Correlation between cognitive impairment and body composition indicators in patients with chronic kidney disease after hemodialysis.

OBJECTIVE: To examine the relationship between cognitive impairment and body composition indicators in chronic kidney disease (CKD) patients post-hemodialysis. METHODS: This retrospective study included 110 CKD patients admitted to Beijing Luhe Hospital, Capital Medical University between January 2019 and January 2023. General clinical data and body composition indicators were compared between patients with and without cognitive impairment. Multiple logistic regression and ROC curve analysis were used to identify influencing factors and to develop a predictive model. RESULTS: Cognitive impairment occurred in 50% of the patients post-hemodialysis. No significant differences were found in demographics, disease duration, comorbidities, or hemodialysis duration between the groups (all P > 0.05). However, significant differences were observed in body mass index (BMI) (P < 0.001), lean body mass index (LTI) (P = 0.007), fat tissue index (FTI) (P = 0.024), and total body water (TBW) (P < 0.001). Multiple logistic regression identified TBW (OR 4.900, 95% CI 3.062-7.511, P < 0.001), the TBW/extracellular water (ECW) ratio (OR 7.244, 95% CI 5.092-8.7613, P = 0.016), and the ECW/body cell mass (BCM) ratio (OR 6.720, 95% CI 4.564-8.692, P = 0.030) as independent risk factors for cognitive impairment post-hemodialysis. ROC analysis confirmed their predictive capacity, with AUC values of 0.840, 0.840, and 0.850 respectively. A predictive model incorporating these indicators was developed, showing good calibration (Hosmer-Lemeshow test, P = 0.912) and discrimination (C-index 0.974, 95% CI 0.952-0.997). CONCLUSION: Total body water, the TBW/ECW ratio, and the ECW/BCM ratio are independently associated with cognitive impairment in CKD patients post-hemodialysis. Body composition analysis serves as a valuable tool for predicting cognitive impairment in this population, guiding clinicians in assessing cognitive function and planning interventions for these patients.

Dynamic Behavior of Rubber Fiber-Reinforced Expansive Soil under Repeated Freeze-Thaw Cycles.

Large volumes of waste tires are generated due to the rapid growth of the transportation industry. An effective method of recycling waste tires is needed. Using rubber from tires to improve problematic soils has become a research topic. In this paper, the dynamic response of rubber fiber-reinforced expansive soil under freeze-thaw cycles is investigated. Dynamic triaxial tests were carried out on rubber fiber-reinforced expansive soil subjected to freeze-thaw cycles. The results showed that with the increase in the number of freeze-thaw cycles, the dynamic stress amplitude and dynamic elastic modulus of rubber fiber-reinforced expansive soils first decrease and then increase, and the damping ratio first increases and then decreases, all of which reach the turning point at the 6th freeze-thaw cycle. The dynamic stress amplitude and dynamic elastic modulus decreased by 59.4% and 52.2%, respectively, while the damping ratio increased by 99.8% at the 6th freeze-thaw cycle. The linear visco-elastic model was employed to describe the hysteretic curve of rubber fiber-reinforced expansive soil. The elastic modulus of the linear elastic element and the viscosity coefficient of the linear viscous element first decrease and then increase with the increase in the number of freeze-thaw cycles; all reach the minimum value at the 6th freeze-thaw cycle. The dynamic stress-dynamic strain curve calculation method is established based on the hyperbolic model and linear visco-elastic model, and the verification shows that the effect is better. The research findings provide guidance for the improvement of expansive soil in seasonally frozen regions.

Constitutive Damage Model for Rubber Fiber-Reinforced Expansive Soil under Freeze-Thaw Cycles.

