Management of Bifurcation Culprit Lesion in the Setting of Anterior ST Elevation Myocardial Infarction

Introduction: Coronary bifurcation lesions are considered one of the challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. However, there is limited data about the proper management of such lesions in the setting of myocardial infarction as most bifurcation lesion studies excluded patients with acute coronary syndromes (ACS). The aim of this study was to compare in-hospital and mid-term outcomes of single-stent and two-stents strategy in the management of bifurcation culprit lesions in patients presenting with anterior STEMI. Methods: This retrospective multi-center study included all patients presented with anterior STEMI who underwent primary PCI between January 2017 and December 2019, coronary angiography showed true bifurcation lesion with sizable side branch that can be managed by stenting. Patients with left main bifurcation, those indicated for urgent CABG, and patients in cardiogenic shock were excluded. Included patients were divided into two groups according to the stenting strategy either single or two stents. Six months follow up data were collected by telephone calls and by examination of medical records. Results: Out of 1355 anterior STEMI patients presented between January 2017 and December 2019, 158 patients (11.6%) were identified to have bifurcation culprit lesions with a sizable diagonal branch. 93 patients (59%) were treated by single stent while 65 patients (41%) were managed by two-stents strategy. The baseline characteristics and angiographic findings were similar in both groups except for higher side branch involvement in the two stents group (83.31%±11.20 vs 71.88%±15.05, t= -5.39, p <0.001). Mean fluoroscopy time (23.96±8.90 vs 17.81±5.72 mins) and contrast volume (259.23± 59.45 vs 232.58± 96.18 ml) were significantly higher in two stents group than single stent group (p=0.049). However, the angiographic success rates (residual stenosis ?30% and restoration of TIMI flow grade II or III) were comparable (96.8% vs 99%, MCp=0.151). There is no significant difference in the overall incidence rate of MACE in both groups 6 months following the index procedure (13.9 % vs 16.9%, FEp=0.698), with no difference between different bifurcation stenting techniques in patients managed with two stents. Conclusion: Although two stents strategy in the setting of STEMI is much complex with more fluoroscopy time and contrast volume, the procedural success rate and the incidence of MACE were comparable to one stent strategy, on medium-term follow up.

Finite Element Simulation of Double-Stent Parallel Thrombectomy at Y-Shaped Bifurcation of Internal Carotid Artery / 医用生物力学

Objective To study the process of single stent and double-stent thrombectomy at the Y-shaped bifurcation of the ideal internal carotid artery by finite element simulation, analyze the stent-thrombus-vessel interaction during the thrombectomy process based on the simulation results, and provide guidance for improving the effect of stent thrombectomy at the bifurcation. Methods The CAD software was used to build the model and the finite element analysis software was used to simulate the process of single stent and double-stent thrombectomy. Results Thrombectomy was unsuccessful in single stent model and successful in double-stent model, and the maximum stress of thrombus during embolus retrieval was twice that of single stent, the maximum strain was 1.12 times that of single stent, and the maximum contact pressure on the surface of vessel was approximately twice that of single stent. Conclusions Double Solitaire stents can effectively prevent thrombus displacement at the bifurcation and successfully retrieve the thrombus, but there is a risk of fracture due to the high stress level in the middle section of the thrombus. The contact pressure of the vessel on the anterior artery side is higher during thrombectomy, and the risk of vessel damage is greater. Therefore, it is necessary to optimize the design of the stent-retriever to improve its flexibility.

Drug-coated balloon in the treatment of coronary bifurcation lesions: A hope or hype?

When compared to non-bifurcation lesions, percutaneous coronary intervention in coronary bifurcation lesions is technically demanding and has historically been limited by lower procedural success rates and inferior clinical results. Following the development of drug-eluting stents, dramatically better results have been demonstrated. In most of the bifurcation lesions, the provisional technique of implanting a single stent in the main branch (MB) remains the default approach. However, some cases require more complex two-stent techniques which carry the risk of side branch (SB) restenosis. The concept of leaving no permanent implant behind is appealing because of the complexity of bifurcation anatomy with significant size mismatch between proximal and distal MB which may drive rates of in-stent restenosis and the potential impact of MB stenting affecting SB coronary flow dynamics. With the perspective of leaving lower metallic burden, a drug-coated balloon (DCB) has been utilized to treat bifurcations in both the MB and SB. The author gives an overview of the existing state of knowledge and prospects for the future for using DCB to treat bifurcation lesions.

