Study of Secondary Cosmic Rays and Astronomical X-Ray Sources using Small Stratospheric Balloons

The X-ray sources of the universe are extraterrestrial in nature which emit X-ray photons.The closest strong X-ray source is the Sun,which is followed by various compact sources such as neutron stars,black holes,the Crab pulsar,etc.In this paper,we analyze the data received from several low-cost lightweight meteorological balloon-borne missions launched by the Indian Centre for Space Physics.Our main interest is to study the variation of the vertical intensity of secondary cosmic rays,the detection of strong X-ray sources,and their spectra in the energy band of^(1)0–80 keV during the complete flights.Due to the lack of an onboard pointing system,low exposure time,achieving a maximum altitude of only~42 km,and freely rotating the payload about its axis,we modeled the background radiation flux for the X-ray detector using physical assumptions.We also present the source detection method,observation of the pulsation of the Crab(^(3)3 Hz),and spectra of some sources such as the quiet Sun and the Crab pulsar.

The Efficacy and Safety of Drug-Coated Balloons in the Treatment of Acute Myocardial Infarction

The incidence of acute myocardial infarction (AMI) is increasing year by year, which seriously endangers human health around the world. The preferred treatment strategy for AMI patients is the use of drug-eluting stents (DES), as there is ample evidence to suggest that stent implantation can reduce major adverse cardiovascular events (MACEs). With the application of drug-coated balloons (DCBs) and the enhancement of the concept of interventional without implantation, the question is whether DCBs can be safely and effectively used in patients with AMI? The purpose of this study was to investigate the safety and effectiveness of DCBs in the treatment of AMI. A retrospective review of clinical data was conducted on 55 AMI patients who underwent primary percutaneous coronary intervention (PCI) from January 2020 to December 2021. Of these patients, 25 were treated with DCBs and 30 were treated with DESs. Optical coherence tomography (OCT) was used to measure the minimum lumen diameter, lumen stenosis, and coronary artery dissection before and after surgery, and angina pectoris attacks and various MACEs were recorded at 1, 6, and 12 months after surgery. The results showed that there were no significant differences in clinical baseline data between the two groups. However, the minimum lumen diameter of the DCB group immediately after the operation was smaller than that of the DES group, and the stenosis degree of the lumen in the DCB group was higher than that in the DES group. The incidence of coronary artery dissection in the DCB group was significantly higher than that in the DES group, but the majority of them were type B. At 1, 6, and 12 months after treatment, there was no significant difference in the occurrence of MACEs between the two groups. In conclusion, DCBs is a safe and effective treatment for AMI. However, the incidence of coronary artery dissection in DCB patients is higher than that in DES patients, but the majority of them are type B. .

Drug-coated balloons for treating de novo lesions in large coronary vessels:A case report

BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug-coated balloons(DCB)in treating acute coronary artery occlusion and in preventing restenosis,there has been limited exploration on the use of DCB in treating de novo lesions in large vessels.Currently,DCB are only recommended for patients with small vessel lesions and in-stent restenosis lesions,those at high risk of bleeding,and other special groups of patients.CASE SUMMARY This report presents a case of successful drug-coated balloon treatment of de novo lesions in large coronary vessels.Postoperatively,the patient demonstrated favorable recovery,with subsequent examination results revealing no significant differences from the previous examination.CONCLUSION The successful treatment of the patient in our case highlights the potential of DCB in the treatment of de novo lesions in large coronary vessels.

Six intragastric balloons:Which to choose?

Endoscopically placed intragastric balloons(IGBs)have played a significant role in obesity treatment over the last 30 years,successfully bridging the gap between lifestyle modification/pharmacotherapy and bariatric surgery.Since they provide a continuous sensation of satiety that helps the ingestion of smaller portions of food,facilitating maintenance of a low-calorie diet,they have generally been considered an effective and reversible,less invasive,non-surgical procedure for weight loss.However,some studies indicate that balloons have limited sustainable effectiveness for the vast majority attempting such therapy,resulting in a return to the previous weight after balloon removal.In this review we try to summarize the pros and cons of various balloon types,to guide decision making for both the physician and the obese individual looking for effective treatment.We analyzed the six most commonly used IGBs,namely the liquid-filled balloons Orbera,Spatz3,ReShape Duo and Elipse,and the gas-filled Heliosphere and Obalon-also including comments on the adjustable Spatz3,and the swallowable Obalon and Elipse-to optimize the choice for maximum efficacy and safety.

