Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techni...Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techniques have been identified to be successful for coronary bifurcations. Reports have demonstrated the main reason for higher incidence of ostial side branch even though drugeluting stent used in side vessel lies in that there were gaps in metal coverage and drug application. Therefore,展开更多
Background Fractional flow reserve （FFR）-guided percutaneous coronary intervention （PCI） is associated with fewer unfavorable events. However, the hemodynamic change in FFR after different stenting approaches for ...Background Fractional flow reserve （FFR）-guided percutaneous coronary intervention （PCI） is associated with fewer unfavorable events. However, the hemodynamic change in FFR after different stenting approaches for bifurcation lesions is still not fully studied. The aim of this study was to analyze the hemodynamic changes in FFR after double kissing （DK） crush and provisional side branch （SB） stenting （PS） for true coronary bifurcation lesions. Methods Seventy-five patients with true bifurcated lesions were randomly divided into DK （n=38） and PS （n=37） groups. Additional SB stenting in the PS group was required if there was any pinched SB ostium 〉70% stenosis, or ≥ type B dissection, or TIMI flow 〈grade 3. FFR at hyperemia in the main vessel （MV） and SB was measured prior- and post-stenting, and at 8 months follow-up. Results Baseline clinical, angiographic and lesion characteristics were matched well between the two groups, with the exception of the final kissing balloon inflation （FKBI, 100.0% in the DK vs. 83.8% in the PS group, P 〈0.001）. Baseline FFR was comparable between the DK and the PS groups, however, the acute gain and late loss of SB FFR at 8-month follow-up in the DK group were 0.18±0.15 and -0.06±0.11, compared to 0.12±0.18 （P=0.044） and -0.002±0.07 （P=-0.037） in the PS group, respectively. MV FFR post-stenting 〉0.94 was seen in about 40% of patients. There was no significant difference in the clinical events at 1-year follow-up between the two groups. Conclusions DK crush was associated with improved acute gain and late loss of SB FFR. The lower rate of FFR 〉0.94 after stenting underscored the further improvement of stentinq quality.展开更多
Background The mechanisms responsible for the occurrence of a kissing unsatisfied （KUS） result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical signific...Background The mechanisms responsible for the occurrence of a kissing unsatisfied （KUS） result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical significance of KUS. Methods Two hundred and thirteen patients with true bifurcation lesions treated with classical crush stenting and final kissing balloon inflation （FKBI） were assigned to upper, middle, and lower groups according to the position of the side branch re-wiring assessed by visual estimation, quantitative coronary analysis （QCA） and intravascular ultrasound （IVUS）. Angiographic follow-up was indexed at 12 months. Results The upper group was characterized by a larger bifurcation angle of 55.53°±25.25° （P=0,030） and a longer procedural time （42.43±23.92） minutes （P=0.015）. The overall rate of KUS by visual estimation was 10.48%, with 5.4% in the upper group, 3.9% in middle group, and 36.1% in lower group （P 〈0.001）. For the diagnosis of KUS, visual inspection demonstrated a good correlation with both QCA and IVUS. Smaller stent diameter was the main reason for KUS in the upper group, while extra-stent side wire location, or re-wire in a low position was the main mechanism attributed to KUS in the lower group. The Lower group had more restenosis, with most restenotic lesions at a lower position of the side branch ostium. KUS （HR 1.652, 95% Cl 1.332-2.088, P 〈0.001） and re-wiring position （HR 2.341, 95% Cl 1.780-4.329, P 〈0.001） were two independent predictors of side branch restenosis. Re-wiring position （OR 0.458, 95%C/0.336-0.874, P=0.001） and side stent expansion （OR 3.122, 95%C/2.883-5.061, P=0.014） were factors predicting the findings of KUS. Conclusions Side wire outside side stents resulted in more KUS and restenosis. Different restenotic lesion types reflected individual mechanisms contributing to the development of plaque proliferation.展开更多
Kissing molars (KMs) is a condition of occlusal molar surfaces in a single follicular space with roots extending in opposite directions. Here, we have reported a case of KMs in a 58-year-old woman. The patient complai...Kissing molars (KMs) is a condition of occlusal molar surfaces in a single follicular space with roots extending in opposite directions. Here, we have reported a case of KMs in a 58-year-old woman. The patient complained of pain in the right mandibular molar region and was diagnosed with KMs consisting of the right mandibular second and third molars. Because of the patient’s pain having subsided at the time of the visit and her unwillingness to undergo tooth extraction, the patient was followed up. KMs is classified into three classes (I-III) and is either true-KMs or pseudo-KMs and presents with or without cystic variants of dental follicles. The presents as true-KMs class II without a cystic variant. With reference to the literature and based on our analysis, the mean age of patients affected by this specific case of KMs is 31.7 years and unilateral KMs is relatively more common (85.7%). Histopathological findings of dentigerous cysts are more often indicated (42.9%). The treatment policy for KMs should therefore be based on the classification of KMs. Importantly, the focus should be on preserving the first and second molars as much as possible. The treatment approach, such as the employment of surgical removal or orthodontics, should be determined by considering the associated factors such as the crowns, tissues, and age of the patient.展开更多