To elucidate the degradation mechanism of expansive soil-rubber fiber (ESR) under freeze-thaw cycles, freeze-thaw cycle tests and consolidated undrained tests were conducted on the saturated ESR. The study quantified the elastic modulus and damage variables of ESR under different numbers of freeze-thaw cycles and confining pressure, and proposed a damage constitutive model for ESR. The primary findings indicate that: (1) The effective stress paths of ESR exhibit similarity across different numbers of freeze-thaw cycles, the critical stress ratio slightly decreased by 8.8%, while the normalized elastic modulus experienced a significant reduction, dropping to 42.1%. (2) When considering the damage threshold, the shear process of ESR can be divided into three stages: weak damage, damage development, and failure. As strain increases, the microdefects of ESR gradually develop, penetrating macroscopic cracks and converging to form the main rupture surface. Eventually, the damage value reaches 1. (3) Due to the effect of freeze-thaw cycles, initial damage exists for ESR, which is positively correlated with the number of freeze-thaw cycles. The rubber fibers act as tensile elements, and the ESR damage evolution curves intersect one after another, showing obvious plastic characteristics in the late stage of shear. (4) Confining pressure plays a role in limiting the development of ESR microcracks. The damage deterioration of ESR decreases with an increase in confining pressure, leading to an increase in ESR strength. (5) Through a comparison of the test curve and the theoretical curve, this study validates the rationality of the damage constitutive model of ESR under established freeze-thaw cycles. Furthermore, it accurately describes the nonlinear impact of freeze-thaw cycles and confining pressure on the ESR total damage.

Analysis of risk factors for refractory peritonitis in patients undergoing peritoneal dialysis.

OBJECTIVE: To explore the risk factors for refractory peritonitis in patients undergoing peritoneal dialysis. METHODS: We retrospectively collected data from 130 patients who underwent peritoneal dialysis (PD) and received peritonitis treatment at the Renal Disease Center of Beijing Luhe Hospital affiliated with Capital Medical University from January 1, 2016 to January 30, 2023. According to clinical treatment results, patients with refractory peritonitis were classified as the refractory group (n=52 cases), and those with non-refractory peritonitis were classified as the non-refractory group (n=78 cases). Baseline information and laboratory indicators of patients in each group were collected, and Logistic regression model was used to identify the risk factors for the poor prognosis of peritonitis patients. RESULTS: There were statistically significant differences in dialysis time, dialysate sugar concentration and inducement type between the refractory group and the non-refractory group (P<0.05). The values of peripheral white blood cells (pWBC), T helper 2 cell (Th2), T regulatory cell (Treg), Treg/Th17 and C-reactive protein (CRP) in the refractory group were significantly higher than those in the non-refractory group, while the values of T helper 17 cell (Th17) and albumin (ALB) were significantly lower (all P<0.05). There were no significant differences in serum creatinine, blood urea, Th1, hemoglobin (Hb) and blood calcium levels between the two groups (all P>0.05). Gram-positive bacteria were the main pathogenic bacteria of peritonitis in all groups. The proportion of enterococcus/streptococcal peritonitis in the refractory group was higher than that in the non-refractory group (P<0.05). Logistic regression identified elevated pWBC, higher dialysate sugar concentration, exit-site infection and gram-negative bacteria infection as independent risk factors for refractory peritonitis in patients undergoing PD (all P<0.05). CONCLUSION: Elevated pWBC, high glucose dialysate concentration, exit-site infection, and gram-negative bacteria infection are risk factors for refractory peritonitis in patients undergoing PD.

Evaluation of the effect of kidney transplantation on left ventricular myocardial work by noninvasive pressure-strain loops.

