Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein:A case report

BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.

Clues for diagnosing misplaced central venous catheter in the right ascending lumbar vein during right femoral venous access

The right ascending lumbar vein is difficult to detect on anteroposterior abdominalradiographs because it overlaps with the inferior vena cava on anteroposteriorradiographs.Intensive observation by medical providers may be a cue fordiagnosis.However,knowledge of catheter misplacement of the right ascendinglumbar vein is also necessary,because misplacement cannot be suspected withoutthat awareness.

Alteration of ascending colon mucosal microbiota in patients after cholecystectomy

BACKGROUND Cholecystectomy is a successful treatment option for gallstones,although the inci-dence of colorectal cancer(CRC)has notably increased in post-cholecystectomy(PC)patients.However,it remains uncertain whether the altered mucosal micro-biota in the ascending colon is related.In total,30 PC patients and 28 healthy controls underwent colonoscopies to collect mucosal biopsy samples.PC patients were divided based on their clinical features.Then,16S-rRNA gene sequencing was used to analyze the amplicon,alpha diversity,beta diversity,and composition of the bacterial communities.Addi-tionally,the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States(PICRUSt)database,sourced from the Kyoto Encyclopedia of Genes and Genomes,was used to predict the functional capabilities of the bac-teria.RESULTS PC patients were comparable with healthy controls.However,PC patients older than 60 years had a distinct composition compared to those under 60 years old.Bacteroidetes richness was considerably higher at the phylum level in PC patients.Bacteroides,Parabacteroides,and Bilophila were more abundant in the PC group than in the control group.Furthermore,PC patients exhibited greater enrichment in metabolic pathways,specifically those related to lipopolysaccharide biosynthesis and vancomycin group antibiotic production,than controls.CONCLUSION This study indicated that the mucosal microbiota in PC patients was altered,perhaps offering new perspectives on the treatment possibilities for CRC and diarrhea following cholecystectomy.

Adventitial Rupture of the Ascending Thoracic Aorta Extended to the Buttock by Thoracic Crushing between Two Tanks at the Thoracic and Cardiovascular Surgery Department at the Besançon CHRU

Traumatic rupture of the ascending aorta is rare. We report the case of a 23-year-old man who suffered a service accident by crushing the thorax between two tanks during army maneuvers that resulted in an adventitial rupture of the ascending thoracic aorta extending to the Crosse. Treatment consisted of replacement of the ascending aorta with a 24 mm Hemashield straight tube and re-implantation of supra-aortic vessels at the dome of the prosthesis.

Case Report of a Pseudoaneurysm of Ascending Aorta Treated by Stent

Pseudoaneurysms of the ascending aorta are a rare complication of aortic and cardiac surgery. In this article, we present a clinical case of a 56-year-old patient with a fortuitous diagnosis of a pseudoaneurysm of ascending aorta that was treated by an endovascular stent-graft. We discuss in this article the diagnostic and therapeutic aspect of the case and the place of endovascular treatment for the ascending aorta.

Laparoscopic right radical hemicolectomy: Central vascular ligation and complete mesocolon excision vs D3 lymphadenectomy - How I do it?

In colon cancer surgery,ensuring the complete removal of the primary tumor and draining lymph nodes is crucial.Lymphatic drainage in the colon follows the vascular supply,typically progressing from pericolic to paraaortic lymph nodes.While NCCN guidelines recommend the removal of 10-12 lymph nodes for ade-quate oncological resection,achieving complete oncological resection involves more than just meeting these numerical targets.Various techniques have been developed and studied over time to attain optimal oncological outcomes.A key technique central to this goal is identifying the ileocolic vessels at their origin from the superior mesenteric vessels.Complete excision of the visceral and parietal mesocolon ensures the intact removal of the specimen,while D3 lymphade-nectomy targets all draining regional lymph nodes.Although these principles emphasize different aspects,they ultimately converge to achieve the same goal of complete oncological resection.This article aims to simplify the surgical steps that align with the principle of central vascular ligation and mesocolon mobilization while ensuring adequate D3 dissection.

