Electricity-Driven Strategies for Bioinspired Multifunctional Swimming Marangoni Robots Based on Super-Aligned Carbon Nanotube Composites.

Marangoni actuators that are propelled by surface tension gradients hold significant potential in small-scale swimming robots. Nevertheless, the release of "fuel" for conventional chemical Marangoni actuators is not easily controllable, and the single swimming function also limits application areas. Constructing controllable Marangoni robots with multifunctions is still a huge challenge. Herein, inspired by water striders, electricity-driven strategies are proposed for a multifunctional swimming Marangoni robot (MSMR), which is fabricated by super-aligned carbon nanotube (SACNT) and polyimide (PI) composite. The MSMR consists of a Marangoni actuator and air-ambient actuators. Owing to the temperature gradient generated by the electrical stimulation on the water surface, the Marangoni actuators can swim controllably with linear, turning, and rotary motions, mimicking the walking motion of water striders. In addition, the Marangoni actuators can also be driven by light. Importantly, the air-ambient actuators fabricated by SACNT/PI bilayer structures demonstrate the function of grasping objects on the water surface when electrically Joule-heated, mimicking the predation behavior of water striders. With the synergistic effect of the Marangoni actuator and air-ambient actuators, the MSMR can navigate mazes with tunnels and grasp objects. This research will provide a new inspiration for smart actuators and swimming robots.

"Sweat-Driven" MXene Composites with Energy-Storage and Thermal-Management Multifunctions: A Platform for Versatile Electronic Skins.

Most exogenous electronic skins (e-skins) currently face challenges of complex structure and poor compatibility with the human body. Utilizing human secretions (e.g., sweat) to develop e-skins is an effective solution strategy. Here, a new kind of "sweat-driven" e-skin is proposed, which realizes energy-storage and thermal-management multifunctions. Through the layer-by-layer assembly of MXene-carbon nanotube (CNT) composite with paper, lightweight and versatile e-skins based on supercapacitors and actuators are fabricated. Long CNTs wrap and entangle MXene nanosheets, enhancing their long-distance conductivity. Furthermore, the CNT network overcomes the structural collapse of MXene in sweat, improving the energy-storage performance of e-skin. The "sweat-driven" all-in-one supercapacitor with a trilayer structure is patternable, which absorbs sweat as electrolyte and harnesses the ions therein to store energy, exhibiting an areal capacitance of 282.3 mF cm-2 and a high power density (2117.8 µW cm-2 ). The "sweat-driven" actuator with a bilayer structure can be driven by moisture (bending curvature of 0.9 cm-1 ) and sweat for personal thermal management. Therefore, the paper serves as a separator, actuating layer, patternable layer, sweat extractor, and reservoir. The "sweat-driven" MXene-CNT composite provides a platform for versatile e-skins, which achieve the interaction with humans and offer insights into the development of multifunctional wearable electronics.

Generation of attosecond micro bunched beam using ionization injection in laser wakefield acceleration.

Micro bunched electron beams with periodic longitudinal density modulation at optical wavelengths give rise to coherent light emission. In this paper, we show attosecond micro bunched beam generation and acceleration in laser-plasma wakefield via particle-in-cell simulations. Due to the near-threshold ionization with the drive laser, the electrons with phase-dependent distributions are non-linearly mapped to discrete final phase spaces. Electrons can preserve this initial bunching structure during the acceleration, leading to an attosecond electron bunch train after leaving the plasma with separations of the same time scale. The modulation of the comb-like current density profile is about 2k0 ∼ 3k0, where k0 is the wavenumber of the laser pulse. Such pre-bunched electrons with low relative energy spread may have potential in applications related to future coherent light sources driven by laser-plasma accelerators and broad application prospects in attosecond science and ultrafast dynamical detection.

Initial experiences of transapical beating-heart mitral valve repair with a novel artificial chordal implantation device.

