SCAI expert consensus statement for femoral‐popliteal arterial intervention appropriate use

Successful endovascular intervention for femoral‐popliteal (FP) arterial disease provides relief of claudication and offers limb‐salvage in cases of critical limb ischemia. Technologies and operator technique have evolved to the point where we may now provide effective endovascular therapy for a spectrum of lesions, patients, and clinical scenarios. Endovascular treatment of this segment offers a significant alternative to surgical revascularization, and may confer improved safety for a wide range of patients, not solely those deemed high surgical risk. Although endovascular therapy of the FP segment has historically been hampered by high rates of restenosis, emerging technologies including drug‐eluting stents, drug‐coated balloons, and perhaps bio‐absorbable stent platforms, provide future hope for more durable patency in complex disease. By combining lessons learned from clinical trials, international trends in clinical practice, and insights regarding emerging technologies, we may appropriately tailor our application of endovascular therapy to provide optimal care to our patients. This document was developed to guide physicians in the clinical decision‐making related to the contemporary application of endovascular intervention among patients with FP arterial disease. © 2014 Wiley Periodicals, Inc.     

Heat Losses Caused by the Temporary Influence of Wind in Timber Frame Walls Insulated with Fibrous Materials

The paper presents the results of research concerning three fiber materials—mineral wool, hemp fiber and wood wool—as loose-fill thermal insulation materials. The analysis used the material parameters determined in previous works conducted by the authors, such as thermal conductivity and air permeability in relation to bulk density. These materials exhibit open porosity; thus, convection is an essential phenomenon in the heat transfer process. The paper aimed at conducting thermal simulations of various frame wall variants which were filled with the above-mentioned insulation materials. The simulations were performed with the Control Volume Method using the Delphin 5.8 software. The studies accounted for the effect of wind pressure and the time of its influence on a wall insulated by means of fiber material with a thickness of 150 as well as 250 mm. The simulation enabled us to obtain such data as maximal R-value reduction and time to return to equilibrium after filtration for the analyzed materials. The study proved that heat transfer in these insulations strongly depends on the bulk density, thickness of the insulation and wind pressure. The decrease in R is reduced as the density increases. This results from the decreased air permeability characterizing the material. Wind washing causes lower R reduction than air filtration in all models. The greater the thickness, the longer it takes for the models to return to the equilibrium state following air filtration (and wind washing). This period is comparable for air filtration and wind washing. Hemp fibers were characterized with the strongest susceptibility to air filtration; in the case of wood wool, it was also high, but lower than for hemp fibers, while mineral wool was characterized with the lowest.     

汪悦教授运用风药治疗痹证经验探析

[目的]总结探讨汪悦教授运用风药治疗痹证的临床经验。[方法]从痹证病因病机、风药功效、选药思路、配伍原则等方面介绍汪师经验,并附验案一则佐证。[结果]针对风邪、湿邪在痹证产生过程中的重要作用,汪师临证常根据邪气偏盛、病位证候等不同,并结合现代药理研究选用不同的风药进行治疗,以达到散风邪、燥湿邪、行气血、止痹痛的效果。遣方用药时常将风药与祛湿药、化瘀药、补血药、养阴药、温阳药等配伍使用,每获良效。所举验案患者患有脊柱关节炎,属于中医"骨痹"范畴,辨证属正虚邪实、肾阳不足、风湿痹阻,治拟温阳益肾、祛风胜湿、通络止痛,以阳和汤加减治疗,其中包括麻黄、独活等多味风药,收效甚佳。[结论]汪师灵活运用风药配伍组方以治疗痹证,疗效显著,值得进一步研究和探讨。     

张锡纯从脑论治痿证特色探析

[目的]探讨张锡纯从脑论治痿证的思路与特色。[方法]从中医文献整理、研究的角度,对张锡纯所著《医学衷中参西录》中从脑病角度论治痿证的相关论述、医案、具体药方进行系统分析,归纳和总结其痿证论治思路和特色。[结果]张锡纯汇通中西,以“肢体痿废”一症立论,结合现代医学对脑病的认识,创造性地提出脑贫血、脑充血两种病因均可导致肢体痿废,在此基础上以传统医学宗气不足、精髓不充、脏腑气血大热的观点诠释二者病机,立益气引血、镇肝熄风大法,创干颓汤、镇肝熄风汤、建瓴汤等,大大扩展了痿证的治疗思路。[结论]张锡纯衷中参西,从脑病角度论治痿证,对痿证理论的继承和发展作出重要贡献,于今日临床启发尤多。     

Anomalously weak solar convection

Convection in the solar interior is thought to comprise structures on a spectrum of scales. This conclusion emerges from phenomenological studies and numerical simulations, though neither covers the proper range of dynamical parameters of solar convection. Here, we analyze observations of the wavefield in the solar photosphere using techniques of time-distance helioseismology to image flows in the solar interior. We downsample and synthesize 900 billion wavefield observations to produce 3 billion cross-correlations, which we average and fit, measuring 5 million wave travel times. Using these travel times, we deduce the underlying flow systems and study their statistics to bound convective velocity magnitudes in the solar interior, as a function of depth and spherical-harmonic degree ℓ. Within the wavenumber band ℓ < 60, convective velocities are 20–100 times weaker than current theoretical estimates. This constraint suggests the prevalence of a different paradigm of turbulence from that predicted by existing models, prompting the question: what mechanism transports the heat flux of a solar luminosity outwards? Advection is dominated by Coriolis forces for wavenumbers ℓ < 60, with Rossby numbers smaller than approximately 10^-2 at r/R_⊙ = 0.96, suggesting that the Sun may be a much faster rotator than previously thought, and that large-scale convection may be quasi-geostrophic. The fact that isorotation contours in the Sun are not coaligned with the axis of rotation suggests the presence of a latitudinal entropy gradient.     

