Multiple paradoxical embolisms caused by central venous catheter thrombus passing through a patent foramen ovale: A case report

BACKGROUND To date,this is the first case of a paradoxical embolism(PDE)that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter(CVC)thrombus via a patent foramen ovale(PFO).CASE SUMMARY Here,we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC.The patient presented to the hospital with acute chest pain and lower limb fatigue.Doppler ultrasound showed a large thrombus in the right internal jugular vein,precisely at the tip of the CVC.Transthoracic and transesophageal echocardiography confirmed the existence of a PFO,with inducible right-to-left shunting by the Valsalva maneuver.The patient was administered an extended course of anticoagulation therapy,and then the CVC was successfully removed.Percutaneous PFO closure was not undertaken.There was no recurrence during follow-up.CONCLUSION Thus,CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.

Safety and Efficacy of Biodegradable Patent Foramen Ovale Occluder in Patients with Migraine:A Clinical Trial

Background:Transcatheter closure of patent foramen ovale(PFO)has been widely accepted as a highly effective way to treat high-risk PFO-related diseases.However,traditional non-degradable occluders made of metal alloys will permanently exist in the body,resulting in thrombosis,valve damage,hemolysis,arrhythmia,or other complications.The biodegradable PFO occluder developed by Shanghai Mallow Medical Instrument Co.,Ltd.,China can be fully absorbed and degrade into nontoxic ingredients,reducing postoperative complications.Objectives:To study the safety and efficacy of biodegradable PFO occluders in treating PFO.Methods:This single-center clinical trial collected 30 patients treated with a biodegradable PFO occluder.The follow-up period lasted 12 months to analyze the echocardiographic characteristics and headache relief through HIT-6 scores.Results:The immediate success rate was 100%,with no intraoperative severe occlusion-related complications.The contrast transcranial Doppler(cTCD)at 12 months showed that all patients’right-to-left shunts(RLS)were grade I or 0 with no serious postoperative complications,indicating the overall success rate was 100%.The biodegradable PFO occluder mostly degraded six months after the occlusion.Conclusion:PFO closure with a Mallow biodegradable occluder is safe and effective and has no severe complications.

Platypnea-Orthodeoxia Syndrome in an Elderly Patient Treated with Percutaneous Patent Foramen Ovale Closure: Report of a Case and Review of the Literature

Introduction: Platypnea-Orthodeoxia syndrome is characterized by dyspnea and hypoxia in the upright position, usually improving in the supine position. Two components are required: an interatrial or intrapulmonary shunt, and a functional component. Diagnosis is made by contrast ultrasonography. We report a case of Platypnea-Orthodeoxia syndrome revealed by positional dyspnea in an 87-year-old patient. The aim of this study is to describe the clinical, therapeutic and evolutionary profile of this syndrome. Case Presentation: This is an 87-year-old patient with a history of pulmonary embolism (PE) and stroke. He was seen for dyspnea and desaturation in orthostatism, revealing a patent foramen ovale (PFO). Progression was favorable after closure of the PFO. Conclusion: Platypnea-Orthodeoxia syndrome may be presented as simple exertional dyspnea. The clinician should check for improvement in symptoms and/or oxygenation during decubitus. Definitive treatment consists of percutaneous closure of the shunt.

基于OVAL的新型漏洞评估系统

漏洞评估技术基于防患于未然思想,采用主动探测方法发现系统存在的安全漏洞并提供相应解决方案.针对目前漏洞评估系统存在误报率高、扫描时间长且需要开发攻击代码的缺点,本文提出一种基于OVAL的新型漏洞评估系统.该系统由控制台、数据中心和检测代理3大模块组成,这三个模块协同实现漏洞评估.与现有漏洞评估系统相比,具有精度高、对目标系统性能影响小、评估时间短和可扩展性强的优点,而且免除传统漏洞评估系统所需的攻击代码开发工作.

从OVAL漏洞信息转换到Nessus扫描插件的研究与实现

网络安全漏洞扫描应充分考虑执行的效率和信息的共享。本文通过对OVAL和Nessus的介绍,分析O- VAL Definition与Nessus plugin之间的异同,提出并实现了一种将OVAL公布的漏洞信息转换成Nessus扫描插件的方法,共享了漏洞信息,并提升了漏洞检测的品质。最后经过实验说明该方法的可行性。

