BACKGROUND:Long-term success rates of catheter ablation (CA) for long-standing persistent atrial fibrillation (LSPAF) are less than satisfactory. Further improvement of ablation methods is crucial for enhancing the treatment of LSPAF. OBJECTIVES:This study sought to compare the outcomes of concurrent vs staged minimally invasive surgical-catheter hybrid ablation for LSPAF. METHODS:From December 2015 to December 2021, 104 matched patients (concurrent and staged, 1:1) were included in study. In the concurrent group, both left unilateral thoracoscopic epicardial ablation (EA) and CA were performed simultaneously in one procedure. In the staged group, EA was performed at the first hospitalization. If the patients experienced atrial fibrillation (AF) recurrence, CA was performed between 3 months and 1 year after EA. RESULTS:In the concurrent group, 4 patients were restored to sinus rhythm after EA, and 41 were patients restored to sinus rhythm during CA; 86.5% (45 of 52) achieved intraprocedural AF termination during concurrent hybrid ablation. In the staged group, all 52 patients underwent staged CA because of the recurrence of AF or atrial tachycardia (AT). Forty-seven (90.4%) patients achieved intraprocedural AF or AT termination during CA. Freedom from AF or AT off antiarrhythmic drugs at 2 years after hybrid ablation was 79.9% ± 5.7% in the concurrent group and 86.0% ± 4.9% in the staged group (P = 0.390). Failure of intraprocedural AF termination (HR: 14.378) was an independent risk factor for AF recurrence after hybrid ablation. CONCLUSIONS:Both concurrent and staged hybrid ablation could be safely and effectively applied to treat LSPAF. Improving the intraprocedural AF termination rate predicted better outcomes.

BackgroundCarotid plaques are major risk factors for stroke. Carotid ultrasound can help to assess the risk and incidence rate of stroke. However, large-scale carotid artery screening is time-consuming and laborious, the diagnostic results inevitably involve the subjectivity of the diagnostician to a certain extent. Deep learning demonstrates the ability to solve the aforementioned challenges. Thus, we attempted to develop an automated algorithm to provide a more consistent and objective diagnostic method and to identify the presence and stability of carotid plaques using deep learning.MethodsA total of 3,860 ultrasound images from 1,339 participants who underwent carotid plaque assessment between January 2021 and March 2023 at the Shanghai Eighth People’s Hospital were divided into a 4:1 ratio for training and internal testing. The external test included 1,564 ultrasound images from 674 participants who underwent carotid plaque assessment between January 2022 and May 2023 at Xinhua Hospital affiliated with Dalian University. Deep learning algorithms, based on the fusion of a bilinear convolutional neural network with a residual neural network (BCNN-ResNet), were used for modeling to detect carotid plaques and assess plaque stability. We chose AUC as the main evaluation index, along with accuracy, sensitivity, and specificity as auxiliary evaluation indices.ResultsModeling for detecting carotid plaques involved training and internal testing on 1,291 ultrasound images, with 617 images showing plaques and 674 without plaques. The external test comprised 470 ultrasound images, including 321 images with plaques and 149 without. Modeling for assessing plaque stability involved training and internal testing on 764 ultrasound images, consisting of 494 images with unstable plaques and 270 with stable plaques. The external test was composed of 279 ultrasound images, including 197 images with unstable plaques and 82 with stable plaques. For the task of identifying the presence of carotid plaques, our model achieved an AUC of 0.989 (95% CI: 0.840, 0.998) with a sensitivity of 93.2% and a specificity of 99.21% on the internal test. On the external test, the AUC was 0.951 (95% CI: 0.962, 0.939) with a sensitivity of 95.3% and a specificity of 82.24%. For the task of identifying the stability of carotid plaques, our model achieved an AUC of 0.896 (95% CI: 0.865, 0.922) on the internal test with a sensitivity of 81.63% and a specificity of 87.27%. On the external test, the AUC was 0.854 (95% CI: 0.889, 0.830) with a sensitivity of 68.52% and a specificity of 89.49%.ConclusionDeep learning using BCNN-ResNet algorithms based on routine ultrasound images could be useful for detecting carotid plaques and assessing plaque instability.

