Temporomandibular joint(TMJ)disc displacement is one of the most significant subtypes of temporomandibular joint disorders,but its etiology and mechanism are poorly understood.In this study,we elucidated the mechanism...Temporomandibular joint(TMJ)disc displacement is one of the most significant subtypes of temporomandibular joint disorders,but its etiology and mechanism are poorly understood.In this study,we elucidated the mechanisms by which destruction of inflamed collagen fibrils induces alterations in the mechanical properties and positioning of the TMJ disc.By constructing a rat model of TMJ arthritis,we observed anteriorly dislocated TMJ discs with aggravated deformity in vivo from five weeks to six months after a local injection of Freund’s complete adjuvant.By mimicking inflammatory conditions with interleukin-1 beta in vitro,we observed enhanced expression of collagen-synthesis markers in primary TMJ disc cells cultured in a conventional two-dimensional environment.In contrast,three-dimensional(3D)-cultivated disc cell sheets demonstrated the disordered assembly of inflamed collagen fibrils,inappropriate arrangement,and decreased Young’s modulus.Mechanistically,inflammation-related activation of the nuclear factor kappa-B(NF-κB)pathway occurs during the progression of TMJ arthritis.NF-κB inhibition reduced the collagen fibril destruction in the inflamed disc cell sheets in vitro,and early NF-κB blockade alleviated collagen degeneration and dislocation of the TMJ discs in vivo.Therefore,the NF-κB pathway participates in the collagen remodeling in inflamed TMJ discs,offering a potential therapeutic target for disc displacement.展开更多
Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment opt...Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion,each carrying specific risks.AF may resolve spontaneously,but often recurs,making a“watch-andwait”strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.展开更多
Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated ev...Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated events can predict two-year survival.Methods Subjects were recruited from participating outpatient practices if they had non-valvular AF, were 65 or over with CHA_(2)DS_(2)-VASc scores of at least 2, and were candidates for anticoagulation. Demographics, clinical history, and geriatric qualities of life were assessed by interview and medical records review using standardized protocols and repeated at one and two years. Events identified were abstracted and submitted for adjudication using standard definitions of events and categories. Nonmortality event categories included hospitalizations(cardiovascular, bleeding, other), bleeding(major, clinically relevant non-major, minor), and seven major adverse cardiovascular events.Results The 1245 subjects experienced 1960 events, primarily hospitalizations(935) and/or bleeding(817);114 subjects(9.2%)died during two years of follow-up. Events initially abstracted to more than one category(172) were combined, resulting in 1788unique incidents. Most subjects had zero or one event(69%) and fewer than 7% had more than 3 types. Most variables were significant in bivariate analysis. Using multiple logistic regression with two-year survival as the outcome variable, the best-fit model included event number and type, number of unique incidents, and number of bleeding events(R^(2) = 0.511, C = 93.1) with sensitivity = 97.9% and specificity = 44.7%.Conclusions Two-year survival was high. This model, if validated, could have major implications for treatment of patients with AF. Patients in the large group with no or one event are at very low risk of death(under 2%). The small group with high risk for further complications, including death, deserve reassessment to determine if this trajectory can be altered.展开更多
Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and mo...Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).展开更多
Fibrillization endows food proteins with anisotropic nanostructures,significantly enhancing their functional properties.The resultant food protein fibrils(FPFs)have garnered attention for their diverse applications ac...Fibrillization endows food proteins with anisotropic nanostructures,significantly enhancing their functional properties.The resultant food protein fibrils(FPFs)have garnered attention for their diverse applications across the food industry.However,the full potential of FPFs is hindered by inherent challenges,particularly their limited stability.This review critically examines the formation of FPFs in food processing,the new protein sources,and on the modification strategies of FPFs,thereby unlocking new avenues for FPF utilization in food processing.In particular,the strategies during and after fibrillization are highlighted.The first strategy is to modify the structure and function of protein fibrils by influencing fibrillization,such as through pretreatment,incubation conditions,nuclei induction,and ingredient interactions.The second strategy is to modify the mature FPFs by regulating their properties and interactions with other components.The review also discusses the potential applications and challenges of FPFs in food systems,such as food preservation,functional food design,and novel delivery carriers.展开更多
Atrial fibrillation(AF)is a prevalent cardiac arrhythmia with a multifactorial pathophysiology involving electrical,structural,and autonomic remodeling of the atria.AF is closely associated with elevated interleukin-6...Atrial fibrillation(AF)is a prevalent cardiac arrhythmia with a multifactorial pathophysiology involving electrical,structural,and autonomic remodeling of the atria.AF is closely associated with elevated interleukin-6(IL-6)levels,which contribute to atrial remodeling and the progression of AF.This review summarizes the mechanisms by which IL-6 promotes AF through inflammatory pathways,atrial fibrosis,electrical remodeling,and calcium mishandling.Experimental models have demonstrated that IL-6 neutralization reduces the incidence of AF,highlighting its potential as a therapeutic target.Future studies should focus on IL-6 blockade strategies to manage AF,aiming to improve patient outcomes.展开更多
Atrial fibrillation(AF)/atrial flutter(AFL)is the most common sustained cardiac arrhythmia.The known risk factors for developing AF/AFL include age,structural heart disease,hypertension,diabetes mellitus,or hyperthyro...Atrial fibrillation(AF)/atrial flutter(AFL)is the most common sustained cardiac arrhythmia.The known risk factors for developing AF/AFL include age,structural heart disease,hypertension,diabetes mellitus,or hyperthyroidism.This study aims to attribute the trends in AF/AFL-related mortalities over the past two decades 1999-2020 concerning race and sex and disparity among them.To the best of our knowledge,this is the first study that estimates the trends and mortality due to AF/AFL from 1999-2020 in older adults in the United States.In this 21-year analysis of mortality data,we found a constant increase in mortality rates due to AF/AFL in older adults.From 1999 to 2020,the overall mortality in older adults aged 65 and above,regardless of sex and race,is found to be almost doubled i.e.about a 50.2%increase in the number of deaths due to AF/AFL.Furthermore,other confounding risk factors such has obesity,prior myocardial infarction,inflammation,hypertension,birth weight,diabetes mellitus,hyperthyroidism,hormone replacement therapy in menopausal women increases the risk in the occurrence or recurrent occurrence of AF.展开更多
