Search

Heart failure with reduced ejection fraction (HFrEF) is associated with structural and functional left ventricular changes. We compared intracardiac vortices between patients with HFrEF and normal participants using echocardiographic vector flow mapping, a novel intracardiac vortex analysis technology.Transthoracic echocardiography was performed on 20 patients with HFrEF (age: 61 ± 15 y, 15 men) and 20 normal participants (age: 59 ± 12 y, 12 men) age- and sex-balanced at the cohort level. Systolic and diastolic energy loss, area (indexed by left ventricular end-diastolic diameter), circulation (reflects vortex strength) and relative positions of the largest vortex during systole (S-vortex), early (E-vortex) and late (A-vortex) diastole and maximal number of vortices in a single frame (MNV) were assessed.Patients with HFrEF had disproportionately sized vortices with smaller indexed vortex areas (p0.0001), and more fragmented vortices with higher MNV during both systole (p = 0.030) and diastole (p0.0001). These accompanied higher diastolic energy loss (p = 0.001). Additionally, the E-vortex (p = 0.002) and A-vortex (p0.0001) were more apically positioned, and the S-vortex was weaker (p = 0.033) in patients with HFrEF. More severe fragmentation (higher MNV) correlated with worse energy efficiency (higher energy loss).Patients with HFrEF had more fragmented intracardiac vortices and lower energy efficiency predominantly during diastole.

While three-dimensional transesophageal echocardiography (3D TEE) has been increasingly used for assessing cardiac anatomy and function, it still suffers from a limited field of view (FoV) of the ultrasound transducer. Therefore, it is difficult to examine a complete region of interest without moving the transducer. Existing methods extend the FoV of 3D TEE images by mosaicing multiview static images, which requires synchronization between 3D TEE images and electrocardiogram (ECG) signal to avoid deformations in the images and can only get the widened image at a specific phase.This work aims to develop a novel multiview nonrigid registration and fusion method to extend the FoV of 3D TEE images at different cardiac phases, avoiding the bias toward the specifically chosen phase.A multiview nonrigid registration and fusion method is proposed to enlarge the FoV of 3D TEE images by fusing dynamic images captured from different viewpoints sequentially. The deformation field for registering images is defined by a collection of affine transformations organized in a graph structure and is estimated by a direct (intensity-based) method. The accuracy of the proposed method is evaluated by comparing it with two B-spline-based methods, two Demons-based methods, and one learning-based method VoxelMorph. Twenty-nine sequences of in vivo 3D TEE images captured from four patients are used for the comparative experiments. Four performance metrics including checkerboard volumes, signed distance, mean absolute distance (MAD), and Dice similarity coefficient (DSC) are used jointly to evaluate the accuracy of the results. Additionally, paired t-tests are performed to examine the significance of the results.The qualitative results show that the proposed method can align images more accurately and obtain the fused images with higher quality than the other five methods. Additionally, in the evaluation of the segmented left atrium (LA) walls for the pairwise registration and sequential fusion experiments, the proposed method achieves the MAD of (0.07 ± 0.03) mm for pairwise registration and (0.19 ± 0.02) mm for sequential fusion. Paired t-tests indicate that the results obtained from the proposed method are more accurate than those obtained by the state-of-the-art VoxelMorph and the diffeomorphic Demons methods at the significance level of 0.05. In the evaluation of left ventricle (LV) segmentations for the sequential fusion experiments, the proposed method achieves a DSC of (0.88 ± 0.08), which is also significantly better than diffeomorphic Demons at the 0.05 level. The FoVs of the final fused 3D TEE images obtained by our method are enlarged around two times compared with the original images.Without selecting the static (ECG-gated) images from the same cardiac phase, this work addressed the problem of limited FoV of 3D TEE images in the deformable scenario, obtaining the fused images with high accuracy and good quality. The proposed method could provide an alternative to the conventional fusion methods that are biased toward the specifically chosen phase.