This study aims at developing a dataset for determining the presence of carotid artery plaques in ultrasound images, composed of 1761 ultrasound images from 1165 participants. A deep learning architecture that combines bilinear convolutional neural networks with residual neural networks, known as the single-input BCNN-ResNet model, was utilized to aid clinical doctors in diagnosing plaques using carotid ultrasound images. Following training, internal validation, and external validation, the model yielded an ROC AUC of 0.99 (95% confidence interval: 0.91 to 0.84) in internal validation and 0.95 (95% confidence interval: 0.96 to 0.94) in external validation, surpassing the ResNet-34 network model, which achieved an AUC of 0.98 (95% confidence interval: 0.99 to 0.95) in internal validation and 0.94 (95% confidence interval: 0.95 to 0.92) in external validation. Consequently, the single-input BCNN-ResNet network model has shown remarkable diagnostic capabilities and offers an innovative solution for the automatic detection of carotid artery plaques.

Background: This study aimed to investigate the association between abdominal aortic calcification (AAC) and coronary heart disease (CHD) in essential hypertension (EH). Methods: This study included patients diagnosed with EH during the 2013–2014 NHANES survey cycle. The study cohort was categorized into the following four groups based on their AAC-24 score: no AAC (0); mild AAC (1–4); moderate AAC (5–15); and severe AAC (16–24). Logistic regression models were used to assess the association between AAC and CHD. Restricted cubic spline curves (RCS) were used to explore possible nonlinear relationships between AAC and CHD. Results: The prevalence of CHD was found to be higher in the moderate AAC and severe AAC groups than in the group without AAC (40.1% versus 30.9%, 47.7% versus 30.9%). On a continuous scale, the fully adjusted model showed a 7% increase in the risk of CHD prevalence per score increase in AAC [OR (95% CI) = 1.07 (1.03–1.11)]. On a categorical scale, the fully adjusted model showed the risk of CHD prevalence in EH patients with moderate AAC and severe AAC was 2.06 (95%CI, 1.23–3.45) and 2.18 (1.09–5.25) times higher than that in patients without AAC, respectively. The RCS curve suggested a dose-response linear relationship between AAC and CHD. Conclusion: These findings highlight that in patients with EH, a higher severity of AAC is associated with a higher risk of CHD prevalence.

BackgroundThe association between Estradiol (E2) levels and abdominal aortic calcification (AAC) in postmenopausal women remains unclear.Methods614 postmenopausal women from the 2013-2014 NHANES survey cycle were included in this study. The study population was divided into 3 groups according to E2 tertiles: Tertile1 (2.12-3.57pg/mL), Tertile2 (3.60-7.04pg/mL), and Tertile3 (7.06-38.4pg/mL). Estrogen concentration data were natural logarithmically transformed. A Kauppila score > 5 was regarded as prominent arterial calcification and was used to define (EAAC). Logistic regression models were used to assess the association between E2 levels and EAAC prevalence. Subgroup analyses were performed to test whether the association between E2 levels and EAAC prevalence was consistent in different groups. Sensitivity analyses tested the stability of the model in women older than 45 years.ResultsEAAC prevalence was significantly higher in Tertile1 (16.6%) than in Tertile2 (9.8%) and Tertile3 (8.3%). On a continuous scale, the adjusted model showed a 58% [OR (95%CI), 1.58 (1.02, 2.54)] increase in the risk of EAAC prevalence for per unit decrease in ln(E2). On a categorical scale, the adjusted model showed that Tertile1 and Tertile2 were 2.55 [OR (95%CI), 2.55 (1.10, 5.92)] and 1.31[OR (95%CI), 1.31(1.03, 2.57)] times higher risk of suffering from EAAC than Tertile3, respectively.ConclusionThis study found that a higher prevalence of AAC in postmenopausal women is closely associated with lower serum E2 levels. Our research further underscores the importance of E2 in maintaining cardiovascular health in postmenopausal women and suggests that monitoring E2 levels may aid in the early prevention and management of AAC and related cardiovascular diseases.

