Objective To evaluate the diagnostic value of myocardial work related parameters in coronary ischemia patients with coronary artery disease(CAD)coronary ischemia using non-invasive left ventricular pressure strain loop(PSL),taking fraction flow reservation(FFR)as the gold standard.Methods From December 2020 to December 2021,53 clinically suspected CAD patients were prospectively enrolled.All patients underwent echocardiography,invasive coronary angiography and FFR measurement.According to the results of coronary angiography,patients were divided into myocardial ischemia group(n=24,FFR≤0.80)and non-myocardial ischemia group(n=29,FFR＞0.80).PSL was used for off-line analysis to obtain the global work index(GWI),global constructive work(GCW),global wasted work(GWW),global work efficiency(GWE),global positive work(GPW),and global systolic constructive work(GSCW)and other myocardial work parameters.The differences of parameter values between the two groups were compared.The diagnostic efficacy of work parameters in myocardial ischemia was analyzed by ROC curve.Results Compared with the non-myocardial ischemia group,GWI,GCW,GPW and GSCW were significantly decreased in the myocardial ischemia group at the 18-,16-,and 12-segment levels(P＜0.001).The ROC curve showed that the AUC results of GWI,GCW,GPW,GSCW at the 18-segment level were 0.803(95％CI 0.679-0.927),0.807(95％CI 0.687-0.928),0.822(95％CI 0.708-0.936),0.819(95％CI 0.703-0.935).The optimal cut-off value of GWI was 1 676.3 mmHg％,and the sensitivity,specificity and accuracy of predicting myocardial ischemia were 70.8％,86.2％and 79.2％,respectively.The optimal cut-off value of GCW was 1 999.4 mmHg％,and the sensitivity,specificity and accuracy of predicting myocardial ischemia were 75.0％,82.8％and 79.2％,respectively.Conclusions Analyzing myocardial work using PSL has good significance for screening suspected myocardial ischemia in CAD patients.

Objective:To explore the effects of the LAmbre device and mitral annulus(MA), as well as left atrium(LA) in patients with non-valvular atrial fibrillation(NVAF) after left atrial appendage closure (LAAC) using real-time-three-dimensional transesophageal echocardiography (3D TEE).Methods:Fity-six consecutive patients who underwent LAAC with the LAmbre device in Zhongshan Hospital of Fudan University from June 2019 to March 2023 were retrospectively enrolled, with no or less than moderate mitral regurgitation (MR). All patients underwent pre-operative and follow-up two-and three-dimensional transesophageal echocardiography (2D TEE, 3D TEE) at 60 days after the operation. The quantitative parameters of MA and LA were obtained by offline analysis using QLab 13.0 (Philips Healthcare, Andover, MA). Importantly, mitral annular measurements were made at seven time points throughout the cardiac cycle: early diastole, mid-diastole, late diastole, mitral valve closure, early systole, mid-systole, and late systole, which facilitates constructing the dynamic model of MA to assess the annular morphology and dynamics.Results:The values of AP diameter (APD), AL-PM diameter (ALPMD), 3D annulus circumference (3DAC), 3D annulus area (3DAA) decreased significantly compared with pre-operative values at all time points of the cardiac cycle (all P<0.05), while non-planar angle (NPA) and AH/CD were not apparently changed (all P>0.05 ). Throughout the cardiac cycle, MA showed regular changes, gradually increased in systole with the saddle shape deepened, and gradually decreased in diastole with the saddle shape shallowed.During systole, there was an increase in the rate of change of AP in MA [pre-operative (3.01±2.64)%, post-operative (3.81±3.51)%, P=0.037] after LAAC, with no significant difference in the rate of change of ALPM, 3DAC, and 3DAA.Meanwhile, we observed an evident reduction in LA minimal volume (LAVmin) [pre-operative (78.36±25.16)ml, post-operative (70.73±22.78)ml, P=0.004] and an obvious increase in LA ejection function [pre-operative (22.88±10.09)%, post-operative (31.41±12.28)%, P<0.05] during follow-up. Conclusions:3D TEE can accurately assess the impact of LAAC on the MA and LA. The LAmbre device can affect the morphology of MA, as well as the structure and function of LA, while the change of the dynamics of MA is not so prominent.

