Abstract To improve forestry solid waste reuse, reduce building energy consumption, and increase building capacity, preparing lightweight concrete with new materials has gained recent attention. This paper used waste wood and expanded perlite (EP) to design lightweight thermal insulation recycled concrete (LTIRC) with different volume admixtures. Compared to mineral aggregate, wood aggregate (WA) and EP show large differences in water absorption, particle morphology, density, and crushing index. Therefore, this paper comprehensively evaluated the dry density, mechanical properties, thermal properties, chloride ion permeability, and frost resistance of LTIRC. The results showed WA and EP introduction effectively reduced concrete bulk weight and met the dry density standard for lightweight concrete. Regarding thermal insulation performance, both WA and EP are characterized by porous, low–density, and low thermal conductivity. Consequently, LTIRC thermal conductivity was reduced by up to 76.5% versus conventional concrete, effectively increasing resistance to heat flow through concrete and providing potential for building energy savings. Additionally, WA and EP addition caused LTIRC to experience mechanical and durability property deterioration. However, some LTIRCs achieved over 80% of the strength of natural aggregate concrete. Moreover, WA addition inhibited internal crack generation in LTIRC and slowed concrete damage from increased WA and EP dosage. The maximum mass loss of LTIPC was 2.72% after 100 freeze–thaw cycles. LTIPC precast panels are suitable for preparing low–carbon insulated building wall panels.
Objective: To investigate the safety and efficacy of transcatheter aortic valve replacement(TAVR) through transcarotid approach for patients with severe aortic valve stenosis. Methods: The clinical data of 9 symptomatic severe aortic valve stenosis patients who had high or prohibitive risk for surgery and not suitable for TAVR through femoral artery access,and thus received TAVR through transcarotid approach in our hospital from November 2015 to February 2017 were retrospectively analyzed.The patients were followed up to observe the safety and efficacy of the procedure. Results: There were 4 male and 5 female patients in this cohort, and age was (75.7±8.7) years old. The Society of Thoracic Surgery (STS) scores were (7.9±1.6)%. All patients were treated by left carotid artery approach. One patient experienced valve dislodgement during the procedure and received surgery, and TAVR procedure was successful in the rest 8 patients. Two patients were implanted with permanent pacemaker because of third degree atrioventricular block during the procedure.One patient had cardiac arrest during the procedure and recovered after external chest compression.One patient developed severe carotid stenosis,and there was no clinical manifestation of nerve function deficit after the procedure. All patients were followed up at (30±3) days after the procedure, and there were no adverse events. The modified Rankin scale score was 0. Echocardiography examination showed that the tranvalvular mean gradient was reduced from (63.0±19.2)mmHg(1 mmHg=0.133 