BACKGROUND:Pelvic-origin extra-pelvic varicose veins are increasingly recognized as a distinct phenotype of chronic venous disease. The optimal treatment sequence remains uncertain and is often selected according to the dominant clinical presentation. This study evaluated outcomes after symptom-driven top-down or bottom-up strategies in women with pelvic-origin extra-pelvic varicose veins. METHODS:We reviewed consecutive women with pelvic-origin extra-pelvic varicose veins treated between 2018 and 2024. Diagnosis was based on clinical examination, duplex ultrasound, and pelvic venous imaging. Patients with clinically relevant pelvic symptoms were generally treated with a top-down strategy, whereas patients with predominantly extra-pelvic manifestations and no significant pelvic symptoms were treated with a bottom-up strategy. Extra-pelvic outcomes were assessed using the revised Venous Clinical Severity Score (rVCSS), the Chronic Venous Insufficiency Questionnaire-20 (CIVIQ-20), technical success, escape point occlusion, and recurrence-free survival. Pelvic pain response in the top-down group was assessed using the visual analog scale (VAS) and parauterine vein diameter. RESULTS:Seventy-five patients were included: 32 in the top-down group and 43 in the bottom-up group. The groups had similar baseline characteristics, except for age (bottom-up group was older). At 3 months, no statistically significant differences were observed in rVCSS and CIVIQ-20 scores between the selected treatment groups (P = 0.71 and P = 0.86, respectively). Escape point occlusion rates were 93.8% and 97.7% (P = 0.58), lower limb symptom resolution rates were 100% and 95.3% (P = 0.24), and vulvar varices resolution rates were 87.5% and 93.0% (P = 0.47), respectively. At 3-year follow-up, the recurrence rate was 6.25% in the top-down group and 11.6% in the bottom-up group. Recurrence-free survival rates at 5 years were not statistically different between the groups (log-rank P = 0.33). Cox regression analysis identified BMI as a significant predictor of recurrence (HR = 2.654, P = 0.015). CONCLUSION:In this retrospective cohort of clinically selected patients, symptom-driven top-down and bottom-up strategies were both associated with favorable short-term outcomes and mid-term durability. Because the two groups represented different clinical phenotypes rather than randomized comparable populations, these findings should not be interpreted as proof of equivalent effectiveness. Treatment selection should be individualized based on pelvic symptoms, pelvic hemodynamics, and extra-pelvic anatomical patterns.

To evaluate whether baseline anxiety–depressive symptom burden is associated with 3-month pain response after venous interventions in women with venous-origin chronic pelvic pain related to pelvic venous disorders (PeVD). This single-center observational cohort study was a retrospective analysis of prospectively collected institutional registry data. A total of 103 women with symptomatic PeVD and venous-origin chronic pelvic pain who underwent venous intervention were included. Pain was assessed using a 0–10 numerical rating scale for average pelvic pain, disease-specific quality of life using the Pelvic Varicose Veins Questionnaire (PVVQ), and anxiety–depressive symptoms using the Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI). Outcomes were assessed at baseline and 3 months. Good pain response was defined as a ≥ 50

