This article presents a case study of a 20-year-old male patient diagnosed with dilated cardiomyopathy(DCM)(NYHA IV).This condition was diagnosed as"heart failure disease"(water overflowing due to yang defic...This article presents a case study of a 20-year-old male patient diagnosed with dilated cardiomyopathy(DCM)(NYHA IV).This condition was diagnosed as"heart failure disease"(water overflowing due to yang deficiency,intermingled phlegm and stasis)in traditional Chinese medicine(TCM).The treatment approach employed a combination of TCM and Western medicine.Western medicine involved the administration of sacubitril valsartan sodium tablets to inhibit ventricular remodeling,in conjunction with diuretics and cardiotonic agents.Initially,TCM utilized a static infusion of Shenfu injection,which was subsequently supplemented with Qiliqiangxin capsules to invigorate qi,warm yang,activate blood circulation,and promote diuresis.After a follow-up period of 3 years,the patient's ejection fraction(EF)improved from 23%to 51%,and the left ventricular end diastolic diameter(LVed)decreased from 68 to 52 mm,accompanied by a significant alleviation of symptoms.These findings indicate that the combined treatment of TCM and Western medicine can synergistically enhance cardiac function and impede the progression of the disease,thereby offering valuable insights for the optimal management of DCM.展开更多
BACKGROUND Dilated cardiomyopathy(DCM)is a common cause of systolic heart failure,and is the most prevalent type of non-ischemic cardiomyopathy.Primary hyperparathyroidism(PHPT)is characterized by hypercalcemia and ex...BACKGROUND Dilated cardiomyopathy(DCM)is a common cause of systolic heart failure,and is the most prevalent type of non-ischemic cardiomyopathy.Primary hyperparathyroidism(PHPT)is characterized by hypercalcemia and excessive secretion of parathyroid hormone(PTH).Generally,PHPT is asymptomatic and is incidentally identified during routine laboratory assessments.CASE SUMMARY This case report details a 52-year-old man diagnosed with DCM and refractory hypercalcemia,who presented with clinical manifestations including dyspnea,recurrent anorexia,and abdominal distention.Laboratory investigations indicated an elevated serum PTH level,and the sestamibi scan suggested the presence of a parathyroid adenoma.Hence,the patient underwent a parathyroidectomy,which pathologically confirmed the diagnosis of a parathyroid adenoma.Postoperatively,the patient's hypercalcemia was corrected,the dimensions of the cardiac chambers were reduced,and there was a marked improvement in cardiac function.CONCLUSION Our findings emphasize the importance of PTH assessment in patients with DCM and concurrent hypercalcemia.展开更多
Brain tumors pose significant diagnostic challenges due to their diverse types and complex anatomical locations.Due to the increase in precision image-based diagnostic tools,driven by advancements in artificial intell...Brain tumors pose significant diagnostic challenges due to their diverse types and complex anatomical locations.Due to the increase in precision image-based diagnostic tools,driven by advancements in artificial intelligence(AI)and deep learning,there has been potential to improve diagnostic accuracy,especially with Magnetic Resonance Imaging(MRI).However,traditional state-of-the-art models lack the sensitivity essential for reliable tumor identification and segmentation.Thus,our research aims to enhance brain tumor diagnosis in MRI by proposing an advanced model.The proposed model incorporates dilated convolutions to optimize the brain tumor segmentation and classification.The proposed model is first trained and later evaluated using the BraTS 2020 dataset.In our proposed model preprocessing consists of normalization,noise reduction,and data augmentation to improve model robustness.The attention mechanism and dilated convolutions were introduced to increase the model’s focus on critical regions and capture finer spatial details without compromising image resolution.We have performed experimentation to measure efficiency.For this,we have used various metrics including accuracy,sensitivity,and curve(AUC-ROC).The proposed model achieved a high accuracy of 94%,a sensitivity of 93%,a specificity of 92%,and an AUC-ROC of 0.98,outperforming traditional diagnostic models in brain tumor detection.The proposed model accurately identifies tumor regions,while dilated convolutions enhanced the segmentation accuracy,especially for complex tumor structures.The proposed model demonstrates significant potential for clinical application,providing reliable and precise brain tumor detection in MRI.展开更多
Background Predicting in-hospital mortality in elderly patients with dilated cardiomyopathy(DCM)is critical for improving clinical management.This study investigated the prognostic significance of mitral valve regurgi...Background Predicting in-hospital mortality in elderly patients with dilated cardiomyopathy(DCM)is critical for improving clinical management.This study investigated the prognostic significance of mitral valve regurgitant area(MVRA)as a predictor of in-hospital mortality.Methods A total of 813 elderly patients(age≥60 years)diag-nosed with DCM were included in this retrospective study,with admissions spanning from January 2010 to Decem-ber 2019.Univariate and multivariate Cox regression analyses were conducted to assess the association between MVRA and in-hospital mortality.Receiver operating characteristic(ROC)curve and Kaplan-Meier survival analy-ses were employed to assess the predictive performance of MVRA and to compare cumulative survival rates be-tween groups,respectively.Results MVRA was significantly associated with in-hospital mortality in both univar-iate and multivariate analyses(HR:1.119,95%CI:1.028-1.218,P=0.009).ROC curve analysis demonstrated good prognostic performance for MVRA[area under curve(AUC):0.714].Kaplan-Meier analysis revealed that patients with high MVRA(HMVRA)had significantly worse in-hospital survival outcomes(log-rank χ2=12.628,P<0.001).Conclusions An increase in MVRA is significantly associated with higher in-hospital mortality in elderly DCM patients,with an MVRA exceeding 7 cm2 indicating a notably increased mortality rate.MVRA serves as a simple and effective parameter for risk assessment and treatment monitoring in DCM patients.展开更多
BACKGROUND Hypertrophic cardiomyopathy(HCM)is one of the most prevalent inherited myocardial disorders and is charac-terized by considerable genetic and phenotypic heterogeneity.A subset of patients with HCM progress ...BACKGROUND Hypertrophic cardiomyopathy(HCM)is one of the most prevalent inherited myocardial disorders and is charac-terized by considerable genetic and phenotypic heterogeneity.A subset of patients with HCM progress to a dilated phase of HCM(DPHCM),which is associated with a poor prognosis;however,the underlying pathogenesis remains inadequately understood.CASE SUMMARY In this study,we present a case involving a pedigree with familial DPHCM and conduct a retrospective review of patients with DPHCM with identified gene mutations.Through panel sequencing targeting the coding regions of 312 genes associated with inherited cardiomyopathy,a heterozygous missense mutation(c.746G>A,p.Arg249Glu)in the MYH7 gene was identified in the proband(III-5).Sanger sequencing subsequently confirmed this pathogenic mutation in three additional family members(II-4,III-4,and IV-3).A total of 26 well-documented patients with DPHCM were identified in the literature.Patients with DPHCM are commonly middle-aged and male.The mean age of patients with DPHCM was 53.43±12.79 years.Heart failure,dyspnoea,and atrial fibrillation were the most prevalent symptoms observed,accompanied by an average left ventricular end-diastolic size of 58.62 mm.CONCLUSION Our findings corroborate the pathogenicity of the MYH7(c.746G>A,p.Arg249Glu)mutation for DPHCM and suggest that the Arg249Gln mutation may be responsible for high mortality.展开更多
