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A 62-year-old man with acute coronary syndrome underwent an echocardiogram for evaluation. A transthoracic echocardiogram revealed masses within a giant coronary sinus. This case highlights the role of multimodality imaging in investigating coronary sinus enlargement, coronary sinus thrombosis, and the approach to management., Competing Interests: Dr Kent Chak-yu So has served as a clinical proctor for Abbott, Boston Scientific, Edwards and Medtronic. Prof Alex Pui-wai Lee has received a research grant from Abott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Objective: To evaluate the use of virtual reality-based infrared pupillometry (VIP) to detect individuals suffering long COVID., Design: Prospective, case-control cross-sectional study., Participants: Participants aged 20-60 were recruited from a community eye screening programme., Methods: Pupillary Light Responses (PLR) were recorded in response to 3 intensities of light stimuli (L6, L7 and L8) using a virtual reality head-mount display (VR-HMD). 9 PLR waveform features for each stimulus, were extracted by 2 masked observers and statistically analyzed. We also use various methods on the whole PLR waveform including trained, validated and tested (6:3:1) by machine learning models including Multi-layer Perceptron, Support Vector Machine, K-nearest Neighbors, Logistic Regression, Decision Tree, Random Forest and Long Short-Term Memory (LSTM) models for two and three-class classification into long-COVID (LCVD), post-COVID (PCVD) or control., Main Outcome Measures: Accuracies/AUC of individual or combination of PLR features and ML models using PLR features or whole pupillometric waveform., Results: PLR from a total of 185 subjects including 112 LCVD, 44 PCVD and 29 age/sex-matched controls were analysed. Models examined the independent effects of age and sex. Constriction Time(CT) after the brightest stimulus(L8) is significantly associated with LCVD status(two-way ANOVA, false discovery rate(FDR)<0.001; multinominal logistic regression, FDR<0.05). The overall accuracy/AUC of CT-L8 alone in differentiating LCVD from control or from PCVD were 0.7808/0.8711 and 0.8654/0.8140 respectively. Using cross-validated backward stepwise variable selection, CT-L8, CT-L6, Constriction Velocity(CV)-L6 were most useful to detect LCVD while CV-L8 for PCVD from other groups. The accuracy/AUC of selected features were 0.8000/0.9000 (control versus LCVD) and 0.9062/0.9710 (PCVD versus LCVD), better than when all 27 pupillometric features were combined. An LSTM model analyzing whole pupillometric waveform achieved the highest accuracy/AUC at 0.9375/1.000 in differentiating LCVD from PCVD and a slightly lower accuracy of 0.7838 for three-class classification (LCVD-PCVD-control)., Conclusions: We reported, for the first time, specific pupillometric signatures in differentiating LCVD from PCVD or control subjects using a VR-HMD. Combining statistical methods to identify specific pupillometric features and ML algorithms to analyse the performance further enhance the performance of VIP as a non-intrusive, low-cost, portable and objective method to detect and monitor long COVID., (Copyright © 2024. Published by Elsevier Inc.)

