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The Authors’ reply We thank Professor Otto and Dr Bermejo for their interest and astute comments regarding our study.1 The echo frame for determining left ventricular volume at peak aortic velocity is estimated by the measuring the total number of frames from the R wave to the end systole and multiplying this by the fraction of time from the R wave to the peak aortic velocity and from the R wave to the end systole. In the initial report of EF1 in aortic stenosis (AS),2 the intraobserver and interobserver coefficients of variation were 6.7% and 9.8%. We acknowledge that EF1 …

BackgroundBalloon aortic valvuloplasty (BAV) remains a treatment option for the selected patients with severe aortic stenosis. We examined clinical outcomes and predictors of prognosis in patients undergoing BAV for severe aortic stenosis.MethodsWe identified all patients undergoing BAV from January 2010 to March 2018 (n=167) at a single transcatheter aortic valve implantation (TAVI) centre. Patient demographics, investigations, subsequent interventions and clinical outcomes were obtained from electronic health records.ResultsPatients undergoing BAV were elderly (median age 80, IQR 73–86 years) and half (n=87, 52%) were male. All-cause mortality at 30 days and 12 months was 11% and 43%, respectively. Reduce ejection fraction (EF 30%–50%: HR 1.76, 95% CI 1.05 to 2.94; EF ConclusionBAV as a bridge to definitive aortic valve intervention in carefully selected patients offers acceptable outcomes. These contemporary observational findings demonstrate the ongoing potential utility of BAV in the TAVI era.

Aims Valvular heart disease can be identified by calcification on coronary computed tomography angiography (CCTA) and has been associated with adverse clinical outcomes. We assessed aortic and mitral valve calcification in patients presenting with stable chest pain and their association with cardiovascular risk factors, coronary artery disease, and cardiovascular outcomes. Methods and results In 1769 patients (58 ± 9 years, 56% male) undergoing CCTA for stable chest pain, aortic and mitral valve calcification were quantified using Agatston score. Aortic valve calcification was present in 241 (14%) and mitral calcification in 64 (4%). Independent predictors of aortic valve calcification were age, male sex, hypertension, diabetes mellitus, and cerebrovascular disease, whereas the only predictor of mitral valve calcification was age. Patients with aortic and mitral valve calcification had higher coronary artery calcium scores and more obstructive coronary artery disease. The composite endpoint of cardiovascular mortality, non-fatal myocardial infarction, or non-fatal stroke was higher in those with aortic [hazard ratio (HR) 2.87; 95% confidence interval (CI) 1.60–5.17; P Conclusion Aortic and mitral valve calcification occurs in one in six patients with stable chest pain undergoing CCTA and is associated with concomitant coronary atherosclerosis. Whilst valvular calcification is associated with a higher risk of cardiovascular events, this was not independent of the burden of coronary artery disease.

ObjectiveFirst-phase ejection fraction (EF1) is a novel measure of early left ventricular systolic dysfunction. We investigated determinants of EF1 and its prognostic value in aortic stenosis.MethodsEF1 was measured retrospectively in participants of an echocardiography/cardiovascular magnetic resonance cohort study which recruited patients with aortic stenosis (peak aortic velocity of ≥2 m/s) between 2012 and 2014. Linear regression models were constructed to examine variables associated with EF1. Cox proportional hazards were used to determine the prognostic power of EF1 for aortic valve replacement (AVR, performed as part of clinical care in accordance with international guidelines) or death.ResultsTotal follow-up of the 149 participants (69.8% male, 70 (65–76) years, mean gradient 33 (21–42) mm Hg) was 238 029 person-days. Sixty-seven participants (45%) had a low baseline EF1 (2 vs 20.6 (16.8–24.3) mL/m2, p=0.002; late gadolinium enhancement (LGE) prevalence 52% vs 20%, pConclusionEF1 quantifies early, potentially reversible systolic dysfunction in aortic stenosis, is associated with global afterload and myocardial fibrosis, and is an independent predictor of AVR.

