Automated valvular heart disease detection using heart sound with a deep learning algorithm.

Background: Insufficient clinicians' auscultation ability delays the diagnosis and treatment of valvular heart disease (VHD); artificial intelligence provides a solution to compensate for the insufficiency in auscultation ability by distinguishing between heart murmurs and normal heart sounds. However, whether artificial intelligence can automatically diagnose VHD remains unknown. Our objective was to use deep learning to process and compare raw heart sound data to identify patients with VHD requiring intervention. Methods: Heart sounds from patients with VHD and healthy controls were collected using an electronic stethoscope. Echocardiographic findings were used as the gold standard for this study. According to the chronological order of enrollment, the early-enrolled samples were used to train the deep learning model, and the late-enrollment samples were used to validate the results. Results: The final study population comprised 499 patients (354 in the algorithm training group and 145 in the result validation group). The sensitivity, specificity, and accuracy of the deep-learning model for identifying various VHDs ranged from 71.4 to 100.0%, 83.5-100.0%, and 84.1-100.0%, respectively; the best diagnostic performance was observed for mitral stenosis, with a sensitivity of 100.0% (31.0-100.0%), a specificity of 100% (96.7-100.0%), and an accuracy of 100% (97.5-100.0%). Conclusions: Based on raw heart sound data, the deep learning model effectively identifies patients with various types of VHD who require intervention and assists in the screening, diagnosis, and follow-up of VHD.

Copper-dependent control of uptake, translocation and accumulation of cadmium in hyperaccumlator Sedum alfredii.

Cadmium (Cd) is detrimental to plant growth and threatens human health. Here, we investigated the potential for remediation of Cd-contaminated soil with high copper (Cu) background using Cd hyperaccumulator ecotype (HE) Sedum alfredii. We assessed effects of Cu on Cd accumulation, compartmentation and translocation in HE S. alfredii, and compared with those in a related non-accumulator ecotype (NHE). We found that Cu supply significantly induced Cd accumulation in roots and shoots of long-term soil-cultivated HE S. alfredii. A large fraction of root Cd was accumulated in the organelles, but a small fraction was stored in the cell wall. Importantly, Cu addition reduced Cd accumulation in the cell wall and the organelles in root cells. Furthermore, leaf cell capacity to sequestrate Cd in the organelles was greatly improved upon Cu exposure. We also found that genes involving metal transport and cell wall remodeling were distinctly regulated to mediate Cd accumulation in HE S. alfredii. These findings indicate that Cu-dependent decrease of root cell-wall-bound Cd, and stimulation of efflux/influx of organelle Cd transport in root and leaf cells plays a role in the dramatic Cd hyperaccumulation expressed in naturally survived HE S. alfredii.

Long-term efficacy and safety of cryoballoon ablation of atrial fibrillation: A systematic review and meta-analysis.

BACKGROUND: This meta-analysis evaluated long-term efficacy and safety of cryoballoon ablation (CB) of atrial fibrillation (AF). METHODS: PubMed, Cochrane Library, and Web of Science were searched until July 31, 2023, for published works investigating efficacy and safety of CB of AF in which mean/median follow-up time was not less than 36 months. Safety was assessed by adverse events. Efficacy was assessed by AF recurrence, defined as any atrial arrhythmias lasting more than 30 s. RESULTS: A total of 19 clinical studies were included. After an average of 58.1 months of follow-up, the overall AF recurrence rate was about 37%. The predictors of recurrence were duration of AF (HR 1.00; 95% CI [1.00 ∼ 1.01]), early recurrence of atrial fibrillation (HR 3.96; 95%CI [1.12 ∼ 14.02]), left atrial diameter (HR 1.04; 95%CI [1.02 ∼ 1.06]), and persistent AF (HR1.47; 95% CI [1.19 ∼ 1.82]). In terms of safety, the incidence of transient phrenic paralysis (PNP) was the highest, about 3%; followed by vascular complications (about 2%); pseudoaneurysm, permanent PNP, and all-cause death was (about 1%); and pericardial effusion and stroke / TIA was very low. CONCLUSION: CB is associated with low rates of severe complications and reasonable success rates.