Abnormal network traffic, as a frequent security risk, requires a series of techniques to categorize and detect it. Existing network traffic anomaly detection still faces challenges: the inability to fully extract loc...Abnormal network traffic, as a frequent security risk, requires a series of techniques to categorize and detect it. Existing network traffic anomaly detection still faces challenges: the inability to fully extract local and global features, as well as the lack of effective mechanisms to capture complex interactions between features;Additionally, when increasing the receptive field to obtain deeper feature representations, the reliance on increasing network depth leads to a significant increase in computational resource consumption, affecting the efficiency and performance of detection. Based on these issues, firstly, this paper proposes a network traffic anomaly detection model based on parallel dilated convolution and residual learning (Res-PDC). To better explore the interactive relationships between features, the traffic samples are converted into two-dimensional matrix. A module combining parallel dilated convolutions and residual learning (res-pdc) was designed to extract local and global features of traffic at different scales. By utilizing res-pdc modules with different dilation rates, we can effectively capture spatial features at different scales and explore feature dependencies spanning wider regions without increasing computational resources. Secondly, to focus and integrate the information in different feature subspaces, further enhance and extract the interactions among the features, multi-head attention is added to Res-PDC, resulting in the final model: multi-head attention enhanced parallel dilated convolution and residual learning (MHA-Res-PDC) for network traffic anomaly detection. Finally, comparisons with other machine learning and deep learning algorithms are conducted on the NSL-KDD and CIC-IDS-2018 datasets. The experimental results demonstrate that the proposed method in this paper can effectively improve the detection performance.展开更多
In order to improve the reconstruction accuracy of magnetic resonance imaging(MRI),an accurate natural image compressed sensing(CS)reconstruction network is proposed,which combines the advantages of model-based and de...In order to improve the reconstruction accuracy of magnetic resonance imaging(MRI),an accurate natural image compressed sensing(CS)reconstruction network is proposed,which combines the advantages of model-based and deep learning-based CS-MRI methods.In theory,enhancing geometric texture details in linear reconstruction is possible.First,the optimization problem is decomposed into two problems:linear approximation and geometric compensation.Aimed at the problem of image linear approximation,the data consistency module is used to deal with it.Since the processing process will lose texture details,a neural network layer that explicitly combines image and frequency feature representation is proposed,which is named butterfly dilated geometric distillation network.The network introduces the idea of butterfly operation,skillfully integrates the features of image domain and frequency domain,and avoids the loss of texture details when extracting features in a single domain.Finally,a channel feature fusion module is designed by combining channel attention mechanism and dilated convolution.The attention of the channel makes the final output feature map focus on the more important part,thus improving the feature representation ability.The dilated convolution enlarges the receptive field,thereby obtaining more dense image feature data.The experimental results show that the peak signal-to-noise ratio of the network is 5.43 dB,5.24 dB and 3.89 dB higher than that of ISTA-Net+,FISTA and DGDN networks on the brain data set with a Cartesian sampling mask CS ratio of 10%.展开更多
The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue ...The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue disorders.There are several classifications for BAV,each with its advantages and drawbacks.The condition can lead to valvular malfunction such as regurgitation and stenosis,but is often associated with dilatation of the aortic root,the ascending aorta,the aortic arch,or a combination.Altered flow patterns due to the valve dysfunction as well as the breakdown of elastin in the aortic wall could be responsible for this development.Published surgical series are usually small and research designs vary,which makes the formulation of universal recommendations for treatment difficult.This narrative review provides data from the most recent series in this respect.Often,the condition becomes symptomatic in patients who are about 10 years younger compared to those with a diseased tricuspid aortic valve.The timing of surgery of the valve depends on the degree of its dysfunction.Repair of a dysfunctional BAV should be attempted whenever possible because of the patient’s age.The options for valve repair are summarized,including the need for the use as the effective geometric height.The use of a pericardial patch and the presence of calcified areas of the valve can be predictors for an increased need for reintervention.In those cases,a valve replacement should be preferred.If a dilatation of the ascending aorta or the aortic root is present,this should also be addressed surgically,but the threshold for such a procedure varies.Several techniques are available to treat a dilated ascending aorta and root.For the latter,remodeling and reimplantation can be applied.Depending on the patient’s characteristics,the size of the dilatation,and the affected part,the most appropriate technique should be selected.This requires surgical expertise,which can only be obtained in high-volume centers.展开更多
Backgrounds Clinical trials have demonstrated that cardiac resynchronization therapy （CRT） is effective in patients with ＂non-is- chemic cardiomyopathy＂. However, patients with dilated-phase hypertrophic cardiomyo...Backgrounds Clinical trials have demonstrated that cardiac resynchronization therapy （CRT） is effective in patients with ＂non-is- chemic cardiomyopathy＂. However, patients with dilated-phase hypertrophic cardiomyopathy （DHCM） have been generally excluded from such trials. We aimed to compare the clinical outcome of CRT in patients with DHCM, idiopathic dilated cardiomyopathy （IDCM）, or ischemic cardiomyopathy （ICM）. Methods A total of 312 consecutive patients （DHCM： n = 16; IDCM： n = 231; ICM： n = 65） undergoing CRT in Fuwai hospital were studied respectively. Response to CRT was defmed as reduction in left ventricular end-systolic volume （LVESV） _〉 15% at 6-month follow-up. Results Compared with DHCM, IDCM was associated with a lower total mortality （HR： 0.35, 95% CI： 0.13-0.90）, cardiac mortality （HR： 0.29; 95% CI： 0.11-0.77）, and total mortality or heart failure （HF） hospitalizations （HR： 0.34, 95% CI： 0.17-0.69）, independent of known confounders. Compared with DHCM, the total mortality, cardiac mortality and total mortality or HF hospitalizations favored ICM but were not statistically significant （HR： 0.59, 95% CI： 0.22-1.61; HR： 0.59, 95% CI： 0.21-1.63; HR： 0.54, 95% CI： 0.26-1.15; respectively）. Response rate to CRT was lower in the DHCM group than the other two groups although the differences didn＇t reach statistical significance. Conclusions Compared with IDCM, DHCM was associated with a worse outcome after CRT. The clinical outcome of DHCM patients receiving CRT was similar to or even worse than that of ICM patients. These indicate that DHCM behaves very differently after CRT.展开更多
Antibodies against &-adrenoceptor can be detected in serum of patients with dilated cardiomyopathy (DCM), which have 5-agonist-like activity, and induce a positive chronotropic effect on cardiac myocytes by its pe...Antibodies against &-adrenoceptor can be detected in serum of patients with dilated cardiomyopathy (DCM), which have 5-agonist-like activity, and induce a positive chronotropic effect on cardiac myocytes by its persistence at full strength. Effects of the antibodies against Padrenoceptor from sera of patients with DCM on myocardial cytotoxicity and cytoplasmic free Ca2+-concentration (LCa2+ji) were observed in the cultured single layer SD rat ventricular cells by using the cytotoxicity assay and fluorescent Ca2+- indicat0r fura-2/AM. The positive sera of the anti-&adrenoceptor antibodies from patients with DCM markedly enhanced myocardial [Ca2+]i. Betaloc, a 5, -receptor blocker, might inhibit the increase of the antibody-mediated myocardial [Ca2+]i, and the sera from healthy donors had no effect on myocardial [Ca2+]i,. Our results suggest that the anti-β-adrenoceptor antibody might increase myocardial [Ca2+]i, and result in myocardial damage. The antibodies might activate receptor-gating Ca2+-channel, thereby causing myocardial [Ca2+]i, rise and calcium overload. Early use of betaloc is recommended in the treatment of dilated cardiomyopathy.展开更多
