Objective:To explore the application value of fetal heart ultrasound image segmentation network model based on knowledge distillation technology in the fine segmentation of fetal heart ultrasound image at three-vessel and trachea (3VT) views.Methods:One thousand and three hundred fetals were retrospectively collected from Sir Run Run Shaw Hospital, Zhejiang University College of Medicine from January 2016 to December 2021, the two-dimensional grayscale ultrasound images of fetal heart at 3VT views were analyzed and then divided into training, validation, and test sets. The training and validation sets were used to construct the auxiliary diagnostic network models, and the test set was used to test the reliability of different network models (U-Net, DeepLabv3+ ). The 3VT views were collected and annotated by an experienced doctor as the reference standard. The intersection over union (IoU), pixel accuracy (PA) and Dice coefficient (Dice) were used as the 3 indexes to evaluate the segmentation accuracy, and the diagnostic efficiency of the training model was evaluated. The training model and the most commonly used segmentation models were identified, and the results were compared. A total of 101 images were randomly selected and assigned to junior doctors, AI and junior doctors assisted AI interpretation. Bland-Altman images were drawn to evaluate their consistency with the reference standard, and the results were compared.Results:The training model of knowledge distillation algorithm achieved better results than U-Net, DeepLabv3+ models on all evaluation indexes, and the average IoU, PA and Dice were 68.6%, 81.4% and 81.3%, respectively. Compared with the U-Net model and DeepLabv3+ model, more accurate segmentation boundaries were obtained by the knowledge distillation algorithm training model, and the quantitative evaluation indexes were improved. With the aid of the model, the diagnostic accuracy of junior doctors was improved.Conclusions:The knowledge distillation algorithm training model segmentation method can identify the anatomical structure of the fetal heart in the 3VT view of the fetal heart ultrasound image, and the recognition result is obviously better than other related methods, and can improve the accuracy of image recognition for doctors with low experience.

Objective To evaluate the effectiveness of tumor cell Vimentin combined with endoscopic ultrasound-guided fine-needle biopsy(EUS-FNB)in diagnosing solid pancreatic tumors.Methods Clinical data from 110 patients who underwent EUS-FNB from October 2021 to December 2023 were retrospectively analyzed.Solid pancreatic tumors including but not limited to pancreatic cancer and pancreatic neuroendocrine tumors.The sensitivity,specificity,and accuracy of EUS-FNB were assessed by comparing its results with the final pathological diagnoses.Result Clear histopathological diagnoses were obtained in 106 cases,accounting for 96.37%.Among them,87 cases were definitively diagnosed as adenocarcinoma or pancreatic ductal adenocarcinoma.Immunohistochemical staining showed that Vimentin was expressed in the tumor cells.There was no statistically significant difference in positive rates among biopsies from different anatomical sites(P>0.05),but significant differences were observed in lesions of different diameters(P<0.05).Immunohistochemical staining suggested that Vimentin expression levels might be associated with the nature of the lesions.The overall diagnostic accuracy,sensitivity,and specificity of Vimentin combined with EUS-FNB for pancreatic masses were 86.09%,84.57%,and 100.00%,respectively.Specifically,for solid masses,the diagnostic accuracy,sensitivity,and specificity were 87.67%,86.55%,and 100.00%,respectively.For pancreatic cystic tumors,the diagnostic accuracy,sensitivity,and specificity were 65.42%,69.79%,and 100.00%,respectively.Conclusion The combination of tumor cell Vimentin and EUS-FNB demonstrates high diagnostic accuracy for solid pancreatic tumors,making it a valuable tool for clinical application.

