Irradiation of carotid baroreceptor with low-intensity pulsed ultrasound exerts different metabolic protection in perirenal, epididymal white adipose tissue and interscapular brown adipose tissue of obese rats.

This study was designed to clarify whether the irradiation of carotid baroreceptor (CB) with low-intensity pulsed ultrasound (LIPUS) protects against obesity by rebalancing the autonomic nervous system (ANS). Obesity was induced using a high-fat diet (HFD) for 8 weeks in Sprague-Dawley rats. Irradiation with LIPUS was daily (20 minutes a day) applied to the right CB. In our study, LIPUS significantly ameliorated metabolic disorders in obese rats. LIPUS partly restored norepinephrine (NE) and acetylcholine (ACH) levels in the perirenal white adipose tissue (PWAT), epididymal white adipose tissue (EWAT), interscapular brown adipose tissue (IBAT), and plasma of obese rats. LIPUS partially rectified the dysregulated AMP-activated protein kinase (AMPK)/peroxisome proliferator-activated receptor (PPAR) α/É£ pathway in the PWAT, EWAT, and IBAT of obese rats. PPARγ and PPARγ target genes respond more sensitively to HFD and LIPUS in PWAT and EWAT than in IBAT. NE, ACH, uncoupling protein-1, phosphorylated AMPK, PPARα, and PPARα target genes respond more sensitively to HFD and LIPUS in IBAT than in PWAT and EWAT. Conclusion: LIPUS irradiation of CB exerts different metabolic protection in PWAT, EWAT, and IBAT by rebalancing the ANS and rectifying the AMPK/PPARα/É£ pathway in obese rats.

Ultrasound Imaging Findings of Acute Testicular Infection in Patients With Coronavirus Disease 2019: A Single-Center-Based Study in Wuhan, China.

OBJECTIVES: Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, raising widespread public health concerns. Our team treated hospitalized patients with COVID-19 in Wuhan, where the outbreak first began, and we suspected that SARS-CoV-2 may cause testicular infection in male patients. We conducted this study to explore that observation. METHODS: We enrolled male patients with a confirmed diagnosis of COVID-19 and performed a bedside ultrasound (US) examination of the scrotum, focused on findings of acute inflammation such as tunica albuginea thickening, enlargement and heterogeneous echogenicity of the testis, epididymis, or both, an abscess, scrotal wall edema, and hydrocele. Then we compared the proportions of observed epididymo-orchitis in patients from different age groups and COVID-19 severity groups. RESULTS: A total of 142 patients with COVID-19 were enrolled in our study, and 32 (22.5%) patients had acute orchitis, epididymitis, or epididymo-orchitis on scrotal US imaging, according to the diagnosis criteria. The observed risk of acute scrotal infection increased with age, with the incidence reaching 53.3% in men older than 80 years. We also observed that men with severe COVID-19 had a significantly higher possibility of epididymo-orchitis compared to the nonsevere COVID-19 group (P = .037). CONCLUSIONS: This study shows US imaging evidence that SARS-CoV-2 may cause infection of the testis or epididymis, and the risk is worthy of the attention of clinicians.

Feasibility and safety of ultrasound-guided percutaneous microwave ablation for tertiary hyperparathyroidism.

Background: Tertiary hyperparathyroidism (THPT) is very common in hemodialysis patients with secondary hyperparathyroidism. However, a medical treatment is not indicated for THPT.Purpose: To investigate the feasibility, safety and efficacy of microwave ablation (MWA) in treating THPT.Materials and methods: Twenty-three patients with THPT were enrolled and treated with MWA. Clinical characteristics, serum levels of intact parathyroid hormone (iPTH), calcium, phosphorus and alkaline phosphatase (ALP), as well as treatment outcomes, were evaluated pre- and post-MWA. All patients were followed for >36 months for all assessable clinical data.Results: All patients successfully completed MWA. The mean follow-up was 47.0 ± 8.4 months. Immediately 1-day post-MWA, iPTH, calcium, phosphorus and ALP levels significantly decreased (all p < 0.001). During the long-term follow-up, iPTH levels increased gradually until 24 months and then remained at stable levels. After MWA, serum calcium reached stable levels at 24 months, while phosphorus and ALP reached stable levels at 6 months, and the levels were in the normal range or slightly higher than the upper normal limit. No obvious blood flow signals or significant recurrence was observed in the surgical nodules during follow-up. In the last follow-up, all nodules were persistent, but their maximum diameter and average volume were significantly lower after MWA (both p < 0.001), with an average reduction of 75.9 ± 11.3%. All patients had no major complications during MWA and follow-up.Conclusions: MWA is feasible, safe, effective and minimally invasive in treating THPT. Thus, MWA can be a nonsurgical alternative for treating THPT patients who are ineligible for surgery.

