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Xinfang Wang,* Dong Xu,* Xin Pei, Yingying Zhang, Yuling Zhang, Yaxing Gu, Ying Li Department of Pediatrics, Shandong Provincial Western Hospital, Jinan 250022, Shandong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ying LiDepartment of Pediatrics, Shandong Provincial Western Hospital, No. 4 Duanxing West Road, Jinan, Shandong 250022, People’s Republic of ChinaTel +86-531 83086400Email dedfedx@163.comBackground: Medulloblastoma (MB) is the most common malignant brain tumor during childhood. Circular RNA (circSKA3) was identified to function as an oncogene in MB. However, the mechanism of circSKA3 in MB remains unclear.Methods: The levels of circSKA3, microRNA-383-5p (miR-383-5p), and forkhead box M1 (FOXM1) in MB tissues were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The cell viability and apoptotic rate were assessed via 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay and flow cytometry, respectively. The protein levels of B-cell lymphoma 2 (Bcl-2), C-Caspase3, and FOXM1 were detected via Western blot assay. Cell cycle was detected by flow cytometry. The migration and invasion abilities were monitored by Transwell assay. The dual-luciferase reporter assay was constructed to verify the interactions between miR-383-5p and circSKA3 or FOXM1. The mice model experiment was carried out to validate the effects of circSKA3 in vivo.Results: The levels of circSKA3 and FOXM1 were significantly elevated, while the level of miR-383-5p was notably declined in MB tissues. CircSKA3 was validated to sponge miR-383-5p, and FOXM1 was a candidate target of miR-383-5p. CircSKA3 silencing impeded cell proliferation, migration, and invasion while promoted apoptosis by targeting miR-383-5p in vitro and retarded xenograft tumor growth in vivo. miR-383-5p suppressed cell proliferation, migration, and invasion but promoted apoptosis in MB cells by regulating FOXM1. CircSKA3 depletion decreased FOXM1 expression via miR-383-5p in MB cells.Conclusion: CircSKA3 augmented MB progression partly through miR-383-5p/FOXM1 axis.Keywords: circSKA3, miR-383-5p, FOXM1, medulloblastoma

The UK introduced carbon budgets in 2008, with an aim to reduce greenhouse gases by 80% by 2050 compared with the 1990 levels. It has been argued that the 2015 Paris Agreement on limiting the global average temperature rise to ‘well below 2° C’ requires deeper and more rapid emission reductions than the current UK targets. Household energy consumption accounts for almost a third of total UK CO2emissions in recent years. This paper explores drivers of high energy consumption in domestic buildings from a sociological practice perspective and through a lens of dominant meanings of ‘home’. Whilst the practice approach and meanings of home have been explored separately in the literature to understand household energy consumption, this paper adds new findings on the interaction between the meanings of home and the elements of practices. Results show the dominant meaning of home differs between householders; this in turn affects the materials and procedures of energy-consuming practices. For instance, if ‘home’ means ‘hospitality’, this changes the standard of comfort and convenience people perceive at home. Understanding how practices and meanings of the home intersect, provides new, much needed insights that could support policy change commensurate with more rapidly reducing CO2emissions from domestic energy consumption.

