A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital.He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previ...A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital.He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previously.After admission to our hospital,gastroscopy and bronchoscopy revealed a fistulous communication between the posterior tracheal wallnear the carina and the upper residual stomach.We measured the diameter of the trachea and bronchus and determined the site and size of the fistula using multislice computed tomography and gastroscopy.A covered self-expanding Y-shaped metallic stent was implanted into the trachea and bronchus.Subsequently,the fistula was closed completely.The patient tolerated the stent well and had good palliation of his symptoms.展开更多
BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the c...BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.展开更多
BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement impro...BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.METHODS This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation.In cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's discretion.The primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event rate.RESULTS Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP success.Among the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.展开更多
BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently estab...BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.展开更多
Background and objective: Coronary aneurysms remain a rare pathology of the coronary vessels, with multiple etiologies and dramatic complications. The majority of patients remain asymptomatic. These complications must...Background and objective: Coronary aneurysms remain a rare pathology of the coronary vessels, with multiple etiologies and dramatic complications. The majority of patients remain asymptomatic. These complications must be prevented through urgent management. However, management is not clearly codified. The aim of our case report is to demonstrate the benefit of covered stenting in the management of coronary aneurysms. Case report: This report is on a patient who was affected by a saccular coronary aneurysm on the anterior interventricular artery, of iatrogenic etiology and had a satisfactory medium-term outcome with a successful covered stenting treatment. Conclusion: Coronary aneurysms are rare, of multiple etiologies, increasingly linked to increasingly complex procedures. Their management, especially in emergencies, is not clearly codified. Covered stenting therefore remains a simple technique with good results.展开更多
BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older g...BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older generation of uncovered stents.Yet,with the advancement of technology,novel innovations of self-expanding metal stents(SEMS)have revolutionized the treatment of benign airway stenosis(BAS),where the insertion of SEMS is known to be easier than silicone stents.AIM To compare the efficacy and safety of covered SEMS against uncovered SEMS,and thereafter propose more direct trials comparing covered SEMS against silicone stents for consideration of revision of current FDA guidelines.METHODS A comprehensive literature review of MEDLINE and EMBASE was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Of 3002 articles,64 publications met the eligibility criteria with a total of 900 patients(468 covered SEMS,432 uncovered SEMS).The collected data were analyzed using Statistical Package for the Social Sciences version 11.5.RESULTS Covered SEMS showed a higher success rate of insertion(98.6%vs 88.2%)and lower complication rates of infection(1.3%vs 13.2%),restenosis(1.5%vs 10.6%),stent fracture(2.6%vs 7.4%),bleeding(0%vs 5.8%),and pneumothorax(0%vs 2.8%)compared to uncovered SEMS.However,covered SEMS compared to uncovered SEMS showed higher complication rates of stent migration(12.4%vs 6.9%)and granulation tissue formation(26.5%vs 20.1%).CONCLUSION Our study suggests that covered SEMS are an effective,safe,and viable option in the treatment of BAS.Thus,further consideration regarding the utilization of covered SEMS over other forms of stent types is appropriate.展开更多
This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obst...This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.展开更多
AIM:To evaluate the short-term efficacy of XEN45 Gel Stent(XEN)implantation for primary open angle glaucoma(POAG)and pseudoexfoliation(PEX)glaucoma across two university eye clinics,aiming to assess the impact of vary...AIM:To evaluate the short-term efficacy of XEN45 Gel Stent(XEN)implantation for primary open angle glaucoma(POAG)and pseudoexfoliation(PEX)glaucoma across two university eye clinics,aiming to assess the impact of varying center-specific protocols during the first postoperative year.METHODS:We retrospectively examined 282 patients(183 in center 1,99 in center 2),who underwent XEN microstent implantation for uncontrolled POAG or PEX glaucoma.Parameters including intraocular pressure(IOP),IOP-lowering medication count,best corrected visual acuity(BCVA),and postoperative complications were evaluated over 12mo.RESULTS:Post-implantation,center 1 reported a mean IOP reduction from 25.3±7.4 to 14.1±4.7 mm Hg(P<0.01)and a decrease in IOP-lowering medications from 3.2±1.2 to 1.0±1.3(P<0.01).Center 2 observed a similar reduction from 24.4±6.5 to 15.1±5.5 mm Hg(P<0.01)and medication decrease from 3.0±1.1 to 1.2±1.0(P<0.01).BCVA remained stable in both cohorts.The most common complications were hypotony(center 1:32;center 2:20)and choroidal detachment(center 1:22,center 2:15),with nearly identical needling rates(40% in center 1,41% in center 2).CONCLUSION:XEN implantation yields consistent reductions in IOP and medication use across different centers using comparable surgical and postoperative treatment regime.These findings underscore XEN’s shortterm effectiveness and suggest standardizable outcomes regardless of exact surgical procedure or treatment differences.展开更多