Background:Wall shear stress (WSS) is related to the pathogenesis of atherosclerosis. WSS is affected by a variety of hemodynamic factors, and there is still a lack of accurate and objective methods for measuring it. This study sought to evaluate hemodynamic changes in WSSmaximum (max), WSSmean, WSSminimum (min) in the common carotid artery of healthy adults of different ages using vascular vector flow mapping (VFM). Methods:A retrospective analysis was conducted on 70 healthy volunteers aged 20-89 years who were recruited from our Ultrasound Department between February 2021 and June 2021. An ultrasound system with a 3-15 MHz probe was used to determine regions of interest (ROIs) of the common carotid artery. VFM-based WSS measurements were obtained by selecting ROIs with optimal image quality from three full cardiac cycles. The participants were divided into the following seven age groups: the 20s group, the 30s group, the 40s group, the 50s group, the 60s group, the 70s group, and the 80s group. The WSS parameters were compared among the age groups. An analysis of variance or a Kruskal-Wallis test was used to evaluate the difference among the groups, and a Pearson analysis and linear regression were used for the correlation and trend analysis. Results:The WSS parameters were quantified using vascular VFM software. The WSSmax, WSSmean, WSSmin differed among the age groups and gradually decreased with age, the elderly were significantly lower than the young. The Pearson correlation coefficient of the WSSmax and age was -0.556 (P<0.001), that of the WSSmean and age was -0.461 (P<0.001), and that of the WSSmin and age was -0.308 (P<0.001). The WSS parameters with age are negatively correlated the carotid intima-media thickness differed between the groups. Conclusions:The carotid WSSmax, WSSmean, WSSmin can be quantitatively and visually analyzed using the vascular VFM technique. In healthy adults of different ages, the carotid WSSmax, WSSmean, WSSmin decreased with age. Our findings about the normal values of carotid WSS maybe have clinical reference value for future studies.

BRAF-V600E mutation is regarded as the source of lung cancer resistance to trametinib (Tr), and no solution available for completely addressing this intractable resistance has emerged yet. Herein, the combination of ultrasonic (US) propelled folic acid (FA)-modified liposomes strategy and BRAF-driven gene silencing program is proposed to effectively reverse Tr's resistance to lung cancer. Meanwhile, the prepared cationic nanoliposomes can assist Tr drug and BRAF siRNA to escape lysosome disposal, thereby avoiding Tr drug pumping out or siRNA degradation. More significantly, loaded BRAF siRNA is designed to silence BRAF-V600E mutation genes via modulating BRAF-ERK-pathway and remarkably reverse the PC9R resistance to Tr. Systematic experiments validate that these cooperatively sensitize PC9R cells to Tr and shrink resistant NSCLC in vivo, especially after combining with FA-mediated targeting and US-enhanced permeability that permits more intratumoral accumulations of Tr. Such a biocompatible targeting drug-resistance liberation agent and its underlying design strategy lay a foundation avenue to completely reverse tumor resistance, which is preferable to treat BRAF mutation-arised resistance of various tumors, holding high clinical translation potentials.

Background:The early surgical intervention for pulmonary ground-glass nodules (GGNs) has become increasingly important, but accurate identification of these nodules during thoracoscopic surgery poses challenges due to the need for sublobar resections and reliance on visual and tactile perception alone. The prognosis of the procedure is closely tied to the use of precise positioning technology. Thus, it is crucial to develop an accurate positioning technology that can improve patient prognosis.Methods:Clinical data from the cardiothoracic department of a tertiary hospital in Shanghai were collected and analyzed between January 2020 and December 2021. The patients were categorized into 2 groups: an indocyanine green (ICG) group and a hook-wire group. Outcome measures including success rate, complications, procedure time, localization-related pain, and interval time were assessed. Adverse events and reactions were reported and compared between the 2 groups.Results:A total of 62 patients (17 males and 45 females, aged 50.5±13.2 years) were in the ICG group, while 66 patients (23 males and 43 females, aged 48.4±12.9 years) were localized in the hook-wire group. The success rate was comparable between the 2 groups. However, the ICG group showed significant advantages over the hook-wire group in terms of procedure time (22.6±4.4 vs. 24.1±4.9 min; P=0.012), localization-related pain (P<0.001), and interval time [median and interquartile range (IQR): 3 (0.7, 104.9) vs. 1.2 (0.5, 3.3) h; P<0.001]. In the ICG group, there were 11 cases of pneumothorax, 4 cases of hemothorax, and 2 cases of ICG diffusion. In the hook-wire group, there were 24 cases of pneumothorax, 25 cases of hemothorax, and 2 cases of dislodgement. The ICG group had fewer complications, including pneumothorax (P=0.018) and hemothorax (P=0.007), compared to the hook-wire group.Conclusions:Computed tomography (CT)-guided intrapulmonary injection of ICG for preoperative localization of peripheral pulmonary GGNs is a practical and safe technique. It offers advantages in terms of reduced procedure time, localization-related pain, and interval time compared to the hook-wire method. Moreover, the ICG technique results in fewer complications, making it a valuable preoperative localization technique worthy of popularization.