Angelica sinensis (Oliv) Diels (Umbelliferae) is a popular Chinese herb that is mainly distributed in Gansu Province, China, accounting for more than 90% of the national output and sales. A survey for diseases of A. sinensis in Gansu Province in August 2019 found foliar disease with an incidence of 60 to100%, and severities ranging from 5 to 15%. The disease mainly occurred in late July and August. The initial symptoms included many light brown, small lesions, round or irregular in shape, which gradually increased in size. White mycelia was visible in the lesions. Severely affected leaves became chlorotic, withered and died. In the Angelica planting area in Weiyuan County (33°26'N, 104°02'E) diseased leaves from 20 plants were collected by the five-point sampling method (Zheng et al. 2018), and small samples (4 × 4 mm2) wee cut from the border between diseased and healthy tissue, successively sterilized with 75% ethanol for 30 sec, washed three times with sterilized water and dried on sterilized filter paper, and placed on potato dextrose agar plates. After 5 days at 25°C, five morphologically similar colonies were obtained. Colonies were somewhat round with pink overall and formed abundant fluffy white mycelium in the center. Conidia were solitary, macrospores slender, straight to slightly falcate with 2 to 6 septa, and ranged from 20.0 to 77.6 µm × 2.5 to 3.6 µm (n=50). The microspores were elliptical and ranged from 3.0 to 8.0 µm × 2.5 to 3.0 µm (n=5). The strong pink pigment was observed on the reverse side of the PDA culture. The morphological characteristics were consistent with the description of Fusarium avenaceum (Parikh et al. 2018; Jahedi et al. 2019). To further identify the strains, the internal transcribed spacer (ITS), β-tubulin, translation elongation factor 1α (EF1-α), and RNA polymerase second largest subunit (RPB2) gene regions were amplified with ITS1/ITS4, Bt2a/Bt2b, EF1/EF2, and 5f2/7cr (Glass and Donaldson 1995; O'Donnell et al. 2010; White et al. 1990), respectively. The sequences of the five strains were identical, and that of representative strain K0721 were deposited in GenBank (ITS, MZ389899; TUB2, MZ398139; EF1-α, MZ388462; RPB2, MZ394004). BLAST analysis revealed that the ITS, β-tubulin, EF1-α, and RPB2 sequences were 100% (563/563), 100% (423/423), 99% (643/649), and 99% (930/935) homology, with those of F. avenaceum (KP295511.1, KY475586.1, KU999088.1, and MH582082.1), respectively. A multigene phylogenetic tree was inferred by Maximum likelihood phylogenetic analyses based on the combined data set with ITS, EF1-α and RPB2. The strain K0721 was clustered with F. avenaceum. Pathogenicity tests were performed on five 1-month-old healthy plants in plastic pots (20 cm. diam.) with sterilized soil. Each was sprayed with 50 μl of a conidial suspension (1×104 conidia/mL), and 5 healthy plants were sprayed with sterile water as controls. Small lesions were observed after 5 days at 25℃ in a greenhouse. Symptoms were similar to those observed under field conditions. Control plants remained symptomless. Six isolates were reisolated from infected leaves and all confirmed to be F. avenaceum based on morphological observations and molecular identification. To our knowledge, only Septoria anthrisci has been previously reported as a pathogen of A. sinensis leaf spot (Wang et al. 2018), and this is the first report of F. avenaceum causing this disease. This discovery needs to be considered in developing and implementing disease management programs in A. sinensis production.

Energy resilience is a complex issue, encapsulating a diversity of factors. Such complexity makes effective policymaking difficult, and requires a whole-systems approach. This paper argues that the bottom-up participatory causal loop mapping method can be helpful in facilitating a shared understanding of the issues, and can help facilitate the application of a whole-systems approach to the design of effective policy interventions. Focusing on Nepal as a case study, this paper outlines the participatory approach, highlighting the method’s value in visualising the variables and interconnections affecting the resilience of Nepal’s electricity supply. Through the mapping, participants identified four interconnected groups of factors as important for resilience: governance, technology, economic and social. Within these, political leadership was noted as particularly important. Environmental factors were largely absent, which is an interesting result given the emphasis on renewable sources and clean technologies in energy policy in Nepal. The outcomes of our bottom-up participatory approach show the significant benefit of using this approach for highlighting context-dependent understandings of complex issues and represents a novel methodological innovation for energy research, which could be applied in diverse geographies and contexts.

Hawthorn polyphenol extract (HPE) is beneficial for patients with type 2 diabetes (T2D). However, the mechanism underlying its beneficial effects remains unclear. We investigated the inhibitory effects and mechanisms of HPE on insulin resistance, inflammation, and aortic injury in T2D rats, using metformin (MF) as a positive control. High-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (HPLC-ESI-MS/MS) was used to determine the primary polyphenols in HPE. HematoxylinEosin (HE) staining was used to evaluate pathological conditions of the skeletal muscle, liver, and aorta vessels in each group. The levels of serum and intestinal tissue oxidative stress, tumor necrosis factor α (TNF-α), and inflammatory interleukin-6 (IL-6) were also assessed. Western blotting was used to evaluate protein expression levels in the associated molecular pathway. Volatile organic compounds (VOCs) from colon contents were determined using headspace-gas chromatography-ion mobility chromatography. Our results showed that supplementation with 300 mg HPE/kg body weight over four weeks significantly improved total cholesterol (TC), total triglyceride (TG), insulin, and lipopolysaccharide (LPS) levels in diabetic rats (p 0.01). The lesions of skeletal muscle, liver, and aorta in diabetic rats were significantly improved. HPE supplementation also significantly downregulated the inflammatory factors (IL-6, TNF-α, and MCP-1) in the liver of diabetic rats via the SIRT1/AMPK/NF-κB signaling pathway. Furthermore, HPE significantly reduced insulin resistance in T2D rats by upregulating the phosphorylation of glucose absorption protein (GLUT4) and insulin resistance-associated proteins, p-IRS1, p-AKT, and p-PI3K, in the rat liver (p 0.01). The findings show that HPE could also alleviate aortic injury by activating SIRT1 and regulating the NF-κB and Wnt2/β-catenin signaling pathways. Overall, the results of this study suggest that both HPE and MF have similar inhibitory effects on T2D in rats and that HPE could be used as a functional food component in the adjuvant treatment of T2D.