BACKGROUND Palliative care for unresectable pancreatic cancer(PC)focuses mainly on the symptoms of the disease,including abdominal pain,obstructive jaundice,and malnutrition.Biliary stent placement using endoscopic re...BACKGROUND Palliative care for unresectable pancreatic cancer(PC)focuses mainly on the symptoms of the disease,including abdominal pain,obstructive jaundice,and malnutrition.Biliary stent placement using endoscopic retrograde cholangiopan-creatography(ERCP)to relieve biliary obstruction has become an internationally recognized treatment.Although a few studies have evaluated the efficacy of endoscopic pancreatic duct stenting in advanced PC,no consensus exists on the use of endoscopic treatment to relieve pain and improve nutritional status.METHODS Patients with unresectable PC were recruited.The participants were randomized into two groups:The double-stent group underwent ERCP with a fully-covered self-expandable metallic biliary stent(FCSEMS)and a pancreatic duct stent,while the single-stent group underwent ERCP with an FCSEMS only.Abdominal pain,nutritional status,and incidence of adverse events were compared between the two groups using the SPSS software.RESULTS Seventy-eight patients with unresectable PC were included in the analysis(40 and 38 in the double-and single-stent groups,respectively).The median pain scores of patients in the double-stent group were lower than those in the single-stent group at 1(0 vs 2.5,P=0.002),2(0 vs 3,P<0.001),3(0 vs 4,P<0.001),and 6 months(0 vs 4,P<0.001)after ERCP.Total serum protein levels in patients in the double-stent group were higher than those in the single-stent group(66.6±8.4 g/L vs 60.4±4.0 g/L,P=0.046)6 months postoperatively.The body mass index(BMI)of patients in both groups decreased at six months.However,the BMI in the single-stent group was higher than that in the double-stent group(P<0.001).CONCLUSION Early pancreatic duct stenting reduces abdominal pain and improves nutritional status in patients with unre-sectable PC without reducing the technical success rate or increasing the incidence of adverse events.展开更多
This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the au...This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the authors for their comprehensive study design and execution,which included a clear delineation of study groups and a robust set of outcome measures.We suggest that future studies incorporate additional biomarkers,such as serum levels of liver enzymes and bilirubin,to provide a more nuanced understanding of liver function changes post-intervention.The study's focus on short-term survival rates is appreciated,but we recommend exploring longer-term follow-up periods to capture the full spectrum of survival outcomes.Additionally,the inclusion of quality of life assessments using validated instruments could offer a more holistic view of patient outcomes.From a critical care perspective,we advocate for the integration of advanced imaging techniques to better characterize biliary anatomy and potentially predict treatment response or complications.We believe that incor-porating these suggestions could enhance the understanding of endoscopic biliary stenting's role in MOJ management and its impact on patient outcomes,influ-encing future clinical guidelines and practice.展开更多
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modifie...BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.展开更多
Novel Y-shaped block copolymers of poly（ethylene glycol） and poly（N-isopropylacrylamide）, PEG-b-（PNIPAM）2, were successfully synthesized through atom transfer radical polymerization （ATRP）. A difunctional macr...Novel Y-shaped block copolymers of poly（ethylene glycol） and poly（N-isopropylacrylamide）, PEG-b-（PNIPAM）2, were successfully synthesized through atom transfer radical polymerization （ATRP）. A difunctional macroinitiator was prepared by esterification of 2,2-dichloroacetyl chloride with poly（ethylene glycol） monomethyl ether （PEG）. The copolymers were obtained via the ATRP ofN-isopropylacrylamide （NIPAM） at 30℃ with CuCl/Me6TREN as a catalyst system and DMF/H2O （v/v = 3：1） mixture as solvent. The resulting copolymers were characterized by gel permeation chromatography （GPC） and ^1H NMR. These block copolymers show controllable molecular weights and narrow molecular weight distributions （PDI 〈 1.15）. Their phase transition temperatures and the corresponding enthalpy changes in aqueous solution were measured by differential scanning calorimetry （DSC）. As a result, the phase transition temperature of PEG45-b-（PNIPAM55）2 is higher than that of PNIPAM, however, the corresponding enthalpy change is much lower, indicating the significant influence of the macromolecular composition and architecture on the phase transition.展开更多
