Effects of adaptive left bundle branch-optimized cardiac resynchronization therapy: a single centre experience.

BACKGROUND: Adaptive cardiac resynchronization therapy (aCRT) is associated with improved clinical outcomes. Left bundle branch area pacing (LBBAP) has shown encouraging results as an alternative option for aCRT. A technique that can be accomplished effectively using LBBAP combined with coronary venous pacing (LOT-aCRT). We aimed to assess the feasibility and outcomes of LOT-aCRT. METHODS: LOT-aCRT, capable of providing two pacing modes, LBBAP alone or LBBAP combined with LV pacing, was attempted in patients with CRT indications. Patients were divided into two groups: those with LBBAP and LV pacing (LOT-aCRT) and those with conventional biventricular pacing (BVP-aCRT). RESULTS: A total of 21 patients were enrolled in the study (10 in the LOT-aCRT group, 11 in the BVP-aCRT group). In the LOT-aCRT group, the QRS duration (QRSd) via BVP was narrowed from 158.0 ± 13.0 ms at baseline to 132.0 ± 4.5 ms (P = 0.019) during the procedure, and further narrowed to 123.0 ± 5.7 ms (P < 0.01) via LBBAP. After the procedure, when LOT-aCRT implanted and worked, QRSd was further changed to 121.0 ± 3.8 ms, but the change was not significant (P > 0.05). In the BVP-aCRT group, BVP resulted in a significant reduction in the QRSd from 176.7 ± 19.7 ms at baseline to 133.3 ± 8.2 ms (P = 0.011). However, compared with LOT-aCRT, BVP has no advantage in reducing QRSd and the difference was statistically significant (P < 0.01). During 9 months of follow-up, patients in both groups showed improvements in the LVEF and NT-proBNP levels (all P < 0.01). However, compared with BVP-aCRT, LOT-aCRT showed more significant changes in these parameters (P < 0.01). CONCLUSIONS: The study demonstrates that LOT-aCRT is clinically feasible in patients with systolic heart failure and LBBB. LOT-aCRT was associated with significant narrowing of the QRSd and improvement in LV function.

Value of detecting peri-device leak and incomplete endothelialization by cardiac CT angiography in atrial fibrillation patients post Watchman LAAC combined with radiofrequency ablation.

OBJECTIVES: To explore the value of detecting the peri-device leak (PDL) and device endothelialization after left atrial appendage closure (LAAC) by cardiac computed tomography (CT) in patients with atrial fibrillation (AF), who underwent Watchman LAAC combined with radiofrequency ablation of atrial fibrillation (AFCA). METHODS: Patients with symptomatic drug-refractory atrial fibrillation at high risk of stroke (CHA2 DS2 -VASc Score ≥ 2), who underwent Watchman LAAC combined with AFCA in our center from March 2017 to December 2018 were enrolled. Maximum diameter of LAA orifice was determined by preoperative CCTA. A standardized view of Watchman device was obtained by postoperative CCTA multiplannar reconstruction to evaluate the PDL and device endothelialization. RESULTS: Approximately 84 patients post successful LAAC and AFCA were enrolled in this study. The satisfactory LAA occlusion rate was 100%. There was no death, bleeding, stroke, and device-related thrombus (DRT) events. At 6-month postprocedure, CCTA images evidenced complete endothelialization in 44 patients (no contrast enhancement in LAA); contrast enhancement in LAA and visible PDL in 33 patients; contrast enhancement in LAA but without PDL in seven patients (incomplete device endothelialization). Maximum diameter of LAA orifice could independently predict the occurrence of PDL (odds ratio, 1.31; 95% confidence interval, 1.11-1.55; p = .002), sensitivity was 69.7% and specificity was 80.4% with the cutoff value of maximum diameter of LAA orifice more than 28.2 mm on predicting PDL. CONCLUSIONS: CCTA is feasible to evaluate PDL and device endothelialization after LAAC. The maximum diameter of LAA orifice derived from CT can independently predict the occurrence of post-LAAC PDL.

Sudden cardiac death in patients with myocardial infarction: 1.5 primary prevention.