The shear wall with frame column has a wide application prospect in practical engineering for it has better ductility, bearing capacity and stiffness degradation than the shear wall with unframed column. In this paper, the finite element model of shear wall with frame column for an experiment was established in ABAQUS software firstly, Then on the base of proving the model’s precision, the axial compression ratio and the stiffness ratio of shear wall with frame column were adjusted, the influence of different axial compression ratio and stiffness ratio on the stiffness degradation coefficient was analyzed and the corresponding formulas were fitted. At last, by changing the axial compression ratio and the stiffness ratio of shear wall with frame column, The influence of stiffness degradation on the maximum displacement amplification coefficient and the bottom shear amplification coefficient were studied and the relevant formulas were fitted.

Chalcone isomerase (CHI) is a key enzyme of the flavonoid pathway that plays crucial roles in plant responses to various pathogens. Our previous study using comparative transcriptome analysis of soybean inoculated with or without Phytophthora sojae revealed Glyma.20G241500, a homolog of CHI1A in Arabidopsis thaliana, to be induced by P.sojae in soybean. In the present study, we isolated the gene from soybean cultivar Nannong 10–1, designating it GmCHI1A. GmCHI1A transcripts were detected in soybean roots, stems and leaves, with the highest levels in roots. Interestingly, GmCHI1A localizes to the cortical endoplasmic reticulum (ER). GmCHI1A was overexpressed in hairy roots to further uncover the roles of CHIs in soybean. Compared to empty vector-expressing hairy roots (EV) infected with P. sojae, hairy roots overexpressing GmCHI1A (OE) exhibited decreased P. sojae biomass accumulation, shortened the lesion lengths and reduced zoospores germination. These results demonstrate that GmCHI1A plays positive roles in the response of soybean to P. sojae.

Bifunctional films of Keggin-type polyoxometalates H3PW12O40 (PW12), H4SiW12O40 (SiW12), H3PMo12O40 (PMo12), and TiO2 were successfully built on Fe3O4@SiO2 microspheres using a layer-by-layer method. The characterization by field emission scan electronic microscopy (FESEM) and energy dispersive X-ray spectroscopy (EDX) shows that TiO2 nanoparticles and polyoxometalate (POM) anions are successfully assembled. The photodegradation of methyl orange (MO) was used to test the photocatalytic efficiency of magnetic catalysts under UV irradiation. For MO decomposition, multilayer films that combine PW12 and SiW12 with TiO2 show high efficiency, which can be attributed to the synergistic effect between POMs and TiO2. The degradation of the model contaminant was also systematically checked under different conditions such as bilayer number deposited on magnetic microspheres, catalyst concentration, inorganic oxidants, and salts. The oxidation process of MO follows an apparent first-order reaction. Furthermore, the composite catalysts deposited on Fe3O4@SiO2 magnetic microspheres can be conveniently, quickly, and efficiently separated by an external magnet from a solution.

Industries are a major fossil energy consumer and economic development contributor in China. The Chinese government is performing the industrial reforms to diminishing the dependence of industrial output on fossil energy consumption. To guide the present industrial policy adjustment, this study employs the Tapio decoupling index, a structural decomposition algorithm, a hybrid forecasting model, and industry-related data from 2001 to 2014 to evaluate, decompose and forecast the relationship between China's industrial output and fossil energy consumption. Empirical results show that the decoupling index of fossil energy consumption from the value added by China's industry was less than 0 in 2015. Consequently, the industrial fossil energy consumption reached its peak at that time and will gradually decrease in the future, even though the added value continuously increased. The mitigation goals set by the Chinese government for industrial fossil energy intensity by 2020 are expected to be achieved ahead of schedule. The attainment of these goals will strongly support the realization of China's fossil energy-related prospects for 2030. To reduce industrial fossil energy consumption, China should develop strategies for non-fossil energy electricity generation, implement electricity price bidding, prevent overheated investments to real estate and infrastructure, and eliminate backward capacity and establish market-access rules for acetic acid, calcium carbide, ethyl alcohol, and dimethyl ether.