Background Bifurcation angles may have an impact on the clinical outcomes of crush stenting. We sought to compare high （≥60°） with low （〈60°） bifurcation angle in patients who underwent either classica...Background Bifurcation angles may have an impact on the clinical outcomes of crush stenting. We sought to compare high （≥60°） with low （〈60°） bifurcation angle in patients who underwent either classical or double kissing （DK） crush stenting for bifurcation lesions from the DKCRUSH-1 data base. Methods There were 212 patients with 220 lesions, some with low-angle （n=138） and some with high-angle （n=74）. Angiography was indexed at 8-month after procedure. Primary endpoint was the occurrence of major adverse cardiac events （MACEs）, defined as cardiac death, myocardial infarction and target lesion revascularization （TLR）. Secondary endpoint included late lumen loss, the rate of restenosis, and final kissing balloon inflation （FKBI）. Results At 8 months, clinical follow-up was 100%; angiographic follow-up was 75% in the low-angle group and 83.3% in the high-angle group. There were no significant differences in the FKBI between the high-angle group （91.43%） and the low-angle group （82.39%）. In the high angle group, there was a significant difference in contrast volume used （P=0.005） but no significant difference in acute gain, minimum lumen diameter （MLD）, late loss and diameter stenosis in the pre-bifurcation segment, post-bifurcation segment or side branch. When lesions were assigned into with- （n=-133） and without-FKBI （n=42）, significant side-branch late loss was seen in the group without-FKBI （（0.65±0.49） mm vs （0.47±0.62） mm, P=0.02）, with a resultant greater restenosis rate （37.68% vs 18.32%, P=0.001）. No difference was detected in the MACE free survival rate between the high and low angle groups （82.39% vs 82.36%, P=0.84）. The rate of stent thrombosis tended to be higher in the lower-angle group although there was no significant difference （P=0.38）. The TLR free survival rate was 87.2% in the with-FKBI group vs 73.5% in the without-FKBI group （P=0.001）. Cox regression analysis showed that the independent predictors for t展开更多
Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including...Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including ＂T＂, ＂V＂, ＂Y＂, ＂culotte＂ and ＂simultaneous kissing stents （SKS）＂. Understanding the drawbacks in classical crush techniques, we proposed a novel double kissing （DK） crush technique being testified in our previous serial studies]＇2 The results from these randomized and pilot studies are describing a fantastic story---DK crush technique, by final kissing balloon inflation （FKBI） in 100% of lesions and high quality of kissing as assessed by both angiography and intravascular ultrasound, significantly improved the clinical outcome at a relative short-term follow-up. However, whether the advantage of the DK crush technique was sustained or not at a long-term remains unclear. The present study aimed to extend clinical follow-up and verify the differences between DK and classic crush techniques.展开更多
A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiati...A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiation of pain or any features suggestive of claudication. There was no history of any comorbidity. The pain was aggravated with extension of the spine and relieved with flexion. There was no swelling or neurological deficit, but muscle spasm was present. Radiographs of the spine revealed degenerative changes in the lumbosacral spine, along with articulation of spinous processes at in lumbar spine at all levels level suggestive of Baastrup's disease, commonly known as "kissing spine". Routine blood investigations were within normal limits. The patient was managed conservatively. He was given a week's course of analgesics and muscle relaxants and then started on spinal flexion exercises, with significant improvement being noted at 6 months follow up.展开更多
In geometry, there are several challenging problems studying numbers associated to convex bodies. For example, the packing density problem, the kissing number problem, the covering density problem, the packing-coverin...In geometry, there are several challenging problems studying numbers associated to convex bodies. For example, the packing density problem, the kissing number problem, the covering density problem, the packing-covering constant problem, Hadwiger＇s covering conjecture and Borsuk＇s partition conjecture. They are flmdamental and fascinating problems about the same objects. However, up to now, both the methodology and the technique applied to them are essentially different. Therefore, a common foundation for them has been much expected. By treating problems of these types as functionals defined on the spaces of n-dimensional convex bodies, this paper tries to create such a foundation. In particular, supderivatives for these functionals will be studied.展开更多