The predictive value of intra-left atrial mechanical delay for 1-year recurrence of atrial fibrillation after catheter ablation: A clinical follow-up study using dual Doppler echocardiography.

PURPOSE: The availability of dual Doppler echocardiography (DDE), which facilitates the simultaneous recording of Doppler waveforms at two different sites, has enhanced ability to assess single-beat atrial mechanical delay. We sought to investigate the predictive value of intra-left atrial mechanical delay for atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) with DDE. METHODS: Eighty-six patients with paroxysmal AF scheduled to undergo RFCA were prospectively enrolled. Intra-atrial and interatrial mechanical delays were evaluated by DDE and traditional tissue Doppler imaging (tTDI), respectively. The time of whole analysis process with each method was recorded. After RFCA, patients were followed for 1 year. RESULTS: Thirty (34.88%) patients had AF recurrence, and 56 (65.12%) patients maintained sinus rhythm. Cut-off values of 39.38 ms for intra-left atrial mechanical delay obtained by DDE and 32.70 ms by tTDI predicted AF recurrence. Areas under curves were comparable in receiver operator characteristic analysis (P > .05). The whole analysis time of DDE was less than tTDI. Parameters obtained by DDE had better reproducibility. CONCLUSION: Intra-left atrial mechanical delay best predicted 1-year AF recurrence after RFCA. Compared with tTDI, DDE can noninvasively assess single-beat atrial mechanical delay with high predictive power, less analysis time, and better reproducibility.

Comparison of Intracoronary and Intravenous Ultrasound-targeted Microbubble Destruction-mediated Ang1 Gene Transfection on Left Ventricular Remodeling in Canines With Acute Myocardial Infarction.

Intravenous ultrasound-targeted microbubble destruction (IV-UTMD) has made distinct but limited progress in gene therapy. Intracoronary (IC) injection may lead to more gene transfection than IV injection. This study compared the therapeutic effects of IC-UTMD-mediated and conventional IV-UTMD-mediated gene transfection in acute myocardial infarction (MI). A canine MI model was successfully established through transcatheter coronary artery embolism, and the animals were divided into several treatment groups: IC injection with UTMD and the negative control plasmid (IC-UTMD); IC injection of the angiopoietin 1 (Ang1) plasmid (IC-Ang1); IC injection with UTMD and the Ang1 plasmid (IC-UTMD-Ang1); and IV injection with UTMD and the Ang1 plasmid (IV-UTMD-Ang1). At 12 hours after injection, more green fluorescence was observed from the fluorescein isothiocyanate-labeled Ang1 plasmid in the IC-UTMD-Ang1 group. After 1 month, compared with the IV-UTMD-Ang1 group, echocardiography showed that the IC-UTMD-Ang1 group exhibited increased left ventricular systolic function and myocardial infusion, with lower fibrous tissue levels and higher blood vessel density and Ang1 mRNA and protein levels. Similar cardiac troponin I and N-terminal pro-B type natriuretic peptide levels were observed in all groups. Compared with IV-UTMD, IC-UTMD can enhance Ang1 plasmid transfection efficiency after MI, promote gene expression and angiogenesis, and improve left ventricular remodeling without decreasing safety.

The differences in left atrial function between ischemic and idiopathic dilated cardiomyopathy patients: A two-dimensional speckle tracking imaging study.

PURPOSE: To evaluate left atrial (LA) function in patients with ischemic (ICM) or idiopathic dilated (DCM) cardiomyopathy via two-dimensional speckle-tracking imaging. METHODS: We measured the LA maximum volume, minimum volume, and volume before the atrial systole, and calculated total emptying volume, expansion index, active emptying volume, and fraction. We measured strain and strain rate during systole and late diastole using two-dimensional speckle-tracking imaging, and analyzed correlations between variables. RESULTS: We found no significant differences in LA size, left ventricle (LV) end-diastole diameter, LV ejection fraction (EF), E/A, E/e', deceleration time of the E wave, and effective mitral regurgitant orifice area between the DCM and the ICM group. However, the LA expansion index, active EF, systolic and late diastolic strain, and strain rate were lower in the ICM group (p < 0.05). The expansion index and active EF were positively correlated with the systolic strain rate and the absolute value of the late diastolic strain rate, respectively. CONCLUSIONS: LA basic echocardiographic variables did not reflect the differences between ICM and DCM patients, but the systolic and late diastolic strain, as well as the strain rate, were lower in DCM patients. Two-dimensional speckle-tracking imaging is a promising method to differentiate these patients. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:437-445, 2016.

Silica-based 2-(N,N-dimethylamino)-1,3-propanediol hydrophilic interaction liquid chromatography stationary phase for separating cephalosporins and carbapenems.

