In recent years,the developed hemostatic technologies are still difficult to be applied to the hemostasis of massive arterial and visceral hemorrhage,owing to their weak hemostatic function,inferior wet tissue adhesio...In recent years,the developed hemostatic technologies are still difficult to be applied to the hemostasis of massive arterial and visceral hemorrhage,owing to their weak hemostatic function,inferior wet tissue adhesion,and low mechanical properties.Herein,a mussel-inspired supramolecular interaction-cross-linked hydrogel with robust mechanical property(308.47±29.20 kPa)and excellent hemostatic efficiency(96.5%±2.1%)was constructed as a hemostatic sealant.Typically,we combined chitosan(CS)with silk fibroin(SF)by cross-linking them through tannic acid(TA)to maintain the structural stability of the hydrogel,especially for wet tissue adhesion ability(shear adhesive strength=29.66±0.36 kPa).Compared with other materials reported previously,the obtained CS/TA/SF hydrogel yielded a lower amount of blood loss and shorter time to hemostasis in various arterial and visceral bleeding models,which could be ascribed to the synergistic effect of wound closure under wet state as well as intrinsic hemostatic activity of CS.As a superior hemostatic sealant,the unique hydrogel proposed in this work can be exploited to offer significant advantages in the acute wound and massive hemorrhage with the restrictive access of therapeutic moieties.展开更多
Objective:To analyze the effect of arterial embolism(AE)in patients with massive urinary system bleeding(MBUS).Methods:From September 2018 to September 2023,175 cases of MBUS patients in the emergency department of th...Objective:To analyze the effect of arterial embolism(AE)in patients with massive urinary system bleeding(MBUS).Methods:From September 2018 to September 2023,175 cases of MBUS patients in the emergency department of the hospital were randomly selected and divided into groups according to the length of stay.Among them,85 cases(September 2018–September 2020)underwent bladder irrigation treatment with aluminum potassium sulfate solution through a catheter(Group A),and 90 cases(October 2020–September 2023)underwent AE treatment(Group B).The treatment effects of the two groups were compared.Results:The treatment effectiveness of Group B is higher than that of Group A(P<0.05).The urinary hemoglobin level of Group B is lower than that of Group A at 1,6,12,and 24 hours after treatment(P<0.05).Among the 90 cases treated with AE,7 cases had a fever,with body temperatures ranging from 37.3°C to 38.9℃,with a mean temperature of 38.2±0.3℃.Four cases experienced local pain,nausea,and vomiting,while two cases of intra-iliac AE showed transient buttock pain.These patients with adverse reactions were treated symptomatically for 7 days.All patients recovered after treatment.Intravenous urography of 87 patients in June showed that the renal pelvis and calyces were in good condition,the renal function returned to normal,and the blood urea nitrogen and blood creatinine test results were within the normal range.After 1 year of follow-up,no hypertension occurred.Conclusion:AE treats MBUS patients in the emergency department with remarkable efficacy.It has the advantages of less damage to the body,rapid hemostasis,high safety,and maximum preservation of organ function.展开更多
Regional portal hypertension is a rare cause of upper gastrointestinal bleeding.We reported an extremely rare case in which regional portal hypertension was associated with both the splenic arteriovenous fistula and c...Regional portal hypertension is a rare cause of upper gastrointestinal bleeding.We reported an extremely rare case in which regional portal hypertension was associated with both the splenic arteriovenous fistula and chronic pancreatitis.In June 2010,our patient,a 41-year-old man,was admitted to a local hospital due to a sudden melena and dizziness without haematemesis and jaundice.The splenic arteriovenous fistula in this patient was successfully occluded through transcatheter arterial embolization.At the 12-mo follow-up,our patient was in good condition.展开更多