The development of the Internet of Things (IoT) plays an important role in smart health. The combination of IoT and ultrasound has great potential applications in telemedicine. The medical information in the echocardiogram stimulates the image analysis of ultrasound IoT devices. Medical image segmentation is a fundamental step in medical image analysis for providing help to the subsequent tasks. However, accurate left ventricular (LV) segmentation in echocardiography is a challenging task due to the cross-vendor and cross-center, multiview ultrasound image characteristics. We introduce an intermediate supervision deep neural networks method in this article, named as deep atrous pyramid intermediate supervision (DAPIS). The SAD block is used as a fixed feature extractor, pyramid pooling module is used to extract context semantic information, global attention upsampling is used for feature fusion module, and intermediate supervision is used to learn a better semantic representation. The performance of the model is evaluated using two echocardiographic data: 1) public data set (CAMUS) and 2) self-made data set (total 18906 images from 160 patients). Sufficient experiments show that DAPIS is prominent generalization and robustness, surpassing other state-of-the-art methods. The correlation graph and Bland–Altman analysis show good clinical correlation, proving the clinical potential of the model.

In this study, 'Golden Delicious' apples were dipped with γ-aminobutyric acid (GABA) solution to investigate the changes of quality parameters, ethylene anabolism, polyamine metabolism and GABA shunt. Results showed that GABA distinctly suppressed respiratory rate, reduced titratable acidity, maintained higher soluble solid content and pericarp firmness of apples. Compared to the control, GABA also repressed the activities and gene expressions of polyamine oxidase (PAO) and diamine oxidase (DAO), enhanced MdMT, MdMS, MdSAMS, MdSAMDC, MdSPDS, MdODC, MdADC, and MdACL5 expressions, and accelerated the accumulation of putrescine, spermidine, and spermine in the exocarp of apples. Moreover, GABA decreased ethylene release, MdACS and MdACO gene expressions in the exocarp. In addition, exogenous GABA activated MdGAD, MdGDH, MdGS expressions and inhibited MdGABA-T and MdSSADH expressions in the GABA shunt, therefore increased endogenous GABA, pyruvic acid and glutamate contents in the exocarp. These findings suggest that exogenous GABA regulates ethylene anabolism, polyamine metabolism and GABA shunt to maintain fruit quality of 'Golden Delicious' apples.

The activation of endogenous neural stem cells (NSCs) is considered an important mechanism of neural repair after mechanical spinal cord injury; however, whether endogenous NSC proliferation can also occur after spinal cord ischemia-reperfusion injury (SCIRI) remains unclear. In this study, we aimed to verify the existence of endogenous NSC proliferation after SCIRI and explore the underlying molecular mechanism. NSC proliferation was observed after SCIRI in vivo and oxygen-glucose deprivation and reperfusion (OGD/R) in vitro, accompanied by a decrease in forkhead box protein O 3a (FOXO3a) expression. This downward trend was regulated by the increased expression of microRNA-872-5p (miR-872-5p). miR-872-5p affected NSC proliferation by targeting FOXO3a to increase the expression of β-catenin and T-cell factor 4 (TCF4). In addition, TCF4 in turn acted as a transcription factor to increase the expression level of miR-872-5p, and knockdown of FOXO3a enhanced the binding of TCF4 to the miR-872-5p promoter. In conclusion, SCIRI in vivo and OGD/R in vitro stimulated the miR-872-5p/FOXO3a/β-catenin-TCF4 pathway, thereby promoting NSC proliferation. At the same time, FOXO3a affected TCF4 transcription factor activity and miR-872-5p expression, forming a positive feedback loop that promotes NSC proliferation.

Chitinase is a hydrolase that uses chitin as a substrate. It plays an important role in plant resistance to fungal pathogens by degrading chitin. Here, we conducted bioinformatics analysis and transcriptome data analysis of the mulberry (Morus notabilis) chitinase gene family to determine its role in the resistance to Botrytis cinerea. A total of 26 chitinase genes were identified, belonging to the GH18 and GH19 families. Among them, six chitinase genes were differentially expressed under the infection of B. cinerea. MnChi18, which significantly responded to B. cinerea, was heterologously expressed in Arabidopsis (Arabidopsis thaliana). The resistance of MnChi18 transgenic Arabidopsis to B. cinerea was significantly enhanced, and after inoculation with B. cinerea, the activity of catalase (CAT) increased and the content of malondialdehyde (MDA) decreased. This shows that overexpression of MnChi18 can protect cells from damage. In addition, our study also indicated that MnChi18 may be involved in B. cinerea resistance through other resistance-related genes. This study provides an important basis for further understanding the function of mulberry chitinase.