A silica-based stationary phase bearing both hydrophilic hydroxyl and amino groups was developed by covalently bonding a small molecular N,N-dimethylamino 1,3-propanediol moiety onto silica beads via copper(I)-catalyzed Huisgen azide-alkyne 1,3-dipolar cycloaddition (CuAAC). This new stationary phase showed good HILIC characteristics and high column efficiency (the theoretical plate number is up to 37000 plates m(-1) in the case of inosine) in the separation of polar compounds, such as nucleosides and bases, organic acids, cephalosporins, and carbapenems.

[The value of area strain imaging diastolic index for predicting left anterior descending severe stenosis].

OBJECTIVE: To evaluate the value of locating and defining severe stenosis of left anterior descending (LAD) with area strain imaging diastolic indexes (ASI-DI) derived from three dimensional speckle tracking imaging (3D-STI). METHODS: A total of 92 suspected coronary heart disease patients with left ventricular ejection fraction (LVEF) ≥ 50% and without regional wall motion abnormality, who underwent echocardiography before coronary angiography in our department from July 2012 to April 2014, were included in this retrospective study. Patients were divided into three groups by the level of LAD stenosis: severe stenosis group (≥ 75%, n = 36), mild to moderate stenosis group (1%-74%, n = 22) and control group (without coronary artery stenosis, n = 34). Global peak systolic area strain (GPSAS), global ASI-DI (GASI-DI), and ASI-DI of the regional myocardial segments with blood supplied by LAD were measured. Receiver operating curves (ROC) were obtained between ASI-DI and stenosis level of LAD to locate and to find out the optimal segment and cutoff values. RESULTS: There was no significant difference of GPSAS among serious stenosis group, mild and moderate stenosis group and control group ((-25.2 ± 6.2) % vs. (-20.3 ± 6.6) % vs. (-21.3 ± 8.6) %, P = 0.159). GASI-DI was significantly lower in severe stenosis group than in mild to moderate stenosis group and control group ((-34.3 ± 14.7) vs. (-48.1 ± 13.3) % vs. (-59.4 ± 12.2) %, both P < 0.01). GASI-DI was similar between mild to moderate stenosis group and control group (P = 0.217). The optimal cutoff values of ASI-DI were 40.3% and area under the curve (AUC) were 0.829 in the base anterior segment for detecting proximal severe stenosis of LAD (sensitivity 0.967, specificity 0.651), 38.3% and 0.843 in the middle anteroseptum for detecting mid-distal sever stenosis of LAD (sensitivity 0.967, specificity 0.651). CONCLUSIONS: Patients with severe LAD stenosis can be screened by ASI-DI among patients with LVEF ≥ 50% and without regional wall motion abnormality. The ASI-DI of base anterior segment and middle anteroseptum can be used to locate the proximal and mid-distal sever stenosis of LAD.

Renal sympathetic denervation inhibits the development of left ventricular mechanical dyssynchrony during the progression of heart failure in dogs.

BACKGROUND: The purpose of this study was to investigate whether transcatheter renal sympathetic denervation (RSD) interfere with the development of left ventricular (LV) mechanical dyssynchrony during the progression of heart failure (HF). METHODS: Nineteen beagles were randomly divided into sham-operated group (six dogs), control group (seven dogs), and RSD group (six dogs). Sham-operated group were implanted with pacemakers without pacing; Control group were implanted with pacemakers and underwent 3 weeks of rapid right ventricular pacing; and RSD group underwent catheter-based RSD bilaterally and were simultaneously implanted with pacemakers. Both LV strain and LV dyssynchrony were analyzed via 2D speckle-tracking strain echocardiography to evaluate LV function. Longitudinal dyssynchrony was determined as the standard deviation for time-to-peak speckle-tracking strain on apical 4- and 2-chamber views. Radial and circumferential dyssynchrony was determined as the standard deviation for time-to-peak speckle-tracking strain in mid- and base-LV short-axis views. Each myocardial function was also evaluated by averaging the peak systolic strains. LV systolic pressure (LVSP) and LV end-diastolic pressure (LVEDP) were measured. The LV interstitial fibrosis was determined by histological analysis. Plasma angiotensin II (Ang II), aldosterone and norepinephrine (NE) levels were also measured. RESULTS: After 3 weeks, all of the dogs in both the control and RSD groups showed greater LV end-diastolic volume compared with the sham-operated group; however, the dogs in the RSD group had a higher LV ejection fraction (LVEF) than the dogs in the control group (p<0.001). The LV systolic strains were higher in the RSD group than in the control group (p<0.001 for longitudinal, circumferential and radial strain, respectively). The levels of LV dyssynchrony were lower in the RSD group than in the control group (p<0.001 for longitudinal, circumferential and radial dyssynchrony, respectively). Compared with dogs with control alone, RSD dogs had lower LV end-diastolic pressures and less fibrous tissue. The levels of plasma Ang II, aldosterone and NE were lower in the RSD group than in the control group. CONCLUSIONS: RSD inhibites the development of left ventricular mechanical dyssynchrony during the progression of heart failure in dogs.

