简介：ObjectivesToassesstheefficiencyandsafetyofdual-wireballoonangioplastysidebranchcombinedstentingthemainbranchinthetreatmentofcoronarybifurcationlesions.MethodsThisstudyincludedthirty-sixpatientswith41coronarybifurcationlesions.Selectivedual-wireballoonangioplastywasperformedinsidebranchand/orinmainbranch,andimplantationofstentswasperformedinmainbranchonly.Clinicaloutcomeandmajoradversecardiaceventswereobservedin-hospitalandfollow-up.ResultsSuccessrateofsidebranchdilatationbeforemainbranchstentingwas100%;mainbranchdirectstentingperformedin4cases;successmainbranchdilatationperformedintheother37cases;kissingtechniquewasperformedsuccessfullyin5cases,whichsidebranchwasjailedaftermainbranchstentingwithTIMIgrade0-2flow.NoQ-wavemyocardialinfarction,acuterevascularizationanddeathoccurredduringin-hospital.Clinicalfollow-upwasavailableinallpatients.NoQ-wavemyocardialinfarction,revascularizationanddeathoccurred,anginapectorisrecurredinthreepatients,releasedbystrengthendrugtreatment.ConclusionsDual-wireballoonangioplastysidebranchcombinedstentingthemainbranchissimple,safeandeffectiveforthetreatmentofcoronarybifurcationlesions.

简介：AbstractBackground:Treatment of coronary bifurcation lesions remains challenging; a simple strategy has been preferred as of late, but the disadvantage is ostium stenosis or even occlusion of the side branch (SB). Only a few single-center studies investigating the combination of a drug-eluting stent in the main branch followed by a drug-eluting balloon in the SB have been reported. This prospective, multicenter, randomized study aimed to investigate the safety and efficacy of a paclitaxel-eluting balloon (PEB) compared with regular balloon angioplasty (BA) in the treatment of non-left main coronary artery bifurcation lesions.Methods:Between December 2014 and November 2015, a total of 222 consecutive patients with bifurcation lesions were enrolled in this study at ten Chinese centers. Patients were randomly allocated at a 1:1 ratio to a PEB group (n = 113) and a BA group (n = 109). The primary efficacy endpoint was angiographic target lesion stenosis at 9 months. Secondary efficacy and safety endpoints included target lesion revascularization, target vessel revascularization, target lesion failure, major adverse cardiac and cerebral events (MACCEs), all-cause death, cardiac death, non-fatal myocardial infarction, and thrombosis in target lesions. The main analyses performed in this clinical trial included case shedding analysis, base-value equilibrium analysis, effectiveness analysis, and safety analysis. SAS version 9.4 was used for the statistical analyses.Results:At the 9-month angiographic follow-up, the difference in the primary efficacy endpoint of target lesion stenosis between the PEB (28.7% ± 18.7%) and BA groups (40.0% ± 19.0%) was -11.3% (95% confidence interval: -16.3% to -6.3%, Psuperiority <0.0001) in the intention-to-treat analysis, and similar results were recorded in the per-protocol analysis, demonstrating the superiority of PEB to BA. Late lumen loss was significantly lower in the PEB group than in the BA group (-0.06 ± 0.32 vs. 0.18 ± 0.34 mm, P < 0.0001). For intention-to-treat, there were no significant differences between PEB and BA in the 9-month percentages of MACCEs (0.9% vs. 3.7%, P = 0.16) or non-fatal myocardial infarctions (0 vs. 0.9%, P = 0.49). There were no clinical events of target lesion revascularization, target vessel revascularization, target lesion failure, all-cause death, cardiac death or target lesion thrombosis in either group.Conclusions:In de novo non-left main coronary artery bifurcations treated with provisional T stenting, SB dilation with the PEB group demonstrated better angiographic results than treatment with regular BA at the 9-month follow-up in terms of reduced target lesion stenosis.Trial registration:ClinicalTrials.gov, NCT02325817; https://clinicaltrials.gov

