When ATCC35984 strain was cultured with N1 and N0 for 12 hours, the difference in biofilm formation ability between groups N1 and N0 was statistically significant (P<0.05), but there was no significant difference at 6, 18, 24, 30, and 48 hours (P>0.05). Scanning electron microscopy examination showed that mature biofilm structure was observed in ATCC35984 strain and was not observed in ATCC12228 strain. Laser confocal microscopy observation showed that the number of bacteria in the group N1 was significantly lower than that in the group N0 at 12 hours, and the most of bacteria were dead bacteria. There was no significant difference in the number of bacteria at 6, 18, and 24 hours, and the most of them were live bacteria. The biofilm thickness of group N1 was significantly lower than that of group N0 at 12 and 18 hours (P<0.05).ConclusionThe intensity of N1 inhibiting the formation of Staphylococcus epidermidis biofilm is dose-dependent. During the aggregation period, N1 can inhibit the biofilm formation by hindering the bacterial growth and aggregation. The inhibition effect on mature biofilm is not obvious.
