Left ventricular reverse remodelling as a promising strategy for resolving left ventricular thrombus.

AIMS: Recent years, several studies have suggested that abnormal baseline left ventricular (LV) function and structure are associated with left ventricular thrombus (LVT) formation. Despite this, most studies have given less attention to the potential role of left ventricular reverse remodelling (LVRR), that is, the improvement of LV function and structure, in resolving LVT. In this study, we aim to investigate the clinical characteristics, prognosis, and LVT resolution in patients with LVRR. METHODS AND RESULTS: This is a retrospective study conducted at The First Affiliated Hospital of Dalian Medical University. Our cohort consists of patients diagnosed with LVT between 1 November 2015 and 31 May 2020. Enrolled patients were categorized into two groups: LVRR and Failure of LVRR. The primary endpoints included LVT resolution and embolic events. A total of 84 patients were included in the study, with 59 patients in the LVRR group and 25 patients in the Failure of LVRR group. In our study, patients in the LVRR group experienced higher incidence of LVT resolution and a lower risk of embolic events. Multivariate logistic analysis revealed that Failure of LVRR was the only independent negative predictor for LVT resolution and positive predictor for embolic events. CONCLUSIONS: Patients with LVRR experience higher incidence of LVT resolution and have lower risk of embolic events, highlighting the significance of identifying and mitigating risk factors that contribute to abnormal LV function and structure in management of patients with LVT.

Distinct metabolic responses to thermal stress between invasive freshwater turtle Trachemys scripta elegans and native freshwater turtles in China.

Different responses or tolerance to thermal stress between invasive and native species can affect the outcome of interactions between climate change and biological invasion. However, knowledge about the physiological mechanisms that modulate the interspecific differences in thermal tolerance is limited. The present study analyzes the metabolic responses to thermal stress by the globally invasive turtle, Trachemys scripta elegans, as compared with two co-occurring native turtle species in China, Pelodiscus sinensis and Mauremys reevesii. Changes in metabolite contents and the expression or enzyme activities of genes involved in energy sensing, glucose metabolism, lipid metabolism, and tricarboxylic acid (TCA) cycle after exposure to gradient temperatures were assessed in turtle juveniles. Invasive and native turtles showed distinct metabolic responses to thermal stress. T. scripta elegans showed greater transcriptional regulation of energy sensors than the native turtles. Enhanced anaerobic metabolism was needed by all three species under extreme heat conditions, but phosphoenolpyruvate carboxykinase and lactate dehydrogenase in the invader showed stronger upregulation or stable responses than the native species, which showed inhibition by high temperatures. These contrasts were pronounced in the muscles of the three species. Regulation of lipid metabolism was observed in both T. scripta elegans and P. sinensis but not in M. reevesii under thermal stress. Thermal stress did not inhibit the TCA cycle in turtles. Different metabolic responses to thermal stress may contribute to interspecific differences in thermal tolerance. Overall, our study further suggested the potential role of physiological differences in mediating interactions between climate change and biological invasion.

Catheter-directed therapy for submassive pulmonary embolism after unsuccessful systemic thrombolysis.

Catheter-directed therapy (CDT) has emerged as an important treatment for pulmonary embolism (PE). We present a patient with life-threatening submassive PE with transient hypotension, progressive right ventricular dysfunction, and respiratory failure who failed anticoagulation and had little improvement with systemic thrombolysis, but responded well to catheter-directed therapy.

Epicardial radiofrequency catheter ablation of Brugada syndrome with electrical storm during ventricular fibrillation: A case report.

RATIONALE: Brugada syndrome (BrS) is characterized by ST segment elevation at the J point ≥2 mm in the right precordial electrocardiogram (ECG) leads, in the absence of structural heart disease, electrolyte disturbances, or ischemia. It is a well-described cause of sudden death in young patients, especially in the age of between 30 and 40 years old. Here, we reported an unusual case of electrical storm (ES) of ventricular fibrillation (VF) caused by BrS with complete right bundle-branch block (CRBBB) in a 75-year-old male patient. PATIENT CONCERNS: A 75-year-old male patient survived sudden cardiac death caused by a ventricular ES. He presented with the cove-shaped ST elevation of 2 mm in lead V1 with typical CRBBB and lacked structural cardiomyopathy and coronary heart disease. The patient suffered ventricular ES again, although the implantable cardioverter defibrillator(ICD) had implanted. DIAGNOSES: Brugada syndrome with complete right bundle-branch block. INTERVENTIONS: Implantable cardioverter defibrillator (ICD) implantation was performed. But this therapy could not prevent the recurrence of malignant arrhythmia. Finally, the ES was treated successfully using radiofrequency catheter ablation (RFCA) at the area of the free wall of the right ventricular outflow tract (RVOT) epicardium. OUTCOMES: During 7 months of follow-up, the patient was asymptomatic and free of arrhythmic events. LESSONS: As far as we know, the patient is the oldest patient reported to have BrS. RFCA offers an alternative therapy for patients with BrS, especially when ICD shocks are encountered.

Clinical feasibility of Gd-EOB-DTPA-enhanced MR imaging for assessing liver function: validation with ICG tests and parenchymal cell volume.

OBJECTIVE: Using Gd-EOB-DTPA-enhanced MRI to assess liver function and validate with indocyanine green (ICG) tests and parenchymal cell volume (PCV). METHODS: Nineteen patients scheduled for operation were enrolled. Functional liver volume (FLV) was computed from 20min post-contrast images. ICG retention was measured in serum 15min after injection. The histological PCV was determined from resected liver specimen. RESULTS: FLV showed significantly correlated with ICG retention (ICG-R15: r=-0.47, P=.042) and PCV (r=0.814, P<.001). CONCLUSIONS: Gd-EOB-DTPA-enhanced MRI is clinically feasible for quantifying liver function.

Pseudocontinuous arterial spin labeling perfusion magnetic resonance imaging--a normative study of reproducibility in the human brain.

Pseudocontinuous arterial spin labeling (PCASL), a newly proposed perfusion magnetic resonance imaging (MRI) technique, has the potential of providing a better balance between labeling efficiency and signal-to-noise ratio than conventional ASL methods. The advantage will not be exploitable until adequate reproducibility can be achieved. In this study, we investigated the reproducibility of PCASL on twelve healthy volunteers by taking into account the inclusion of correction for coil sensitivity (CS) and labeling efficiency (α). Each subject underwent two identical sessions scheduled two weeks apart. For comparison, pulsed ASL (PASL) imaging was also conducted using the flow-sensitive alternating inversion recovery method. MR imaging was performed on a 3T whole body system using a 12-channel phased array for reception. Blood flow was quantified for gray matter and assessed globally as well as in the flow territories of the internal carotid arteries and posterior cerebral arteries. Experimental results showed that CS accounted for 35% and 60% of inter-session variability in PCASL and PASL, respectively. With CS correction alone, coefficient of variance (CV) remained larger with PCASL than PASL (p=0.02). CV was 12% with CS-corrected PASL and 11% with PCASL when CS and α were corrected for in conjunction. We concluded that CS correction is necessary for ASL imaging when using phased array receiver and that after CS correction, PCASL requires α correction to provide reproducibility comparable to PASL.