Recent methodological advances in quantitative wood anatomy have provided new insights into the climatic responses of radial growth at the scale of cell structure of tree rings. This study considered long-term chronol...Recent methodological advances in quantitative wood anatomy have provided new insights into the climatic responses of radial growth at the scale of cell structure of tree rings. This study considered long-term chronologies of tracheid measurements, indexed by a novel approach to separate their specific climatic responses from signal recorded in cell production(closely reflected in tree-ring width). To fill gaps in understanding the impact of climate on conifer xylem structure, Scots pine(Pinus sylvestris L.)trees > 200 years old were selected within the forest-steppe zone in southern Siberia. Such habitats undergo mild moisture deficits and the resulting climatic regulation of growth processes. Mean and maximum values of cell radial diameter and cell wall thickness were recorded for each tree ring.Despite a low level of climatogenic stress, components of cell chronologies independent of cambial activity were separated to obtain significant climatic signals revealing the timing of the specific stages of tracheid differentiation. Cell expansion lasted from mid-April to July and was impacted similarly to tree-ring width(stimulated by precipitation and stressed by heat), maximum cell size formed late June. A switch in the climatic responses of mean anatomical traits indicated transition to latewood in mid-July. Secondary wall deposition lasted until mid-September, suppressed by end of season temperatures. Generally, anatomical climatic responses were modulated by a less dry May and September compared with summer months.展开更多
To provide practical and surgical anatomy for the imaging diagnosis and surgical treatment of the disease of the caudate lobe of the liver. Methods： Based on Chinese Visible Human 1-5 data sets and assisted by 3D vis...To provide practical and surgical anatomy for the imaging diagnosis and surgical treatment of the disease of the caudate lobe of the liver. Methods： Based on Chinese Visible Human 1-5 data sets and assisted by 3D visualization and reconstruction, the 3D models of the upper abdomen or the liver were reconstructed and the cross-sectional images were converted to the coronal and sagittal images. The anatomy of the caudate lobe of the liver on the coronal and sagittal planes was investigated on serial planes of the upper abdomen. Results： The caudate lobe was bordered on the left by the fissura ligamenti venosi, posteriorly by the IVC, superiorly by the hepatic veins and inferiorly by the hepatic hilum. Its right and ventral borders might be obscure, with only relative borders existent. The right wall of the IVC was a good landmark to judge the relative realm of paracaval portion, and the relative ventral plane might exist between the hepatic hilum and entrance of hepatic veins. The caudate lobe could be divided into two principal regions： the left Spiegel lobe and the right paracaval portion. The caudate process, and the right rear process occurring in some individuals belonged to the right paracaval portion. The caudate lobe was blood supplied by the portal vein, which directly drained into the IVC. Conclusion： There are not definite borders for the right part of the caudate lobe, and most of the knowledge on it is based on the cast study, which may not suit for the clinical diagnosis and practice. The coronal and sagittal sections can better show the anatomic relationships between the caudate lobe, the other parts of the liver and the adjacent structures. The 3D digital visualization is an accurate and convenient study method for clinical anatomy.展开更多
The Covid-19 pandemic launched the full use of online courses in Chinese medical schools.To evaluate the state of gross anatomy education in China during the pandemic,a nationwide survey was conducted through convenie...The Covid-19 pandemic launched the full use of online courses in Chinese medical schools.To evaluate the state of gross anatomy education in China during the pandemic,a nationwide survey was conducted through convenience sampling.Total 359 questionnaires were received.The first response from a given school was included to represent that school,thus 77 questionnaires were used for analyses.Schools represented were from all provinces in China's Mainland as well as Hong Kong and Macao.The survey found that before the pandemic,74.0%and 33.8%of the 77 schools conducted online theoretical and practical sessions of gross anatomy,respectively,36 schools had temporarily suspended practical sessions at the time the survey was performed. Body donation programs wereaffected with 26.0% and 27.3% of the 77 schools having suspended donation programs or saw a decreased numberof donations. During the pandemic, 40.3% of the 77 schools kept or initiated the implementation of activelearning, and online assessment was continued in 49.4% of the 77 schools. Another 26 schools initiated onlineassessment during the pandemic.展开更多
Fast Fourier Transfer Image Processing was widely applied to the analysis of wood anatomy structure in re-cent years. The cells in the wood transverse section have obviously periodicity and regularity. FFT power spect...Fast Fourier Transfer Image Processing was widely applied to the analysis of wood anatomy structure in re-cent years. The cells in the wood transverse section have obviously periodicity and regularity. FFT power spectral patternscan extract the periodic characteristics so that they can be compared. identified and classified quaytitatively. This paperSummarizes the application of FFT image analysis in wood science and the general way to study wood anatomy by FFT.展开更多
