BACKGROUND The recently introduced ultrasonic flow ratio(UFR),is a novel fast computational method to derive fractional flow reserve(FFR)from intravascular ultrasound(IVUS)images.In the present study,we evaluate the d...BACKGROUND The recently introduced ultrasonic flow ratio(UFR),is a novel fast computational method to derive fractional flow reserve(FFR)from intravascular ultrasound(IVUS)images.In the present study,we evaluate the diagnostic performance of UFR in patients with intermediate left main(LM)stenosis.METHODS This is a prospective,single center study enrolling consecutive patients with presence of intermediated LM lesions(diameter stenosis of 30%-80%by visual estimation)underwent IVUS and FFR measurement.An independent core laboratory assessed offline UFR and IVUS-derived minimal lumen area(MLA)in a blinded fashion.RESULTS Both UFR and FFR were successfully achieved in 41 LM patients(mean age,62.0±9.9 years,46.3%diabetes).An acceptable correlation between UFR and FFR was identified(r=0.688,P<0.0001),with an absolute numerical difference of 0.03(standard difference:0.01).The area under the curve(AUC)in diagnosis of physiologically significant coronary stenosis for UFR was 0.94(95%CI:0.87-1.01),which was significantly higher than angiographic identified stenosis>50%(AUC=0.66,P<0.001)and numerically higher than IVUS-derived MLA(AUC=0.82;P=0.09).Patient level diagnostic accuracy,sensitivity and specificity for UFR to identify FFR≤0.80 was 82.9%(95%CI:70.2-95.7),93.1%(95%CI:82.2-100.0),58.3%(95%CI:26.3-90.4),respectively.CONCLUSION In patients with intermediate LM diseases,UFR was proved to be associated with acceptable correlation and high accuracy with pressure wire-based FFR as standard reference.The present study supports the use of UFR for functional evaluation of intermediate LM stenosis.展开更多
BACKGROUND Ultrasound guide technology,which can provide real-time visualization of the needle tip and tissues and avoid many adverse events,is widely used in mini-mally invasive therapy.However,the studies on ultraso...BACKGROUND Ultrasound guide technology,which can provide real-time visualization of the needle tip and tissues and avoid many adverse events,is widely used in mini-mally invasive therapy.However,the studies on ultrasound-guided Lateral recess block(LRB)are limited,this is probably because there is no recognized standard method for ultrasound scanning.This study aimed to evaluate the effect of ultrasound-guided LRB in patients with lateral recess stenosis(LRS).CASE SUMMARY A 65-year-old patient complained of low back pain accompanied occasionally by pain and numbness in the left lower limb.Physical examination showed ten-derness on the spinous process and paraspinal muscles from L1 to S1,extensor hallucis longus and tibialis anterior weakness(muscle strength:4-),and a positive straight leg raising test in the left lower limb(60°).Magnetic resonance imaging showed L4–L5 disc degeneration with left LRS and nerve root entrapment.Subsequently,the patient was diagnosed with LRS.This patient was treated with a novel ultrasound-guided LRB approach.The patient’s symptoms significantly improved without any complications at 1 wk postoperatively and at the 3-month follow-up.CONCLUSION This is the first report on the LRS treatment with ultrasound-guided LRB from the contralateral spinous process along the inner side of the articular process by out-plane technique.Further studies are expected to investigate the efficacy and safety of ultrasound-guided LRB for patients with LRS.展开更多
Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the...Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the aim of improving the quality of bladder emptying. The aim of the study was to evaluate the indication and results of EIU in the treatment of stenosis of the male urethra in the Urology-Andrology Department of Kara Teaching Hospital. Methodology: This was a cross-sectional descriptive study with retrospective data collection in the Urology-Andrology department of Kara Teaching Hospital. It involved 21 records of patients with urethral stenosis treated by endoscopic internal urethrotomy (EIU) in the said department during the period from January 2021 to September 2023. The following variables were evaluated: age, circumstance of discovery, site, length, number, etiology of the urethral stenosis and evolution of the patients. Results: The mean age of the patients was 59.2 ± 11.7 years. Infectious etiology of stenosis was predominant with 10 patients (47.6%) followed by trauma with 5 cases (23.8%). The bulbar urethra was the most frequently observed site, with 11 cases (52.4%). The length was mostly less than 2 cm in 12 patients (57.1%). Stenosis was unique in 14 patients (66.7%). The mean postoperative follow-up time was 3.2 months. The result was immediately better in 11 patients (52.4%) and it was poor in 8 patients (38.1%) who required maintenance dilation sessions.展开更多
BACKGROUND At present,there is no unified and effective treatment for extreme corrosive esophageal stenosis(CES)with esophagotracheal fistula(ETF).This case had extreme and severe esophageal stenosis(ES)and ETF after ...BACKGROUND At present,there is no unified and effective treatment for extreme corrosive esophageal stenosis(CES)with esophagotracheal fistula(ETF).This case had extreme and severe esophageal stenosis(ES)and ETF after ingesting an enzyme-based chemical detergent,resulting in a serious pulmonary infection and severe malnutrition.Upper gastrointestinal imaging showed that he had an ETF,and endoscopy showed that he had extreme and severe esophageal stricture.This case was complex and difficult to treat.According to the domestic and foreign lite-rature,there is no universal treatment that is low-risk.CASE SUMMARY A patient came to our hospital with extreme ES,an ETF,and severe malnutrition complicated with pulmonary tuberculosis 1 mo after the consumption of an enzy-me-based detergent.The ES was serious,and the endoscope was unable to pass through the esophagus.We treated him by endoscopic incision method(EIM),esophageal stent placement(ESP),and endoscopic balloon dilation(EBD)by using the bronchoscope and gastroscope.This treatment not only closed the ETF,but also expanded the esophagus,with minimal trauma,greatly reducing the pain of the patient.According to the literature,there are no similar reported cases.CONCLUSION We report,for the first time,a patient with extreme CES complicated with ETF,where the endoscope could not be passed through his esophagus but he could be examined by bronchoscopy and treated by EIM,ESP,and EBD.展开更多
Persistent fifth aortic arch (PFAA) is a rare congenital cardiovascular malformation that occurs when the pharyngeal fifth aortic arch does not degenerate during the embryonic period. The first case of PFAA was descri...Persistent fifth aortic arch (PFAA) is a rare congenital cardiovascular malformation that occurs when the pharyngeal fifth aortic arch does not degenerate during the embryonic period. The first case of PFAA was described in an autopsy specimen in 1969.[1] In 1973, the persistence of a left fifth aortic arch was first reported.[2] Since then, several case reports have described PFAA in different forms. PFAA stenosis associated with type A interruption of the aortic arch (type-A IAA) is most common in clinical practice and requires surgical intervention. From 2013 to 2018, six cases [Table 1 and Table 2] were diagnosed using echocardiography and computed tomography angiography (CTA). Five cases were successfully treated with surgery and followed-up. The purpose of this study was to summarize the clinical characteristics and diagnostic features of PFAA stenosis associated with type-A IAA to improve its diagnostic accuracy and allow for complete pre-operative preparation and proper treatment.展开更多