Deep learning (DL) has been applied for automatic left ventricle (LV) ejection fraction (EF) measurement, but the diagnostic performance was rarely evaluated for various phenotypes of heart disease. This study aims to evaluate a new DL algorithm for automated LVEF measurement using two-dimensional echocardiography (2DE) images collected from three centers. The impact of three ultrasound machines and three phenotypes of heart diseases on the automatic LVEF measurement was evaluated. Using 36890 frames of 2DE from 340 patients, we developed a DL algorithm based on U-Net (DPS-Net) and the biplane Simpson's method was applied for LVEF calculation. Results showed a high performance in LV segmentation and LVEF measurement across phenotypes and echo systems by using DPS-Net. Good performance was obtained for LV segmentation when DPS-Net was tested on the CAMUS data set (Dice coefficient of 0.932 and 0.928 for ED and ES). Better performance of LV segmentation in study-wise evaluation was observed by comparing the DPS-Net v2 to the EchoNet-dynamic algorithm (

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome of shortness of breath and/or exercise intolerance secondary to elevated left ventricular filling pressures at rest or with exertion either as a result of primary diastolic dysfunction (primary HFpEF) or secondary to specific underlying causes (secondary HFpEF). In secondary HFpEF, early intervention of underlying valvular heart disease generally improves symptoms and prolongs survival. In primary HFpEF, there is increasing awareness of the existence and prognostic implications of secondary atrioventricular valve regurgitation. Further studies will clarify their mechanisms and the effectiveness of valvular intervention in this intriguing HFpEF subgroup.

The efficacy of trehalose on the lesion diameter of apples (cv. Golden Delicious) inoculated with

Screening questions for sarcopenia used in the community (SARC-F) may be regarded as indicators of exercise tolerance. Observational study. We tested the hypothesis that community-living older people who are screened positive for sarcopenia using the SARC-F tool but without a history of heart failure (HF) have a higher prevalence of cardiac abnormalities compared with those who are SARC-F negative. Participants were recruited from a territory-wide primary care needs assessment for older people based in community centres, and from non-acute hospitals in the same region as the study centre. Participants with a total score of >=4 and who did not have any history of HF were invited to attend for further cardiac assessment. Grip strength, walking speed, and the 6-minute walk test and echocardiography were carried out. Patients with frailty and at least Grade II diastolic dysfunction were considered to have heart failure with preserved ejection fraction (HFpEF) if they also had concomitant elevated N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) of at least 300 pg/ml. Diastolic dysfunction (DD) was significantly associated with SARC-F score >=4 and higher circulating NT-proBNP levels. ROC curves evaluating the predictive values of SARC-F, HGS and gait speed for DD showed that a combination of SARC-F and HGS or gait speed provided significant incremental value in predicting DD. Community living older people with sarcopenia detected using a simple questionnaire have a higher prevalence of DD accompanied by elevated NT proBNP. Addition of hand grip strength or walking speed improve the magnitude of the association. SARC-F may be used as a tool to detect early cardiac dysfunction in the community.

