BACKGROUND The Food and Drug Administration has approved percutaneous atrial septal defect(ASD)and patent foramen ovale(PFO)closure devices for hemodynamically significant interatrial shunts,paradoxical emboli includi...BACKGROUND The Food and Drug Administration has approved percutaneous atrial septal defect(ASD)and patent foramen ovale(PFO)closure devices for hemodynamically significant interatrial shunts,paradoxical emboli including stroke,and decompression sickness.We aimed to study the trends in utilization and reimbursements of transcatheter ASD/PFO closure devices.AIM To analyze trends in utilization and Medicare reimbursements for transcatheter ASD/PFO closure procedures from 2013 to 2022.METHODS A query of administrative data on United States Medicare beneficiaries undergoing transcatheter ASD/PFO was conducted from 2013 to 2022 using the Centers for Medicare and Medicaid Services Part B National Summary Data File.Inflation adjustments were made using the 2023 Consumer Price Index.Trend analysis was quantified using growth rate and simple linear regression calculations.All analyses were performed using Microsoft Excel 16.77.1(2023).RESULTS The annual number of transcatheter ASD/PFO closure procedures increased by 81%since 2013,with an average yearly growth rate of 44%cases per year(P<0.001).Annual Medicare reimbursements for transcatheter ASD/PFO therapies mirrored the annual procedure trends.The per-case reimbursements decreased by 18%,i.e.,$1128.80 in 2013 and$770.21 in 2022(P<0.001).There was a significant drop in the number of procedures in the year 2020,which correlates to the onset of the coronavirus disease 2019 pandemic,followed by a sharp uptick in the number of cases in 2021 and 2022.CONCLUSION Medicare utilization of transcatheter ASD/PFO closure therapies has grown significantly in procedural volume from 2013 to 2022.However,this has been accompanied by a decrease in per-case reimbursements.展开更多
Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiograp...Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts(RLSs)in patients with PFO.In this letter,regarding an original study presented by Yao et al,we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.展开更多
Compared with traditional nickel-titanium alloy patent foramen ovale occluders,which are widely used in clinical practice,biodegradable patent foramen ovale occluders have obvious differences in material characteristi...Compared with traditional nickel-titanium alloy patent foramen ovale occluders,which are widely used in clinical practice,biodegradable patent foramen ovale occluders have obvious differences in material characteristics,interventional operation mode and postoperative management strategy.This article gives expert consensus on the selection of clinical indications and standardized operating procedures,so as to standardize the clinical application of biodegradable patent foramen ovale occluders.展开更多
This study aimed to evaluate the feasibility,safety,and efficacy of a noveltranscatheter suture closure system(HaloStitch^(®))for patent foramen ovale(PFO)closure in a swine model.Methods:Thirteen swine underwent...This study aimed to evaluate the feasibility,safety,and efficacy of a noveltranscatheter suture closure system(HaloStitch^(®))for patent foramen ovale(PFO)closure in a swine model.Methods:Thirteen swine underwentexperimental PF0 model creation.All animals received implantationof the transcatheter suture closure system to evaluate procedural success.Comprehensive follow-up over sixmonths included serial ultrasound imaging,histopathological analysis,and gross anatomical exaninationof cardiac specimens.Results:Successful HaloStitch^(®)device implantation was adhieved in 11 of 13 swine.Gross anatomical examination confirrned secure positioning of all sutures in the atrial septum,with noredundancy or thrombus formation.Postoperative ultrasound demonstrated stable suture and staplepositions throughout follow-up,with no evidence of suture breakage,displacement,or thrombus.Stapleswere clearly visualized under ultrasound imaging,Both the atrial septal defect orifice diameter and residualseptal shunt flow velocity decreased significantly during the observation period.Histopathological analysisrevealed partially organized thrombi at the implant head and fibrous connective tissue encapsulation withlocalized inflammatory cell infiltration surrounding the polymer material.Conclsions:The transcathetersuture closure system(HaloStitch^(®))demonstrated feasibility,safety,and biocompatib ility for PFO closure ina swine model,supporting its potential for clinical translation.展开更多
