Objective:To establish a liquid chromatography tandem mass spectrometry (LC-MS/MS) method for accurate determination of plasma Lyso-GL-3 concentration.Method:Solid phase extraction technology was used to process plasma samples, and under positive ion mode and multiple reaction monitoring (MRM) conditions, LC-MS/MS was used to determine the concentration of Lyso-GL-3. The linear range, detection and quantification limits, accuracy, precision, matrix effect, carrier effect of the method, and plasma sample stability were validated. And the accuracy of Lyso-GL-3 positive patients was compared by combining enzymatic and genetic testing results.Result:Lyso-GL-3 had good linearity in the range of 1.25-400 nmol/L. The detection limit and quantification limit were 0.15 nmol/L and 0.50 nmol/L, respectively. The spiked recovery rate was 88.78%-108.96%. The coefficient of variation ( CV) for intra batch precision, inter batch precision, and matrix effect were all less than 15%, the result of carrier effect was 0.55%. Plasma samples could be stably stored for 30 days under refrigeration conditions. The clinical conformity of the patient was 100%. Conclusion:The established LC-MS/MS detection method for plasma Lyso-GL-3 concentration takes 2.5 minutes, which is simple, fast, accurate, and reliable.

Objective:To establish a liquid chromatography tandem mass spectrometry (LC-MS/MS) method for accurate determination of plasma Lyso-GL-3 concentration.Method:Solid phase extraction technology was used to process plasma samples, and under positive ion mode and multiple reaction monitoring (MRM) conditions, LC-MS/MS was used to determine the concentration of Lyso-GL-3. The linear range, detection and quantification limits, accuracy, precision, matrix effect, carrier effect of the method, and plasma sample stability were validated. And the accuracy of Lyso-GL-3 positive patients was compared by combining enzymatic and genetic testing results.Result:Lyso-GL-3 had good linearity in the range of 1.25-400 nmol/L. The detection limit and quantification limit were 0.15 nmol/L and 0.50 nmol/L, respectively. The spiked recovery rate was 88.78%-108.96%. The coefficient of variation ( CV) for intra batch precision, inter batch precision, and matrix effect were all less than 15%, the result of carrier effect was 0.55%. Plasma samples could be stably stored for 30 days under refrigeration conditions. The clinical conformity of the patient was 100%. Conclusion:The established LC-MS/MS detection method for plasma Lyso-GL-3 concentration takes 2.5 minutes, which is simple, fast, accurate, and reliable.

Objective:To explore the relationship between macrophage infiltration in the coronary plaque and downstream myocardial perfusion in mice.Methods:The experimental group consisted of 20 ApoE knockout mice models of the coronary plaque established by feeding with cholesterol-rich diets, and the control group consisted of 20 sex- and age-matched C57BL/6 mice with the same genetic background as ApoE mice.Adenosine stress myocardial contrast echocardiography was performed on all experimental animals to obtain the values of A, β and A×β of the left ventricular myocardium in anteroseptal and posterior walls both in the resting status and during adenosine stress. Concentrations of serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were determined using mouse enzyme-linked immunosorbent assay kits according to the manufacturer′s instructions. The degree of macrophage infiltration in the coronary plaque was evaluated by pathological immunohistochemistry staining and the correlations with the above indicators were analyzed.Results:There were no statistically significant differences in heart rate and left ventricular structural parameters between two groups (all P>0.05). The experimental group had a lower left ventricular ejection fraction( P=0.021), and higher weight and serum levels of triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, IL-6, and TNF-α than the control group (all P<0.05). The values of A, β and A × β of the left ventricular myocardium in anteroseptal and posterior walls in the experimental group were significantly lower than those in the control group during adenosine stress (all P<0.05). In the experimental group, the value of the macrophage infiltration found in the plaque of the left main coronary artery correlated positively with the level of serum TNF-α ( r=0.63, P=0.003) and negatively correlated with the values of A×β of the left ventricular myocardium in anteroseptal and posterior walls during adenosine stress ( r=-0.74, P<0.001; r=-0.72, P<0.001; respectively). Conclusions:Myocardial perfusion in ApoE knockout mice models of the coronary atherosclerosis was related with degree of macrophage infiltration in the coronary plaque, and macrophages may play a role by releasing inflammatory mediator TNF-α.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

