BACKGROUND A complete replacement left hepatic artery(LHA)solely originating from the left gastric artery(LGA),with no supply from the hepatic artery proper,is exce-ptionally rare.This variant places entire left lobe ...BACKGROUND A complete replacement left hepatic artery(LHA)solely originating from the left gastric artery(LGA),with no supply from the hepatic artery proper,is exce-ptionally rare.This variant places entire left lobe perfusion on the LGA.Literature review confirms no prior reports of such an isolated LHA replacement pattern in surgical/radiological publications.Unrecognized,this anatomy carries significant intraoperative injury risk during hepatobiliary/upper gastrointestinal surgery.CASE SUMMARY A 62-year-old man underwent laparoscopic radical gastrectomy with D2 Lymphadenectomy for gastric cancer.During dissection of the hepatogastric ligament,an unexpected vascular anatomy was encountered:The LHA originated exclusively from the LGA,with no conventional branch from the hepatic artery proper.Recognizing this variant artery was essential for left liver perfusion,the LGA was ligated proximally near its celiac origin while meticulously preserving blood flow through the anomalous LHA.The gastrectomy and reconstruction were completed without complication.Postoperative recovery was smooth,with serial liver function tests remaining normal,confirming preserved hepatic arterial supply.CONCLUSION Preoperative mapping detected a critical aberrant left hepatic artery;its preser-vation prevented liver ischemia,ensured safety.展开更多
BACKGROUND The advantages and disadvantages of various surgical procedures for radical dissection of left hemicolonic malignancies are controversial.We aimed to determine which procedures are best for patients with di...BACKGROUND The advantages and disadvantages of various surgical procedures for radical dissection of left hemicolonic malignancies are controversial.We aimed to determine which procedures are best for patients with different characteristics.The focus of this study was to investigate the safety and clinical efficacy of three different surgical procedures,namely,robotic-assisted surgery(RAS),handassisted laparoscopic surgery(HALS)and conventional laparoscopic surgery(CLS),for the dissection of malignant tumors of the left hemicolon and the effect of these procedures on long-term prognosis.AIM To determine which procedures are best for patients with malignant tumors of the left hemicolon and the safety and clinical efficacy of three different surgical procedures.METHODS A retrospective analysis of the clinical data of 224 patients with left hemicolonic malignancies admitted to the Department of General Surgery of the First Affiliated Hospital of Nanchang University from June 2015 to June 2024 was conducted.Patient data were analyzed to determine tumor stage,duration of surgery,number of lymph nodes cleared,incidence and severity of postoperative complications,amount of intraoperative bleeding,overall survival(OS),and progressionfree survival.RESULTS The short-term postoperative outcomes after RAS,HALS and CLS were compared.The leukocyte and absolute neutrophil counts on postoperative day 4 were highest after RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The length of postoperative hospital stay was highest after CLS,followed by RAS and then HALS,and the differences were statistically significant(P<0.05).The postoperative recovery time of gastrointestinal function was shortest after HALS,followed by RAS and CLS,which had equal values,and the differences were statistically significant(P<0.05).Hospitalization costs were highest among patients who underwent RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The OS among patients who underwent HALS,CLS,and RAS did not significantly differ(P=0.384).CONCLUSION There were no significant differences between procedures in the number of lymph nodes cleared or OS,and all procedures successfully achieved radical dissection of the malignant tumors.HALS had lower hospitalization costs and shorter postoperative recovery time of gastrointestinal function,and CLS performed between HALS and RAS.Different surgical procedures have varying impacts on the length of postoperative hospital stay and the degree of postoperative inflammation,so selection should be individualized to each patient.展开更多
Background:Left atrioventricular coupling index(LACI)is a promising marker for predicting major adverse cardiac events in individuals with acute ST-segment elevation myocardial infarction(STEMI).However,the relationsh...Background:Left atrioventricular coupling index(LACI)is a promising marker for predicting major adverse cardiac events in individuals with acute ST-segment elevation myocardial infarction(STEMI).However,the relationship between LACI and adverse left ventricular(LV)remodeling(ALVR)in patients with STEMI remains to be fully elucidated.Methods:In this retrospective study,143 patients with STEMI who had undergone primary percutaneous coronary inter-vention(PCI)underwent cardiovascular magnetic resonance(CMR)imaging.The examinations were performed at 5±2 days(baseline)after PCI and at 6 months after STEMI.Left atrial and LV structural and functional indicators were evaluated.ALVR was defined as an increase of≥20%in LV end-diastolic volume(LVEDV)or an increase of≥15%in LV end-systolic volume at 6 months on CMR images.The patients were divided into two groups depending on the presence or absence of ALVR,and the CMR features were compared between the two groups.Results:Overall,51 patients(mean age 57±11 years;42 men)experienced ALVR after 6 months.In the univariable regression analysis,LVEDV index and LACI were significantly correlated with ALVR(odds ratio[OR]:0.989,95%confidence interval[CI]:0.979-0.999,p=0.025;OR:1.046,95%CI:1.012-1.080,p=0.007,respectively).Following adjustment for fundamental clinical variables,multivariate logistic regression analysis showed that baseline LACI was an independent predictor of ALVR at 6 months(OR:1.324,95%CI:1.055-1.662,p=0.016).Conclusions:CMR-derived LACI in patients with acute STEMI was an independent predictor of ALVR.展开更多
Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is...Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is considered the gold standard for achieving CRT;however,approximately 30%–40%of patients do not respond to BVP-CRT.Recent studies have demonstrated that LBB pacing(LBBP)produces remarkable results in CRT.In this meta-analysis,LBBP-CRT showed better outcomes than conventional BVP-CRT,including greater QRS duration reduction and left ventricular ejection fraction improvement,along with consistently lower pacing thresholds on follow-up.Additionally,there was a grea-ter reduction in New York Heart Association class and brain natriuretic peptide levels.This study contributes to the growing body of encouraging data on LBBP-CRT from recent years.With ongoing technological advancements and increasing operator expertise,the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.展开更多
