Triple-negative breast cancer(TNBC)is a subtype of breast cancer in which the estrogen receptor and progesterone receptor are not expressed,and human epidermal growth factor receptor 2 is not amplified or overexpresse...Triple-negative breast cancer(TNBC)is a subtype of breast cancer in which the estrogen receptor and progesterone receptor are not expressed,and human epidermal growth factor receptor 2 is not amplified or overexpressed either,which make the clinical diagnosis and treatment very challenging.Molecular imaging can provide an effective way to diagnose TNBC.Upconversion nanoparticles(UCNPs),are a promising new generation of molecular imaging probes.However,UCNPs still need to be improved for tumor-targeting ability and biocompatibility.This study describes a novel probe based on cancer cell membrane-coated upconversion nanoparticles(CCm-UCNPs),owing to the low immunogenicity and homologous-targeting ability of cancer cell membranes,and modified multifunctional UCNPs.This probe exhibits excellent performance in breast cancer molecular classification and TNBC diagnosis through UCL/MRI/PET tri-modality imaging in vivo.By using this probe,MDA-MB-231 was successfully differentiated between MCF-7 tumor models in vivo.Based on the tumor imaging and molecular classification results,the probe is also expected to be modified for drug delivery in the future,contributing to the treatment of TNBC.The combination of nanoparticles with biomimetic cell membranes has the potential for multiple clinical applications.展开更多
Objective To observe the value of deep learning (DL) models for automatic classification of echocardiographic views. Methods Totally 100 patients after heart transplantation were retrospectively enrolled and divided i...Objective To observe the value of deep learning (DL) models for automatic classification of echocardiographic views. Methods Totally 100 patients after heart transplantation were retrospectively enrolled and divided into training set, validation set and test set at a ratio of 7 ∶ 2 ∶ 1. ResNet18, ResNet34, Swin Transformer and Swin Transformer V2 models were established based on 2D apical two chamber view, 2D apical three chamber view, 2D apical four chamber view, 2D subcostal view, parasternal long-axis view of left ventricle, short-axis view of great arteries, short-axis view of apex of left ventricle, short-axis view of papillary muscle of left ventricle, short-axis view of mitral valve of left ventricle, also 3D and CDFI views of echocardiography. The accuracy, precision, recall, F1 score and confusion matrix were used to evaluate the performance of each model for automatically classifying echocardiographic views. The interactive interface was designed based on Qt Designer software and deployed on the desktop. Results The performance of models for automatically classifying echocardiographic views in test set were all good, with relatively poor performance for 2D short-axis view of left ventricle and superior performance for 3D and CDFI views. Swin Transformer V2 was the optimal model for automatically classifying echocardiographic views, with high accuracy, precision, recall and F1 score was 92.56%, 89.01%, 89.97% and 89.31%, respectively, which also had the highest diagonal value in confusion matrix and showed the best classification effect on various views in t-SNE figure. Conclusion DL model had good performance for automatically classifying echocardiographic views, especially Swin Transformer V2 model had the best performance. Using interactive classification interface could improve the interpretability of prediction results to some extent.展开更多
The objective of this study was to evaluate the diagnostic value of 128-slice spiral CT combined with virtual colonoscopy in diagnosis of colorectal cancer.We retrospectively analyzed 45 patients of colorectal disease...The objective of this study was to evaluate the diagnostic value of 128-slice spiral CT combined with virtual colonoscopy in diagnosis of colorectal cancer.We retrospectively analyzed 45 patients of colorectal diseases who underwent definition AS+128-slice spiral CT combined with virtual colonoscopy after bowel preparation and gas injection to evaluate the clinical diagnostic value of this technology.All the patients received electronic colonoscopy and were confirmed by pathology.In total,colorectal cancer was confirmed in 42 cases and inflammation in 3 cases.Diagnostic results shows:there were 17 cases of lump,10 cases of infiltration,6 cases of ulcer,9 cases of mixed type,4 cases of liver metastases,and 36 cases of lymph node metastasis.There was no significant difference between 128-slice spiral CT combined with virtual colonoscopy and electronic colonoscopy in detection,localization and characterization of colorectal tumors.CT virtual endoscopy has great advantages in observing the invasion around the lesion and the presence or absence of metastasis in distant organs and lymph node metastasis.It is also possible to understand the shape of the lesion in the intestinal lumen and the length of the lesion involving the lumen of the intestine.展开更多
Myocardial fiber deformation measurements have been reported to be associated with adverse outcomes in patients with acute heart failure and those with myocardial infarction.However,few studies have addressed the prog...Myocardial fiber deformation measurements have been reported to be associated with adverse outcomes in patients with acute heart failure and those with myocardial infarction.However,few studies have addressed the prognostic value of global circumferential strain(GCS)in dilated cardiomyopathy(DCM)patients with severely impaired systolic function.This study aimed to evaluate the prognostic value of cardiac magnetic resonance(CMR)-derived GCS in DCM patients with severely reduced ejection.Consecutive DCM patients with severely reduced ejection fraction(EF<35%)who underwent CMR were included.GCS was calculated from CMR cine images.The clinical endpoint was a composite of all-cause mortality,heart transplantation,implantable cardioverter defibrillator(ICD)implantation and aborted sudden cardiac death(SCD).A total of 129 patients with a mean EF of 15.33%(11.36%–22.27%)were included.During a median follow-up of 518 days,endpoint events occurred in 50 patients.Patients with GCS≥the median(−5.17%)had significantly reduced event-free survival as compared with those with GCS<the median(P<0.01).GCS was independently associated with adverse events after adjusting for clinical and imaging risk factors including extent of late gadolinium enhancement(LGE)(P<0.05).Adding GCS into the model including the extent of LGE resulted in significant improvements in the C-statistic(from 0.706 to 0.742;P<0.05)with a continuous net reclassification improvement(NRI)of 29.71%.It was concluded that GCS derived from CMR could be useful for risk stratification in DCM patients with severely reduced EF,which may increase common imaging risk factors including LGE.展开更多
Objectives:To compare the clinical outcomes in terms of structure and function between the insertion of a transjugular intrahepatic portosystemic shunt(TIPS) created with the Viabahn ePTFE covered stent/bare metal ste...Objectives:To compare the clinical outcomes in terms of structure and function between the insertion of a transjugular intrahepatic portosystemic shunt(TIPS) created with the Viabahn ePTFE covered stent/bare metal stent(BMS) combination and the Fluency ePTFE covered stent/BMS combination.Methods:A total of 101 consecutive patients who received a TIPS from February 2016 to August 2018 in our center were retrospectively analyzed.Sixty-four subjects were enrolled in the Viabahn group and 37 were enrolled in the Fluency group.The geometry characteristics of the TIPS were calculated,and the associated occurrence of shunt dysfunction,survival,overt hepatic encephalopathy,and variceal rebleeding were evaluated.Results:The technical success rate was 100%.After the insertion of the TIPS,the rate of shunt dysfunction during the first 3 months was significantly different between the Viabahn and Fluency groups(1.6% and 13.5%,respectively;p=0.024).Multivariate analysis indicated that the angle of portal venous inflow(α) was the only independent risk factor for shunt dysfunction(hazard ratio=1.060,95% confidence interval=1.009-1.112,p=0.020).In addition,3 months after the TIPS insertion,the a angle distinctly increased from 20.9°±14.3°-26.9°±20.1°(p=0.005) in the Fluency group but did not change significantly in the Viabahn group(from 21.9°±15.1°-22.9°± 17.6°,p=0.798).Conclusions:Shunt dysfunction was related to the a angle owing to the slight effect on the a angle after the implantation of the TIPS.The Viabahn ePTFE covered stent/BMS combination was more stable in structure and promised higher short-term stent patency compared with the Fluency ePTFE covered stent/BMS combination.展开更多