BACKGROUND With the development of percutaneous coronary intervention(PCI),the number of interventional procedures without implantation,such as bioresorbable stents(BRS)and drug-coated balloons,has increased annually....BACKGROUND With the development of percutaneous coronary intervention(PCI),the number of interventional procedures without implantation,such as bioresorbable stents(BRS)and drug-coated balloons,has increased annually.Metal drug-eluting stent unloading is one of the most common clinical complications.Comparatively,BRS detachment is more concealed and harmful,but has yet to be reported in clinical research.In this study,we report a case of BRS unloading and successful rescue.This is a case of a 59-year-old male with the following medical history:“Type 2 diabetes mellitus”for 2 years,maintained with metformin extended-release tablets,1 g PO BID;“hypertension”for 20 years,with long-term use of metoprolol sustained-release tablets,47.5 mg PO QD;“hyperlipidemia”for 20 years,without regular medication.He was admitted to the emergency department of our hospital due to intermittent chest pain lasting 18 hours,on February 20,2022 at 15:35.Electrocardiogram results showed sinus rhythm,ST-segment elevation in leads I and avL,and poor R-wave progression in leads V1–3.High-sensitivity troponin I level was 4.59 ng/mL,indicating an acute high lateral wall myocardial infarction.The patient’s family requested treatment with BRS,without implanta-tion.During PCI,the BRS became unloaded but was successfully rescued.The patient was followed up for 2 years;he had no episodes of angina pectoris and was in generally good condition.CONCLUSION We describe a case of a 59-year-old male experienced BRS unloading and successful rescue.By analyzing images,the causes of BRS unloading and the treatment plan are discussed to provide insights for BRS release operations.We discuss preventive measures for BRS unloading.展开更多
Hydroforming process of a Y-shaped stainless steel tube was investigated through numerical simulation and experiments. The forming process and reasons of typical defects were analyzed with three different loading path...Hydroforming process of a Y-shaped stainless steel tube was investigated through numerical simulation and experiments. The forming process and reasons of typical defects were analyzed with three different loading paths. Thickness distribution of formed Y-shaped tube was obtained. It is shown by numerical and experimental results that the transition regions are depressed in the forming condition of low inner pressure and wrinkles occur, while fracture occurs in the forming condition of high inner pressure. After forming, the thickness in left transition fillet region is the largest, that in fight transition fillet region is thinner, and the thinnest thickness is at the top of the protrusion. The original thickness line is below the top of the protrusion. The thinning area occurs above this line, while the thickening area is below this line. The maximum thinning rate is significantly increased as the calibration pressure increases, while the maximum thickening rate remains almost unchanged.展开更多
BACKGROUND Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced(ECE)delivery of lumen-apposing metal stent(LAMS)is gradually being re-cognized as a viable palliative technique for malignant bili...BACKGROUND Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced(ECE)delivery of lumen-apposing metal stent(LAMS)is gradually being re-cognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography(ERCP)failure.However,most of the studies that have assessed its efficacy and safety were small and hetero-geneous.Prior meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing evidence.AIM To update the efficacy and safety of ECE-LAMS for treatment of biliary ob-struction after ERCP failure.METHODS We searched PubMed,EMBASE,and Scopus databases from the inception of the ECE technique to May 13,2022.Primary outcome measure was pooled technical success rate,and secondary outcomes were pooled rates of clinical success,re-intervention,and adverse events.Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R soft-ware(version 4.1.3).RESULTS Fourteen eligible studies involving 620 participants were ultimately included.The pooled rate of technical success was 96.7%,and clinical success was 91.0%.Adverse events were reported in 17.5%of patients.Overall reinter-vention rate was 7.3%.Subgroup analyses showed results were generally consistent.CONCLUSION ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is impossible.The consistency of results across most subgroups suggested that this is a generalizable approach.展开更多
We implement a binary collision approximation to study solitary wave propagation in a two-dimensional double Y- shaped granular chain. The solitary wave was transmitted and reflected when it met the interface of the b...We implement a binary collision approximation to study solitary wave propagation in a two-dimensional double Y- shaped granular chain. The solitary wave was transmitted and reflected when it met the interface of the bifurcated branches of the Y-shaped granular chains. We obtain the analytic results of the ratios of the transmitted and reflected speeds to the incident speed of the solitary wave, the maximum force between the two neighbor beads in a solitary wave, and the total time taken by the pulse to pass through each branch. All of the analytic results are in good agreement with the experimental observations from Daraio et al. [Phys. Rev. E 82 036603 （2010）]. Moreover, we also discuss the delay effects on the arrival of split pulses, and predict the recombination of the split waves traveling in branches in the final stem of asymmetric systems. The prediction of pulse recombination is verified by our numerical results.展开更多
