Background: Transcatheter aortic valve replacement (TAVR) has emerged as the preferred treatment for symptomatic severe aortic stenosis (AS). However, China’s unique patient population presents distinct challenges, including a higher prevalence of bicuspid aortic valves (BAVs) and severe valve calcification. This study used real-world clinical data from Chinese patients to assess the safety and efficacy of the SAPIEN 3 balloon-expandable transcatheter heart valve (THV) in TAVR, particularly in patients with BAVs. Methods: This retrospective, multicenter study enrolled consecutive severe AS patients treated with SAPIEN 3 THVs via a transfemoral approach from June 2020 to March 2024. The primary endpoint was 30-day mortality, while secondary endpoints included procedural mortality, procedural success, conversion to surgery, coronary artery occlusion, THV-in-THV deployment, permanent pacemaker implantation, and paravalvular leaks (PVLs). Results: Among the 1642 enrolled patients, 56.0% had BAVs, and 44.0% had tricuspid aortic valves (TAVs). The 30-day mortality rate was 0.90%. Propensity score matching revealed no statistically significant differences between patients with BAVs and TAVs in terms of 30-day mortality (odds ratio (OR): 1.51, 95% confidence interval (CI): 0.42 to 5.36; p = 0.531), immediate procedural mortality, procedural success, coronary artery occlusion, THV-in-THV deployment, permanent pacemaker implantation, or moderate to severe PVLs. However, a significant difference was found in the conversion rate to open surgery (OR: 5.07, 95% CI: 1.11 to 23.2; p = 0.036). Conclusions: This study demonstrates the safety and feasibility of SAPIEN 3 balloon-expandable THVs in TAVR for Chinese patients with severe AS, including those with BAV stenosis. These findings challenge historical relative contraindications for TAVR in BAV patients and highlight the potential of TAVR in diverse patient populations. Larger prospective studies with extended follow-ups are needed to refine patient selection and evaluate longer-term outcomes.

Self-expandable valves (SEVs) and balloon-expandable valves (BEVs) are the most widely used transcatheter heart valves. In patients with ascending aortic dilation (AAD) who undergo transcatheter aortic valve replacement (TAVR), comparison of two type of valves is lacking. The AAD-CHOICE trial is a multi-center, randomized controlled, open-label study. The trial will randomly assign 100 patients with AAD (ascending aortic diameter ≥ 45 mm) who undergo TAVR in 1:1 ratio to either SEV group or BEV group. Participants will be followed for a minimum of 1 year. The primary end point is device success, 30-day all-cause mortality and 30-day adverse aortic events. The key secondary end point is 1-year all-cause mortality, 1-year cardiovascular mortality, adverse aortic events, major adverse cardiovascular and cerebrovascular events, and aortic expansion rate ≥ 3 mm/year. The study will provide evidence regarding the performance of SEVs and BEVs in patients with AAD who undergo TAVR. ClinicalTrials.gov NCT06009588. Registered on August 12, 2023.

The objective is to differentiate between patent foramen ovale (PFO) and pulmonary arteriovenous malformations (PAVM) using simultaneous contrast transthoracic echocardiography (cTTE) and contrast transcranial cerebral Doppler (cTCD). A total of 193 patients suspected of having a right-to-left shunt were classified into four groups based on the reference standard, including PFO (n = 102), PAVM (n = 18), negative subjects (n = 53), and indeterminate group (n = 20). Simultaneous cTTE and cTCD were performed in all patients. The comparison between PFO and PAVM was as follows: (1) The cut-off for cardiac cycles was set at ≤ 3 for PFO and ≥ 4 for PAVM. (2) Regarding the quantity of left atrial (LA) bubbles at rest, less than 30 bubbles were observed in 76.4% of patients with PFO, while more than 30 bubbles were found in 94.4% of patients with PAVM. (3) The cut-off of incremental bubbles during modified Valsalva were set at ≥ 10 bubbles for PFO and ≤ 1 bubble for PAVM. (4) The percentages of observed bubbles crossing either interatrial septum or pulmonary vein were 11.8% and 72.2% in the PFO and PAVM groups, respectively. In PFO group, the simultaneous use of cTTE and cTCD demonstrated a high area under the curve (AUC) of 0.973 using incremental bubbles. The successful application of cTCD-guide Valsalva maneuver resulted in a higher quantity of LA bubbles observed in cTTE findings. Simultaneous use of cTTE and cTCD enables differential diagnosis between PFO and PAVM. Moreover, the use of cTCD-guide Valsalva maneuver is recommended for PFO diagnosis.