Gamma-aminobutyric acid (GABA) has been reported to accumulate in plants when subjected to salt stress, and GABA-transaminase (GABA-T) is the main GABA-degrading enzyme in the GABA shunt pathway. So far, the salt tolerance mechanism of the GABA-T gene behind the GABA metabolism remains unclear. In this study, the cDNA (designated MuGABA-T) of GABA-T gene was cloned from mulberry, and our data showed that MuGABA-T protein shares some conserved characteristics with its homologs from several plant species. MuGABA-T gene was constitutively expressed at different levels in mulberry tissues, and was induced substantially by NaCl, ABA and SA. In addition, our results demonstrated that exogenous application of GABA significantly reduced the salt damage index and increased plant resistance to NaCl stress. We further performed a functional analysis of MuGABA-T gene and demonstrated that the content of GABA was reduced in the transgenic MuGABA-T Arabidopsis plants, which accumulated more ROS and exhibited more sensitivity to salt stress than wild-type plants. However, exogenous application of GABA significantly increased the activities of antioxidant enzymes and alleviated the active oxygen-related injury of the transgenic plants under NaCl stress. Moreover, the MuGABA-T gene was overexpressed in the mulberry hairy roots, and similar results were obtained for sensitivity to salt stress in the transgenic mulberry plants. Our results suggest that the MuGABA-T gene plays a pivotal role in GABA catabolism and is responsible for a decrease in salt tolerance, and it may be involved in the ROS pathway in the response to salt stress. Taken together, the information provided here is helpful for further analysis of the function of GABA-T genes, and may promote mulberry resistance breeding in the future.

Senescence is a pivotal factor that causes quality breakdown and economic loss of fruit after harvest. In this study, 'Golden Delicious' apples were used as the materials to investigate the effect of melatonin dipping on quality parameters and sucrose metabolism during room temperature storage. Postharvest melatonin treatment inhibited respiratory intensity and ethylene release, increased flesh firmness, soluble sugar, ascorbic acid, and soluble solid contents, and titratable acid in apples. Furthermore, melatonin treatment inhibited acid invertase and neutral invertase activities, increased sucrose synthase and sucrose phosphate synthase activities, and repressed the activities of sorbitol dehydrogenase, sorbitol oxidase and sucrose synthase cleavage in apple fruit. All these findings suggest that exogenous application of melatonin could maintain quality of 'Golden Delicious' apples by mediating the enzyme activity in sucrose metabolism.

Analysis of the cardiac vortex has been used for a deeper understanding of the pathophysiology in heart diseases. However, physiological changes of the cardiac vortex with normal aging are incompletely defined. Vector flow mapping (VFM) is a novel echocardiographic technique based on Doppler and speckle tracking for analysis of the cardiac vortex. Transthoracic echocardiography and VFM analysis were performed in 100 healthy adults (33 men, age = 18–67 years). The intracardiac flow was assessed throughout the cardiac cycle. The size (cross-sectional area) and circulation (equivalent to the integral of normal component of vorticity) of the largest vortices in systole (S-vortex), early diastole (E-vortex), and late diastole (A-vortex) were measured. Peak energy loss (EL) was calculated from information of the velocity vector of intracardiac flow in systole and diastole. With normal aging, the circulation (p = 0.049) of the E-vortex decreased, while that of the A-vortex increased (both p &lt, 0.001). E-vortex circulation correlated directly to e’ (p = 0.003), A-vortex circulation correlated directly to A and a’ (both p &lt, 0.001), and S-vortex circulation correlated directly to s’ (p = 0.032). Despite changes in vortex patterns, energy loss was not significantly different in older individuals. Normal aging is associated with altered intracardiac vortex patterns throughout the cardiac cycle, with the late-diastolic A-vortex becoming physiologically more dominant. Maintained energy efficiency accompanies changes in vortex patterns in aging hearts.

To test the utility of the FRAIL questionnaire as a screening tool for heart failure. Cross sectional study. Chinese older people in Hong Kong. Participants aged 60 years and over were recruited from a territory-wide primary care needs assessment for older people based in community centers as well as two nonacute hospitals. Questionnaire administered included the five-item FRAIL scale, and information regarding sociodemographic data, smoking and alcohol use, history of cardiovascular disease and diabetes, and heart failure symptoms. Handgrip strength, walking speed and 6 minute walk distance were recorded. Cardiac assessment included electrocardiogram, echocardiography, and blood assay for N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). The prevalence of diastolic dysfunction was high, being 52% in the robust group, increasing to 65% in the pre-frail and 85% in the frail group. This finding is accompanied by a corresponding increase in NT-proBNP from 64.18 pg/ml in the robust group, to 118.57 pg/ml in the pre-frail and 167.98 pg/ml in the frail group. Three of the five components of the FRAIL scale, fatigue, resistance and ambulation, were associated with increased odds ratios of diastolic dysfunction among those aged 75 years and older, while resistance alone was associated with increased odds ratio among those less than 75 years old. Frailty is associated with heart failure with preserved ejection fraction (HFpEF), and frailty screening may be used to detect undiagnosed HFpEF. The findings support the proposal that HFpEF be considered a geriatric syndrome.