The fascial vessels of skin flap in leg were studied systematically and quantitatively so as to find out the survival mechanism of fasciocutaneous flap and provide morphological basis for clinical application. Methods...The fascial vessels of skin flap in leg were studied systematically and quantitatively so as to find out the survival mechanism of fasciocutaneous flap and provide morphological basis for clinical application. Methods: Thirteen legs from adultcadavers were observed and measured by dissection under operating and biological microscopes, tissue clearing, slice and imageanalysis. Results: There were four types of source artery in fascia of leg and the intermuscular septal cutaneous artery was predominant and often anstomosed as a chain. The source arteries had supra- and subfascial branches in deep fascia and the former wasmore in number and larger in diameter. In the same way, the vascular network was thicker in the suprafascial level than in the subfascial. Aa% of the deep fascia was larger than that of the superficial fascia. Conclusion: The deep fascial vasculature is the basis of the blood supply of fasciocutaneous flap in leg and the suprafascial vascular network is especially important. It is suggestedthat the fascial pedicle should be selected wilers the arterial chain exists.展开更多
Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients wit...Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients with severe symptomatic aortic stenosis.[1]This is due to its non-open-heart,minimally invasive and off-pump advantages.[1]Nevertheless,as a result of the frequent frailty and comorbidity profiles of patients undergoing TAVI,such as advanced cardiac dysfunction and extensive coronary artery disease,or technically difficult anatomy for the procedure itself,[2-4]it is common for these patients to experience critical circulatory collapse perioperatively.These factors are linked to elevated mortality rates,necessitating suitable mechanical circulatory support(MCS)to reverse the disastrous situations.[5]展开更多
Coronary angiography has long been the standard for coronary imaging,but it has limitations in assessing vessel wall anatomy and guiding percutaneous coronary intervention(PCI).Intracoronary imaging techniques like in...Coronary angiography has long been the standard for coronary imaging,but it has limitations in assessing vessel wall anatomy and guiding percutaneous coronary intervention(PCI).Intracoronary imaging techniques like intravascular ultrasound(IVUS)and optical coherence tomography(OCT)can overcome these limitations.IVUS uses ultrasound and OCT uses near-infrared light to visualize coronary pathology in unique ways due to differences in temporal and spatial resolution.These techniques have evolved to offer clinical utility in plaque characterization and vessel assessment during PCI.Meta-analyses and adjusted observational studies suggest that both IVUS and OCT-guided PCI correlate with reduced cardiovascular risks compared to angiographic guidance alone.While IVUS demonstrates consistent clinical outcome benefits,OCT evidence is less robust.IVUS has progressed from early motion detection to high-resolution systems,with smaller compatible catheters.OCT utilizes near infrared light to achieve unparalleled resolutions,but requires temporary blood clearance for optimal imaging.Enhanced visualization and guidance make IVUS and OCT well-suited for higher risk PCI in patients with diabetes and chronic kidney disease by allowing detailed visualization of complex lesions and ensuring optimal stent deployment and positioning in PCI for patients with type 2 diabetes and chronic kidney disease,improving outcomes.IVUS and recent advancements in zero-and low-contrast OCT techniques can reduce nephrotoxic contrast exposure,thus helping to minimize PCI complications in these high-risk patient groups.IVUS and OCT provide valuable insights into coronary pathophysiology and guide interventions precisely compared to angiography alone.Both have comparable clinical outcomes,emphasizing the need for tailored imaging choices based on clinical scenarios.Continued refinement and integration of intravascular imaging will likely play a pivotal role in optimizing coronary interventions and outcomes.This systematic review aims to delve into the nuances of IVUS and OCT,highlighting their strengths and limitations as PCI adjuncts.展开更多