CBCT Evaluation of Unilateral Accessory Mental Foramina: Under Reported Anatomic Variant in Children

ABSTRACT: The following manuscript presents two paediatric cases with incidental finding of unilateral accessory mental foramina. Both the cases illustrate CBCT evaluation of a unilateral accessory foramina on the left side of the mandible, one of which, is a 12-year-old baby girl with pre-diagnosed medical history of precocious puberty and oral findings of supernumerary teeth and the other is an 8-year-old boy with oral bifurcation cyst. The not so frequent presence of additional foramina and canals in the mandible are frequently undervalued in clinical procedures and to our knowledge has not yet been reported in paediatric cases in the literature so far. In these case reports, authors attempt to document a rare and first of its type ever reported anatomic variant of mandible in paediatric patients in the whole literature.

RESUMEN: El manuscrito presenta dos casos pediátricos con hallazgo incidental de forámenes mentonianos accesorios unilaterales. Ambos casos se refieren a la evaluación CBCT de un foramen accesorio unilateral en el lado izquierdo de la mandíbula, uno de los cuales era una niña de 12 años con antecedentes medicos prediagnosticados de pubertad precoz y hallazgos orales de dientes supernumerarios y el otro un niño de 8 años con quiste de bifurcación bucal. La presencia no tan frecuente de forámenes y canales adicionales en la mandíbula se subestima con frecuencia en los procedimientos clínicos y, hasta donde sabemos, aún no se ha informado en casos pediátricos en la literatura hasta el momento. En esta serie de casos, los autores intentan documentar una variante anatómica rara y primera de su tipo de la mandíbula en pacientes pediátricos en toda la literatura.

Application of drug-coated balloons in percutaneous coronary intervention / 中国基层医药

Percutaneous coronary intervention is the main treatment of coronary heart disease. Both the original bare metal stent and drug-coated stent have the possibility of developing in-stent restenosis, and have poor therapeutic effect on small vessel lesions and bifurcation lesions, which limit their clinical application. In recent years, drug-coated balloons have made considerable progress. They provide a new treatment method for in-stent restenosis, chronic total occlusion, bifurcation lesions and small vessel lesions, and can shorten the duration of dual antiplatelet therapy and reduce the risk of bleeding. This paper reviews the clinical research progress of drug-coated balloon.

Modified Fired Glycyrrhizae Decoction as adjunct therapy on the hemodynamics and myocardial enzymes of the patients with coronary arrhythmia after bifurcation lesion surgery / 国际中医中药杂志

Objective:To explore the effects of modified Fired Glycyrrhizae Decoction on hemodynamics and levels of myocardial enzymes in coronary arrhythmia (CA) after bifurcation lesion (BCL) surgery.Methods:According to simple random method, 100 patients with CA after BCL surgery in the hospital who met the inclusion criteria were divided into two groups between May 2019 and May 2021, 50 in each group. The control group was treated with intravenous drip of amiodarone and routine treatment, while the observation group was treated with modified Fired Glycyrrhizae Decoction on basis of control group. Both groups were treated for 2 weeks. Before and after treatment, TCM syndromes were scored. The quality of life was assessed by World Health Organization Quality of Life Scale (WHOOLQ-100). The plasma or serum specific viscosity, fibrinogen and ESR were detected by non-invasive hemodynamic detector. The levels of cardiac troponin (cTnT), creatine kinase (CK) and brain natriuretic peptide (BNP) were detected by ELISA. The disappearance time of symptoms was observed. The adverse reactions were recorded. And the clinical responsive effect was evaluated.Results:The difference in total response rate between observation group and control group was not statistically significant [92.0% (46/50) vs. 90.0% (45/50); χ2=0.12, P=0.727]. After treatment, scores of fluster and shortness of breath, panic and irritability, and mental fatigue in the observation group were significantly lower than those in the control group ( t=7.38, 9.88, 4.87, P<0.01), and scores of physical function, independence and social relations were significantly higher than those in the control group ( t=8.69, 6.32, 5.76, P<0.01). After treatment, levels of plasma specific viscosity, fibrinogen and ESR in the observation group were significantly lower than those in the control group ( t=13.59, 8.30, 8.80, P<0.01). After treatment, levels of serum cTnT [(33.45±3.44) mg/L vs. ( 39.71±4.02) mg/L, t=8.37], CK [(70.49±7.32) U/L vs. (82.15±8.41) U/L, t=7.40] and BNP [(223.41±20.36) ng/L vs. (244.58±20.74) ng/L, t=5.15] in the observation group were significantly lower than those in the control group ( P<0.01). The disappearance time of palpitation, chest tightness and dizziness in the observation group was significantly earlier than those in the control group ( t=10.44, 11.91, 5.75, P<0.01). During treatment, differences in incidence of adverse reactions between observation group and control group was statistically significant [4.0% (2/50) vs. 32.0% (16/50); χ2=4.00, P=0.046]. Conclusion:The modified Fired Glycyrrhizae Decoction combined with routine western medicine can improve clinical symptoms, hemodynamics and levels of myocardial enzymes in CA patients after BCL surgery, and improve the clinical curative effect.

