Search

Background: Application of electrocautery to a J‐wire is used to perform transseptal puncture (TSP), but with limited evidence supporting safety and efficacy. We conducted a prospective randomized controlled trial to evaluate the safety and efficacy of this technique. Methods: Two hundred consecutive patients were randomized in a 1:1 fashion to either the ICE‐guided electrified J‐wire TSP group or a conventional Brockenbrough (BRK) needle TSP group. The TSP was performed with a 0.032″ guidewire under 20 W, "coag" mode and was compared to TSP using the BRK needle. The primary safety endpoints were complications related to TSP. The primary efficacy endpoints included the TSP success rate, the total TSP time, and the total procedure time. Results: All patients complete the procedure safely. The electrified J‐wire TSP group had a significantly shorter TSP time than BRK needle TSP group. The total procedure time, number of TSP attempts required to achieve successful LA access, width of the intra‐atrial shunt at the end of ablation were similar between the two groups. The incidence of new cerebral infarction detected by MRI were similar between the two groups (3/32 patients in the J‐wire TSP group and 2/26 patients in conventional BRK TSP group, p =.82). And no difference in the incidence of residual intra‐atrial shunt (4.3% vs. 6%, p =.654) during the 3‐month's follow up. Conclusion: Using an electrified J‐wire for TSP under the guidance of ICE appears to be as safe as and more efficient than conventional BRK needle TSP, which may be especially useful in the era of non‐fluoroscopy AF ablation. [ABSTRACT FROM AUTHOR]

Low-density reef limestone is widely distributed in tropical oceans; exploring its mechanical properties is of significance to practices in marine foundation engineering. In this research, laboratory experiments on low-density reef limestones with two different types of porous structures were conducted using image recognition methods to study the special mechanical properties of low-reef limestone. S ¯ was defined as the parameter quantifying the pore geometry, and the calculation method of S ¯ was optimized based on image recognition data. Finally, the influencing factors of uniaxial compressive strength (UCS) of low-density reef limestone were analyzed, and a modified formula considering pore structure was proposed. The results indicate the following: Image recognition methods were used to determine feasibility and convenience of capturing 2D pore geometric information of specimens. The optimization method of S ¯ is conducive to improving automatic image recognition accuracy. Low-density reef limestones with different porous structures show small difference in porosity and density, while they exhibit large differences in pore sizes and UCS. The UCS of low-density reef limestone is found to be jointly influenced by pore structure and density (it increases with the decrease in parameter S ¯ and increase in density). The results may provide help for those investigating the mechanical properties of reef limestone and practices in marine foundation engineering. [ABSTRACT FROM AUTHOR]

To investigate the mechanical behaviors of failure and rockburst proneness of fractured rock mass during excavation unloading under high in-situ stress. Triaxial loading and unloading tests of fractured rock samples with different dip angles under different stress paths were conducted, and mechanisms inducing catastrophic effects of deeply buried fractured granite were discussed from the perspectives of mechanical characteristics of failure and energy evolution. The results imply that failure modes of fractured granite under triaxial loading and unloading are mainly dominated by shear failure. Coplanar cracks produced by granite under unloading generally often are composite tensile-shear cracks, which show more significant brittle failure. Under loading and unloading, the energy storage limit Uem of rock first decreases, then increases with the increase of the dip angle of fractures. When the dip angle of prefabricated fractures is closer to the fracture angle of the intact rock mass, the energy storage limit is smaller and shows an increasing linear relationship with the unloading ratio. The rate of change of elastic strain energy in fractured rock under triaxial loading suddenly increases more frequently. The elastic energy release rate δ was defined to evaluate the rockburst proneness of deeply buried fractured granite under loading and unloading. Under unloading, the elastic energy release rate δ of rock is slightly affected by changes of the dip angle; the elastic strain energy in the rock is rapidly released, greatly increasing the rockburst proneness. [ABSTRACT FROM AUTHOR]

