Objective: To compare the effect of intracoronary arterial injection of tirofiban and sodium nitroprusside (SNP) on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) underw...Objective: To compare the effect of intracoronary arterial injection of tirofiban and sodium nitroprusside (SNP) on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coro-nary intervention (PCI). Methods: A total of 68 patients with acute STEMI who had no-reflow phenomenon during PCI were chosen and randomly divided into SNP group (n = 34) and tirofiban group (n = 34). Aiming at no-reflow phenomenon during PCI, with the use of microcatheters, intracoronary arterial injection of tirofiban was given in tirofiban group, while intracoronary bolus of SNP was given in SNP group. Coronary angiography was conducted to record TIMI flow grade of the infarct-related artery after 10 minutes. Plasma brain natriuretic peptide (BNP) was monitored before and after PCI (in 24 hours). With the help of ultrasound cardiogram, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) were recorded and compared in 30 days after PCI. Results: The ratio of TIMI grade 3 blood flow in tirofiban group was significantly higher than that in SNP group (76.5% (26/34) vs. 52.9% (18/34), p = .03)BNP levels in two groups had no statistical significance before PCI (p = .16), but in 24 h after PCI, BNP levels in tirofiban group were significantly lower than those in SNP group ((439.00 ± 4.90) μmol/L vs. (632.00 ± 3.63) μmol/L, p = .02)In 30 days after PCI, LVEF, LVEDD and LVESD in tirofiban group were all superior to those in SNP group (all p < .05). Conclusions: Intracoronary arterial injection of tirofiban was superior to SNP in improving no-reflow phenomenon in STEMI patients after PCI in the emergency treatment. Tirofiban therapy can increase coronary blood flow and myocardial perfusion after the occurrence of no-reflow phenomenon during PCI in STEMI patients, and improve long-term prognosis.展开更多
Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor pa...Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.展开更多
BACKGROUND Splenic artery aneurysm(SAA)rupture is a rare,life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability.Ruptured SAAs may exhibit a biphasic and relatively slo...BACKGROUND Splenic artery aneurysm(SAA)rupture is a rare,life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability.Ruptured SAAs may exhibit a biphasic and relatively slow clinical progression,commonly referred to as the“double-rupture phenomenon”.The reported incidence of the double-rupture phenomenon ranges 12%-21%in patients with ruptured SAAs,potentially due to variations in intra-abdominal pressure.Following anesthesia induction,muscle relaxation can decrease intra-abdominal pressure,potentially triggering the double-rupture phenomenon and leading to circulatory collapse.CASE SUMMARY A 61-year-old female presented to the Department of Emergency with upper abdominal pain,abdominal distension,dizziness,and vomiting.Her vital signs were initially stable.Physical examination revealed abdominal tenderness and positive-shifting dullness.Abdominal contrast-enhanced computed tomography revealed cirrhosis,severe portal hypertension,and splenomegaly.Acute rupture was suggested by a hematoma on the upper left side outside the SAA.Surgeons deemed intravascular intervention challenging and open splenectomy inevitable.Circulatory collapse occurred after anesthesia induction,likely due to a double rupture of the SAA.This double-rupture phenomenon may have resulted from an initial rupture of the SAA into the omental bursa,forming a hematoma that exerted a tamponade effect.A second rupture into the peritoneal cavity may have been triggered by decreased intra-abdominal pressure following anesthesia induction.The patient’s life was saved through early,coordinated,multidisciplinary significant postoperative bleeding or hypoxic encephalopathy.CONCLUSION Anesthesia-induced pressure reduction may trigger a second SAA rupture,causing collapse.Early diagnosis and multidisciplinary teamwork improve outcomes.This is a rare and life-threatening case of SAA rupture,which is of great significance to the medical community for understanding and handling such emergencies.展开更多