Association between carotid ultrasonographic parameters and microvascular and macrovascular complications in diabetes: A systematic review and meta-analysis.

OBJECTIVE: The present meta-analysis aimed to assess the association between carotid ultrasonographic parameters and diabetic microvascular and macrovascular complications. METHODS: All published articles were searched in electronic databases including PubMed, Embase, Cochrane Library, and Web of Science databases from the inception to May 27, 2023. Common carotid artery intima-media thickness (CCA-IMT), carotid bifurcation intima-media thickness (CB-IMT), internal carotid artery intima-media thickness (ICA-IMT), carotid plaque, carotid plaque score, plaque number, plaque thickness, carotid atherosclerosis, and resistivity indices (RIs) of ultrasonographic parameters were assessed. The odds ratio (OR), weighted mean difference (WMD), with the 95 % confidence interval (CI) were pooled to estimate the effect. Subgroup analyses were performed in terms of the type of diabetes and study design. Sensitivity analysis was used to evaluate the robustness of the results. RESULTS: A total of 25 studies involving 12,102 diabetic patients were included in this systematic review and meta-analysis. Our findings suggested the associations between increased CCA-IMT and the risk of diabetic microvascular (WMD: 0.059, 95%CI: 0.026 to 0.091, P < 0.001) and macrovascular complications (WMD: 0.124, 95%CI: 0.061 to 0.187, P < 0.001) including cardiovascular events (OR: 2.362, 95%CI: 1.913 to 2.916, P < 0.001). Subgroup analyses also elaborated an association between CCA-IMT and diabetic microvascular and macrovascular complications. The results of sensitivity analysis show that the association is relatively stable. CONCLUSION: Our findings revealed associations between carotid ultrasonographic parameters and microvascular and macrovascular complications of diabetes. Application of the carotid ultrasonographic parameters could be a non-invasive method for the early detection of long-term complications of diabetes.

Low-intensity focused ultrasound guided dodecafluoropentane-loaded acoustic phase-change nanoparticles for treatment of porcine coronary microthromboembolism.

BACKGROUND: Coronary microthromboembolism after acute myocardial infarction (AMI) requires urgent and effective treatment. Early and effective recovery of coronary microcirculation perfusion for the management of AMI would be crucial for better prognosis. Ultrasound assisted thrombolysis in the in-vitro experiments have great potential for the elimination of acute coronary microthromboembolism, especially with stable cavitation using low-intensity focused ultrasound (LIFU) and dodecafluoropentane-loaded acoustic phase-change nanoparticles (DDFP@NPs). Therefore, our study sought to perform animal experiments using this novel treatment method in a porcine model with acute coronary microthromboembolism for further investigation of potential therapeutic values. METHODS: Porcine model with acute coronary thromboembolism was established using percutaneous coronary intervention and autologous thrombus injection. For ultrasound assisted thrombolysis, DDFP@NPs were prepared by rotary evaporation and sonication process, and LIFU was optimized. Echocardiography and TTC staining were performed for the evaluation of porcine model establishment and treatment effect. RESULTS: The treatment using LIFU guided DDFP@NPs had almost completely recanalized culprit coronary branch after treatment procedure, and smaller infarcted size (5.4 ± 1.0%), better LVEF (52.5 ± 1.8%) and better coronary microcirculation after 28 days of treatment, which outperformed treatments using LIFU+SonoVue microbubbles (infarcted size: 26.4 ± 3.5% and LVEF: 37.2 ± 3.1%) and LIFU only (infarcted size: 32.2 ± 3.1% and LVEF: 32.2 ± 0.4%) (all P < 0.05), while the treatment effect were similar to treatment using intravenous tissue-plasminogen activator (infarcted size: 4.9 ± 0.9% and LVEF: 53.1 ± 1.1%) (all P > 0.05). CONCLUSIONS: Our study has innovatively established a treatment method using DDFP@NPs combined with LIFU irradiation for coronary thrombolysis and verified its treatment effect with high-efficient thrombolysis in the in-vivo experiments, which can be considered as powerful experimental evident of the novel method for potential clinical use of acute coronary thrombolysis. Multidimensional experimental investigations and cautious verification may need before the method could be used as treatment before preliminary clinical trials.