kPa) on baseline to (18.1±4.9)mmHg(P<0.001), 4 cases had mild paravalvular leakage, and there was no moderate or severe paravalvular leakage.The NYHA classes was significantly improved at 30 days when compared with before the procedure(2 cases class Ⅱ, 4 cases class Ⅲ,3 cases class Ⅳ before the procedure,and 5 cases classⅠ, 4 cases class Ⅱ after the procedure, P=0.006) , and left ventricular ejection fraction increased from (55.9±13.1)% to (60.4±10.0)% (P=0.030). Conclusion: Our initial experience indicates that transcarotid TAVR is safe and effective for patients with severe aortic valve stenosis.目的： 探讨经颈动脉途径行经导管主动脉瓣置换术（TAVR）治疗重度主动脉瓣狭窄的安全性和有效性。 方法： 纳入2015年11月至2017年2月在复旦大学附属中山医院经颈动脉途径行TAVR的症状性重度主动脉瓣狭窄患者（存在外科手术禁忌证或手术风险高危，且不适合经股动脉途径行TAVR）9例，对其临床资料进行回顾性分析。术后对患者进行随访，观察TAVR治疗重度主动脉瓣狭窄的有效性及安全性。 结果： 9例患者中，男性4例，年龄（75.7±8.7）岁，美国胸外科医师协会（STS）评分为（7.9±1.6）%。患者均经左颈动脉途径行TAVR。1例患者在术中发生瓣膜脱落，转行外科手术，其余患者均完成TAVR。2例患者术中因出现Ⅲ度房室传导阻滞，而植入永久起搏器。1例患者术中出现心脏骤停，胸外按压后生命体征恢复稳定。1例患者缝合左颈动脉后造影显示左颈总动脉严重狭窄，术后无神经功能损伤的临床表现。患者随访时间为术后（30±3）d，均未发生不良事件。患者的改良Rankin量表评分均为0分。超声心动图显示，8例成功行TAVR的患者主动脉瓣瓣膜均无反流；主动脉瓣跨瓣压差由术前的（63.0±19.2）mmHg（1 mmHg=0.133 kPa）降低至术后的（18.1±4.9）mmHg（P<0.001）；轻度瓣周漏4例，无中度以上瓣周漏。术后纽约心脏协会（NYHA）心功能分级较术前改善（术前Ⅱ级2例、Ⅲ级4例、Ⅳ级3例，术后Ⅰ级5例、Ⅱ级4例，P=0.006）。左心室射血分数由术前的（55.9±13.1）%升高至术后的（60.4±10.0）%（P=0.030）。 结论： 初步经验表明，对主动脉瓣狭窄患者经颈动脉行TAVR安全、有效。.
The “dual carbon” strategy has drawn attention to distributed PV systems for their flexibility and variability, but the rising need for direct-current (DC) loads on the load side has created additional difficulties for microgrid system upgrades. In this article, a PV-based microgrid design approach for residential buildings is suggested, working on the assumption that distributed PV systems are given top priority to handle domestic DC needs. The residential DC microgrid system’s overall design concept is first put out, and the circuit system is then concentrated to supply the main idea for the ensuing verification of the system’s viability. Secondly, the actual power generation in the selected area was clarified by testing, and then the electricity consumption of DC loads accounted for about 20.03% of the total power consumption according to the survey of 100 users. In addition, the circuit system is subjected to spectral model measurements and physical measurements to verify the operational performance of the circuit system; the feasibility of the PV microgrid system is further verified using dual testing of the PV system and the circuit system. The test results show that the proposed DC microgrid system can accurately provide the required voltage for small household DC appliances, such as 24 V, 14 V, 5 V, etc. Finally, the system economics were analyzed, and the equipment payback years were estimated. The supply and demand of PV power generation and DC appliances can be balanced via the construction of a microgrid. This study offers a fresh concept for the use of PV technology. The concept behind this research can serve as a model for the creation and application of other new energy sources.
