Numerical simulation on the seismic performance of retrofitted masonry walls based on the combined finite-discrete element method

Due to the long construction life,improper design methods,brittle material properties and poor construction techniques,most existing masonry structures do not perform well during earthquakes.The retrofitting method using an external steel-meshed mortar layer is widely used to retrofit existing masonry buildings.Assessing the seismic performance of masonry walls reinforced by an external steel-meshed mortar layer reasonably and effectively is a difficult subject in the research field of masonry structures.Based on the combined finite-discrete elements method,the numerical models of retrofitted brick walls with four different masonry mortar strengths by an external mortar layer are established.The shear strength of mortar and the contact between the retrofitted mortar layer and the brick blocks are discussed in detail.The failure patterns and load-displacement curves of the retrofitted brick walls were obtained by applying low cycle reciprocating loads to the numerical model,and the bearing capacity and the failure mechanism of the retrofitted walls were obtained by comparing the failure patterns,ultimate bearing capacity,deformability and other aspects with the tests.This study provides a basis for improving the seismic strengthening design method of masonry structures and helps to better assess the seismic performance of masonry structures after retrofitting.

Grain Yield,Biomass Accumulation,and Leaf Photosynthetic Characteristics of Rice under Combined Salinity-Drought Stress

Simultaneous stresses of salinity and drought often coincide during rice-growing seasons in saline lands,primarily due to insufficient water resources and inadequate irrigation facilities.Consequently,combined salinity-drought stress poses a major threat to rice production.In this study,two salinity levels(NS,non-salinity;HS,high salinity)along with three drought treatments(CC,control condition;DJ,drought stress imposed at jointing;DH,drought stress imposed at heading)were performed to investigate their combined influences on leaf photosynthetic characteristics,biomass accumulation,and rice yield formation.Salinity,drought,and their combination led to a shortened growth period from heading to maturity,resulting in a reduced overall growth duration.Grain yield was reduced under both salinity and drought stress,with a more substantial reduction under the combined salinity-drought stress.The combined stress imposed at heading caused greater yield losses in rice compared with the stress imposed at jointing.Additionally,the combined salinity-drought stress induced greater decreases in shoot biomass accumulation from heading to maturity,as well as in shoot biomass and nonstructural carbohydrate(NSC)content in the stem at heading and maturity.However,it increased the harvest index and NSC remobilization reserve.Salinity and drought reduced the leaf area index and SPAD value of flag leaves and weakened the leaf photosynthetic characteristics as indicated by lower photosynthetic rates,transpiration rates,and stomatal conductance.These reductions were more pronounced under the combined stress.Salinity,drought,and especially their combination,decreased the activities of ascorbate peroxidase,catalase,and superoxide dismutase,while increasing the contents of malondialdehyde,hydrogen peroxide,and superoxide radical.Our results indicated a more significant yield loss in rice when subjected to combined salinity-drought stress.The individual and combined stresses of salinity and drought diminished antioxidant enzyme activities,inhibited leaf photosynthetic functions,accelerated leaf senescence,and subsequently lowered assimilate accumulation and grain yield.

Lateral earth pressure of granular backfills on retaining walls with expanded polystyrene geofoam inclusions under limited surcharge loading

Existing studies have focused on the behavior of the retaining wall equipped with expanded polystyrene(EPS)geofoam inclusions under semi-infinite surcharge loading rather than limited surcharge loading.In this paper,the failure mode and the earth pressure acting on the rigid retaining wall with EPS geofoam inclusions and granular backfills(henceforth referred to as EPS-wall),under limited surcharge loading are investigated through two-and three-dimensional model tests.The testing results show that different from the sliding of almost all the backfill in the EPS-wall under semi-infinite surcharge loading,only an approximately triangular backfill slides in the wall under limited surcharge loading.The distribution of the lateral earth pressure on the EPS-wall under limited surcharge loading is non-linear,and the distribution changes from the increase of the wall depth to the decrease with the increase of the limited surcharge loading.An approach based on the force equilibrium of a differential element is developed to predict the lateral earth pressure behind the EPS-wall subjected to limited surcharge loading,and its performance was fully validated by the three-dimensional model tests.