Based on Mindlin stress solution, a numerical computational method was proposed to calculate the stresses in the ground induced by side friction and the resistance of Y-shaped vibro-pile. The improved Terzaghi's a...Based on Mindlin stress solution, a numerical computational method was proposed to calculate the stresses in the ground induced by side friction and the resistance of Y-shaped vibro-pile. The improved Terzaghi's and ЪерезанцевВГ's methods for ultimate bearing capacity evaluation were proposed by considering the stress strength induced by friction resistance at pile head level of Y-pile. A new method to calculate the ultimate bearing capacity of Y-pile was also proposed based on the assumptions of soil failure mode at the tip of Y-pile and the use of Mohr-Coulomb soil yield criterion and Vesic compressive correction coefficient with the induced stresses in the ground. Based on the comparisons with the field static load test results, it is found that the improved Terzaghi's method gives higher ultimate capacity, while the other two methods shows good agreement with the field results.展开更多
The transports of the dynamic biochemical signals in the non-reversing pulsatile flows in the mixing microchannel of a Y-shaped microfluidic device are ana- lyzed. The results show that the mixing micro-channel acts a...The transports of the dynamic biochemical signals in the non-reversing pulsatile flows in the mixing microchannel of a Y-shaped microfluidic device are ana- lyzed. The results show that the mixing micro-channel acts as a low-pass filter, and the biochemical signals are nonlinearly modulated by the pulsatile flows, which depend on the biochemical signal frequency, the flow signal frequency, and the biochemical signal transporting distance. It is concluded that, the transfer characteristics of the dynamic biochemical signals, which are transported in the time-varying flows, should be carefully considered for better loading biochemical signals on the cells cultured on the bottom of the microfluidic channel.展开更多
The role of endoscopy in pathologies of the bile duct and gallbladder has seen notable advancements over the past two decades.With advancements in stent technology,such as the development of lumen-apposing metal stent...The role of endoscopy in pathologies of the bile duct and gallbladder has seen notable advancements over the past two decades.With advancements in stent technology,such as the development of lumen-apposing metal stents,and adoption of endoscopic ultrasound and electrosurgical principles in therapeutic endoscopy,what was once considered endoscopic failure has transformed into failure of an approach that could be salvaged by a second-or third-line endoscopic strategy.Incorporation of these advancements in routine patient care will require formal training and multidisciplinary acceptance of established techniques and collaboration for advancement of experimental techniques to generate robust evidence that can be utilized to serve patients to the best of our ability.展开更多
文摘A 67-year-old man had a sev-ere cough and pulmonary infection for 1 wk before seeking evaluation at our hospital.He had undergone esophagectomy with gastric pull-up and radiotherapy for esophageal cancer 3 years previously.After admission to our hospital,gastroscopy and bronchoscopy revealed a fistulous communication between the posterior tracheal wallnear the carina and the upper residual stomach.We measured the diameter of the trachea and bronchus and determined the site and size of the fistula using multislice computed tomography and gastroscopy.A covered self-expanding Y-shaped metallic stent was implanted into the trachea and bronchus.Subsequently,the fistula was closed completely.The patient tolerated the stent well and had good palliation of his symptoms.
文摘BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.
文摘BACKGROUND Needle-knife precut papillotomy(NKP)is typically performed freehand.However,it remains unclear whether pancreatic stent(PS)placement can improve the outcomes of NKP.AIM To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.METHODS This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation.In cases with incidental pancreatic duct cannulation during conventional biliary cannulation,the decision for pre-NKP PS placement was made at the endoscopist's discretion.The primary outcome was the difference in the NKP success rate between patients with and without PS placement;the secondary outcome was the adverse event rate.RESULTS Among the 190 participants,82 received pre-NKP PS(PS-NKP group)whereas 108 did not[freehand or freehand NKP(FH-NKP)group].Post-NKP selective biliary cannulation was successful in 167(87.9%)patients,and the PS-NKP had a significantly higher success rate than the FH-NKP group(93.9%vs 83.3%,P=0.027).The overall adverse event rates were 7.3%and 11.1%in the PS-NKP and FH-NKP groups,respectively(P=0.493).A periampullary diverticulum(PAD)and significant intraoperative bleeding during NKP were independently associated with NKP failure;however,a pre-NKP PS was the only predictor of NKP success.Among the 44 participants with PADs,the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group(87.5%and 65%,respectively;P=0.076).CONCLUSION PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.
