简介：BackgroundThecoronarycollateralcirculationhasapositiveeffectontheischemicmyocardium.Butitislimitedforpatientsmissingthetimewindowoftotalocclusionofthecoronaryarteryelectivepercutaneouscoronaryintervention(PCI).Theeffectofcollateralcirculationonleftcardiacfunctionhasbeenlessstudied.MethodsAtotalof34patientswithoneormorecoronaryarteryocclusionwhounderwentcoronaryangiographyandRentrop'smethodweredividedinto2groups:Goodcollateralcirculation(Agroups,Rentropscore2-3,n=19)and(Bgroups,Rentropscore1-2,n=15).Theimprovementofleftventricularenddiastolicvolume(LVEDV)andleftventricularejectionfraction(LVEF)werecomparedbetweenthetwogroupsbeforeandafterPCI.ResultsIngoodcollateralcirculationgroup,leftventricularejectionfraction(LVEF)wassignificantlyhigherafterPCI(P<0.05).Inpoorcollateralcirculationgroup,leftventricularenddiastolicvolumeindex(LVEDV)wassignificantlyincreasedafterPCI(P<0.05).ConclusionsGoodcollateralcirculationhasasignificantprotectiveeffectonleftventricularfunction.PCIoperationcansignificantlyimprovetheprognosisofpatientswithgoodcollateralcirculationofcoronaryarteryocclusion.

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简介：BackgroundManypatientshavesymptomssuggestiveofcoronaryarterydisease(CAD)andareoftenevaluatedwiththeuseofdiagnostictesting,althoughtherearelimiteddatafromrandomizedtrialstoguidecare.MethodsWerandomlyassigned10,003symptomaticpatientstoastrategyofinitialanatomicaltestingwiththeuseofcoronarycomputedtomographicangiography(CTA)ortofunctionaltesting(exerciseelectrocardiography,nuclearstresstesting,orstressechocardiography).Thecompositeprimaryendpointwasdeath,myocardialinfarction,hospitalizationforunstableangina,ormajorproceduralcomplication.SecondaryendpointsincludedinvasivecardiaccatheterizationthatdidnotshowobstructiveCADandradiationexposure.ResultsThemeanageofthepatientswas60.8±8.3years,52.7%werewomen,and87.7%hadchestpainordyspneaonexertion.ThemeanpretestlikelihoodofobstructiveCADwas53.3±21.4%.Overamedianfollow-upperiodof25months,aprimaryend-pointeventoccurredin164of4996patientsintheCTAgroup(3.3%)andin151of5007(3.0%)inthefunctional-testinggroup(adjustedhazardratio,1.04;95%confidenceinterval,0.83to1.29;P=0.75).CTAwasassociatedwithfewercatheterizationsshowingnoobstructiveCADthanwasfunctionaltesting(3.4%vs.4.3%,P=0.02),althoughmorepatientsintheCTAgroupunderwentcatheterizationwithin90daysafterrandomization(12.2%vs.8.1%).ThemediancumulativeradiationexposureperpatientwaslowerintheCTAgroupthaninthefunctional-testinggroup(10.0mSvvs.11.3mSv),but32.6%ofthepatientsinthefunctional-testinggrouphadnoexposure,sotheoverallexposurewashigherintheCTAgroup(mean,12.0mSvvs.10.1mSv;P<0.001).ConclusionsInsymptomaticpatientswithsuspectedCADwhorequirednoninvasivetesting,astrategyofinitialCTA,ascomparedwithfunctionaltesting,didnotimproveclinicaloutcomesoveramedianfollow-upof2years.