简介：AbstractBackground:Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization. Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a comprehensive system to evaluate the complexity of the overall lesions. We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease (CAD).Methods:In this single-center, historical control study, patients with stable CAD with coronary lesion stenosis ≥50% were consecutively recruited. During the control period, SYNTAX scores were calculated by treating cardiologists. During the intervention period, SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making. The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.Results:A total of 3245 patients were enrolled and assigned to the control group (08/2016-03/2017, n = 1525) or the intervention group (03/2017-09/2017, n= 1720). For SYNTAX score tertiles, 17.9% patients were overestimated and 4.3% were underestimated by cardiologists in the control group. After adjustment, inappropriate revascularization significantly decreased in the intervention group compared with the control group (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.73-0.95; P = 0.007). Both inappropriate percutaneous coronary intervention (adjusted OR: 0.82; 95% CI: 0.74-0.92; P < 0.001) and percutaneous coronary intervention utilization (adjusted OR: 0.88; 95% CI: 0.79-0.98; P = 0.016) decreased significantly in the intervention group. There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.Conclusions:Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.Clinical trial registration:Nos. NCT03068858 and NCT02880605; https://www.clinicaltrials.gov.

简介：Toevaluatetheeffectofatrovastatintherapyonborderlinevulnerablelesionsinpatientswithacutecoronarysyndrome(ACS).MethodsPatientswithACSunderwentcoronaryangiography(CAG)andintravascularultrasound(IVUS)investigation.Patientswithculpritvulnerableborderlinelesionswereenrolled.Nocoronaryinter-ventionwasperformedontheselesions.Allthepatientsreceivedatrovastatintherapyfor12monthsandunderwentclin-icalfollow-upalongwithIVUSfollow-up.Crosssectionarea(CSA)ofthetargetedlesion,CSAofthereferencearter-ies(extraelasticmembrane),minimallumenCSA,andplaqueareaweremeasuredatbaselineandfollow-ups.Ad-verseeventsincludedrecurrentangina,recurrentmyocardialinfarction,revascularizationanddeath.ResultsNoad-verseeventswasreportedduringfollow-upperiod.Comparedwithbaselinedata,thelevelofApoBdecreasedsignifi-cantlyattheendofthestudy(0.589±0.136g/Lvs0.681±0.132g/L,P=0.03).Boththepercentdiametersteno-sisandthepercentareastenosisdetectedbyCAGdisplayedminimalchange((62.50±10.21)%vs(54.79±12.35)%,P=0.48and(58.61±8.36)%vs(48.18+10.56)%,P=0.78).DetectedbyIVUS,theminimallu-minalCSAofthetargetedlesionincreasedsignificantly(6.32±2.42mm2vs5.63±2.51mm2,P<0.01),theplaqueareaandCSAstenosisdecreased(7.70±2.19mm2vs8.17±2.55mm2,P<0.05and56.94±8.47%vs61.4±110.34%,P<0.01).Atotalof25softplaques(50%)transformedintofibrousplaque.ConclusionsAtro-vastatintherapystabilizesborderlinevulnerableplaqueandreversesatherosclerosisprogressioninpatientswithACS.

简介：AbstractBackground:Coronary atherosclerotic plaque could go through rapid progression and induce adverse cardiac events. This study aimed to evaluate the impacts of smoking status on clinical outcomes of coronary non-target lesions.Methods:Consecutive patients with coronary heart disease who underwent two serial coronary angiographies were included. All coronary non-target lesions were recorded at first coronary angiography and analyzed using quantitative coronary angiography at both procedures. Patients were grouped into non-smokers, quitters, and smokers according to their smoking status. Clinical outcomes including rapid lesion progression, lesion re-vascularization, and myocardial infarction were recorded at second coronary angiography. Multivariable Cox regression analysis was used to investigate the association between smoking status and clinical outcomes.Results:A total of 1255 patients and 1670 lesions were included. Smokers were younger and more likely to be male compared with non-smokers. Increase in percent diameter stenosis was significantly lower (2.7 [0.6, 7.1]% vs. 3.5 [0.9, 8.9]%) and 3.4 [1.1, 7.7]%, P= 0.020) in quitters than those in smokers and non-smokers. Quitters tended to have a decreased incidence of rapid lesions progression (15.8% [76/482] vs. 21.6% [74/342] and 20.6% [89/431], P= 0.062), lesion re-vascularization (13.1% [63/482] vs. 15.5% [53/432] and 15.5% [67/431], P= 0.448), lesion-related myocardial infarction (0.8% [4/482] vs. 2.6% [9/342] and 1.4% [6/431], P= 0.110) and all-cause myocardial infarction (1.9% [9/482] vs. 4.1% [14/342] and 2.3% [10/431], P= 0.128) compared with smokers and non-smokers. In multivariable analysis, smoking status was not an independent predictor for rapid lesion progression, lesion re-vascularization, and lesion-related myocardial infarction except that a higher risk of all-cause myocardial infarction was observed in smokers than non-smokers (hazards ratio: 3.00, 95% confidence interval: 1.04-8.62, P= 0.042).Conclusion:Smoking cessation mitigates the increase in percent diameter stenosis of coronary non-target lesions, meanwhile, smokers are associated with increased risk for all-cause myocardial infarction compared with non-smokers.

