In heart failure with preserved ejection fraction,significant left ventricular diastolic abnormalities are present,despite a normal systolic ejection fraction.This article will consider whether this is consistent with...In heart failure with preserved ejection fraction,significant left ventricular diastolic abnormalities are present,despite a normal systolic ejection fraction.This article will consider whether this is consistent with the law of conservation of energy,also know as the first law of thermodynamics.展开更多
BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evalu...BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.展开更多
Objective:To determine factors that affect the health-related quality of life(HRQOL)of congestive heart failure(CHF)patients with preserved and reduced ejection fraction.Methods:A cross-sectional study design was used...Objective:To determine factors that affect the health-related quality of life(HRQOL)of congestive heart failure(CHF)patients with preserved and reduced ejection fraction.Methods:A cross-sectional study design was used for this study.The stratified random sampling was applied for each subgroup.HRQOL was measured with the Minnesota Living with Hear t Failure Questionnaire.The data were analyzed using chi-square,Spearman's correlation analysis,and independent t-test.Results:A number of 67 respondents participated in the recent study.The total mean scores of HRQOL were significantly different(P=0.001)between heart failure(HF)patients with reduced and preserved ejection fractions,41.07±7.54 and 54.97±4.36,respectively.It related with the physical(mean±standard deviation[SD]=10.4±2.14;t=-10.08,95%CI=-12.46 to-8.34;P-value=0.001)and psychological(mean±SD=3.5±0.5;t=-6.68,95%CI=-4.55 to-2.45;P-value=0.001)domain.Strong correlation was found between age(r=-0.898,P<0.05),NYHA functional classes(r=-0.858,P<0.01),duration of HF(r=-0.807,P<0.01),family support(r=0.927,P<0.01),and quality of life(Qo L).Conclusions:HRQOL in HF patients with reduced ejection fraction was higher than in those with preserved ejection fraction.Family suppor t is a fur ther determinant factor that has a positive correlation to the Qo L.展开更多
Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the mo...Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the most common type of heart failure in the elderly and its prevalence increases with age and is higher in females at any given age.HFpEF is frequently accompanied of comorbid conditions such as diabetes mellitus,obesity,atrial fibrillation and renal dysfunction.The diagnosis relies in the integration of clinical information,laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise.Conditions that have a specific treatment such as coronary artery disease,valvular disease,cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate.Aggressive management of comorbidities,optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations.There are no specific therapies that have shown to decrease mortality in HFpEF.In symptomatic patients with history of hospital admission for decompensated heart failure,the implantation of a wireless pulmonary artery pressure monitor should be considered.Finally,given the high mortality of this condition,goals of care discussion should be initiated early and involvement of palliative care medicine should be considered.展开更多
micro RNAs(mi RNAs) are powerful regulators of posttranscriptional gene expression and play an important role in pathophysiological processes. Circulating mi RNAs can be quantified in body liquids and are promising bi...micro RNAs(mi RNAs) are powerful regulators of posttranscriptional gene expression and play an important role in pathophysiological processes. Circulating mi RNAs can be quantified in body liquids and are promising biomarkers in numerous diseases. In cardiovascular disease mi RNAs have been proven to be reliable diagnostic biomarkers for different disease entities. In cardiac fibrosis(CF) and heart failure(HF) dysregulated circulating mi RNAs have been identified,indicating their promising applicability as diagnostic biomarkers. Some mi RNAs were successfully tested in risk stratification of HF implementing their potential use as prognostic biomarkers. In this respect mi RNAs might soon be implemented in diagnostic clinical routine. In the young field of mi RNA based research advances have been made in identifying mi RNAs as potential targets for the treatment of experimental CF and HF. Promising study results suggest their potential future application as therapeutic agents in treatment of cardiovascular disease. This article summarizes the current state of the various aspects of mi RNA research in the field of CF and HF with reduced ejection fraction as well as preserved ejection fraction. The review provides an overview of the application of circulating mi RNAs as biomarkers in CF and HF and current approaches to therapeutically utilize mi RNAs in this field of cardiovascular disease.展开更多
Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Va...Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF.Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF.We present a brief overview of the currently recommended therapeutic options with available evidence.展开更多
In this study,we established a dynamic ejection coal burst model for a coalmine roadway subject to stress,and held that the stress concentration zone at the roadway side is the direct energy source of this ejection.Th...In this study,we established a dynamic ejection coal burst model for a coalmine roadway subject to stress,and held that the stress concentration zone at the roadway side is the direct energy source of this ejection.The formation and development of such burst undergoes three stages:(1)instability and propagation of the cracks in the stress concentration zone,(2)emerging of a layered energy storage structure in the zone,and(3)ejection of coal mass or coal burst due to instability.Moreover,we figured out the initial strength of periodic cracks is parallel to the maximal dominant stress direction in the stress concentration zone and derived from the damage strain energy within the finite area of the zone based on the Griffith energy theory.In addition,we analyzed the formation process of the layered energy storage structure in the zone,simplified it as a simply supported restraint sheet,and calculated the minimum critical load and the internally accumulated elastic energy at the instable state.Furthermore,we established a criterion for occurrence of the coal burst based on the variational principle,and analyzed the coal mass ejection due to instability and coal burst induced by different intensity disturbances.At last,with the stratum conditions of Junde Coalmine as the model prototype,we numerically simulated the load displacement distribution of the stress concentration zone ahead of the working face disturbed by the main roof-fracture-induced dynamic load during the mining process as well as their varying characteristics,and qualitatively verified the above model.展开更多