The LuX-Valve Plus is a novel radial force-independent orthotopic transjugular transcatheter tricuspid valve replacement device proven to be effective in TR reduction. We describe preprocedural assessment for eligibility and procedural planning by means of computed tomography as well as procedural steps of device implantation under multimodality imaging guidance including transesophageal echocardiography (TEE), intracardiac echocardiography (ICE), and fluoroscopy: steering into the right ventricle, leaflet capture by graspers, fine valve adjustment, and septal anchor deployment. Potential pitfalls are avoided by achieving optimal alignment by means of TEE multiplanar reconstruction to steer the delivery system, and using mid-esophageal and deep gastric views of 3-dimensional TEE and supplementary ICE to visualize the graspers for leaflet capture, especially when TEE imaging is technically challenging. In the presence of paravalvular leak after valve deployment, use fine adjustment functions to optimize the result before final release., Competing Interests: Dr So is a clinical proctor for Abbott, Boston Scientific, Edwards Lifescience, and Medtronic. Dr Lee is a speaker and consultant for Abbott Structural and Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Long Fiber Spray-up Molding (LFSM) deviates from the conventional approach in liquid composite molding (LCM) processes by utilizing extremely long chopped strands of fibers as the primary reinforcement material in its fabrication process. In LFSM, chopped fibers are impregnated with resin that is sprayed vertically downwards before reaching the mold surface. The spraying mechanism is mounted on an actuator, which is capable of spraying freely in any specified pattern or direction. Under LFSM, it is extremely difficult to fabricate a composite part with uniformly distributed fiber content throughout its volume. The consequences of the non-uniform fiber volume distribution arise from the fiber entanglement as the length of the fiber reaches up to 100 mm in LFSM. In this study, the effect of fiber entanglement during LFSM was analyzed through various approaches. This included measuring the coefficient of friction between fibers in contact and examining the correlation between fiber lengths and the number of intersections. Furthermore, the viscoelastic properties of the uncured composite part were assessed by experimenting with the influence of viscosity on fiber length during compression molding. The results were then computed, modeled, and visualized in MATLAB, considering variations in viscosity and fiber length, both before and after compression molding., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier Ltd.)

Transcatheter structural heart intervention (TSHI) has gained popularity over the past decade as a means of cardiac intervention in patients with prohibitive surgical risks. Following the exponential rise in cases and devices developed over the period, there has been increased focus on developing the role of "structural imagers" amongst cardiologists. This review, as part of a growing initiative to develop the field of interventional echocardiography, aims to highlight the role of echocardiography in myriad TSHIs available within Asia. We first discuss the various echocardiography-based imaging modalities, including 3-dimensional echocardiography, fusion imaging, and intracardiac echocardiography. We then highlight a selected list of structural interventions available in the region-a combination of established interventions alongside novel approaches-describing key anatomic and pathologic characteristics related to the relevant structural heart diseases, before delving into various aspects of echocardiography imaging for each TSHI., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2023 The Authors.)

Background: Severe coronary artery calcification (CAC) remains challenging during percutaneous coronary intervention (PCI) and often requires 1 or more advanced calcium modification tools., Objectives: We describe the combination use of rotational (RA) or orbital atherectomy (OA), with intravascular lithotripsy (IVL), termed rotatripsy and orbital-tripsy, respectively, for modifying CAC prior to stent implantation during PCI., Methods: We performed a retrospective analysis of patients treated with rotatripsy or orbital-tripsy at our center between July 2019 and March 2022. The primary efficacy endpoint was procedural success (successful stent implantation, <30% residual stenosis visually, Thrombolysis in Myocardial Infarction 3 flow; absence of types C to F dissection/perforation or loss of side branch ≥2.0mm visually) without in-hospital major adverse cardiovascular event (MACE, defined as cardiovascular death, myocardial infarction [MI], target-vessel revascularization)., Results: A total of 25 patients (14 rotatripsy and 11 orbital-tripsy) were included in our study. The mean age was 72.2 ± 7.6 years and 76% were men. PCI was guided by intravascular imaging in 24 patients (96%). All cases were treated with either RA or OA before utilization of IVL. Procedural success was achieved in 22 cases (88%) with 1 sidebranch loss without periprocedural MI (4%) and 2 in-patient deaths (8%) unrelated to the procedure (1 intracerebral hemorrhage and 1 cardiac arrest)., Conclusion: We describe efficacious use of both rotatripsy and orbital-tripsy to modify severe CAC during PCI in a real-world setting. Intravascular imaging can guide appropriate use of these devices to complement each other to modify severe CAC to achieve optimal outcomes.