Objective:To understand the status of frailty among elderly inpatients,analyze its influencing factors,and explore the relationship of frailty with sarcopenia,and subjective social isolation in elderly inpatients.Methods:A total of 518 elderly inpatients from a tertiary hospital in Wuhu were selected as the research subjects.General information questionnaire,Frail Scale,SARC-F Scale,and Subjective Social Isolation Scale were used for investigation.Logistic regression analysis was used to analyze the influencing factors of frailty among elderly inpatients.Results:The incidence of frailty in 518 elderly inpatients was 52.5%(272/518).Logistic regression analysis revealed that recent falls(OR=3.458,95%CI:1.454-8.229),sarcopenia(OR=5.622,95%CI:2.494-12.677),subjective social isolation(OR=181.165,95%CI:57.307-572.721),polypharmacy(OR=2.409,95%CI:1.336-4.346),and 80-89 years old(OR=8.982,95%CI:0.640-2.357)were risk factors for frailty in elderly inpatients(P＜0.05).Conclusions:The prevalence of frailty is high among elderly inpatients.Healthcare professionals should pay attention to the assessment of frailty in elderly inpatients,and promptly implement targeted interventions to slow down or prevent the progression of frailty.

Transcatheter tricuspid valve intervention is the new frontier of interventional cardiology. The LuX-Valve is a radial force-independent orthotopic tricuspid valve replacement device developed in China. The LuX-Valve Plus transcatheter tricuspid valve replacement (TTVR) system is changed from the trans-atrial to the transjugular approach, which further reduces trauma and pulmonary complications compared with the first generation LuX-Valve. The first-in-human study has been completed at Zhongshan Hospital, Fudan University and an exploratory multicentre clinical study is underway. Echocardiography plays an important role in pre-TTVR screening, intraoperative guidance and postoperative evaluation and follow-up, especially two-dimensional transoesophageal echocardiography (2D-TEE) and three-dimensional transoesophageal echocardiography (3D-TEE). However, there is a lack of appropriate intraoperative guidance and assessment protocols. In this study, we briefly described the protocols and imaging considerations for intraoperative 2D-TEE and 3D-TEE to ensure the successful implantation of TTVR.

Humans ; Transcranial Magnetic Stimulation ; Pain Management ; Psychotic Disorders/therapy* ; Depressive Disorder, Major ; Treatment Outcome ; Transcranial Direct Current Stimulation

Objective This study aimed to explore the experience and needs of dignity-conserving care of disabled elderly people in nursing homes,and to provide a basis for formulating a quality evaluation system for dignity-conserving care.Methods This descriptive qualitative study,involving a semi-structured in-depth interview of 13 disabled elderly people based on purposive sampling,was conducted from August to November 2022 at a nursing home in Hangzhou.Based on the harmony nursing theory,the directional content analysis method was performed in order to summarize and extract themes from the interview texts.Results The dignity-conserving care experience and needs of disabled elderly people were extracted and classified into 5 themes,including physical safety(physical health maintenance,privacy protection,hygiene and image maintenance),psychological health(psychological counseling,psychological support),social communication(well communication environment,harmonious way of communication),spiritual culture(self-realization,respect for faith),needs of dignity-conserving care(individualized health needs,activity participation needs,dignified communication needs,spiritual needs of respecting the elderly).Conclusion When conducting the dignity-conserving care,nursing homes should pay attention to the physical health of the disabled elderly,actively maintain the image and privacy of the disabled elderly people,pay attention to the needs of psychological health,provide psychological counseling and support,strengthen the construction of barrier-free environments and cultural environments,build mutual respect way of communication,fully respect the religious beliefs of disabled elderly people,promote the realization of self-value of disabled elderly people,broaden the channels of personalized service and activity participation,strengthen the interaction of the dignity and spirit of the respect for the elderly of nursing homes,comprehensively improve the quality of dignity-conserving care in nursing homes.

Tricuspid regurgitation (TR) interventions are under rapid development. The K-Clip? system is the first domestic transcatheter tricuspid annuloplasty system with unique clamping procedure to achieve annular reduction.Intraoperative echocardiographic monitoring procedures for transcatheter tricuspid annuloplasty have not been reported yet in China. Thus, this review aimed to propose the standard two-dimensional and three-dimensional transesophageal echocardiographic workplanes and procedures to guide and monitor the implantation of K-Clip system based on our experience in Zhongshan Hospital, Fudan University to provide a reference point for the intraoperative echocardiographic monitoring of future transcatheter tricuspid annuloplasty devices in China.