BACKGROUND:The main objective of this study was to examine the impact of endovascular therapy versus conservative therapy on mortality rates among patients with chronic limb-threatening ischemia (CLTI). In addition, the outcomes of amputation-free survival (AFS) were also studied in both groups. METHODS:In this observational registry study, we retrospectively analyzed patients admitted to the Department of Vascular Surgery at Beijing Shijitan Hospital, Capital Medical University, from January 2016 to September 2023. Patients were categorized into an endovascular treatment group and a conservative treatment group. The primary endpoint was all-cause mortality. Propensity score matching was employed to balance covariates between the 2 groups, resulting in matched samples. We compared all-cause mortality between the groups and used univariate and multivariate Cox regression analyses to assess the impact of treatment on patient mortality both before and after matching. RESULTS:A total of 120 patients with a mean age of (72 ± 11) years were enrolled in this study, comprising 76 patients in the endovascular treatment group and 44 patients in the conservative treatment group. The median follow-up duration was 33.5 (21.3-45.0) months, during which the all-cause mortality rate was 32 out of 120 (26.7%). In terms of clinical characteristics, significant differences were observed between the 2 groups regarding age, hypertension, Rutherford classifications, and Wounds, Ischemia, and foot Infection scores (P < 0.05). However, no significant differences were found in gender, diabetes, coronary artery disease, smoking status, hyperlipidemia, prior ischemic stroke, or lesion site (P > 0.05). Before propensity score matching, univariate Cox regression analysis indicated that age, gender, smoking status, Rutherford classifications, and Wounds, Ischemia, and foot Infection scores were significantly associated with patient mortality (P < 0.05). Multivariate Cox regression analysis revealed that age and smoking status were independently associated with patient mortality (P < 0.05). Using propensity score matching, 23 pairs of patients were successfully matched between the 2 groups. The 1-year and 3-year mortality rates in the endovascular group were 13.0% and 38.5%, respectively, compared to 17.4% and 36.0% in the conservative treatment group. No statistically significant differences were observed in 1-year (P = 0.681) or 3-year (P = 0.753) mortality rates between the 2 groups. Cox regression analysis also showed no significant difference in the risk of death between the 2 groups (hazard ratio [HR] 0.87, 95% cofidence interval [CI] 0.14-5.55; P = 0.880). AFS did not differ significantly between the 2 groups (Breslow-Wilcoxon P = 0.225). CONCLUSION:No significant differences were observed in 1-year and 3-year mortality rates between endovascular treatment and conservative treatment, and not all patients with CLTI require revascularization to achieve an AFS that is similar to patients undergoing revascularization, although the efficacy of conservative versus endovascular treatment in CLTI patients is still unclear. Age and smoking status emerged as independent risk factors associated with an elevated risk of mortality.

Objective The use of radiofrequency ablation (RFA) in the treatment of varicose veins (VVs) of the lower extremities has experienced a rapid increase. However, the clinical outcomes of RFA for VVs in patients with grade II iliac vein compression (IVC) are not clear. This study aimed to investigate the long-term outcomes of RFA in patients with VVs combined with grade II IVC. Methods A prospective study was conducted between January 2020 and June 2023 involving 511 patients with VVs of the left leg who underwent RFA over the 3-year period. Among these patients, 101 had grade II IVC. Grade II IVC was screened using duplex ultrasound and further determined using CTV and venography. All patients underwent RFA for VVs of the left leg and were followed-up for three years. The chronic venous insufficiency questionnaire (CIVIQ) score and venous clinical severity score (VCSS) were recorded to evaluate the improvement after the RFA surgery. Results Significant reductions in VCSS were observed from baseline to 36 months postoperatively (VVs group: 5.8 to 0.8; VVs + IVC group: 5.5 to 1.0; P < 0.01). Similarly, there were significant differences in CIVIQ scores (VVs group: 38.1 to 20.7; VVs + IVC group: 38.3 to 20.9; P < 0.01). Throughout the follow-up period, no statistical differences were found in VCSS, CIVIQ scores, surgical complications, or occlusion rates between the two groups. Conclusion Radiofrequency ablation emerges as a highly effective and durable treatment option for varicose veins in the lower extremities of patients with grade II IVC, offering an alternative to stent implantation.

AIM:To compare 1-year outcomes of computed tomography venography (CTV) combined with ultrasound-guided minimally invasive treatment with ascending phlebography and ultrasound-guided treatment for recurrent varicose veins. MATERIALS AND METHODS:Consecutive patients with unilateral recurrent varicose veins were matched by gender, age, C classification, and degree of obesity, and randomised in a 1:1 ratio to receive either CTV (CTV group) or ascending phlebography (control group) combined with ultrasound-guided minimally invasive treatment. Patients were followed up by clinical and ultrasound examination. Follow-up was scheduled at 1 week, and 3, 6, and 12 months. The primary outcome measure was the Venous Clinical Severity Score (VCSS) at 12 months. Measures of secondary outcome included Chronic Insufficiency Venous International Questionnaire-20 (CIVIQ-20) score, recurrence of varicose vein or ulcer during 12 months, ulcer healing time, detection and location of treated veins. RESULTS:Eighty patients were enrolled. Median VCSS in the CTV group was lower than it in the control group (p=0.04) and the CIVIQ-20 score was higher than the control group (p=0.02). By 12 months, no symptomatically recurrent varicose veins or ulcers had occurred. The ulcer healing time in CTV group was shorter (p<0.01). A greater number of patients had treated veins detected using CTV than by ascending venography (p=0.01), especially among patients with recurrence reflux veins in the groin, perineum, and vulva (p<0.01). CONCLUSION:CTV combined with ultrasound may be more helpful than ascending phlebography combined with ultrasound to improve treatment efficacy for recurrent varices. These results should be verified by an future study with more patients and long-term follow-up.