Background Data on mitral valve transcatheter edge-to-edge repair (M-TEER) in Asian patients are limited. This study evaluates the anatomical suitability and clinical efficacy of M-TEER in Chinese patients with moderate-to-severe or severe mitral regurgitation (MR). Methods This study included symptomatic patients with moderate-to-severe or severe MR who underwent M-TEER echocardiographic screening at Fuwai Hospital from January 2021 to February 2024. Patients were classified according to current anatomical criteria for M-TEER. Clinical characteristics, echocardiographic parameters, and treatments were summarized, focusing on the procedural success of M-TEER and 1-year MR recurrence rates. Results A total of 481 patients were enrolled, including 304 with degenerative MR (DMR) and 150 with functional MR (FMR). The average age was 68.81 years, 44.28 % were female, and 70.69 % had severe MR. DMR patients had smaller absolute left atrial and ventricular diameters compared to FMR patients. Ideal, suitable, challenging, and impossible M-TEER anatomy was found in 23.49 %, 36.17 %, 13.93 %, and 26.4 % of patients, respectively. Among those who underwent M-TEER, these proportions were 36 %, 46 %, 15 %, and 3 %. The 1-year cumulative incidence of MR recurrence was similar between different etiologies but significantly lower in patients with ideal/suitable anatomy compared to those with challenging/impossible anatomy (5.28 % vs 11.86 %, P = 0.003). Multivariable analysis showed that a leaflet-to-annulus index <1.2 was associated with approximately a 5.8-fold increased risk of MR recurrence within one year. Conclusion Among patients with significant MR, 59.66 % had ideal/suitable M-TEER anatomy, but only 48 % received treatment, indicating potential undertreatment. Patients with ideal/feasible anatomy had higher procedural success rates and lower recurrence risks.

INTRODUCTION AND OBJECTIVES:This study aimed to retrospectively analyze the anatomical characteristics and classification of multiple coronary artery fistulas (MCAFs), and to compare the outcomes of transcatheter closure between MCAFs and single fistulas. METHODS:All patients who underwent attempts at transcatheter closure of coronary artery fistulas (CAFs) at Fuwai Hospital from 2010 to 2023 were retrospectively reviewed. Patients were categorized into single fistula and MCAFs groups, and anatomical characteristics and transcatheter closure outcomes were compared between the 2 groups. RESULTS:This retrospective study included 146 patients who underwent attempted transcatheter closure of CAFs, with a 14.38% failure rate. Among the 146 patients with CAFs, 32.19% were identified as having MCAFs, with types I, II, and III constituting 40.43%, 42.55%, and 17.02%, respectively. Unlike single fistulas, which predominantly originated from the right coronary artery and terminated in the left ventricle, MCAFs mainly had simultaneous origins from the right coronary artery and left anterior descending artery (29.79%), and predominantly drained into the pulmonary artery (70.21%), with a notable prevalence of plexus-like morphology (38.3% vs 2.02%, P<.001). The success rate of transcatheter closure was significantly lower for multiple fistulas compared with single fistula (64.29% vs 84.34%, P=.011). Multivariate regression analysis indicated that the risk of closure failure for MCAFs was 2.64 times that of single fistulas. CONCLUSIONS:MCAFs are common among CAFs and can be classified into 3 types based on the number and location of their origins and terminations. The risk of failure of transcatheter closure is significantly higher in MCAFs than in single fistulas.

Radar data acquisition constrained by uncertainties requires that the radar target recognition system needs to have dynamic learning capability. As a key, automatic sample annotation directly restricts the practicalization of radar target recognition technology, which is mainly based on the supervised learning method. Aiming at the automatic sample annotation problem in radar target recognition based on high resolution range profiles, a radar target recognition architecture with automatic sample annotation capability is proposed by combining traditional target recognition technology with deep learning technology, which can effectively improve the robustness of radar target recognition system. The experimental results based on the measured data show that the proposed architecture can efficiently complete the automatic annotation of data samples required for training radar target recognition models, accelerate the application of radar target recognition under the condition of insufficient data, support the online learning of radar target recognition, and have strong engineering practicability.