BACKGROUND: Severe mitral regurgitation (MR) is associated with progressive heart failure and impairment of survival. Degenerative MR accounts for most MV repair surgeries. Conventional mitral valve repair surgery requires cardiopulmonary bypass and is associated with significant morbidity and risks. Transapical beating-heart mitral valve repair by artificial chordae implantation with transesophageal echocardiography (TEE) guidance has the potential to significantly reduce surgical morbidity. We report the first-in-human experience of degenerative MR repair using a novel artificial chordae implantation device (MitralstitchTM system). METHODS: Ten patients with severe MR underwent transapical artificial chordae implantation using MitralstitchTM system. The procedure was performed through a small left thoracotomy under general anesthesia and TEE guidance. Patients underwent transthoracic echocardiography and other assessments during the follow-up. RESULTS: All 10 patients with an average age of 63.7 ± 9.6 years successfully received transapical artificial chordae implantation. Their MR reduced from severe to none or trace in five patients, mild in five patients before discharge. Five patients received one artificial chordal implantation, four patients received two, and one patient received three and edge-to-edge repair by locking two of them. The safety and efficacy endpoint were achieved in all patients at 1-month follow-up. At 1-year follow-up, six patients had mild MR, three patients had moderate MR, one patient had recurrence of severe MR and underwent surgical repair. CONCLUSIONS: The results of this first-in-human study show safety and feasibility of transapical mitral valve repair using MitralStitch system. Patient selection and technical refinement are crucial to improve the outcomes.

Investigation of Dropwise Condensation on a Super-Aligned Carbon Nanotube Mesh-Coated Surface.

Enhanced vapor condensation is a critical issue for improving the efficiency of energy conversion, thermal management, water recovery, and treatment. Low-energy surfaces incorporating micro/nanoscale roughness have been reported to significantly promote vapor condensation. In this research, the mesh structures of super-aligned carbon nanotube (SACNT) films were prepared by crossing monolayer SACNT films on a copper substrate. Then, the sustaining dropwise condensation was achieved on the SACNT mesh-coated surface. The SACNT mesh-coated surface could obviously enhance the coalescence and sweeping departure of the condensing droplets. Additionally, the measured overall heat transfer coefficient (HTC) of the SACNT mesh-coated surface demonstrated a 36% enhancement compared to that on the bare copper surface. The parallel stacking of SACNT films with different groove structures was also studied, and a 15% enhancement in the HTC was shown as compared with the bare copper surface. Furthermore, we developed a morphology-based model to theoretically analyze the condensation-enhancement mechanism on a SACNT mesh-coated surface. The SACNT surfaces also have advantages of low cost, durability, flexibility, and extensibility. Our findings revealed that the SACNT films could be readily used as vapor condensation-strengthening surfaces, further extending their potential applications to industrial equipment.

Cellular analysis of a novel mutation p. Ser287Tyr in TOR1A in late-onset isolated dystonia.

BACKGROUND: Variations in TOR1A were thought to be associated with early-onset isolated dystonia. The variant S287Y (NM_000113.2: c.860C > A, p. Ser287Tyr, rs766483672) was found in our late-onset isolated dystonia patient. This missense variant is adjacent to R288Q (c.863G > A, p. Arg288Gln), which was reported to be associated with isolated dystonia. The potentially pathogenic role of S287Y is not conclusively known. METHODS: Cytological and molecular biological analyses were performed in vitro to determine whether this variant damages the structure and function of the cell. RESULTS: Compared with the SH-SY5Y cells overexpressing wild-type TOR1A, the cells overexpressing the protein with S287Y have an enlarged peri-nuclear space. The same changes in nuclear morphology were also found in the cells overexpressing the pathogenic variants ΔE (NM_000113.2:c.904_906delGAG, p. Glu302del), F205I (NM_000113.2:c.613 T > A, p. Phe205Ile), and R288Q (NM_000113.2:c.863G > A, p. Arg288Gln). Mutated proteins with S287Y presented a higher tendency to form dimers under reducing conditions. The same tendencies were observed in other mutated proteins but not in wild-type torsinA. CONCLUSIONS: TorsinA with S287Y damages the structure of the cell nucleus and may be a novel pathogenic mutation that causes isolated dystonia.