Effects of Plaque Classification and Bifurcation Angle on Coronary Plaques: A Hemodynamic Simulation / 医用生物力学

Objective To analyze the influence of plaque classification and bifurcation angle on hemodynamics in coronary artery, so as to further discuss the influence on vulnerable atherosclerotic plaques. Methods Based on average geometric parameters of human coronary bifurcation vessels, the model of fluid-solid interaction for coronary bifurcation vessels with different plaque classifications and vessel bifurcation angles was constructed, and the distributions of blood flow velocity, pressure and shear stress at critical positions were investigated. Results The upstream shoulder of the plaque was the site with the highest shear stress on plaque surface, which was prone to ulceration or rupture with further growth. When there were plaques on one side of the bifurcation vessels, the shear stress at the carina of bifurcations was greater than that at the bilateral plaques. The pressure and shear stress at the carina of bifurcations gradually increased as the bifurcation angle decreased. Conclusions When there are plaques on one side of the bifurcation vessels, the probability of ulceration or rupture is greater. The presence of plaque in main vessels can promote formation and growth of the plaque at bifurcations. The inner wall of blood vessels at the carina of bifurcations is more easily damaged in the case of small angle vessels. The results can provide theoretical references for the design and optimization of vulnerable atherosclerotic plaque treatment.

Imaging-anatomic Measurements of Carotid Artery Bifurcation

ABSTRACT Objective: To have anatomic measurements of carotid artery bifurcation (CAB) with 64-spiral computed tomography angiography (64-SCTA), and provide anatomic basis for related research. Methods: Imaging data of 92 subjects (45 males, 47 females, the age range 20-82 years and mean age 48.4 ± 6.1 years) without pathology of CAB, who underwent 64-SCTA in head and neck from June 1, 2008 to June 30, 2010, were selected from the Picture Archiving and Communication Systems in Zhongshan Hospital of Xiamen University, Fujian, China. On the 3D images, the angle and size of CAB were measured, and the statistical comparisons of measurements were made between the bilateral, sex and age groups. Results: The measurements of CAB were divided into young (≤ 40 years) and older (> 40 years) groups: bifurcation angle is 36.206° ± 10.210° and 49.343° ± 16.489°, respectively; the inner diameter of common carotid artery (CCA) is 6.820 ± 0.635 and 6.845 ± 0.838 mm, respectively; the proximal inner diameter of internal carotid artery (ICA) is 7.143 ± 0.992 and 7.476 ± 1.630 mm, of the enlargement is 7.568 ± 1.069 and 8.554 ± 1.733 mm, of the distal is 4.897 ± 0.508 and 5.123 ± 0.699 mm, respectively; the inner diameter of external carotid artery (ECA) is 4.324 ± 0.580 and 4.104 ± 0.638 mm, respectively. There were statistically significant differences in all the measurements between male and female groups, in the bifurcation angle, inner diameters of ICA and ECA between young and older groups, and in the bifurcation angle between the left and right (p < 0.05). Conclusion: A 64-SCTA with 3D image post-processing technique can clearly observe and show the CAB. All CAB measurements will provide the objective basis for applied anatomy, imaging diagnosis and surgery treatment.