Objective To observe the correlations of two-dimensional speckle tracking imaging(2D-STI)parameters of healthy fetal heart and gestational age in middle and late pregnancy.Methods Fetal echocardiography was prospectively performed in 279 healthy singleton fetuses in middle and late pregnancy.The fetuses were divided into group A(20-23+6 weeks of pregnancy,n=49),B(24-27+6 weeks of pregnancy,n=112),C(28-31+6 weeks of pregnancy,n=63),D(32-35+6 weeks of pregnancy,n=30)and group E(≥36 weeks of pregnancy,n=25)according to gestational age.Fetal left ventricle(LV)ejection fraction,LV and right ventricle(RV)area change fraction,LV and RV global radial strain(GRS),LV and RV myocardium and endocardium global longitudinal strain(MyoGLS,EndoGLS),LV myocardium and endocardium global circumferential strain(MyoGCS,EndoGCS)were obtained with 2D-STI and compared among 5 groups,and the correlations with gestational age were analyzed.Results Significant differences of fetal LV EndoGLS was found among 5 groups(P=0.044).Fetal LV GRS and RV GRS were positively correlated with gestational age(r=0.165,0.122,both P＜0.05)in middle and late pregnancy,while the absolute value of LV EndoGLS was negatively correlated with gestational age(r=-0.133,P=0.026).Conclusion LV GRS and RV GRS were positively correlated with gestational age in healthy fetuses in middle and late pregnancy,while the absolute value of LV EndoGLS was negatively correlated with gestational age.

Objective:To evaluate the morphological characteristics of the fetal heart and the contractile function of the left and right ventricles in fetuses with pulmonary stenosis (PS) and pulmonary atresia (PA) using fetal heart quantitative analysis technology (fetal HQ), and to assess the impact of different degrees of right ventricular outflow tract obstruction (RVOTO) on the contractile function of the fetal left and right ventricles. To accumulate early data and explore parameters for constructing a predictive model and clinical decision-making tool for the progression of fetal PS and PA.Methods:A retrospective analysis was conducted on 42 cases of mild to moderate PS and 23 cases of severe PS or PA detected through fetal echocardiography in the Department of Ultrasound, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, from July 2020 to December 2021. A control group of 195 normal fetal cases matching gestational weeks was selected. The fetal HQ technique was employed to measure the global sphericity index (GSI), left ventricular ejection fraction (EF), left/right ventricular area change percentage (LVFAC, RVFAC), and left/right ventricular longitudinal strain (LVGLS, RVGLS). Additionally, 24-segment sphericity index (SI) and fractional shortening (FS) for both left and right ventricles were measured. Comparative analyses were performed between the case and control groups, as well as within the case group.Results:In comparison with the control group, the case group exhibited significantly decreased GSI, LVGLS, LVEF, LVFAC, RVGLS, and RVFAC.The differences were statistically significant in the mild to moderate PS group (all P<0.05) and highly significant in the severe PS/PA group (all P<0.01). In the mild to moderate PS group, the left ventricle′s 2nd segment, right ventricle′s 24th segment SI, and the left ventricle′s 1st-13th segments, right ventricle′s 1st-16th and 20th-24th segments FS showed statistically significant differences compared to the control group (all P<0.05). In the severe PS/PA group, the right ventricle′s 1st-22nd segment SI, and the left ventricle′s 6th-13th, 21st-24th segments, and the right ventricle′s 1st-14th segments FS were reduced, showing statistically significant differences compared to the control group (all P<0.05). The severe PS/PA group showed lower RVGLS, RVFAC, and SI for the right ventricle′s 1st to 17th segments when compared to the mild to moderate PS group, with statistically significant differences (all P<0.05). Conclusions:Quantitative indices derived by fetal HQ is capable of evaluating the cardiac morphology and function of fetuses with PS/PA, which may provide for reference information for comprehensive understanding of cardiac morphological and functional changes in such fetuses.