BACKGROUND Left colon cancer surgery relies on laparoscopic hemicolectomy,with digestive tract reconstruction critical.End-to-side anastomosis(ESA)and side-to-side anastomosis(SSA)anastomoses are common,but their comp...BACKGROUND Left colon cancer surgery relies on laparoscopic hemicolectomy,with digestive tract reconstruction critical.End-to-side anastomosis(ESA)and side-to-side anastomosis(SSA)anastomoses are common,but their comparative outcomes,especially in splenic flexure handling and efficacy,need clarification.This study compares ESA and SSA to guide surgical practice.AIM To compare the clinical outcomes of laparoscopically assisted left hemicolectomy with ESA and SSA.METHODS A total of 334 patients were included,with 105 patients from the First Affiliated Hospital of Xiamen University and 229 patients from the First Affiliated Hospital of Fujian Medical University,between January 1,2012,and May 31,2020.The patients were divided into two groups:146 cases in the ESA group and 188 cases in the SSA group.Clinical data from both groups were compared,and the survival prognosis was followed up.RESULTS The operation time for the ESA group was significantly shorter than that of the SSA group(197.1±57.7 minutes vs 218.6±67.5 minutes,χ2=4.298,P=0.039).There were no significant differences between the two groups in intraoperative blood loss,postoperative pain score at 48 hours,time to first bowel movement,number of lymph nodes dissected,or postoperative complications such as anastomotic leakage,bleeding,stenosis.and adhesive intestinal obstruction at 6 months,12 months,and 24 months(P>0.05).Specifically,the incidence of complications like anastomotic leakage was 2.1%in the ESA group vs 4.3%in the SSA group(P=0.264).The 5-year disease-free survival(DFS)rate was 66.4%for the ESA group and 63.9%for the SSA group(P=0.693).There were no significant differences in the overall survival rate between the two groups.The incidence of splenic laceration was significantly higher in the SSA group(3.7%vs 0.7%,P=0.018).Overall,the 5-year DFS was 66.4%for ESA and 63.9%for SSA,with no significant difference in survival between the groups(P=0.693).CONCLUSION Both laparoscopically assisted left hemicolectomy with ESA and SSA are feasible and offer comparable long-term outcomes.ESA may reduce the need for splenic flexure dissociation,particularly when the tumor is located at the descending colon or its junction with the sigmoid colon,and especially in obese patients,elderly individuals with multiple complications,or those with severe adhesions in the splenic flexure of the surgical field.展开更多
Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left ...Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left atrial aneurysm following isolated Staphylococcus aureus pericarditis.She initially presented in decompensated shock and was later diagnosed with constrictive pericarditis.Despite undergoing pericardiectomy,she subsequently developed a left atrial aneurysm,necessitating surgical closure.This case highlights the aggressive nature of bacterial pericarditis and its potential to cause rare structural cardiac complications.展开更多
The accurate assessment of cardiac motion is crucial for diagnosing and monitoring cardiovascular diseases.In this context,digital volume correlation(DVC)has emerged as a promising technique for tracking cardiac motio...The accurate assessment of cardiac motion is crucial for diagnosing and monitoring cardiovascular diseases.In this context,digital volume correlation(DVC)has emerged as a promising technique for tracking cardiac motion from cardiac computed tomography angiographic(CTA)images.This paper presents a comprehensive performance evaluation of the DVC method,specifically focusing on tracking the motion of the left atrium using cardiac CTA data.The study employed a comparative experimental approach while simultaneously optimizing the existing DVC algorithm.Multiple sets of controlled experiments were designed to conduct quantitative analyses on the parameters“radius”and“step”.The results revealed that the optimized DVC algorithm enhanced tracking accuracy within a reasonable computational time.These findings contributed to the understanding of the efficacy and limitations of the DVC algorithm in analyzing heart deformation.展开更多
BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exa...BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exact relationship between depression and cardiac remodeling and left ventricular functional changes remains incompletely understood.This study sets out to explore,with a clinically grounded perspective,how depressive states may subtly or profoundly influence the trajectory of cardiac remodeling and the functional dynamics of the left ventricle in individuals grappling with CHF.Beyond mere observation,it also aims to untangle the underlying physiological or neurohormonal pathways that might bridge emotional distress and cardiac dysfunction.AIM To delve into how depressive symptoms might shape the progression of cardiac remodeling and impair left ventricular function among individuals living with CHF.Particular attention is given to the role of inflammatory signaling and disruptions in neuroendocrine balance as possible mediating factors.By examining these intertwined physiological and psychological processes,the study seeks to shed light on the reciprocal link between emotional distress and CHF,offering insights that may inform more precise,mechanism-based treatment strategies.METHODS In this retrospective clinical trial,248 patients diagnosed with CHF were analyzed in the tertiary treatment center between January 2018 and December 2022.According to Hamilton's Depression Scale score,participants were classified into two cohort of depression(score 17)and no significant depression characteristics(score 17).Cardiac morphology and functional parameters were assessed using a combination of hyperechocardiocardiocardiography,heart magnetic resonance,and associated blood biomarkers.RESULTS The results of this study underscore the significant effects that depression can have on both the structure and function of the heart in patients with CHF.In particular,the individuals in the cohort with depression were 42.3%±6.7%of the individuals without depression vs 51.6%±5.9%,P<0.01)In comparison,the left ventricular ejection fraction,an important measure of contractional performance,was significantly reduced,underlining the harmful physiological interaction between mood disorders and cardiac efficiency.The measurement of the left ventricular end-diastolic diameter showed a significant expansion of the ventricular envelope in the depression group(68.2±7.5 mm vs 59.6±6.3 mm,P<0.01).Inflammatory markers,including high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α),were significantly elevated in the depressed group(hs-CRP:8.7±2.3 mg/L vs 4.5±1.6 mg/L;TNF-α:42.5±7.6 pg/mL vs 28.3±5.4 pg/mL).Both B-type natriuretic peptide(1256±345 pg/mL vs 756±234 pg/mL)and angiotensin II(86.4±15.7 ng/mL vs 62.5±12.3 ng/mL)levels were significantly higher in the depressed group.CONCLUSION Among people with CHF,the presence of depressive symptoms appears to be closely related to pronounced changes in heart structure and impaired functional abilities.It is likely that depressive states contribute to the progress of heart reform and deterioration of left stomach function,possibly due to increased inflammatory cascades and increased activation of neuroendocrine regulatory pathways.展开更多