To evaluate the expression of recombinant activating gene (RAG) and B cell receptor (BCR) gene rearrangements in mature peripheral B lymphocytes in Takayasu arteritis (TA) to explore the possible mechanism of humoral immune response in TA. Ten patients with TA and 10 age- and sex-matched healthy volunteers (control group) from Beijing Shijitan Hospital, Capital Medical University and Peking Union Medical College Hospital, between 2022 and 2023, were included in this study. The mRNA of the RAG was measured using real-time quantitative PCR (RT-PCR). Western blotting was used to detect RAG protein expression levels. NGS technology was used to detect BCR gene rearrangement. The mRNA expression level of RAG1 and RAG2 in peripheral mature B lymphocytes in patients with TA was significantly higher than in the control group (RAG1 5.56 ± 1.71 vs. 1.94 ± 0.86, p < 0.05; RAG2 5.26 ± 1.59 vs. 1.65 ± 0.64, p < 0.05), respectively. The protein expression level of the RAG1 and the RAG2 in peripheral mature B lymphocytes in patients with TA was significantly higher than in the healthy control group (RAG1 4.33 ± 1.58 vs. 1.52 ± 0.59, p < 0.001; RAG2 4.67 ± 1.88 vs. 1.59 ± 0.56, p < 0.001). The number of peripheral B lymphocyte BCR clonotypes in the group of patients with TA was significantly higher than in the normal control group (1574 ± 317.7 vs. 801.3 ± 202.1, p < 0.05). The abundance of IGHV clones in patients with TA was higher than in the normal control group (31.185% vs. 13.449%), which was positively correlated with the expression levels of RAG1 and RAG2 (correlation coefficient r = 1.00, p < 0.001), respectively. High expression of the RAG gene coexists with secondary BCR gene rearrangement in mature peripheral B lymphocytes in patients with TA, providing important clues regarding the potential humoral response in TA; however, further studies with larger samples are needed.

目的 探讨手术患者合并静脉血栓栓塞症(venous thromboembolism,VTE)的危险因素.方法 回顾性分析2017年3月～2020年3月首都医科大学附属北京世纪坛医院收治的604例手术患者的病例资料,根据术后是否新发确诊VTE将其分为两组:发生VTE的手术患者作为病例组,未发生VTE的手术患者作为对照组,每组各302例.使用Logistic回归分析评价影响VTE的危险因素.结果 两组患者在年龄、性别、糖尿病、住院天数、手术时间、急性心肌梗死、急性脑卒中偏瘫、抗肿瘤治疗、中心静脉置管、糖皮质激素、机械通气、住ICU、出血风险等级、Caprini评分等级、出血风险等级、D-二聚体水平方面比较,差异均有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,年龄、性别、住院时间、抗肿瘤治疗、机械通气、D-二聚体水平是手术患者合并VTE的独立危险因素.结论 高龄、女性、住院时间增加、进行机械通气、D-二聚体水平较高可能增加手术患者VTE风险.

Venous cystic adventitial disease (VCAD) is a rare vascular anomaly located in the common femoral vein in most cases. We describe the case of a 59-year-old female patient with right leg edema who was misdiagnosed with deep vein thrombosis of the lower extremity at another hospital. Magnetic resonance angiography revealed a round mass in the popliteal vein, with a narrow lumen. Considering the location of the lesion, absence of a history of deep venous thrombosis and trauma, and clinical manifestations, the diagnosis is likely a popliteal vein adventitial cyst. Segmental popliteal vein resection and reconstruction were performed using a cylindrical great saphenous vein graft. No joint connection was found during the operation, and the postoperative pathology confirmed VCAD.

