简介：MitralstenosisduetorheumaticheartdiseaseisnotcommonintheUnitedStatesbutiscommoninthedevelopingworldbecauserheumaticfeverisstilloccurringfrequently.Symptomsusuallygraduallyoccurintheyoungadult(mostcommonlyfemale).Atrialfibrillationisacommonaccompanyingrhythminpatientswithprovenmitralstenosis.Themainphysiologiceventisapressuregradientbetweentheleftatriumandtheleftventricle.DiagnosisisrelativelystraightforwardusingphysicalexamandsimplelaboratorystudiessuchasChestX-Ray(elevatedLeftmainstembronchus,DoubleDensityindicatingenlargedleftatrium)andECG(P-Mitrale).Cardiacultrasoundconfirmstheclinicaldiagnosis(Domingofmitralvalveindiastole,Hockeystickdeformityoftheanteriormitralvalveleaflet,largeleftatrium,Dopplerestimationofvalvegradient).Mitralcommisurotomy(surgicalorBalloon)iswarrantedifthevalveispliableandnotheavilycalcified.

简介：BackgroundCongenitaltrachealstenosis(CTS)isachallengingairwayproblem.CTSininfantsandchildrencanbelife-threatening.Duringlastthirtyyears,alargenumberofstudiescoveringthediagnosis,clinicalpresentation,managements,especiallysurgicaltreatmentsofCTShavebeenreported.ThisreviewaimedtoconcluderecognizedknowledgeofCTSandprovidecluesformanaginginfantsandchildrenwithCTS.

简介：Theheartistheprincipalorganthatcirculatesblood.Innormalconditionsitproducesfoursoundsforeachcardiaccycle.However,mostoftenonlytwosoundsappearessential:S1andS2.Twoothersounds:S3andS4,withloweramplitudethanS1orS2,appearoccasionallyinthecardiaccyclebytheeffectofdiseaseorage.Thepresenceofabnormalsoundsinonecardiaccycleprovidevaluableinformationonvariousdiseases.Theaorticstenosis(AS),asbeingavalvularpathology,ischaracterizedbyasystolicmurmurduetoanarrowingoftheaorticvalve.Themitralstenosis(MS)ischaracterizedbyadiastolicmurmurduetoareductioninthemitralvalve.Earlyscreeningofthesediseasesisnecessary;it'sdonebyasimpletechniqueknownas:phonocardiography.Analysisofphonocardiogramssignalsusingsignalprocessingtechniquescanprovideforcliniciansusefulinformationconsideredasaplatformforsignificantdecisionsintheirmedicaldiagnosis.Inthisworktwotypesofdiseaseswerestudied:aorticstenosis(AS)andmitralstenosis(MS).Eachonepresentssixdifferentcases.Theapplicationofthediscretewavelettransform(DWT)toanalysepathologicalseverityofthe(ASandMSwaspresented.Then,thecalculationofvariousparameterswasperformedforeachpatient.ThisstudyexaminesthepossibilityofusingtheDWTintheanalysisofpathologicalseverityofASandMS.

简介：A70-year-oldmanisseenforevaluationofaheartmurmurheardbyhisprimarycareprovider.Thepatientplaysdoublestennistwiceperweekandclaimstobeasymptomatic.–Medication:amlodipineforhypertension.–Physicalexamination(PE):pulse82bpm;bloodpressure140/90mmHg.–Neck:neckveinsflat.Carotidsdelayed.–Chest:clear.–Cardiovascular:grade2/6latepeakingsystolicejectionmurmur.–Extremities:normalpulses.–Echocardiogram:heavilycalcifiedaorticvalve.Peakjetvelocity4.6m/s.Aorticvalvearea0.7cm2.Rightventricularsystolicpressurenotobtainable.