Based on twin-roll casting technology and multi-roll groove rolling technology,a Multi-Roll Solid-Liquid Cast-Rolling Bonding(MRSLCRB)process was proposed to fabricate Cu/steel cladding bars,which processes the advant...Based on twin-roll casting technology and multi-roll groove rolling technology,a Multi-Roll Solid-Liquid Cast-Rolling Bonding(MRSLCRB)process was proposed to fabricate Cu/steel cladding bars,which processes the advantages of short flow and high-efficiency.However,it is a typical 3-D thermal-fluid-mechanics coupled problem,and determining cast-rolling force is difficult during the equipment design.Therefore,the geometrical evolution of the cast-rolling area was studied,laying the foundation to establish contact boundary equations and analyze mechanical schematics and metal flow.Then,a 3-D steady-state thermal-fluid coupled simulation model,including casting roll,substrate bar,and cladding metal,was established.The Kissing Point(KP)height,average outlet temperature,and process window were predicted,and simulation results of the three-roll layout indicate that the KP distribution along the circumferential direction can be considered uniform.Hence,the engineering cast-rolling force model was derived based on the differential element method and plane deformation hypothesis.The accuracy was verified by the 3-D finite element model,and the influences of process layouts and technological parameters on the castrolling force were analyzed.Through the indirect multi-field coupled analysis method,the temperature–pressure evolution and reasonable process window can be predicted,which provides a significant basis for guiding equipment design and improving product quality.展开更多
Kissing molars (KMs), first reported by Van Hoof in 1973, refer to molars with occlusal surfaces that contact each other in a single follicular space while their roots extend in opposite directions. This is a case of ...Kissing molars (KMs), first reported by Van Hoof in 1973, refer to molars with occlusal surfaces that contact each other in a single follicular space while their roots extend in opposite directions. This is a case of a 20-year-old male who presented with complaints of right mandibular molar pain with cold water contact and occlusion. Panoramic and cone-beam computed tomography (CBCT) images revealed impaction of the right mandibular third and fourth molars, with the occlusal surfaces contacting each other while the roots extended in opposite directions. KMs are classified according to the impaction of the mandibular first and second molars (Class I), second and third molars (Class II), and third and fourth molars (Class III). Our patient was considered Class III. Given the patient’s preference for surgical treatment, successful teeth extraction and extirpation were performed under intravenous sedation. The patient’s postoperative course was unremarkable. We describe a case of KMs Class III with a cystic variant assessed by panoramic and CBCT images. We additionally review all KMs Class III reported in the literature.展开更多
Introduction: To report a case of isolated “endocarditic” aortic regurgitation in a 17-year old female with infective vegetations on aortic valve. Case Report: A 17-year old female was admitted with features of hear...Introduction: To report a case of isolated “endocarditic” aortic regurgitation in a 17-year old female with infective vegetations on aortic valve. Case Report: A 17-year old female was admitted with features of heart failure and a febrile illness. Blood cultures were negative and ECG revealed normal. Echocardiography revealed a “kissing-type” of vegetation on the bicuspid aortic valve with severe aortic regurgitation and a dilated left ventricle with moderate dysfunction. Conclusion: The management of aortic insufficiency occurring in infective endocarditis may differ and the presence of intractable pulmonary edema or shock is a clear indication for prompt valve replacement. The traditional diagnostic criteria are insufficient to diagnose infective endocarditis and the modified Duke criteria provide high sensitivity and specificity over 80% for the diagnosis of native valve endocarditis with positive blood cultures.展开更多
BACKGROUND Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists.Left main(LM)bifurcation lesions have a higher risk due to the vast blood supply in this area and treatmen...BACKGROUND Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists.Left main(LM)bifurcation lesions have a higher risk due to the vast blood supply in this area and treatment choice is difficult.Ostial compromise of the side branch decreases patient prognosis,and its management is still an issue despite the different strategies and devices available.CASE SUMMARY A 42-year-old male patient was admitted to hospital due to chest pain and syncope.Coronary angiography showed acute LM occlusion.Following thrombus aspiration,a LM bifurcation lesion remained.Coronary angiography was repeated one week later,and at the same time,3D optical coherence tomography(OCT)was carried out to better show the geometry of the bifurcation,which confirmed that the stenosis in the ostial left circumflex artery was caused by a long carina.After assessment of the plaque characteristics and the minimum lumen area,the cross-over strategy,kissing balloon inflation and proximal optimization technique were chosen to treat the bifurcation lesion.A“moving”carina was found twice during the intervention.Good stent apposition and expansion were confirmed by OCT after proximal optimization technique.The three-month follow-up showed good recovery and normal cardiac function.CONCLUSION 3D-OCT can facilitate decision-making for coronary interventions in patients with critical bifurcation lesions.展开更多
