Successful occluding by absorbable sutures for epicardial collateral branch perforation

In order to improve the success rate of chronic total occlusion (CTO)percutaneous coronary intervention (PCI), retrograde approach has been attracted more attention.Recent study reported the collateral perforation rate was 6.9% in retrograde CTO PCI.[1,2] Collateral related perforations were higher in patients with the epicardial collateral than that with the septal collateral.[3]Several techniques have been developed to deal with the collateral branch perforation.Here,we described the treatment of epicardial collateral branch perforation by absorbable suture segments embolization through microcatheter during retrograde CTO PCI.

Left atrial appendage occluder detachment treated with transthoracic ultrasound combined with digital subtraction angiography guided catcher:A case report

BACKGROUND There are very few cases of cardiac occluder detachment,and it is rare to completely remove the occluder using interventional methods without undergoing thoracotomy surgery after detachment.This case innovatively used ultrasound guidance combined with digital subtraction angiography(DSA)to completely remove the occluder,accumulating some experience.CASE SUMMARY The patient underwent left atrial appendage occlusion surgery in our hospital due to atrial fibrillation.After the surgery,the occluder fell off and became free in the left ventricle,which is very dangerous.We innovatively used ultrasound guidance,combined with DSA,and interventional surgery to successfully capture the free occluder using a catcher,completely remove it,and then re implant a new left atrial appendage occluder.After the surgery,the patient recovered very well.CONCLUSION The size selection of the occluder is slightly conservative,and the shape of the left atrial appendage opening is irregular.

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.

DTHN: Dual-Transformer Head End-to-End Person Search Network

Person search mainly consists of two submissions,namely Person Detection and Person Re-identification(reID).Existing approaches are primarily based on Faster R-CNN and Convolutional Neural Network(CNN)(e.g.,ResNet).While these structures may detect high-quality bounding boxes,they seem to degrade the performance of re-ID.To address this issue,this paper proposes a Dual-Transformer Head Network(DTHN)for end-to-end person search,which contains two independent Transformer heads,a box head for detecting the bounding box and extracting efficient bounding box feature,and a re-ID head for capturing high-quality re-ID features for the re-ID task.Specifically,after the image goes through the ResNet backbone network to extract features,the Region Proposal Network(RPN)proposes possible bounding boxes.The box head then extracts more efficient features within these bounding boxes for detection.Following this,the re-ID head computes the occluded attention of the features in these bounding boxes and distinguishes them from other persons or backgrounds.Extensive experiments on two widely used benchmark datasets,CUHK-SYSU and PRW,achieve state-of-the-art performance levels,94.9 mAP and 95.3 top-1 scores on the CUHK-SYSU dataset,and 51.6 mAP and 87.6 top-1 scores on the PRW dataset,which demonstrates the advantages of this paper’s approach.The efficiency comparison also shows our method is highly efficient in both time and space.

Effectiveness and Safety of Transcatheter Closure of Various Ventricular Septal Defects Using Second-Generation Amplatzer Duct Occluders

Objective:This study was designed to determine the long-term safety and efficacy of using the Amplatzer Duct Occluder II(ADO II)for the closure of various ventricular septal defects(VSDs).Methods:From January 2011 to December 2019,selected VSD patients were treated through transcatheter intervention using ADO II occluders.The closure results and complications from 188 patients,involving 167 perimembranous ventricular septal defects(pmVSDs),9 intracristal VSDs,11 post surgery residual shunts and 1 post closure residual shunt with the mean outlet diameter3.1±0.8 mm under angiography,were enrolled in this study.Results:The success rate was 98.9%for all procedures.During the median 77-month follow-up period,no cases of complete atrioventricular block(cAVB),infective endocarditis or death occurred.One major adverse event(0.5%)was recorded:cerebrovascular accident occurred 1 day after the procedure in one patient who was transferred to the neurology department.The residual shunt rate was 44.6%,which was the most common minor adverse event.The cardiac conduction block rate was 4.3%.Specifically,one pmVSD patient developed intermittent LBBB during the 28-month follow-up.There were 3 patients(1.6%)with new-onset mild tricuspid insufficiency,and the insufficiency degree was stable during follow-up.There was no new-onset aortic insufficiency that occurred.Conclusions:Transcatheter closure of pmVSDs,some intracristal VSDs,some postsurgery or postclosure residual shunts using ADO II occluders were both safe and effective and yielded excellent long-term results in selected patients.