Resilient performance of self-centering hybrid rocking walls with curved interface under pseudo-static loading

Frame and rocking wall(FRW)structures have excellent resilient performance during earthquakes.However,the concrete at interfacial corners of rocking walls(RWs)is easily crushed due to local extreme compression during the rocking process.An innovative RW with a curved interface is proposed to prevent interfacial corners from producing local damage,enhancing its earthquake resilient performance(ERP).The precast wall panel with a curved interface is assembled into an integral self-centering hybrid rocking wall(SCRW)by two post-tensioned unbonded prestressed tendons.Moreover,two ordinary energy dissipation steel rebars and two shear reinforcements are arranged to increase the energy dissipation capacity and lateral resistance.Two SCRW specimens and one monolithic reinforced concrete(RC)shear wall(SW)were tested under pseudo-static loading to compare the ERPs of the proposed SCRW and the SW,focusing on studying the effect of the curved interface on the SCRW.The key resilient performance of rocking effects,failure modes,and hysteretic properties of the SCRW were explored.The results show that nonlinear deformations of the SCRW are concentrated along the interface between the SCRW and the foundation,avoiding damage within the SCRW.The restoring force provided by the prestressed tendons can effectively realize self-centering capacity with small residual deformation,and the resilient performance of the SCRW is better than that of monolithic SW.In addition,the curved interface of the SCRW makes the rocking center change and move inward,partially relieving the stress concentration and crush of concrete.The rocking range of the rocking center is about 41.4%of the width of the SCRW.

Dynamic simulation analysis of molten salt reactor-coupled air-steam combined cycle power generation system

A nonlinear dynamic simulation model based on coordinated control of speed and flow rate for the molten salt reactor and combined cycle systems is proposed here to ensure the coordination and stability between the molten salt reactor and power system.This model considers the impact of thermal properties of fluid variation on accuracy and has been validated with Simulink.This study reveals the capability of the control system to compensate for anomalous situations and maintain shaft stability in the event of perturbations occurring in high-temperature molten salt tank outlet parameters.Meanwhile,the control system’s impact on the system’s dynamic characteristics under molten salt disturbance is also analyzed.The results reveal that after the disturbance occurs,the controlled system benefits from the action of the control,and the overshoot and disturbance amplitude are positively correlated,while the system power and frequency eventually return to the initial values.This simulation model provides a basis for utilizing molten salt reactors for power generation and maintaining grid stability.

Pressure stimulated current in progressive failure process of combined coal-rock under uniaxial compression:Response and mechanism

Effective monitoring of the structural health of combined coal-rock under complex geological conditions by pressure stimulated currents(PSCs)has great potential for the understanding of dynamic disasters in underground engineering.To reveal the effect of this way,the uniaxial compression experiments with PSC monitoring were conducted on three types of coal-rock combination samples with different strength combinations.The mechanism explanation of PSCs are investigated by resistivity test,atomic force microscopy(AFM)and computed tomography(CT)methods,and a PSC flow model based on progressive failure process is proposed.The influence of strength combinations on PSCs in the progressive failure process are emphasized.The results show the PSC responses between rock part,coal part and the two components are different,which are affected by multi-scale fracture characteristics and electrical properties.As the rock strength decreases,the progressive failure process changes obviously with the influence range of interface constraint effect decreasing,resulting in the different responses of PSC strength and direction in different parts to fracture behaviors.The PSC flow model is initially validated by the relationship between the accumulated charges of different parts.The results are expected to provide a new reference and method for mining design and roadway quality assessment.