Background No-reflow phenomenon during percutaneous coronary intervention （PCI） for acute myocardial infarction （AMI） is a predictive factor of continuous myocardial ischemia, ventricular remodeling and cardiac dy...Background No-reflow phenomenon during percutaneous coronary intervention （PCI） for acute myocardial infarction （AMI） is a predictive factor of continuous myocardial ischemia, ventricular remodeling and cardiac dysfunction, which is closely associated with a worse prognosis. This study aimed to evaluate intracoronary nitroprusside in the prevention of the no-reflow phenomenon in AMI.Methods Ninety-two consecutive patients with AMI, who underwent primary PCI within 12 hours of onset, were randomly assigned to 2 groups： intracoronary administration of nitroprusside （group A, n=46）, intracoronary administration of nitroglycerin （group B, n=46）. The angJographic results were observed. The real-time myocardial contrast echocardiography （RT-MCE）, including contrast score index （CSI）, wall motion score index （WMSI）, transmural contrast defect length （CDL） and serious WM abnormal length （WML） were recorded at 24 hours and 1 week post-PCI. High sensitivity C-reactive protein （Hs-CRP） was examined by immune rate nephelometry. N-terminal prohormone brain natriuretic peptide （NT-proBNP） was tested with enzyme-linked immunosorbent assay. Patients were followed up for six months. Major adverse cardiac events （MACE） were recorded. Results The incidence of final TIMI-3 flow in group A was much higher than that in Group B （P 〈0.05）, final corrected TIMI frame count （cTFC） in group A decreased significantly than that in group B （P 〈0.01）. The CSI, CDL/LV length, WMSI and WL/LV length in group A were significantly lower than that in group B （P 〈0.01）. Levels of Hs-CRP and NT-proBNP at 1 week post-PCI decreased significantly in group A than that in group B （P 〈0.01）. Patients were followed up for 6 months and the incidence of MACE in group A was significantly lower than that in group B （P〈0.05）.Conclusion Intracoronary nitroprusside can improve myocardial microcirculation, leading to the decrease of the incidence of no-reflow phenomenon and better prognosis.展开更多
Background Percutaneous coronary intervention （PCI） is used as a treatment for acute myocardial infarction （AMI）, and one of its major complications is the angiographic no-reflow phenomenon （NR）. Although intra-...Background Percutaneous coronary intervention （PCI） is used as a treatment for acute myocardial infarction （AMI）, and one of its major complications is the angiographic no-reflow phenomenon （NR）. Although intra-aortic balloon pumping （IABP） is sometimes used in such patients to increase the diastolic coronary blood flow, there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon. Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 and December 2009, of which 12 patients were selected for IABP therapy and the left 10 were selected as the control group by group procedure of odd and even days; We observed the vasoactive substance in both groups on the days of 1, 2, 3, 5, 7, 10 after the different interventions, which include plasma renin activity （PRA）, angiotensin Ⅱ （ANG Ⅱ）, aldosterone （ALD）, adrenaline （E）, and noradrenalin （NE）; In addition, cardiac structure and cardiac ventricle systolic function including left atrium medial diameter （LAMD）, left ventricular medial diameter （LVMD） Finally, left ventricular ejection fraction （LVEF） were evaluated after 10 days, 3 months and 6 months; statistics was taken to analysis. Results According to the time concentration curve, vasoactive substance of the IABP group decreased faster than that of the control group, and this difference had statistical significance （P 〈 0.01 ） ; In terms of LAMD, LVMD, and LVEF, echocardiography difference of the IABP and the control group in 10 days, 3 months, and 6 months also showed statistical significance （P 〈 0.05）. Conclusions IABP can significantly reduce the release of vasoactive substances of NR in patients of primary PCI for AMI; LAMD, LVMD and LVEF in 10 days, 3 months, and 6 months can be improved using this method, which is conducive to recovery of heart function.展开更多
Background To investigate the effect of intra-aortic balloon pumping （IABP） on no-reflow phenomenon primary percutaneous coronary intervention （PCI） for ST-Elevation Myocardial Infarction （STEMI）. Methods Clinic...Background To investigate the effect of intra-aortic balloon pumping （IABP） on no-reflow phenomenon primary percutaneous coronary intervention （PCI） for ST-Elevation Myocardial Infarction （STEMI）. Methods Clinical data of 22 acute myocardial infarction patients after PCI with angiographic no-reflow phenomenon were retrospectively analyzed between January 2006 and December 2009.12 patients underwent IABP, other 10 patients as control group. We observed difference of cardiac structure, brain natriuretic peptide （BNP） and ventricular systolic function between two group, as well as cardiac injury markers （MYO,CK-MB, cTnI） in both groups on the days of 1, 2, 3, 5, 7, 10 after the different interventions. In addition, cardiac structure and ventricular systolic function including left atrium medial diameter （LAMD）, left ventricular medial diameter （LVMD）, left ventricular ejection fraction （LVEF） was evaluated after 10 days, 3 months,6 months Finally, statistics was used to analysis the data. Results The several vasoactive substances as well as cardiac injury markers and LAMD, LVMD, LVEF of 10 days, 3 months, 6 months of IABP group were significant difference with control group significant difference （P 〉 0.0 PCI with angiographic no-reflo （P 〈 0.05）. 5）. Conclusions w phenomenon, BNP targets of IABP group compared with the control group no IABP has effects on prognosis in STEMI patients who performed which is conducive to recovery of heart function.展开更多
Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary interventio...Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary intervention(PCI). The lymphocyte-to-monocyte ratio(LMR) is a novel inflammatory marker which is associated with slow coronary flow. We aimed to investigate the predictive value of LMR for no-reflow phenomenon in patients with STEMI undergoing primary PCI. Methods A total of 1350 STEMI patients were enrolled in this study from January 2014 to January 2018. Blood samples were obtained at initial admission for analysis of LMR.The univariate and multivariate logistic regression analysis was performed to study the relationship between LMR and no-reflow phenomenon. Results All the 156 patients among the study population suffered from no-reflow phenomenon during the procedure. The LMR level was significantly lower in patients with no-reflow(1.6 ±1.0 vs. 3.25 ± 1.8, P<0.001). Multivariate logistic regression analysis showed that LMR was independently associated with no-reflow post primary PCI in STEMI patients.(OR 2.356, 95% CI 1.201-5.945;P=0.030). The area under the ROC curve for the LMR was 0.757 [95% confidence interval(CI) 0.686-0.828, P<0.001]. Conclusions LMR at admission could serve as a biomarker for no-reflow phenomenon in patients undertaken primary PCI for STEMI.[S Chin J Cardiol 2019;20(4):228-235]展开更多
Background:Various experimental and clinical studies have reported on coronary microcirculatory dysfunction("no-reflow"phenomenon).Nevertheless,pathogenesis and effective treatment are yet to be fully elucid...Background:Various experimental and clinical studies have reported on coronary microcirculatory dysfunction("no-reflow"phenomenon).Nevertheless,pathogenesis and effective treatment are yet to be fully elucidated.This study aimed to measure the intracoronary pressure gradient in the no-reflow artery during emergent percutaneous coronary intervention and explore the potential mechanism of no-reflow.Methods:From September 1st,2018 to June 30th,2019,intracoronary pressure in acute myocardial infarction patient was continuously measured by aspiration catheter from distal to proximal segment in the Department of Coronary Care Unit,Tianjin Chest Hospital,respectively in no-reflow arteries(no-reflow group)and arteries with thrombolysis in myocardial infarction-3 flow(control group).At least 12 cardiac cycles were consecutively recorded when the catheter was pulled back.The forward systolic pressure gradient was calculated as proximal systolic pressure minus distal systolic pressure.Comparison between groups was made using the Student t test,Mann-Whitney U-test or Chi-square test,as appropriate.Results:Intracoronary pressure in 33 no-reflow group and 26 in control group were measured.The intracoronary forward systolic pressure gradient was-1.3(-4.8,0.7)and 3.8(0.8,8.8)mmHg in no-reflow group and control group(Z=-3.989,P<0.001),respectively,while the forward diastolic pressure gradient was-1.0(-3.2,0)and 4.6(0,16.5)mmHg in respective groups(Z=-3.851,P<0.001).Moreover,the intracoronary forward pressure gradient showed significant difference between that before and after nicorandil medication(Z=-3.668,P<0.001 in systolic pressure gradient and Z=-3.530,P<0.001 in diastolic pressure gradient).Conclusions:No reflow during emergent coronary revascularization is significantly associated with local hemodynamic abnormalities in the coronary arteries.Intracoronary nicorandil administration at the distal segment of a coronary artery with an aspiration catheter could improve the microcirculatory dysfunction and resume normal coronary pressure gradient.Clinical trial registration:www.ClinicalTrials.gov(No.NCT 03600259).展开更多