Digital inclusive finance, government intervention, and urban green technology innovation.

Digital inclusive finance eases credit constraints on innovative small and medium-sized enterprises which contributes to urban green technology innovation in China. Government intervention plays an essential role in the development of digital inclusive finance. Based on the panel data of 243 cities in China from 2011 to 2019, this paper empirically examines the relationship between digital inclusive finance and urban green technology innovation as well as the intrinsic mechanism of government intervention. The findings show that, even after a series of robustness tests, digital inclusive finance can promote the quantity and quality of green technology innovation. In terms of its mechanism, digital inclusive finance can empower green technology innovation by complementing traditional financial development and stimulating green consumption, both in terms of supply and demand. At the same time, in the dynamic process of digital financial inclusion from low to high, the development of traditional finance and green consumption level on the marginal promotion of green technology innovation continues to strengthen. The nonlinear relationship test reveals that there is a significant double threshold effect on the positive impact of digital inclusive finance on urban green technology innovation with the evolution of government intervention. The innovation incentive effect of digital financial inclusion will be marginal decreasing with the increase of government intervention. Further considering the heterogeneity of urban geographic location and environmental regulation, it is found that digital financial inclusion promotes green technology innovation more in eastern and high-environmental regulation cities. Based on the above research conclusions, this paper argues that while developing digital inclusion finance, government support policies should be adjusted promptly to constantly stimulate the "Metcalfe's law" effect of digital inclusive finance enabling green technology innovation.

[Efficacy evaluation of transaxillary non-inflatable endoscopic surgery and open neck surgery in the treatment of PTC: a single center report of 342 cases].

Objective:To compare the clinical effect of transaxillary non-inflatable endoscopic surgery and traditional open thyroid surgery in the treatment of PTC. Methods:A retrospective analysis was performed on 342 patients with PTC treated in the Otorhinolaryngology Department of Qilu Hospital of Shandong University from December 2020 to December 2022. There were 73 males and 269 females, aged 16-72 years, who underwent unilateral non-inflatable transaxillary endoscopic thyroid surgery（endoscopic group） and unilateral traditional open thyroid surgery（open group）. There were 108 patients in the endoscopic group and 234 in the open group. Results:The endoscopic group was lower in age（37.1±9.4 vs 43.5±11.2） years and BMI（23.4±3.4 vs 25.7±3.8 ）kg/m² than that in the open group, and the difference was statistically significant（t was 5.53, 5.67 respectively, P<0.01）. There was no significant difference in hospitalization days between the two groups（P>0.05）. The logarithmic curve of the operation time showed a smooth downward trend, and the overall operation time of the endoscopic group was relatively consistent. There was no significant difference in intraoperative blood loss between the endoscopic group（13.3±3.2） mL and the open group（14.7±6.3） mL（P>0.05）, but the operation time（130.1±37.9） min was longer than that in the open group（57.4±13.7） min, and the difference was statistically significant（t=19.40, P<0.01）. There was no significant difference in complications such as temporary recurrent laryngeal nerve injury within 3 days after operation between the two groups（P>0.05）. The aesthetic satisfaction score of the surgical incision and the incision concealment effect score in the endoscopic group were higher than those in the open group, and the difference was statistically significant（P<0.05）. Conclusion:Compared with traditional open thyroidectomy, transaxillary non-inflatable endoscopic thyroidectomy has more advantages in the concealment and aesthetics of postoperative incision. Although the former has longer operation time and more drainage, it is still a safe and feasible surgical method with good postoperative clinical effect.

Associations between modifiable risk factors and frailty: a Mendelian randomisation study.