Objective:To explore the evidence-based nursing optimization strategy for catheter tip positioning during peripherally inserted central catheter(PICC)insertion in patients with persistent left superior vena cava(PLSVC...Objective:To explore the evidence-based nursing optimization strategy for catheter tip positioning during peripherally inserted central catheter(PICC)insertion in patients with persistent left superior vena cava(PLSVC).Methods:For one ovarian cancer patient with PICC malposition in the coronary sinus(CS)due to PLSVC,multimodal imaging techniques were integrated to accurately locate the catheter tip.The catheter position was adjusted based on evidence(withdrawing 5 cm),and a standardized nursing process was established,including personalized health education,catheter fixation and displacement monitoring,complication monitoring,establishment of a specialized disease information archive system,and formulation of a follow-up plan.Results:The catheter tip was successfully withdrawn from the coronary sinus(at the T8 level)to the middle and lower part of the PLSVC(at the T6 vertebral level),and the catheter functioned normally after adjustment.No complications such as arrhythmia or thrombosis occurred during the 332-day chemotherapy period.Conclusion:The PICC tip in PLSVC patients should be positioned in the middle and lower part of the PLSVC(at the T5–T7 vertebral level).This new standard can effectively avoid CS-related complications.The integration of multi-modal imaging techniques and evidence-based nursing management are key to ensuring safe infusion.展开更多
Persistent left superior vena cava(PLSVC)is a congenital anomaly where the left-sided vena cava,which usually regresses during fetal development,persists.Double superior vena cava resulting from a PLSVC is indeed a ra...Persistent left superior vena cava(PLSVC)is a congenital anomaly where the left-sided vena cava,which usually regresses during fetal development,persists.Double superior vena cava resulting from a PLSVC is indeed a rare phenomenon.In the general population,the incidence of this condition is reported to be between 0.3%and 2.1%.[1]While this anatomical variation is often asymptomatic and discovered incidentally,it becomes relevant in certain clinical scenarios.Indeed,the presence of a PLSVC and double superior vena cava can pose challenges as incorrect positioning and result in failure.展开更多
Hypoplastic left heart syndrome is a severe congenital defect involving underdeveloped left-sided cardiac structures,leading to significant mortality and morbidity.Prenatal diagnosis using fetal ultrasound and echocar...Hypoplastic left heart syndrome is a severe congenital defect involving underdeveloped left-sided cardiac structures,leading to significant mortality and morbidity.Prenatal diagnosis using fetal ultrasound and echocardiography enables early detection,family counseling,and improved clinical decision-making.Advanced prenatal interventions,such as fetal aortic valvuloplasty and atrial septostomy,show promise but require careful patient selection.A multidisciplinary approach involving obstetricians,neonatologists,and pediatric cardiologists is vital for effective management.Future directions include refining imaging techniques,such as three-dimensional ultrasound,cardiovascular magnetic resonance imaging,and exploring bioengineering solutions,stem cell therapies,and genetic research.These advancements aim to improve therapeutic options and address current limitations,including transplant scarcity and postoperative complications.Although surgical innovations have improved survival rates,challenges remain,including neurological risks and long-term hemodynamic issues.Ongoing research and technological advancements are essential to enhance outcomes and quality of life for hypoplastic left heart syndrome patients.展开更多
Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complica...Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.展开更多
Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LA...Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.展开更多
Machine learning(ML)efficiently and accurately processes dense seismic array data,improving earthquake catalog creation,which is crucial for understanding earthquake sequences and fault systems;analyzing its reliabili...Machine learning(ML)efficiently and accurately processes dense seismic array data,improving earthquake catalog creation,which is crucial for understanding earthquake sequences and fault systems;analyzing its reliability is also essential.An M5.8 earthquake struck Alxa Left Banner,Inner Mongolia,China on April 15,2015,a region with limited CENC monitoring capabilities,making analysis challenging.However,abundant data from ChinArray provided valuable observations for assessing the event.This study leveraged ChinArray data from the 2015 Alxa Left Banner earthquake sequence,employing machine learning(specifically PhaseNet,a deep learning method,and GaMMA,a Bayesian approach)for automated seismic phase picking,association,and location analysis.Our generated catalog,comprising 10,432 phases from 708 events,is roughly ten times larger than the CENC catalog,encompassing all CENC events with strong consistency.A slight magnitude overestimation is observed only at lower magnitudes.Furthermore,the catalog adheres to the Gutenberg-Richter and Omori laws spatially,temporally,and in magnitude distribution,demonstrating its high reliability.Double-difference tomography refined locations for 366 events,yielding a more compact spatial distribution with horizontal errors within 100m,vertical errors within 300m,and travel-time residuals within 0.05s.Depths predominantly range from 10-30km.Aftershocks align primarily NEE,with the mainshock east of the aftershock zone.The near-vertical main fault plane dips northwestward,exhibiting a Y-shaped branching structure,converging at depth and expanding towards the surface.FOCMEC analysis,using first motion and amplitude ratios,yielded focal mechanism solutions for 10 events,including the mainshock.These solutions consistently indicate a strike-slip mechanism with a minor extensional component.Integrating the earthquake sequence's spatial distribution and focal mechanisms suggests the seismogenic structure is a negative flower structure,consistent with the Dengkou-Benjing fault.Comparing the CENC and ML-generated catalogs using the maximum curvature(MAXC)method reveals a 0.6 decrease in completeness magnitude(M_(C)).However,magnitude-frequency distribution discrepancies above the MAXC-estimated M_(C)suggest MAXC may underestimate both M_(C)and the b-value.This study analyzes the 2015 Alxa Left Banner M5.8 earthquake using a reliable,MLgenerated earthquake catalog,revealing detailed information about the sequence,faulting structure,aftershock distribution,and stress characteristics.展开更多
BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and he...BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.展开更多
BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systo...BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systolic dysfunction(LVSD).In patients with type 2 diabetes(DM2)albuminuria is a predictor of symptomatic heart failure,but data on the relationship between GLS and albuminuria are conflicting.AIM To explore the relationship between GLS and albuminuria in a contemporary cohort of DM2 patients.METHODS The study was performed on DM2 patients consecutively enrolled in the TESEO study.Patients with symptoms/signs of heart failure,EF<50%,coronary artery,other cardiac diseases,or non-adequate acoustic window for GLS assessment were excluded.We collected clinical data,screened for complications,and measured GLS by speckle-tracking echocardiography.Univariate and multiple linear regression analyses were performed to identify independent explanatory variables associated with GLS.Logistic regression analysis was used to assess whether albuminuria was independently associated with GLS-diagnosed(GLS>-18%)LVSD.RESULTS Patients(n=193,age:60.6±8.1,male:57%)had a short DM2 duration(3.8±4.9 years)and good metabolic control(glycated haemoglobin A1c:6.5%±1.0).Preclinical GLS-LVSD was present in 21.8%of the patients.GLS values were significantly higher in patients with albuminuria(-19.88±2.16 vs-18.29±2.99,P<0.001)and in multivariate analysis natural logarithm of albumin-creatinine ratio and uric acid were independent predictors of GLS.In logistic regression analysis,albuminuria was associated with a 6.01(95%confidence interval:1.874-19.286)increased odds ratio of GLS-LVSD,independent of age,sex,diastolic blood pressure,chronic kidney disease,EF,mitral annulus velocity lateral,uric acid,and treatments.CONCLUSION Albuminuria was independently associated with subclinical LVSD in our contemporary cohort of DM2 patients.展开更多