Understanding fingering, as a challenge to stable displacement during the immiscible flow, has become a crucial phenomenon for geological carbon sequestration, enhanced oil recovery, and groundwater protection. Typica...Understanding fingering, as a challenge to stable displacement during the immiscible flow, has become a crucial phenomenon for geological carbon sequestration, enhanced oil recovery, and groundwater protection. Typically governed by gravity, viscous and capillary forces, these factors lead invasive fluids to occupy pore space irregularly and incompletely. Previous studies have demonstrated capillary numbers,describing the viscous and capillary forces, to quantificationally induce evolution of invasion patterns.While the evolution mechanisms of invasive patterns have not been deeply elucidated under the constant capillary number and three variable parameters including velocity, viscosity, and interfacial tension.Our research employs two horizontal visualization systems and a two-phase laminar flow simulation to investigate the tendency of invasive pattern transition by various parameters at the pore scale. We showed that increasing invasive viscosity or reducing interfacial tension in a homogeneous pore space significantly enhanced sweep efficiency, under constant capillary number. Additionally, in the fingering crossover pattern, the region near the inlet was prone to capillary fingering with multi-directional invasion, while the viscous fingering with unidirectional invasion was more susceptible occurred in the region near the outlet. Furthermore, increasing invasive viscosity or decreasing invasive velocity and interfacial tension promoted the extension of viscous fingering from the outlet to the inlet, presenting that the subsequent invasive fluid flows toward the outlet. In the case of invasive trunk along a unidirectional path, the invasive flow increased exponentially closer to the outlet, resulting in a significant decrease in the width of the invasive interface. Our work holds promising applications for optimizing invasive patterns in heterogeneous porous media.展开更多
The Fourier series of the 2π-periodic functions tg(x2)and 1sin(x)and some of their relatives (first of their integrals) are investigated and illustrated with respect to their convergence. These functions are Generali...The Fourier series of the 2π-periodic functions tg(x2)and 1sin(x)and some of their relatives (first of their integrals) are investigated and illustrated with respect to their convergence. These functions are Generalized functions and the convergence is weak convergence in the sense of the convergence of continuous linear functionals defining them. The figures show that the approximations of the Fourier series possess oscillations around the function which they represent in a broad band embedding them. This is some analogue to the Gibbs phenomenon. A modification of Fourier series by expansion in powers cosn(x)for the symmetric part of functions and sin(x)cosn−1(x)for the antisymmetric part (analogous to Taylor series) is discussed and illustrated by examples. The Fourier series and their convergence behavior are illustrated also for some 2π-periodic delta-function-like sequences connected with the Poisson theorem showing non-vanishing oscillations around the singularities similar to the Gibbs phenomenon in the neighborhood of discontinuities of functions. .展开更多
Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is...Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction （AMI） undergoing primary PCI. Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study. Patients with high risk of no-reflow （no-flow score 〉 10, by using a no-flow risk prediction model, n = 216） were randomly divided into a controlled group （n = 108） and a combination therapy group （n = 108）. Patients in the controlled group received conventional treatment, while patients in combination therapy group received high-dose （80 mg） atorvastatin pre-treatment, intracoronary administration of adenosine （140 ~tg/min per kilogram） during PCI procedure, platelet membrane glycoprotein lib/Ilia receptor antagonist （tirofiban, 101.tg/kg bolus followed by 0.15 ~tg/kg per minute） and thrombus aspiration. Myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI. Major adverse cardiac events （MACE） were followed up for six months. Results Incidence of no-reflow in combination therapy group was 2.8%, which was similar to that in low risk group 2.7% and was significantly lower than that in control group （35.2%, P 〈 0.01）. The myocardial perfusion （A= 13） values were higher in combination therapy group than that in control group 72 h after PCI. After 6 months, there were six （6.3%） MACE events （one death, two non-fatal MIs and three revasculafizations） in combination therapy group and 12 （13.2%） （four deaths, three non-fatal MIs and five revascularizations, P 〈 0.05） in control group. Conclusions Combination of thrombus aspiration, high-dose statin pre-treatment, intmcoronary administration of adenosine during PCI procedure and platelet membrane glycoprotein Ⅱ b/Ⅲa receptor antagonist reduces the incidence of no-reflow after primary PCI in patients with acute myocardial infarction who are at high risk of no-reflow.展开更多