BACKGROUND Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding(NVUGIB),rebleeding remains a major concern.AIM To assess the role of prophylactic transcatheter arterial ...BACKGROUND Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding(NVUGIB),rebleeding remains a major concern.AIM To assess the role of prophylactic transcatheter arterial embolization(PTAE)added to successful hemostatic treatment among NVUGIB patients.METHODS We searched three databases from inception through October 19th,2020.Randomized controlled trials(RCTs)and observational cohort studies were eligible.Studies compared patients with NVUGIB receiving PTAE to those who did not get PTAE.Investigated outcomes were rebleeding,mortality,reintervention,need for surgery and transfusion,length of hospital(LOH),and intensive care unit(ICU)stay.In the quantitative synthesis,odds ratios(ORs)and weighted mean differences(WMDs)were calculated with the random-effects model and interpreted with 95%confidence intervals(CIs).RESULTS We included a total of 3 RCTs and 9 observational studies with a total of 1329 patients,with 486 in the intervention group.PTAE was associated with lower odds of rebleeding(OR=0.48,95%CI:0.29–0.78).There was no difference in the 30-d mortality rates(OR=0.82,95%CI:0.39–1.72)between the PTAE and control groups.Patients who underwent PTAE treatment had a lower chance for reintervention(OR=0.48,95%CI:0.31–0.76)or rescue surgery(OR=0.35,95%CI:0.14–0.92).The LOH and ICU stay was shorter in the PTAE group,but the difference was non-significant[WMD=-3.77,95%CI:(-8.00)–0.45;WMD=-1.33,95%CI:(-2.84)–0.18,respectively].CONCLUSION PTAE is associated with lower odds of rebleeding and any reintervention in NVUGIB.However,further RCTs are needed to have a higher level of evidence.展开更多
Arterioportal fistulas(APFs)are defined as vascular communications between the systemic arteries and portal circulation.APFs are classified as congenital or acquired,large or small,intrahepatic or extrahepatic,and tra...Arterioportal fistulas(APFs)are defined as vascular communications between the systemic arteries and portal circulation.APFs are classified as congenital or acquired,large or small,intrahepatic or extrahepatic,and traumatic or spontaneous.The consistent abnormal connection may result in severe presinusoidal portal hypertension,leading to gastrointestinal bleeding(GIB),ascites,elevated liver function enzymes,heart failure,diarrhea,and even pancreatitis or hematobilia in some unusual cases.Indeed,less than half reported cases have GIB,predominately caused by variceal rupture.Peptic ulcer bleeding has rarely been reported in the setting of APFs.Herein,we describe a case in which intrahepatic APF manifested as gastric ulcer bleeding,progressive portal thrombosis,and massive ascites,with these symptoms successfully relieved by endovascular treatment.展开更多
基金This work was financially supported by the National Natural Science Foundation of China(Grant No 51903050)the Natural Science Foundation of Fujian Province(Grant No.2019J01258)+2 种基金the Opening Project of State Key Laboratory of Polymer Materials Engineering(Sichuan University,Grant No.sklpme2019-4-34)the Key Program of Qingyuan Innovation Laboratory(Grant No.00221002)the Fuzhou University Testing Fund of Precious Apparatus(Grant No.2021T025).
文摘In recent years,the developed hemostatic technologies are still difficult to be applied to the hemostasis of massive arterial and visceral hemorrhage,owing to their weak hemostatic function,inferior wet tissue adhesion,and low mechanical properties.Herein,a mussel-inspired supramolecular interaction-cross-linked hydrogel with robust mechanical property(308.47±29.20 kPa)and excellent hemostatic efficiency(96.5%±2.1%)was constructed as a hemostatic sealant.Typically,we combined chitosan(CS)with silk fibroin(SF)by cross-linking them through tannic acid(TA)to maintain the structural stability of the hydrogel,especially for wet tissue adhesion ability(shear adhesive strength=29.66±0.36 kPa).Compared with other materials reported previously,the obtained CS/TA/SF hydrogel yielded a lower amount of blood loss and shorter time to hemostasis in various arterial and visceral bleeding models,which could be ascribed to the synergistic effect of wound closure under wet state as well as intrinsic hemostatic activity of CS.As a superior hemostatic sealant,the unique hydrogel proposed in this work can be exploited to offer significant advantages in the acute wound and massive hemorrhage with the restrictive access of therapeutic moieties.