Purpose: Kidney transplantation (KT) has the potential to reverse the cardiac changes caused by end-stage renal disease, and it may be inaccurate to analysis the left ventricular function by conventional echocardiography due to afterload. This study aimed to investigate the utility of pressure strain loops (PSLs) in evaluating left ventricular performance in patients underwent KT. Methods: We enrolled 60 patients with end-stage renal disease who underwent KT between January 2022 and July 2023, and 60 healthy controls with a similar distribution of gender and age to the patients. All participants underwent conventional echocardiography and three-dimensional speckle tracking echocardiography (3D-STE). Long axis, short axis, and four cavity images were collected and cardiac parameters were measured. The echocardiographic changes of cardiac structure and function of all patients before KT and about 12 months after KT were recorded. Left ventricular myocardial work parameters were acquired by PSLs, including the global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) and global longitudinal strain (GLS). In addition, the correlation between PSLs and clinical data were explored. Results: Compared with controls, the conventional echocardiographic parameters, myocardial function indicators GWI and GCW appeared no difference in post-KT group, while the GWE and GLS decreased (p < 0.05), and the GWW increased (p < 0.05). Compared with pre-KT, the GLS, GWI, GCW and GWE increased in post-KT group, while the GWW decreased (all p < 0.05). The above indicators were correlated with left ventricular GLS and left ventricular ejection fraction. Conclusion: PSLs were more sensitive than traditional echocardiographic indicators in detecting changes in myocardial work and predicting left ventricular myocardial damage. This indicator could quantitatively evaluate myocardial work and provide a new and reliable non-invasive reference for clinical diagnosis and treatment of patients underwent KT.

Comparison of clinical and echocardiographic outcomes between mini-thoracotomy transatrial LuX-Valve transcatheter and surgical tricuspid valve replacement.

Background and aims: Transcatheter tricuspid valve replacement (TTVR) has recently emerged as a novel therapeutic approach for managing severe tricuspid regurgitation (TR). However, surgical tricuspid valve replacement (STVR) continues to be the predominant treatment modality. There are limited comparative data on both procedures. This study aimed to compare clinical and echocardiographic outcomes between patients who underwent mini-thoracotomy transatrial LuX-Valve TTVR and those who underwent STVR. Methods: This study prospectively collected patients with severe TR who underwent TTVR (n = 29) or isolated STVR (n = 59) at Wuhan Union Hospital from 2019 to 2022. All TTVR patients received the LuX-Valve via a mini-thoracotomy and transatrial approach. The clinical and echocardiographic outcomes were compared at 30-day and one-year follow-ups. Results: At baseline, patients with LuX-Valve TTVR had higher surgical risk scores and a greater proportion of right ventricular dysfunction compared with STVR. In the early postoperative period, the STVR group had a greater decrease in right ventricular function. Hospital length of stay (LOS), intensive care unit LOS, total procedure time, and tracheal intubation time were shorter in the TTVR than in the STVR group. The incidence of postoperative paravalvular leaks was higher among patients who underwent TTVR. Compared to the STVR group, the pacemaker implantation rate was lower in the TTVR group. During follow-up, the peak tricuspid valve velocity and mean gradient in the TTVR group were consistently lower than those in the STVR group. There was similar mortality between TTVR and STVR at 30-day and one-year follow-ups. Conclusions: The mini-thoracotomy transatria LuX-Valve TTVR has a higher incidence of paravalvular leaks and a lower rate of pacemaker implantation than STVR, with similar 30-day and one-year mortality rates. In some respects, mini-thoracotomy transatrial LuX-Valve TTVR may be a feasible and safe treatment option for specific populations, or it could potentially serve as an alternative therapy to supplement conventional STVR. Further follow-up is required to assess differences in long-term clinical outcomes and valve durability.

Surface chemical polishing and passivation minimize non-radiative recombination for all-perovskite tandem solar cells.

All-perovskite tandem solar cells have shown great promise in breaking the Shockley-Queisser limit of single-junction solar cells. However, the efficiency improvement of all-perovskite tandem solar cells is largely hindered by the surface defects induced non-radiative recombination loss in Sn-Pb mixed narrow bandgap perovskite films. Here, we report a surface reconstruction strategy utilizing a surface polishing agent, 1,4-butanediamine, together with a surface passivator, ethylenediammonium diiodide, to eliminate Sn-related defects and passivate organic cation and halide vacancy defects on the surface of Sn-Pb mixed perovskite films. Our strategy not only delivers high-quality Sn-Pb mixed perovskite films with a close-to-ideal stoichiometric ratio surface but also minimizes the non-radiative energy loss at the perovskite/electron transport layer interface. As a result, our Sn-Pb mixed perovskite solar cells with bandgaps of 1.32 and 1.25 eV realize power conversion efficiencies of 22.65% and 23.32%, respectively. Additionally, we further obtain a certified power conversion efficiency of 28.49% of two-junction all-perovskite tandem solar cells.