Objective: The aim of this study was to investigate whether intermediate kissing balloon dilation(IKBD) is necessary during mini-culotte stenting(MCS) and how it can be properly conducted. Methods: MCS was emulated in...Objective: The aim of this study was to investigate whether intermediate kissing balloon dilation(IKBD) is necessary during mini-culotte stenting(MCS) and how it can be properly conducted. Methods: MCS was emulated in a bifurcation model with a branch diameter difference(BDD) in three-step sizes of 0.50, 0.75 and 1.00 mm, and with intermediate balloon dilation(IBD) in three treatments of routine intermediate solo balloon dilation(rISBD), concurrent IKBD(cIKBD) or sequential IKBD. Microcomputed tomography was performed to assess stent under-expansion(SUE) around the polygon of confluence(POC), residual ostial stenosis(ROS) at the ostial side-branch(SB) and main-branch(MB) and stent cell distortion(SCD) in the bifurcation segments. Results: There were both main and interactive effects of IBD and BDD on ROS at the ostial SB and SCD in the ostial SB, but there were only main effects of IBD or BDD on SUE around the POC, ROS at the ostial MB and SCD in the ostial MB. Analysis of the main effects showed that SUE around the POC or ROS at the ostial SB was significantly different between sI KBD and rISBD and between cI KBD and rISBD. There was also a significant difference in SCD in the ostial SB between sI KBD and rI SBD and between sI KBD and cIKBD. Analysis of the interactive effects showed that ROS at the ostial SB or SCD in the ostial SB was affected by all IBD treatments in all BDD step-sizes. Moreover, increasing the BDD step-sizes significantly increased ROS at the ostial SB as treated by rISBD and SCD in the ostial SB as treated by rISBD or cIKBD. Conclusions: SIKBD was shown to be essential and superior to rISBD or cIKBD, resulting in better bifurcated stent expansion and coverage when using MCS.展开更多
Kissing bonds are defects in the adhesive bonds with intimate contact of touching surface but considerably lowered shear strength. Their detection specifically in the aerospace area is so not satisfactory. Usually, ki...Kissing bonds are defects in the adhesive bonds with intimate contact of touching surface but considerably lowered shear strength. Their detection specifically in the aerospace area is so not satisfactory. Usually, kissing bonds are inconspicuous in ultrasonic C-scans. However, the determination of attributes in the time domain and the frequency domain of an ultrasound signal provides the opportunity to derive a pattern for bonded area. Deviations from the pattern found in inconspicuous bonding areas indicate kissing bonds. The survey described here deals with the manufacturing of adhesively joint samples that purposefully include kissing bonds, as well as potential solutions for detecting them through ultrasonic testing combined with pattern recognition. The properties of the epoxy-based adhesive were varied by changing the mixing ratios between resin and hardener. Samples with a mixing ratio far apart from the manufacturer’s recommendation with an inconspicuous appearance in a C-scan, but low shear strength values were taken for further evaluation. After a definition and learning phase, a 100 percent hit rate to separate good bondings from kissing bonds could be derived in a blind test. The discriminating feature found is due to the frequency shift between good and kissing bonds as well as the relative amplitude of the second peak.展开更多
The effects of final kissing balloon dilatation （FKBD） have not been systemically evaluated in patients with coronary bifurcation lesions treated with 1-stent strategy. A meta-analysis was performed to in- tegrate t...The effects of final kissing balloon dilatation （FKBD） have not been systemically evaluated in patients with coronary bifurcation lesions treated with 1-stent strategy. A meta-analysis was performed to in- tegrate the results of independent studies to provide a more precise estimate of the treatment effect. Methods A systematic literature search was carried out for all the relevant articles up till March 2012. Only studies with adequate data reporting major adverse cardiac events （MACE） and target lesion revascularization （TLR）, and follow-up of at least 6 months were included. The endpoints analyzed in this meta-analysis were stent throm- bosis （ST）, all-cause death, myocardial infarction （MI）, MACE and TLR. Result Four studies were found to be eligible for inclusion in the meta-analysis. There were also no significant differences with the occurrence of MI （1.7% vs. 1.5%, OR 1.14, 95% CI 0.38 to 3.44, P = 0.81）, all-cause death （1.1% vs. 1.1%, P = 0.84, OR 0.91, 95% CI 0.35 to 2.35） and stent thrombosis （0.9% vs. 0.8%, OR 1.03, 95% CI 0.35 to 3.09, P = 0.95） in patients with FKBD or No FKBD. However, FKBD was associated with a higher risk of MACE （8.0% vs. 5.3%, OR 1.56, 95% CI, 1.02-2.39, P = 0.04）, primarily as a result of an increased risk of TLR （6.4% vs. 3.4%, OR 2.12, 95% CI 1.30 to 3.48 P = 0.003）. Conclusions In patients with coronary bifurca- tion lesions treated with 1-stent technique, FKBD may be associated with adverse outcomes mainly because of a higher rate of TLR.展开更多