MR pulmonary angiography(MRPA)combined with indirect MR venography(MRV)was attempted by using 3D contrast-enhanced MR volume interpolated body examination(VIBE)sequence.Agreement rate for deep venous thrombosis(DVT)de...MR pulmonary angiography(MRPA)combined with indirect MR venography(MRV)was attempted by using 3D contrast-enhanced MR volume interpolated body examination(VIBE)sequence.Agreement rate for deep venous thrombosis(DVT)detection between MRV and duplex sonography(DUS)was evaluated;the potential of this method for venous thromoembolism(VTE)was also investigated.Thirty-four patients with DUS-identified DVT were enrolled in this study.MRI was performed after a single administration of Gadopentetate dimeglumine.Fatsuppressed 3D VIBE was applied for visualizing pulmonary arteries,abdominal veins,pelvic and leg veins,ranging from lung apex to ankle level.Two radiologists observed the MR images in consensus,recorded the location and number of emboli.MRV images were assessed based on per-vein segment.The agreement rate between MRV and DUS for venous segment-to-segment comparison was analyzed by Wilcoxon rank sum test.All the patients were diagnosed as having DV 1 by MRV.MRV detected 55 more venous segments with thrombi than DUS based on per-vein segment analysis.Twenty-three patients with pulmonary embolism(PE)were detected by MRPA.Twenty-one patients underwent both pulmonary CT angiography and MRPA,and consistency for PE detection was 100%.Total examination time of the combined MR protocol was 7 min for each patient.The contrast-enhanced VIBE sequence proves to be a feasible and reliable method for VTE diagnosis in one-stop MR scanning procedure,and contrast-enhanced VIBE performs better to depict DVT than DUS on per-vein segment basis.展开更多
Objective Apatinib is a novel inhibitor of vascular endothelial growth factor receptor-2.The goal of this study was to evaluate overall survival(OS)after a combination of transarterial chemoembolization(TACE)and apati...Objective Apatinib is a novel inhibitor of vascular endothelial growth factor receptor-2.The goal of this study was to evaluate overall survival(OS)after a combination of transarterial chemoembolization(TACE)and apatinib in patients with advanced hepatocellular carcinoma(HCC)and to identify the factors affecting patient survival.Methods Fifty-one patients with advanced HCC who received TACE in combination with apatinib in our hospital from June 2015 to May 2017 were enrolled.The OS and progression-free survival(PFS)were calculated using the Kaplan-Meier method.The log-rank test and Cox regression model were used to determine the factors affecting OS.Results The median OS and PFS of the patients were 15 months and 10 months,respectively.The 1-,2-,and 3-year survival rates were 64.7%,23.5%,and 1.8%,respectively.Univariate survival analysis showed that patients with Child-Pugh A(P=0.006),reduction rate of proper hepatic artery(P=0.016),hand-foot syndrome(P=0.005),secondary hypertension(P=0.050),and without ascites(P=0.010)had a better OS.Multivariate analysis showed that hand-foot syndrome(P=0.014),secondary hypertension(P=0.017),and reduction rate of proper hepatic artery(P=0.025)were independent predictors of better OS.Conclusion TACE combined with apatinib is a promising treatment for advanced HCC.Hand-foot syndrome,secondary hypertension,and the reduction rate of proper hepatic artery were associated with a better OS.展开更多
Purpose: To analyze causes of acute nonvariceal gastrointestinal bleeding(GIB) with negative digital subtraction angiography(DSA) results.Materials and methods: The clinical and follow-up data of 133 patients-recruite...Purpose: To analyze causes of acute nonvariceal gastrointestinal bleeding(GIB) with negative digital subtraction angiography(DSA) results.Materials and methods: The clinical and follow-up data of 133 patients-recruited between February 2008 and November 2016-with acute nonvariceal GIB and negative DSA results were included in this study. DSA results,diagnoses, and clinical outcomes were recorded.Results: The DSA results were negative in all 133 patients. Of the total, 55 patients(41.4%) chose to undergo surgery and 78(58.6%) opted for conservative treatment. Within 30 days, there was no significant difference in the rebleeding or mortality rates between the two groups(P <.05). Of all 133 patients, 76(57.1%) had upper GIB and 57(42.9%) had lower GIB;within 30 days, the rebleeding rate in the upper GIB group(44.7%, 34/76) was significantly higher than that in the lower GIB group(26.3%, 15/57). There was no significant statistical difference(P <.05) within 30 days in the mortality rates between the two groups.Among patients with upper GIB, 26(34.2%, 26/76) opted to undergo surgery and 50(65.8%, 50/76) chose conservative treatment;within 30 days, the rebleeding rate in the group that chose surgery(61.5%, 16/26) was higher than that in the conservative treatment group(36%, 18/50). There was no significant difference(P <.05)within 30 days in the mortality rate between the two groups.Among the patients with lower GIB, 29(50.9%, 29/57) chose to undergo surgery and 28(49.1%, 28/57) opted for conservative treatment. Within 30 days, the rebleeding rate in the surgery group(13.8%, 4/29) was lower than that in conservative treatment group(39.3%, 11/28). There was no significant difference(P <.05) within 30 days in the mortality rate between the two groups.Sixteen patients underwent prophylactic arterial embolization;in 6 of these, bleeding was stopped for 30 days.DSA was then repeated in these 16 patients after a median interval of 1 day, and a positive bleeding site was found in 9 of the 16. Causes of bleeding were found in 111 patients by surgery or endoscopy, whereas the causes remained unknown in 22 patients.Conclusions: Upper GIB with negative DSA results was stopped by conservative treatment, whereas lower GIB required surgery to detect the culprit bleeding site. Rare causes of GIB should be considered and appropriate management selected in a timely manner in order to detect unusual causes.展开更多
Hemangioma is the most common benign hepatic tumor.Although spontaneous rupture is rare,the mortality rate ranges from 60 to 75%.Only 34 cases have been reported in the literature,with only one report using transcathe...Hemangioma is the most common benign hepatic tumor.Although spontaneous rupture is rare,the mortality rate ranges from 60 to 75%.Only 34 cases have been reported in the literature,with only one report using transcatheter arterial embolization(TAE) alone as treatment.We report a case of spontaneous rupture with "flowering sign" of a giant hepatic hemangioma,presenting with acute abdominal pain and shock,while the volume of the hemangioma and blood loss were similar.The patient was successfully managed by transarterial chemoembolization(TACE) alone,which has an operative mortality rate of up to 36.4%.展开更多
BACKGROUND There is significant heterogeneity between gastroesophageal varices(GOV2)and isolated gastric varices(IGV1).The data on the difference between GOV2 and IGV1 are limited.AIM To determine the etiology,clinica...BACKGROUND There is significant heterogeneity between gastroesophageal varices(GOV2)and isolated gastric varices(IGV1).The data on the difference between GOV2 and IGV1 are limited.AIM To determine the etiology,clinical profiles,endoscopic findings,imaging signs,portosystemic collaterals in patients with GOV2 and IGV1.METHODS Medical records of 252 patients with gastric fundal varices were retrospectively collected,and computed tomography images were analyzed.RESULTS Significant differences in routine blood examination,Child-Pugh classification and MELD scores were found between GOV2 and IGV1.The incidence of peptic ulcers in patients with IGV1(26.55%)was higher than that of GOV2(11.01%),while portal hypertensive gastropathy was more commonly found in patients with GOV2(22.02%)than in those with IGV1(3.54%).Typical radiological signs of cirrhotic liver were more commonly observed in patients with GOV2 than in those with IGV1.In patients with GOV2,the main afferent vessels were via the left gastric vein(LGV)(97.94%)and short gastric vein(SGV)(39.18%).In patients with IGV1,the main afferent vessels were via the LGV(75.61%),SGV(63.41%)and posterior gastric vein(PGV)(43.90%).In IGV1 patients with pancreatic diseases,spleno-gastromental-superior mesenteric shunt(48.15%)was a major collateral vessel.In patients with fundic varices,the sizes of gastric/esophageal varices were positively correlated with afferent vessels(LGVs and PGVs)and efferent vessels(gastrorenal shunts).The size of the esophageal varices was negatively correlated with gastrorenal shunts in GOV2 patients.CONCLUSION Significant heterogeneity in the etiology and vascular changes between GOV2 and IGV1 is useful in making therapeutic decisions.展开更多
