Unroofing Technique for Anomalous Origin of the Left Coronary Artery from the Right Sinus of Valsalva: Report of a Case

Anomalous origin of the left coronary artery (AOLCA) from the right sinus of Valsalva constitutes a rare congenital coronary artery anomaly. Patients with an anomalous left main coronary artery face a significantly higher risk of sudden cardiac death compared to those with an anomalous right coronary artery. The anomalous coronary artery traversing between the ascending aorta and the pulmonary artery markedly heightens the risk of myocardial ischemia, arrhythmia, and sudden death. Symptomatic patients often exhibit a longer intramural course of the coronary artery, which may necessitate earlier intervention or influence the choice of surgical repair method. Surgical intervention is advocated for patients with this anomaly, even in the absence of symptoms. For anomalous aortic origin of a coronary artery from the opposite sinus of Valsalva with an intramural course, coronary unroofing is the preferred revascularization procedure. This report presents a case of AOLCA originating from the right sinus of Valsalva, treated surgically using the unroofing technique for the aortic intramural segment of the anomalous coronary artery traversing between the great vessels. The unroofing technique is recommended for treating AOLCA with an extensive intramural course that does not involve the commissure.

Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation

BACKGROUND Prior studies have shown that preserving the left colic artery(LCA)during laparo-scopic radical resection for rectal cancer(RC)can reduce the occurrence of anasto-motic leakage(AL),without compromising oncological outcomes.However,anatomical variations in the branches of the inferior mesenteric artery(IMA)and LCA present significant surgical challenges.In this study,we present our novel three dimensional(3D)printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.AIM To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.METHODS We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People’s Hospital.Patients were divided into the 3D printing and control groups for sta-tistical analysis of perioperative characteristics.RESULTS The 3D printing observation group comprised of 72 patients,while the control group comprised 68 patients.The operation time(174.5±38.2 minutes vs 198.5±49.6 minutes,P=0.002),intraoperative blood loss(43.9±31.3 mL vs 58.2±30.8 mL,P=0.005),duration of hospitalization(13.1±3.1 days vs 15.9±5.6 days,P<0.001),postoperative recovery time(8.6±2.6 days vs 10.5±4.9 days,P=0.007),and the postoperative complication rate(P<0.05)were all significantly lower in the observation group.CONCLUSION Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively,thereby reducing intraoperative bleeding and shortening operating time,demonstrating better clinical application potential.

Superior Mesenteric Artery Syndrome, a Rare Complication of Severe Malnutrition: Two Cases from a Subsaharian Endocrinology Department

Introduction: Superior mesenteric artery syndrome (SMAS), a rare diagnosis due to compression of the third duodenum between the superior mesenteric artery (SMA) and the aorta resulting in bowel obstruction, may lead to severe malnutrition. We report two cases of patients hospitalised in the Internal Medicine, Endocrinology, Diabetology, and Nutrition Department of the National Hospital Center (NHC) of Pikine. Observations: Patient 1: A 35-year-old female was referred for an aetiological diagnosis due to a rapid weight loss of 15 kilograms in one month, accompanied by persistent vomiting, following an appendectomy performed a month before admission. Upon clinical examination, she presented severe malnutrition (Buzby index of 76%), early post-prandial chronic vomiting, and a poor general condition. An abdominal CT scan revealed aortomesenteric clamp syndrome (AMCS) with an angulation between the aorta and the SMA of 13˚. The underlying cause in this patient was severe malnutrition. Fortunately, her condition improved with medical treatment. Patient 2: We report the case of a 30-year-old female hospitalized due to unusual weight-bearing post-prandial epigastric pain and intermittent vomiting over the past six months. Upon physical examination at admission, she exhibited severe malnutrition with a body mass index (BMI) of 14 kg/m2, a Buzby index of 71%, trophic disorders, and a stage IV general condition assessment according to the World Health Organization (WHO). An abdominal CT scan revealed AMCS with an angle between the aorta and the SMA of 22˚ and an aortomesenteric space of 4 mm. The outcome was poor with medical treatment failure and, unfortunately, the patient died before surgery. Conclusion: SMAS is rarely evoked in clinical practice despite the presence of contributing factors and suggestive clinical signs. The prognosis depends on management time.

