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BACKGROUND: Stent ablation with rotational atherectomy has been considered a bail-out strategy for the treatment of severe stent underexpansion. Only a few reports have yet shown rotational ablation for double-layer metal struts. CASE PRESENTATION: We present a case of 80-year-old female patient presented to our hospital because of worsening effort angina. Coronary angiography revealed severe in-stent restenosis in the proximal left anterior descending artery. Optical coherence tomography (OCT) examinations found that severe stenosis occurred at the overlap region with 2-layer underexpanded stents and circumferential calcification beneath them. Under the guidance of 2-dimensional (2D) and 3-dimensional (3D) OCT, we successfully performed percutaneous coronary intervention (PCI) of this lesion after adequate stent ablation, high-pressure balloon dilatation, and subsequent everolimus-eluting stent implantation. The patient recovered well uneventfully and discharged from hospital 7 days later. No restenosis occurred after 12 months. CONCLUSIONS: We report a very rare case of in-stent restenosis due to double-layer underexpanded stents. The entire percutaneous coronary intervention procedure was performed step by step under the guidance of high-resolution OCT. Our findings highlight the specific value of 2D and 3D OCT guidance in double-layer stents rotational ablation.

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INTRODUCTION: Atrial premature contractions (APCs) are commonly encountered in clinical practice. The APCs may influence heart conduction system and induce other arrhythmia. The disorder of atrioventricular conduction is related to electrophysiological phenomena, difficult to understand and diagnose. CASE REPORT: We presented a 15-year-old male patient whose baseline electrocardiogram (ECG) was confused with multiple rhythms. Electrophysiological study results showed sinus rhythm with nonconducted APCs in bigeminal rhythm. Nonconducted APCs were blocked without H wave. Some APCs conducted to ventricle with longer AH interval and HV interval. When APCs were abolished by radiofrequency ablation, this patient was free from any arrhythmia during follow-up. CONCLUSION: We considered that the basic rhythm of the baseline ECG was sinus rhythm with atrial bigeminy rhythm and narrow QRS extrasystoles (junctional); some APCs were blocked and some APCs conducted to ventricle with aberrant QRS complexes. The phenomenon of baseline ECG was caused by the APCs.

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Objective To compare the clinical effects of percutaneous foramen rotundum and percutaneous foramen ovale radiofrequency thermocoagulation (PRT) on maxillary neuralgia.Methods Eighty patients with primary maxillary neuralgia were randomly divided into puncture foramen (group A) and foramen rotundum through pterygopalatine fossa (group B).Visual analogue scale (VAS) scores,puncture time,surgical side effects,and complications were recorded before surgery,one week,and one,3,6 and 12 months after operation.Recurrent rate and excellent and good results were calculated one week,and one,3,6 and 12 months after operation.Results The operation time of group A was significantly shorter than that of group B (P＜0.05),however,complications (involved V1 and V3 branches) of group A were significantly higher than those of group B (P＜0.05).VAS scores of two groups showed no significant differences at each time points (P＞0.05).Recurrence rate of group A 3,6 and 12 months after surgery was 5.1％(2/39),7.8％(3/39) and 15.4％(6/39),respectively,which showed no significant differences as compared with that of group B (2.8％[1/36],11.1％[4/36] and 11.1％[4/36],P＞ 0.05).Rate excellent and good results showed no significant differences between each two groups one week,and 3,6 and 12 months after operation (P＞0.05).Conclusion Percutaneous punctures of the foramen ovale and foramen rotundum approach radiofrequency therrnocoagulation for the treatment of maxillary neuralgia are safe and effective operation methods;surgical complications in foramen rotundum approach are less than those in the foramen ovale approach.

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In 48 postoperative cases using ear-clinoidal line positioning in radiofrequency thermocoagulation for treatment of trigeminal neuralgia,observing its recurrence and postoperative pain and complications in a five-year review. The successful rate of puncturing one time was 100%. Pain disappeared completely in 46 cases with one therapy. Two cases alleviated pain and decreased outbreak times. No recurrence and postoperative complications were observed. The vertical distance between the needle tip and the ear-clinoidal line were confirmed 8-10 mm in the third branch, 6-7 mm in the twice branch, 4-5 mm in the first branch. In order to avoid the first branch of trigeminal nerve injury, the vertical distance must be less than 6 mm, and the needle tip can not exceed ear-clinoidal line.

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Objective To study the mechanism of myocardical aging. Methods Wistar rats used were divided aging group (22 months old) and adult group (7 months old). Qualitative morphological changes of organelles of myocardium were observed by TEM. Quantitative morphological changes of organelles of myocardium were determined by stereological method, Ca 2+ regulation of organelles of myocardium were analysed by EDS. Results Compared with adult group, aging group:(1) The nuclei were indented, myofibril were arranged irregularly, intercalated disk were separated, mitochondria and sarcoplasmic reticulum were swelled, lipofuscin and residual body were increased. (2) The volume of myocardium not occupied by myocyte were increased, the volume density of mitochondria and sarcoplasmic reticulum were reduced, specific surface of outer membrance of mitochondria inter membrane plus cristae of mitochondria and the membrane of sarcoplasmic reticulum were also reduced. (3) Ca 2+ in myofibril and mitochondria were increased, but Ca 2+ in sarcoplasmic reticulum were decreased. Conclusion The contractility of aging myocardium were declined, the morphological changes and Ca 2+ regulation of mitochondria and sarcoplasmic reticulum might be directly related to myocardical aging.