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简介：BackgroundDuringprimarypercutaneouscoronaryintervention(PCI),manualthrombectomymayreducedistalembolizationandthusimprovemicrovascularperfusion.Smalltrialshavesuggestedthatthrombectomyimprovessurrogateandclinicaloutcomes,butalargertrialhasreportedconflictingresults.MethodsWerandomlyassigned10,732patientswithST-segmentelevationmyocardialinfarction(STEMI)undergoingprimaryPCItoastrategyofroutineupfrontmanualthrombectomyversusPCIalone.Theprimaryoutcomewasacompositeofdeathfromcardiovascularcauses,recurrentmyocardialinfarction,cardiogenicshock,orNewYorkHeartAssociation(NYHA)classIVheartfailurewithin180days.Thekeysafetyoutcomewasstrokewithin30days.ResultsTheprimaryoutcomeoccurredin347of5033patients(6.9%)inthethrombectomygroupversus351of5030patients(7.0%)inthePCI-alonegroup(hazardratiointhethrombectomygroup,0.99;95%confidenceinterval[CI],0.85to1.15;P=0.86).Theratesofcardiovasculardeath(3.1%withthrombectomyvs.3.5%withPCIalone;hazardratio,0.90;95%CI,0.73to1.12;P=0.34)andtheprimaryoutcomeplusstentthrombosisortarget-vesselrevascularization(9.9%vs.9.8%;hazardratio,1.00;95%CI,0.89to1.14;P=0.95)werealsosimilar.Strokewithin30daysoccurredin33patients(0.7%)inthethrombectomygroupversus16patients(0.3%)inthePCI-alonegroup(hazardratio,2.06;95%CI,1.13to3.75;P=0.02).ConclusionsInpatientswithSTEMIwhowereundergoingprimaryPCI,routinemanualthrombectomy,ascomparedwithPCIalone,didnotreducetheriskofcardiovasculardeath,recurrentmyocardialinfarction,cardiogenicshock,orNYHAclassIVheartfailurewithin180daysbutwasassociatedwithanincreasedrateofstrokewithin30days.

简介：BackgroundAlthoughalotofstudieshavebeenperformedonthelongtermoutcomeinadultswithrepairedtetralogyofFallot(TOF)indevelopedcountries,butrareinformationforprimarycorrectionofadultTOFisavailable.Theresearchfocusingontheeffectoftransanularpatch(TAP)forprimarycorrectionofTOFinadulthoodisstillabsent.Viaretrogradeanalysisof7-yearfollow-up,thisstudywasdesignedtoexploretheeffectofthetransanularpatchforprimarycorrectioninadultTOFonthesurgicaloutcome,postoperativecardiacfunctionandmorbidity,aswellastoaddressthemanagementofthecomplication.MethodsAtotalof151consecutiveadultpatients(age≥18)whounderwentprimaryradicalcorrectionofTOFform2007-2014wereselectedanddividedintoTAPandnon-TAPgroupsbasedontheEACTSdatabase.Resultsofdemographicstatisticcharacteristics,echocardiography,color-Dopplerechocardiography,cardiovascularenhancedcontrastcomputedtomography(CT),and/orcardiaccatheterization;intraoperativeinformation,postoperativeresultsandoutcomeswerereported.Duringfollow-up,shorttermwasdefinedwithin3monthsafterdischarge,andmidtermwasdefinedas6-12monthsafterdischarge.ResultsTotalpostoperativemortalitywas5.96%inallthecases,6.96%inTAPgroup,and2.78%(1/36)innon-TAPgroup.Therewasnosignificantdifferencebetweentwogroups.Follow-upperiodrangedfrom3monthsto62months.Readmissionoccurredandwasfollowedbymedicaltreatmentwithoutre-dosurgeryin6cases(3.97%).TheshorttermechocardiographydemonstratedthatpulmonaryregurgitationandshorttermtricuspidregurgitationafterdischargeinTAPgroupweremoresevere(P<0.001).Theshorttermresidualpulmonarystenosis(RVOTO)severityafterdischargeinTAPgroupwaslesssevere(P=0.018).MidtermechocardiographyafterdischargedemonstratedpulmonaryregurgitationandtricuspidregurgitationinTAPgroupwerestillmoresevere(P=0.003).TheseverityofresidualpulmonarystenosisinT

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简介：INTRODUCTIONPulmonaryarteriovenousfistula(PAVF)isararecongenitalpulmonaryvascularmalformationwiththeincidenceof2-3/100,000.Itistheabnormalcommunicationbetweenthepulmonaryarteryandpulmonaryvein.Theclinicalmanifestationsofthisdiseasearevarioussothatitiseasytobemisdiagnosed1.Atpresent,DSAisthegoldstandardforthediagnosisof