Ángulo de bifurcación corregido versus ángulo de bifurcación distal para la predicción de la rama lateral. Compromiso después de la bifurcación provisional Intervención Coronaria / Corrected Bifurcation Angle versus Distal Bifurcation Angle for Prediction of Side Branch Compromise after Provisional Bifurcation Coronary Intervention

Provisional bifurcation percutaneous coronary intervention (PCI) is recommended over two stent strategy but with the risk of side branch (SB) compromise. Prediction SB compromise is crucial for optimizing of the procedure outcome. Neglecting the proximal bifurcation angle (BA), the distal BA was presented as a reliable predictor of SB compromise supposing that the main vessel is always a straight vessel. However, its impact on the fate of side branch is debated. This study aims to compare between of the corrected BA, the sum of proximal and distal BAs, and the distal BA in terms of prediction of SB compromise. This prospective cohort study was conducted in Zagazig university hospitals in the duration between March 2019 and March 2020, and involved 185 patients who underwent provisional bifurcation PCI. Patients were divided according to the corrected BA into two groups; straight bifurcation model group which involved 73 patients with corrected BA = 180º, and wide bifurcation model group which involved 112 patients with corrected BA > 180 º. Compared to the wide bifurcation model, the incidence of SB compromise was substantially higher in the straight bifurcation model (52.1% vs. 15.2%; P < 0.001). The corrected BA had a better area under the curve compared to the distal BA with statistically significant difference (0.711 vs. 0.580; P = 0.023). Multivariate analysis demonstrated that the corrected BA was among the independent predictors of SB compromise. The study concluded that the corrected BA could be a novel strong predictor of SB compromise after provisional bifurcation PCI for future verification.

A Short Term Clinical Outcome of Provisional versus Routine Kissing Balloon Technique after Main Vessel Crossover Stenting for Coronary Bifurcation Lesions

Background: Kissing Balloon Inflation (KBI) technique was the first technique for percutaneous intervention in bifurcation lesions. It's the standard strategy in the two-stent procedure. Its benefit in one-stent approach remains uncertain. Several trials comparing KBI strategy with the No-KBI strategy in one-stent technique did not show any advantages in the clinical outcome. Clinical outcome and the follow up of ischemic symptoms is a useful method to compare the effectiveness of both strategies.Aims: To study the short-term clinical outcome (3and 6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions.Patients and Methods: The study included sixty consecutive patients. They were randomized to receive different side branch (SB) intervention strategies: group I (provisional final kissing balloon inflation group -PFKBI) (FKBI only when SB Flow less than TIMI 3) and group II (routine final kissing balloon inflation group –RFKBI).Results: 1-Dissection of side branchand conversion to two stent strategy was significantly higher in PFKBI group (14,3%) than in RFKBI group (0) 2-The amount of dye, total procedure time and time of admission was significantly higher in RFKBI group. 3-Chest pain immediately after the procedure was significantly higher in PFKBI group while at 3 and 6 months follow up no significant difference between both groups was noticed. 4-MACE, target lesion revascularization (TLR) and stent thrombosis were similar between both groups at 3 and 6 months.Conclusions: Main vessel stenting with and without final kissing balloon dilatation was associated with favorable and similar 3 and 6-month clinical outcomes

CHEMical KINetics SimuLATOR (Chemkinlator): A friendly user interface for chemical kinetics simulations / CHEMical KINetics SimuLATOR (Chemkinlator): Una herramienta amigable para realizar simulaciones de cinética química / CHEMical KINetics SimuLATOR (Chemkinlator): Uma ferramenta amigável para realizar simulações de cinética química

Abstract CHEMicalKINetics SimuLATOR (Chemkinlator) is a Graphical User Interface for the simulation of reaction mechanisms. The interface allows the user to see and change the parameters of a reaction network within a single window. Chemkinlator comes with built-in support for three types of kinetic simulations: Time Series, which computes the concentration of all species in an interval of time for the defined model; Bifurcation diagrams, which are the result of running several Time Series simulations over gradually different kinetic rate constants; and Flow/Temperature time series, which takes into account the effect of flow in the Continuous-flow well-Stirred Tank Reactor, and the effect of temperature on the rates constants according to the Arrhenius equation. In our research group, Chemkinlator has been the primary tool used to test the predictions made by algorithms that analyze homochirality phenomena. Chemkinlator is written in C++14 and Qt, and it uses the Fortran subroutine DLSODE to solve the differential equations associated with the reaction networks. Chemkinlator is open source software under the Apache 2.0 license and can be downloaded freely from https://gitlab.com/homochirality/chemkinlator.