Objective: To investigate the effects of transcatheter aortic valve replacement (TAVR) in patients with severe aortic valve stenosis. Methods: The clinical data of 130 patients with severe aortic valve stenosis, who underwent TAVR in our hospital with self-expanding valve between January 1,2010 and October 30, 2016, were analyzed retrospectively. The patients were divided into calcific aortic valve stenosis (CAS) group (112 cases) and non-calcific aortic valve stenosis (NCAS) group (18 cases) according to 3D volume-rendering reconstruction under multiple detector computed tomography before TAVR. The baseline clinical features, imageology results, procedural details, and clinical prognosis were compared between the 2 groups. Results: (1) Compared with CAS group, the patients in NCAS group were younger, had higher proportion of rheumatic heart disease, and less proportion of bicuspid aortic valve morphology (P<0.01 or 0.05). Except for minimum value of sinotubular junction (P=0.017), there were no significant differences in multiple detector computed tomography measurements of aortic valve annulus and aortic root structure between the 2 groups (all P>0.05). (2) Compared with CAS group, the proportions of valve release under rapid pacing and oversized valve release were larger than pre-procedural evaluation, and the proportion of post-dilation was lower in NCAS group (P<0.01 or 0.05). (3) Post-procedural transthoracic echocardiography revealed that left ventricular ejection fraction was higher than baseline level in CAS group (P<0.001), while which was similar in NCAS group (P=0.552). Compared with before TAVR, mean pressure gradient and maximum transvalvular velocity were significantly reduced, aortic valve orifice area was significantly increased, and proportion of moderate to severe aortic regurgitation was significantly reduced after the procedure in both groups (all P<0.01). There were no significant differences in left ventricular ejection fraction, mean pressure gradient, maximum transvalvular velocity, aortic valve orifice area, and proportion of moderate to severe aortic regurgitation after TAVR between the 2 groups (all P>0.05). (4) There were no significant differences in successful rate of device placement and cardiovascular related death within 30 days after TAVR between the 2 groups (105/112 vs. 17/18, P=0.909; 3/112 vs. 1/18, P=0.453, respectively). Conclusion: TAVR is safe and effective for patients with severe aortic valve stenosis.目的： 探讨经导管主动脉瓣置换术（TAVR）治疗重度主动脉瓣狭窄的效果。 方法： 回顾性分析2010年1月1日至2016年10月30日在复旦大学附属中山医院接受TAVR（置入自膨胀式主动脉瓣瓣膜）的130例重度主动脉瓣狭窄患者的临床资料。根据术前多层螺旋CT重建图像，将重度主动脉瓣狭窄患者分为钙化性主动脉瓣狭窄组（112例）和无钙化主动脉瓣狭窄组（18例），对两组患者的临床基线特征、影像学检查结果、手术过程和临床预后进行比较。 结果： （1）与钙化性主动脉瓣狭窄组患者比较，无钙化主动脉瓣狭窄组患者的年龄较小，合并风湿性心脏病的比例较大，二叶式主动脉瓣畸形的比例较小（P<0.01或0.05）。TAVR术前多层螺旋CT显示，除窦管交界直径最小值外（P=0.017），两组患者的主动脉瓣瓣环及主动脉根部参数差异均无统计学意义（P均>0.05）。（2）与钙化性主动脉瓣狭窄组患者比较，无钙化主动脉瓣狭窄组患者快速心室起搏下置入瓣膜和瓣膜型号>术前多层螺旋CT预测的比例均较高，瓣膜释放后行球囊后扩张的比例较低（P<0.01或0.05）。（3）钙化性主动脉瓣狭窄组患者术后左心室射血分数高于术前（P<0.001），无钙化主动脉瓣狭窄组患者手术前后的左心室射血分数差异无统计学意义（P=0.552）；与术前比较，两组患者术后的平均主动脉瓣跨瓣压差和主动脉瓣收缩期最大流速均变小，主动脉瓣瓣口面积均变大，中重度主动脉瓣反流比例均变小（P均<0.01）。TAVR术后，两组患者之间的左心室射血分数、平均主动脉瓣跨瓣压差、主动脉瓣收缩期最大流速、主动脉瓣瓣口面积和中重度主动脉瓣反流比例差异均无统计学意义（P均>0.05）。（4）钙化性主动脉瓣狭窄组与无钙化主动脉瓣狭窄组患者的器械置入成功率和术后30 d内心血管相关死亡事件发生率差异均无统计学意义[分别为105/112比17/18，P=0.909；3/112比1/18，P=0.453]。 结论： TAVR是一种安全、有效的治疗重度主动脉瓣狭窄方法。.