简介：AIM:Toclarifythecorrelationwithphenotypicexpression,clinicopathologicalfeatures,geneticalterationandmicrosatellite-instabilitystatusinsmallintestinaladenocarcinoma(SIA).METHODS:Thecasesof47patientsdiagnosedwithprimarySIAsthatweresurgicallyresectedatourinstitutionin1975-2005werestudied.Wereviewedclinicopathologicalfindings(age,gender,tumorsize,grossappearance,histologicalmorphologictype,invasiondepth,lymphaticpermeation,venousinvasion,andlymphnodemetastasis),andtheimmunohistochemicalexpressionofMUC5AC,MUC6,MUC2,CD10,andmismatch-repair(MMR)proteins(MLH1andMSH2).WeanalyzedKRASandBRAFgenemutations,andthemicrosatelliteinstability(MSI)status.TheimmunohistochemicalstainingofCD10,MUC2,MUC5ACandMUC6wasconsideredpositivewhendistinctstainingin>5%oftheadenocarcinomacellswasrecorded.ToevaluateofMMRproteinexpression,weusedadjacentnormaltissueincludinglymphoidfollicles,inflammatorycells,andstromalcellsasaninternalpositivecontrol.SectionswithoutnuclearstaininginthetumorcellswereconsideredtohavelosttheexpressionoftherespectiveMMRprotein.RESULTS:Therewere29malesand18femalespatients(meanage59.9years,range:23-87years).Tumorswerelocatedintheduodenumin14cases(30%),thejejunumin21cases(45%),andtheileumin12cases(25%).Aphenotypicexpressionanalysisrevealed20MUC2-positivetumors(42.6%),11MUC5AC-positive(23.4%),4MUC6-positive(8.5%),and7CD10-positive(14.9%).ThetumorsizesoftheMUC2(+)tumorsweresignificantlylargerthanthoseoftheMUC2(-)tumors(mean,5.7±1.4cmvs4.7±2.1cm,P<0.05).AllthreetumorswithadenomatouscomponentwerepositiveforMUC2(P<0.05).PolypoidappearancewasseensignificantlymorefrequentlyintheCD10(+)groupthanintheCD10(-)group(P<0.05).ThetumorsizewassignificantlylargerintheCD10(+)groupthanintheCD10(-)group(mean,5.9±1.4cmvs5.0±2.1cm,P<0.05).Of34SIAswithsuccessfullyobtainedMSIdata,4wereMSI-high.O

简介：Objective:Theobjectiveofthecurrentstudywastoevaluatethefeasibilityandsafetyofnonintubateduniportalvideo-assistedthoracoscopicsurgery（VATS）forthemanagementofprimaryspontaneouspneumothorax（PSP）.Methods:FromNovember2011toJune2013,32consecutivepatientswithPSPweretreatedbynonintubateduniportalthoracoscopicbullectomyusingepiduralanaesthesiaandsedationwithoutendotrachealintubation.Anincision2cminlengthwasmadeatthe6thintercostalspaceinthemedianaxillaryline.Thepleuralspacewasenteredbybluntdissectionforplacementofasoftincisionprotector.Instrumentsweretheninsertedthroughtheincisionprotectortoperformthoracoscopicbullectomy.Datawerecollectedwithinaminimumfollow-upperiodof10months.Results:Theaveragetimeofsurgerywas49.0min（range,33-65min）.Nocomplicationswererecorded.Thepostoperativefeedingtimewas6h.Themeanpostoperativechesttubedrainageandhospitalstaywere19.3hand41.6h,respectively.Thepostoperativepainwasmildfor30patients（93.75%）andmoderatefortwopatients（6.25%）.Norecurrencesofpneumothoraxwereobservedatfollow-up.Conclusions:Theinitialresultsindicatedthatnonintubateduniportalvideo-assistedthoracoscopicoperationsarenotonlytechnicallyfeasible,butmayalsobeasafeandlessinvasivealternativeforselectpatientsinthemanagementofPSP.ThisisthefirstreporttoincludetheuseofanonintubateduniportaltechniqueinVATSforsuchalargenumberofPSPcases.Furtherworkanddevelopmentofinstrumentsareneededtodefinetheapplicationsandadvantagesofthistechnique.