A case of ascending colon variceal bleeding treated with venous coil embolization

A 38-year-old female with a history of alcoholic liver cirrhosis visited our hospital with a massive hematochezia.An esophagogastroduodenoscopy did not demonstrate any bleeding source,and a colonoscopy showed a massive hemorrhage in the ascending colon but without an obvious focus.The source of the bleeding could not be found with a mesenteric artery angiography.We performed an enhanced abdominal computed tomography,which revealed a distal ascending colonic varix,and assumed that the varix was the source of the bleeding.We performed a venous coil embolization and histoacryl injection to obliterate the colon varix.The intervention appeared to be successful because the vital signs and hemoglobin laboratory data remained stable and because the hematochezia was no longer observed.We report here on a rare case of colonic variceal bleeding that was treated with venous coil embolization.

Can semipermeable membranes coating materials influence in vivo performance for paliperidone tri-layer ascending release osmotic pump tablet:In vitro evaluation and in vivo pharmacokinetics study

One purpose of this study was to develop a paliperidone(PAL)tri-layer ascending release pushepull osmotic pump(TA-PPOP)tablet which could meet the needs of clinical applications.And another purpose was to investigate whether different coating materials influenced in vivo performance of TA-PPOP.The ascending release mechanism of this trilayer delivery system on theory was elaborated.TA-PPOP was prepared by means of coating with cellulose acetate(CA)or ethyl cellulose(EC).Several important influence factors such as different core tablet compositions and different coating solution ingredients involved in the formulation procedure were investigated.The optimization of formulation and process was conducted by comparing different in vitro release behaviors of PAL.In vitro dissolution studies indicated that both the two formulations of different coating materials were able to deliver PAL at an ascending release rate during the whole 24 h test.The in vivo pharmacokinetics study showed that both self-made PPOP tablets with different coating had a good in vitro-in vivo correlation(IVIVC)and were bioequivalent with the brand product,which demonstrated no significant influence of the coating materials on the in vivo release acceleration of TA-PPOP.

Left to Right Extracardial Shunt to Control Hemorrhage of Ascending Aorta and Left Ventricle: A Report of 3 Cases

Presented in this paper are 3 cases of hemorrhage of ascending aorta and left ventricle after open heart surgery treated by extracardial bypass in our hospital from Oct. 1994 to Dec. 1995. Remained aneurysmal wall enclosing conduit graft was used as a sac bypassed to right atrium to form a extracardial left-toright shunt in order to control bleeding and the results turned out to be satisfactory. The bypass and hemodynamically ignorable shunt can close spontaneously without complications with recovery of coagulation system. The technique may find wide application in clinical practice.

Laparoscopic right hemicolectomy for ascending colon cancer with persistent mesocolon

Persistent ascending or descending mesocolon is an embryological anomaly that occurs during the final process of intestinal development in organogenesis.Specifically,the primitive dorsal mesocolon fails to fuse with the parietal peritoneum in the fifth month of gestation.Herein,we describe a case of ascending colon cancer with persistent ascending and descending mesocolon treated by laparoscopic right hemicolectomy.Preoperative computed tomography imaging of the abdomen demonstrated that the descending colon shifted at the midline of the abdomen and the sigmoid colon was located under the ascending colon.The detailed preoperative imaging examination revealed malpositioning of the large intestine and aided in the procedural planning.Because persistent mesocolon may result in the formation of abnormal adhesions,an accurate preoperative diagnosis is essential.We propose that it is important to consider this anomaly when making the preoperative imaging diagnosis to ensure a safe operation.

