[Effect analysis of myectomy guided by personalized three-dimensional reconstruction and printing in the treatment of obstructive hypertrophic cardiomyopathy]

Objective: To examine the clinical efficacy of myectomy guided by personalized three-dimensional reconstruction and printing for patients with obstructive hypertrophic cardiomyopathy. Methods: The clinical data of 28 patients with obstructive hypertrophic cardiomyopathy, who underwent septal myectomy guided by personalized three-dimensional reconstruction and printing in the Department of Cardiaovascular Surgery, Guangdong Provincial People's Hospital from May 2020 to December 2021, were retrospectively analyzed. There were 14 males and 14 females, aging (51.1±14.0) years (range: 18 to 72 years). Enhanced cardiac computed tomography images were imported into Mimics software for preoperative three-dimensional reconstruction. The direction of the short axial plane of each segment was marked perpendicularly to the interventricular septum on the long axial plane of the digital cardiac model, then the thickness was measured on each short axial plane. A figurative digital model was used to determine the extent of resection and to visualize mitral valve and papillary muscle abnormalities. Correlation between the length, width, thickness, and volume of the predicted resected myocardium and those of the surgically resected myocardium was assessed by Pearson correlation analysis or Spearman correlation analysis. The accuracy of detecting mitral valve and papillary muscle abnormalities of transthoracic echocardiography and three-dimensional reconstruction was also compared. Results: There was no death or serious complications like permanent pacemaker implantation, re-sternotomy for bleeding, low cardiac output syndrome, stroke, or multiple organ dysfunction syndromes in the whole group. Namely, the obstruction of the left ventricular outflow tract was effectively relieved. The systolic anterior motion of the anterior mitral valve leaflet was absent in all patients after myectomy. The length, width, and thickness of the predicted resected myocardium by three-dimensional reconstruction were significantly positively correlated with the length (R=0.65, 95%CI: 0.37 to 0.82, P<0.01), width (R=0.39, 95%CI: 0.02 to 0.67, P<0.01), and thickness (R=0.82, 95%CI: 0.65 to 0.92, P<0.01) of the surgically resected myocardium, while the relation of the volume of the predicted resected myocardium and the volume of the surgically resected myocardium was a strong positive correlation (R=0.88, 95%CI: 0.76 to 0.94, P<0.01). Importantly, the interventricular septal myocardial thickness measured by preoperative transthoracic echocardiography showed a moderate positive correlation with the volume of surgically resected myocardium (R=0.52, 95%CI: 0.19 to 0.75, P<0.01). During a follow-up of (14.4±6.8) months (range: 3 to 22 months), no death occurred, and 1 patient was readmitted for endocardial radiofrequency ablation due to atrial fibrillation. Conclusion: Personalized three-dimensional reconstruction and printing can not only visualize the intracardiac structure but also guide septal myectomy by predicting the thickness, volume, and extent of resected myocardium to achieve ideal resection.

Sex Specific Global Burden of Osteoporosis in 204 Countries and Territories, from 1990 to 2030: An Age-Period-Cohort Modeling Study

BACKGROUND

Osteoporosis is a highly prevalent disease with distinct sex pattern. We aimed to estimate the sex specific incidence, prevalence, and disability-adjusted life (DALYs) years of osteoporosis between 1990 and 2019, with additional predictions from 2020 to 2034.

METHODS

We collected osteoporosis disease burden data from the Global Burden of Disease study covering the years 1990 through 2019 in 204 countries and territories. The data included information on the number of incident cases of osteoporosis, DALYs, age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR) and age-standardized DALYs rates. Additionally, we performed an age-period-cohort analysis to forecast the burden of osteoporosis.

RESULTS

The global number of incidence cases of osteoporosis, in 2019, reached 41.5 million cases. From 1990 to 2019, the low-middle socio-demographic index (SDI) region had the highest estimated annual percentage change in the world. Compared to males, female's ASIR and ASPR were all about 1.5 times higher than males for the same years in the same SDI regions. The projected global total number of incidence cases for osteoporosis between 2030 and 2034 is estimated to reach 263.2 million (154.4 million for females and 108.8 for males). Additionally, the burden in terms of DALYs is predicted to be 128.7 million (with 78.4 million for females and 50.3 million for males).