Bipolar disorder is characterised by recurrent and alternating episodes of mania/hypomania and depression.Current breakthroughs in functional MRI techniques have uncovered the functional neuroanatomy of bipolar disord...Bipolar disorder is characterised by recurrent and alternating episodes of mania/hypomania and depression.Current breakthroughs in functional MRI techniques have uncovered the functional neuroanatomy of bipolar disorder.However,the pathophysiology underlying mood instability,mood switching and the development of extreme mood states is less well understood.This reviewpresents a comprehensive overviewof current evidence from functional MRI studies from the perspective of mood states.We first summarise the disrupted brain activation patterns and functional connectivity that have been reported in bipolar disorder,irrespective of the mood state.We next focus on research that solely included patients in a single mood state for a better understanding of the pathophysiology of bipolar disorder and research comparing patients with different mood states to dissect mood state-related effects.Finally,we briefly summarise current theoretical models and conclude this review by proposing potential avenues for future research.A comprehensive understanding of the pathophysiology with consideration of mood states could not only deepen our understanding of how acute mood episodes develop at a neurophysiological level but could also facilitate the identification of biological targets for personalised treatment and the development of new interventions for bipolar disorder.展开更多
Atmospheric pollution is an important concern in urban environments.The impact of urban pollution on the physiological,biochemical and anatomical properties of leaves of oriental plane(Platanus orientalis L.)was studi...Atmospheric pollution is an important concern in urban environments.The impact of urban pollution on the physiological,biochemical and anatomical properties of leaves of oriental plane(Platanus orientalis L.)was studied.The leaves were collected from an urban site(Tehran,Iran)and a non-urban forest park(Chitgar Forest Park).Anatomical(stomata,parenchyma,and cuticle)and physiological(chlorophyll content,enzyme activities)properties were analyzed.The concentrations of Cd(cadmium),Pb(lead),Ni(nickel),and Cr(chromium)in leaves were significantly higher and Zn(zinc)lower at the urban site relative to the forest park.Chlorophyll a,total chlorophyll,and carotenoid content in leaves of the urban site were significantly less than those of the forest park,but there was no significant difference in chlorophyll b.In addition,the activities of superoxide dismutase,catalase,ascorbate peroxidase,and guaiacol peroxidase in urban leaves were significantly higher than in the leaves of the forest park.In the urban area,leaves experienced a significant decrease in leaf surface area,stomata density,stomata pore area,epidermis,and spongy mesophyll thickness,but a significant increase in cuticle and palisade thicknesses relative to forest park leaves.The increase in enzyme activities may indicate that the trees are attempting to cope with increased reactive oxygen species(ROS)because of pollution-induced stress.Our study suggests that oriental plane trees alter their physiological and anatomical properties when living in a polluted urban environment.展开更多
Objective Recently it has been suggested that, in patients with large patent foramen ovale （PFO） and atrial septal aneurysms （ASA）, a certain amount of left atrial （LA） dysfunction may be active as an alternate ...Objective Recently it has been suggested that, in patients with large patent foramen ovale （PFO） and atrial septal aneurysms （ASA）, a certain amount of left atrial （LA） dysfunction may be active as an alternate mechanism promoting arterial embolism. Following this hypothesis, elderly patients, being more susceptible to atrial chambers stiffness, should present a more severe LA dysfunction profile. We sought to evaluate the grade of LA dysfunction in elderly patients submitted to transcatheter PFO closure. Methods We retrospectively enrolled 28 consecutive patients with previous stroke （mean age 674-12.5 years, 18 females） referred to our centre for catheter-based PFO closure after recurrent stroke. Baseline values of LA passive and active emptying, LA conduit function, LA ejection fraction, and spontaneous echocontrast （SEC） in the LA and LA appendage were compared with those of 50 atrial fibrillation patients, as well as a sex/age/cardiac risk matched population of 70 healthy controls. Results Pre-closure elderly subjects demonstrated significantly greater reservoir function as well as passive and active emptying, with reduced conduit function and LA ejection fraction, when compared to healthy and younger patients. After closure in elderly patients, LAparameters did not return completely to the levels of healthy patients, whereas LA dysfunction in younger subjects returned normal. Conclusions This study suggests that elderly patients have more severe LA dysfunction than younger patients, which affects the LA remodelling after closure.展开更多
Patent foramen ovale(PFO)is a remnant of normal fetal anatomy,which occurs in about 20%–25%of cases.Patients with PFO are at increased risk for migraine,acute limb ischemia secondary to emboli and cryptogenic(no othe...Patent foramen ovale(PFO)is a remnant of normal fetal anatomy,which occurs in about 20%–25%of cases.Patients with PFO are at increased risk for migraine,acute limb ischemia secondary to emboli and cryptogenic(no other identifiable cause)stroke.The traditional approach has been to use a fluoroscopically guided blocking device,but this is contraindicated in patients with severe allergies to contrast media or inability to undergo angiography.With the advancements in technology,ultrasonic robotic systems have become available for medical procedures.In the current study,we reported a case of using the ultrasonic robotic teleoperation system to achieve closure of PFO at the Chinese PLA General Hospital,Beijing,China.展开更多