Introduction and objectives: This study aimed to retrospectively analyze the anatomical characteristics and classification of multiple coronary artery fistulas (MCAFs), and to compare the outcomes of transcatheter closure between MCAFs and single fistulas.Methods: All patients who underwent attempts at transcatheter closure of coronary artery fistulas (CAFs) at Fuwai Hospital from 2010 to 2023 were retrospectively reviewed. Patients were categorized into single fistula and MCAFs groups, and anatomical characteristics and transcatheter closure outcomes were compared between the 2 groups.Results: This retrospective study included 146 patients who underwent attempted transcatheter closure of CAFs, with a 14.38% failure rate. Among the 146 patients with CAFs, 32.19% were identified as having MCAFs, with types I, II, and III constituting 40.43%, 42.55%, and 17.02%, respectively. Unlike single fistulas, which predominantly originated from the right coronary artery and terminated in the left ventricle, MCAFs mainly had simultaneous origins from the right coronary artery and left anterior descending artery (29.79%), and predominantly drained into the pulmonary artery (70.21%), with a notable prevalence of plexus-like morphology (38.3% vs 2.02%, P < .001). The success rate of transcatheter closure was significantly lower for multiple fistulas compared with single fistula (64.29% vs 84.34%, P = .011). Multivariate regression analysis indicated that the risk of closure failure for MCAFs was 2.64 times that of single fistulas.Conclusions: MCAFs are common among CAFs and can be classified into 3 types based on the number and location of their origins and terminations. The risk of failure of transcatheter closure is significantly higher in MCAFs than in single fistulas.

Spermiation is the process that releases mature spermatids from Sertoli cells into the lumen of the seminiferous tubule. Tubulobulbar complexes (TBCs) are elaborate cytoskeleton-related structures that are indispensable for spermiation. Despite well-defined ultrastructural events, the molecular regulation of TBCs during spermiation remains largely unknown. Here, we show that autophagy is active in TBC regions, and impaired autophagy in Sertoli cells affects spermiation. Further studies demonstrated that many TBC components bound to LC3 and could be selectively degraded through the autophagy-lysosome pathway. Perturbed autophagy impaired the degradation of some TBC components in Sertoli cells, such as VCL and CTTN, and led to the accumulation of TBC components surrounding the spermatid head, which may be associated with the sperm-releasing defect. Together, our results reveal that autophagy is essential for the TBC components degradation in mouse Sertoli cells and define a functional role of autophagy during spermiation.

Background Pretricuspid shunts have been associated with poorer survival rates in patients with Eisenmenger syndrome compared with postricuspid shunts and complex lesions. However, the risk stratification for persistent pulmonary hypertension (PH) in this population remains uncertain. Methods and Results We retrospectively enrolled 103 patients with pretricuspid shunts with high total pulmonary resistance >4.5 Wood units (estimated pulmonary vascular resistance ≥3 Wood units). During a mean±SD follow‐up of 20.95±24.84 months, 32 patients developed postoperative persistent PH after shunt correction. We identified 3 significant predictors of postoperative persistent PH, including mean pulmonary artery pressure after inhaled oxygen ≥40.5 mm Hg (odds ratio [OR], 7.78 [95% CI, 2.02–30.03]; P <0.01), total pulmonary resistance after inhaled oxygen ≥6.5 Wood units (estimated pulmonary vascular resistance ≥5 Wood units; OR, 12.23 [95% CI, 2.12–70.46]; P <0.01), and artery oxygen saturation at rest <95% (OR, 3.34 [95% CI, 1.07–10.44]; P =0.04). We established the prediction model with the C‐statistics of 0.85 (95% CI, 0.77–0.93; P <0.01), and the C‐statistic was 0.83 (95% CI, 0.80–0.86) after bootstrapping 10 000 times with a good performance of the nomogram calibration curve for predicting persistent PH. Conclusions Our study presents a multivariable risk stratification model for persistent PH after shunt correction in adults with pretricuspid shunts. This model, based on 3 hemodynamic predictors after inhaled oxygen, may assist in identifying individuals at higher risk of persistent PH after shunt correction.