Background: Intracardiac echocardiography (ICE) technology has been increasingly accepted as an integral part of atrial fibrillation (AF) ablation procedures. It is still unknown whether ICE can routinely replace transesophageal echocardiography (TEE) for routine thrombus screening in non‐selective AF patients. Objective: To assess whether ICE can routinely replace TEE in screening for left atrial (LA)/left atrial appendage (LAA) thrombus in general patients undergoing catheter ablation for AF. Methods: A total of 2003 consecutive patients undergoing AF ablation were included. 1155 patients (ICE group) received intra‐procedural ICE examination for LA/LAA thrombus screening, while 848 patients (TEE group) received pre‐procedure TEE examination. The incidence of thrombus, peri‐procedure complications, and hospital efficiency were assessed. Results: The LA and LAA were adequately visualized in all patients. Five patients in the ICE group and 15 patients in the TEE group were found to have LAA thrombus. The incidence of major periprocedural thrombo‐embolic events was comparable between two groups (0.2% vs. 0.1%, p =.76), none were due to undetected LA/LAA thrombus. Other major periprocedural complications occurred at similar rates in both groups, while post‐procedure fever was less common in the ICE group (12.7% vs. 17.4%, p <.001). Procedure times and hospital length of stay were both shorter in the ICE group (142 min [87–197 min] vs. 150 min [95–205 min], and 3[2–4] day vs. 4[3–5] day, respectively, both p <.001). Conclusions: ICE can replace TEE for atrial thrombus screening in AF patients undergoing ablation without increased complications. An "ICE replacing TEE" workflow can also reduce the incidence of postoperative fever and improve hospital efficiency. [ABSTRACT FROM AUTHOR]

Deep convolutional neural networks (DCNNs) are widely utilized for the semantic segmentation of dense nerve tissues from light and electron microscopy (EM) image data; the goal of this technique is to achieve efficient and accurate three-dimensional reconstruction of the vasculature and neural networks in the brain. The success of these tasks heavily depends on the amount, and especially the quality, of the human-annotated labels fed into DCNNs. However, it is often difficult to acquire the gold standard of human-annotated labels for dense nerve tissues; human annotations inevitably contain discrepancies or even errors, which substantially impact the performance of DCNNs. Thus, a novel boosting framework consisting of a DCNN for multilabel semantic segmentation with a customized Dice-logarithmic loss function, a fusion module combining the annotated labels and the corresponding predictions from the DCNN, and a boosting algorithm to sequentially update the sample weights during network training iterations was proposed to systematically improve the quality of the annotated labels; this framework eventually resulted in improved segmentation task performance. The microoptical sectioning tomography (MOST) dataset was then employed to assess the effectiveness of the proposed framework. The result indicated that the framework, even trained with a dataset including some poor-quality human-annotated labels, achieved state-of-the-art performance in the segmentation of somata and vessels in the mouse brain. Thus, the proposed technique of artificial intelligence could advance neuroscience research. [ABSTRACT FROM AUTHOR]