ObjectiveCT quantification of aortic valve calcification (CT-AVC) is useful in the assessment of aortic stenosis severity. Our objective was to assess its ability to track aortic stenosis progression compared with echocardiography.MethodsSubjects were recruited in two cohorts: (1) a reproducibility cohort where patients underwent repeat CT-AVC or echocardiography within 4 weeks and (2) a disease progression cohort where patients underwent annual CT-AVC and/or echocardiography. Cohen’s d-statistic (d) was computed from the ratio of annualised progression and measurement repeatability and used to estimate group sizes required to detect annualised changes in CT-AVC and echocardiography.ResultsA total of 33 (age 71±8) and 81 participants (age 72±8) were recruited to the reproducibility and progression cohorts, respectively. Ten CT scans (16%) were excluded from the progression cohort due to non-diagnostic image quality. Scan-rescan reproducibility was excellent for CT-AVC (limits of agreement −12% to 10 %, intraclass correlation (ICC) 0.99), peak velocity (−7% to +17%; ICC 0.92) mean gradient (−25% to 27%, ICC 0.96) and dimensionless index (−11% to +15%; ICC 0.98). Repeat measurements of aortic valve area (AVA) were less reliable (−44% to +28%, ICC 0.85).CT-AVC progressed by 152 (65–375) AU/year. For echocardiography, the median annual change in peak velocity was 0.1 (0.0–0.3) m/s/year, mean gradient 2 (0–4) mm Hg/year and AVA −0.1 (−0.2–0.0) cm2/year. Cohen’s d-statistic was more than double for CT-AVC (d=3.12) than each echocardiographic measure (peak velocity d=0.71 ; mean gradient d=0.66; AVA d=0.59, dimensionless index d=1.41).ConclusionCT-AVC is reproducible and demonstrates larger increases over time normalised to measurement repeatability compared with echocardiographic measures.

Xiyanping Injection is widely used in the treatment of respiratory infectious diseases. However,its package insert is still less instructive for physicians in understanding the specific clinical application of Xiyanping Injection. To discover potential clinical advantages of Xiyanping Injection,the team invited clinical experts of traditional Chinese medicine and western medicine from the field of respiratory diseases,pharmacists and methodologists of evidence-based medicine to compile the consensus. The consensus was based on a combination of clinical research evidence and expert experience,involving recommendations for clinical problems supported by clini-cal evidence as well as consensus suggestions for clinical problems with no clinical evidence. The consensus recommended the indication,timing of intervention,usage,dosage,course of treatment,combined medication of Xiyanping Injection used for adults,and introduced the safety and precautions of its clinical application. It is suitable for guiding clinical medical workers to rationally use Xiyanping Injection in the treatment of adultapos;s respiratory infectious diseases.

This review focuses on the available data regarding the utility of advanced left ventricular (LV) imaging in aortic stenosis (AS) and its potential impact for optimising the timing of aortic valve replacement. Ejection fraction is currently the only LV parameter recommended to guide intervention in AS. The cut-off value of 50%, recommended for decision-making in asymptomatic patients with AS, is currently under debate. Several imaging parameters have emerged as predictors of disease progression and clinical outcomes in this setting. Global longitudinal LV strain by speckle tracking echocardiography is useful for risk stratification of asymptomatic patients with severe AS and preserved LV ejection fraction. Its prognostic value was demonstrated in these patients, but further work is required to define the best thresholds to aid the decision-making process. The assessment of myocardial fibrosis is the most studied application of cardiac magnetic resonance in AS. The detection of replacement fibrosis by late gadolinium enhancement offers incremental prognostic information in these patients. Clinical implementation of this technique to optimise the timing of aortic valve intervention in asymptomatic patients is currently tested in a randomised trial. The use of T1 mapping techniques can provide an assessment of interstitial myocardial fibrosis and represents an expanding field of interest. However, convincing data in patients with AS is still lacking. All these imaging parameters have substantial potential to influence the management decision in patients with AS in the future, but data from randomised clinical trials are awaited to define their utility in daily practice.

Aims To assess contemporary pre-test probability estimates for obstructive coronary artery disease in patients with stable chest pain. Methods and results In this substudy of a multicentre randomized controlled trial, we compared 2019 European Society of Cardiology (ESC)-endorsed pre-test probabilities with observed prevalence of obstructive coronary artery disease on computed tomography coronary angiography (CTCA). We assessed associations between pre-test probability, 5-year coronary heart disease death or non-fatal myocardial infarction and study intervention (standard care vs. CTCA). The study population consisted of 3755 patients (30–75 years, 46% women) with a median pre-test probability of 11% of whom 1622 (43%) had a pre-test probability of >15%. In those who underwent CTCA (n = 1613), the prevalence of obstructive disease was 22%. When divided into deciles of pre-test probability, the observed disease prevalence was similar but higher than the corresponding median pre-test probability [median difference 2.3 (1.3–5.6)%]. There were more clinical events in patients with a pre-test probability >15% compared to those at 5–15% and 15% (2.8% vs. 5.3%, log rank P = 0.01), although this interaction was not statistically significant on multivariable modelling. Conclusion The updated 2019 ESC guideline pre-test probability recommendations tended to slightly underestimate disease prevalence in our cohort. Pre-test probability is a powerful predictor of future coronary events and helps select those who may derive the greatest absolute benefit from CTCA.