Background:White matter lesion(WML)is common in aging brain and is associated with cognitive impairment and dementia.However,recent studies reported an association between patent foramen ovale(PFO)and WML in migraineu...Background:White matter lesion(WML)is common in aging brain and is associated with cognitive impairment and dementia.However,recent studies reported an association between patent foramen ovale(PFO)and WML in migraineurs,especially in young,middle-aged migraineurs.Our retrospective,case-control study aims to describe the clinical characteristics of WML in this population and to explore potential risk factors.Methods:226 patients with migraine and PFO were consecutively initially screened.Relevant factors were selected by the least absolute shrinkage and selection operator(LASSO)regression and multivariable logistic regression model.A Nomogram was employed to visualize the prediction model conveniently.The discrimination and calibration abilities were evaluated using the Receiver Operating Characteristic(ROC)curve,the Hosmer-Lemeshow test,and calibration curves.Results:One hundred and nineteen participants were ultimately enrolled in our study,with a median age of 36.9±12.7 years and 80.7%of females.Brain magnetic resonance imaging MRI showed 67(56.3%)patients had WML,whereas 52(43.7%)patients were categorized into the non-WML group.LASSO regression screened out potential variables and subsequent multivariate analysisfinally identified age,mean platelet volume,andfibri-nogen(FIB)as independent predictive factors of WML.The area under the ROC curve(AUC)was 0.807.Hos-mer-Lemeshow test and calibration curve verified a consistency between the predicted and actual probability.Conclusion:The predictive nomogram established and validated in our study may assist clinicians in screening WML among young middle-aged migraineurs with PFO and developing individualized preventive and treatment strategies.展开更多
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 for...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.展开更多
Background The incidence of cryptogenic stroke(CS)accounts for about 25%of ischemic stroke.Current studies have shown that cryptogenic stroke is closely related to patent foramen ovale(PFO).Evaluating the correlation ...Background The incidence of cryptogenic stroke(CS)accounts for about 25%of ischemic stroke.Current studies have shown that cryptogenic stroke is closely related to patent foramen ovale(PFO).Evaluating the correlation between PFO and CS needs to be combined with multidisciplinary evaluation.Many clinical studies have shown that drug therapy can reduce the risk of ischemic stroke in elderly PFO patients(>60 years old).However,whether elderly PFO patients(>60 years old)can benefit from PFO closure is still controversial.This article reviewed the research progress of drug therapy and PFO closure therapy for cryptogenic stroke associated with PFO in the elderly.[S Chin J Cardiol 2024;25(1):50-56].展开更多
Atrial septal aneurysm(ASA)is defined as excursion of the atrial septum exceeding 10 mm beyond the atrial septum into the right or left atrium,or a combined total excursion of 15 mm on the right and left sides during ...Atrial septal aneurysm(ASA)is defined as excursion of the atrial septum exceeding 10 mm beyond the atrial septum into the right or left atrium,or a combined total excursion of 15 mm on the right and left sides during the cardiac cycle.According to previous studies,20–40%of patent foramen ovale(PFO)cases are accompanied by ASAs.ASA is associated with the presence of PFO,left atrial dysfunction,cryptogenic stroke,migraine,and arterial embolism,thus making closure of PFO in patients with concomitant ASA necessary but challenging.The anatomy of ASAs associated with PFO has crucial effects on complications after the closure procedure;therefore,several factors must be considered.Herein,we review the clinical implications of concomitant PFO and ASA;discuss the complications occurring after the closure procedure;and provide practical guidance for the closure of concomitant PFO and ASA.展开更多
A patent foramen ovale(PFO)is a clinical condition linked to ischemic stroke,aura migraine,and other pathologies.Current medical consensus posits that PFO closure may mitigate the risk of recurrent strokes.This case r...A patent foramen ovale(PFO)is a clinical condition linked to ischemic stroke,aura migraine,and other pathologies.Current medical consensus posits that PFO closure may mitigate the risk of recurrent strokes.This case report details the management of a 61-year-old female diagnosed with colon cancer for one month.Preoperative transthoracic echocardiography indicated a potential left-to-right shunt through the foramen ovale and mild regurgitation of both the mitral and aortic valves.The patient’s history revealed previous left-sided migraines,and a review of her medical records disclosed multifocal cerebral infarctions identified by a head CT.A pulmonary artery computed tomography angiography suggested embolization in the anterior branch of the right upper pulmonary artery and several branches of the right lower lung’s posterior and