Deep underground projects(e.g., coal mines), are often faced with complex conditions such as high stress and extremely soft rock. The strength and rigidity of the traditional support system are often insufficient,whic...Deep underground projects(e.g., coal mines), are often faced with complex conditions such as high stress and extremely soft rock. The strength and rigidity of the traditional support system are often insufficient,which makes it difficult to meet the requirements of ground control under complex conditions. As a new support form with high strength and rigidity, the confined concrete arch plays an important role in controlling the rock deformation under complex conditions. The section shape of the tunnel has an important impact on the mechanical properties and design of the support system. However, studies on the mechanical properties and influence mechanism of the new confined concrete arch are rarely reported. To this end, the mechanical properties of traditional U-shaped steel and new confined concrete arches are compared and comparative tests on arches of circular and straight-leg semicircular shapes in deep tunnels are conducted. A large mechanical testing system for underground engineering support structure is developed. The mechanical properties and influence mechanism of confined concrete arches with different section shapes under different loading modes and cross-section parameters are systematically studied. Test results show that the bearing capacity of the confined concrete arch is 2.10 times that of the U-shaped steel arch, and the bearing capacity of the circular confined concrete arch is 2.27 times that of the straight-leg semicircular arch. Among the various influencing factors and their engineering parameters,the lateral stress coefficient has the greatest impact on the bearing capacity of the confined concrete arch,followed by the steel pipe wall thickness, steel strength, and core concrete strength. Subsequently, the economic index of bearing capacity and cost is established, and the optimization design method for the confined concrete arch is proposed. Finally, this design method is applied to a high-stress tunnel under complex conditions, and the deformation of the surrounding rock is effectively controlled.展开更多
A huge number of old arch bridges located in rural regions are at the peak of maintenance.The health monitoring technology of the long-span bridge is hardly applicable to the small-span bridge,owing to the absence of ...A huge number of old arch bridges located in rural regions are at the peak of maintenance.The health monitoring technology of the long-span bridge is hardly applicable to the small-span bridge,owing to the absence of technical resources and sufficient funds in rural regions.There is an urgent need for an economical,fast,and accurate damage identification solution.The authors proposed a damage identification system of an old arch bridge implemented with amachine learning algorithm,which took the vehicle-induced response as the excitation.A damage index was defined based on wavelet packet theory,and a machine learning sample database collecting the denoised response was constructed.Through comparing three machine learning algorithms:Back-Propagation Neural Network(BPNN),Support Vector Machine(SVM),and Random Forest(R.F.),the R.F.damage identification model were found to have a better recognition ability.Finally,the Particle Swarm Optimization(PSO)algorithm was used to optimize the number of subtrees and split features of the R.F.model.The PSO optimized R.F.model was capable of the identification of different damage levels of old arch bridges with sensitive damage index.The proposed framework is practical and promising for the old bridge’s structural damage identification in rural regions.展开更多
Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical tre...Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical treatment is always challenging. Here we report a minimally invasive and endovascular management of these two pathologies in a 89-year-old man with LAD-stented ischemic cardiomyopathy. We describe our initial therapeutic strategy, per procedure difficulties and final management of this challenging case. Finally, we discuss the different therapeutic options for the endovascular treatment of aortic arch aneurysm associated with aortic valve stenosis.展开更多
BACKGROUND With the introduction of transcatheter aortic valve replacement and an evolving understanding of the natural progression and history of aortic stenosis,the potential for earlier intervention in appropriate ...BACKGROUND With the introduction of transcatheter aortic valve replacement and an evolving understanding of the natural progression and history of aortic stenosis,the potential for earlier intervention in appropriate patients is promising;however,the benefit of aortic valve replacement in moderate aortic stenosis remains unclear.METHODS Pubmed,Embase,and the Cochrane Library databases were searched up until 30th of December 2021 using keywords including moderate aortic stenosis and aortic valve replacement.Studies reporting all-cause mortality and outcomes in early aortic valve replacement(AVR)compared to conservative management in patients with moderate aortic stenosis were included.Hazard ratios were generated using random-effects meta-analysis to determine effect estimates.RESULTS 3470 publications were screened with title and abstract review,which left 169 articles for full-text review.Of these studies,7 met inclusion criteria and were included,totalling 4,827 patients.All studies treated AVR as a time-dependent co-variable in cox-regression multivariate analysis of all-cause mortality.Intervention with surgical or transcatheter AVR was associated with a 45% decreased risk of all-cause mortality(HR=0.55[0.42-0.68],I2=51.5%,P<0.001).All studies were representative of the overall cohort with appropriate sample sizes,with no evidence of publication,detection,or information biases in any of the studies.CONCLUSION In this systematic review and meta-analysis,we report a 45% reduction in all-cause mortality in patients with moderate aortic stenosis who were treated with early aortic valve replacement compared to a strategy of conservative management.Randomised control trials are awaited to determine the utility of AVR in moderate aortic stenosis.展开更多
Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of...Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of pCO<sub>2</sub> and BE in infants suspected to have IHPS. Methods: We collected data from 80 “surgical” infants younger than 100 days with prolonged nonbilious vomiting who were suspected to have IHPS. In 65 infants, pyloric stenosis was confirmed, and 15 infants had nonsurgical conditions. Capillary blood was tested for standard acid-base parameters and lactate. The two groups were compared. Results: Eighty-eight percent of the IHPS infants had elevated standard bicarbonate levels (st bicarb) > 25 mmol/l, and 60% had BE > 3.5 mmol/l;12% of the infants showed hypercapnia (pCO<sub>2</sub> ≥ 50 mmHg) associated with markedly increased standard bicarbonate and BE. Infants with nonsurgical vomiting were older at admission (p = 0.002), had a longer duration of vomiting (p < 0.001), were older (p = 0.002) and weighted more at admission (p = 0.004), had lower pCO<sub>2</sub> (p = 0.021), lower st bicarb (p < 0.001) and lower BE (p = 0.001). In addition, nonsurgical infants showed a trend to anemia (p = 0.002). Conclusions: In infants with IHPS/nonbilious vomiting, acid-base analysis (ABA) is equivocal or inconclusive. These findings may be misleading and could result in a false clinical decision. Nonsurgical vomiting is associated with a lower degree of alkalosis, normocapnia to slight hypercapnia and a base deficit. However, even infants with IHPS may present with a negative BE. In infants with IHPS and severe alkalosis, hypercapnia carries a risk for respiratory depression. Monitoring the infant’s respiration allows for the early detection of respiratory deterioration.展开更多
