Objective We report the morphologic findings and treatment of spontaneous isolated dissection of the celiac artery (SIDCA). Methods Twenty-three patients with SIDCA presenting between January 2009 ...and December 2014 were enrolled in this retrospective study. The demographic data, clinical features, morphologic findings, treatment modalities, and follow-up results of these patients were reviewed. We proposed a morphologic classification for SIDCA similar to that of spontaneous isolated dissection of the superior mesenteric artery. Results Initially, 11 patients were treated endovascularly, and 12 were treated medically. Four patients treated medically had an aggravation of the dissection and needed endovascular salvage. All patients recovered successfully. None of the patients developed abdominal pain, required reintervention, or died. In the medically treated group, the false lumen was completely thrombosed and absorbed in 4 patients, partially thrombosed in 2, and patent in 2. All stents were patent with the false lumen completely thrombosed and absorbed in the endovascular group. Conclusions SIDCA can be treated medically in stable patients but requires intensive follow-up. Endovascular therapy can be applied in high-risk patients with recurrent symptoms, visceral malperfusion, or aneurysm. Open surgery should be considered if endovascular repair is not suitable or has failed. The short-term results of endovascular management are encouraging but further evaluation with long-term follow-up is necessary.
ChatGPT is attracting widespread attention from all walks of life with its excellent multi-round dialogue ability and strong user intent understanding ability, triggering a new wave of artificial ...intelligence. From the perspective of technical analysis, this article sorts out the various related technologies used in the GPT (Generative Pre-training Transformer) series models as well as large-scale multimodal models, which are more powerful and perform better in multiple downstream tasks. Meanwhile, we guide users to use LLM (Large Language Model) along with GPT more scientifically to maximize their potential. Finally, we analyze the application prospect of the GPT as well as the large-scale multimodal models in the medical field, and the problems are discussed from the perspectives of the risks and limitations of large-scale models applied into the medical field.
Objective We report our experience of endovascular management and postoperative aortic remodeling of all types of isolated abdominal aortic dissection (IAAD). Methods This was retrospective study of ...28 IAAD patients treated by endovascular means in our department between January 2007 and July 2013. We reviewed the risk factors, clinical features, computed tomography images, follow-up results, and aortic remodeling of these IAAD patients and propose a new morphologic classification into three types—supraceliac, paravisceral, and infrarenal—according to the location of the primary entry site. Results There were four supraceliac IAADs, one paravisceral IAAD, and 23 infrarenal IAADs in our case series. Suprarenal (supraceliac + paravisceral) IAAD patients were relatively younger than infrarenal patients (45.2 ± 8.6 years vs 60.6 ± 15.5 years; P < .05). No difference was observed between suprarenal and infrarenal IAADs with respect to true lumen, false lumen, and dissection length on imaging ( P > .05). All patients received endovascular treatment. The primary technical success rate was 100%. During a follow-up of 35.7 ± 19.9 months, only one infrarenal patient needed an endovascular reintervention. All patients with supraceliac or infrarenal IAADs were alive at the time of follow-up; however, a paravisceral patient died of a dissecting abdominal aortic aneurysm rupture 21 months after endovascular treatment. In the suprarenal and infrarenal groups, endovascular treatment was associated with a significant decrease in the false lumen size and increase in the true lumen size ( P < .05). The maximum abdominal aorta diameter decreased after endovascular treatment in both groups but was statistically significant only in the infrarenal group ( P < .05). Conclusions IAAD is a rare vascular disease. We propose it should be categorized as supraceliac, paravisceral, and infrarenal IAAD according to the location of the primary entry site. Endovascular treatment for supraceliac and infrarenal IAADs is a safe method with a high technical success rate and promising aortic remodeling, whereas endovascular treatment for paravisceral IAADs remains difficult.
Objective: To identify the characteristics and differences between type I and type II papillary renal cell carcinoma (PRCC) using ultrasound. Methods: Twenty-five patients with PRCC, including 16 ...cases of type I and 9 cases of type II PRCC, were enrolled in this study. All lesions were surgically resected and pathologically confirmed. A conventional ultrasound and a contrast-enhanced ultrasound were performed on each of the 25 patients with PRCC before the operation. Both ultrasounds were performed by a single highlyqualified doctor with more than 10 years of experience. Features, including maximum diameter, boundary, shape, and growth pattern of the mass, color Doppler flow image (CDFI), enhancement pattern, degree, and uniformity, arrival time; and time to peak, obtained from the conventional and contrast-enhanced ultrasounds, were analyzed and compared between type I and type II PRCC. Results: On conventional ultrasound, type II PRCCs were significantly larger (P = 0.000), less clear (P = 0.001) and more irregular (P = 0.004) than type I PRCCs. There was also a statistically significant difference in growth pattern (P = 0.019) and enhancement uniformity (P = 0.016) between type I and II PRCC. Conclusion: There are statistically significant differences in sonographic features between the two types of PRCC. This knowledge could assist clinicians when choosing surgical procedures.
Background
Previous evidences have been proved that age, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and ejection fraction are tightly associated with the long-term outcomes in patients ...suffered from coronary artery disease (CAD). Therefore, the present study aimed to assess the prognosis value of age, NT-proBNP, and ejection fraction (ABEF) score in CAD patients who underwent percutaneous coronary intervention (PCI).