Apples (cv. Golden Delicious) were used as the materials to investigate methyl jasmonate (MeJA) dipping on quality parameters, organic acids metabolism and GABA shunt during storage at 21 ± 1 °C and 75 ± 5 % relative humidity. Results demonstrated that MeJA treatment reduced mass loss, respiratory intensity and ethylene release, and maintained higher flesh firmness and soluble solid content of apples. MeJA also decreased malic acid content, increased succinic and tartaric acids contents, and inhibited cytoplasmic aconitase (Cyt-ACO), NADP-malate (NADP-ME), phosphoenolpyruvate dehydrogenase (PEPC), mitochondrial citrate synthase (Mit-CS), glutamate dehydrogenase (GAD), and GABA transferase (GABA-T) activities in apples. NADP-isocitrate dehydrogenase (NADP-IDH), mitochondrial cis-aconitase (Mit-ACO), and cytoplasmic NAD-malate dehydrogenase (CytNAD-MDH) activities in apples were also enhanced by MeJA dipping. Moreover, MeJA dipping enhanced MdCytNAD-MDH and MdNADP-IDH expressions, and down-regulated MdGAD, MdGABA-T, MdNADP-ME, MdPEPC, MdCyt-ACO and MdMit-CS expressions in apples. These results suggest that MeJA dipping can maintain storage quality of "Golden Delicious" apples by regulating organic acids metabolism and GABA shunt.

Left ventricular hypertrophy (LVH) caused by cardiac variant Fabry disease (FD) is typically late-onset and may mimic LVH caused by abnormal loading conditions. We aimed to determine the prevalence of FD in a non-selective patient population of everyday practice presenting with LVH, including those with hypertension and valve disease. We measured plasma alpha-galactosidase A activity using dried blood spot tests in 499 (age = 66 ± 13 years, 336 men) Hong Kong Chinese patients with LVH defined as maximal LV septal/posterior wall thickness ≥13 mm on echocardiography. Patients with low enzyme activity underwent mutation analysis of the GLA gene. Eight (age = 53−74 years, all men) unrelated patients (1.6%) had low plasma alpha-galactosidase A activity (0.57 ± 0.27 μmol/L wb/hr) and all were confirmed to have the GLA IVS4 + 919G &gt, A mutation. FD patients presented with heart failure (n = 5), heart block (n = 2), ventricular tachycardia (n = 1), chest pain (n = 3), and/or murmur (n = 1). Uncontrolled hypertension (n = 4) and/or severe mitral/aortic valve pathology (n = 2) were frequent. Ethnic subgroups included Teochew (n = 5), Canton (n = 2), and Wenzhou (n = 1). Endomyocardial biopsy (n = 6) revealed hypertrophic myocytes with vacuolization and dense lamellar bodies. Late-onset IVS4 + 919G &gt, A FD is prevalent among Chinese LVH patients, and should be considered as a cause of LVH in adult patients even when hypertension and/or valve pathology are present.