Sudden cardiac death (SCD) is one of the most common causes of death in the world. Coronary heart disease (CHD) is the root cause of most patients with SCD, and myocardial infarction (MI) is the main cause of SCD among all types of CHD. Early identification of high-risk patients after an MI, and the application of related prevention strategies and disease-specific treatments will be the key to reduce SCD. The mechanism of SCD after MI varies over time, and the relevant risk prediction indicators are also dynamic and different. In the existing guidelines for MI patients, the static and slightly single stratification of primary (PP) and secondary (SP) prevention has significant room for improvement. The 1.5 primary prevention (1.5PP) is defined as patients with PP who also had the following risk factors: non-sustained ventricular tachycardia (NSVT), frequent premature ventricular contractions (PVCs), severe heart failure (left ventricular ejection fraction, LVEF <25%), and syncope or pre-syncope. The emergence of 1.5PP has provided a new method for the stratification and management of SCD after an MI.

Berberine Attenuates Cholesterol Accumulation in Macrophage Foam Cells by Suppressing AP-1 Activity and Activation of the Nrf2/HO-1 Pathway.

Atherosclerosis is a chronic inflammation condition resulting from the interaction between lipoproteins, monocyte-derived macrophages, T lymphocytes, and other cellular elements in the arterial wall. Macrophage-derived foam cells play a key role in both early and advanced stage of atherosclerosis. Previous studies have shown that berberine could inhibit foam cell formation and prevent experimental atherosclerosis. However, its underlying molecular mechanisms have not been fully clarified. In this study, we explored the cholesterol-lowering effects of berberine in macrophage-derived foam cells and investigated its possible mechanisms in prevention and treatment of atherosclerosis. Here, we demonstrated that berberine could inhibit atherosclerosis in apolipoprotein E-deficient mice and induce cholesterol reduction as well as decrease the content of macrophages. Berberine can regulate oxLDL uptake and cholesterol efflux, thus suppresses foam cell formation. Mechanisms study showed that berberine can suppress scavenger receptor expression via inhibiting the activity of AP-1 and upregulate ATP-binding cassette transporter via activating Nrf2/HO-1 signaling in human macrophage. In summary, berberine significantly inhibits atherosclerotic disease development by regulating lipid homeostasis and suppressing macrophage foam cell formation.

WITHDRAWN: HMGB1 and COX2 are regulated during organ damage following obesity-induced hypertension in a metabolic syndrome mouse model.

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Permanent left bundle branch area pacing utilizing intracardiac echocardiogram.

BACKGROUND: Recently, left bundle branch area pacing (LBBAP) has been shown to be feasible. However, the right ventricular (RV) implantation site for LBBAP remains elusive. We believe that the RV implantation site should be located at the posteromedial basal septum, and in this paper, we propose a new method to help guide lead implantation. The aim of this study is to demonstrate the feasibility of the proposed method. METHODS: The RV implantation site was positioned by a combination of a nine-grid system on fluoroscopy and the use of intracardiac echocardiogram (ICE) and then verified by ICE. RESULTS: Fifteen patients were enrolled for LBBAP using our method. The acute success rate was 86.7% (13/15), which demonstrated that our method is useful for assisting with lead implantation. According to ICE, the distance between the implantation site and apex (the front) and the distance between the implantation site and tricuspid annulus (the back) were 44.9 ± 10.7 and 33.2 ± 10.4 mm, respectively, and the ratio of the front and the back was 1.57 ± 0.80. The distance between the implantation site and the front junction point of the left-right ventricle (the upper) and the distance between the implantation site and the back junction point (the lower) were 33.4 ± 10.6 and 24.5 ± 10.2 mm, respectively. The ratio of the upper to the lower was 1.76 ± 1.36. These results suggest that the implantation site was at the posteromedial basal septum. The width of the QRS duration increased from 110.4 ± 33.1 ms at baseline to 114.1 ± 16.1 ms post LBBAP (P > 0.05). The operation time was 133 ± 32.9 min. The time of X-ray fluoroscopy was 21.2 ± 5.9 min. The mean time for lead positioning during LBBAP was 33.8 ± 16.6 min. During a follow-up of 3 months, the LBB capture threshold remained stable in 12 patients, except for one patient who had an increase in the LBB capture threshold to 3.0 v/0.4 ms. CONCLUSIONS: Our preliminary results indicate that the posteromedial basal septum could be seen as the implantation site for LBBAP. As a technique for LBBAP, ICE is a useful method for assisting with lead implantation. It is feasible and safe to use a nine-grid system combined with ICE for LBBAP.

Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure.

INTRODUCTION: Catheter ablation of atrial fibrillation (AFCA) and left atrial appendage closure (LAAC) exert opposite effects on left atrial (LA) size. We aim to observe the net impact of combined AFCA and LAAC strategy on LA size and explore those factors which might affect the postprocedure LA structural remodeling. METHODS: A total of 53 patients, who underwent combined AFCA and Watchman LAAC in our center from March to December 2017, were enrolled. Atrial fibrillation (AF) recurrence was monitored after the procedure. Left atrial volume (LAV) and left atrial appendage volume (LAAV) were measured by Mimics based on dual-source computed tomography images. RESULTS: At 6 months, sinus rhythm (SR) was maintained in 79.2% patients. LAV was significantly reduced (130.2 ± 36.3 mL to 107.1 ± 30.0 ml; P < .001) in SR maintenance group, but not in AF recurrence group (138.8 ± 39.3 mL to 137.9 ± 36.9 mL; P = .671). In SR group, preoperative LAAV/LAV ratio (B = -0.894; P = .015), NT-proBNP (B = 0.005; P = .019) and left ventricular ejection fraction (LVEF) (B = -0.778; P < .001) could interactively affect the extent of postoperative LA structural reverse remodeling, among which LAAV/LAV ratio could independently predict the significance of reverse remodeling (≥15% reduction in LAV) (OR, 0.56; 95% CI, 0.34-0.90; P = .018). A preoperative LAAV/LAV ratio less than 7.1% is indicative of significant LA structural reverse remodeling in this patient cohort. CONCLUSIONS: LA structural reverse remodeling could be evidenced in patients with maintained SR following combined AFCA and LAAC. Smaller LAAV/LAV ratio, higher NT-proBNP or lower LVEF at baseline are associated with more significant LA structural reverse remodeling, while LAAV/LAV ratio can predict the significance of the process after one-stop treatment.

Risk factor analysis of device-related infections: value of re-sampling method on the real-world imbalanced dataset.

BACKGROUND: The incidence of cardiac implantable electronic device infection (CIEDI) is low and usually belongs to the typical imbalanced dataset. We sought to describe our experience on the management of the imbalanced CIEDI dataset. METHODS: Database from two centers of patients undergoing device implantation from 2001 to 2016 were reviewed retrospectively. Re-sampling technique was used to improve the classifier accuracy. RESULTS: CIEDI was identified in 28 out of 4959 procedures (0.56%); a high imbalance existed in the sizes of the patient profiles. In univariate analyses, replacement procedure and male were significantly associated with an increase in CIEDI: (53.6% vs. 23.4, 0.8% vs. 0.3%, P < 0.01). Multivariate logistic regression analysis showed that gender (odds ratio, OR = 3.503), age (OR = 1.032), replacement procedure (OR = 3.503), and use of antibiotics (OR = 0.250) remained as independent predictors of CIEDI (all P < 0.05) after adjustment for diabetes, post-operation fever, and device style, device company. There were 616 under-sampled cases and 123 over-sampled cases in the analyzed cohort after re-sampling. The re-sampling and bootstrap results were robust and largely like the analysis results prior re-sampling method, while use of antibiotics lost the predicting capacity for CIEDI after re-sampling technique (P > 0.05). CONCLUSION: The application of re-sampling techniques can generate useful synthetic samples for the classification of imbalanced data and improve the accuracy of predicting efficacy of CIEDI. The peri-operative assessment should be intensified in male and aged patients as well as patients receiving replacement procedures for the risk of CIEDI.

Feasibility and Safety of Left Atrial Appendage Closure Using the LAmbre Device in Patients with Nonvalvular Atrial Fibrillation with or Without Prior Catheter Ablation.

