A code-generation and recognition technology that uses a modified ejection system in the diecasting process is presented.To achieve the highest level of quality management,the first requirement in the manufacturing pr...A code-generation and recognition technology that uses a modified ejection system in the diecasting process is presented.To achieve the highest level of quality management,the first requirement in the manufacturing process is to establish a product management system according to the specific product unit.Thus,a method to individually identify each product,such as a barcode or QR code,is required during the production process.Products manufactured in the die-casting process always have ejector pin(EP)marks.Herein,an ejection system was modified to generate a unique code using EP marks.This ejection system has two features:an EP with a modified head to show the direction of rotation,and a function to dependently rotate EPs(five or six EPs)with a constant angle.The EPs are numbered according to the rotation angle.Thus,the EP marks can be viewed as a five-or six-digit code.A program was also developed to individually identify the products by automatically detecting and reading the EPs using deep learning-based object detection and classification technology.展开更多
In this study,it is aimed to develop a generic model which calculates the trajectory of the ejection seat from the jet aircraft,by taking into account the parameters that will affect the seat movement such as the seat...In this study,it is aimed to develop a generic model which calculates the trajectory of the ejection seat from the jet aircraft,by taking into account the parameters that will affect the seat movement such as the seat’s launch speed,ejection direction,ejection angle,altitude of the aircraft,distance/height from the aircraft rudder and canopy,pilot and ejection seat weight.With the model algorithm proposed,the ejection seat trajectory model was developed on MATLAB.The ejection seat trajectory model is based on point mass trajectory mathematical model.In this study,an analytical study of the problem has been made for modeling the flight trajectory of the ejection seat after it has been ejected.Past studies were used as a basis for validation and simulation.By writing a generic MATLAB code,a user interface was developed and presented to the user as a module.This generic code that has been developed could be used for simulations by users in the future by revising it in accordance with their own job descriptions.展开更多
BACKGROUND There is no available data about the trajectory of heart failure(HF)with improved ejection fraction(EF)and patient clinical outcomes in Qatar.AIM To explore the difference in characteristics and outcomes be...BACKGROUND There is no available data about the trajectory of heart failure(HF)with improved ejection fraction(EF)and patient clinical outcomes in Qatar.AIM To explore the difference in characteristics and outcomes between patients with transient and sustained improvement in left ventricular ejection fraction(LVEF)and to determine the independent predictors for sustained improvement in LVEF.METHODS This is a retrospective cohort study that was conducted at the advanced HF clinic of a tertiary care hospital in Qatar between January 2017 and December 2018.This were divided into two groups:HF with transient improvement in EF(HFtimpEF)and HF with sustained improvement in EF(HFsimpEF).RESULTS A total of 175 patients with HF and improved EF were included.Among them 136(77.7%)patients showed sustained improvement in LVEF.The remaining patients with HFtimpEF were predominantly males[37(94.9%)vs 101(74.3%),P=0.005]with a higher incidence of ischemic cardiomyopathy[32(82.1%)vs 68(50.4%),P=0.002],dyslipidemia[24(61.5%)vs 54(39.7%),P=0.03],and hypertension[34(87.2%)vs 93(68.4%),P=0.03]than those with HFsimpEF.The latter experienced significantly lower rates of hospitalization[39(28.7%)vs 20(51.3%),P=0.01]and diagnosis of new cardiovascular conditions during the follow-up(e.g.,acute coronary syndrome,stroke,decompensated HF,and atrial fibrillation)[14(10.3%)vs 10(25.6%),P=0.03]without a difference in emergency department visits or in-hospital death.Sustained improvement in LVEF was positively associated with being female[adjusted odds ratio(aOR)=6.8,95%confidence interval(CI):1.4-32.3,P=0.02],having non-ischemic etiology of HF(aOR=3.1,95%CI:1.03-9.3,P=0.04),and using a mineralocorticoid receptor antagonist(aOR=7.0,95%CI:1.50-31.8,P=0.01).CONCLUSION Patients with HFsimpEF experienced significantly lower rates of hospitalization and diagnosis of new cardiova-scular conditions than patients with HFtimpEF.Sustained improvement in LVEF was positively associated with being a female,having non-ischemic etiology of HF,and using a mineralocorticoid receptor antagonist.展开更多
Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory proces...Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.展开更多
The high-pressure mercury intrusion (HPMI) experiment is widely used to assess the pore architecture oftight sandstone reservoirs. However, the conventional analysis of the high- pressure mercury intrusionhas always f...The high-pressure mercury intrusion (HPMI) experiment is widely used to assess the pore architecture oftight sandstone reservoirs. However, the conventional analysis of the high- pressure mercury intrusionhas always focused on the mercury injection curves themselves, neglecting the important geologicalinformation conveyed by the mercury ejection curves. This paper quantitatively describes the fractalcharacteristics of ejection curves by using four fractal models, i.e.,. Menger model, Thermodynamicmodel, Sierpinski model, and multi- fractal model. In comparison with mercury injection curves, weexplore the fractal significance of mercury ejection curves and define the applicability of different fractalmodels in characterizing pore architectures. Investigated tight sandstone samples can be divided intofour types (Types A, B, C and D) based on porosity, permeability, and mercury removal efficiency. Type Dsamples are unique in that they have higher permeability (>0.6 mD) but lower mercury removal effi-ciency (<35%). Fractal studies of the mercury injection curve show that it mainly reflects the pore throatcharacteristics, while the mercury ejection curve serves to reveal the pore features, and porosity andpermeability correlate well with the fractal dimension of the injection curve, while mercury removalefficiency correlates only with the Ds' value of the ejection curve. The studies on the mercury ejectioncurves also reveal that the small pores and micropores of the Type C and Type D samples are moredeveloped, with varying pore architecture. The fractal dimension Ds' value of Type D samples is greaterthan that of Type C samples, and the dissolution of Type D samples is more intense than that of Type Csamples, which further indicates that the Type D samples are smaller in pore size, rougher in surface, andwith greater difficulty for the hydrocarbon to enter, resulting in their reservoir capacity probably lessthan that of Type C samples. In this regard, the important information characterized by the mercuryejection curve should be considered in evaluating the tight sandstone reservoirs. Finally, the Menger andThermodynamic models prove to be more suitable for describing the total pore architecture, while theSierpinski model is better for characterizing the variability of the interconnected pores.展开更多