Objective:To investigate the changes of left atrial structure and function in patients with apical hypertrophic cardiomyopathy (ApHCM) by three-dimensional (3D) echocardiography.Methods:From September 2020 to December 2022, 112 patients with ApHCM(ApHCM group) diagnosed at Tongji Hospital Tongji Medical College, Huazhong University of Science and Technology and 41 age- and sex-matched normal controls(control group) were finally enrolled. In 'pure’ ApHCM patients, cardiac hypertrophy was confined to the apical segment below the papillary muscle. The wall thickness of apical and intermediate segments in 'mixed’ ApHCM patients increased, but the wall thickness of apical segment was the largest. Two-dimensional(2D) and 3D volume and strain parameters of left atrium were compared between control group and ApHCM group, 'pure’ and 'mixed’ ApHCM patients.The correlations between 2D and 3D volume and strain parameters of left atrium and intraclass correlation coefficient (ICC) of those parameters were analyzed. The ROC curve was performed to determine the cutoff values of 3D left atrial volume abnormalities in all subjects. Logistics regression analysis was performed to analyze the impact factors of the left atrial enlargement in patients with ApHCM.Results:Compared with the control group, 2D left atrial maximum volume index (2D LAVimax), 2D left atrial minimum volume index (2D LAVimin), 3D left atrial maximum volume index (3D LAVimax), 3D left atrial minimum volume index (3D LAVimin), and 3D left atrial presystolic volume index (3D LAVipreA) significantly increased in ApHCM group( Z=-6.54, -6.38, -6.98, -7.40, -6.96; all P<0.001). However, 2D left atrial ejection fraction (2D LAEF) ( Z=-3.75, P<0.001), 2D left atrial expansion index (2D LAEI) ( t=-4.15, P<0.001), 3D left atrial ejection fraction (3D LAEF) ( Z=-5.09, P<0.001), 3D left atrial expansion index (3D LAEI) ( t=-5.49, P<0.001), 2D left atrial reservoir strain (2D LASr) ( t=-12.03, P<0.001), 2D left atrial conduit strain (2D LAScd) ( t=7.91, P<0.001), 2D left atrial contractile strain (2D LASct) ( t=6.06, P<0.001), 3D left atrial reservoir strain (3D LASr) ( t=-9.23, P<0.001), 3D left atrial conduit strain (3D LAScd) ( t=7.12, P<0.001) and 3D left atrial contractile strain (3D LASct) ( t=4.78, P<0.001) significantly decreased in ApHCM group. Compared with the 'pure’ ApHCM group, 2D LAVimax, 3D LAVimax, 2D LAVimin, 3D LAVimin, 3D LAVipreA in patients with mixed ApHCM increased more significantly, while 2D LAEF, 2D LAEI and 2D LASr decreased more significantly. The measurements of left atrial volume and strain by 3D echocardiography were significantly correlated with 2D measurements ( P<0.05). The correlations between 2D LAVimax and 3D LAVimax, 2D LAVimin and 3D LAVimin, 2D LAEF and 3D LAEF, 2D LASr and 3D LASr, 2D LAEI and 3D LAEI ( r=0.91, 0.93, 0.72, 0.76, 0.57; all P<0.05) were more than moderate. The repeatability of 3D left atrial strain was lower than 2D results, while the repeatability of 3D left atrial volume was higher than 2D results. ROC curve analysis showed that 3D echocardiography parameters could identify left atrial volume abnormality in all subjects. The cutoff values of 3D LAVimax, 3D LAVimin, 3D LAVipreA in all subjects were 36 ml/m 2, 18 ml/m 2 and 27 ml/m 2, respectively. Multivariate binary logistic regression analyses showed that ratio of LV systolic obliteration to cavity was independent factor affecting left atrial enlargement in ApHCM patients( OR=1.20, P<0.001). Conclusions:Three-dimensional echocardiography is significant for the accurate evaluation of left atrial structural changes in patients with ApHCM. Ratio of left ventricular systolic obliteration to cavity was an independent impact factor of left atrial enlargement in ApHCM patients.