Left atrial appendage (LAA) closure (LAAC) has emerged as an alternative therapeutic approach to medical therapy for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). However, complex LAA anatomy may preclude its use. LAmbre is a new, self-expanding LAA occluder, and is highly adaptable to different LAA morphologies. We explored the feasibility, safety, and efficacy of LAAC using LAmbre device in NVAF patients with or without prior catheter ablation (CA). LAAC using LAmbre device was applied in NVAF patients with (group C) or without (group N) prior CA. Transesophageal echocardiography (TEE) was performed at 3, and 12 months post-LAAC. Among 17 LAAC patients (group C, 6 & group N, 11), 4 cases were implanted with special type devices, 5 were implanted with large devices. Besides one case of cardiac tamponade (N group), there were two minor peri-procedural complications only. Successful sealing of the LAA was documented in all the patients (100%) by TEE both post LAAC and at 3 months. At 3 months, no residual flow was achieved in 11 patients (64.7%); six patients (35.3%) had residual flow < 5 mm. There was no device dislocation or leakage during the mean of 30 months follow up. At 545 days after LAAC, one patient in group C experienced sudden death. Baseline, peri-procedural, and follow-up characteristics were similar between two groups (P > 0.05). LAAC with LAmbre device, subsequent to prior CA for AF, can be performed successfully and safely. The design and distinguishing features of this device could be of help in patients with complex anatomy of LAA.

Development, safety and efficacy of a novel circular-irrigated deca-channel mapping and ablation catheter for pulmonary vein isolation.

BACKGROUND: Pulmonary vein isolation (PVI), a cornerstone for catheter ablation of atrial fibrillation (AF), remains a complex and time-consuming procedure. Present study introduces a novel, circular-irrigated, deca-channel mapping and ablation catheter (CIDMA), describes the in vitro test results on feasibility, safety, and acute efficacy of the CIDMA catheter. METHODS: An assembled CIDMA catheter was subjected to a number of in vitro tests. With this catheter, ablation procedures were first performed in a pig's myocardial strips in vitro to determine the effects in unipolar or bipolar configuration. RESULTS: Three catheters were assembled. The adjustable circular diameter was changed from initial state of 32.41 ± 0.61 mm into controlled state of 28.61 ± 0.47 mm (P = 0.013). In the plastic model, the push-ability, torque-ability, and kink resistance of CIDMA catheter were shown to be satisfactory. In vitro, our findings showed that ablation could produce obvious ablation lesions, and unipolar ablation (at length, width and depth of 5.0 ± 1.3, 4.6 ± 0.7, and 4.2 ± 0.6 mm, respectively) was more effective than bipolar (at length, width and depth of 2.8 ± 0.2, 4.2 ± 0.5, and 2.3 ± 0.4 mm, respectively) (P < 0.01). CONCLUSIONS: In vitro, our preliminary data suggest that the CIDMA catheter produced optimal ablation lesions, especially in the unipolar ablation mode. Future in vivo animal and clinical studies are warranted to test the efficacy of this catheter in real-world scenario.

Pharmacogenetics-based warfarin dosing algorithm decreases time to stable anticoagulation and the risk of major hemorrhage: an updated meta-analysis of randomized controlled trials.