Background: Procedural success of transcatheter left atrial appendage closure (LAAC) is dependent on correct device selection. Three-dimensional transesophageal echocardiography (3DTEE) is more accurate than the two-dimensional (2D) modality for evaluation of the complex anatomy of LAA. However, 3D-TEE analysis of LAA is challenging and highly expertise dependent. In this study, we sought to evaluate the feasibility and accuracy of a novel software tool for automated 3D analysis of the LAA using 3D-TEE data. Methods: The intra-procedural 3D TEE data of 158 patients who underwent LAAC were retrospectively analyzed with a novel automated LAA analysis software tool. Based on the 3D TEE data, the software semi-automatically segmented the 3D LAA structure, determined the device landing zone (LZ), and generated measurements of the LZ dimensions and the LAA length, allowing manual editing if necessary. The accuracy of LAA pre-implantation anatomic measurement reproducibility, and time for analysis of the automated software were compared against expert manual 3D analysis. The software feasibility to predict the optimal device size was directly compared to implanted models. Results: Automated 3D analysis of the LAA on 3D-TEE was feasible in all patients. There were excellent agreements between automated and manual measurements of LZ maximal diameter (bias:-0.32, LOA:-3.56; 2.92), area-derived mean diameter (bias:-0.24, LOA:-3.12, 2.64), and LAA depth (bias:0.02, LOA:-3.14; 3.18). Automated 3D analysis, with manual editing if necessary, accurately identified the implanted device size in 90.5% of patients, outperforming 2DTEE (68.9%, p, This work was funded by the projects “NORTE-01-0145-FEDER-000045” and “NORTE-01-0145-FEDER-000059”, supported by Northern Portugal Regional Operational Programme (Norte2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER). It was also funded by national funds, through the FCT – Fundação para a Ciência e Tecnologia and FCT/MCTES in the scope of the project UIDB/05549/2020 and UIDP/05549/2020 and the grant CEECIND/03064/2018. This work was also funded by the Hong Kong Special Administrative Region Government Health and Medical Research Fund (05160976)

Background Real-time three-dimensional transesophageal echocardiography (3D TEE) has been increasingly used in clinic for fast 3D analysis of cardiac anatomy and function. However, 3D TEE still suffers from the limited field of view (FoV). It is challenging to adopt conventional multi-view fusion methods to 3D TEE images because feature-based registration methods tend to fail in the ultrasound scenario, and conventional intensity-based methods have poor convergence properties and require an iterative coarse-to-fine strategy. Methods A novel multi-view registration and fusion method is proposed to enlarge the FoV of 3D TEE images efficiently. A direct method is proposed to solve the registration problem in the Lie algebra space. Fast implementation is realized by searching voxels on three orthogonal planes between two volumes. Besides, a weighted-average 3D fusion method is proposed to fuse the aligned images seamlessly. For a sequence of 3D TEE images, they are fused incrementally. Results Qualitative and quantitative results of in-vivo experiments indicate that the proposed registration algorithm outperforms a state-of-the-art PCA-based registration method in terms of accuracy and efficiency. Image registration and fusion performed on 76 in-vivo 3D TEE volumes from nine patients show apparent enlargement of FoV (enlarged around two times) in the obtained fused images. Conclusions The proposed methods can fuse 3D TEE images efficiently and accurately so that the whole Region of Interest (ROI) can be seen in a single frame. This research shows good potential to assist clinical diagnosis, preoperative planning, and future intraoperative guidance with 3D TEE.

Historic topographic maps, which are georeferenced and made publicly available by the United States Geological Survey (USGS) and the National Map’s Historical Topographic Map Collection (HTMC), are a valuable source of historic land cover and land use (LCLU) information that could be used to expand the historic record when combined with data from moderate spatial resolution Earth observation missions. This is especially true for landscape disturbances that have a long and complex historic record, such as surface coal mining in the Appalachian region of the eastern United States. In this study, we investigate this specific mapping problem using modified UNet semantic segmentation deep learning (DL), which is based on convolutional neural networks (CNNs), and a large example dataset of historic surface mine disturbance extents from the USGS Geology, Geophysics, and Geochemistry Science Center (GGGSC). The primary objectives of this study are to (1) evaluate model generalization to new geographic extents and topographic maps and (2) to assess the impact of training sample size, or the number of manually interpreted topographic maps, on model performance. Using data from the state of Kentucky, our findings suggest that DL semantic segmentation can detect surface mine disturbance features from topographic maps with a high level of accuracy (Dice coefficient = 0.902) and relatively balanced omission and commission error rates (Precision = 0.891, Recall = 0.917). When the model is applied to new topographic maps in Ohio and Virginia to assess generalization, model performance decreases; however, performance is still strong (Ohio Dice coefficient = 0.837 and Virginia Dice coefficient = 0.763). Further, when reducing the number of topographic maps used to derive training image chips from 84 to 15, model performance was only slightly reduced, suggesting that models that generalize well to new data and geographic extents may not require a large training set. We suggest the incorporation of DL semantic segmentation methods into applied workflows to decrease manual digitizing labor requirements and call for additional research associated with applying semantic segmentation methods to alternative cartographic representations to supplement research focused on multispectral image analysis and classification.