Knowing the optimal operating parameters of Stirling engines is important for efficient combustion through adaptability to changed pressures and oxygen atmospheres. In this study, the optimum operating conditions for ...Knowing the optimal operating parameters of Stirling engines is important for efficient combustion through adaptability to changed pressures and oxygen atmospheres. In this study, the optimum operating conditions for efficient combustion in a singular Stirling engine combustor at different oxygen atmospheres were investigated and determined. Numerical simulations were performed to investigate the effects of ejection ratio and pressure on combustion performance. In an oxygen/carbon dioxide atmosphere, the results show that increasing the ejection ratio substantially alters the flame distribution in the Stirling engine combustor, increasing heat transfer and external combustion efficiency. In contrast, increasing the ejection ratio reduces the average and maximum temperatures of the Stirling engine combustor. Increased pressure affects the flame distribution in the Stirling engine combustor and impedes the flow and convective heat transfer in the combustor, reducing the overall external combustion efficiency at pressures above 6.5 MPa. In an air/carbon dioxide atmosphere, an increased ejection ratio reduces the average and maximum temperatures in the Stirling engine combustor. However, the overall flame distribution does not change substantially. The external combustion efficiency tends to increase and then decrease because of two opposing factors: the increase in the convective heat transfer coefficient and the decrease in the temperature difference. Increasing pressure inhibits forced convection heat transfer in the Stirling engine combustor, reducing external combustion efficiency, which drops from 78% to 65% when pressure increases from 0.2 MPa to 0.5 MPa.展开更多
Background Elderly patients(age≥60 years)with ST-segment elevation myocardial infarction(STEMI)are at an elevated risk of mortality.This study aimed to investigate the association of the creatinine to ejection fracti...Background Elderly patients(age≥60 years)with ST-segment elevation myocardial infarction(STEMI)are at an elevated risk of mortality.This study aimed to investigate the association of the creatinine to ejection fraction ratio(CER)with in-hospital and 1-year death in elderly patients with STEMI.Methods A total of 753 consecutive elderly patients(age≥60 years)with STEMI undergoing percutaneous coronary intervention(PCI)were enrolled and divided into three groups according to the tertiles of CER at admission:<1.5(n=250),1.5-2.2(n=249)and>2.2(n=254).Multivariate analyses were performed to evaluate the prognostic value of CRE for short-term death in this population.Results The in-hospital and 1-year mortality reached 6.0%and 13.3%,respectively.Patients with higher CER exhibited a higher in-hospital mortality(0.8%vs.2.8%vs.14.2%,P<0.001).An optimal cut-off value of 2.5 for CER was identified for predicting in-hospital death by receiver operating characteristic curve analysis,yielding a sensitivity of 77.8%and a specificity of 76.1%[area under curve(AUC):0.791,95%confidence interval(CI):0.734-0.847,P<0.001].Multivariate regression analyses revealed that CER>2.5 was an independent risk factor for both in-hospital[adjusted odds ratio(OR):9.006,95%CI:2.707-29.967,P<0.001]and 1-year mortality[adjusted hazard ratio(HR):5.082,95%CI:2.462-10.490,P<0.001].Conclusions Elevated CER is associated with adverse short-term mortality in elderly STEMI patients undergone PCI,offering valuable insights for the early identification and management of high-risk individuals in clinical practice.展开更多
BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore...BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.展开更多
In this study,a novel hybrid ejection system with hydraulic system and pulley-rope mechanism is proposed to accurately track the speed command of the hybrid ejection system.Aiming at the high-order,nonlinear and uncer...In this study,a novel hybrid ejection system with hydraulic system and pulley-rope mechanism is proposed to accurately track the speed command of the hybrid ejection system.Aiming at the high-order,nonlinear and uncertain characteristics of hybrid ejection system,a new improved method of active disturbance rejection controller is proposed,which achieves good antiinterference performance while maintaining the system stability.The controller is obtained by combining fuzzy control algorithm with extended state observer by backstepping method.By adding a state feedback,two extended state observers are applied to hydraulic system and pulley-rope mechanism respectively,which solves the problem that the extended state observers of the high-order system cannot determine the appropriate controller parameters to achieve the expected performance.Meanwhile,fuzzy control algorithm is addressed to reduce the oscillations or even instability induced by large controller bandwidth.With this idea,the mathematical model and the co-simulation model based on MATLAB-AMESim are established.The simulation results show that the proposed controller can significantly improve the speed tracking accuracy and shorten the response time.Finally,the proposed control strategy is verified by experiments.展开更多
BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evalu...BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.展开更多
BACKGROUND Gliflozins or Sodium glucose cotransporter 2 inhibitors(SGLT2i)are relatively novel antidiabetic medications that have recently been shown to represent favorable effects on patients’cardiorenal outcomes.Ho...BACKGROUND Gliflozins or Sodium glucose cotransporter 2 inhibitors(SGLT2i)are relatively novel antidiabetic medications that have recently been shown to represent favorable effects on patients’cardiorenal outcomes.However,there is shortage of data on potential disparities in this therapeutic effect across different patient subpopulations.AIM To investigate differential effects of SGLT2i on the cardiorenal outcomes of heart failure patients across left ventricular ejection fraction(LVEF)levels.METHODS Literature was searched systematically for the large randomized double-blind controlled trials with long enough follow up periods reporting cardiovascular and renal outcomes in their patients regarding heart failure status and LVEF levels.Data were then meta-analyzed after stratification of the pooled data across the LVEF strata and New York Heart Associations(NYHA)classifications for heart failure using Stata software version 17.0.RESULTS The literature search returned 13 Large clinical trials and 13 post hoc analysis reports.Meta-analysis of the effects of gliflozins on the primary composite outcome showed no significant difference in efficacy across the heart failure subtypes,but higher efficacy were detected in patient groups at lower NYHA classifications(I2=46%,P=0.02).Meta-analyses across the LVEF stratums revealed that a baseline LVEF lower than 30%was associated with enhanced improvement in the primary composite outcome compared to patients with higher LVEF levels at the borderline statistical significance(HR:0.70,95%CI:0.60 to 0.79 vs 0.81,95%CI:0.75 to 0.87;respectively,P=0.06).Composite renal outcome was improved significantly higher in patients with no heart failure than in heart failure patients with preserved ejection fraction(HFpEF)(HR:0.60,95%CI:0.49 to 0.72 vs 0.94,95%CI:0.74 to 1.13;P=0.04).Acute renal injury occurred significantly less frequently in heart failure patients with reduced ejection fraction who received gliflozins than in HFpEF(HR:0.67,95%CI:51 to 0.82 vs 0.94,95%CI:0.82 to 1.06;P=0.01).Volume depletion was consistently increased in response to SGLT2i in all the subgroups.CONCLUSION Heart failure patients with lower LVEF and lower NYHA sub-classifications were found to be generally more likely to benefit from therapy with gliflozins.Further research are required to identify patient subgroups representing the highest benefits or adverse events in response to SGLT2i.展开更多