OVALS海洋资料同化系统并行计算研究

海洋数值预报技术的发展与高性能计算密切相关。为提高OVALS海洋资料同化系统的时效性,本文实现了OVALS系统的并行化。在温盐资料同化模块并行化过程中,本文提出了层优先处理器划分算法,并研究了基于该算法的并行I/O、全局通讯等实现方法;在高度计资料同化模块并行化过程中,设计实现了基于预处理的非规则区域分解算法,较好地实现了OVALS并行计算负载平衡。数值实验表明,OVALS并行系统在36并行规模下取得了17.45的并行加速比。

Novel way of patent foramen ovale detection and percutaneous closure by intracardiac echocardiography:A case report

BACKGROUND Patent foramen ovale(PFO)is the most common congenital heart disease and is associated with several diseases,including stroke and migraine.PFO diagnosis involves transoesophageal echocardiography,transthoracic echocardiography,and transcranial Doppler.Recent studies have shown that intracardiac echocardiography(ICE)can be used to diagnose and guide percutaneous transcatheter closure.CASE SUMMARY A 70-year-old male presented with paroxysmal dizziness and limb weakness for the past 3 mo.Magnetic resonance imaging revealed a history of stroke,and a bubble test revealed the presence of PFO.The patient was then transferred to our hospital for PFO closure.Under ICE guidance,the separation of the septum primum and septum secundum was unclear;we then used a Swartz catheter to confirm PFO by applying physical pressure on the right part of the atrial septum without using any contrast.The ICE continuously and clearly guided the procedure.CONCLUSION ICE can guide PFO closure in patients with a history of stroke.When PFO is not evident under ICE,a Swartz catheter can be used.

基于OVAL新型漏洞检测器漏洞库的设计与实现

针对目前主流的漏洞扫描技术中漏洞库的不完整,本文提出了一种新型的基于OVAL的漏洞检测器,其漏洞库可根据需要扫描系统软件、硬件和配置信息等,并以此确定系统中存在的安全漏洞。此检查器所能扫描的操作系统很多,该篇文章以RedHat为载体讲述工作原理和实现。

川芎内生菌Pseudeurotium ovale代谢产物研究

通过大孔树脂柱层析、凝胶柱层析和高效液相色谱等方法对川芎中分离得到的内生菌Pseudeurotium ovale的代谢物进行分离纯化,从中分离得到5个化合物,并通过核磁共振和质谱等波谱学技术手段确认所有化合物的结构,其中包含一个新的化合物4-methoxy-3-methyl-6-(1 E,3 E)-1,3-pentadien-1-yl-2 H-pyran-2-one(1)和四个首次从中分离得到的已知化合物:(2 E,4 E)-1-(2,6-dihydroxy-3,5-dimethylphenyl)-2,4-hexadien-1-one(2)、2-deoxy-sohirnone C(3)、trichodimerol(4)、3,7-dihydroxy-1,9-dimethyl-dibenzofuran(5)。体外抗炎活性测试表明化合物1可抑制经脂多糖(LPS)处理的RAW 264.7细胞中NO、IL-6和TNF-α等炎症因子的分泌。

NUMERICAL SIMULATION OF ROUND TO OVAL ROLLING PROCESS

Three dimensional thermal-mechanical coupled elasto-plastic FEM has been used for simulation of round to oval single pass rolling. The analysis was conducted using MARC/AUTOFORCE1. 2 code. The material is assumed to be elasto-plastic and it obey the Von Mises yield criterion and Prandtl- Reuss rule. Deformation of the workpiece is simulated in a step-by-step manner,updating the coordinates of material points and the property after each step, so that both nonsteady-state and stendy-state deformation can be simulated. The heat transfter between the workpiece, the rolls, and enviroment and the heat generation due to plastic work and friction force, are considered in the analys- is.Predicted the deformation shape of the workpiece, distributions of strains, stresses, strain rates and temperatures, roll-separating force and roll torque are presented.

Immunohistochemical study of hepatic oval cells in human chronic viral hepatitis

AIM To detect immunohistochemically the presence of oval cells in chronic viral hepatitis with antibody against c-kit.METHODS We detected oval cells in paraffin-embedded liver sections of 3 normal controls and 26 liver samples from patients with chronic viral hepatitis, using immunohistochemistry with antibodies against c-kit, π-class glutathione Stransferase ( Tr-GST ) and cytokeratins 19(CK19).RESULTS Oval cells were not observed in normal livers. In chronic viral hepatitis, hepatic oval cells were located predominantly in the periportal . region and fibrosis septa,characterized by an ovoid nucleus, small size,and scant cytoplasm. Antibody against stem cell factor receptor, c-kit, had higher sensitivity and specificity than π-GST and CK19. About 50% -70% of c-kit positive oval cells were stained positively for either π-GST or CK19.CONCLUSION Oval cells are frequently detected in human livers with chronic viral hepatitis, suggesting that oval cell proliferation is associated with the liver regeneration in this condition.