Background Previous studies had demonstrated hemostatic abnormalities in patients with heart failure (HF) and several studies have shown that abnormal coagulation indices, represented by elevated D-dimer, had prognost...Background Previous studies had demonstrated hemostatic abnormalities in patients with heart failure (HF) and several studies have shown that abnormal coagulation indices, represented by elevated D-dimer, had prognostic significance in patients with compatible or acute decompensated HF. However, the impact of D-dimer on the outcome in patients with end-stage HF remains unclear. Methods A total of 244 consecutive patients with end-stage HF due to idiopathic dilated cardiomyopathy (DCM) were prospectively enrolled from February 2011 to September 2014. D-dimer levels were measured and its prognostic value was assessed. Primary endpoint was all-cause mortality during the follow-up period. Secondary endpoints were stroke, bleeding, occurrence of sustained ventricular tachycardia or ventricular fibrillation, and major adverse cardiovascular events (MACE). Results D-dimer was significantly elevated in the non-survivors (median: 0.8 vs. 1.1 mg/L, P < 0.001). Traditional markers including B-type natriuretic peptide, troponin I, left ventricular ejection fraction, and left ventricular end-diastolic dimension provided limited prognostic value;but the addition of D-dimer refined the risk stratification. The optimal cut-off value of D-dimer to predict all-cause mortality was 0.84 mg/L by receiver operator characteristic analysis. Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (HR = 2.315, 95% CI: 1.570–3.414, P < 0.001) and MACE (HR = 1.256, 95% CI: 1.058–1.490, P = 0.009), and the predictive value was independent of age, sex, atrial fibrillation and anticoagulation status. Conclusions Elevated D-dimer level was independently associated with poor long-term outcome in patients with end-stage HF secondary to idiopathic DCM, and the predictive value was superior to that of traditional prognostic markers.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
Malignant ventricular arrhythmias are a major adverse event and worsen the prognosis of patients affected by ischemic and non-ischemic dilated cardiomyopathy.The main parameter currently used to stratify arrhythmic ri...Malignant ventricular arrhythmias are a major adverse event and worsen the prognosis of patients affected by ischemic and non-ischemic dilated cardiomyopathy.The main parameter currently used to stratify arrhythmic risk and guide decision making towards the implantation of a cardioverter defibrillator is the evaluation of the left ventricular ejection fraction.However,this strategy is characterized by several limitations and consequently additional parameters have been suggested in order to improve arrhythmic risk stratification.The aim of this review is to critically revise the prognostic significance of non-invasive diagnostic tools in order to better stratify the arrhythmic risk prognosis of dilated cardiomyopathy patients.展开更多
Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However,limited evidence is available regarding the effect of those medications in...Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However,limited evidence is available regarding the effect of those medications in patients with idiopathic dilated cardiomyopathy (IDCM),particularly in China. We sought to analyze the trends in clinical characteristics and the prescription rate of recommended therapies and its prognostic impact in patients with IDCM. Methods From 2009 to 2016,1441 consecutive patients (age: 55±14 years,68% men,LVEF: 33%± 12%) fulfilling World Health Organization criteria for IDCM were enrolled in the current retrospective cohort study. Temporal trends of baseline clinical characteristics,treatment and prognosis were analyzed,and potential influential factors were explored. Results Rates of patients receiving angiotensin-converting enzyme inhibitors/angiotensin II receptors blockers,β-blockers,aldosterone receptor antagonists and diuretics increased from 55%,45%,58%,51% in 2009 to 67%,69%,71%,64% in 2016,respectively (P < 0.05);whereas,the proportion of patients receiving digoxin decreased from 39% in 2009 to 28% in 2016 (P < 0.05). The overall proportion of patients with optimal guideline-directed medical therapy (GDMT) was 44.6%;however,that rate increased from 33% in 2009 to 41%,49% and 56% in 2012,2014 and 2016 respectively (P < 0.05). Patients with optimal GDMT had a better outcome than those without,but there was no temporal trend toward improvement in the overall long-term prognosis of IDCM patients with the years. There was a trend towards admission of patients with milder disease and toward increased admission to a cardiology ward with the years. Conclusions An improvement in prescription rates of guideline-recommended medications in IDCM patients was observed. However,it remains suboptimal,and there is still some room for improvement. The prognosis of patients with optimal GDMT was better than those without. Moreover,the following patient category also had an improved prognosis: patients with LVEF ≥ 40%,with device therapy,and those admitted to a cardiology ward.展开更多
AIM To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts(TIPS) and compare outcomes with maximally dilated TIPS.METHODS Polytetrafluoroethylene covered TIPS(Viatorr) ...AIM To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts(TIPS) and compare outcomes with maximally dilated TIPS.METHODS Polytetrafluoroethylene covered TIPS(Viatorr) from July 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm(m TIPS), while 43 patients who were at increased risk for hepatic encephalopathy(HE), based on clinical evaluation or low pre-TIPS portosystemic gradient(PSG), had 10 mm TIPS sub-maximally dilated to 8 mm(sm TIPS). Group characteristics(age, gender, Model for End-Stage Liver Disease score, post-TIPS PSG and clinical outcomes were compared between groups, including clinical success(ascites or varices), primary patency,primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with sm TIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging(< 6 mo and > 6 mo). Change in diameter and crosssectional area were measured with 3D imaging software to evaluate for passive expansion.RESULTS Patient characteristics were similar between the sm TIPS and m TIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the sm TIPS group(19.4 mm Hg ± 6.8 vs 22.4 mm Hg ± 7.1, P = 0.01). Primary patency and primary assisted patency between sm TIPS and m TIPS was not significantly different(P = 0.64 and 0.55, respectively). Four of the 55 patients(7%) with sm TIPS required TIPS reduction for severe refractory HE, while this occurred in 6 of the 218 patients(3%) with m TIPS(P = 0.12). For the 14 patients with follow-up computed tomography(CT) imaging, the median imaging follow-up was 373 d. There was an increase in median TIPS diameter, median percent diameter change, median area, and median percent area change in patients with CT follow-up greater than 6 mo after TIPS placement compared to follow-up within 6 mo(8.45 mm, 5.58%, 56.04 mm^2, and 11.48%, respectively, P = 0.01).CONCLUSION Passive expansion of sm TIPS does occur but clinical outcomes of sm TIPS and m TIPS were similar. Sub-maximal dilation can prevent complications related to overshunting in select patients.展开更多
Emotion recognition from speech data is an active and emerging area of research that plays an important role in numerous applications,such as robotics,virtual reality,behavior assessments,and emergency call centers.Re...Emotion recognition from speech data is an active and emerging area of research that plays an important role in numerous applications,such as robotics,virtual reality,behavior assessments,and emergency call centers.Recently,researchers have developed many techniques in this field in order to ensure an improvement in the accuracy by utilizing several deep learning approaches,but the recognition rate is still not convincing.Our main aim is to develop a new technique that increases the recognition rate with reasonable cost computations.In this paper,we suggested a new technique,which is a one-dimensional dilated convolutional neural network(1D-DCNN)for speech emotion recognition(SER)that utilizes the hierarchical features learning blocks(HFLBs)with a bi-directional gated recurrent unit(BiGRU).We designed a one-dimensional CNN network to enhance the speech signals,which uses a spectral analysis,and to extract the hidden patterns from the speech signals that are fed into a stacked one-dimensional dilated network that are called HFLBs.Each HFLB contains one dilated convolution layer(DCL),one batch normalization(BN),and one leaky_relu(Relu)layer in order to extract the emotional features using a hieratical correlation strategy.Furthermore,the learned emotional features are feed into a BiGRU in order to adjust the global weights and to recognize the temporal cues.The final state of the deep BiGRU is passed from a softmax classifier in order to produce the probabilities of the emotions.The proposed model was evaluated over three benchmarked datasets that included the IEMOCAP,EMO-DB,and RAVDESS,which achieved 72.75%,91.14%,and 78.01%accuracy,respectively.展开更多