Objective: To investigate the safety and effectiveness of venous stenting in patients with chronic iliofemoral venous obstruction and secondary lymphedema from malignancy.Methods: From July 2012 to December 2020, patients with iliofemoral venous obstruction and secondary lymphedema who underwent venous stenting in our institution were reviewed retrospectively. Clinical characteristics, surgical com-plications, and symptom relief were assessed. Stent patency was evaluated with duplex ultrasound or computed tomographic venography. Twelve-month outcomes were reported.Results: Fifty-three patients with concurrent secondary lymphedema who had stents placed for iliofemoral venous obstruction were included. There were 42 females, and the mean age was 56.9 years. Nonthrombotic iliac vein lesions were identified in 16 patients (30.1%). Immediate technical success was 100%, with an average of two stents implanted. The median Villalta score, and Chronic Venous Disease Quality of Life quality of life questionnaire scores decreased from 12 (IQR, 10-15) and 58 (IQR, 50-66) at baseline, respectively, to 5 (interquartile range [IQR], 4-6) and 28 (IQR, 22-45) at 12 months after the procedure (P < .05), showing significant improvement in the quality of life. At the end of a median follow-up of 12 months (range, 3-25 months), the cumulative primary, assisted primary, and secondary patency rates were 70.8%, 76.9%, and 90.1%, respectively.Conclusions: In patients with secondary lymphedema from malignancy, venous stent placement is safe and effective for iliofemoral venous obstruction. (J Vasc Surg Venous Lymphat Disord 2023;11:626-33.)

Objective: To compare the efficacy of lower extremity three dimensional CT venography (CTV) and lower extremity ascending phlebography in evaluating recurrent varicose veins. Methods: A retrospective analysis was conducted on clinical data from 235 patients with unilateral recurrent varicose veins who were treated at the Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University, between January 2015 and December 2020.There were 112 males and 123 females, with an age of (62.5±11.4)years (range:24 to 75 years).Patients were stratified into two groups based on preoperative imaging examination:the CTV group (utilizing lower extremity venous ultrasound+lower extremity CTV) and the control group (employing lower extremity venous ultrasound+lower extremity ascending phlebography).The two groups were matched in a 1∶1 ratio using propensity score matching, resulting in 43 cases per group.Comparative analyses between the groups at the one-year postoperative follow-up were performed using independent sample t tests, Wilcoxon rank-sum tests, χ2 tests, and linear regression analysis. Results: One year post-surgery,the CTV group exhibited a lower venous clinical severity score (VCSS) compared to the control group(M(IQR),3.0(4.3) vs.4.0(5.8),Z=-2.038,P=0.040).Additionally, the chronic venous insufficiency patients' quality of life questionnaire (CIVIQ-20) scores were significantly higher in the CTV group than in the control group (89.0(8.0) vs.82.5(17.0), Z=-2.627, P=0.010).Patients in the CTV group also experienced a shorter ulcer healing time compared to the control group (4.0(4.0) weeks vs.12.0(7.0) weeks, Z=-3.217,P<0.01).Both groups showed no clinically symptomatic recurrent varicose veins or ulcers.However, they exhibited ultrasound-detectable varicose vein recurrence, with no statistically significant difference (χ2=0.453,P=0.500).The number of diseased vessels requiring management based on ultrasound supplemented by CTV was 16, while the number supplemented by ascending phlebography was 7,with a statistically significant difference (χ2=4.800,P=0.030).Linear regression analysis demonstrated that clinical-etiology-anatomy-pathology clinical grading and the preoperative imaging examination method exerted independent influences on VCSS and CIVIQ-20 during the one-year postoperative assessment. Conclusions: CTV-assisted ultrasound enables a direct and comprehensive evaluation and localization of diseased veins in patients with recurrent varicose veins.The utilization of lower extremity vein ultrasound combined with CTV-guided management of lower extremity vessels in minimally invasive treatment significantly improves patient prognosis, surpassing the assessment provided by ascending phlebography.