Double kissing(DK)crush stenting for coronary bifurcation lesions has gain popularity worldwide because of its superior randomized studies data and excellent clinical outcomes.This review evaluates all DK crush clinic...Double kissing(DK)crush stenting for coronary bifurcation lesions has gain popularity worldwide because of its superior randomized studies data and excellent clinical outcomes.This review evaluates all DK crush clinical trials and studies.It also reveals the contemporary technique steps by steps as well as the trouble shooting with illustrated clinical scenarios.Among all the available evidence,the DK crush technique is superior when compared to the provisional stenting technique for complex bifurcation lesion.DK crush stenting provides the best evidence-based approach to complex bifurcation lesions especially the left main coronary artery bifurcation lesions.Future direction of how to make this DK crush technique better is also proposed.展开更多
Bifurcation lesions are encountered and treated in up to 1 in 5 cases of percutaneous coronary intervention(PCI).Such lesions pose a technical challenge to PCI,leading to lower procedural success and a higher rate of ...Bifurcation lesions are encountered and treated in up to 1 in 5 cases of percutaneous coronary intervention(PCI).Such lesions pose a technical challenge to PCI,leading to lower procedural success and a higher rate of long-term adverse events.However,each bifurcation is unique in terms of anatomy and pathological presentation.There is no“one size fits all”strategy for coronary bifurcation PCI.Nevertheless,in most scenarios,provisional stenting is the preferred technique.This method is easy to apply and involves a logical stepwise escalation approach that is highly successful and safe.展开更多
文摘Bifurcation lesions are still technically challenging even in the era of modern stents. High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techniques have been identified to be successful for coronary bifurcations. Reports have demonstrated the main reason for higher incidence of ostial side branch even though drugeluting stent used in side vessel lies in that there were gaps in metal coverage and drug application. Therefore,
文摘Background Fractional flow reserve （FFR）-guided percutaneous coronary intervention （PCI） is associated with fewer unfavorable events. However, the hemodynamic change in FFR after different stenting approaches for bifurcation lesions is still not fully studied. The aim of this study was to analyze the hemodynamic changes in FFR after double kissing （DK） crush and provisional side branch （SB） stenting （PS） for true coronary bifurcation lesions. Methods Seventy-five patients with true bifurcated lesions were randomly divided into DK （n=38） and PS （n=37） groups. Additional SB stenting in the PS group was required if there was any pinched SB ostium 〉70% stenosis, or ≥ type B dissection, or TIMI flow 〈grade 3. FFR at hyperemia in the main vessel （MV） and SB was measured prior- and post-stenting, and at 8 months follow-up. Results Baseline clinical, angiographic and lesion characteristics were matched well between the two groups, with the exception of the final kissing balloon inflation （FKBI, 100.0% in the DK vs. 83.8% in the PS group, P 〈0.001）. Baseline FFR was comparable between the DK and the PS groups, however, the acute gain and late loss of SB FFR at 8-month follow-up in the DK group were 0.18±0.15 and -0.06±0.11, compared to 0.12±0.18 （P=0.044） and -0.002±0.07 （P=-0.037） in the PS group, respectively. MV FFR post-stenting 〉0.94 was seen in about 40% of patients. There was no significant difference in the clinical events at 1-year follow-up between the two groups. Conclusions DK crush was associated with improved acute gain and late loss of SB FFR. The lower rate of FFR 〉0.94 after stenting underscored the further improvement of stentinq quality.
文摘Background The mechanisms responsible for the occurrence of a kissing unsatisfied （KUS） result after classical crush stenting remain unclear. The present study aimed at analyzing the mechanisms and clinical significance of KUS. Methods Two hundred and thirteen patients with true bifurcation lesions treated with classical crush stenting and final kissing balloon inflation （FKBI） were assigned to upper, middle, and lower groups according to the position of the side branch re-wiring assessed by visual estimation, quantitative coronary analysis （QCA） and intravascular ultrasound （IVUS）. Angiographic follow-up was indexed at 12 months. Results The upper group was characterized by a larger bifurcation angle of 55.53°±25.25° （P=0,030） and a longer procedural time （42.43±23.92） minutes （P=0.015）. The overall rate of KUS by visual estimation was 10.48%, with 5.4% in the upper group, 3.9% in middle group, and 36.1% in lower group （P 〈0.001）. For the diagnosis of KUS, visual inspection demonstrated a good correlation with both QCA and IVUS. Smaller stent diameter was the main reason for KUS in the upper group, while extra-stent side wire location, or re-wire in a low position was the main mechanism attributed to KUS in the lower group. The Lower group had more restenosis, with most restenotic lesions at a lower position of the side branch ostium. KUS （HR 1.652, 95% Cl 1.332-2.088, P 〈0.001） and re-wiring position （HR 2.341, 95% Cl 1.780-4.329, P 〈0.001） were two independent predictors of side branch restenosis. Re-wiring position （OR 0.458, 95%C/0.336-0.874, P=0.001） and side stent expansion （OR 3.122, 95%C/2.883-5.061, P=0.014） were factors predicting the findings of KUS. Conclusions Side wire outside side stents resulted in more KUS and restenosis. Different restenotic lesion types reflected individual mechanisms contributing to the development of plaque proliferation.