CONCLUSION

The global burden of osteoporosis is still increasing, mainly observed in high SDI countries. Females bear a burden 1.5 times higher than males in terms of incidence and DALYs. Steps should be taken to reduce the osteoporosis burden, especially in high SDI countries.

Automated Experiments of Local Non-Linear Behavior in Ferroelectric Materials

An automated experiment in multimodal imaging to probe structural, chemical, and functional behaviors in complex materials and elucidate the dominant physical mechanisms that control device function is developed and implemented. Here, the emergence of non-linear electromechanical responses in piezoresponse force microscopy (PFM) is explored. Non-linear responses in PFM can originate from multiple mechanisms, including intrinsic material responses often controlled by domain structure, surface topography that affects the mechanical phenomena at the tip-surface junction, and the presence of surface contaminants. Using an automated experiment to probe the origins of non-linear behavior in ferroelectric lead titanate (PTO) and ferroelectric Al_0.93 B_0.07 N films, it is found that PTO shows asymmetric nonlinear behavior across a/c domain walls and a broadened high nonlinear response region around c/c domain walls. In contrast, for Al_0.93 B_0.07 N, well-poled regions show high linear piezoelectric responses, when paired with low non-linear responses regions that are multidomain show low linear responses and high nonlinear responses. It is shown that formulating dissimilar exploration strategies in deep kernel learning as alternative hypotheses allows for establishing the preponderant physical mechanisms behind the non-linear behaviors, suggesting that automated experiments can potentially discern between competing physical mechanisms. This technique can also be extended to electron, probe, and chemical imaging.

Reading activities compensate for low education-related cognitive deficits

BACKGROUND

The incidence of cognitive impairment is increasing with an aging population. Developing effective strategies is essential to prevent dementia. Higher education level is associated with better baseline cognitive performance, and reading activities can slow down cognitive decline. However, it is unclear whether education and reading activities are synergistic or independent contributors to cognitive performance.

METHODS

This was a sub-study of an ongoing prospective community cohort of China National Clinical Research Center Alzheimer's Disease and Neurodegenerative Disorder Research (CANDOR). Demographic and clinical information, educational levels, and reading activities were collected. All participants finished neuropsychological testing batteries and brain MRIs. We analyzed cognitive performance and brain structures with education and reading activities.

RESULTS

Four hundred fifty-nine subjectively cognitively normal participants were enrolled in the study. One hundred sixty-nine (36.82%) of them had regular reading activities. Participants in the reading group had better performance in all cognitive tests compared with those in the non-reading group, but no difference in brain MRI variables. Participants with higher education levels (more than 13 years) had better cognitive performance and higher hippocampal volumes. In low education groups (less than 12 years), more reading activities were associated with better cognitive test scores.

CONCLUSIONS

Both education and reading activities are important and synergistic for baseline cognitive function. Higher education level is associated with larger hippocampal volumes. Education may stimulate the growth and development of the hippocampus. Reading activities help to maintain and improve cognitive function in people with low levels of education.

TRIAL REGISTRATION

NCT04320368.

Enumeration of the Gutman and Schultz indices in the random polygonal chains

The Gutman index and Schultz index of a connected graph are degree-distance-based topological indices. In this paper, we devoted to establish the explicit analytical expressions for the simple formulae of the expected values of the Gutman and Schultz indices in a random polygonal. Based on these results above, we get the extremal values and average values of Gunman and Schultz indices of all polygonal chains.

Impact of diabetic retinopathy on prognosis of patients with heart failure with preserved ejection fraction

BACKGROUND AND AIMS

Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes mellitus (DM), and could increase the risks of adverse cardiovascular events among DM patients. Since heart failure with preserved ejection fraction (HFpEF) and DM often coexist, our present study aimed to explore the associations of DR with adverse outcomes in HFpEF patients.