OBJECTIVE:To investigate the effects of Shenqi Yangxin decoction(SQYXD)on heart function in a rat model of dilated cardiomyopathy(DCM)and its potential mechanisms.METHODS:Sprague-Dawley rats were randomly divided into...OBJECTIVE:To investigate the effects of Shenqi Yangxin decoction(SQYXD)on heart function in a rat model of dilated cardiomyopathy(DCM)and its potential mechanisms.METHODS:Sprague-Dawley rats were randomly divided into normal(10 rats)and DCM(150 rats)groups.DCM was induced by an intraperitoneal injection of adriamycin.Then,DCM baseline group was randomly selected sixteen DCM rats.The remaining DCM rats were randomly divided into DCM control,perindopril,metoprolol,and SQYXD groups.Cardiac function and histological analysis plus biochemical measurement of serum levels of brain natriuretic peptide(BNP),and inflammatory factors were measured.The mRNA and protein expression levels of high-mobility group box 1(HMGB1),Toll-like receptor 4(TLR-4),receptor for advanced glycation end products(RAGE),and nuclear factor-κB(NF-κB)were determined.Myocardial metabolism imaging was performed on the normal,SQYXD and DCM control groups to evaluate the effectiveness of treatments.RESULTS:Rats in the DCM control group exhibited dilated left ventricular diameter,impaired cardiac function,disorganized sarcomere,impaired glucose metabolism,increased heart weight index,and increased levels of BNP,which were improved by treatment with SQYXD.In addition,hearts from rats in the DCM baseline group exhibited significantly higher levels of HMGB1,TLR-4,RAGE,NF-κB,tumor necrosis factor-α,interleukin-1,interleukin-6,interleukin-10,compared with the normal group.Interestingly,the mRNA level of HMGB1 in the DCM baseline group was positively correlated with that of TLR-4,RAGE,NF-κB,BNP,and LVEDD,but negatively correlated with LVEF.SQYXD inhibited the upregulation of HMGB1 expression and its downstream inflammatory factors.CONCLUSION:Shenqi Yangxin decoction effectively reduced the dilated left ventricular diameter and improved heart function in dilated cardiomyopathy.The mechanisms underlying the action on DCM involve regulating the gene and protein expression of HMGB1 and its inflammatory signal pathways in the DCM rat model.展开更多
To compare the continuous infusion and intermittent bolus injection administration protocols of doxorubicin（Dox） under the same cumulative dose（12 mg/kg）, and establish a rat dilated cardiomyopathy model with impr...To compare the continuous infusion and intermittent bolus injection administration protocols of doxorubicin（Dox） under the same cumulative dose（12 mg/kg）, and establish a rat dilated cardiomyopathy model with improved survival, a total of 150 Sprague-Dawley（SD） rats were divided into three groups： a control group, administered with normal saline; a Dox 1 group, administration twice a week at 1 mg/kg; a Dox 2, administration once a week at 2 mg/kg. Mortality rates in the Dox 1 and Dox 2 groups were 22% and 48%, respectively（P〈0.05）. As shown by echocardiography, both Dox groups exhibited significant chamber dilatation and reduced cardiac function（all P〈0.05 vs. control）. Plasma brain natriuretic peptide and C-reactive protein concentrations were significantly increased（P〈0.05） with both Dox regimens. The concentrations of Caspase-3 in myocardial tissues of rats significantly increased in both doxorubicin regimens. Myocardial metabolism imaging by histology and ^18F-fluoro-deoxyglucose-positron emission tomography（^18FDG-PET） both revealed decreased myocardial viability and necrosis, and even interstitial fibrosis, in left ventricles（LVs） in both Dox groups. Serum creatinine and aspartate aminotransferase concentrations were significantly higher in the Dox 2 model than in the Dox 1 model. Doxorubicin given at both regimens induced dilated cardiomyopathy, while its administration at lower doses with more frequent infusions reduced the mortality rate.展开更多
Objective:Mutations in LIM domain binding 3(LDB3)gene cause idiopathic dilated cardiomyopathy(IDCM),a structural heart disease with a complicated genetic background.However,the association of polymorphisms in the LDB3...Objective:Mutations in LIM domain binding 3(LDB3)gene cause idiopathic dilated cardiomyopathy(IDCM),a structural heart disease with a complicated genetic background.However,the association of polymorphisms in the LDB3 gene with susceptibility to IDCM in Chinese populations remains unexplored as dose the impact on clinical presentation.Methods:We sequenced all exons and the adjacent part of introns of the LDB3 gene in 159 Chinese Han IDCM patients and 247 healthy controls.Then we detected the distribution of polymorphisms in the LDB3 gene in all participants and assessed their associations with risk of IDCM.Additionally,we conducted a stratified genotype–phenotype correlation analysis.Results:The A allele of rs4468255 was significantly associated with IDCM(P<0.01).The rs4468255,rs11812601,rs56165849,and rs3740346 were also associated with diastolic blood pressure(DBP)and left ventricular ejection fraction(LVEF)(P<0.05).Notably,a higher frequency of rs4468255 polymorphism was observed in implantable cardioverter defibrillator(ICD)recipients under a recessive model(P<0.01),whereas the significant association disappeared after adjusting for potential confounders.However,in the dominant model,notable correlations could only be observed after adjusting for multi parameters.Conclusions:The rs4468255 was significantly correlated with IDCM of Chinese Han population.A allele of rs4468255 is higher in IDCM patients with ICD implantation,suggesting the influence of genetic background in the generation of this response.In addition,rs11812601,rs56165849,and rs3740346 in LDB3 show association with brain natriuretic peptide,DBP,and LVEF levels in patients with IDCM but did not show any association with IDCM susceptibility.展开更多
Cardiac involvement of sarcoid lesions is diagnosed by myocardial biopsy which is frequently false-negative,and patients with cardiac sarcoidosis(CS) who have impaired left ventricular(LV) systolic function are someti...Cardiac involvement of sarcoid lesions is diagnosed by myocardial biopsy which is frequently false-negative,and patients with cardiac sarcoidosis(CS) who have impaired left ventricular(LV) systolic function are sometimes diagnosed with dilated cardiomyopathy(DCM).Late gadolinium enhancement(LE) in magnetic resonance imaging is now a critical finding in diagnosing CS,and the novel Japanese guideline considers myocardial LE to be a major criterion of CS.This article describes the value of LE in patients with CS who have impaired LV systolic function,particularly the diagnostic and clinical significance of LE distribution in comparison with DCM.LE existed at all LV segments and myocardial layers in patients with CS,whereas it was localized predominantly in the midwall of basal to mid septum in those with DCM.Transmural(nodular),circumferential,and subepicardial and subendocardial LE distribution were highly specific in patients with CS,whereas the prevalence of striated midwall LE were high both in patients with CS and with DCM.Since sarcoidosis patients with LE have higher incidences of heart failure symptoms,ventricular tachyarrhythmia and sudden cardiac death,the analyses of extent and distribution of LE are crucial in early diagnosis and therapeutic approach for patients with CS.展开更多
文摘This article presents a case study of a 20-year-old male patient diagnosed with dilated cardiomyopathy(DCM)(NYHA IV).This condition was diagnosed as"heart failure disease"(water overflowing due to yang deficiency,intermingled phlegm and stasis)in traditional Chinese medicine(TCM).The treatment approach employed a combination of TCM and Western medicine.Western medicine involved the administration of sacubitril valsartan sodium tablets to inhibit ventricular remodeling,in conjunction with diuretics and cardiotonic agents.Initially,TCM utilized a static infusion of Shenfu injection,which was subsequently supplemented with Qiliqiangxin capsules to invigorate qi,warm yang,activate blood circulation,and promote diuresis.After a follow-up period of 3 years,the patient's ejection fraction(EF)improved from 23%to 51%,and the left ventricular end diastolic diameter(LVed)decreased from 68 to 52 mm,accompanied by a significant alleviation of symptoms.These findings indicate that the combined treatment of TCM and Western medicine can synergistically enhance cardiac function and impede the progression of the disease,thereby offering valuable insights for the optimal management of DCM.