BACKGROUND The high-degree atrioventricular block(HAVB)in patients with bicuspid aortic valve(BAV)treated with transcatheter aortic valve implantation(TAVI)remains high.The study aims to explore this poorly understood...BACKGROUND The high-degree atrioventricular block(HAVB)in patients with bicuspid aortic valve(BAV)treated with transcatheter aortic valve implantation(TAVI)remains high.The study aims to explore this poorly understood subject of mech-anisms and predictors for HAVB in BAV self-expandable TAVI patients.METHODS We retrospectively included 181 BAV patients for analysis.Using computed tomography data,the curvature of ascending aorta(AAo)was quantified by the angle(AAo angle)between annulus and the cross-section at 35 mm above annulus(where the stent interacts with AAo the most).The valvular anatomy and leaflet calcification were also characterized.RESULTS The 30-day HAVB rate was 16.0%(median time to HAVB was three days).Type-1 morphology was found in 79 pat-ients(43.6%)(left-and right-coronary cusps fusion comprised 79.7%).Besides implantation below membrane septum,large AAo angle[odds ratio(OR)=1.08,P=0.016]and type-1 morphology(OR=4.97,P=0.001)were found as the independent predictors for HAVB.Together with baseline right bundle branch block,these predictors showed strong predictability for HAVB with area under the cure of 0.84(sensitivity=62.1%,specificity=92.8%).Bent AAo and calcified raphe had a synergistic effect in facilita-ting high implantation,though the former is associated with at-risk deployment(device implanted above annulus+prothesis pop-out,versus straight AAo:9.9%vs.2.2%,P=0.031).CONCLUSIONS AAo curvature and type-1 morphology are novel predictors for HAVB in BAV patients following self-expandable TAVI.For patients with bent AAo or calcified raphe,a progressive approach to implant the device above the lower edge of membrane septum is favored,though should be done cautiously to avoid pop-out.展开更多
The prevalence of tricuspid regurgitation(TR)increases with age,affecting 65%-85%of adults.Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus(leaflets,chordae,papillary muscl...The prevalence of tricuspid regurgitation(TR)increases with age,affecting 65%-85%of adults.Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus(leaflets,chordae,papillary muscles,or annulus).Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle(RV)or right at-rium(RA)remodeling and increased RV pressures.Isolated TR is without increased RV pressures and is associated with atrial fibrillation.Mild TR is a benign disease.Moderate to severe tricuspid regurgitation has independently been associated with in-creased mortality.Most of these patients are treated medically due to poor outcomes with surgical repair of isolated TR.The in-hospital mortality rate is 8.8%,and the median length of stay in hospital is 11 days resulting in higher healthcare costs.Even if the patients undergo surgical repair or replacement,available data do not show improvement in survival.With a more detailed un-derstanding of the complex anatomy and physiology of the tricuspid valve and significant complications from untreated tricusp-id valve disease,the approach to the management of TR has shifted from a conservative approach to a process of prevention and intervention.In the past decade,transcatheter tricuspid valve interventions and tricuspid annuloplasty rings have been de-veloped,contributing to decreased mortality from surgical repair.Transcatheter tricuspid valve intervention techniques have im-proved survival,quality of life,and reduced heart failure rehospitalization.This review summarizes normal anatomy,types of TR,etiology and different mechanisms of TR,echocardiographic assessment of the severe TR,and highlights various percu-taneous transcatheter techniques for tricuspid valve repair.展开更多
In order to evaluate the accuracy of preoperative segmental localization of hepatic mass lesions,68 cases were prospectively studied and evaluated by the correlation of magnetic resonance imaging (MRI) and surgical fi...In order to evaluate the accuracy of preoperative segmental localization of hepatic mass lesions,68 cases were prospectively studied and evaluated by the correlation of magnetic resonance imaging (MRI) and surgical findings. Right, middle and left hepatic veins were seen in 100%, 97% and 94% of the subjects respectively on MRI. The right and left portal veins were seen in 100% and 95.6% respectively. The accuracy in determining the segmental location of hepatic lesions was 89.7%. The accuracy could be increased to 91. 3% if the lesion was located at single segment whereas it was only 86. 4% when the lesion extended across several segments. It is possible to say that MRI is an important modality in the preoperative segmental localization of masses.展开更多
1 Introduction Isolated atrial septal defects （ASD） represent 7% of all cardiac anomalies and can present at any age. Adolescents and adults with simple congenital heart disease such as isolated atrial septal defec...1 Introduction Isolated atrial septal defects （ASD） represent 7% of all cardiac anomalies and can present at any age. Adolescents and adults with simple congenital heart disease such as isolated atrial septal defects are more likely to reach adult age without being diagnosed. Secundum ASD （sASD） is by far the most common type, occurring in 1/1500 live births, with 65% to 75% involving females, On the other hand, patent foramen ovale （PFO） represents an endemic variant in the normal population with a prevalence of 25%-27%. These two entities appear so different that is difficult to fred a conjunction ring： nevertheless we use the same philosophy for the treatment, Indeed, device-based closure has been proved to be effective in both settings.展开更多