Objective:To evaluate the efficacy and safety of immediate intraoperative transapical beating-heart septal myectomy (TA-BSM) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and explored the clinical value of three-dimensional transesophageal echocardiography (3D-TEE) during the procedure of TA-BSM.Methods:One hundred and thirty-seven HOCM patients who underwent TA-BSM surgery in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2022 to March 2023 were selected.During the operation, 3D-TEE was used to locate the position of the myocardial circumcision system and navigate the range of myocardial circumcision. The interventricular septal thickness( IVST) and peak pressure gradient of the left ventricular outflow tract (LVOT-PG) were measured, and the degree of mitral systolic anterior motion (SAM) and mitral regurgitation (MR) were evaluated in HOCM patients before and after the operation. The range of the incisal margin was measured, and the number of resection knives and the weight of the removed myocardium were recorded.Results:TA-BSM under 3D-TEE navigation was successfully performed in 137 HOCM patients. The number of resection was 7(5, 9), and the weight of the removed myocardium was 5.6(3.4, 8.9)g. During the operation, there were no adverse events such as death, aortic valve injury, and iatrogenic interventricular septal perforation. Compared with those before the operation, the wall thickness of basal and middle segments of the anterior and posterior interventricular septum decreased significantly (all P<0.001), and LVOT-PG decreased significantly ( P<0.001). After TA-BSM, the number of patients with SAM≥3 decreased from 94 cases (68.6%) to 2 cases (1.5%), and the number of patients with MR≥3+ decreased from 86 cases (62.8%) to 9 cases (6.6%)(all P<0.001). For the patients with different degrees of ventricular septal hypertrophy (mild, moderate, and severe), the postoperative IVST and LVOT-PG were significantly lower than the preoperative values, and the degree of MR and SAM signs was relieved considerably. The length of the incisal margin, the weight of excised myocardium, and the number of resection in the group with extensive septal hypertrophy in all three regions were significantly higher than those in the group with localized interventricular septal hypertrophy in single or two areas (all P<0.05). Conclusions:3D-TEE can guide and monitor the process of TA-BSM myocardial resection in real-time. By accurately evaluating the IVST and the range and hemodynamic characteristics of HOCM patients, it can effectively relieve LVOTO and significantly reduce MR to ensure the safety and effectiveness of TA-BSM in HOCM patients with different degrees and ranges of hypertrophy.

Objective:To investigate the relationship between vulnerability of mouse coronary artery plaque and downstream myocardial perfusion and myocardial strain.Methods:Thirteen ApoE knockout mice with stable coronary plaques (stable plaque group)and 13 ApoE knockout mice with vulnerable coronary plaques(vulnerable plaque group) were selected as the experimental group, and 15 sex- and age-matched C57BL/6 mice with the same genetic background as ApoE mice were chosed as the control group. Myocardial contrast echocardiography (MCE) was carried out to quantify regional myocardial perfusion at rest and during adenosine stress using a Vevo 2100 system (Visual sonics). Replenishment curves of myocardial contrast were obtained, and rates of signal rise (β) and plateau intensity (A) were recorded. MBF was estimated by the product of A and β. Speckle tracking imaging combined with adenosine stress test was used to evaluate the longitudinal strain of left ventricular myocardium in mice. The vulnerability of the plaque was assessed by histopathology in serial tissue sections of proximal and middle left coronary artery according to the previously reported method.Results:There were no significant differences in body weight, heart rate, left ventricular end diastolic volume, left ventricular end systolic volume, left ventricular mass and ejection fraction among the three groups( P>0.05). The levels of serum triglyceride, total cholesterol, high density lipoprotein and low density lipoprotein in stable plaque group and vulnerable plaque group were significantly increased when compared with those in control group (all P<0.05). The pathological results showed that the coronary luminal stenosis rates in the stable plaque group and the vulnerable plaque group were (74.3±4.9)% and (75.5±7.1)% respectively, with no significant difference between the two groups( P>0.05). MBF of the middle anterior septum and left ventricular posterior wall in the experimental groups were significantly decreased when compared with that in the control group both in the resting status and during adenosine stress(all P<0.05). There were no significant differences in the MCE parameters between the stable plaque group and the vulnerable plaque group at rest( P>0.05). However, during adenosine stress, MBF of the vulnerable plaque group was decreased more significantly than that of the stable plaque group ( P<0.05). Compared with the control group, the values of longitudinal strain of the left ventricle in both experimental groups were decreased during resting status, without statistical significance (all P>0.05), but decreased significantly during adenosine stress and with more decrease in the vulnerable plaque group (all P<0.05). Conclusions:For the same degree of coronary artery stenosis in mice, the coronary artery vulnerable plaque group has less downstream myocardial perfusion and myocardial strain than the stable plaque group during adenosine stress. That is, the plaque vulnerability can affect the downstream myocardial perfusion and myocardial strain in the mouse model.