Buried interface molecular hybrid for inverted perovskite solar cells.

Perovskite solar cells with an inverted architecture provide a key pathway for commercializing this emerging photovoltaic technology because of the better power conversion efficiency and operational stability compared with the normal device structure. Specifically, power conversion efficiencies of the inverted perovskite solar cells have exceeded 25% owing to the development of improved self-assembled molecules1-5 and passivation strategies6-8. However, poor wettability and agglomeration of self-assembled molecules9-12 cause interfacial losses, impeding further improvement in the power conversion efficiency and stability. Here we report a molecular hybrid at the buried interface in inverted perovskite solar cells that co-assembled the popular self-assembled molecule [4-(3,6-dimethyl-9H-carbazol-9-yl)butyl]phosphonic acid (Me-4PACz) with the multiple aromatic carboxylic acid 4,4',4″-nitrilotribenzoic acid (NA) to improve the heterojunction interface. The molecular hybrid of Me-4PACz with NA could substantially improve the interfacial characteristics. The resulting inverted perovskite solar cells demonstrated a record certified steady-state efficiency of 26.54%. Crucially, this strategy aligns seamlessly with large-scale manufacturing, achieving one of the highest certified power conversion efficiencies for inverted mini-modules at 22.74% (aperture area 11.1 cm2). Our device also maintained 96.1% of its initial power conversion efficiency after more than 2,400 h of 1-sun operation in ambient air.

Photonic convolution accelerator based on a hybrid integrated multi-wavelength laser array by photonic wire bonding for real-time image classification.

We propose and experimentally demonstrate a compact and efficient photonic convolution accelerator based on a hybrid integrated multi-wavelength DFB laser array by photonic wire bonding. The photonic convolution accelerator operates at 60.12 GOPS for one 3 × 3 kernel with a convolution window vertical sliding stride of 1 and generates 500 images of real-time image classification. Furthermore, real-time image classification on the MNIST database of handwritten digits with a prediction accuracy of 93.86% is achieved. This work provides a novel, to the best of our knowledge, compact hybrid integration platform to realize the optical convolutional neural networks.

Suppressed Phase Segregation with Small A-Site and Large X-Site Incorporation for Photostable Wide-Bandgap Perovskite Solar Cells.

Wide-bandgap (WBG) perovskite solar cells (PSCs) have been widely used as the top cell of tandem solar cells. However, photoinduced phase segregation and high open-circuit voltage loss pose significant obstacles to the development of WBG PSCs. Here, a two-step small-size A-site and large-size X-site incorporation strategy is reported to modulate the lattice distortion and improve the film quality of WBG formamidinium-methylammonium (FAMA) perovskite films for photostable PSCs based on two-step deposition method. First, CsI with content of 0-20% is introduced to tune the lattice distortion and film quality of FAMA perovskite with a bandgap of 1.70 eV. Then, 4% RbI is incorporated to further modulate the perovskite growth and lattice distortion, leading to the suppression of photoinduced phase segregation in the resultant RbCsFAMA quadruple cation perovskites. As a result, the 20%CsI/4%RbI-doped device obtains a promising efficiency of 20.6%, and the corresponding perovskite film shows good photothermal stability. Even without encapsulation, the device can maintain 92% of its initial efficiency after 1000 h of continuous operation under 1 sun equivalent white light-emitting diode illumination.

Highly-reflective facet-coated multi-wavelength DFB laser array with exact wavelength spacings.

