Fiber micro-architecture in the longitudinal-radial and circumferential-radial planes of ascending thoracic aortic aneurysm media

It was recently demonstrated by our group that the delamination strength of ascending thoracic aortic aneurysms (ATAA) was lower than that of control (CTRL, non-aneurysmal) ascending thoracic aorta (ATA), and the reduced strength was more pronounced among bicuspid (BAV) vs. tricuspid aortic valve (TAV) patients, suggesting a different risk of aortic dissection for BAV patients. We hypothesized that aortic valve morphologic phenotype predicts fiber micro-architectural anomalies in ATA. To test the hypothesis, we characterized the micro-architecture in the longitudinal-radial (Z-RAD) and circumferential-radial (Θ-RAD) planes of human ATA tissue that was artificially dissected medially. The outer and inner-media of CTRL-ATA, BAV-ATAA and TAV-ATAA were imaged using multi-photon microscopy in the Z-RAD and Θ-RAD planes to observe collagen and elastin. Micrographs were processed using an image-based tool to quantify several micro-architectural characteristics. In the outer-media of BAV-ATAA, elastin was more undulated and less aligned about the Θ-axis when compared with CTRL-ATA, which is consistent with increased tensile stretch at inflection point of Θ-strips of adventitial-medial half of BAV-ATAA (1.28) when compared with CTRL-ATA (1.13). With increasing age, collagen became more undulated about the Z-axis within the outer-media of TAV-ATAA, and elastin became more oriented in the Z-axis and collagen less radially-oriented within the inner-media of TAV-ATAA. This discrepancy in the micro-architecture with fibers in the inner layers being more stretched and with disrupted radially-oriented components than fibers in the outer layers may be associated with the development, progression and vascular remodeling in aneurysms arising in TAV patients.     

电子胃镜下行食管破裂修补术治疗食管破裂患者的护理体会(附1病例报道)

目的:分析并总结食管破裂的患者急诊住院后经过系统、科学、快速的护理手段和临床治疗,及使用特殊的治疗方法(借助电子胃镜行食管破裂的修补治疗)得到救治的过程中的护理体会.方法:入院后急检血常规、血型、凝血象、生化系列等相关检查;给予禁食水,重症监护,对症处理,营养支持,胸腔闭式引流术排出引流液,应用敏感抗生素等治疗方法;给予科学的严密护理(生命体征的监测护理、严密观察体温的变化及对症处理、胃管的护理、胸腔闭式引流管的护理、心里支持的护理).结果:通过上述方法,患者在无明显并发症发生的情况下,最终在较短的时间内顺利痊愈出院.结论:与常规开胸下行食管破裂修补术治疗食管破裂的患者相比,在电子胃镜下行食管破裂修补术拥有治疗时间短,恢复快,住院时间短,患者医疗费降低等优点.     

上胸段硬膜外阻滞治疗慢性心力衰竭合并房颤的临床研究

目的:比较上胸段硬膜外阻滞对有无合并房颤的扩张型心肌病心衰患者的疗效差异。方法:入选40例扩张型心肌病心衰患者,根据入院心电图有无房颤分为房颤组和非房颤组。所有患者均在抗心力衰竭常规治疗基础上,给予胸段硬膜外阻滞治疗4周,比较治疗前、后NYHA心功能分级、血浆N末端脑钠肽前体(NT-pro BNP)水平、左室射血分数(LVEF)、左室舒张期内径(LVEDD)及左房前后径(LAD)的变化情况。结果:与治疗前比较,两组患者经治疗后的NYHA心功能分级、NT-pro BNP、LVEF、LVEDD及LAD均明显改善(均P0.05),差异有统计学意义,但两组间各指标治疗前后的差值无统计学意义(P0.05)。结论:对于慢性心力衰竭合并房颤的患者而言,给予抗心力衰竭常规治疗基础上联合上胸段硬膜外阻滞治疗有效,且房颤的存在与否不影响上胸段硬膜外阻滞的疗效。     