基金Supported by Sichuan Province Science and Technology Program,No.2024YFHZ0214 and No.2023YFS0299Chengdu Science and Technology Program,No.2024-YF05-01820-SN.
文摘BACKGROUND Dilated cardiomyopathy(DCM)is a common cause of systolic heart failure,and is the most prevalent type of non-ischemic cardiomyopathy.Primary hyperparathyroidism(PHPT)is characterized by hypercalcemia and excessive secretion of parathyroid hormone(PTH).Generally,PHPT is asymptomatic and is incidentally identified during routine laboratory assessments.CASE SUMMARY This case report details a 52-year-old man diagnosed with DCM and refractory hypercalcemia,who presented with clinical manifestations including dyspnea,recurrent anorexia,and abdominal distention.Laboratory investigations indicated an elevated serum PTH level,and the sestamibi scan suggested the presence of a parathyroid adenoma.Hence,the patient underwent a parathyroidectomy,which pathologically confirmed the diagnosis of a parathyroid adenoma.Postoperatively,the patient's hypercalcemia was corrected,the dimensions of the cardiac chambers were reduced,and there was a marked improvement in cardiac function.CONCLUSION Our findings emphasize the importance of PTH assessment in patients with DCM and concurrent hypercalcemia.
基金supported by the European University of Atlantic.
文摘Brain tumors pose significant diagnostic challenges due to their diverse types and complex anatomical locations.Due to the increase in precision image-based diagnostic tools,driven by advancements in artificial intelligence(AI)and deep learning,there has been potential to improve diagnostic accuracy,especially with Magnetic Resonance Imaging(MRI).However,traditional state-of-the-art models lack the sensitivity essential for reliable tumor identification and segmentation.Thus,our research aims to enhance brain tumor diagnosis in MRI by proposing an advanced model.The proposed model incorporates dilated convolutions to optimize the brain tumor segmentation and classification.The proposed model is first trained and later evaluated using the BraTS 2020 dataset.In our proposed model preprocessing consists of normalization,noise reduction,and data augmentation to improve model robustness.The attention mechanism and dilated convolutions were introduced to increase the model’s focus on critical regions and capture finer spatial details without compromising image resolution.We have performed experimentation to measure efficiency.For this,we have used various metrics including accuracy,sensitivity,and curve(AUC-ROC).The proposed model achieved a high accuracy of 94%,a sensitivity of 93%,a specificity of 92%,and an AUC-ROC of 0.98,outperforming traditional diagnostic models in brain tumor detection.The proposed model accurately identifies tumor regions,while dilated convolutions enhanced the segmentation accuracy,especially for complex tumor structures.The proposed model demonstrates significant potential for clinical application,providing reliable and precise brain tumor detection in MRI.
基金supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project(No.2023ZD0504600)the National Science Foundation of Guangdong Province(No.2023B1515020082)。
文摘Background Predicting in-hospital mortality in elderly patients with dilated cardiomyopathy(DCM)is critical for improving clinical management.This study investigated the prognostic significance of mitral valve regurgitant area(MVRA)as a predictor of in-hospital mortality.Methods A total of 813 elderly patients(age≥60 years)diag-nosed with DCM were included in this retrospective study,with admissions spanning from January 2010 to Decem-ber 2019.Univariate and multivariate Cox regression analyses were conducted to assess the association between MVRA and in-hospital mortality.Receiver operating characteristic(ROC)curve and Kaplan-Meier survival analy-ses were employed to assess the predictive performance of MVRA and to compare cumulative survival rates be-tween groups,respectively.Results MVRA was significantly associated with in-hospital mortality in both univar-iate and multivariate analyses(HR:1.119,95%CI:1.028-1.218,P=0.009).ROC curve analysis demonstrated good prognostic performance for MVRA[area under curve(AUC):0.714].Kaplan-Meier analysis revealed that patients with high MVRA(HMVRA)had significantly worse in-hospital survival outcomes(log-rank χ2=12.628,P<0.001).Conclusions An increase in MVRA is significantly associated with higher in-hospital mortality in elderly DCM patients,with an MVRA exceeding 7 cm2 indicating a notably increased mortality rate.MVRA serves as a simple and effective parameter for risk assessment and treatment monitoring in DCM patients.
基金Supported by National Natural Science Foundation of China,No.81770379.
文摘BACKGROUND Hypertrophic cardiomyopathy(HCM)is one of the most prevalent inherited myocardial disorders and is charac-terized by considerable genetic and phenotypic heterogeneity.A subset of patients with HCM progress to a dilated phase of HCM(DPHCM),which is associated with a poor prognosis;however,the underlying pathogenesis remains inadequately understood.CASE SUMMARY In this study,we present a case involving a pedigree with familial DPHCM and conduct a retrospective review of patients with DPHCM with identified gene mutations.Through panel sequencing targeting the coding regions of 312 genes associated with inherited cardiomyopathy,a heterozygous missense mutation(c.746G>A,p.Arg249Glu)in the MYH7 gene was identified in the proband(III-5).Sanger sequencing subsequently confirmed this pathogenic mutation in three additional family members(II-4,III-4,and IV-3).A total of 26 well-documented patients with DPHCM were identified in the literature.Patients with DPHCM are commonly middle-aged and male.The mean age of patients with DPHCM was 53.43±12.79 years.Heart failure,dyspnoea,and atrial fibrillation were the most prevalent symptoms observed,accompanied by an average left ventricular end-diastolic size of 58.62 mm.CONCLUSION Our findings corroborate the pathogenicity of the MYH7(c.746G>A,p.Arg249Glu)mutation for DPHCM and suggest that the Arg249Gln mutation may be responsible for high mortality.
