Background:Left bundle branch block(LBBB)-induced cardiomyopathy has been proposed,but the association between LBBB and cardiac resynchronization therapy(CRT)response remains unclear and practical criteria for selecti...Background:Left bundle branch block(LBBB)-induced cardiomyopathy has been proposed,but the association between LBBB and cardiac resynchronization therapy(CRT)response remains unclear and practical criteria for selecting CRT candidates are needed.Methods:One hundred and seventeen consecutive heart failure patients were reviewed,24 of whom received CRT.Only two patients had a clear temporal relation between cardiomyopathy and LBBB.Results:Compared with the patient with“cardiomyopathy-induced LBBB,”the patient with“LBBB-induced cardiomyopathy”had higher left ventricular(LV)wall thickness,higher LV wall thickening rate,higher peak circumferential strain,and longer peak circumferential strain delay.The LV deformation patterns in the two patients were obviously distinct on cardiovascular magnetic resonance tissue tracking.During follow-up,the patient with LBBB-induced cardiomyopathy had a good response to CRT(LV ejection fraction 23 before CRT vs.30%at 6 months vs.29 at 12 months vs.32%at 18 months;LV end-diastolic diameter 77 mm before CRT vs.66 mm at 6 months vs.62 mm at 12 months vs.63 mm at 18 months),and the other patient had no response to CRT(LV ejection fraction 29 before CRT vs.29%at 6 months vs.26 at 12 months vs.22%at 24 months;LV end-diastolic diameter 85 mm before CRT vs.88 mm at 6 months vs.85 mm at 12 months vs.84 mm at 24 months).Conclusion:The temporal relation between cardiomyopathy and LBBB could be a determinant for CRT response.Cardiovascular magnetic resonance tissue tracking may be a useful tool to identify the chronological order and a principal consideration for selecting candidates for CRT.Larger prospective clinical trials are needed to study the prevalence of,time course of,and risk factors for LBBB-induced cardiomyopathy.展开更多
Trade-offs between survival and growth are widely observed in plants.Melon is an annual,trailing herb that produces economically valuable fruits that are traditionally cultivated in early spring in China.Melon seedlin...Trade-offs between survival and growth are widely observed in plants.Melon is an annual,trailing herb that produces economically valuable fruits that are traditionally cultivated in early spring in China.Melon seedlings are sensitive to low temperatures,and thus usually suffer from cold stress during the early growth period.However,little is known about the mechanism behind the trade-offs between seedling cold tolerance and fruit quality in melon.In this study,a total of 31 primary metabolites were detected from the mature fruits of eight melon lines that differ with respect to seedling cold tolerance;these included 12 amino acids,10 organic acids,and 9 soluble sugars.Our results showed that concentrations of most of the primary metabolites in the cold-resistant melons were generally lower than in the cold-sensitive melons;the greatest difference in metabolite levels was observed between the cold-resistant line H581 and the moderately cold-resistant line HH09.The metabolite and transcriptome data for these two lines were then subjected to weighted correlation network analysis,resulting in the identification of five key candidate genes underlying the balancing between seedling cold tolerance and fruit quality.Among these genes,CmEAF7 might play multiple roles in regulating chloroplast development,photosynthesis,and the ABA pathway.Furthermore,multi-method functional analysis showed that CmEAF7 can certainly improve both seedling cold tolerance and fruit quality in melon.Our study identified an agriculturally important gene,CmEAF7,and provides a new insight into breeding methods to develop melon cultivars with seedling cold tolerance and high fruit quality.展开更多
Background:Elderly adults with atrial fi brillation(AF)are at increased risk of frailty and thromboembolic complications.However,studies on the prevalence of frailty in AF patients and data on the relationship between...Background:Elderly adults with atrial fi brillation(AF)are at increased risk of frailty and thromboembolic complications.However,studies on the prevalence of frailty in AF patients and data on the relationship between frailty and the use of anticoagulants are limited.Methods:We conducted a cross-sectional study involving 500 participants.Patients aged 65 years or older were consecutively selected from the Chinese Atrial Fibrillation Registry study.The patient’s frailty status was assessed with use of the Canadian Study of Health and Aging Clinical Frailty Scale.We assessed the prevalence of and factors associated with frailty,and how frailty affects anticoagulant therapy.Results:In 500 elderly adults with AF(age 75.2±6.7 years;51.6%female),201 patients(40.2%)were frail.The prevalence of frailty was higher in females(P=0.002)and increased with age and CHA 2 DS 2-VASc score(P for trend less than 0.001 for both).The factors associated with frailty were a history of heart failure(odds ratio[OR]2.40,95%confi dence interval[CI]1.39–4.14),female sex(OR 2.09,95%CI 1.27–3.43),and advanced age(OR 1.13,95%CI 1.09–1.17).Frail patients were signifi cantly less likely to have ever been prescribed anticoagulants compared with nonfrail patients(81.7 vs.54.9%,P<0.001).Conclusions:Frailty is prevalent in elderly adults with AF,especially in females,those of advanced age,and those with heart failure.Frailty status has a signifi cant impact on prescription of anticoagulants for high-risk AF patients.展开更多
Background:Signifi cant left ventricular dysfunction may arise in right-sided accessory pathways with ventricular preexcitation in the absence of recurrent or incessant tachycardia.This has just been realized and not ...Background:Signifi cant left ventricular dysfunction may arise in right-sided accessory pathways with ventricular preexcitation in the absence of recurrent or incessant tachycardia.This has just been realized and not enough attention has been paid to it.Methods:In the last 7 years,we identifi ed 12 consecutive children with a diagnosis of ventricular preexcitation–induced dilated cardiomyopathy.This report describes the clinical and echocardiographic characteristics of the patients before and after ablation.Results:Dyssynchronous ventricular contraction was observed by M-mode echocardiography and two-dimensional strain analysis in all patients.The basal and middle segments of the interventricular septum became thin and moved similarly to an aneurysm,with typical bulging during the end of systole.The locations of the accessory pathways were the right-sided septum(n=5)and the free wall(n=7).Left ventricular synchrony was obtained shortly after ablation.The left ventricular function recovered to normal and the left ventricular end-diastolic diameter decreased gradually during follow-up.Conclusions:A causal relationship between ventricular preexcitation and the development of dilated cardiomyopathy is supported by the complete recovery of left ventricular function and reversed left ventricular remodeling after the loss of ventricular preexcitation.Preexcitation-related dyssynchrony was thought to be the crucial mechanism.Ventricular preexcitation–induced dilated cardiomyopathy is an indication for ablation with a good prognosis.展开更多
Background:Pseudoaneurysm with median nerve injury is a serious complication of radial artery puncture.It is very important to summarize the prevention and treatment experience of this complication through case discus...Background:Pseudoaneurysm with median nerve injury is a serious complication of radial artery puncture.It is very important to summarize the prevention and treatment experience of this complication through case discussion.Case report:A 66-year-old woman was admitted to the hospital because of‘‘paroxysmal chest tightness and suffocation for 5 days.”Coronary angiography was performed.During insertion of the arterial sheath,the patient experienced severe pain in the right forearm,which radiated to the palm.The puncture sheath did not return blood after the sheath core was withdrawn.The sheath was removed and local compression was used to stop bleeding.There was no obvious bleeding at the puncture point,and the compression was removed 6 hours after the procedure.Local swelling and increased tension were seen in the right forearm.At the 1-week follow-up she exhibited swelling,high local tension,small blisters,and bluish-purple skin of the right forearm,with an acceptable right radial artery pulsation.She had severe pain in the affected limb,which radiated to the thumb,index fi nger,and middle fi nger.Case discussion:We discuss the causes of and treatment measures for pseudoaneurysm with median nerve injury caused by radial artery puncture.展开更多