Objective:To explore the potential application of two-dimensional speckle tracking echocardiography (2D-STE) in terms of quantification and evaluating left and right atrial function in normal fetuses, and to investigate the relevant factors affecting left and right atrial function in normal fetuses as well as differences between both atrial function.Methods:A total of 100 single fetuses underwent fetal echocardiography in the Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine from January 2019 to October 2022 were retrospectively enrolled. The standard basal or apical four-chamber view clips were obtained, and the left and right atrial function were quantitatively analyzed using TomTec-ARENA off-line cardiac analysis software for quantitative assessment of both atrial strain measurements including left atrial reservoir phase longitudinal strain (LASr), left atrial ductal phase longitudinal strain (LAScd), left atrial systolic phase longitudinal strain (LASct), right atrial reservoir phase longitudinal strain (RASr), right atrial ductal phase longitudinal strain (RAScd), right atrial systolic phase longitudinal strain (RASct), and the ratio of systolic longitudinal strain to conduit longitudinal strain in left and right atrial systolic display groups were calculated which was denoted as Sct/Scd.Routine fetal obstetric ultrasound measurements and fetal echocardiographic parameters in the two groups were obtained including fetal heart rate (FHR), left atrial end-systolic length (LAESL), left atrial end-systolic diameter (LAESD), left atrial end-systolic area (LAESA), left ventricular end-diastolic transverse diameter (LVEDD), right atrial end-systolic length (RAESL), right atrial end-systolic diameter (RAESD), right atrial end-systolic area (RAESA), right ventricular end-diastolic transverse diameter (RVEDD), peak blood flow velocity of mitral valve and tricuspid valve in early and late diastolic period (E, A), peak ratio of E and A: E/A (MV), E/A (TV), and the difference between the left and right atrial strain indices and the routine fetal obstetric ultrasound and fetal echocardiographic parameters, as well as the correlation between the above parameters and gestational age were analyzed. The repeatability tests were performed using the intra-class correlation coefficientt (ICC).Results:Significant differences were found in LASr and RASr, LAScd and RAScd, LASct and LAScd, Sct/Scd between the left atrium and right atrium, E/A (MV) and E/A (TV), LAESD and RAESD, LAESL and RAESL (all P<0.05), there was significant difference in FHR between the left atrial contraction display group and the no atrial contraction display group ( P=0.011), no significant difference in other parameters (all P>0.05). Correlation analysis showed that, LASr, LASct, RASr, and RASct showed moderate negative correlation with gestational age ( rs=-0.570, -0.601, -0.469, -0.568; all P<0.001). While LAScd, RAScd, E/A (MV), E/A (TV) were moderately positively related with gestational age ( rs=0.310, 0.350, 0.330, 0.343; all P<0.05). LAESL, LAESD, LAESA, RAESL, RAESD, RAESA, LVEDD and RVEDD were significantly positively related with gestational age ( rs=0.662, 0.768, 0.792, 0.728, 0.828, 0.822, 0.838, 0.802, all P<0.001). The inter-examiner ICC of fetal LASr and RASr were 0.89 and 0.84 (both P<0.05) and the intra-examiner ICC of fetal RASr and LASr both were 0.80 (both P<0.05), with good consistency. Conclusions:2D-STE is highly feasible and reproducible in assessing fetal atrial function. The corresponding variation values of fetal atria at different gestational weeks were obtained in this study, which provides a new reference index for us to further study normal fetal atria as well as comparative analysis of fetal cardiac function under prenatal pathological conditions.