Warfarin is yet the most widely used oral anticoagulant for thromboembolic diseases, despite the recently emerged novel anticoagulants. However, difficulty in maintaining stable dose within the therapeutic range and subsequent serious adverse effects markedly limited its use in clinical practice. Pharmacogenetics-based warfarin dosing algorithm is a recently emerged strategy to predict the initial and maintaining dose of warfarin. However, whether this algorithm is superior over conventional clinically guided dosing algorithm remains controversial. We made a comparison of pharmacogenetics-based versus clinically guided dosing algorithm by an updated meta-analysis. We searched OVID MEDLINE, EMBASE, and the Cochrane Library for relevant citations. The primary outcome was the percentage of time in therapeutic range. The secondary outcomes were time to stable therapeutic dose and the risks of adverse events including all-cause mortality, thromboembolic events, total bleedings, and major bleedings. Eleven randomized controlled trials with 2639 participants were included. Our pooled estimates indicated that pharmacogenetics-based dosing algorithm did not improve percentage of time in therapeutic range [weighted mean difference, 4.26; 95% confidence interval (CI), -0.50 to 9.01; P = 0.08], but it significantly shortened the time to stable therapeutic dose (weighted mean difference, -8.67; 95% CI, -11.86 to -5.49; P < 0.00001). Additionally, pharmacogenetics-based algorithm significantly reduced the risk of major bleedings (odds ratio, 0.48; 95% CI, 0.23 to 0.98; P = 0.04), but it did not reduce the risks of all-cause mortality, total bleedings, or thromboembolic events. Our results suggest that pharmacogenetics-based warfarin dosing algorithm significantly improves the efficiency of International Normalized Ratio correction and reduces the risk of major hemorrhage.

Triple decker sandwiches and related compounds of the first row transition metals with cyclopentadienyl and hexafluorobenzene rings: remarkable effects of fluorine substitution.

The complete series of Cp2M2(µ-C6F6) (M = Ti, V, Cr, Mn, Fe, Co, Ni) structures have been examined theoretically for comparison with their unsubstituted Cp2M2(µ-C6H6) analogues. The singlet triple decker sandwich titanium complex Cp2Ti2(η(6),η(6)-C6F6) with a closed shell electronic structure and a non-planar C6F6 ring is preferred energetically by a wide margin (>20 kcal mol(-1)) over other isomers and spin states. This is in contrast to the hydrogen analogue for which related triplet spin state structures are clearly preferred. A similar low-energy triple-decker sandwich Cp2V2(η(6),η(6)-C6F6) structure is found for vanadium but with a quintet spin state. The later transition metals from Cr to Ni energetically prefer the so-called "rice-ball" cis-Cp2M2(µ-C6F6) structures with varying hapticities of metal-ring bonding, a range of formal orders of metal-metal bonding, and varying spin states depending on the metal atom. Thus the lowest energy Cp2Cr2(µ-C6F6) structures are triplet and quintet structures with pentahapto-trihapto η(5),η(3)-µ-C6F6 rings and formal Cr=Cr double bonds. This contrasts with the structure of Cp2Cr2(µ-C6H6) having a bis(tetrahapto) η(4),η(4)-C6H6 ring and a formal Cr-Cr quadruple bond. The lowest energy Cp2Mn2(µ-C6F6) structures are trans and cis quintet spin state structures. This contrasts with Cp2Mn2(µ-C6H6) for which a closed-shell singlet triple decker sandwich structure is preferred. The lowest energy Cp2Fe2(µ-C6F6) structure is a triplet cis structure with a tetrahapto-dihapto η(4),η(2)-µ-C6F6 ring and a formal Fe-Fe single bond. The lowest energy Cp2Co2(µ-C6F6) structures are singlet spin state structures with formal M-M single bonds and either bridging bis(trihapto) η(3),η(3)-C6F6 or tetrahapto-dihapto η(4),η(2)-C6F6 rings. For Cp2Ni2(µ-C6F6) low energy singlet cis and trans structures are both found. The singlet cis-Cp2Ni2(µ-C6F6) structure has a Ni-Ni single bond of length ∼2.5 Å and a bridging bis(dihapto) η(2),η(2)-C6F6 ligand with an uncomplexed C=C double bond. The singlet trans-Cp2Ni2(µ-C6F6) structure has a bis(trihapto) η(3),η(3)-C6F6 ligand.

[Association between CHADS2 score and long-term atrial fibrillation recurrence rate after catheter ablation].

