Hepatocellular carcinoma(HCC) is one of the most common malignant tumors in China. The Barcelona Clinic Liver Cancer(BCLC) staging system is regarded as the gold standard staging system for HCC, classifying HCC as ear...Hepatocellular carcinoma(HCC) is one of the most common malignant tumors in China. The Barcelona Clinic Liver Cancer(BCLC) staging system is regarded as the gold standard staging system for HCC, classifying HCC as early, intermediate, or advanced. For intermediate HCC, trans-catheter arterial chemoembolization(TACE) is recommended as the optimal strategy by the BCLC guideline. This review investigates whether liver resection is better than TACE for intermediate HCC. Based on published studies, we compare the survival benefits and complications of liver resection and TACE for intermediate HCC. We also compare the survival benefits of liver resection in early and intermediate HCC. We find that liver resection can achieve better or at least comparable survival outcomes compared with TACE for intermediate HCC; however, we do not observe a significant difference between liver resection and TACE in terms of safety and morbidity. We conclude that liver resection may improve the short- and long-term survival of carefully selected intermediate HCC patients, and the procedure may be safely performed in the management of intermediate HCC.展开更多
Over the last half century,surgical aortic valve replacement(SAVR)has evolved to offer a durable and efficient valve haemodynamically,with low procedural complications that allows favourable remodelling of left ventri...Over the last half century,surgical aortic valve replacement(SAVR)has evolved to offer a durable and efficient valve haemodynamically,with low procedural complications that allows favourable remodelling of left ventricular(LV)structure and function.The latter has become more challenging among elderly patients,particularly following trans-catheter aortic valve implantation(TAVI).Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss,valvular-vascular impedance to myocardial activation,force-velocity relationship,and myocardial strain.LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour.Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome.Physiological pacing via the His-Purkinje system for conduction abnormalities,further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression,LV coordinate contraction,and global vascular function.TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions.Until comparable long-term durability and the resolution of TAVI related complications become available,SAVR remains the first choice for lower risk younger patients.展开更多
Objectives: The aim of this study is to introduce protocols for choosing trans-arterial embolization (TAE) or surgical hemostasis as an initial therapy for obstetric hemorrhage. Materials and Methods: From 2002 to 201...Objectives: The aim of this study is to introduce protocols for choosing trans-arterial embolization (TAE) or surgical hemostasis as an initial therapy for obstetric hemorrhage. Materials and Methods: From 2002 to 2011 at our hospital, the medical records of the patients who underwent TAE or surgical hemostasis for obstetric hemorrhage were reviewed to assess the following data: The causes of obstetric hemorrhage, Shock Index (SI) and obstetrical disseminated intra-vascular coagulation (DIC) score, amount of bleeding, transfusion, and operation time. Results: Twenty-five patients underwent TAE and six underwent surgical hemostasis. SI and obstetrical DIC score of the TAE group were 1.0 (0.4 - 2.2) and 6.0 (1 - 32), respectively. They were significantly lower than those of the surgical hemostasis group (SI: 1.6, obstetrical DIC score: 12.5, p < 0.05). Though the hemorrhage could be controlled sufficiently in 23 cases of the TAE group, 5 cases went into shock during TAE. The SI and obstetrical DIC score of shock group were 1.2 (1 - 2) and 10 (2 - 32), respectively. Conclusion: Though TAE is a useful therapy to control obstetric inevitable hemorrhage, special attention should be paid to the vital signs during TAE, especially in cases where SI and/or obstetrical DIC score are higher than 1.2 and 10, respectively.展开更多