Objective:To explore the potential application of two-dimensional speckle tracking echocardiography (2D-STE) in terms of quantification and evaluating left atrial function in normal fetuses and fetuses with left ventricular outflow tract obstruction (LVOTO).Methods:A total of 32 fetuses diagnosed with LVOTO, who underwent fetal echocardiography at Sir Run Run Shaw Hospital, Zhejiang University College of Medicine between May 2020 to June 2022, were selected as the case group, and 100 pregnant women with normal singleton fetuses between January 2019 to October 2022 were chosen as the control group. The standard basal or apical four-chamber view clips were obtained and were quantitatively analyzed using TomTec-Arena off-line cardiac analysis software to obtain the left atrial strain parameters of the two groups of fetuses including left atrial reservoir phase longitudinal strain(LASr), left atrial ductal phase longitudinal strain(LAScd), left atrial systolic phase longitudinal strain (LASct), as well as the routine obstetric ultrasound measurements and fetal echocardiographic parameters of the two groups: biparietal diameter (BPD), femur length (FL), aortic annulus end-systolic inner diameter (AO), pulmonary annulus end-systolic inner diameter (PA), left atrial end-systolic long length (LAESL), left atrial end-systolic transverse diameter (LAESD), right atrial end-systolic long length (RAESL), right atrial end-systolic transverse diameter (RAESD), left ventricular end-diastolic transverse diameter (LVEDD) and right ventricular diastole end-diastolic transverse diameter (RVEDD). The ratio of right ventricular end-diastolic transverse diameter to left ventricular end-diastolic transverse diameter (RVd/LVd) and the ratio of pulmonary annulus diameter to aortic annulus diameter (PA/AO) were calculated. The differences of strain parameters between the two groups were compared, and the correlation between strain parameters and gestational age, RVd/LVd and other conventional measurement parameters were analyzed. ROC curve was used to compare the specificity and sensitivity of LASr and RVd/LVd in evaluating fetal cardiac dysfunction with LVOTO.Results:There were significant differences in LASr, LAScd, LASct, MAPSE, AO, LAESL, LVEDD, RVd/LVd and PA/AO between the two groups (all P<0.05), there were no significant differences in other parameters (all P>0.05). Correlation analysis showed that LASr was negatively correlated with RVd/LVd in LVOTO group ( rs=-0.394, P=0.025), and LASct was negatively correlated with RVd/LVd ( rs=-0.626, P=0.004). In the control group, LASr was negatively correlated with gestational age, AO and PA ( r/ rs=-0.570, -0.440, -0.493; all P<0.001), and LASct was negatively correlated with gestational age, AO and PA ( r/ rs=-0.601, -0.532, -0.568; all P<0.001). LAScd was positively correlated with gestational age, AO and PA ( r/ rs=0.310, 0.370, 0.314; all P<0.05). There were no significant correlations between the other parameters (all P>0.05). ROC curve analysis showed that the area under the curve(AUC) in LASr evaluation of fetal cardiac dysfunction with LVOTO was 0.890 (0.826, 0.953) and the AUC in RVd/LVd evaluation of fetal cardiac dysfunction with LVOTO was 0.742 (0.637, 0.846), there were significant differences between them( P<0.05). Conclusions:2D-STE is highly feasible and reproducible in assessing fetal left atrial function. Evaluation of fetal left atrial function by 2D-STE provides a new reference index for quantitative analysis of fetal cardiac dysfunction.

Objective:To investigate the metabolic profiles of hemangioma-derived endothelial cells (HemECs) based on untargeted metabolomics analysis.Methods:Primary human umbilical vein endothelial cells (HUVECs) served as the control group, and HemECs as the experimental group. Cellular metabolites were extracted and analyzed using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS) for untargeted metabolomics analysis of HUVECs and HemECs. Bioinformatics analysis was employed to screen differentially expressed metabolites, followed by Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis and metabolic pathway analysis. Univariate analysis including t test and fold change analysis, as well as multivariate analysis including unsupervised principal component analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) were carried out. Results:A total of 542 and 241 differential metabolites were identified between HemECs and HUVECs by using the positive and negative ion modes of UPLC-MS, respectively. In the positive ion mode, the differential metabolites were mainly lipids and lipid-like molecules (35.142%) as well as organic acids and derivatives (24.537%), while in the negative ion mode the differential metabolites were organic acids and derivatives (31.466%) as well as lipids and lipid-like molecules (28.879%). Annotation analysis of differential metabolites indicated that differential metabolites were mainly clustered and enriched in amino acid metabolic pathways in both positive and negative ion modes. KEGG metabolic pathway analysis revealed that 3 significantly differential metabolic pathways were screened out in the positive ion mode ( P < 0.05), including "arginine and proline metabolism","glutamic acid and glutamine metabolism" and "sphingolipid metabolism"; in the negative ion mode, 12 significantly differential metabolic pathways were screened out ( P < 0.05), including "arginine and proline metabolism", "tricarboxylic acid cycle", "glycine, serine and threonine metabolism", etc. Conclusion:There were significant differences in metabolic profiles between HemECs and HUVECs, and amino acid metabolism, especially arginine and proline metabolism, was an important metabolic pathway involved in the regulation of HemEC metabolism.