简介：ObjectivesToevaluatetheeffectivenessoffirebirdstentforthetreatmentofcoronarydenovolesioncomparedwithcypherstent.MethodsNinety-oneconsecutivepatientswith156lesionswhounderwentcoronarycypher(n=68lesions)andfirebird(n=88lesions)implantation,quantitativecoronaryangiography(QCA)wasperformedatthetimeofstentimplantationandsubsequentlyat8monthspost-stenting.Smallvesseldiseasewasdefinedas≤2.5mmofreferencevesseldiametermeasuredbyQCA.Majoradversecardiacevents(MACE)includingdeath,thrombosis,nonfatalmyocardialinfarctionandtargetlesionrevascularization(TLR)werecomparedbetweenthetwogroups.ResultsBaselineclinicalcharacteristicsandangiographicparametersweresimilarbetweenthetwogroups.Seven-monthangiographicfollow-up,thelatelosswasnotdifferentbetweenthetwogroups(0.14±0.38mmvs0.13±0.17mm,P>0.05).Similarly,overallthrombosisrateweresimilarinbothgroups(1.5%vs1.1%,P>0.05).However,in-stentrestenosisaswellasin-segmentrestenosisrateweresignificantlyhigherincyphergroupthanthatinfirebirdgroup(4.4%vs0%and19.1%vs3.4%,P=0.047andP=0.001respectively).TLRwasalsohigherinthecyphergroup(10.3%vs2.3%,P=0.033)comparedwithfirebirdgroup.ConclusionsInthissmallsamplesize,non-randomizedstudy,thedataindicatedthatimplantationoffirebirdstentforthetreatmentofsmallcoronarylesionshowedmorefavorableresultsinrespectiveofrestenosiscomparedwithcypherstentimplantation.Amulti-center,large-samplesize,randomizedstudy,therefore,maybewarranted.

简介：Bifurcationswithconstraintsareopenproblemsappearedinresearchonperiodicbifurcationsofnonlineardynamicalsystems,butthepresentsingularitytheorydoesn'tcontainanyanalyticalmethodsandresultsaboutit.Asthecomplementtosingularitytheoryandthefirststeptostudyonconstrainedbifurcations,herearegiventhetransitionsetsandpersistentperturbedbifurcationdiagramsof10elementarybifurcationofcodimensionnomorethanthree.

简介：AbstractBackground:Andersson lesions (ALs) are not uncommon in ankylosing spondylitis (AS). Plain radiography (PR) is widely used for the diagnosis of ALs. However, in our practice, there were some ALs in AS patients that could not be detected on plain radiographs. This study aimed to propose the concept of occult ALs and evaluate the prevalence and radiographic characteristics of the occult ALs in AS patients.Methods:A total of 496 consecutive AS patients were admitted in the Affiliated Drum Tower Hospital, Medical School of Nanjing University between April 2003 and November 2019 and they were retrospectively reviewed. The AS patients with ALs who met the following criteria were included for the investigation of occult ALs: (1) with pre-operative plain radiographs of the whole-spine and (2) availability of pre-operative computed tomography (CT) and/or magnetic resonance imaging (MRI) of the whole-spine. The occult ALs were defined as the ALs which were undetectable on plain radiographs but could be detected by CT and/or MRI. The extensive ALs involved the whole discovertebral junction or manifested as destructive lesions throughout the vertebral body. Independent-samples t test was used to compare the age between the patients with only occult ALs and those with only detectable ALs. Chi-square or Fisher exact test was applied to compare the types, distribution, and radiographic characteristics between detectable and occult ALs as appropriate.Results:Ninety-two AS patients with a mean age of 44.4 ± 10.1 years were included for the investigation of occult ALs. Twenty-three patients had occult ALs and the incidence was 25% (23/92). Fifteen extensive ALs were occult, and the proportion of extensive ALs was significantly higher in detectable ALs (97% vs. 44%, χ2 = 43.66, P < 0.001). As assessed by PR, the proportions of osteolytic destruction with reactive sclerosis (0 vs. 100%, χ2 = 111.00, P < 0.001), angular kyphosis of the affected discovertebral units or vertebral body (0 vs. 22%, χ2 = 8.86, P = 0.003), formation of an osseous bridge at the intervertebral space adjacent to ALs caused by the ossification of the anterior longitudinal ligament (38% vs. 86%, χ2 = 25.91, P < 0.001), and an abnormal height of the affected intervertebral space were all significantly lower in occult ALs (9% vs. 84%, χ2 = 60.41, P < 0.001).Conclusions:Occult ALs presented with more subtle radiographic changes. Occult ALs should not be neglected, especially in the case of extensive occult ALs, because the stability of the spine might be severely impaired by these lesions.

