Left atrial appendage (LAA) closure is a new treatment option for the prevention of stroke in patients with nonvalvular atrial fibrillation (AF). Conventional 2-dimensional transesophageal echocardiography (2D TEE) has some limitations in the imaging assessment of LAA closure. Real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) allows for detailed morphologic assessment of the LAA. In this study, we aim to determine the clinical values of RT-3D TEE in the periprocedure of LAA closure.Thirty-eight persistent or paroxysmal AF patients with indications for LAA closure were enrolled in this study. RT-3D TEE full volume data of the LAA were recorded before operation to evaluate the anatomic feature, the landing zone dimension, and the depth of the LAA. On this basis, selection of LAA closure device was carried out. During the procedure, RT-3D TEE was applied to guide the interatrial septal puncture, device operation, and evaluate the occlusion effects. The patients were follow-up 1 month and 3 months postclosure.Twenty-eight (73.7%) patients with AF received placement of LAA occlusion device under RT-3D TEE. Eleven cases with single-lobe LAAs were identified using RT-3D TEE, among which 4 showed limited depth. Seventeen cases showed bilobed or multilobed LAA. Seven cases received LAA closure using Lefort and 21 using LAmbre based on the 3D TEE and radiography. The landing zone dimension of the LAA measured by RT-3D TEE Flexi Slice mode was better correlated with the device size used for occlusion (r = 0.90) than 2D TEE (r = 0.88). The interatial septal puncture, the exchange of the sheath, as well as the release of the device were executed under the guidance of RT-3D TEE during the procedure. The average number of closure devices utilized for optimal plugging was (1.11 ± 0.31). There were no clinically unacceptable residual shunts, pericardial effusion, or tamponade right after occlusion. All the patients had the device well-seated and no evidence of closure related complications in the follow-up.Assessment of LAA morphology by RT-3D TEE contributes to the decision of device selection for the closure. 3D TEE is a reliable imaging modality to guide device operation and assess on-site closure.
Objectives-The purpose of this study was to investigate the technical feasibility and accuracy of applying 3-dimensional (3D) printing of normal and abnormal fetal hearts based on spatiotemporal image correlation (STIC) volume-rendered data. Methods-Spatiotemporal image correlation volume images of 15 healthy fetuses and 15 fetuses with cardiac abnormalities were collected, and Mimics software (Materialise NV, Leuven, Belgium) was used to postprocess the volume data to obtain a 3D digital model of fetal heart and large blood vessel morphologic characteristics and to output the file to a 3D printer for printing the 3D model of the fetal heart and large blood vessels. The effect accuracy of the 3D printed model was qualitatively evaluated by showing the 3D anatomic structure of the model combined with echocardiographic or autopsy results, and the dimensional accuracy of the 3D printed model was quantitatively evaluated by comparing the measured data of the model and echocardiography. Results-In all 30 fetuses, STIC volume data of the fetal heart were successfully reprocessed and printed out, which could visually display the morphologic characteristics of the fetal heart chamber and passage of the great vessels under normal and abnormal pathologic conditions. No significant differences in all of the heart size parameters were found between the 3D digital model, 3D printed model, and routine echocardiographic images (all P > .05). Moreover, the size parameters were concordant well between the methods, and all of the data points fell within the limits of agreement. Conclusions-It is feasible to 3D print the fetal heart using STIC volumetric images as the data source, and the 3D printed model can fully and accurately display abnormal anatomic structures of the heart.
This study aimed to verify the feasibility and efficacy of ultrasound-targeted microbubble destruction (UTMD)-mediated angiopoietin-1 (Ang-1) gene delivery into the infarcted myocardium. Microbubbles carrying anti-intercellular adhesion molecule-1 (ICAM-1) antibody were prepared and identified. The microbubbles carrying anti-ICAM-1 antibody selectively adhered to the interleukin (IL)-1β-stimulated ECV304 cells and to the ischemic vascular endothelium, and the infarct area was examined to evaluate the targeting ability of ICAM-1 microbubbles in vitro and in vivo. The intravenous administration of the Ang-1 gene was carried out by UTMD in rabbits with acute myocardial infarction (AMI). The rabbits were divided into the control (no treatment), non-targeted microbubble destruction (non-TMB) and the ICAM-1 TMB (TMB) group. Gene delivery by direct intramyocardial injection (IMI) served as a reference. Two weeks later, regional myocardial perfusion and cardiac function were evaluated by echocardiography, and Ang-1 gene-mediated angiogenesis was assessed histologically and biochemically. The results revealed that the ICAM-1-targeted microbubbles selectively adhered to the IL-1β-stimulated ECV304 cells in vitro and to the ischemic vascular endothelium in the infarct area of the rabbits with AMI. Two weeks after the delivery of the Ang-1 gene, compared with the non-TMB group, left ventricular function and myocardial perfusion at the infarct area had improved in the TMB and IMI group (p<0.01). Ang-1 gene expression was detectable in the non-TMB, TMB and IMI group, while its expression was higher in the latter 2 groups (all p<0.01). The microvascular density (MVD) of the infarct area in the non-TMB, TMB and IMI group was 65.6±4.4, 96.7±2.1 and 100.7±3.6, respectively (p<0.01). The findings of our study indicate that UTMD-mediated gene delivery may be used to successfully deliver the Ang-1 gene to the infarcted myocardium, thus improving the efficacy of therapeutic angiogenesis. This may provide a novel strategy for future gene therapy.