Aims To describe the cardiac abnormalities in patients with COVID-19 and identify the characteristics of patients who would benefit most from echocardiography. Methods and results In a prospective international survey, we captured echocardiography findings in patients with presumed or confirmed COVID-19 between 3 and 20 April 2020. Patient characteristics, indications, findings, and impact of echocardiography on management were recorded. Multivariable logistic regression identified predictors of echocardiographic abnormalities. A total of 1216 patients [62 (52–71) years, 70% male] from 69 countries across six continents were included. Overall, 667 (55%) patients had an abnormal echocardiogram. Left and right ventricular abnormalities were reported in 479 (39%) and 397 (33%) patients, respectively, with evidence of new myocardial infarction in 36 (3%), myocarditis in 35 (3%), and takotsubo cardiomyopathy in 19 (2%). Severe cardiac disease (severe ventricular dysfunction or tamponade) was observed in 182 (15%) patients. In those without pre-existing cardiac disease (n = 901), the echocardiogram was abnormal in 46%, and 13% had severe disease. Independent predictors of left and right ventricular abnormalities were distinct, including elevated natriuretic peptides [adjusted odds ratio (OR) 2.96, 95% confidence interval (CI) 1.75–5.05) and cardiac troponin (OR 1.69, 95% CI 1.13–2.53) for the former, and severity of COVID-19 symptoms (OR 3.19, 95% CI 1.73–6.10) for the latter. Echocardiography changed management in 33% of patients. Conclusion In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography. Abnormalities were often unheralded or severe, and imaging changed management in one-third of patients.

Ultrathin nanorods self-assembled porous nanoflowers to form hierarchical mesoporous beta-manganese dioxide (β-MnO2) with extremely high specific surface areas of >400 m2 g−1 are fabricated in high yield at room temperature in a simple 1,2-butanediol/KMnO4 system. As supercapacitor electrodes, specific capacitances of as-prepared β-MnO2 nanoflowers can reach 500-430 F g−1 at a current density of 0.1 A g−1 in 0.5 M Na2SO4 aqueous electrolytes. And greatly enhanced rate capability of 66.4% at 20 A g−1 with a good cycling stability of 95.5% (10 A g−1, after 5000 cycles) is obtained by reducing the particle size of β-MnO2 nanoflowers with well-defined morphologies, which can be achieved by regulating the molar ratios of the reactants. In view of its easy preparation, the as-prepared β-MnO2 is considered as a promising candidate for high-performance supercapacitor electrode material.

Despite recent advances, cardiovascular disease remains the leading cause of death globally. As such, there is a need to optimise our current diagnostic and risk stratification pathways in order to better deliver individualised preventative therapies. Non-invasive imaging of coronary artery plaque can interrogate multiple aspects of coronary atherosclerotic disease, including plaque morphology, anatomy and flow. More recently, disease activity is being assessed to provide mechanistic insights into in vivo atherosclerosis biology. Molecular imaging using positron emission tomography is unique in this field, with the potential to identify specific biological processes using either bespoke or re-purposed radiotracers. This review provides an overview of non-invasive vulnerable plaque detection and molecular imaging of coronary atherosclerosis.

Mesoporous Mn 3 O 4 with 3D network and high specific surface areas have been successfully synthesized at room temperature via a template-free way. Acting as a supercapacitor electrode in 1 M Na 2 SO 4 electrolyte, the sponge-like mesoporous Mn 3 O 4 exhibits high specific capacitances (230~280 F g −1 at 0.5 A g −1 ) as well as greatly improved rate and cycling performance. Their capacitance retentions of ca 52.8% obtained when the current density increasing from 0.5 A g −1 to 30 A g −1 , and a cycle stability reached 98.9% after 5000 cycles at a current density of 2 A g −1 . Furthermore, the high yield, facile and environmental friendly synthetic route allows the mesoporous Mn 3 O 4 preparation to be readily scaled-up. The results indicate that the as-prepared mesoporous Mn 3 O 4 with a 3D cross-link network structure has a great potential as the electrode material for supercapacitors with high electrochemical performance.

Objective: To study the protective effects of Toll-like receptor 4 (TLR4) inhibitor on myocardial injury and lung injury in sepsis rat model. Methods: A total of 18 adult male SD rats were selected as experimental animals and randomly divided into control group, model group and intervention group, with 6 in each group. The sepsis models were established by cecal ligation and given intragastric administration of TLR4 inhibitor C34. Twenty four hours after model establishment, the levels of myocardial injury molecules and lung injury molecules in serum as well as the expression of inflammatory cytokines, the levels of oxidative stress molecules and the expression of apoptosis molecules in myocardial tissue and lung tissue were determined. Results: KL-6, cTnI and CK-MB levels in serum, NF-kB, TNF-α, IL-1β, Bax, Caspase-3 and Caspase-9 mRNA expression as well as MDA and OH﹣ levels in myocardial tissue and lung tissue of model group were significantly higher than those of control group while SOD levels in myocardial tissue and lung tissue were significantly lower than those of control group; KL-6, cTnI and CK-MB levels in serum, NF-kB, TNF-α, IL-1β, Bax, Caspase-3 and Caspase-9 mRNA expression as well as MDA and OH﹣levels in myocardial tissue and lung tissue of intervention group were significantly lower than those of model group while SOD levels in myocardial tissue and lung tissue were significantly higher than those of model group. Conclusions: Toll-like receptor 4 inhibitor has protective effect on myocardial injury and lung injury in model rats with sepsis.