Cardiovascular diseases(CVD)have become the main cause of death and a critical public health burden in contemporary China.I was invited by Dr.Richard Conti,editor in chief of the journal as the vip editor of this is...Cardiovascular diseases(CVD)have become the main cause of death and a critical public health burden in contemporary China.I was invited by Dr.Richard Conti,editor in chief of the journal as the vip editor of this issue focusing on CVD in China.It is my privilege to work with the leading cardiologists and research scientists in the field to delineate the outline of CVD in China,including epidemiology,prevention,rehabilitation,clinical management et al.This issue not only elaborates the major clinical issues but also highlights future perspectives in cardiovascular disease of China.展开更多
The tapered angles of an artery significantly influence the local hemodynamics. However, as gravity is considered, little is known about the effect of tapered angles on the hemodynamics. In this study, we explored whe...The tapered angles of an artery significantly influence the local hemodynamics. However, as gravity is considered, little is known about the effect of tapered angles on the hemodynamics. In this study, we explored whether the effect of tapered angles on the distribution of blood flow pressure (DBFP) differed with gravity considered or not. Numerical simulations of the DBFP in a single vessel were performed based on such tapered angles as 0°, 0.5° and 1°. In the model used for simulation, gravity was introduced as a body force. We obtained the following simulations: i) The larger the tapered angles were, the better distributed the blood flow pressure;ii) The tapered effect was an important factor leading to nonlinearity in blood flow pressure;iii) Gravity affected DBFP coupling with the tapered angles, yet independently influenced the dimension of the DBFP. At the same time, the effective intensity of gravity decreased with the increase of tapered angles.展开更多
Background:People with atrial fibrillation(AF)have elevated risk of developing cognitive impairment.At present,there is a dearth of randomized controlled trials investigating cognitive impairment management in patient...Background:People with atrial fibrillation(AF)have elevated risk of developing cognitive impairment.At present,there is a dearth of randomized controlled trials investigating cognitive impairment management in patients with AF.The Atrial Fibrillation Follow-up Investigation to Recover Memory and learning(AFFIRMING)study is aimed at evaluating the potential for computerized cognitive training to improve cognitive function in patients with AF.Methods:The study is a multi-center,double-blind,randomized controlled study using a 1:1 parallel design.A total of 200 patients with AF and mild cognitive decline without dementia are planned to be recruited.The intervention group will use the adaptive training software with changes in difficulty,whereas the positive control group will use basic training software with minimal or no variation in difficulty level.At the end of 12 weeks,the participants will be unblinded,and the positive control group will stop training.The intervention group will be rerandomized 1:1 to stop training or continue training.All participants will be followed up until 24 weeks.The primary endpoint is the propor-tion of the improvement of the global cognitive function at week 12 compared with baseline,using the Basic Cognitive Ability Test(BCAT).展开更多
Background:Statins,a first-line therapeutic option for atherosclerotic cardiovascular disease(ASCVD),have prompted concerns regarding dysglycemia and diabetes,thus posing a dilemma in treating patients with prediabete...Background:Statins,a first-line therapeutic option for atherosclerotic cardiovascular disease(ASCVD),have prompted concerns regarding dysglycemia and diabetes,thus posing a dilemma in treating patients with prediabetes.Xuezhikang(XZK)decreases blood cholesterol levels without affecting glucose metabolism,and may serve as a potential substitute.Methods:The XTREME study is a prospective,randomized,open-label,multi-center trial evaluating whether XZK 1200 mg/d,compared with atorvastatin 20 mg/d,has favorable effects on HbA1c levels after 24 weeks of treatment in patients with dyslipidemia and prediabetes.After a 1-week run-in period for adherence assessment,the study will ran-domly assign(1:1)392 patients meeting the protocol inclusion criteria to one of two treatment groups:an experimental group(XZK 1200 mg/day)or a control group(atorvastatin 20 mg/day).All participants will be recruited from approxi-mately 20 Chinese medical centers.The last participant is planned to be recruited before December 2023.The primary endpoint will be change in HbA1c level from baseline to 24 weeks,or before anti-diabetic therapy initiation within 24 weeks.The key secondary outcomes will include other biomarkers reflecting blood glucose or lipid metabolism.Discussion:Delaying diabetes is desirable for individuals with prediabetes.The XTREME trial presents a unique oppor-tunity to demonstrate whether XZK might provide an alternative to statins for patients with dyslipidemia and prediabetes.展开更多
Wild bees are ecologically vital but increasingly threatened by anthropogenic activities,leading to uncertain survival and health outcomes in urban environments.The gut microbiome contains features indicating host hea...Wild bees are ecologically vital but increasingly threatened by anthropogenic activities,leading to uncertain survival and health outcomes in urban environments.The gut microbiome contains features indicating host health and reflecting long-term evolutionary adaptation and acute reactions to real-time stressors.Moving beyond bacteria,we propose a comprehensive analysis integrating diet,bacteriome,virome,resistome,and their association to understand the survival status of urban lives better.We conducted a study on mason bees(Osmia excavata)across 10 urban agricultural sites in Suzhou,China,using shotgun gut metagenome sequencing for data derived from total gut DNA.Our findings revealed that most ingested pollen originated from Brassica crops and the unexpected garden tree Plantanus,indicating that floral resources at the 10 sites supported Osmia but with limited plant diversity.Varied city landscapes revealed site-specific flowers that all contributed to Osmia sustenance.The gut bacterial community,dominated by Gammaproteobacteria,showed remarkable structural stability across 8 sites but suggested perturbations at 2 sites.Antibiotic resistance gene profiles highly varied across 10 sites with prevalent unclassified drug classes,highlighting environmental threats to both bees and humans.The virome analysis identified honeybee pathogens,suggesting potential virus spillover.Many unknown bacteriophages were detected,some of which targeted the core gut bacteria,underscoring their role in maintaining gut homeostasis.These multifaceted metagenomic insights hold the potential to predict bee health and identify environmental threats,thereby guiding probiotic development and city management for effective bee conservation.展开更多
Cardiovascular disease is the leading cause of mortality in China.Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prev...Cardiovascular disease is the leading cause of mortality in China.Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prevent the occurrence of cardiovascular events.To promote a healthy lifestyle and enhance the detection,diagnosis,and treatment of cardiovascular risk factors such as hypertension,dyslipidemia,and diabetes,and to improve the overall capacity of primary prevention of cardiovascular disease,the Chinese Society of Cardiology of Chinese Medical Association has collaborated with multiple societies to summarize and evaluate the latest evidence with reference to relevant guidelines and subsequently to develop recommendations for primary cardiovascular disease prevention in Chinese adults.The guideline consists of 10 sections:introduction,methodology for developing the guideline,epidemiology of cardiovascular disease in China and challenges in primary prevention,general recommendations for primary prevention,assessment of cardiovascular risk,lifestyle intervention,blood pressure control,lipid management,management of type 2 diabetes,and use of aspirin.The promulgation and implementation of this guideline will play a key role in promoting the practice of primary prevention for cardiovascular disease in China.展开更多