A distributed feedback (DFB) laser array of twenty wavelengths with highly reflective and anti-reflective (HR-AR) coated facets is both theoretically analyzed and experimentally validated. While the HR facet coating enhances high wall-plug efficiency, it inadvertently introduces a random facet grating phase, thereby compromising the lasing wavelength's predictability and the stability of the single-longitudinal-mode (SLM). In this study, two key advancements are introduced: first, the precisely spaced wavelength is achieved with an error of within ±0.2 nm using the reconstruction-equivalent-chirp (REC) technique; second, the random grating phase on the HR-coated facet is compensated by a controllable distributed phase shift through a two-section laser structure. The SLM stability can be improved while the wavelength can be continuously tuned to the standard wavelength grid. The overall chip size is compact with an area of 4000 × 500 µm2. The proposed laser array has a light power intensity above 13 dBm per wavelength, a high side mode suppression ratio above 50 dB, and low relative intensity noise under -160 dB/Hz. These attributes make it apt for deployment in DWDM-based optical communication systems and as a light source for optical I/O.

Recent Advances in Interface Engineering for Enhanced Open-Circuit Voltage Regulation in Perovskite Solar Cells.

In recent years, perovskite solar cells (PSCs) have attracted significant attention due to their excellent photoelectric properties. However, several key performance parameters of these devices still fall short of their theoretical limits. Among these parameters, the regulation of open-circuit voltage (VOC) has been a focal point of intensive research efforts, playing a pivotal role in advancing the efficiency of PSCs. This review first provides an overview of the generation and loss mechanism of VOC. It then discusses the significance of interface engineering in VOC regulation. Recent developments in high-efficiency PSCs realized via interface engineering have been summarized and categorized into three key areas: surface modification, interface structure optimization, and surface dimensional engineering. Finally, a comprehensive summary of past research in this domain and offered insights into the future prospects of enhancing VOC in PSCs is provided.

Early left ventricular systolic function is a more sensitive predictor of adverse events after heart transplant.

BACKGROUND: First-phase ejection fraction (EF1) is a novel measure of early changes in left ventricular systolic function. This study was to investigate the prognostic value of EF1 in heart transplant recipients. METHODS: Heart transplant recipients were prospectively recruited at the Union Hospital, Wuhan, China between January 2015 and December 2019. All patients underwent clinical examination, biochemistry measures [brain natriuretic peptide (BNP) and creatinine] and transthoracic echocardiography. The primary endpoint was a combined event of all-cause mortality and graft rejection. RESULTS: In 277 patients (aged 48.6 ± 12.5 years) followed for a median of 38.7 [26.8-45.0] months, there were 35 (12.6%) patients had adverse events including 20 deaths and 15 rejections. EF1 was negatively associated with BNP (ß = -0.220, p < 0.001) and was significantly lower in patients with events compared to those without. EF1 had the largest area under the curve in ROC analysis compared to other measures. An optimal cut-off value of 25.8% for EF1 had a sensitivity of 96.3% and a specificity of 97.1% for prediction of events. EF1 was the most powerful predictor of events with hazard ratio per 1% change in EF1: 0.628 (95%CI: 0.555-0.710, p < 0.001) after adjustment for left ventricular ejection fraction and global longitudinal strain. CONCLUSIONS: Early left ventricular systolic function as measured by EF1 is a powerful predictor of adverse outcomes after heart transplant. EF1 may be useful in risk stratification and management of heart transplant recipients.

Ultrasound-targeted microbubble destruction promotes PDGF-primed bone mesenchymal stem cell transplantation for myocardial protection in acute Myocardial Infarction in rats.