Drug-coated balloons for the treatment of ostial left anterior descending or ostial left circumflex artery lesions:a patientlevel propensity score-matched analysis

BACKGROUND Controversy exists as to the optimal treatment approach for ostial left anterior descending(LAD)or ostial left circumflex artery(LCx)lesions.Drug-coated balloons(DCB)may overcome some of the limitations of drug-eluting stents(DES).Therefore,we investigated the security and feasibility of the DCB policy in patients with ostial LAD or ostial LCx lesions,and compared it with the conventional DES-only strategy.METHODS We retrospectively enrolled patients with de novo ostial lesions in the LAD or LCx who underwent interventional treatment.They were categorized into two groups based on their treatment approach:the DCB group and the DES group.The treatment strategies in the DCB group involved the use of either DCB-only or hybrid strategies,whereas the DES group utilized crossover or precise stenting techniques.Two-year target lesion revascularization was the primary endpoint,while the rates of major adverse cardiovascular events,cardiac death,target vessel myocardial infarction,and vessel thrombosis were the secondary endpoints.Using propensity score matching,we assembled a cohort with comparable baseline characteristics.To ensure result analysis reliability,we conducted sensitivity analyses,including interaction,and stratified analyses.RESULTS Among the 397 eligible patients,6.25%of patients who were planned to undergo DCB underwent DES.A total of 108 patients in each group had comparable propensity scores and were included in the analysis.Two-year target lesion revascularization occurred in 5 patients(4.90%)and 16 patients(16.33%)in the DCB group and the DES group,respectively(odds ratio=0.264,95%CI:0.093–0.752,P=0.008).Compared with the DES group,the DCB group demonstrated a lower major adverse cardiovascular events rate(7.84%vs.19.39%,P=0.017).However,differences with regard to cardiac death,non-periprocedural target vessel myocardial infarction,and definite or probable vessel thrombosis between the groups were non-significant.CONCLUSIONS The utilization of the DCB approach signifies an innovative and discretionary strategy for managing isolated ostial lesions in the LAD or LCx.Nevertheless,a future randomized trial investigating the feasibility and safety of DCB compared to the DES-only strategy specifically for de novo ostial lesions in the LAD or LCx is highly warranted.

Flow Past an Accumulator Unit of an Underwater Energy Storage System： Three Touching Balloons in a Floral Configuration

An LES simulation of flow over an accumulator unit of an underwater compressed air energy storage facility was conducted. The accumulator unit consists of three touching underwater balloons arranged in a floral configuration. The structure of the flow was examined via three dimensional iso surfaces of the Q criterion. Vortical cores were observed on the leeward surface of the balloons. The swirling tube flows generated by these vortical cores were depicted through three dimensional path lines. The flow dynamics were visualized via time series snapshots of two dimensional vorticity contours perpendicular to the flow direction; revealing the turbulent swinging motions of the aforementioned shedding-swirling tube flows. The time history of the hydrodynamic loading was presented in terms of lift and drag coefficients. Drag coefficient of each individual balloon in the floral configuration was smaller than that of a single balloon. It was found that the total drag coefficient of the floral unit of three touching balloons, i.e. summation of the drag coefficients of the balloons, is not too much larger than that of a single balloon whereas it provides three times the storage capacity. In addition to its practical significance in designing appropriate foundation and supports, the instantaneous hydrodynamic loading was used to determine the frequency of the turbulent swirling-swinging motions of the shedding vortex tubes; the Strouhal number was found to be larger than that of a single sphere at the same Reynolds number.

Drug-eluting balloons versus new generation drug-eluting stents for the management of in-stent restenosis: an updated meta-analysis of randomized studies