Biodegradation of occluded hydrocarbons and kerogen macromolecules of the Permian Lucaogou shales,Junggar Basin,NW China

Three kerogen samples(JJZG-1,JJZG-2 and JJZG-3)isolated from the Permian Lucaogou shales of varying biodegradation levels(BLs≈0,3 and 7,respectively)were subjected to sequential stepwise pyrolysis combined with on-line detection of gas chromatography-mass spectrometry(GC-MS).Occluded fractions(bitumenⅡ)released at low-temperature steps(≥410℃)show consistent biodegradative signatures with that reported for solvent-extracted fractions(bitumenⅠ)of the original shales,e.g.,broad range of abundant n-alkanes,isoprenoids and regular hopanes for the non-biodegraded JJZG-1;trace n-alkanes and abundant hopanes for the moderately biodegraded JJZG-2;and no n-alkanes but still prominent hopanes including the microbially produced 25-nohopanes for the severely biodegraded JJZG-3.This consistency between bitumenⅡand bitumenⅠfractions indicates the biodegradability of the kerogenoccluded bitumenⅡwith limited protection from host kerogen.A minor level of protection was suggested by the trace distribution of n-alkanes in the bitumenⅡof JJZG-2,whereas the bitumenⅠhad no nalkanes.The kerogen itself was more resistant to biodegradation as reflected by the persistence of high abundances of both n-alkanes and hopanes in the high temperature(≥460℃)products of all three kerogen samples.However,the relative abundances of these product groups did show some evidence of biodegradation alteration,e.g.,ratios of n-C_(15)alkene/C_(27)hop-17(21)-ene at 510℃pyrolysis decreased by order of magnitude from the non-biodegraded(JJZG-1=27.4)to highly biodegraded(0.3 for JJZG-3)samples.The reduced biodegradation impact on the kerogen fraction(Cf.bitumen fractions)was also evident by the absence of 25-norhopanes in the high-temperature analysis of the JJZG-3 kerogen.

左归降糖解郁方对模拟糖尿病并发抑郁症环境下海马NVU结构蛋白的作用及机制研究

目的:从海马神经血管单元(neurovascular unit,NVU)结构蛋白探讨左归降糖解郁方对糖尿病并发抑郁症(diabetes mellitus with depression,DD)的作用机制。方法:采用海马神经元、星形胶质细胞、脑微血管内皮细胞建立海马NVU体外共培养体系,采用葡萄糖联合皮质酮干预模拟DD环境,将实验分为正常组、模型组、空白对照组、阳性药含药组、左归降糖解郁方含药组,造模干预18 d后,细胞电阻仪检测跨内皮细胞电阻值,千分尺检测4 h渗漏试验的液面高度值,Western blot法检测胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)、间隙连接蛋白(Connexin43,Cx43)与脑微血管内皮细胞(The brain microvascular endothelial cells,BMECs)结构蛋白occluding的表达变化。结果:与正常对照组比较,模型组跨内皮细胞电阻值显著降低(P<0.05),4 h渗漏试验液面差显著增加(P<0.01),NVU结构蛋白GFAP、CX43、occluding表达均显著下调(P<0.01,P<0.05);与模型组比较,中药复方左归降糖解郁方与阳性药二甲双胍+氟西汀均能明显逆转上述现象(P<0.01,P<0.05)。结论:左归降糖解郁方对模拟DD环境下海马NVU损伤具有一定修复作用,其作用机制可能与调控海马NVU结构蛋白GFAP、CX43及occluding的表达有关。

Isolated Major Aortopulmonary Collateral Artery Causing Heart Failure: Transcatheter Occlusion of Mapcas Using Amplatzer Vascular Plugs and Amplatzer Piccolo Occluders

Major aortopulmonary collateral arteries (MAPCAs) are congenital vessels that arise from the aorta or its first-order branches and are distally connected to the pulmonary arterial vasculature, thereby providing pulmonary blood flow. MAPCAs are often associated with cyanotic congenital heart disease with decreased pulmonary blood flow. Isolated MAPCAs are rare in patients without congenital heart disease with structurally normal hearts. Sometimes, isolated congenital MAPCAs can occur without any lung disease. Isolated MAPCAs represent the occurrence of collaterals in the absence of underlying heart disease, which commonly presents as heart failure, recurrent respiratory tract infection, and pulmonary artery hypertension. We report a rare case of congestive heart failure in a 6-year-old patient with dual arterial supply to an otherwise normal right lung, with a normal bronchial tree, and a structurally normal heart. The patient was successfully managed by the closure of collaterals by Amplatzer vascular plugs II (AVPII) and Amplatzer Piccolo Occluders.