BACKGROUND: Early identification of modifiable risk factors is essential for the prevention of frailty. This study aimed to explore the causal relationships between a spectrum of genetically predicted risk factors and frailty. METHODS: Univariable and multivariable Mendelian randomisation (MR) analyses were performed to explore the relationships between 22 potential risk factors and frailty, using summary genome-wide association statistics. Frailty was accessed by the frailty index. RESULTS: Genetic liability to coronary artery disease (CAD), type 2 diabetes mellitus (T2DM), ischaemic stroke, atrial fibrillation and regular smoking history, as well as genetically predicted 1-SD increase in body mass index, systolic blood pressure, diastolic blood pressure, low-density lipoprotein cholesterol, triglycerides, alcohol intake frequency and sleeplessness were significantly associated with increased risk of frailty (all p<0.001). In addition, there was a significant inverse association between genetically predicted college or university degree with risk of frailty (beta -0.474; 95% CI (-0.561 to -0.388); p<0.001), and a suggestive inverse association between high-density lipoprotein cholesterol level with risk of frailty (beta -0.032; 95% CI (-0.055 to -0.010); p=0.004). However, no significant causal associations were observed between coffee consumption, tea consumption, serum level of total testosterone, oestradiol, 25-hydroxyvitamin D, C reactive protein or moderate to vigorous physical activity level with frailty (all p>0.05). Results of the reverse directional MR suggested bidirectional causal associations between T2DM and CAD with frailty. CONCLUSIONS: This study provided genetic evidence for the causal associations between several modifiable risk factors with lifetime frailty risk. A multidimensional approach targeting these factors may hold a promising prospect for prevention frailty.

Estimation of Target Motion Parameters from the Tonal Signals with a Single Hydrophone.

In the shallow-water waveguide environment, the tonal signals radiated by moving targets carry modal interference and Doppler shift information. The modal interference can be used to obtain the time of the closest point of approach (tCPA) and the ratio of the range at the closest point of approach to the velocity of the source (rCPA/v). However, parameters rCPA and v cannot be solved separately. When tCPA is known, the rCPA and the v of the target can be obtained theoretically by using the Doppler information. However, when the Doppler frequency shift is small or at a low signal-to-noise ratio, there will be a strong parametric coupling between rCPA and v. In order to solve the above parameter coupling problem, a target motion parameter estimation method from tonal signals with a single hydrophone is proposed in this paper. The method uses the Doppler and modal interference information carried by the tonal signals to obtain two different parametric coupling curves. Then, the parametric coupling curves can be used to estimate the two motion parameters. Simulation experiments verified the rationality of this method. The proposed method was applied to the SWellEx-96 and speedboat experiments, and the estimation errors of the motion parameters were within 10%, which shows the method is effective in its practical applications.

Modal wavenumber estimation by combining physical informed neural network.

Estimation of modal wavenumbers is important for inference of geoacoustic properties and data-driven matched field processing in shallow water waveguides. This paper introduces a deep neural network called combining physical informed neural network (CPINN) for modal wavenumber estimation using a vertical linear array (VLA). Note that the sound field recorded by a VLA can be expressed as a linear superposition of finite modal depth functions, and the differential equations satisfied by the modal depth functions are related to the corresponding modal wavenumbers. CPINN can estimate the modal wavenumbers by introducing the proxies of the modal depth functions and constraining them to satisfy the corresponding differential equations. The performance of the CPINN is evaluated by simulated data in a noisy shallow water environment. Numerical results show that, when compared with the previous methods, CPINN does not need to know the exact horizontal distance between the sound source and the VLA. Moreover, CPINN can estimate the modal wavenumbers at the VLA position in the case where the range segment traversed by the source, i.e., the aperture in the range direction, is smaller than the maximum modal cycle distance and in a range-dependent waveguide.

Arabidopsis COPT1 copper transporter uses a single histidine to regulate transport activity and protein stability.