BACKGROUND Although endoscope-assisted magnetic compression anastomosis has already been reported for colonic anastomosis,there is no report on a single-approach operation using the natural orifice.AIM To design a def...BACKGROUND Although endoscope-assisted magnetic compression anastomosis has already been reported for colonic anastomosis,there is no report on a single-approach operation using the natural orifice.AIM To design a deformable self-assembled magnetic anastomosis ring(DSAMAR)for colonic anastomosis for use in single-approach operation and evaluate its feasibility and safety through animal experiments.METHODS The animal model for colonic stenosis was prepared by partial colonic ligation in eight beagles.The magnetic compression anastomosis of their colonic stricture was performed by endoscopically assisted transanal implantation of the DSAMAR.The anastomotic specimen,obtained 2 wk after the operation,was observed by both the naked eye and a light microscope.RESULTS The DSAMAR was successfully inserted into the proximal end of colon stenosis through the anus.The DSAMAR of seven dogs was successfully transformed into rings,while that of the remaining dog was removed after the first deformation failed.The rings were successfully retransformed after optimization.All animals underwent colonic anastomosis using the DSAMAR.No device-related or procedure-related adverse events were observed.The colostomy specimens of the experimental dogs were obtained 2 wk after the operation.Both gross and histological observations showed good anastomotic healing.CONCLUSION The DSAMAR is a safe and feasible option for the treatment of colon stenosis.Its specific deformation and selfassembly capability maximize the applicability of the minimally invasive treatment.展开更多
BACKGROUND The diagnosis of peripheral arteriopathy in the diabetic foot is complicated by diabetes and its advanced complications.It has been found that diabetic foot can be categorized into arterial stenosis and non...BACKGROUND The diagnosis of peripheral arteriopathy in the diabetic foot is complicated by diabetes and its advanced complications.It has been found that diabetic foot can be categorized into arterial stenosis and non-arterial stenosis,both of which have significant differences in hemodynamic characteristics.AIM To evaluate the early hemodynamic changes in diabetic foot patients with nonarterial stenosis and arterial stenosis treated by tibial transverse transport(TTT)using high-frequency color Doppler ultrasonography(HFCDU)and a laser Doppler flowmeter.METHODS Twenty-five patients with Wagner grades 3-5 diabetic foot ulcers were treated with TTT,and the wound healing time and rate were recorded.Patients were grouped according to the results of preoperative lower-extremity ultrasonography.Cases with≥50%stenosis in any of the femoral,popliteal,posterior tibial,anterior tibial,and peroneal arteries of the affected limb were classified as the arterial stenosis group(n=16);otherwise,they were classified as the nonarterial stenosis group(n=9).Before and one month after surgery,HFCDU was used to evaluate the degree of lower limb artery lesions and hemodynamic changes in patients.The degree of femoral-popliteal atherosclerotic stenosis,the degree of vascular stenosis and occlusion of the lower-knee outflow tract,and the degree of medial arterial calcification were scored;the three scores were added together to obtain the total score of lower extremity arteriopathy.PeriScanPIM3,a laser Doppler flowmeter system,was used to detect alterations in plantar microcirculation before and 1 mo after surgery.Wound healing and hemodynamic indices were compared between the two groups.RESULTS The wound healing time of the diabetic foot was significantly shorter in the nonarterial stenosis group than in the arterial stenosis group(47.8±13 vs 85.8±26,P<0.05),and the wound healing rate of both groups was 100%.The preoperative total lower extremity arteriopathy scores were lower in the nonarterial stenosis group than those in the arterial stenosis group(18.89±8.87 vs 24.63±3.52,P<0.05).The nonarterial stenosis group showed higher preoperative popliteal artery(POA)blood flow than the arterial stenosis group(204.89±80.76 cc/min vs 76.75±48.49 cc/min,P<0.05).Compared with the baseline(before surgery),the postoperative POA blood flow of the affected limb in the nonarterial stenosis group decreased one month after surgery(134.11±47.84 cc/min vs 204.89±80.76 cc/min,P<0.05),while that in the arterial stenosis group increased(98.44±30.73 cc/min vs 61.69±21.70 cc/min,P<0.05).Although the POA blood flow in the arterial stenosis group was obviously improved one month after surgery,it was still lower than that in the nonarterial stenosis group(98.44±30.73 cc/min vs 134.11±47.84 cc/min,P<0.05).The nonarterial stenosis group had higher preoperative plantar microcirculation than the arterial stenosis group(56.1±9.2 vs 33.2±7.5,P<0.05);compared with the baseline,the plantar microcirculation in the arterial stenosis group was significantly improved one month after surgery(51.9±7.2,P<0.05),while that in the nonarterial stenosis group was reduced(35.9±7.2,P<0.05).CONCLUSION Based on preoperative HFCDU findings,diabetic foot patients can be divided into two categories:Those with nonarterial stenosis and those with arterial stenosis,with obvious differences in hemodynamic changes in the early postoperative period between them.In the early stage after TTT,the blood flow volume and velocity and the plantar microcirculation perfusion of the affected limb of the diabetic foot with nonarterial stenosis decreased compared with the baseline,while those of the diabetic foot with arterial stenosis improved significantly compared with the baseline,although both had smoothly healed diabetic foot ulcers.展开更多
Liver cancer is the fifth most common tumor and the second highest death-related cancer in the world.Hepatocarcinoma(HCC)represents 90%of liver cancers.According to the Barcelona Clinic Liver Cancer group,different tr...Liver cancer is the fifth most common tumor and the second highest death-related cancer in the world.Hepatocarcinoma(HCC)represents 90%of liver cancers.According to the Barcelona Clinic Liver Cancer group,different treatment options could be offered to patients in consideration of tumor burden,liver function,pa-tient performance status and biochemical marker serum concentration such as alpha-fetoprotein.Trans-arterial chemoembolization(TACE)is the treatment of choice in patients with diagnosis of unresectable HCC not eligible for liver trans-plantation,and preserved arterial supply.TACE is known to be safe and its com-plications are generally mild such as post-TACE syndrome,a self-resolving adverse event that occurs in about 90%of patients after the procedure.However,albeit rarely,more severe adverse events such as biloma,sepsis,hepatic failure,chemoagents induced toxicities,and post-TACE liver necrosis can occur.A prompt diagnosis of these clinical conditions is fundamental to prevent further complications.As a result,biliary stenosis could be a rare post-TACE necrosis complication and can be difficult to manage.Complications from untreated biliary strictures include recurring infections,jaundice,chronic cholestasis,and secon-dary biliary cirrhosis.展开更多
BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantag...BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery sten-ting(CAS).CASE SUMMARY Case 1:A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke.Physical examination showed decreased strength(5-/5)in both lower limbs.Carotid artery ultrasound,magnetic resonance angiography,and computed tomography angiography(CTA)showed a right proximal internal carotid artery(ICA)stenosis(70%-99%),acute cerebral infarction,and severe right ICA stenosis,respectively.We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation.Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence.CTA six months postoperatively showed no significant increase in in-stent stenosis.Case 2:A 36-year-old man was admitted with a right common carotid artery(CCA)dissection detected by ultrasound.Physical examination showed no positive neurological signs.Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow(dissection or carotid web).IVUS-assisted DSA confirmed right CCA dissection.CAS was performed and intraoperative IVUS suggested a large residual false lumen.Post-stent balloon dilatation was performed reducing the false lumen.DSA three months postoperatively indicated good stent expansion with mild stenosis.CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively,dissection and stenosis morphology intraoperatively,and visualizing and confirming CAS postoperatively.展开更多
The structural behavior of the Xiaowan ultrahigh arch dam is primarily influenced by external loads and time-varying characteristics of dam concrete and foundation rock mass during long-term operation. According to ov...The structural behavior of the Xiaowan ultrahigh arch dam is primarily influenced by external loads and time-varying characteristics of dam concrete and foundation rock mass during long-term operation. According to overload testing with a geological model and the measured time series of installed perpendicular lines, the space and time evolution characteristics of the arch dam structure were analyzed, and its mechanical performance was evaluated. Subsequently, the deformation centroid of the deflective curve was suggested to indicate the magnitude and unique distribution rules for a typical dam section using the measured deformation values at multi-monitoring points. The ellipse equations of the critical ellipsoid for the centroid were derived from the historical measured time series. Hydrostatic and seasonal components were extracted from the measured deformation values with a traditional statistical model, and residuals were adopted as a grey component. A time-varying grey model was developed to accurately predict the evolution of the deformation behavior of the ultrahigh arch dam during future operation. In the developed model, constant coefficients were modified so as to be time-dependent functions, and the prediction accuracy was significantly improved through introduction of a forgetting factor. Finally, the critical threshold was estimated, and predicted ellipsoids were derived for the Xiaowan arch dam. The findings of this study can provide technical support for safety evaluation of the actual operation of ultrahigh arch dams and help to provide early warning of abnormal changes.展开更多
Osteopetrosis incidence is less than 1:200,000 births in most populations. It’s more common in consanguineous people as it’s unusual for two members of the same family. The incidence of Hypertrophic pyloric stenosis...Osteopetrosis incidence is less than 1:200,000 births in most populations. It’s more common in consanguineous people as it’s unusual for two members of the same family. The incidence of Hypertrophic pyloric stenosis is 1 in 300 - 900 newborns. Hypertrophic pyloric stenosis is due to hypertrophy of the smooth muscle of the pyloric sphincter. The classic age of occurrence is the first few months of life, and the classic presentation is non-bilious projectile vomiting after feeding. We report a rare association of osteopetrosis and pyloric stenosis in four siblings and osteopetrosis in three cousins. All four patients were operated on and followed by nephrology and metabolic departments for osteopetrosis and metabolic acidosis.展开更多
Background: The introduction of transcatheter aortic valve implantation (TAVI) for the treatment of severe aortic stenosis (SAS) has expanded the therapeutic possibilities for successfully managing SAS in cases with i...Background: The introduction of transcatheter aortic valve implantation (TAVI) for the treatment of severe aortic stenosis (SAS) has expanded the therapeutic possibilities for successfully managing SAS in cases with intermediate and high surgical risks. However, the complications and outcomes of new devices have not been studied enough. Hence, the purpose of this study is to evaluate the midterm results of the Core Valve and Evolute R self-expandable (SE) devices versus the Edwards SAPIEN balloon-expandable (BE) devices. Methods and Material: This was a quasi-experimental study conducted in Tehran, Iran, from May 2012 to June 2017. SAS patients who were not ideal candidates for surgery were randomly assigned to either SE or BE groups. For each patient, a questionnaire, including four sections comprised of Basic characteristics, echocardiographic, angiographic, and Computed Tomography (CT) scan data was filled. TAVI was followed by echocardiography a week later and after three months they were reevaluated by another questionnaire. Results: The total number of patients was 60. The mean ages of patients undergoing the procedure with SE or BE devices were 81.2 ± 8 and 79.8 ± 7, respectively. Mortality occurred in 20% of the patients (5 cases in the SE group and 7 cases in the BE);mortality causes were 66.6 % cardiac and 33% non-cardiac. Moderate to severe Paravalvular leakage in both groups did not differ significantly. The mortality rate was 5 (41.6%) in the SE group versus 7 (58.3%) in the BE group (P > 0.05). Conclusion: In conclusion, the BE group did not experience fewer paravalvular leaks in comparison with the SE. Morbidity and mortality between the BE and the SE groups did not differ significantly.展开更多
Piled embankments have many advantages that have been applied in high-speed railway construction engineering.However,the load transfer mechanism of piled embankments,such as soil arching and tension membranes,is still...Piled embankments have many advantages that have been applied in high-speed railway construction engineering.However,the load transfer mechanism of piled embankments,such as soil arching and tension membranes,is still unclear,especially under dynamic loads.To investigate the soil arching and tension membrane under dynamic train loads on high-speed railways,a large-scale piled embankment model test with X-shaped piles as vertical reinforcement was performed,in which twenty-eight earth pressure cells were installed in the piled embankment and an M-shaped wave was adopted to simulate the high-speed railway train load.The results show that dynamic soil arching only occurs when two bogies of a carriage pass by and disappears at other times.The dynamic soil arching and membrane effect are the most significant under the concrete base.The arching height,stress concentration ratio and pile-soil load sharing ratio have a minimal value at 25 Hz.The dynamic soil arching degrades severely at 25 Hz,whose height at 25 Hz is only 0.35 times that at 5 Hz.The arching height fluctuates over a narrow range with increasing loading amplitude.The stress concentration ratio and the pile-soil load sharing ratio increase monotonically as the loading amplitude increases.展开更多
文摘2019年发表的全球ARCHES试验(NCT02677896)结果显示,与安慰剂(placebo,PBO)+雄激素剥夺治疗(androgen deprivation therapy,ADT)相比,恩扎卢胺+ADT延长了转移性激素敏感性前列腺癌(metastatic hormone-sensitive prostate cancer,mHSPC)患者的总生存期和放射影像学无进展生存期(radiographic progression-free survival,rPFS)^([1])。然而,该试验无中国患者入组。欧洲肿瘤内科学会(European Society for Medical Oncology,ESMO)2023年会议报道了中国ARCHES研究(NCT04076059)的初步结果,这是一项评估恩扎卢胺+ADTvs.PBO+ADT在中国m HSPC患者中的疗效和安全性的多中心、随机、双盲、PBO对照的Ⅲ期试验^([2])。
基金supported by CAMS Innovation Fund for Medical Sciences(CIFMS)(2022–12M-C&TB-043).