文摘Kissing molars (KMs) is a condition of occlusal molar surfaces in a single follicular space with roots extending in opposite directions. Here, we have reported a case of KMs in a 58-year-old woman. The patient complained of pain in the right mandibular molar region and was diagnosed with KMs consisting of the right mandibular second and third molars. Because of the patient’s pain having subsided at the time of the visit and her unwillingness to undergo tooth extraction, the patient was followed up. KMs is classified into three classes (I-III) and is either true-KMs or pseudo-KMs and presents with or without cystic variants of dental follicles. The presents as true-KMs class II without a cystic variant. With reference to the literature and based on our analysis, the mean age of patients affected by this specific case of KMs is 31.7 years and unilateral KMs is relatively more common (85.7%). Histopathological findings of dentigerous cysts are more often indicated (42.9%). The treatment policy for KMs should therefore be based on the classification of KMs. Importantly, the focus should be on preserving the first and second molars as much as possible. The treatment approach, such as the employment of surgical removal or orthodontics, should be determined by considering the associated factors such as the crowns, tissues, and age of the patient.
文摘Background Bifurcation angles may have an impact on the clinical outcomes of crush stenting. We sought to compare high （≥60°） with low （〈60°） bifurcation angle in patients who underwent either classical or double kissing （DK） crush stenting for bifurcation lesions from the DKCRUSH-1 data base. Methods There were 212 patients with 220 lesions, some with low-angle （n=138） and some with high-angle （n=74）. Angiography was indexed at 8-month after procedure. Primary endpoint was the occurrence of major adverse cardiac events （MACEs）, defined as cardiac death, myocardial infarction and target lesion revascularization （TLR）. Secondary endpoint included late lumen loss, the rate of restenosis, and final kissing balloon inflation （FKBI）. Results At 8 months, clinical follow-up was 100%; angiographic follow-up was 75% in the low-angle group and 83.3% in the high-angle group. There were no significant differences in the FKBI between the high-angle group （91.43%） and the low-angle group （82.39%）. In the high angle group, there was a significant difference in contrast volume used （P=0.005） but no significant difference in acute gain, minimum lumen diameter （MLD）, late loss and diameter stenosis in the pre-bifurcation segment, post-bifurcation segment or side branch. When lesions were assigned into with- （n=-133） and without-FKBI （n=42）, significant side-branch late loss was seen in the group without-FKBI （（0.65±0.49） mm vs （0.47±0.62） mm, P=0.02）, with a resultant greater restenosis rate （37.68% vs 18.32%, P=0.001）. No difference was detected in the MACE free survival rate between the high and low angle groups （82.39% vs 82.36%, P=0.84）. The rate of stent thrombosis tended to be higher in the lower-angle group although there was no significant difference （P=0.38）. The TLR free survival rate was 87.2% in the with-FKBI group vs 73.5% in the without-FKBI group （P=0.001）. Cox regression analysis showed that the independent predictors for t
文摘Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including ＂T＂, ＂V＂, ＂Y＂, ＂culotte＂ and ＂simultaneous kissing stents （SKS）＂. Understanding the drawbacks in classical crush techniques, we proposed a novel double kissing （DK） crush technique being testified in our previous serial studies]＇2 The results from these randomized and pilot studies are describing a fantastic story---DK crush technique, by final kissing balloon inflation （FKBI） in 100% of lesions and high quality of kissing as assessed by both angiography and intravascular ultrasound, significantly improved the clinical outcome at a relative short-term follow-up. However, whether the advantage of the DK crush technique was sustained or not at a long-term remains unclear. The present study aimed to extend clinical follow-up and verify the differences between DK and classic crush techniques.
文摘A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiation of pain or any features suggestive of claudication. There was no history of any comorbidity. The pain was aggravated with extension of the spine and relieved with flexion. There was no swelling or neurological deficit, but muscle spasm was present. Radiographs of the spine revealed degenerative changes in the lumbosacral spine, along with articulation of spinous processes at in lumbar spine at all levels level suggestive of Baastrup's disease, commonly known as "kissing spine". Routine blood investigations were within normal limits. The patient was managed conservatively. He was given a week's course of analgesics and muscle relaxants and then started on spinal flexion exercises, with significant improvement being noted at 6 months follow up.
基金Supported by 973 Programs(Grant Nos.2013CB834201 and 2011CB302401)the National Science Foundation of China(Grant No.11071003)the Chang Jiang Scholars Program of China
文摘In geometry, there are several challenging problems studying numbers associated to convex bodies. For example, the packing density problem, the kissing number problem, the covering density problem, the packing-covering constant problem, Hadwiger＇s covering conjecture and Borsuk＇s partition conjecture. They are flmdamental and fascinating problems about the same objects. However, up to now, both the methodology and the technique applied to them are essentially different. Therefore, a common foundation for them has been much expected. By treating problems of these types as functionals defined on the spaces of n-dimensional convex bodies, this paper tries to create such a foundation. In particular, supderivatives for these functionals will be studied.
基金This study was co-supported by the National Key Research and Development Program,China(No.2018YFA0707300)the National Natural Science Foundation of China(Nos.51974278 and 52205406)+2 种基金China Post Doctoral Science Foundation(No.2023M732572)the Key Science and Technology Project of Shanxi Province,China(No.20191102009)the Fundamental Research Program of Shanxi Province,China(No.202203021212289).