Heart failure(HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of p...Heart failure(HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of patients who have signs or symptoms of HF have preserved left ventricular ejection fraction. This HF type predominantly affects women and the elderly with other co-morbidities, such as diabetes, hypertension, and overt volume status. Most of the current treatment strategies are based on morbidity benefits such as quality of life and reduction of clinical HF symptoms. Treatment of patients with HF with preserved ejection fraction displayed disappointing results from several large randomized controlled trials. The heterogeneity of HF with preserved ejection fraction, understood as complex syndrome, seems to be one of the primary reasons. Here, we present an overview of the current management strategies with available evidence and new therapeutic approach from drugs currently in clinical trials, which target diastolic dysfunction, chronotropic incompetence, and risk factor management. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction.展开更多
Left ventricular ejection fraction(LVEF)is an impor-tant predictor of cardiac outcome and helps in makingimportant diagnostic and therapeutic decisions suchas the treatment of different types of congestive heartfailur...Left ventricular ejection fraction(LVEF)is an impor-tant predictor of cardiac outcome and helps in makingimportant diagnostic and therapeutic decisions suchas the treatment of different types of congestive heartfailure or implantation of devices like cardiac resynchro-nization therapy-defibrillator.LVEF can be measuredby various techniques such as transthoracic echo-cardiography,contrast ventriculography,radionuclidetechniques,cardiac magnetic resonance imaging andcardiac computed tomographic angiography(CTA).Thedevelopment of cardiac CTA using multi-detector rowCT(MDCT)has seen a very rapid improvement in thetechnology for identifying coronary artery stenosis andcoronary artery disease in the last decade.During theacquisition,processing and analysis of data to studycoronary anatomy,MDCT provides a unique opportunityto measure left ventricular volumes and LVEF simulta-neously with the same data set without the need foradditional contrast or radiation exposure.The develop-ment of semi-automated and automated software to measure LVEF has now added uniformity,efficiency and reproducibility of practical value in clinical practice rather than just being a research tool.This article will address the feasibility,the accuracy and the limitations of MDCT in measuring LVEF.展开更多
In pulsed laser drilling, melt ejection greatly influences the keyhole shape and its quality as well, but its mechanism has not been well understood. In this paper, numerical simulation and experimental investigations...In pulsed laser drilling, melt ejection greatly influences the keyhole shape and its quality as well, but its mechanism has not been well understood. In this paper, numerical simulation and experimental investigations based on 304 stainless steel and aluminum targets are performed to study the effects of material parameters on melt ejection. The numerical method is employed to predict the temperatures, velocity fields in the solid, liquid, and vapour front, and melt pool dynamics of targets as well. The experimental methods include the shadow-graphic technique, weight method, and optical microscope imaging, which are applied to real-time observations of melt ejection phenomena, measurements of collected melt and changes of target mass, observations of surface morphology and the cross-section of the keyhole, respectively. Numerical and experimental results show that the metallic material with high thermal diffusivity like aluminum is prone to have a thick liquid zone and a large quantity of melt ejection. Additionally, to the best of our knowledge, the liquid zone is used to illustrate the relations between melt ejection and material thermal diffusivity for the first time. The research result in this paper is useful for manufacturing optimization and quality control in laser-material interaction.展开更多
Background Endogenous aldehyde damages DNA and potentiates an ageing phenotype. The aldehyde dehydrogenase 2(ALDH2) rs671 polymorphism has a prevalence of 30%–50% in Asian populations. In this study, we aimed to anal...Background Endogenous aldehyde damages DNA and potentiates an ageing phenotype. The aldehyde dehydrogenase 2(ALDH2) rs671 polymorphism has a prevalence of 30%–50% in Asian populations. In this study, we aimed to analyze risk factors contributing to the development of heart failure with preserved ejection fraction(HFpEF) along with the genetic exposure in Chinese patients hospitalized with cardiovascular diseases(CVD). Methods From July 2017 to October 2018, a total of 770 consecutive Chinese patients with normal left ventricular ejection fractions(LVEF) and established CVD(hypertension, coronary heart diseases, or diabetes) were enrolled in this prospective cross-sectional study. HFpEF was defined by the presence of at least one of symptom(dyspnoea and fatigue) or sign(rales and ankle swelling) related to heart failure;N-terminal pro-B-Type natriuretic peptide(NT pro-BNP ≥ 280 pg/mL);LVEF ≥ 50%;and at least one criterion related to elevated ventricular filling pressure or diastolic dysfunction(left atrial diameter > 40 mm, E/E’ ≥ 13, E’/A’ < 1 or concurrent atrial fibrillation). Logistic regression was performed to yield