Patent foramen ovale closure reduces recurrent stroke risk in cryptogenic stroke:A systematic review and metaanalysis of randomized controlled trials

AIM To investigate if patent foramen ovale(PFO) closure device reduces the risk of recurrent stroke in patients with cryptogenic stroke.METHODS We searched five databases-Pub Med,EMBASE,Cochrane,CINAHL and Web-of-Science and clinicaltrials.gov from January 2000 to September 2017 for randomized trials comparing PFO closure to medical therapy in cryptogenic stroke.Heterogeneity was determined using Cochrane's Q statistics.Random effects model was used.RESULTS Five randomized controlled trials with 3440 patients were included in the analysis.Mean follow-up was 50 ± 20 mo.PFO closure was associated with a 41% reduction in incidence of recurrent strokes when compared to medical therapy alone in patients with cryptogenic stroke [risk ratio(RR): 0.59,95%CI: 0.40-0.87,P = 0.008].Atrial fibrillation was higher with device closure when compared to medical therapy alone(RR: 4.97,95%CI: 2.22-11.11,P < 0.001).There was no difference between the two groups with respect to all-cause mortality,major bleeding or adverse events.CONCLUSION PFO device closure in appropriately selected patients with moderate to severe right-to-left shunt and/or atrial septal aneurysm shows benefit with respect to recurrent strokes,particularly in younger patients.Further studies are essential to evaluate the impact of higher incidence of atrial fibrillation seen with the PFO closure device on long-term mortality and stroke rates.

Clinical relevance of atrial septal aneurysm and patent foramen ovale with migraine

AIM To test the potential association between atrial septal aneurysm(ASA) and migraine in patent foramen ovale(PFO) closure patients through an observational, singlecenter, case-controlled study.METHODS We studied a total of 450 migraineurs who had rightto-left shunts and underwent PFO closure in a retrospective single-center non-randomized registry from February 2012 to October 2016 on the condition that they were aged 18-45 years old. Migraine was diagnosed according to the International Classification of Headache Disorders, 3^(rd) edition and evaluated using the Headache Impact Test-6(HIT-6). All patients underwent preoperative transesophageal echocardiography, contrast transthoracic echocardiography, and computed tomography or magnetic resonance imaging examinations, with subsequent fluoroscopy-guided PFO closure. Based on whether they have ASA or not, the patients were divided into two groups: A(PFO with ASA, n = 80) and B(PFO without ASA, n = 370). Baseline characteristics and procedural and follow-up data were reviewed. RESULTS Compared to group B, group A had an increased frequency of ischemic lesions(11.3% vs 6.2%, P = 0.038) and migraine with aura(32.5% vs 21.1%, P = 0.040). The PFO size was significantly larger in group A(P = 0.007). There was no significant difference in HIT-6 scores between the two groups before and at the oneyear follow-up after the PFO closure [61(9) vs 63(9), P = 0.227; 36(13) vs 36(10), P = 0.706].CONCLUSION Despite its small sample size, our study suggests that the prevalence of ASA in PFO with migraine patients is associated with ischemic stroke, larger PFO size, and migraine with aura.

The expression of c-kit and proliferating cell nuclear antigen in oval cells of rats with hepatocellular carcinoma

OBJECTIVE: To study the relationship between oval cells and primary hepatocarcinoma and the expression of c-kit and proliferating cell nuclear antigen (PCNA) in oval cells of rats with hepatocellular carcinoma. METHODS: A hundred and twenty clean SD rats were divided into three groups: normal group, cancer-induction group and intervention group. The normal group was fed with standard forage while the rest two groups were fed with 3'-methyl-2-methylamino-azobenzene (DAB) to induce carcinoma for 14 weeks and then fed with standard forage and water. Uscharidin was injected abdominally to the intervention group from the first week to the 14th week. All rats were killed and biopsy specimens were taken from the left and right liver lobes for immunohistochemical staining of c-kit and PCNA on the 2nd, 4th, 6th, 8th, 10th, 12th, 14th, 16th, 18th, 20th, 22nd, and 24th week. RESULTS: From the 2nd to 14th week after liver infection, c-kit positive cells, mainly oval cells were found in the portal area in the carcinoma-induction group and dotted positive pigmentations in liver lobules. In the 22nd week, a large number of cancerous nodes occurred and nuclei heteromorphi-m was apparent; the number of positive cell decreased but positive cells could be sparsely observed in cancerous nodes. In the 2nd week of the carcinoma-induction process, PCNA positive cells were oval cells in the portal area. In the 4th week, a lot of hepatic cells were positively stained, especially in the central vein area. In the 6th week, PCNA positive cells could be seen in the lobules of the liver. In the 8th week, the number of PCNA cells decreased comparatively. From the 10th to 14th week, oval cells in the portal area were still over-expressed. From the 16th to 24th week, a large number of cancerous nodes occurred and PCNA was over-expressed in some of them. In necrotic cancerous nodes, the para-cancerous PCNA positive cells were sparsely distributed and their number was less than that of PCNA positive cells of cancerous tissues. CONCLUSIONS: Hepatic stem cells originating from the terminal biliary plexus of the portal area are involved in the development of hepatocarcinoma because c-kit positive cells expressed in cancerous nodes, accompany the whole process of the development. In the middle inflammatory period of carcinoma-induction, the expression of PCNA in hepatic cells peaked, but the index decreased in the late inflammatory period and in the proliferated fibrosis stage. The expression of PCNA is a tortuous process, going up, down, then up again from normal tissues to cancerous tissues. Combined with pathological findings, PCNA can be considered as a warning index for carcinomatous cells.