简介：无

简介：无

简介：ObjectivesPercutaneousballoonmitralvalvuloplasty(PBMV)isonewaytoimprovetherheumaticmitralstenosis.Howdoestheprocedureworkingravidaandfetusisnotveryclear.WeanalyzedtheeffectsandsafetyofPBMVoperationonpregnantpatientswithsevererheumaticmitralstenosis.MethodsEightpregnantpatientssufferingfromseveremitralstenosisunderwentfacilitatedPBMVoperationwithInoueballoon,andwerefollowedupfor(2.0±1.1)years.Contentsincludedoutcomeofpregnancy,infantgrowth,hemodynamics,echocardiography,cardiacfunction,mitralvalvesreplacementorrepeatvalvuloplasty.ResultsMitralvalvearea(MVA)before,oneweekandoneyearafterfacilitatedPBMVwere(0.84±0.21)cm2,(1.69±0.23)cm2and(1.51±0.24)cm2respectively.Thetransmitralpressuregradientdroppedfrom(22.1±4.7)mmHgto(9.9±3.1)mmHg(P<0.001)(1mmHg=0.133kPa).AfterfacilitatedPBMV,allpatientsshowedremarkableimmediatesymptomaticandhemodynamicimprovementwithoutseveremitralregurgitation.AllofthesepatientscouldmaintainNewYorkheartassociation(NYHA)ⅠorⅡfor(2.0±1.1)yearsaftertheoperation.TwopatientsdemandedinducedabortionconcerningabouttheteratogeniceffectofX-rayonfetus.Alltheothersixpatientscontinuedtheirgestationandhadfull-termcesareansectionwithoutcomplications.Theirnewbornsdevelopedhealthyandnormallytillnow.ConclusionsFacilitatedPBMVisafeasible,safeandeffectivedeviceforselectedpregnantpatientswithmitralstenosis.Theoperationiswelltoleratedbythefetus.

简介：无

简介：Transcatheteraorticvalvereplacement(TAVR)isincreasinglyusedforthetreatmentofhighorveryhighsurgicalriskpatientswithsevereaorticstenosis(AS)orfailingsurgicalbioprosthesis(valve-in-valve,VIV-TAVR).InTAVR,thecollapsedtranscatheterheartvalve(THV)isintroducedusingthedeliverysysteminsertedfromthefemoralartery(preferred)orotheralternativeaccesses(transapical,transaortic,transcarotid,subclavian/transinnominateortranscaval).Thedeliverysystemisthenadvanceduntilcoaxiallyalignedwiththeaorticannulus,wheretheTHVisdeployed.Thisprocedurecanbeassociatedwithcomplicationssuchasaccesssiteinjury(vascularcomplication),paravalvarleak,cerebrovasculareventsandconductiondisturbances.However,therapidacceptanceandsuccessesobservedwithTAVRhavebeenmadepossiblethroughcarefulpatientselection,preproceduralplanning(i.e.MDCTannularsizing),THVtechnology(i.e.newgenerationvalves),andproceduraltechniques(i.e.minimalistTF-TAVRandalternativepercutaneousaccessoptions),aswellasadecreaseincomplicationsasTAVRexperiencegrows.ThoughtheresultsorongoingclinicaltrialsevaluatingTAVRinintermediatesurgicalriskpatientsarepending,itislikelythatTAVRwillsoonbeapprovedforlowerriskpatientsaswell.