目的:评价单纯经胸超声心动图(TTE)引导经皮介入治疗复杂房间隔缺损的临床疗效.方法:选取中国医学科学院阜外医院 2019 年 1 月至 2019 年 12 月在单纯TTE引导下接受经皮介入封堵复杂房间隔缺损的 47 例患者(男性 9 例、女性 38 例)的临床资料.所有患者术前均经超声心动图明确诊断,术中在TTE引导下经股静脉完成治疗.收集患者术前、术后 6 个月和 12 个月的超声心动图和心电图数据.结果:所有患者均使用1个封堵器完成介入封堵,平均手术时间为(55.2±21.0)min,平均住院时间为(5.0±1.7)d,封堵器的平均直径为(22.0±6.6)mm.出院前1例(2.1%)患者房水平分流7 mm(使用8 mm带孔封堵器),中量、少量、微量残余分流患者分别有 4 例(8.5%)、2 例(4.3%)、1 例(2.1%).术后新发不完全性右束支阻滞 1 例(2.1%),经药物治疗后好转.与术前相比,术后6个月和12个月时患者的右心房内径、右心室舒张末期内径均明显减小(P均＜0.05).术后 1 年时,出院前的 3 例少量和微量残余分流均消失,4 例中量残余分流变为少量残余分流,1 例患者房水平分流由出院前的 7 mm减少为 5 mm;1 年完全封堵率为 89.4%(42/47).结论:单纯TTE引导经皮介入封堵复杂房间隔缺损的效果良好,该方法不仅避免了放射线损伤,而且保持了传统经皮介入治疗安全、微创的优点.

(1) Background: the indications for transcatheter closure of large patent ductus arteriosus (PDA) with severe pulmonary hypertension (PH) are still unclear, and scholars have not fully elucidated the factors that affect PH prognosis. (2) Methods: we retrospectively enrolled 134 consecutive patients with a PDA diameter ≥10 mm or a ratio of PDA and aortic >0.5. We collected clinical data to explore the factors affecting follow-up PH. (3) Results: 134 patients (mean age 35.04 ± 10.23 years; 98 women) successfully underwent a transcatheter closure, and all patients had a mean pulmonary artery pressure (mPAP) >50 mmHg. Five procedures were deemed to have failed because their mPAP did not decrease, and the patients experienced uncomfortable symptoms after the trial occlusion. The average occluder (pulmonary end) size was almost twice the PDA diameter (22.33 ± 4.81 mm vs. 11.69 ± 2.18 mm). Left ventricular end-diastolic dimension (LVEDD), mPAP, and left ventricular ejection fraction (LVEF) significantly reduced after the occlusion, and LVEF recovered during the follow-up period. In total, 42 of the 78 patients with total pulmonary resistance >4 Wood Units experienced clinical outcomes, and all of them had PH in the follow-up, while 10 of them had heart failure, and 4 were hospitalized again because of PH. The results of a logistic regression analysis revealed that the postoperative mPAP had an independent risk factor (odds ratio = 1.069, 95% confidence interval: 1.003 to 1.140, p = 0.040) with a receiver operating characteristic curve cut-off value of 35.5 mmHg (p < 0.001). (4) Conclusions: performing a transcatheter closure of large patent ductus arteriosus is feasible, and postoperative mPAP was a risk factor that affected the follow-up PH. Patients with a postoperative mPAP >35.5 mmHg should be considered for targeted medical therapy or should undergo right heart catheterization again after the occlusion.

目的 比较经颈静脉与经股静脉两种途径在门诊行房间隔缺损(ASD)封堵术的临床治疗效果及特点.方法 回顾性分析中国医学科学院阜外医院门诊2021年3—12月收治的行单纯超声引导经皮ASD封堵术的56例患者的临床资料.根据血管途径不同,将患者分入经股静脉途径组(n=31)与经颈静脉途径组(n=25).比较两组患者的手术成功率、封堵器大小、手术操作时间、在院时间、住院费用等指标,观察围术期和随访期间的并发症发生情况.结果 两组患者在经胸超声引导下完成手术,手术成功率均为100％,术中未出现外周血管损伤、心包积液、封堵器脱落等严重并发症.经股静脉途径组和经颈静脉途径组封堵器大小和手术操作时间比较,差异均无统计学意义(P>0.05).经颈静脉途径组在院时间短于经股静脉途径组,住院费用少于经股静脉途径组,差异均有统计学意义(P<0.05).经股静脉途径组中的1例患者因术后5 h下床后伤口渗血而于术后第1天出院,其余患者均于手术当天出院.两组患者均接受6(3,6)个月随访,随访期间无残余分流、外周血管损伤、心脏穿孔、封堵器脱落等严重并发症.结论 门诊开展单纯超声引导经颈静脉或经股静脉途径ASD封堵术安全有效,建议在技术成熟的心脏中心首选经颈静脉途径.

