简介：AbstractBackground:Endoscopic resection bleeding (ERB) classification was proposed by the authors’ team to evaluate the severity of intraoperative bleeding (IB) during endoscopic submucosal dissection (ESD). This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB (MIB) and postoperative bleeding (PB) associated with ESD for gastric neoplastic lesions.Methods:We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital. All patients were divided into the non-MIB group (including ERB-0, ERB-controlled 1 [ERB-c1], and ERB-c2) and the MIB group (including ERB-c3 and ERB-uncontrolled [ERB-unc]) according to the ERB classification. Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.Results:Among the 1334 patients, 773 (57.95%) had ERB-0, 477 (35.76%) had ERB-c1, 77 (5.77%) had ERB-c2, 7 (0.52%) had ERB-c3, and no patients had ERB-unc. The rate of PB in patients with IB classifications of ERB-0, ERB-c1, ERB-c2, and ERB-c3 were 2.20% (17/773), 3.35% (16/477), 9.09% (7/77), and 2/7, respectively. In multivariate analysis, proximal location (odds ratio [OR]: 1.488; 95% confidence interval [CI]: 1.045-3.645; P = 0.047) was the only significant risk factor of MIB. Chronic kidney disease (CKD) (OR: 7.844; 95% CI: 1.637-37.583; P = 0.010) and MIB (ERB-c3) (OR: 13.932; 95% CI: 2.585-74.794; P = 0.002) were independent risk factors of PB.Conclusions:Proximal location of lesions was a significant risk factor of MIB. Additionally, CKD and MIB (ERB-c3) were independent risk factors of PB. More attention should be paid to these high-risk patients for MIB and PB.

简介：Chronicpancreatitisisanongoingdiseasecharacterizedbypersistentinflammationofpancreatictissues.Withdiseaseprogression,patientswithchronicpancreatitismaydeveloptroublesomecomplicationsinadditiontoexocrineandendocrinepancreaticfunctionalloss.Amongthem,apseudoaneurysm,mainlyinducedbydigestiveenzymeerosionofvesselsinproximitytothepancreas,isarareandlife-threateningcomplicationifbleedingofthepseudoaneurysmoccurs.Atpresent,noprospectiverandomizedtrialshaveinvestigatedthetherapeuticstrategyforthisrarebutcriticalsituation.Theroleofarterialembolization,thetimingofsurgicalinterventionandevensurgicalproceduresarestillcontroversial.Inthisreview,wesuggestthatdynamicabdominalcomputedtomographyandangiographyshouldbeperformedfirsttolocalizethebleedersandtoevaluatetheassociatedcomplicationssuchaspseudocystformation,followedbyarterialembolizationtostopthebleedingandtoachieveearlystabilizationofthepatient’scondition.Withadvancesandimprovementsinendoscopicdevicesandtechniques,therapeuticendoscopyforpancreaticpseudocystsistechnicallyfeasible,safeandeffective.Surgicalinterventionisrecommendedforableedingpseudoaneurysminpatientswithchronicpancreatitiswhoareinanunstablecondition,forthoseinwhomarterialembolizationofthebleedingpseudoaneurysmfails,andwhenendoscopicmanagementofthepseudocystisunsuccessful.Ifableedingpseudoaneurysmislocatedoverthetailofthepancreas,resectionisapreferentialprocedure,whereasifthelesionissituatedovertheheadorbodyofthepancreas,relativelyconservativesurgicalproceduresarerecommended.

简介：Lidui(厉兑ST45)istheJing(井Well)pointoftheStomachMeridianofFoot-Yangming.It'seffectivetoreducetheheatfromthestomachortheStomachMeridian.TheStomachMeridianisabundantwithqiandblood,andisinchargeofhemopathy.So,inclinic,weoftenapplyLidui(ST45)pointbleedingmethodtothetreatmentofmanykindsofdiseasesandgetgoodtherapeuticeffects.Followingare3typicalcases.