The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynami...The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynamic characteristics of the area of ASD were observed, and the overall and local volume and functions of the patients with ASD were measured. RT 3DE was performed on the 27 normal controls and 28 patients with ASD. Based on the three-dimensional data workstations, the area of ASD was measured at P wave vertex, R wave vertex, T wave starting point, and T wave terminal point and in the T-P section. The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured. The measured value of the area of ASD was analyzed. The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared. The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane（LA 8-plane） method. Real-time three-dimensional volume imaging was performed in the normal control group and ASD group（n=30）. The right ventricular inflow tract, outflow tract, cardiac apex muscular trabecula dilatation, end-systolic volume, overall dilatation, end-systolic volume, and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method（4D RVQ） and compared. The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis. Dynamic changes occurred to the area of ASD in the cardiac cycle. The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent. The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared. The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve. The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same. The displacement of the tricuspid annulus exhibited directionality. The measured values of the area of ASD at P wave vertex, R wave vertex, T wave starting point, T wave terminal point and in the T-P section were properly correlated with the right atrial volume（P〈0.001）. The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated（P〈0.05）. The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group（P=0.0001）. The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group（P=0.043）. The right ventricular ejection fraction in the ASD group was lower than that in the normal control group（P=0.032）. The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction. The difference was statistically significant（P=0.005）. The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group（P=0.031）. The a RVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group（P=0.0005）. The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics. RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle. The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people. The right ventricular cardiac apex and the overall systolic function decrease.展开更多
Objective The influence of the coronary artery anatomy on the prognosis of patients receiving an arterial switch operation(ASO)is currently controversial,and the risk factors for this operation may change in more comp...Objective The influence of the coronary artery anatomy on the prognosis of patients receiving an arterial switch operation(ASO)is currently controversial,and the risk factors for this operation may change in more complicated patients.This study aimed to investigate the influence of coronary artery anomalies on the in-hospital and post-discharge outcomes of ASO in patients with transposition of the great arteries(TGA)and Taussig-Bing anomaly(TBA).Methods We retrospectively reviewed 206 patients who underwent ASO from January 2007 to December 2019.The median age at operation was 33[interquartile range(IQR):20–71]days.Median follow-up time was 7.2 years(IQR:4.0–10.3 years).Results Coronary anomalies were present in 86 patients(41.7%),with 9(4.4%)of them having a single coronary artery.Additional coronary features included intramural courses in 5(2.4%)patients,ostial stenosis in 1(0.5%)patient,and accessory coronary artery orifices in 5(2.4%)patients.There were 32(15.5%)in-hospital deaths and 8(4.6%)post-discharge deaths,yielding an overall survival of 81.3%,80.7%and 79.9%at 1,5 and 10 years,respectively.Mortality due to ASO has been drastically decreased since 2013.Patients with a single coronary artery had higher rate of in-hospital mortality,but this finding was not statistically significant.The earlier surgical era(OR:2.756)and a longer cardiopulmonary bypass time(OR:2.336)were significantly associated with in-hospital mortality,while coronary patterns were not.An intramural coronary artery(HR:10.034)and a patient age of older than 1 year at the time of ASO(HR:9.706)were independent predictors of post-discharge mortality.Conclusion ASO remains the procedure of choice for TGA with coronary anomalies with acceptable in-hospital and post-discharge outcomes in terms of overall survival and freedom of reoperation.However,intramural coronary artery is an independent risk factor for post-discharge mortality.Timely surgery within the 1st year of life helps improve overall midterm survival of ASO.展开更多
Purpose: To investigate the feasibility and effectiveness of in situ formation of the loop snare technique for retrieval of foreign bodies from vessels. Materials and methods: We retrospectively reviewed in situ forma...Purpose: To investigate the feasibility and effectiveness of in situ formation of the loop snare technique for retrieval of foreign bodies from vessels. Materials and methods: We retrospectively reviewed in situ formation of the loop snare technique for retrieval of foreign bodies in 6 patients. After placing the guide wire and the loop of the gooseneck snare on each side of the tubes, the soft tip of the guide wire was caught with the gooseneck snare to form a new loop structure. The foreign body was retrieved with the new loop snare by combining the gooseneck snare and the guide wire. We reviewed the application of this technique in 6 patients with fractured central venous catheters without free ends. Results: With in situ formation of the loop snare technique, the internal ruptured catheter was successfully removed from all of the 6 patients in about 2 to 4 min. There were no complications such as arrhythmia or heart valve injury in the 6 patients with the distal end of the fragment in the pulmonary artery or right atrium. Conclusion: The in situ formation loop snare technique is an effective and fast means of retrieving tubular foreign bodies without free ends from vessels. Further research is needed to investigate the practical utility of the method for retrieval of all kinds of foreign bodies.展开更多
Background:Severe portal hypertension is life-threatening and can bring adverse complications such as ascites,gastroesophageal varices,and edema.It can,even cause variceal hemorrhage,which may lead to a high risk of d...Background:Severe portal hypertension is life-threatening and can bring adverse complications such as ascites,gastroesophageal varices,and edema.It can,even cause variceal hemorrhage,which may lead to a high risk of death.There is a rare incidence in bleeding of hemorrhoids caused by severe ectopic varices.Case presentation:We report the case of a female patient with a 20-year history of hepatitis B virus infection who presented with repeated bleeding of hemorrhoids caused by severe portal hypertension with ectopic varices that is connection between the superior mesenteric vein and rectal venous plexus.Laboratory results revealed a hemoglobin level of 74 g/L.Finally,the patient was successfully treated with transjugular intrahepatic portosystemic shunt(TIPSS)placement without variceal embolization after a multidisciplinary comprehensive opinion.In the two-month follow-up period,the patient had failed to develop hepatic encephalopathy or hematochezia,and computed tomography venography(CTV)indicated that the stent was unobstructed and ascites disappeared.Conclusions:TIPSS placement is effective for the case,and we hope this case can help improve clinicians’awareness of hemorrhoidal bleeding with severe portal hypertension.Portal hypertension should also be considered during the diagnosis and treatment,as opposed to hemorrhoidal bleeding alone.Moreover,abdominal CTV is recommended as an effective imaging examination method to determine the stent status after operation.展开更多