Objectives: To explore the efficacy and safety of emergency transcatheter aortic valve replacement (TAVR). Methods: Data of patients who underwent emergency TAVR in eight centers, namely Fuwai Hospital, Wuhan Asia Heart Hospital, Xijing Hospital, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Guangdong Provincial People's Hospital, Zhongshan Hospital Affiliated to Fudan University, the First Affiliated Hospital of Zhengzhou University, the Second Xiangya Hospital of Central South University, between May 2017 and December 2020 were retrospectively analyzed. The use of mechanical circulatory support system (MCS) and the results of laboratory tests (N-terminal B-type natriuretic peptide (NT-proBNP)) and echocardiography (mean aortic valve cross valve pressure difference and left ventricular ejection fraction) before and after operation were collected. The primary endpoint was all-cause death, and the secondary endpoints were stroke, major bleeding, major vascular complications, myocardial infarction, permanent pacemaker implantation, and acute renal injury. Device success was caculated, which refered to absence of procedural mortality and correct positioning of a single prosthetic heart valve into the proper anatomical location and intended performance of the prosthetic heart valve (mean aortic valve gradient<20 mmHg(1 mmHg=0.133 kPa) or peak velocity<3 m/s, with no moderate or severe prosthetic valve regurgitation). Kaplan-Meier survival curve was used to estimate the survival rate of patients during follow-up. Results: This study included 48 patients. The age was (72.5±8.1) years, and 34 patients were males (70.8%). Device success rate was 91.7% (44/48). The mean aortic valve transvalvular pressure was significantly decreased after operation ((12.3±6.4)mmHg vs. (60.2±23.8)mmHg, P<0.000 1). Left ventricular ejection fraction was significantly increased ((41.5±11.7)% vs. (31.0±11.3)%, P<0.000 1). NT-proBNP significantly decreased (3 492.0 (1 638.8, 7 165.5) ng/L vs. 12 418.5 (6 693.8, 35 000.0) ng/L, P<0.000 1). In-hospital all-cause mortality was 8.3% (4/48). During hospitalization, the rate of stroke was 2.1% (1/48), major bleeding was 6.3% (3/48), major vascular complications was 10.4% (5/48), myocardial infarction was 4.2% (2/48), permanent pacemaker implantation was 6.3% (3/48), and the rate of acute renal injury was 12.5% (6/48). MCS was used in 20 patients (41.7%). The median follow-up time was 196 days. During the follow-up, one patient died (due to systemic metastasis of pancreatic cancer), two cases suffered new myocardial infarction and one case received permanent pacemaker implantation. The survival rate of 30 days, 1 year and 2 years after the operation were 91.7% (44/48), 89.6% (43/48), 89.6% (43/48), respectively. Conclusion: Emergency TAVR may be a safe and effective treatment for patients with severe decompensated aortic valve stenosis.目的： 初步探讨急诊经导管主动脉瓣置换术（TAVR）的有效性及安全性。 方法： 该研究为回顾性研究。入选2017年5月至2020年12月于中国医学科学院阜外医院、广东省人民医院、华中科技大学同济医学院附属协和医院、第四军医大学西京医院、上海复旦大学附属中山医院、武汉亚洲心脏病医院、郑州大学第一附属医院、中南大学湘雅二医院8家中心行急诊TAVR的患者。收集机械循环辅助装置（MCS）使用情况及手术前后实验室检验［N末端B型利钠肽原（NT-proBNP）］及超声心动图检查结果（平均主动脉瓣跨瓣压差、左心室射血分数）。主要终点事件为全因死亡，次要终点事件为卒中、大出血、主要血管并发症、心肌梗死、永久起搏器置入、急性肾损伤。计算器械置入成功率，器械置入成功指患者存活，单个人工主动脉瓣置入位置合适且术后平均主动脉瓣跨瓣压差<20 mmHg（1 mmHg=0.133 kPa）或主动脉瓣峰值流速<3 m/s，同时无中度及以上人工主动脉瓣膜反流。采用Kaplan-Meier生存曲线法估计患者随访期间生存率。 结果： 共纳入48例患者，年龄（72.5±8.1）岁，其中男性34例（70.8%）。器械置入成功率为91.7%（44/48）。全部患者的术后平均主动脉瓣跨瓣压差较术前降低［（12.3±6.4）mmHg比（60.2±23.8）mmHg，P<0.000 1］，左心室射血分数升高［（41.5±11.7）%比（31.0±11.3）%，P<0.000 1］，NT-proBNP下降［3 492.0（1 638.8，7 165.5）ng/L比12 418.5（6 693.8，35 000.0）ng/L，P<0.000 1］。入选患者的院内全因死亡率为8.3%（4/48），住院期间卒中发生率为2.1%（1/48），大出血发生率为6.3%（3/48），主要血管并发症发生率为10.4%（5/48），心肌梗死发生率为4.2%（2/48），永久起搏器置入率为6.3%（3/48），急性肾损伤发生率为12.5%（6/48）。20例患者应用了MCS，使用率达41.7%。中位随访时间196 d，随访期间全因死亡1例（因胰腺癌全身转移），新增心肌梗死2例，置入永久起搏器1例。术后30 d、1年及2年的生存率分别为91.7%（44/48）、89.6%（43/48）、89.6%（43/48）。 结论： 对于急危重症状态的失代偿性主动脉瓣重度狭窄患者，急诊TAVR可能是一种安全有效的治疗手段。.