The pivotal role of four anatomical landmarks:inferior horn of thyroid cartilage,inferior thyroid artery(ITA),Berry's ligament(BL)and Zuckerkandl's tubercle(ZT)on recurrent laryngeal nerve(RLN)protection has r...The pivotal role of four anatomical landmarks:inferior horn of thyroid cartilage,inferior thyroid artery(ITA),Berry's ligament(BL)and Zuckerkandl's tubercle(ZT)on recurrent laryngeal nerve(RLN)protection has received more attention.In our study,anatomy of 14 specimens(28 sides in total)were dissected to investigate the relationship between RLN and these four landmarks.展开更多
基金supported by the Russian Science Foundation grant no. 23-44-00067the National Natural Science Foundation of China grant no.42261134537 in the framework of a joint Russian-Chinese project (fieldwork)by the Russian Ministry of Science and Higher Education,grant number FSRZ-2023-0007 (for data analysis)
文摘Recent methodological advances in quantitative wood anatomy have provided new insights into the climatic responses of radial growth at the scale of cell structure of tree rings. This study considered long-term chronologies of tracheid measurements, indexed by a novel approach to separate their specific climatic responses from signal recorded in cell production(closely reflected in tree-ring width). To fill gaps in understanding the impact of climate on conifer xylem structure, Scots pine(Pinus sylvestris L.)trees > 200 years old were selected within the forest-steppe zone in southern Siberia. Such habitats undergo mild moisture deficits and the resulting climatic regulation of growth processes. Mean and maximum values of cell radial diameter and cell wall thickness were recorded for each tree ring.Despite a low level of climatogenic stress, components of cell chronologies independent of cambial activity were separated to obtain significant climatic signals revealing the timing of the specific stages of tracheid differentiation. Cell expansion lasted from mid-April to July and was impacted similarly to tree-ring width(stimulated by precipitation and stressed by heat), maximum cell size formed late June. A switch in the climatic responses of mean anatomical traits indicated transition to latewood in mid-July. Secondary wall deposition lasted until mid-September, suppressed by end of season temperatures. Generally, anatomical climatic responses were modulated by a less dry May and September compared with summer months.
基金Supported by the National Natural Science Fund Aided Project (60473128)
文摘To provide practical and surgical anatomy for the imaging diagnosis and surgical treatment of the disease of the caudate lobe of the liver. Methods： Based on Chinese Visible Human 1-5 data sets and assisted by 3D visualization and reconstruction, the 3D models of the upper abdomen or the liver were reconstructed and the cross-sectional images were converted to the coronal and sagittal images. The anatomy of the caudate lobe of the liver on the coronal and sagittal planes was investigated on serial planes of the upper abdomen. Results： The caudate lobe was bordered on the left by the fissura ligamenti venosi, posteriorly by the IVC, superiorly by the hepatic veins and inferiorly by the hepatic hilum. Its right and ventral borders might be obscure, with only relative borders existent. The right wall of the IVC was a good landmark to judge the relative realm of paracaval portion, and the relative ventral plane might exist between the hepatic hilum and entrance of hepatic veins. The caudate lobe could be divided into two principal regions： the left Spiegel lobe and the right paracaval portion. The caudate process, and the right rear process occurring in some individuals belonged to the right paracaval portion. The caudate lobe was blood supplied by the portal vein, which directly drained into the IVC. Conclusion： There are not definite borders for the right part of the caudate lobe, and most of the knowledge on it is based on the cast study, which may not suit for the clinical diagnosis and practice. The coronal and sagittal sections can better show the anatomic relationships between the caudate lobe, the other parts of the liver and the adjacent structures. The 3D digital visualization is an accurate and convenient study method for clinical anatomy.
文摘The Covid-19 pandemic launched the full use of online courses in Chinese medical schools.To evaluate the state of gross anatomy education in China during the pandemic,a nationwide survey was conducted through convenience sampling.Total 359 questionnaires were received.The first response from a given school was included to represent that school,thus 77 questionnaires were used for analyses.Schools represented were from all provinces in China's Mainland as well as Hong Kong and Macao.The survey found that before the pandemic,74.0%and 33.8%of the 77 schools conducted online theoretical and practical sessions of gross anatomy,respectively,36 schools had temporarily suspended practical sessions at the time the survey was performed. Body donation programs wereaffected with 26.0% and 27.3% of the 77 schools having suspended donation programs or saw a decreased numberof donations. During the pandemic, 40.3% of the 77 schools kept or initiated the implementation of activelearning, and online assessment was continued in 49.4% of the 77 schools. Another 26 schools initiated onlineassessment during the pandemic.