The coexistence of coronary artery disease(CAD)and atrial fibrillation(AF)is common in clinical practice.Patients with CAD require antiplatelet therapy to reduce the occurrence of myocardial ischemic events.However,pa...The coexistence of coronary artery disease(CAD)and atrial fibrillation(AF)is common in clinical practice.Patients with CAD require antiplatelet therapy to reduce the occurrence of myocardial ischemic events.However,patients with AF at high risk of thromboembolism require oral anticoagulants to reduce the occurrence of thromboembolic events such as stroke.In cases where CAD coexists with AF,the combined use of antiplatelet and anticoagulation therapy can effectively reduce the risk of ischemic and thromboembolic events but increase the risk of bleeding at the same time.The optimal antithrombotic regimen in patients with both CAD and AF has been controversial in clinical practice.In recent years,the expert consensuses on antithrombotic therapy in patients with AF presenting with acute coronary syndrome and/or undergoing percutaneous coronary intervention have been successively released in Europe and North America,and have been updated in a timely manner.In contrast,the guidelines on antithrombotic therapies in China are lacking.Based on published clinical evidence,this consensus incorporated relevant international and Chinese guidelines,consensuses,and expert recommendations,and addressed the issues encountered in the clinical practice of antithrombotic therapy in patients with AF and different types of CAD.The current guideline is of great significance to guide treatment in patients with both CAD and AF in China.展开更多
Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients'quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past 2 decades,th...Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients'quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past 2 decades,there have been significant breakthroughs in AF risk prediction and screening,stroke prevention,rhythm control,catheter ablation,and integrated management.During this period,the scale,quality,and experience of AF management in China have greatly improved,providing a solid foundation for the development of guidelines for the diagnosis and management of AF.To further promote standardized AF management,and apply new technologies and concepts to clinical practice in a timely and comprehensive manner,the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation.The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA,DS,-VASc-60 stroke risk score based on the characteristics of AF in the Asian population.The guidelines have also reevaluated the clinical application of AF screening,emphasized the significance of early rhythm control,and highlighted the central role of catheter ablation in rhythm control.展开更多
Evidence-based treatment strategies for patients with cardiovascular disease and diabetes have been updated in recent years.However,substantial gaps remain between guideline recommendations and clinical practice,which...Evidence-based treatment strategies for patients with cardiovascular disease and diabetes have been updated in recent years.However,substantial gaps remain between guideline recommendations and clinical practice,which justify the urgent need to improve the quality of care for patients with these conditions.The Chinese Society of Cardiology and the Chinese Society of Diabetes,in collaboration with the American Heart Association and the American Diabetes Association,designed the China Diabetes Cardiovascular project.The China Diabetes Cardiovascular project is a nationwide registry study aimed at improving the quality of care for patients with acute coronary syndrome and diabetes in China.Launched in 2021,this project has enrolled 36 hospitals across China's mainland.Patients with a primary discharge diagnosis of comorbid acute coronary syndrome and diabetes will be eligible to participate.Pre-defined performance measures will be adopted to evaluate the quality of care for these patients.Multiple quality improvement strategies will be adopted,including providing monthly quality reports based on these measures,conducting a series of training courses,and distributing educational materials.A comprehensive dataset,encompassing patients’characteristics,medical history,treatment before and during the current hospitalization,and discharge medications for secondary prevention,will be collected through a web-based data collection platform.This project has the potential to improve the quality of care and reduce the care disparities in the management of patients with these diseases.Moreover,with its comprehensive data collection,this project will provide a strong foundation for exploring key clinical questions.展开更多
Ischemic stroke,the second leading cause of human mortality,presents a formidable challenge to healthcare.Following ischemic insult,the brain undergoes intricate pathological transformations,prominently marked by mito...Ischemic stroke,the second leading cause of human mortality,presents a formidable challenge to healthcare.Following ischemic insult,the brain undergoes intricate pathological transformations,prominently marked by mitochondrial damage,including swelling,fission,and mitophagy,collectively termed mitochondrial quality control disorder.Mitochondria,pivotal in energy regulation and oxidative stress modulation,play a critical role in neuronal apoptosis post‐stroke.To solve the problems caused by mitochondrial quality control disorders,mitochondrial transfer has become a new therapeutic strategy for central nervous system diseases.Mitochondrial transfer refers to the process by which certain cell types export their mitochondria and pass them on to other cell types,a process also known as intercellular mitochondrial transfer.Mechanistically,mitochondrial transfer occurs via tunneling nanotubes,extracellular vesicles,and free mitochondrial transfer,exerting multifaceted effects such as anti‐inflammatory,anti‐lipid peroxidation,ferroptosis modulation,and enhancement of mitochondrial metabolism.This review explores the therapeutic efficacy,current obstacles,and future prospects of mitochondrial transfer in ischemic stroke,offering insights to researchers and instilling hope in patients for conquering this debilitating condition.展开更多
Background：Numerous previous studies have shown that renal insufficiency （RI） in patients with acute coronary syndrome is associated with poor cardiovascular outcomes.These studies do not well address the impact of...Background：Numerous previous studies have shown that renal insufficiency （RI） in patients with acute coronary syndrome is associated with poor cardiovascular outcomes.These studies do not well address the impact of RI on the long-term outcome of patients with acute ST-elevation myocardial infarction （STEMI） in China.The aim of this study was to investigate the association of admission RI and inhospital and long-term mortality of patients with acute STEMI.Methods：This was a multicenter,observational,prospective-cohort study.718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI,between January 1,2006 and December 31,2006.Estimation of glomerular filtration rate （eGFR） was calculated using the modified abbreviated modification of diet in renal disease equation-based on the Chinese chronic kidney disease patients.The patients were categorized according to eGFR,as normal renal dysfunction （eGFR ≥ 90 ml·min^-1·1.73 m^-2）,mild RI （60 ml·min^-1· 1.73 m^-2 〈 eGFR 〈 90 ml·min^-1· 1.73 m^2） and moderate or severe RI （eGFR 〈 60 ml·min^-1· 1.73 m^2）.The association between RI and inhospital and 6-year mortality of was evaluated.Results：Seven hundred and eighteen patients with STEMI were evaluated.There were 551 men and 167 women with a mean age of 61.0 ＆#177; 13.0 years.Two hundred and eighty patients （39.0%） had RI,in which 61 patients （8.5%） reached the level of moderate or severe RI.Patients with RI were more often female,elderly,hypertensive,and more patients had heart failure and stroke with higher killip class.Patients with RI were less likely to present with chest pain.The inhospital mortality （1.4% vs.5.9% vs.22.9%,P 〈 0.001）,6-year all-cause mortality （9.5% vs.19.8 vs.45.2%,P 〈 0.001） and 6-year cardiac mortality （2.9% vs.12.2% vs.23.8%,P 〈 0.001） were markedly increased in patients with RI.After adjusting for other confounding factors,classification of admission renal function was an independent predictor of inhospital mortality （Odd ratio,1.966; 95% confidence interval [CO,1.002-3.070,P =0.019）,6-year all-cause mortality （relative risk [RR] =1.501,95% CI：1.018-4.373,P =0.039） and 6-year cardiac mortality （RR =1.663,95% CI：1.122-4.617,P =0.042）.Conclusions：RI is very common in STEMI patients.RI evaluated by eGFR is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.展开更多
Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this stud...Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation(CCC-AF)registry,guideline-recommended OAC use in eligible patients was assessed.Results:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019,of whom 38,203 were at a high risk of stroke,9717 were at a moderate risk,and 4610 were at a low risk.On admission,only 20.0%(6075/30,420)of patients with a diagnosed AF and a high risk of stroke were taking OAC.The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population(adjusted odds ratio:0.54,95%confidence interval:0.43-0.68;P<0.001).At discharge,the prescription rate of OAC was 45.2%(16,757/37,087)in eligible patients with high stroke risk and 60.7%(2778/4578)in eligible patients with low stroke risk.OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time(all P<0.001).Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies,including catheter ablation(adjusted odds ratio[OR]11.63,95%confidence interval[CI]10.04-13.47;P<0.001),electronic cardioversion(adjusted OR 2.41,95%CI 1.65-3.51;P<0.001),and anti-arrhythmic drug use(adjusted OR 1.45,95%CI 1.38-1.53;P<0.001).Conclusions:In hospitals participated in the CCC-AF project,>70%of AF patients were at a high risk of stroke.Although poor performance on guideline-recommended OAC use was found in this study,over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov,NCT02309398.展开更多
Cardiovascular diseases(CVDs)have been recognized as the leading cause of death worldwide.It is estimated that CVDs led to 17.8 million deaths worldwide in 2017,increased by 21.1%from 2007.[1]China is one of the count...Cardiovascular diseases(CVDs)have been recognized as the leading cause of death worldwide.It is estimated that CVDs led to 17.8 million deaths worldwide in 2017,increased by 21.1%from 2007.[1]China is one of the countries that have the highest burden of CVDs with stroke and ischemic heart disease being the top two overall causes of deaths in China.[2]The massive population with CVDs,the high mortality rate and disability rate,and the great burden to the society and the economy have significantly promoted investments in CVDs research globally,making it the fastest growing discipline in the medical field.展开更多
Background:The age,biomarkers,and clinical history(ABC)-atrial fibrillation(AF)-Stroke score have been proposed to refine stroke risk stratification,beyond what clinical risk scores such as the CHA2DS2-VASc score can ...Background:The age,biomarkers,and clinical history(ABC)-atrial fibrillation(AF)-Stroke score have been proposed to refine stroke risk stratification,beyond what clinical risk scores such as the CHA2DS2-VASc score can offer.This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations.Methods:A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry(CAFR)between 2013 and 2019 were included.Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk.The ABC-AF-Stroke score was evaluated in terms of discrimination,including concordance index(C-index),net reclassification improvement(NRI)and integrated discrimination improvement(IDI),clinical utilization by decision curve analysis(DCA),and calibration by comparing the predicted risk with the observed annualized event rate.Results:After a median follow-up of 3.5 years,64 patients experienced thromboembolism events.Age,prior history of stroke/transient ischemic attack(TIA),high-sensitivity cardiac troponin T(cTnT-hs),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were independently associated with thromboembolism risk.The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index(0.67,95%confidence interval[CI]:0.59-0.74 vs.0.60,95%CI:0.52-0.67,P=0.030)and reclassification capacity.The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score.The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population.Conclusions:In this real-world study enrolling non-anticoagulated AF patients following successful ablations,age,prior history of stroke/TIA,level of NT-proBNP,and cTnT-hs were independently associated with an increased risk of thromboembolism.The ABC-AF-Stroke score was well-calibrated and statistically significantly outperformed the CHA2DS2-VASc score in predicting thromboembolism risk.展开更多
Objective:The long QT syndrome type 2 is caused by the loss-of-function mutations in the KCNH2 gene,which encodes hERG1,the voltage-gated potassium channel.The hERG1 channels conduct rapid delayed rectifier K^(+)curre...Objective:The long QT syndrome type 2 is caused by the loss-of-function mutations in the KCNH2 gene,which encodes hERG1,the voltage-gated potassium channel.The hERG1 channels conduct rapid delayed rectifier K^(+)currents(I_(Kr))in the human cardiac tissue.KCNH2 encodes 2 main isoforms-hERG1a and hERG1b,which assemble to form the homomeric or heteromeric hERG1 channels.However,the functional characteristics of the heteromeric hERG1 channels in long QT syndrome type 2 are not clear.In this study,a novel mutation in the N-terminus of hERG1a(F129l)was identified in a proband of long QT syndrome type 2.The purpose of this study was to identify the electrophysiological change of homomeric and heteromeric hERG1 channels with theF129l-hERG1a.Methods:Candidate genes were screened by direct sequencing.F129l-hERG1a was cloned in the pcDNA3.1 vector by site-directed mutagenesis.Then,the wild-type(WT)hERG1a and/or F129l-hERG1a were transiently expressed in the HEK293 cells with or without hERG1b co-expression.The expression levels of the transgenes,cellular distribution of hERG1a and hERG1b,and the electrophysiological features of the homomeric and the heteromeric hERG1 channels with the WT-hERG1a or F129l-hERG1a were analyzed using whole-cell patch-clamp electrophysiology,western blotting,and immunofluorescence techniques.Results:The proband was clinically diagnosed with long QT syndrome type 2 and carried a heterozygous mutation c.385T>A(F1291)in the KCNH2 gene.Electrophysiology study proved that the F129l substitution in hERG1a significantly decreased I_(Kr) in both the homomeric and heteromeric hERG1channels by 86%and 70%,respectively(WT-hERG1a(54.88±18.74)pA/pF vs.F129l-hERG1a(7.34±1.90)pA/pF,P<0.001;WT-hERG1a/hERG1b(89.92±24.51)pA/pF vs.F129l-hERG1a/hERG1b(26.54±9.83)pA/pF,P<0.001).The voltage dependence of I_(Kr) activation(V_(1/2) and k)was not affected by the mutation in both the homomeric and heteromeric hERG1 channels.The peak current densities and the kinetic characteristics of I_(Kr) were comparable for both WT/F129l-hERG1a and WT-hERG1a.The channel inactivation and deactivation analysis showed that F129l substitution did not affect deactivation of the homomeric hERG1a channel,but significantly accelerated the deactivation and recovery from inactivation of the heteromeric hERG1a/hERG1b channel based on the time constants of fast and slow recovery from deactivation F129l-hERG1a/hERG1b vs.WT-hERG1a/hERG1b(P<0.05).Western blotting and immunofluorescence labeling experiments showed that maturation and intracellular trafficking of the F129l-hERG1a protein was impaired and potentially increased the ratio of hERG1b to hERG1a in the F129l-hERG1a/hERG1b tetramer channel,thereby resulting in electrophysiological changes characteristic of the long QT syndrome type 2 pathology.Conclusions: I_(Kr) Was significantly reduced in the homomeric and heteromeric hERG1 channels with F129l-hERG1a.The F129l mutation significantly accelerated the deactivation and recovery from inactivation of the heteromeric F129l-hERG1a/hERG1b channel.F129l-hERG1a exhibited impaired maturation and intracellular trafficking,thereby potentially increasing the ratio of the hERG1b to hERG1a stoichiometry in the hERG1 tetrameric channel.These changes demonstrated the importance of the heteromeric hERG1 channel in long QT syndrome type 2 pathophysiology.展开更多
基金the Ministry of Science and Technology of the People’s Republic of China(grants 2016YFC1301000 and 2016YFC0900900).