基金supported by the Xiamen Science and Technology Subsidy Project(No.2023CXY0318).
文摘Abnormal network traffic, as a frequent security risk, requires a series of techniques to categorize and detect it. Existing network traffic anomaly detection still faces challenges: the inability to fully extract local and global features, as well as the lack of effective mechanisms to capture complex interactions between features;Additionally, when increasing the receptive field to obtain deeper feature representations, the reliance on increasing network depth leads to a significant increase in computational resource consumption, affecting the efficiency and performance of detection. Based on these issues, firstly, this paper proposes a network traffic anomaly detection model based on parallel dilated convolution and residual learning (Res-PDC). To better explore the interactive relationships between features, the traffic samples are converted into two-dimensional matrix. A module combining parallel dilated convolutions and residual learning (res-pdc) was designed to extract local and global features of traffic at different scales. By utilizing res-pdc modules with different dilation rates, we can effectively capture spatial features at different scales and explore feature dependencies spanning wider regions without increasing computational resources. Secondly, to focus and integrate the information in different feature subspaces, further enhance and extract the interactions among the features, multi-head attention is added to Res-PDC, resulting in the final model: multi-head attention enhanced parallel dilated convolution and residual learning (MHA-Res-PDC) for network traffic anomaly detection. Finally, comparisons with other machine learning and deep learning algorithms are conducted on the NSL-KDD and CIC-IDS-2018 datasets. The experimental results demonstrate that the proposed method in this paper can effectively improve the detection performance.
基金the National Natural Science Foundation of China(No.61962032)。
文摘In order to improve the reconstruction accuracy of magnetic resonance imaging(MRI),an accurate natural image compressed sensing(CS)reconstruction network is proposed,which combines the advantages of model-based and deep learning-based CS-MRI methods.In theory,enhancing geometric texture details in linear reconstruction is possible.First,the optimization problem is decomposed into two problems:linear approximation and geometric compensation.Aimed at the problem of image linear approximation,the data consistency module is used to deal with it.Since the processing process will lose texture details,a neural network layer that explicitly combines image and frequency feature representation is proposed,which is named butterfly dilated geometric distillation network.The network introduces the idea of butterfly operation,skillfully integrates the features of image domain and frequency domain,and avoids the loss of texture details when extracting features in a single domain.Finally,a channel feature fusion module is designed by combining channel attention mechanism and dilated convolution.The attention of the channel makes the final output feature map focus on the more important part,thus improving the feature representation ability.The dilated convolution enlarges the receptive field,thereby obtaining more dense image feature data.The experimental results show that the peak signal-to-noise ratio of the network is 5.43 dB,5.24 dB and 3.89 dB higher than that of ISTA-Net+,FISTA and DGDN networks on the brain data set with a Cartesian sampling mask CS ratio of 10%.
文摘The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue disorders.There are several classifications for BAV,each with its advantages and drawbacks.The condition can lead to valvular malfunction such as regurgitation and stenosis,but is often associated with dilatation of the aortic root,the ascending aorta,the aortic arch,or a combination.Altered flow patterns due to the valve dysfunction as well as the breakdown of elastin in the aortic wall could be responsible for this development.Published surgical series are usually small and research designs vary,which makes the formulation of universal recommendations for treatment difficult.This narrative review provides data from the most recent series in this respect.Often,the condition becomes symptomatic in patients who are about 10 years younger compared to those with a diseased tricuspid aortic valve.The timing of surgery of the valve depends on the degree of its dysfunction.Repair of a dysfunctional BAV should be attempted whenever possible because of the patient’s age.The options for valve repair are summarized,including the need for the use as the effective geometric height.The use of a pericardial patch and the presence of calcified areas of the valve can be predictors for an increased need for reintervention.In those cases,a valve replacement should be preferred.If a dilatation of the ascending aorta or the aortic root is present,this should also be addressed surgically,but the threshold for such a procedure varies.Several techniques are available to treat a dilated ascending aorta and root.For the latter,remodeling and reimplantation can be applied.Depending on the patient’s characteristics,the size of the dilatation,and the affected part,the most appropriate technique should be selected.This requires surgical expertise,which can only be obtained in high-volume centers.
文摘Backgrounds Clinical trials have demonstrated that cardiac resynchronization therapy （CRT） is effective in patients with ＂non-is- chemic cardiomyopathy＂. However, patients with dilated-phase hypertrophic cardiomyopathy （DHCM） have been generally excluded from such trials. We aimed to compare the clinical outcome of CRT in patients with DHCM, idiopathic dilated cardiomyopathy （IDCM）, or ischemic cardiomyopathy （ICM）. Methods A total of 312 consecutive patients （DHCM： n = 16; IDCM： n = 231; ICM： n = 65） undergoing CRT in Fuwai hospital were studied respectively. Response to CRT was defmed as reduction in left ventricular end-systolic volume （LVESV） _〉 15% at 6-month follow-up. Results Compared with DHCM, IDCM was associated with a lower total mortality （HR： 0.35, 95% CI： 0.13-0.90）, cardiac mortality （HR： 0.29; 95% CI： 0.11-0.77）, and total mortality or heart failure （HF） hospitalizations （HR： 0.34, 95% CI： 0.17-0.69）, independent of known confounders. Compared with DHCM, the total mortality, cardiac mortality and total mortality or HF hospitalizations favored ICM but were not statistically significant （HR： 0.59, 95% CI： 0.22-1.61; HR： 0.59, 95% CI： 0.21-1.63; HR： 0.54, 95% CI： 0.26-1.15; respectively）. Response rate to CRT was lower in the DHCM group than the other two groups although the differences didn＇t reach statistical significance. Conclusions Compared with IDCM, DHCM was associated with a worse outcome after CRT. The clinical outcome of DHCM patients receiving CRT was similar to or even worse than that of ICM patients. These indicate that DHCM behaves very differently after CRT.
文摘Antibodies against &-adrenoceptor can be detected in serum of patients with dilated cardiomyopathy (DCM), which have 5-agonist-like activity, and induce a positive chronotropic effect on cardiac myocytes by its persistence at full strength. Effects of the antibodies against Padrenoceptor from sera of patients with DCM on myocardial cytotoxicity and cytoplasmic free Ca2+-concentration (LCa2+ji) were observed in the cultured single layer SD rat ventricular cells by using the cytotoxicity assay and fluorescent Ca2+- indicat0r fura-2/AM. The positive sera of the anti-&adrenoceptor antibodies from patients with DCM markedly enhanced myocardial [Ca2+]i. Betaloc, a 5, -receptor blocker, might inhibit the increase of the antibody-mediated myocardial [Ca2+]i, and the sera from healthy donors had no effect on myocardial [Ca2+]i,. Our results suggest that the anti-β-adrenoceptor antibody might increase myocardial [Ca2+]i, and result in myocardial damage. The antibodies might activate receptor-gating Ca2+-channel, thereby causing myocardial [Ca2+]i, rise and calcium overload. Early use of betaloc is recommended in the treatment of dilated cardiomyopathy.