The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure（CHF）. A total of 348 consecutive CHF patients who were admitted for ...The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure（CHF）. A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization（CRT） and presented with low ejection fraction（EF） and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio（FT/RR）, left ventricular pre-ejection delay（PED）, interventricular mechanical delay（IVMD）, longitudinal opposing wall delay（LOWD） and radial septal to posterior wall delay（RSPWD）. Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group（P〈0.01）. In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter（LVESd）, LV end-diastolic volume（LVEDV） and LV end-systolic volume（LVESV）（P〈0.01）, but positively with the LVEF（P〈0.01）. Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV（P〈0.01）, but negatively with the LVEF（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group（78% sensitivity, 83% specificity）, those in QRS-2 group（83% sensitivity, 77% specificity） and in QRS-3 group（89% sensitivity, 79% specificity）. In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.展开更多
Objective： To investigate the effect of different therapeutic ultrasound （TUS） parameters and culture conditions on the cell viability and transfection efficiency of human cervical cancer cells （HeLa）. Methods： ...Objective： To investigate the effect of different therapeutic ultrasound （TUS） parameters and culture conditions on the cell viability and transfection efficiency of human cervical cancer cells （HeLa）. Methods： HeLa cells were cultured using two different protocols （in suspension or in monolayer）. Subsequently, cells were exposed to different TUS intensity （0.4 W/cm^2, 1.0 W/cm^2, 1.6 W/cm^2, 2.2 W/cm^2）, duty cycle （DC）（10%, 20%, 50%）, exposure time （1 min or 3 min）. Cell viability was analyzed by flow cytometry. Gene transfection of red fluorescent protein （DsRED） was detected. Results： TUS intensity and duty cycle had a great impact on the overall results （P〈0.01）. Cell injury were found to increase progressively with intensity （1.6 W/cm^2, 2.2 W/cm^2） and duty cycle （50%） and cell detachment was accompanied by ultrasound exposure in adherent cells Results of factorial design showed that the fashion of cell culture and the TUS parameters had interaction （P〈0.01）. The ideal conditions that cell viability above 80% producing maximum efficiency were noted to be at 1.0 W/cm^2 irradiated 3 min with a duty cycle of 20% in cell suspension. Conclusion： TUS parameters and transfection conditions have a great impact on the gene transfection and cell viability. Optimal parameters could enhance cell inembrane permeability, which facilitate to delivering the macromolecules into cells.展开更多
We report two cases of hepatic encephalopathy caused by molecular targeted drugs after the Transjugular intrahepatic portosystemic shunt(TIPS)procedure in our center.The liver toxicities and anti-angiogenic effects in...We report two cases of hepatic encephalopathy caused by molecular targeted drugs after the Transjugular intrahepatic portosystemic shunt(TIPS)procedure in our center.The liver toxicities and anti-angiogenic effects induced by targeted drugs may generate an imbalance in ammonia metabolism,elevating blood ammonia levels.TIPS diverts partial blood supply from the liver,aggravates liver impairment,and shunts ammonia-rich blood from the intestine into the systemic circulation.These may be the mechanisms leading to hepatic encephalopathy caused by molecular targeted drugs following TIPS.When clinicians choose molecular targeted therapy as the second or third targeted therapy for patients who have undergone TIPS,the consequence of drug-induced hepatic encephalopathy should also be considered.展开更多
Doxorubicin (DOX), also known as adriamycin, is an anthracycline chemotherapy drug that exerts anticancer effects. However, the clinical application of DOX is severely limited by its cardiotoxicity. Recent researches ...Doxorubicin (DOX), also known as adriamycin, is an anthracycline chemotherapy drug that exerts anticancer effects. However, the clinical application of DOX is severely limited by its cardiotoxicity. Recent researches show that the mechanism of DOX-induced cardiotoxicity is very complex and includes oxidative stress, inflammation, mitochondrial dysfunction, autophagy, cell apoptosis and death. These factors jointly promote the occurrence and development of DOX-induced cardiotoxicity. In addition, a large number of studies have shown that some active ingredients of traditional Chinese medicine antagonized DOX-induced cardiotoxicity. The combination of doxorubicin and relevant traditional Chinese medicine can maximize the therapeutic effect of tumor patients, reduce mortality rates, and improve the quality of life of tumor patients. In conclusion, this review provides new insights to further explore ingredients of traditional Chinese medicine in the treatment of DOX-induced cardiotoxicity.展开更多
The aim of present study was to evaluate the feasibility and efficiency of enhanced green fluorescent protein （EGFP） gene delivery to myocardium in vivo by ultrasound targeted microbubble destruction （UTMD） and po...The aim of present study was to evaluate the feasibility and efficiency of enhanced green fluorescent protein （EGFP） gene delivery to myocardium in vivo by ultrasound targeted microbubble destruction （UTMD） and polyethylenimine （PEI）. SonoVue/DNA and PEI/DNA/SonoVue complexes were prepared. Gel electrophoresis analysis was performed to determine the structural integrity of plasmid DNA or PEI/DNA after UTMD. Solutions of plasmid DNA, SonoVue/DNA, PEI/DNA complexes or PEI/DNA/SonoVue complexes were respectively transduced into BALB/c mice hearts by means of transthoracic ultrasound irradiation. Mice undergoing PBS injection, plasmid injection or PEI/DNA complexes injection without ultrasound irradiation served as controls. Gene expression in myocardium was detected 4 days after treatment. Cryosections and histological examinations were conducted. Electrophoresis gel assay showed no damage to DNA or PEI/DNA complexes after UTMD. When the heart was not exposed to ultrasound, the expression of EGFP was observed in the subendocardial myocardium obviously. The strongest expression was detected in the anterior wall of the left ventricle when the heart was exposed to ultrasound alone. Injection of PEI/DNA complexes and UTMD resulted in the highest transfection efficiency and the distributional difference of EGFP was not obvious. No tissue damage was seen histologically. In conclusion, a combination of UTMD and PEI was highly effective in transfecting mice hearts without causing any apparently adverse effect. It provides an alternative to current clinical gene therapy and opens a new concept of non-viral gene delivery for the treatment of cardiac disease.展开更多
Examining the spontaneous BOLD activity to understand the neural mechanism of Parkinson’s disease(PD)with mild cognitive impairment(MCI)is a focus in resting-state functional MRI(rs-fMRI)studies.This study aimed to i...Examining the spontaneous BOLD activity to understand the neural mechanism of Parkinson’s disease(PD)with mild cognitive impairment(MCI)is a focus in resting-state functional MRI(rs-fMRI)studies.This study aimed to investigate the alteration of brain functional connectivity in PD with MCI in a systematical way at two levels:functional connectivity analysis within resting state networks(RSNs)and functional network connectivity(FNC)analysis.Using group independent component analysis(ICA)on rs-fMRI data acquired from 30 participants(14 healthy controls and 16 PD patients with MCI),16 RSNs were identified,and functional connectivity analysis within the RSNs and FNC analysis were carried out between groups.Compared to controls,patients with PD showed decreased functional connectivity within putamen network,thalamus network,cerebellar network,attention network,and self-referential network,and increased functional connectivity within execution network.Globally disturbed,mostly increased functional connectivity of FNC was observed in PD group,and insular network and execution network were the dominant network with extensively increased functional connectivity with other RSNs.Cerebellar network showed decreased functional connectivity with caudate network,insular network,and self-referential network.In general,decreased functional connectivity within RSNs and globally disturbed,mostly increased functional connectivity of FNC may be characteristics of PD.Increased functional connectivity within execution network may be an early marker of PD.The multi-perspective study based on RSNs may be a valuable means to assess functional changes corresponding to specific RSN,contributing to the understanding of the neural mechanism of PD.展开更多
基金the National Natural Science Foundation of China(Nos.81630049 and 81501532).