adjusted odds ratios(ORs) for HFp EF incidence associated with traditional and/or genetic exposures. Results Finally, among 770 patients with CVD, 92(11.9%) patients were classified into the HFpEF group according to the diagnostic criteria. The mean age of the participants was 67 ± 12 years, and 278(36.1%) patients were females. A total of 303(39.4%) patients were ALDH2*2 variant carriers. In the univariate analysis, eight exposures were found to be associated with HFpEF: atrial fibrillation, ALDH2*2 variants, hypertension, age, anaemia, smoking, alcohol consumption and sex. Multivariable logistic regression showed that 4 ‘A’ variables(atrial fibrillation, ALDH2*2 variants, age and anaemia) were significantly associated with an increased risk of HFpEF. Atrial fibrillation was associated with a 3.8-fold increased HFpEF risk(95% CI: 2.21–6.61, P < 0.001), and the other three exposures associated with increased HFpEF risk were the ALDH2*2 variant(OR = 2.41, 95% CI: 1.49–3.87, P < 0.001), age(OR = 2.14, 95% CI: 1.27–3.60, P = 0.004), and anaemia(OR = 1.79, 95% CI: 1.05–3.03, P = 0.032). These four variables predicted HFpEF incidence in Chinese CVD patients(C-statistic = 0.745, 95% CI: 0.691–0.800, P < 0.001). Conclusions 4 A traits(atrial fibrillation, ALDH2*2 variants, age and anaemia) were associated with an increased risk of HFpEF in Chinese CVD patients. Our results provide potential clues to the aetiology, pathophysiology and therapeutic targets of HFpEF.展开更多
The parachute container cover ejection separation is the first and foremost motion for the return capsule recovery system,which is related to the success of a recovery system.Adopting the computational fluid dynamics(...The parachute container cover ejection separation is the first and foremost motion for the return capsule recovery system,which is related to the success of a recovery system.Adopting the computational fluid dynamics(CFD)simulation and flight dynamics coupling method,the parachute container cover ejection separation is simulated.The rationality of the ejection separation speed and dynamic characteristics of the separation process is analyzed.Meanwhile,the influences of angle of attack,Mach number and ejection separation speed on the parachute container cover ejection are also investigated.Results show that the ejection separation speed design is reasonable.It has a certain design margin for parachute container cover to escape from the wake region,and to pull out the drag parachute completely.The results may provide a theoretical basis for recovery system engineering design of the lunar exploration project.展开更多
The ejection velocity of rock fragments during rock burst, one of the important indexes representing the rock burst strength, is used most conveniently in the supporting design of tunnel with rock burst tendency and i...The ejection velocity of rock fragments during rock burst, one of the important indexes representing the rock burst strength, is used most conveniently in the supporting design of tunnel with rock burst tendency and is often determined by means of observation devices. In order to calculate the average ejection velocity of rock fragments theoretically, the energy of rock burst was divided into damage consuming energy and kinetic energy gained by unit volume of rock firstly, and then the rock burst kinetic proportional coefficient η was brought up which could be determined according to the rock-burst damage energy index W_D , at last the expression of the average ejection velocity of rock fragments during rock burst was obtained and one deep level underground tunnel was researched using the mentioned method. The results show that the calculation method is valid with or without considering the tectonic stress of tunnels, and that the method can be a reference for supporting design of deep mining.展开更多
As for the present situation of coronal mass ejection (CME) triggering models, the distributions of Alfv@n waves in flux ropes are different from model to model, and thus examining those distributions in interplanet...As for the present situation of coronal mass ejection (CME) triggering models, the distributions of Alfv@n waves in flux ropes are different from model to model, and thus examining those distributions in interplanetary coronal mass ejection (ICME) is an effective way to connect ICME observations with these theoretical models of CME triggering. However, previous observations of Alfv@nic fluctuations in ICMEs were rare with locations ranging from 0.3 AU to 0.68 AU only, which is usually explained as rapid dissipation of those remnant waves. Here we present an observation of Alfv@n waves in a magnetic cloud (MC) near 1 AU, in situ detected by WIND in February 17,-~20, 2011. The MC was generated by a CME accompanied with the first X-class flare in the 24th solar cycle. The slope of the power spectral densities of magnetic fluctuation in the MC, are similar to those modes in ambient solar wind, but more anisotropic. The results will also be helpful for studies of CME theories and ICME thermodynamics.展开更多
The molecular biomechanics of DNA ejection from bacteriophage is of interest to not only fundamental biological understandings but also practical applications such as the design of advanced site-specific and controlla...The molecular biomechanics of DNA ejection from bacteriophage is of interest to not only fundamental biological understandings but also practical applications such as the design of advanced site-specific and controllable drug delivery systems. In this paper, we analyze the viscous motion of a semiflexible polymer chain coming out of a strongly confined space as a model to investigate the effects of various structure confinements and frictional resistances encountered during the DNA ejection process. The theoretically predicted relations between the ejection speed, ejection time, ejection length, and other physical parameters, such as the phage type, total genome length and ionic state of external buffer solutions, show excellent agreement with in vitro experimental observations in the literature.展开更多
Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators(ICD), after an efficient risk stratificat...Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators(ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.展开更多