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简介：BackgroundPreviousstudieshaveimplicatedastronglinkbetweencirculatingplasmaresistinandcoronaryarterydisease(CAD).Theaimofthisstudywastoinvestigatewhetherresistinelevationpredictsworseoutcomeofstent-placementinacutecoronarysyndrome(ACS)patients.MethodsTotally126ACSparticipantswhowereeligibleforstent-placementwereenrolledfor2years'follow-upbymonitoringclinicalendpointsoccurringviaoutpatientvisitsor/andtelephonecall.Baselinecharacteristicswerecollected.Allparticipantsweredividedintolowresistingroup(<3.464μg/mL)andhighresistingroup(>3.464μg/mL).Clinicalendpointsintermsofmajoradversecardiovascularevents(MACE),cardiovasculardeath,non-fatalmyocardialinfarction,ischemicstroke,andcoronaryrevascularization(CR)werecompared.ResultsPatientswithstenosisinthreevesselspresentedmorefrequentlyinhighresistingroupthaninlowresistingroup(35.6%vs.48.3%,P=0.001).IncidencesofMACEandCRweresignificantlyhigherinhighresistingroupthanthoseinlowresistingroup(31.6%vs.18.8%,P=0.018);15%vs.7.58%,P=0.006).ConclusionsInpatientswithbaselineresistinelevation,theincidenceofMACEissignificantlyincreasedafterstent-placement.

简介：Pheochromocytomaisatumorarisingfromneuroectodermalchromaffintissuesintheadrenalglandorextra-adrenalparaganglia(paragangliomas).Theprevalenceofthetumoris0.1%-0.6%inthehypertensivepopulation,ofwhich10%-20%aremalignant.Pheochromocytomaproduces,stores,andsecretescatecholamines,aswellasleadstohypertensivecrisis,arrhythmia,angina,andacutemyocardialinfarctionwithoutcoronaryarterydiseases.Wereportacaseofacutecoronarysyndrome(ACS)withafinaldiagnosisofmultipleendocrineneoplasiawithpheochromocytomaandmedullarythyroidcarcinoma(MTC).

简介：‘Stent对stent’研究是被设计与以前同意的相比显示出新stent图案的优势的一种使随机化的试用。这些研究被规章的机构通常使用，例如美国食物药品管理局(食物及药品管理局)，到表示同意到新stent图案。有这些临床的试用的问题是他们的高费用和困难。在这份报纸，为‘stent对stent’的一种数字选择复杂临床的研究被介绍。一个有限元素模型被开发在冠的stent放置以后在结果上调查stent设计的影响。二商业地可得到的stents(NIR和多连接stents)被建模，他们的行为以压力分发在推广期间被比较，光线的获得，外部直径变化并且节略。而且，狭窄率上的stent设计的效果被在动脉以内比较压力分发调查。在stented动脉的动脉的墙压力的分析显示多连接stent设计原因与slotted试管NIR设计相比与局部性的stenotic损害降低应力到一个动脉粥样硬化患者容器。有观察临床的狭窄的调查结果相互关联与多连接stent设计相比在NIR评估狭窄率，它更高报导了。

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简介：Afewclassesoforganiccompoundsarepromisingelectrode-activematerialsduetotheirhighpowerandenergydensities,lowcost,environmentalfriendliness,andfunctionality.Inthepresentwork,thepossibilityofusingKlasonligninextractedfrombuckwheathusksasacathode-activematerialforaprimarylithiumbatteryhasbeeninvestigatedforthefirsttime.Thereactionmechanisminthelithium/ligninelectrochemicalcellwassuggestedbasedonthedeepgalvanostaticdischarge(upto0.005V)dataandcyclicvoltammetryresults.ThedependenceoftheelectrochemicalbehavioroftheKlasonligninonthemillingdegreewasevaluated.Themaximumspecificcapacityoftheligninisequalto600mAhg-1atadischargecurrentdensityof75μAcm-2.BeneficialeffectofthethermaltreatmentoftheKlasonlignincathodeat250°Conthecellperformancewasestablished.Itwasfoundthatthedischargecapacityofthecellincreasedby30%intherangefrom3.3to0.9Vforthetreatedcathodematerial.TheseresultsdemonstratetheprospectsofusingKlasonlignin-basedelectrochemicalcellsaslow-rateprimarypowersources.

简介：在备课和课堂教学中,经常会发现,把一堂课中的每个教学环节自然、流畅地融合和衔接在一起是一件很困难的事,尤其是想把一节课如同讲故事般行云流水地上完,是煞费脑筋的。笔者的这节课正是基于以上一点,力求做到课堂和线索的完整性。

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