Objective: To explore the short-term efficacy of fenestrated atrial septal defect (ASD) occulders in the treatment of pulmonary arterial hypertension (PAH). Methods: Thirty-six healthy dogs were divided into the balloon atrial septostomy (BAS)+fenestrated ASD occulders group (n=12), BAS group (n=12) and non-septostomy group (n=12). PAH was induced by intra-atrial injection of dehydrogenized monocrotaline (1.5 mg/kg) in all dogs. Animals in the BAS+fenestrated ASD occulders group underwent atrial septal puncture and fenestrated ASD occulders implantation. Animals in the BAS group underwent balloon atrial septostomy. The non-septostomy group received no surgical intervention. The hemodynamic indexes and blood N-terminal pro-B-type natriuretic peptide (NT-proBNP) of dogs were measured before modeling, 2 months after modeling, 1, 3, and 6 months after surgery, respectively. Echocardiography was performed to observe the patency of the shunt and atrial septostomy of the dogs in the BAS+fenestrated ASD occulders group and BAS group at 1, 3, and 6 months after surgery. Three dogs were sacrificed in each group at 1, 3, and 6 months after surgery, respectively. Atrial septal tissue and fenestrated ASD occulders were removed to observe the patency and endothelialization of the device. Lung tissues were obtained for hematoxylin-eosin (HE) staining to observe the inflammatory cells infiltration and the thickening and narrowing of the pulmonary arterials. Results: Among 36 dogs, 2 dogs died within 24 hours after modeling, and 34 dogs were assigned to BAS+fenestrated ASD occulders group (n=12), BAS group (n=11), and non-septostomy group (n=11). Compared with BAS group, the average right atrial pressure (mRAP) and NT-proBNP of dogs in the BAS+fenestrated ASD occulders group were significantly reduced at 3 months after surgery (P<0.05), and the cardiac output (CO) was significantly increased at 6 months after surgery, arterial oxygen saturation (SaO2) was also significantly reduced (P<0.05). Compared with non-septostomy group, dogs in the BAS+fenestrated ASD occulders group had significantly lower mRAP and NT-proBNP at 1, 3, and 6 months after surgery (P<0.05), and higher CO and lower SaO2 at 6 months after surgery (P<0.05). Compared with the non-septostomy group, the dogs in the BAS group had significantly lower mRAP and NT-proBNP at 1 month after surgery (P<0.05), and there was no significant difference on mRAP and NT-proBNP at 3 and 6 months after surgery (P>0.05). Echocardiography showed that there was a minimal right-to-left shunt in the atrial septum in the BAS group at 1 month after the surgery, and the ostomy was closed in all the dogs in the BAS group at 3 months after the surgery. There was still a clear right-to-left shunt in the dogs of BAS+fenestrated ASD occulders group. The shunt was well formed and satisfactory endothelialization was observed at 1, 3 and 6 months after surgery. The results of HE staining showed that the pulmonary arterials were significantly thickened, stenosis and collapse occurred in the non-septostomy group. Pulmonary