文摘Fast Fourier Transfer Image Processing was widely applied to the analysis of wood anatomy structure in re-cent years. The cells in the wood transverse section have obviously periodicity and regularity. FFT power spectral patternscan extract the periodic characteristics so that they can be compared. identified and classified quaytitatively. This paperSummarizes the application of FFT image analysis in wood science and the general way to study wood anatomy by FFT.
文摘The fascial vessels of skin flap in leg were studied systematically and quantitatively so as to find out the survival mechanism of fasciocutaneous flap and provide morphological basis for clinical application. Methods: Thirteen legs from adultcadavers were observed and measured by dissection under operating and biological microscopes, tissue clearing, slice and imageanalysis. Results: There were four types of source artery in fascia of leg and the intermuscular septal cutaneous artery was predominant and often anstomosed as a chain. The source arteries had supra- and subfascial branches in deep fascia and the former wasmore in number and larger in diameter. In the same way, the vascular network was thicker in the suprafascial level than in the subfascial. Aa% of the deep fascia was larger than that of the superficial fascia. Conclusion: The deep fascial vasculature is the basis of the blood supply of fasciocutaneous flap in leg and the suprafascial vascular network is especially important. It is suggestedthat the fascial pedicle should be selected wilers the arterial chain exists.
基金supported by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support(ZYLX202111,to XTH)Beijing Hospitals Authority“Ascent Plan”(FDL20190601,to XTH)+2 种基金Young Elite Scientists Sponsorship Program by CAST(2022QNRC001,to LSW)National Natural Science Foundation of China(82200433,to LSW)Beijing Hospitals Authority Youth Programme(QML20230602,to LSW).
文摘Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients with severe symptomatic aortic stenosis.[1]This is due to its non-open-heart,minimally invasive and off-pump advantages.[1]Nevertheless,as a result of the frequent frailty and comorbidity profiles of patients undergoing TAVI,such as advanced cardiac dysfunction and extensive coronary artery disease,or technically difficult anatomy for the procedure itself,[2-4]it is common for these patients to experience critical circulatory collapse perioperatively.These factors are linked to elevated mortality rates,necessitating suitable mechanical circulatory support(MCS)to reverse the disastrous situations.[5]
文摘Coronary angiography has long been the standard for coronary imaging,but it has limitations in assessing vessel wall anatomy and guiding percutaneous coronary intervention(PCI).Intracoronary imaging techniques like intravascular ultrasound(IVUS)and optical coherence tomography(OCT)can overcome these limitations.IVUS uses ultrasound and OCT uses near-infrared light to visualize coronary pathology in unique ways due to differences in temporal and spatial resolution.These techniques have evolved to offer clinical utility in plaque characterization and vessel assessment during PCI.Meta-analyses and adjusted observational studies suggest that both IVUS and OCT-guided PCI correlate with reduced cardiovascular risks compared to angiographic guidance alone.While IVUS demonstrates consistent clinical outcome benefits,OCT evidence is less robust.IVUS has progressed from early motion detection to high-resolution systems,with smaller compatible catheters.OCT utilizes near infrared light to achieve unparalleled resolutions,but requires temporary blood clearance for optimal imaging.Enhanced visualization and guidance make IVUS and OCT well-suited for higher risk PCI in patients with diabetes and chronic kidney disease by allowing detailed visualization of complex lesions and ensuring optimal stent deployment and positioning in PCI for patients with type 2 diabetes and chronic kidney disease,improving outcomes.IVUS and recent advancements in zero-and low-contrast OCT techniques can reduce nephrotoxic contrast exposure,thus helping to minimize PCI complications in these high-risk patient groups.IVUS and OCT provide valuable insights into coronary pathophysiology and guide interventions precisely compared to angiography alone.Both have comparable clinical outcomes,emphasizing the need for tailored imaging choices based on clinical scenarios.Continued refinement and integration of intravascular imaging will likely play a pivotal role in optimizing coronary interventions and outcomes.This systematic review aims to delve into the nuances of IVUS and OCT,highlighting their strengths and limitations as PCI adjuncts.
基金the National Key Technology R&D Program(2015BA/13B01)Beijing National Science Foundation(7222236)+1 种基金Capital Health Research and Development of Special Fund(2022-1-4111)National Natural Science Foundation of China(82071528,82171529,82271569,82371530).