Objective:To evaluate the diagnostic evaluation process and the effectiveness and safety of intracavitary therapy for pelvic congestion syndrome (PCS).Methods:A retrospective analysis was conducted on 38 patients admitted to Beijing Shijitan Hospital affiliated to Capital Medical University from March 2019 to February 2022. Combined with the patient′s symptoms, PCS was diagnosed by color Doppler ultrasound, computed tomography venography (CTV), and venography. The ovarian vein was embolized with controllable spring coil and polydocanol foam sclerosing agent. The patients were followed up 1, 3 and 6 months after operation.Results:The total surgical success rate of 38 patients was 100%, and the incidence of complications was 5.3%(2/38); Spring coils (2.8±0.3)per person; The dosage of hardener was (7.0±2.1)ml/person. The improvement rate of patient symptoms was 97.4%(37/38); After 1, 3, and 6 months of surgery, color Doppler ultrasound was reexamined and no recanalization was observed in the embolized ovarian veins; The diameter of the parauterine vein was (2.8±0.5)mm, which was significantly lower than the preoperative (7.5±1.9)mm ( P<0.05); The Visual Analogue Scale (VAS) score was significantly lower than the preoperative score [(2.12±1.87)points vs (7.58±0.82)points, P<0.001]. Conclusions:Process based assessment is helpful in identifying and diagnosing PCS patients who urgently need treatment; Endovascular treatment based on embolization of ovarian vein with controllable spring coil and foam sclerosing agent is minimally invasive, safe and effective.

Objective:To evaluate the role of Angiojet thrombus clearance device in the treatment of dialysis access thrombosis.Methods:The clinical data of 37 patients with Angiojet thrombus clearance due to hemodialysis thrombosis from May 2019 to May 2021 were retrospectively analyzed.Results:The clinical success rate was 100%, the mean operation time was (42±21) minutes. The time of aspiration was (35±18) s, and the average length of occlusion was (8±5) cm. All patients were treated with balloon dilation after aspiration. The average postoperative dialysis flow was (270±15) ml/min. The mean length of stay was (2.0±1.5) days. There were no surgically related deaths, no vascular rupture or bleeding, no major complications. Dilated local pseudoaneurysm formation was observed in 5 patients after dilation by angiography without special treatment. The mean follow-up time was 11 months. The primary patency rate was 85% and the secondary patency rate was 87% at 6 months post operatively.Conclusion:Angiojet thrombus removal device has the advantages of minimally invasive, short operation time and repeatability.

原发性下肢静脉曲张是由于血液由深静脉向浅静脉反流而引起的.高压反流的血液通过反流点远心端的一支或多支穿静脉回流入深静脉,从而形成了"深静脉-浅静脉-穿静脉-深静脉"之间的无效循环.进入该循环的血液增加了穿静脉及深静脉的血流负荷,导致二者扩张,继而可能出现功能不全,此即为"超载理论".而不同类型的静脉曲张手术,若能有效阻断这一病理性"深静脉-浅静脉-穿静脉-深静脉"之间的循环,减少大量反流血液重新通过穿静脉进入深静脉,即对穿静脉及深静脉存在保护作用,并可能会改善穿静脉及深静脉功能.既往研究揭示了下肢静脉回流时不同水平深静脉、浅静脉内压力的变化规律,以及浅静脉反流及浅静脉反流阻断后穿静脉及深静脉的形态及功能变化情况.本文通过广泛查阅国内外关于下肢静脉曲张与深静脉功能及静脉曲张术后深静脉变化相关研究的文献,对下肢静脉曲张术后深静脉内径及功能变化情况进行综述.

医务工作者频繁接触罹患各类疾病的患者,在提供诊疗、护理服务过程中,容易接触带有各类病原体的体液、血液或含患者体液、血液的医疗废弃物,是感染性职业暴露的高危人群[1].合理减少锐器的使用、更换安全器械、规范诊疗护理操作及规范职业防护措施等,有助于预防感染性职业暴露[2].本研究调查分析北京市某医院医务工作者感染性职业暴露现状,旨在寻找职业暴露的危险环节或时间等,为其职业防护提供参考依据.