Down-regulation of the insulin signaling pathway by SHC may correlate with congenital heart disease in Chinese populations.

BACKGROUND/AIMS: Congenital heart disease (CHD) is one of the most common and severe congenital defects. The incidence of fetal cardiac malformation is increased in the context of maternal gestational diabetes mellitus (GDM). Therefore, we wanted to determine whether abnormalities in the insulin signaling pathway are associated with the occurrence of nonsyndromic CHD (ns-CHD). METHODS: We used digital gene expression profiling (DGE) of right atrial myocardial tissue samples from eight ns-CHD patients and four controls. The genes potentially associated with CHD were validated by real-time fluorescence quantitative PCR analysis of right atrial myocardial tissues from 37 patients and 10 controls and the H9C2 cell line. RESULTS: The results showed that the insulin signaling pathway, which is mediated by the SHC gene family, was inhibited in the ns-CHD patients. The expression levels of five genes (PTPRF, SHC4, MAP2K2, MKNK2, and ELK1) in the pathway were significantly down-regulated in the patients' atrial tissues (P<0.05 for all). In vitro, the H9C2 cells cultured in high glucose (33 mmol/l) expressed less SHC4, MAP2K2, and Elk-1 than those cultured in low glucose (25 mmol/l). Furthermore, the high glucose concentration down-regulated the 25 genes associated with blood vessel development based on Gene Ontology (GO) term enrichment analyses of RNA-seq data. CONCLUSION: We considered that changes in the insulin signaling pathway mediated by SHC might be involved in the heart development process. This mechanism might account for the increase in the incidence of fetal cardiac malformations in the context of GDM.

Value of Implantable Loop Recorders in Monitoring Efficacy of Radiofrequency Catheter Ablation in Atrial Fibrillation.

BACKGROUND The aim of this study was to evaluate the value of the implantable loop recorder (ILR) in diagnosing atrial fibrillation (AF) and assessing the postoperative efficacy of radiofrequency catheter ablation (RFCA). MATERIAL AND METHODS A total of 32 patients who successfully underwent RFCA were selected. These patients discontinued antiarrhythmic medication with no AF recurrence for more than 3 months after RFCA, and underwent ILR placement by a conventional method. The clinical manifestations and information on arrhythmias recorded by the ILR were followed up to assess the efficacy of AF RFCA. RESULTS The mean follow-up period was 24.7±12.5 months. Of 32 patients with ILR information, 27 had successful RFCA and 5 had recurrent AF. The follow-up results obtained by traditional methods showed 29 patients with successful RFCA and 3 with recurrent AF (P<0.05). Among the 18 patients with clinical symptoms, 13 had recorded cardiac arrhythmic events (72.2%) and 5 showed sinus rhythm (27.8%). The ILRs recorded 18 patients with arrhythmic events (56.3%), including 12 cases of atrial arrhythmias, among whom 5 recurred at 9, 12, 16, 17, and 32 months after AF RFCA; there were also 2 patients with ventricular tachycardia (VT) and 4 with bradycardia. CONCLUSIONS The value of ILR in assessing the efficacy of AF RFCA was superior to that of traditional methods. ILR can promptly detect asymptomatic AF, and can monitor electrocardiogram features after RFCA, thus providing objective evidence of efficacy.

Biventricular pacing with ventricular fusion by intrinsic activation in cardiac resynchronization therapy.