Low-intensity pulsed ultrasound of different intensities differently affects myocardial ischemia/reperfusion injury by modulating cardiac oxidative stress and inflammatory reaction.

Introduction: The prevalence of ischemic heart disease has reached pandemic levels worldwide. Early revascularization is currently the most effective therapy for ischemic heart diseases but paradoxically induces myocardial ischemia/reperfusion (MI/R) injury. Cardiac inflammatory reaction and oxidative stress are primarily involved in the pathology of MI/R injury. Low-intensity pulsed ultrasound (LIPUS) has been demonstrated to reduce cell injury by protecting against inflammatory reaction and oxidative stress in many diseases, including cardiovascular diseases, but rarely on MI/R injury. Methods: This study was designed to clarify whether LIPUS alleviates MI/R injury by alleviating inflammatory reaction and oxidative stress. Simultaneously, we have also tried to confirm which intensity of the LIPUS might be more suitable to ameliorate the MI/R injury, as well as to clarify the signaling mechanisms. MI/R and simulated ischemia/reperfusion (SI/R) were respectively induced in Sprague Dawley rats and human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs). LIPUS treatment, biochemical measurements, cell death assay, estimation of cardiac oxidative stress and inflammatory reaction, and protein detections by western blotting were performed according to the protocol. Results: In our study, both in vivo and in vitro, LIPUS of 0.1 W/cm2 (LIPUS0.1) and 0.5 W/cm2 (LIPUS0.5) make no significant difference in the cardiomyocytes under normoxic condition. Under the hypoxic condition, MI/R injury, inflammatory reaction, and oxidative stress were partially ameliorated by LIPUS0.5 but were significantly aggravated by LIPUS of 2.5 W/cm2 (LIPUS2.5) both in vivo and in vitro. The activation of the apoptosis signal-regulating kinase 1 (ASK1)/c-Jun N-terminal kinase (JNK) pathway in cardiomyocytes with MI/R injury was partly rectified LIPUS0.5 both in vivo and in vitro. Conclusion: Our study firstly demonstrated that LIPUS of different intensities differently affects MI/R injury by regulating cardiac inflammatory reaction and oxidative stress. Modulations on the ASK1/JNK pathway are the signaling mechanism by which LIPUS0.5 exerts cardioprotective effects. LIPUS0.5 is promising for clinical translation in protecting against MI/R injury. This will be great welfare for patients suffering from MI/R injury.

Early hemodynamics after tibial transverse transport in patients with nonarterial stenosis and arterial stenosis diabetic foot.

BACKGROUND: The diagnosis of peripheral arteriopathy in the diabetic foot is complicated by diabetes and its advanced complications. It has been found that diabetic foot can be categorized into arterial stenosis and non-arterial stenosis, both of which have significant differences in hemodynamic characteristics. AIM: To evaluate the early hemodynamic changes in diabetic foot patients with nonarterial stenosis and arterial stenosis treated by tibial transverse transport (TTT) using high-frequency color Doppler ultrasonography (HFCDU) and a laser Doppler flowmeter. METHODS: Twenty-five patients with Wagner grades 3-5 diabetic foot ulcers were treated with TTT, and the wound healing time and rate were recorded. Patients were grouped according to the results of preoperative lower-extremity ultrasonography. Cases with ≥ 50% stenosis in any of the femoral, popliteal, posterior tibial, anterior tibial, and peroneal arteries of the affected limb were classified as the arterial stenosis group (n = 16); otherwise, they were classified as the nonarterial stenosis group (n = 9). Before and one month after surgery, HFCDU was used to evaluate the degree of lower limb artery lesions and hemodynamic changes in patients. The degree of femoral-popliteal atherosclerotic stenosis, the degree of vascular stenosis and occlusion of the lower-knee outflow tract, and the degree of medial arterial calcification were scored; the three scores were added together to obtain the total score of lower extremity arteriopathy. PeriScanPIM3, a laser Doppler flowmeter system, was used to detect alterations in plantar microcirculation before and 1 mo after surgery. Wound healing and hemodynamic indices were compared between the two groups. RESULTS: The wound healing time of the diabetic foot was significantly shorter in the nonarterial stenosis group than in the arterial stenosis group (47.8 ± 13 vs 85.8 ± 26, P < 0.05), and the wound healing rate of both groups was 100%. The preoperative total lower extremity arteriopathy scores were lower in the nonarterial stenosis group than those in the arterial stenosis group (18.89 ± 8.87 vs 24.63 ± 3.52, P < 0.05). The nonarterial stenosis group showed higher preoperative popliteal artery (POA) blood flow than the arterial stenosis group (204.89 ± 80.76 cc/min vs 76.75 ± 48.49 cc/min, P < 0.05). Compared with the baseline (before surgery), the postoperative POA blood flow of the affected limb in the nonarterial stenosis group decreased one month after surgery (134.11 ± 47.84 cc/min vs 204.89 ± 80.76 cc/min, P < 0.05), while that in the arterial stenosis group increased (98.44 ± 30.73 cc/min vs 61.69 ± 21.70 cc/min, P < 0.05). Although the POA blood flow in the arterial stenosis group was obviously improved one month after surgery, it was still lower than that in the nonarterial stenosis group (98.44 ± 30.73 cc/min vs 134.11 ± 47.84 cc/min, P < 0.05). The nonarterial stenosis group had higher preoperative plantar microcirculation than the arterial stenosis group (56.1 ± 9.2 vs 33.2 ± 7.5, P < 0.05); compared with the baseline, the plantar microcirculation in the arterial stenosis group was significantly improved one month after surgery (51.9 ± 7.2, P < 0.05), while that in the nonarterial stenosis group was reduced (35.9 ± 7.2, P < 0.05). CONCLUSION: Based on preoperative HFCDU findings, diabetic foot patients can be divided into two categories: Those with nonarterial stenosis and those with arterial stenosis, with obvious differences in hemodynamic changes in the early postoperative period between them. In the early stage after TTT, the blood flow volume and velocity and the plantar microcirculation perfusion of the affected limb of the diabetic foot with nonarterial stenosis decreased compared with the baseline, while those of the diabetic foot with arterial stenosis improved significantly compared with the baseline, although both had smoothly healed diabetic foot ulcers.