BACKGROUND: Ultrasound-targeted microbubble destruction (UTMD) has emerged as a promising strategy for the targeted delivery of bone marrow mesenchymal stem cells (MSCs) to the ischemic myocardium. However, the limited migration capacity and poor survival of MSCs remains a major therapeutic barrier. The present study was performed to investigate the synergistic effect of UTMD with platelet-derived growth factor BB (PDGF-BB) on the homing of MSCs for acute myocardial infarction (AMI). METHODS: MSCs from male donor rats were treated with PDGF-BB, and a novel microbubble formulation was prepared using a thin-film hydration method. In vivo, MSCs with or without PDGF-BB pretreatment were transplanted by UTMD after inducing AMI in experimental rats. The therapeutic efficacy of PDGF-BB-primed MSCs on myocardial apoptosis, angiogenesis, cardiac function and scar repair was estimated. The effects and molecular mechanisms of PDGF-BB on MSC migration and survival were explored in vitro. RESULTS: The results showed that the biological effects of UTMD increased the local levels of stromal-derived factor-1 (SDF-1), which promoted the migration of transplanted MSCs to the ischemic region. Compared with UTMD alone, UTMD combined with PDGF-BB pretreatment significantly increased the cardiac homing of MSCs, which subsequently reduced myocardial apoptosis, promoted neovascularization and tissue repair, and increased cardiac function 30 days after MI. The vitro results demonstrated that PDGF-BB enhanced MSC migration and protected these cells from H2O2-induced apoptosis. Mechanistically, PDGF-BB pretreatment promoted MSC migration and inhibited H2O2-induced MSC apoptosis via activation of the phosphatidylinositol 3-kinase/serine-threonine kinase (PI3K/Akt) pathway. Furthermore, crosstalk between PDGF-BB and stromal-derived factor-1/chemokine receptor 4 (SDF-1/CXCR4) is involved in the PI3K/AKT signaling pathway. CONCLUSION: The present study demonstrated that UTMD combined with PDGF-BB treatment could enhance the homing ability of MSCs, thus alleviating AMI in rats. Therefore, UTMD combined with PDGF-BB pretreatment may offer exciting therapeutic opportunities for strengthening MSC therapy in ischemic diseases.

Preparation and Mechanical Properties of UV-Curable Epoxy Acrylate/Modified Aramid Nanofiber Nanocomposite Films.

In order to enhance the mechanical properties of UV-curable epoxy acrylate (EA)-based coatings, 3-(trimethoxysilyl)propyl methacrylate modified aramid nanofibers (T-ANFs) were synthesized and used as nanofillers to prepare EA/T-ANF nanocomposite films. The morphology of T-ANFs was characterized by transmission electron microscopy. The chemical structure of T-ANFs was analyzed via infrared spectroscopy, confirming successful grafting of methyl methacryloyloxy groups onto the surface of aramid nanofibers (ANFs). Real-time infrared spectroscopy was employed to investigate the influence of ANFs and T-ANFs on the photopolymerization kinetics of the EA film. The results revealed that the addition of ANFs and T-ANFs led to a decrease in the photopolymerization rate during the initial stage but had little impact on the final double bond conversion, with all samples exhibiting a conversion rate of over 83%. The incorporation of ANFs improved the tensile strength of the films while significantly reducing their Young's modulus. In contrast, the addition of T-ANFs led to a substantial increase in both tensile stress and Young's modulus of the films. For instance, the tensile strength and Young's modulus of the 0.1 wt% of T-ANF film increased by 52.7% and 41.6%, respectively, compared to the pure EA film. To further study the dispersion morphology and reinforcement mechanism, the cross-sectional morphology of the films was characterized by scanning electron microscopy.

PRMT3-Mediated Arginine Methylation of METTL14 Promotes Malignant Progression and Treatment Resistance in Endometrial Carcinoma.