Resumen CHEMical KINetics SimuLATOR (Chemkinlator) es una interfaz gráfica para realizar simulaciones de mecanismos de reacción. La interfaz le permite al usuario ver y cambiar los parámetros de una red de reacciones en una única ventana. Chemkinlator puede realizar tres tipos de simulaciones cinéticas: Time Series, calcula la concentración de cada especie en un intervalo de tiempo del modelo estudiado; Bifurcation, es el resultado de ejecutar varias veces las simulaciones del modo Time Series, cambiando gradualmente diferentes constantes de velocidad; y Flow/ Temperature es una serie de tiempo en la que se tiene en cuenta el efecto del flujo considerando un Reactor de Flujo Continuo bien Agitado y el efecto de la temperatura sobre las constantes de velocidad según la ecuación de Arrhenius. En nuestro grupo de investigación, Chemkinlator ha sido la herramienta principal para verificar las predicciones hechas por los algoritmos que analizan el fenómeno de homochiralidad. Chemkinlator está escrito en C++14 y Qt, y usa la subrutina de Fortran DLSODE para resolver las ecuaciones diferenciales relacionadas con los mecanismos de reacción. Chemkinlator es software de código abierto bajo la licencia Apache 2.0 y se puede descargar libremente de https://gitlab.com/homochirality/chemkinlator.

Resumo O CHEMical KINetics SimuLATOR (Chemkinlator) é uma interface gráfica para realizar simulações de mecanismos de reação. A interface permite ao usuário visualizar e alterar os parâmetros de uma rede de reação em uma única janela. O Chemkinlator pode realizar três tipos de simulações cinéticas: Time Series, calcula a concentração de cada espécie em um intervalo de tempo do modelo estudado; Bifurcation, é o resultado de executar várias vezes as simulações do modo Time Series, modificando gradualmente diferentes constantes de velocidade; e Flow/Temperature é uma serie de tempo que se considera o efeito do fluxo considerando um Reator de Fluxo Continuo bem Agitado e o efeito da temperatura sobre as constantes de velocidade pela equação de Arrhenius. No nosso grupo de investigação, o Chemkinlator tem sido a principal ferramenta para verificar as predições realizadas pelos algoritmos que analisam o fenómeno de homoquiralidade. O Chemkinlator está escrito em C++14 e Qt, e usa a sub-rotina de Fortran DLSODE para resolver as equações diferenciais relacionadas com os mecanismos de reação. O Chemkinlator é um software de código aberto baixo a licença Apache 2.0 e pode ser descarregado livremente em https://gitlab.com/homochirality/chemkinlator.

A high risk unstable case of left main bifurcation lesion treated with simultaneous kissing stents as salvage procedure

Bifurcation treatment with percutaneous coronary intervention is still one challenging task especially the left main bifurcation. And it becomes still more challenging when it is done in emergency situation in a very unstable patients. There are many one-stent and two-stent approaches available to treat the bifurcation lesions but no approach has proven superior to other. Here, we present a case of a 78-year-old male diagnosed with distal left main bifurcation lesion treated with simultaneous kissing stents technique presented with acute coronary syndrome, non-ST elevation myocardial infarction with pulmonary oedema in cardiogenic shock.

Efficacy of cutting balloon versus semi-compliant balloon for predilation of coronary bifurcation lesions / 中国组织工程研究