Patients treated with peritoneal dialysis (PD) experience complex body composition changes that are not adequately reflected by traditional anthropometric parameters. While lean and adipose tissue mass can be readily assessed by bioimpedance spectroscopy (BIS), there is concern about the potential confounding effect of volume overload on these measurements. This study aimed to assess the influence of fluid status (by echocardiography) on body composition parameters measured by BIS and to describe the longitudinal changes in adipose and lean tissue mass. We conducted a prospective observational study in a tertiary hospital. Incident Chinese PD patients underwent baseline echocardiography and repeated BIS measurements at baseline and 12 months later. Among 101 PD patients, lean tissue index (LTI) or fat tissue index (FTI) was not associated with echocardiographic parameters that reflected left ventricular filling pressure (surrogate of volume status). Sixty-eight patients with repeated BIS had a significant increase in body weight and FTI, while LTI remained similar. Gains in fat mass were significantly associated with muscle wasting (beta = −0.71, p < 0.0001). Moreover, progressive fluid accumulation independently predicted decrease in FTI (beta = −0.35, p < 0.0001) but not LTI. Body composition assessments by BIS were not affected by fluid status and should be considered as part of comprehensive nutrition assessment in PD patients., Competing Interests: Philip Li received speaker honoraria from FibroGen, AstraZeneca and Baxter Healthcare. All other authors declare no conflicts of interest.

Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Competing Interests: Funding Support and Author Disclosures Dr Lee is a speaker and consultant for Abbott Structural and Philips Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The early stages of gay and bisexual men's relationships are a critical period for communicating about HIV prevention strategies. This study sought to: (1) explore facilitators to decision-making to use prevention strategies and (2) describe the prevention strategies being used by same-gender male couples in new relationships. Individual interviews were conducted with 76 partnered men, representing 37 couples and 2 individuals. Couples had been together for one year or less, and varied by U.S. geographical region of residence and HIV serostatus: 8 seroconcordant positive, 17 seroconcordant negative, and 13 serodiscordant couples. Two overarching qualitative themes emerged: (1) communication and (2) information and resources. Notably, few couples had both partners mention the same facilitator. The most commonly used HIV prevention strategies were treatment as prevention for partners in seroconcordant positive and serodiscordant couple relationships, and HIV/STI testing for partners of seroconcordant negative couples. Compared to the other two couple groups, fewer seroconcrdant negative couples were aware of each other's use of strategies. Study findings suggest these facilitators are important to include in future interventions. Efforts are also needed to improve within-dyad awareness about which strategies partners are using and how they may best support one another toward their sexual health goals.

Objective: This study explored factors which predict stroke survivors who could achieve "clinically significant functional gain" and return home when being discharged from a local hospital after in-patient stroke rehabilitation programme., Methods: This study included 562 inpatients with stroke who were residing at community dwellings before onset of stroke, and transferred to a convalescent hospital for rehabilitation from four acute hospitals over one year. The main outcome variables of prediction were (a) achieving "clinically significant functional gain" as measured by (a1) achievement of "minimal clinically important difference" (MCID) of improvement in Functional Independence Measure Motor Measure (FIM-MM)", (a2) one or more level(s) of improvement in function group according to the patients' FIM-MM, and (b) discharge to home. Sixteen predictor variables were identified and studied firstly with univariate binary logistic regression and those significant variables were then put into multivariate binary logistic regression., Results: Based on multivariate regression, the significant predictors for "clinically significant functional gain" were: younger age <75 years old, higher Glasgow Coma Scale score at admission, with haemorrhagic stroke, intermediate FIM-MM function group. Those significant predictors for "discharge to home" were: living with family/caregivers before stroke, higher FIM score at admission, and one or more level(s) of improvement in FIM-MM function group., Conclusions: This study identified findings consistent with overseas studies in additional to some new interesting findings. Early prediction of stroke discharge outcomes helps rehabilitation professionals and occupational therapists to focus on the use of appropriate intervention strategies and pre-discharge preparation., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Competing Interests: Author Relationship With Industry The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Glass is a well-known non-conductive material that has many useful properties, and considerable research has been conducted into making circuits on glass. Many deposition techniques have been studied, and laser-induced chemical liquid phase deposition (LCLD) is a well-known and cost-effective method for rapid prototyping of copper deposition on glass. However, the deposition results from the LCLD method on the surface of glass, which shows an issue in its detachment from the substrates because of the relatively low adhesion between deposited copper and the nontreated glass surface. This problem undermines the usability of deposited glass in industrial applications. In this study, the laser-induced backside wet etching (LIBWE) method was performed as a preceding process to fabricate microchannels, which were filled with copper by LCLD. Additional durable copper wire was produced as a result of the enhanced adhesion between the glass and the deposited copper. The adhesion was enhanced by a rough surface and metal layer, which are characteristics of LIBWE machining. Furthermore, the proposed method is expected to broaden the use of deposited glass in industrial applications, such as in stacked or covered multilayer structures with built-in copper wires, because the inserted copper can be physically protected by the microstructures.