Relieving Stress Concentration through Anion-Cation Codoping toward Highly Stable Nickel-Rich Cathode.

Nickel-rich LiNi0.8Co0.15Al0.015O2 (NCA) with excellent energy density is considered one of the most promising cathodes for lithium-ion batteries. Nevertheless, the stress concentration caused by Li+/Ni2+ mixing and oxygen vacancies leads to the structural collapse and obvious capacity degradation of NCA. Herein, a facile codoping of anion (F-)-cation (Mg2+) strategy is proposed to address these problems. Benefiting from the synergistic effect of F- and Mg2+, the codoped material exhibits alleviated Li+/Ni2+ mixing and demonstrates enhanced electrochemical performance at high voltage (≥4.5 V), outperformed the pristine and F-/Mg2+ single-doped counterparts. Combined experimental and theoretical studies reveal that Mg2+ and F- codoping decreases the Li+ diffusion energy barrier and enhances the Li+ transport kinetics. In particular, the codoping synergistically suppresses the Li+/Ni2+ mixing and lattice oxygen escape, and alleviates the stress-strain accumulation, thereby inhibiting crack propagation and improving the electrochemical performance of the NCA. As a consequence, the designed Li0.99Mg0.01Ni0.8Co0.15Al0.05O0.98F0.02 (Mg1+F2) demonstrates a much higher capacity retention of 82.65% than NCA (55.69%) even after 200 cycles at 2.8-4.5 V under 1 C. Furthermore, the capacity retention rate of the Mg1+F2||graphite pouch cell after 500 cycles is 89.6% compared to that of the NCA (only 79.4%).

Misdiagnosis of aorta-right atrial tunnel.

First reported by Coto in 1980, aorta-right atrial tunnel (ARAT) is a rare congenital vascular connection between the aortic root and RA. The case report presents a 38-year-old male patient with ARAT. Echocardiography showed a tunnel-like structure which appeared to be a connection between the left coronary sinus and the left atrium although the tunnel was connected to the right atrium. The misdiagnosis may be explained that the images were overlaid and abnormal color flow signal was not detected in RA because of the failure to detect color flow spectrum at the outlet of superior vena cava (SVC). We have discussed the diagnostic experience of the rare congenital cardiac anomaly in echocardiography: (1) carefully detect the origin and termination of abnormal tunnel structure; (2) the outlet of SVC into RA should be detected for possible artery flow spectrum and color flow signal into RA; (3) transesophageal echocardiography should be performed for identifying the diagnosis of ARAT if it is necessary.

Platelet Membrane Biomimetic Nanoparticles Combined With UTMD to Improve the Stability of Atherosclerotic Plaques.