文摘Based on twin-roll casting technology and multi-roll groove rolling technology,a Multi-Roll Solid-Liquid Cast-Rolling Bonding(MRSLCRB)process was proposed to fabricate Cu/steel cladding bars,which processes the advantages of short flow and high-efficiency.However,it is a typical 3-D thermal-fluid-mechanics coupled problem,and determining cast-rolling force is difficult during the equipment design.Therefore,the geometrical evolution of the cast-rolling area was studied,laying the foundation to establish contact boundary equations and analyze mechanical schematics and metal flow.Then,a 3-D steady-state thermal-fluid coupled simulation model,including casting roll,substrate bar,and cladding metal,was established.The Kissing Point(KP)height,average outlet temperature,and process window were predicted,and simulation results of the three-roll layout indicate that the KP distribution along the circumferential direction can be considered uniform.Hence,the engineering cast-rolling force model was derived based on the differential element method and plane deformation hypothesis.The accuracy was verified by the 3-D finite element model,and the influences of process layouts and technological parameters on the castrolling force were analyzed.Through the indirect multi-field coupled analysis method,the temperature–pressure evolution and reasonable process window can be predicted,which provides a significant basis for guiding equipment design and improving product quality.
文摘Kissing molars (KMs), first reported by Van Hoof in 1973, refer to molars with occlusal surfaces that contact each other in a single follicular space while their roots extend in opposite directions. This is a case of a 20-year-old male who presented with complaints of right mandibular molar pain with cold water contact and occlusion. Panoramic and cone-beam computed tomography (CBCT) images revealed impaction of the right mandibular third and fourth molars, with the occlusal surfaces contacting each other while the roots extended in opposite directions. KMs are classified according to the impaction of the mandibular first and second molars (Class I), second and third molars (Class II), and third and fourth molars (Class III). Our patient was considered Class III. Given the patient’s preference for surgical treatment, successful teeth extraction and extirpation were performed under intravenous sedation. The patient’s postoperative course was unremarkable. We describe a case of KMs Class III with a cystic variant assessed by panoramic and CBCT images. We additionally review all KMs Class III reported in the literature.
文摘Introduction: To report a case of isolated “endocarditic” aortic regurgitation in a 17-year old female with infective vegetations on aortic valve. Case Report: A 17-year old female was admitted with features of heart failure and a febrile illness. Blood cultures were negative and ECG revealed normal. Echocardiography revealed a “kissing-type” of vegetation on the bicuspid aortic valve with severe aortic regurgitation and a dilated left ventricle with moderate dysfunction. Conclusion: The management of aortic insufficiency occurring in infective endocarditis may differ and the presence of intractable pulmonary edema or shock is a clear indication for prompt valve replacement. The traditional diagnostic criteria are insufficient to diagnose infective endocarditis and the modified Duke criteria provide high sensitivity and specificity over 80% for the diagnosis of native valve endocarditis with positive blood cultures.
基金Supported by National Natural Science Foundation of China,No.81570360Beijing Lisheng Cardiovascular Grant,No.LHJJ201612425
文摘BACKGROUND Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists.Left main(LM)bifurcation lesions have a higher risk due to the vast blood supply in this area and treatment choice is difficult.Ostial compromise of the side branch decreases patient prognosis,and its management is still an issue despite the different strategies and devices available.CASE SUMMARY A 42-year-old male patient was admitted to hospital due to chest pain and syncope.Coronary angiography showed acute LM occlusion.Following thrombus aspiration,a LM bifurcation lesion remained.Coronary angiography was repeated one week later,and at the same time,3D optical coherence tomography(OCT)was carried out to better show the geometry of the bifurcation,which confirmed that the stenosis in the ostial left circumflex artery was caused by a long carina.After assessment of the plaque characteristics and the minimum lumen area,the cross-over strategy,kissing balloon inflation and proximal optimization technique were chosen to treat the bifurcation lesion.A“moving”carina was found twice during the intervention.Good stent apposition and expansion were confirmed by OCT after proximal optimization technique.The three-month follow-up showed good recovery and normal cardiac function.CONCLUSION 3D-OCT can facilitate decision-making for coronary interventions in patients with critical bifurcation lesions.