Vertebral Artery Stenting for Acute Multiple Cerebral Infarctions Caused by Vertebral Artery Dissection After Massage:A Case Report

Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 32-year old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage.She underwent emergency vertebral artery stent implantation at the site of the dissection.Symptoms were relieved the day after treatment.The patient recovered without adverse complications or endovascular restenosis in the following year.

Transanal eco-Doppler evaluation after hemorrhoidal artery embolization

BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and 94%,with a rebleeding rate of 13.6%.AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.METHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center,Treviso Regional Hospital,Italy.In a 2 months period(February-March 2022),consecutive patients with hemorrhoidal bleeding scores(HBSs)≥4,Goligher scores of II or III,failure of non-operative management,and a candidate for Emborrhoid were included.Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure.The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment.The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.RESULTS Eleven patients underwent Emborrhoid.The overall pretreatment mean systolic peak(MSP)was 14.66 cm/s.The highest MSP values were found in the anterior left lateral(17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock)and in the posterior right lateral(14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock)quadrants of the anal canal.After treatment,the overall MSP values were significantly reduced(P=0.008)although the correlation between MSP and HBS changes was weak(P=0.570).A statistical difference was found between distal embolization compared with proximal embolization(P=0.047).However,the coil landing zone was not related to symptoms improvement(P=1.000).A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery(SRA)anatomy(P=0.040).No relationship between hemorrhoidal grades(P=1.000),SRA anatomy(P=1.000)and treatment outcomes was found.CONCLUSION The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease.However,the correlation between the post-operative MSP and HBS changes was weak.Hemorrhoidal grade,SRA anatomy and type of embolization were not related to treatment outcomes.

Efficacy and safety of targeted therapy plus immunotherapy combined with hepatic artery infusion chemotherapy (FOLFOX) for unresectable hepatocarcinoma

BACKGROUND The advent of cutting-edge systemic therapies has driven advances in the treatment of hepatocellular carcinoma(HCC),and therapeutic strategies with multiple modes of delivery have been shown to be more efficacious than mono-therapy.However,the mechanisms underlying this innovative treatment modality have not been elucidated.AIM To evaluate the clinical efficacy of targeted therapy plus immunotherapy combined with hepatic arterial infusion chemotherapy(HAIC)of FOLFOX in patients with unresectable HCC.METHODS We enrolled 53 patients with unresectable HCC who received a combination of targeted therapy,immunotherapy,and HAIC of FOLFOX between December 2020 and June 2021 and assessed the efficacy and safety of the treatment regimen.RESULTS The objective response rate was 60.4%(32/53),complete response was 24.5%(13/53),partial response was 35.9%(19/53),and stable disease was 39.6%(21/53).The median duration of response and median progression-free survival were 9.1 and 13.9 months,respectively.The surgical conversion rate was 34.0%(18/53),and 1-year overall survival was 83.0%without critical complicating diseases or adverse events(AEs).CONCLUSION The regimen of HAIC of FOLFOX,targeted therapy,and immunotherapy was curative for patients with unresectable HCC,with no serious AEs and a high rate of surgical conversion.

Orbital and sinus rhabdomyosarcoma with concurrent central retinal artery occlusion:A case report

BACKGROUND Both rhabdomyosarcoma(RMS)and central retinal artery occlusion(CRAO)are rare medical diseases,and their simultaneous occurrence in the same patient is extraordinarily uncommon.This study presents a comprehensive overview of the clinical manifestations,diagnostic imaging results,and therapeutic interventions of a patient with both conditions.CASE SUMMARY In this report,we present a 30-year-old male who presented with significant protrusion,pain and vision loss and was diagnosed with RMS in the orbit and sinus with CRAO.Following resection of the sinus and orbital mass and enucleation of the right eye,the patient experienced symptom improvement.CONCLUSION This article provides an in-depth analysis of the patient’s clinical manifestations,the tumor’s anatomical origin,and the etiology of CRAO.The concurrent manifestation of both RMS and CRAO is exceedingly uncommon in clinical practice.