简介：BackgroundIncreasedlevelofglycatedhemoglobin(HbA1c)isassociatedwithhigherincidenceofcoronaryarterydisease(CAD)inthediabetics.However,therelationshipbetweenHbA1candtheriskofcoronaryarterystenosisinthenon-diabeticsiscontroversial.MethodsAretrospectiveresearchwasconductedon338enrolledparticipantswhohaveundergone2timesofcoronaryangiographicexaminationwithinthepastyear.Clinicalandlaboratoryvariablesattheinitialandthesecondtimeofadmissionwerecollected.AccordingtotheinitialmedianHbA1clevel,allparticipantsweredividedintotwogroupsnamedlowerandhighergroups.TherelationshipbetweenHbA1clevelandtheriskofcoronaryarterystenosisovertimewasevaluated.ResultsTheinitialvaluesofHbA1cinloweranduppergroupswere5.78±0.35%and6.21±0.32%(P<0.05).Ascomparedtothelowergroup,thepercentagesofmaleandsmokingparticipants,andtheserumlevelofCRPweresignificantlyhigherinthehighergroup(P<0.05).Othertraditionalriskfactorswerecomparablebetweenthetwogroups.Therewere54.2%and55.2%participantswithsinglevesselstenosis,and45.8%and44.8%withmultiplevesselstenoses,respectivelyinthetwogroupswithoutsignificantdifference.Thesecondtimeofadmission,were308.5±25.4days(lowergroup)and300.7±30.1days(highergroup)fromtheinitialadmission.AlthoughnosignificantchangesofHbA1clevelwereobservedwhencomparedtoinitial,HbA1clevelinthehighergroupwasstillsignificantlyhigherincomparisontothelowergroup(6.24±0.39%vs.5.80±0.36%,P=0.008).Thepercentageofnewcoronaryarterystenosis(≥50%stenosis)washigherinthehighergroupthanthatinthelowergroup(41.7%vs.32.3%,P<0.001).MultivariateregressionanalysessuggestedthatHbA1cremainedindependentfactorassociatedwithcoronaryarterystenosesafterextensiveadjustmentforriskfactors.ConclusionInthenondiabetics,increasedbaselineHbA1clevelportendstheriskofcorona

简介：ＴＨＥＨＥＭＯＲＨＥＯＬＯＧＹＣＨＡＮＧＥＩＮＩＳＣＨＥＭＩＣＲＥＧＩＯＮＢＹＣＯＲＯＮＡＲＹＳＴＥＮＯＳＩＳＡＦＴＥＲＬＡＳＥＲＩＲＲＡＤＩＡＴＩＯＮＯＮＢＬＯＯＤＴＨＥＨＥＭＯＲＨＥＯＬＯＧＹＣＨＡＮＧＥＩＮＩＳＣＨＥＭＩＣＲＥＧＩＯＮＢＹＣＯＲ...

简介：

简介：AbstractBackground:Previous studies have shown that inflammation plays an important role in intracranial atherosclerotic stenosis (ICAS). The platelet-to-lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker. This study aimed to explore the association of the PLR with ICAS in a Chinese Han population.Methods:A total of 2134 participants (518 with ICAS, 1616 without ICAS) were enrolled in this study. ICAS was defined as atherosclerotic stenosis >50% or the occlusion of several main intracranial arteries. Multivariable logistic regression analyses were used to assess the association of the PLR with ICAS. Additional subgroup analyses were performed according to age (<60 vs. ≥ 60 years) and acute ischemic stroke.Results:Multivariate regression analysis showed that a high PLR was associated with a higher risk of ICAS in all participants (P < 0.001). Compared with the lowest quartile, the fourth PLR quartile was significantly associated with ICAS (OR 1.705, 95% confidence interval 1.278–2.275, P < 0.001). In the subgroups stratified by age, an association between the PLR and ICAS was found in the late-life group (P < 0.001), but not in the mid-life group (P = 0.650). In the subgroups stratified by acute ischemic stroke, the relationship between an elevated PLR and a higher risk of ICAS remained unchanged (stroke group, P < 0.001; non-stroke group, P = 0.027).Conclusions:An elevated PLR was associated with a higher risk of ICAS in a Chinese Han population. The PLR might serve as a potential biomarker for ICAS in the elderly population.

简介：无

简介：Themanagementofpatientswithseveresymptomaticaorticstenosisandahightransvalvulargradientisstraightforward.Itrequiresaorticvalvereplacement.Managementofaorticstenosispatientswithlowflow,lowejectionfractionandlowgradientisfraught.Suchpatientsrarelyfulfillallthetenetsof“severity”andalsohavesevereleftventriculardysfunction.Bothcircumstancesmaketheoutcomeofaorticvalvereplacementuncertain.Thusthemanagementofthisgroupofpatientsrequiresintegrationofalldiagnosticmodalitiesavailable.Thephysicalexamination,degreeofvalvecalcification,theappearanceofthevalveduringsonographicexaminationandthepresenceofinotropicreserveallcontributeimportantlyinjudgingstenosisseverityandthelikelihoodofsuccessfulvalvereplacement.