Quantitative analysis of clinical function parameters from MRI images is crucial for diagnosing and assessing cardiovascular disease.However,the manual calculation of these parameters is challenging due to the high va...Quantitative analysis of clinical function parameters from MRI images is crucial for diagnosing and assessing cardiovascular disease.However,the manual calculation of these parameters is challenging due to the high variability among patients and the time-consuming nature of the process.In this study,the authors introduce a framework named MultiJSQ,comprising the feature presentation network(FRN)and the indicator prediction network(IEN),which is designed for simultaneous joint segmentation and quantification.The FRN is tailored for representing global image features,facilitating the direct acquisition of left ventricle(LV)contour images through pixel classification.Additionally,the IEN incorporates specifically designed modules to extract relevant clinical indices.The authors’method considers the interdependence of different tasks,demonstrating the validity of these relationships and yielding favourable results.Through extensive experiments on cardiac MR images from 145 patients,MultiJSQ achieves impressive outcomes,with low mean absolute errors of 124 mm^(2),1.72 mm,and 1.21 mm for areas,dimensions,and regional wall thicknesses,respectively,along with a Dice metric score of 0.908.The experimental findings underscore the excellent performance of our framework in LV segmentation and quantification,highlighting its promising clinical application prospects.展开更多
Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricl...Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricle(RV)is also affected by diabetes and may be independently responsible for adverse outcomes in diabetic patients with or without LV failure.Yu et al conducted a 30-week longitudinal evaluation of biventricular function and pathology in OVE26 diabetic mice and revealed early diastolic dysfunction preceding systolic decline,suggesting that early LV diastolic impairment precedes the later onset of systolic dysfunction.With age,the animals developed fibrosis,hypertrophy,and pulmonary arterial hypertension in the RV.The purpose of this editorial is to contextualize these findings within the existing literature by highlighting the interplay between cardiac chambers and the vasculature.We also seek to reiterate that DCM is a condition extending beyond left ventricular dysfunction.As the authors note,the right side of the heart may remain"the forgotten ventricle"in diabetic patients.We hope that the mechanisms discussed in this paper will help researchers to understand the pathogenesis of cardiovascular disease in this context and encourage clinicians to be more attentive to the associated clinical symptoms.展开更多
To the Editor:Theoretically,autologous liver transplantation is posited as a treatment for patients experiencing traumatic liver rupture.How-ever,the procedural complexity and its infrequent application by the medical...To the Editor:Theoretically,autologous liver transplantation is posited as a treatment for patients experiencing traumatic liver rupture.How-ever,the procedural complexity and its infrequent application by the medical community have resulted in a lack of documented suc-cesses.This report presented the efficacious intervention in a pa-tient presenting with polytraumatic injuries involving the thoracic and abdominal regions,namely right-sided hemothorax,contusion and hematoma of the right lung,splenic rupture,lateral damage to the common bile duct,disruption of the left portal vein branch and left hepatic duct,incisions in the hepatic segments IV,V,VI,VII,and VIII,laceration of the right adrenal gland,rupture of the right hepatic venous trunk and retro-hepatic inferior vena cava(RHIVC),and pancreatic hematoma.展开更多
Background:Anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)is a rare congenital anomalous coronary artery origin disorder.Objective:We sought to summarize the clinical experience and prog...Background:Anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)is a rare congenital anomalous coronary artery origin disorder.Objective:We sought to summarize the clinical experience and prognostic characteristics of surgical treatment of ALCAPA.Methods:We retrospectively analyzed clinical information on patients who had ALCAPA and underwent surgery at our center from February 2016 to October 2023.Results:This comparative study of 23 ALCAPA patients(9 infants<1 year;14 children>1 year)demonstrated significant age-dependent outcomes.Infant patients exhibited markedly prolonged mechanical ventilation(183±105.6 vs.48.5±62.2 min,p=0.001)and hospitalization(30.8±8.2 vs.19.5±6.2 days,p=0.001),despite comparable operative times(p>0.05).The perioperative mortality rate was 8.7%(2/23).Early postoperative mortality showed a non-significant trend in infants(22.2%vs.0%,p=0.11).Serial follow-up revealed substantial functional improvement,with abnormal left ventricular ejection fractions decreasing from 56.5%preoperatively to 14.3%at 1-month(p<0.01),and severe mitral regurgitation declining from 34.7%to 14.3%.However,persistent left ventricular enlargement(81%at follow-up)and moderate mitral regurgitation(52.4%)were frequently observed.Conclusion:Surgical correction of ALCPA effectively restores coronary perfusion and reduces severe mitral regurgitation,though residual ventricular dilation and moderate valvular dysfunction persist in the short-term postoperative period.Nevertheless,the overall prognosis remains favorable when timely intervention is performed.展开更多
基金Supported by Lanzhou Science and Technology Project,No.2024-9-139.
文摘BACKGROUND A complete replacement left hepatic artery(LHA)solely originating from the left gastric artery(LGA),with no supply from the hepatic artery proper,is exce-ptionally rare.This variant places entire left lobe perfusion on the LGA.Literature review confirms no prior reports of such an isolated LHA replacement pattern in surgical/radiological publications.Unrecognized,this anatomy carries significant intraoperative injury risk during hepatobiliary/upper gastrointestinal surgery.CASE SUMMARY A 62-year-old man underwent laparoscopic radical gastrectomy with D2 Lymphadenectomy for gastric cancer.During dissection of the hepatogastric ligament,an unexpected vascular anatomy was encountered:The LHA originated exclusively from the LGA,with no conventional branch from the hepatic artery proper.Recognizing this variant artery was essential for left liver perfusion,the LGA was ligated proximally near its celiac origin while meticulously preserving blood flow through the anomalous LHA.The gastrectomy and reconstruction were completed without complication.Postoperative recovery was smooth,with serial liver function tests remaining normal,confirming preserved hepatic arterial supply.CONCLUSION Preoperative mapping detected a critical aberrant left hepatic artery;its preser-vation prevented liver ischemia,ensured safety.
基金Supported by Jiangxi Provincial Natural Science Foundation of China,No.20224BAB206063.