文摘Background Previous studies had demonstrated hemostatic abnormalities in patients with heart failure (HF) and several studies have shown that abnormal coagulation indices, represented by elevated D-dimer, had prognostic significance in patients with compatible or acute decompensated HF. However, the impact of D-dimer on the outcome in patients with end-stage HF remains unclear. Methods A total of 244 consecutive patients with end-stage HF due to idiopathic dilated cardiomyopathy (DCM) were prospectively enrolled from February 2011 to September 2014. D-dimer levels were measured and its prognostic value was assessed. Primary endpoint was all-cause mortality during the follow-up period. Secondary endpoints were stroke, bleeding, occurrence of sustained ventricular tachycardia or ventricular fibrillation, and major adverse cardiovascular events (MACE). Results D-dimer was significantly elevated in the non-survivors (median: 0.8 vs. 1.1 mg/L, P < 0.001). Traditional markers including B-type natriuretic peptide, troponin I, left ventricular ejection fraction, and left ventricular end-diastolic dimension provided limited prognostic value;but the addition of D-dimer refined the risk stratification. The optimal cut-off value of D-dimer to predict all-cause mortality was 0.84 mg/L by receiver operator characteristic analysis. Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (HR = 2.315, 95% CI: 1.570–3.414, P < 0.001) and MACE (HR = 1.256, 95% CI: 1.058–1.490, P = 0.009), and the predictive value was independent of age, sex, atrial fibrillation and anticoagulation status. Conclusions Elevated D-dimer level was independently associated with poor long-term outcome in patients with end-stage HF secondary to idiopathic DCM, and the predictive value was superior to that of traditional prognostic markers.
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.
文摘Malignant ventricular arrhythmias are a major adverse event and worsen the prognosis of patients affected by ischemic and non-ischemic dilated cardiomyopathy.The main parameter currently used to stratify arrhythmic risk and guide decision making towards the implantation of a cardioverter defibrillator is the evaluation of the left ventricular ejection fraction.However,this strategy is characterized by several limitations and consequently additional parameters have been suggested in order to improve arrhythmic risk stratification.The aim of this review is to critically revise the prognostic significance of non-invasive diagnostic tools in order to better stratify the arrhythmic risk prognosis of dilated cardiomyopathy patients.
基金supported by grants from the National Natural Science Foundation of China (No.81400267 & No.81370219)the Sichuan Provincial Department of Science and Technology (2016FZ0084)
文摘Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However,limited evidence is available regarding the effect of those medications in patients with idiopathic dilated cardiomyopathy (IDCM),particularly in China. We sought to analyze the trends in clinical characteristics and the prescription rate of recommended therapies and its prognostic impact in patients with IDCM. Methods From 2009 to 2016,1441 consecutive patients (age: 55±14 years,68% men,LVEF: 33%± 12%) fulfilling World Health Organization criteria for IDCM were enrolled in the current retrospective cohort study. Temporal trends of baseline clinical characteristics,treatment and prognosis were analyzed,and potential influential factors were explored. Results Rates of patients receiving angiotensin-converting enzyme inhibitors/angiotensin II receptors blockers,β-blockers,aldosterone receptor antagonists and diuretics increased from 55%,45%,58%,51% in 2009 to 67%,69%,71%,64% in 2016,respectively (P < 0.05);whereas,the proportion of patients receiving digoxin decreased from 39% in 2009 to 28% in 2016 (P < 0.05). The overall proportion of patients with optimal guideline-directed medical therapy (GDMT) was 44.6%;however,that rate increased from 33% in 2009 to 41%,49% and 56% in 2012,2014 and 2016 respectively (P < 0.05). Patients with optimal GDMT had a better outcome than those without,but there was no temporal trend toward improvement in the overall long-term prognosis of IDCM patients with the years. There was a trend towards admission of patients with milder disease and toward increased admission to a cardiology ward with the years. Conclusions An improvement in prescription rates of guideline-recommended medications in IDCM patients was observed. However,it remains suboptimal,and there is still some room for improvement. The prognosis of patients with optimal GDMT was better than those without. Moreover,the following patient category also had an improved prognosis: patients with LVEF ≥ 40%,with device therapy,and those admitted to a cardiology ward.
文摘AIM To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts(TIPS) and compare outcomes with maximally dilated TIPS.METHODS Polytetrafluoroethylene covered TIPS(Viatorr) from July 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm(m TIPS), while 43 patients who were at increased risk for hepatic encephalopathy(HE), based on clinical evaluation or low pre-TIPS portosystemic gradient(PSG), had 10 mm TIPS sub-maximally dilated to 8 mm(sm TIPS). Group characteristics(age, gender, Model for End-Stage Liver Disease score, post-TIPS PSG and clinical outcomes were compared between groups, including clinical success(ascites or varices), primary patency,primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with sm TIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging(< 6 mo and > 6 mo). Change in diameter and crosssectional area were measured with 3D imaging software to evaluate for passive expansion.RESULTS Patient characteristics were similar between the sm TIPS and m TIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the sm TIPS group(19.4 mm Hg ± 6.8 vs 22.4 mm Hg ± 7.1, P = 0.01). Primary patency and primary assisted patency between sm TIPS and m TIPS was not significantly different(P = 0.64 and 0.55, respectively). Four of the 55 patients(7%) with sm TIPS required TIPS reduction for severe refractory HE, while this occurred in 6 of the 218 patients(3%) with m TIPS(P = 0.12). For the 14 patients with follow-up computed tomography(CT) imaging, the median imaging follow-up was 373 d. There was an increase in median TIPS diameter, median percent diameter change, median area, and median percent area change in patients with CT follow-up greater than 6 mo after TIPS placement compared to follow-up within 6 mo(8.45 mm, 5.58%, 56.04 mm^2, and 11.48%, respectively, P = 0.01).CONCLUSION Passive expansion of sm TIPS does occur but clinical outcomes of sm TIPS and m TIPS were similar. Sub-maximal dilation can prevent complications related to overshunting in select patients.
基金supported by the National Research Foundation of Korea funded by the Korean Government through the Ministry of Science and ICT under Grant NRF-2020R1F1A1060659 and in part by the 2020 Faculty Research Fund of Sejong University。
文摘Emotion recognition from speech data is an active and emerging area of research that plays an important role in numerous applications,such as robotics,virtual reality,behavior assessments,and emergency call centers.Recently,researchers have developed many techniques in this field in order to ensure an improvement in the accuracy by utilizing several deep learning approaches,but the recognition rate is still not convincing.Our main aim is to develop a new technique that increases the recognition rate with reasonable cost computations.In this paper,we suggested a new technique,which is a one-dimensional dilated convolutional neural network(1D-DCNN)for speech emotion recognition(SER)that utilizes the hierarchical features learning blocks(HFLBs)with a bi-directional gated recurrent unit(BiGRU).We designed a one-dimensional CNN network to enhance the speech signals,which uses a spectral analysis,and to extract the hidden patterns from the speech signals that are fed into a stacked one-dimensional dilated network that are called HFLBs.Each HFLB contains one dilated convolution layer(DCL),one batch normalization(BN),and one leaky_relu(Relu)layer in order to extract the emotional features using a hieratical correlation strategy.Furthermore,the learned emotional features are feed into a BiGRU in order to adjust the global weights and to recognize the temporal cues.The final state of the deep BiGRU is passed from a softmax classifier in order to produce the probabilities of the emotions.The proposed model was evaluated over three benchmarked datasets that included the IEMOCAP,EMO-DB,and RAVDESS,which achieved 72.75%,91.14%,and 78.01%accuracy,respectively.