The airborne missile launch mechanism often subjects to significant deformations induced by the large ejection force during high-speed actuations in missile ejection process,leading to a substantial deviation of separ...The airborne missile launch mechanism often subjects to significant deformations induced by the large ejection force during high-speed actuations in missile ejection process,leading to a substantial deviation of separation parameters from designed values that threats safety of the carrier.This study proposes a novel variable topology design for launch mechanism,achieved via a Prsmatic-Revolute-Revolute pair(PR-R)motion formed by the structural gap with a specific direction.It enables launch mechanism variability during missile ejection process and optimizes the ejection force given by the front and back ejection arms,and greatly optimizes the separation parameters during missile ejection.The kinetics simulation analysis is conducted under working conditions of the original ejection mechanism and the novel mechanism with variable topology design,respectively.The results show that the novel variable topology design is more befitting for the launch process in terms of system safety and controllability,effectively improving the separation posture,restraining the flexible effect of the mechanism,and fulfilling the effectiveness of the design value of multi-rigid body.展开更多
Inspired by the finding that the large waiting time of solar flares presents a power-law distribution, we investigate the waiting time distribution (WTD) of coronal mass ejections (CMEs). SOHO/LASCO CME observations f...Inspired by the finding that the large waiting time of solar flares presents a power-law distribution, we investigate the waiting time distribution (WTD) of coronal mass ejections (CMEs). SOHO/LASCO CME observations from 1996 to 2003 are used in this study. It is shown that the observed CMEs have a similar power-law behavior to the flares, with an almost identical power-law index. This strongly supports the viewpoint that solar flares and CMEs are different manifestations of the same physical process. We have also investigated separately the WTDs of fast-type and slow-type CMEs and found that their indices are identical, which imply that both types of CME may originate from the same physical mechanism.展开更多
We revisit the Bastille Day flare/CME Event of 2000 July 14, and demonstrate that this flare/CME event is not related to only one single active region (AR). Activation and eruption of a huge transequatorial filament...We revisit the Bastille Day flare/CME Event of 2000 July 14, and demonstrate that this flare/CME event is not related to only one single active region (AR). Activation and eruption of a huge transequatorial filament are seen to precede the simultaneous filament eruption and flare in the source active region, NOAA AR 9077, and the full halo-CME in the high corona. Evidence of reconfiguration of large-scale magnetic structures related to the event is illustrated by SOHO EIT and Yohkoh SXT observations, as well as, the reconstructed 3D magnetic lines of force based on the force-free assumption. We suggest that the AR filament in AR 9077 was connected to the transequatorial filament. The large-scale magnetic composition related to the transequatorial filament and its sheared magnetic arcade appears to be an essential part of the CME parent magnetic structure. Estimations show that the filament- arcade system has enough magnetic helicity to account for the helicity carried by the related CMEs. In addition, rather global magnetic connectivity, covering almost all the visible range in longitude and a huge span in latitude on the Sun, is implied by the Nan^ay Radioheliograph (NRH) observations. The analysis of the Bastille Day event suggests that although the triggering of a global CME might take place in an AR, a much larger scale magnetic composition seems to be the source of the ejected magnetic flux, helicity and plasma. The Bastille Day event is the first described ex- ample in the literature, in which a transequatorial filament activity appears to play a key role in a global CME. Many tens of halo-CME are found to be associated with transequatorial filaments and their magnetic environment.展开更多
Using Nancay Radioheliograph (NRH) imaging observations, combined with SOHO/Michelson Doppler Imager (MDI) magnetogram observations and coronal magnetic field extrapolation, we studied the magnetic nature of metri...Using Nancay Radioheliograph (NRH) imaging observations, combined with SOHO/Michelson Doppler Imager (MDI) magnetogram observations and coronal magnetic field extrapolation, we studied the magnetic nature of metric noise storms that are associated with coronal mass ejections (CMEs). Four events arc selected: the events of 2000 July 14, 2001 April 26, 2002 August 16 and 2001 March 28. The identified noise storm sources cover or partially cover the active regions (ARs), but the centers of storm sources are offset from the ARs. Using extrapolated magnetic field lines, we find that the noise storm sources trace the boundary between the open and closed field lines. We demonstrate that the disappearance of noise storm source is followed by the appearance of the burst source. The burst sources spread on the solar disk and their distributions correspond to the extent of the CME in LASCO C2 field of view. All the SOHO/Extreme Ultraviolet Imaging Telescope (EIT) dimmings associated with noise storm sources are located at the periphery of noise storms where the magnetic lines of force were previously closed and low-lying. When the closed field becomes partially or fully open, the basic configurations of noise storm sources are changed, then the noise storm sources are no longer observed. These observations provide the information that the variations of noise storms manifest the restructuring or reconfiguring of the coronal magnetic field.展开更多
文摘In heart failure with preserved ejection fraction,significant left ventricular diastolic abnormalities are present,despite a normal systolic ejection fraction.This article will consider whether this is consistent with the law of conservation of energy,also know as the first law of thermodynamics.