METHODS AND RESULTS

We conducted this study in a large, international population suffering from HFpEF (n = 3442) based on the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. The associations of baseline DR with clinical outcomes were expressed as adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) using the Cox proportional hazard regression models. The crude incidence rates of all the outcomes studied were significantly increased when DM patients with or without DR compared to those without DM (all P < 0.05), whereas there were no differences between DM patients without DR versus those with DR (all P > 0.05). In the multivariate cox regression analysis, DR was not significantly associated with increased risks of the primary composite outcome (HR, 1.178 [95% CI, 0.870-1.596]) and secondary outcomes including all-cause death, cardiovascular death, all-cause hospitalization, hospitalization for HF, myocardial infarction, and stroke (all P > 0.05).

CONCLUSIONS

Our results of current study suggested that DM but not DR could be regarded as an independent risk factor for the prognosis of HFpEF.

CLINICAL TRIAL REGISTRATION

URL: https://clinicaltrials.gov. Unique identifier: NCT00094302.

POS1002 DIAGNOSTIC DELAY AND ITS ASSOCIATED FACTORS IN CHINESE AXIAL SPONDYLOARTHRITIS: A RETROSPECTIVE STUDY

Background

Few data on the prolonged diagnosis and its associated factors in Chinese axial spondyloarthritis (axSpA) is available.

Objectives

To delineate the landscape of diagnostic delay in Chinese axSpA, investigate its associated factors and explore its potential impact on medication modalities.

Methods

A total of 1,295 patients fulfilling the ASAS classification criteria were obtained. Demographic and clinical data were collected through predesigned questionnaires and available medical records. Logistic regression analyses in univariate and multivariable model were performed, using the median of diagnostic delay as cut-off point for group classification. Differences between early and late diagnosed group were subsequently compared by the Pearson chi-square test or Mann-Whitney U test.

Results

The median (IQR) diagnostic delay in Chinese axSpA was 3.0 (1.0~7.0) years and 24.8% of them reported a history of misdiagnosis. Older age at onset (OR=0.97, P<0.001) and higher education attainment (P=0.001) were correlated with early diagnosis of axSpA, whereas coming from less developed areas (P=0.002), a history of peripheral arthritis at the time of diagnosis (OR=1.58, P=0.002) and history of misdiagnosis (OR=1.98, P<0.001) increased the risk of diagnostic delay. Medication modalities were similar between two groups, but the proportion with no medication ever and percentage without regular medication in recent 3 months were higher in the late diagnosed group than early group (26.5% vs. 20.7%, P=0.02; 34.7% vs. 28.6%, P=0.02).

Conclusion

Our findings depicted a detailed spectrum of diagnostic delay in Chinese axSpA, verified five associated factors and pinpointed a remarkable treatment delay even after diagnosis, especially in late diagnosis group.

References

[1]Masson Behar V, Dougados M, Etcheto A, Kreis S, Fabre S, Hudry C, et al. Diagnostic delay in axial spondyloarthritis: A cross-sectional study of 432 patients. Joint bone spine. 2017;84(4):467-71.

Figure 1.

Cumulative distribution of age at onset and age at diagnosis in Chinese axSpA

(A) the entire group. (B) stratified by early and late diagnosed group. (C) stratified by education level (college, middle school, secondary school). (D) stratified by history of peripheral arthritis when diagnosed. (E) stratified by history of misdiagnoses when diagnosed. (F) stratified by native place, as statistical significance was found between eastern coastal and western China, only these two groups were presented.

Disclosure of Interests

None declared

Aberrant Cross-Tissue Functional Connectivity in Alzheimer’s Disease: Static, Dynamic, and Directional Properties