目的 分析住院新发静脉血栓栓塞症(venous thromboembolism,VTE)患者不同血栓风险分层下的临床相关特征,为VTE的分级临床流程管理建设和完善提供数据支持.方法 纳入2017年11月 ～2018年8月住院后新发生的经下肢血管超声诊断的VTE患者,分析不同血栓初始风险评估分组患者的基本住院信息、血栓形成部位、血栓危险因素、临床检查、临床治疗与预防的特征与差异.结果 纳入669例新发VTE患者,661例(98.80％)行血栓初始风险评估.新发VTE患者的初始风险评估分层中,极高危311例(47.05％)、高危284例(42.96％)、中危59例(8.93％)、低危7例(1.06％).不同风险分组间血栓形成的肢体(Fisher,P=0.35)及解剖部位(χ2=4.28,P=0.90)分布比较,差异均无统计学意义.外科危险分层分布比较,差异有统计学意义(Fisher,P=0.02),其中极高危与高危比较,差异有统计学意义(Fisher,P=0.03).不同风险分层的VTE患者,在基本住院信息、危险因素、临床检查、预防与治疗管理流程中的多个环节的分布比较,差异有统计学意义(P<0.05).结论 不同VTE风险分层的新发VTE患者临床特征的差异性,可作为血栓风险分级指导下VTE临床管理流程的建设与完善提供数据支持.

OBJECTIVE:Endothelial progenitor cells-released extracellular vesicles (EPCs-EVs) have previously been reported to promote the dissolution of deep venous thrombosis (DVT) through delivery of microRNA (miR). Given that, this research was projected to search the relative action of EPCs-EVs transferring of miR-136-5p in DVT. METHODS:From EPCs transfected with miR-136-5p agomir or antagomir, EVs were extracted and then injected into DVT mice. Meanwhile, based on the treatment with EPCs-EVs loading miR-136-5p antagomir, silenced thioredoxin-interacting protein (TXNIP) lentivirus was injected into DVT mice to perform the rescue experiments. Afterwards, the length and weight of venous thrombosis, EPC apoptosis and inflammatory factors, plasmin, fibrinogen, and thrombin-antithrombin were measured. miR-136-5p and TXNIP expression in DVT mice, and their targeting relationship were evaluated. RESULTS:miR-136-5p expression was suppressed and TXNIP expression was elevated in DVT mice. EPCs-EV reduced the length and weight of venous thrombosis, suppressed cell apoptosis and inflammatory reaction, as well as elevated level of plasmin, and reduced levels of fibrinogen and thrombin-antithrombin in DVT mice. Restored miR-136-5p loaded by EPCs-EV further attenuated DVT but EPCs-EV transfer of depleted miR-136-5p resulted in the opposite consequences. miR-136-5p targeted TXNIP and silenced TXNIP rescued the effect of EPCs-EV transfer of depleted miR-136-5p on DVT. CONCLUSION:miR-136-5p from EPCs-EV suppresses TXNIP expression to reduce the thrombus size in DVT, offering a promising treatment target for DVT.

Objective Long non-coding RNA (lncRNA) essentially controls many physiological and pathological processes of deep vein thrombosis (DVT). Based on that, lncRNA taurine upregulated gene 1 (TUG1)-involved angiogenesis of endothelial progenitor cells (EPCs) and dissolution of DVT was explored. Methods In the in-vitro experiments, EPCs were engineered with mimic, inhibitor, siRNA, and plasmid, after which tube formation, proliferation, migration, and apoptosis were checked. In the in-vivo experiments, a DVT mouse model was established. Before the DVT operation, the mice were injected with agomir, antagomir, siRNA, and plasmid. Subsequently, thrombosis and damage to the femoral vein were pathologically evaluated. TUG1, miR-92a-3p, and 3-Hydroxy-3-methylglutaryl coenzyme A reductase (Hmgcr) expression in the femoral vein was tested. The relationship between TUG1, miR-92a-3p, and Hmgcr was validated. Results DVT mice showed suppressed TUG1 and Hmgcr expression, and elevated miR-92a-3p expression. In EPCs, TUG1 overexpression or miR-92a-3p inhibition promoted cellular angiogenesis, whereas Hmgcr silencing blocked cellular angiogenesis. In DVT mice, elevated TUG1 or inhibited miR-92a-3p suppressed thrombosis and damage to the femoral vein whilst Hmgcr knockdown acted oppositely. In both cellular and animal models, TUG1 overexpression-induced effects could be mitigated by miR-92a-3p up-regulation. Mechanically, TUG1 interacted with miR-92a-3p to regulate Hmgcr expression. Conclusion Evidently, TUG1 promotes the angiogenesis of EPCs and dissolution of DVT via the interplay with miR-92a-3p and Hmgcr.