At the late stage of solidification with ultrasonic treatment （UST） in Al-Si alloys, a part of semisolid overflows and climbs along the probe. The interesting phenomenon and its influence on the solidification micro...At the late stage of solidification with ultrasonic treatment （UST） in Al-Si alloys, a part of semisolid overflows and climbs along the probe. The interesting phenomenon and its influence on the solidification microstructure were investigated in order to better study the mechanism of UST. It is considered that the overflowing phenomenon occurs due to the changes of vibration and flow in the remaining semisolid. Because the overflowed portion comes from the region with intense UST effect and vibrates with the probe during solidification, great modification of primary and euteetic Si （about 10 pm in length） and refinement of primary a（Al） （about 70 μm in size） are observed in this portion.展开更多
文摘Objective: To compare the effect of intracoronary arterial injection of tirofiban and sodium nitroprusside (SNP) on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coro-nary intervention (PCI). Methods: A total of 68 patients with acute STEMI who had no-reflow phenomenon during PCI were chosen and randomly divided into SNP group (n = 34) and tirofiban group (n = 34). Aiming at no-reflow phenomenon during PCI, with the use of microcatheters, intracoronary arterial injection of tirofiban was given in tirofiban group, while intracoronary bolus of SNP was given in SNP group. Coronary angiography was conducted to record TIMI flow grade of the infarct-related artery after 10 minutes. Plasma brain natriuretic peptide (BNP) was monitored before and after PCI (in 24 hours). With the help of ultrasound cardiogram, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) were recorded and compared in 30 days after PCI. Results: The ratio of TIMI grade 3 blood flow in tirofiban group was significantly higher than that in SNP group (76.5% (26/34) vs. 52.9% (18/34), p = .03)BNP levels in two groups had no statistical significance before PCI (p = .16), but in 24 h after PCI, BNP levels in tirofiban group were significantly lower than those in SNP group ((439.00 ± 4.90) μmol/L vs. (632.00 ± 3.63) μmol/L, p = .02)In 30 days after PCI, LVEF, LVEDD and LVESD in tirofiban group were all superior to those in SNP group (all p < .05). Conclusions: Intracoronary arterial injection of tirofiban was superior to SNP in improving no-reflow phenomenon in STEMI patients after PCI in the emergency treatment. Tirofiban therapy can increase coronary blood flow and myocardial perfusion after the occurrence of no-reflow phenomenon during PCI in STEMI patients, and improve long-term prognosis.
文摘Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.
基金Supported by National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-119.
文摘BACKGROUND Splenic artery aneurysm(SAA)rupture is a rare,life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability.Ruptured SAAs may exhibit a biphasic and relatively slow clinical progression,commonly referred to as the“double-rupture phenomenon”.The reported incidence of the double-rupture phenomenon ranges 12%-21%in patients with ruptured SAAs,potentially due to variations in intra-abdominal pressure.Following anesthesia induction,muscle relaxation can decrease intra-abdominal pressure,potentially triggering the double-rupture phenomenon and leading to circulatory collapse.CASE SUMMARY A 61-year-old female presented to the Department of Emergency with upper abdominal pain,abdominal distension,dizziness,and vomiting.Her vital signs were initially stable.Physical examination revealed abdominal tenderness and positive-shifting dullness.Abdominal contrast-enhanced computed tomography revealed cirrhosis,severe portal hypertension,and splenomegaly.Acute rupture was suggested by a hematoma on the upper left side outside the SAA.Surgeons deemed intravascular intervention challenging and open splenectomy inevitable.Circulatory collapse occurred after anesthesia induction,likely due to a double rupture of the SAA.This double-rupture phenomenon may have resulted from an initial rupture of the SAA into the omental bursa,forming a hematoma that exerted a tamponade effect.A second rupture into the peritoneal cavity may have been triggered by decreased intra-abdominal pressure following anesthesia induction.The patient’s life was saved through early,coordinated,multidisciplinary significant postoperative bleeding or hypoxic encephalopathy.CONCLUSION Anesthesia-induced pressure reduction may trigger a second SAA rupture,causing collapse.Early diagnosis and multidisciplinary teamwork improve outcomes.This is a rare and life-threatening case of SAA rupture,which is of great significance to the medical community for understanding and handling such emergencies.