In heart failure with preserved ejection fraction,significant left ventricular diastolic abnormalities are present,despite a normal systolic ejection fraction.This article will consider whether this is consistent with...In heart failure with preserved ejection fraction,significant left ventricular diastolic abnormalities are present,despite a normal systolic ejection fraction.This article will consider whether this is consistent with the law of conservation of energy,also know as the first law of thermodynamics.展开更多
It is generally believed that coronal mass ejections(CMEs)have magnetic flux rope structures because of their helical shapes.However,only about 30%–40%of interplanetary CMEs(ICMEs)have a local magnetic flux rope stru...It is generally believed that coronal mass ejections(CMEs)have magnetic flux rope structures because of their helical shapes.However,only about 30%–40%of interplanetary CMEs(ICMEs)have a local magnetic flux rope structure.The usual explanations are that the spacecraft only crossed the flank of the ropes and failed to detect the complete magnetic flux rope structure or that some processes destroyed these magnetic flux rope structures.Several studies suggest that some ICMEs inherently possess disordered magnetic fields and consequently exhibit no magnetic flux-rope structures.We introduce a special kind of ICME which has a low magnetic field magnitude and stable magnetic field direction,relatively fast expansion speed,and lower proton temperature and density.All three of the measured magnetic field components are relatively stable.We want to know whether these ICMEs also have magnetic flux rope structures or not.We identified 20 special ICMEs and analyzed their evolution based on their observed characteristics.We took a special ICME as an example,which had an apparent rope configuration at 1 au but evolved to a special ICME at 5.4 au,to illustrate that this kind of ICME could come from magnetic clouds(MCs)whose rope structure had been being stretched due to expansion.We inferred that the missing obvious flux rope structure may be due to the expansion of MCs,not the flank crossing effect.However,more than 50%of the events were associated with the dominant x-component of the magnetic field,which indicates a leg crossing.Therefore,the detection of part of these special ICMEs may also be the result of the leg-crossing effect.展开更多
Heart failure (HF) is a chronic condition characterized by the heart’s inability to pump blood effectively. Hypertension is a frequent contributing factor. The reduced cardiac output leads to fluid accumulation, caus...Heart failure (HF) is a chronic condition characterized by the heart’s inability to pump blood effectively. Hypertension is a frequent contributing factor. The reduced cardiac output leads to fluid accumulation, causing respiratory distress and chest pain. Ejection fraction (EF), a measure of the left ventricle’s pumping capacity, is crucial in HF diagnosis. HF with reduced EF (HFrEF) is defined by an EF below 40%, often caused by coronary artery disease—approximately half of all HF patients present with HFrEF. The remaining cases encompass HF with mid-range EF (40% - 50%) or HF with preserved EF (HFpEF, EF ≥ 50%).展开更多
Objective:To determine factors that affect the health-related quality of life(HRQOL)of congestive heart failure(CHF)patients with preserved and reduced ejection fraction.Methods:A cross-sectional study design was used...Objective:To determine factors that affect the health-related quality of life(HRQOL)of congestive heart failure(CHF)patients with preserved and reduced ejection fraction.Methods:A cross-sectional study design was used for this study.The stratified random sampling was applied for each subgroup.HRQOL was measured with the Minnesota Living with Hear t Failure Questionnaire.The data were analyzed using chi-square,Spearman's correlation analysis,and independent t-test.Results:A number of 67 respondents participated in the recent study.The total mean scores of HRQOL were significantly different(P=0.001)between heart failure(HF)patients with reduced and preserved ejection fractions,41.07±7.54 and 54.97±4.36,respectively.It related with the physical(mean±standard deviation[SD]=10.4±2.14;t=-10.08,95%CI=-12.46 to-8.34;P-value=0.001)and psychological(mean±SD=3.5±0.5;t=-6.68,95%CI=-4.55 to-2.45;P-value=0.001)domain.Strong correlation was found between age(r=-0.898,P<0.05),NYHA functional classes(r=-0.858,P<0.01),duration of HF(r=-0.807,P<0.01),family support(r=0.927,P<0.01),and quality of life(Qo L).Conclusions:HRQOL in HF patients with reduced ejection fraction was higher than in those with preserved ejection fraction.Family suppor t is a fur ther determinant factor that has a positive correlation to the Qo L.展开更多
Background:Formononetin(FMN)has beneficial effects in cardiovascular diseases but its functions and mechanisms in heart failure with preserved ejection fraction(HFpEF)remain unclear.This study aimed at determining whe...Background:Formononetin(FMN)has beneficial effects in cardiovascular diseases but its functions and mechanisms in heart failure with preserved ejection fraction(HFpEF)remain unclear.This study aimed at determining whether FMN ameliorated HFpEF-induced cardiac dysfunction and exploring its underlying mechanisms.Methods:The mouse model of HFpEF was established through uninephrectomy surgery and d-aldosterone infusion in C57BL/6 mice.Cardiac remodeling and potential mechanisms of FMN in HFpEF were assessed by histological analysis,immunofluorescence,echocardiography,real-time PCR and western blotting sequentially.Results:FMN prevented myocardial dysfunction,fibrosis and cardiomyocyte apoptosis.The mRNA levels of left ventricular hypertrophy markers were increased in HFpEF mice but they remained unchanged in FMN-treated mice.In addition,the expression levels of PPARαand PGC-1 were increased in HFpEF mice for FMN treatment.The PPARα-PGC-1 complex affected the expression of fatty acid content and encoded enzymes in glucose metabolism.Both the hypertrophy and metabolic impairment due to FMN in HFpEF mice were alleviated after the addition of PPARαantagonist GW6471.Conclusion:In conclusion,FMN could prevent the cardiac hypertrophy in HFpEF mice by activating the PPARα/PGC-1 pathway and regulating energy metabolism,which provides a new therapeutic strategy for HFpEF patients.展开更多
In this paper,we perform a follow-up investigation of the solar eruption originating from active region 13575 on 2024 February 9.The primary eruption of a hot channel generates an X3.4 class flare,a full-halo coronal ...In this paper,we perform a follow-up investigation of the solar eruption originating from active region 13575 on 2024 February 9.The primary eruption of a hot channel generates an X3.4 class flare,a full-halo coronal mass ejection(CME),and an extreme-ultraviolet(EUV)wave.Interaction between the wave and a quiescent prominence(QP)leads to a large-amplitude,transverse oscillation of QP.After the transverse oscillation,QP loses equilibrium and rises up.The ascending motion of the prominence is coherently detected and tracked up to∼1.68 R_(⊙)by the Solar UltraViolet Imager onboard the GOES-16 spacecraft and up to∼2.2 R_(⊙)by the Solar Corona Imager(SCI_UV)of the LyαSolar Telescope onboard the ASO-S spacecraft.The velocity increases linearly from 12.3 to 68.5 km s^(−1)at 18:30 UT.The sympathetic eruption of QP drives the second CME with a typical three-part structure.The bright core comes from the eruptive prominence,which could be further observed up to∼3.3 R_(⊙) by the Large Angle Spectroscopic Coronagraph onboard the Solar and Heliospheric Observatory mission.The leading edge of the second CME accelerates continuously from∼120 to∼277 km s^(−1).The EUV wave plays an important role in linking the primary eruption with the sympathetic eruption.展开更多