文摘BACKGROUND Acute ischemic stroke(AIS)is an abrupt blood flow cessation to a specific brain region within a vascular zone,causing a subsequent decline in neurological capabilities.Stent thrombectomy is a recently established technique for treating AIS.It provides the benefits of being a relatively simple and safe procedure,capable of partially enhancing a patient’s condition.However,some patients may experience endothelial damage and recurrent thrombosis,with clinical outcomes that are not always satisfactory.Hence,the efficacy of this method remains unclear.AIM To survey the association of stent thrombectomy vs standard treatment with neurological function protection,complications,and short-term prognosis in patients diagnosed with AIS.METHODS This study assigned 90 patients with AIS to the observation and control groups(n=45 patients)from December 2020 to December 2022.Stent thrombectomy was conducted in the observation group,whereas routine treatment was provided to the control group.The study assessed the therapeutic outcomes of two groups,including a comparison of their neurological function,living ability,anxiety and depression status,plaque area,serum inflammatory factors,serum Smur100βprotein,neuron-specific enolase(NSE),homocysteine(Hcy),and vascular endo-thelial function.Additionally,the incidence of complications was calculated and analyzed for each group.RESULTS The total effective rate of treatment was 77.78%and 95.56%in the control and observation groups,respectively.After 8 weeks of treatment,the scores on the National Institutes of Health Stroke Scale,Hamilton Anxiety Scale,and Hamilton Depression Scale decreased remarkably;the Barthel index increased remarkably,with better improvement effects of the scores in the observation group(P<0.05);total cholesterol,triglyceride,C-reactive protein,and plaque area lessened remarkably,with fewer patients in the observation group(P<0.05);S-100βprotein,NSE,and Hcy levels lessened remarkably,with fewer patients in the observation group(P<0.05);serum vascular endothelial growth factor and nitric oxide synthase levels increased remarkably,whereas the endothelin-1 level decreased,with better improvement effect in the observation group(P<0.05).Complications occurred in 8.88%of patients in the observation group compared with 33.33%in the control group.CONCLUSION Stent thrombectomy appeared to provide more remarkable neuroprotective effects in patients with AIS compared to the intravenous thrombolysis regimen.Additionally,it has effectively improved the neurological function,daily activities,and vascular endothelial function of patients,while reducing the incidence of complications and improving short-term prognosis.
文摘Background and objective: Coronary aneurysms remain a rare pathology of the coronary vessels, with multiple etiologies and dramatic complications. The majority of patients remain asymptomatic. These complications must be prevented through urgent management. However, management is not clearly codified. The aim of our case report is to demonstrate the benefit of covered stenting in the management of coronary aneurysms. Case report: This report is on a patient who was affected by a saccular coronary aneurysm on the anterior interventricular artery, of iatrogenic etiology and had a satisfactory medium-term outcome with a successful covered stenting treatment. Conclusion: Coronary aneurysms are rare, of multiple etiologies, increasingly linked to increasingly complex procedures. Their management, especially in emergencies, is not clearly codified. Covered stenting therefore remains a simple technique with good results.
文摘BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older generation of uncovered stents.Yet,with the advancement of technology,novel innovations of self-expanding metal stents(SEMS)have revolutionized the treatment of benign airway stenosis(BAS),where the insertion of SEMS is known to be easier than silicone stents.AIM To compare the efficacy and safety of covered SEMS against uncovered SEMS,and thereafter propose more direct trials comparing covered SEMS against silicone stents for consideration of revision of current FDA guidelines.METHODS A comprehensive literature review of MEDLINE and EMBASE was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Of 3002 articles,64 publications met the eligibility criteria with a total of 900 patients(468 covered SEMS,432 uncovered SEMS).The collected data were analyzed using Statistical Package for the Social Sciences version 11.5.RESULTS Covered SEMS showed a higher success rate of insertion(98.6%vs 88.2%)and lower complication rates of infection(1.3%vs 13.2%),restenosis(1.5%vs 10.6%),stent fracture(2.6%vs 7.4%),bleeding(0%vs 5.8%),and pneumothorax(0%vs 2.8%)compared to uncovered SEMS.However,covered SEMS compared to uncovered SEMS showed higher complication rates of stent migration(12.4%vs 6.9%)and granulation tissue formation(26.5%vs 20.1%).CONCLUSION Our study suggests that covered SEMS are an effective,safe,and viable option in the treatment of BAS.Thus,further consideration regarding the utilization of covered SEMS over other forms of stent types is appropriate.