The novel 3-dimensional printing (3DP) technique has shown its ability to assist personalized cardiac intervention therapy. This study aimed to determine the feasibility of 3D-printed left atrial appendage (LAA) models based on 3D transesophageal echocardiography (3D TEE) data and their application value in treating LAA occlusions.Eighteen patients with transcatheter LAA occlusion, and preprocedure 3D TEE and cardiac computed tomography were enrolled. 3D TEE volumetric data of the LAA were acquired and postprocessed for 3DP. Two types of 3D models of the LAA (ie, hard chamber model and flexible wall model) were printed by a 3D printer. The morphological classification and lobe identification of the LAA were assessed by the 3D chamber model, and LAA dimensions were measured via the 3D wall model. Additionally, a simulation operative rehearsal was performed on the 3D models in cases of challenging LAA morphology for the purpose of understanding the interactions between the device and the model.Three-dimensional TEE volumetric data of the LAA were successfully reprocessed and printed as 3D LAA chamber models and 3D LAA wall models in all patients. The consistency of the morphological classifications of the LAA based on 3D models and cardiac computed tomography was 0.92 (P < .01). The differences between the LAA ostium dimensions and depth measured using the 3D models were not significant from those measured on 3D TEE (P > .05). A simulation occlusion was successfully performed on the 3D model of the 2 challenging cases and compared with the real procedure.The echocardiographic 3DP technique is feasible and accurate in reflecting the spatial morphology of the LAA, which may be promising for the personalized planning of transcatheter LAA occlusion.
Three-dimensional (3D) printing is widely used in medicine. Most research remains focused on forming rigid anatomical models, but moving from static models to dynamic functionality could greatly aid preoperative surgical planning. This work reviews literature on dynamic 3D heart models made of flexible materials for use with a mock circulatory system. Such models allow simulation of surgical procedures under mock physiological conditions, and are; therefore, potentially very useful to clinical practice. For example, anatomical models of mitral regurgitation could provide a better display of lesion area, while dynamic 3D models could further simulate in vitro hemodynamics. Dynamic 3D models could also be used in setting standards for certain parameters for function evaluation, such as flow reserve fraction in coronary heart disease. As a bridge between medical image and clinical aid, 3D printing is now gradually changing the traditional pattern of diagnosis and treatment.
The present study aimed to construct targeted cationic microbubbles (TCMBs) by synthesizing cationic microbubbles conjugated to an intercellular adhesion molecule-1 (ICAM-1) antibody, and then to use the TCMBs to deliver the angiopoietin-1 (Ang-1) gene into infarcted heart tissue using ultrasound-mediated microbubble destruction. It was hypothesized that the TCMBs would accumulate in higher numbers than non-targeted cationic microbubbles (CMBs) in the infarcted heart, and would therefore increase the efficiency of targeted Ang-1 gene transfection and promote angiogenesis. The results of the study demonstrated that the ability of TCMBs to target inflammatory endothelial cells was 18.4-fold higher than that of the CMBs in vitro. The accumulation of TCMBs was greater than that of CMBs in TNF-α-stimulated human umbilical cord veins, indicated by a 212% higher acoustic intensity. In vivo, the TCMBs specifically accumulated in the myocardial infarct area in a rabbit model. Three days after ultrasound microbubble-mediated gene transfection, Ang-1 protein expression in the TCMB group was 2.7-fold higher than that of the CMB group. Angiogenesis, the thickness of the infarct region and the heart function of the TCMB group were all significantly improved compared with those in the CMB and control groups at 4 weeks following gene transfection (all P<0.01). Therefore, the results of the current study demonstrate that ultrasound-mediated TCMB destruction effectively delivered the Ang-1 gene to the infarcted myocardium, resulting in improved cardiac morphology and function in the animal model. Ultrasound-mediated TCMB destruction is a promising strategy for improving gene therapy in the future.
The purpose of this study was mainly to explore the role and mechanism of microRNA-18a-5p (miR-18a-5p) in oral squamous cell carcinoma (OSCC). The expression of miR-18a-5p in OSCC cells and normal cells was firstly detected using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The cell viability, apoptosis, migration and invasion abilities of OSCC cells were determined by MTT, cell apoptosis, wound healing and Transwell assays respectively. Additionally, bioinformatics software analysis and luciferase reporter assays were performed to predict and confirm the candidate target of miR-18a-5p. Western blot analysis was used to assess protein expression. It was revealed that the expression of miR-18a-5p in OSCC cells was higher than that in normal cells. In vitro studies revealed that the cell viability, migration and invasion abilities of OSCC cells were promoted and cell apoptosis was inhibited by miR-18a-5p overexpression. In addition, Smad2 was identified as a target of miR-18a-5p. It was also revealed that miR-18a-5p overexpression significantly inhibited the expression of Smad2, Smad4 and E-cadherin, and the levels of Smad7, collagen I, transforming growth factor-β (TGF-β), α-smooth muscle actin (α-SMA), vimentin were enhanced. While miR-18a-5p downregulation presented the opposite effects. In conclusion, the results indicated that miR-18a-5p can regulate the biological process of OSCC by targeting Smad2 and miR-18a-5p/Smad2 may be potential therapeutic targets for OSCC.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.