Morphology of the ascending aorta: a study on 114 Chinese patients

Purpose: This study aimed to investigate the morphological characteristics of ascending aortic dissection in detail. Materials and Methods: The ascending aorta was morphologically assessed in a consecutive series of patients between January 2009 and October 2014. A new assessment and evaluation method was used to describe 114 patients with ascending aortic dissection. Results: A large difference was found in the degree of curvature between the ascending aorta with and without dissection. The shape of the former was straighter and steeper(control group R, 47.46 ± 6.40 mm; experimental group R, 59.70 ± 10.27 mm, P < 0.001). In the case of aortic dissection involving the valves, the proximal edge of the first entry was obviously close to the aortic sinus. The orientation of the entries was mainly around the 10 o'clock and 1–2 o'clock positions, and most of their shapes were fusiform(111; 70.02%). The distance of the distal extending dissection was associated with cases involving the branch arteries(involving three branches 441.40 ± 101.13 mm vs 159.85 ± 131.86 mm in others, P < 0.001). Conclusion: The morphological features of the ascending aorta after dissection and the correlations among dissections, entries, and related factors were found.

Metabolite profile comparisons between ascending and descending colon tissue in healthy adults

BACKGROUND Obesity is a risk factor for colorectal cancer,yet metabolic distinctions between healthy right and left colon tissue,before cancer is diagnosed,remains largely unknown.This study compared right-ascending and left-descending colon tissue metabolomes to identify differences from the stool metabolome in normal weight,overweight,and obese adults.AIM To examine right and left colon tissue metabolites according to body mass index that may serve as mechanistic targets for interventions and biomarkers for colon cancer risk.METHODS Global,non-targeted metabolomics was applied to assess right-ascending and left-descending colon tissue collected from healthy adults undergoing screening colonoscopies to test the hypothesis that BMI differentially impacts colon tissue metabolite profiles.The colon tissue and stool metabolome of healthy adults(n=24)was analyzed for metabolite signatures and metabolic pathway networks implicated in progression of colorectal cancer.RESULTS Ascending and descending colon contained 504 host,food,and microbiotaderived metabolites from normal weight,overweight and obese adults grouped according to body mass index.Amino acids,lipids,and nucleotides were among the chemical types that further differentiated from the stool metabolite profiles.Normal weight adults had 46 significantly different metabolites between ascending and descending colon tissue locations,whereas there were 37 metabolite differences in overweight and 28 metabolite differences for obese adults(P<0.05).Obese adults had trimethylamine N-oxide,endocannabinoids and monoacylglycerols with different relative abundances identified between ascending and descending colon.Primary and secondary bile acids,vitamins,and fatty acids also showed marked relative abundance differences in colon tissue from overweight/obese adults.CONCLUSION There were metabolite profile differences between right-ascending and leftdescending colon tissue in healthy adults.Colon lipids and other metabolites in obese and overweight adults were distinguished from normal weight participants and associated with gut inflammation,nutrient absorption,and products of microbiota metabolism.

Clinical Study of the Ascending Aorta Wall Motion by Velocity Vector Imaging in Patients with Primary Hypertension

We studied the wall motion characteristics of the ascending aorta by velocity vector imaging （VVI） in primary hypertension patients. The ascending aortas both in 30 patients with primary hypertension and 30 normal controls were examined by Acuson sequoia 512 equiped with VVI. The maximum velocity （Vs, Ve） of every point on the anterior wall of ascending aorta both in systole and diastole was measured. The aortic diameter was wider in the hypertension patients than that in the healthy subjects （P〈0.05）. The movement amplitude of the anterior wall of the ascending aorta in long axis view in the hypertension patients was lower than that in the healthy subjects （P〈0.05）. The motion and time to peak in systole of each point of the ascending aorta in the healthy subjects had no significant difference （P〉0.05）. The velocity curves of the anterior wall of ascending aorta both in the hypertension and healthy subjects were regular, and the curve in systole was named S wave and that in diastole named E wave. The velocity of S wave and E wave was slower in the hypertension patients than that in the healthy subjects （P〈0.05）. The time to peak of S wave on the anterior wall of ascending aorta in systole was shorter in the hypertension patients than in the healthy subjects （P〈0.05）. VVI could be used to accurately and directly observe the movement character of the ascending aorta walls, which would help us understand the elasticity of great arteries in patients with hypertension.