microvascular stenosis and inflammatory cell infiltration in the pulmonary arterials were observed in the non-septostomy group. Pulmonary arterial histological results were comparable between BAS+fenestrated ASD occulders group and non-septostomy group at 6 months after surgery.Conclusions: The fenestrated ASD occulder has the advantage of maintaining the open fistula hole for a longer time compared with simple balloon dilation. The fenestrated ASD occulder can improve cardiac function, and it is safe and feasible to treat PAH in this animal model.目的： 初步探讨带孔房间隔分流器治疗肺动脉高压犬模型的短期疗效。 方法： 健康雄性比格犬36只，犬龄1~2岁，采用简单随机抽样法分为经导管球囊扩张房间隔造口术（BAS）+分流器组、BAS组和无造口组3组，每组12只。在犬右心房内注射脱氢野百合碱（1.5 mg/kg），建立肺动脉高压模型。建模成功后，BAS+分流器组犬行BAS，术后置入带孔房间隔分流器，BAS组犬行球囊扩张房间隔造口术，无造口组犬不予任何干预。于建模前，建模后2个月，手术治疗后1、3、6个月，分别测量各组犬的血流动力学指标及血N末端B型利钠肽原（NT-proBNP）水平。于手术治疗后1、3、6个月对BAS组和BAS+分流器组犬行超声心动图检查，观察分流器及房间隔造口的开通情况。于手术治疗后1、3、6个月各组分别处死3只犬，取心脏房间隔组织及房间隔分流器进行大体观察，观察分流器内皮化情况；取肺组织进行苏木素-伊红（HE）染色，观察肺中小血管附近炎症细胞浸润以及肺血管内膜增厚和狭窄的情况。 结果： 2只犬在建模后24 h内死亡，剩余34只犬，其中BAS+分流器组12只、BAS组11只、无造口组11只。与BAS组比较，BAS+分流器组犬手术治疗后3个月平均右心房压力（mRAP）和NT-proBNP较低（P均<0.05），手术治疗后6个月心输出量（CO）较高、动脉血氧饱和度（SaO2）较低（P均<0.05）。与无造口组比较，BAS+分流器组犬手术治疗后1、3和6个月mRAP和NT-proBNP较低（P均<0.05），手术治疗后6个月CO较高、SaO2较低（P均<0.05）。与无造口组比较，BAS组犬手术治疗后1个月mRAP和NT-proBNP较低（P均<0.05），手术治疗后3、6个月mRAP、NT-proBNP差异无统计学意义（P均>0.05）。超声心动图检查结果示，手术治疗后1个月BAS组犬房间隔存在极细束右向左分流，手术治疗后3个月BAS组所有犬的造口基本闭合，手术治疗后1、3、6个月BAS+分流器组犬的分流器处仍存在明显右向左分流，分流器成形良好。大体观察结果示，手术治疗后1个月BAS组犬房间隔处有明显穿刺孔，但手术治疗后3个月时房间隔穿刺孔闭合；手术治疗后6个月BAS+分流器组犬分流器表面内皮化进程良好，边缘无血栓形成。HE染色结果示，无造口组犬肺血管内膜明显增厚，肺血管狭窄，肺泡组织塌陷，周围有大量炎症细胞浸润，肺微小血管闭塞、机化，手术治疗6个月后BAS+分流器组犬肺血管内膜厚度与无造口组相仿。 结论： 采用带孔房间隔分流器治疗肺动脉高压犬模型具有长期维持造口开放的优点，疗效优于单纯球囊扩张。.
Purpose: To date, little is known about the prevalence of Calcific Aortic Valve Disease (CAVD) in Eastern country. Using a large echocardiographic database, the study sought to analyze the prevalence of Aortic Valve Calcification (AVC) and Calcific Aortic Stenosis (CAS) in Chinese population. Methods: This study retrospectively analyzed an echocardiographic database of 287,556 cases in our department from 2004 to 2011. Results: The ratio of AVC increased dramatically with age increasing, from 0.41% in patients <40 years, and 52.32% in patients≥ 65 years to 82.75% in those ≥ 85 years. In patients <65 years, rheumatic disease was the primary cause of aortic vavle stenosis (AS). In patients ≥ 65 years, the primary cause was CAS (about 50%), followed by rheumatic disease. The incidence of CAS in patients≥ 65, 65-84 and ≥ 85 years old was 0.60%, 0.55% and 1.41%, respectively and incidence of severe CAS (SCAS) in patients≥ 65, 65-84 and ≥ 85 years old was 0.17%, 0.16% and 0.34%, respectively (Figure 1). The prevalence rate of CAS in this study population was about 1/3 to 1/2 of that reported from Western community population. Figure 1. Incidence of CAS and SCAS. Conclusion: AVC was very common in Chinese elderly population. CAS may be less common and candidates for transcatheter aortic valve implantation may be much fewer in Chinese population as compared with Western population.
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