BACKGROUND: There is no efficient and unified optimal scheme for treating coronary bifurcation diseases. Simple strategies such as drug-eluting stent implantation in the main branch and drug-coated balloon dilation in the sub-branches are mostly adopted. However, direct drug-coated balloon dilation cannot overcome the problem of elastic retraction of vascular wall, and there is still a risk of branch loss in the long term. OBJECTIVE: To investigate the efficacy and safety of a cutting balloon versus a semi-compliant balloon for predilation of coronary bifurcation lesions. METHODS: From August 2016 to May 2018, 110 patients with coronary bifurcation lesions admitted at Jiaozuo People’s Hospital were selected, including 83 males and 27 females, aged 18-88 years. The patients were randomized into observation and control groups (n=55/group) and received percutaneous coronary intervention. The main branch in the observation group was predilated by a cutting balloon prior to drug-eluting stent implantation, and the sub-branches were predilated by a cutting balloon prior to drug-coated balloon dilation. The main branch in the control group was predilated by a semi-compliant balloon prior to drug-eluting stent implantation, and the sub-branches were predilated by a semi-compliant balloon prior to drug-coated balloon dilation. Immediate postoperative angiography was performed to determine the forward blood flow TIMI grading of main branches and sub-branches and whether vascular dissection occurred. Coronary angiography quantitative analysis was used to detect the reference diameter, minimum inner diameter and stenosis degree of main and sub-branches before, immediately, 6 and 12 months after surgery. Major cardiovascular adverse events within 12 months after surgery were recorded in both groups. The study was approved by the Ethics Committee of Jiaozuo People’s Hospital. RESULTS AND CONCLUSION: (1) Immediate postoperative angiography showed that the TIMI level 3 rate of the main branches and sub-branches in the observation group was higher than that in the control group (P=0.007, 0.015), the incidence of vascular dissection was lower than that in the control group (P=0.023, 0.012), and the emergency target vessel reconstruction rate was lower than that in the control group (P=0.006, 0.026). (2) The success rate of coronary artery maintenance immediately and at 6 and 12 months after surgery in the observation group was higher than that in the control group (all P < 0.001). (3) The minimum inner diameter of main branches and sub-branches in the observation group was larger than that in the control group immediately and at 6 and 12 months after surgery (all P < 0.01). The degree of inner diameter stenosis was smaller than that in the control group (all P < 0.01). (4) The target vessel restenosis rate of main branch and sub-branches in the observation group was lower than that in the control group within 12 months after surgery (P=0.038, 0.043). The incidence of major cardiovascular adverse events was lower than that in the control group (P=0.025). (5) These results indicate that in coronary bifurcation lesions, drug-eluting stent implantation is suitable for main branch lesions and drug coated balloon is suitable for sub-branch lesion. Cutting balloon predilation is safer and more effective than semi-compliant balloon predilation. Cutting balloon predilation can also reduce the rate of target restenosis and the incidence of major cardiovascular adverse events.

Difference in the culture of dorsal root ganglion cells in serum-free medium and serum medium / 中国组织工程研究

BACKGROUND: Both serum-free and serum media have been used to culture dorsal root ganglion cells, but the difference between the two remains unclear. OBJECTIVE: To explore whether serum-free medium can completely replace serum medium for culture of dorsal root ganglion cells. METHODS: The dorsal root ganglion of ICR mice at 8-10 weeks was taken and treated with collagenase and trypsin. After that, the mice were divided into the electroporation + serum group, electroporation + serum-free group, non-electroporation + serum group and non-electroporation + serum-free group. In the electroporation groups, the dorsal root ganglion cells were transfected with electroporation buffer and enhanced green fluorescent protein particles. Cells were cultured for three days. After Tuj1 antibody staining, in the non-electroporation + serum group and non-electroporation + serum-free group, axon branches, axon regeneration length, number of cell survival and the expression of proteins related to axon regeneration were counted. In the electroporation + serum group and electroporation + serum-free group, axon branches, length of axon regeneration, number of cell survival, and electroporation efficiency were measured. This study was approved by the Laboratory Animal Ethics Committee of the First Affiliated Hospital of Soochow University. RESULTS AND CONCLUSION: (1) In the non-electroporation + serum group and non-electroporation + serum-free group, there was no significant difference in axon branches, axon regeneration length, number of cell survival and the expression of axon regeneration related proteins (P > 0.05). (2) In the electroporation + serum group and electroporation + serum-free group, there was no significant difference in axon branches, axon regeneration length and electroporation efficiency (P > 0.05). Compared with electroporation + serum group, the number of cell survival of the electroporation + serum-free group was significantly lower (P 0.05). The number of cell survival of the non-electroporation + serum group was significantly higher than that of the electroporation + serum group (P < 0.05). (4) The results showed that, in the condition of non-electroporation, the absence of serum does not affect the culture of dorsal root ganglion in vitro, and serum-free medium can replace serum medium. However, under the condition of electroporation, the number of cell survival would be decreased without serum medium, suggesting that serum plays an important role in the culture of dorsal root ganglion in vitro under the condition of electroporation. Therefore, serum-free media cannot replace serum media.