文摘Background:Left bundle branch block(LBBB)-induced cardiomyopathy has been proposed,but the association between LBBB and cardiac resynchronization therapy(CRT)response remains unclear and practical criteria for selecting CRT candidates are needed.Methods:One hundred and seventeen consecutive heart failure patients were reviewed,24 of whom received CRT.Only two patients had a clear temporal relation between cardiomyopathy and LBBB.Results:Compared with the patient with“cardiomyopathy-induced LBBB,”the patient with“LBBB-induced cardiomyopathy”had higher left ventricular(LV)wall thickness,higher LV wall thickening rate,higher peak circumferential strain,and longer peak circumferential strain delay.The LV deformation patterns in the two patients were obviously distinct on cardiovascular magnetic resonance tissue tracking.During follow-up,the patient with LBBB-induced cardiomyopathy had a good response to CRT(LV ejection fraction 23 before CRT vs.30%at 6 months vs.29 at 12 months vs.32%at 18 months;LV end-diastolic diameter 77 mm before CRT vs.66 mm at 6 months vs.62 mm at 12 months vs.63 mm at 18 months),and the other patient had no response to CRT(LV ejection fraction 29 before CRT vs.29%at 6 months vs.26 at 12 months vs.22%at 24 months;LV end-diastolic diameter 85 mm before CRT vs.88 mm at 6 months vs.85 mm at 12 months vs.84 mm at 24 months).Conclusion:The temporal relation between cardiomyopathy and LBBB could be a determinant for CRT response.Cardiovascular magnetic resonance tissue tracking may be a useful tool to identify the chronological order and a principal consideration for selecting candidates for CRT.Larger prospective clinical trials are needed to study the prevalence of,time course of,and risk factors for LBBB-induced cardiomyopathy.
基金Thisworkwas supported by the National Natural Science Foundation of China(Grant numbers 31872101 and 32072564)the Henan Special Funds for Major Science and Technology(221100110400)+1 种基金the Excellent Youth Foundation of Henan Scientific Committee(222300420009)the Foundation for Young Talents of Henan Agricultural University(30500728).
文摘Trade-offs between survival and growth are widely observed in plants.Melon is an annual,trailing herb that produces economically valuable fruits that are traditionally cultivated in early spring in China.Melon seedlings are sensitive to low temperatures,and thus usually suffer from cold stress during the early growth period.However,little is known about the mechanism behind the trade-offs between seedling cold tolerance and fruit quality in melon.In this study,a total of 31 primary metabolites were detected from the mature fruits of eight melon lines that differ with respect to seedling cold tolerance;these included 12 amino acids,10 organic acids,and 9 soluble sugars.Our results showed that concentrations of most of the primary metabolites in the cold-resistant melons were generally lower than in the cold-sensitive melons;the greatest difference in metabolite levels was observed between the cold-resistant line H581 and the moderately cold-resistant line HH09.The metabolite and transcriptome data for these two lines were then subjected to weighted correlation network analysis,resulting in the identification of five key candidate genes underlying the balancing between seedling cold tolerance and fruit quality.Among these genes,CmEAF7 might play multiple roles in regulating chloroplast development,photosynthesis,and the ABA pathway.Furthermore,multi-method functional analysis showed that CmEAF7 can certainly improve both seedling cold tolerance and fruit quality in melon.Our study identified an agriculturally important gene,CmEAF7,and provides a new insight into breeding methods to develop melon cultivars with seedling cold tolerance and high fruit quality.
基金This work was supported by the National Key Research and Development Program of China(2016YFC0900901,2016YFC1301002,2017YFC0908803,2018YFC1312501)a grant from the National Natural Science Foundation of China(81530016).
文摘Background:Elderly adults with atrial fi brillation(AF)are at increased risk of frailty and thromboembolic complications.However,studies on the prevalence of frailty in AF patients and data on the relationship between frailty and the use of anticoagulants are limited.Methods:We conducted a cross-sectional study involving 500 participants.Patients aged 65 years or older were consecutively selected from the Chinese Atrial Fibrillation Registry study.The patient’s frailty status was assessed with use of the Canadian Study of Health and Aging Clinical Frailty Scale.We assessed the prevalence of and factors associated with frailty,and how frailty affects anticoagulant therapy.Results:In 500 elderly adults with AF(age 75.2±6.7 years;51.6%female),201 patients(40.2%)were frail.The prevalence of frailty was higher in females(P=0.002)and increased with age and CHA 2 DS 2-VASc score(P for trend less than 0.001 for both).The factors associated with frailty were a history of heart failure(odds ratio[OR]2.40,95%confi dence interval[CI]1.39–4.14),female sex(OR 2.09,95%CI 1.27–3.43),and advanced age(OR 1.13,95%CI 1.09–1.17).Frail patients were signifi cantly less likely to have ever been prescribed anticoagulants compared with nonfrail patients(81.7 vs.54.9%,P<0.001).Conclusions:Frailty is prevalent in elderly adults with AF,especially in females,those of advanced age,and those with heart failure.Frailty status has a signifi cant impact on prescription of anticoagulants for high-risk AF patients.
文摘Background:Signifi cant left ventricular dysfunction may arise in right-sided accessory pathways with ventricular preexcitation in the absence of recurrent or incessant tachycardia.This has just been realized and not enough attention has been paid to it.Methods:In the last 7 years,we identifi ed 12 consecutive children with a diagnosis of ventricular preexcitation–induced dilated cardiomyopathy.This report describes the clinical and echocardiographic characteristics of the patients before and after ablation.Results:Dyssynchronous ventricular contraction was observed by M-mode echocardiography and two-dimensional strain analysis in all patients.The basal and middle segments of the interventricular septum became thin and moved similarly to an aneurysm,with typical bulging during the end of systole.The locations of the accessory pathways were the right-sided septum(n=5)and the free wall(n=7).Left ventricular synchrony was obtained shortly after ablation.The left ventricular function recovered to normal and the left ventricular end-diastolic diameter decreased gradually during follow-up.Conclusions:A causal relationship between ventricular preexcitation and the development of dilated cardiomyopathy is supported by the complete recovery of left ventricular function and reversed left ventricular remodeling after the loss of ventricular preexcitation.Preexcitation-related dyssynchrony was thought to be the crucial mechanism.Ventricular preexcitation–induced dilated cardiomyopathy is an indication for ablation with a good prognosis.
基金the Hebei Province Key Research and Development Program(no.182777166).
文摘Background:Pseudoaneurysm with median nerve injury is a serious complication of radial artery puncture.It is very important to summarize the prevention and treatment experience of this complication through case discussion.Case report:A 66-year-old woman was admitted to the hospital because of‘‘paroxysmal chest tightness and suffocation for 5 days.”Coronary angiography was performed.During insertion of the arterial sheath,the patient experienced severe pain in the right forearm,which radiated to the palm.The puncture sheath did not return blood after the sheath core was withdrawn.The sheath was removed and local compression was used to stop bleeding.There was no obvious bleeding at the puncture point,and the compression was removed 6 hours after the procedure.Local swelling and increased tension were seen in the right forearm.At the 1-week follow-up she exhibited swelling,high local tension,small blisters,and bluish-purple skin of the right forearm,with an acceptable right radial artery pulsation.She had severe pain in the affected limb,which radiated to the thumb,index fi nger,and middle fi nger.Case discussion:We discuss the causes of and treatment measures for pseudoaneurysm with median nerve injury caused by radial artery puncture.