Objective To investigate the protective effects and underlying mechanism of Qingdu decoction (QDD) on experimental rats with severe liver injury induced by thioacetamide (TAA). Methods A total of 40 Wistar rats were randomly divided into normal group ( n = 10) and experimental group ( n = 30). Rats were administrated the same content of saline in normal group. The rats in the experimental group were pretreated with TAA at dose of 12 mg/kg lasting 8 weeks, and from 9th week to 12th week, with TAA at concentration of 36 mg/kg. During the 9th week to 12th week period, the rats were randomly divided into three subgroups ( n = 10 each) simultaneously based on the treatment categories: model group, lactulose (LA, 3.5 mL/kg) group and QDD (5.95 g/kg) group, orally once per day respectively. At the 12th week, the content of serum alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), endotoxin (ET) and tumor necrosis factor Δ (TNF-Δ) was detected by automatic biochemical analyzer. The plasma prothrombin time (PT), prothrombin time-international normalized ratio (PTR) and prothrombin time activity (PTA) were measured by automatic coagulation analyzer. The level of lipopolysaccharide (LPS)-binding protein (LBP), cluster differentiation 14 (CD14) and Toll-like receptor 4 (TLR4) expressions was measured by both western blot (WB) and real-time polymerase chain reaction (real-time PCR). Results Compared with the model group, hepatic morphology in the QDD group was improved under light microscope and transmission electron microscope; at the same time, the contents of serum ALT, AST, TBIL, ET and TNF-Δ, and level of LBP, CD14 and TLR4 expressions in liver tissues were significantly decreased compared with the model group ( P P Conclusion QDD has the functional effect on improving the injured liver through inhibiting the LPS/TLR4 signaling pathway thus decreasing the level of the inflammatory medicators.

This study aims at contributing to the debate opposing results-based utility to procedural utility by evaluating the effect of self-employment on job satisfaction. Data is taken from the second Cameroonian Household Survey (2015). Many propensity scores matching techniques were used in addition to models of qualitative variables which led to the conclusion that self-employed workers are more satisfied with work than employees. This satisfaction is felt despite the fact that self-employment generates low income, almost has no job security and calls for long working hours. The high level of autonomy enjoyed by self-employed workers explains this result, which is in line with the procedural utility approach. Furthermore, this study shows that self-employed workers by necessity are less satisfied than self-employed workers by opportunity, meaning that the level of satisfaction varies.

Hugan Tablets is a Chinese patent medicine,it has the function of anti-inflammation and reducing transaminase. Based on questionnaire investigation of doctors and a systematic review of research literature on Hugan Tablets,using international clinical practice guidelines' developing methods,with the best available evidence and fully combining expert experience,and following the principle of " evidence-based,consensus-based and experience-based",Expert consensus statement on Hugan Tablets in clinical practice was developed by more than 30 multidisciplinary experts from the nationwide,aimed at guiding and standardizing the rational use of Hugan Tablets by clinicians and to improve clinical efficacy and safety. The expert consensus adopts internationally recognized recommendation criteria for classification of evidence: GRADE. The formation of expert consensus adopts the nominal group technique. Six main considerations are quality of evidence,curative effect,safety,economical efficiency,patient acceptability and other factors. If there is sufficient evidence,a " recommendation" is formed,using GRADE grid voting rule. If there isn' t sufficient evidence,a " consensus opinion" is formed,using majority counting rule. Focus on the indication,usage and dosage,drug use in special population and safety of Hugan Tablets,two recommendations and eight consensus opinions were put forward. Through expert meetings and correspondence,a nationwide consultation and peer review was conducted. This consensus applies to clinicians in hospitals and grass-roots health services,to provide guidance and reference for the rational use of Hugan Tablets.