• Reef limestone was classified into four types according to measured data. • Sixteen test schemes were designed for mix proportions to prepare similar materials by using the foaming agent, powdered talc, sea sand, cement, gypsum powder, and air-entraining agent as base materials. • The mix proportions were optimized and the optimal mix proportions that separately meet similarity requirements of four types of reef limestone were obtained. Reef limestone is different from conventional terrestrial rocks and is characterized by high porosity, low density, and low strength. To study similar materials applicable to model tests of reef limestone, reef limestone was classified into four types, i.e. weakly-cemented and dense (WD), strongly-cemented and dense (SD), weakly-cemented and loose (WL), and strongly-cemented and loose (SL) according to measured data. Sixteen test schemes were designed for mix proportions to prepare similar materials by using an orthogonal scheme. Therein, the foaming agent, powdered talc, sea sand, cement, gypsum powder, and air-entraining agent were used as base materials, and the cement/gypsum ratio, foaming agent/water ratio, and talc/water ratio were taken as controlling factors for the density, porosity, and uniaxial compressive strength (UCS). The physico-mechanical parameters of the similar materials were evaluated using range analysis. Results show that the foaming agent/water ratio exerts a strong controlling effect on the porosity and UCS and a certain controlling effect on the density; the cement/gypsum ratio and the talc/water ratio both have certain controlling effects on the density and UCS while do not exert obvious controlling effects on the porosity. On this basis, the mix proportions were optimized and the optimal mix proportions that separately meet similarity requirements of the above four types of reef limestone were obtained. That is, the ratios of the cement/gypsum ratio, foaming agent/water ratio, and talc/water ratio are separately 2.5:0.03:0.1, 2:0.02:0.15, 3.5:0.04:0.15, and 3:0.01:0.2. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate the association between the albumin-corrected anion gap (ACAG) and the prognosis of cardiogenic shock (CS)., Design: A multicentre retrospective cohort study., Setting: Data were collected from the Medical Information Mart for Intensive Care (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD) datasets., Participants: 808 and 700 individuals from the MIMIC-IV and eICU-CRD, respectively, who were diagnosed with CS., Primary and Secondary Outcomes: The primary endpoint was short-term all-cause mortality, including intensive care unit (ICU), in-hospital and 28-day mortality. The secondary endpoints were the 28-day free from the ICU duration and the length of ICU stay., Results: CS patients were divided into two groups according to the admission ACAG value: the normal ACAG group (≤20 mmol/L) and the high ACAG group (> 20 mmol/L). CS patients with higher ACAG values exhibited increased short-term all-cause mortality rates, including ICU mortality (MIMIC-IV cohort: adjusted HR: 1.43, 95% CI=1.05-1.93, p=0.022; eICU-CRD cohort: adjusted HR: 1.38, 95% CI=1.02-1.86, p=0.036), in-hospital mortality (MIMIC-IV cohort: adjusted HR: 1.31, 95% CI=1.01-1.71, p=0.03; eICU-CRD cohort: adjusted HR: 1.47, 95% CI=1.12-1.94, p=0.006) and 28-day mortality (adjusted HR: 1.42, 95% CI: 1.11 to 1.83, p=0.007). A positive linear correlation was observed between the ACAG value and short-term mortality rates via restricted cubic splines. Compared with the AG, the ACAG presented a larger area under the curve for short-term mortality prediction. In addition, the duration of intensive care was longer, whereas the 28-day free from the ICU duration was shorter in patients with a higher ACAG value in both cohorts., Conclusion: The ACAG value was independently and strongly associated with the prognosis of patients with CS, indicating that the ACAG value is superior to the conventional AG value., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Hepatocellular carcinoma (HCC) is an aggressive malignancy, and CCL18, a marker of M2 macrophage activation, is often associated with tumor immune suppression. However, the role of CCL18 and its signaling pathway in HCC is still limited. Our study focuses on investigating the prognostic impact of CCL18 and its signaling pathway in HCC patients and biological functions in vitro ., Methods: HCC-related RNA-seq data were obtained from TCGA, ICGC, and GEO. The 6 hub genes with the highest correlation to prognosis were identified using univariate Cox and LASSO regression analysis. Multivariate Cox regression analysis was performed to assess their independent prognostic potential and a nomogram was constructed. In vitro experiments, including CCK8, EdU, RT-qPCR, western blot, and transwell assays, were conducted to investigate the biological effects of exogenous CCL18 and 6 hub genes. A core network of highly expressed proteins in the high-risk group of tumors was constructed. Immune cell infiltration was evaluated using the ESTIMATE and CIBERSORT packages. Finally, potential treatments were explored using the OncoPredict package and CAMP database., Results: We identified 6 survival-related genes (BMI1, CCR3, CDC25C, CFL1, LDHA, RAC1) within the CCL18 signaling pathway in HCC patients. A nomogram was constructed using the TCGA&#95;LIHC cohort to predict patient survival probability. Exogenous CCL18, as well as overexpression of BMI1, CCR3, CDC25C, CFL1, LDHA, and RAC1, can promote proliferation, migration, invasion, stemness, and increased expression of PD-L1 protein in LM3 and MHCC-97H cell lines. In the high-risk group of patients from the TCGA&#95;LIHC cohort, immune suppression was observed, with a strong correlation to 21 immune-related genes and suppressive immune cells., Conclusion: Exogenous CCL18 promotes LM3 and MHCC-97H cells proliferation, migration, invasion, stemness, and immune evasion. The high expression of BMI1, CCR3, CDC25C, CFL1, LDHA, and RAC1 can serve as a biomarkers for immune evasion in HCC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mao, Tao, Wang, Sun, Zhang, Jin and Pan.)