We sought to evaluate the impact of biventricular (BiV) pacing with ventricular fusion by intrinsic atrioventricular nodal (AVN) conduction (BiV + intrinsic pacing) on clinical outcomes in patients with chronic heart failure (CHF) receiving cardiac resynchronization therapy (CRT).A total of 44 patients were randomized to receive either BiV or BiV + intrinsic pacing for one month. Echocardiographic optimization was performed for the BiV pacing mode, while the BiV + intrinsic pacing mode was achieved by titrating AV delay under electrocardiography (ECG) monitoring. Symptoms, quality of life, ECG, echocardiography, and cardiovascular events were recorded at baseline and the end of the follow-up for each pacing mode.Patients undergoing BiV + intrinsic pacing mode had shorter QRS duration compared to those with conventional BiV pacing (118.4 ± 21.6 ms versus 146.4 ± 5.3 ms, P < 0.0001). Also, these patients had improved echocardiographic left ventricular fractional shortening (LVFS) (17.4 ± 5.9 versus 15.7 ± 4.9, P = 0.019), higher left ventricular ejection fraction (LVEF) (35.5 ± 9.7 versus 32.7 ± 9.7, P = 0.048), longer 6-minute walk test (6MWT) (372.5 ± 80.9 m versus 328.7 ± 108.9 m, P = 0.0001), and better Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores (12.5 ± 6.6 versus 18.2 ± 12.3, P = 0.0001).Treating CHF patients with BiV+intrinsic pacing resulted in improved cardiac function and quality of life. BiV + intrinsic pacing can be used in CHF patients with sinus rhythm and normal AV nodal conduction to improve CRT efficacy.

WW domain containing oxidoreductase induces apoptosis in gallbladder-derived malignant cell by upregulating expression of P73 and PUMA.

Gallbladder cancer (GBC) is one leading cause of cancer-related death worldwide. WW domain-containing oxidoreductase (WWOX) is a tumor suppressor gene which can suppress proliferation of a variety of tumors. However, little was known about the relationships between WWOX and gallbladder cancer. In the current study, we intended to investigate the tumor suppressive role of WWOX in gallbladder malignant cells both in vitro and in vivo, and explore the potential mechanism of tumor toxic function of WWOX. Our results have shown that WWOX triggerred apoptosis in GBC cells and increased the expression of P73 and PUMA in cytoplasm. We also have found that Bax has been upregulated after overexpression of WWOX, whereas, Bcl-2 was downregulated by WWOX. To further validate the results in vivo, we evaluated the tumor suppressive role of WWOX in mouse model of gallbladder cancer. The results have shown that the proliferation of the tumor was inhibited after delivery of WWOX, and the expressions of P73 and PUMA were upregulated in target tissues. The mice models administrated with WWOX have shown better prognosis than mice in negative control groups. The results from our study indicated that WWOX could be used as a therapeutic agent in the gene therapy of gallbladder cancer.

Association study of FLT4 and HYDIN single nucleotide polymorphisms with atrial septal defect susceptibility in the Han Chinese population of Southwest China.

BACKGROUND: Atrial septal defect (ASD) is a common form of congenital heart disease. Although several genes related to ASD have been found, the genetic factors of ASD remain unclear. This study aimed to evaluate the correlation between 10 candidate single nucleotide polymorphisms (SNPs) and sporadic atrial septal defects. METHODS: Based on the results of 34 individual whole exome sequences, 10 candidate SNPs were selected. In total, 489 ASD samples and 420 normal samples were collected. The 10 SNPs in the case group and the control group were identified through Snapshot genotyping technology. The χ2-test and unconditional regression model were used to evaluate the relationship between ASD and each candidate SNP. Haploview software was used to perform linkage disequilibrium and haplotype analysis. RESULTS: The χ2 results showed that the FLT4 rs383985 (P = 0.003, OR = 1.115-1.773), HYDIN rs7198975 (P = 0.04621, OR = 1.003-1.461), and HYDIN rs1774266 (P = 0.04621, OR = 1.003-1.461) alleles were significantly different between the control group and the case group (P < 0.05). Only the association with the FLT4 polymorphism was statistically significant after adjustment for multiple comparisons. CONCLUSION: These findings suggest that a possible molecular pathogenesis associated with sporadic ASD is worth exploring in future studies.

Randomized and double-blind controlled clinical trial of extracorporeal cardiac shock wave therapy for coronary heart disease.