文摘Background No-reflow phenomenon during percutaneous coronary intervention （PCI） for acute myocardial infarction （AMI） is a predictive factor of continuous myocardial ischemia, ventricular remodeling and cardiac dysfunction, which is closely associated with a worse prognosis. This study aimed to evaluate intracoronary nitroprusside in the prevention of the no-reflow phenomenon in AMI.Methods Ninety-two consecutive patients with AMI, who underwent primary PCI within 12 hours of onset, were randomly assigned to 2 groups： intracoronary administration of nitroprusside （group A, n=46）, intracoronary administration of nitroglycerin （group B, n=46）. The angJographic results were observed. The real-time myocardial contrast echocardiography （RT-MCE）, including contrast score index （CSI）, wall motion score index （WMSI）, transmural contrast defect length （CDL） and serious WM abnormal length （WML） were recorded at 24 hours and 1 week post-PCI. High sensitivity C-reactive protein （Hs-CRP） was examined by immune rate nephelometry. N-terminal prohormone brain natriuretic peptide （NT-proBNP） was tested with enzyme-linked immunosorbent assay. Patients were followed up for six months. Major adverse cardiac events （MACE） were recorded. Results The incidence of final TIMI-3 flow in group A was much higher than that in Group B （P 〈0.05）, final corrected TIMI frame count （cTFC） in group A decreased significantly than that in group B （P 〈0.01）. The CSI, CDL/LV length, WMSI and WL/LV length in group A were significantly lower than that in group B （P 〈0.01）. Levels of Hs-CRP and NT-proBNP at 1 week post-PCI decreased significantly in group A than that in group B （P 〈0.01）. Patients were followed up for 6 months and the incidence of MACE in group A was significantly lower than that in group B （P〈0.05）.Conclusion Intracoronary nitroprusside can improve myocardial microcirculation, leading to the decrease of the incidence of no-reflow phenomenon and better prognosis.
文摘Background Percutaneous coronary intervention （PCI） is used as a treatment for acute myocardial infarction （AMI）, and one of its major complications is the angiographic no-reflow phenomenon （NR）. Although intra-aortic balloon pumping （IABP） is sometimes used in such patients to increase the diastolic coronary blood flow, there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon. Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 and December 2009, of which 12 patients were selected for IABP therapy and the left 10 were selected as the control group by group procedure of odd and even days; We observed the vasoactive substance in both groups on the days of 1, 2, 3, 5, 7, 10 after the different interventions, which include plasma renin activity （PRA）, angiotensin Ⅱ （ANG Ⅱ）, aldosterone （ALD）, adrenaline （E）, and noradrenalin （NE）; In addition, cardiac structure and cardiac ventricle systolic function including left atrium medial diameter （LAMD）, left ventricular medial diameter （LVMD） Finally, left ventricular ejection fraction （LVEF） were evaluated after 10 days, 3 months and 6 months; statistics was taken to analysis. Results According to the time concentration curve, vasoactive substance of the IABP group decreased faster than that of the control group, and this difference had statistical significance （P 〈 0.01 ） ; In terms of LAMD, LVMD, and LVEF, echocardiography difference of the IABP and the control group in 10 days, 3 months, and 6 months also showed statistical significance （P 〈 0.05）. Conclusions IABP can significantly reduce the release of vasoactive substances of NR in patients of primary PCI for AMI; LAMD, LVMD and LVEF in 10 days, 3 months, and 6 months can be improved using this method, which is conducive to recovery of heart function.
文摘Background To investigate the effect of intra-aortic balloon pumping （IABP） on no-reflow phenomenon primary percutaneous coronary intervention （PCI） for ST-Elevation Myocardial Infarction （STEMI）. Methods Clinical data of 22 acute myocardial infarction patients after PCI with angiographic no-reflow phenomenon were retrospectively analyzed between January 2006 and December 2009.12 patients underwent IABP, other 10 patients as control group. We observed difference of cardiac structure, brain natriuretic peptide （BNP） and ventricular systolic function between two group, as well as cardiac injury markers （MYO,CK-MB, cTnI） in both groups on the days of 1, 2, 3, 5, 7, 10 after the different interventions. In addition, cardiac structure and ventricular systolic function including left atrium medial diameter （LAMD）, left ventricular medial diameter （LVMD）, left ventricular ejection fraction （LVEF） was evaluated after 10 days, 3 months,6 months Finally, statistics was used to analysis the data. Results The several vasoactive substances as well as cardiac injury markers and LAMD, LVMD, LVEF of 10 days, 3 months, 6 months of IABP group were significant difference with control group significant difference （P 〉 0.0 PCI with angiographic no-reflo （P 〈 0.05）. 5）. Conclusions w phenomenon, BNP targets of IABP group compared with the control group no IABP has effects on prognosis in STEMI patients who performed which is conducive to recovery of heart function.