文摘BACKGROUND The recently introduced ultrasonic flow ratio(UFR),is a novel fast computational method to derive fractional flow reserve(FFR)from intravascular ultrasound(IVUS)images.In the present study,we evaluate the diagnostic performance of UFR in patients with intermediate left main(LM)stenosis.METHODS This is a prospective,single center study enrolling consecutive patients with presence of intermediated LM lesions(diameter stenosis of 30%-80%by visual estimation)underwent IVUS and FFR measurement.An independent core laboratory assessed offline UFR and IVUS-derived minimal lumen area(MLA)in a blinded fashion.RESULTS Both UFR and FFR were successfully achieved in 41 LM patients(mean age,62.0±9.9 years,46.3%diabetes).An acceptable correlation between UFR and FFR was identified(r=0.688,P<0.0001),with an absolute numerical difference of 0.03(standard difference:0.01).The area under the curve(AUC)in diagnosis of physiologically significant coronary stenosis for UFR was 0.94(95%CI:0.87-1.01),which was significantly higher than angiographic identified stenosis>50%(AUC=0.66,P<0.001)and numerically higher than IVUS-derived MLA(AUC=0.82;P=0.09).Patient level diagnostic accuracy,sensitivity and specificity for UFR to identify FFR≤0.80 was 82.9%(95%CI:70.2-95.7),93.1%(95%CI:82.2-100.0),58.3%(95%CI:26.3-90.4),respectively.CONCLUSION In patients with intermediate LM diseases,UFR was proved to be associated with acceptable correlation and high accuracy with pressure wire-based FFR as standard reference.The present study supports the use of UFR for functional evaluation of intermediate LM stenosis.
基金Supported by the National Natural Science Foundation of China,No.82305380The Postdoctoral Research Program,West China Hospital,Sichuan University,No.2020HXBH018.
文摘BACKGROUND Ultrasound guide technology,which can provide real-time visualization of the needle tip and tissues and avoid many adverse events,is widely used in mini-mally invasive therapy.However,the studies on ultrasound-guided Lateral recess block(LRB)are limited,this is probably because there is no recognized standard method for ultrasound scanning.This study aimed to evaluate the effect of ultrasound-guided LRB in patients with lateral recess stenosis(LRS).CASE SUMMARY A 65-year-old patient complained of low back pain accompanied occasionally by pain and numbness in the left lower limb.Physical examination showed ten-derness on the spinous process and paraspinal muscles from L1 to S1,extensor hallucis longus and tibialis anterior weakness(muscle strength:4-),and a positive straight leg raising test in the left lower limb(60°).Magnetic resonance imaging showed L4–L5 disc degeneration with left LRS and nerve root entrapment.Subsequently,the patient was diagnosed with LRS.This patient was treated with a novel ultrasound-guided LRB approach.The patient’s symptoms significantly improved without any complications at 1 wk postoperatively and at the 3-month follow-up.CONCLUSION This is the first report on the LRS treatment with ultrasound-guided LRB from the contralateral spinous process along the inner side of the articular process by out-plane technique.Further studies are expected to investigate the efficacy and safety of ultrasound-guided LRB for patients with LRS.
文摘Introduction: Endoscopic internal urethrotomy (EIU) is a method for stricture opening using transurethral incision by direct visualisation of the urethral channel, resulting in a widening of the urinary canal with the aim of improving the quality of bladder emptying. The aim of the study was to evaluate the indication and results of EIU in the treatment of stenosis of the male urethra in the Urology-Andrology Department of Kara Teaching Hospital. Methodology: This was a cross-sectional descriptive study with retrospective data collection in the Urology-Andrology department of Kara Teaching Hospital. It involved 21 records of patients with urethral stenosis treated by endoscopic internal urethrotomy (EIU) in the said department during the period from January 2021 to September 2023. The following variables were evaluated: age, circumstance of discovery, site, length, number, etiology of the urethral stenosis and evolution of the patients. Results: The mean age of the patients was 59.2 ± 11.7 years. Infectious etiology of stenosis was predominant with 10 patients (47.6%) followed by trauma with 5 cases (23.8%). The bulbar urethra was the most frequently observed site, with 11 cases (52.4%). The length was mostly less than 2 cm in 12 patients (57.1%). Stenosis was unique in 14 patients (66.7%). The mean postoperative follow-up time was 3.2 months. The result was immediately better in 11 patients (52.4%) and it was poor in 8 patients (38.1%) who required maintenance dilation sessions.
文摘BACKGROUND At present,there is no unified and effective treatment for extreme corrosive esophageal stenosis(CES)with esophagotracheal fistula(ETF).This case had extreme and severe esophageal stenosis(ES)and ETF after ingesting an enzyme-based chemical detergent,resulting in a serious pulmonary infection and severe malnutrition.Upper gastrointestinal imaging showed that he had an ETF,and endoscopy showed that he had extreme and severe esophageal stricture.This case was complex and difficult to treat.According to the domestic and foreign lite-rature,there is no universal treatment that is low-risk.CASE SUMMARY A patient came to our hospital with extreme ES,an ETF,and severe malnutrition complicated with pulmonary tuberculosis 1 mo after the consumption of an enzy-me-based detergent.The ES was serious,and the endoscope was unable to pass through the esophagus.We treated him by endoscopic incision method(EIM),esophageal stent placement(ESP),and endoscopic balloon dilation(EBD)by using the bronchoscope and gastroscope.This treatment not only closed the ETF,but also expanded the esophagus,with minimal trauma,greatly reducing the pain of the patient.According to the literature,there are no similar reported cases.CONCLUSION We report,for the first time,a patient with extreme CES complicated with ETF,where the endoscope could not be passed through his esophagus but he could be examined by bronchoscopy and treated by EIM,ESP,and EBD.
文摘Persistent fifth aortic arch (PFAA) is a rare congenital cardiovascular malformation that occurs when the pharyngeal fifth aortic arch does not degenerate during the embryonic period. The first case of PFAA was described in an autopsy specimen in 1969.[1] In 1973, the persistence of a left fifth aortic arch was first reported.[2] Since then, several case reports have described PFAA in different forms. PFAA stenosis associated with type A interruption of the aortic arch (type-A IAA) is most common in clinical practice and requires surgical intervention. From 2013 to 2018, six cases [Table 1 and Table 2] were diagnosed using echocardiography and computed tomography angiography (CTA). Five cases were successfully treated with surgery and followed-up. The purpose of this study was to summarize the clinical characteristics and diagnostic features of PFAA stenosis associated with type-A IAA to improve its diagnostic accuracy and allow for complete pre-operative preparation and proper treatment.