Background Accurate measurement of left ventricular ejection fraction(LVEF)is crucial in diagnosing and managing cardiac conditions.Deep learning(DL)models offer potential to improve the consistency and efficiency of ...Background Accurate measurement of left ventricular ejection fraction(LVEF)is crucial in diagnosing and managing cardiac conditions.Deep learning(DL)models offer potential to improve the consistency and efficiency of these measurements,reducing reliance on operator expertise.Objective The aim of this study was to develop an innovative software-hardware combined device,featuring a novel DL algorithm for the automated quantification of LVEF from 2D echocardiographic images.Methods A dataset of 2,113 patients admitted to the Affiliated Hospital of Qingdao University between January and June 2023 was assembled and split into training and test groups.Another 500 patients from another campus were prospectively collected as external validation group.The age,sex,reason for echocardiography and the type of patients were collected.Following standardized protocol training by senior echocardiographers using domestic ultrasound equipment,apical four-chamber view images were labeled manually and utilized for training our deep learning framework.This system combined convolutional neural networks(CNN)with transformers for enhanced image recognition and analysis.Combined with the model that was named QHAutoEF,a‘one-touch’software module was developed and integrated into the echocardiography hardware,providing intuitive,realtime visualization of LVEF measurements.The device’s performance was evaluated with metrics such as the Dice coefficient and Jaccard index,along with computational efficiency indicators.The dice index,intersection over union,size,floating point operations per second and calculation time were used to compare the performance of our model with alternative deep learning architectures.Bland-Altman analysis and the receiver operating characteristic(ROC)curve were used for validation of the accuracy of the model.The scatter plot was used to evaluate the consistency of the manual and automated results among subgroups.Results Patients from external validation group were older than those from training group((60±14)years vs.(55±16)years,respectively,P<0.001).The gender distribution among three groups were showed no statistical difference(43%vs.42%vs.50%,respectively,P=0.095).Significant differences were showed among patients with different type(all P<0.001)and reason for echocardiography(all P<0.001 except for other reasons).QHAutoEF achieved a high Dice index(0.942 at end-diastole,0.917 at end-systole)with a notably compact model size(10.2 MB)and low computational cost(93.86 G floating point operations(FLOPs)).It exhibited high consistency with expert manual measurements(intraclass correlation coefficient(ICC)=0.90(0.89,0.92),P<0.001)and excellent capability to differentiate patients with LVEF≥60%from those with reduced function,yielding an area under the operation curve(AUC)of 0.92(0.90–0.95).Subgroup analysis showed a good correlation between QHAutoEF results and manual results from experienced experts among patients of different types(R=0.93,0.73,0.92,respectively,P<0.001)and ages(R=0.92,0.94,0.89,0.91,0.81,respectively,P<0.001).Conclusions Our software-hardware device offers an improved solution for the automated measurement of LVEF,demonstrating not only high accuracy and consistency with manual expert measurements but also practical adaptability for clinical settings.This device might potentially support clinicians and augment clinical decision.展开更多
Heart failure(HF)has emerged as one of the foremost global health threats due to its intricate pathophysiological mechanisms and multifactorial etiology.Adeno-sine triphosphate(ATP)-induced cell death represents a nov...Heart failure(HF)has emerged as one of the foremost global health threats due to its intricate pathophysiological mechanisms and multifactorial etiology.Adeno-sine triphosphate(ATP)-induced cell death represents a novel form of regulated cell deaths,marked by cellular energy depletion and metabolic dysregulation stemming from excessive ATP accumulation,identifying its uniqueness compared to other cell death processes modalities such as programmed cell death and necrosis.Growing evidence suggests that ATP-induced cell death(AICD)is predominantly governed by various biological pathways,including energy meta-bolism,redox homeostasis and intracellular calcium equilibrium.Recent research has shown that AICD is crucial in HF induced by pathological conditions like myocardial infarction,ischemia-reperfusion injury,and chemotherapy.Thus,it is essential to investigate the function of AICD in the pathogenesis of HF,as this may provide a foundation for the development of targeted therapies and novel treatment strategies.This review synthesizes current advancements in under-standing the link between AICD and HF,while further elucidating its invol-vement in cardiac remodeling and HF progression.展开更多
BACKGROUND Early diagnosis of left ventricular diastolic dysfunction(LVDD)is essential for preventing heart failure.B-type natriuretic peptide(BNP)is a viable marker for predicting LVDD,as elevated BNP levels have bee...BACKGROUND Early diagnosis of left ventricular diastolic dysfunction(LVDD)is essential for preventing heart failure.B-type natriuretic peptide(BNP)is a viable marker for predicting LVDD,as elevated BNP levels have been associated with worsening LVDD in patients with diabetes over time.However,the utility of BNP as a diagnostic marker in diabetes is controversial,as BNP levels are often low in overweight individuals.AIM To examine the effectiveness of BNP levels and fragmented QRS(fQRS)on electrocardiography for diagnosing LVDD in patients with type 2 diabetes.METHODS This retrospective cohort study included 303 patients with type 2 diabetes(67.4±12.3 years old)with preserved ejection fraction(EF)≥50%admitted to Toyama University Hospital for glycemic management and comorbidity evaluation between November 2017 and April 2021.All participants underwent plasma BNP measurement,electrocardiography,and echocardiography.Cardiologists who were blinded to the BNP results assessed the electrocardiograms and echocardiograms.Subgroup analyses were conducted for overweight individuals.RESULTS Receiver operating characteristic(ROC)curve analysis determined optimal BNP cut-off values of 34.8 pg/mL and 7.2 pg/mL for diagnosing LVDD in non-overweight[area under the ROC curve(AUC):0.70]and overweight(AUC:0.55)groups,respectively(P=0.040).In the overweight subgroup,fQRS showed greater diagnostic accuracy for LVDD(AUC:0.67),indicating moderate diagnostic utility compared with the low performance of the BNP cutoff of 35 pg/mL(AUC:0.52)(P=0.010).Multivariate analyses confirmed that fQRS was superior to BNP for LVDD diagnosis regardless of the patient’s weight.CONCLUSION A BNP level≥35 pg/mL in non-overweight individuals may be a reliable LVDD marker.Additionally,fQRS was more effective than BNP in diagnosing LVDD irrespective of the patient’s weight.fQRS can complement BNP in the early detection of LVDD,especially in overweight patients,potentially improving early detection and mitigating progression to heart failure with preserved EF in patients with type 2 diabetes.展开更多
基金the development project of Industrial and Manufacturing Source Technology of the Korea Institute of Industrial Technology(KITECH)granted financial resource by the Ministry of Economy and Finance,Republic of Korea(No.EO190031).