Our aim was to evaluate the safety and effectiveness of extracorporeal cardiac shock wave therapy (CSWT) for the patients with coronary heart disease (CHD) using a randomized, double-blind, controlled clinical trial design. Twenty-five patients with CHD were enrolled in this study. Fourteen of the patients were randomized into the CSWT group and 11 into the control group. We applied the CSWT procedure to each patient by using nine shock treatments during 3 months, but the shock wave (SW) energy was only applied to the patients in the CSWT group and not to the patients in the control group. Technetium-99m sestamibi myocardial perfusion, fluorine-18 fluorodeoxyglucose myocardial metabolism single-photon emission computed tomography (SPECT), and two-dimensional echocardiography were performed to identify segments of myocardial ischemia, myocardial viability, and ejection fraction before and after CSWT. We also followed the patients to evaluate adverse effects. After CSWT, the New York Heart Association class, the Canadian Cardiovascular Society angina scale, nitroglycerin dosage, myocardial perfusion and myocardial metabolic imaging scores of dual-isotope SPECT in the CSWT group were reduced significantly (P = 0.019, 0.027, 0.039, 0.000, 0.001, respectively), and the Seattle Angina Questionnaire scale, 6-min walking test, and left ventricular ejection fraction were increased significantly (P = 0.021, 0.024, 0.016, respectively) compared with those before the SW treatment. All of the parameters in the control group did not change significantly after the treatment (all P > 0.05). No serious adverse effects of CSWT were observed. Cardiac shock wave therapy is a safe and effective treatment for CHD patients.

Pencil-Drawn Generator Built-in Actuator for Integrated Self-Powered/Visual Dual-Mode Sensing Functions and Rewritable Display.

Multifunctionality is important to the development of next-generation actuators and intelligent robots. However, current multi-functional actuating systems are achieved based on the integration of diverse functional units with complex design, especially lacking in multi-mode sensing and displaying functions. Herein, a light-driven actuator integrated with self-powered/visual dual-mode sensing functions and rewritable display function is proposed. The actuator demonstrates a bending curvature of 0.93 cm-1 under near-infrared light irradiation. Meanwhile, by embedding a pencil-drawn graphite generator and thermochromic materials, the actuator also provides two independent sensing functions. First, owing to the photo-thermoelectric effect of graphite, the actuator spontaneously outputs a self-powered voltage (Seebeck coefficient: 23 µV K-1 ), which can reflect the deformation trend of actuator. Second, color changes occur on the actuator during deformation, which provide a visual sensing due to the thermochromic property. Furthermore, the actuator can be utilized as a rewritable display, owing to the integrated color-memorizing component. Intelligent robots, switches, and smart homes are further demonstrated as applications. All of them can spontaneously provide self-powered and visual sensing signals to demonstrate the working states of actuating systems, accompanied by rewritable displays on the actuators. This study will open a new direction for self-powered devices, multi-functional actuators, and intelligent robots.

A PEDOT:PSS/MXene-based actuator with self-powered sensing function by incorporating a photo-thermoelectric generator.

Actuators with sensing functions are becoming increasingly important in the field of soft robotics. However, most of the actuators are lack of self-powered sensing ability, which limits their applications. Here, we report a light-driven actuator with self-powered sensing function, which is designed to incorporate a photo-thermoelectric generator into the actuator based on poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS)/MXene composite and polyimide. The actuator shows a large bending curvature of 1.8 cm-1 under near-infrared light (800 mW cm-2) irradiation for 10 s, which is attribute to photothermal expansion mismatch between PEDOT:PSS/MXene composite and polyimide. Simultaneously, the actuator shows enhanced thermoelectric properties with Seebeck coefficient of 35.7 µV K-1, which are mainly attributed to a combination of energy filtering effects between the PEDOT:PSS and MXene interfaces as well as the synergistic effect of its charge carrier migration. The output voltage of the actuator changes in accordance with the bending curvature, so as to achieve the self-powered sensing function and monitor the operating state of the actuator. Moreover, a bionic flower is fabricated, which not only simulates the blooming and closing of the flower, but also perceives the real-time actuation status through the output voltage signal. Finally, a smart Braille system is elaborately designed, which can not only simulate Braille characters for tactile recognition of the blind people, but also automatically output the voltage signal of Braille for self-powered sensing, enabling multi-channel output and conversion of light energy. This research proposes a new idea for exploring multifunctional actuators, integrated devices and self-powered soft robots.