基金National Natural Science Foundation of China,No.81873887National Natural Science Foundation of China Youth Project,No.82101981Shanghai Jiao Tong University School of Medicine Double Hundred Outstanding Person Project,No.20191904。
文摘BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.
文摘Objective:To determine factors that affect the health-related quality of life(HRQOL)of congestive heart failure(CHF)patients with preserved and reduced ejection fraction.Methods:A cross-sectional study design was used for this study.The stratified random sampling was applied for each subgroup.HRQOL was measured with the Minnesota Living with Hear t Failure Questionnaire.The data were analyzed using chi-square,Spearman's correlation analysis,and independent t-test.Results:A number of 67 respondents participated in the recent study.The total mean scores of HRQOL were significantly different(P=0.001)between heart failure(HF)patients with reduced and preserved ejection fractions,41.07±7.54 and 54.97±4.36,respectively.It related with the physical(mean±standard deviation[SD]=10.4±2.14;t=-10.08,95%CI=-12.46 to-8.34;P-value=0.001)and psychological(mean±SD=3.5±0.5;t=-6.68,95%CI=-4.55 to-2.45;P-value=0.001)domain.Strong correlation was found between age(r=-0.898,P<0.05),NYHA functional classes(r=-0.858,P<0.01),duration of HF(r=-0.807,P<0.01),family support(r=0.927,P<0.01),and quality of life(Qo L).Conclusions:HRQOL in HF patients with reduced ejection fraction was higher than in those with preserved ejection fraction.Family suppor t is a fur ther determinant factor that has a positive correlation to the Qo L.
文摘Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the most common type of heart failure in the elderly and its prevalence increases with age and is higher in females at any given age.HFpEF is frequently accompanied of comorbid conditions such as diabetes mellitus,obesity,atrial fibrillation and renal dysfunction.The diagnosis relies in the integration of clinical information,laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise.Conditions that have a specific treatment such as coronary artery disease,valvular disease,cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate.Aggressive management of comorbidities,optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations.There are no specific therapies that have shown to decrease mortality in HFpEF.In symptomatic patients with history of hospital admission for decompensated heart failure,the implantation of a wireless pulmonary artery pressure monitor should be considered.Finally,given the high mortality of this condition,goals of care discussion should be initiated early and involvement of palliative care medicine should be considered.
基金Supported by The European Union,Biomar Ca RE,No.HEALTH-2011-278913
文摘micro RNAs(mi RNAs) are powerful regulators of posttranscriptional gene expression and play an important role in pathophysiological processes. Circulating mi RNAs can be quantified in body liquids and are promising biomarkers in numerous diseases. In cardiovascular disease mi RNAs have been proven to be reliable diagnostic biomarkers for different disease entities. In cardiac fibrosis(CF) and heart failure(HF) dysregulated circulating mi RNAs have been identified,indicating their promising applicability as diagnostic biomarkers. Some mi RNAs were successfully tested in risk stratification of HF implementing their potential use as prognostic biomarkers. In this respect mi RNAs might soon be implemented in diagnostic clinical routine. In the young field of mi RNA based research advances have been made in identifying mi RNAs as potential targets for the treatment of experimental CF and HF. Promising study results suggest their potential future application as therapeutic agents in treatment of cardiovascular disease. This article summarizes the current state of the various aspects of mi RNA research in the field of CF and HF with reduced ejection fraction as well as preserved ejection fraction. The review provides an overview of the application of circulating mi RNAs as biomarkers in CF and HF and current approaches to therapeutically utilize mi RNAs in this field of cardiovascular disease.
文摘Heart failure with preserved ejection fraction(HFPEF)is common and represents a major challenge in cardiovascular medicine.Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction.Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF.Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF.We present a brief overview of the currently recommended therapeutic options with available evidence.
基金supported by the Science Foundation of the National Natural Science Foundation of China(Nos.51634001and 51774023)the Fundamental Research Funds for the Central Universities of China(No.FRF-TP-18-007C1)
文摘In this study,we established a dynamic ejection coal burst model for a coalmine roadway subject to stress,and held that the stress concentration zone at the roadway side is the direct energy source of this ejection.The formation and development of such burst undergoes three stages:(1)instability and propagation of the cracks in the stress concentration zone,(2)emerging of a layered energy storage structure in the zone,and(3)ejection of coal mass or coal burst due to instability.Moreover,we figured out the initial strength of periodic cracks is parallel to the maximal dominant stress direction in the stress concentration zone and derived from the damage strain energy within the finite area of the zone based on the Griffith energy theory.In addition,we analyzed the formation process of the layered energy storage structure in the zone,simplified it as a simply supported restraint sheet,and calculated the minimum critical load and the internally accumulated elastic energy at the instable state.Furthermore,we established a criterion for occurrence of the coal burst based on the variational principle,and analyzed the coal mass ejection due to instability and coal burst induced by different intensity disturbances.At last,with the stratum conditions of Junde Coalmine as the model prototype,we numerically simulated the load displacement distribution of the stress concentration zone ahead of the working face disturbed by the main roof-fracture-induced dynamic load during the mining process as well as their varying characteristics,and qualitatively verified the above model.