Ruptured Splenic Artery Aneurysm (SAA) in an Elderly Patient with Hypercoagulability: A Very Vague Presentation

Here, we discuss a 78-year-old woman with symptoms of shortness of breath and intermittent productive cough, which worsened over time. She had a history of Factor V Leiden and unprovoked pulmonary embolism (PE) and was on lifelong warfarin. The patient was found to have a widened mediastinum and a small left-sided pleural effusion on chest X-ray, leading to CT aortogram to assess for aortic pathology. While in the CT scanner, she experienced an acute deterioration and went into shock. The initial diagnosis was anaphylactic reaction to the contrast agent, but the CT images revealed an active bleeding in the left upper quadrant, possibly of splenic origin. The patient was stabilized with aggressive resuscitation measures and transferred to a referral hospital for urgent surgery. The surgery revealed a ruptured splenic artery aneurysm (SAA), and the patient was taken to the intensive care unit (ICU) for further management. However, she developed a large infarct in the left occipital lobe and passed away after six days. The case highlights the significance of recognizing the symptoms and signs of SAA and then taking a multidisciplinary approach in managing SAA patients, particularly those with hypercoagulability (Graphic 1).

Employing a random forest model to forecast the likelihood of coronary artery lesions in Kawasaki disease: a study centered on four biomarkers

Background:Kawasaki disease is an acute immune vasculitis,which is more common in children under 5 years old.Kawasaki disease mainly affects the cardiovascular system,especially the coronary arteries.Once coronary artery damage occurs,it can significantly impact the patient’s prognosis.Therefore,in some countries and regions,Kawasaki disease has become a common acquired heart disease.Methods:First,univariate analysis was conducted on each predictive factor.Then,Least Absolute Shrinkage and Selection Operator and random forest algorithms were used to screen all predictive factors,and the prediction model was evaluated using receiver operating characteristic curve,calibration curve,and Decision Curve Analysis.Results:This study,based on data from 228 Kawasaki disease patients,utilized a random forest model to identify four predictive factors:white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count.These factors were used to construct a prediction model,which achieved an area under the curve of 0.743.Conclusions:We developed a forest plot based on white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count to effectively predict the occurrence of coronary artery lesions in Kawasaki disease.

Analysis of the Effects of Preoperative Hepatic Artery Chemoembolization and Quality Nursing Intervention on the Perioperative Safety and Short-term Prognosis of Liver Transplantation in Patients with Hepatocellular Carcinoma

Objective: To investigate the effects of preoperative hepatic artery chemoembolization (TACE) and quality nursing interventions on the perioperative safety and short-term prognosis in patients with hepatocellular carcinoma undergoing liver transplantation. Methods: The study period spanned from January 2021 to December 2023, and 125 patients with hepatocellular carcinoma admitted to our hospital were selected, all of whom underwent liver transplantation. They were randomly divided into an observation group (n = 63) and a control group (n = 62). The patients in the control group did not undergo TACE before the operation, and the patients in the observation group underwent TACE and quality nursing intervention before the operation. The operation time, intraoperative blood loss, length of hospitalization, liver- free period, complication rate, short-term prognosis, and liver function indexes between the two groups were compared. Results: There was no significant difference in operation time, intraoperative blood loss, and length of hospitalization between the two groups (P < 0.05). The liver-free period of patients in the observation group was longer than that of the control group (P < 0.05). The two groups had no significant difference in the incidence of biliary complications, vascular complications, and postoperative infections (P > 0.05). The rate of immune reactive complications in the observation group was lower than that of the control group (P < 0.05). There was no significant difference in the perioperative mortality rate, 1-year postoperative survival rate, and 2-year postoperative survival rate (P > 0.05). The two groups had no significant difference in postoperative liver function indexes (P > 0.05). Conclusion: Preoperative TACE and high-quality nursing intervention in patients with hepatocellular carcinoma had no adverse effect on the perioperative safety and short-term prognosis, prolonged the liver-free time, and reduced the incidence of immune-reactive complications.

Proprotein convertase subtilisin/kexin type 9 inhibitors in peripheral artery disease:A review of efficacy,safety,and outcomes

Peripheral artery disease(PAD)is a common condition characterized by atherosclerosis in the peripheral arteries,associated with concomitant coronary and cerebrovascular diseases.Proprotein convertase subtilisin/kexin type 9(PCSK9)inhibitors are a class of drugs that have shown potential in hypercholesterolemic patients.This review focuses on the efficacy,safety,and clinical outcomes of PCSK9 inhibitors in PAD based on the literature indexed by PubMed.Trials such as FOURIER and ODYSSEY demonstrate the efficacy of evolocumab and alirocumab in reducing cardiovascular events,offering a potential treatment option for PAD patients.Safety evaluations from trials show few adverse events,most of which are injection-site reactions,indicating the overall safety profile of PCSK9 inhibitors.Clinical outcomes show a reduction in cardiovascular events,ischemic strokes,and major adverse limb events.However,despite these positive findings,PCSK9 inhibitors are still underutilized in clinical practice,possibly due to a lack of awareness among care providers and cost concerns.Further research is needed to establish the long-term effects and cost-effectiveness of PCSK9 inhibitors in PAD patients.