OBJECTIVES To examine the repeatability of quantitative time-intensity curve analysis of neovascularization within carotid plaques with contrast-enhanced ultrasonography (US) and to investigate carotid plaque neovascularization in patients with coronary heart disease using contrast-enhanced US and the correlation between risk factors and acute coronary syndrome (ACS). METHODS Sixty patients with ACS and 60 with stable coronary artery disease (CAD) underwent conventional carotid and contrast-enhanced US, and plaque enhancement was observed and analyzed quantitatively. Carotid contrast-enhanced US was performed within 1 month of ACS occurrence. Interobserver and intraobserver variability of the measurements was assessed. The peak signal intensity was the maximum number of contrast microbubbles that local tissues could accumulate, reflecting the local microvascular density and representing the capillary volume. RESULTS The ACS group had higher low-density lipoprotein cholesterol (mean ± SD, 3.21 ± 0.75 versus 2.53 ± 0.71 mmol/L; P

The prefix array was apparently first computed and used algorithmically in 1984, playing a pivotal role in an optimal algorithm to determine all the tandem repeats in a given (DNA or protein) sequence. However, it is especially since the turn of the 21st century that applications of the prefix array to fundamental sequencing problems have been recognized. An important aspect of this expanding role has been the recognition that the prefix table and the border array are “equivalent” data structures 一 that is, one can be computed from the other in linear time. Since the border array in turn specifies all the periods of every prefix of the sequence, the prefix array thus turns out to be a structure of central importance. In this paper we survey important applications of the prefix array 一 in particular to approximate string matching under Hamming distance, as well as to the computation of covers and enhanced covers 一 and show how, unlike border array algorithms, these are extendible to sequences containing “don’t-care” or indeterminate letters such as {a, c} or {g, t}. This extension leads to a surprising correspondence between prefix arrays and undirected graphs that seems likely to be a fertile source of new insights in future. We conclude with an overview of sequencing problems that the authors believe can be handled using prefix array technology.

Contrast echocardiography with left ventricular opacification (LVO) improves the definition of endocardium in two-dimensional echocardiography (2DE). This study was aimed to determine whether LVO offered added diagnostic value in noncompaction of left ventricular myocardium (NCVM). A total of 85 patients (40 ± 20 years, 54 males) with suspected NCVM were subjected to transthoracic 2DE and LVO, and 40 healthy volunteers were examined with 2DE and assigned as control subjects. The location of NCVM, the thickness ratio of noncompacted to compacted myocardium (NCR), and the cavity size and ejection fraction of LV were quantified. Results revealed that NCVM was mainly located in the LV medium (53.2%), apical (46.2%) segments, and lateral wall (39.8%). The NCR obtained through LVO was greater than that detected through 2DE (4.2 ± 1.3 vs. 3.3 ±1.2, P < 0.001), and higher inter-correlations and less intra- and inter-observer variabilities were determined in the former than in the latter. The NCVM detection rates were also increased from 63.5% via 2DE to 83.5% via LVO and 89.4% via 2DE combined with LVO (2DE + LVO) (P = 0.0004). The LV cavity size was greater and the LVejection fraction (LVEF) was lower in the NCVM patients than in the control group (P < 0.01). In the NCVM group, the LV cavity size was higher and the LVEF was lower in LVO than in 2DE (P < 0.01). In conclusion, contrast echocardiography contributes significant sensitivity and reproducibility to routine transthoracic echocardiography in NCVM diagnosis. Therefore, this technique should be clinically performed to diagnose suspected NCVM.

The rapid growth of household electricity consumption is threatening the sustainable development of China&rsquo, s economy and environment because of its impacts on the operation efficiency of the electric power system. To recognize the driving factors of the consumption growth and offer policy implications, based on the consumption-related data of 2015 and 2016, this research used the rank sum ratio (RSR) method to divide China&rsquo, s 30 provinces into 5 groups and a logarithmic mean Divisia index (LMDI) algorithm to decompose the composition growth of each group into the quantitative contribution of each driving factor. The following conclusions were drawn from the empirical analysis. (1) The Yangtze basin is the most vigorous region of consumption growth and should be principally monitored. (2) Climate conditions have a remarkable impact on consumption growth and should be a key consideration when making differentiated household electricity policies. (3) The rebound effect has already appeared in a few of the most developed regions. Electricity price is an effective measure in dealing with this effect. (4) The improvement of the income level is the most important driving factor for consumption growth. (5) For provinces with high growth vitality, the change in the burden level of electricity expenditure prompts consumption growth. However, for provinces with low growth vitality, the situations are opposite. (6) The impacts of electricity price and population on consumption growth are negligible.

The aim of this study is to explore the value of transthoracic echocardiography in the diagnosis of eosinophilic myocarditis. The echocardiographic characteristics of nine patients with eosinophilic myocarditis in our hospital between January 2004 and January 2012 were retrospectively reviewed. In our study, four of the nine patients were diagnosed to have small pericardial effusion. The obliteration of the apical cavity was observed in five of the nine patients. There were six patients with both mitral and tricuspid regurgitation, one patient with only mitral regurgitation, and one patient with only tricuspid regurgitation. Transthoracic echocardiography showed that the diameters of the left and right atria were both increased in eight of the nine patients. The diameter of the left ventricle was increased in five patients, and the right ventricular diameter was increased in four patients. The left ventricular ejection fraction was decreased in two of the nine patients. Five of the nine patients had pulmonary hypertension, and one patient had severe pulmonary hypertension. Transthoracic echocardiography is the primary method for the diagnosis of eosinophilic myocarditis and is also useful in follow-up of the disease.