Zonula occludin toxin,a microtubule binding protein

AIM To investigate the interaction of Zot withmicrotubule.METHODS Zot affinity column was applied topurify Zot-binding protein（s）from crudeintestinal cell lysates.After incubation at roomtemperature,the column was washed and theproteins bound to the Zot affinity column wereeluted by step gradient with NaCl(0.3 mol·L-1-0.5mol·L-1).The fractions were subjected to6.0%-15.0%（w/v）gradient SDS-PAGE andthen transferred to PVDF membrane for N-terminal sequencing.Purified Zot and tauprotein were blotted by using anti-Zot or anti-tauantibodies.Finally,purified Zot was tested in anin vitro tubulin binding assay.RESULTS Fractions from Zot affinity columnyielded two protein bands with a Mr of 60 kU and45kU respectively.The N-terminal sequence ofthe 60 kU band resulted identical to β-tubulin.Zot also cross-reacts with anti-tau antibodies.Inthe in vitro tubulin binding assay,Zot co-precipitate with Mt,further suggesting that Zotpossesses tubulin-binding properties.CONCLUSION Taken together,these resultssuggest that Zot regulates the permeability ofintestinal tight junctions by binding tointracellular Mt,with the subsequent activationof the intracellular signaling leading to thepermeabilization of intercellular tight junctions.

Indirect Tensile Characterization of Graphite Platelet Reinforced Vinyl Ester Nanocomposites at High-Strain Rate

An indirect tensile testing method is proposed for characterizing low strength graphite platelet reinforced vinyl ester nanocomposites at high-strain rate. In this technique, the traditional Brazilian disk (diametrical compression) test method for brittle materials is utilized along with conventional split-Hopkinson pressure bars (SHPB) for evaluating cylindrical disk specimens. The cylindrical disk specimen is held snugly in between two concave end fixtures attached to the incident and transmission bars. To eliminate the complexities of conventional strain gage application, a non-contact Laser Occluding Expansion Gage (LOEG) has been adapted for measuring the diametrical transverse expansion of the specimen under high-strain rate diametrical compressive loading. Failure diagnosis using high-speed digital photography validates the viability of utilizing this indirect test method for characterizing the tensile properties of xGnP (exfoliated graphite nanoplatelets) reinforced and additional CTBN (Carboxyl Terminated Butadiene Nitrile) toughened vinyl ester based nanocomposites. Also, quasi-static indirect tensile response agrees with previous investigations conducted using the traditional dog-bone specimen in direct tensile tests. Investigation of both quasi-static and dynamic indirect tensile test responses shows the strain rate effect on the tensile strength and energy absorbing capacity of the candidate materials. The contribution of reinforcement to the tensile properties of the candidate materials is presented.

Computer Aided Modeling and Dynamic Analysis of A New Surgical Instrument

One major difference among surgical instruments is the level of bodily disruption and tissue trauma that surgical devices might cause the patients. This newly designed and developed surgical instrument aims at minimally invasive therapy procedure, more reliable and durable function, less operational force, and reduced manufacturing cost. The computer aided modeling and simulation have been applied to help this new instrument design and analysis. This improved new surgical instrument is designed to use in general surgery to prevent patient's vessels and tissues from being damaging due to reliable motion control of surgical clips with no unexpected clip drop. It can also be applied to surgical education purpose to educate medical students for their future surgical careers. The prototype testing indicated that the handle operational force to close surgical clips is lower than current surgical clip instruments, product manufacturing is cost-effective due to less dimensional tolerance control of this new instrument design, more reliable instrument function, and good mechanical advantage.

Management of an occluded biliary metallic stent

In patients with a malignant biliary obstruction who require biliary drainage,a self-expandable metallic stent(SEMS) provides longer patency duration than a plastic stent(PS).Nevertheless,a stent occlusion by tumor ingrowth,tumor overgrowth and biliary sludge may develop.There are several methods to manage occluded SEMS.Endoscopic management is the preferred treatment,whereas percutaneous intervention is an alternative approach.Endoscopic treatment involves mechanical cleaning with a balloon and a second stent insertion as stent-in-stent with either PS or SEMS.Technical feasibility,patient survival and cost-effectiveness are important factors that determine the method of re-drainage and stent selection.