基金supported by the National Natural Science Foundation of China (Nos. 42277174, 42077267, and 52074164)the Natural Science Foundation of Shandong Province, China (No. ZR2020JQ23)+2 种基金Major Scientific and Technological Innovation Project of Shandong Province, China (No. 2019SDZY04)the Project of Shandong Province Higher Educational Youth Innovation Science and Technology Program, China (No. 2019KJG013)the opening project of State Key Laboratory of Explosion Science and Technology, Beijing Institute of Technology (No. KFJJ21-02Z)。
文摘Deep underground projects(e.g., coal mines), are often faced with complex conditions such as high stress and extremely soft rock. The strength and rigidity of the traditional support system are often insufficient,which makes it difficult to meet the requirements of ground control under complex conditions. As a new support form with high strength and rigidity, the confined concrete arch plays an important role in controlling the rock deformation under complex conditions. The section shape of the tunnel has an important impact on the mechanical properties and design of the support system. However, studies on the mechanical properties and influence mechanism of the new confined concrete arch are rarely reported. To this end, the mechanical properties of traditional U-shaped steel and new confined concrete arches are compared and comparative tests on arches of circular and straight-leg semicircular shapes in deep tunnels are conducted. A large mechanical testing system for underground engineering support structure is developed. The mechanical properties and influence mechanism of confined concrete arches with different section shapes under different loading modes and cross-section parameters are systematically studied. Test results show that the bearing capacity of the confined concrete arch is 2.10 times that of the U-shaped steel arch, and the bearing capacity of the circular confined concrete arch is 2.27 times that of the straight-leg semicircular arch. Among the various influencing factors and their engineering parameters,the lateral stress coefficient has the greatest impact on the bearing capacity of the confined concrete arch,followed by the steel pipe wall thickness, steel strength, and core concrete strength. Subsequently, the economic index of bearing capacity and cost is established, and the optimization design method for the confined concrete arch is proposed. Finally, this design method is applied to a high-stress tunnel under complex conditions, and the deformation of the surrounding rock is effectively controlled.
基金supported by the Elite Scholar Program of Northwest A&F University (Grant No.Z111022001)the Research Fund of Department of Transport of Shannxi Province (Grant No.22-23K)the Student Innovation and Entrepreneurship Training Program of China (Project Nos.S202110712555 and S202110712534).
文摘A huge number of old arch bridges located in rural regions are at the peak of maintenance.The health monitoring technology of the long-span bridge is hardly applicable to the small-span bridge,owing to the absence of technical resources and sufficient funds in rural regions.There is an urgent need for an economical,fast,and accurate damage identification solution.The authors proposed a damage identification system of an old arch bridge implemented with amachine learning algorithm,which took the vehicle-induced response as the excitation.A damage index was defined based on wavelet packet theory,and a machine learning sample database collecting the denoised response was constructed.Through comparing three machine learning algorithms:Back-Propagation Neural Network(BPNN),Support Vector Machine(SVM),and Random Forest(R.F.),the R.F.damage identification model were found to have a better recognition ability.Finally,the Particle Swarm Optimization(PSO)algorithm was used to optimize the number of subtrees and split features of the R.F.model.The PSO optimized R.F.model was capable of the identification of different damage levels of old arch bridges with sensitive damage index.The proposed framework is practical and promising for the old bridge’s structural damage identification in rural regions.
文摘Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical treatment is always challenging. Here we report a minimally invasive and endovascular management of these two pathologies in a 89-year-old man with LAD-stented ischemic cardiomyopathy. We describe our initial therapeutic strategy, per procedure difficulties and final management of this challenging case. Finally, we discuss the different therapeutic options for the endovascular treatment of aortic arch aneurysm associated with aortic valve stenosis.
文摘BACKGROUND With the introduction of transcatheter aortic valve replacement and an evolving understanding of the natural progression and history of aortic stenosis,the potential for earlier intervention in appropriate patients is promising;however,the benefit of aortic valve replacement in moderate aortic stenosis remains unclear.METHODS Pubmed,Embase,and the Cochrane Library databases were searched up until 30th of December 2021 using keywords including moderate aortic stenosis and aortic valve replacement.Studies reporting all-cause mortality and outcomes in early aortic valve replacement(AVR)compared to conservative management in patients with moderate aortic stenosis were included.Hazard ratios were generated using random-effects meta-analysis to determine effect estimates.RESULTS 3470 publications were screened with title and abstract review,which left 169 articles for full-text review.Of these studies,7 met inclusion criteria and were included,totalling 4,827 patients.All studies treated AVR as a time-dependent co-variable in cox-regression multivariate analysis of all-cause mortality.Intervention with surgical or transcatheter AVR was associated with a 45% decreased risk of all-cause mortality(HR=0.55[0.42-0.68],I2=51.5%,P<0.001).All studies were representative of the overall cohort with appropriate sample sizes,with no evidence of publication,detection,or information biases in any of the studies.CONCLUSION In this systematic review and meta-analysis,we report a 45% reduction in all-cause mortality in patients with moderate aortic stenosis who were treated with early aortic valve replacement compared to a strategy of conservative management.Randomised control trials are awaited to determine the utility of AVR in moderate aortic stenosis.
文摘Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of pCO<sub>2</sub> and BE in infants suspected to have IHPS. Methods: We collected data from 80 “surgical” infants younger than 100 days with prolonged nonbilious vomiting who were suspected to have IHPS. In 65 infants, pyloric stenosis was confirmed, and 15 infants had nonsurgical conditions. Capillary blood was tested for standard acid-base parameters and lactate. The two groups were compared. Results: Eighty-eight percent of the IHPS infants had elevated standard bicarbonate levels (st bicarb) > 25 mmol/l, and 60% had BE > 3.5 mmol/l;12% of the infants showed hypercapnia (pCO<sub>2</sub> ≥ 50 mmHg) associated with markedly increased standard bicarbonate and BE. Infants with nonsurgical vomiting were older at admission (p = 0.002), had a longer duration of vomiting (p < 0.001), were older (p = 0.002) and weighted more at admission (p = 0.004), had lower pCO<sub>2</sub> (p = 0.021), lower st bicarb (p < 0.001) and lower BE (p = 0.001). In addition, nonsurgical infants showed a trend to anemia (p = 0.002). Conclusions: In infants with IHPS/nonbilious vomiting, acid-base analysis (ABA) is equivocal or inconclusive. These findings may be misleading and could result in a false clinical decision. Nonsurgical vomiting is associated with a lower degree of alkalosis, normocapnia to slight hypercapnia and a base deficit. However, even infants with IHPS may present with a negative BE. In infants with IHPS and severe alkalosis, hypercapnia carries a risk for respiratory depression. Monitoring the infant’s respiration allows for the early detection of respiratory deterioration.