文摘BACKGROUND The advantages and disadvantages of various surgical procedures for radical dissection of left hemicolonic malignancies are controversial.We aimed to determine which procedures are best for patients with different characteristics.The focus of this study was to investigate the safety and clinical efficacy of three different surgical procedures,namely,robotic-assisted surgery(RAS),handassisted laparoscopic surgery(HALS)and conventional laparoscopic surgery(CLS),for the dissection of malignant tumors of the left hemicolon and the effect of these procedures on long-term prognosis.AIM To determine which procedures are best for patients with malignant tumors of the left hemicolon and the safety and clinical efficacy of three different surgical procedures.METHODS A retrospective analysis of the clinical data of 224 patients with left hemicolonic malignancies admitted to the Department of General Surgery of the First Affiliated Hospital of Nanchang University from June 2015 to June 2024 was conducted.Patient data were analyzed to determine tumor stage,duration of surgery,number of lymph nodes cleared,incidence and severity of postoperative complications,amount of intraoperative bleeding,overall survival(OS),and progressionfree survival.RESULTS The short-term postoperative outcomes after RAS,HALS and CLS were compared.The leukocyte and absolute neutrophil counts on postoperative day 4 were highest after RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The length of postoperative hospital stay was highest after CLS,followed by RAS and then HALS,and the differences were statistically significant(P<0.05).The postoperative recovery time of gastrointestinal function was shortest after HALS,followed by RAS and CLS,which had equal values,and the differences were statistically significant(P<0.05).Hospitalization costs were highest among patients who underwent RAS,followed by CLS and then HALS,and the differences were statistically significant(P<0.05).The OS among patients who underwent HALS,CLS,and RAS did not significantly differ(P=0.384).CONCLUSION There were no significant differences between procedures in the number of lymph nodes cleared or OS,and all procedures successfully achieved radical dissection of the malignant tumors.HALS had lower hospitalization costs and shorter postoperative recovery time of gastrointestinal function,and CLS performed between HALS and RAS.Different surgical procedures have varying impacts on the length of postoperative hospital stay and the degree of postoperative inflammation,so selection should be individualized to each patient.
基金supported by the National Natural Science Foundation of China(Grant 82471937)Beijing Hospitals Authority Youth Programme(Grant QML20230610).
文摘Background:Left atrioventricular coupling index(LACI)is a promising marker for predicting major adverse cardiac events in individuals with acute ST-segment elevation myocardial infarction(STEMI).However,the relationship between LACI and adverse left ventricular(LV)remodeling(ALVR)in patients with STEMI remains to be fully elucidated.Methods:In this retrospective study,143 patients with STEMI who had undergone primary percutaneous coronary inter-vention(PCI)underwent cardiovascular magnetic resonance(CMR)imaging.The examinations were performed at 5±2 days(baseline)after PCI and at 6 months after STEMI.Left atrial and LV structural and functional indicators were evaluated.ALVR was defined as an increase of≥20%in LV end-diastolic volume(LVEDV)or an increase of≥15%in LV end-systolic volume at 6 months on CMR images.The patients were divided into two groups depending on the presence or absence of ALVR,and the CMR features were compared between the two groups.Results:Overall,51 patients(mean age 57±11 years;42 men)experienced ALVR after 6 months.In the univariable regression analysis,LVEDV index and LACI were significantly correlated with ALVR(odds ratio[OR]:0.989,95%confidence interval[CI]:0.979-0.999,p=0.025;OR:1.046,95%CI:1.012-1.080,p=0.007,respectively).Following adjustment for fundamental clinical variables,multivariate logistic regression analysis showed that baseline LACI was an independent predictor of ALVR at 6 months(OR:1.324,95%CI:1.055-1.662,p=0.016).Conclusions:CMR-derived LACI in patients with acute STEMI was an independent predictor of ALVR.
文摘Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is considered the gold standard for achieving CRT;however,approximately 30%–40%of patients do not respond to BVP-CRT.Recent studies have demonstrated that LBB pacing(LBBP)produces remarkable results in CRT.In this meta-analysis,LBBP-CRT showed better outcomes than conventional BVP-CRT,including greater QRS duration reduction and left ventricular ejection fraction improvement,along with consistently lower pacing thresholds on follow-up.Additionally,there was a grea-ter reduction in New York Heart Association class and brain natriuretic peptide levels.This study contributes to the growing body of encouraging data on LBBP-CRT from recent years.With ongoing technological advancements and increasing operator expertise,the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.
文摘BACKGROUND Left colon cancer surgery relies on laparoscopic hemicolectomy,with digestive tract reconstruction critical.End-to-side anastomosis(ESA)and side-to-side anastomosis(SSA)anastomoses are common,but their comparative outcomes,especially in splenic flexure handling and efficacy,need clarification.This study compares ESA and SSA to guide surgical practice.AIM To compare the clinical outcomes of laparoscopically assisted left hemicolectomy with ESA and SSA.METHODS A total of 334 patients were included,with 105 patients from the First Affiliated Hospital of Xiamen University and 229 patients from the First Affiliated Hospital of Fujian Medical University,between January 1,2012,and May 31,2020.The patients were divided into two groups:146 cases in the ESA group and 188 cases in the SSA group.Clinical data from both groups were compared,and the survival prognosis was followed up.RESULTS The operation time for the ESA group was significantly shorter than that of the SSA group(197.1±57.7 minutes vs 218.6±67.5 minutes,χ2=4.298,P=0.039).There were no significant differences between the two groups in intraoperative blood loss,postoperative pain score at 48 hours,time to first bowel movement,number of lymph nodes dissected,or postoperative complications such as anastomotic leakage,bleeding,stenosis.and adhesive intestinal obstruction at 6 months,12 months,and 24 months(P>0.05).Specifically,the incidence of complications like anastomotic leakage was 2.1%in the ESA group vs 4.3%in the SSA group(P=0.264).The 5-year disease-free survival(DFS)rate was 66.4%for the ESA group and 63.9%for the SSA group(P=0.693).There were no significant differences in the overall survival rate between the two groups.The incidence of splenic laceration was significantly higher in the SSA group(3.7%vs 0.7%,P=0.018).Overall,the 5-year DFS was 66.4%for ESA and 63.9%for SSA,with no significant difference in survival between the groups(P=0.693).CONCLUSION Both laparoscopically assisted left hemicolectomy with ESA and SSA are feasible and offer comparable long-term outcomes.ESA may reduce the need for splenic flexure dissociation,particularly when the tumor is located at the descending colon or its junction with the sigmoid colon,and especially in obese patients,elderly individuals with multiple complications,or those with severe adhesions in the splenic flexure of the surgical field.
文摘Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left atrial aneurysm following isolated Staphylococcus aureus pericarditis.She initially presented in decompensated shock and was later diagnosed with constrictive pericarditis.Despite undergoing pericardiectomy,she subsequently developed a left atrial aneurysm,necessitating surgical closure.This case highlights the aggressive nature of bacterial pericarditis and its potential to cause rare structural cardiac complications.