简介：AbstractBackground:Insufficient cerebral perfusion is suggested to play a role in the development of Alzheimer disease (AD). However, there is a lack of direct evidence indicating whether hypoperfusion causes or aggravates AD pathology. We investigated the effect of chronic cerebral hypoperfusion on AD-related pathology in humans.Methods:We enrolled a group of cognitively normal patients (median age: 64 years) with unilateral chronic cerebral hypoperfusion. Regions of interest with the most pronounced hypoperfusion changes were chosen in the hypoperfused region and were then mirrored in the contralateral hemisphere to create a control region with normal perfusion. 11C-Pittsburgh compound-positron emission tomography standard uptake ratios and brain atrophy indices were calculated from the computed tomography images of each patient.Results:The median age of the 10 participants, consisting of 4 males and 6 females, was 64 years (47-76 years). We found that there were no differences in standard uptake ratios of the cortex (volume of interest [VOI]: P = 0.721, region of interest [ROI]: P = 0.241) and grey/white ratio (VOI: P = 0.333, ROI: P = 0.445) and brain atrophy indices (Bicaudate, Bifrontal, Evans, Cella, Cella media, and Ventricular index, P > 0.05) between the hypoperfused regions and contralateral normally perfused regions in patients with unilateral chronic cerebral hypoperfusion.Conclusion:Our findings suggest that chronic hypoperfusion due to large vessel stenosis may not directly induce cerebral β-amyloid deposition and neurodegeneration in humans.

简介：Theangiotensin-convertingenzymegeneisacandidategeneofstroke.Thepresentstudyinvolved62healthyvolunteersand148patientswithmiddlecerebralarterystenosisasconfirmedbybraincolorultrasoundfromaHanpopulationinNorthChina,anddeterminedtheperipheralbloodangiotensin-convertingenzymegenotypeusingPCR-restrictionfragmentlengthpolymorphismanalysis.TheresultsshowedthatthefrequenciesoftheDDgenotypeandDallelewereincreasedinpatientswithmiddlecerebralarterystenosis,butthedifferencewasnotstatisticallysignificantcomparedwithhealthycontrols.ThefindingsofthisstudyontherelationshipbetweenstrokegenesandmiddlecerebralarterystenosisindicatenosignificantcorrelationbetweenthefrequenciesoftheDDgenotypeandDalleleofangiotensin-convertingenzymeandmiddlecerebralarterystenosisinthisHanpopulationfromNorthChina.Inthefuture,studieswillbecarriedouttoinvestigatecorrelationsbetweenmultiplestrokecandidategenesynergyandmiddlecerebralarterystenosistoprovideafoundationforthedevelopmentofgenetherapy.

简介：AbstractIntroduction:Congenital nasal pyriform aperture stenosis (CNPAS) is a rare congenital condition of structural nasal obstruction. Respiratory distress, stertor, and poor feeding are often presenting features.Case Presentation:We report a case of a newborn diagnosed with CNPAS at 3 weeks of life. The diagnosis was missed on a nasoendoscopy at day 3 of life but was realised following a facial CT when the infant presented with ongoing symptoms of upper airway obstruction. Nasal dilation was performed successfully.Conclusion:CNPAS should be considered in any neonate with upper airway obstruction. A normal nasoendoscopy does not exclude the diagnosis.

简介：Leftbundlebranchblock(LBBB),traditionallyviewedasanelectrophysiologicabnormality,isincreasinglyrecognizedforitseffectsonhemodynamicsandpatient’sprognosis[1].Exercisenuclearstudiesfrequentlyshowreversibleperfusiondefectsintheabsenceofobstructivecoronaryarterydisease[2]andsomepatientswithintermittentLBBBdevelopanginacoincidentwiththeonsetofLBBB[3].WereportacaseofintermittentLBBBwithabnormalstresstechnetium99mTcsingle-photonemissioncomputedtomography(SPECT)studyandnormalcoronaryarteryangiography.

简介：无