Background: BOLD signals in the gray matter (GM) and white matter (WM) are tightly coupled. However, our understanding of the cross-tissue functional network in Alzheimer’s disease (AD) is limited. Objective: We investigated the changes of cross-tissue functional connectivity (FC) metrics for the GM regions susceptible to AD damage. Methods: For each GM region in the default mode (DMN) and limbic networks, we obtained its low-order static FC with any WM region, and the high-order static FC between any two WM regions based on their FC pattern similarity with multiple GM regions. The dynamic and directional properties of cross-tissue FC were then acquired, specifically for the regional pairs whose low- or high-order static FCs showed significant differences between AD and normal control (NC). Moreover, these cross-tissue FC metrics were correlated with voxel-based GM volumes and MMSE in all participants. Results: Compared to NC, AD patients showed decreased low-order static FCs between the intra-hemispheric GM-WM pairs (right ITG-right fornix; left MoFG-left posterior corona radiata), and increased low-order static, dynamic, and directional FCs between the inter-hemispheric GM-WM pairs (right MTG-left superior/posterior corona radiata). The high-order static and directional FCs between the left cingulate bundle-left tapetum were increased in AD, based on their FCs with the GMs of DMN. Those decreased and increased cross-tissue FC metrics in AD had opposite correlations with memory-related GM volumes and MMSE (positive for the decreased and negative for the increased). Conclusion: Cross-tissue FC metrics showed opposite changes in AD, possibly as useful neuroimaging biomarkers to reflect neurodegenerative and compensatory mechanisms.

[Application of augmented reality and mixed reality navigation technology in laparoscopic limited right hepatectomy]

Objective: To investigate the application effect of augmented reality and mixed reality navigation technology in three-dimensional(3D) laparoscopic narrow right hepatectomy(LRH). Methods: A retrospective analysis was performed on the clinical data of 5 patients with hepatic malignancy admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from September 2020 to June 2021,all of whom were males,aged from 42 to 74 years.Preoperative evaluation was performed using the self-developed 3D abdominal medical image visualization system; if all the 5 patients were to receive right hemihepatectomy,the remnant liver volume would be insufficient,so LRH were planned.During the operation,the independently developed 3D laparoscopic augmented reality and mixed reality surgical navigation system was used to perform real-time multi-modal image fusion and interaction between the preoperative 3D model and 3D laparoscopic scene.Meanwhile,intraoperative ultrasound assisted indocyanine green fluorescence was used to determine the surgical path.In this way,the LRH under the guidance of augmented reality and mixed reality navigation was completed.The predicted liver resection volume was evaluated before surgery,actual resected liver volume,surgical indicators and postoperative complications were analyzed. Results: All the 5 patients completed LRH under the guidance of augmented reality and mixed reality navigation technology,with no conversion to laparotomy.The median operative time was 300 minutes(range:270 to 360 minutes),no intraoperative blood transfusion was performed,and the median postoperative hospital stay was 8 days(range:7 to 9 days).There were no perioperative deaths,or postoperative complications such as liver failure,bleeding,or biliary fistula. Conclusion: For patients who need to undergo LRH,the use of augmented and mixed reality navigation technology can safely and effectively guide the implementation of surgery,retain more functional liver volume,improve surgical safety,and reduce postoperative complications.

[Evaluation of the efficacy of a new variable frequency stimulation sacral neuromodulation in the treatment of detrusor hyperactivity with impaired contractility]

A total of 16 detrusor hyperactivity with impaired contractility (DHIC) patients who received 12 weeks remote variable frequency stimulation (VFS) were enrolled at the First Affiliated Hospital of Zhengzhou University from September 2020 to February 2021. The voiding diary, symptom score scales and incidence of complications were completed and recorded at baseline, constant frequency stimulation (CFS) and VFS phases. Compared with the CFS phase, voiding times, urge incontinence times and daily catheterization volume were reduced; average voiding amount and functional bladder capacity increased; and the quality of life score and mental health questionnaire assessment were improved in the VFS phase(all P<0.05). In the end, among all 16 patients, there were 14 whose symptoms had improved, and there were no new complications such as pain or infection at the implantation site, electrode displacement, and electric shock sensation in the stimulation area. VFS-SNM can not only improve the DHIC patients' lower urinary tract symptoms during storage and urination period, but also improve the patients' quality of life and satisfaction of the therapy.

[How to change from traditional surgery to intelligent navigation surgery?]