文摘Triple-negative breast cancer(TNBC)is a subtype of breast cancer in which the estrogen receptor and progesterone receptor are not expressed,and human epidermal growth factor receptor 2 is not amplified or overexpressed either,which make the clinical diagnosis and treatment very challenging.Molecular imaging can provide an effective way to diagnose TNBC.Upconversion nanoparticles(UCNPs),are a promising new generation of molecular imaging probes.However,UCNPs still need to be improved for tumor-targeting ability and biocompatibility.This study describes a novel probe based on cancer cell membrane-coated upconversion nanoparticles(CCm-UCNPs),owing to the low immunogenicity and homologous-targeting ability of cancer cell membranes,and modified multifunctional UCNPs.This probe exhibits excellent performance in breast cancer molecular classification and TNBC diagnosis through UCL/MRI/PET tri-modality imaging in vivo.By using this probe,MDA-MB-231 was successfully differentiated between MCF-7 tumor models in vivo.Based on the tumor imaging and molecular classification results,the probe is also expected to be modified for drug delivery in the future,contributing to the treatment of TNBC.The combination of nanoparticles with biomimetic cell membranes has the potential for multiple clinical applications.
文摘Objective To observe the value of deep learning (DL) models for automatic classification of echocardiographic views. Methods Totally 100 patients after heart transplantation were retrospectively enrolled and divided into training set, validation set and test set at a ratio of 7 ∶ 2 ∶ 1. ResNet18, ResNet34, Swin Transformer and Swin Transformer V2 models were established based on 2D apical two chamber view, 2D apical three chamber view, 2D apical four chamber view, 2D subcostal view, parasternal long-axis view of left ventricle, short-axis view of great arteries, short-axis view of apex of left ventricle, short-axis view of papillary muscle of left ventricle, short-axis view of mitral valve of left ventricle, also 3D and CDFI views of echocardiography. The accuracy, precision, recall, F1 score and confusion matrix were used to evaluate the performance of each model for automatically classifying echocardiographic views. The interactive interface was designed based on Qt Designer software and deployed on the desktop. Results The performance of models for automatically classifying echocardiographic views in test set were all good, with relatively poor performance for 2D short-axis view of left ventricle and superior performance for 3D and CDFI views. Swin Transformer V2 was the optimal model for automatically classifying echocardiographic views, with high accuracy, precision, recall and F1 score was 92.56%, 89.01%, 89.97% and 89.31%, respectively, which also had the highest diagonal value in confusion matrix and showed the best classification effect on various views in t-SNE figure. Conclusion DL model had good performance for automatically classifying echocardiographic views, especially Swin Transformer V2 model had the best performance. Using interactive classification interface could improve the interpretability of prediction results to some extent.
文摘The objective of this study was to evaluate the diagnostic value of 128-slice spiral CT combined with virtual colonoscopy in diagnosis of colorectal cancer.We retrospectively analyzed 45 patients of colorectal diseases who underwent definition AS+128-slice spiral CT combined with virtual colonoscopy after bowel preparation and gas injection to evaluate the clinical diagnostic value of this technology.All the patients received electronic colonoscopy and were confirmed by pathology.In total,colorectal cancer was confirmed in 42 cases and inflammation in 3 cases.Diagnostic results shows:there were 17 cases of lump,10 cases of infiltration,6 cases of ulcer,9 cases of mixed type,4 cases of liver metastases,and 36 cases of lymph node metastasis.There was no significant difference between 128-slice spiral CT combined with virtual colonoscopy and electronic colonoscopy in detection,localization and characterization of colorectal tumors.CT virtual endoscopy has great advantages in observing the invasion around the lesion and the presence or absence of metastasis in distant organs and lymph node metastasis.It is also possible to understand the shape of the lesion in the intestinal lumen and the length of the lesion involving the lumen of the intestine.
基金the National Natural Science Foundation of China(Nos.81701653 and 81570348).
文摘Myocardial fiber deformation measurements have been reported to be associated with adverse outcomes in patients with acute heart failure and those with myocardial infarction.However,few studies have addressed the prognostic value of global circumferential strain(GCS)in dilated cardiomyopathy(DCM)patients with severely impaired systolic function.This study aimed to evaluate the prognostic value of cardiac magnetic resonance(CMR)-derived GCS in DCM patients with severely reduced ejection.Consecutive DCM patients with severely reduced ejection fraction(EF<35%)who underwent CMR were included.GCS was calculated from CMR cine images.The clinical endpoint was a composite of all-cause mortality,heart transplantation,implantable cardioverter defibrillator(ICD)implantation and aborted sudden cardiac death(SCD).A total of 129 patients with a mean EF of 15.33%(11.36%–22.27%)were included.During a median follow-up of 518 days,endpoint events occurred in 50 patients.Patients with GCS≥the median(−5.17%)had significantly reduced event-free survival as compared with those with GCS<the median(P<0.01).GCS was independently associated with adverse events after adjusting for clinical and imaging risk factors including extent of late gadolinium enhancement(LGE)(P<0.05).Adding GCS into the model including the extent of LGE resulted in significant improvements in the C-statistic(from 0.706 to 0.742;P<0.05)with a continuous net reclassification improvement(NRI)of 29.71%.It was concluded that GCS derived from CMR could be useful for risk stratification in DCM patients with severely reduced EF,which may increase common imaging risk factors including LGE.