Background: Left atrial appendage (LAA) occlusion is an alternative to anticoagulation for stroke prevention in patients with atrial fibrillation. Accurate device sizing is crucial for optimal outcome. Patient-specific LAA models can be created using three-dimensional (3D) printing from 3D transesophageal echocardiographic (TEE) images, allowing in vitro model testing for device selection. The aims of this study were to assess the association of model-based device selection with procedural safety and efficacy and to determine if preprocedural model testing leads to superior outcomes., Methods: In 72 patients who underwent imaging-guided LAA occlusion, 3D models of the LAA were created from 3D TEE data sets retrospectively (retrospective cohort). The optimal device determined by in vitro model testing was compared with the actual device used. Associations of model-match and model-mismatch device sizing with outcomes were analyzed. In another 32 patients, device selection was prospectively guided by 3D models in adjunct to imaging (prospective cohort). The impact of model-based sizing on outcomes was assessed by comparing the two cohorts., Results: Patients in the retrospective cohort with model-mismatch sizing had longer procedure times, more implantation failures, more devices used per procedure, more procedural complications, more peridevice leak, more device thrombus, and higher cumulative incidence rates of ischemic stroke and cardiovascular or unexplained death (P < .05 for all) over 3.0 ± 2.3 years after LAA occlusion. Compared with the retrospective imaging-guided cohort, the prospective model-guided patients achieved higher implantation success and shorter procedural times (P < .05) without complications. Clinical device compression (r = 0.92) and protrusion (r = 0.95) agreed highly with model testing (P < .0001). Predictors for sizing mismatch were nonwindsock morphology (odds ratio, 4.7) and prominent LAA trabeculations (odds ratio, 7.1)., Conclusions: In patients undergoing LAA occlusion, device size selection in agreement with 3D-printed model-based sizing is associated with improved safety and efficacy. Preprocedural device sizing with 3D models in adjunct to imaging guidance may lead to superior outcomes., (Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Although reported failure rates of the Watchman device are low, the ballshaped device is not suitable for shallow and multilobed left atrial appendages (LAAs). The LAmbre device is available in two configurations - standard (cover 4-6 mm larger in diameter than the umbrella) and special (cover 12- 14 mm larger than the umbrella) - which allows the closure of a wide range of LAA anatomies. This case illustrates that the LAmbre device can be used for complex LAA anatomies that are not suitable for the Watchman device.