lateral basilar artery,along with thickening of the trunk canals of the pulmonary arteries.After a thorough assessment and extensive consultation with the surgical team,the procedure was transitioned from a laparoscopic radical resection to an open total colectomy.Anesthesia induction required careful avoidance of hypoxia,breath-holding,and coughing.Vigilant management of respiratory and circulatory functions was crucial during periods prone to intraoperative embolism formation.Postoperatively,attention was given to the stabilization of respiratory and circulatory functions during extubation,ensuring adequate sputum suction to prevent choking and close monitoring of breathing to avert airway obstruction post-extubation.Additionally,the patient was closely monitored for postoperative nausea and vomiting,a high-risk condition for this patient cohort.Strategies were implemented to minimize the risk of right-to-left shunting,ensuring the patient’s vital signs remained stable throughout the perioperative period.The patient was discharged safely after a 10-day recovery.For patients with cancer and PFO,comprehensive risk assessment and meticulous safety management are paramount.This case confirms the patient’s history of patent foramen ovale through the association between some atypical symptoms such as migraine,pulmonary embolism and cerebral infarction,which provides guidance for the management of anesthesia in the perioperative period,offering significant clinical implications.展开更多
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...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。展开更多
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,transthora...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.展开更多
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 b...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.展开更多
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 t...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.展开更多
AIM： To elucidate the interaction between non- parenchymal cells, extracellular matrix and oval cells during the restituting process of liver injury induced by partial hepatectomy （PH）. METHODS： We examined the lo...AIM： To elucidate the interaction between non- parenchymal cells, extracellular matrix and oval cells during the restituting process of liver injury induced by partial hepatectomy （PH）. METHODS： We examined the localization of oval cells, non-parenchymal cells, and the extracellular matrix components using immunohistochemical and double immunofluorescent analysis during the proliferation and differentiation of oval cells in N-2- acetylaminofluorene （2-AAF）/PH rat model. RESULTS： By day 2 after PH, small oval cells began to proliferate around the portal area. Most of stellate cells and laminin were present along the hepatic sinusoids in the periportal area. Kupffer cells and fibronectin markedly increased in the whole hepatic Iobule. From day 4 to 9, oval cells spread further into hepatic parenchyma, closely associated with stellate cells, fibronectin and laminin. Kupffer cells admixed with oval cells by day 6 and then decreased in the periportal zone. From day 12 to 15, most of hepatic stellate cells （HSCs）, laminin and fibronectin located around the small hepatocyte nodus, and minority of them appeared in the nodus. Kupffer cells were mainly limited in the pericentral sinusoids. After day 18, the normal liver Iobule structures began to recover.CONCLUSION： Local hepatic microenvironment may participate in the oval cell-mediated liver regeneration through the cell-cell and cell-matrix interactions.展开更多
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-Scie...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.展开更多
AIM： To investigate the effect of activation of canonical Wnt signaling pathway on the proliferation and differentiation of hepatic oval cells in vitro. METHODS： WB-F344 cells were treated with recombinant Wnt3a （2...AIM： To investigate the effect of activation of canonical Wnt signaling pathway on the proliferation and differentiation of hepatic oval cells in vitro. METHODS： WB-F344 cells were treated with recombinant Wnt3a （20, 40, 80, 160, 200 ng/mL） in serum-free medium for 24 h. Cell proliferation was measured by Brdu incorporation analysis; untreated WB-F344 cells were taken as controls. After treatment with Wnt3a （160 ng/mL） for 24 h, subcellular localization and protein expression of p-catenin in WB-F344 cells treated and untreated with Wnt3a were examined by immunofluorescence staining and Western blot analysis. CyclinD1 mRNA expression was determined by semi-quantitative reverse-transcript polymerase chain reaction （RT-PCR）. The mRNA levels of some phenotypic markers （AFP, CK-19, ALB） and two hepatic nuclear factors （HNF-4, HIVF-6） were measured by RT-PCR. Expressions of CK-19 and AFP protein were detected by Western blot analysis. RESULTS： Wnt3a promoted proliferation of WB-F344 cells. Stimulation of WB-F344 cells with recombinant Wnt3a resulte^l in accumulation of the transcriptional activator β-catenin, together with its translocation into the nuclei, and up-regulated typical Wnt target gene CyclinD1. After 3 d of Wnt3a treatment in the absence of serum, WB-F344 cells retained their bipotential to express several specific phenotypic markers of hepatocytes and cholangiocytes, such as AFP and CK-19, following activation of the canonical Wnt signaling pathway. CONCLUSION： The canonical Wnt signaling pathway promotes proliferation and self-renewal of rat hepatic oval cells.展开更多