Objective:To compare the effect of self-radiopaque markers guiding physician-modified fenestration, chimney technique and hybrid Ⅳb technique on reconstruction of left subclavian artery (LSA) in endovascular treatment of aortic dissection (TEVAR).Methods:The clinical and follow-up data of 312 TEVAR patients treated with LSA blood supply reconstruction technology from Jan 2016 to Dec 2019 at Fuwai hospital were retrospectively analyzed.Results:There were 35 patients in the hybrid Ⅳb technique group, 93 in the chimney technique group, and 184 in the in vitro fenestration group. The follow-up period ranged from 12 to 24 months. No artificial blood vessel and stent occlusion occurred in all patients during follow-up, and the LSA blood flow was unobstructed. A total of 19 patients had endoleak by the last follow-up, and there was no statistical difference between the three groups. Eleven patients underwent reintervention surgery, all were from chimney technique group and in vitro fenestration group, with no statistical difference ( P>0.05). Severe complications occurred in 28 patients during hospitalization, and the incidence of complications was the highest in the hybrid Ⅳb technique group ( P<0.01). During follow-up, 4 patients died in the bypass group, 6 died in the external window group, and 8 died in the chimney group, with no significant difference ( P>0.05). Conclusions:The safety and efficacy of the left subclavian artery flow reconstruction by in vitro fenestration and chimney technique were similar. The occurrences of early complications were lower than that of the hybrid Ⅳb technique, but the reintervention rate of endoleak was higher.

Objective:To investigate the pathogenic genes, clinical features and treatment as well as follow-up of children with congenital long QT syndrome (LQTS).Methods:The clinical data, genetic test results and follow-up data of 16 congenital LQTS children with syncope as the first manifestation admitted to the Department of Cardiology, Beijing Children′s Hospital Affiliated to Capital Medical University from August 2016 to March 2023 were collected and retrospectively analyzed.Results:Among the 16 LQTS patients, the age of first syncope onset was 1.3-13.3 (7.37±3.41) years, and the interval between first syncope onset and clinical diagnosis was 0-48 (14.8±16.2) months.A total of 13 (81.3%) patients had triggers of syncope, of which nine were exercise-induced and four were emotional induced.Genetic testing was performed in 13 patients with LQTS, of which 12 (92.3%) were found to have pathogenic or suspected pathogenic mutations from KCNQ1, KCNH2, and SCN5A gene.The corrected QT interval of 16 patients was (550.0±50.2) ms, all cases≥460 ms.Schwartz scored 6.0 (5.0, 6.0) points, all cases≥4 points.All patients were initially treated with metoprolol or propranolol, of which 14 patients were followed up to date, three patients had recurrent syncope, and five patients stopped taking the medicines by themselves.One patient with high-dose metoprolol (LQT2) was treated with mexiletine after recurrent episodes.One patient who was intolerant to high-dose propranolol underwent left cardiac sympathectomy and was followed up after surgery without syncope episodes.None of the patients underwent implantable cardioverter defibrillator implantation. Conclusion:Children with LQTS and syncope symptoms have high positive rate of genetic tests.The genetic results could assist typing of patients with LQTS and guide treatment.Routine electrocardiogram screening in children with syncope may diagnose LQTS earlier and reduce misdiagnosis and missed diagnosis.β-blockers are the cornerstone of treatment for patients with LQTS.Strengthening follow-up management and improving patients′ treatment compliance is conducive to further improving the treatment response rate of patients.

Lower extremity chronic total occlusion (CTO) is the most severe manifestation of peripheral artery disease (PAD), with high amputation and mortality rates. As a minimal invasive reconstruction therapy, endovascular therapy (EVT) plays an important role in limb salvage for CTO in current clinical practice. The complexity of CTO lesions leads to a high risk for complications and a low success rate of EVT. Therefore, establishing a grading or scoring system to predict the success rate of revascularization strategy will be helpful in developing appropriate treatment strategies and assessing benefits and risks. This paper summarizes the most popular CTO scoring systems, such as PACSS grading, PARC grading, TAC grading, CTOP classification, Infrapop-CTO scoring, and J-BTK CTO scoring. PACSS grading and PARC grading are suitable for evaluating the severity of vascular calcification including iliofemoral segment, femoral-popliteal segment, and below-the-knee artery segment. TAC grading is suitable for grading calcification below the knee lesions; with low intervention success rate in a high calcification grading. CTOP classification was developed by analyzing the effect of morphological characteristics of proximal and distal fibrous caps of lower extremity CTO lesions on the outcome of EVT. The success rate of antegrade intervention is lower in type IV. The Infrapop-CTO score and J-BTK CTO score can predict successful anterograde crossing of infrapopliteal CTO lesions, with low intervention success rate in high score. Both scoring systems use three variables, namely, shape of proximal stump, calcification, and occlusion length.