Cardiac function evaluated by two-dimensional speckle tracking imaging in fetuses with congenital heart disease of ventricular afterload increase.

AIMS: To study myocardial deformation in fetuses with ventricular afterload increase compared with gestational age-matched controls using speckle tracking echocardiography. METHODS AND RESULTS: Eighty-nine fetuses were retrospectively selected from the pregnancy screen by echocardiography. There are 41 fetuses with gestational age-matched normal heart served as the control group, 25 fetuses with congenital heart disease (CHD) leading to left ventricular (LV) afterload increase as group LVA and 23 fetuses with CHD leading to right ventricular(RV) afterload increases as group RVA. LV and RV fractional shortening (FS) were measured by conventional methods. The longitudinal strain (LS) and strain rate (LSr) were analyzed by EchoPac software. Group LVA and RVA compared with control group, the LV FS was no significant difference, but LS and LSr values of LV were lower in fetuses with LVA compared to the control group (LS:-15.97(-12.50,-22.52)vs -27.53(-24.33,-29.16) %, p < .01; systolic strain rate (SRs):-1.34(-1.12,-2.16) vs -2.55(-2.28,-2.92) 1/sec, p < .01; early diastolic strain rate (SRe):1.70 ± 0.57 vs 2.46 ± 0.61 1/sec, p < 0.01; late diastolic strain rate (SRa):1.62 ± 0.82 vs 2.39 ± 0.81 1/sec, p < .01). LS and LSr values of LV or RV were lower in fetuses with RVA compared to the control group (LV: LS:-21.52 ± 6.68 vs -26.79 ± 3.22%, p < .01; SRs:-2.11 ± 0.78 vs -2.56 ± 0.43 1/sec; p = .02; RV: LS:-17.64 ± 7.58 vs -26.38 ± 3.97%, p < .01; SRs:-1.62 ± 0.67 vs -2.37 ± 0.44 1/sec; p < .01). CONCLUSION: The results of this study showed that the ventricular LS, LSr, SRs, SRe, SRa values were lower in fetuses with LV or RV afterload increasing CHD estimated by speckle tracking imaging but LV and RV FS were normal,which indicated the strain imaging is feasible in evaluating cardiac function of fetus, and may be more sensitive.

Self-chargeable supercapacitor made with MXene-bacterial cellulose nanofiber composite for wearable devices.

The development of wearable electronics is restricted by the developments of supporting energy storage devices, especially flexible supercapacitors. Nowadays, miniaturized supercapacitors based on MXenes due to their obvious advantages in the specific capacity have received extensive attention. The energy existing in the surrounding environment has been used to directly charge energy storage devices. However, the hybrid wearable electronics integrated supercapacitors are mechanically connected through metal wires leading to non-compact devices. Thus, it is urgent to develop a general and universal method to fabricate high-performance robust MXene-based flexible electrodes with high electrical conductivity and apply them to self-chargeable supercapacitors and compact wearable devices. Herein, the bacterial cellulose (BC) nanofibers are used as a crosslinking agent to connect two-dimensional MXene nanosheets through the hydrogen bond, which greatly improves the mechanical strength of MXene-bacterial cellulose (MXene-BC) composite films (Young's modulus reaching 6.8 GPa). The supercapacitors made with the electrodes of MXene-BC composite films (BC content is 10%) present high capacitance behavior (areal capacitance up to 346 mF cm-2) because the introduction of BC nanofibers increases the interlayer spacing of MXene nanosheets, providing more storage space for the ions in the electrolyte. Then, a self-chargeable supercapacitor is proposed based on the combination of a zinc-air (Zn-air) battery and a supercapacitor. The self-chargeable supercapacitor can realize self-charging after dropping a drop of electrolyte solution into the Zn-air battery. The charging voltage of a single self-chargeable supercapacitor can reach 0.6 V after adding artificial sweat as the electrolyte. Finally, a smart wristband with the function of self-charging is proposed, which can absorb the sweat generated by the human for self-chargeable supercapacitors to drive the pedometer integrated within the smart wristband to work. The proposed self-chargeable supercapacitors are simple and effective, not restricted by the use environment, providing a promising way for self-powered wearable electronics.