文摘A code-generation and recognition technology that uses a modified ejection system in the diecasting process is presented.To achieve the highest level of quality management,the first requirement in the manufacturing process is to establish a product management system according to the specific product unit.Thus,a method to individually identify each product,such as a barcode or QR code,is required during the production process.Products manufactured in the die-casting process always have ejector pin(EP)marks.Herein,an ejection system was modified to generate a unique code using EP marks.This ejection system has two features:an EP with a modified head to show the direction of rotation,and a function to dependently rotate EPs(five or six EPs)with a constant angle.The EPs are numbered according to the rotation angle.Thus,the EP marks can be viewed as a five-or six-digit code.A program was also developed to individually identify the products by automatically detecting and reading the EPs using deep learning-based object detection and classification technology.
文摘In this study,it is aimed to develop a generic model which calculates the trajectory of the ejection seat from the jet aircraft,by taking into account the parameters that will affect the seat movement such as the seat’s launch speed,ejection direction,ejection angle,altitude of the aircraft,distance/height from the aircraft rudder and canopy,pilot and ejection seat weight.With the model algorithm proposed,the ejection seat trajectory model was developed on MATLAB.The ejection seat trajectory model is based on point mass trajectory mathematical model.In this study,an analytical study of the problem has been made for modeling the flight trajectory of the ejection seat after it has been ejected.Past studies were used as a basis for validation and simulation.By writing a generic MATLAB code,a user interface was developed and presented to the user as a module.This generic code that has been developed could be used for simulations by users in the future by revising it in accordance with their own job descriptions.
文摘BACKGROUND There is no available data about the trajectory of heart failure(HF)with improved ejection fraction(EF)and patient clinical outcomes in Qatar.AIM To explore the difference in characteristics and outcomes between patients with transient and sustained improvement in left ventricular ejection fraction(LVEF)and to determine the independent predictors for sustained improvement in LVEF.METHODS This is a retrospective cohort study that was conducted at the advanced HF clinic of a tertiary care hospital in Qatar between January 2017 and December 2018.This were divided into two groups:HF with transient improvement in EF(HFtimpEF)and HF with sustained improvement in EF(HFsimpEF).RESULTS A total of 175 patients with HF and improved EF were included.Among them 136(77.7%)patients showed sustained improvement in LVEF.The remaining patients with HFtimpEF were predominantly males[37(94.9%)vs 101(74.3%),P=0.005]with a higher incidence of ischemic cardiomyopathy[32(82.1%)vs 68(50.4%),P=0.002],dyslipidemia[24(61.5%)vs 54(39.7%),P=0.03],and hypertension[34(87.2%)vs 93(68.4%),P=0.03]than those with HFsimpEF.The latter experienced significantly lower rates of hospitalization[39(28.7%)vs 20(51.3%),P=0.01]and diagnosis of new cardiovascular conditions during the follow-up(e.g.,acute coronary syndrome,stroke,decompensated HF,and atrial fibrillation)[14(10.3%)vs 10(25.6%),P=0.03]without a difference in emergency department visits or in-hospital death.Sustained improvement in LVEF was positively associated with being female[adjusted odds ratio(aOR)=6.8,95%confidence interval(CI):1.4-32.3,P=0.02],having non-ischemic etiology of HF(aOR=3.1,95%CI:1.03-9.3,P=0.04),and using a mineralocorticoid receptor antagonist(aOR=7.0,95%CI:1.50-31.8,P=0.01).CONCLUSION Patients with HFsimpEF experienced significantly lower rates of hospitalization and diagnosis of new cardiova-scular conditions than patients with HFtimpEF.Sustained improvement in LVEF was positively associated with being a female,having non-ischemic etiology of HF,and using a mineralocorticoid receptor antagonist.
基金Supported by Wenzhou Science Technology Bureau Foundation,No.2022Y0726.
文摘Heart failure(HF)with preserved ejection fraction(HFpEF)has exceeded HF with reduced ejection fraction(HFrEF),becoming the most common type of HF.Unlike HFrEF,HFpEF is primarily a chronic low-grade inflammatory process closely associated with metabolic disorders.The coexistence of HFpEF and metabolic dysfunction-associated steatotic liver disease(MASLD)presents significant clinical challenges due to shared metabolic pathophysiology and complex inter-play.Management strategies for HFpEF and MASLD remain challenging.Sodium-glucose cotransporter 2 inhibitors have shown benefits in managing both conditions.Additionally,glucagon-like peptide-1 receptor agonists are being actively investigated for their potential benefits,particularly in MASLD.A comprehensive,patient-centered approach that combines metabolic and cardiova-scular care is essential for improving outcomes in patients with HFpEF and MASLD,addressing the global metabolic health challenges.
基金The research project was co-funded by the National Natural Science Foundation of China(No.42072172,No.41772120)Shandong Province Natural Science Fund for Distinguished Young Scholars(No.JQ201311)the Graduate Scientific and Technological Innovation Project Financially Supported by Shandong University of Science and Technology(No.SDKDYC190313).
文摘The high-pressure mercury intrusion (HPMI) experiment is widely used to assess the pore architecture oftight sandstone reservoirs. However, the conventional analysis of the high- pressure mercury intrusionhas always focused on the mercury injection curves themselves, neglecting the important geologicalinformation conveyed by the mercury ejection curves. This paper quantitatively describes the fractalcharacteristics of ejection curves by using four fractal models, i.e.,. Menger model, Thermodynamicmodel, Sierpinski model, and multi- fractal model. In comparison with mercury injection curves, weexplore the fractal significance of mercury ejection curves and define the applicability of different fractalmodels in characterizing pore architectures. Investigated tight sandstone samples can be divided intofour types (Types A, B, C and D) based on porosity, permeability, and mercury removal efficiency. Type Dsamples are unique in that they have higher permeability (>0.6 mD) but lower mercury removal effi-ciency (<35%). Fractal studies of the mercury injection curve show that it mainly reflects the pore throatcharacteristics, while the mercury ejection curve serves to reveal the pore features, and porosity andpermeability correlate well with the fractal dimension of the injection curve, while mercury removalefficiency correlates only with the Ds' value of the ejection curve. The studies on the mercury ejectioncurves also reveal that the small pores and micropores of the Type C and Type D samples are moredeveloped, with varying pore architecture. The fractal dimension Ds' value of Type D samples is greaterthan that of Type C samples, and the dissolution of Type D samples is more intense than that of Type Csamples, which further indicates that the Type D samples are smaller in pore size, rougher in surface, andwith greater difficulty for the hydrocarbon to enter, resulting in their reservoir capacity probably lessthan that of Type C samples. In this regard, the important information characterized by the mercuryejection curve should be considered in evaluating the tight sandstone reservoirs. Finally, the Menger andThermodynamic models prove to be more suitable for describing the total pore architecture, while theSierpinski model is better for characterizing the variability of the interconnected pores.