基金supported by the Australian Research Council(ARC)(Grant No.DP200103492)the National Natural Science Foundation of China(Grant Nos.12172089,12372307,and 61821002)+2 种基金Medical Research Future Fund(Grant Nos.2016165 and 2023977)the CBT Early Career Researcher Grant funded and the Roland Bishop Biomedical Engineering Research Award by Queensland University of Technologythe Springboard Funding and the Global Collaboration Funding by London South Bank University.Computational resources and services used in this work were provided by the High-Performance Computing and Research Support Group,Queensland University of Technology,Brisbane,Australia.
文摘The accurate assessment of cardiac motion is crucial for diagnosing and monitoring cardiovascular diseases.In this context,digital volume correlation(DVC)has emerged as a promising technique for tracking cardiac motion from cardiac computed tomography angiographic(CTA)images.This paper presents a comprehensive performance evaluation of the DVC method,specifically focusing on tracking the motion of the left atrium using cardiac CTA data.The study employed a comparative experimental approach while simultaneously optimizing the existing DVC algorithm.Multiple sets of controlled experiments were designed to conduct quantitative analyses on the parameters“radius”and“step”.The results revealed that the optimized DVC algorithm enhanced tracking accuracy within a reasonable computational time.These findings contributed to the understanding of the efficacy and limitations of the DVC algorithm in analyzing heart deformation.
文摘BACKGROUND Chronic heart failure(CHF)is a severe cardiovascular disease that significantly threatens human health.Depression,a common comorbidity,may substantially impact cardiac structure and function.However,the exact relationship between depression and cardiac remodeling and left ventricular functional changes remains incompletely understood.This study sets out to explore,with a clinically grounded perspective,how depressive states may subtly or profoundly influence the trajectory of cardiac remodeling and the functional dynamics of the left ventricle in individuals grappling with CHF.Beyond mere observation,it also aims to untangle the underlying physiological or neurohormonal pathways that might bridge emotional distress and cardiac dysfunction.AIM To delve into how depressive symptoms might shape the progression of cardiac remodeling and impair left ventricular function among individuals living with CHF.Particular attention is given to the role of inflammatory signaling and disruptions in neuroendocrine balance as possible mediating factors.By examining these intertwined physiological and psychological processes,the study seeks to shed light on the reciprocal link between emotional distress and CHF,offering insights that may inform more precise,mechanism-based treatment strategies.METHODS In this retrospective clinical trial,248 patients diagnosed with CHF were analyzed in the tertiary treatment center between January 2018 and December 2022.According to Hamilton's Depression Scale score,participants were classified into two cohort of depression(score 17)and no significant depression characteristics(score 17).Cardiac morphology and functional parameters were assessed using a combination of hyperechocardiocardiocardiography,heart magnetic resonance,and associated blood biomarkers.RESULTS The results of this study underscore the significant effects that depression can have on both the structure and function of the heart in patients with CHF.In particular,the individuals in the cohort with depression were 42.3%±6.7%of the individuals without depression vs 51.6%±5.9%,P<0.01)In comparison,the left ventricular ejection fraction,an important measure of contractional performance,was significantly reduced,underlining the harmful physiological interaction between mood disorders and cardiac efficiency.The measurement of the left ventricular end-diastolic diameter showed a significant expansion of the ventricular envelope in the depression group(68.2±7.5 mm vs 59.6±6.3 mm,P<0.01).Inflammatory markers,including high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α),were significantly elevated in the depressed group(hs-CRP:8.7±2.3 mg/L vs 4.5±1.6 mg/L;TNF-α:42.5±7.6 pg/mL vs 28.3±5.4 pg/mL).Both B-type natriuretic peptide(1256±345 pg/mL vs 756±234 pg/mL)and angiotensin II(86.4±15.7 ng/mL vs 62.5±12.3 ng/mL)levels were significantly higher in the depressed group.CONCLUSION Among people with CHF,the presence of depressive symptoms appears to be closely related to pronounced changes in heart structure and impaired functional abilities.It is likely that depressive states contribute to the progress of heart reform and deterioration of left stomach function,possibly due to increased inflammatory cascades and increased activation of neuroendocrine regulatory pathways.
文摘Objective:To explore the evidence-based nursing optimization strategy for catheter tip positioning during peripherally inserted central catheter(PICC)insertion in patients with persistent left superior vena cava(PLSVC).Methods:For one ovarian cancer patient with PICC malposition in the coronary sinus(CS)due to PLSVC,multimodal imaging techniques were integrated to accurately locate the catheter tip.The catheter position was adjusted based on evidence(withdrawing 5 cm),and a standardized nursing process was established,including personalized health education,catheter fixation and displacement monitoring,complication monitoring,establishment of a specialized disease information archive system,and formulation of a follow-up plan.Results:The catheter tip was successfully withdrawn from the coronary sinus(at the T8 level)to the middle and lower part of the PLSVC(at the T6 vertebral level),and the catheter functioned normally after adjustment.No complications such as arrhythmia or thrombosis occurred during the 332-day chemotherapy period.Conclusion:The PICC tip in PLSVC patients should be positioned in the middle and lower part of the PLSVC(at the T5–T7 vertebral level).This new standard can effectively avoid CS-related complications.The integration of multi-modal imaging techniques and evidence-based nursing management are key to ensuring safe infusion.
文摘Persistent left superior vena cava(PLSVC)is a congenital anomaly where the left-sided vena cava,which usually regresses during fetal development,persists.Double superior vena cava resulting from a PLSVC is indeed a rare phenomenon.In the general population,the incidence of this condition is reported to be between 0.3%and 2.1%.[1]While this anatomical variation is often asymptomatic and discovered incidentally,it becomes relevant in certain clinical scenarios.Indeed,the presence of a PLSVC and double superior vena cava can pose challenges as incorrect positioning and result in failure.
文摘Hypoplastic left heart syndrome is a severe congenital defect involving underdeveloped left-sided cardiac structures,leading to significant mortality and morbidity.Prenatal diagnosis using fetal ultrasound and echocardiography enables early detection,family counseling,and improved clinical decision-making.Advanced prenatal interventions,such as fetal aortic valvuloplasty and atrial septostomy,show promise but require careful patient selection.A multidisciplinary approach involving obstetricians,neonatologists,and pediatric cardiologists is vital for effective management.Future directions include refining imaging techniques,such as three-dimensional ultrasound,cardiovascular magnetic resonance imaging,and exploring bioengineering solutions,stem cell therapies,and genetic research.These advancements aim to improve therapeutic options and address current limitations,including transplant scarcity and postoperative complications.Although surgical innovations have improved survival rates,challenges remain,including neurological risks and long-term hemodynamic issues.Ongoing research and technological advancements are essential to enhance outcomes and quality of life for hypoplastic left heart syndrome patients.