PEI/SA/Cu三元体系改性荷正电纳滤膜及其脱盐性能

通过将海藻酸钠(SA)与聚乙烯亚胺(PEI)共混作为二次界面聚合反应的水相溶液,SA与PEI强相互作用使SA嵌入到聚酰胺层中,从而提高膜的致密性.随后通过Cu^(2+)与SA结合提高膜表面荷正电性,提高膜对多价阳离子的截留性能.对比研究了SA和Cu^(2+)浓度对复合膜物化性质、表面形貌及分离性能的影响.结果表明,荷正电纳滤膜的最佳制备条件为:SA质量分数为0.01%,Cu^(2+)浓度为25 mmol/L,所对应的PS/Cu-3复合膜亲水性提高.与Control-PEI膜相比,其通量提高了257%,为(40.0±0.8)L/(m^(2)·h),对MgCl2的截留率从92.0%提升至97.1%,且具有良好的耐压性和稳定性.

卫生健康标准中关系型数据共现矩阵计算及SAS程序实现

目的设计卫生健康标准中关系型数据共现矩阵的求解路径及其SAS实现方法。方法文章以计算一组标准的起草单位共现矩阵为例,将“标准-起草单位”二维表格导入SAS(版本号:9.4),按照“两两相乘”的计算思路自行设计宏程序计算起草单位之间的共现矩阵。结果以计算一组标准的起草单位共现矩阵为例,采用自行构建的模拟数据进行演示。首先,导入宏循环起始的数据集,并计算共现频次C_(j,k);然后,导出为out数据集,进一步合并数据集,形成最终的共现矩阵。结论SAS宏程序计算标准中关系型数据共现矩阵具有灵活高效的优势,可用于社会网络分析和互动演进规律总结。

心理韧性、父母情感支持与学生主观幸福感间的关系——基于PISA2018中国四省市数据分析

提升学生的幸福感是实现人的全面发展的必然要求,也是教育事业的重大使命。学生身心等非智力因素的发展在提高教育质量,全面推进素质教育等方面越来越受到重视。基于PISA2018中国四省市12058名中学生的调查数据,发现心理韧性、父母情感支持与学生主观幸福感均呈现正相关性;父母情感支持与心理韧性对学生主观幸福感有显著正向的线性影响,同时父母情感支持通过心理韧性的中介作用影响学生的主观幸福感。由此,提出了在言语鼓励、创造积极性情境、增强亲子互动方面父母应当给予学生情感支持以及从学校、教师与学生自身三个层面提升学生心理韧性的建议。

预热温度对SA387焊后残余应力和力学性能的影响

为了研究预热温度对SA387材料焊后力学性能和残余应力的影响,采用4种不同的预热温度分别焊接试板。对焊接完毕后的试板进行残余应力测定,发现随着预热温度的升高,焊接残余应力呈现先降低后升高的情况;通过力学性能测试和显微组织观察,发现预热温度对材料力学性能有很大影响,材料的抗拉强度和屈服强度随预热温度的升高而降低,韧性随着预热温度的升高先降低后升高。综合焊接残余应力和材料力学性能的测试结果,建议SA387 Gr11 Cl2的预热温度选择265~290℃。

多子阵SAS方位空变运动补偿子孔径算法

为解决方位空变的侧摆和偏航误差存在情形下合成孔径声纳的快速运动补偿与成像问题,提出一种多子阵合成孔径声纳方位空变运动补偿子孔径算法。首先,建立运动误差存在情形下的双程距离历程模型,并利用泰勒级数展开对双根号形式距离历程进行近似;然后,利用子孔径运动补偿和单基等效处理,将含有方位空变的侧摆和偏航误差的多子阵回波数据转换为理想的单阵回波数据;最后,利用经典的单阵频域逐线成像算法,实现快速运动补偿和高分辨成像。仿真实验与实测数据成像结果均验证了所提算法的有效性。