Congenital hepatic arterio-venous malformations (AVM) are rare vascular anomalies and have rarely been reported in the presence of congeni-tal heart disease. The reported cases are mostly hemangiomas fed either by the...Congenital hepatic arterio-venous malformations (AVM) are rare vascular anomalies and have rarely been reported in the presence of congeni-tal heart disease. The reported cases are mostly hemangiomas fed either by the hepatic artery itself or by one of its branches. We present two unique hepatic AVM cases in the presence of congenital heart defects in which the AVM was not fed by the hepatic arterial system. Transcatheter coil embolisation was successfully carried out in both of them by using non-detachable Gianturco coils. Complete occlusion was achieved without any sequel.展开更多
Objective: Trans-catheter Aortic Valve Replacement/Aortic Valve Implantation (TAVR) are increasingly performed today. We compared insulin requirements between TAVR and Surgical Aortic Valve Replacement (SAVR) patients...Objective: Trans-catheter Aortic Valve Replacement/Aortic Valve Implantation (TAVR) are increasingly performed today. We compared insulin requirements between TAVR and Surgical Aortic Valve Replacement (SAVR) patients with and without diabetes mellitus (DM) to determine optimal glucose management strategies during the perioperative period (POP). Methods: Charts of consecutive patients undergoing aortic procedures were retrospectively reviewed for glucose ranges, insulin requirements and routes of insulin administration (subcutaneous vs. intravenous) for patients with and without DM to maintain BG Results: Patients with SAVRs without DM and A1C Conclusions: TAVR patients have different insulin requirements compared to SAVRs (p < 0.05). This information helps build a glucose management algorithm for a procedure which is increasingly performed.展开更多
Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-...Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.展开更多
Background Very elderly patients represent a distinct patient group in clinical setting in terms of a decision for trans-catheter aortic valve replacement （TAVR） when one considers the potential improvement in the q...Background Very elderly patients represent a distinct patient group in clinical setting in terms of a decision for trans-catheter aortic valve replacement （TAVR） when one considers the potential improvement in the quality of life （QoL） on one hand and the benefit to risk ratio on the other. This study aimed to compare functional and QoL outcomes of TAVR between octogenarians and septuagenarians. Methods This prospective cohort study included 136 elderly patients （70 to 89 years of age）, who tmderwent Wansfemoral TAVR due to degenerative aortic stenosis. Patients were allocated into one of the following age groups： septuagenarians （n = 67） and octogenarians （n = 69）. Preoperative and early postoperative clinical parameteT：s were recorded. In addition, QoL of the patients was evaluated using SF-36 questionnaire preoperatively and six month postoperatively. Results Groups were similar in terms of early postoperative mortality and morbidity parameters. The mean New York Heart Association （NYHA） class improved after TAVR in both groups. In addition, all SF-36 norm-based scale and SF-36 summary scale scores improved significantly in both groups during the postoperative period. Postoperatively, physical functioning, general health and physical component summary scores were significantly better in the septuagenarian group （P = 0.02, 0.01, 0.03, respectively）. ConcLusion Although the improvement in the QoL in terms of physical health was more marked in septuagenarians than in octogenarians, substantial benefits on the QoL and particularly on mental health seem to justify re-consideration of TAVR indications in the very elderly.展开更多
目的:探讨二叶式主动脉瓣狭窄患者主动脉根部形态学特点对经导管主动脉瓣置换术(TAVR)疗效的影响。方法:回顾性选取2014年1月至2016年12月在阜外医院、四川大学华西医院及浙江大学附属第二医院行TAVR的二叶式主动脉瓣狭窄患者49例。分...目的:探讨二叶式主动脉瓣狭窄患者主动脉根部形态学特点对经导管主动脉瓣置换术(TAVR)疗效的影响。方法:回顾性选取2014年1月至2016年12月在阜外医院、四川大学华西医院及浙江大学附属第二医院行TAVR的二叶式主动脉瓣狭窄患者49例。分析患者主动脉根部形态学特点、手术有效性及安全性,并进行随访。结果:二叶式主动脉瓣无嵴与带嵴类型占比相当(55.1%vs 44.9%),瓣叶钙化程度重[钙化体积HU850=(604.1±318.7) mm^3],平均瓣环周长大于平均瓣环上水平周长[(78.8±7.4) mm vs (67.1±6.7) mm,P<0.001],平均左心室流出道(LVOT)周长大于平均瓣环周长[(81.6±10.5) mm vs (78.8±7.4) mm,P=0.003]。置入瓣中瓣患者12例(24.5%),瓣膜置入过深患者14例(34.1%)。置入瓣中瓣患者比无瓣中瓣患者瓣环平均内经[(26.8±2.4) mm vs(23.9±2.0) mm,P<0.001]、周长[(85.7±7.0) mm vs (76.6±6.1) mm,P<0.001]及LVOT平均内径[(28.4±2.7) mm vs (24.3±3.1) mm,P<0.001]、周长[(91.3±9.1) mm vs (78.4±8.9) mm,P<0.001]更大,LVOT周长/瓣环上水平周长比值虽差异无统计学意义[(125.5±12.3)%vs (119.4±15.7)%,P=0.067],但趋近阈值。瓣膜置入过深患者比无置入过深患者LVOT周长/瓣环周长比值更大[(108.0±7.4)%vs (101.2±6.7)%,P=0.005]。结论:二叶式主动脉瓣患者的瓣环和LVOT平均内径及LVOT周长/瓣环周长比值对于TAVR中瓣中瓣的置入及瓣膜置入深度具有一定影响。展开更多