Objective:The occurrence and development of atrial fibrillation(AF)are influenced by the autonomic nervous system and inflammation.Acupuncture is an effective treatment for AF.This study explored the protective effect...Objective:The occurrence and development of atrial fibrillation(AF)are influenced by the autonomic nervous system and inflammation.Acupuncture is an effective treatment for AF.This study explored the protective effects of acupuncture in a rat model of paroxysmal AF and investigated its mechanisms.Methods:Male Sprague-Dawley rats(n=130)were randomly divided into blank control(Con),sham operation(Sham),AF,and acupuncture treatment(Acu)groups.A paroxysmal AF model was established by rapid atrial pacing through the jugular vein.Rats in the Acu group were immobilized to receive acupuncture treatment at Neiguan acupoint(PC6)for 20 min daily for seven days.The other groups were immobilized for the same duration over the treatment period but did not receive acupuncture.The AF induction rate,AF duration,cardiac electrophysiological parameters,and heart rate variability were evaluated by monitoring surface electrocardiogram and vagus nerve discharge signals.After the intervention,the rats were euthanized,and atrial morphology was assessed using haematoxylin and eosin staining.The expression of macrophage F4/80 antigen(F4/80)and cluster of differentiation(CD)86 in atrial myocardial tissue was detected using immunohistochemistry,immunofluorescence and flow cytometry.The expression levels or contents of interleukin(IL)-1β,IL-6,tumor necrosis factor-a(TNF-a),a7 nicotinic acetylcholine receptor(a7nAChR),phosphorylated Janus kinase 2(p-JAK2),and phosphorylated signal transducer and activator of transcription 3(p-STAT3)in atrial myocardial tissue were detected using Western blotting,reverse transcription-quantitative polymerase chain reaction,or enzyme-linked immunosorbent assay.The role of a7nAChR in acupuncture treatment was verified by intraperitoneal injection of the a7nAChR antagonist methyllycaconitine(MLA).Results:Compared with the AF group,acupuncture significantly reduced AF duration and induction rate,improved cardiac electrophysiology by enhancing vagus nerve activity and regulating autonomic balance.It also decreased the pro-inflammatory M1 macrophage proportion,alleviating myocardial injury and infiltration.MLA weakened acupuncture's electrophysiological improvement and anti-inflammatory effect.Results suggest that acupuncture triggers the a7nAChR-JAK2/STAT3 pathway and exerts cardioprotection via neuroimmune regulation.Conclusion:Acupuncture significantly reduced the AF induction rate,shortened AF duration,improved cardiac electrophysiological parameters,enhanced vagus nerve activity,and decreased the expression of pro-inflammatory M1 macrophages and inflammatory factors in rats with paroxysmal AF.展开更多
AIM To test of the implantable-cardioverter-defibrillator is done at the time of implantation. We investigate if any testing should be performed.METHODS All consecutive patients between January 2006 and December 2008 ...AIM To test of the implantable-cardioverter-defibrillator is done at the time of implantation. We investigate if any testing should be performed.METHODS All consecutive patients between January 2006 and December 2008 undergoing implantable cardioverterdefibrillator(ICD) implantation/replacement(a total of 634 patients) were included in the retrospective study.RESULTS Sixteen patients(2.5%) were not tested(9 with LA/LVthrombus, 7 due to operator's decision). Analyzed were 618 patients [76% men, 66.4 + 11 years, 24% secondary prevention(SP), 46% with left ventricular ejection fraction(LVEF) < 20%, 56% had coronary artery disease(CAD)] undergoing defibrillation safety testing(SMT) with an energy of 21 + 2.3 J. In 22/618 patients(3.6%) induced ventricular fibrillation(VF) could not be terminated with maximum energy of the ICD. Six of those(27%) had successful SMT after system modification or shock lead repositioning, 14 patients(64%) received a subcutaneous electrode array. Younger age(P = 0.0003), non-CAD(P = 0.007) and VF as index event for SP(P = 0.05) were associated with a higher incidence of ineffective SMT. LVEF < 20% and incomplete revascularisation in patients with CAD had no impact on SMT.CONCLUSION Defibrillation testing is well-tolerated. An ineffective SMT occurred in 4% and two third of those needed implantation of a subcutaneous electrode array to passa SMT > 10 J.展开更多
Diabetes mellitus and atrial fibrillation(AF)are two global epidemics that frequently coexist,with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis.Pathophysiological mech...Diabetes mellitus and atrial fibrillation(AF)are two global epidemics that frequently coexist,with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis.Pathophysiological mechanisms underlying this relationship include chronic inflammation,oxidative stress,atrial remodeling,autonomic dysfunction,advanced glycation end-products and epicardial adiposity.Management remains challenging;however,recent advances offer promise,including guideline-directed anticoagulation,tailored rate and rhythm control,and particularly,novel antidiabetic therapies,such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists,may improve AF outcomes.A comprehensive,individualized approach is essential to mitigate morbidity and mortality in this high-risk population.展开更多
This review explores the emerging connection between psoriasis and atrial fibrillation(AF),focusing on shared inflammatory mechanisms,clinical implications,and research gaps.Psoriasis,characterized by chronic systemic...This review explores the emerging connection between psoriasis and atrial fibrillation(AF),focusing on shared inflammatory mechanisms,clinical implications,and research gaps.Psoriasis,characterized by chronic systemic inflammation,has been associated with increased AF risk,driven by elevated pro-inflammatory cytokines such as interleukin(IL)-6,IL-17,and tumor necrosis factor-alpha.These inflammatory mediators contribute to atrial remodeling,fibrosis,and conduction abnormalities,evidenced by prolonged P-wave dispersion and atrial electromechanical delay in psoriasis patients.Severe psoriasis further exacerbates atrial dysfunction,increasing susceptibility to AF.This review synthesizes existing epidemiological and biological data,highlighting the need for interdisciplinary management of psoriasis patients to mitigate cardiovascular risks.However,the reliance on observational studies limits definitive conclusions about causality.We emphasize the necessity for large-scale,multicenter research to validate these findings,investigate genetic predispositions,and evaluate lifestyle factors and AF burden.Future research should aim to delineate the pathophysiological link between psoriasis and AF.By examining the interplay of systemic inflammation,electrophysiological changes,and clinical outcomes,this review aims to advance understanding of the psoriasis-AF link and guide strategies for early detection,prevention,and management of AF in psoriasis patients.Comprehensive care integrating dermatology and cardiology is essential for improving patient outcomes.展开更多
BACKGROUND Atrial fibrillation(AF)is a prevalent cardiac arrhythmia associated with significant morbidity and mortality,particularly in patients with concomitant renal dysfunction.Anticoagulation therapy reduces the r...BACKGROUND Atrial fibrillation(AF)is a prevalent cardiac arrhythmia associated with significant morbidity and mortality,particularly in patients with concomitant renal dysfunction.Anticoagulation therapy reduces the risk of thromboembolic complications in AF but presents challenges in patients with renal impairment due to altered pharmacokinetics and increased bleeding risk.AIM To support clinicians in navigating the complexities of anticoagulation in this high-risk population,ensuring optimal outcomes.METHODS The present review followed PRISMA guidelines.Data extraction was conducted using a standardized template that captured key study characteristics:Population demographics,renal function metrics,anticoagulant dosing strategies,and primary and secondary outcomes.For quality assessment,we employed the Cochrane Risk of Bias 2.0 tool for randomized controlled trials.Observational studies were appraised using the Newcastle-Ottawa Scale.RESULTS We analyze data from 16 studies to provide recommendations on optimal anticoagulation strategies,balancing thrombotic and bleeding risks.Current evidence supports the preferential use of apixaban in moderate chronic kidney disease and cautiously in end-stage renal disease,emphasizing the importance of individualized therapy.CONCLUSION The management of anticoagulation in AF patients with renal dysfunction is challenging but critical for reducing stroke risk.展开更多