基金Supported by the Shanghai Rising Star Program (Grant No. 21QB1403900)the Shanghai Municipal Commission of Science and Technology (Grant No. 22170712600)。
文摘Knowing the optimal operating parameters of Stirling engines is important for efficient combustion through adaptability to changed pressures and oxygen atmospheres. In this study, the optimum operating conditions for efficient combustion in a singular Stirling engine combustor at different oxygen atmospheres were investigated and determined. Numerical simulations were performed to investigate the effects of ejection ratio and pressure on combustion performance. In an oxygen/carbon dioxide atmosphere, the results show that increasing the ejection ratio substantially alters the flame distribution in the Stirling engine combustor, increasing heat transfer and external combustion efficiency. In contrast, increasing the ejection ratio reduces the average and maximum temperatures of the Stirling engine combustor. Increased pressure affects the flame distribution in the Stirling engine combustor and impedes the flow and convective heat transfer in the combustor, reducing the overall external combustion efficiency at pressures above 6.5 MPa. In an air/carbon dioxide atmosphere, an increased ejection ratio reduces the average and maximum temperatures in the Stirling engine combustor. However, the overall flame distribution does not change substantially. The external combustion efficiency tends to increase and then decrease because of two opposing factors: the increase in the convective heat transfer coefficient and the decrease in the temperature difference. Increasing pressure inhibits forced convection heat transfer in the Stirling engine combustor, reducing external combustion efficiency, which drops from 78% to 65% when pressure increases from 0.2 MPa to 0.5 MPa.
文摘Background Elderly patients(age≥60 years)with ST-segment elevation myocardial infarction(STEMI)are at an elevated risk of mortality.This study aimed to investigate the association of the creatinine to ejection fraction ratio(CER)with in-hospital and 1-year death in elderly patients with STEMI.Methods A total of 753 consecutive elderly patients(age≥60 years)with STEMI undergoing percutaneous coronary intervention(PCI)were enrolled and divided into three groups according to the tertiles of CER at admission:<1.5(n=250),1.5-2.2(n=249)and>2.2(n=254).Multivariate analyses were performed to evaluate the prognostic value of CRE for short-term death in this population.Results The in-hospital and 1-year mortality reached 6.0%and 13.3%,respectively.Patients with higher CER exhibited a higher in-hospital mortality(0.8%vs.2.8%vs.14.2%,P<0.001).An optimal cut-off value of 2.5 for CER was identified for predicting in-hospital death by receiver operating characteristic curve analysis,yielding a sensitivity of 77.8%and a specificity of 76.1%[area under curve(AUC):0.791,95%confidence interval(CI):0.734-0.847,P<0.001].Multivariate regression analyses revealed that CER>2.5 was an independent risk factor for both in-hospital[adjusted odds ratio(OR):9.006,95%CI:2.707-29.967,P<0.001]and 1-year mortality[adjusted hazard ratio(HR):5.082,95%CI:2.462-10.490,P<0.001].Conclusions Elevated CER is associated with adverse short-term mortality in elderly STEMI patients undergone PCI,offering valuable insights for the early identification and management of high-risk individuals in clinical practice.
文摘BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.
文摘In this study,a novel hybrid ejection system with hydraulic system and pulley-rope mechanism is proposed to accurately track the speed command of the hybrid ejection system.Aiming at the high-order,nonlinear and uncertain characteristics of hybrid ejection system,a new improved method of active disturbance rejection controller is proposed,which achieves good antiinterference performance while maintaining the system stability.The controller is obtained by combining fuzzy control algorithm with extended state observer by backstepping method.By adding a state feedback,two extended state observers are applied to hydraulic system and pulley-rope mechanism respectively,which solves the problem that the extended state observers of the high-order system cannot determine the appropriate controller parameters to achieve the expected performance.Meanwhile,fuzzy control algorithm is addressed to reduce the oscillations or even instability induced by large controller bandwidth.With this idea,the mathematical model and the co-simulation model based on MATLAB-AMESim are established.The simulation results show that the proposed controller can significantly improve the speed tracking accuracy and shorten the response time.Finally,the proposed control strategy is verified by experiments.
基金National Natural Science Foundation of China,No.81873887National Natural Science Foundation of China Youth Project,No.82101981Shanghai Jiao Tong University School of Medicine Double Hundred Outstanding Person Project,No.20191904。
文摘BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.
文摘BACKGROUND Gliflozins or Sodium glucose cotransporter 2 inhibitors(SGLT2i)are relatively novel antidiabetic medications that have recently been shown to represent favorable effects on patients’cardiorenal outcomes.However,there is shortage of data on potential disparities in this therapeutic effect across different patient subpopulations.AIM To investigate differential effects of SGLT2i on the cardiorenal outcomes of heart failure patients across left ventricular ejection fraction(LVEF)levels.METHODS Literature was searched systematically for the large randomized double-blind controlled trials with long enough follow up periods reporting cardiovascular and renal outcomes in their patients regarding heart failure status and LVEF levels.Data were then meta-analyzed after stratification of the pooled data across the LVEF strata and New York Heart Associations(NYHA)classifications for heart failure using Stata software version 17.0.RESULTS The literature search returned 13 Large clinical trials and 13 post hoc analysis reports.Meta-analysis of the effects of gliflozins on the primary composite outcome showed no significant difference in efficacy across the heart failure subtypes,but higher efficacy were detected in patient groups at lower NYHA classifications(I2=46%,P=0.02).Meta-analyses across the LVEF stratums revealed that a baseline LVEF lower than 30%was associated with enhanced improvement in the primary composite outcome compared to patients with higher LVEF levels at the borderline statistical significance(HR:0.70,95%CI:0.60 to 0.79 vs 0.81,95%CI:0.75 to 0.87;respectively,P=0.06).Composite renal outcome was improved significantly higher in patients with no heart failure than in heart failure patients with preserved ejection fraction(HFpEF)(HR:0.60,95%CI:0.49 to 0.72 vs 0.94,95%CI:0.74 to 1.13;P=0.04).Acute renal injury occurred significantly less frequently in heart failure patients with reduced ejection fraction who received gliflozins than in HFpEF(HR:0.67,95%CI:51 to 0.82 vs 0.94,95%CI:0.82 to 1.06;P=0.01).Volume depletion was consistently increased in response to SGLT2i in all the subgroups.CONCLUSION Heart failure patients with lower LVEF and lower NYHA sub-classifications were found to be generally more likely to benefit from therapy with gliflozins.Further research are required to identify patient subgroups representing the highest benefits or adverse events in response to SGLT2i.