Efficiency and equity are the two crucial factors to be considered when allocating public resources such as voting machines. Existing allocation models are all single-objective, focusing on maximizing either efficiency or equity despite the fact that the actual decision-making process involves both issues simultaneously. We propose a bi-objective integer program to analyse the tradeoff between the two competing objectives. The new model quantifies the sacrifice in efficiency in order to achieve a certain improvement in equity and vice versa. Using data from the 2008 United States Presidential election in Franklin County, Ohio, we demonstrate that our model is capable of producing significantly more balanced allocation plans, in terms of efficiency and equity, than current practice or other competing methods.

Background Anomalous origin of pulmonary artery (AOPA) from the ascending aorta is a rare but serious congenital cardiac malformation, which frequently involves the right pulmonary artery (RPA). Methods We retrospectively analyzed the echocardiographic characteristics of 9 cases with anomalous origin of the right pulmonary artery from the ascending aorta (AORPA) studied from 2007 to 2014 in our institution. The results were compared with the findings at surgery. Results The corrective surgery was performed in all 9 cases with AORPA. The diagnosis by transthoracic echocardiography (TTE) of 8 cases with AORPA was confirmed at surgery. The coincidence rate for TTE and surgical findings was 88.9%. One case was misdiagnosed as anomalous origin of the left pulmonary artery from the ascending aorta. The anomalous RPA in all cases had a proximal origin from the posterior or lateral part of the ascending aorta in our series. The mean distance from the aortic valve to the site of origin of pulmonary artery was 16.1±6.6mm (range: 7.0mm–24.0mm). The mean diameter of the anomalous pulmonary artery was 9.6±4.5mm (range: 4.5mm–17.0mm). In 4 of 9 (44.5%) cases there were associated aortopulmonary septal defect, intact ventricular septum, patent ductus arteriosus and interruption of aortic arch (Type A), also known as the Berry's syndrome. Other associated cardiovascular abnormalities included patent ductus arteriosus, ventricular septal defect and atrial septal defect. Severe pulmonary arterial hypertension was noted in all cases. Conclusions TTE plays an important role in the non-invasive and accurate diagnosis of AORPA. TTE can clearly display its site of origin and course, as well as other associated malformations and hemodynamic changes. TTE also plays an important role in the preoperative diagnosis of AORPA.

To examine the repeatability of quantitative time-intensity curve analysis of neovascularization within carotid plaques with contrast-enhanced ultrasonography (US) and to investigate carotid plaque neovascularization in patients with coronary heart disease using contrast-enhanced US and the correlation between risk factors and acute coronary syndrome (ACS).Sixty patients with ACS and 60 with stable coronary artery disease (CAD) underwent conventional carotid and contrast-enhanced US, and plaque enhancement was observed and analyzed quantitatively. Carotid contrast-enhanced US was performed within 1 month of ACS occurrence. Interobserver and intraobserver variability of the measurements was assessed. The peak signal intensity was the maximum number of contrast microbubbles that local tissues could accumulate, reflecting the local microvascular density and representing the capillary volume.The ACS group had higher low-density lipoprotein cholesterol (mean ± SD, 3.21 ± 0.75 versus 2.53 ± 0.71 mmol/L; P .01) and high-sensitivity C-reactive protein (CRP; 3.76 ± 0.19 versus 2. 93 ± 0.15 mg/L; P .01) levels than the stable CAD group. The proportion of soft plaques in the ACS group (81%) was higher than in the stable CAD group (53%). The proportion of plaque enhancement, peak signal intensity, and plaque-to-carotid lumen enhancement intensity ratio were higher in the ACS group than the stable CAD group. The peak signal intensity was correlated with the high-sensitivity CRP value. Logistic regression analyses indicated that age (65-74 years), high-sensitivity CRP, and enhancement intensity were correlated with the occurrence of ACS. The sensitivity and specificity of the peak signal intensity in carotid plaques were 80.0% and 88.3%, respectively (cutoff value, 9.97 dB; area under the receiver operating characteristic curve, 0.865). The time-intensity curve measurements had good repeatability.Carotid plaque enhancement is a potential independent risk factor for ACS occurrence. These results illustrate the correlation of carotid plaque vulnerability with the coronary artery symptomatic state according to the common pathogenetic mechanism of atherosclerosis.