基金supported by the National Natural Science Foundation of China (No. 81873917)。
文摘Objectives:To compare the clinical outcomes in terms of structure and function between the insertion of a transjugular intrahepatic portosystemic shunt(TIPS) created with the Viabahn ePTFE covered stent/bare metal stent(BMS) combination and the Fluency ePTFE covered stent/BMS combination.Methods:A total of 101 consecutive patients who received a TIPS from February 2016 to August 2018 in our center were retrospectively analyzed.Sixty-four subjects were enrolled in the Viabahn group and 37 were enrolled in the Fluency group.The geometry characteristics of the TIPS were calculated,and the associated occurrence of shunt dysfunction,survival,overt hepatic encephalopathy,and variceal rebleeding were evaluated.Results:The technical success rate was 100%.After the insertion of the TIPS,the rate of shunt dysfunction during the first 3 months was significantly different between the Viabahn and Fluency groups(1.6% and 13.5%,respectively;p=0.024).Multivariate analysis indicated that the angle of portal venous inflow(α) was the only independent risk factor for shunt dysfunction(hazard ratio=1.060,95% confidence interval=1.009-1.112,p=0.020).In addition,3 months after the TIPS insertion,the a angle distinctly increased from 20.9°±14.3°-26.9°±20.1°(p=0.005) in the Fluency group but did not change significantly in the Viabahn group(from 21.9°±15.1°-22.9°± 17.6°,p=0.798).Conclusions:Shunt dysfunction was related to the a angle owing to the slight effect on the a angle after the implantation of the TIPS.The Viabahn ePTFE covered stent/BMS combination was more stable in structure and promised higher short-term stent patency compared with the Fluency ePTFE covered stent/BMS combination.
文摘MR pulmonary angiography(MRPA)combined with indirect MR venography(MRV)was attempted by using 3D contrast-enhanced MR volume interpolated body examination(VIBE)sequence.Agreement rate for deep venous thrombosis(DVT)detection between MRV and duplex sonography(DUS)was evaluated;the potential of this method for venous thromoembolism(VTE)was also investigated.Thirty-four patients with DUS-identified DVT were enrolled in this study.MRI was performed after a single administration of Gadopentetate dimeglumine.Fatsuppressed 3D VIBE was applied for visualizing pulmonary arteries,abdominal veins,pelvic and leg veins,ranging from lung apex to ankle level.Two radiologists observed the MR images in consensus,recorded the location and number of emboli.MRV images were assessed based on per-vein segment.The agreement rate between MRV and DUS for venous segment-to-segment comparison was analyzed by Wilcoxon rank sum test.All the patients were diagnosed as having DV 1 by MRV.MRV detected 55 more venous segments with thrombi than DUS based on per-vein segment analysis.Twenty-three patients with pulmonary embolism(PE)were detected by MRPA.Twenty-one patients underwent both pulmonary CT angiography and MRPA,and consistency for PE detection was 100%.Total examination time of the combined MR protocol was 7 min for each patient.The contrast-enhanced VIBE sequence proves to be a feasible and reliable method for VTE diagnosis in one-stop MR scanning procedure,and contrast-enhanced VIBE performs better to depict DVT than DUS on per-vein segment basis.
基金supported by the National Natural Science Foundation of China(No.81771950,No.81471765 and No.81601578).
文摘Objective Apatinib is a novel inhibitor of vascular endothelial growth factor receptor-2.The goal of this study was to evaluate overall survival(OS)after a combination of transarterial chemoembolization(TACE)and apatinib in patients with advanced hepatocellular carcinoma(HCC)and to identify the factors affecting patient survival.Methods Fifty-one patients with advanced HCC who received TACE in combination with apatinib in our hospital from June 2015 to May 2017 were enrolled.The OS and progression-free survival(PFS)were calculated using the Kaplan-Meier method.The log-rank test and Cox regression model were used to determine the factors affecting OS.Results The median OS and PFS of the patients were 15 months and 10 months,respectively.The 1-,2-,and 3-year survival rates were 64.7%,23.5%,and 1.8%,respectively.Univariate survival analysis showed that patients with Child-Pugh A(P=0.006),reduction rate of proper hepatic artery(P=0.016),hand-foot syndrome(P=0.005),secondary hypertension(P=0.050),and without ascites(P=0.010)had a better OS.Multivariate analysis showed that hand-foot syndrome(P=0.014),secondary hypertension(P=0.017),and reduction rate of proper hepatic artery(P=0.025)were independent predictors of better OS.Conclusion TACE combined with apatinib is a promising treatment for advanced HCC.Hand-foot syndrome,secondary hypertension,and the reduction rate of proper hepatic artery were associated with a better OS.
文摘Purpose: To analyze causes of acute nonvariceal gastrointestinal bleeding(GIB) with negative digital subtraction angiography(DSA) results.Materials and methods: The clinical and follow-up data of 133 patients-recruited between February 2008 and November 2016-with acute nonvariceal GIB and negative DSA results were included in this study. DSA results,diagnoses, and clinical outcomes were recorded.Results: The DSA results were negative in all 133 patients. Of the total, 55 patients(41.4%) chose to undergo surgery and 78(58.6%) opted for conservative treatment. Within 30 days, there was no significant difference in the rebleeding or mortality rates between the two groups(P <.05). Of all 133 patients, 76(57.1%) had upper GIB and 57(42.9%) had lower GIB;within 30 days, the rebleeding rate in the upper GIB group(44.7%, 34/76) was significantly higher than that in the lower GIB group(26.3%, 15/57). There was no significant statistical difference(P <.05) within 30 days in the mortality rates between the two groups.Among patients with upper GIB, 26(34.2%, 26/76) opted to undergo surgery and 50(65.8%, 50/76) chose conservative treatment;within 30 days, the rebleeding rate in the group that chose surgery(61.5%, 16/26) was higher than that in the conservative treatment group(36%, 18/50). There was no significant difference(P <.05)within 30 days in the mortality rate between the two groups.Among the patients with lower GIB, 29(50.9%, 29/57) chose to undergo surgery and 28(49.1%, 28/57) opted for conservative treatment. Within 30 days, the rebleeding rate in the surgery group(13.8%, 4/29) was lower than that in conservative treatment group(39.3%, 11/28). There was no significant difference(P <.05) within 30 days in the mortality rate between the two groups.Sixteen patients underwent prophylactic arterial embolization;in 6 of these, bleeding was stopped for 30 days.DSA was then repeated in these 16 patients after a median interval of 1 day, and a positive bleeding site was found in 9 of the 16. Causes of bleeding were found in 111 patients by surgery or endoscopy, whereas the causes remained unknown in 22 patients.Conclusions: Upper GIB with negative DSA results was stopped by conservative treatment, whereas lower GIB required surgery to detect the culprit bleeding site. Rare causes of GIB should be considered and appropriate management selected in a timely manner in order to detect unusual causes.
文摘Hemangioma is the most common benign hepatic tumor.Although spontaneous rupture is rare,the mortality rate ranges from 60 to 75%.Only 34 cases have been reported in the literature,with only one report using transcatheter arterial embolization(TAE) alone as treatment.We report a case of spontaneous rupture with "flowering sign" of a giant hepatic hemangioma,presenting with acute abdominal pain and shock,while the volume of the hemangioma and blood loss were similar.The patient was successfully managed by transarterial chemoembolization(TACE) alone,which has an operative mortality rate of up to 36.4%.
基金Supported by National Natural Science Foundation of China,No.82070631.