Voltage substrate mapping is a promising tool for the treatment of atrial fibrillation(AF).It is helpful to detect atrial fibrosis,which includes areas with low bipolar voltage,heterogeneous conduction properties,and ...Voltage substrate mapping is a promising tool for the treatment of atrial fibrillation(AF).It is helpful to detect atrial fibrosis,which includes areas with low bipolar voltage,heterogeneous conduction properties,and shortened effective refractory period.The voltage amplitude is typically defined as the maximal peakto-peak level within a specified time window of interest.Contemporary electroanatomic mapping platforms now enable many thousands of data points to be mapped,so that a geometric model of the atrial endocardium is constructable over a short period of time.This mapping procedure is often done with bipolar electrodes to cancel the far-field signal.The recording site coordinates are projected onto an atrial shell,with interpolation of the voltage data across the shell surface.The amplitude of the recorded bipolar electrogram depicted on the threedimensional shell provides detailed information for substrate mapping.Wherever there are areas of low peak-to-peak voltage,it is thought to mark the presence of abnormal tissue properties and conduction.However,uncontrolled variables and environmental factors affecting voltage level include the oncoming electrical activation wavefront direction,the catheter incidence angle,the force applied to the catheter,and the region-variable shape and structure of atrial tissue.Techniques and settings to acquire atrial voltage data for AF analysis have not been standardized.Methods to characterize atrial electrograms are also presently limited.These factors affect quality and reproducibility of the mapping results.Herein,voltage substrate mapping and its variables pertaining to AF and radiofrequency ablation are described and discussed,with suggestions for future work efforts.展开更多
Background and Objective Hypertension(HT)and atrial fibrillation(AF)are highly prevalent cardiovascular conditions that frequently coexist.Coronary artery disease(CAD)is a major global cause of mortality.The co-occurr...Background and Objective Hypertension(HT)and atrial fibrillation(AF)are highly prevalent cardiovascular conditions that frequently coexist.Coronary artery disease(CAD)is a major global cause of mortality.The co-occurrence of HT,AF,and CAD presents significant management challenges.This study aims to explore the clinical characteristics and risk factors associated with CAD in patients with HT and persistentAF(HT-AF).Methods In this retrospective cross-sectional study,data were collected from 384 hospitalized HT-AF patients at the People's Liberation Army General Hospital between January 2010 and December 2019.CAD diagnosis was confirmed by coronary angiography or computed tomography angiography.Clinical characteristics and comorbidities were compared between patients with and without CAD.Multivariate logistic regression analyses were performed to identify independent risk factors associated with CAD development.Results The prevalence of CAD among HT-AF patients was 66.41%(255/384).Cardiovascular complications,particularly heart failure(44.7%vs 25.6%,P<0.05),were significantly more prevalent in the CAD group than in the non-CAD group.Only age was identified as an independent risk factor for CAD(adjusted OR:1.047;95%CI:1.022–1.073;P=0.000).Of all HT-AF patients,54.7%had a CHA2DS2-VASc score of≥4,indicating high stroke risk.There was a slightly higher anticoagulant usage rate in the CAD group than those without CAD(8.6%vs 4.7%,P=0.157),and the overall anticoagulant usage remained low.Conclusion There is a high prevalence of CAD among hospitalized HT-AF patients,among whom age is the sole independent risk factor for CAD.Despite a high stroke risk,the utilization of oral anticoagulants is alarmingly low.展开更多
Amidst the ever-growing interest in high-mass-loading Li battery electrodes,a persistent challenge has been the insufficient continuity of their ion/electron conduction pathways.Here,we propose cellulose elementary fi...Amidst the ever-growing interest in high-mass-loading Li battery electrodes,a persistent challenge has been the insufficient continuity of their ion/electron conduction pathways.Here,we propose cellulose elementary fibrils(CEFs)as a class of deagglomerated binder for high-mass-loading electrodes.Derived from natural wood,CEF represents the most fundamental unit of cellulose with nanoscale diameter.The preparation of the CEFs involves the modulation of intermolecular hydrogen bonding by the treatment with a proton acceptor and a hydrotropic agent.This elementary deagglomeration of the cellulose fibers increases surface area and anionic charge density,thus promoting uniform dispersion with carbon conductive additives and suppressing interfacial side reactions at electrodes.Consequently,a homogeneous redox reaction is achieved throughout the electrodes.The resulting CEF-based cathode(overlithiated layered oxide(OLO)is chosen as a benchmark electrode active material)exhibits a high areal-mass-loading(50 mg cm^(-2),equivalent to an areal capacity of 12.5 mAh cm^(-2))and a high specific energy density(445.4 Wh kg–1)of a cell,which far exceeds those of previously reported OLO cathodes.This study highlights the viability of the deagglomerated binder in enabling sustainable high-mass-loading electrodes that are difficult to achieve with conventional synthetic polymer binders.展开更多
Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite ...Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite advancements in anticoagulation and rhythm control,patient outcomes remain suboptimal.Aim:This review synthesizes current evidence on the pathophysiological mechanisms,multidimensional management strategies,and emerging innovations in NVAF to inform clinical practice and future research directions.Methods:A systematic literature search was conducted across nine databases(CNKI,Wanfang,SinoMed,VIP,PubMed,Web of Science,Cochrane Library,Embase,and MEDLINE)using combined Medical Subject Headings(MeSH)and free-text terms,including“atrial fibrillation,”“non-valvular atrial fibrillation,”“risk factors,”and“mechanism”(and their Chinese equivalents).Studies on NVAF pathogenesis,therapeutic interventions,and risk stratification tools were analyzed.Results:(1)Risk Factors and Pathophysiology:NVAF progression is driven by hemodynamic stress(e.g.,hypertension),metabolic disorders(e.g.,obesity,diabetes),chronic inflammation,and fibrosis.Biomarkers such as CRP and Galectin-3,along with TGF-β/Smad signaling,are central to atrial remodeling.(2)Anticoagulation Controversies:While NOACs reduce stroke risk compared to warfarin(HR=0.79),challenges persist in extreme body weight populations and drug-drug interactions(e.g.,with P-glycoprotein inhibitors).(3)Left Atrial Appendage Closure(LAAC):LAAC demonstrates non-inferiority to anticoagulation in stroke prevention(HR=0.79)with reduced major bleeding(HR=0.49),though device-related thrombosis(1.8–7%)remains a concern.(4)Precision Medicine:AI-driven models enhance stroke prediction(AUC=0.71;sensitivity 92%),while genotype-guided warfarin dosing shortens INR stabilization by 40%.(5)Lifestyle Interventions:Combined Mediterranean diet and moderate exercise reduce AF burden(HR=0.69)and reverse left atrial enlargement(LAVI reduced by 12%).(6)Multidisciplinary Care:Integrated“heart-brain team”approaches combining LAAC and PFO closure lower annual stroke recurrence from 8.2%to 2.1%,while comprehensive rehabilitation improves functional capacity(6MWD+45 m)and quality of life(SF-36+12 points).Conclusion:NVAF management has evolved from isolated anticoagulation to a multidimensional paradigm integrating genomics,AI,and lifestyle modification.Future priorities include validating long-term outcomes of novel therapies,addressing evidence gaps in special populations,and implementing digitally enabled,cross-disciplinary care models to mitigate the global burden of NVAF-related complications.展开更多
BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-r...BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-related mortality among CKD patients is crucial for effective clinical and public health strategies.AIM To investigate AF-CKD comorbidity and mortality on the national level.METHODS Death certificates from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research database spanning 2011-2020 were analyzed to investigate AF-related CKD mortality in adults aged 35 to 85 or more years.Age-adjusted mortality rates(AAMRs)per 100000 persons and annual percent change(APC)were calculated,stratified by year,sex,race/ethnicity,and geographic region.RESULTS A total of 110733 deaths occurred among adults(aged 35-85 or more years)related to AF associated with CKD in the United States.Overall AAMR declined from 8.1 in 2011 to 5.5 in 2014(APC:-14.89;95%confidence interval(CI):-30.44 to-4.06),followed by an increase to 10.3 in 2020(APC:9.91;95%CI:6.1-19.62).Men had higher AAMRs than women(men:7.6,95%CI:7.6-7.7).Non-Hispanic White adults had the highest AAMR(7.8),followed by non-Hispanic Black(5).States in the top 90th percentile had approximately four times higher AAMRs than those in the lower 10th percentile.AAMR also varied by region(Midwest:7.6,West:6.7,Northeast:6.3,South:5.6),with nonmetropolitan areas exhibiting higher AF-associated CKD mortality.CONCLUSION Temporal trends in AF-related mortality among CKD patients showed fluctuations over the study period,with notable disparities across demographic and geographic factors.Targeted interventions are warranted to mitigate the burden of AF associated with CKD and reduce mortality rates in the United States.展开更多
This study aimed to investigate the influence of stable coronary artery disease(SCAD)on anticoagulation monotherapy.A total of 260 patients with nonvalvular atrial fibrillation who were admitted to Fujian Provincial H...This study aimed to investigate the influence of stable coronary artery disease(SCAD)on anticoagulation monotherapy.A total of 260 patients with nonvalvular atrial fibrillation who were admitted to Fujian Provincial Hospital between November 2021 and June 2023 were enrolled.The study compared the trough plasma concentrations of rivaroxaban,coagulation parameters,efficacy endpoints(stroke,systemic embolism,and myocardial infarction[MI]),and safety outcomes(including major bleeding,clinically relevant nonmajor bleeding[CRB],minor bleeding,and overall bleeding)between SCAD and non-SCAD patients after propensity score matching(PSM).Additionally,the association between prothrombin time-international normalized ratio(PT-INR)and total bleeding risk was analyzed using restricted cubic spline models and Cox proportional hazards regression.Baseline characteristics,including ABCB1 genotypes,concomitant medications,and other clinical variables,were retrospectively collected.Following PSM,159 patients were included in the final analysis.The results indicated no significant differences in efficacy outcomes or CRB between SCAD and non-SCAD patients.However,SCAD patients exhibited a significantly higher risk of minor bleeding(adjusted HR:2.08,95%CI:1.07–4.04;P=0.030)and total bleeding(HR:1.96,95%CI:1.05–3.64;P=0.034).Moreover,among SCAD patients with a history of MI,the risk of CRB(HR:5.50,95%CI:1.00–30.14;P=0.0497)and total bleeding(HR:2.61,95%CI:1.09–6.27;P=0.032)was notably increased.Furthermore,in SCAD patients,PT-INR demonstrated a nonlinear positive correlation with total bleeding risk.展开更多
Atrial fibrillation(Afib)is a common arrhythmia with significant public health implications,affecting millions of individuals worldwide.Catheter ablation(CA)is an established treatment for drug-resistant Afib,yet recu...Atrial fibrillation(Afib)is a common arrhythmia with significant public health implications,affecting millions of individuals worldwide.Catheter ablation(CA)is an established treatment for drug-resistant Afib,yet recurrence remains a major concern,impacting quality of life in a significant portion of patients.Inflammation plays a critical role in the recurrence of Afib after ablation,with systemic inflammatory markers such as C-reactive protein being linked to higher recurrence rates.In this editorial,we discuss the study by Wang et al,published in the latest issue,which investigates the predictive role of the systemic immune inflammation index(SII)in Afib recurrence following radiofrequency CA.Elevated pre-ablation SII levels are identified as an independent predictor of recurrence,significantly enhancing the predictive power of the APPLE score.Integration of SII improved the APPLE score’s predictive performance,as shown by enhanced area under the curve,net reclassification improvement,and integrated discrimination improvement.This combined model highlights the importance of both structural and inflammatory factors in Afib recurrence,offering a more personalized approach to patient management.Additionally,the affordability and accessibility of SII enhance its practicality in clinical workflows.The study by Wang et al underscores the potential of integrating SII with existing scoring systems to refine risk stratification and optimize treatment strategies.Future research should validate these findings across diverse populations,explore limitations such as the potential influence of comorbidities on SII reliability,and investigate additional biomarkers to enhance predictive accuracy.展开更多
BACKGROUND The Perceval Sorin S(perceval valve)is a sutureless bioprosthetic designed for use in a high-risk cohort who may not be suitable for transcatheter aortic valve implantation or a conventional surgical aortic...BACKGROUND The Perceval Sorin S(perceval valve)is a sutureless bioprosthetic designed for use in a high-risk cohort who may not be suitable for transcatheter aortic valve implantation or a conventional surgical aortic valve replacement(AVR).AIM To compare five-year post-operative outcomes in a cohort undergoing isolated AVR with the perceval valve to a contemporary cohort undergoing surgical AVR with a sutured bioprosthesis.METHODS This study was a retrospective,cohort study at a single tertiary unit.Between 2017 and 2023,982 suitable patients were identified.174 Perceval valve replacements were matched to 174 sutured valve replacements.Cohort characteristics,intra-operative details,and post-operative outcomes were compared between the two groups.RESULTS Time under the aortic cross-clamp(P<0.001),time on the cardiopulmonary bypass(P<0.001)and total operative time(P<0.001)were significantly reduced in the Perceval group.Patients in the Perceval valve group were at a lower risk of postoperative pneumonia[odds ratio(OR)=0.53(0.29-0.94)]and atrial fibrillation[OR=0.58(0.36-0.93)].After propensity-matching,all-cause mortality did not significantly differ between the two groups in the five-year follow-up period.Larger valve sizes conferred an increased risk of mortality(P=0.020).CONCLUSION Sutureless surgical AVR(SAVR)is a safe and efficient alternative to SAVR with a sutured bioprosthesis,and may confer a reduced risk of post-operative atrial fibrillation.Clinician tendency towards‘oversizing’sutureless aortic valves translates into adverse clinical outcomes.Less time on the cardiopulmonary bypass circuit allows for the treatment of otherwise high-risk patients.展开更多
基金supported by the National Natural Science Foundation of China Nos.82370983,81671015(X.W.),82230030(Y.L.),82101043(S.C.)and 82370922(Y.F.)Beijing International Science and Technology Cooperation Project No.Z221100002722003(Y.L.)+4 种基金Beijing Natural Science Foundation Nos.L234017,JL23002(Y.L.),No.7242282(S.C.)and 7232217(Y.G.)Clinical Medicine Plus X-Young Scholars Project of Peking University No.PKU2024LCXQ039(Y.L.)National Program for Multidisciplinary Cooperative Treatment on Major Diseases No.PKUSSNMP-202013(X.W.)Hygiene and Health Development Scientific Research Fostering Plan of Haidian District Beijing No.HP2023-12-509001(J.Z.)Young Clinical Research Fund of the Chinese Stomatological Association No.CSA-02022-03(J.Z.).