Impaired consciousness caused by injury of the lower ascending reticular activating system: evaluation by diffusion tensor tractography

A 34-year-old male patient underwent conservative management for traumatic hemorrhage in the right frontal lobe（Figure 1A）.The patient lost consciousness for approximately 4 weeks and experienced post-traumatic amnesia continuously from the time of the accident.The patient’s Glasgow Coma Scale score（Teasdale et al.,1974）was 6

Relationships between In SAR Seismic Deformation and Fault Motion Sense,Fault Strike,and Ascending/Descending Modes

Based on the working principle of satellite radars, the earthquake deformation field measured by interferometric synthetic aperture（InSAR） is the projection of ground displacement associated with the seismogenic fault in the line of sight（LOS） of the satellite. However, LOS projections are complex, and are not only related to the ascending/descending modes and incidence angles of SAR data, but also related to the strike and motion senses of the fault. Even for the same earthquake, the LOS deformation derived from different ascending/descending data can be almost identical in one case, but quite different in another case, which makes the interpretation of InSAR seismic deformation and its comparison with field observations difficult. In this study, we undertook a quantitative analysis of the relationships between LOS observation sensitivity of InSAR and fault strike, fault motion sense, and ascending/descending modes, as well as 3D deformation fields. We studied the features and differences of the LOS deformation fields in different types of earthquakes using ascending/descending modes, with a particularly detailed analysis of the relations for a strikeslip type of earthquake. We also summarized the characteristics of LOS deformation fields of faults with different strikes and optimal observational data modes. Taking the strike-slip Yushu earthquake and the normal Gaize event as examples, we used SAR data of the ascending/descending modes to verify the results of quantitative calculations. These analyses will not only provide a more reasonable interpretation of InSAR seismic deformation fields and but also help understand the differences of seismic deformation fields revealed by data with different observational modes, therefore promoting the application of InSAR technology in seismology.

Recovery of multiply injured ascending reticular activating systems in a stroke patient

Consciousness is controlled by ular activating system （ARAS）. lower and upper parts between activation of the ascending retic- The ARAS consists mainly of the the thalamus and cerebral cortex （Edlow et al., 2012; Yeo et al., 2013; Jang et al., 2014）. Because the ARAS is composed of several neuronal circuits connecting the brainstem to the cortex. These neuronal connections begin from the reticular formation （RF） of the brainstem and the intralaminar nucleus of thalamus to the cerebral cortex （Gosseroes et al., 2011）. In addition, the ARAS system also includes several brainstem nuclei （such as dorsal raphe, locus coeruleus, pedun-culopontine nucleus, median raphe and parabrachial nucleus）, non-specific thalamic nuclei, hypothalamus, and basal forebrain （Fuller et al., 2011）.

Tablets of paliperidone using compression-coated technology for controlled ascending release

The aim of this work was to prepare ascending release compression-coated(CC) tablets with paliperidone(PAL) using a simple manufacturing technique and short manufacturing process.The release behavior and mechanisms in vitro of the final tablets was investigated and evaluated. The PAL CC tablets were comprised of a core layer of high viscosity hydroxypropyl cellulose(HPC-H) and a coating layer of high viscosity hydroxypropyl methylcellulose(HPMCK100 M). Several factors such as materials and core tablet compositions were studied for their influence in the formulation procedure. The drug release mechanism was studied using gravimetric analysis. The data could be fitted to the Peppas model. The ascending drug release results were expressed in terms of the slope of the release curve at different time points.Results showed that the formulation could achieve a good ascending drug release when the weight ratio of PAL was 5:1(core:layer). The fraction of HPC and HPMC was 33 %, and the combination of Eudragit RL-PO was 10%. The ascending release mechanism was due to solvent penetration into the PAL CC tablets, and subsequent drug dissolution from the gelatinous HPC and HPMC matrix erosion. The release mechanism was therefore a combination of diffusion and erosion. This work demonstrated that the compression-coated tablets could achieve controlled ascending release over 24 h for the oral administration systems.