文摘Objective:To analyze the effect of arterial embolism(AE)in patients with massive urinary system bleeding(MBUS).Methods:From September 2018 to September 2023,175 cases of MBUS patients in the emergency department of the hospital were randomly selected and divided into groups according to the length of stay.Among them,85 cases(September 2018–September 2020)underwent bladder irrigation treatment with aluminum potassium sulfate solution through a catheter(Group A),and 90 cases(October 2020–September 2023)underwent AE treatment(Group B).The treatment effects of the two groups were compared.Results:The treatment effectiveness of Group B is higher than that of Group A(P<0.05).The urinary hemoglobin level of Group B is lower than that of Group A at 1,6,12,and 24 hours after treatment(P<0.05).Among the 90 cases treated with AE,7 cases had a fever,with body temperatures ranging from 37.3°C to 38.9℃,with a mean temperature of 38.2±0.3℃.Four cases experienced local pain,nausea,and vomiting,while two cases of intra-iliac AE showed transient buttock pain.These patients with adverse reactions were treated symptomatically for 7 days.All patients recovered after treatment.Intravenous urography of 87 patients in June showed that the renal pelvis and calyces were in good condition,the renal function returned to normal,and the blood urea nitrogen and blood creatinine test results were within the normal range.After 1 year of follow-up,no hypertension occurred.Conclusion:AE treats MBUS patients in the emergency department with remarkable efficacy.It has the advantages of less damage to the body,rapid hemostasis,high safety,and maximum preservation of organ function.
基金Supported by The National Natural Science Foundation of China,No.81171444
文摘Regional portal hypertension is a rare cause of upper gastrointestinal bleeding.We reported an extremely rare case in which regional portal hypertension was associated with both the splenic arteriovenous fistula and chronic pancreatitis.In June 2010,our patient,a 41-year-old man,was admitted to a local hospital due to a sudden melena and dizziness without haematemesis and jaundice.The splenic arteriovenous fistula in this patient was successfully occluded through transcatheter arterial embolization.At the 12-mo follow-up,our patient was in good condition.
基金by Economic Development and Innovation Operative Programme Grant,No.GINOP 2.3.2-15-2016-00048 and No.GINOP-2.3.4-15-2020-00010Human Resources Development Operational Programme Grant,No.EFOP-3.6.2-16-2017-00006 and No.EFOP-3.6.1.-16-2016-00004.
文摘BACKGROUND Despite the improvement in the endoscopic hemostasis of non-variceal upper gastrointestinal bleeding(NVUGIB),rebleeding remains a major concern.AIM To assess the role of prophylactic transcatheter arterial embolization(PTAE)added to successful hemostatic treatment among NVUGIB patients.METHODS We searched three databases from inception through October 19th,2020.Randomized controlled trials(RCTs)and observational cohort studies were eligible.Studies compared patients with NVUGIB receiving PTAE to those who did not get PTAE.Investigated outcomes were rebleeding,mortality,reintervention,need for surgery and transfusion,length of hospital(LOH),and intensive care unit(ICU)stay.In the quantitative synthesis,odds ratios(ORs)and weighted mean differences(WMDs)were calculated with the random-effects model and interpreted with 95%confidence intervals(CIs).RESULTS We included a total of 3 RCTs and 9 observational studies with a total of 1329 patients,with 486 in the intervention group.PTAE was associated with lower odds of rebleeding(OR=0.48,95%CI:0.29–0.78).There was no difference in the 30-d mortality rates(OR=0.82,95%CI:0.39–1.72)between the PTAE and control groups.Patients who underwent PTAE treatment had a lower chance for reintervention(OR=0.48,95%CI:0.31–0.76)or rescue surgery(OR=0.35,95%CI:0.14–0.92).The LOH and ICU stay was shorter in the PTAE group,but the difference was non-significant[WMD=-3.77,95%CI:(-8.00)–0.45;WMD=-1.33,95%CI:(-2.84)–0.18,respectively].CONCLUSION PTAE is associated with lower odds of rebleeding and any reintervention in NVUGIB.However,further RCTs are needed to have a higher level of evidence.
文摘Arterioportal fistulas(APFs)are defined as vascular communications between the systemic arteries and portal circulation.APFs are classified as congenital or acquired,large or small,intrahepatic or extrahepatic,and traumatic or spontaneous.The consistent abnormal connection may result in severe presinusoidal portal hypertension,leading to gastrointestinal bleeding(GIB),ascites,elevated liver function enzymes,heart failure,diarrhea,and even pancreatitis or hematobilia in some unusual cases.Indeed,less than half reported cases have GIB,predominately caused by variceal rupture.Peptic ulcer bleeding has rarely been reported in the setting of APFs.Herein,we describe a case in which intrahepatic APF manifested as gastric ulcer bleeding,progressive portal thrombosis,and massive ascites,with these symptoms successfully relieved by endovascular treatment.