Automated deep neural network-based identification, localization, and tracking of cardiac structures for ultrasound-guided interventional surgery.

Background: The increase in the use of ultrasound-guided interventional therapy for cardiovascular diseases has increased the importance of intraoperative real-time cardiac ultrasound image interpretation. We thus aimed to develop a deep learning-based model to accurately identify, localize, and track the critical cardiac structures and lesions (9 kinds in total) and to validate the algorithm's performance using independent data sets. Methods: This diagnostic study developed a deep learning-based model using data collected from Fuwai Hospital between January 2018 and June 2019. The model was validated with independent French and American data sets. In total, 17,114 cardiac structures and lesions were used to develop the algorithm. The model findings were compared with those of 15 specialized physicians in multiple centers. For external validation, 516,805 tags and 27,938 tags were used from 2 different data sets. Results: Regarding structure identification, the area under the receiver operating characteristic curve (AUC) of each structure in the training data set, optimal performance in the test data set, and median AUC of each structure identification were 1 (95% CI: 1-1), 1 (95% CI: 1-1), and 1 (95% CI: 1-1), respectively. Regarding structure localization, the optimal average accuracy was 0.83. As for structure identification, the accuracy of the model significantly outperformed the median performance of the experts (P<0.01). The optimal identification accuracies of the model in 2 independent external data sets were 89.5% and 90%, respectively (P=0.626). Conclusions: The model outperformed most human experts and was comparable to the optimal performance of all human experts in cardiac structure identification and localization, and could be used in the external data sets.

A generalized deep learning model for heart failure diagnosis using dynamic and static ultrasound.

Objective: Echocardiography (ECG) is the most common method used to diagnose heart failure (HF). However, its accuracy relies on the experience of the operator. Additionally, the video format of the data makes it challenging for patients to bring them to referrals and reexaminations. Therefore, this study used a deep learning approach to assist physicians in assessing cardiac function to promote the standardization of echocardiographic findings and compatibility of dynamic and static ultrasound data. Methods: A deep spatio-temporal convolutional model r2plus1d-Pan (trained on dynamic data and applied to static data) was improved and trained using the idea of "regression training combined with classification application," which can be generalized to dynamic ECG and static cardiac ultrasound views to identify HF with a reduced ejection fraction (EF < 40%). Additionally, three independent datasets containing 8976 cardiac ultrasound views and 10085 cardiac ultrasound videos were established. Subsequently, a multinational, multi-center dataset of EF was labeled. Furthermore, model training and independent validation were performed. Finally, 15 registered ultrasonographers and cardiologists with different working years in three regional hospitals specialized in cardiovascular disease were recruited to compare the results. Results: The proposed deep spatio-temporal convolutional model achieved an area under the receiveroperating characteristic curve (AUC) value of 0.95 (95% confidence interval [CI]: 0.947 to 0.953) on the training set of dynamic ultrasound data and an AUC of 1 (95% CI, 1 to 1) on the independent validation set. Subsequently, the model was applied to the static cardiac ultrasound view (validation set) with simultaneous input of 1, 2, 4, and 8 images of the same heart, with classification accuracies of 85%, 81%, 93%, and 92%, respectively. On the static data, the classification accuracy of the artificial intelligence (AI) model was comparable with the best performance of ultrasonographers and cardiologists with more than 3 working years (P = 0.344), but significantly better than the median level (P = 0.0000008). Conclusion: A new deep spatio-temporal convolution model was constructed to identify patients with HF with reduced EF accurately (< 40%) using dynamic and static cardiac ultrasound images. The model outperformed the diagnostic performance of most senior specialists. This may be the first HF-related AI diagnostic model compatible with multi-dimensional cardiac ultrasound data, and may thereby contribute to the improvement of HF diagnosis. Additionally, the model enables patients to carry "on-the-go" static ultrasound reports for referral and reexamination, thus saving healthcare resources.