基金Supported by the Projects of Medical Technology of Management Center of Wuxi Hospital,Jiangsu Province(No.YGZXM14047:Application of Standardized Diagnosis and Treatment Scheme for Dilated Cardiomyopathy Combined with Staging)the Projects of Jiangsu Province Chinese Medicine Leading Personnel Training Target Fund(Treatment of Dilated Cardiomyopathy with Classic Compound)
文摘OBJECTIVE:To investigate the effects of Shenqi Yangxin decoction(SQYXD)on heart function in a rat model of dilated cardiomyopathy(DCM)and its potential mechanisms.METHODS:Sprague-Dawley rats were randomly divided into normal(10 rats)and DCM(150 rats)groups.DCM was induced by an intraperitoneal injection of adriamycin.Then,DCM baseline group was randomly selected sixteen DCM rats.The remaining DCM rats were randomly divided into DCM control,perindopril,metoprolol,and SQYXD groups.Cardiac function and histological analysis plus biochemical measurement of serum levels of brain natriuretic peptide(BNP),and inflammatory factors were measured.The mRNA and protein expression levels of high-mobility group box 1(HMGB1),Toll-like receptor 4(TLR-4),receptor for advanced glycation end products(RAGE),and nuclear factor-κB(NF-κB)were determined.Myocardial metabolism imaging was performed on the normal,SQYXD and DCM control groups to evaluate the effectiveness of treatments.RESULTS:Rats in the DCM control group exhibited dilated left ventricular diameter,impaired cardiac function,disorganized sarcomere,impaired glucose metabolism,increased heart weight index,and increased levels of BNP,which were improved by treatment with SQYXD.In addition,hearts from rats in the DCM baseline group exhibited significantly higher levels of HMGB1,TLR-4,RAGE,NF-κB,tumor necrosis factor-α,interleukin-1,interleukin-6,interleukin-10,compared with the normal group.Interestingly,the mRNA level of HMGB1 in the DCM baseline group was positively correlated with that of TLR-4,RAGE,NF-κB,BNP,and LVEDD,but negatively correlated with LVEF.SQYXD inhibited the upregulation of HMGB1 expression and its downstream inflammatory factors.CONCLUSION:Shenqi Yangxin decoction effectively reduced the dilated left ventricular diameter and improved heart function in dilated cardiomyopathy.The mechanisms underlying the action on DCM involve regulating the gene and protein expression of HMGB1 and its inflammatory signal pathways in the DCM rat model.
基金supported by the Medical Technology Major Projects on Hospital Management Center in Wuxi City,Jiangsu Province(No.YGZX1102),China
文摘To compare the continuous infusion and intermittent bolus injection administration protocols of doxorubicin（Dox） under the same cumulative dose（12 mg/kg）, and establish a rat dilated cardiomyopathy model with improved survival, a total of 150 Sprague-Dawley（SD） rats were divided into three groups： a control group, administered with normal saline; a Dox 1 group, administration twice a week at 1 mg/kg; a Dox 2, administration once a week at 2 mg/kg. Mortality rates in the Dox 1 and Dox 2 groups were 22% and 48%, respectively（P〈0.05）. As shown by echocardiography, both Dox groups exhibited significant chamber dilatation and reduced cardiac function（all P〈0.05 vs. control）. Plasma brain natriuretic peptide and C-reactive protein concentrations were significantly increased（P〈0.05） with both Dox regimens. The concentrations of Caspase-3 in myocardial tissues of rats significantly increased in both doxorubicin regimens. Myocardial metabolism imaging by histology and ^18F-fluoro-deoxyglucose-positron emission tomography（^18FDG-PET） both revealed decreased myocardial viability and necrosis, and even interstitial fibrosis, in left ventricles（LVs） in both Dox groups. Serum creatinine and aspartate aminotransferase concentrations were significantly higher in the Dox 2 model than in the Dox 1 model. Doxorubicin given at both regimens induced dilated cardiomyopathy, while its administration at lower doses with more frequent infusions reduced the mortality rate.
基金the Key Projects of Zhejiang Medical and Health Science and Technology Plan(Provincial and Ministerial Co-construction)(No.WKJ-ZJ-1819)the Fundamental Research Funds for the Zhejiang Province Universities(No.2019XZZX003-15)the National Natural Science Foundation of China(No.81470370)
文摘Objective:Mutations in LIM domain binding 3(LDB3)gene cause idiopathic dilated cardiomyopathy(IDCM),a structural heart disease with a complicated genetic background.However,the association of polymorphisms in the LDB3 gene with susceptibility to IDCM in Chinese populations remains unexplored as dose the impact on clinical presentation.Methods:We sequenced all exons and the adjacent part of introns of the LDB3 gene in 159 Chinese Han IDCM patients and 247 healthy controls.Then we detected the distribution of polymorphisms in the LDB3 gene in all participants and assessed their associations with risk of IDCM.Additionally,we conducted a stratified genotype–phenotype correlation analysis.Results:The A allele of rs4468255 was significantly associated with IDCM(P<0.01).The rs4468255,rs11812601,rs56165849,and rs3740346 were also associated with diastolic blood pressure(DBP)and left ventricular ejection fraction(LVEF)(P<0.05).Notably,a higher frequency of rs4468255 polymorphism was observed in implantable cardioverter defibrillator(ICD)recipients under a recessive model(P<0.01),whereas the significant association disappeared after adjusting for potential confounders.However,in the dominant model,notable correlations could only be observed after adjusting for multi parameters.Conclusions:The rs4468255 was significantly correlated with IDCM of Chinese Han population.A allele of rs4468255 is higher in IDCM patients with ICD implantation,suggesting the influence of genetic background in the generation of this response.In addition,rs11812601,rs56165849,and rs3740346 in LDB3 show association with brain natriuretic peptide,DBP,and LVEF levels in patients with IDCM but did not show any association with IDCM susceptibility.
文摘Cardiac involvement of sarcoid lesions is diagnosed by myocardial biopsy which is frequently false-negative,and patients with cardiac sarcoidosis(CS) who have impaired left ventricular(LV) systolic function are sometimes diagnosed with dilated cardiomyopathy(DCM).Late gadolinium enhancement(LE) in magnetic resonance imaging is now a critical finding in diagnosing CS,and the novel Japanese guideline considers myocardial LE to be a major criterion of CS.This article describes the value of LE in patients with CS who have impaired LV systolic function,particularly the diagnostic and clinical significance of LE distribution in comparison with DCM.LE existed at all LV segments and myocardial layers in patients with CS,whereas it was localized predominantly in the midwall of basal to mid septum in those with DCM.Transmural(nodular),circumferential,and subepicardial and subendocardial LE distribution were highly specific in patients with CS,whereas the prevalence of striated midwall LE were high both in patients with CS and with DCM.Since sarcoidosis patients with LE have higher incidences of heart failure symptoms,ventricular tachyarrhythmia and sudden cardiac death,the analyses of extent and distribution of LE are crucial in early diagnosis and therapeutic approach for patients with CS.