Copper acquisition and subsequent delivery to target proteins are essential for many biological processes. However, the cellular levels of this trace element must be controlled because of its potential toxicity. The COPT1 protein rich in potential metal-binding amino acids functions in high affinity copper uptake at the plasma membrane of Arabidopsis cells. The functional role of these putative metal-binding residues is largely unknown. Through truncations and site-directed mutagenesis, we identified His43, a single residue within the extracellular N-terminal domain as absolutely critical for copper uptake of COPT1. Substitution of this residue with leucine, methionine or cysteine almost inactivated transport function of COPT1, implying that His43 fails to serves as a copper ligand in the regulation of COPT1 activity. Deletion of all extracellular N-terminal metal-binding residues completely blocked copper-stimulated degradation but did not alter the subcellular distribution and multimerization of COPT1. Although mutation of His43 to alanine and serine retained the transporter activity in yeast cells, the mutant protein was unstable and degraded in the proteasome in Arabidopsis cells. Our results demonstrate a pivotal role for the extracellular residue His43 in high affinity copper transport activity, and suggest common molecular mechanisms for regulating both metal transport and protein stability of COPT1.

Long-Term Atherosclerotic Cardiovascular Disease Risk in Patients With Cancer: A Population-Based Study.

The long-term risk of incident atherosclerotic cardiovascular diseases (ASCVD) among cancer patients remains incompletely defined. This study aimed to evaluate the long-term ASCVD risk in cancer patients compared with the noncancer population. This was a prospective population-based study using data from the Kailuan cohort, 6204 individuals with newly diagnosed cancer, free of ASCVD, were matched in a 1:1 ratio to noncancer controls for age (±1) and sex, from June 2006 to December 2020. Multivariable competing risk analyses were performed to evaluate the association between cancer diagnosis and risk of incident ASCVD events (including myocardial infarction, ischemic stroke, heart failure, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention). During a median follow-up of 5.3 (1.7, 9.7) years, 1019 incident ASCVD events were observed. Compared to participants without cancer, there was a similar risk for incident ASCVD events among cancer patients within the first few years after cancer diagnosis, and the risk declined over time. Overall, cancer patients showed lower risks of incident ASCVD compared to the noncancer patients over the long term, with a hazard ratio (95% confidence interval) of 0.52 (0.45-0.60) for composite ASCVD events, 0.43 (0.35-0.53) for ischemic stroke, 0.63 (0.42-0.95) for myocardial infarction, 0.63 (0.48-0.83) for heart failure, and 0.82 (0.60-1.11) for coronary revascularization. Baseline level of low-density lipoprotein cholesterol, fasting blood glucose, blood pressure, and high-sensitivity C-reactive protein could independently predict the incident ASCVD among the study population. Subgroup analyses according to cancer types revealed a significantly lower risk of ASCVD events among patients with digestive cancer or respiratory cancer compared with noncancer controls, but not for urologic or genital cancer. Multiple sensitivity analyses yielded similar results to the primary analysis. Long-term ASCVD risk among cancer survivors is not increased compared with the noncancer individuals, probably driven by a favorable profile of baseline risk factor in cancer population.

Electrocardiographic Features of Immune Checkpoint Inhibitor-Associated Myocarditis.

Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events including myocarditis, whilst improving cancer-related outcomes. There is thus a clinical need to identify electrocardiographic manifestations of ICI-related myocarditis to guide clinical management. PubMed was searched for clinical studies and case reports describing electrocardiographic changes in patients with ICI-related myocarditis. A total of 6 clinical studies and 79 case reports were included. This revealed a range of presentations for patients on ICIs, including supraventricular arrhythmias, ventricular arrhythmias and heart block, and new changes of ST-T segment unrelated to coronary artery disease, ST-segment elevation or depression and T-wave abnormalities. Several patients showed low voltages in multiple leads and new onset Q-wave development. Patients with ICI-related myocarditis may develop new arrhythmia and ST-T changes, and infrequently low voltages in multiple leads.

Novel lipometabolism biomarker for chemotherapy and immunotherapy response in breast cancer.