Although research on the treatment of atherosclerosis has progressed recently, challenges remain in developing more effective, safer and transformative strategies for the treatment of atherosclerosis. Nanomaterials have recently played a unique role in many fields, including atherosclerosis treatment. Platelets are common component in the blood. Due to their inherent properties, platelets can target and adhere to atherosclerotic plaques. Ultrasound-targeted microbubble destruction (UTMD) shows great prospects in promoting the efficiency of drug delivery in treating solid tumors. In this study, we explored the possibility that UTMD assists platelet biomimetic rapamycin (RAP)-loaded poly (lactic-co-glycolic acid) (PLGA) nanoparticles (RAP@PLT NPs) in the treatment of atherosclerosis. The biomimetic nano-formulations exhibit better targeting ability to plaques when administered in vivo. Targeted destruction of Sonovue™ in the aortic area further improved the efficiency of targeting plaques. Moreover, the progression of atherosclerotic plaques was inhibited, and the stability of plaques was improved. Together, our study established a novel strategy for targeted delivery of nanoparticles in atherosclerotic plaques, by combining the advantages of the ultrasonic cavitation effect and biomimicking nanoparticles in drug delivery.

Value of layer-specific speckle tracking echocardiography for early detection of myocardial injury caused by chemotherapy in breast cancer patients with cardiovascular risk.

The probability of toxicity-related myocardial injury event with anthracyclines is controversial, which could be related to the underlying cardiac status before chemotherapy. Our study sought to investigate the influence of cardiovascular risk factors on myocardial motion and cardiac function using layer-specific speckle tracking echocardiography (STE) during chemotherapy with epirubicin. Female patients with first-diagnosed breast cancer were prospectively enrolled in our study and received 4 chemotherapeutic cycles with epirubicin in each cycle of 21 days. All patients underwent echocardiography for layer-specific STE analysis before and after all chemotherapy. Clinical data including cardiovascular risk factors were collected. According to the Framingham score, patients with cardiovascular risk factors were divided into groups with low, medium, and high risk. 134 patients existed in the final analysis. The accumulated dose of epirubicin for were 560.0 ± 103.8 mg. 97 (72.4%) patients had cardiovascular risk factors. According to the Framingham score, 57 (42.5%) patients categorized in high risk. Endocardial layer strain after chemotherapy were lower than those at baseline (p < 0.05, all), especially for patients with high risk. The changes of endocardial longitudinal strain during chemotherapy were associated with cardiovascular risks at baseline with correlation coefficient of 0.627. Our study found that layer-specific STE is valuable for early detection of toxicity-related myocardial injury for patients with breast cancer after epirubicin chemotherapy and cardiovascular risk factors have greatly influenced on cardiac function during chemotherapy. The endocardial layer strain is sensitive to evaluate early-stage toxicity-related myocardial injury after epirubicin chemotherapy.

Thermal Transport in Multidimensional Silicon-Graphene Hybrid Nanostructures.

In this work, we fabricate multidimensional silicon-graphene hybrid nanostructures composed of three-dimensional (3D) out-of-plane graphene flakes on a silicon nanowire core. By changing the synthesis temperature (700 and 1100 °C) and time (5, 10, and 20 min), we obtain two different types of 3D graphene flakes with tunable dimensions and structure parameters. We characterize the thermal transport behavior of this hybrid multidimensional material in a broad temperature range of 20-460 K. With different morphologies and structures, the effective thermal conductivity of the silicon-graphene hybrid nanostructures varies from 1 to 7 W/(m·K) at room temperature. We also apply molecular dynamics simulation and density functional theory to elucidate the thermal transport mechanisms in the silicon-graphene hybrid nanostructures.

[Effect evaluation of bedside ultrasound monitoring of left ventricular functional parameters combined with clinical indicators on veno-arterial extracorporeal membrane oxygenation].