Methods
Observational cohort methodology was used in this study which enrolled totally 3561 patients. And the patients were followed up regularly for 37.59 ± 22.24 months. Patients were classed into three groups based on the tertiles of ABEF sore: first tertile (<5.06, n = 831), second tertile (5.06-6.25, n = 839), and third tertile (≥ 6.25, n = 834). The ABEF score was calculated as follows: age (years)/ejection fraction (%) + NT-proBNP (NT-proBNP<177pg/mL was 1, 177≤NT-proBNP≥524pg/mL was 2 and NT-proBNP > 524pg/mL is 3). The association between ABEF score and adverse prognosis, including all-cause death (ACD), cardiac death (CD), major adverse cardiovascular events (MACEs) and major adverse cardiac and cerebrovascular events (MACCEs), in patients who underwent PCI was analyzed.
Results
According to the risk category of ABEF score, the incidences of ACD (P < .001), CD (P < .001) and MACCEs (P = .021) among the three groups showed significant differences. Multivariate Cox regression analysis suggested that the respective risks of ACD and CD were increased 3.013 folds (hazard risk HR = 4.013 95% confidence interval CI: 1.922-8.378, P < .001) and 4.922 folds (HR = 5.922 95% CI: 2.253-15.566, P < .001) in the third tertile compared with those in the first tertile. Kaplan-Meier survival analyses showed that the cumulative risks of ACD,CD and MACCEs in patients with the high ABEF score tended to increase.
Conclusion
The present study indicated ABEF score was a novel biomarker suitable for predicting adverse prognosis in patients after PCI, which may be used for early recognition and risk stratification.
Summary Background Rectal indometacin decreases the occurrence of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, the population most at risk and the optimal timing ...of administration require further investigation. We aimed to assess whether pre-procedural administration of rectal indometacin in all patients is more effective than post-procedural use in only high-risk patients to prevent post-ERCP pancreatitis. Methods We did a multicentre, single-blinded, randomised controlled trial at six centres in China. Eligible patients with native papilla undergoing ERCP were randomly assigned in a 1:1 ratio (with a computer-generated list) to universal pre-procedural indometacin or post-procedural indometacin in only high-risk patients, with stratification by trial centres and block size of ten. In the universal indometacin group, all patients received a single dose (100 mg) of rectal indometacin within 30 min before ERCP. In the risk-stratified, post-procedural indometacin group, only patients at predicted high risk received rectal indometacin, immediately after ERCP. Investigators, but not patients, were masked to group allocation. The primary outcome was overall ocurrence of post-ERCP pancreatitis. The analysis followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov , number NCT02002650. Findings Between Dec 15, 2013, and Sept 21, 2015, 2600 patients were randomly assigned to universal, pre-procedural indometacin (n=1297) or risk-stratified, post-procedural indometacin (n=1303). Overall, post-ERCP pancreatitis occurred in 47 (4%) of 1297 patients assigned to universal indometacin and 100 (8%) of 1303 patients assigned to risk-stratified indometacin (relative risk 0·47; 95% CI 0·34–0·66; p<0·0001). Post-ERCP pancreatitis occurred in 18 (6%) of 305 high-risk patients in the universal group and 35 (12%) of 281 high-risk patients in the risk-stratified group (p=0·0057). Post-ERCP pancreatitis was also less frequent in average-risk patients in the universal group (3% 29/992), in which they received indometacin, than in the risk-stratified group (6% 65/1022), in which they did not receive the drug (p=0·0003). Other than pancreatitis, adverse events occurred in 41 (3%; two severe) patients in the universal indometacin group and 48 (4%; one severe) patients in the risk-stratified group. The most common adverse events were biliary infection (22 2% patients vs 33 3% patients) and gastrointestinal bleeding (13 1% vs ten 1%). Interpretation Compared with a risk-stratified, post-procedural strategy, pre-procedural administration of rectal indometacin in unselected patients reduced the overall occurrence of post-ERCP pancreatitis without increasing risk of bleeding. Our results favour the routine use of rectal indometacin in patients without contraindications before ERCP. Funding National Key Technology R&D Program, National Natural Science Foundation of China.
Loeys-Dietz syndrome presents early in life with rapidly progressive aortic aneurysmal disease. Aortic emergency in young children with Loeys-Dietz syndrome is an extremely rare occurrence. In this ...communication we report on 2 young children whose diagnoses were missed and consequently underwent urgent aortic repair due to aortic emergencies. For personalized management of aortic disease in Loeys-Dietz syndrome patients, when and how do we intervene?
Objective: To quantitatively analyze the difference of texture features of skeletal muscle in high-frequency ultrasound images under different physiological states using the multiscale decomposition ...method of ultrasound echo intensity interface reflections.Methods: High frequency ultrasound images of the biceps brachii in different physiological states were collected from 20 healthy volunteers. In offline state, eight texture parameters including mean of texture gray scale (Mean), standard variance (SDev) of gray scale, number of blobs (NOB) of texture density, irregularity (IRGL) of texture primitive shape, mean size of blobs (SOB) of texture primitive, homogeneity of distribution (HOD) of texture uniformity, directionality of texture distribution (DOD), and periodicity of texture distribution (POD) were extracted by MATLAB software and compared and analyzed statistically.Results: With the use of high frequency ultrasound, all healthy volunteers' biceps brachii showed isoechoic muscle bundles, organized arrangement of muscle fibers, and distinct and intact texture of structure. In different physiological states of biceps brachii of the same gender group, the NOB and the Mean showed statistically differences (P < 0.05). In the relaxation state of biceps brachii between different gender groups, the average SOB and the DOD showed statistically differences (P < 0.05). In the load state of biceps brachii between different genders, the NOB and the Mean showed statistically differences (P < 0.05).Conclusions: The ultrasonic image changes of muscle fibers under different physiological states can be identified by quantitative texture characteristic parameters, providing more information for clinical computer-aided diagnosis of skeletal muscle injury.
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