文摘Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary intervention(PCI). The lymphocyte-to-monocyte ratio(LMR) is a novel inflammatory marker which is associated with slow coronary flow. We aimed to investigate the predictive value of LMR for no-reflow phenomenon in patients with STEMI undergoing primary PCI. Methods A total of 1350 STEMI patients were enrolled in this study from January 2014 to January 2018. Blood samples were obtained at initial admission for analysis of LMR.The univariate and multivariate logistic regression analysis was performed to study the relationship between LMR and no-reflow phenomenon. Results All the 156 patients among the study population suffered from no-reflow phenomenon during the procedure. The LMR level was significantly lower in patients with no-reflow(1.6 ±1.0 vs. 3.25 ± 1.8, P<0.001). Multivariate logistic regression analysis showed that LMR was independently associated with no-reflow post primary PCI in STEMI patients.(OR 2.356, 95% CI 1.201-5.945;P=0.030). The area under the ROC curve for the LMR was 0.757 [95% confidence interval(CI) 0.686-0.828, P<0.001]. Conclusions LMR at admission could serve as a biomarker for no-reflow phenomenon in patients undertaken primary PCI for STEMI.[S Chin J Cardiol 2019;20(4):228-235]
基金supported by a grant from the Major Engineering Projects from Tianjin Science and Technology Committee(No.16ZXMJSY00150)。
文摘Background:Various experimental and clinical studies have reported on coronary microcirculatory dysfunction("no-reflow"phenomenon).Nevertheless,pathogenesis and effective treatment are yet to be fully elucidated.This study aimed to measure the intracoronary pressure gradient in the no-reflow artery during emergent percutaneous coronary intervention and explore the potential mechanism of no-reflow.Methods:From September 1st,2018 to June 30th,2019,intracoronary pressure in acute myocardial infarction patient was continuously measured by aspiration catheter from distal to proximal segment in the Department of Coronary Care Unit,Tianjin Chest Hospital,respectively in no-reflow arteries(no-reflow group)and arteries with thrombolysis in myocardial infarction-3 flow(control group).At least 12 cardiac cycles were consecutively recorded when the catheter was pulled back.The forward systolic pressure gradient was calculated as proximal systolic pressure minus distal systolic pressure.Comparison between groups was made using the Student t test,Mann-Whitney U-test or Chi-square test,as appropriate.Results:Intracoronary pressure in 33 no-reflow group and 26 in control group were measured.The intracoronary forward systolic pressure gradient was-1.3(-4.8,0.7)and 3.8(0.8,8.8)mmHg in no-reflow group and control group(Z=-3.989,P<0.001),respectively,while the forward diastolic pressure gradient was-1.0(-3.2,0)and 4.6(0,16.5)mmHg in respective groups(Z=-3.851,P<0.001).Moreover,the intracoronary forward pressure gradient showed significant difference between that before and after nicorandil medication(Z=-3.668,P<0.001 in systolic pressure gradient and Z=-3.530,P<0.001 in diastolic pressure gradient).Conclusions:No reflow during emergent coronary revascularization is significantly associated with local hemodynamic abnormalities in the coronary arteries.Intracoronary nicorandil administration at the distal segment of a coronary artery with an aspiration catheter could improve the microcirculatory dysfunction and resume normal coronary pressure gradient.Clinical trial registration:www.ClinicalTrials.gov(No.NCT 03600259).