2002年,Peter Lanzer和Eric Topol两位学者基于对血管系统疾病的统一认知,首次提出"泛血管疾病(panvascular diseases)"的概念.近年来,我国连续发布多个心血管疾病防控政策性指导文件,2019年5月《中国泛血管疾病防治蓝皮书2018》发布,至此我国泛血管医学不断从各个层面逐步推进[1].泛血管指人体的血管系统,是动脉、静脉、淋巴管等构成的一个复杂网络,是机体重要器官的"灌溉渠"和人体健康的"生命线".

2014年,Heureaux等[1]发现超声结合微泡可以驱动力敏感离子通道的开放.2015年,Ibsen等[2]首次引入"声遗传学"的方法,使用超声结合微泡激活线虫的特定机械敏感神经元.在声遗传学技术中,微泡是超声监测细胞活动的关键介质.声报告基因(acoustic reporter genes,ARGs)作为生物分子造影剂,允许超声对活体动物体内的基因表达进行高分辨率成像,实现了超声对细胞分子功能的可视化.本文对声遗传学及ARGs的生物学特性作一综述.

Piezo1 channels are non-selective cationic mechanosensitive ion channels and intrinsically mechanosensitive, are mainly expressed in non-excited cells, and have been proved to play significant roles in a variety of physiological processes. Abnormalities in Piezo1 channel structure and function can lead to a variety of diseases, such as lymphedema, bicuspid aortic valve, and embryonic vascular remodeling defects. In this article, we will describe the research progress on Piezo1 and circulatory diseases from three aspects: cardiac, vascular, and lymphatic systems.

Objectives Quality can be a challenge for Investigator initiated trials (IITs) since these trials are scarcely overseen by a sponsor or monitoring team. Therefore, quality assessment for departments managing clinical research grants program is important and urgently needed. Our study aims at developing a handy quality assessment tool for IITs that can be applied by both departments and project teams. Methods The framework of the quality assessment tool was developed based on the literature studies, accepted guidelines and the Delphi method. A total of 272 ongoing IITs funded by Shanghai non-profit organizations in 2015 and 2016 were used to extract quality indexes. Confirmatory factor analysis (CFA) was used to further evaluate the validity and feasibility of the conceptual quality assessment tool. Results The tool consisted of 4 critical quality attributes, including progress, quality, regulation, scientificity, and 13 observed quality indexes. A total of 257 IITs were included in the validity and feasibility assessment. The majority (60.29%) were Randomized Controlled Trial (RCT), and 41.18% were multi-center studies. In order to test the validity and feasibility of IITs quality assessment tool, CFA showed that the model fit the data adequately. (CMIN/DF = 1.868, GFI = 0.916; CFI = 0.936; TLI = 0.919; RMSEA = 0.063; SRMR = 0.076). Different types of clinical studies fit well in the tool. However, RCT scored lower than prospective cohort and retrospective study in enrollment progress (7.02 vs. 7.43, 9.63, respectively). Conclusion This study established a panoramic quality assessment tool based on the Delphi method and CFA, and the feasibility and effectiveness of the tool were verified through clinical research examples. The use of this tool can help project management departments effectively and dynamically manage research projects, rationally allocate resources, and ensure the quality of IITs.