Introduction Despite recent improvements in management, infective endocarditis remains associated with high morbidity and mortality. Over the last few decades, several factors have impacted on both the incidence and outcomes following infective endocarditis. Purpose Using a national linkage approach, we describe the changing age- and sex-stratified incidence and outcomes of infective endocarditis in Scotland over the last 25 years. Methods We conducted a consecutive retrospective individual patient linkage study across multiple national databases. Using data extracted from the Scottish hospital discharge dataset held by the Information Services Division of NHS National Services Scotland, we extracted episodes for all patients aged 20 years or older who were admitted with infective endocarditis between January 1, 1990, and December 31, 2014 in Scotland, UK. Patient episodes with infective endocarditis were linked to national prescribing and microbiology databases. The primary outcome was 1-year mortality following the index presentation. Generalised additive models were constructed to estimate the crude and age- and sex-stratified incidence rates (using a poison distribution) as well as trends in mortality (using a binomial distribution) adjusted for age, sex and comorbidity. Results Across 12,446 individual patients, there were a total of 12,667 hospitalisations (mean age 68±17 years, 55% females) with infective endocarditis using a 5-year look back period. The estimated crude rate of hospitalisation increased from 7.38 per 100,000 (95% CI 6.58 to 8.28) in 1990 to 15.09 per 100,000 (95% CI 13.90 to 16.39) in 2014 (p Conclusions Despite the crude incidence of infective endocarditis doubling over the last 25 years and case fatality remaining high, the risk of death has markedly fallen over the last two decades. Staphylococcus cultures remain an independent marker of poor prognosis in this cohort. Acknowledgement/Funding British Heart Foundation

Objective To study the changes in gray matter volume (GMV) in patients with advanced monocular blindness (MB) using voxel‐based morphometry (VBM). Methods Thirty‐one patients with advanced MB (25 males and six females) and 31 normal controls (25 males and six females) were enrolled. The t test was applied to determine the differences in GMV, white matter volume (WMV), and volume of cerebrospinal fluid in different regions of the brain. The local characteristics of spontaneous concentrations of brain tissue were evaluated by the VBM method. The effects of blindness duration on differences in the GMV were evaluated by correlation and regression analyses. Results Compared with the control group, the GMV was decreased in the upper right margin, bilateral insular cortex, right cingulate gyrus, left occipital gyrus, and right suboccipital lobe, and negatively correlated with blindness duration in the upper right posterior margin, bilateral insular cortex, and right cingulate cortex. Conclusions We found that patients with MB showed abnormal WMV and GMV, as evidenced by local changes in the brain. In addition, reduced GMV in specific parts of the brain was associated with the duration of blindness, which may indicate neuropathological mechanisms of visual loss in patients with MB., Patients with advanced monocular blindness (MB) showed abnormal white matter volume (WMV) and gray matter volume (GMV), as evidenced by local changes in the brain. In addition, reduced GMV in specific parts of the brain was associated with the duration of blindness, which may indicate neuropathological mechanisms of visual loss in patients with MB.

Introduction Cardiac arrest is a major healthcare burden; survival has historically been poor. Contemporary therapies have been associated with improvements in out-of-hospital cardiac arrest survival in other healthcare systems. Purpose To determine temporal trends and predictors of 30-day and overall survival in patients with cardiac arrest who survive to hospital admission in Scotland. Methods We conducted a consecutive individual patient linkage study using data from the Scottish Morbidity Records held by the Information Services Division, National Health Service Scotland. We identified all patients who had an index cardiac arrest hospitalisation from 1st January 1990 to 31st December 2014. The primary outcome was 30-day mortality. Generalised additive models were used to estimate temporal trends. Year of admission was the primary explanatory variable, adjusted for age, sex, comorbidities (stroke, myocardial infarction, heart failure), Scottish Index of Multiple Deprivation (SIMD, a national deprivation score), and angiography within 30 days of admission. Cox regression models were constructed for overall mortality, adjusting for the above variables. Results In total, 47,692 patients had an index hospitalisation with cardiac arrest in Scotland between 1990 and 2014. The mean age was 69±16 years; 45% (n=21,257) were female. Most patients (n=24,867, 52.4%) were in top two SIMD quintiles (greater deprivation). Incidence was lowest in 1990 (27 per 100,000 population), rising until 1998 (47 per 100,000) before declining (mean 30 per 100,000 for 2010–2014) (Figure 1A). Overall rates of angiography and PCI at 30 days were low (5.4% and 3.1% respectively), albeit higher in more recent years (14.1% and 9.6% respectively for 2010–2014). Thirty-day mortality was high but decreased over time (73.7% from 1990–1994 to 63.1% from 2010–2014, p Temporal trends in cardiac arrest Conclusions Hospital episodes with cardiac arrest in Scotland peaked in the late 1990s and have since fallen. Thirty-day mortality remains high, with an improvement over time that is independent of baseline patient characteristics.