文摘BACKGROUND The Food and Drug Administration has approved percutaneous atrial septal defect(ASD)and patent foramen ovale(PFO)closure devices for hemodynamically significant interatrial shunts,paradoxical emboli including stroke,and decompression sickness.We aimed to study the trends in utilization and reimbursements of transcatheter ASD/PFO closure devices.AIM To analyze trends in utilization and Medicare reimbursements for transcatheter ASD/PFO closure procedures from 2013 to 2022.METHODS A query of administrative data on United States Medicare beneficiaries undergoing transcatheter ASD/PFO was conducted from 2013 to 2022 using the Centers for Medicare and Medicaid Services Part B National Summary Data File.Inflation adjustments were made using the 2023 Consumer Price Index.Trend analysis was quantified using growth rate and simple linear regression calculations.All analyses were performed using Microsoft Excel 16.77.1(2023).RESULTS The annual number of transcatheter ASD/PFO closure procedures increased by 81%since 2013,with an average yearly growth rate of 44%cases per year(P<0.001).Annual Medicare reimbursements for transcatheter ASD/PFO therapies mirrored the annual procedure trends.The per-case reimbursements decreased by 18%,i.e.,$1128.80 in 2013 and$770.21 in 2022(P<0.001).There was a significant drop in the number of procedures in the year 2020,which correlates to the onset of the coronavirus disease 2019 pandemic,followed by a sharp uptick in the number of cases in 2021 and 2022.CONCLUSION Medicare utilization of transcatheter ASD/PFO closure therapies has grown significantly in procedural volume from 2013 to 2022.However,this has been accompanied by a decrease in per-case reimbursements.
文摘Patent foramen ovale(PFO)is a common congenital heart disorder associated with stroke,decompression sickness and migraine.Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts(RLSs)in patients with PFO.In this letter,regarding an original study presented by Yao et al,we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.
基金Chinese Academy of Medical Sciences Fuwai Hospital High Level Hospital clinical research fund(2022-GSPGG-18).
文摘Compared with traditional nickel-titanium alloy patent foramen ovale occluders,which are widely used in clinical practice,biodegradable patent foramen ovale occluders have obvious differences in material characteristics,interventional operation mode and postoperative management strategy.This article gives expert consensus on the selection of clinical indications and standardized operating procedures,so as to standardize the clinical application of biodegradable patent foramen ovale occluders.
基金supported by grants from National High-Level Hospital Clinical Research Funding(2023-GSP-RC-04).
文摘This study aimed to evaluate the feasibility,safety,and efficacy of a noveltranscatheter suture closure system(HaloStitch^(®))for patent foramen ovale(PFO)closure in a swine model.Methods:Thirteen swine underwentexperimental PF0 model creation.All animals received implantationof the transcatheter suture closure system to evaluate procedural success.Comprehensive follow-up over sixmonths included serial ultrasound imaging,histopathological analysis,and gross anatomical exaninationof cardiac specimens.Results:Successful HaloStitch^(®)device implantation was adhieved in 11 of 13 swine.Gross anatomical examination confirrned secure positioning of all sutures in the atrial septum,with noredundancy or thrombus formation.Postoperative ultrasound demonstrated stable suture and staplepositions throughout follow-up,with no evidence of suture breakage,displacement,or thrombus.Stapleswere clearly visualized under ultrasound imaging,Both the atrial septal defect orifice diameter and residualseptal shunt flow velocity decreased significantly during the observation period.Histopathological analysisrevealed partially organized thrombi at the implant head and fibrous connective tissue encapsulation withlocalized inflammatory cell infiltration surrounding the polymer material.Conclsions:The transcathetersuture closure system(HaloStitch^(®))demonstrated feasibility,safety,and biocompatib ility for PFO closure ina swine model,supporting its potential for clinical translation.