文摘Cardiovascular diseases(CVD)have become the main cause of death and a critical public health burden in contemporary China.I was invited by Dr.Richard Conti,editor in chief of the journal as the vip editor of this issue focusing on CVD in China.It is my privilege to work with the leading cardiologists and research scientists in the field to delineate the outline of CVD in China,including epidemiology,prevention,rehabilitation,clinical management et al.This issue not only elaborates the major clinical issues but also highlights future perspectives in cardiovascular disease of China.
文摘The tapered angles of an artery significantly influence the local hemodynamics. However, as gravity is considered, little is known about the effect of tapered angles on the hemodynamics. In this study, we explored whether the effect of tapered angles on the distribution of blood flow pressure (DBFP) differed with gravity considered or not. Numerical simulations of the DBFP in a single vessel were performed based on such tapered angles as 0°, 0.5° and 1°. In the model used for simulation, gravity was introduced as a body force. We obtained the following simulations: i) The larger the tapered angles were, the better distributed the blood flow pressure;ii) The tapered effect was an important factor leading to nonlinearity in blood flow pressure;iii) Gravity affected DBFP coupling with the tapered angles, yet independently influenced the dimension of the DBFP. At the same time, the effective intensity of gravity decreased with the increase of tapered angles.
基金funded by Capital’s Funds for Health Improvement and Research,grant/award number 2022-2-2067The trial is supported by the Science and Technology Foundation of Beijing Anzhen Hospital,Capital Medical University,grant/award number:KCGY2022.
文摘Background:People with atrial fibrillation(AF)have elevated risk of developing cognitive impairment.At present,there is a dearth of randomized controlled trials investigating cognitive impairment management in patients with AF.The Atrial Fibrillation Follow-up Investigation to Recover Memory and learning(AFFIRMING)study is aimed at evaluating the potential for computerized cognitive training to improve cognitive function in patients with AF.Methods:The study is a multi-center,double-blind,randomized controlled study using a 1:1 parallel design.A total of 200 patients with AF and mild cognitive decline without dementia are planned to be recruited.The intervention group will use the adaptive training software with changes in difficulty,whereas the positive control group will use basic training software with minimal or no variation in difficulty level.At the end of 12 weeks,the participants will be unblinded,and the positive control group will stop training.The intervention group will be rerandomized 1:1 to stop training or continue training.All participants will be followed up until 24 weeks.The primary endpoint is the propor-tion of the improvement of the global cognitive function at week 12 compared with baseline,using the Basic Cognitive Ability Test(BCAT).
文摘Background:Statins,a first-line therapeutic option for atherosclerotic cardiovascular disease(ASCVD),have prompted concerns regarding dysglycemia and diabetes,thus posing a dilemma in treating patients with prediabetes.Xuezhikang(XZK)decreases blood cholesterol levels without affecting glucose metabolism,and may serve as a potential substitute.Methods:The XTREME study is a prospective,randomized,open-label,multi-center trial evaluating whether XZK 1200 mg/d,compared with atorvastatin 20 mg/d,has favorable effects on HbA1c levels after 24 weeks of treatment in patients with dyslipidemia and prediabetes.After a 1-week run-in period for adherence assessment,the study will ran-domly assign(1:1)392 patients meeting the protocol inclusion criteria to one of two treatment groups:an experimental group(XZK 1200 mg/day)or a control group(atorvastatin 20 mg/day).All participants will be recruited from approxi-mately 20 Chinese medical centers.The last participant is planned to be recruited before December 2023.The primary endpoint will be change in HbA1c level from baseline to 24 weeks,or before anti-diabetic therapy initiation within 24 weeks.The key secondary outcomes will include other biomarkers reflecting blood glucose or lipid metabolism.Discussion:Delaying diabetes is desirable for individuals with prediabetes.The XTREME trial presents a unique oppor-tunity to demonstrate whether XZK might provide an alternative to statins for patients with dyslipidemia and prediabetes.
基金supported by the Research Development Fund(RDF-23-01-067)the Summer Undergraduate Research Fellowship(SURF)Program(SURF-2023-0079)from Xi'an Jiaotong-Liverpool University to M.T.
文摘Wild bees are ecologically vital but increasingly threatened by anthropogenic activities,leading to uncertain survival and health outcomes in urban environments.The gut microbiome contains features indicating host health and reflecting long-term evolutionary adaptation and acute reactions to real-time stressors.Moving beyond bacteria,we propose a comprehensive analysis integrating diet,bacteriome,virome,resistome,and their association to understand the survival status of urban lives better.We conducted a study on mason bees(Osmia excavata)across 10 urban agricultural sites in Suzhou,China,using shotgun gut metagenome sequencing for data derived from total gut DNA.Our findings revealed that most ingested pollen originated from Brassica crops and the unexpected garden tree Plantanus,indicating that floral resources at the 10 sites supported Osmia but with limited plant diversity.Varied city landscapes revealed site-specific flowers that all contributed to Osmia sustenance.The gut bacterial community,dominated by Gammaproteobacteria,showed remarkable structural stability across 8 sites but suggested perturbations at 2 sites.Antibiotic resistance gene profiles highly varied across 10 sites with prevalent unclassified drug classes,highlighting environmental threats to both bees and humans.The virome analysis identified honeybee pathogens,suggesting potential virus spillover.Many unknown bacteriophages were detected,some of which targeted the core gut bacteria,underscoring their role in maintaining gut homeostasis.These multifaceted metagenomic insights hold the potential to predict bee health and identify environmental threats,thereby guiding probiotic development and city management for effective bee conservation.
文摘Cardiovascular disease is the leading cause of mortality in China.Primary prevention of cardiovascular disease with a focus on lifestyle intervention and risk factor control has been shown to effectively delay or prevent the occurrence of cardiovascular events.To promote a healthy lifestyle and enhance the detection,diagnosis,and treatment of cardiovascular risk factors such as hypertension,dyslipidemia,and diabetes,and to improve the overall capacity of primary prevention of cardiovascular disease,the Chinese Society of Cardiology of Chinese Medical Association has collaborated with multiple societies to summarize and evaluate the latest evidence with reference to relevant guidelines and subsequently to develop recommendations for primary cardiovascular disease prevention in Chinese adults.The guideline consists of 10 sections:introduction,methodology for developing the guideline,epidemiology of cardiovascular disease in China and challenges in primary prevention,general recommendations for primary prevention,assessment of cardiovascular risk,lifestyle intervention,blood pressure control,lipid management,management of type 2 diabetes,and use of aspirin.The promulgation and implementation of this guideline will play a key role in promoting the practice of primary prevention for cardiovascular disease in China.