To design an oral health self-efficacy scale for patients with dental implants and to evaluate their reliability and validity.Based on literature review, we designed and developed a self-efficacy energy table that met the characteristics of implant patients. The scale consisted of 16 items which were divided into 3 dimensions, including self-efficacy of dental implant surgery, self-efficacy of postoperative supportive care, and self-efficacy of oral hygiene habits. The reliability and validity of the scale were evaluated by factor analysis in 102 outpatients with dental implants using SPSS 13.3 software package.A total of 4 common factors were extracted from the scale, and the cumulative contribution rate was 75.35%. The overall Cronbach's α coefficient of the scale was 0.910, and the retest correlation coefficient was 0.882, which belonged to high-signal scale.The oral health self-efficacy energy scale for implant patients with independent design has high reliability and validity. It can provide targeted guidance for oral health education for implant patients and improve the success rate of implant surgery.

Cardiovascular disease is one of the leading causes of mortality and morbidity worldwide. Atherosclerosis imaging has traditionally focused on detection of obstructive luminal stenoses or ...

CoronaryIn a prospective observational study, patients with multi-vessel coronary artery disease underwent serialThirty patients (90% male, 20 patients with stable coronary artery disease, and 10 with recent type 1 myocardial infarction) underwent paired serial positron emission tomography-coronary computed tomography angiography imaging within an interval of 12±5 days. A mean of 3.7±1.8CoronaryURL: http://www.clinicaltrials.gov. Unique identifiers: NCT02110303 and NCT02278211.

Background: Coronary 18 F-fluoride positron emission tomography identifies ruptured and high-risk atherosclerotic plaque. The optimal method to identify, to quantify, and to categorize increased coronary 18 F-fluoride uptake and determine its reproducibility has yet to be established. This study aimed to optimize the identification, quantification, categorization, and scan-rescan reproducibility of increased 18 F-fluoride activity in coronary atherosclerotic plaque. Methods: In a prospective observational study, patients with multi-vessel coronary artery disease underwent serial 18 F-fluoride positron emission tomography. Coronary 18 F-fluoride activity was visually assessed, quantified, and categorized with reference to maximal tissue to background ratios. Levels of agreement for both visual and quantitative methods were determined between scans and observers. Results: Thirty patients (90% male, 20 patients with stable coronary artery disease, and 10 with recent type 1 myocardial infarction) underwent paired serial positron emission tomography-coronary computed tomography angiography imaging within an interval of 12±5 days. A mean of 3.7±1.8 18 F-fluoride positive plaques per patient was identified after recent acute coronary syndrome, compared with 2.4±2.3 positive plaques per patient in stable coronary artery disease. The bias in agreement in maximum tissue to background ratio measurements in visually positive plaques was low between observers (mean difference, −0.01; 95% limits of agreement, −0.32 to 0.30) or between scans (mean difference, 0.06; 95% limits of agreement, −0.49 to 0.61). Good agreement in the categorization of focal 18 F-fluoride uptake was achieved using visual assessment alone (κ=0.66) and further improved at higher maximum tissue to background ratio values. Conclusions: Coronary 18 F-fluoride activity is a precise and reproducible metric in the coronary vasculature. The analytical performance of 18 F-fluoride is sufficient to assess the prognostic utility of this radiotracer as a noninvasive imaging biomarker of plaque vulnerability. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifiers: NCT02110303 and NCT02278211.

Cardiac MR (CMR) imaging contributes uniquely to the comprehensive assessment and management of aortic stenosis (AS), beyond the information provided by transthoracic echocardiography. The severity of AS and subsequent ventricular remodeling response can be assessed using cine images and phase-contrast mapping. CMR imaging also identifies myocardial tissue characteristics, which are valuable markers of left ventricular decompensation and adverse outcomes in AS. CMR imaging may be used as an alternative modality for transcatheter aortic valve replacement (TAVR) planning and post-TAVR management. This article explores the clinical utility of CMR imaging evaluation.

Introduction High-risk coronary atherosclerotic plaque is associated with higher plasma troponin concentrations suggesting ongoing myocardial injury that may be a target for dual antiplatelet therapy. The aim of this study is to determine whether ticagrelor reduces high-sensitivity troponin I concentrations in patients with established coronary artery disease and high-risk coronary plaque using coronary 18F-fluoride positron emission tomography-computed tomography. Methods In a randomised double-blind placebo-controlled trial, patients with multivessel coronary artery disease underwent coronary 18F-fluoride positron emission tomography-computed tomography and measurement of high-sensitivity cardiac troponin I and were randomised (1:1) to ticagrelor 90 mg twice daily or matched placebo. The primary endpoint was troponin I concentration at 30 days in patients with increased coronary 18F-fluoride uptake. Results In total, 202 patients were randomized and 191 met the pre-specified criteria for inclusion in the primary analysis. In patients with increased coronary 18F-fluoride uptake (n=120/191) there was no evidence that ticagrelor had an effect on plasma troponin concentrations at 30 days (ratio of geometric means for ticagrelor versus placebo, 1.11, [95% confidence interval 0.90 to 1.36], p=0.32). Over 1 year, ticagrelor had no effect on troponin concentrations in patients with increased coronary 18F-fluoride uptake (ratio of geometric means, 0.86, 95% confidence interval 0.63 to 1.17, p=0.33). Conclusion Dual antiplatelet therapy with ticagrelor does not reduce plasma troponin concentrations in patients with coronary 18F-fluoride uptake. This suggests that subclinical plaque thrombosis does not contribute to ongoing myocardial injury in this setting.