文摘In heart failure with preserved ejection fraction,significant left ventricular diastolic abnormalities are present,despite a normal systolic ejection fraction.This article will consider whether this is consistent with the law of conservation of energy,also know as the first law of thermodynamics.
基金support from the National Natural Science Foundation of China(NSFC,Grant Nos.41974197,41804162,and 42104158)supported by Central Plains Science and Technology Innovation Leading Talents of Henan Province under grant No.244200510012。
文摘It is generally believed that coronal mass ejections(CMEs)have magnetic flux rope structures because of their helical shapes.However,only about 30%–40%of interplanetary CMEs(ICMEs)have a local magnetic flux rope structure.The usual explanations are that the spacecraft only crossed the flank of the ropes and failed to detect the complete magnetic flux rope structure or that some processes destroyed these magnetic flux rope structures.Several studies suggest that some ICMEs inherently possess disordered magnetic fields and consequently exhibit no magnetic flux-rope structures.We introduce a special kind of ICME which has a low magnetic field magnitude and stable magnetic field direction,relatively fast expansion speed,and lower proton temperature and density.All three of the measured magnetic field components are relatively stable.We want to know whether these ICMEs also have magnetic flux rope structures or not.We identified 20 special ICMEs and analyzed their evolution based on their observed characteristics.We took a special ICME as an example,which had an apparent rope configuration at 1 au but evolved to a special ICME at 5.4 au,to illustrate that this kind of ICME could come from magnetic clouds(MCs)whose rope structure had been being stretched due to expansion.We inferred that the missing obvious flux rope structure may be due to the expansion of MCs,not the flank crossing effect.However,more than 50%of the events were associated with the dominant x-component of the magnetic field,which indicates a leg crossing.Therefore,the detection of part of these special ICMEs may also be the result of the leg-crossing effect.
文摘Heart failure (HF) is a chronic condition characterized by the heart’s inability to pump blood effectively. Hypertension is a frequent contributing factor. The reduced cardiac output leads to fluid accumulation, causing respiratory distress and chest pain. Ejection fraction (EF), a measure of the left ventricle’s pumping capacity, is crucial in HF diagnosis. HF with reduced EF (HFrEF) is defined by an EF below 40%, often caused by coronary artery disease—approximately half of all HF patients present with HFrEF. The remaining cases encompass HF with mid-range EF (40% - 50%) or HF with preserved EF (HFpEF, EF ≥ 50%).
文摘Objective:To determine factors that affect the health-related quality of life(HRQOL)of congestive heart failure(CHF)patients with preserved and reduced ejection fraction.Methods:A cross-sectional study design was used for this study.The stratified random sampling was applied for each subgroup.HRQOL was measured with the Minnesota Living with Hear t Failure Questionnaire.The data were analyzed using chi-square,Spearman's correlation analysis,and independent t-test.Results:A number of 67 respondents participated in the recent study.The total mean scores of HRQOL were significantly different(P=0.001)between heart failure(HF)patients with reduced and preserved ejection fractions,41.07±7.54 and 54.97±4.36,respectively.It related with the physical(mean±standard deviation[SD]=10.4±2.14;t=-10.08,95%CI=-12.46 to-8.34;P-value=0.001)and psychological(mean±SD=3.5±0.5;t=-6.68,95%CI=-4.55 to-2.45;P-value=0.001)domain.Strong correlation was found between age(r=-0.898,P<0.05),NYHA functional classes(r=-0.858,P<0.01),duration of HF(r=-0.807,P<0.01),family support(r=0.927,P<0.01),and quality of life(Qo L).Conclusions:HRQOL in HF patients with reduced ejection fraction was higher than in those with preserved ejection fraction.Family suppor t is a fur ther determinant factor that has a positive correlation to the Qo L.
基金supported by the National Natural Science Foundation of China(82274313)Key R&D Program of Shaanxi Province(2023GHZD43)the National Natural Science Foundation of China(81870284).
文摘Background:Formononetin(FMN)has beneficial effects in cardiovascular diseases but its functions and mechanisms in heart failure with preserved ejection fraction(HFpEF)remain unclear.This study aimed at determining whether FMN ameliorated HFpEF-induced cardiac dysfunction and exploring its underlying mechanisms.Methods:The mouse model of HFpEF was established through uninephrectomy surgery and d-aldosterone infusion in C57BL/6 mice.Cardiac remodeling and potential mechanisms of FMN in HFpEF were assessed by histological analysis,immunofluorescence,echocardiography,real-time PCR and western blotting sequentially.Results:FMN prevented myocardial dysfunction,fibrosis and cardiomyocyte apoptosis.The mRNA levels of left ventricular hypertrophy markers were increased in HFpEF mice but they remained unchanged in FMN-treated mice.In addition,the expression levels of PPARαand PGC-1 were increased in HFpEF mice for FMN treatment.The PPARα-PGC-1 complex affected the expression of fatty acid content and encoded enzymes in glucose metabolism.Both the hypertrophy and metabolic impairment due to FMN in HFpEF mice were alleviated after the addition of PPARαantagonist GW6471.Conclusion:In conclusion,FMN could prevent the cardiac hypertrophy in HFpEF mice by activating the PPARα/PGC-1 pathway and regulating energy metabolism,which provides a new therapeutic strategy for HFpEF patients.
基金supported by the Strategic Priority Research Program on Space Science,Chinese Academy of Sciencessupported by the National Key R&D Program of China 2022YFF0503003(2022YFF0503000),2021YFA1600500 (2021YFA1600502)+3 种基金the Strategic Priority Research Program of the Chinese Academy of Sciences,grant No.XDB0560000the National Natural Science Foundation of China (NSFC,grant Nos.12373065,12203102,12403064,and 12403068)Natural Science Foundation of Jiangsu Province (BK20231510,BK20241707)Supported by the Specialized Research Fund for State Key Laboratories,and Yunnan Key Laboratory of Solar Physics and Space Science under the grant No.YNSPCC202206
文摘In this paper,we perform a follow-up investigation of the solar eruption originating from active region 13575 on 2024 February 9.The primary eruption of a hot channel generates an X3.4 class flare,a full-halo coronal mass ejection(CME),and an extreme-ultraviolet(EUV)wave.Interaction between the wave and a quiescent prominence(QP)leads to a large-amplitude,transverse oscillation of QP.After the transverse oscillation,QP loses equilibrium and rises up.The ascending motion of the prominence is coherently detected and tracked up to∼1.68 R_(⊙)by the Solar UltraViolet Imager onboard the GOES-16 spacecraft and up to∼2.2 R_(⊙)by the Solar Corona Imager(SCI_UV)of the LyαSolar Telescope onboard the ASO-S spacecraft.The velocity increases linearly from 12.3 to 68.5 km s^(−1)at 18:30 UT.The sympathetic eruption of QP drives the second CME with a typical three-part structure.The bright core comes from the eruptive prominence,which could be further observed up to∼3.3 R_(⊙) by the Large Angle Spectroscopic Coronagraph onboard the Solar and Heliospheric Observatory mission.The leading edge of the second CME accelerates continuously from∼120 to∼277 km s^(−1).The EUV wave plays an important role in linking the primary eruption with the sympathetic eruption.