Safety of an improved patent ductus arteriosus occluder for transcatheter closure of perimembranous ventricular septal defects with abnormally attached tricuspid chordae tendineae

BACKGROUND The off-label use of various devices has been reported for the transcatheter closure of perimembranous ventricular septal defects(PmVSD) because of serious complications, such as heart block and tricuspid regurgitation(TR),associated with conventional ventricular septal defect devices. However, whether certain defects such as PmVSD with abnormally attached tricuspid are fit for interventional treatment is still disputable.AIM To explore the feasibility and safety of transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae using an improved patent ductus arteriosus(PDA) occluder.METHODS We retrospectively analyzed 20 patients diagnosed with PmVSD with abnormally attached tricuspid chordae tendineae who underwent interventional treatment using an improved PDA occluder at our center from January 2012 to January 2016. Baseline characteristics and procedural and follow-up data were analyzed.RESULTS All 20 patients achieved procedure success. No heart block occurred during the operation. One patient had a transient complete right bundle branch block within48 h post-procedure and reverted to normal rhythm after intravenous injections of dexamethasone for 3 d. For all 20 patients, no residual shunt was observed by transthoracic echocardiography post-procedure. During the average follow-up period of 2.4 years, no severe TR was observed.CONCLUSION Using of the improved PDA occluder for the transcatheter closure of PmVSD with abnormally attached tricuspid chordae tendineae is a safe and promising treatment option. However, long-term follow-up in a large group of patients is still warranted.

Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension: How can patients be better selected?

Chronic thromboembolic pulmonary hypertension (CTEPH) comprises organizing thrombotic obstructions in the pulmonary arteries by nonresolving thromboemboli, formation of fibrosis and remodeling of pulmonary blood vessels. Surgical pulmonary endarterectomy (PEA) is the therapy of choice for patients with surgically accessible CTEPH, which leads to a profound improvement in hemodynamics, functional class and survival. Select- ing the candidates that will benefit from surgery is still a challenging task. Criteria for surgical suitability have been described but the decision-making for or against surgical intervention remains still subjective. The optimal characterization of the reciprocal contribution of large vessel and small vessel disease in the elevation of pulmonary vascular resistance is crucial for the indication and outcome of PEA. Recently, Toshner et al intended to validate the partition resistance into small and large vessels compartments (upstream resistance:Rup) by the occlusion technique in the preoperative assessment of PEA. We discuss the advantages and disadvantages of Rup and compare it with other hemodynamic predictor to evaluate operative risk in CTEPH patients.

Dynamic Audio-Visual Biometric Fusion for Person Recognition

Biometric recognition refers to the process of recognizing a person’s identity using physiological or behavioral modalities,such as face,voice,fingerprint,gait,etc.Such biometric modalities are mostly used in recognition tasks separately as in unimodal systems,or jointly with two or more as in multimodal systems.However,multimodal systems can usually enhance the recognition performance over unimodal systems by integrating the biometric data of multiple modalities at different fusion levels.Despite this enhancement,in real-life applications some factors degrade multimodal systems’performance,such as occlusion,face poses,and noise in voice data.In this paper,we propose two algorithms that effectively apply dynamic fusion at feature level based on the data quality of multimodal biometrics.The proposed algorithms attempt to minimize the negative influence of confusing and low-quality features by either exclusion or weight reduction to achieve better recognition performance.The proposed dynamic fusion was achieved using face and voice biometrics,where face features were extracted using principal component analysis(PCA),and Gabor filters separately,whilst voice features were extracted using Mel-Frequency Cepstral Coefficients(MFCCs).Here,the facial data quality assessment of face images is mainly based on the existence of occlusion,whereas the assessment of voice data quality is substantially based on the calculation of signal to noise ratio(SNR)as per the existence of noise.To evaluate the performance of the proposed algorithms,several experiments were conducted using two combinations of three different databases,AR database,and the extended Yale Face Database B for face images,in addition to VOiCES database for voice data.The obtained results show that both proposed dynamic fusion algorithms attain improved performance and offer more advantages in identification and verification over not only the standard unimodal algorithms but also the multimodal algorithms using standard fusion methods.