基金the Institutional Foundation of The First Affiliated Hospital of Xi’an Jiaotong University,No.2022MS-07the Key Research&Development Program-Social Development of Shaanxi Province of China,No.2023-YBSF-247.
文摘BACKGROUND Although endoscope-assisted magnetic compression anastomosis has already been reported for colonic anastomosis,there is no report on a single-approach operation using the natural orifice.AIM To design a deformable self-assembled magnetic anastomosis ring(DSAMAR)for colonic anastomosis for use in single-approach operation and evaluate its feasibility and safety through animal experiments.METHODS The animal model for colonic stenosis was prepared by partial colonic ligation in eight beagles.The magnetic compression anastomosis of their colonic stricture was performed by endoscopically assisted transanal implantation of the DSAMAR.The anastomotic specimen,obtained 2 wk after the operation,was observed by both the naked eye and a light microscope.RESULTS The DSAMAR was successfully inserted into the proximal end of colon stenosis through the anus.The DSAMAR of seven dogs was successfully transformed into rings,while that of the remaining dog was removed after the first deformation failed.The rings were successfully retransformed after optimization.All animals underwent colonic anastomosis using the DSAMAR.No device-related or procedure-related adverse events were observed.The colostomy specimens of the experimental dogs were obtained 2 wk after the operation.Both gross and histological observations showed good anastomotic healing.CONCLUSION The DSAMAR is a safe and feasible option for the treatment of colon stenosis.Its specific deformation and selfassembly capability maximize the applicability of the minimally invasive treatment.
基金the General Project of Hubei Provincial Department of Health,No.WJ2021M139.the People's Hospital of Wuhan University(Approval No.WDRY2022-K200).
文摘BACKGROUND The diagnosis of peripheral arteriopathy in the diabetic foot is complicated by diabetes and its advanced complications.It has been found that diabetic foot can be categorized into arterial stenosis and non-arterial stenosis,both of which have significant differences in hemodynamic characteristics.AIM To evaluate the early hemodynamic changes in diabetic foot patients with nonarterial stenosis and arterial stenosis treated by tibial transverse transport(TTT)using high-frequency color Doppler ultrasonography(HFCDU)and a laser Doppler flowmeter.METHODS Twenty-five patients with Wagner grades 3-5 diabetic foot ulcers were treated with TTT,and the wound healing time and rate were recorded.Patients were grouped according to the results of preoperative lower-extremity ultrasonography.Cases with≥50%stenosis in any of the femoral,popliteal,posterior tibial,anterior tibial,and peroneal arteries of the affected limb were classified as the arterial stenosis group(n=16);otherwise,they were classified as the nonarterial stenosis group(n=9).Before and one month after surgery,HFCDU was used to evaluate the degree of lower limb artery lesions and hemodynamic changes in patients.The degree of femoral-popliteal atherosclerotic stenosis,the degree of vascular stenosis and occlusion of the lower-knee outflow tract,and the degree of medial arterial calcification were scored;the three scores were added together to obtain the total score of lower extremity arteriopathy.PeriScanPIM3,a laser Doppler flowmeter system,was used to detect alterations in plantar microcirculation before and 1 mo after surgery.Wound healing and hemodynamic indices were compared between the two groups.RESULTS The wound healing time of the diabetic foot was significantly shorter in the nonarterial stenosis group than in the arterial stenosis group(47.8±13 vs 85.8±26,P<0.05),and the wound healing rate of both groups was 100%.The preoperative total lower extremity arteriopathy scores were lower in the nonarterial stenosis group than those in the arterial stenosis group(18.89±8.87 vs 24.63±3.52,P<0.05).The nonarterial stenosis group showed higher preoperative popliteal artery(POA)blood flow than the arterial stenosis group(204.89±80.76 cc/min vs 76.75±48.49 cc/min,P<0.05).Compared with the baseline(before surgery),the postoperative POA blood flow of the affected limb in the nonarterial stenosis group decreased one month after surgery(134.11±47.84 cc/min vs 204.89±80.76 cc/min,P<0.05),while that in the arterial stenosis group increased(98.44±30.73 cc/min vs 61.69±21.70 cc/min,P<0.05).Although the POA blood flow in the arterial stenosis group was obviously improved one month after surgery,it was still lower than that in the nonarterial stenosis group(98.44±30.73 cc/min vs 134.11±47.84 cc/min,P<0.05).The nonarterial stenosis group had higher preoperative plantar microcirculation than the arterial stenosis group(56.1±9.2 vs 33.2±7.5,P<0.05);compared with the baseline,the plantar microcirculation in the arterial stenosis group was significantly improved one month after surgery(51.9±7.2,P<0.05),while that in the nonarterial stenosis group was reduced(35.9±7.2,P<0.05).CONCLUSION Based on preoperative HFCDU findings,diabetic foot patients can be divided into two categories:Those with nonarterial stenosis and those with arterial stenosis,with obvious differences in hemodynamic changes in the early postoperative period between them.In the early stage after TTT,the blood flow volume and velocity and the plantar microcirculation perfusion of the affected limb of the diabetic foot with nonarterial stenosis decreased compared with the baseline,while those of the diabetic foot with arterial stenosis improved significantly compared with the baseline,although both had smoothly healed diabetic foot ulcers.
文摘Liver cancer is the fifth most common tumor and the second highest death-related cancer in the world.Hepatocarcinoma(HCC)represents 90%of liver cancers.According to the Barcelona Clinic Liver Cancer group,different treatment options could be offered to patients in consideration of tumor burden,liver function,pa-tient performance status and biochemical marker serum concentration such as alpha-fetoprotein.Trans-arterial chemoembolization(TACE)is the treatment of choice in patients with diagnosis of unresectable HCC not eligible for liver trans-plantation,and preserved arterial supply.TACE is known to be safe and its com-plications are generally mild such as post-TACE syndrome,a self-resolving adverse event that occurs in about 90%of patients after the procedure.However,albeit rarely,more severe adverse events such as biloma,sepsis,hepatic failure,chemoagents induced toxicities,and post-TACE liver necrosis can occur.A prompt diagnosis of these clinical conditions is fundamental to prevent further complications.As a result,biliary stenosis could be a rare post-TACE necrosis complication and can be difficult to manage.Complications from untreated biliary strictures include recurring infections,jaundice,chronic cholestasis,and secon-dary biliary cirrhosis.
基金Supported by Shenzhen Second People’s Hospital Clinical Research Fund of the Shenzhen High-level Hospital Construction Project,No.20223357021 and 20223357030and Research Project of Teaching Reform in Shenzhen Second People’s Hospital,No.202209.