文摘BACKGROUND There is significant heterogeneity between gastroesophageal varices(GOV2)and isolated gastric varices(IGV1).The data on the difference between GOV2 and IGV1 are limited.AIM To determine the etiology,clinical profiles,endoscopic findings,imaging signs,portosystemic collaterals in patients with GOV2 and IGV1.METHODS Medical records of 252 patients with gastric fundal varices were retrospectively collected,and computed tomography images were analyzed.RESULTS Significant differences in routine blood examination,Child-Pugh classification and MELD scores were found between GOV2 and IGV1.The incidence of peptic ulcers in patients with IGV1(26.55%)was higher than that of GOV2(11.01%),while portal hypertensive gastropathy was more commonly found in patients with GOV2(22.02%)than in those with IGV1(3.54%).Typical radiological signs of cirrhotic liver were more commonly observed in patients with GOV2 than in those with IGV1.In patients with GOV2,the main afferent vessels were via the left gastric vein(LGV)(97.94%)and short gastric vein(SGV)(39.18%).In patients with IGV1,the main afferent vessels were via the LGV(75.61%),SGV(63.41%)and posterior gastric vein(PGV)(43.90%).In IGV1 patients with pancreatic diseases,spleno-gastromental-superior mesenteric shunt(48.15%)was a major collateral vessel.In patients with fundic varices,the sizes of gastric/esophageal varices were positively correlated with afferent vessels(LGVs and PGVs)and efferent vessels(gastrorenal shunts).The size of the esophageal varices was negatively correlated with gastrorenal shunts in GOV2 patients.CONCLUSION Significant heterogeneity in the etiology and vascular changes between GOV2 and IGV1 is useful in making therapeutic decisions.
文摘The dynamic characteristics of the area of the atrial septal defect（ASD） were evaluated using the technique of real-time three-dimensional echocardiography（RT 3DE）, the potential factors responsible for the dynamic characteristics of the area of ASD were observed, and the overall and local volume and functions of the patients with ASD were measured. RT 3DE was performed on the 27 normal controls and 28 patients with ASD. Based on the three-dimensional data workstations, the area of ASD was measured at P wave vertex, R wave vertex, T wave starting point, and T wave terminal point and in the T-P section. The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured. The measured value of the area of ASD was analyzed. The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared. The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane（LA 8-plane） method. Real-time three-dimensional volume imaging was performed in the normal control group and ASD group（n=30）. The right ventricular inflow tract, outflow tract, cardiac apex muscular trabecula dilatation, end-systolic volume, overall dilatation, end-systolic volume, and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method（4D RVQ） and compared. The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis. Dynamic changes occurred to the area of ASD in the cardiac cycle. The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent. The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared. The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve. The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same. The displacement of the tricuspid annulus exhibited directionality. The measured values of the area of ASD at P wave vertex, R wave vertex, T wave starting point, T wave terminal point and in the T-P section were properly correlated with the right atrial volume（P〈0.001）. The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated（P〈0.05）. The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group（P=0.0001）. The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group（P=0.043）. The right ventricular ejection fraction in the ASD group was lower than that in the normal control group（P=0.032）. The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction. The difference was statistically significant（P=0.005）. The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group（P=0.031）. The a RVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group（P=0.0005）. The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics. RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle. The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people. The right ventricular cardiac apex and the overall systolic function decrease.
基金the National Natural Science Foundation of China(No.81727805 and No.82001854)the Shenzhen Science and Technology(No.SGDX20190917094601717 and No.JCYJ20210324141216040).
文摘Objective The influence of the coronary artery anatomy on the prognosis of patients receiving an arterial switch operation(ASO)is currently controversial,and the risk factors for this operation may change in more complicated patients.This study aimed to investigate the influence of coronary artery anomalies on the in-hospital and post-discharge outcomes of ASO in patients with transposition of the great arteries(TGA)and Taussig-Bing anomaly(TBA).Methods We retrospectively reviewed 206 patients who underwent ASO from January 2007 to December 2019.The median age at operation was 33[interquartile range(IQR):20–71]days.Median follow-up time was 7.2 years(IQR:4.0–10.3 years).Results Coronary anomalies were present in 86 patients(41.7%),with 9(4.4%)of them having a single coronary artery.Additional coronary features included intramural courses in 5(2.4%)patients,ostial stenosis in 1(0.5%)patient,and accessory coronary artery orifices in 5(2.4%)patients.There were 32(15.5%)in-hospital deaths and 8(4.6%)post-discharge deaths,yielding an overall survival of 81.3%,80.7%and 79.9%at 1,5 and 10 years,respectively.Mortality due to ASO has been drastically decreased since 2013.Patients with a single coronary artery had higher rate of in-hospital mortality,but this finding was not statistically significant.The earlier surgical era(OR:2.756)and a longer cardiopulmonary bypass time(OR:2.336)were significantly associated with in-hospital mortality,while coronary patterns were not.An intramural coronary artery(HR:10.034)and a patient age of older than 1 year at the time of ASO(HR:9.706)were independent predictors of post-discharge mortality.Conclusion ASO remains the procedure of choice for TGA with coronary anomalies with acceptable in-hospital and post-discharge outcomes in terms of overall survival and freedom of reoperation.However,intramural coronary artery is an independent risk factor for post-discharge mortality.Timely surgery within the 1st year of life helps improve overall midterm survival of ASO.
基金funded by the National Natural Science Foundation of China(No.81471766)
文摘Purpose: To investigate the feasibility and effectiveness of in situ formation of the loop snare technique for retrieval of foreign bodies from vessels. Materials and methods: We retrospectively reviewed in situ formation of the loop snare technique for retrieval of foreign bodies in 6 patients. After placing the guide wire and the loop of the gooseneck snare on each side of the tubes, the soft tip of the guide wire was caught with the gooseneck snare to form a new loop structure. The foreign body was retrieved with the new loop snare by combining the gooseneck snare and the guide wire. We reviewed the application of this technique in 6 patients with fractured central venous catheters without free ends. Results: With in situ formation of the loop snare technique, the internal ruptured catheter was successfully removed from all of the 6 patients in about 2 to 4 min. There were no complications such as arrhythmia or heart valve injury in the 6 patients with the distal end of the fragment in the pulmonary artery or right atrium. Conclusion: The in situ formation loop snare technique is an effective and fast means of retrieving tubular foreign bodies without free ends from vessels. Further research is needed to investigate the practical utility of the method for retrieval of all kinds of foreign bodies.
基金supported by the National Natural Science Foundation of China(No.81873917)
文摘Background:Severe portal hypertension is life-threatening and can bring adverse complications such as ascites,gastroesophageal varices,and edema.It can,even cause variceal hemorrhage,which may lead to a high risk of death.There is a rare incidence in bleeding of hemorrhoids caused by severe ectopic varices.Case presentation:We report the case of a female patient with a 20-year history of hepatitis B virus infection who presented with repeated bleeding of hemorrhoids caused by severe portal hypertension with ectopic varices that is connection between the superior mesenteric vein and rectal venous plexus.Laboratory results revealed a hemoglobin level of 74 g/L.Finally,the patient was successfully treated with transjugular intrahepatic portosystemic shunt(TIPSS)placement without variceal embolization after a multidisciplinary comprehensive opinion.In the two-month follow-up period,the patient had failed to develop hepatic encephalopathy or hematochezia,and computed tomography venography(CTV)indicated that the stent was unobstructed and ascites disappeared.Conclusions:TIPSS placement is effective for the case,and we hope this case can help improve clinicians’awareness of hemorrhoidal bleeding with severe portal hypertension.Portal hypertension should also be considered during the diagnosis and treatment,as opposed to hemorrhoidal bleeding alone.Moreover,abdominal CTV is recommended as an effective imaging examination method to determine the stent status after operation.