Background New-generation drug-eluting stents (DES) was more effective in the treatment of in-stent restenosis (ISR) compared with the first-generation DES. Drug-eluting balloons (DEB) and new-generation DES had been available strategies in treatment of bare-metal stents/DES ISR (BMS/DES-ISR). Six new randomized trials have recently examined the angiographic outcomes and one-year clinical outcomes of DEB and new generation DES in BMS/DES-ISR. However, the optimal management for BMS/DES-ISR lesions remains controversial. Methods We searched the randomized clinical trials evaluating the angiographic outcomes and one-year clinical outcomes of DEB and new-generation DES in patients with BMS/DES-ISR. The primary endpoints were the angiographic outcomes, including the minimal luminal diameter (MLD), diameter stenosis %(DS%), late lumen loss (LLL), and binary restenosis (BR). Results A total of six randomized clinical trials with 1177 BMS/DES-ISR patients were included in our meta-analysis. For angiographic outcomes, there were significantly less MLD and more DS% with DEB compared to new-generation DES (MLD: MD =?0.18, 95% CI:?0.31– ?0.04, P < 0.001;DS%: MD = 5.68, 95% CI: 1.00–10.37, P < 0.001). Moreover, for one-year clinical outcomes, DEB was associated with a significant increase risk in target lesion revascularization (TLR)(RR = 2.93, 95% CI: 1.50–5.72, P = 0.002). However, DEB was associated with higher risks of major adverse cardiac event, target vessel revascularization, TLR, BR, and more DS% only in DES-ISR group. Conclusions DEB and new-generation DES have the similar clinical efficacy for the treatment of BMS-ISR. However, DES showed more MLD, less DS%, and a decreased risk of TLR for the treatment of DES-ISR.

Water Balloons Snake模型的数字图像轮廓提取算法

为解决数字图像如左心室MRI图像存在着弱边缘、与周围组织之间的低对比度区域的特点,传统的Snake模型算法分割数字图像,出现变形曲线泄漏现象这一问题,提出一种改进的Balloons Snake模型—Water Balloons Snake图像分割算法。该算法利用数学形态学理论自动获取左心室数字MRI图像的重心以及边界形状变化允许空间,采用分水岭变换算法获取图像轮廓内壁分水岭线,并以此作为Snake数字模型的初始样条曲线进行进一步轮廓捕获。以小香猪左室加标记MRI数字医学图像作为应用研究对象,对比了几种模型的不同处理结果。实验表明WaterBalloons Snake模型算法比经典Snake模型或Balloons Snake模型算法能够更有效地处理变形曲线泄漏问题,并且具有较快的收敛速度。

Comparison of the safety and efficacy of two types of drug-eluting balloons （RESTORE DEB and SeQuent Please） in the treatment of coronary in-stent restenosis： study protocol for a randomized controlled trial （RESTORE ISR China）

1 Introduction In-stent restenosis （ISR）, characterized by neointimal proliferation and/or neoatherosclerosis in the vessel of the stent, can cause a reduction in lumen diameter after stent implantation, which can directly induce the recurrence of angina symptoms or an acute coronary syndrome in patients and is usually life-threatening.

Ampulla dilation with different sized balloons to remove common bile duct stones

AIM:To assess the outcomes of ampulla dilation with different sized balloons to remove common bile duct (CBD) stones.METHODS:Patients (n=208) were divided into five groups based on the largest CBD stone size of < 5,6-8,8-12,12-14,and > 14 mm.Patients underwent limited endoscopic sphincterotomy (EST) alone or limited EST followed by endoscopic papillary balloon dilation with 8,10,12 and 14 mm balloons,such that the size of each balloon did not exceed the size of the CBD.Short-and long-term outcomes,such as post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis,perforation,bleeding,and pneumobilia were compared among the five groups.RESULTS:The overall rate of successful stone removal in all groups was 100%,and all patients were cured.Eight (3.85%) patients had post-ERCP pancreatitis,none had perforations,and 6 (2.9%) had bleeding re-quiring transfusion.There were no significant differences in early complication rates among the five groups.We observed significant correlations between increased balloon size and the short-and long-term rates of postERCP pneumobilia.Post-ERCP pancreatitis and bleeding correlated significantly with age,with post-ERCP pancreatitis occurring more frequently in patients aged < 60 years,and bleeding occurring more frequently in patients aged > 70 years.We observed a significant correlation between patient age and the diameter of the largest CBD stone,with stones > 12 mm occurring more frequently in patients > 60 years old.CONCLUSION:Choosing a balloon size based on the largest stone diameter is safe and effective for removing CBD stones.Balloon size should not exceed 15 mm.

Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration

A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, spaceoccupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo Over Stitch, Trans Oral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoB arrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons(Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and Sati Sphere. The Aspire Assist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo Over Stitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.