Numerical Investigation of Combined Production of Natural Gas Hydrate and Conventional Gas

Natural gas hydrate(NGH)is generally produced and accumulated together with the underlying conventional gas.Therefore,optimizing the production technology of these two gases should be seen as a relevant way to effectively reduce the exploitation cost of the gas hydrate.In this study,three types of models accounting for the coexistence of these gases are considered.Type A considers the upper hydrate-bearing layer(HBL)adjacent to the lower conventional gas layer(CGL);with the Type B a permeable interlayer exists between the upper HBL and the lower CGL;with the type C there is an impermeable interlayer between the upper HBL and the lower CGL.The production performances associated with the above three models are calculated under different conditions,including only a depressurized HBL(only HBL DP);only a depressurized CGL(only CGL DP);and both the HBL and the CGL being depressurized(HBL+CGL DP).The results show that for Type A and Type B coexistence accumulation models,when only HBL or CGL is depressurized,the gas from the other layer will flow into the production layer due to the pressure difference between the two layers.In the coexistence accumulation model of type C,the cumulative gas production is much lower than that of Type A and Type B,regardless of whether only HBL DP,only CGL DP,or HBL+CGL DP are considered.This indicates that the impermeable interlayer restricts the cross-flow of gas between HBL and CGL.For three different coexistence accumulation models,CGL DP has the largest gas-to-water ratio.

Influence of Various Earth-Retaining Walls on the Dynamic Response Comparison Based on 3D Modeling

The present work aims to assess earthquake-induced earth-retaining(ER)wall displacement.This study is on the dynamics analysis of various earth-retaining wall designs in hollow precast concrete panels,reinforcement concrete facing panels,and gravity-type earth-retaining walls.The finite element(FE)simulations utilized a 3D plane strain condition to model full-scale ER walls and numerous nonlinear dynamics analyses.The seismic performance of differentmodels,which includes reinforcement concrete panels and gravity-type and hollowprecast concrete ER walls,was simulated and examined using the FE approach.It also displays comparative studies such as stress distribution,deflection of the wall,acceleration across the wall height,lateral wall displacement,lateral wall pressure,and backfill plastic strain.Three components of the created ER walls were found throughout this research procedure.One is a granular reinforcement backfill,while the other is a wall-facing panel and base foundation.The dynamic response effects of varied earth-retaining walls have also been studied.It was discovered that the facing panel of the model significantly impacts the earthquake-induced displacement of ER walls.The proposed analytical model’s validity has been evaluated and compared with the reinforcement concrete facing panels,gravity-type ER wall,scientifically available data,and American Association of State Highway and Transportation Officials(AASHTO)guidelines results based on FE simulation.The results of the observations indicate that the hollow prefabricated concrete ER wall is the most feasible option due to its lower displacement and high-stress distribution compared to the two types.The methodology and results of this study establish standards for future analogous investigations and professionals,particularly in light of the increasing computational capabilities of desktop computers.

Anti-OX40 Antibody Combined with HBc VLPs Delays Tumor Growth in a Mouse Colon Cancer Model

Objective Combination immunotherapy strategies targeting OX40,a co-stimulatory molecule that can enhance antitumor immunity by modulating the proliferation,differentiation,and effector function of tumor-infiltrating T cells,have attracted much attention for their excellent therapeutic effects.In this study,we aimed to evaluate the antitumor efficacy of combined anti-OX40 and hepatitis B core viruslike particles(HBc VLPs)therapy using a mouse colon cancer model.Methods Humanized B-h OX40 mice were injected subcutaneously with MC38 colon tumor cells and treated with HBc VLPs+anti-h OX40 antibody.Tumor growth was monitored.Flow cytometric analysis was performed to evaluate the populations of T cell subsets in the tumors.Results The combination of anti-OX40 with HBc VLPs resulted in a significant delay in tumor growth,suggesting that a potent antitumor immunity was induced by the combination therapy.Further studies revealed that HBc VLPs+anti-OX40 treatment induced a significant increase in effector T cells(Teffs)and a significant decrease in regulatory T cells(Tregs)in the tumor microenvironment(TME),which accounted for the synergistic antitumor effect of anti-OX40 in combination with HBc VLPs.Conclusion Combination therapy of anti-h OX40 and HBc VLPs provides synergistic antitumor activity in colon cancer-bearing mice,which may represent a potential design strategy for cancer immunotherapy.