Objective:To evaluate the influence of transcatheter aortic valve replacement (TAVR) on left atrial strain by two-dimensional speckle tracking echocardiography.Methods:Thirty-five patients, who were admitted for TAVR in Zhongshan Hospital of Fudan University from September 2015 to July 2018, were recruited. Echocardiography was performed 1 day before and 12 months after TAVR. Traditional ultrasound results, including aortic valve area (AVA), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), left atrial volume index (LAVI), peak velocity of tricuspid regurgitation (Vtr), peak velocity of the lateral wall of mitral annulus in early diastolic period (e′) and the ratios of peak mitral orifice velocity in early diastolic period to e′ (E/e′), were recorded. Two-dimensional speckle tracking imaging derived left atrial strain, which included reservoir (LASr), conduction (LAScd) and contraction (LASct), were recorded as well. The differences between pre-operation and post-operation were analyzed.Results:Compared to pre-operation, aortic valve area was increased ( P<0.001). Left ventricular systolic function was improved significantly (LVEDV and LVESV were decreased, LVEF was increased, all P<0.001). As to the left ventricular diastolic function, although LAVI and Vtr were decreased (both P<0.05), e′ and E/e′ were hardly changed (both P>0.05). Meanwhile, left atrial strain, including LASr, LAScd and LASct, were improved significantly 1 year post-TAVR (all P<0.01). Conclusions:Left atrial strain is able to evaluate the left atrial function of reservoir, conduction and contraction.Left atrial strain can be a promising tool of assessing left atrial function in patients underwent TAVR.

Objective:To investigate the relationship between Watchman occluder and structure of mitral valve apparatus in patients with nonvalvular atrial fibrillation after left atrial appendage closure(LAAC) by transesophageal echocardiography.Methods:From January 2018 to December 2020, 29 patients [20 male, 9 female, (69.55±10.06)years old] with nonvalvular atrial fibrillation underwent LAAC in Zhongshan Hospital (implanted Watchman occluder), and all patients underwent pre-operative and follow-up two and three dimensional transesophageal echocardiography(2DTEE, 3DTEE) at 60 days after the operation. The quantitative parameters of mitral valve apparatus were obtained by offline analysis using the MVA module in QLab 13.0 (Philips Healthcare, Andover, MA), the differences between pre-operation and post-operation were compared, and the relationship between occluder compression ratio and mitral valve parameters with significant changes after operation was analyzed.Results:①The values of AL-PM diameter(AL-PM), 3D annulus circumference(3DAC), 2D annulus area(2DAA), 3D annulus area(3DAA), tenting volume(TnV), tenting area(TnA) and commissural diameter(CD) decreased significantly compared with pre-operative values(all P<0.05), while the annulus sphericity index(SPI) increased significantly ( P<0.05). ②In the quantitative mitral value parameters with significant pre- and post-operation changes, TnV was correlated with the occluder compression ratio ( r=0.403, P=0.030), but AL-PM, SPI, 3DAC, 2DAA, 3DAA, TnA, CD were not correlated with it(all P>0.05). Conclusions:3DTEE can accurately evaluate the effect of Watchman occluder on the morphology of mitral valve device. Implanting Watchman occluder in left atrial appendage can make three-dimensional mitral valve apparatus flat and decrease annulus left-right diameter and annulus area; the pre-operative TnV, the more susceptible to the occluder implantation, and TnV is correlated with the compression ratio.

Objective To evaluate the role of transthoracic echocardiography ( T T E ) and transesophageal echocardiography( T EE) in the process of transapical mitral valve repair using a novel edge‐to‐edge device( ValveClamp) and this device′s efficacy and safety in a preliminary clinical trial . Methods Six patients with moderate to severe or severe degenerative mitral regurgitation ( DM R) confirmed by T T E and T EE were enrolled . T T E was performed pre and post procedure as well as 30 days post procedures . Related cardiac structure and hemodynamic parameters ,including mitral regurgitation area ( MRA‐max ) , vena contracta width ( VCW ) ,mitral valve effective orifice area ( M VEOA ) ,left ventricular end diastolic diameter ( LVEDD ) , left ventricular end systolic diameter ( LVESD ) , left ventricular ejection fraction ( LVEF) ,max and mean mitral valve pressure gradient ( M VPG‐max and M VPG‐mean) were recorded and evaluated in a central core laboratory . Results All the procedures were successfully performed .M RA‐max , VCW and M VEOA decreased significantly post procedures ( all P ＜ 0 .000 ) , and they remained no significant changes within 30 days post procedures ( all P ＞ 0 .05 ) . M eanwhile ,M VPG‐max and M VPG‐mean slightly increased ( all P ＜0 .01 ) and left atrial anterior‐posterior dimension attenuated 30 days post procedures( P ＜0 .05) ,but all M VPG‐mean were lower than 5 mm Hg ( 1 mm Hg＝0 .133 kPa) . T here were no significant changes in other hemodynamic parameters ( all P ＞ 0 .05) . Conclusions T ransapical mitral valve repair using ValveClamp can be performed safely and a significant reduction in mitral regurgitation can be achieved in patients with DM R . T EE and T T E facilitate the patient selection for ValveClamp procedures as well as perioperative navigation and assessment .