文摘Left ventricular assist devices (LVADs) represent a cornerstone therapy foradvanced heart failure. However, their efficacy in patients with type 2 diabetesmellitus (T2DM) is challenged by diabetes-exacerbated complications. To determineoptimal pharmacological strategies to mitigate major LVAD-relatedcomplications in patients with T2DM. This review provides evidence for pharmacologicalstrategies to mitigate major LVAD-related complications in T2DM, inwhich endothelial dysfunction (via impaired PI3K/Akt-NO signaling), chronicinflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding,infection, and right ventricular (RV) failure. For thromboembolism prevention,individualized warfarin management (international normalized ratio: 2.0-3.0)with intensified monitoring is essential, while aspirin omission in magneticallylevitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors showpromise for thrombosis reduction, but require bleeding risk assessment. Glycemiccontrol necessitates the proactive de-escalation of insulin/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoringSGLT-2 inhibitors/GLP-1 receptor agonists for cardiometabolic benefits. Drivelineinfection management requires renal-adjusted antimicrobial prophylaxis, culturedirectedtherapy, and novel approaches for drug-resistant cases. The preventionof RV failure depends on preoperative hemodynamic optimization and postoperativeinotropic support. A multidisciplinary approach integrating anticoagulationprecision, infection control, glycemic tailoring, and hemodynamic stabilizationis critical to counter T2DM-pathophysiology interactions.
文摘Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.
基金funded by the Inner Mongolia Natural Science Foundation(No.2024MS04021)the Science and Technology Plan of Inner Mongolia Autonomous Region(No.2023YFSH0004)the Director Fund of the Inner Mongolia Autonomous Region Seismological Bureau(No.2023GG01,No.2023GG02,No.2023MS05,No.2023QN13)。
文摘Machine learning(ML)efficiently and accurately processes dense seismic array data,improving earthquake catalog creation,which is crucial for understanding earthquake sequences and fault systems;analyzing its reliability is also essential.An M5.8 earthquake struck Alxa Left Banner,Inner Mongolia,China on April 15,2015,a region with limited CENC monitoring capabilities,making analysis challenging.However,abundant data from ChinArray provided valuable observations for assessing the event.This study leveraged ChinArray data from the 2015 Alxa Left Banner earthquake sequence,employing machine learning(specifically PhaseNet,a deep learning method,and GaMMA,a Bayesian approach)for automated seismic phase picking,association,and location analysis.Our generated catalog,comprising 10,432 phases from 708 events,is roughly ten times larger than the CENC catalog,encompassing all CENC events with strong consistency.A slight magnitude overestimation is observed only at lower magnitudes.Furthermore,the catalog adheres to the Gutenberg-Richter and Omori laws spatially,temporally,and in magnitude distribution,demonstrating its high reliability.Double-difference tomography refined locations for 366 events,yielding a more compact spatial distribution with horizontal errors within 100m,vertical errors within 300m,and travel-time residuals within 0.05s.Depths predominantly range from 10-30km.Aftershocks align primarily NEE,with the mainshock east of the aftershock zone.The near-vertical main fault plane dips northwestward,exhibiting a Y-shaped branching structure,converging at depth and expanding towards the surface.FOCMEC analysis,using first motion and amplitude ratios,yielded focal mechanism solutions for 10 events,including the mainshock.These solutions consistently indicate a strike-slip mechanism with a minor extensional component.Integrating the earthquake sequence's spatial distribution and focal mechanisms suggests the seismogenic structure is a negative flower structure,consistent with the Dengkou-Benjing fault.Comparing the CENC and ML-generated catalogs using the maximum curvature(MAXC)method reveals a 0.6 decrease in completeness magnitude(M_(C)).However,magnitude-frequency distribution discrepancies above the MAXC-estimated M_(C)suggest MAXC may underestimate both M_(C)and the b-value.This study analyzes the 2015 Alxa Left Banner M5.8 earthquake using a reliable,MLgenerated earthquake catalog,revealing detailed information about the sequence,faulting structure,aftershock distribution,and stress characteristics.
文摘BACKGROUND Left ventricular noncompaction(LVNC)is a genetic cardiomyopathy.It is characterized by intensely developed trabeculae in the ventricles with deep intertrabecular lacunae.LVNC manifests as arrhythmias and heart failure with a predisposition for thrombus formation.AIM To study predictors of arrhythmic,thromboembolic events and adverse outcomes(death/transplantation)in adult patients with LVNC.METHODS Adult patients with LVNC were included(n=125;mean follow-up:14 months).Electrocardiography,echocardiography,and 24-hour electrocardiography monitoring were performed.Other procedures were conducted for some patients including:Coronary angiography;cardiac magnetic resonance imaging;cardiac computed tomography;genetic testing;myocardial pathological examination;and anti-cardiac antibody level estimation.Primary endpoints were death,heart transplantation,combined endpoint(death+transplantation),and sudden cardiac death.Secondary endpoints were intracardiac thrombosis,embolic events,myocardial infarction,sustained ventricular tachycardia(VT),and implantable cardioverter-defibrillator intervention.RESULTS LVNC manifestations included non-sustained VT,thrombosis/embolism,sustained VT, and sudden cardiac death. Non-sustained VT was associated with the New York Heart Association(NYHA) chronic heart failure (CHF) class, poor R-wave progression, superimposed myocarditis, and highermortality. Thrombosis/embolism was associated with NYHA CHF class ≥ 3, right ventricular end-diastolicdiameter ≥ 3 cm, right atrium volume ≥ 67 mL, left ventricle end-diastolic diameter ≥ 6.3 cm, and velocity timeintegral ≤ 11.2 cm. Sustained VT was associated with premature ventricular contractions (PVCs), low QRS voltage,and atrioventricular block. PVCs > 500/day were predictive of defibrillator intervention. Fatal outcomes wereassociated with E wave/A wave ratio > 1.9, left ventricle ejection fraction < 35%, NYHA CHF class ≥ 3, VT, andmyocarditis.CONCLUSIONFrequent PVCs, non-sustained VT, low QRS voltage, and signs of systolic dysfunction on echocardiogram arepredictors of life-threatening events in patients with LVNC.
基金Supported by the Italian Ministry for Education,University and Research under the Programme“Dipartimenti di Eccellenza 2018-2022”Project,No.D15D18000410001Novo Nordisk“Gestione delle complicanze croniche del diabete:From bedside to bench?”,No.n1/2021.