The intubation of conventional transesophageal echocardiography (TEE) probes into patients causes serious esophagus irritation, and thus the use of TEE probes in pediatric practice is limited. In this study, we aimed at the development of a special probe which could be inserted through the nasopharyngeal cavity into the esophagus to obtain the same high-quality echocardiography images as those obtained by conventional TEE and improve patients' experience. During the examination, the patients felt relaxed for a longer time and cooperated with the sonographers in the process of cardiac catheterization conducted in the surgery room or the intensive care unit (ICU), resulting in improved accuracy of the diagnosis and timely administration of appropriate treatment. Two years ago, Prof. Xin-fang WANG put theories into practice by inserting the probe through the nasal cavity and pharynx into the esophagus of volunteers to successfully detect the heart and great vessels at the retrocardiac space. Later, Prof. Ming-xing XIE performed the transnasal TEE examination in 12 atrial septal defect (ASD) patients and proved the safety and reliability of this method, which could become a new way for clinical diagnosis and treatment.

Annual electricity consumption forecasting is one of the important foundations of power system planning. Considering that the long-term electricity consumption curves of developing countries usually present approximately exponential growth trends and linear and accelerated growth rate trends may also appear in certain periods, this paper first proposes a small-sample adaptive hybrid model (AHM) to extrapolate the above curves. The iterative trend extrapolation equation of the proposed model can simulate the linear, exponential, and steep trends adaptively at the same time. To estimate the equation parameters using small samples, the partial least squares (PLS) and iteration starting point optimization algorithms are suggested. To evaluate forecasting performance, the artificial neural network (ANN), grey model (GM), and AHM are used to forecast electricity consumption in China from 1991 to 2014, and then the results of these models are compared. Analysis of the forecasting results shows that the AHM can overcome stochastic changes and respond quickly to changes in the main electricity consumption trend because of its specialized equation structure. Overall error analysis indicators also show that AHM often obtains more precise forecasting results than the other two models.

Objective To evaluate the value and improve the diagnostic accuracy of echocardiography in the diagnosis of a sinus of Valsalva aneurysm (SVA) with rare pathological patterns. Methods Echocardiographic features and surgical findings from 270 Chinese patients with SVA treated in the last 18 years (1995–2013) at the Union Hospital were compared retrospectively; 22 of 270 cases had rare patterns. Results The patients with SVA, a rare origin, a rare extending position, or a rare course accounted for 3.4%, 7.4%, and 0.4% of the 270 cases, respectively. The three most common aneurysmal complications of the patients with rare patterns were severe aortic regurgitation (16), obstruction of the ventricular outflow tract or valvular orifice (3), and conduction disturbance (3). The origin, course, extending position and rupture status of the SVAs determined by echocardiography were entirely consistent with surgical findings in 81.8% of the 22 cases. With the exception of one failed diagnosis of an aneurysmal wall dissection and one misdiagnosis of a descending aortic dissection, the echocardiographic results of SVA complications and associated cardiovascular lesions were also confirmed. Conclusion We could accurately diagnose SVAs with rare pathological patterns by echocardiographic identification of distinguishing features. However, for several conditions, we could not accurately identify the origin or course of the aneurysm or define its relationship to adjacent structures using conventional echocardiography alone. Therefore, we recommend combining conventional echocardiography with different imaging techniques, such as transesophageal echocardiography, three-dimensional echocardiography, computed tomography angiography, and aortic angiography.

Background Coronary artery fistula (CAF) is a rare congenital anomaly, which is conventionally diagnosed by coronary arteriography; however, the relation of the coronary artery fistulas to other structures, their origin and course may not be always apparent. Methods The echocardiograms of 63 patients with coronary artery fistulas, who had undergone coronary arteriography and/or surgery from June 2002 to December 2012 at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, and the results were compared with findings by coronary arteriography and at surgery. Results Right CAFs were detected in 33 of the 63 patients (52.4%); 11 had drainage to the right atrium, 10 to the right ventricle, 2 to the left ventricle, 9 to the main pulmonary artery, and 1 to the coronary sinus. Left CAFs were detected in 29 patients (46.0%); 6 had drainage to the right atrium, 12 to the right ventricle, 1 to the left atrium, 2 to the left ventricle, 7 to the main pulmonary artery, and 1 to the coronary sinus. One patient (1.6%) had the origin of the fistula in both coronary arteries. The entry point of the fistula was most often a single orifice (96.8%) and rarely multi-orificial (3.2%). 57 patients (90.5%) had isolated coronary fistulas (90.5%); 6 patients (9.5%) had other congenital cardiac malformations. The ultrasonic diagnosis of 60 patients was in line with findings at surgery and/or coronary arteriography. The diagnostic accuracy rate for coronary artery fistula was 95.2%. Preoperative transthoracic echocardiography missed the diagnosis of coronary artery fistula in three patients (4.8%). There is no difference (P>0.05) in diagnostic accuracy between echocardiography and coronary arteriography and/or surgery. Conclusions Transthoracic echocardiography, in comparison with coronary arteriography and/or surgery, is much simpler, easier, less expensive, safer, readily repeatable, and more convenient with equal accuracy, and should be the first-line method for the diagnosis of congenital coronary artery fistula.