简介：Japaneseaggressivewarcommittedextremelyseriouscrimes,whichbroughtmiserableexperiencesanddamagetoAsianpeopleincludingChinese.UndoubtedlywarcrimescommittedbythegovernmentandthearmyofJapanweretheviolationofhumanrightsphysicallyandemotionally.However,Japanrefusedtoadmitthesecrimesandevenmadeexcusespostwar,whichconstitutedfurtherviolationofhumanrights.IfJapanrespectedhumanrights,tooktheresponsibilityandapologizedforwhatthey’vedone,itwouldhelpthosenationsrecoverfromtraumaandcontributetobuildmorepeacefulrelationshipsamongnations.

简介：Severalcomplicationsofinsertionanduseofpulmonaryarterycatheter(PAC),includingcatheterentrapment,arerecognizedduringoraftercardiacsurgery.Earlydetectionisveryimportant.WereportacaseofPACentrapmentbecausethethecatheterwasaccidentallysuturedtothesuperiorvenacava.Bleedingfromthethermistorconnectorwasinitiallydetectedaftersurgerybecausetheneedlepuncturedthelumenofthermistorconnector.ThePACwasremovedthroughre-exploration.Therefore,bleedingfromthethermistorconnectorcouldearlyindicatethePACentrapment.Wesuggestthatabnormalbleedingfromthenon-injectatelumenportsofPACshouldbecheckedbeforesternalclosure.

简介：AbstractPlacenta percreta with bladder bleeding can occur during gestation or postpartum, posing a great threat to both mother and fetus. But it is rare and lacks standard management strategies. We reported four cases suffering from bladder bleeding caused by placenta percreta even with hemorrhagic shock admitted between January 1st, 2011 and December 31th, 2020 in The First Affiliated Hospital of Zhengzhou University. Clinical information, including age, gravidity and parity, ultrasound and magnetic resonance imaging manifestations, onset gestational age, bladder bleeding volume, clinical manifestations under bleeding, diagnosis, hemostatic methods, hospital stay, treatment cost, and prognosis, are presented. Two cases had bladder bleeding during the second trimester, respectively on the 22+3 and 23+5 weeks. Pregnancy was terminated timely. The other two cases had bladder bleeding on the 2nd day post near-term cesarean section when activity. All the four cases achieved successful hemostasis following angiography and concomitant embolization for iliac vessels, and one of them received electrocoagulation hemostasis under cystoscopy, but failed. They all had favorable clinical outcomes and had no long-term complications. The neonatal outcome in the two cases that bladder hemorrhage occurred after near-term c-section was good. The newborns did not survive in two cases in which bladder hemorrhage occurred at the second trimester of pregnancy. Timely termination of pregnancy is recommended when such a condition develops during gestation. Diagnosis of bladder bleeding is relatively easy, for it is characterized by fast speed and large volume, with concomitant distension of the lower abdomen, blood discharge from the urethral orifice, or the indwelling catheter. Interventional embolization is an effective means to treat bladder bleeding caused by placenta percreta, while electrocoagulation hemostasis under cystoscopy must be applied with great caution. For the pregnant women with a high risk of placenta percreta, timely and accurate diagnosis should be achieved during the gestational age, and bladder bleeding should be concerned when placenta penetrates through the anterior wall of uterus.

简介：Copperprocessorsusingsolventextraction/electrowinning(SX/EW)haveknownforyearsthateliminatingtheelectrolytebleedcouldbenefitprocesseconomicsdramaticallyUntilnow.therewasnopracticalsolutiontoeliminatethebleed.Availableprocesseseithercouldnorreduceironcontaminantssufficiently,orpulledouttoomuchvaluablecopperandcobaltalongwiththeiron.Basedonpilottestsofanewbreedofionexchangeseparatioinsystematthreedifferentminesitesonrepresentativeelectrolytes,analternmativetobleedingelectrolytesnowexists.Onthisbasis,processorscanshelvethewastefulelectrolytebleedingpractice.Already,onemajorcopperproducerisinstallingafullscalesystem.