随着临床诊疗技术的发展,肿瘤患者生存期显著延长.但是近年来,已有证据表明一些化疗药物如蒽环类、5-氟尿嘧啶等的确会导致左心功能不全、心力衰竭等心脏毒性[1-2],降低患者生存率和远期生活质量.因此,如何早期识别、评估和长期随访化疗药物导致的心脏毒性,以提高肿瘤患者远期治疗效果成为备受关注的问题.目前,临床上用以评估心脏毒性的方法包括心脏特异性标志物(N-末端脑钠肽前体、肌钙蛋白)、超声心动图、心电图、心脏磁共振(cardiovascular magnetic resonance,CMR)等[3].相比其他方法,超声心动图具有动态、方便、重复性好等优点,通过二维超声心动图、组织多普勒,以及三维超声心动图、超声造影(contrast enhanced ultrasound,CEUS)、应变超声等方法测量心脏收缩和舒张功能,可以达到对心脏毒性进展早期预测、准确评估和长期随访的目的,其目前已成为评估化疗相关心脏毒性最常用的方法.

BackgroundBlood flowing in the arterial lumen acts on the surface of the vessel wall to form wall shear stress (WSS). To date, there has been limited research on the utility of non-invasive technology in the accurate quantification of carotid WSS in patients with hypertension (HP).ObjectiveThe present study aimed to explore the usage of vascular vector flow mapping (VFM) in the quantitative assessment of carotid WSS in hypertensive patients at an early stage and to validate its clinical utility.MethodsA total of 50 individuals confirmed without carotid plaques were grouped into a HP group (n = 25) and a control (CON) group (n = 25) according to blood pressure. An ALOKA LISENDO 880 Color Doppler Ultrasound with a L441 3–15 MHZ probe was used to obtain a longitudinal section scan to determine the regions of interests (ROIs) of the common carotid artery. VFM-based WSS measurements were obtained by selecting the ROI with optimal image quality from three full cardiac cycles. WSS-derived measurements, including WSSmax, WSSmin, and WSSmean, were analyzed and compared between the HP and CON groups. In addition, the correlations between WSS-derived measurements and the carotid artery intima-media thickness (IMT) were also analyzed.ResultsThere were significant statistical differences in WSSmax and WSSmean between patients in the HP and CON groups. Specifically, the HP group had significantly decreased WSSmax and WSSmean compared to the CON group (WSSmax: 1.781 ± 0.305 Pa vs. 2.286 ± 0.257 Pa; WSSmean: 1.276 ± 0.333 Pa vs. 1.599 ± 0.293 Pa, both p < 0.001). However, there was no statistical difference in WSSmin between the groups (0.79 ± 0.36 vs. 0.99 ± 0.42, p = 0.080). Additionally, Spearman’s correlation analysis indicated that the WSS-derived parameters were negatively correlated with the IMT (p < 0.001).ConclusionVascular VFM technology shows promising results in the quantitative assessment of difference in hemodynamics of the vascular flow field between patients with HP and normal controls. Difference in WSS may serve as a potential predictor for the development of arteriosclerosis risks.

脂肪组织包括内脏脂肪组织和皮下脂肪组织，其中内脏脂肪组织异常沉积引起的心血管事件的发生率和病死率较高。心外膜脂肪组织归类为内脏脂肪组织，尽管重量仅占全身脂肪组织的0.02%，但因解剖位置和生物学功能特殊，其在冠心病、心房颤动、心力衰竭、新型冠状病毒肺炎相关的心肌损伤、高血压等心血管疾病的发生和发展中发挥着重要作用。该文主要就心外膜脂肪的解剖与生物学功能、影像学评估及其与心血管疾病的关系进行了综述。