基金supported by the National Key Research and Development Projects(No.2018YFC1312502)to Shulin Wu。
文摘The coexistence of coronary artery disease(CAD)and atrial fibrillation(AF)is common in clinical practice.Patients with CAD require antiplatelet therapy to reduce the occurrence of myocardial ischemic events.However,patients with AF at high risk of thromboembolism require oral anticoagulants to reduce the occurrence of thromboembolic events such as stroke.In cases where CAD coexists with AF,the combined use of antiplatelet and anticoagulation therapy can effectively reduce the risk of ischemic and thromboembolic events but increase the risk of bleeding at the same time.The optimal antithrombotic regimen in patients with both CAD and AF has been controversial in clinical practice.In recent years,the expert consensuses on antithrombotic therapy in patients with AF presenting with acute coronary syndrome and/or undergoing percutaneous coronary intervention have been successively released in Europe and North America,and have been updated in a timely manner.In contrast,the guidelines on antithrombotic therapies in China are lacking.Based on published clinical evidence,this consensus incorporated relevant international and Chinese guidelines,consensuses,and expert recommendations,and addressed the issues encountered in the clinical practice of antithrombotic therapy in patients with AF and different types of CAD.The current guideline is of great significance to guide treatment in patients with both CAD and AF in China.
文摘Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,significantly impacting patients'quality of life and increasing the risk of death,stroke,heart failure,and dementia.Over the past 2 decades,there have been significant breakthroughs in AF risk prediction and screening,stroke prevention,rhythm control,catheter ablation,and integrated management.During this period,the scale,quality,and experience of AF management in China have greatly improved,providing a solid foundation for the development of guidelines for the diagnosis and management of AF.To further promote standardized AF management,and apply new technologies and concepts to clinical practice in a timely and comprehensive manner,the Chinese Society of Cardiology of the Chinese Medical Association and the Heart Rhythm Committee of the Chinese Society of Biomedical Engineering have jointly developed the Chinese Guidelines for the Diagnosis and Management of Atrial Fibrillation.The guidelines have comprehensively elaborated on various aspects of AF management and proposed the CHA,DS,-VASc-60 stroke risk score based on the characteristics of AF in the Asian population.The guidelines have also reevaluated the clinical application of AF screening,emphasized the significance of early rhythm control,and highlighted the central role of catheter ablation in rhythm control.
文摘Evidence-based treatment strategies for patients with cardiovascular disease and diabetes have been updated in recent years.However,substantial gaps remain between guideline recommendations and clinical practice,which justify the urgent need to improve the quality of care for patients with these conditions.The Chinese Society of Cardiology and the Chinese Society of Diabetes,in collaboration with the American Heart Association and the American Diabetes Association,designed the China Diabetes Cardiovascular project.The China Diabetes Cardiovascular project is a nationwide registry study aimed at improving the quality of care for patients with acute coronary syndrome and diabetes in China.Launched in 2021,this project has enrolled 36 hospitals across China's mainland.Patients with a primary discharge diagnosis of comorbid acute coronary syndrome and diabetes will be eligible to participate.Pre-defined performance measures will be adopted to evaluate the quality of care for these patients.Multiple quality improvement strategies will be adopted,including providing monthly quality reports based on these measures,conducting a series of training courses,and distributing educational materials.A comprehensive dataset,encompassing patients’characteristics,medical history,treatment before and during the current hospitalization,and discharge medications for secondary prevention,will be collected through a web-based data collection platform.This project has the potential to improve the quality of care and reduce the care disparities in the management of patients with these diseases.Moreover,with its comprehensive data collection,this project will provide a strong foundation for exploring key clinical questions.
基金National Natural Science Foundation of China,Grant/Award Number:82101410Medicine and Health Science and Technology Development Plan Project of Shandong,Grant/Award Number:202101040805Research and Innovation Plan Project of Wei fang Medical University,Grant/Award Number:2021BKQ009。
文摘Ischemic stroke,the second leading cause of human mortality,presents a formidable challenge to healthcare.Following ischemic insult,the brain undergoes intricate pathological transformations,prominently marked by mitochondrial damage,including swelling,fission,and mitophagy,collectively termed mitochondrial quality control disorder.Mitochondria,pivotal in energy regulation and oxidative stress modulation,play a critical role in neuronal apoptosis post‐stroke.To solve the problems caused by mitochondrial quality control disorders,mitochondrial transfer has become a new therapeutic strategy for central nervous system diseases.Mitochondrial transfer refers to the process by which certain cell types export their mitochondria and pass them on to other cell types,a process also known as intercellular mitochondrial transfer.Mechanistically,mitochondrial transfer occurs via tunneling nanotubes,extracellular vesicles,and free mitochondrial transfer,exerting multifaceted effects such as anti‐inflammatory,anti‐lipid peroxidation,ferroptosis modulation,and enhancement of mitochondrial metabolism.This review explores the therapeutic efficacy,current obstacles,and future prospects of mitochondrial transfer in ischemic stroke,offering insights to researchers and instilling hope in patients for conquering this debilitating condition.
文摘Background：Numerous previous studies have shown that renal insufficiency （RI） in patients with acute coronary syndrome is associated with poor cardiovascular outcomes.These studies do not well address the impact of RI on the long-term outcome of patients with acute ST-elevation myocardial infarction （STEMI） in China.The aim of this study was to investigate the association of admission RI and inhospital and long-term mortality of patients with acute STEMI.Methods：This was a multicenter,observational,prospective-cohort study.718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI,between January 1,2006 and December 31,2006.Estimation of glomerular filtration rate （eGFR） was calculated using the modified abbreviated modification of diet in renal disease equation-based on the Chinese chronic kidney disease patients.The patients were categorized according to eGFR,as normal renal dysfunction （eGFR ≥ 90 ml·min^-1·1.73 m^-2）,mild RI （60 ml·min^-1· 1.73 m^-2 〈 eGFR 〈 90 ml·min^-1· 1.73 m^2） and moderate or severe RI （eGFR 〈 60 ml·min^-1· 1.73 m^2）.The association between RI and inhospital and 6-year mortality of was evaluated.Results：Seven hundred and eighteen patients with STEMI were evaluated.There were 551 men and 167 women with a mean age of 61.0 ＆#177; 13.0 years.Two hundred and eighty patients （39.0%） had RI,in which 61 patients （8.5%） reached the level of moderate or severe RI.Patients with RI were more often female,elderly,hypertensive,and more patients had heart failure and stroke with higher killip class.Patients with RI were less likely to present with chest pain.The inhospital mortality （1.4% vs.5.9% vs.22.9%,P 〈 0.001）,6-year all-cause mortality （9.5% vs.19.8 vs.45.2%,P 〈 0.001） and 6-year cardiac mortality （2.9% vs.12.2% vs.23.8%,P 〈 0.001） were markedly increased in patients with RI.After adjusting for other confounding factors,classification of admission renal function was an independent predictor of inhospital mortality （Odd ratio,1.966; 95% confidence interval [CO,1.002-3.070,P =0.019）,6-year all-cause mortality （relative risk [RR] =1.501,95% CI：1.018-4.373,P =0.039） and 6-year cardiac mortality （RR =1.663,95% CI：1.122-4.617,P =0.042）.Conclusions：RI is very common in STEMI patients.RI evaluated by eGFR is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.