文摘Bipolar disorder is characterised by recurrent and alternating episodes of mania/hypomania and depression.Current breakthroughs in functional MRI techniques have uncovered the functional neuroanatomy of bipolar disorder.However,the pathophysiology underlying mood instability,mood switching and the development of extreme mood states is less well understood.This reviewpresents a comprehensive overviewof current evidence from functional MRI studies from the perspective of mood states.We first summarise the disrupted brain activation patterns and functional connectivity that have been reported in bipolar disorder,irrespective of the mood state.We next focus on research that solely included patients in a single mood state for a better understanding of the pathophysiology of bipolar disorder and research comparing patients with different mood states to dissect mood state-related effects.Finally,we briefly summarise current theoretical models and conclude this review by proposing potential avenues for future research.A comprehensive understanding of the pathophysiology with consideration of mood states could not only deepen our understanding of how acute mood episodes develop at a neurophysiological level but could also facilitate the identification of biological targets for personalised treatment and the development of new interventions for bipolar disorder.
文摘Atmospheric pollution is an important concern in urban environments.The impact of urban pollution on the physiological,biochemical and anatomical properties of leaves of oriental plane(Platanus orientalis L.)was studied.The leaves were collected from an urban site(Tehran,Iran)and a non-urban forest park(Chitgar Forest Park).Anatomical(stomata,parenchyma,and cuticle)and physiological(chlorophyll content,enzyme activities)properties were analyzed.The concentrations of Cd(cadmium),Pb(lead),Ni(nickel),and Cr(chromium)in leaves were significantly higher and Zn(zinc)lower at the urban site relative to the forest park.Chlorophyll a,total chlorophyll,and carotenoid content in leaves of the urban site were significantly less than those of the forest park,but there was no significant difference in chlorophyll b.In addition,the activities of superoxide dismutase,catalase,ascorbate peroxidase,and guaiacol peroxidase in urban leaves were significantly higher than in the leaves of the forest park.In the urban area,leaves experienced a significant decrease in leaf surface area,stomata density,stomata pore area,epidermis,and spongy mesophyll thickness,but a significant increase in cuticle and palisade thicknesses relative to forest park leaves.The increase in enzyme activities may indicate that the trees are attempting to cope with increased reactive oxygen species(ROS)because of pollution-induced stress.Our study suggests that oriental plane trees alter their physiological and anatomical properties when living in a polluted urban environment.
文摘Objective Recently it has been suggested that, in patients with large patent foramen ovale （PFO） and atrial septal aneurysms （ASA）, a certain amount of left atrial （LA） dysfunction may be active as an alternate mechanism promoting arterial embolism. Following this hypothesis, elderly patients, being more susceptible to atrial chambers stiffness, should present a more severe LA dysfunction profile. We sought to evaluate the grade of LA dysfunction in elderly patients submitted to transcatheter PFO closure. Methods We retrospectively enrolled 28 consecutive patients with previous stroke （mean age 674-12.5 years, 18 females） referred to our centre for catheter-based PFO closure after recurrent stroke. Baseline values of LA passive and active emptying, LA conduit function, LA ejection fraction, and spontaneous echocontrast （SEC） in the LA and LA appendage were compared with those of 50 atrial fibrillation patients, as well as a sex/age/cardiac risk matched population of 70 healthy controls. Results Pre-closure elderly subjects demonstrated significantly greater reservoir function as well as passive and active emptying, with reduced conduit function and LA ejection fraction, when compared to healthy and younger patients. After closure in elderly patients, LAparameters did not return completely to the levels of healthy patients, whereas LA dysfunction in younger subjects returned normal. Conclusions This study suggests that elderly patients have more severe LA dysfunction than younger patients, which affects the LA remodelling after closure.
基金the National Key Research and Development Program(2021YFC2501106)the Key Discipline Construction Project of Chinese PLA Medical College during the 13^(th) Five-Year Plan Period(A350109).
文摘Patent foramen ovale(PFO)is a remnant of normal fetal anatomy,which occurs in about 20%–25%of cases.Patients with PFO are at increased risk for migraine,acute limb ischemia secondary to emboli and cryptogenic(no other identifiable cause)stroke.The traditional approach has been to use a fluoroscopically guided blocking device,but this is contraindicated in patients with severe allergies to contrast media or inability to undergo angiography.With the advancements in technology,ultrasonic robotic systems have become available for medical procedures.In the current study,we reported a case of using the ultrasonic robotic teleoperation system to achieve closure of PFO at the Chinese PLA General Hospital,Beijing,China.