文摘Temporomandibular joint(TMJ)disc displacement is one of the most significant subtypes of temporomandibular joint disorders,but its etiology and mechanism are poorly understood.In this study,we elucidated the mechanisms by which destruction of inflamed collagen fibrils induces alterations in the mechanical properties and positioning of the TMJ disc.By constructing a rat model of TMJ arthritis,we observed anteriorly dislocated TMJ discs with aggravated deformity in vivo from five weeks to six months after a local injection of Freund’s complete adjuvant.By mimicking inflammatory conditions with interleukin-1 beta in vitro,we observed enhanced expression of collagen-synthesis markers in primary TMJ disc cells cultured in a conventional two-dimensional environment.In contrast,three-dimensional(3D)-cultivated disc cell sheets demonstrated the disordered assembly of inflamed collagen fibrils,inappropriate arrangement,and decreased Young’s modulus.Mechanistically,inflammation-related activation of the nuclear factor kappa-B(NF-κB)pathway occurs during the progression of TMJ arthritis.NF-κB inhibition reduced the collagen fibril destruction in the inflamed disc cell sheets in vitro,and early NF-κB blockade alleviated collagen degeneration and dislocation of the TMJ discs in vivo.Therefore,the NF-κB pathway participates in the collagen remodeling in inflamed TMJ discs,offering a potential therapeutic target for disc displacement.
文摘Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion,each carrying specific risks.AF may resolve spontaneously,but often recurs,making a“watch-andwait”strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.
文摘Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated events can predict two-year survival.Methods Subjects were recruited from participating outpatient practices if they had non-valvular AF, were 65 or over with CHA_(2)DS_(2)-VASc scores of at least 2, and were candidates for anticoagulation. Demographics, clinical history, and geriatric qualities of life were assessed by interview and medical records review using standardized protocols and repeated at one and two years. Events identified were abstracted and submitted for adjudication using standard definitions of events and categories. Nonmortality event categories included hospitalizations(cardiovascular, bleeding, other), bleeding(major, clinically relevant non-major, minor), and seven major adverse cardiovascular events.Results The 1245 subjects experienced 1960 events, primarily hospitalizations(935) and/or bleeding(817);114 subjects(9.2%)died during two years of follow-up. Events initially abstracted to more than one category(172) were combined, resulting in 1788unique incidents. Most subjects had zero or one event(69%) and fewer than 7% had more than 3 types. Most variables were significant in bivariate analysis. Using multiple logistic regression with two-year survival as the outcome variable, the best-fit model included event number and type, number of unique incidents, and number of bleeding events(R^(2) = 0.511, C = 93.1) with sensitivity = 97.9% and specificity = 44.7%.Conclusions Two-year survival was high. This model, if validated, could have major implications for treatment of patients with AF. Patients in the large group with no or one event are at very low risk of death(under 2%). The small group with high risk for further complications, including death, deserve reassessment to determine if this trajectory can be altered.
文摘Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).
基金supported by the Natural Science Foundation of Jiangxi Province(20232BAB205075,20224ACB205014).
文摘Fibrillization endows food proteins with anisotropic nanostructures,significantly enhancing their functional properties.The resultant food protein fibrils(FPFs)have garnered attention for their diverse applications across the food industry.However,the full potential of FPFs is hindered by inherent challenges,particularly their limited stability.This review critically examines the formation of FPFs in food processing,the new protein sources,and on the modification strategies of FPFs,thereby unlocking new avenues for FPF utilization in food processing.In particular,the strategies during and after fibrillization are highlighted.The first strategy is to modify the structure and function of protein fibrils by influencing fibrillization,such as through pretreatment,incubation conditions,nuclei induction,and ingredient interactions.The second strategy is to modify the mature FPFs by regulating their properties and interactions with other components.The review also discusses the potential applications and challenges of FPFs in food systems,such as food preservation,functional food design,and novel delivery carriers.
基金supported by the National Natural Science Foundation of China(No.82170326 and No.82470328 to Y.D.,No.82100339 to Q.D.).
文摘Atrial fibrillation(AF)is a prevalent cardiac arrhythmia with a multifactorial pathophysiology involving electrical,structural,and autonomic remodeling of the atria.AF is closely associated with elevated interleukin-6(IL-6)levels,which contribute to atrial remodeling and the progression of AF.This review summarizes the mechanisms by which IL-6 promotes AF through inflammatory pathways,atrial fibrosis,electrical remodeling,and calcium mishandling.Experimental models have demonstrated that IL-6 neutralization reduces the incidence of AF,highlighting its potential as a therapeutic target.Future studies should focus on IL-6 blockade strategies to manage AF,aiming to improve patient outcomes.
文摘Atrial fibrillation(AF)/atrial flutter(AFL)is the most common sustained cardiac arrhythmia.The known risk factors for developing AF/AFL include age,structural heart disease,hypertension,diabetes mellitus,or hyperthyroidism.This study aims to attribute the trends in AF/AFL-related mortalities over the past two decades 1999-2020 concerning race and sex and disparity among them.To the best of our knowledge,this is the first study that estimates the trends and mortality due to AF/AFL from 1999-2020 in older adults in the United States.In this 21-year analysis of mortality data,we found a constant increase in mortality rates due to AF/AFL in older adults.From 1999 to 2020,the overall mortality in older adults aged 65 and above,regardless of sex and race,is found to be almost doubled i.e.about a 50.2%increase in the number of deaths due to AF/AFL.Furthermore,other confounding risk factors such has obesity,prior myocardial infarction,inflammation,hypertension,birth weight,diabetes mellitus,hyperthyroidism,hormone replacement therapy in menopausal women increases the risk in the occurrence or recurrent occurrence of AF.