Emerging proof shows that abnormal lipometabolism affects invasion, metastasis, stemness and tumor microenvironment in carcinoma cells. However, molecular markers related to lipometabolism have not been further established in breast cancer. In addition, numerous studies have been conducted to screen for prognostic features of breast cancer only with RNA sequencing profiles. Currently, there is no comprehensive analysis of multiomics data to extract better biomarkers. Therefore, we have downloaded the transcriptome, single nucleotide mutation and copy number variation dataset for breast cancer from the TCGA database, and constructed a riskScore of twelve genes by LASSO regression analysis. Patients with breast cancer were categorized into high and low risk groups based on the median riskScore. The high-risk group had a worse prognosis than the low-risk group. Next, we have observed the mutated frequencies and the copy number variation frequencies of twelve lipid metabolism related genes LMRGs and analyzed the association of copy number variation and riskScore with OS. Meanwhile, the ESTIMATE and CIBERSORT algorithms assessed tumor immune fraction and degree of immune cell infiltration. In immunotherapy, it is found that high-risk patients have better efficacy in TCIA analysis and the TIDE algorithm. Furthermore, the effectiveness of six common chemotherapy drugs was estimated. At last, high-risk patients were estimated to be sensitive to six chemotherapeutic agents and six small molecule drug candidates. Together, LMRGs could be utilized as a de novo tumor biomarker to anticipate better the prognosis of breast cancer patients and the therapeutic efficacy of immunotherapy and chemotherapy.

Retinal Microvascular Abnormalities Predict Clinical Outcomes in Patients with Heart Failure.

BACKGROUND: Narrower retinal arterioles and wider retinal venules have been associated with the incidence of heart failure (HF). However, whether they are predictive of the prognosis of heart failure (HF) is unclear. We aimed to explore the role of retinal vessel calibers in predicting long-term clinical outcomes of HF. METHODS: This is a prospective, single-center, observational study that surveyed patients in a tertiary referral hospital for the treatment of HF. Retinal vessel caliber was graded using retinal photography. The primary endpoint was the composite endpoint of HF rehospitalization and mortality at 12 months. RESULTS: There were 55 patients with chronic HF included in the final analysis. At 12 months, the cumulative incidence of the primary endpoint, HF rehospitalization, and mortality tended to be higher with the widening of the central retinal venular equivalent (CRVE) (p for non-linearity = 0.059) and was significantly increased when CRVE reached a cut-off value (283 µm) (p = 0.011) following adjustment for age, sex, etiology of HF, and diabetes. No association between the central retinal arteriolar equivalent (CRAE) and arteriolar-to-venular caliber ratio (AVR) was found with the clinical outcome in both univariable and multivariable Cox regression. CRAE, CRVE, and AVR had no relationship with the concentration of the N-terminal pro-B-type natriuretic peptide. In addition, CRVE was not associated with cardiac diastolic and systolic function. CONCLUSIONS: When the retinal venular caliber widens to a certain point, the composite incidence of HF rehospitalization and mortality significantly increase, suggesting retinal vessel caliber imaging may provide insight into the development of HF.

Waveguide invariant in a gradual range- and azimuth-varying waveguide.

Experimental data indicate that in a sloped area, the value of ß abruptly changes before and after a given source arrives at the closest point of approach to the hydrophone, which has not been previously reported. The adiabatic approximation is employed to explain the above abrupt change in ß, and it is found that the azimuthal variance in the sound path is the reason for this phenomenon. Simulations are performed to confirm the model and experimental data, and perfect agreement is achieved. This work suggests that ß should be carefully set in related applications in a sloped area.

High-resolution modal wavenumber estimation in range-dependent shallow water waveguides using vertical line arrays.

Estimation of modal wavenumbers is important for inference of geoacoustic properties and matched field processing in shallow water waveguides. However, it is challenging in a range-dependent environment, because modal content varies locally in response to changes in the environment. Moreover, the scales of the spatial variations in the waveguide may be on the same order as the range aperture required for resolvability of the individual modes. To this end, high-resolution (HR) wavenumber estimation methods have been widely used. In this paper, the matrix pencil and MUSIC algorithms are generalized to geometry involving a synthetic horizontal aperture (SHA) formed by a towed acoustic source and a fixed full-spanning vertical line array (VLA). The performance of the proposed methods is evaluated by simulated data in a noisy shallow water environment. Numerical results show that, when compared with the previous methods, the proposed methods significantly outperform the previous methods in terms of aperture requirement.