Objective To explore the effects of adenosine stress on myocardial perfusion in healthy mice by myocardial contrast echocardiography ( MCE) . Methods MCE was carried out to quantify regional myocardial perfusion at rest and during adenosine stress using a VEVO 2100 system in 26 C57BL/6 mice . Echocardiography images from standardized parasternal long axis and short axis at papillary muscle level were consecutively acquired in real‐time . All dynamic images were recorded for off‐line analysis . Left ventricular myocardial perfusion quantitative parameters were acquired both under resting status and during adenosine stress . Replenishment curves of myocardial contrast were obtained and myocardial blood flow ( MBF) was calculated . Results Twenty‐six experimental animals successfully underwent MCE before and during adenosine stress . T here was no significant difference in heart rate ,left ventricular structure and functional parameters before and during adenosine stress ( all P ＞0 .05) . Rates of signal rise β values which were used to estimate blood velocity of middle anterior septum and posterior wall in left ventricular long‐axis view and anterior wall ,lateral wall ,inferior wall and septal wall in short‐axis view at papillary muscle increased significantly during stress compared with those at rest ( all P ＜0 .05 ) . T here was no significant difference in the plateau intensity A values( all P ＞0 .05 ) . T he MBF in each segment of the myocardium increased significantly during stress compared with those in resting state ( all P ＜0 .05) . Conclusions T he physiological characteristics of myocardial perfusion in mice before and during adenosine stress were preliminarily obtained ,w hich provided a basis for the application of adenosine stress echocardiography in cardiovascular disease models such as coronary heart disease in mice .

Objective To explore the effects of adenosine stress on myocardial strain in healthy mice by speckle tracking imaging (STI).Methods A high-resolution rodent ultrasound machine Vevo 2100 was used to perform conventional transthoracic echocardiography at baseline and after intravenous infusion of adenosine in 34 C57BL/6 mice.Echocardiography images from standardized parasternal long axis and short axis at papillary muscle level were consecutively acquired in real-time.All dynamic images were recorded for off-line analysis.Left ventricular myocardial mechanical strain parameters were acquired both under resting status and during adenosine stress.Results Thirty-four experimental animals successfully underwent STI before and during adenosine stress. There was no significant difference in heart rate,left ventricular structure and functional parameters between before and after the adenosine stress ( P >0.05).Global peak longitudinal strain value in left ventricular long-axis view was significantly increased during stress compared with those at resting status ( P < 0.05);while there was no significant increase in the global peak circumferential strain and global peak radial strain values in short-axis view at papillary muscle ( P >0.05).Conclusions Myocardial strain is obtained in healthy mice before and after adenosine stress.This provides an evidence to the application of stress echocardiography in mice with coronary heart disease or other cardiovascular disease in the future.

Objective To assess the aorta elastic properties in the procession of atherosclerosis by ultra‐high frequency ultrasound ,and to detect the relationship between the aorta elastic properties and the atherosclerotic plaque burden .Methods Mice deficient for the apolipoprotein E (ApoE‐/‐) with high‐cholestrol diet were studied as an age‐dependent model of atherosclerosis .At 8 ,16 ,24 and 32 weeks of age , the blood pressure in the ascending aorta was measured by catheter ,and the aorta mechanical properties were assessed by measuring aortic elastic modulus of the ascending aorta with ultra‐high frequency ultrasound .The plaque burden was assessed by high‐frequency ultrasound and Masson′s trichrome stain , separately .Results Vessel thickness at the lesion‐prone sites of the lesser curvature of the aorta and the proximal brachiocephalic artery increased with age ,consistent with the Masson′s trichrome staining which showed age‐dependent worsening of atherosclerosis in the mice model .Elastic modulus of the aorta significantly increased from 8 to 32 weeks of age in E‐/‐mice .There was a statistically difference between any two groups .Conclusions With the progression of atherosclerosis and the increased plaque burden ,aorta mechanical properties deteriorated in Apo E‐/‐mice .Ultra‐high frequency ultrasound was a potential tool for assessment of plaque burden and aorta mechanical properties in mouse model .