Transcatheter closure of perimembranous ventricular septal defect using a novel fully bioabsorbable occluder: multicenter randomized controlled trial.

Although the use of bioabsorbable occluder is expected to reduce the risk of metal occluder-related complications, it has not been approved due to incomplete degradation and new complications. Novel fully bioabsorbable occluders were designed to overcome such limitations. The aim of this study was to investigate the efficacy and safety of a fully biodegradable occluder in patients with ventricular septal defects. 125 patients with perimembranous ventricular septal defect (VSD) larger than 3 mm were screened from April 2019 to January 2020 in seven centers. 108 patients were enrolled and randomized into the bioabsorbable occluder group (n = 54 patients) and nitinol occluder group (n = 54). A non-inferiority design was utilized and all patients underwent transcatheter device occlusion. Outcomes were analyzed with a 24-month follow-up. All patients were successfully implanted and completed the trial. No residual shunt >2 mm was observed during follow-up. Transthoracic echocardiography showed a hyperechoic area corresponding to the bioabsorbable occluder which decreased primarily during the first year after implantation and disappeared within 24 months. Postprocedural arrhythmia was the only occluder-related complication with an incidence of 5.56% and 14.81% for the bioabsorbable and nitinol groups, respectively (P = 0.112). The incidence of sustained conduction block was lower in the bioabsorbable occluder group (0/54 vs. 6/54, P = 0.036) at 24-month follow-up. In conclusion, the novel fully bioabsorbable occluder can be successfully and safely implanted under echocardiography guidance and reduce the incidence of sustained postprocedural arrythmia. The efficacy and safety of this fully biodegradable occluder are non-inferior to that of a traditional nitinol one.

[Effects of extracorporeal cardiac shock wave therapy in patients with ischemic heart failure].

OBJECTIVE: To evaluate the feasibility, safety and efficiency of extracorporeal cardiac shock wave therapy (CSWT) in patients with ischemic heart failure. METHODS: Fifty patients with ischemic heart failure and left ventricular ejection fraction (LVEF) < 50% were randomized to CSWT (shots/spot at 0.09 mJ/mm(2) for 9 spots, 9 times within 3 month) or control group. Dual isotope simultaneous acquisition single-photon emission computed tomography with (99)Tc(m)-sestamibi/(18)F-fluorodeoxyglucose ((99)Tc(m)-MIBI/(18)F-FDG) was performed before randomization and at 1 month after CSWT/control to locate and evaluate viable myocardium region. Canadian cardiovascular society (CCS) class sores, NYHA, Seattle Angina Questionnaire (SAQ), 6-min walk test (6 MWT), left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and the dosage of nitroglycerin use were compared between two groups at each time point. RESULTS: All patients completed the study protocol without procedural complications. At 1 month, patients in CSWT group experienced improvement in NYHA (P < 0.01), CCS (P < 0.01), SAQ (P = 0.021), 6 MWT (P = 0.012) and dosage of nitroglycerin use (P < 0.01) compared to baseline. LVEF [45.0 (39.0, 48.0) vs. 47.0 (42.0, 50.0) P = 0.001], LVEDD [58.0 (56.0, 59.0) vs. 56.0 (55.0, 58.0) P = 0.002], summed perfused score [23.0 (20.5, 24.5) vs. 20.0 (18.0, 22.0) P < 0.01] and metabolic score [25.0 (23.0, 26.0) vs. 24.0 (21.5, 25.0) P = 0.028] were also improved in CSWT group. All these parameters remained unchanged in control group between baseline and at 1 month. CSWT was independent factor for improved cardiac function, quality of life and echocardiography parameters after adjusting for known factors which might affect outcome. CONCLUSION: CSWT could improve symptom, cardiac function, quality of life and exercise tolerance in patients with ischemic heart failure, CSWT might serve as a new, non-invasive, safe and efficient therapy for these patients.