目的 利用根因分析法分析不同科室新发静脉血栓栓塞症(venous thromboembolism,VTE)患者的防治现状,为医院VTE患者的临床流程管理和完善提供政策建议及数据支持.方法 纳入2019年3月至2020年3月北京世纪坛医院院内新发VTE患者993例,分析患者的基本情况、风险评估分层、防治措施等.结果 内外科新发VTE患者以高危及极高危为主,高龄、肿瘤、手术为患者新发VTE的前三位危险因素,患者在动态风险评估、出血风险评估、专科会诊、物理预防、主动预防、治疗规范等方面均不理想,内外科患者在基本住院信息、血栓风险分层、危险因素、临床检查与诊断、预防与治疗多个方面的差异具有统计学意义(P＜0.05,P＜0.01).结论 高龄、手术、肿瘤患者仍是VTE防治的重点人群,VTE出血及动态风险评估不容忽视,完善VTE相关检查流程、关注主动预防、提升治疗规范化,依据不同科室特点实行差异化防治管理值得思索.

目的 对比分析Denali和Celect可回收下腔静脉滤器回收的难易程度和手术相关并发症.方法 收集2015年6月至2019年6月在北京世纪坛医院接受Denali或Celect可回收下腔静脉滤器置入的196例患者临床资料,其中Denali组101例,Celect组95例.分析两组一般资料、回收过程及相关并发症情况.结果 患者一般资料差异无统计学意义,具可比性.Denali组、Celect组分别有87例(86.1％)、75例(78.9％)尝试回收,回收成功率分别为98.9％(86/87)、97.3％(73/75)(P>0.05).Denali组滤器留置时间显著长于Celect组[(95.8±44.5)d对(73.6±38.2)d,P=0.001)].Celect组有更多患者需结合其他技术取出,通常更多需通过颈部和腹股沟入路双向进行,相应手术时间、手术费用均显著高于Denali组[(67.2±17.8)min对(58.5±18.9)min,P=0.003;(15539.4±6082.6)元对(13127.5±3252.6)元,P=0.002],但对比剂用量未明显增加.CT评价显示Celect组倾斜、穿透发生率均较高(P<0.001).结论 Denali滤器相对Celect滤器体内留置时间更长,取出时需应用额外回收技术概率较小,滤器倾斜和穿透并发症发生率较低.

OBJECTIVESTo screen and validate differential proteins as novel biomarkers in active Takayasu's arteritis (TAK).METHODSPlasma samples from 40 active, 40 inactive patients, and 40 healthy controls were collected. Protein profiles of plasma were mapped by two-dimensional gel electrophoresis. Differential protein spots were detected and identified by image analysis and mass spectrometry. Plasma concentrations of proteins were measured to validate candidate biomarkers. The area under the receiver operating characteristic (ROC) curve (AUC) of circulating plasma concentrations of candidate biomarkers were calculated to assess diagnostic value.RESULTSWith a total of 1507 matched gel spots, there were 170 differential expression spots between active and inactive TAK, including 139 up-regulated and 31 downregulated. Only 11 proteins could be identified by mass spectrometry. Serum amyloid A(SAA), fibrinogen, complement C4a, complement C3c, complement C4b binding protein(C4bp), recombination acting gene protein 1(RAG1), alpha-1-acid glycoprotein, alpha-1-microglobulin, complement C7, complement factor H related protein-1 were up-regulated in active patients, while serum amyloid P was down-regulated. Active patients had higher circulating levels of RAG1(P<0.001), C4bp (p=0.012) and SAA (p<0.001), compared to inactive patients, while inactive patients had higher levels than controls (RAG1, p=0.011; C4bp, p=0.012; SAA, p=0.005). The composite AUC with SAA, RAG1, and C4bp was 0.94 (95%CI 0.86-0.98) for discriminating activity, larger than 0.71(95% CI 0.60-0.80) for ESR (p=0.0004) or 0.75(95%CI 0.64-0.84) for CRP (p=0.0014), respectively.ONCLUSIONSSome acute-phase and immunology-related proteins may serve as novel biomarkers of TAK. Further study of these proteins may be helpful to elucidate the pathologic mechanism.