It is generally accepted that inflammation within the CNS contributes to neurodegeneration after traumatic brain injury (TBI), but it is not clear how inflammation is initiated in the absence of infection and whether this neuroinflammation is predominantly beneficial or detrimental. We have previously found that brain-enriched glycosphingolipids within neuronal lipid rafts (NLR) induced platelet degranulation and secretion of neurotransmitters and pro-inflammatory factors. In the present study, we compared TBI-induced inflammation and neurodegeneration in wild-type vs. St3gal5 deficient (ST3 -/- ) mice that lack major CNS-specific glycosphingolipids. After TBI, microglial activation and CNS macrophage infiltration were substantially reduced in ST3 -/- animals. However, ST3 -/- mice had a larger area of CNS damage with marked neuronal/axonal loss. The interaction of platelets with NLR stimulated neurite growth, increased the number of PSD95-positive dendritic spines, and intensified neuronal activity. Adoptive transfer and blocking experiments provide further that platelet-derived serotonin and platelet activating factor plays a key role in the regulation of sterile neuroinflammation, hemorrhage and neuronal plasticity after TBI., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Accurate localization of mitral valve prolapse (MVP) is crucial for surgical planning. Despite improved visualization of the mitral valve by three-dimensional transesophageal echocardiography, image interpretation remains expertise dependent. Manual construction of mitral valve topographic maps improves diagnostic accuracy but is time-consuming and requires substantial manual input. A novel computer-learning technique called Anatomical Intelligence in ultrasound (AIUS) semiautomatically tracks the annulus and leaflet anatomy for parametric analysis. The aims of this study were to examine whether AIUS could improve accuracy and efficiency in localizing MVP among operators with different levels of experience., Methods: Two experts and four intermediate-level echocardiographers (nonexperts) retrospectively performed analysis of three-dimensional transesophageal echocardiographic images to generate topographic mitral valve models in 90 patients with degenerative MVP. All echocardiographers performed both AIUS and manual segmentation in sequential weekly sessions. The results were compared with surgical findings., Results: Manual segmentation by nonexperts had significantly lower sensitivity (60% vs 90%, P < .001), specificity (91% vs 97%, P = .001), and accuracy (83% vs 95%, P < .001) compared with experts. AIUS significantly improved the accuracy of nonexperts (from 83% to 89%, P = .003), particularly for lesions involving the A3 (from 81% to 94%, P = .006) and P1 (from 78% to 88%, P = .001) segments, presumably related to anatomic variants of the annulus that made tracking more challenging. AIUS required significantly less time for image analysis by both experts (1.9 ± 0.7 vs 9.9 ± 3.5 min, P < .0001) and nonexperts (5.0 ± 0.5 vs 13 ± 1.5 min, P < .0001), especially for complex lesions., Conclusions: Anatomic assessment of mitral valve pathology by three-dimensional transesophageal echocardiography is experience dependent. A semiautomated algorithm using AIUS improves accuracy and efficiency in localizing MVP by less experienced operators., (Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Background: Quantitative analysis of mitral valve morphology with three-dimensional (3D) transesophageal echocardiography (TEE) provides anatomic information that can assist clinical decision-making. However, routine use of mitral valve quantification has been hindered by tedious workflow and high operator-dependence. The purpose of this paper was to evaluate the feasibility, accuracy and efficiency of a novel computer-learning algorithm using anatomical intelligence in ultrasound (AIUS) to automatically detect and quantitatively assess the mitral valve anatomy., Methods: A novice operator used AIUS to quantitatively assess mitral valve anatomy on the 3D TEE images of 55 patients (33 with mitral valve prolapse, 11 with functional mitral regurgitation, and 11 normal valves). The results were compared to that of manual mitral valve quantification by an experienced 3D echocardiographer and, in the 24 patients who underwent mitral valve repair, the surgical findings. Time consumption and reproducibility of AIUS were compared to the manual method., Results: AIUS mitral valve quantification was feasible in 52 patients (95%). There were excellent agreements between AIUS and expert manual quantification for all mitral valve anatomic parameters (r=0.85-0.99, p<0.05). AIUS accurately classified surgically defined location of prolapse in 139 of 144 segments analyzed (97%). AIUS improved the intra- [intraclass-correlation coefficient (ICC)=0.91-0.99] and inter-observer (ICC=0.86-0.98) variability of novice users, surpassing the manual approach (intra-observer ICC=0.32-0.95; inter-observer ICC=0.45-0.93), yet requiring significantly less time (144±24s vs. 770±89s, p<0.0001)., Conclusion: Anatomic intelligence in 3D TEE image can provide accurate, reproducible, and rapid quantification of the mitral valve anatomy., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

The mitral valve (MV) has complex 3-dimensional (3D) morphology and motion. Advance in real-time 3D echocardiography (RT3DE) has revolutionized clinical imaging of the MV by providing clinicians with realistic visualization of the valve. Thus far, RT3DE of the MV structure and dynamics has adopted an approach that depends largely on subjective and qualitative interpretation of the 3D images of the valve, rather than objective and reproducible measurement. RT3DE combined with image-processing computer techniques provides precise segmentation and reliable quantification of the complex 3D morphology and rapid motion of the MV. This new approach to imaging may provide additional quantitative descriptions that are useful in diagnostic and therapeutic decision-making. Quantitative analysis of the MV using RT3DE has increased our understanding of the pathologic mechanism of degenerative, ischemic, functional, and rheumatic MV disease. Most recently, 3D morphologic quantification has entered into clinical use to provide more accurate diagnosis of MV disease and for planning surgery and transcatheter interventions. Current limitations of this quantitative approach to MV imaging include labor-intensiveness during image segmentation and lack of a clear definition of the clinical significance of many of the morphologic parameters. This review summarizes the current development and applications of quantitative analysis of the MV morphology using RT3DE.