Anatomical study on sciatic nerve variations in Andhra Pradesh, India

Background: The sciatic nerve is the largest and widest nerve in the body and is derived from ventral rami of spinal nerves L2 to S3. Sciatic nerve appears in the Gluteal region below Piriformis from Pelvic cavity by passing through Greater Sciatic foramen. In between the Ischial tuberosity and greater trochanter of Femur, it reaches the back of the thigh. At the superior angle of Popliteal fossa, it divides into Tibial and common Peroneal (fibular) nerves. The division varies, and it may occur within the pelvis, Gluteal, upper, mid and lower part of thigh. The anatomical variations of the level at which the Sciatic nerve divides is considered important by Neurosurgeons, Anaesthetists, Orthopaedicians and Surgeons.Methods: This study was conducted on 52 lower limbs to determine the level of sciatic nerve bifurcation and its variations on 26 embalmed human cadavers. The data was analyzed manually using numbers, frequencies and percentages.Results: The findings of this study states that in 2 limbs (3.84%) the nerve divided in the gluteal region; in 4 limbs (7.69%) in the pelvic region; in 10 limbs (19.23%) at the junction between upper and middle thigh. The highest incidence of division occurs in 36 limbs (69.23%) at the superior angle of the popliteal fossa.Conclusions: The findings of this study revealed that the majority of sciatic nerve divisions occur   at the superior angle of popliteal fossa while some divided into other regions such as Pelvis, Gluteal and thigh regions.

Angiographic determinants for side branch treatment in distal unprotected left main coronary artery bifurcation percutaneous coronary intervention with single stent crossover technique

 Background: The aim of this study was to analyze angiographic parameters such as bifurcation angle, diameter at the polygon of confluence (POC) and SYNTAX score in predicting the need for side branch treatment with single-stent crossover technique from distal unprotected left main coronary artery (ULMCA) to the major side branch.Methods: This was a retrospective and observational study. A total of 83 patients with distal ULMCA lesions were enrolled. Patients who underwent provisional single-stent crossover technique were compared with patients that required side branch treatment though plain old balloon angioplasty (POBA) 5 (6.0%) or stenting 7 (8.4%). Angiographic parameters, bifurcation angle, diameter at the POC and the SYNTAX score were analyzed for their ability to predict the need for side branch treatment.Results: Mean age of patients was 58.2±5.3 years. Males constituted 61 (73.5%) patients. Post main branch stenting 5 (6.0%) and 7 (8.4%) patients required side branch treatment with POBA and stent implantation, respectively. Binary regression revealed bifurcation angle (Z: 1.15, OR: 0.99, 95% CI: 0.97-1.01, p=0.25), diameter at the POC (Z: 1.1, OR: 0.82, 95% CI: 0.32-2.13, p=0.272) and SYNTAX score (Z: 1.51, OR: 1.18, 95% CI: 0.95-1.45, p=0.132) did not correctly predict the requirement of side branch treatment.Conclusion: Left main coronary artery to main branch stenting can be performed safely with single-stent crossover technique, irrespective of presence of side branch disease across a wide range of bifurcation angles, diameters at the POC and SYNTAX scores.

Determination of subcarinal angle of trachea using computed tomography

Background: Change in tracheal bifurcation angle (subcarinal angle) is an indirect marker of various cardiac, pulmonary and mediastinal pathologies. Helical computed tomography (CT) allows acquisition of volumetric set of data of the chest and can be used for accurate measurements of subcarinal angle using reconstructed images on a workstation using minimum intensity projection (MinIP).The objective of this study was to estimate normal subcarinal angle (SCA) of trachea by computed tomography and to assess its relationship with gender.Methods: This was an observational study comprising a study cohort of 552 patients comprising of 312 males and 240 females who were subjected to CT chest for various indications in our department. Patients with no underlying cardiac, mediastinal or pulmonary disease were included in the study. Spiral CT scan of chest was performed on 64-slice seimens CT SOMATOM and images were reconstructed with thickness of 1.5mm and the images were viewed in coronal reformatted minimum intensity projection (MinIP) for determination of subcarinal angle using the angle measuring tool provided in the workstationResults: The mean subcarinal angle (SCA) in males was (67.60±14.55). The mean subcarinal angle (SCA) in females was (78.90±11.04). Females had a higher mean SCA compared to males with a statistically significant difference (p-value <0.05).Conclusions: The mean SCA in females was higher compared to males with a statistically significant difference between the two. This study holds practical relevance with regard to the performance of invasive trachea-bronchial procedures like bronchoscopy and tracheal/bronchial intubation.