Safety and efficacy of amplatzer duct occluder for percutaneous closure of ventricular septal defects with tunnel shape aneurysm: Medium term follow up

Objectives: Different devices including Amplatzer duct occluder has been used for percutaneous closure of ventricular septal defects. This study reports our medium term follow up of perimembranous and muscular ventricular septal defects with tunnel shape aneurysm closure using the Amplatzer duct occluder. Materials and Methods: From May 2006-December 2012, we used Amplatzer duct occluder in seven ventricular septal defect patients here atHamad General Hospital,Doha,Qatar. There were 4 male and 3 female patients with an age range of 4 - 32 years with a median of 8 years and weight range of 16 - 63 kgwith a median of33 kg. In this group, 6 were perimembranous and 1 muscular and all these ventricular septal defects had a tunnel shape aneurysm. Transesophageal echocardiographic diameter ranged from 4 - 8 mmand Qp/Qs was 1 - 1.6. Angiographically, the diameter on the left ventricular side measured 3.5 - 10 mmand on right ventricular side 2.4?- 5 mm. 8/6 mmAmplatzer duct occluder was used to close these ventricular septal defects. Results: There were no major complications and immediately after the procedure there was no residual shunt in any of these patients and all the patients remained in normal sinus rhythm. One patient was expatriate and no further follow up was available. The rest of the 6 patients had 1 - 80 months with a median of 54 months follow up and none of these patients had any residual shunt and all remained in normal sinus rhythm. Two patients developed trivial aortic valve regurgitation immediate post procedure, one remained unchanged and the 2nd has progressed to mild at this latest follow up. Conclusion: Amplatzer duct occluder is feasible and a safe device for percutaneous closure of selective tunnel shape aneurysmal perimembranous and muscular ventricular septal defects.

Occlusion of atrial septal defect utilizing occluder devise via minimally invasive right chest approach

Objective To evaluate atrial septal defect(ASD) occlusion employing a small right anterior thoracotomy approach. Methods A total of 21 patients with ASD underwent general anesthesia and 2-3 cm incision was made in the fourth right intercostal space.Utilizing transesophageal or transthoracic echocardiography,the occluder was released using a monotube unit. Results All patients were occluded successfully.No patient required open surgery utilizing extracorporeal circulation.There were no major complications and no evidence of residual atrial shunt. Conclusion ASD occlusion via a minimal surgical incision is safe,less invasive,and has excellent outcomes.

Transcatheter Closure of Perimembranous Ventricular Septal Defect Using the Amplatzer Duct Occluder II

Objective:To evaluate the efficacy of Amplatzer duct occluder II(ADO II)in the treatment of perimembranous ventricular septal defect(pmVSD)in children.Methods:Between June 2017 and June 2020,13 patients with pmVSD had attempted transcatheter closure using ADO II,seven of patients were used antegrade approach and six of them were used retrograde approach.Results:There were 8 males and 5 females,age from 1 to 7 years,weight from 10.5 to 31.0 kg,and VSD size from 2.0 to 4.0 mm.Procedure was successful in all cases with the outer diameter of the occluders ranging from 4 to 6 mm.No aortic,tricuspid regurgitation or residual shunt was found in the immediate ultrasound assessment.No arrhythmia was observed in the Holter monitoring 3 days after the intervention.Discharge echocardiography indicated complete shunt closure.No evidence of occluder prolapse,malignant arrhythmia,or intensed valve regurgitation was seen on a median follow-up of 18 months(range,6 to 36 months).Conclusions:Based on our experience,ADO II showed good efficacy in the early and middle stages of pediatric pmVSD closures.

Turbulent Flow Action of Pulp in Wet - Laid Non - Woven Processes

The paper deals with the fluid field of web forming in wet-laid non-woven production.The influence of the turbulent flow on blending fiber and occluded fluid produced in pulp flow has been discussed in theory and practice.The suitable use of the imported velocity of pulp is very important in producing wet-laid products of good quality.

Transcatheter Closure of a Right Pulmonary Artery to Left Atrium Fistula Using a Ventricular Septal Defect Occluder

Background:Communication between the right pulmonary artery(RPA)and left atrium(LA)is a rare cause of central cyanosis in pediatric patients.Case presentation:We describe a 3-year-old female patient with an oxygen saturation of 70%at admission.The echocardiogram indicated an abnormal color flow Doppler in the LA and she underwent standard cardiac catheterization.The angiography of pulmonary artery revealed a 7.4 mm×7.6 mm fistula between the RPA and LA and achieved successful closure using ventricular septal defect occlusion.Conclusion:The fistula between pulmonary artery and left atrium is an extremely rare but treatable congenital defect.It should be considered in differential diagnosis of cyanosis in children.