文摘This article discusses Wang et al’s essay.Endoscopic biliary stenting,a less invasive alternative to surgery,is effective for malignant obstructive jaundice.This article summarizes the pathophysiology of biliary obstruction,the technical aspects of stenting,and the clinical outcomes.By comparison of endoscopic stenting with percutaneous biliary drainage,improvements and complications are focused on.Additionally,patient selection for stenting and future advancements in stent technology are important.Overall,endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice,especially those ineligibles for surgery.
基金Funded by the Open Access Publishing Fund of Leipzig University supported by the German Research Foundation within the program Open Access.
文摘AIM:To evaluate the short-term efficacy of XEN45 Gel Stent(XEN)implantation for primary open angle glaucoma(POAG)and pseudoexfoliation(PEX)glaucoma across two university eye clinics,aiming to assess the impact of varying center-specific protocols during the first postoperative year.METHODS:We retrospectively examined 282 patients(183 in center 1,99 in center 2),who underwent XEN microstent implantation for uncontrolled POAG or PEX glaucoma.Parameters including intraocular pressure(IOP),IOP-lowering medication count,best corrected visual acuity(BCVA),and postoperative complications were evaluated over 12mo.RESULTS:Post-implantation,center 1 reported a mean IOP reduction from 25.3±7.4 to 14.1±4.7 mm Hg(P<0.01)and a decrease in IOP-lowering medications from 3.2±1.2 to 1.0±1.3(P<0.01).Center 2 observed a similar reduction from 24.4±6.5 to 15.1±5.5 mm Hg(P<0.01)and medication decrease from 3.0±1.1 to 1.2±1.0(P<0.01).BCVA remained stable in both cohorts.The most common complications were hypotony(center 1:32;center 2:20)and choroidal detachment(center 1:22,center 2:15),with nearly identical needling rates(40% in center 1,41% in center 2).CONCLUSION:XEN implantation yields consistent reductions in IOP and medication use across different centers using comparable surgical and postoperative treatment regime.These findings underscore XEN’s shortterm effectiveness and suggest standardizable outcomes regardless of exact surgical procedure or treatment differences.
基金Supported by The Health Commission of Zhejiang Provence,China,No.WKJ-ZJ-2136.
文摘BACKGROUND Palliative care for unresectable pancreatic cancer(PC)focuses mainly on the symptoms of the disease,including abdominal pain,obstructive jaundice,and malnutrition.Biliary stent placement using endoscopic retrograde cholangiopan-creatography(ERCP)to relieve biliary obstruction has become an internationally recognized treatment.Although a few studies have evaluated the efficacy of endoscopic pancreatic duct stenting in advanced PC,no consensus exists on the use of endoscopic treatment to relieve pain and improve nutritional status.METHODS Patients with unresectable PC were recruited.The participants were randomized into two groups:The double-stent group underwent ERCP with a fully-covered self-expandable metallic biliary stent(FCSEMS)and a pancreatic duct stent,while the single-stent group underwent ERCP with an FCSEMS only.Abdominal pain,nutritional status,and incidence of adverse events were compared between the two groups using the SPSS software.RESULTS Seventy-eight patients with unresectable PC were included in the analysis(40 and 38 in the double-and single-stent groups,respectively).The median pain scores of patients in the double-stent group were lower than those in the single-stent group at 1(0 vs 2.5,P=0.002),2(0 vs 3,P<0.001),3(0 vs 4,P<0.001),and 6 months(0 vs 4,P<0.001)after ERCP.Total serum protein levels in patients in the double-stent group were higher than those in the single-stent group(66.6±8.4 g/L vs 60.4±4.0 g/L,P=0.046)6 months postoperatively.The body mass index(BMI)of patients in both groups decreased at six months.However,the BMI in the single-stent group was higher than that in the double-stent group(P<0.001).CONCLUSION Early pancreatic duct stenting reduces abdominal pain and improves nutritional status in patients with unre-sectable PC without reducing the technical success rate or increasing the incidence of adverse events.