文摘Background:White matter lesion(WML)is common in aging brain and is associated with cognitive impairment and dementia.However,recent studies reported an association between patent foramen ovale(PFO)and WML in migraineurs,especially in young,middle-aged migraineurs.Our retrospective,case-control study aims to describe the clinical characteristics of WML in this population and to explore potential risk factors.Methods:226 patients with migraine and PFO were consecutively initially screened.Relevant factors were selected by the least absolute shrinkage and selection operator(LASSO)regression and multivariable logistic regression model.A Nomogram was employed to visualize the prediction model conveniently.The discrimination and calibration abilities were evaluated using the Receiver Operating Characteristic(ROC)curve,the Hosmer-Lemeshow test,and calibration curves.Results:One hundred and nineteen participants were ultimately enrolled in our study,with a median age of 36.9±12.7 years and 80.7%of females.Brain magnetic resonance imaging MRI showed 67(56.3%)patients had WML,whereas 52(43.7%)patients were categorized into the non-WML group.LASSO regression screened out potential variables and subsequent multivariate analysisfinally identified age,mean platelet volume,andfibri-nogen(FIB)as independent predictive factors of WML.The area under the ROC curve(AUC)was 0.807.Hos-mer-Lemeshow test and calibration curve verified a consistency between the predicted and actual probability.Conclusion:The predictive nomogram established and validated in our study may assist clinicians in screening WML among young middle-aged migraineurs with PFO and developing individualized preventive and treatment strategies.
基金Supported by Natural Science Foundation of Guangdong Province,No.2021A1515011267and Guangzhou Municipal Science and Technology Bureau,No.2023A03J0984.
文摘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.
基金supported by the National Natural Science Foundation of China(No.81370242)the Guangdong Provincial College Students Innovation and Entrepreneurship Training Program in 2023(No.S202310571076)+3 种基金the Zhanjiang Science and Technology Program(No.2022A01166/No.2022A01183)the Non-funded Science and Technology Research Program of Zhanjiang(No.2021B01145)the Guangdong Medical University Youth Scientific Research Training Fund(No.GDMUQ2021011)the Universty-level Innovation and Entrepreneurship Training Program of Guangdong Medical University(No.GDMU2021163/No.GDMU2021207)。
文摘Background The incidence of cryptogenic stroke(CS)accounts for about 25%of ischemic stroke.Current studies have shown that cryptogenic stroke is closely related to patent foramen ovale(PFO).Evaluating the correlation between PFO and CS needs to be combined with multidisciplinary evaluation.Many clinical studies have shown that drug therapy can reduce the risk of ischemic stroke in elderly PFO patients(>60 years old).However,whether elderly PFO patients(>60 years old)can benefit from PFO closure is still controversial.This article reviewed the research progress of drug therapy and PFO closure therapy for cryptogenic stroke associated with PFO in the elderly.[S Chin J Cardiol 2024;25(1):50-56].
文摘Atrial septal aneurysm(ASA)is defined as excursion of the atrial septum exceeding 10 mm beyond the atrial septum into the right or left atrium,or a combined total excursion of 15 mm on the right and left sides during the cardiac cycle.According to previous studies,20–40%of patent foramen ovale(PFO)cases are accompanied by ASAs.ASA is associated with the presence of PFO,left atrial dysfunction,cryptogenic stroke,migraine,and arterial embolism,thus making closure of PFO in patients with concomitant ASA necessary but challenging.The anatomy of ASAs associated with PFO has crucial effects on complications after the closure procedure;therefore,several factors must be considered.Herein,we review the clinical implications of concomitant PFO and ASA;discuss the complications occurring after the closure procedure;and provide practical guidance for the closure of concomitant PFO and ASA.
基金supported by grants from the Anhui Provincial Natural Science Foundation(Grant No.2208085Y32 to Chaoliang Tang)the Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei Province(Grant No.CXPJJH12000005-07-115 to Chaoliang Tang).