The effects of a bare metal stent on the healing of a huge coronary pseudoaneurysm: A case report

We experienced a rapidly growing huge coronary pseudoaneurysm with symptomatic restenosis after rotational atherectomy. A BMS had successfully obliterated the huge coronary pseudoaneurysm at 3 months follow‐up on CTA. The OCT at 9 months follow‐up showed that the most of stent strut was covered with neo‐intima. This case suggests that BMS deployment is recommended as a useful method for treating coronary pseudoaneurysms. © 2011 Wiley Periodicals, Inc.     

皮下蒂皮瓣与旋转皮瓣在颞部皮肤缺损修复中的联合应用

目的：探讨利用耳前邻近皮瓣与颞区邻近皮瓣联合应用修复颞部皮肤缺损的方法。方法：根据患者颞部皮肤肿物的大小,设计患侧耳前方皮下蒂皮瓣的切取范围并将切口线设计在耳前皱襞上。在颞部肿物外缘向耳上方延长切口线约为皮肤肿物直径的4倍,设计旋转皮瓣。2个皮瓣联合应用,修复颞部较大面积皮肤缺损。供区直接缝合。结果：共施行此类手术12例,患侧皮肤缺损修复满意,切口线相对隐蔽,面部器官形态功能均未受到影响,供区头发自然生长,瘢痕不明显。结论：利用皮下蒂皮瓣与旋转皮瓣联合修复颞部较大面积皮肤缺损,辅助切口少且切口隐蔽,同时皮瓣转移后自然平滑过渡,创面修复满意,无需植皮,瘢痕不明显。     

手指旋转撕脱性离断再植的临床研究

目的探讨手指旋转撕脱性离断再植方法及临床疗效。方法2007年5月-2011年9月对21例30指旋转撕脱性离断的断指进行再植,根据手指旋转撕脱离断的程度,分别采用血管移植、血管神经束转位、带血管皮瓣转移等方法重建血循环及感觉。结果30指成活29指,失败1指,成活率96．7％。术后随访20例,随访时间6个月～3年,平均1年5个月,以最后一次随访结果为准,按中华医学会手外科学会上肢部分功能评定试用标准评定：优20指,良7指。差3指,优良率90％。结论按照手指旋转撕脱性离断伤不同情况采用不同再植方法,可获得较高的成活率,并能恢复较好的外形与功能。     

微晶纤维素对疏风解毒配方提取物粉末直压性能影响的研究

目的研究微晶纤维素(MCC)对疏风解毒配方提取物粉末(SFJDE)直压性能的影响。探讨压片前粉体的基础物理性质与其功能性质之间的相关性。方法 SFJDE和MCC按照不同比例混合后,分别测定混合粉体物理性质和在不同压力下的压缩参数。采用线性回归和偏最小二乘法(PLS)对粉末基础物理性质和功能性参数进行处理分析。结果 SFJDE中MCC的加入量与粉末的含水量(MC)、松密度(ρb)、孔隙率(ε)等呈现较好的线性关系(r2≥0.991 9),与流动性指标Hausner比(HR)、Carr’s指数(CI)呈现良好的正相关性(r2≥0.8342);表征粉体压缩性的参数压缩比(CR)、屈服应力(Py)逐渐降低,单位有效功(Esp)、参数a逐渐升高;表征粉体成型性参数kA逐渐增大,kB逐渐变小。PLS分析粉体的基本物理性质MC、ρb、振实密度(ρt)、真密度(ρtrue)、中值粒径(D0.5)对这些参数影响最大,而粒径分布(span)、HR、CI对其影响较小,但这3个指标对于表征粉体破碎和重排参数ab和f的影响最大。结论 MCC的增加降低了SFJDE的流动性,提高了SFJDE的压缩和成型能力,在使用的过程中应该要注意其流动性和压力敏感性的影响。     

Hip range‐of‐motion (ROM) is less than normal after rotational acetabular osteotomy for developmental dysplasia of the hip: A simulated ROM analysis

The optimal reorientation of the acetabulum for developmental dysplasia of the hip (DDH) is unknown in terms of hip range‐of‐motion (ROM). The simulated ROMs of 52 DDHs after rotational acetabular osteotomy (RAO) with several patterns of femoral head coverage and those of 73 normal hips were analyzed using computer models reconstructed from CT images. After RAO with a lateral center edge angle (LCEA) of 30° and an anterior center edge angle (ACEA) of 55° producing coverage similar to that of normal hips, the maximal flexion and maximal internal rotation at 110° flexion with 20° adduction were significantly smaller than those of the normal group. To achieve ROMs after RAO similar to those of the normal group, an LCEA of 30° with an ACEA of 45°, an LCEA of 25° with an ACEA of 45° to 50°, and an LCEA of 20° with an ACEA of 50° could be preferred angles to target, even though they provided smaller coverage than that of normal hips. After RAO producing femoral head coverage similar to that of normal hips, the maximal flexion and the maximal internal rotation at 110° flexion with 20° adduction were significantly smaller than those of the normal group. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:217–223, 2016.