文摘This letter responds to Wang et al's recent publication on endoscopic biliary stenting for malignant obstructive jaundice(MOJ)by offering constructive feedback and suggestions for future research.We commend the authors for their comprehensive study design and execution,which included a clear delineation of study groups and a robust set of outcome measures.We suggest that future studies incorporate additional biomarkers,such as serum levels of liver enzymes and bilirubin,to provide a more nuanced understanding of liver function changes post-intervention.The study's focus on short-term survival rates is appreciated,but we recommend exploring longer-term follow-up periods to capture the full spectrum of survival outcomes.Additionally,the inclusion of quality of life assessments using validated instruments could offer a more holistic view of patient outcomes.From a critical care perspective,we advocate for the integration of advanced imaging techniques to better characterize biliary anatomy and potentially predict treatment response or complications.We believe that incor-porating these suggestions could enhance the understanding of endoscopic biliary stenting's role in MOJ management and its impact on patient outcomes,influ-encing future clinical guidelines and practice.
文摘BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.
基金support from the National Natural Science Foundation of China(No. 20134020)the Visiting Scholar Project of Shandong Province of China(No.20081001)the Science Research Fund of Shandong Jiaotong University of China(No.Z200802)
文摘Novel Y-shaped block copolymers of poly（ethylene glycol） and poly（N-isopropylacrylamide）, PEG-b-（PNIPAM）2, were successfully synthesized through atom transfer radical polymerization （ATRP）. A difunctional macroinitiator was prepared by esterification of 2,2-dichloroacetyl chloride with poly（ethylene glycol） monomethyl ether （PEG）. The copolymers were obtained via the ATRP ofN-isopropylacrylamide （NIPAM） at 30℃ with CuCl/Me6TREN as a catalyst system and DMF/H2O （v/v = 3：1） mixture as solvent. The resulting copolymers were characterized by gel permeation chromatography （GPC） and ^1H NMR. These block copolymers show controllable molecular weights and narrow molecular weight distributions （PDI 〈 1.15）. Their phase transition temperatures and the corresponding enthalpy changes in aqueous solution were measured by differential scanning calorimetry （DSC）. As a result, the phase transition temperature of PEG45-b-（PNIPAM55）2 is higher than that of PNIPAM, however, the corresponding enthalpy change is much lower, indicating the significant influence of the macromolecular composition and architecture on the phase transition.
基金Supported by Health Commission of Hunan Province,No.202203014389Chinese Medicine Research Project of Hunan Province,No.A2023051the Natural Science Foundation of Hunan Province,No.2024JJ9414.
文摘BACKGROUND With the development of percutaneous coronary intervention(PCI),the number of interventional procedures without implantation,such as bioresorbable stents(BRS)and drug-coated balloons,has increased annually.Metal drug-eluting stent unloading is one of the most common clinical complications.Comparatively,BRS detachment is more concealed and harmful,but has yet to be reported in clinical research.In this study,we report a case of BRS unloading and successful rescue.This is a case of a 59-year-old male with the following medical history:“Type 2 diabetes mellitus”for 2 years,maintained with metformin extended-release tablets,1 g PO BID;“hypertension”for 20 years,with long-term use of metoprolol sustained-release tablets,47.5 mg PO QD;“hyperlipidemia”for 20 years,without regular medication.He was admitted to the emergency department of our hospital due to intermittent chest pain lasting 18 hours,on February 20,2022 at 15:35.Electrocardiogram results showed sinus rhythm,ST-segment elevation in leads I and avL,and poor R-wave progression in leads V1–3.High-sensitivity troponin I level was 4.59 ng/mL,indicating an acute high lateral wall myocardial infarction.The patient’s family requested treatment with BRS,without implanta-tion.During PCI,the BRS became unloaded but was successfully rescued.The patient was followed up for 2 years;he had no episodes of angina pectoris and was in generally good condition.CONCLUSION We describe a case of a 59-year-old male experienced BRS unloading and successful rescue.By analyzing images,the causes of BRS unloading and the treatment plan are discussed to provide insights for BRS release operations.We discuss preventive measures for BRS unloading.
基金the National Natural Science Foundation of China (Grant No.50525516)
文摘Hydroforming process of a Y-shaped stainless steel tube was investigated through numerical simulation and experiments. The forming process and reasons of typical defects were analyzed with three different loading paths. Thickness distribution of formed Y-shaped tube was obtained. It is shown by numerical and experimental results that the transition regions are depressed in the forming condition of low inner pressure and wrinkles occur, while fracture occurs in the forming condition of high inner pressure. After forming, the thickness in left transition fillet region is the largest, that in fight transition fillet region is thinner, and the thinnest thickness is at the top of the protrusion. The original thickness line is below the top of the protrusion. The thinning area occurs above this line, while the thickening area is below this line. The maximum thinning rate is significantly increased as the calibration pressure increases, while the maximum thickening rate remains almost unchanged.