文摘BACKGROUND Digital subtraction angiography(DSA),the gold standard of cerebrovascular disease diagnosis,is limited in its diagnostic ability to evaluate arterial diameter.Intravascular ultrasonography(IVUS)has advantages in assessing stenosis and plaque nature and improves the evaluation and effectiveness of carotid artery sten-ting(CAS).CASE SUMMARY Case 1:A 65-year-old man presented with a five-year history of bilateral lower limb weakness due to stroke.Physical examination showed decreased strength(5-/5)in both lower limbs.Carotid artery ultrasound,magnetic resonance angiography,and computed tomography angiography(CTA)showed a right proximal internal carotid artery(ICA)stenosis(70%-99%),acute cerebral infarction,and severe right ICA stenosis,respectively.We performed IVUS-assisted CAS to measure the stenosis and detected a low-risk plaque at the site of stenosis prior to stent implantation.Post-stent balloon dilatation was performed and postoperative IVUS demonstrated successful expansion and adherence.CTA six months postoperatively showed no significant increase in in-stent stenosis.Case 2:A 36-year-old man was admitted with a right common carotid artery(CCA)dissection detected by ultrasound.Physical examination showed no positive neurological signs.Carotid ultrasound and CTA showed lumen dilation in the proximal CCA with an intima-like structure and bulging in the proximal segment of the right CCA with strip-like low-density shadow(dissection or carotid web).IVUS-assisted DSA confirmed right CCA dissection.CAS was performed and intraoperative IVUS suggested a large residual false lumen.Post-stent balloon dilatation was performed reducing the false lumen.DSA three months postoperatively indicated good stent expansion with mild stenosis.CONCLUSION IVUS aids decision-making during CAS by accurately assessing carotid artery wall lesions and plaque nature preoperatively,dissection and stenosis morphology intraoperatively,and visualizing and confirming CAS postoperatively.
基金supported by the National Natural Science Foundation of China(Grant No.52079046)the Fundamental Research Funds for the Central Universities(Grant No.B210202017).
文摘The structural behavior of the Xiaowan ultrahigh arch dam is primarily influenced by external loads and time-varying characteristics of dam concrete and foundation rock mass during long-term operation. According to overload testing with a geological model and the measured time series of installed perpendicular lines, the space and time evolution characteristics of the arch dam structure were analyzed, and its mechanical performance was evaluated. Subsequently, the deformation centroid of the deflective curve was suggested to indicate the magnitude and unique distribution rules for a typical dam section using the measured deformation values at multi-monitoring points. The ellipse equations of the critical ellipsoid for the centroid were derived from the historical measured time series. Hydrostatic and seasonal components were extracted from the measured deformation values with a traditional statistical model, and residuals were adopted as a grey component. A time-varying grey model was developed to accurately predict the evolution of the deformation behavior of the ultrahigh arch dam during future operation. In the developed model, constant coefficients were modified so as to be time-dependent functions, and the prediction accuracy was significantly improved through introduction of a forgetting factor. Finally, the critical threshold was estimated, and predicted ellipsoids were derived for the Xiaowan arch dam. The findings of this study can provide technical support for safety evaluation of the actual operation of ultrahigh arch dams and help to provide early warning of abnormal changes.
文摘Osteopetrosis incidence is less than 1:200,000 births in most populations. It’s more common in consanguineous people as it’s unusual for two members of the same family. The incidence of Hypertrophic pyloric stenosis is 1 in 300 - 900 newborns. Hypertrophic pyloric stenosis is due to hypertrophy of the smooth muscle of the pyloric sphincter. The classic age of occurrence is the first few months of life, and the classic presentation is non-bilious projectile vomiting after feeding. We report a rare association of osteopetrosis and pyloric stenosis in four siblings and osteopetrosis in three cousins. All four patients were operated on and followed by nephrology and metabolic departments for osteopetrosis and metabolic acidosis.
文摘Background: The introduction of transcatheter aortic valve implantation (TAVI) for the treatment of severe aortic stenosis (SAS) has expanded the therapeutic possibilities for successfully managing SAS in cases with intermediate and high surgical risks. However, the complications and outcomes of new devices have not been studied enough. Hence, the purpose of this study is to evaluate the midterm results of the Core Valve and Evolute R self-expandable (SE) devices versus the Edwards SAPIEN balloon-expandable (BE) devices. Methods and Material: This was a quasi-experimental study conducted in Tehran, Iran, from May 2012 to June 2017. SAS patients who were not ideal candidates for surgery were randomly assigned to either SE or BE groups. For each patient, a questionnaire, including four sections comprised of Basic characteristics, echocardiographic, angiographic, and Computed Tomography (CT) scan data was filled. TAVI was followed by echocardiography a week later and after three months they were reevaluated by another questionnaire. Results: The total number of patients was 60. The mean ages of patients undergoing the procedure with SE or BE devices were 81.2 ± 8 and 79.8 ± 7, respectively. Mortality occurred in 20% of the patients (5 cases in the SE group and 7 cases in the BE);mortality causes were 66.6 % cardiac and 33% non-cardiac. Moderate to severe Paravalvular leakage in both groups did not differ significantly. The mortality rate was 5 (41.6%) in the SE group versus 7 (58.3%) in the BE group (P > 0.05). Conclusion: In conclusion, the BE group did not experience fewer paravalvular leaks in comparison with the SE. Morbidity and mortality between the BE and the SE groups did not differ significantly.
基金Natural Science Research Project of Anhui Educational Committee under Grant No.2022AH050844Anhui Provincial Natural Science Foundation of China under Grant No.2008085ME143+1 种基金the Doctoral Foundation of Anhui University of Science and Technology under Grant No.13190018Innovation and Entrepreneurship Training Program for College Students under Grant No.S202110361059。
文摘Piled embankments have many advantages that have been applied in high-speed railway construction engineering.However,the load transfer mechanism of piled embankments,such as soil arching and tension membranes,is still unclear,especially under dynamic loads.To investigate the soil arching and tension membrane under dynamic train loads on high-speed railways,a large-scale piled embankment model test with X-shaped piles as vertical reinforcement was performed,in which twenty-eight earth pressure cells were installed in the piled embankment and an M-shaped wave was adopted to simulate the high-speed railway train load.The results show that dynamic soil arching only occurs when two bogies of a carriage pass by and disappears at other times.The dynamic soil arching and membrane effect are the most significant under the concrete base.The arching height,stress concentration ratio and pile-soil load sharing ratio have a minimal value at 25 Hz.The dynamic soil arching degrades severely at 25 Hz,whose height at 25 Hz is only 0.35 times that at 5 Hz.The arching height fluctuates over a narrow range with increasing loading amplitude.The stress concentration ratio and the pile-soil load sharing ratio increase monotonically as the loading amplitude increases.