Background:Transcatheter closure of inferior sinus venosus defect (ISVD) is still contraindication. To explore whether transcatheter closure with patent ductus arteriosus (PDA) occluders is possible for ISVD.Methods:From June 2014 to March 2021, 12 patients were recruited diagnosed as <25 mm ISVD. The three-dimensional printing (3DP) heart model was produced based on multi-slice computed tomography (MSCT) scans. Preoperative closure simulation was planned on the personalized 3D model for each patient. Follow-up including electrocardiography (ECG), transthoracic echocardiography (TTE), and X-ray was traced.Results:3DP models of 12 patients were successfully printed. Twelve patients had been diagnosed with <25 mm ISVD and 4 of them had another secundum atrial septal defect (ASD). All patients were produced interventional therapy successfully. PDA occluder was implanted to closed ISVD, and ASD was closed using ASD occluder simultaneously. The average diameter of ISVD measured by TTE was (12.67±3.80), and the average diameter of sagittal axes and longitudinal axes measured by the 3D-printed model was (17.08±3.20) and (18.42±4.62) mm, respectively. The average size of PDA (diameter of pulmonary artery side) was (28.17±3.35) mm. Compared with the preoperative, the X-ray cardiothoracic ratio (0.51±0.04 vs. 0.47±0.06, P=0.007) and the right ventricle anterior-posterior diameter (31.17±5.65 vs. 24.58±3.75 mm, P<0.001) of postoperative was significantly decreased. During the average (47.75±27.52) months follow-up, it has achieved satisfying results, and there were no severe adverse events such as device transposition, death, and pericardial tamponade occurred.Conclusions:Assisting by 3D heart model, transcatheter closure of ISVD with PDA occluder had an excellent outcome. This method provides a new considerable treatment strategy for ISVD.

Objective:To explore the feasibility of three-dimensional CT axial sequence assisted volumetric measurement (CTAS) in evaluating atrial septal defect (ASD).Methods:The patients with single secundum ASD who successfully underwent interventional therapy in Fuwai Hospital from January 2016 to December 2019 were retrospectively collected. The patients underwent coronary CT angiography (CTA) before and on the second day after closures, and DSA examinations during operation. A total of 52 cases met the inclusion conditions, among them, there were 37 patients with large defects which had deficient inferior rims ≤3 mm, and 15 patients with severe pulmonary arterial hypertension that occluded with fenestrated ASD occluder. The CT data of patients before and after operation were reconstructed by CTAS. Then the anatomical structure of ASD before the operation was evaluated, including the long diameter and short diameter of ASD, and the CT three-dimensional volume diameter of ASD was calculated by using the equivalent circle conversion formula of ellipse. The waist diameter of occluder and rims of the ASD were measured after occlusion on postoperative CT three-dimensional volume reconstruction images. Meanwhile, the deployed occluder waist dimension was measured in DSA examination during the operation by simulating the balloon measurement of ASD. Lastly, paired t-test and consistency analysis were carried out among the values of parameters. Results:Before operation, the equivalent circle diameter of ASD was (32.3±5.4) mm measured by CTAS. After ASD occlusion, the size of the waist dimension measured by DSA and CTAS were (32.5±4.9) mm and (32.6±4.9) mm. There were no significant differences between them ( P>0.05). There were also no significant differences for each rims of the ASD pre and post operation on CTAS except for the inferior rims and the total length of atrial septum in superior-inferior direction ( P>0.05). Conclusion:As an alternative to balloon sizing, CTAS can be used as a reference standard to conduct ASD interventional treatment.