基金The authors have read the PRISMA 2009 Checklist,and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
文摘BACKGROUND Endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced(ECE)delivery of lumen-apposing metal stent(LAMS)is gradually being re-cognized as a viable palliative technique for malignant biliary obstruction after endoscopic retrograde cholangiopancreatography(ERCP)failure.However,most of the studies that have assessed its efficacy and safety were small and hetero-geneous.Prior meta-analyses of six or fewer studies that were published 2 years ago were therefore underpowered to yield convincing evidence.AIM To update the efficacy and safety of ECE-LAMS for treatment of biliary ob-struction after ERCP failure.METHODS We searched PubMed,EMBASE,and Scopus databases from the inception of the ECE technique to May 13,2022.Primary outcome measure was pooled technical success rate,and secondary outcomes were pooled rates of clinical success,re-intervention,and adverse events.Meta-analysis was performed using a random-effects model following Freeman-Tukey double-arcsine transformation in R soft-ware(version 4.1.3).RESULTS Fourteen eligible studies involving 620 participants were ultimately included.The pooled rate of technical success was 96.7%,and clinical success was 91.0%.Adverse events were reported in 17.5%of patients.Overall reinter-vention rate was 7.3%.Subgroup analyses showed results were generally consistent.CONCLUSION ECE-LAMS has favorable success with acceptable adverse events in relieving biliary obstruction when ERCP is impossible.The consistency of results across most subgroups suggested that this is a generalizable approach.
基金Project supported by the Science Fund for Creative Research Groups of the National Natural Science Foundation of China (Grant No. 50921002)the Fundamental Research Funds for the Central Universities of China (Grant No. 2010LKWL09)
文摘We implement a binary collision approximation to study solitary wave propagation in a two-dimensional double Y- shaped granular chain. The solitary wave was transmitted and reflected when it met the interface of the bifurcated branches of the Y-shaped granular chains. We obtain the analytic results of the ratios of the transmitted and reflected speeds to the incident speed of the solitary wave, the maximum force between the two neighbor beads in a solitary wave, and the total time taken by the pulse to pass through each branch. All of the analytic results are in good agreement with the experimental observations from Daraio et al. [Phys. Rev. E 82 036603 （2010）]. Moreover, we also discuss the delay effects on the arrival of split pulses, and predict the recombination of the split waves traveling in branches in the final stem of asymmetric systems. The prediction of pulse recombination is verified by our numerical results.
文摘Based on Mindlin stress solution, a numerical computational method was proposed to calculate the stresses in the ground induced by side friction and the resistance of Y-shaped vibro-pile. The improved Terzaghi's and ЪерезанцевВГ's methods for ultimate bearing capacity evaluation were proposed by considering the stress strength induced by friction resistance at pile head level of Y-pile. A new method to calculate the ultimate bearing capacity of Y-pile was also proposed based on the assumptions of soil failure mode at the tip of Y-pile and the use of Mohr-Coulomb soil yield criterion and Vesic compressive correction coefficient with the induced stresses in the ground. Based on the comparisons with the field static load test results, it is found that the improved Terzaghi's method gives higher ultimate capacity, while the other two methods shows good agreement with the field results.
基金Project supported by the National Natural Science Foundation of China(Nos.11172060 and11672065)
文摘The transports of the dynamic biochemical signals in the non-reversing pulsatile flows in the mixing microchannel of a Y-shaped microfluidic device are ana- lyzed. The results show that the mixing micro-channel acts as a low-pass filter, and the biochemical signals are nonlinearly modulated by the pulsatile flows, which depend on the biochemical signal frequency, the flow signal frequency, and the biochemical signal transporting distance. It is concluded that, the transfer characteristics of the dynamic biochemical signals, which are transported in the time-varying flows, should be carefully considered for better loading biochemical signals on the cells cultured on the bottom of the microfluidic channel.
文摘The role of endoscopy in pathologies of the bile duct and gallbladder has seen notable advancements over the past two decades.With advancements in stent technology,such as the development of lumen-apposing metal stents,and adoption of endoscopic ultrasound and electrosurgical principles in therapeutic endoscopy,what was once considered endoscopic failure has transformed into failure of an approach that could be salvaged by a second-or third-line endoscopic strategy.Incorporation of these advancements in routine patient care will require formal training and multidisciplinary acceptance of established techniques and collaboration for advancement of experimental techniques to generate robust evidence that can be utilized to serve patients to the best of our ability.