基金supported by the National Natural Science Foundation of China Joint Fund Project (Grant/Award Number: U20B6003)National Natural Science Foundation of China (Grant/Award Number: 52304054)。
文摘Understanding fingering, as a challenge to stable displacement during the immiscible flow, has become a crucial phenomenon for geological carbon sequestration, enhanced oil recovery, and groundwater protection. Typically governed by gravity, viscous and capillary forces, these factors lead invasive fluids to occupy pore space irregularly and incompletely. Previous studies have demonstrated capillary numbers,describing the viscous and capillary forces, to quantificationally induce evolution of invasion patterns.While the evolution mechanisms of invasive patterns have not been deeply elucidated under the constant capillary number and three variable parameters including velocity, viscosity, and interfacial tension.Our research employs two horizontal visualization systems and a two-phase laminar flow simulation to investigate the tendency of invasive pattern transition by various parameters at the pore scale. We showed that increasing invasive viscosity or reducing interfacial tension in a homogeneous pore space significantly enhanced sweep efficiency, under constant capillary number. Additionally, in the fingering crossover pattern, the region near the inlet was prone to capillary fingering with multi-directional invasion, while the viscous fingering with unidirectional invasion was more susceptible occurred in the region near the outlet. Furthermore, increasing invasive viscosity or decreasing invasive velocity and interfacial tension promoted the extension of viscous fingering from the outlet to the inlet, presenting that the subsequent invasive fluid flows toward the outlet. In the case of invasive trunk along a unidirectional path, the invasive flow increased exponentially closer to the outlet, resulting in a significant decrease in the width of the invasive interface. Our work holds promising applications for optimizing invasive patterns in heterogeneous porous media.
文摘The Fourier series of the 2π-periodic functions tg(x2)and 1sin(x)and some of their relatives (first of their integrals) are investigated and illustrated with respect to their convergence. These functions are Generalized functions and the convergence is weak convergence in the sense of the convergence of continuous linear functionals defining them. The figures show that the approximations of the Fourier series possess oscillations around the function which they represent in a broad band embedding them. This is some analogue to the Gibbs phenomenon. A modification of Fourier series by expansion in powers cosn(x)for the symmetric part of functions and sin(x)cosn−1(x)for the antisymmetric part (analogous to Taylor series) is discussed and illustrated by examples. The Fourier series and their convergence behavior are illustrated also for some 2π-periodic delta-function-like sequences connected with the Poisson theorem showing non-vanishing oscillations around the singularities similar to the Gibbs phenomenon in the neighborhood of discontinuities of functions. .
文摘Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction （AMI） undergoing primary PCI. Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study. Patients with high risk of no-reflow （no-flow score 〉 10, by using a no-flow risk prediction model, n = 216） were randomly divided into a controlled group （n = 108） and a combination therapy group （n = 108）. Patients in the controlled group received conventional treatment, while patients in combination therapy group received high-dose （80 mg） atorvastatin pre-treatment, intracoronary administration of adenosine （140 ~tg/min per kilogram） during PCI procedure, platelet membrane glycoprotein lib/Ilia receptor antagonist （tirofiban, 101.tg/kg bolus followed by 0.15 ~tg/kg per minute） and thrombus aspiration. Myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI. Major adverse cardiac events （MACE） were followed up for six months. Results Incidence of no-reflow in combination therapy group was 2.8%, which was similar to that in low risk group 2.7% and was significantly lower than that in control group （35.2%, P 〈 0.01）. The myocardial perfusion （A= 13） values were higher in combination therapy group than that in control group 72 h after PCI. After 6 months, there were six （6.3%） MACE events （one death, two non-fatal MIs and three revasculafizations） in combination therapy group and 12 （13.2%） （four deaths, three non-fatal MIs and five revascularizations, P 〈 0.05） in control group. Conclusions Combination of thrombus aspiration, high-dose statin pre-treatment, intmcoronary administration of adenosine during PCI procedure and platelet membrane glycoprotein Ⅱ b/Ⅲa receptor antagonist reduces the incidence of no-reflow after primary PCI in patients with acute myocardial infarction who are at high risk of no-reflow.
基金Project(50874022)supported by the National Natural Science Foundation of China
文摘At the late stage of solidification with ultrasonic treatment （UST） in Al-Si alloys, a part of semisolid overflows and climbs along the probe. The interesting phenomenon and its influence on the solidification microstructure were investigated in order to better study the mechanism of UST. It is considered that the overflowing phenomenon occurs due to the changes of vibration and flow in the remaining semisolid. Because the overflowed portion comes from the region with intense UST effect and vibrates with the probe during solidification, great modification of primary and euteetic Si （about 10 pm in length） and refinement of primary a（Al） （about 70 μm in size） are observed in this portion.