文摘BACKGROUND Global longitudinal strain(GLS)of the left ventricular is a highly sensitive and reliable marker of systolic function and GLS outperforms ejection fraction(EF)in detecting preclinical left ventricular systolic dysfunction(LVSD).In patients with type 2 diabetes(DM2)albuminuria is a predictor of symptomatic heart failure,but data on the relationship between GLS and albuminuria are conflicting.AIM To explore the relationship between GLS and albuminuria in a contemporary cohort of DM2 patients.METHODS The study was performed on DM2 patients consecutively enrolled in the TESEO study.Patients with symptoms/signs of heart failure,EF<50%,coronary artery,other cardiac diseases,or non-adequate acoustic window for GLS assessment were excluded.We collected clinical data,screened for complications,and measured GLS by speckle-tracking echocardiography.Univariate and multiple linear regression analyses were performed to identify independent explanatory variables associated with GLS.Logistic regression analysis was used to assess whether albuminuria was independently associated with GLS-diagnosed(GLS>-18%)LVSD.RESULTS Patients(n=193,age:60.6±8.1,male:57%)had a short DM2 duration(3.8±4.9 years)and good metabolic control(glycated haemoglobin A1c:6.5%±1.0).Preclinical GLS-LVSD was present in 21.8%of the patients.GLS values were significantly higher in patients with albuminuria(-19.88±2.16 vs-18.29±2.99,P<0.001)and in multivariate analysis natural logarithm of albumin-creatinine ratio and uric acid were independent predictors of GLS.In logistic regression analysis,albuminuria was associated with a 6.01(95%confidence interval:1.874-19.286)increased odds ratio of GLS-LVSD,independent of age,sex,diastolic blood pressure,chronic kidney disease,EF,mitral annulus velocity lateral,uric acid,and treatments.CONCLUSION Albuminuria was independently associated with subclinical LVSD in our contemporary cohort of DM2 patients.
基金Hefei Municipal Natural Science Foundation,Grant/Award Number:2022009Suqian Guiding Program Project,Grant/Award Number:Z202309Suqian Traditional Chinese Medicine Science and Technology Plan,Grant/Award Number:MS202301。
文摘Quantitative analysis of clinical function parameters from MRI images is crucial for diagnosing and assessing cardiovascular disease.However,the manual calculation of these parameters is challenging due to the high variability among patients and the time-consuming nature of the process.In this study,the authors introduce a framework named MultiJSQ,comprising the feature presentation network(FRN)and the indicator prediction network(IEN),which is designed for simultaneous joint segmentation and quantification.The FRN is tailored for representing global image features,facilitating the direct acquisition of left ventricle(LV)contour images through pixel classification.Additionally,the IEN incorporates specifically designed modules to extract relevant clinical indices.The authors’method considers the interdependence of different tasks,demonstrating the validity of these relationships and yielding favourable results.Through extensive experiments on cardiac MR images from 145 patients,MultiJSQ achieves impressive outcomes,with low mean absolute errors of 124 mm^(2),1.72 mm,and 1.21 mm for areas,dimensions,and regional wall thicknesses,respectively,along with a Dice metric score of 0.908.The experimental findings underscore the excellent performance of our framework in LV segmentation and quantification,highlighting its promising clinical application prospects.
文摘Diabetic cardiomyopathy(DCM)has long been considered as a left ventricular(LV)disease with diastolic dysfunction preceding systolic dysfunction in diabetes.However,it is increasingly recognized that the right ventricle(RV)is also affected by diabetes and may be independently responsible for adverse outcomes in diabetic patients with or without LV failure.Yu et al conducted a 30-week longitudinal evaluation of biventricular function and pathology in OVE26 diabetic mice and revealed early diastolic dysfunction preceding systolic decline,suggesting that early LV diastolic impairment precedes the later onset of systolic dysfunction.With age,the animals developed fibrosis,hypertrophy,and pulmonary arterial hypertension in the RV.The purpose of this editorial is to contextualize these findings within the existing literature by highlighting the interplay between cardiac chambers and the vasculature.We also seek to reiterate that DCM is a condition extending beyond left ventricular dysfunction.As the authors note,the right side of the heart may remain"the forgotten ventricle"in diabetic patients.We hope that the mechanisms discussed in this paper will help researchers to understand the pathogenesis of cardiovascular disease in this context and encourage clinicians to be more attentive to the associated clinical symptoms.
基金supported by a grant from the Climbing Project for Medical Talent of Zhongnan Hospital,Wuhan University(PDJH202215).
文摘To the Editor:Theoretically,autologous liver transplantation is posited as a treatment for patients experiencing traumatic liver rupture.How-ever,the procedural complexity and its infrequent application by the medical community have resulted in a lack of documented suc-cesses.This report presented the efficacious intervention in a pa-tient presenting with polytraumatic injuries involving the thoracic and abdominal regions,namely right-sided hemothorax,contusion and hematoma of the right lung,splenic rupture,lateral damage to the common bile duct,disruption of the left portal vein branch and left hepatic duct,incisions in the hepatic segments IV,V,VI,VII,and VIII,laceration of the right adrenal gland,rupture of the right hepatic venous trunk and retro-hepatic inferior vena cava(RHIVC),and pancreatic hematoma.
文摘Background:Anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)is a rare congenital anomalous coronary artery origin disorder.Objective:We sought to summarize the clinical experience and prognostic characteristics of surgical treatment of ALCAPA.Methods:We retrospectively analyzed clinical information on patients who had ALCAPA and underwent surgery at our center from February 2016 to October 2023.Results:This comparative study of 23 ALCAPA patients(9 infants<1 year;14 children>1 year)demonstrated significant age-dependent outcomes.Infant patients exhibited markedly prolonged mechanical ventilation(183±105.6 vs.48.5±62.2 min,p=0.001)and hospitalization(30.8±8.2 vs.19.5±6.2 days,p=0.001),despite comparable operative times(p>0.05).The perioperative mortality rate was 8.7%(2/23).Early postoperative mortality showed a non-significant trend in infants(22.2%vs.0%,p=0.11).Serial follow-up revealed substantial functional improvement,with abnormal left ventricular ejection fractions decreasing from 56.5%preoperatively to 14.3%at 1-month(p<0.01),and severe mitral regurgitation declining from 34.7%to 14.3%.However,persistent left ventricular enlargement(81%at follow-up)and moderate mitral regurgitation(52.4%)were frequently observed.Conclusion:Surgical correction of ALCPA effectively restores coronary perfusion and reduces severe mitral regurgitation,though residual ventricular dilation and moderate valvular dysfunction persist in the short-term postoperative period.Nevertheless,the overall prognosis remains favorable when timely intervention is performed.