文摘Heart failure(HF) is the leading cause of hospitalization among older adults and the prevalence is growing with the aging populations in the Western countries. Epidemiologic reports suggest that approximately 50% of patients who have signs or symptoms of HF have preserved left ventricular ejection fraction. This HF type predominantly affects women and the elderly with other co-morbidities, such as diabetes, hypertension, and overt volume status. Most of the current treatment strategies are based on morbidity benefits such as quality of life and reduction of clinical HF symptoms. Treatment of patients with HF with preserved ejection fraction displayed disappointing results from several large randomized controlled trials. The heterogeneity of HF with preserved ejection fraction, understood as complex syndrome, seems to be one of the primary reasons. Here, we present an overview of the current management strategies with available evidence and new therapeutic approach from drugs currently in clinical trials, which target diastolic dysfunction, chronotropic incompetence, and risk factor management. We provide an outline and interpretation of recent clinical trials that failed to improve outcome and survival in patients with HF with preserved ejection fraction.
文摘Left ventricular ejection fraction(LVEF)is an impor-tant predictor of cardiac outcome and helps in makingimportant diagnostic and therapeutic decisions suchas the treatment of different types of congestive heartfailure or implantation of devices like cardiac resynchro-nization therapy-defibrillator.LVEF can be measuredby various techniques such as transthoracic echo-cardiography,contrast ventriculography,radionuclidetechniques,cardiac magnetic resonance imaging andcardiac computed tomographic angiography(CTA).Thedevelopment of cardiac CTA using multi-detector rowCT(MDCT)has seen a very rapid improvement in thetechnology for identifying coronary artery stenosis andcoronary artery disease in the last decade.During theacquisition,processing and analysis of data to studycoronary anatomy,MDCT provides a unique opportunityto measure left ventricular volumes and LVEF simulta-neously with the same data set without the need foradditional contrast or radiation exposure.The develop-ment of semi-automated and automated software to measure LVEF has now added uniformity,efficiency and reproducibility of practical value in clinical practice rather than just being a research tool.This article will address the feasibility,the accuracy and the limitations of MDCT in measuring LVEF.
基金Project supported by the Natural Science Foundation of Jiangsu Province,China(Grant No.KYLX 0341)the National Natural Science Foundation of China(Grant No.61405147)
文摘In pulsed laser drilling, melt ejection greatly influences the keyhole shape and its quality as well, but its mechanism has not been well understood. In this paper, numerical simulation and experimental investigations based on 304 stainless steel and aluminum targets are performed to study the effects of material parameters on melt ejection. The numerical method is employed to predict the temperatures, velocity fields in the solid, liquid, and vapour front, and melt pool dynamics of targets as well. The experimental methods include the shadow-graphic technique, weight method, and optical microscope imaging, which are applied to real-time observations of melt ejection phenomena, measurements of collected melt and changes of target mass, observations of surface morphology and the cross-section of the keyhole, respectively. Numerical and experimental results show that the metallic material with high thermal diffusivity like aluminum is prone to have a thick liquid zone and a large quantity of melt ejection. Additionally, to the best of our knowledge, the liquid zone is used to illustrate the relations between melt ejection and material thermal diffusivity for the first time. The research result in this paper is useful for manufacturing optimization and quality control in laser-material interaction.
基金supported by the he National Natural Science Foundation of China (No. 81770441, No. 81700398, No. 81970309)Nanjing Municipal Healthcare Grant YKK16127
文摘Background Endogenous aldehyde damages DNA and potentiates an ageing phenotype. The aldehyde dehydrogenase 2(ALDH2) rs671 polymorphism has a prevalence of 30%–50% in Asian populations. In this study, we aimed to analyze risk factors contributing to the development of heart failure with preserved ejection fraction(HFpEF) along with the genetic exposure in Chinese patients hospitalized with cardiovascular diseases(CVD). Methods From July 2017 to October 2018, a total of 770 consecutive Chinese patients with normal left ventricular ejection fractions(LVEF) and established CVD(hypertension, coronary heart diseases, or diabetes) were enrolled in this prospective cross-sectional study. HFpEF was defined by the presence of at least one of symptom(dyspnoea and fatigue) or sign(rales and ankle swelling) related to heart failure;N-terminal pro-B-Type natriuretic peptide(NT pro-BNP ≥ 280 pg/mL);LVEF ≥ 50%;and at least one criterion related to elevated ventricular filling pressure or diastolic dysfunction(left atrial diameter > 40 mm, E/E’ ≥ 13, E’/A’ < 1 or concurrent atrial fibrillation). Logistic regression was performed to yield adjusted odds ratios(ORs) for HFp EF incidence associated with traditional and/or genetic exposures. Results Finally, among 770 patients with CVD, 92(11.9%) patients were classified into the HFpEF group according to the diagnostic criteria. The mean age of the participants was 67 ± 12 years, and 278(36.1%) patients were females. A total of 303(39.4%) patients were ALDH2*2 variant carriers. In the univariate analysis, eight exposures were found to be associated with HFpEF: atrial fibrillation, ALDH2*2 variants, hypertension, age, anaemia, smoking, alcohol consumption and sex. Multivariable logistic regression showed that 4 ‘A’ variables(atrial fibrillation, ALDH2*2 variants, age and anaemia) were significantly associated with an increased risk of HFpEF. Atrial fibrillation was associated with a 3.8-fold increased HFpEF risk(95% CI: 2.21–6.61, P < 0.001), and the other three exposures associated with increased HFpEF risk were the ALDH2*2 variant(OR = 2.41, 95% CI: 1.49–3.87, P < 0.001), age(OR = 2.14, 95% CI: 1.27–3.60, P = 0.004), and anaemia(OR = 1.79, 95% CI: 1.05–3.03, P = 0.032). These four variables predicted HFpEF incidence in Chinese CVD patients(C-statistic = 0.745, 95% CI: 0.691–0.800, P < 0.001). Conclusions 4 A traits(atrial fibrillation, ALDH2*2 variants, age and anaemia) were associated with an increased risk of HFpEF in Chinese CVD patients. Our results provide potential clues to the aetiology, pathophysiology and therapeutic targets of HFpEF.