简介：瞄准：比nonsteroidal评估风险因素其它反煽动性的药为在一张西洋化的人口的结肠的憩室的流血。方法：140个病人，在一个社区为征兆的憩室的疾病对待基于的医院，被包括。(21%)三十有憩室的流血的符号。colonoscopy的年龄，性，和结果被收集并且与有非为征兆的憩室形成放血的一组病人相比。记录为comorbidities被考察，例如肥胖，白酒消费，吸烟习惯和新陈代谢的疾病。特殊强调被放在动脉的高血压，心血管的事件，糖尿病mellitus，hyperuricemia和hypercholesterinemia上。结果：与非关于性比率(男性/女性的9/21对47/63)和憩室的本地化为征兆的憩室形成放血有憩室的出血和那些的病人之间没有差别。流血病人在尊重不同变老(73.4+/-9.9对67。8+/-13.0，P<0.013)。重要差别关于hyperuricemia的存在在两个组之间被发现并且类固醇和nonsteroidal使用反煽动性的药。有新陈代谢的疾病也是的三伴随物的病人作为在流血的风险识别了。向前逐步的逻辑回归分析表明类固醇，hyperuricemia和钙隧道的使用作为流血的独立风险因素堵住ers。结论：在nonsteroidal旁边反煽动性的类固醇药使用，反高血压的药和伴随物动脉硬化的疾病是为结肠的憩室的出血的风险因素。我们的结果作为流血的来源支持一个改变的动脉硬化的容器的假设。

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简介：AIMToverifythevalidityoftheendoscopyguidelinesforpatientstakingwarfarinordirectoralanticoagulants(DOAC).METHODSWecollecteddatafrom218patientsreceivingoralanticoagulants(73DOACusers,145warfarinusers)and218patientsnotreceivinganyantithrombotics(age-andsexmatchedcontrols)whounderwentpolypectomy.(1)Weevaluatedpost-polypectomybleeding(PPB)riskinpatientsweassessedtherisksofPPBandthromboembolismbetweenthreeACmanagementmethods:DiscontinuingACwithheparinbridge(HPB)(endoscopyguidelinerecommendation),continuingAC,anddiscontinuingACwithoutHPB.RESULTSPPBratewassignificantlyhigherinwarfarinusersandDOACuserscomparedwithcontrols(13.7%and13.7%vs0.9%,P<0.001),butwasnotsignificantlydifferentbetweenrivaroxaban(13.2%),dabigatran(11.1%),andapixaban(13.3%)users.Twothromboemboliceventsoccurredinwarfarinusers,butnoneinDOACusers.Comparedwiththecontinuinganticoagulantgroup,thediscontinuinganticoagulantwithHPBgroup(guidelinerecommendation)hadahigherPPBrate(10.8%vs19.6%,P=0.087).ThesefindingsweresignificantlyevidentinwarfarinbutnotDOACusers.OnethromboticeventoccurredinthediscontinuinganticoagulantwithHPBgroupandthediscontinuinganticoagulantwithoutHPBgroup;noneoccurredinthecontinuinganticoagulantgroup.CONCLUSIONPPBriskwassimilarbetweenpatientstakingwarfarinandDOAC.Thromboembolismwasobservedinwarfarinusersonly.TheguidelinerecommendationsforHPBshouldbere-considered.

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简介：瞄准：低剂量的阿司匹林的使用很好被建立阻止心血管的疾病事件。然而，上面的胃肠的流血的发生和有它的使用的预言者(UGIB)是未知的。我们有希望地在低剂量的阿司匹林用户学习了消化剂溃疡的发生和结果。方法：有低剂量的阿司匹林上的冠的动脉疾病(CAD)的991个病人的一个总数是有希望地跟随起来的为出现和UGIB的首先就医的事件的临床的特征的二年了。结果：UGIB有一个双性人有45%发生在四月阿司匹林开始以内的形式的表示并且每年有1.5%的全面流行。没有UGIB相关的死亡。高血压(或=4.6，95%CI1.5-14.7，P=0.009)，消化剂溃疡的历史(或=3.1，95%CI1.1-9.0，P=0.039)，第三级的教育(或=3.08，95%CI1.1-9.0，P=0.039)并且更高瘦的身体质量(P=0.016)独立因素与UGIB被联系。硝酸盐的使用没减少UGIB。结论：在有长期的低剂量的阿司匹林上的CAD的病人的UGIB的发生是低的，但是伴有重要病态。与阿司匹林的延长使用，UGIB继续是为有风险因素并且特别在有消化性溃疡，UGIB在趋于在阿司匹林治疗以后早发生的历史的病人的那些的一个问题。