文摘Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation(CCC-AF)registry,guideline-recommended OAC use in eligible patients was assessed.Results:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019,of whom 38,203 were at a high risk of stroke,9717 were at a moderate risk,and 4610 were at a low risk.On admission,only 20.0%(6075/30,420)of patients with a diagnosed AF and a high risk of stroke were taking OAC.The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population(adjusted odds ratio:0.54,95%confidence interval:0.43-0.68;P<0.001).At discharge,the prescription rate of OAC was 45.2%(16,757/37,087)in eligible patients with high stroke risk and 60.7%(2778/4578)in eligible patients with low stroke risk.OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time(all P<0.001).Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies,including catheter ablation(adjusted odds ratio[OR]11.63,95%confidence interval[CI]10.04-13.47;P<0.001),electronic cardioversion(adjusted OR 2.41,95%CI 1.65-3.51;P<0.001),and anti-arrhythmic drug use(adjusted OR 1.45,95%CI 1.38-1.53;P<0.001).Conclusions:In hospitals participated in the CCC-AF project,>70%of AF patients were at a high risk of stroke.Although poor performance on guideline-recommended OAC use was found in this study,over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov,NCT02309398.
文摘Cardiovascular diseases(CVDs)have been recognized as the leading cause of death worldwide.It is estimated that CVDs led to 17.8 million deaths worldwide in 2017,increased by 21.1%from 2007.[1]China is one of the countries that have the highest burden of CVDs with stroke and ischemic heart disease being the top two overall causes of deaths in China.[2]The massive population with CVDs,the high mortality rate and disability rate,and the great burden to the society and the economy have significantly promoted investments in CVDs research globally,making it the fastest growing discipline in the medical field.
基金funded by the National Key Research and Development Program of China(2020YFC2004803)the National Natural Science Foundation of China(82100326,82103904)+2 种基金the Beijing Municipal Science and Technology Commission(D171100006817001)the Beijing Municipal Education Commission(KM202210025012)The construction of CARF was supported by grants from Bristol-Myers Squibb,Pfizer,Johnson&Johnson,Boehringer Ingelheim,and Bayer.
文摘Background:The age,biomarkers,and clinical history(ABC)-atrial fibrillation(AF)-Stroke score have been proposed to refine stroke risk stratification,beyond what clinical risk scores such as the CHA2DS2-VASc score can offer.This study aimed to identify risk factors associated with thromboembolism and evaluate the performance of the ABC-AF-Stroke score in predicting thromboembolism in non-anticoagulated AF patients following successful ablations.Methods:A total of 2692 patients who underwent successful ablations with discontinued anticoagulation after a 3-month blanking period in the Chinese Atrial Fibrillation Registry(CAFR)between 2013 and 2019 were included.Cox regression analysis was conducted to present the association of risk factors with thromboembolism risk.The ABC-AF-Stroke score was evaluated in terms of discrimination,including concordance index(C-index),net reclassification improvement(NRI)and integrated discrimination improvement(IDI),clinical utilization by decision curve analysis(DCA),and calibration by comparing the predicted risk with the observed annualized event rate.Results:After a median follow-up of 3.5 years,64 patients experienced thromboembolism events.Age,prior history of stroke/transient ischemic attack(TIA),high-sensitivity cardiac troponin T(cTnT-hs),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were independently associated with thromboembolism risk.The ABC-AF-Stroke score performed statistically significantly better than the CHA2DS2-VASc score in terms of C-index(0.67,95%confidence interval[CI]:0.59-0.74 vs.0.60,95%CI:0.52-0.67,P=0.030)and reclassification capacity.The DCA implied that the ABC-AF-Stroke score could identify more thromboembolism events without increasing the false positive rate compared to the CHA2DS2-VASc score.The calibration curve showed that the ABC-AF-Stroke score was well calibrated in this population.Conclusions:In this real-world study enrolling non-anticoagulated AF patients following successful ablations,age,prior history of stroke/TIA,level of NT-proBNP,and cTnT-hs were independently associated with an increased risk of thromboembolism.The ABC-AF-Stroke score was well-calibrated and statistically significantly outperformed the CHA2DS2-VASc score in predicting thromboembolism risk.
文摘Objective:The long QT syndrome type 2 is caused by the loss-of-function mutations in the KCNH2 gene,which encodes hERG1,the voltage-gated potassium channel.The hERG1 channels conduct rapid delayed rectifier K^(+)currents(I_(Kr))in the human cardiac tissue.KCNH2 encodes 2 main isoforms-hERG1a and hERG1b,which assemble to form the homomeric or heteromeric hERG1 channels.However,the functional characteristics of the heteromeric hERG1 channels in long QT syndrome type 2 are not clear.In this study,a novel mutation in the N-terminus of hERG1a(F129l)was identified in a proband of long QT syndrome type 2.The purpose of this study was to identify the electrophysiological change of homomeric and heteromeric hERG1 channels with theF129l-hERG1a.Methods:Candidate genes were screened by direct sequencing.F129l-hERG1a was cloned in the pcDNA3.1 vector by site-directed mutagenesis.Then,the wild-type(WT)hERG1a and/or F129l-hERG1a were transiently expressed in the HEK293 cells with or without hERG1b co-expression.The expression levels of the transgenes,cellular distribution of hERG1a and hERG1b,and the electrophysiological features of the homomeric and the heteromeric hERG1 channels with the WT-hERG1a or F129l-hERG1a were analyzed using whole-cell patch-clamp electrophysiology,western blotting,and immunofluorescence techniques.Results:The proband was clinically diagnosed with long QT syndrome type 2 and carried a heterozygous mutation c.385T>A(F1291)in the KCNH2 gene.Electrophysiology study proved that the F129l substitution in hERG1a significantly decreased I_(Kr) in both the homomeric and heteromeric hERG1channels by 86%and 70%,respectively(WT-hERG1a(54.88±18.74)pA/pF vs.F129l-hERG1a(7.34±1.90)pA/pF,P<0.001;WT-hERG1a/hERG1b(89.92±24.51)pA/pF vs.F129l-hERG1a/hERG1b(26.54±9.83)pA/pF,P<0.001).The voltage dependence of I_(Kr) activation(V_(1/2) and k)was not affected by the mutation in both the homomeric and heteromeric hERG1 channels.The peak current densities and the kinetic characteristics of I_(Kr) were comparable for both WT/F129l-hERG1a and WT-hERG1a.The channel inactivation and deactivation analysis showed that F129l substitution did not affect deactivation of the homomeric hERG1a channel,but significantly accelerated the deactivation and recovery from inactivation of the heteromeric hERG1a/hERG1b channel based on the time constants of fast and slow recovery from deactivation F129l-hERG1a/hERG1b vs.WT-hERG1a/hERG1b(P<0.05).Western blotting and immunofluorescence labeling experiments showed that maturation and intracellular trafficking of the F129l-hERG1a protein was impaired and potentially increased the ratio of hERG1b to hERG1a in the F129l-hERG1a/hERG1b tetramer channel,thereby resulting in electrophysiological changes characteristic of the long QT syndrome type 2 pathology.Conclusions: I_(Kr) Was significantly reduced in the homomeric and heteromeric hERG1 channels with F129l-hERG1a.The F129l mutation significantly accelerated the deactivation and recovery from inactivation of the heteromeric F129l-hERG1a/hERG1b channel.F129l-hERG1a exhibited impaired maturation and intracellular trafficking,thereby potentially increasing the ratio of the hERG1b to hERG1a stoichiometry in the hERG1 tetrameric channel.These changes demonstrated the importance of the heteromeric hERG1 channel in long QT syndrome type 2 pathophysiology.