Background Early detection of right ventricular (RV) and left ventricular (LV) dysfunction in patients with repaired tetralogy of Fallot (TOF) is essential because dysfunction is correlated with a poor clinical outcome. The aim of this study was to assess RV and LV function in asymptomatic children with repaired TOF by two-dimensional ultrasound speckle tracking echocardiography (STE). Methods Fifty-six asymptomatic children with a preserved biventricular ejection fraction (EF) after repair of TOF and 35 healthy control subjects were studied. RV and LV strain and strain rate were measured by STE. RVEF and pulmonary regurgitation (PR) were assessed using cardiac magnetic resonance imaging. Results Compared with the control subjects, RV regional longitudinal strain and strain rate and global longitudinal strain (GLS) and strain rate (GLSR) were impaired in children with repaired TOF. Likewise, LV circumferential and radial strain and strain rate were reduced in patients with TOF. In contrast, longitudinal strain and strain rate did not differ between the groups. RV and LV GLSR were correlated with postoperative follow-up period (r1 = −0.44; r2 = −0.48). RV GLS and GLSR were associated with RVEF (r1 = 0.64; r2 = 0.60) and PR (r1 = −0.48; r2 = −0.49). LV circumferential strain rate was related to PR (r = −0.45). Conclusions STE can identify abnormalities that may represent early impairment of RV and LV systolic function in postoperative TOF patients with a preserved EF. PR is associated with decreased biventricular performance in repaired patients. STE-derived strain and strain rate may be useful indices for detecting the early deterioration of biventricular performance in patients with TOF.

Left ventricular aneurysms mainly occur in patients with transmural myocardial infarction caused by left anterior descending coronary artery occlusion. Left ventricular apical aneurysm is rarely found in patients with normal coronary arteriograms, and even rarer in these patients following cardiac operations. We analyzed 37 patients with postoperative left ventricular apical aneurysm, including 1 case from our hospital and 36 cases from the literature; 23 cases (62%) had left ventricular apical true aneurysms and 14 cases (38%) had left ventricular apical pseudoaneurysms, all confirmed at surgery and/or angiography. All cases, with the exception of one, had previously undergone cardiac surgery under cardiopulmonary bypass with apical venting. Although left ventriculography is generally regarded as the gold standard for diagnosis of ventricular aneurysm, echocardiography is an accurate and sensitive method in the evaluation of left ventricular apical aneurysm. Differential diagnosis of left ventricular apical aneurysm includes takotsubo cardiomyopathy, post transapical approach for transcatheter aortic valve implantation, and left ventricular diverticulum.

The arterial switch operation (ASO) is currently the treatment of choice for infants with transposition of the great arteries (TGA). Little is known, however, about the alteration of anatomic left ventricular (LV) torsional mechanics after the operation. This study sought to evaluate LV torsion in patients of transposition of the great arteries with intact ventricular septum (TGA/IVS) using speckle tracking echocardiography.Echocardiographic images were prospectively acquired in 32 infants (age range, 0.5-60 months) who successfully underwent ASO repair at about 1 month of age and in 48 normal controls. They were divided into early and late categories according to the age at the time of the study. The LV peak systolic torsion and systolic twisting and diastolic untwisting velocities were determined by speckle tracking. Mitral inflow velocity obtained by Pulsed-wave Doppler and mitral annular velocities drawn by septal tissue Doppler were also analyzed.Compared with controls, the early postoperative group (TGA1) had significantly higher septal E/e' (P=0.000). In contrast, septal e' velocity (P=0.000), LV peak apical rotation (P=0.01), twist (P=0.02) and peak untwisting velocity (PUV) (P=0.001) were lower in patients than in controls. For the normal younger group (Control1), PUV correlated positively with e' (r=0.68, P0.001). No significant difference in LV twisting and untwisting was noted between the TGA2 and Control2.Two dimensional speckle tracking echocardiography may sensitively detect impaired LV torsional mechanics in patients with TGA/IVS early after ASO, and the impairment of LV relaxation leads to increased LV filling pressure which is consistent with higher E/e'. However, all patients recovered well thereafter and the overall midterm outcome of ASO is satisfactory.