Percutaneous transluminal angioplasty balloons for endoscopic ultrasound-guided pancreatic duct interventions

BACKGROUND Endoscopic ultrasound(EUS)-guided main pancreatic duct(PD)access may be used when conventional endoscopic retrograde cholangiopancreatography(ERCP)techniques fail.The use of a percutaneous transluminal angioplasty balloon(PTAB),originally developed for vascular interventions,can be used to facilitate transmural(e.g.,transgastric)PD access and to dilate high-grade pancreatic strictures.AIM To describe the technique,efficacy,and safety of PTABs for EUS-guided PD interventions.METHODS Patients who underwent EUS with use of a PTAB from March 2011 to August 2021 were retrospectively identified from a tertiary care medical center supply database.PTABs included 3-4 French angioplasty catheters with 3-4 mm balloons designed to use over a 0.018-inch guidewire.The primary outcome was technical success.Secondary outcomes included incidence of adverse events(AEs)and need for early reintervention.RESULTS A total of 23 patients were identified(48%female,mean age 55.8 years).Chronic pancreatitis was the underlying etiology in 13(56.5%)patients,surgically altered anatomy(SAA)with stricture in 7(30.4%),and SAA with post-operative leak in 3(13.0%).Technical success was achieved in 20(87%)cases.Overall AE rate was 26%(n=6).All AEs were mild and included 1 pancreatic duct leak,2 cases of post-procedure pancreatitis,and 3 admissions for post-procedural pain.No patients required early re-intervention.CONCLUSION EUS-guided use of PTABs for PD access and/or stricture management is feasible with an acceptable safety profile and can be considered in patients when conventional ERCP cannulation fails.

Drug eluting balloons for the treatment of coronary artery disease: What can we expect?

Drug-eluting balloons (DEBs) represent an enhancement of the therapeutic repertoire for the interventional cardiologist. The therapeutic concept of DEBs is promising, notably on the basis of initial studies in patients with diffuse in-stent restenosis (ISR). At present, however, a number of questions regarding long-term efficacy and safety remain, specifically in indications other than diffuse ISR. The results of the evaluation of different substances, balloon systems and clinical indications will determine the long-term success of DEBs.

Paclitaxel-coated balloons angioplasties for extra-long femoropopliteal artery atherosclerotic lesions(>30 cm):12 months outcomes from a single center

Objective:To evaluate the efficacy of paclitaxel-coated balloon(PCB)in the treatment of extra-long femoropopliteal artery atherosclerotic disease(>30 cm).Materials and methods:Forty-nine patients with extra-long femoropopliteal artery atherosclerotic disease were treated with PCB alone in a single center from July 2016 to May 2018.Primary patency and freedom from clinically driven target lesion revascularization(FF-CDTLR)rates during 12 months were analyzed retrospectively.Results:All patients were followed up for 18.2±7.5 months,and the mean treated lesion length was 34.9±3.7 cm.The primary patency rates were 87.8%(43/49)and 71.4%(35/49)at 6 and 12 months,respectively.FFCDTLR was 91.8%(45/49)and 77.6%(38/49)at 6 and 12 months,respectively.No mortality or amputation occurred in these patients during the follow-up period.Conclusions:PCB has favorable clinical efficacy in patients with extra-long femoropopliteal artery atherosclerotic lesions.

Hot Air Balloons

Dear Big Mouth English readers,Did you take a hot air ballon ride?I did.It was so fun!How does a hot air balloon fly then?Let's read.

经鼓室口咽鼓管球囊扩张术的疗效及咽鼓管功能的影响

目的探讨经鼓室口咽鼓管球囊扩张(balloon dilatation Eustachian tuboplasty,BET)联合腺样体消融术对慢性分泌性中耳炎(chronic secretory otitis media,CSOM)患儿的疗效及咽鼓管功能的影响。方法选取2020年6月~2022年12月间在中山市小榄人民医院就诊的CSOM患儿82例作为研究对象,采用随机数字表法分为对照组和观察组,每组41例。对照组接受腺样体消融术+鼓膜切开置管术治疗,观察组接受腺样体消融术+鼓膜切开置管术+BET术。比较两组手术相关指标及住院时间、临床症状、咽鼓管功能、临床疗效及随访6个月并发症及复发情况。结果两组术中出血量比较,差异无统计学意义(P>0.05),与对照组相比,观察组手术时间更长,住院时间更短(P<0.05)。与对照组相比,观察组中耳积液消失时间、耳鸣消失时间、鼓膜愈合时间、听力恢复时间均更短(P<0.05)。与治疗前相比,治疗后两组咽鼓管评分(Eustachian tube score,ETS)升高、咽鼓管功能障碍评分量表(Eustachian tube dysfunction questionnaire-7,ETDQ-7)评分降低(P<0.05),观察组ETS评分高于对照组,ETDQ-7评分则低于对照组(P<0.05)。观察组临床总有效率高于对照组,差异具有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(14.63%vs.9.76%,P>0.05),与对照组相比,观察组复发率更低,差异具有统计学意义(21.95%vs.2.44%,P<0.05)。结论经鼓室口BET联合腺样体消融术有助于提高CSOM患儿的临床疗效,改善咽鼓管功能,促进术后恢复,减少复发率,且并发症发生率低。