Protein arginine methyltransferase (PRMT) plays essential roles in tumor initiation and progression, but its underlying mechanisms in the treatment sensitivity of endometrial cancer (EC) remain unclear and warrant further investigation. Here, a comprehensive analysis of the Cancer Genome Atlas database and Clinical Proteomic Tumor Analysis Consortium database identifies that PRMT3 plays an important role in EC. Specifically, further experiments show that PRMT3 inhibition enhances the susceptibility of EC cells to ferroptosis. Mechanistically, PRMT3 interacts with Methyltransferase 14 (METTL14) and is involved in its arginine methylation. In addition, PRMT3 inhibition-mediated METTL14 overexpression promotes methylation modification via an m6 A-YTHDF2-dependent mechanism, reducing Glutathione peroxidase 4 (GPX4) mRNA stability, increasing lipid peroxidation levels, and accelerating ferroptosis. Notably, combined PRMT3 blockade and anti-PD-1 therapy display more potent antitumor effects by accelerating ferroptosis in cell-derived xenograft models. The specific PRMT3 inhibitor SGC707 exerts the same immunotherapeutic sensitizing effect in a patient-derived xenograft model. Notably, blocking PRMT3 improves tumor suppression in response to cisplatin and radiation therapy. Altogether, this work demonstrates that PRMT3 depletion is a promising target for EC.

Precise management system for chronic intractable pain patients implanted with spinal cord stimulation based on a remote programming platform: study protocol for a randomized controlled trial (PreMaSy study).

BACKGROUND: Spinal cord stimulation (SCS) is a surgical technique used in patients with chronic intractable pain, and its effectiveness and safety have been validated by multiple studies. However, to maintain an optimal and steady long-term effect is still challenging. Here, we report a new management paradigm integrating smartphone application and remote programming. Chronic pain patients with SCS implants can monitor their pain status on the phone and change stimulation parameters accordingly. The PreMaSy study is a randomized controlled trial to evaluate the clinical effectiveness and safety of this precise management system. METHODS: Patients with chronic intractable pain will be screened for eligibility, and 82 participants are anticipated to be enrolled in this trial. After the electrode implantation, the stimulation effectiveness will be tested. Participants with a reduction of more than 50% in the visual analog scale (VAS) will receive implantation of an implantable pulse generator and randomized (1:1) into the experimental group or control group. All participants will be asked to take online follow-ups and complete assessments using a smartphone application. Daily pain characteristic assessments and monthly quality of life questionnaires are integrated into the App, and participants will be required to complete these assessments. The daily VAS for pain intensity will be monitored and a threshold will be set based on baseline VAS score. The interventional appointment will be scheduled once the threshold is reached. The primary outcome is the health condition and quality of life assessed by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). Utility values of EQ-5D-5L will be assessed at baseline and 1, 3, and 6 months post-operative. DISCUSSION: The PreMaSy study aims to evaluate the effectiveness and safety of a novel App-based, patient-centered, self-assessment management system for chronic intractable pain. A randomized controlled trial is designed to test the non-inferiority of this precise management system compared to the monthly online follow-ups. It is also expected to yield valuable experiences regarding precision medicine. TRIAL REGISTRATION: ClinicalTrials.gov NCT05761392. Registered on March 07, 2023.

10×10 Gbs directly modulated DFB laser array based on the REC technique.

We proposed and experimentally demonstrated a directly modulated distributed feedback (DFB) laser array with a transmission rate of 100 Gbps (10c h a n n e l s×10G b p s). The grating design is based on the reconstruction equivalent chirp (REC) technique, which enables precise control of the channel wavelength spacing to 100 GHz, as specified in the ITU-DWDM standard. DFB laser arrays incorporating the REC technique demonstrate excellent consistency performance, with a side-mode suppression ratio exceeding 48 dB, threshold current of approximately 20 mA, and modulation bandwidth of greater than 13 GHz at a bias current of 100 mA. We evaluated the laser's performance by loading a 10 Gbps nonreturn-to-zero signal onto the laser using direct modulation and transmitting it over a 10 km single-mode fiber. Based on our experimental results, the proposed DFB laser array is promising to be utilized in the next generation of low-cost, 100 Gbps DWDM communication systems.

Echocardiographic diagnosis of rupture of mitral valve papillary muscle.