基于SA-Apriori的道路事故风险评估研究

道路事故风险评估是提高道路安全水平的有效方式。为实现在道路网络特征视角下的道路事故风险评估,融合线段分析与频繁集算法,提出SA-Apriori的特征提取算法,进而构建SA-Apriori道路事故风险评估模型,以重庆市大渡口区作为分析对象,建立以道路网络特征变量为指标的道路事故风险等级划分体系,评估其道路事故风险水平,结合商业点位分布情况对该评估方法的有效性进行验证。并针对大渡口区道路事故风险情况,提出道路事故风险的管理对策与建议。结果表明:该道路事故风险评估方法具有较高的可靠性,可为基于路网特征的道路事故风险评估提供参考。

认知行为干预在冠心病临床护理中的应用效果及对SAS、SDS评分的影响

目的:研究冠心病患者实施认知行为干预后的成效。方法:将聊城市第二人民医院2022年10月至2023年10月收治的80例冠心病患者作为研究对象,采用随机数字表法随机分成试验组和对照组,各40例。试验组受试者实施认知行为干预,对照组受试者实施常规护理。对干预后两组患者的护理满意度、抑郁焦虑评分、生活质量评分等观察指标进行评价。结果:干预后,试验组护理满意度高于对照组(P<0.05);干预后,试验组抑郁焦虑评分低于对照组(P<0.05);干预后,试验组生活质量评分高于对照组(P<0.05)。结论:对于冠心病患者展开认知行为干预的成效显著。该护理能够将患者的护理满意度、生活质量提升,使其心理状态得以改善。

基于DSA的前循环动脉干形态镜像性的观察

目的探讨基于DSA的前循环动脉干的形态镜像性,分析前循环大动脉闭塞血管内治疗时参考健侧动脉走行进行导丝探查的价值。方法纳入2021年1月至2022年8月在胜利油田中心医院行脑血管造影术患者250例(造影组),分为3组:青年造影组(年龄<50岁),中年造影组(50~69岁),老年造影组(年龄≥70岁);另选行急诊机械取栓治疗的急性前循环大血管闭塞患者170例(取栓组)。观察造影组与取栓组(责任血管成功开通后)患者的脑血管造影影像资料,分析造影组双侧颈内动脉C1段、C2-C3段、虹吸段、大脑中动脉M1分叉前段以及分叉后段走行的镜像性情况,并分析取栓组血管开通率、双侧走行一致率。结果造影组双侧颈内动脉C1段、C2-C3段、虹吸段、M1分叉前段、M1分叉后段走行差异均无统计学意义(均P>0.05),M1分叉前段双侧镜像性一般,其余各段均双侧镜像性良好,青年造影组、中年造影组、老年造影组双侧颈内动脉C1段、C2-C3段、虹吸段、M1分叉前段、M1分叉后段走行差异均无统计学意义(均P>0.05),青年造影组C1段、各组M1分叉前段双侧镜像性一般,其余各分段双侧镜像性良好;取栓组闭塞血管开通率95.5%,全组双侧走行一致率89.0%。结论双侧颈内动脉C1段、C2-C3段、虹吸段、大脑中动脉M1分叉前段、分叉后段走行均存在镜像性,为脑动脉机械取栓和大动脉慢性闭塞开通时参照病变对侧血管走行操控血管内治疗材料提供了依据。

分位数回归模型在公共卫生领域中的应用及SAS实现

目的探讨分位数回归模型在公共卫生领域中应用及SAS实现,为该方法推广使用提供参考。方法在介绍分位数回归模型基本概念基础上,介绍了分位数回归模型应用情景与优势,并以血清克拉拉细胞蛋白水平和第一秒用力呼气容积/用力肺活量(FEV1/FVC)变化数据为例,与简单线性回归模型相比,探讨分位数回归模型应用及SAS实现过程。结果分位数回归模型不仅可以分析血清克拉拉细胞蛋白水平对FEV1/FVC均值的影响,还可以分析血清克拉拉细胞蛋白水平对FEV1/FVC不同分位数的影响,得到更全面的信息,且通过统计软件SAS可方便实现。结论分位数回归模型可弥补简单线性回归模型仅关注应变量均值特征而不能分析其完整分布特征的不足,SAS软件提供了相对成熟的分析语句,值得推广。