OBJECTIVE: To investigate the association between CHADS2 score and long-term ( ≥ 3 years) outcomes post catheter ablation in patients with atrial fibrillation (AF). METHODS: AF patients who received single catheter ablation in our hospital from January 2004 to March 2009 in our department were included and patients received regular follow-up. AF recurrence was defined as the occurrence of atrial arrhythmias (AF, atrial flutter and atrial tachycardia) recorded by electrocardiogram monitor ( ≥ 30 seconds) after ablation during follow-up period (after 3 months blanking period). The relationship between baseline clinical and echocardiographic characteristics and the time to recurrence during follow-up was evaluated using Cox multivariate analysis. RESULTS: A total of 280 patients who received single catheter ablation procedure were included in the study, 3 patients died and there were 50 patients lost to follow-up. A total of 227 patients with AF (163 paroxysmal and 64 non-paroxysmal ) were enrolled in the final analysis. During a median follow-up of 51 months (41-56 months), 109 patients experienced AF recurrences and the recurrence rate after catheter ablation ( ≥ 3 years) was 48.0% (109/227). Cox multivariate analysis showed that the high CHADS2 score (HR: 1.417, 95%CI 1.194-1.682, P < 0.001) and AF non-termination during ablation (HR: 2.077, 95%CI 1.380-3.126, P = 0.043) were risk factors of AF recurrence. AF recurrence rates in the termination and non-termination group were 41.0% (75/183) and 77.3% (34/44), respectively. In the AF termination group, the recurrence rates and the median recurrence free time in patients with CHADS2 score ≥ 3 were 80.0% (12/15) and 1 year, respectively. In the non-AF termination group, the recurrence rates in patients with CHADS2 score = 0, CHADS2 score = 1-2 and CHADS2 score ≥ 3 were 60.0% (6/10), 77.8% (21/27) and 100% (7/7), respectively; the median recurrence free time of patients with CHADS2 score = 0, CHADS2 score = 1-2 and CHADS2 score ≥ 3 were 30 months, 12 months and 6 months, respectively. CONCLUSIONS: CHADS2 score is a predictor of AF recurrences after catheter ablation. Patients with high CHADS2 score is associated with higher risk of long-term ( ≥ 3 years) AF recurrences.

Channel-Specific and Spatial Residual Attention Network for Medical Image Denoising.

Medical image quality is crucial for physicians to ensure accurate diagnosis and therapeutic strategies. However, due to the interference of noise, there are often various types of noise and artifacts in medical images. This not only damages the visual clarity of images, but also reduces the accuracy of information extraction. Considering that the edges of medical images are rich in high-frequency information, to enhance the quality of medical images, a dual attention mechanism, the channel-specific and spatial residual attention network (CSRAN) in the U-Net framework is proposed. The CSRAN seamlessly integrates the U-Net architecture with channel-wise and spatial feature attention (CSAR) modules, as well as low-frequency channel attention modules. Combined with the two modules, the ability of medical image processing to extract high-frequency features is improved, thereby significantly improving the edge effects and clarity of reconstructed images. This model can present better performance in capturing high-frequency information and spatial structures in medical image denoising and super-resolution reconstruction tasks. It cannot only enhance the ability to extract high-frequency features and strengthen its nonlinear representation capability, but also endow strong edge detection capabilities of the model. The experimental results further prove the superiority of CSRAN in medical image denoising and super-resolution reconstruction tasks.

Safety and efficacy of ablation for atrial fibrillation in combination with left atrial appendage occlusion in octogenarians.

BACKGROUND: Catheter ablation (CA) combined with left atrial appendage occlusion (LAAO) is a feasible approach for atrial fibrillation (AF) patients. Its role in octogenarians with AF is unclear. HYPOTHESIS: In AF patients over 80 years, CA combined with LAAO is a feasible way in restoring sinus rhythm and preventing stroke. METHODS: This is a single-center retrospective study. Patients who underwent CA and LAAO in a single procedure between March 2018 and December 2020 were included. Efficacy endpoints included procedural success rate, AF recurrence rate, and thromboembolic events. Safety endpoints included pericardial effusion/cardiac tamponade, device-related thrombus (DRT), all-cause death, and major bleeding. RESULTS: Five hundred and five patients (mean age 69.5 ± 7.7 years; 230 [45.5%] female) were included, with 46 (9.1%) patients aged ≥80 years old (octogenarian group). Prevalence of paroxysmal AF (25 [54.3%] vs. 207 [45.1%], p < 0.001) and CHA2DS2VASc score (4.1 ± 1.3 vs. 3.1 ± 1.4, p < 0.0001) were higher in octogenarian patients. There were six cases (1.2%) of pericardial effusion (all in nonoctogenarian patients). At 3 months postprocedure, 437 patients underwent TEE/CT. Thirty-two (80%) octogenarian patients and 308 (77.6%) nonoctogenarian patients had no peri-device leak. After a mean follow-up of 26.9 ± 9.1 months, AF was documented in 10 (21.7%) patients in octogenarian group and in 103 (22.4%) patients in nonoctogenarian group (p = 0.99). The annual thromboembolic risk was 2.1% and 0.8% in the octogenarian group and nonoctogenarian group, respectively. Death occurred in 16 nonoctogenarian patients. One major bleeding was recorded in the octogenarian group. CONCLUSIONS: The combination of CA and LAAO in a single procedure is a feasible treatment option in octogenarians with comparable efficacy and safety profile.