Noninvasive Assessment of Cardiac Index with Transesophageal Echocardiography in Patients Undergoing Mitral Valve Replacement: A Comparison between Determinations at the Mitral Valve and the Ascending Aorta

Methods: Sixteen patients with American Society of Anesthesiologists status (ASA) II-III, age ≤ 70 yr, male or female, preoperatively NYHA II-III and EF ≥ 45%, scheduled for mitral valve replacement (MVR) were studied. Complete intravenous general anesthesia was used for induction and anesthesia maintenance. After anesthesia induction we put the TEE probe into the esophagus. The cardiac index was determined at three periods following MVR: T1 30 minutes later following cessation of bypass, T2 60 minutes after cessation of bypass, T3 90 minutes after cessation of bypass. Statistical analysis was made with the Bland and Altman method. Results: Ninety-six measurements were compared. The cardiac index values at the level of prosthesis mitral valve (CIMV) ranged from 1.3 to 5.5 L·min-1·m-2 (mean 2.6 ± 0.9). The Values of cardiac index at aortic valve (CIAA) ranged from 2.7 to8.8 L·min-1·m-2 (mean 4.9 ± 1.7). Bias was -2.3 L·min-1·m-2 and limits of agreement -5.6 to 1.0 L·min-1·m-2. Conclusion: During mitral valve replacement, doubtful correlations were observed between values of cardiac index at the mitral valve and the ascending aorta using TEE.

Time-domain characteristics of overlying strata failure under condition of longwall ascending mining

Ascending mining is one of the most effective ways to solve problems of water inrush, gas outburst and rock burst in coal seams mining. In order to reveal the law of motion and spatiotemporal relationship of overlaying strata, field measurement has been done in a mine. Long distance drillings were constructed from 4# coal seam to 6# coal seam at several certain typical positions, and movement and failure law of overlying strata after mining was analyzed by drilling video and observing the fluid leakage. Besides, we also analyzed the spatiotemporal development law of overlying strata failure with different mining heights and time intervals in the lower coal seam. The results show that: ascending mining is significantly affected by time-domain characteristics of overlaying strata failure after the lower coal seam's mining, height equations of caving zone and fractured zone are given in this paper, and the feasibility of ascending mining was compartmentalized concretely according to the spatiotemporal relationship. Research methods and conclusions of this paper have certain referential significance for the study of ascending mining, mining under water, mining under building, mining under railway and stress-relief mining.

Central neuromechanisms underlying control of intragastric pressure through acupuncture at Zusanli(ST36) in rats: the upper cervical cord is the key link between the ascending and descending pathways

Sensory inputs stimulated by Zusanli（ST36） acupuncture in the abdomen are known to converge in the upper cervical cord. However, it is unclear whether these inputs are subsequently conveyed to the hypothalamic paraventricular nucleus and what kind of afferent fibers are involved. We focused on the upper cervical cord, where afferent inputs converge, and detected c-fos expression in oxytocinergic neurons. We found that Zusanli acupuncture therapy effectively elevated intragastric pressure, but inhibited expression of c-fos in oxytocinergic neurons of the paraventricular nucleus in upper cervical cord injured rats. These Zusanli acupuncture effects remained even after complete dorsal cord transection. However, after complete transection of the spinal cord or dorsolateral funiculus, the effects were significantly attenuated and even disappeared. These findings suggest that the paraventricular nucleus is responsible for pooling and integrating signals from the Zusanli acupuncture and sensory information from the intragastric pressure variation, thereby contributing to the regulation of intragastric pressure. The upper cervical cord serves as the key link between ascending and descending pathways, which conveys afferent inputs to the paraventricular nucleus through the dorsolateral funiculus.