文摘Hepatocellular carcinoma(HCC) is one of the most common malignant tumors in China. The Barcelona Clinic Liver Cancer(BCLC) staging system is regarded as the gold standard staging system for HCC, classifying HCC as early, intermediate, or advanced. For intermediate HCC, trans-catheter arterial chemoembolization(TACE) is recommended as the optimal strategy by the BCLC guideline. This review investigates whether liver resection is better than TACE for intermediate HCC. Based on published studies, we compare the survival benefits and complications of liver resection and TACE for intermediate HCC. We also compare the survival benefits of liver resection in early and intermediate HCC. We find that liver resection can achieve better or at least comparable survival outcomes compared with TACE for intermediate HCC; however, we do not observe a significant difference between liver resection and TACE in terms of safety and morbidity. We conclude that liver resection may improve the short- and long-term survival of carefully selected intermediate HCC patients, and the procedure may be safely performed in the management of intermediate HCC.
基金The authors received financial support for the research work in cardiac physiology and aortic valve surgery by research grant from Garfield Weston Trust,London(to Xu Yu Jin and John R Pepper)from Oxford Hospital Charity,Oxford(to Xu Yu Jin).
文摘Over the last half century,surgical aortic valve replacement(SAVR)has evolved to offer a durable and efficient valve haemodynamically,with low procedural complications that allows favourable remodelling of left ventricular(LV)structure and function.The latter has become more challenging among elderly patients,particularly following trans-catheter aortic valve implantation(TAVI).Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss,valvular-vascular impedance to myocardial activation,force-velocity relationship,and myocardial strain.LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour.Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome.Physiological pacing via the His-Purkinje system for conduction abnormalities,further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression,LV coordinate contraction,and global vascular function.TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions.Until comparable long-term durability and the resolution of TAVI related complications become available,SAVR remains the first choice for lower risk younger patients.
文摘Objectives: The aim of this study is to introduce protocols for choosing trans-arterial embolization (TAE) or surgical hemostasis as an initial therapy for obstetric hemorrhage. Materials and Methods: From 2002 to 2011 at our hospital, the medical records of the patients who underwent TAE or surgical hemostasis for obstetric hemorrhage were reviewed to assess the following data: The causes of obstetric hemorrhage, Shock Index (SI) and obstetrical disseminated intra-vascular coagulation (DIC) score, amount of bleeding, transfusion, and operation time. Results: Twenty-five patients underwent TAE and six underwent surgical hemostasis. SI and obstetrical DIC score of the TAE group were 1.0 (0.4 - 2.2) and 6.0 (1 - 32), respectively. They were significantly lower than those of the surgical hemostasis group (SI: 1.6, obstetrical DIC score: 12.5, p < 0.05). Though the hemorrhage could be controlled sufficiently in 23 cases of the TAE group, 5 cases went into shock during TAE. The SI and obstetrical DIC score of shock group were 1.2 (1 - 2) and 10 (2 - 32), respectively. Conclusion: Though TAE is a useful therapy to control obstetric inevitable hemorrhage, special attention should be paid to the vital signs during TAE, especially in cases where SI and/or obstetrical DIC score are higher than 1.2 and 10, respectively.
文摘Congenital hepatic arterio-venous malformations (AVM) are rare vascular anomalies and have rarely been reported in the presence of congeni-tal heart disease. The reported cases are mostly hemangiomas fed either by the hepatic artery itself or by one of its branches. We present two unique hepatic AVM cases in the presence of congenital heart defects in which the AVM was not fed by the hepatic arterial system. Transcatheter coil embolisation was successfully carried out in both of them by using non-detachable Gianturco coils. Complete occlusion was achieved without any sequel.