基金support of the National Natural Science Foundation of China(Grant No.81370311)the Key Program of Social Development of Fujian Science and Technology Department(Grant No.2013Y0043)
文摘Objective: The aim of this study was to investigate whether intermediate kissing balloon dilation(IKBD) is necessary during mini-culotte stenting(MCS) and how it can be properly conducted. Methods: MCS was emulated in a bifurcation model with a branch diameter difference(BDD) in three-step sizes of 0.50, 0.75 and 1.00 mm, and with intermediate balloon dilation(IBD) in three treatments of routine intermediate solo balloon dilation(rISBD), concurrent IKBD(cIKBD) or sequential IKBD. Microcomputed tomography was performed to assess stent under-expansion(SUE) around the polygon of confluence(POC), residual ostial stenosis(ROS) at the ostial side-branch(SB) and main-branch(MB) and stent cell distortion(SCD) in the bifurcation segments. Results: There were both main and interactive effects of IBD and BDD on ROS at the ostial SB and SCD in the ostial SB, but there were only main effects of IBD or BDD on SUE around the POC, ROS at the ostial MB and SCD in the ostial MB. Analysis of the main effects showed that SUE around the POC or ROS at the ostial SB was significantly different between sI KBD and rISBD and between cI KBD and rISBD. There was also a significant difference in SCD in the ostial SB between sI KBD and rI SBD and between sI KBD and cIKBD. Analysis of the interactive effects showed that ROS at the ostial SB or SCD in the ostial SB was affected by all IBD treatments in all BDD step-sizes. Moreover, increasing the BDD step-sizes significantly increased ROS at the ostial SB as treated by rISBD and SCD in the ostial SB as treated by rISBD or cIKBD. Conclusions: SIKBD was shown to be essential and superior to rISBD or cIKBD, resulting in better bifurcated stent expansion and coverage when using MCS.
文摘Kissing bonds are defects in the adhesive bonds with intimate contact of touching surface but considerably lowered shear strength. Their detection specifically in the aerospace area is so not satisfactory. Usually, kissing bonds are inconspicuous in ultrasonic C-scans. However, the determination of attributes in the time domain and the frequency domain of an ultrasound signal provides the opportunity to derive a pattern for bonded area. Deviations from the pattern found in inconspicuous bonding areas indicate kissing bonds. The survey described here deals with the manufacturing of adhesively joint samples that purposefully include kissing bonds, as well as potential solutions for detecting them through ultrasonic testing combined with pattern recognition. The properties of the epoxy-based adhesive were varied by changing the mixing ratios between resin and hardener. Samples with a mixing ratio far apart from the manufacturer’s recommendation with an inconspicuous appearance in a C-scan, but low shear strength values were taken for further evaluation. After a definition and learning phase, a 100 percent hit rate to separate good bondings from kissing bonds could be derived in a blind test. The discriminating feature found is due to the frequency shift between good and kissing bonds as well as the relative amplitude of the second peak.
文摘The effects of final kissing balloon dilatation （FKBD） have not been systemically evaluated in patients with coronary bifurcation lesions treated with 1-stent strategy. A meta-analysis was performed to in- tegrate the results of independent studies to provide a more precise estimate of the treatment effect. Methods A systematic literature search was carried out for all the relevant articles up till March 2012. Only studies with adequate data reporting major adverse cardiac events （MACE） and target lesion revascularization （TLR）, and follow-up of at least 6 months were included. The endpoints analyzed in this meta-analysis were stent throm- bosis （ST）, all-cause death, myocardial infarction （MI）, MACE and TLR. Result Four studies were found to be eligible for inclusion in the meta-analysis. There were also no significant differences with the occurrence of MI （1.7% vs. 1.5%, OR 1.14, 95% CI 0.38 to 3.44, P = 0.81）, all-cause death （1.1% vs. 1.1%, P = 0.84, OR 0.91, 95% CI 0.35 to 2.35） and stent thrombosis （0.9% vs. 0.8%, OR 1.03, 95% CI 0.35 to 3.09, P = 0.95） in patients with FKBD or No FKBD. However, FKBD was associated with a higher risk of MACE （8.0% vs. 5.3%, OR 1.56, 95% CI, 1.02-2.39, P = 0.04）, primarily as a result of an increased risk of TLR （6.4% vs. 3.4%, OR 2.12, 95% CI 1.30 to 3.48 P = 0.003）. Conclusions In patients with coronary bifurca- tion lesions treated with 1-stent technique, FKBD may be associated with adverse outcomes mainly because of a higher rate of TLR.
文摘Double kissing(DK)crush stenting for coronary bifurcation lesions has gain popularity worldwide because of its superior randomized studies data and excellent clinical outcomes.This review evaluates all DK crush clinical trials and studies.It also reveals the contemporary technique steps by steps as well as the trouble shooting with illustrated clinical scenarios.Among all the available evidence,the DK crush technique is superior when compared to the provisional stenting technique for complex bifurcation lesion.DK crush stenting provides the best evidence-based approach to complex bifurcation lesions especially the left main coronary artery bifurcation lesions.Future direction of how to make this DK crush technique better is also proposed.
文摘Bifurcation lesions are encountered and treated in up to 1 in 5 cases of percutaneous coronary intervention(PCI).Such lesions pose a technical challenge to PCI,leading to lower procedural success and a higher rate of long-term adverse events.However,each bifurcation is unique in terms of anatomy and pathological presentation.There is no“one size fits all”strategy for coronary bifurcation PCI.Nevertheless,in most scenarios,provisional stenting is the preferred technique.This method is easy to apply and involves a logical stepwise escalation approach that is highly successful and safe.