Objective To explore the value of transthoracic and right heart contrast echocardiography in the diagnosis of coronary sinus septal defect (CSSD), also known as unroofed coronary sinus. Methods The echocardiographic characteristics of 20 patients with CSSD who underwent surgery in our hospital between October 1999 and June 2012 were reviewed retrospectively, including results of 9 cases studied by contrast echocardiography, and compared with surgical results. Results Of the coronary sinuses in these 20 patients, 40% were totally unroofed, 35% partially unroofed in mid-portion, 20% partially unroofed in terminal portion, and 5% mixed type (mid- and terminal portions). Of these 20 patients, 65% were associated with other types of atrial septal defects, and 65% had a persistent left superior vena cava. The diagnostic accuracy of echocardiography for the CSSD was 65%. In patients whose diagnoses were confirmed by echocardiography, the accuracy for the types of CSSD was 84.6%. All of the first 6 cases studied before 2002 were either undiagnosed or misdiagnosed, and 78.6% of the last 14 cases studied were diagnosed accurately. Of 9 patients who underwent contrast echocardiography, 8 were correctly diagnosed, including 5 type II and 3 Raghib syndromes. 1 case of type IIIa was misdiagnosed as Raghib syndrome. Conclusions The combination of transthoracic and contrast echocardiography can diagnose and classify CSSD accurately in most cases and should be the first choice for diagnosing CSSD.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare but potentially fatal complication of infective endocarditis and aortic valve surgery. 149 patients with P-MAIVF, including 7 cases in our hospital and 142 cases from the literatures, were comprehensively analyzed. P-MAIVF is located in the mitral-aortic intervalvular fibrosa area, which communicates with the left ventricular outflow tract. The cavity of P-MAIVF expands during systole and collapses during diastole. Endocarditis and aortic valve surgery are the most frequent causes. Symptoms of endocarditis, chest pain, heart failure, dyspnea, cerebrovascular accidents and systemic embolism are important clinical presentations. The formation of a fistulous tract, coronary artery compression, and rupture into pericardium are important complications. Transesophageal echocardiography is superior to transthoracic echocardiography in identifying P-MAIVF. Surgery is the treatment of choice with P-MAIVF repair and aortic valve replacement.

Right ventricular (RV) and left ventricular (LV) dysfunction is an important determinant of poor clinical status in repaired patients with tetralogy of Fallot (TOF). The purpose of our study is to assess the impact of surgical repair on short-term RV and LV function by 2-dimensional speckle tracking echocardiography (STE). Sixty-seven patients (median age 12 months) with TOF before and 6 months after repair and 35 healthy subjects were studied. The patients were divided into the younger (age at surgery ≤12 months) and older (age at surgery >12 months) subgroups. RV and LV global longitudinal systolic strain and strain rate (SR), and LV global circumferential and radial systolic strain and SR were measured by STE. After repair, RV longitudinal strain and SR increased in the younger patients, whereas RV longitudinal SR was decreased in the older patients. LV deformation parameters were unchanged in all patients. In the multivariate analysis, patients with better RV and LV deformation parameters preoperatively were identified to have better RV and LV strain and SR postoperatively (P

The purpose of the study is to evaluate right ventricular (RV) regional and global systolic function in patients with pulmonary arterial hypertension (PAH) by 2-dimensional ultrasound speckle tracking echocardiography (STE) and explore the impact of pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) on RV systolic function. 42 patients with PAH and 31 healthy controls were included in this study. RV longitudinal peak systolic strain (LS) and strain rate (LSRs) were measured at the basal, mid and apical segments of the RV free wall and septum by STE. RV global longitudinal peak systolic strain (GLS) and strain rate (GLSRs) were also measured by STE. RV ejection fraction (EF) was determinated by cardiac magnetic resonance (CMR) imaging. LS and LSRs of RV 6 segments were significantly reduced in patients with PAH compared with controls. RV GLS and GLSRs were lower in patients with varying degrees of PAH than controls. Furthermore, RV GLS were most altered in patients with severe PAH compared with mild PAH. PVR was correlated with RV GLS and GLSRs (r 1 = −0.549; r 2 = −0.466, respectively, P < 0.05). Similarly, there was correlation between PASP and RV GLS and GLSRs (r 1 = −0.551; r 2 = −0.425, respectively, P < 0.05). GLS and GLSRs were correlated with CMR-derived RVEF. (r 1 = 0.693; r 2 = 0.560, respectively, P < 0.05). STE can identify impaired RV regional and global systolic function in patients with PAH. STE-derived strain and strain rate can be used as novel indices for RV function assessment from 2-dimensional echocardiographic images.