A Subdivision-Based Combined Shape and Topology Optimization in Acoustics

We propose a combined shape and topology optimization approach in this research for 3D acoustics by using the isogeometric boundary element method with subdivision surfaces.The existing structural optimization methods mainly contain shape and topology schemes,with the former changing the surface geometric profile of the structure and the latter changing thematerial distribution topology or hole topology of the structure.In the present acoustic performance optimization,the coordinates of the control points in the subdivision surfaces fine mesh are selected as the shape design parameters of the structure,the artificial density of the sound absorbing material covered on the structure surface is set as the topology design parameter,and the combined topology and shape optimization approach is established through the sound field analysis of the subdivision surfaces boundary element method as a bridge.The topology and shape sensitivities of the approach are calculated using the adjoint variable method,which ensures the efficiency of the optimization.The geometric jaggedness and material distribution discontinuities that appear in the optimization process are overcome to a certain degree by the multiresolution method and solid isotropic material with penalization.Numerical examples are given to validate the effectiveness of the presented optimization approach.

Lenvatinib combined with sintilimab plus transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma

BACKGROUND Recently,combination therapy has shown a better trend towards improved tumour response and survival outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,research on triple therapy[lenvatinib+sintilimab+transarterial chemoembolization(TACE)]as a first-line treatment for advanced HCC is limited.AIM To evaluate the safety and efficacy of triple therapy as a first-line treatment for advanced HCC.METHODS HCC patients with Barcelona Clinic Liver Cancer stage C treated with triple therapy were enrolled.All patients were treated with lenvatinib every day and sintilimab once every 3 wk.Moreover,TACE was performed every 4-6 wk if necessary.The primary outcome of the study was overall survival(OS).The secondary outcomes were the objective response rate(ORR),disease control rate(DCR),and incidence of adverse events.RESULTS Forty HCC patients who underwent triple therapy were retrospectively analysed from January 2019 to January 2022.With a median follow-up of 8.5 months,the 3-,6-,and 12-mo OS rates were 100%,88.5%,and 22.5%,respectively.The ORR and DCR were 45%and 90%,respectively.The median progressive free survival and median OS were not reached.Common complications were observed in 76%of the patients(grade 3,15%;grade 4,2.5%).CONCLUSION Combination therapy comprising lenvatinib,sintilimab and TACE achieved promising outcomes in advanced HCC patients and had manageable effects.

Analytical model for predicting time-dependent lateral deformation of geosynthetics-reinforced soil walls with modular block facing

To date,few models are available in the literature to consider the creep behavior of geosynthetics when predicting the lateral deformation(d)of geosynthetics-reinforced soil(GRS)retaining walls.In this study,a general hyperbolic creep model was first introduced to describe the long-term deformation of geosynthetics,which is a function of elapsed time and two empirical parameters a and b.The conventional creep tests with three different tensile loads(Pr)were conducted on two uniaxial geogrids to determine their creep behavior,as well as the a-Pr and b-Pr relationships.The test results show that increasing Pr accelerates the development of creep deformation for both geogrids.Meanwhile,a and b respectively show exponential and negatively linear relationships with Pr,which were confirmed by abundant experimental data available in other studies.Based on the above creep model and relationships,an accurate and reliable analytical model was then proposed for predicting the time-dependent d of GRS walls with modular block facing,which was further validated using a relevant numerical investigation from the previous literature.Performance evaluation and comparison of the proposed model with six available prediction models were performed.Then a parametric study was carried out to evaluate the effects of wall height,vertical spacing of geogrids,unit weight and internal friction angle of backfills,and factor of safety against pullout on d at the end of construction and 5 years afterwards.The findings show that the creep effect not only promotes d but also raises the elevation of the maximum d along the wall height.Finally,the limitations and application prospects of the proposed model were discussed and analyzed.

Early Application Study of Intravenous Pain Pump Combined with Parecoxib Injection in Relieving Pain in Patients after Thoracoscopy

Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.