Introduction Combined positron emission tomography and computed tomography (PET-CT) using the radiotracer 18F-sodium fluoride (18F-NaF) to detect microcalcification provides imaging of both coronary artery anatomy and disease activity simultaneously. While recent studies have suggested that 18F-NaF activity may help identify high-risk coronary atherosclerosis, the role of 18F-NaF uptake in predicting progression of coronary atherosclerosis is unknown. In this study, we aimed to investigate the relationship between baseline coronary arterial 18F-NaF activity and the subsequent progression of coronary arterial calcification in patients with clinically stable coronary artery disease. Methods Patients with clinically stable, multivessel coronary artery disease underwent combined 18F-NaF PET-CT and CT coronary calcium scoring at baseline with repeat CT coronary calcium scoring at one year. Coronary arterial PET uptake was analysed qualitatively and semi-quantitatively in diseased vessels by measuring maximum tissue-to-background ratio (TBRmax) – defined as the maximum standardised uptake value in a plaque divided by the mean blood pool activity measured in the right atrium. Coronary calcification was quantified by measuring calcium mass (mg), volume (mm3), average calcium density (mg/mm3) and total Agatston score (AU). Results One hundred and eighty-three patients who underwent baseline and repeat imaging at one year were included in the study (81% male, median age 66). Of these participants, 116 (63%) had evidence of increased 18F-NaF activity in at least one vessel. Patients with increased 18F-NaF uptake had a higher total calcium score (524[242–1091] AU), volume (491[247–984], mm3) mass (99[46–212] mg) and average calcium density (0.20[0.18–0.23] mg/mm3) at baseline compared to patients without increased uptake (136[55–361] AU, 131[54–343] mm3, 24[11–69] mg, 0.18[0.16–0.20] mg/mm3; P Conclusion Coronary PET-CT using 18F-NaF identifies patients with a higher calcification burden and predicts progression of coronary arterial calcification at one year. Conflict of Interest none

Brain amyloid-β (Aβ) deposition is a hallmark to define Alzheimer's disease (AD). We investigated the positive rate of brain amyloid deposition assessed with 11C-Pittsburgh compound (PiB)-PET and blood Aβ levels in a cohort of probable AD patients who were diagnosed according to the 1984 NINCDS-ADRDA criteria. Eighty-four subjects with a clinical diagnosis of probable AD dementia, amnestic mild cognitive impairment (MCI), and cognitively normal (CN) status were subjected to PiB-PET and 18F-fluorodeoxyglucose (FDG)-PET scans. Plasma biomarkers of Aβ42, Aβ40, and T-tau were measured using single molecule array technology. The positive rate of PiB-PET, the associations between PiB-PET status and FDG-PET, plasma biomarkers, and clinical manifestations were analyzed. PiB-PET was positive in 77.36% of probable AD patients, 31.80% of MCI patients, and 0 of NC. Plasma Aβ42/Aβ40 ratio was associated with PiB-PET, the ROC curve analysis revealing an AUC of 0.77 (95% CI: 0.66-0.87), with a sensitivity of 82% and specificity of 64%. Some clinical manifestations were associated with PiB-PET imaging. Our findings indicate that only three-fourths of patients diagnosed with probable AD fit the pathological criteria, suggesting that we should be cautious regarding the accuracy of AD diagnosis when no biomarker evidence is available in our clinical practice.