基于OVAL的安卓漏洞检测评估系统

传统漏洞检测工具检测时间长,占用大量系统资源,需要对系统进行模拟攻击,难以应对越来越复杂的安卓漏洞威胁。提出了一种"C/S"架构的、基于开放漏洞评估语言(OVAL)的安卓漏洞检测评估系统。这种架构将大部分评估工作放在控制台端执行,减少了对安卓系统性能的影响,其以OVAL作为漏洞评估标准,在保证评估高精度的同时也具有更好的开放性和可扩展性。

Distribution of oval cells and c-myc mRNA expression in mouse hepatocarcinogenesis

BACKGROUND: This study was designed to assess theroles of oval cells and c-myc mRNA in the process of hepa-tocarcinogenesis and to clarify the function of carcinogenec-myc in the development of hepatocellular carcinoma( HCC) and the mechanism of inhibitory function of uscha-ridin on HCC in mouse hepatocarcinogenesis.METHODS: A total of 120 clean SD mice were divided intonormal group, cancer induction group, and interventiongroup. The normal group was fed with standard foragewhile the rest two groups were given p-dimethylaminoazo-benzene (DAB) to induce cancer. Thirteen weeks after in-duction of cancer, the two groups were fed with standardforage and water. Once the pattern was set up, the inter-vention group was given uscharidin injection into the ab-dominal cavity from the first week to the 14th week. Onthe 2nd, 4th, 6th, 8th, 10th, 12th, 14th, 16th, 18th, 20th,22nd, and 24th week, all mice were killed and biopsiedfrom the liver lobe for pathological analysis. At the sametime, the number of tumor nodes was counted and the ex-pression of c-myc mRNA was tested by RT-PCR.RESULTS: Since the 2nd week after cancer induction, pro-liferated oval cells could be seen in the portal area. Initially,the oval cells appeared in the cortical layer of the portalarea, then proliferated gradually and immigrated into theliver parenchyma. In the period of fibrosis after liver proli-feration, proliferated heaps of oval cells were noted in bothportal and peripheral areas. In the period of carcinomatouschange, oval cells could be seen both outside and inside ofcancer nodes, but most of them were distributed outside.The c-myc gene was expressed negatively in the liver tissueof mice. The quantity of the expression began to increaseat the time of infection of the liver and tended to increasewith the degree of hepatic injury. In the period of cancera-tion, the expression level of c-myc mRNA increased gra-dually. The intervention of uscharidin could not inhibit butdelay the increase of the expression of c-myc mRNA.CONCLUSION: Oval cells are closely related to hepatocar-cinoma cells, which play an important role in the occur-rence and development of hepatocarcinogenesis. Uschari-din can inhibit the occurrence of hepatocarcinogenesis orlocal spreading at the early stage of cancer induction byDAB, but it cannot inhibit the expression of c-myc.