基金This study was supported by the National Natural Science Foundation of China(No.81970325&No.81900348&No.81901825)the Science and Technology Support Plan of Sichuan Province(2019YFS0299&2019YFS0433)。
文摘BACKGROUND The high-degree atrioventricular block(HAVB)in patients with bicuspid aortic valve(BAV)treated with transcatheter aortic valve implantation(TAVI)remains high.The study aims to explore this poorly understood subject of mech-anisms and predictors for HAVB in BAV self-expandable TAVI patients.METHODS We retrospectively included 181 BAV patients for analysis.Using computed tomography data,the curvature of ascending aorta(AAo)was quantified by the angle(AAo angle)between annulus and the cross-section at 35 mm above annulus(where the stent interacts with AAo the most).The valvular anatomy and leaflet calcification were also characterized.RESULTS The 30-day HAVB rate was 16.0%(median time to HAVB was three days).Type-1 morphology was found in 79 pat-ients(43.6%)(left-and right-coronary cusps fusion comprised 79.7%).Besides implantation below membrane septum,large AAo angle[odds ratio(OR)=1.08,P=0.016]and type-1 morphology(OR=4.97,P=0.001)were found as the independent predictors for HAVB.Together with baseline right bundle branch block,these predictors showed strong predictability for HAVB with area under the cure of 0.84(sensitivity=62.1%,specificity=92.8%).Bent AAo and calcified raphe had a synergistic effect in facilita-ting high implantation,though the former is associated with at-risk deployment(device implanted above annulus+prothesis pop-out,versus straight AAo:9.9%vs.2.2%,P=0.031).CONCLUSIONS AAo curvature and type-1 morphology are novel predictors for HAVB in BAV patients following self-expandable TAVI.For patients with bent AAo or calcified raphe,a progressive approach to implant the device above the lower edge of membrane septum is favored,though should be done cautiously to avoid pop-out.
文摘The prevalence of tricuspid regurgitation(TR)increases with age,affecting 65%-85%of adults.Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus(leaflets,chordae,papillary muscles,or annulus).Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle(RV)or right at-rium(RA)remodeling and increased RV pressures.Isolated TR is without increased RV pressures and is associated with atrial fibrillation.Mild TR is a benign disease.Moderate to severe tricuspid regurgitation has independently been associated with in-creased mortality.Most of these patients are treated medically due to poor outcomes with surgical repair of isolated TR.The in-hospital mortality rate is 8.8%,and the median length of stay in hospital is 11 days resulting in higher healthcare costs.Even if the patients undergo surgical repair or replacement,available data do not show improvement in survival.With a more detailed un-derstanding of the complex anatomy and physiology of the tricuspid valve and significant complications from untreated tricusp-id valve disease,the approach to the management of TR has shifted from a conservative approach to a process of prevention and intervention.In the past decade,transcatheter tricuspid valve interventions and tricuspid annuloplasty rings have been de-veloped,contributing to decreased mortality from surgical repair.Transcatheter tricuspid valve intervention techniques have im-proved survival,quality of life,and reduced heart failure rehospitalization.This review summarizes normal anatomy,types of TR,etiology and different mechanisms of TR,echocardiographic assessment of the severe TR,and highlights various percu-taneous transcatheter techniques for tricuspid valve repair.
文摘In order to evaluate the accuracy of preoperative segmental localization of hepatic mass lesions,68 cases were prospectively studied and evaluated by the correlation of magnetic resonance imaging (MRI) and surgical findings. Right, middle and left hepatic veins were seen in 100%, 97% and 94% of the subjects respectively on MRI. The right and left portal veins were seen in 100% and 95.6% respectively. The accuracy in determining the segmental location of hepatic lesions was 89.7%. The accuracy could be increased to 91. 3% if the lesion was located at single segment whereas it was only 86. 4% when the lesion extended across several segments. It is possible to say that MRI is an important modality in the preoperative segmental localization of masses.
文摘1 Introduction Isolated atrial septal defects （ASD） represent 7% of all cardiac anomalies and can present at any age. Adolescents and adults with simple congenital heart disease such as isolated atrial septal defects are more likely to reach adult age without being diagnosed. Secundum ASD （sASD） is by far the most common type, occurring in 1/1500 live births, with 65% to 75% involving females, On the other hand, patent foramen ovale （PFO） represents an endemic variant in the normal population with a prevalence of 25%-27%. These two entities appear so different that is difficult to fred a conjunction ring： nevertheless we use the same philosophy for the treatment, Indeed, device-based closure has been proved to be effective in both settings.
文摘The pivotal role of four anatomical landmarks:inferior horn of thyroid cartilage,inferior thyroid artery(ITA),Berry's ligament(BL)and Zuckerkandl's tubercle(ZT)on recurrent laryngeal nerve(RLN)protection has received more attention.In our study,anatomy of 14 specimens(28 sides in total)were dissected to investigate the relationship between RLN and these four landmarks.
