Anatomical basis of laparoscopic medial‐to‐lateral mobilization of the descending colon

In laparoscopic colorectal resection, the medial‐to‐lateral approach has been largely adopted. This approach can be initiated by the division of either the inferior mesenteric artery (IMA) or the inferior mesenteric vein (IMV). This cadaveric study aimed to establish the feasibility of IMV dissection as the initial landmark of medial‐to‐lateral left colonic mobilization for evaluating the size of the peritoneal window between the IMV at the lower part of the pancreas and the origin of the IMA (IMA‐IMV distance) and the point of origin of the IMA compared to the lower edge of the third part of the duodenum (IMA‐D3 distance). These distances were recorded on 30 fresh cadavers. The IMA‐D3 distance was 0.4 ± 2.2 cm (mean ± SD). The IMA originated from the aorta at the level of or below the D3 in 21 cases (70%). The IMA‐IMV distance was 5.5 ± 1.8 cm and was greater or equal to 5 cm (large window) in 21 cases (70%). IMA‐IMV distance was correlated with IMA‐D3 showing that a large window was inversely correlated with a low IMA origin (P < 0.001). IMA‐D3 distance was not correlated with weight, height and sex. IMA‐IMV distance was largerin male (6.7 ± 0.9 vs. 4.9 ± 1.8, P = 0.001) and correlated with weight, (r = 0.60, 95%CI = 0.03–0.10, P < 0.001) and height (r = 0.54, 95%CI = 0.05–0.21, P = 0.002). IMV can be used as the initial landmark for laparoscopic medial‐to‐lateral dissection in two‐thirds of cases. A too‐small window can require first IMA division. The choice between the two different medial‐to‐lateral approaches could be made by evaluating the anatomical relationship between IMA, IMV, and D3. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.     

支气管动脉栓塞治疗大咯血的临床应用

目的探讨支气管栓塞术在治疗大咯血中的临床价值.方法回顾性析海军安庆医院2009年1月至2011年12月收治的经内科治疗无效的咯血患者29例,在选择性支气管动脉造影下,以聚乙烯醇颗粒或明胶海绵行栓塞治疗,并对术后临床疗效和不良反应进行观察.结果术后治疗总有效率达96.6%,治愈率为79.3%,未见明显的不良反应,术后平均随访5.6个月(3～12个月),未见复发病例.结论支气管栓塞术治疗大咯血具有创伤小、操作简单、疗效可靠、起效快等特点,值得临床推广.     

In vitro hemocompatibility and vascular endothelial cell functionality on titania nanostructures under static and dynamic conditions for improved coronary stenting applications

The usefulness of nanoscale topography in improving vascular response in vitro was established previously on hydrothermally modified titanium surfaces. To propose this strategy of surface modification for translation onto clinically used metallic stents, it is imperative that the surface should be also hemocompatible: an essential attribute for any blood-contacting device. The present in vitro study focuses on a detailed hemocompatibility evaluation of titania nanostructures created through an alkaline hydrothermal route on metallic Ti stent prototypes. Direct interactions of TiO₂ nanocues of various morphologies with whole blood were studied under static conditions as well as using an in vitro circulation model mimicking arterial flow, with respect to a polished Ti control. Nanomodified stent surfaces upon contact with human blood showed negligible hemolysis under constant shear and static conditions. Coagulation profile testing indicated that surface roughness of nanomodified stents induced no alterations in the normal clotting times, with insignificant thrombus formation and minimal inflammatory reaction. Endothelialized nanomodified Ti surfaces were found to inhibit both activation as well as aggregation of platelets compared with the control surface, with the endothelium formed on the nanosurfaces having an increased expression of anti-thrombogenic genes. Such a nanotextured Ti surface, which is anti-thrombogenic and promotes endothelialization, would be a cost-effective alternative to drug-eluting stents or polymer-coated stents for overcoming in-stent restenosis.     

Quantification of coronary arterial stenoses in CTA using fuzzy distance transform

Quantification of coronary arterial stenoses is useful for the diagnosis of several coronary heart diseases. Being noninvasive, economical and informative, computed tomographic angiography (CTA) has become a common modality for monitoring disease status and treatment effects. Here, we present a new method for detecting and quantifying coronary arterial stenosis in CTA using fuzzy distance transform (FDT) approach and a new coherence analysis of observed data for computing expected local diameter. FDT allows computing local depth at each image point in the presence of partial voluming and thus, eliminates the need for binarization, commonly, associated with inclusion of additional errors. In the current method, coronary arterial stenoses are detected and their severities are quantified by analyzing FDT values along the medial axis of an arterial tree obtained by its skeletonization. A new skeletal pruning algorithm has been developed toward improving the quality of medial axes and thereby, enhancing the accuracy of stenosis detection and quantification. Further, we have developed a new method to estimate “expected diameter” along a given arterial branch using a new coherence analysis of observed diameter values along the branch. The overall method is completed in the following steps - (1) fuzzy segmentation of coronary artery in CTA, (2) FDT computation of coronary arteries, (3) medial axis computation, (4) estimation of observed and expected diameters along arteries and (5) detection of stenoses and quantification of arterial blockage. The performance of this method has been quantitatively evaluated on a realistic coronary artery phantom dataset with randomly simulated stenoses and the results have been compared with a binary distance transform based and a conventional binary algorithm. The method has also been applied on a clinical CTA dataset from thirteen heart patients and the results have been compared with an expert's quantitative assessment of stenoses. Results of the phantom experiment indicate that the new method (error: 0.53%) is significantly more accurate as compared to both binary distance transform based (error 2.11%) and conventional binary (error 3.71%) methods. Also, the results of the clinical study indicate that the new FDT-based method (kappa coefficient = 87.9%) is highly in agreement with the expert's assessments and, in this respect, outperforms the other two methods (kappa coefficients = 75.2% and 69.5%).     