文摘The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure（CHF）. A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization（CRT） and presented with low ejection fraction（EF） and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio（FT/RR）, left ventricular pre-ejection delay（PED）, interventricular mechanical delay（IVMD）, longitudinal opposing wall delay（LOWD） and radial septal to posterior wall delay（RSPWD）. Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group（P〈0.01）. In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter（LVESd）, LV end-diastolic volume（LVEDV） and LV end-systolic volume（LVESV）（P〈0.01）, but positively with the LVEF（P〈0.01）. Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV（P〈0.01）, but negatively with the LVEF（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group（78% sensitivity, 83% specificity）, those in QRS-2 group（83% sensitivity, 77% specificity） and in QRS-3 group（89% sensitivity, 79% specificity）. In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.
基金supported by a grant from the National Natural Science Foundation of China(No.30670548).
文摘Objective： To investigate the effect of different therapeutic ultrasound （TUS） parameters and culture conditions on the cell viability and transfection efficiency of human cervical cancer cells （HeLa）. Methods： HeLa cells were cultured using two different protocols （in suspension or in monolayer）. Subsequently, cells were exposed to different TUS intensity （0.4 W/cm^2, 1.0 W/cm^2, 1.6 W/cm^2, 2.2 W/cm^2）, duty cycle （DC）（10%, 20%, 50%）, exposure time （1 min or 3 min）. Cell viability was analyzed by flow cytometry. Gene transfection of red fluorescent protein （DsRED） was detected. Results： TUS intensity and duty cycle had a great impact on the overall results （P〈0.01）. Cell injury were found to increase progressively with intensity （1.6 W/cm^2, 2.2 W/cm^2） and duty cycle （50%） and cell detachment was accompanied by ultrasound exposure in adherent cells Results of factorial design showed that the fashion of cell culture and the TUS parameters had interaction （P〈0.01）. The ideal conditions that cell viability above 80% producing maximum efficiency were noted to be at 1.0 W/cm^2 irradiated 3 min with a duty cycle of 20% in cell suspension. Conclusion： TUS parameters and transfection conditions have a great impact on the gene transfection and cell viability. Optimal parameters could enhance cell inembrane permeability, which facilitate to delivering the macromolecules into cells.
基金funded by the National Natural Science Foundation of China(81873917)。
文摘We report two cases of hepatic encephalopathy caused by molecular targeted drugs after the Transjugular intrahepatic portosystemic shunt(TIPS)procedure in our center.The liver toxicities and anti-angiogenic effects induced by targeted drugs may generate an imbalance in ammonia metabolism,elevating blood ammonia levels.TIPS diverts partial blood supply from the liver,aggravates liver impairment,and shunts ammonia-rich blood from the intestine into the systemic circulation.These may be the mechanisms leading to hepatic encephalopathy caused by molecular targeted drugs following TIPS.When clinicians choose molecular targeted therapy as the second or third targeted therapy for patients who have undergone TIPS,the consequence of drug-induced hepatic encephalopathy should also be considered.
基金supported by the National Natural Science Foundation of China(No.82300451)Research Foundation of Wuhan Union Hospital(2022xhyn050).
文摘Doxorubicin (DOX), also known as adriamycin, is an anthracycline chemotherapy drug that exerts anticancer effects. However, the clinical application of DOX is severely limited by its cardiotoxicity. Recent researches show that the mechanism of DOX-induced cardiotoxicity is very complex and includes oxidative stress, inflammation, mitochondrial dysfunction, autophagy, cell apoptosis and death. These factors jointly promote the occurrence and development of DOX-induced cardiotoxicity. In addition, a large number of studies have shown that some active ingredients of traditional Chinese medicine antagonized DOX-induced cardiotoxicity. The combination of doxorubicin and relevant traditional Chinese medicine can maximize the therapeutic effect of tumor patients, reduce mortality rates, and improve the quality of life of tumor patients. In conclusion, this review provides new insights to further explore ingredients of traditional Chinese medicine in the treatment of DOX-induced cardiotoxicity.
基金a grant from the National Natural Sciences Foundation of China (No. 30670548).
文摘The aim of present study was to evaluate the feasibility and efficiency of enhanced green fluorescent protein （EGFP） gene delivery to myocardium in vivo by ultrasound targeted microbubble destruction （UTMD） and polyethylenimine （PEI）. SonoVue/DNA and PEI/DNA/SonoVue complexes were prepared. Gel electrophoresis analysis was performed to determine the structural integrity of plasmid DNA or PEI/DNA after UTMD. Solutions of plasmid DNA, SonoVue/DNA, PEI/DNA complexes or PEI/DNA/SonoVue complexes were respectively transduced into BALB/c mice hearts by means of transthoracic ultrasound irradiation. Mice undergoing PBS injection, plasmid injection or PEI/DNA complexes injection without ultrasound irradiation served as controls. Gene expression in myocardium was detected 4 days after treatment. Cryosections and histological examinations were conducted. Electrophoresis gel assay showed no damage to DNA or PEI/DNA complexes after UTMD. When the heart was not exposed to ultrasound, the expression of EGFP was observed in the subendocardial myocardium obviously. The strongest expression was detected in the anterior wall of the left ventricle when the heart was exposed to ultrasound alone. Injection of PEI/DNA complexes and UTMD resulted in the highest transfection efficiency and the distributional difference of EGFP was not obvious. No tissue damage was seen histologically. In conclusion, a combination of UTMD and PEI was highly effective in transfecting mice hearts without causing any apparently adverse effect. It provides an alternative to current clinical gene therapy and opens a new concept of non-viral gene delivery for the treatment of cardiac disease.
基金This project was supported by grants from National Natural Science Foundation of China(No.81701655 and No.81600317)Platform Research Foundation of Union Hospital,Tongji Medical College,Huazhong university of Science and Technology(No.02.03.2017-14).
文摘Examining the spontaneous BOLD activity to understand the neural mechanism of Parkinson’s disease(PD)with mild cognitive impairment(MCI)is a focus in resting-state functional MRI(rs-fMRI)studies.This study aimed to investigate the alteration of brain functional connectivity in PD with MCI in a systematical way at two levels:functional connectivity analysis within resting state networks(RSNs)and functional network connectivity(FNC)analysis.Using group independent component analysis(ICA)on rs-fMRI data acquired from 30 participants(14 healthy controls and 16 PD patients with MCI),16 RSNs were identified,and functional connectivity analysis within the RSNs and FNC analysis were carried out between groups.Compared to controls,patients with PD showed decreased functional connectivity within putamen network,thalamus network,cerebellar network,attention network,and self-referential network,and increased functional connectivity within execution network.Globally disturbed,mostly increased functional connectivity of FNC was observed in PD group,and insular network and execution network were the dominant network with extensively increased functional connectivity with other RSNs.Cerebellar network showed decreased functional connectivity with caudate network,insular network,and self-referential network.In general,decreased functional connectivity within RSNs and globally disturbed,mostly increased functional connectivity of FNC may be characteristics of PD.Increased functional connectivity within execution network may be an early marker of PD.The multi-perspective study based on RSNs may be a valuable means to assess functional changes corresponding to specific RSN,contributing to the understanding of the neural mechanism of PD.