Objective Preclinical research suggests that the combined use of radiofrequency ablation and balloon dilation (CURB) could create stable interatrial communications without device implantation. This study examined the first in-human use of CURB for modified atrial septostomy in patients with severe pulmonary arterial hypertension (PAH). Methods Between July 2018 and October 2021, CURB was performed in 19 patients with severe PAH (age: 31.5±9.1 years; mean pulmonary artery pressure: 73 mm Hg (IQR: 66–92); pulmonary vascular resistance: 18.7 Wood units (IQR: 17.8–23.3)). Under guidance of intracardiac echocardiography and three-dimensional location system, (1) fossae ovalis was reconstructed and ablated point-by-point with radiofrequency; (2) then graded balloon dilation was performed after transseptal puncture and the optimal size was determined according to the level of arterial oxygen saturation (SatO 2 ); (3) radiofrequency ablation was repeated around the rims of the created fenestration. The interatrial fenestrations were followed-up serially. Results After CURB, the immediate fenestration size was 4.4 mm (IQR: 4.1–5.1) with intracardiac echocardiography, systolic aortic pressure increased by 10.2±6.9 mm Hg, cardiac index increased by 0.7±0.3 L/min/m 2 and room-air resting SatO2 decreased by 6.2±1.9% (p<0.001). One patient experienced increased pericardiac effusion postoperatively; the others had no complications. On follow-up (median: 15.5 months), all interatrial communications were patent with stable size (intraclass correlation coefficient=0.96, 95%CI:0.89 to 0.99). The WHO functional class increased by 1 (IQR: 1–2) (p<0.001) with improvement of exercise capacity (+159.5 m, P<0.001). Conclusion The interatrial communications created with CURB in patients with severe PAH were stable and the mid-term outcomes were satisfactory. Trial registration number NCT03554330 .

Background: There have been marked advances in devices such as Amplatzer Duct Occluder II (ADO-II) or vascular plug through 5Fr delivery sheath for closure of patent ductus arteriosus (PDA) in the past five decades, making it possible for cardiologists to deliver occluders via different approaches. However, comparisons of these different approaches have not been reported. Therefore, the aim of this study was to summarize and compare the advantages of different approaches for PDA closure, and to guide clinical strategies. Methods: This retrospective study included all patients undergoing transcatheter closure of PDA from 2019 to 2020. Patients were matched by 1:1 propensity score matching (PSM). The retrograde femoral artery approach (FAA) and simple vein approach (SVA) groups were compared with the conventional arteriovenous approach (CAA). Results: The average age of the 476 patients was 21.05 ± 21.15 years. Their average weight was 38.23 ± 24.1 kg and average height was 130.14 ± 34.45 cm. The mean diameter of the PDA was 4.29 ± 2.25 mm. There were 127 men and 349 women, comprising 205 adults and 271 children. Among them, 197 patients underwent CAA, 223 underwent SVA, and 56 underwent retrograde FAA. The diameter in the FAA group was smaller than that in the other two groups, but was similar in adults and children. In the PSM comparison of CAA and SVA, 136 patients with CAA and 136 patients with SVA were recruited. Simple vein approach was associated with markedly reduced length of hospital stay, length of operation, and contrast medium usage as compared with CAA (all P < 0.05). In the PSM comparison of FAA and CAA, 30 patients with CAA and 30 patients with FAA were recruited. The operation duration was longer in the CAA than in the FAA group. There were no significant differences in postoperative complications among groups. Conclusion: Patent ductus arteriosus closure by using the SVA and FAA is safe and effective, and has certain advantages in some respects as compared with CAA.

A 60-year-old man was diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH) based on pulmonary angiography and one occlusive vessel was shown in the selective pulmonary angiography (Panel A). During the balloon pulmonary angioplasty (BPA) procedure, the debris was collected by a distal embolic protection device (Panel C) and then the debris was sent for histological examination. The occlusive vessel was recanalized (Panel B) after the operation. The pulmonary arterial pressures decreased from 79/28/47 to 56/21/35 mmHg. The histological examination showed that the debris was composed of amorphous mass of collagen fibres (★), fibroblast (the black arrow), fibrin clumps (▲), erythrocytes, and necrotic fragment (Panel D: Haematoxylin–Eosin staining ×200; Panel E: Masson staining ×200). BPA has been conformed as a feasible and efficient technique for inoperable CTEPH. For the first time, we confirmed the components of debris during the BPA procedure, which...