After more than 20 years of multidisciplinary integration of medical science and technology,as well as research and practice in innovative diagnosis and treatment,digital medicine 4.0 has made a profound and important impact on the development of traditional surgery. To combine traditional surgery with digital medicine 4.0 technology is the direction of surgery development in the future.New technologies represented by digital intelligent navigation surgery have been deeply explored and widely applied in the diagnosis and treatment of many surgical diseases. With the innovative development and application of artificial intelligence,Big Data and mixed reality technology,the surgery will develop in ways similar to aerospace automatic and intelligent navigation,leading to the advent of digital medicine 5.0.

Experimental Realization of the 1D Random Field Ising Model

We have measured magnetic-field-induced avalanches in a square artificial spin ice array of interacting nanomagnets. Starting from the ground state ordered configuration, we imaged the individual nanomagnet moments after each successive application of an incrementally increasing field. The statistics of the evolution of the moment configuration show good agreement with the canonical one-dimensional random field Ising model. We extract information about the microscopic structure of the arrays from our macroscopic measurements of their collective behavior, demonstrating a process that could be applied to other systems exhibiting avalanches.

White matter hyperintensities segmentation using an ensemble of neural networks

White matter hyperintensities (WMHs) represent the most common neuroimaging marker of cerebral small vessel disease (CSVD). The volume and location of WMHs are important clinical measures. We present a pipeline using deep fully convolutional network and ensemble models, combining U‐Net, SE‐Net, and multi‐scale features, to automatically segment WMHs and estimate their volumes and locations. We evaluated our method in two datasets: a clinical routine dataset comprising 60 patients (selected from Chinese National Stroke Registry, CNSR) and a research dataset composed of 60 patients (selected from MICCAI WMH Challenge, MWC). The performance of our pipeline was compared with four freely available methods: LGA, LPA, UBO detector, and U‐Net, in terms of a variety of metrics. Additionally, to access the model generalization ability, another research dataset comprising 40 patients (from Older Australian Twins Study and Sydney Memory and Aging Study, OSM), was selected and tested. The pipeline achieved the best performance in both research dataset and the clinical routine dataset with DSC being significantly higher than other methods (p < .001), reaching .833 and .783, respectively. The results of model generalization ability showed that the model trained on the research dataset (DSC = 0.736) performed higher than that trained on the clinical dataset (DSC = 0.622). Our method outperformed widely used pipelines in WMHs segmentation. This system could generate both image and text outputs for whole brain, lobar and anatomical automatic labeling WMHs. Additionally, software and models of our method are made publicly available at https://www.nitrc.org/projects/what_v1.

The transcriptional landscape of the clustered protocadherins in the cardiovascular system

Background

The alpha, beta and gamma clustered protocadherins (cPcdhs) genes encode homotypic cell adhesion molecules that are highly expressed in the brain. They are well described to be expressed in a combinatorial fashion to specify neuronal identity for coding synaptic connectivity. Unexpectedly, we recently uncovered evidence from studies in mice and human showing PCHDA variants can cause congenital heart defects. As all the genes of the alpha or gamma PCDH cluster share a common 3' end and are highly homologous, the expression of these gene clusters has been underestimated or overlooked due to multimapping issues. This is especially problematic in single cell RNAseq (scRNA) data generated using 3' based amplification protocols.

Methods and results

We constructed a modified bioinformatic pipeline for analyzing the cPcdhs transcripts (Fig. 1a). Raw data of Publicly available scRNA datasets were downloaded and re-processed and analyzed for expression of the cPCDH transcripts using our custom pipeline. Integrating 10 scRNA datasets of mouse heart tissues from embryonic 7.75 (E7.75) to postnatal 30 months (PM30) were performed by Harmony and Seurat. This showed Pcdhg had the highest expression among the three Pcdh gene clusters, with next being Pcdhb and then Pcdha (Fig. 1b). Pcdhb and Pcdhg were enriched in endocardial cells and fibroblasts (Fig. 1b). Unlike gene expression in neurons, expression of the cPcdhs in cardiac cell types did not shown the stochastic, sparse, combinatorial expression patterns seen in neurons (Fig. 1b). Despite the relatively low level of Pcdha expression in all cardiac cell types, it is intriguing that independent scRNA datasets showed Pcdha is expressed most highly in the atrium in the early embryo, possibly due to known atrial dominance in the early embryo (Fig. 1c). Pcdhb is highly expressed in the OFT and atrioventricular canal of both human and mouse heart, suggesting its perturbation may contribute to outflow tract or AV valve abnormalities (Fig. 1c-d). Consistent with our previous finding of an important role for the Pcdha gene cluster in left ventricular outflow obstructive (LVOTO) lesions, we observed expression of Pcdhg was broadly upregulated in the Adamts19 homozygous knockout mice exhibiting aortic valve dysfunction, a CHD phenotype in the LVOTO spectrum (Fig. 1e).