Introduction: The genetic mutation IVS4+919G>A commonly found among Chinese is associated with later-onset cardiac variant of Fabry disease (FD). Patients with left ventricular hypertrophy (LVH) may be screened for FD by measuring plasma α-galactosidase activity. Objective: The aim of our study is to determine the prevalence of FD among Chinese LVH patients and to define demographic and echocardiographic predictors of FD. Methods: We measured plasma α-galactosidase activity using dried blood spot test in 500 Hong Kong Chinese patients with LVH (defined as maximal left ventricular septal or posterior wall thickness ≥13 mm on transthoracic echocardiography). LVH and deficiency in α-galactosidase activity prompted genetic analysis of galactosidase alpha gene. Demographic and echocardiographic predictors of FD were analysed. Results: There are 9 (1.8%) of 500 LVH patients (all men, age 53–74 years) had low α-galactosidase activity (0.64±0.32 μmol/L wb/hr) and all were confirmed to have the FD genotype IVS4+919G>A. Among these 9 FD patients, 6 (66.7%) could be traced to the ancestral home Chaozhou (southern part of China), 4 had hypertension, but none exhibited extracardiac manifestations of FD. The left ventricular mass of FD patients ranged from 64.91–811.81 g. Ancestral home Chaozhou (odds ratio, 10.28; 95% confidence Interval, 2.52–41.94; p=0.001) and LVM ≥290 g (odds ratio, 7.39; 95% confidence Interval, 1.94–28.20; p=0.003) were predictors of FD. On receiver operating characteristic curve analysis, sensitivity and specificity of LVM ≥290 g to diagnose FD vs non-FD LVH are 67% and 86.4% respectively (area under curve, 0.8; p=0.002). Conclusion: There is a high prevalence of later-onset cardiac variant FD among Hong Kong Chinese LVH patients that is associated with IVS4+919G>A genotype. Male patients with ancestral home Chaozhou and LVM ≥290 g are at an increased risk of FD among Chinese LVH patients and should be screened with dried blood spot test.

The coronary artery, which divides into the left coronary artery and the right coronary artery, is the first branch of the ascending aorta. The left coronary artery is a short trunk that originates from the left aortic sinus. It passes through the beginning of the pulmonary artery and the left atrial appendage and travels 3–5 mm along the coronary sulcus to the front of the left side of the heart. It is immediately divided into the anterior descending branch and the circumflex branch. The anterior descending branch descends along the anterior interventricular sulcus, bypassing the apical notch to the diaphragm of the heart, and anastomoses with the posterior interventricular branch of the right coronary artery. The right coronary artery originates from the right aortic sinus, travels along the right coronary sulcus between the root of the pulmonary artery and the right auricle, bypasses the right edge of the heart, continues along the coronary sulcus of the diaphragm, and projects into the posterior descending branch near the atrioventricular junction, that is, the posterior interventricular branch.

The left atrial appendage (LAA) is a narrow, tubular, blind-ended structure extending anterolaterally from the main body of the left atrium (LA). The LAA is located above the LV, on the left side of the pulmonary artery and ascending aorta, between the left superior pulmonary vein and the mitral annulus. With prominent muscular ridges, the LAA has active contraction. The appendage is also an endocrine organ, containing almost 30% of the heart atrial natriuretic factor [1]. Because of its increased distensibility, the LAA may augment hemodynamic function by alleviating pressure rise in the LA and ensure filling of the left ventricle (LV). In cardiovascular diseases, the LAA is the main site of thrombus formation because of its special anatomical structure and functional characteristics. Thrombi originating from the LAA account for 90% of atrial thrombi in nonvalvular atrial fibrillation [2].