简介：无

简介：The3-Dspiralstructureresultingfromthebalancebetweenthepressuregradientforce,Coriolisforce,andviscousforceisacommonatmosphericmotionpattern.Ifthenonlinearadvectivetermsareconsidered,thistypicalpatterncanbebifurcated.Itisshownthatthesurfacelowpressurewithconvergentcyclonicvorticityandsurfacehighpressurewithdivergentanticyclonicvorticityareallstableundercertainconditions.Theanomalousstructurewithconvergentanticyclonicvorticityisalwaysunstable.Buttheanomalousweakhighpressurestructurewithconvergentcyclonicvorticitycanexist,andthisdenotesthecyclone'sdyingout.

简介：Ｏｎ　△Ｉ＝４　Ｂｉｆｕｒｃａｔｉｏｎ　ＰｈｅｎｏｍｅｎａＯｎ△Ｉ＝４ＢｉｆｕｒｃａｔｉｏｎＰｈｅｎｏｍｅｎａ￥ＺｈａｎｇＪｉｎｇｙｅ；ＹａｎｇＳｕｎａｎｄＭｉｋｅＧｕｉｄｒｙＴｈｅｅｘｐｅｒｉｍｅｎｔｓ－ｂｙｔｈｅｎｅｗ７－－ｒａｙｄｅｔｅｃｔｏｒ...

简介：Inthispaper,westudytheperturbationofcertainofcubicsystem.Byusingthemethodofmulti-parameterperturbationtheoryandqualitativeanalysis,weinferthatthesystemunderconsiderationcanhavefivelimitcycles.

简介：Objective:Toexploretheeffectofmorphologicalchangesinthedevelopmentofcondylomaacuminatum(CA)MaterialsandMethods:LesionsinfivepatientswithCAwereobserved.Results:Uponelectronmicroscopy,themostcharacteristicfeatureofthelesionsimportantfordiagnosis,wasthepresenceofdistinctperinuclearvacuolizations,orso-calledkoilocytes,amongsomeepithelialcells.Thesecellspossessedhyperchromaticnuclei,swollenmitochondria,dilatedendoplasmicreticulumanddissolvedglycogen.Therewereinterchromatingranulesandperichromatingranulesinsomenuclei.Moreoversomevirusparticleswerealsoseeninthenucleiofsomeinfectedcells.Conclusions:Theultrastructuralfindingsmaybeusedtohistopathologicallyexplainthepathogenesisandmechanismofthisdisease,anditishelpfulfordiagnosisofCA.

简介：AbstractBackground:Thermal ablation of thyroid nodules is new modality for the management of the benign and malign lesions. This minimally invasive treatment is performed as an outpatient, local anesthetic, single professional procedure that can treat neoplastic lesions without removing normal thyroid tissue and thus avoiding hypothyroidism.Method:A comprehensive review of the most relevant literature regarding the thermal ablation of benign and malign nodules was performed in order to currently define its role on the management of the nodular thyroid disease. The data was divided into benign and malign literature.Results:The benign nodules can be effectively treated by radiofrequency ablation (RFA) but some limitation exists regarding the nodule’s size but not nodules characteristics. The RFA of primary malign tumors of the thyroid recently demonstrated positive and safe long-term follow-up and encouraged additional investigation and possibly a definitive role in the management of these low risk nodules.Conclusion:RFA is a safe, cost-effective minimally invasive procedure that avoids thyroid tissue removal while destroying neoplastic one thus, preventing hypothyroidism.