Conclusions

Using a new bioinformatics pipeline, we systematically mapped the transcriptional landscapes of cPcdhs during heart development using scRNA data. This revealed cell type-specific and anatomical characteristics in the expression of the different cPcdhs. These findings show the cPcdhs are transcriptionally regulated very differently in the cardiovascular system from regulation observed in the brain. The single cell transcriptional profile for the cPcdhs in the cardiovascular system can serve as the foundation for future investigations into the broader role of the cPcdhs in cardiovascular development and disease.

Funding Acknowledgement

Type of funding sources: None.

Single-cell transcriptome analysis yields new insights into the pathogenic mechanisms and possible genetic etiology of cardiomyopathies

Background

Inherited cardiomyopathies (CM) represent a clinically heterogeneous group of primary cardiac muscle disorders with a strong genetic underpinning. Recent rapid genomic advances have led to the identification of numerous disease-causing genes for both non-syndromic (nsCM) and syndromic (sCM) cardiomyopathies. This has greatly facilitated molecular genetic testing, thus enabling accurate disease diagnosis needed for the practice of precision medicine and the optimization of patient outcome. However, many cardiomyopathies remain unexplained with the known genes and dominant genetic model of disease.

Purpose

To reassess the genetic features of known CM genes as a strategy to recover novel candidate CM genes.

Methods

Known hypertrophic CM (HCM), dilated CM (DCM) and pediatric CM genes were curated from the literature and from 23 commercial CM diagnostic panels. They were classified as non-syndromic and syndromic, and further annotated using two constraint metrics, the missense Z score and pLI score obtained from the GnomAD database. Publicly available mouse (n=6) and human (n=3) single-cell RNA (scRNA) datasets were downloaded and cardiomyocyte specific differentially expressed genes (DEGs) (fold change &gt;0.1; adjusted P&lt;0.0001) were recovered. Genes identified as DEGs in at least 4 mouse or 3 human scRNA datasets were recovered as nsCM candidate genes.

Results

Analyses of 9 scRNA datasets showed the majority of known nsCM genes are cardiomyocyte specific (Fig. 1a-b). nsCM and sCM genes have distinct expression and genetic profile. nsCM genes are associated with higher heart expression and lower loss intolerance (Fig. 1c). In contrast, syndromic CM genes mostly showed lower expression with high loss intolerance, consistent with their higher clinical impact. However, interestingly some of the nsCM genes (MYLK2, TMPO and KLF10) show low or even no detectable expression in mouse and human cardiac cells. Using the scRNA data, we assessed cellular expression of genes in the 23 commercial CM diagnostic panels. This analysis showed some of the CM genes with high cardiomyocytes expression have low coverage on the current commercial CM panels (Fig. 1d). Using human and mouse scRNA data, we recovered 224 mouse and 157 human nsCM candidate genes. MTUS2 (microtubule-associated tumor suppressor candidate 2) was identified as a strong nsCM candidate gene supported by evidence from both mouse and human studies (Fig. 1e-f).

Conclusions

Our analysis showed many of the nsCM genes have differential cardiomyocyte expression with low loss intolerance, while the reverse was observed for many sCM genes. We propose increasing commercial panel coverage of cardiomyocytes-specific expressed genes may help increase disease diagnostic yield. Additionally, novel candidate genes uncovered trained on cardiomyocyte expression profile may help accelerate elucidation of unsolved cardiomyopathy cases.

Funding Acknowledgement

Type of funding sources: None.