Targeted anti-tumor synergistic effects of Myc decoy oligodeoxynucleotides-loaded selenium nanostructure combined with chemoradiotherapy on LNCaP prostate cancer cells

In the present study,we investigated the synergistic effects of targeted methotrexate-selenium nanostructure containing Myc decoy oligodeoxynucleotides along with X-irradiation exposure as a combination therapy on LNCaP prostate cancer cells.Myc decoy ODNs were designed based on the promoter of Bcl-2 gene and analyzed by molecular docking and molecular dynamics assays.ODNs were loaded on the synthesized Se@BSA@Chi-MTX nanostructure.The physicochemical characteristics of nanostructures were determined by FTIR,DLS,UV-vis,TEM,EDX,in vitro release,and hemolysis tests.Subsequently,the cytotoxicity properties of them with and without X-irradiation were investigated by uptake,MTT,cell cycle,apoptosis,and scratch assays on the LNCaP cell line.The results of DLS and TEM showed negative charge(−9 mV)and nanometer size(40 nm)for Se@BSA@Chi-DEC-MTX NPs,respectively.The results of FTIR,UV-vis,and EDX showed the proper interaction of different parts and the correct synthesis of nanoparticles.The results of hemolysis showed the hemocompatibility of this nanoparticle in concentrations less than 6 mg/mL.The ODNs release from the nanostructures showed a pH-dependent manner,and the release rate was 15%higher in acidic pH.The targeted Se@BSA@Chi-labeled ODN-MTX NPs were efficiently taken up by LNCaP cells by targeting the prostate-specific membrane antigen(PSMA).The significant synergistic effects of nanostructure(containing MTX drug)treatment along with X-irradiation showed cell growth inhibition,apoptosis induction(~57%),cell cycle arrest(G2/M phase),and migration inhibition(up to 90%)compared to the control.The results suggested that the Se@BSA@Chi-DEC-MTX NPs can potentially suppress the cell growth of LNCaP cells.This nanostructure system can be a promising approach for targeted drug delivery and chemoradiotherapy in prostate cancer treatment.

A technique for enhancing tight oil recovery by multi-field reconstruction and combined displacement and imbibition

A seepage-geomechanical coupled embedded fracture flow model has been established for multi-field coupled simulation in tight oil reservoirs,revealing the patterns of change in pressure field,seepage field,and stress field after long-term water injection in tight oil reservoirs.Based on this,a technique for enhanced oil recovery(EOR)combining multi-field reconstruction and combination of displacement and imbibition in tight oil reservoirs has been proposed.The study shows that after long-term water flooding for tight oil development,the pressure diffusion range is limited,making it difficult to establish an effective displacement system.The variation in geostress exhibits diversity,with the change in horizontal minimum principal stress being greater than that in horizontal maximum principal stress,and the variation around the injection wells being more significant than that around the production wells.The deflection of geostress direction around injection wells is also large.The technology for EOR through multi-field reconstruction and combination of displacement and imbibition employs water injection wells converted to production and large-scale fracturing techniques to restructure the artificial fracture network system.Through a full lifecycle energy replenishment method of pre-fracturing energy supplementation,energy increase during fracturing,well soaking for energy storage,and combination of displacement and imbibition,it effectively addresses the issue of easy channeling of the injection medium and difficult energy replenishment after large-scale fracturing.By intensifying the imbibition effect through the coordination of multiple wells,it reconstructs the combined system of displacement and imbibition under a complex fracture network,transitioning from avoiding fractures to utilizing them,thereby improving microscopic sweep and oil displacement efficiencies.Field application in Block Yuan 284 of the Huaqing Oilfield in the Ordos Basin has demonstrated that this technology increases the recovery factor by 12 percentage points,enabling large scale and efficient development of tight oil.

Performance of Gas-Steam Combined Cycle Cogeneration Units Influenced by Heating Network Terminal Steam Parameters