OBJECTIVE: To explore the monitoring value of left ventricular functional parameters obtained by bedside ultrasound combined with clinically relevant indicators in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). METHODS: A retrospective study was conducted. A total of 24 patients receiving VA-ECMO adjuvant support in Renmin Hospital of Wuhan University from June 2018 to January 2020 were selected. The bedside ultrasound was performed on the first day of ECMO support, the day before weaning, the clinical indicators before weaning were obtained. The differences in clinical indicators and the left ventricular functional parameters between the two groups of whether weaning successfully were compared; univariate Logistic regression analysis was used to screen out the related factors affecting weaning. RESULTS: Sixteen patients were successful weaned and 8 patients failed. Compared with the weaning failure group, patients in the weaning success group required less continuous renal replacement therapy (CRRT, cases: 4 vs. 6, P < 0.05), mean arterial pressure (MAP) before weaning was higher [mmHg (1 mmHg = 0.133 kPa): 84.64±9.55 vs. 62.30±8.79, P < 0.05], and the pulse oxygen saturation (SpO2) was also higher (0.966±0.670 vs. 0.866±0.061, P < 0.05), while vasoactive-inotropic score (VIS), serum creatinine (SCr) and serum lactic acid (Lac) were lower [VIS score: 7.27±1.42 vs. 16.93±8.52, SCr (µmol/L): 123.60±83.64 vs. 213.10±117.39, Lac (mmol/L): 1.94±0.91 vs. 5.62±5.48, all P < 0.05]. Univariate Logistic regression analysis showed that the MAP, VIS, SCr, Lac, SpO2 before weaning were the related factors affecting weaning [odds ratio (OR) were 0.306, -0.740, -0.011, -0.632, -4.069; 95% confidence interval (95%CI) were 1.065-1.732, 0.235-0.899, 0.979-0.999, 0.285-0.992 and 0.001-0.208; P values were 0.014, 0.022, 0.038, 0.047, 0.002]. In the weaning success group, left ventricular ejection fraction (LVEF), velocity of mitralannulus in systolic (LatSa), maximum flow velocity of aortic valve (AV-Vmax), velocity-time integral (VTI), left ventricular global longitudinal strain (LVGLS), left ventricular global longitudinal strain rate (LVGLSr) were all increased on the day before ECMO weaning compared with the first day of ECMO support [LVEF: 0.40±0.05 vs. 0.28±0.07, LatSa (cm/s): 6.81±0.91 vs. 4.62±1.02, AV-Vmax (cm/s): 104.81±33.98 vs. 64.44±16.85, VTI (cm): 14.56±3.11 vs. 7.96±1.98, LVGLS: (-8.95±2.59)% vs. (-5.26±1.28)%, LVGLSr (1/s): -0.48±0.11 vs. -0.29±0.09], whereas the ECMO flow was significantly reduced (L/min: 1.46±0.47 vs. 2.64±0.31), the differences were statistically significant (all P < 0.05). There was no significant difference in left ventricular functional parameters between the first day of ECMO support and the day before ECMO weaning in the weaning failure group. Compared with the weaning failure group, the weaning success group had higher LVEF, LatSa, AV-Vmax, VTI, LVGLS, LVGLSr on the day before ECMO weaning [LVEF: 0.40±0.05 vs. 0.26±0.07, LatSa (cm/s): 6.81±0.91 vs. 4.31±1.03, AV-Vmax (cm/s): 104.81±33.98 vs. 67.67±18.46, VTI (cm): 14.56±3.11 vs. 7.75±2.77, LVGLS: (-8.95±2.59)% vs. (-4.81±1.81)%, LVGLSr (1/s): -0.48±0.11 vs. -0.30±0.10, all P < 0.05] and lower ECMO flow (L/min: 1.46±0.47 vs. 2.20±0.62, P < 0.05). CONCLUSIONS: Bedside echocardiographic left ventricular function parameters (LVEF, LatSa, AV-Vmax, VTI, LVGLS, LVGLSr) combined with clinical indicators (MAP, VIS, SCr, Lac, SpO2) were helpful to evaluate the therapeutic effect of patients receiving VA-ECMO support and can provide important guiding value in the selection of VA-ECMO weaning timing and the judgment of prognosis.

Morphology display and hemodynamic testing using 3D printing may aid in the prediction of LVOT obstruction after mitral valve replacement.

AIMS: Left ventricular outflow tract(LVOT) obstruction after mitral valve replacement can be life-threatening once occur. We simulated mitral valve replacement preoperatively using dynamic, three-dimensional(3D) printed models to help predict LVOT obstruction in this study. METHODS: 56 patients who underwent mitral valve replacement were included. Prediction of LVOT obstruction in vitro was based on the data from 4 sources: digital, anatomical, flexible, and dynamic model. Digital 3D models were designed based on computed tomography (CT) image dataset and printed with photopolymer resin to create a 3D anatomical model, which contributed to the morphology display. Then, flexible models were made from specialized silicone, which is similar to cardiac tissue in terms of its softness and elasticity. Dynamic function was achieved by coupling flexible models to a mock circulatory system (MCS). Besides, surgery simulation and hemodynamic testing was done using dynamic 3D printed model and patients were regrouped based on hemodynamic change. Finally, different methods for prediction of LVOT obstruction as well as classification based on two-dimensional image data and dynamic model were compared with surgical results as golden standard. RESULTS: (1)Qualitatively, the prediction of LVOT obstruction using the dynamic 3D model was the most accurate and was consistent with clinical outcomes. In the four patients who developed LVOT obstruction after surgery, only two were at a high risk based on the other three models. (2)Quantitatively, the area of neo-LVOT predicted by the digital, anatomical, and flexible models was higher compared with the dynamic models and in-vivo after surgery. (3)Classification based on traditional criteria(two-dimensional image data) was different from surgical results. While the difference between dynamic model and surgical results was not statistically different. CONCLUSIONS: After coupling the flexible model with the mock circulatory system, the dynamic 3D model predicted LVOT obstruction more accurately with hemodynamic testing compared with morphological evaluation. 3D printing can assist surgeons to better plan mitral valve replacement than traditional image data.