Activation of the renin-angiotensin-aldosterone system (RAAS) results in vasoconstriction, muscular (vascular and cardiac) hypertrophy and fibrosis. Established arterial stiffness and cardiac dysfunction are key factors contributing to subsequent cardiovascular and renal complications. Blockade of RAAS has been shown to be beneficial in patients with hypertension, acute myocardial infarction, chronic systolic heart failure, stroke and diabetic renal disease. An aggressive approach for more extensive RAAS blockade with combination of two commonly used RAAS blockers [ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)] yielded conflicting results in different patient populations. Combination therapy is also associated with more side effects, in particular hypotension, hyperkalaemia and renal impairment. Recently published ONTARGET study showed ACEI/ARB combination therapy was associated with more adverse effects without any increase in benefit. The Canadian Hypertension Education Program responded with a new warning: 'Do not use ACEI and ARB in combination'. However, the European Society of Cardiology in their updated heart failure treatment guidelines still recommended ACEI/ARB combo as a viable option. This apparent inconsistency among guidelines generates debate as to which approach of RAAS inhibition is the best. The current paper reviews the latest evidence of isolated ACEI or ARB use and their combination in cardiovascular diseases, and makes recommendations for their prescriptions in specific patient populations.

The objective of this paper is to compare social policy on occupational rehabilitation services in two mega industrial cities in southern China: Hong Kong and Guangzhou. Comparative policy study was employed as the research and analytical method in this paper. Aim, finance, target, coverage, organization and administration, service delivery and provision of the occupational rehabilitation policy and its linkages with industrial injury compensation system and re-employment policy in the two cities were critically reviewed and compared. The results of the study reflect that the Guangzhou policy is more aggressive and more tailor-made to the specific needs of occupational rehabilitation compared to the Hong Kong policy, whereas occupational rehabilitation in Hong Kong has long been developed and knowledge and skills in the occupational rehabilitation service are more mature and fruitful. Based on the research findings, it is concluded that through experience sharing and exchange, there will be more mutual understanding regarding the system, practice, success, faults and limitations in the two cities, as well as awareness of alternative courses of action. These will help in the better development of occupational rehabilitation services with the aims to safeguard the rights and wellbeing of workers in both cities.

The aim of the study was to investigate the effects of a chicken-meat extract known as Essence of Chicken (EOC) on immune function in a normal and scalded animal model. In this experimental study, 120 rats were randomly allocated into three groups: a SHAM group (inflicted with a sham wound), a BURN group (inflicted with a full-thickness scald wound covering 30 % of total body surface area) and a CONTROL group. Rats in the SHAM and BURN groups were further divided into normal saline (NS)-fed and EOC-fed groups. They were fed by force-feeding with a feeding needle and blood samples were taken from each group on days 1, 8, 15 and 22 postburn. Serum IgG, IgA and IgM concentrations were determined by ELISA and the results of the EOC-fed and NS-fed cohorts of both the SHAM and BURN groups were compared. The level of significance was set at P<0.05. Serum IgG level of both SHAM-EOC and BURN-EOC cohorts showed significant elevation on day 8. IgA exhibited a significant increase in the SHAM-EOC group on day 15 and in the BURN-EOC group on day 22. A significant increase of IgM level was found on days 1 and 22 for the SHAM-EOC group and on day 15 for the BURN-EOC group. Conclusively, EOC was shown to have an enhancing effect on serum Ig levels for both normal and tissue-stressed rats. It is suggested that EOC may help improve immune function when the immune system is at normal status or when it faces a challenge.