基金Supported by the Aeronautical Science Foundation of China(2012ZC52035)
文摘The parachute container cover ejection separation is the first and foremost motion for the return capsule recovery system,which is related to the success of a recovery system.Adopting the computational fluid dynamics(CFD)simulation and flight dynamics coupling method,the parachute container cover ejection separation is simulated.The rationality of the ejection separation speed and dynamic characteristics of the separation process is analyzed.Meanwhile,the influences of angle of attack,Mach number and ejection separation speed on the parachute container cover ejection are also investigated.Results show that the ejection separation speed design is reasonable.It has a certain design margin for parachute container cover to escape from the wake region,and to pull out the drag parachute completely.The results may provide a theoretical basis for recovery system engineering design of the lunar exploration project.
文摘The ejection velocity of rock fragments during rock burst, one of the important indexes representing the rock burst strength, is used most conveniently in the supporting design of tunnel with rock burst tendency and is often determined by means of observation devices. In order to calculate the average ejection velocity of rock fragments theoretically, the energy of rock burst was divided into damage consuming energy and kinetic energy gained by unit volume of rock firstly, and then the rock burst kinetic proportional coefficient η was brought up which could be determined according to the rock-burst damage energy index W_D , at last the expression of the average ejection velocity of rock fragments during rock burst was obtained and one deep level underground tunnel was researched using the mentioned method. The results show that the calculation method is valid with or without considering the tectonic stress of tunnels, and that the method can be a reference for supporting design of deep mining.
基金supported by National Natural Science Foundation of China (Nos.40974104,40731056,and 10975012)Doctoral Fund of Ministry of Education of China (20090001110012)National Key Basic Research Science Foundation of China (2011CB811400,2009GB105004)
文摘As for the present situation of coronal mass ejection (CME) triggering models, the distributions of Alfv@n waves in flux ropes are different from model to model, and thus examining those distributions in interplanetary coronal mass ejection (ICME) is an effective way to connect ICME observations with these theoretical models of CME triggering. However, previous observations of Alfv@nic fluctuations in ICMEs were rare with locations ranging from 0.3 AU to 0.68 AU only, which is usually explained as rapid dissipation of those remnant waves. Here we present an observation of Alfv@n waves in a magnetic cloud (MC) near 1 AU, in situ detected by WIND in February 17,-~20, 2011. The MC was generated by a CME accompanied with the first X-class flare in the 24th solar cycle. The slope of the power spectral densities of magnetic fluctuation in the MC, are similar to those modes in ambient solar wind, but more anisotropic. The results will also be helpful for studies of CME theories and ICME thermodynamics.
基金supported by the National Natural Science Foundation of China (11032006, 11072094, and 11121202)the PhD Program Foundation of the Ministry of Education of China (20100211110022)+1 种基金New Century Excellent Talents in University (NCET-10-0445)supported by the National Science Foundation through grant CMMI-1028530 to Brown University
文摘The molecular biomechanics of DNA ejection from bacteriophage is of interest to not only fundamental biological understandings but also practical applications such as the design of advanced site-specific and controllable drug delivery systems. In this paper, we analyze the viscous motion of a semiflexible polymer chain coming out of a strongly confined space as a model to investigate the effects of various structure confinements and frictional resistances encountered during the DNA ejection process. The theoretically predicted relations between the ejection speed, ejection time, ejection length, and other physical parameters, such as the phage type, total genome length and ionic state of external buffer solutions, show excellent agreement with in vitro experimental observations in the literature.