基金supported by the National Key Research and Development Program of China(No.2019YFC1712100)the National Natural Science Foundation of China(No.82105017)。
文摘Objective:The occurrence and development of atrial fibrillation(AF)are influenced by the autonomic nervous system and inflammation.Acupuncture is an effective treatment for AF.This study explored the protective effects of acupuncture in a rat model of paroxysmal AF and investigated its mechanisms.Methods:Male Sprague-Dawley rats(n=130)were randomly divided into blank control(Con),sham operation(Sham),AF,and acupuncture treatment(Acu)groups.A paroxysmal AF model was established by rapid atrial pacing through the jugular vein.Rats in the Acu group were immobilized to receive acupuncture treatment at Neiguan acupoint(PC6)for 20 min daily for seven days.The other groups were immobilized for the same duration over the treatment period but did not receive acupuncture.The AF induction rate,AF duration,cardiac electrophysiological parameters,and heart rate variability were evaluated by monitoring surface electrocardiogram and vagus nerve discharge signals.After the intervention,the rats were euthanized,and atrial morphology was assessed using haematoxylin and eosin staining.The expression of macrophage F4/80 antigen(F4/80)and cluster of differentiation(CD)86 in atrial myocardial tissue was detected using immunohistochemistry,immunofluorescence and flow cytometry.The expression levels or contents of interleukin(IL)-1β,IL-6,tumor necrosis factor-a(TNF-a),a7 nicotinic acetylcholine receptor(a7nAChR),phosphorylated Janus kinase 2(p-JAK2),and phosphorylated signal transducer and activator of transcription 3(p-STAT3)in atrial myocardial tissue were detected using Western blotting,reverse transcription-quantitative polymerase chain reaction,or enzyme-linked immunosorbent assay.The role of a7nAChR in acupuncture treatment was verified by intraperitoneal injection of the a7nAChR antagonist methyllycaconitine(MLA).Results:Compared with the AF group,acupuncture significantly reduced AF duration and induction rate,improved cardiac electrophysiology by enhancing vagus nerve activity and regulating autonomic balance.It also decreased the pro-inflammatory M1 macrophage proportion,alleviating myocardial injury and infiltration.MLA weakened acupuncture's electrophysiological improvement and anti-inflammatory effect.Results suggest that acupuncture triggers the a7nAChR-JAK2/STAT3 pathway and exerts cardioprotection via neuroimmune regulation.Conclusion:Acupuncture significantly reduced the AF induction rate,shortened AF duration,improved cardiac electrophysiological parameters,enhanced vagus nerve activity,and decreased the expression of pro-inflammatory M1 macrophages and inflammatory factors in rats with paroxysmal AF.
文摘AIM To test of the implantable-cardioverter-defibrillator is done at the time of implantation. We investigate if any testing should be performed.METHODS All consecutive patients between January 2006 and December 2008 undergoing implantable cardioverterdefibrillator(ICD) implantation/replacement(a total of 634 patients) were included in the retrospective study.RESULTS Sixteen patients(2.5%) were not tested(9 with LA/LVthrombus, 7 due to operator's decision). Analyzed were 618 patients [76% men, 66.4 + 11 years, 24% secondary prevention(SP), 46% with left ventricular ejection fraction(LVEF) < 20%, 56% had coronary artery disease(CAD)] undergoing defibrillation safety testing(SMT) with an energy of 21 + 2.3 J. In 22/618 patients(3.6%) induced ventricular fibrillation(VF) could not be terminated with maximum energy of the ICD. Six of those(27%) had successful SMT after system modification or shock lead repositioning, 14 patients(64%) received a subcutaneous electrode array. Younger age(P = 0.0003), non-CAD(P = 0.007) and VF as index event for SP(P = 0.05) were associated with a higher incidence of ineffective SMT. LVEF < 20% and incomplete revascularisation in patients with CAD had no impact on SMT.CONCLUSION Defibrillation testing is well-tolerated. An ineffective SMT occurred in 4% and two third of those needed implantation of a subcutaneous electrode array to passa SMT > 10 J.
文摘Diabetes mellitus and atrial fibrillation(AF)are two global epidemics that frequently coexist,with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis.Pathophysiological mechanisms underlying this relationship include chronic inflammation,oxidative stress,atrial remodeling,autonomic dysfunction,advanced glycation end-products and epicardial adiposity.Management remains challenging;however,recent advances offer promise,including guideline-directed anticoagulation,tailored rate and rhythm control,and particularly,novel antidiabetic therapies,such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists,may improve AF outcomes.A comprehensive,individualized approach is essential to mitigate morbidity and mortality in this high-risk population.
文摘This review explores the emerging connection between psoriasis and atrial fibrillation(AF),focusing on shared inflammatory mechanisms,clinical implications,and research gaps.Psoriasis,characterized by chronic systemic inflammation,has been associated with increased AF risk,driven by elevated pro-inflammatory cytokines such as interleukin(IL)-6,IL-17,and tumor necrosis factor-alpha.These inflammatory mediators contribute to atrial remodeling,fibrosis,and conduction abnormalities,evidenced by prolonged P-wave dispersion and atrial electromechanical delay in psoriasis patients.Severe psoriasis further exacerbates atrial dysfunction,increasing susceptibility to AF.This review synthesizes existing epidemiological and biological data,highlighting the need for interdisciplinary management of psoriasis patients to mitigate cardiovascular risks.However,the reliance on observational studies limits definitive conclusions about causality.We emphasize the necessity for large-scale,multicenter research to validate these findings,investigate genetic predispositions,and evaluate lifestyle factors and AF burden.Future research should aim to delineate the pathophysiological link between psoriasis and AF.By examining the interplay of systemic inflammation,electrophysiological changes,and clinical outcomes,this review aims to advance understanding of the psoriasis-AF link and guide strategies for early detection,prevention,and management of AF in psoriasis patients.Comprehensive care integrating dermatology and cardiology is essential for improving patient outcomes.
文摘BACKGROUND Atrial fibrillation(AF)is a prevalent cardiac arrhythmia associated with significant morbidity and mortality,particularly in patients with concomitant renal dysfunction.Anticoagulation therapy reduces the risk of thromboembolic complications in AF but presents challenges in patients with renal impairment due to altered pharmacokinetics and increased bleeding risk.AIM To support clinicians in navigating the complexities of anticoagulation in this high-risk population,ensuring optimal outcomes.METHODS The present review followed PRISMA guidelines.Data extraction was conducted using a standardized template that captured key study characteristics:Population demographics,renal function metrics,anticoagulant dosing strategies,and primary and secondary outcomes.For quality assessment,we employed the Cochrane Risk of Bias 2.0 tool for randomized controlled trials.Observational studies were appraised using the Newcastle-Ottawa Scale.RESULTS We analyze data from 16 studies to provide recommendations on optimal anticoagulation strategies,balancing thrombotic and bleeding risks.Current evidence supports the preferential use of apixaban in moderate chronic kidney disease and cautiously in end-stage renal disease,emphasizing the importance of individualized therapy.CONCLUSION The management of anticoagulation in AF patients with renal dysfunction is challenging but critical for reducing stroke risk.