Who benefits from percutaneous closure of patent foramen ovale vs medical therapy for stroke prevention? In-depth and updated metaanalysis of randomized trials

BACKGROUND A few randomized clinical trials(RCT) and their meta-analyses have found patent foramen ovale closure(PFOC) to be beneficial in prevention of stroke compared to medical therapy. Whether the benefit is extended across all groups of patients remains unclear.AIM To evaluate the efficacy and safety of PFOC vs medical therapy in different groups of patients presenting with stroke, we performed this meta-analysis of RCTs.METHODS Electronic search of PubMed, EMBASE, Cochrane Central, CINAHL and ProQuest Central and manual search were performed from inception through September 2018 for RCTs. Ischemic stroke(IS), transient ischemic attack(TIA), a composite of IS, TIA and systemic embolism(SE), mortality, major bleeding,atrial fibrillation(AF) and procedural complications were the major outcomes.Random-effects model was used to perform analyses.RESULTS Meta-analysis of 6 RCTs including 3560 patients showed that the PFOC,compared to medical therapy reduced the risk of IS [odds ratio: 0.34; 95%confidence interval: 0.15-0.78; P = 0.01] and the composite of IS, TIA and SE [0.55(0.32-0.93); P = 0.02] and increased the AF risk [4.79(2.35-9.77); P < 0.0001]. No statistical difference was observed in the risk of TIA [0.86(0.54-1.38); P = 0.54],mortality [0.74(0.28-1.93); P = 0.53] and major bleeding [0.81(0.42-1.56); P = 0.53]between two strategies. Subgroup analyses showed that compared to medical therapy, PFOC reduced the risk of stroke in persons who were males, ≤ 45 years of age and had large shunt or atrial septal aneurysm.CONCLUSION In certain groups of patients presenting with stroke, PFOC is beneficial in preventing future stroke compared to medical therapy.

Closing patent foramen ovale in cryptogenic stroke:The underscored importance of other interatrial shunt variants

Recent trials and metanalysis even not fully conclusive and still debated,at least suggested that mechanical device-based closure of patent foramen ovale(PFO)is more effective than medical therapy in prevent recurrence of stroke. In a proportion ranging from 20% to nearly 40% of patients in literature,PFO is associated to atrial septal aneurysm(ASA):ASA is a well-known entity often associated with additional fenestration. Additionally small atrial septal defects("Flat ASD") can present with signs of paradoxical embolism and cannot be easily detected by transthoracic echocardiography or even by transesophageal echocardiography and are usually discovered by intracardiac echocardiography at the moment of transcatheter closure. This evidence might change potentially the anatomical diagnosis from PFO to fenestrated ASA or as we called it to "hybrid defect",being a bidirectional flow through a small ASD or/and an additional fenestration,often present. Despite the differences in anatomy,pathophysiology and haemodynamic paradoxical embolism may occur in both entities and also may be the first appearance of fenestrated ASA. Because some overlapping do really exist between PFO and hybrid defects,which are often not clearly differentiable by standard diagnostic tools,it is likely that a proportion of patients evaluated for potential transcatheter closure of PFO had actually a different anatomical substrate. These different anatomical and pathophysiologic entities have not been address in any of the previous trials,potentially having an impact on overall results despite the similar mechanical treatment. Neurologists and general cardiologists in charge of clinical management of PFOrelated cryptogenic stroke should be aware of the role of hybrid defects in the pathophysiology of paradoxical embolism- mediated cerebral ischemic events in order to apply the correct decision- making process and avoid downgrading of patients with paradoxical embolism-related interatrial shunt variants different from PFO.

Scala tympani drill-out technique for oval window atresia with malformed facial nerve: A report of three cases

Objective: To report a scala tympani drill-out technique for managing malformed facial nerve covering the entire oval window(OW).Methods: Data from three cases with OW atresia, malformed stapes and abnormal facial nerve courses were reported, in which a scala tympani drill-out technique was employed with a TORP between the tympanic membrane and scala tympani fenestration for hearing reconstruction.Results: Air conduction hearing improved in two of the three cases following surgery. In the third case, there was no improvement in air conduction hearing following a canal wall up mastoidectomy and tympanoplasty. There were no vertigo, tinnitus or sensorineural hearing loss in the three cases.Conclusion: The scala tympani drill-out technique, which is basically fenestration at the initial part of the basal turn, provides a choice in hearing reconstruction when the OW is completely covered by abarrently coursed facial nerve.

Paradoxical embolus straddling patent foramen ovale demonstrated by computed tomographic pulmonary angiography

An elderly gentleman presented to the emergency department with a recent history of dyspnoea, collapse and transient neurological symptoms. He was noted to be hypoxic with a significantly elevated D Dimer. A computer tomography pulmonary angiogram demonstrated a large embolus with a further filling defects within the left and the right atria, abutting the interatrial septum. Suspicion of a paradoxical pulmonary embolus was raised and the patient subsequently underwent echocardiography which confirmed a patent foramen ovale(PFO). He was commenced on warfarin therapy. In patients with elevated right heart pressure, a PFO can be unmasked and give rise to cerebral emboli. Clinical suspicion should be raised in patients with pulmonary emboli or deep venous thrombosis if there is a concomitant history of focal neurological symptoms.