Dirac cone, flat band and saddle point in kagome magnet YMn6Sn6.

Kagome-lattices of 3d-transition metals hosting Weyl/Dirac fermions and topological flat bands exhibit non-trivial topological characters and novel quantum phases, such as the anomalous Hall effect and fractional quantum Hall effect. With consideration of spin-orbit coupling and electron correlation, several instabilities could be induced. The typical characters of the electronic structure of a kagome lattice, i.e., the saddle point, Dirac-cone, and flat band, around the Fermi energy (EF) remain elusive in magnetic kagome materials. We present the experimental observation of the complete features in ferromagnetic kagome layers of YMn6Sn6 helically coupled along the c-axis, by using angle-resolved photoemission spectroscopy and band structure calculations. We demonstrate a Dirac dispersion near EF, which is predicted by spin-polarized theoretical calculations, carries an intrinsic Berry curvature and contributes to the anomalous Hall effect in transport measurements. In addition, a flat band and a saddle point with a high density of states near EF are observed. These multi-sets of kagome features are of orbital-selective origin and could cause multi-orbital magnetism. The Dirac fermion, flat band and saddle point in the vicinity of EF open an opportunity in manipulating the topological properties in magnetic materials.

Tunable Synthesis of Hierarchical Yolk/Double-Shelled SiOx @TiO2 @C Nanospheres for High-Performance Lithium-Ion Batteries.

Invited for the cover of this issue is Qinghua Gong, Guowei Zhou, and co-workers at Qilu University of Technology. The dial represents the etching time of SiOx yolk in NaOH solution and the brightness of the Chinese red lantern represents the electrochemical performance of the composites. Read the full text of the article at 10.1002/chem.202003246.

Recovering reverberation interference striations by a conditional generative adversarial network.

In shallow water, the reverberation interference striations (RISs) are often polluted by serious random seafloor scattering, and it is the main limitation for the performance of active sonar. In this letter, a conditional generative adversarial network (CGAN) is used to recover the clear RISs from distorted ones. The experimental distorted RIS data induced by an explosive source are imported into the well-trained CGAN, and the precise interference striations are obtained. This means that the deterministic part of reverberation can be extracted exactly from the stochastic scattering field. The CGAN is robust when reverberation-to-noise ratios are higher than 2 dB.

Tunable Synthesis of Hierarchical Yolk/Double-Shelled SiOx @TiO2 @C Nanospheres for High-Performance Lithium-Ion Batteries.

This work reports the preparation of unique hierarchical yolk/double-shelled SiOx @TiO2 @C nanospheres with different voids by a facile sol-gel method combined with carbon coating. In the preparation process, SiOx nanosphere is used as a hard template. Etch time of SiOx yolk affects the morphology and electrochemical performance of SiOx @TiO2 @C. With the increase in etch time, the yolk/double-shelled SiOx @TiO2 @C with 15 and 30 nm voids and the TiO2 @C hollow nanospheres are obtained. The yolk/double-shelled SiOx @TiO2 @C nanospheres exhibit remarkable lithium-ion battery performance as anodes, including high lithium storage capacity, outstanding rate capability, good reversibility, and stable long-term cycle life. The unique structure can accommodate the large volume change of the SiOx yolk, provide a unique buffering space for the discharge/charge processes, improve the structural stability of the electrode material during repeated Li+ intercalation/deintercalation processes, and enhance the cycling stability. The SiOx @TiO2 @C with 30 nm void space exhibits a high discharge specific capacity of ≈1195.4 mA h g-1 at the current density of 0.1 A g-1 after 300 cycles and ≈701.1 mA h g-1 at 1 A g-1 for over 800 cycles. These results suggest that the proposed particle architecture is promising and may have potential applications in improving various high performance anode materials.