Objectives The goal of this study was to determine whether ticagrelor reduces high-sensitivity troponin I concentrations in patients with established coronary artery disease and high-risk coronary plaque. Background High-risk coronary atherosclerotic plaque is associated with higher plasma troponin concentrations suggesting ongoing myocardial injury that may be a target for dual antiplatelet therapy. Methods In a randomized, double-blind, placebo-controlled trial, patients with multivessel coronary artery disease underwent coronary 18F-fluoride positron emission tomography/coronary computed tomography scanning and measurement of high-sensitivity cardiac troponin I. Patients were randomized (1:1) to receive ticagrelor 90 mg twice daily or matched placebo. The primary endpoint was troponin I concentration at 30 days in patients with increased coronary 18F-fluoride uptake. Results In total, 202 patients were randomized to treatment, and 191 met the pre-specified criteria for inclusion in the primary analysis. In patients with increased coronary 18F-fluoride uptake (120 of 191), there was no evidence that ticagrelor had an effect on plasma troponin concentrations at 30 days (ratio of geometric means for ticagrelor vs. placebo: 1.11; 95% confidence interval: 0.90 to 1.36; p = 0.32). Over 1 year, ticagrelor had no effect on troponin concentrations in patients with increased coronary 18F-fluoride uptake (ratio of geometric means: 0.86; 95% confidence interval: 0.63 to 1.17; p = 0.33). Conclusions Dual antiplatelet therapy with ticagrelor did not reduce plasma troponin concentrations in patients with high-risk coronary plaque, suggesting that subclinical plaque thrombosis does not contribute to ongoing myocardial injury in this setting. (Dual Antiplatelet Therapy to Reduce Myocardial Injury [DIAMOND]; NCT02110303), Central Illustration

Through C-O-Mn bonding, graphene nanosheets are homogeneously dispersed in porous Mn

Despite decades of research and major innovations in technology, cardiovascular disease remains the leading cause of death globally. Our understanding of major cardiovascular events and their prevention is centred around the atherosclerotic plaque and the processes that ultimately lead to acute plaque rupture. Recent advances in hybrid imaging technology allow the combination of high spatial resolution and anatomical detail with molecular assessments of disease activity. This provides the ability to identify vulnerable plaque characteristics and differentiate active and quiescent disease, with the potential to improve patient risk stratification. Combined positron emission tomography and computed tomography is the prototypical non-invasive hybrid imaging technique for coronary artery plaque assessment. In this review we discuss the current state of play in the field of hybrid coronary atherosclerosis imaging.

The increasing generation of toxic heavy metals from smelting activities poses significant threat to food safety, human health, and soil ecosystem, due to their unacceptable exposure risks and long term persistence. As a consequence, heavy metals in soils surrounding smelting areas are often known as causative contaminants for site remediation. According to an extensive review of the scientific literature (2010–2020), this study investigated the current pollution situation of heavy metals in soils near Chinese nonferrous metal smelters. Then, their main source approaches and health risk implications for soil remediation were discussed in detail. It should be noted that, inaccurate risk information would result in high remediation costs and unintended interventions. In addition, recent remediation progress for smelter contaminated sites were mainly introduced. By contrast, limited novel remediation approaches are currently available for stakeholders. Important considerations regarding site remediation technologies were further pointed out to highlight research gaps. Thus, more innovative studies need to be conducted for remediation enhancement of smelter sites. Lastly, this review concluded with an outlook of future research directions, which was expected be great helpful for the broad spectrum of researchers in this field.

Manganese dioxide porous nanoflowers are deemed as a potential supercapacitor electrode material due to its high surface-to-bulk ratio and abundant pore. In this paper, hierarchical porous manganese dioxide (MnO2) self-assembled by particle-size controlled porous nanoflowers with specific surface areas of > 300 m2 g−1 are prepared at room temperature by a simple template-free approach. The formation of porous nanoflowers as well as their particle sizes are found to be determined by the nucleation concentration in initial reaction. And investigation on the electrochemical performance and microstructures demonstrates that the specific capacitance of mesoporous MnO2 with similar crystallizations and morphologies is mainly determined by their specific surface areas (SSAs). And sample with average particle size of 60~80 nm as well as SSA of 380 m2 g−1 and a pore volume of 1.97cc g−1 exhibits the best electrochemical performance, a high specific capacitance of 245 F g−1 with excellent cycling stability of 99.1% after 5000 cycles at 5 A g−1 in 1 M aqueous Na2SO4, due to its well-defined morphology with proper particle size, larger specific surface areas (SSA) and higher pore volume.

In this paper, we reported the measured results of the antenna efficiency, sensitivity, and system noise temperature of the TM65m radio telescope. The key parameters describing a radio astronomy receiving system were introduced at first. Then, we discussed the measurement methods and the measuring errors. Finally, the measured results of the antenna efficiency, sensitivity, and system noise temperature performances at the L, S, C, and X bands were given. The results show that the efficiency and SEFD (System Equivalent Flux Density) decrease dramatically at both low and high elevations when the position of the subreflector is fixed. The antenna efficiencies at the C and X bands can be raised to 60% and more in the whole elevation range when the subreflector (servo) model is activated. The system noise temperature is independent to the subreflector model. Among the four wavebands, the C-band sensitivity and system noise temperature are optimal.