Fabry Disease (FD) is a systemic disorder that can result in cardiovascular, renal, and neurovascular disease leading to reduced life expectancy. FD should be considered in the differential of all patients with unexplained left ventricular hypertrophy (LVH). We therefore performed a prospective screening study in Edmonton and Hong Kong using Dried Blood Spot (DBS) testing on patients with undiagnosed LVH. Participants found to have unexplained LVH on echocardiography were invited to participate and subsequently subjected to DBS testing. DBS testing was used to measure α-galactosidase (α-GAL) enzyme activity and for mutation analysis of the α-galactosidase (GLA) gene, both of which are required to make a diagnosis of FD. DBS testing was performed as a screening tool on patients (n = 266) in Edmonton and Hong Kong, allowing for detection of five patients with FD (2% prevalence of FD) and one patient with hydroxychloroquine-induced phenocopy. Left ventricular mass index (LVMI) by GLA genotype showed a higher LVMI in patients with IVS4 + 919G > A mutations compared to those without the mutation. Two patients were initiated on ERT and hydroxychloroquine was discontinued in the patient with a phenocopy of FD. Overall, we detected FD in 2% of our screening cohort using DBS testing as an effective and easy to administer screening tool in patients with unexplained LVH. Utilizing DBS testing to screen for FD in patients with otherwise undiagnosed LVH is clinically important due to the availability of effective therapies and the value of cascade screening in extended families.

The term atrial functional mitral regurgitation refers to a newly recognized disease entity in which mitral regurgitation occurs secondary to left atrial disease, without left ventricular dilatation and intrinsic mitral valve disease, typically in the setting of long-standing atrial fibrillation. Recent evidence suggests that atrial functional mitral regurgitation is associated with increased risk of death and heart failure re-hospitalization. The etiology, pathophysiology, and mechanism of atrial functional mitral regurgitation is not completely understood but they should not be regarded as the same as for the conventional type of functional mitral regurgitation secondary to left ventricular dilatation and dysfunction. Mitral annular dilatation, atriogenic leaflet distortion, insufficient leaflet remodeling, and subtle left ventricular dysfunction may play a role in the pathogenesis of atrial functional mitral regurgitation. The therapeutic and surgical considerations of atrial functional mitral regurgitation are different from those of ventricular functional mitral regurgitation. In this review, we assess current evidence regarding this new disease entity and propose a new surgical approach based on up-to-date understanding and experience of this condition.

We develop the Crank–Nicolson finite element (CNFE) method for the two-dimensional (2D) uniform transmission line equation, study the stability and existence as well as error estimates for the CNFE solutions of the 2D uniform transmission line equation by strict theoretical approaches. We verify the correctness of the obtained theoretical results by means of numerical tests.

In this work, we successfully developed poly(acrylamido phenylboronic acid)/sodium alginate nanoparticles (NPs) via formation of cycloborates (glucose- and H2O2-responsive functional groups), as an improved glucose-mediated insulin delivery system loaded with glucose oxidase (GOx). Dynamic light scattering revealed that the GOx-loaded NPs showed better glucose-sensitivity than the GOx-unloaded NPs. In addition, compared to insulin-loaded NPs, the insulin/GOx-loaded NPs displayed faster glucose-responsive insulin release. Importantly, there was a significant hypoglycemic effect on diabetic mice following the subcutaneous injection of insulin/GOx-loaded NPs. Furthermore, the NPs exhibited favorable biocompatibility as demonstrated by cytotoxicity assay, hemolysis study, and histopathological examination. The NPs have the advantages of easy preparation, enhanced glucose-responsiveness, and good biocompatibility, making them as potential candidates for subcutaneous insulin delivery.