Abstract Introduction. Investigator initiated trials (IITs) are laid on the optimization and improvement of already existing therapies or treatment approaches and attempts to answer problems faced by clinicians in their daily practice. However, the quality assessment for conducting these sometimes complex studies is scarce of evidence. Our study aims at developing a handy quality assessment tool for IITs and providing investigators with resources to conduct their studies effectively. Furthermore, patient safety and data quality will also be kept as top priorities.Data and methods. The framework of the quality assessment tool was based on the literature studies and accepted guidelines and the Delphi method. Confirmatory factor analysis (CFA) is used to further evaluate the validity and feasibility of the conceptual quality assessment tool. Results. The panorama quality assessment tool for IITs contains four critical quality attributes, including progress, quality, regulation, scientificity, and 13 observed quality indexes. 272 IITs were collected, finally, 252 IITs were included in the validity and feasibility assessment. The majority of the studies (60.29%) were in Randomized Controlled Trial (RCT), and 41.18% of the studies were multi-center. In order to test for validity and feasibility of IITs quality assessment tool, CFA method was showed a fit for the model (CMIN/DF=1.868, GFI=0.916; CFI=0.936; TLI=0.919; RMSEA=0.063). Multiple types of studies of clinical studies, including RCT, prospective cohort study, retrospective, and real-world research fitted well in the tool by assessing their subject management, reasonable clinical research methods, and quality control methods. However, RCT ended with lower scores than prospective cohort study, retrospective and real-world research in enrollment progress (7.02 vs. 7.43, 9.63, 7.85, respectively). Conclusions. The panorama tool for overall quality assessment of IITs from this study combines the advantages of both qualitative and quantitative recognized evaluation indexes, which are further validated by CFA. The panorama evaluation tool can timely and dynamically find errors, take actions to prevent major bias. It is hoped that this framework can provide project management departments with resources for effective and dynamic management of their research and avoid waste of resources, as well as a manner to improve the quality of IIT in the future.

The low delivery efficiency of nanoparticles to solid tumors greatly reduces the therapeutic efficacy and safety which is closely related to low permeability and poor distribution at tumor sites. In this work, an "intrinsic plus extrinsic superiority" administration strategy is proposed to dramatically enhance the mean delivery efficiency of nanoparticles in prostate cancer to 6.84% of injected dose, compared to 1.42% as the maximum in prostate cancer in the previously reported study. Specifically, the intrinsic superiority refers to the virus-mimic surface topology of the nanoparticles for enhanced nano-bio interactions. Meanwhile, the extrinsic stimuli of microbubble-assisted low-frequency ultrasound is to enhance permeability of biological barriers and improve intratumor distribution. The enhanced intratumor enrichment can be verified by photoacoustic resonance imaging, fluorescence imaging, and magnetic resonance imaging in this multifunctional nanoplatform, which also facilitates excellent anticancer effect of photothermal treatment, photodynamic treatment, and sonodynamic treatment via combined laser and ultrasound irradiation. This study confirms the significant advance in nanoparticle accumulation in multiple tumor models, which provides an innovative delivery paradigm to improve intratumor accumulation of nanotherapeutics.

目的 研究应用纳泡结合超声技术介导成纤维细胞生长因子(fibroblast growth factor,FGF)21对糖尿病(diabetes mellitus,DM)小鼠心功能保护作用.方法 采用双乳化法制备FGF21纳泡,并进行质量评价.48只雄性C57BL/6J小鼠随机选择40只小鼠经腹腔注射链脲佐菌素(streptozotocin,STZ)建立DM模型,其余作为对照组.将DM小鼠随机分为DM组、FGF21组、FGF21纳泡组和FGF21纳泡+超声组.各组分别给予相应干预8周后,行超声心动图检查,评价各组小鼠心脏收缩功能.处死小鼠取出心肌组织,行HE染色,天狼猩红染色检测心肌胶原容积分数(collagen volume fraction,CVF).结果 本研究制备的纳泡呈分散均匀、稳定的圆球形结构.经不同药物形式干预8周后,与对照组比较,DM组小鼠LVEF、LVFS显著降低(P＜0.05);与DM组比较,FGF21组、FGF21纳泡+超声组小鼠LVEF、LVFS显著升高(P＜0.05);与FGF21组比较,FGF21纳泡+超声组小鼠LVEF、LVFS显著升高(P＜0.05);而FGF21纳泡组与DM组小鼠心脏功能指标比较,差异无统计学意义.HE染色和天狼星红染色显示,FGF21纳泡+超声组的心肌肥大程度和CVF显著低于DM组和其他药物治疗组(P＜0.05).结论 载FGF21纳泡结合超声技术能够将FGF21高效、靶向递送到心肌组织,抑制心肌细胞肥大及间质纤维化,从而改善左心室收缩功能,发挥心脏保护作用.