OBJECTIVE: To explore the value of echocardiography in diagnosing papillary muscle rupture (PMR) of the mitral valve, and summarize the characteristic echocardiographic features of different types. METHODS: Echocardiograms of 13 PMR patients confirmed by surgery in Wuhan Union Hospital between January 2009 and December 2022 were retrospectively analyzed and their preoperative transthoracic echocardiography (TTE) was compared with surgical findings. RESULTS: A total of 9020 patients underwent mitral valve repair or replacement surgery during the study period including 13 (0.14%) for PMR. Of the 13 PMRs, 8 cases were partial PMR(P-PMR), 5 cases were complete PMR(C-PMR); 3 cases were anterolateral PMR, and 10 were posteromedial PMR. The diagnostic accuracy, sensitivity, and specificity of the preoperative TTE were 99.9%, 53.8% and 99.9% respectively. Echocardiographic features of 10 patients (5-C-PMR and 5 P-PMR) with detailed TTE and intraoperative transesophageal echocardiography (TEE) data included: both anterior and posterior leaflets prolapse (C-PMR 60% vs P-PMR 60%); flail leaflet (C-PMR100% vs P-PMR 40%); All C-PMRs and P-PMRs have severe, eccentric and lateral regurgitation; flail attachment (chordae tendinae and ruptured PM) at the tip of prolapsed leaflet (C-PMR100% vs P-PMR 60%); high-echo masses resembled "champagne glasses" in 100% of the C-PMR; high-echo masses resembled "lotus-seedpod" in 60% and "dumbbell-shaped" torn PM in remaining 40% of the P-PMR. CONCLUSIONS: Different PMR subtypes have different echocardiographic characteristics. Combining TTE and TEE can accurately identify the typical features of PMR such as ipsilateral hemipetal leaflet prolapse, high-echoic mass at the tip of the leaflet, massive eccentricity and lateral regurgitation.

Biventricular longitudinal strain as a predictor of functional improvement after D-shant device implantation in patients with heart failure.

Background: The creation of an atrial shunt is a novel approach for the management of heart failure (HF), and there is a need for advanced methods for detection of cardiac function response to an interatrial shunt device. Ventricular longitudinal strain is a more sensitive marker of cardiac function than conventional echocardiographic parameters, but data on the value of longitudinal strain as a predictor of improvement in cardiac function after implantation of an interatrial shunt device are scarce. We aimed to investigate the exploratory efficacy of the D-Shant device for interatrial shunting in treating heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), and to explore the predictive value of biventricular longitudinal strain for functional improvement in such patients. Methods: A total of 34 patients were enrolled (25 with HFrEF and 9 with HFpEF). All patients underwent conventional echocardiography and two-dimensional speckle tracking echocardiogram (2D-STE) at baseline and 6 months after implantation of a D-Shant device (WeiKe Medical Inc., WuHan, CN). Left ventricular global longitudinal strain (LVGLS) and right ventricular free wall longitudinal strain (RVFWLS) were evaluated by 2D-STE. Results: The D-Shant device was successfully implanted in all cases without periprocedural mortality. At 6-month follow-up, an improvement in New York Heart Association (NYHA) functional class was observed in 20 of 28 patients with HF. Compared with baseline, patients with HFrEF showed significant reduced left atrial volume index (LAVI) and increased right atrial (RA) dimensions, as well as improved LVGLS and RVFWLS, at 6-month follow-up. Despite reduction in LAVI and increase in RA dimensions, improvements in biventricular longitudinal strain did not occur in HFpEF patients. Multivariate logistic regression demonstrated that LVGLS [odds ratio (OR): 5.930; 95% CI: 1.463-24.038; P = 0.013] and RVFWLS (OR: 4.852; 95% CI: 1.372-17.159; P = 0.014) were predictive of improvement in NYHA functional class after D-Shant device implantation. Conclusion: Improvements in clinical and functional status are observed in patients with HF 6 months after implantation of a D-Shant device. Preoperative biventricular longitudinal strain is predictive of improvement in NYHA functional class and may be helpful to identify patients who will experience better outcomes following implantation of an interatrial shunt device.