目的 比较二维经胸超声心动图(2D-TTE)、二维CT血管造影(2D-CTA)及三维CT横断序列辅助(3D-CTAS)技术测量房间隔缺损(ASD)大小的准确性及相关性,探讨二维与三维测量偏倚产生的原因.方法 回顾性研究2015年1月至2019年12月成功行介入治疗的不合并房间隔瘤的单发继发孔型ASD患者,患者于封堵前和封堵后第2天均行心电门控CT血管造影(CTA)检查.分别利用2D-TTE、2D-CTA和3D-CTAS技术测量ASD的最大横径(a)和上下径(b),并利用转换公式推算各技术测得的ASD直径[等效圆直径(ED)=短径+2×(长径-短径)/3].在术后复查CTA图像上测量封堵器腰部直径(DCT-POD),以此作为ASD直径的参考标准,并据此将患者分为A组(DCT-POD<20 mm)及B组(DCT-POD≥20 mm).将上述相应测量值进行比较.结果 共纳入72例(平均年龄46岁,范围18～72岁)患者,其中A组22例,B组50例.对于ASD直径,2D-TTE、2D-CTA和3D-CTAS测得的ED(ED-TTE、ED-CTA和ED-CTAS)与DCT-POD均有良好的相关性(r=0.93、r=0.97及r=0.98),ED-TTE和ED-CTA均明显小于DCT-POD[(-5.09±3.45)mm,P<0.05;(-1.74±2.26)mm,P<0.05],ED-CTAS与DCT-POD相比则差异无统计学意义[(-0.13±1.89)mm,P=0.56].横径a:2D-TTE与3D-CTAS测量值在A组中[(-1.83±2.37)mm,P<0.001]及B组中[(-2.64±4.69)mm,P<0.001]的差异均有统计学意义,但其差值在两组间差异无统计学意义(P=0.611).上下径b:2D-TTE与3D-CTAS测量值在A组中[(-2.23±2.30)mm,P<0.001]及B组中[(-7.31±5.22)mm,P<0.001]的差异均有统计学意义,且其差值在两组间差异有统计学意义(P<0.001);A组2D-CTA与3D-CTAS测量值的差异无统计学意义[(-0.28±1.34)mm,P=0.341],B组则差异有统计学意义[(-2.64±4.36)mm,P<0.001],且其差值在两组间差异有统计学意义(P<0.001).结论 3D-CTAS测量ASD大小与金标准没有明显差异,其优于二维测量技术的关键是能准确测量ASD上下径并消除其薄弱边缘.

This study aims to explore the role of MARK2 in chemotherapeutic resistance and potential mechanism within cisplatin resistance models of CD133+ MG-63 and MNNG/HOS cells.CD133− and CD133+ MG-63 and MNNG/HOS cells were differentiated and obtained by MACS(Magnetic bead sorting). Cell activity was determined by CCK-8 assay. siRNA was employed to down regulate the Microtubule Affinity Regulated Kinase 2 (MARK2) expression. Immunofluorescence detection and RT-qPCR were used to measure the expressions of MARK2 and DNA-PKcs at both protein and mRNA levels. Western blot was applied to test the levels of MARK2, γH2AX (S139), DNA-PKcs, Phospho-PI3 Kinase p85 (Tyr458), Akt, phospho-Akt (T308) antibodies, mTOR, phospho-mTOR (Ser2448).Compared with CD133− MG-63 cells, CD133+ MG-63 cells showed significantly strong cisplatin resistance, with high levels of MARK2, DNA-PKcs and potent DNA damage repair ability (p<0.05). Down regulation of MARK2 reduced the cisplatin resistance of CD133+ MG-63 cells, with deceasing expression of DNA-PKcs (p<0.05). PI3K/Akt/mTOR pathway was potentially activated in CD133+ MG-63 cells, and involved in the cisplatin resistance of MG-63 cells. The similar results were observed in CD133+ MNNG/HOS cells. The reduction of MARK2 retarded the activity of PI3K/Akt/mTOR pathway and further impeded the cisplatin resistance in CD133+ MG-63 and MNNG/HOS cell.Our data suggested that MARK2 was related to cisplatin resistance in CD133+ MG-63 and MNNG/HOS cells. The decrease of MARK2 restricted the cisplatin resistance of CD133+ MG-63 and MNNG/HOS cells by down regulating the expression of DNA dependent protein kinase catalytic subunit (DNA-PKcs) and inhibiting activity of PI3K/Akt/mTOR signaling pathway, which provides new clues for the osteosarcoma chemotherapy strategy.