眼底炫彩成像联合光相干断层扫描对视网膜动脉阻塞快速诊断及分类

目的:探讨眼底炫彩成像(MCI)联合光相干断层扫描成像(OCT)在视网膜动脉阻塞(RAO)的快速诊断及分类中的应用。方法:对本院2018-02/2020-07诊断为RAO的患者19例19眼进行回顾性研究。所有患者在经过眼科检查后确诊为RAO,均为单眼发病,其中视网膜中央动脉阻塞(CRAO)13眼,视网膜分支动脉阻塞(BRAO)5眼,睫状视网膜动脉残留的CRAO 1眼。所有患者行最佳矫正视力、裂隙灯、OCT、MCI、FFA及视野检查及分析。结果:经裂隙灯检查,12眼(63%)出现瞳孔对光反射迟钝或消失,16眼(84%)可发现全部或部分后极部视网膜苍白水肿,10眼(53%)可发现视网膜动脉变细。行FFA检查的患者为10例(53%),其余9例未行检查,其中6例患有严重的系统性疾病,2例拒绝检查、1例有药物过敏史。所有患者经MCI及OCT检查可发现特征性眼底表现,OCT特征性改变为弥漫性内层视网膜反射增强与MCI图像绿色缺血区域形成严密的一对一关系。结论:联合MCI及OCT检查可快速确诊RAO,而且结合两者的图像特征可更精确辨认出视网膜缺血区域,有助于疾病分类及预后判断。     

A direct anastomosis between the stems of celiac trunk and left colic artery by an anomalous fourth celiac trunk branch: First cadaveric study

Coeliac trunk (CT) is a ventral branch of abdominal aorta (AA) supplying the foregut through its three main branches, left gastric (LGA), common hepatic (CHA) and splenic artery (Standring et al., 2009). Branching pattern of CT may vary from above mentioned classical three to four, five or six. Additional branches include inferior phrenic artery, dorsal pancreatic artery, middle colic or accessory middle colic artery (Hamilton and Mossman, 1972; Amonoo‐Kuofi et al., 1995). Anastmosis between CT and Superior mesenteric artery (SMA) which supplies the midgut derivatives in the form of Bühler's arcade (1‐2%) is present posterior to the body of pancreas (Douard et al., 2006; McNulty et al., 2001). Anastomoses between SMA and Inferior mesenteric artery (IMA) which supplies hindgut derivatives are also documented (Lange et al, 2007; Van Damme and Bonte, 1990). Until recently no communications between arteries of foregut and hindgut were reported (Manoharan et al., 2010; Patel et al., 2010; Stimec et al., 2011). We report the first cadaveric finding demonstrating a direct communication between the stems of CT and left colic artery (LCA) via a fourth anomalous CT branch in the absence of any co‐existing stenosis or aneurysm in the main vessels. Clin. Anat. 26:984–986, 2013. © 2012 Wiley Periodicals, Inc.     

外科手术与介入治疗冠状动脉瘘疗效比较

目的 探讨外科手术与介入两种方法治疗冠状动脉瘘的疗效.方法 回顾性分析25例冠状动脉瘘患者的临床资料,外科手术治疗7例,介入治疗18例.结果 7例外科手术治疗患者中6例术后复查心脏彩超无残余分流,1例术中发现冠状动脉瘤,冠状动脉与右心室间有多发瘘口,切开冠状动脉瘤,自冠状动脉瘤体内修补瘘口,术后复查心脏彩超有残余分流.18例介入治疗患者中12例术后高选择性冠状动脉造影及心脏彩超检查无残余分流,2例有残余分流,4例因冠状动脉迂曲致建立轨道困难,未能行介入治疗.结论 冠状动脉瘘外科手术与介入治疗均安全、有效,应依据具体情况决定使用不同方法.     

Decision support for tendon tissue engineering

The aim of this study is to provide decision support with artificial intelligence for tendon tissue engineering strategies. The experimental data of tissue-engineered tendons were integrated and standardized with a centralized database, and a decision support system was developed using both artificial neural networks and decision trees. The decision support system was trained with existing cases in the database, and then was used to generate tissue engineering schemes for new experimental animals. Following the schemes generated by the artificial intelligent system, we cured 28 of the 30 experimental animals. In conclusion, artificial intelligence is a powerful method for decision support in the tendon tissue engineering realm.     

平板运动试验阳性的女性患者冠脉造影结果分析

目的 探讨女性平板运动试验(TET)假阳性的原因及颈动脉斑块检查对冠心病无创性诊断的意义.方法 对96例TET阳性的女性患者进行冠脉造影(CAG)及颈动脉斑块检查,对三种检查结果进行比较,回顾性分析女性患者出现平板运动试验假阳性的原因.结果 CAG证实为冠心病(CHD)58例(占60.4%),非CHD 38例(占39.6%);颈动脉斑块检查阳性者71.2%被证实为CHD,而阴性者仅36.7%被证实为CHD;非CHD 38例中临床最后诊断:心血管神经症20例,高血压病4例,单纯血脂异常4例,糖尿病3例,X综合征2例,高血压合并糖尿病2例,冠状动脉心肌桥2例,心尖部肥厚型心肌病1例.结论 平板运动试验假阳性与心血管神经症、X综合征、冠状动脉肌桥、高血压病、糖尿病等因素有关,心血管神经症为最常见病因.TET结合颈动脉斑块检查可显著提高冠心病无创性检查的诊断率.