Multi-scale information with attention integration for classification of liver fibrosis in B-mode US image.

BACKGROUND AND OBJECTIVE: Chronic hepatitis B (CHB) is one of the most common liver diseases in the world, which threats a lot to people's usual life. The increased deposition of fibrotic tissues in livers for patients with CHB may lead to the development of liver cirrhosis, hepatocellular carcinoma, or even liver failure. Accurate fibrosis staging is very important for the targeted treatment of liver fibrosis and its recovery. METHODS: In this paper, we propose a new deep convolutional neural network (DCNN) with functions of multi-scale information extraction and attention integration for more accurate liver fibrosis classification from ultrasound (US) images. The proposed network uses two pyramid-structured CNN elements to extract multi-scale features from US images. Such a design significantly enlarges the receptive field of the convolution layer, such that more useful information can be explored by the neural network to associate with the final classification. Based on this, a new feature distillation method is also proposed to enhance the ability of deep features derived from multi-scale information. The proposed distillation method employs attention maps to automatically extract class-related features from multi-scale information, which effectively suppress the influence of potential distractors. RESULTS: Experimental results on the US liver fibrosis dataset collected from 286 participants show that the proposed deep framework achieves promising classification performance. The proposed method achieves a classification accuracy of 95.66% on the test dataset. CONCLUSION: Our proposed framework could stage liver fibrosis highly accurately. It might provide effective suggestions for the clinical treatment of liver fibrosis that can facilitate its recovery.

Long-term outcome of combined catheter ablation and left atrial appendage closure in atrial fibrillation patients.

BACKGROUND: The combined procedure of catheter ablation and left atrial appendage closure (LAAC) aims to simultaneously control the heart rhythm and reduce the risk of strokes in patients with atrial fibrillation (AF). The study aims to evaluate the procedural safety and long-term outcome of the combined procedure in a large patient cohort. METHODS: Clinical data of AF patients who underwent the combined procedure was retrospectively analyzed. Procedural and imaging follow-up parameters were compared between the transesophageal echocardiography-guided standard process and fluoroscopy-guided modified process, and between the single-seal WATCHMAN and dual-seal LACBES devices. Long-term outcomes included all-cause mortality, thromboembolic events, major bleeding, and recurrence of atrial tachyarrhythmias. RESULTS: A total of 1114 patients were included. The rates of procedure-related major complications were comparable between the standard and modified processes (3.7% vs. 2.2%, p = 0.219), except for a higher incidence of respiratory depression in standard process group (0.9% vs 0%, p = 0.037), and between WATCHMAN and LACBES devices (2.4% vs. 3.3%, p = 0.535). The follow-up imaging evaluation revealed a high rate of satisfactory seals (99.7%) and a low rate of device related thrombus (1.9%), which were similar between two process groups and devices. The follow-up of over 1960 patient-years revealed low rates of mortality, thromboembolism, and nonprocedural major bleeding (1.8, 3.2, and 0.9 per 100 patient-years, respectively). Recurrent atrial tachyarrhythmias was observed in 23.9% patients. CONCLUSIONS: The results supported the safety and long-term efficacy of the combined procedure of catheter ablation and LAAC. Fluoroscopy-guided LAAC device implantation may be considered in experienced centers.