Variations, relations and clinical significance of carotid arterial system in anterior neck: a cadaveric study

Background: The common carotid, internal and external carotid arteries and their branches serve as major source of blood supply in head-neck region of human and are often encountered during numerous surgical and clinical interventions of neck.Methods: We dissected and examined both sides of neck in 49 well embalmed cadavers (98 sides). We recorded the following anatomical parameters of carotid arterial system-level of bifurcation, the relation between internal and external carotid arteries, branching pattern of anterior branches of external carotid artery, tortuosity in carotid arterial system, and relation of hypoglossal nerve with the carotid arteries.Results: In 56.16 % cases, the common carotid arterial bifurcation took place at the upper border of thyroid cartilage though high bifurcation was quite common (43.88%). The external carotid artery was located antero-medial to internal carotid artery in most cases (93.87%). Abnormal tortuosity of carotid arterial system was detected in 2.04% cases only. In 86.73% cases, the hypoglossal nerve crossed the internal and external carotid artery superior to carotid bifurcation above the level of hyoid bone while in 1 case it crossed immediately inferior to carotid bifurcation. In branching pattern, following variations were observed- linguo-facial trunk in 15.3% cases, thyro-lingual trunk in 5.1% cases, origin of superior thyroid artery from common carotid in 10.02% cases and origin of superior thyroid from internal carotid in one case (1.02%).Conclusions: The carotid arterial system has complex and variable anatomy in neck and this information should be kept in mind to avoid unwanted damage during surgical procedures of neck.

In Vivo Stress Analysis of an Atherosclerotic Plaque at Carotid Bifurcation / 医用生物力学

Objective To investigate the in vivo stress distribution of the atherosclerotic plaque at carotid bifurcation, so as to provide references for the mechanical mechanisms of plaque rupture at carotid bifurcation and the design for further medical treatment. Methods The three-dimensional geometric model of carotid bifurcation and plaque were established according to average geometric parameters of human carotid bifurcation. Residual stress of the carotid bifurcation and plague was reestablished with “thermal-structure” coupling method, and in vivo stresses of vessels with the plaque at carotid bifurcation under blood pressure and blood flow were calculated. Results Both the maximum principal stress and elastic shear stress concentrated on the shoulder of the plaque. Elastic shear stress increased with the increase of stenosis ratio and blood pressure. Wall shear stress in the upstream of the plaque was considerably higher than that of the downstream. The distribution of oscillatory shear index(OSI) was quite the opposite. The changing patterns of the elastic shear stress and flow shear stress were quite different with the change of stenosis ratios. Conclusions Tension grew gradually from the centrality to shoulder surface of the plaque. The centrality of the plaque might bear compression when the stenosis was very severe. The periodic variation of the structural stress might cause structural fatigue of the plaque, thus increasing the rupture risk. Distinction of the component and vulnerability of the plaque between upstream and downstream might be caused by differences in hemodynamic parameters of the plaque between upstream and downstream.

Efficacy and safety of active transfer of plaque versus provisional stenting with drug-eluting stents for the treatment of coronary bifurcation lesions / 中华心血管病杂志

Objective@#To compare the efficacy and safety of active transfer of plaque (ATP) versus provisional stenting (PS) with drug-eluting stents (DES) for the treatment of coronary bifurcation lesions.@*Methods@#A total of 1 136 patients with bifurcation lesions hospitalized in 6 selected hospitals between January 2010 and January 2014 were included in this prospective observational trial, patients were divided into either ATP (n=560) or PS group (n=576) accordingly. The primary endpoint was target lesion revascularization within 1 year, and the second endpoints were all-cause death, cardiogenic death, myocardial infarction, stent thrombosis, stroke, recurrent angina within 1 year.@*Results@#There were no significant differences in age, sex, hypertension, diabetes, hyperlipidemia and smoking history between the two groups (P>0.05). The incidence of TIMI blood flow <3 grade in the side branch (1.6%(9/560) vs. 7.5% (43/576), P<0.01), acute occlusion of the side branch (1.3%(7/560) vs. 7.1%(41/576), P<0.01) and implanted stents of side branch (1.8%(10/560) vs. 7.8% (45/576), P<0.01) were significantly lower in the ATP group than those in the PS group. During the one year follow up, the rate of target lesion revascularization was similar between ATP group and PS group (4.6%(26/560) vs. 4.0%(23/576), P=0.66).@*Conclusions@#The effectiveness and safetyof ATP techniquein the patients with coronary bifurcation lesions is comparable to the PS technique. However, ATP technique is superior to PS technique on effectively reducing the incidence of implanted stents in the side branch.