闭合复位与切开复位治疗桡骨远端骨折的疗效对比

目的:探讨闭合复位与切开复位对桡骨远端骨折患者的临床疗效。方法:回顾性分析2013年6月至2014年3月我院收治的60例桡骨远端骨折患者,随机数字表法分为切开复位组和闭合复位组,每组30例。闭合复位组患者给予闭合复位小夹板或石膏固定治疗,切开复位组患者给予切开复位内固定术治疗。观察并比较两组患者治疗前后掌倾角、尺偏角以及桡骨长度、术中出血量和手术时间,骨折愈合时间以及患者临床疗效进行检测并比较。结果:与治疗前相比,治疗后患者的掌倾角、尺偏角、桡骨长度水平均升高(P0.05);与闭合复位组相比,切开复位组患者掌倾角、尺偏角、桡骨长度评分水平较高(P0.05),术中出血量、手术时间水平较高(P0.05),临床治疗的优良率较高(P0.05),两组患者的骨折愈合时间无显著差异(P0.05)。结论:与闭合复位相比,切开复位能够明显恢复桡骨远端骨折患者的掌倾角、尺偏角以及桡骨长度,但手术时间以及术中出血量较多,临床疗效较好,两组患者的骨折愈合时间无明显差异。     

Entailment of ambiguity

Everything in Rosen's work flows from the principle of 'closure to efficient cause', the necessary and sufficient distinguishing feature of complexity, and a necessary distinguishing feature of an organism. Some students of Rosen find considerable confusion over the meaning of 'closure to efficient cause'. Such confusion is unnecessary. The matter is entirely cleared up by the (M,R)-system, a set of three algebraic maps. Each map must include one of the others in its co-domain, and is itself in the co-domain of the remaining map. Structurally, the three maps form a circular hierarchy of containment. This peculiar structure is Rosen's closure. Since each map represents an efficient cause, they reveal the character of efficient cause. The efficient cause of a process is represented as its 'dynamical law', and is a constraint that arises from the intersection of the morphology of the process and the inherent constraints in reality represented by the 'laws of Nature'. A critical, observable property (evidently unnoticed by Rosen), entailed by the closure, is its inherent ambiguity. From a foundation of ambiguity, the bizarre properties of complexity (e.g., non-computability, non-fractionability, undecidability, and incompleteness) follow in a straightforward manner, often with proofs simpler than those that Rosen discovered.     

Monitoring clinical trials with multiple arms

In order to benefit from the substantial overhead expenses of a large group sequential clinical trial, the simultaneous investigation of several competing treatments becomes more popular. If at some interim analysis any treatment arm reveals itself to be inferior to any other treatment under investigation, this inferior arm may be or may even need to be dropped for ethical and/or economic reasons. Recently proposed methods for monitoring and analysis of group sequential clinical trials with multiple treatment arms are compared and discussed. The main focus of the article is on the application and extension of (adaptive) closed testing procedures in the group sequential setting that strongly control the familywise error rate. A numerical example is given for illustration.     

Morphology and ultrastructure of spiracles in phlebotomine sandfly larvae

The morphology and ultrastructure of the larval spiracle system of three phlebotomine sandfly species, Phlebotomus perniciosus, P. perfiliewi and P. papatasi, were examined by scanning (SEM) and transmission (TEM) electron microscopy and by confocal scanning laser microscopy (CSLM). During larval development, thoracic and abdominal spiracles show considerable modifications. In fourth instar larvae, the spiracles consist of a plate with a sclerotized central portion and a peripheral circle of papillae. The latter is distinctive in the larvae of P. papatasi, which are readily distinguished from the other species. Opening clefts across the papillae communicate with an internal chamber that encircles an electrondense plug. Many cylindrical projections cross the chamber, uniting the central plug with the larval body, forming an air filter. Spiracular development in successive larval instars has both a taxonomic and adaptive value.     

The mitotic spindle and associated membranes in the closed mitosis of trichomonads

In the present work, we followed the several phases of Tritrichomonas foetus and Trichomonas vaginalis cell cycles using immunofluorescence, serial thin sections, three-dimensional (3D) reconstruction, and transmission electron microscopy. In motile trichomonad cells or in pseudocyst forms, the nuclear envelope persists throughout mitosis, and the spindle is extranuclear. We found three types of spindle microtubules: pole-to-nucleus microtubules which are attached to the nuclear envelope, pole-to-pole microtubules forming a cylindrical, cytoplasmic groove on the nuclear compartment in pseudocysts of T. foetus cells, and pole-to-cytosol microtubules which extend freely into the cytoplasm. We demonstrated that: (1) in T. foetus, the spindle is assembled from an MTOC located at the base of the costa, underneath one of the basal bodies; (2) the spindle presents an unusual arc shape during the initial phases of mitosis in motile trophozoites; (3) the spindle microtubules are glutamylated, but not acetylated; (4) several membranes similar to those of the endoplasmic reticulum follow the spindle microtubules; (5) finger-like projections extend from the nucleus towards the cell poles in pseudocysts and multinucleated cells; and (6) vesicles formed in between the two nuclear membranes are seen in the course of mitosis in both trophozoite and pseudocyst forms.