文摘A patent foramen ovale(PFO)is a clinical condition linked to ischemic stroke,aura migraine,and other pathologies.Current medical consensus posits that PFO closure may mitigate the risk of recurrent strokes.This case report details the management of a 61-year-old female diagnosed with colon cancer for one month.Preoperative transthoracic echocardiography indicated a potential left-to-right shunt through the foramen ovale and mild regurgitation of both the mitral and aortic valves.The patient’s history revealed previous left-sided migraines,and a review of her medical records disclosed multifocal cerebral infarctions identified by a head CT.A pulmonary artery computed tomography angiography suggested embolization in the anterior branch of the right upper pulmonary artery and several branches of the right lower lung’s posterior and lateral basilar artery,along with thickening of the trunk canals of the pulmonary arteries.After a thorough assessment and extensive consultation with the surgical team,the procedure was transitioned from a laparoscopic radical resection to an open total colectomy.Anesthesia induction required careful avoidance of hypoxia,breath-holding,and coughing.Vigilant management of respiratory and circulatory functions was crucial during periods prone to intraoperative embolism formation.Postoperatively,attention was given to the stabilization of respiratory and circulatory functions during extubation,ensuring adequate sputum suction to prevent choking and close monitoring of breathing to avert airway obstruction post-extubation.Additionally,the patient was closely monitored for postoperative nausea and vomiting,a high-risk condition for this patient cohort.Strategies were implemented to minimize the risk of right-to-left shunting,ensuring the patient’s vital signs remained stable throughout the perioperative period.The patient was discharged safely after a 10-day recovery.For patients with cancer and PFO,comprehensive risk assessment and meticulous safety management are paramount.This case confirms the patient’s history of patent foramen ovale through the association between some atypical symptoms such as migraine,pulmonary embolism and cerebral infarction,which provides guidance for the management of anesthesia in the perioperative period,offering significant clinical implications.
文摘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。
基金Supported by the National Key Research and Development Program of China,No.2017YFC0908800。
文摘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.
文摘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.
文摘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.
基金Supported by A grant from National Natural Science Foundation of China
文摘AIM： To elucidate the interaction between non- parenchymal cells, extracellular matrix and oval cells during the restituting process of liver injury induced by partial hepatectomy （PH）. METHODS： We examined the localization of oval cells, non-parenchymal cells, and the extracellular matrix components using immunohistochemical and double immunofluorescent analysis during the proliferation and differentiation of oval cells in N-2- acetylaminofluorene （2-AAF）/PH rat model. RESULTS： By day 2 after PH, small oval cells began to proliferate around the portal area. Most of stellate cells and laminin were present along the hepatic sinusoids in the periportal area. Kupffer cells and fibronectin markedly increased in the whole hepatic Iobule. From day 4 to 9, oval cells spread further into hepatic parenchyma, closely associated with stellate cells, fibronectin and laminin. Kupffer cells admixed with oval cells by day 6 and then decreased in the periportal zone. From day 12 to 15, most of hepatic stellate cells （HSCs）, laminin and fibronectin located around the small hepatocyte nodus, and minority of them appeared in the nodus. Kupffer cells were mainly limited in the pericentral sinusoids. After day 18, the normal liver Iobule structures began to recover.CONCLUSION： Local hepatic microenvironment may participate in the oval cell-mediated liver regeneration through the cell-cell and cell-matrix interactions.
文摘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.
文摘AIM： To investigate the effect of activation of canonical Wnt signaling pathway on the proliferation and differentiation of hepatic oval cells in vitro. METHODS： WB-F344 cells were treated with recombinant Wnt3a （20, 40, 80, 160, 200 ng/mL） in serum-free medium for 24 h. Cell proliferation was measured by Brdu incorporation analysis; untreated WB-F344 cells were taken as controls. After treatment with Wnt3a （160 ng/mL） for 24 h, subcellular localization and protein expression of p-catenin in WB-F344 cells treated and untreated with Wnt3a were examined by immunofluorescence staining and Western blot analysis. CyclinD1 mRNA expression was determined by semi-quantitative reverse-transcript polymerase chain reaction （RT-PCR）. The mRNA levels of some phenotypic markers （AFP, CK-19, ALB） and two hepatic nuclear factors （HNF-4, HIVF-6） were measured by RT-PCR. Expressions of CK-19 and AFP protein were detected by Western blot analysis. RESULTS： Wnt3a promoted proliferation of WB-F344 cells. Stimulation of WB-F344 cells with recombinant Wnt3a resulte^l in accumulation of the transcriptional activator β-catenin, together with its translocation into the nuclei, and up-regulated typical Wnt target gene CyclinD1. After 3 d of Wnt3a treatment in the absence of serum, WB-F344 cells retained their bipotential to express several specific phenotypic markers of hepatocytes and cholangiocytes, such as AFP and CK-19, following activation of the canonical Wnt signaling pathway. CONCLUSION： The canonical Wnt signaling pathway promotes proliferation and self-renewal of rat hepatic oval cells.