文摘Objective: Trans-catheter Aortic Valve Replacement/Aortic Valve Implantation (TAVR) are increasingly performed today. We compared insulin requirements between TAVR and Surgical Aortic Valve Replacement (SAVR) patients with and without diabetes mellitus (DM) to determine optimal glucose management strategies during the perioperative period (POP). Methods: Charts of consecutive patients undergoing aortic procedures were retrospectively reviewed for glucose ranges, insulin requirements and routes of insulin administration (subcutaneous vs. intravenous) for patients with and without DM to maintain BG Results: Patients with SAVRs without DM and A1C Conclusions: TAVR patients have different insulin requirements compared to SAVRs (p < 0.05). This information helps build a glucose management algorithm for a procedure which is increasingly performed.
文摘Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.
文摘Background Very elderly patients represent a distinct patient group in clinical setting in terms of a decision for trans-catheter aortic valve replacement （TAVR） when one considers the potential improvement in the quality of life （QoL） on one hand and the benefit to risk ratio on the other. This study aimed to compare functional and QoL outcomes of TAVR between octogenarians and septuagenarians. Methods This prospective cohort study included 136 elderly patients （70 to 89 years of age）, who tmderwent Wansfemoral TAVR due to degenerative aortic stenosis. Patients were allocated into one of the following age groups： septuagenarians （n = 67） and octogenarians （n = 69）. Preoperative and early postoperative clinical parameteT：s were recorded. In addition, QoL of the patients was evaluated using SF-36 questionnaire preoperatively and six month postoperatively. Results Groups were similar in terms of early postoperative mortality and morbidity parameters. The mean New York Heart Association （NYHA） class improved after TAVR in both groups. In addition, all SF-36 norm-based scale and SF-36 summary scale scores improved significantly in both groups during the postoperative period. Postoperatively, physical functioning, general health and physical component summary scores were significantly better in the septuagenarian group （P = 0.02, 0.01, 0.03, respectively）. ConcLusion Although the improvement in the QoL in terms of physical health was more marked in septuagenarians than in octogenarians, substantial benefits on the QoL and particularly on mental health seem to justify re-consideration of TAVR indications in the very elderly.
文摘目的:探讨二叶式主动脉瓣狭窄患者主动脉根部形态学特点对经导管主动脉瓣置换术(TAVR)疗效的影响。方法:回顾性选取2014年1月至2016年12月在阜外医院、四川大学华西医院及浙江大学附属第二医院行TAVR的二叶式主动脉瓣狭窄患者49例。分析患者主动脉根部形态学特点、手术有效性及安全性,并进行随访。结果:二叶式主动脉瓣无嵴与带嵴类型占比相当(55.1%vs 44.9%),瓣叶钙化程度重[钙化体积HU850=(604.1±318.7) mm^3],平均瓣环周长大于平均瓣环上水平周长[(78.8±7.4) mm vs (67.1±6.7) mm,P<0.001],平均左心室流出道(LVOT)周长大于平均瓣环周长[(81.6±10.5) mm vs (78.8±7.4) mm,P=0.003]。置入瓣中瓣患者12例(24.5%),瓣膜置入过深患者14例(34.1%)。置入瓣中瓣患者比无瓣中瓣患者瓣环平均内经[(26.8±2.4) mm vs(23.9±2.0) mm,P<0.001]、周长[(85.7±7.0) mm vs (76.6±6.1) mm,P<0.001]及LVOT平均内径[(28.4±2.7) mm vs (24.3±3.1) mm,P<0.001]、周长[(91.3±9.1) mm vs (78.4±8.9) mm,P<0.001]更大,LVOT周长/瓣环上水平周长比值虽差异无统计学意义[(125.5±12.3)%vs (119.4±15.7)%,P=0.067],但趋近阈值。瓣膜置入过深患者比无置入过深患者LVOT周长/瓣环周长比值更大[(108.0±7.4)%vs (101.2±6.7)%,P=0.005]。结论:二叶式主动脉瓣患者的瓣环和LVOT平均内径及LVOT周长/瓣环周长比值对于TAVR中瓣中瓣的置入及瓣膜置入深度具有一定影响。