简介：AbstractBackground:Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy; however, the relatively narrow nasal cavity results in difficulties related to bronchoscope insertion. This study aimed to investigate whether pre-operative nasal probe tests could reduce the time to pass the glottis, improve the first-pass success rate and patients’ tolerance, and reduce postoperative bleeding.Methods:This three-arm prospective randomized controlled trial was conducted in a tertiary hospital between May and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: control group, simple cotton bud detection group (CD group), and adrenaline + lidocaine detection group (AD group). The primary outcome was the time to pass the glottis. Secondary outcomes included the first-pass success rate, the patients’ tolerance scores, and post-operative bleeding. One-way analysis of variance, Kruskal-Wallis H test, Chi-squared test, Fisher’s exact test, and Bonferroni’s multiple comparison tests were used in this study.Results:In total, 189 men and 111 women were enrolled in this study, with a mean age of 55.72 ± 12.86 years. The insertion time was significantly shorter in the AD group than in the control group (18.00 s [12.00–26.50 s] vs. 24.00 s [14.50–45.50 s], P = 0.005). Both the AD (99% vs. 83%, χ2 = 15.62, P < 0.001) and CD groups (94% vs. 83%, χ2 = 5.94, P = 0.015) had a significantly higher first-pass success rate than the control group. Compared with the control group, post-operative bleeding (1% vs. 13%, χ2 = 11.06, P < 0.001) was significantly lower in the AD group. However, no significant difference was found in the patients’ tolerance scores.Conclusions:Pre-operative nasal cavity probe tests especially with adrenaline and lidocaine during flexible bronchoscopy can significantly reduce the time to pass the glottis, improve the first-pass success rate, and reduce post-operative nasal bleeding. Pre-operative nasal probe tests are recommended as a time-saving procedure for patients undergoing flexible bronchoscopy.Trial registration:Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000032668; http://www.chictr.org.cn/showprojen.aspx?proj=53321.

简介：BackgroundPriorrandomizedtrialshaveshownreducedbleedingwithbivalirudincomparedwithunfractionatedheparin(UFH)inpatientsundergoingpercutaneouscoronaryintervention(PCI).However,itisnotknownifthisbenefitisalsopresentwhenUFHdosesaremoretightlycontrolled(asmeasuredbyactivatedclot-tingtime,ACT).MethodsandResultsPatientsenrolledintheEVENT(EvaluationofDrug-ElutingStentsandIschemicEvents)registry,weredividedinto3groups,basedontheantithromboticdrugusedduringPCI(UFHmonotherapy,UFH+glycoproteinIIb-IIIareceptorinhibitor[GPI],orbivalirudinalone).Propensityscorematchingwasusedtoadjustformeasuredcovariates(89variables)andtocomparebivalirudinversusUFHmonotherapyandbivalirudinversusUFH+GPIgroups.TheUFHgroupswerestratifiedbasedonACTachieved(optimalACTdefinedas250-300forUFHmonotherapyand200-250whenGPIwasalsoused).Theprimarybleedingoutcomewasin-hospitalcompositebleeding,definedaseventsofaccesssitebleeding,ThrombolysisInMyocardialInfarctionmajor/minorbleeding,ortransfusion.Primary(in-hospitaldeath/myocardialinfarction)andsecondaryischemicoutcomes(death/MI/unplannedrepeatrevascularizationat12months)werealsoevaluated.Propensityscorematchingyielded3022patientsfortheUFHmonotherapyversusbivalirudincomparisonand3520patientsfortheUFH+GPIversusbivalirudincomparison.BivalirudinusewasassociatedwithnumericallylowerbleedingratesatallcategoriesofachievedACTwhencomparedwithUFH(low,optimal,highACT:2.5%versus4.7%,1.9%versus6.0%,3.1%versus4.8%,respectively)orheparin+GPIgroups(low,optimal,highACT:0.0%versus2.7%,2.7%versus5.2%,2.4%versus6.1%,respectively)andwasnotassociatedwithanystatisticallysignificantincreaseineitherprimaryorsecondaryischemicoutcomes.ConclusionsAmongunselectedpatientsundergoingPCI,bivalirudinuseduringPCIwasassociatedwithalowerriskofbleedingatall