文摘Sudden cardiac death threats ischaemic and dilated cardiomyopathy patients. Anti- arrhythmic protection may be provided to these patients with implanted cardiac defibrillators(ICD), after an efficient risk stratification approach. The proposed risk stratifier of an impaired left ventricular ejection fraction has limited sensitivity meaning that a significant number of victims will remain undetectable by this risk stratification approach because they have a preserved left ventricular systolic function. Current risk stratification strategies focus on combinations of non invasive methods like T wave alternans, late potentials, heart rate turbulence, deceleration capacity and others, with invasive methods like the electrophysiologic study. In the presence of an electrically impaired substrate with formed post myocardial infarction fibrotic zones, programmed ventricular stimulation provides important prognostic information for the selection of the patients expected to benefit from an ICD implantation, while due to its high negative predictive value, patients at low risk level may also be detected. Clustering evidence from different research groups and electrophysiologic labs support an electrophysiologic testing guided risk stratification approach for sudden cardiac death.
基金funding support,which is Aerospace Science Foundation(NO.2017ZC12008)。
文摘The airborne missile launch mechanism often subjects to significant deformations induced by the large ejection force during high-speed actuations in missile ejection process,leading to a substantial deviation of separation parameters from designed values that threats safety of the carrier.This study proposes a novel variable topology design for launch mechanism,achieved via a Prsmatic-Revolute-Revolute pair(PR-R)motion formed by the structural gap with a specific direction.It enables launch mechanism variability during missile ejection process and optimizes the ejection force given by the front and back ejection arms,and greatly optimizes the separation parameters during missile ejection.The kinetics simulation analysis is conducted under working conditions of the original ejection mechanism and the novel mechanism with variable topology design,respectively.The results show that the novel variable topology design is more befitting for the launch process in terms of system safety and controllability,effectively improving the separation posture,restraining the flexible effect of the mechanism,and fulfilling the effectiveness of the design value of multi-rigid body.
文摘Inspired by the finding that the large waiting time of solar flares presents a power-law distribution, we investigate the waiting time distribution (WTD) of coronal mass ejections (CMEs). SOHO/LASCO CME observations from 1996 to 2003 are used in this study. It is shown that the observed CMEs have a similar power-law behavior to the flares, with an almost identical power-law index. This strongly supports the viewpoint that solar flares and CMEs are different manifestations of the same physical process. We have also investigated separately the WTDs of fast-type and slow-type CMEs and found that their indices are identical, which imply that both types of CME may originate from the same physical mechanism.
基金Supported by the National Natural Science Foundation of China.
文摘We revisit the Bastille Day flare/CME Event of 2000 July 14, and demonstrate that this flare/CME event is not related to only one single active region (AR). Activation and eruption of a huge transequatorial filament are seen to precede the simultaneous filament eruption and flare in the source active region, NOAA AR 9077, and the full halo-CME in the high corona. Evidence of reconfiguration of large-scale magnetic structures related to the event is illustrated by SOHO EIT and Yohkoh SXT observations, as well as, the reconstructed 3D magnetic lines of force based on the force-free assumption. We suggest that the AR filament in AR 9077 was connected to the transequatorial filament. The large-scale magnetic composition related to the transequatorial filament and its sheared magnetic arcade appears to be an essential part of the CME parent magnetic structure. Estimations show that the filament- arcade system has enough magnetic helicity to account for the helicity carried by the related CMEs. In addition, rather global magnetic connectivity, covering almost all the visible range in longitude and a huge span in latitude on the Sun, is implied by the Nan^ay Radioheliograph (NRH) observations. The analysis of the Bastille Day event suggests that although the triggering of a global CME might take place in an AR, a much larger scale magnetic composition seems to be the source of the ejected magnetic flux, helicity and plasma. The Bastille Day event is the first described ex- ample in the literature, in which a transequatorial filament activity appears to play a key role in a global CME. Many tens of halo-CME are found to be associated with transequatorial filaments and their magnetic environment.
基金Supported by the National Natural Science Foundation of China.
文摘Using Nancay Radioheliograph (NRH) imaging observations, combined with SOHO/Michelson Doppler Imager (MDI) magnetogram observations and coronal magnetic field extrapolation, we studied the magnetic nature of metric noise storms that are associated with coronal mass ejections (CMEs). Four events arc selected: the events of 2000 July 14, 2001 April 26, 2002 August 16 and 2001 March 28. The identified noise storm sources cover or partially cover the active regions (ARs), but the centers of storm sources are offset from the ARs. Using extrapolated magnetic field lines, we find that the noise storm sources trace the boundary between the open and closed field lines. We demonstrate that the disappearance of noise storm source is followed by the appearance of the burst source. The burst sources spread on the solar disk and their distributions correspond to the extent of the CME in LASCO C2 field of view. All the SOHO/Extreme Ultraviolet Imaging Telescope (EIT) dimmings associated with noise storm sources are located at the periphery of noise storms where the magnetic lines of force were previously closed and low-lying. When the closed field becomes partially or fully open, the basic configurations of noise storm sources are changed, then the noise storm sources are no longer observed. These observations provide the information that the variations of noise storms manifest the restructuring or reconfiguring of the coronal magnetic field.