简介：Duodenalpolypsorlesionsareuncommonlyfoundonupperendoscopy.Duodenallesionscanbecategorizedassubepithelialormucosally-based,andthetypeoflesionoftendictatesthework-upandpossibletherapeuticoptions.Subepitheliallesionsthatcanariseintheduodenumincludelipomas,gastrointestinalstromaltumors,andcarcinoids.Endoscopicultrasonographywithfineneedleaspirationisusefulinthecharacterizationanddiagnosisofsubepitheliallesions.Duodenalgastrointestinalstromaltumorsandlargeormultifocalcarcinoidsarebestmanagedbysurgicalresection.Brunner＇sglandtumors,solitaryPeutz-Jegherspolyps,andnon-ampullaryandampullaryadenomasaremucosally-basedduodenallesions,whichcanrequireremovalandaretypicallyamenabletoendoscopicresection.Severalanatomiccharacteristicsoftheduodenummakeendoscopicresectionofduodenallesionschallenging.However,advancedendoscopictechniquesexistthatenabletheresectionoflargemucosally-basedduodenallesions.Endoscopicpapillectomyisnotwithoutrisk,butthisprocedurecaneffectivelyresectampullaryadenomasandallowspatientstoavoidsurgery,whichtypicallyinvolvespancreaticoduodenectomy.Endoscopicmucosalresectionanditsvariations（suchascap-assisted,cap-band-assisted,andunderwatertechniques）enablethesafeandeffectiveresectionofmostduodenaladenomas.Endoscopicsubmucosaldissectionispossiblebutverydifficulttosafelyperformintheduodenum.

简介：AbstractPediatric skull base lesions are complex and challenging disorders. Safe and comprehensive management of this diverse group of disorders requires the expertise of an experienced multidisciplinary skull base team. Adult endoscopic skull base surgery has evolved due to technologic and surgical advancements, multidisciplinary team approaches, and continued innovation. Similar principles continue to advance the care delivered to the pediatric population. The approach and management of these lesions varies considerably based on tumor anatomy, pathology, and surgical goals. An understanding of the nuances of skull base reconstruction unique to the pediatric population is critical for successful outcomes.

简介：Tileterm‘percutaneouscoronaryintervention'(PCI)isusedtodescribevariousproceduresthatcanbeusedtomechanicallyimprovemyocardialperfusionwithoutresortingtosurgery.Themostcommonprocedureispercutaneoustransluminalcoronaryangioplasty(PTCA),usuallywithimplantationofanintracoronarystent.Othermethodsmaybeappropriateinsmallsubsetsofpatients.Morethan1millionPCIprocedureswereperformedworldwidein2000.

简介：Coronaryarterybypassgrafting(CABG)isenteringaneweraasminimallyinvasivetechniques,off-pumpsurgeryandtotal'arterialrevascularizationhavefotmdrolesinthesurgicaltreatmentofpatientswithcoronaryarterydisease.Thecontinueddevelopmentofthetechniquesofpercutaneouscoronaryintervention(PCI)isalsohavinganimpactonthetypeofpatientreferredforCABG.

简介：Theeffectsoftheconstantexcitationonthelocalbifurcationoftheperiodicsolutionsinthe1:2internalresonantsystemswereanalyzedbasedonthesingularitytheory.Itisshownthattheconstantexcitationmakeinfluenceonlywhenthereexistsomenonlinearterms,intheoscillatorwithlowerfrequency.Besidesactingasmainbifurcationparameter,theconstantexcitation,togetherwithcoefficientsofsomenonlinearterms,maychangethevaluesofunfoldingparametersandthetypeofthebifurcation.Underthenon-degeneratecases,theeffectofthethirdordertermscanbeneglected.

简介：我们与处理描述并且分析一个简单SIS模型。特别地，我们借助于asymptotically自治的系统的理论给完全质的分析。如果足够的接触率或能力是小的，向后的分叉发生，这被发现。在那里存在，也被发现双稳态地方性的equilibria。在导致疾病的死亡的情况中，向后的分叉也发生，这被显示出。而且，在一些条件，和潜水艇下面没有限制周期批评Hopf分叉发生在另外一个下面条件。