文摘Background Accurate measurement of left ventricular ejection fraction(LVEF)is crucial in diagnosing and managing cardiac conditions.Deep learning(DL)models offer potential to improve the consistency and efficiency of these measurements,reducing reliance on operator expertise.Objective The aim of this study was to develop an innovative software-hardware combined device,featuring a novel DL algorithm for the automated quantification of LVEF from 2D echocardiographic images.Methods A dataset of 2,113 patients admitted to the Affiliated Hospital of Qingdao University between January and June 2023 was assembled and split into training and test groups.Another 500 patients from another campus were prospectively collected as external validation group.The age,sex,reason for echocardiography and the type of patients were collected.Following standardized protocol training by senior echocardiographers using domestic ultrasound equipment,apical four-chamber view images were labeled manually and utilized for training our deep learning framework.This system combined convolutional neural networks(CNN)with transformers for enhanced image recognition and analysis.Combined with the model that was named QHAutoEF,a‘one-touch’software module was developed and integrated into the echocardiography hardware,providing intuitive,realtime visualization of LVEF measurements.The device’s performance was evaluated with metrics such as the Dice coefficient and Jaccard index,along with computational efficiency indicators.The dice index,intersection over union,size,floating point operations per second and calculation time were used to compare the performance of our model with alternative deep learning architectures.Bland-Altman analysis and the receiver operating characteristic(ROC)curve were used for validation of the accuracy of the model.The scatter plot was used to evaluate the consistency of the manual and automated results among subgroups.Results Patients from external validation group were older than those from training group((60±14)years vs.(55±16)years,respectively,P<0.001).The gender distribution among three groups were showed no statistical difference(43%vs.42%vs.50%,respectively,P=0.095).Significant differences were showed among patients with different type(all P<0.001)and reason for echocardiography(all P<0.001 except for other reasons).QHAutoEF achieved a high Dice index(0.942 at end-diastole,0.917 at end-systole)with a notably compact model size(10.2 MB)and low computational cost(93.86 G floating point operations(FLOPs)).It exhibited high consistency with expert manual measurements(intraclass correlation coefficient(ICC)=0.90(0.89,0.92),P<0.001)and excellent capability to differentiate patients with LVEF≥60%from those with reduced function,yielding an area under the operation curve(AUC)of 0.92(0.90–0.95).Subgroup analysis showed a good correlation between QHAutoEF results and manual results from experienced experts among patients of different types(R=0.93,0.73,0.92,respectively,P<0.001)and ages(R=0.92,0.94,0.89,0.91,0.81,respectively,P<0.001).Conclusions Our software-hardware device offers an improved solution for the automated measurement of LVEF,demonstrating not only high accuracy and consistency with manual expert measurements but also practical adaptability for clinical settings.This device might potentially support clinicians and augment clinical decision.
基金Supported by Science and Technology Department of Yunnan Province-Kunming Medical University,Kunming Medical Joint Special Project-Surface Project,No.202401AY070001-164Yunnan Provincial Clinical Research Center Cardiovascular Diseases-New Technology Research for Development Project for Diagnosis and Treatment Cardiovascular Diseases,No.202102AA310002the Key Technology Research and Device Development Project for Innovative Diagnosis and Treatment of Structural Heart Disease in the Southwest Plateau Region,No.202302AA310045.
文摘Heart failure(HF)has emerged as one of the foremost global health threats due to its intricate pathophysiological mechanisms and multifactorial etiology.Adeno-sine triphosphate(ATP)-induced cell death represents a novel form of regulated cell deaths,marked by cellular energy depletion and metabolic dysregulation stemming from excessive ATP accumulation,identifying its uniqueness compared to other cell death processes modalities such as programmed cell death and necrosis.Growing evidence suggests that ATP-induced cell death(AICD)is predominantly governed by various biological pathways,including energy meta-bolism,redox homeostasis and intracellular calcium equilibrium.Recent research has shown that AICD is crucial in HF induced by pathological conditions like myocardial infarction,ischemia-reperfusion injury,and chemotherapy.Thus,it is essential to investigate the function of AICD in the pathogenesis of HF,as this may provide a foundation for the development of targeted therapies and novel treatment strategies.This review synthesizes current advancements in under-standing the link between AICD and HF,while further elucidating its invol-vement in cardiac remodeling and HF progression.
基金Supported by the JSPS KAKENHI,No.JP21K10300 and No.JP24K02714.
文摘BACKGROUND Early diagnosis of left ventricular diastolic dysfunction(LVDD)is essential for preventing heart failure.B-type natriuretic peptide(BNP)is a viable marker for predicting LVDD,as elevated BNP levels have been associated with worsening LVDD in patients with diabetes over time.However,the utility of BNP as a diagnostic marker in diabetes is controversial,as BNP levels are often low in overweight individuals.AIM To examine the effectiveness of BNP levels and fragmented QRS(fQRS)on electrocardiography for diagnosing LVDD in patients with type 2 diabetes.METHODS This retrospective cohort study included 303 patients with type 2 diabetes(67.4±12.3 years old)with preserved ejection fraction(EF)≥50%admitted to Toyama University Hospital for glycemic management and comorbidity evaluation between November 2017 and April 2021.All participants underwent plasma BNP measurement,electrocardiography,and echocardiography.Cardiologists who were blinded to the BNP results assessed the electrocardiograms and echocardiograms.Subgroup analyses were conducted for overweight individuals.RESULTS Receiver operating characteristic(ROC)curve analysis determined optimal BNP cut-off values of 34.8 pg/mL and 7.2 pg/mL for diagnosing LVDD in non-overweight[area under the ROC curve(AUC):0.70]and overweight(AUC:0.55)groups,respectively(P=0.040).In the overweight subgroup,fQRS showed greater diagnostic accuracy for LVDD(AUC:0.67),indicating moderate diagnostic utility compared with the low performance of the BNP cutoff of 35 pg/mL(AUC:0.52)(P=0.010).Multivariate analyses confirmed that fQRS was superior to BNP for LVDD diagnosis regardless of the patient’s weight.CONCLUSION A BNP level≥35 pg/mL in non-overweight individuals may be a reliable LVDD marker.Additionally,fQRS was more effective than BNP in diagnosing LVDD irrespective of the patient’s weight.fQRS can complement BNP in the early detection of LVDD,especially in overweight patients,potentially improving early detection and mitigating progression to heart failure with preserved EF in patients with type 2 diabetes.