文摘Voltage substrate mapping is a promising tool for the treatment of atrial fibrillation(AF).It is helpful to detect atrial fibrosis,which includes areas with low bipolar voltage,heterogeneous conduction properties,and shortened effective refractory period.The voltage amplitude is typically defined as the maximal peakto-peak level within a specified time window of interest.Contemporary electroanatomic mapping platforms now enable many thousands of data points to be mapped,so that a geometric model of the atrial endocardium is constructable over a short period of time.This mapping procedure is often done with bipolar electrodes to cancel the far-field signal.The recording site coordinates are projected onto an atrial shell,with interpolation of the voltage data across the shell surface.The amplitude of the recorded bipolar electrogram depicted on the threedimensional shell provides detailed information for substrate mapping.Wherever there are areas of low peak-to-peak voltage,it is thought to mark the presence of abnormal tissue properties and conduction.However,uncontrolled variables and environmental factors affecting voltage level include the oncoming electrical activation wavefront direction,the catheter incidence angle,the force applied to the catheter,and the region-variable shape and structure of atrial tissue.Techniques and settings to acquire atrial voltage data for AF analysis have not been standardized.Methods to characterize atrial electrograms are also presently limited.These factors affect quality and reproducibility of the mapping results.Herein,voltage substrate mapping and its variables pertaining to AF and radiofrequency ablation are described and discussed,with suggestions for future work efforts.
文摘Background and Objective Hypertension(HT)and atrial fibrillation(AF)are highly prevalent cardiovascular conditions that frequently coexist.Coronary artery disease(CAD)is a major global cause of mortality.The co-occurrence of HT,AF,and CAD presents significant management challenges.This study aims to explore the clinical characteristics and risk factors associated with CAD in patients with HT and persistentAF(HT-AF).Methods In this retrospective cross-sectional study,data were collected from 384 hospitalized HT-AF patients at the People's Liberation Army General Hospital between January 2010 and December 2019.CAD diagnosis was confirmed by coronary angiography or computed tomography angiography.Clinical characteristics and comorbidities were compared between patients with and without CAD.Multivariate logistic regression analyses were performed to identify independent risk factors associated with CAD development.Results The prevalence of CAD among HT-AF patients was 66.41%(255/384).Cardiovascular complications,particularly heart failure(44.7%vs 25.6%,P<0.05),were significantly more prevalent in the CAD group than in the non-CAD group.Only age was identified as an independent risk factor for CAD(adjusted OR:1.047;95%CI:1.022–1.073;P=0.000).Of all HT-AF patients,54.7%had a CHA2DS2-VASc score of≥4,indicating high stroke risk.There was a slightly higher anticoagulant usage rate in the CAD group than those without CAD(8.6%vs 4.7%,P=0.157),and the overall anticoagulant usage remained low.Conclusion There is a high prevalence of CAD among hospitalized HT-AF patients,among whom age is the sole independent risk factor for CAD.Despite a high stroke risk,the utilization of oral anticoagulants is alarmingly low.
基金supported by the Institute of Civil Military Technology Cooperation funded by the Defense Acquisition Program Administration and Ministry of Trade,Industry and Energy of Korean government under grant No 23-CM-AI-08.
文摘Amidst the ever-growing interest in high-mass-loading Li battery electrodes,a persistent challenge has been the insufficient continuity of their ion/electron conduction pathways.Here,we propose cellulose elementary fibrils(CEFs)as a class of deagglomerated binder for high-mass-loading electrodes.Derived from natural wood,CEF represents the most fundamental unit of cellulose with nanoscale diameter.The preparation of the CEFs involves the modulation of intermolecular hydrogen bonding by the treatment with a proton acceptor and a hydrotropic agent.This elementary deagglomeration of the cellulose fibers increases surface area and anionic charge density,thus promoting uniform dispersion with carbon conductive additives and suppressing interfacial side reactions at electrodes.Consequently,a homogeneous redox reaction is achieved throughout the electrodes.The resulting CEF-based cathode(overlithiated layered oxide(OLO)is chosen as a benchmark electrode active material)exhibits a high areal-mass-loading(50 mg cm^(-2),equivalent to an areal capacity of 12.5 mAh cm^(-2))and a high specific energy density(445.4 Wh kg–1)of a cell,which far exceeds those of previously reported OLO cathodes.This study highlights the viability of the deagglomerated binder in enabling sustainable high-mass-loading electrodes that are difficult to achieve with conventional synthetic polymer binders.
文摘Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite advancements in anticoagulation and rhythm control,patient outcomes remain suboptimal.Aim:This review synthesizes current evidence on the pathophysiological mechanisms,multidimensional management strategies,and emerging innovations in NVAF to inform clinical practice and future research directions.Methods:A systematic literature search was conducted across nine databases(CNKI,Wanfang,SinoMed,VIP,PubMed,Web of Science,Cochrane Library,Embase,and MEDLINE)using combined Medical Subject Headings(MeSH)and free-text terms,including“atrial fibrillation,”“non-valvular atrial fibrillation,”“risk factors,”and“mechanism”(and their Chinese equivalents).Studies on NVAF pathogenesis,therapeutic interventions,and risk stratification tools were analyzed.Results:(1)Risk Factors and Pathophysiology:NVAF progression is driven by hemodynamic stress(e.g.,hypertension),metabolic disorders(e.g.,obesity,diabetes),chronic inflammation,and fibrosis.Biomarkers such as CRP and Galectin-3,along with TGF-β/Smad signaling,are central to atrial remodeling.(2)Anticoagulation Controversies:While NOACs reduce stroke risk compared to warfarin(HR=0.79),challenges persist in extreme body weight populations and drug-drug interactions(e.g.,with P-glycoprotein inhibitors).(3)Left Atrial Appendage Closure(LAAC):LAAC demonstrates non-inferiority to anticoagulation in stroke prevention(HR=0.79)with reduced major bleeding(HR=0.49),though device-related thrombosis(1.8–7%)remains a concern.(4)Precision Medicine:AI-driven models enhance stroke prediction(AUC=0.71;sensitivity 92%),while genotype-guided warfarin dosing shortens INR stabilization by 40%.(5)Lifestyle Interventions:Combined Mediterranean diet and moderate exercise reduce AF burden(HR=0.69)and reverse left atrial enlargement(LAVI reduced by 12%).(6)Multidisciplinary Care:Integrated“heart-brain team”approaches combining LAAC and PFO closure lower annual stroke recurrence from 8.2%to 2.1%,while comprehensive rehabilitation improves functional capacity(6MWD+45 m)and quality of life(SF-36+12 points).Conclusion:NVAF management has evolved from isolated anticoagulation to a multidimensional paradigm integrating genomics,AI,and lifestyle modification.Future priorities include validating long-term outcomes of novel therapies,addressing evidence gaps in special populations,and implementing digitally enabled,cross-disciplinary care models to mitigate the global burden of NVAF-related complications.