Chinese expert consensus on the clinical application of drugcoated balloon(2^(nd) Edition)

Percutaneous coronary interventions have progressed through the era of plain balloon dilation, bare-metal stent insertion to drug-eluting stent treatment, which has significantly reduced the acute occlusion and restenosis rates of target vessels and improved patient prognosis, making drug-eluting stents the mainstream interventional treatment for coronary artery disease. In recent years, drug-coated balloons(DCBs) have become a new treatment strategy for coronary artery disease, and the drugs used in the coating and the coating technology have progressed in the past years. Without permanent implant, a DCB delivers antiproliferative drugs rapidly and uniformly into the vessel wall via the excipient during a single balloon dilation. Many evidence suggests that DCB angioplasty is an effective measure for dealing with in-stent restenosis and de novo lesions in small coronary vessels.As more clinical studies are published, new evidence is emerging for the use of DCB angioplasty in a wide range of coronary diseases, and the indications are expanding internationally. Based on the latest research from China and elsewhere, the Expert Writing Committee of the Chinese Expert Consensus on Clinical Applications of Drug-Coated Balloon has updated the previous DCB consensus after evidence-based discussions and meetings in terms of adequate preparation of in-stent restenosis lesions, expansion of the indications for coronary de novo lesions, and precise guidance of DCB treatment by intravascular imaging and functional evaluation.

Indian monsoon drove the dispersal of the thoracica group of Scytodes spitting spiders

We examined the global biogeography of the Scytodes thoracica group of spitting spiders based on 23 years of sampling at the species level(61 species in the thoracica group and 84 species of Scytodes)using DNA data from six loci.Our results indicated that the thoracica group initially dispersed from Southeast Asia to East Africa between 46.5 and 33.0 million years ago,and dispersal events intensified between Southeast/South Asia and East/South Africa from the early to late Miocene.The timing of these events indicates that Asian-African faunal exchange of the thoracica group was driven by the Indian monsoon,and the pattern of dispersal suggests that colonialization took root when the Indian monsoon shifted from a North-South direction to an East-West direction from the middle Eocene.

Pre-hospital application of REBOA for life-threatening hemorrhage

Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military and civilian conditions,non-compressible torso hemorrhage always caused rapid exsanguination and high mortality rates before definitive treatment[2].More than half of the deaths due to non-compressible torso hemorrhage occur before hospital care can be provided[2].Therefore,early and rapid pre-hospital hemorrhage control is essential to reduce mortality.

Long-term outcomes of urethral balloon dilation for anterior urethral stricture: A prospective cohort study

Objective:To prospectively follow up a cohort of anterior urethral stricture disease patients managed with balloon dilation(BD)for 3 years to evaluate the long-term outcomes and to study factors that contribute to recurrence.Methods:This study included men who had urethral BD for significant anterior urethral stricture disease between January 2017 and March 2019.Data about the patient age,stricture characteristics,and recurrence date were recorded,along with information on postoperative indwelling catheter use and operative complications.Furthermore,information about the self-calibration procedure was collected and where available,free flow(FF)measurements during the follow-up period were recorded and analyzed.Success was defined as a lack of symptoms and acceptable FF rates(maximum flow rate>12 mL/s).Results:The final analysis was conducted on 187 patients.The mean follow-up period was 37 months.The long-term overall success rate at the end of our study was 66.8%.Our recurrence rate was 7.4%at 12 months,24.7%at 24 months,and reached 33.2%at the end of our study.The time to recurrence ranged from 91 days to 1635 days,with a mean of 670 days.The stricture-free survival was significantly shorter with lengthy peno-bulbar(p=0.031)and multiple strictures(p=0.015),and in the group of patients who were not committed to self-calibration protocol(p<0.011).However,post-procedural self-calibration was the most important factor that may have decreased the incidence of recurrence(odds ratioZ5.85).Adjuvant self-calibration after BD not only reduced the recurrence rate from 85.4%in the non-self-calibration group to 15.1%in the self-calibration one(p<0.001),but also improved the overall stricture-free survival and FF parameters.