The determination of source-side extracted heating parameters is of great significance to the economic operation of cogeneration systems.This paper investigated the coupling performance of a cogeneration heating and power system multidimensionally based on the operating characteristics of the cogeneration units,the hydraulic and thermodynamic characteristics of the heating network,and the energy loads.Taking a steam network supported by a gas-steam combined cycle cogeneration system as the research case,the interaction effect among the source-side prime movers,the heating networks,and the terminal demand thermal parameters were investigated based on the designed values,the plant testing data,and the validated simulation.The operating maps of the gas-steam combined cycle cogeneration units were obtained using THERMOFLEX,and the minimum source-side steam parameters of the steam network were solved using an inverse solution procedure based on the hydro-thermodynamic coupling model.The cogeneration operating maps indicate that the available operating domain considerably narrows with the rise of the extraction steam pressure and flow rate.The heating network inverse solution demonstrates that the source-side steam pressure and temperature can be optimized from the originally designed 1.11 MPa and 238.8°C to 1.074 MPa and 191.15°C,respectively.Under the operating strategy with the minimum source-side heating parameters,the power peak regulation depth remarkably increases to 18.30%whereas the comprehensive thermal efficiency decreases.The operation under the minimum source-side heating steam parameters can be superior to the originally designed one in the economy at a higher price of the heating steam.At a fuel price of$0.38/kg and the power to fuel price of 0.18 kg/(kW·h),the critical price ratio of heating steam to fuel is 119.1 kg/t.The influence of the power-fuel price ratio on the economic deviation appears relatively weak.

Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery

Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion,representing their morphological relationship in the axial plane.Along with the increasing understanding of hip dysplasia in recent years,numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia.At present,the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery.As an important surgery index,combined femoral and acetabular anteversion have a crucial role in these surgeries.Herein,we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia,total hip replacement,and redirectional hip preservation surgery.

Combined hepatocellular cholangiocarcinoma: A clinicopathological update

Combined hepatocellular-cholangiocarcinoma(cHCC-CCA)is a rare primary liver cancer associated with an appalling prognosis.The diagnosis and manage-ment of this entity have been challenging to physicians,radiologists,surgeons,pathologists,and oncologists alike.The diagnostic and prognostic value of biomarkers such as the immunohistochemical expression of nestin,a progenitor cell marker,have been explored recently.With a better understanding of biology and the clinical course of cHCC-CCA,newer treatment modalities like immune checkpoint inhibitors are being tried to improve the survival of patients with this rare disease.In this review,we give an account of the recent developments in the pathology,diagnostic approach,and management of cHCC-CCA.

Comprehensive Evaluation of Distributed PV Grid-Connected Based on Combined Weighting Weights and TOPSIS-RSR Method

To effectively quantify the impact of distributed photovoltaic(PV)access on the distribution network,this paper proposes a comprehensive evaluation method of distributed PV grid connection combining subjective and objective combination of assignment and technique for order preference by similarity to an ideal solution(TOPSIS)—rank sum ratio(RSR)(TOPSIS-RSR)method.Based on the traditional distribution network evaluation system,a comprehensive evaluation system has been constructed.It fully considers the new development requirements of distributed PV access on the environmental friendliness and absorptive capacity of the distribution grid and comprehensively reflects the impact of distributed PV grid connection.The analytic hierarchy process(AHP)was used to determine the subjective weights of the primary indicators,and the Spearman consistency test was combined to determine the weights of the secondary indicators based on three objective assignment methods.The subjective and objective combination weights of each assessment indicator were calculated through the principle of minimum entropy.Calculate the distance between the indicators to be evaluated and the positive and negative ideal solutions,the relative closeness ranking,and qualitative binning by TOPSIS-RSR method to obtain the comprehensive evaluation results of different scenarios.By setting up different PV grid-connected scenarios and utilizing the IEEE33 node simulation algorithm,the correctness and effectiveness of the proposed subject-object combination assignment and integrated assessment method are verified.

Left atrial appendage occluder detachment treated with transthoracic ultrasound combined with digital subtraction angiography guided catcher:A case report

BACKGROUND There are very few cases of cardiac occluder detachment,and it is rare to completely remove the occluder using interventional methods without undergoing thoracotomy surgery after detachment.This case innovatively used ultrasound guidance combined with digital subtraction angiography(DSA)to completely remove the occluder,accumulating some experience.CASE SUMMARY The patient underwent left atrial appendage occlusion surgery in our hospital due to atrial fibrillation.After the surgery,the occluder fell off and became free in the left ventricle,which is very dangerous.We innovatively used ultrasound guidance,combined with DSA,and interventional surgery to successfully capture the free occluder using a catcher,completely remove it,and then re implant a new left atrial appendage occluder.After the surgery,the patient recovered very well.CONCLUSION The size selection of the occluder is slightly conservative,and the shape of the left atrial appendage opening is irregular.