文摘BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-related mortality among CKD patients is crucial for effective clinical and public health strategies.AIM To investigate AF-CKD comorbidity and mortality on the national level.METHODS Death certificates from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research database spanning 2011-2020 were analyzed to investigate AF-related CKD mortality in adults aged 35 to 85 or more years.Age-adjusted mortality rates(AAMRs)per 100000 persons and annual percent change(APC)were calculated,stratified by year,sex,race/ethnicity,and geographic region.RESULTS A total of 110733 deaths occurred among adults(aged 35-85 or more years)related to AF associated with CKD in the United States.Overall AAMR declined from 8.1 in 2011 to 5.5 in 2014(APC:-14.89;95%confidence interval(CI):-30.44 to-4.06),followed by an increase to 10.3 in 2020(APC:9.91;95%CI:6.1-19.62).Men had higher AAMRs than women(men:7.6,95%CI:7.6-7.7).Non-Hispanic White adults had the highest AAMR(7.8),followed by non-Hispanic Black(5).States in the top 90th percentile had approximately four times higher AAMRs than those in the lower 10th percentile.AAMR also varied by region(Midwest:7.6,West:6.7,Northeast:6.3,South:5.6),with nonmetropolitan areas exhibiting higher AF-associated CKD mortality.CONCLUSION Temporal trends in AF-related mortality among CKD patients showed fluctuations over the study period,with notable disparities across demographic and geographic factors.Targeted interventions are warranted to mitigate the burden of AF associated with CKD and reduce mortality rates in the United States.
基金The Guiding Projects issued by the Fujian Provincial Department of Science and Technology,China(Grant No.2023Y0045)the Department of Finance,Fujian Province(Grant No.006009210417)+1 种基金the Fujian Medical University Student Innovation Training Program(Grant No.C2024177)Joint Funds for the Innovation of Science and Technology,Fujian Province(Grant No.2024Y9009).
文摘This study aimed to investigate the influence of stable coronary artery disease(SCAD)on anticoagulation monotherapy.A total of 260 patients with nonvalvular atrial fibrillation who were admitted to Fujian Provincial Hospital between November 2021 and June 2023 were enrolled.The study compared the trough plasma concentrations of rivaroxaban,coagulation parameters,efficacy endpoints(stroke,systemic embolism,and myocardial infarction[MI]),and safety outcomes(including major bleeding,clinically relevant nonmajor bleeding[CRB],minor bleeding,and overall bleeding)between SCAD and non-SCAD patients after propensity score matching(PSM).Additionally,the association between prothrombin time-international normalized ratio(PT-INR)and total bleeding risk was analyzed using restricted cubic spline models and Cox proportional hazards regression.Baseline characteristics,including ABCB1 genotypes,concomitant medications,and other clinical variables,were retrospectively collected.Following PSM,159 patients were included in the final analysis.The results indicated no significant differences in efficacy outcomes or CRB between SCAD and non-SCAD patients.However,SCAD patients exhibited a significantly higher risk of minor bleeding(adjusted HR:2.08,95%CI:1.07–4.04;P=0.030)and total bleeding(HR:1.96,95%CI:1.05–3.64;P=0.034).Moreover,among SCAD patients with a history of MI,the risk of CRB(HR:5.50,95%CI:1.00–30.14;P=0.0497)and total bleeding(HR:2.61,95%CI:1.09–6.27;P=0.032)was notably increased.Furthermore,in SCAD patients,PT-INR demonstrated a nonlinear positive correlation with total bleeding risk.
文摘Atrial fibrillation(Afib)is a common arrhythmia with significant public health implications,affecting millions of individuals worldwide.Catheter ablation(CA)is an established treatment for drug-resistant Afib,yet recurrence remains a major concern,impacting quality of life in a significant portion of patients.Inflammation plays a critical role in the recurrence of Afib after ablation,with systemic inflammatory markers such as C-reactive protein being linked to higher recurrence rates.In this editorial,we discuss the study by Wang et al,published in the latest issue,which investigates the predictive role of the systemic immune inflammation index(SII)in Afib recurrence following radiofrequency CA.Elevated pre-ablation SII levels are identified as an independent predictor of recurrence,significantly enhancing the predictive power of the APPLE score.Integration of SII improved the APPLE score’s predictive performance,as shown by enhanced area under the curve,net reclassification improvement,and integrated discrimination improvement.This combined model highlights the importance of both structural and inflammatory factors in Afib recurrence,offering a more personalized approach to patient management.Additionally,the affordability and accessibility of SII enhance its practicality in clinical workflows.The study by Wang et al underscores the potential of integrating SII with existing scoring systems to refine risk stratification and optimize treatment strategies.Future research should validate these findings across diverse populations,explore limitations such as the potential influence of comorbidities on SII reliability,and investigate additional biomarkers to enhance predictive accuracy.
文摘BACKGROUND The Perceval Sorin S(perceval valve)is a sutureless bioprosthetic designed for use in a high-risk cohort who may not be suitable for transcatheter aortic valve implantation or a conventional surgical aortic valve replacement(AVR).AIM To compare five-year post-operative outcomes in a cohort undergoing isolated AVR with the perceval valve to a contemporary cohort undergoing surgical AVR with a sutured bioprosthesis.METHODS This study was a retrospective,cohort study at a single tertiary unit.Between 2017 and 2023,982 suitable patients were identified.174 Perceval valve replacements were matched to 174 sutured valve replacements.Cohort characteristics,intra-operative details,and post-operative outcomes were compared between the two groups.RESULTS Time under the aortic cross-clamp(P<0.001),time on the cardiopulmonary bypass(P<0.001)and total operative time(P<0.001)were significantly reduced in the Perceval group.Patients in the Perceval valve group were at a lower risk of postoperative pneumonia[odds ratio(OR)=0.53(0.29-0.94)]and atrial fibrillation[OR=0.58(0.36-0.93)].After propensity-matching,all-cause mortality did not significantly differ between the two groups in the five-year follow-up period.Larger valve sizes conferred an increased risk of mortality(P=0.020).CONCLUSION Sutureless surgical AVR(SAVR)is a safe and efficient alternative to SAVR with a sutured bioprosthesis,and may confer a reduced risk of post-operative atrial fibrillation.Clinician tendency towards‘oversizing’sutureless aortic valves translates into adverse clinical outcomes.Less time on the cardiopulmonary bypass circuit allows for the treatment of otherwise high-risk patients.
