Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is...Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is considered the gold standard for achieving CRT;however,approximately 30%–40%of patients do not respond to BVP-CRT.Recent studies have demonstrated that LBB pacing(LBBP)produces remarkable results in CRT.In this meta-analysis,LBBP-CRT showed better outcomes than conventional BVP-CRT,including greater QRS duration reduction and left ventricular ejection fraction improvement,along with consistently lower pacing thresholds on follow-up.Additionally,there was a grea-ter reduction in New York Heart Association class and brain natriuretic peptide levels.This study contributes to the growing body of encouraging data on LBBP-CRT from recent years.With ongoing technological advancements and increasing operator expertise,the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.展开更多
BACKGROUND Cardiac metastatic tumors(CMTs)are rare yet pose significant medical concerns.Clinical studies on CMT are limited,particularly those involving multicenter data analysis.AIM To systematically analyze the eti...BACKGROUND Cardiac metastatic tumors(CMTs)are rare yet pose significant medical concerns.Clinical studies on CMT are limited,particularly those involving multicenter data analysis.AIM To systematically analyze the etiology,sources,classification,treatment,and prognosis of CMT.METHODS A total of 226 CMT patients from two centers(2013 to 2023)were reviewed,and 153 tumor patients from China Health and Retirement Longitudinal Study were used as controls.The survival rates of 96 CMT patients were tracked through medical records and telephone follow-ups.Logistic regression and survival analyses were conducted to characterize CMT.RESULTS CMTs were predominantly male(67.26%vs 39.47%,P<0.001).Intracardiac metastasis patients had worse heart and coagulation function than pericardial metastasis patients(prothrombin time:13.90 vs 13.30,P=0.002),D-dimer levels(2.16 vs 0.85,P=0.001),B-type natriuretic peptide(BNP)levels(324.00 vs 136.50,P=0.004),and troponin levels(5.35 vs 0.03,P<0.001)).Lung and liver cancers were the predominant primary tumor types in CMT.Patients with lung cancer(76.40%vs 30.77%)and thymoma(7.45%vs 1.54%)exhibited a higher prevalence of pericardial metastasis,while those with liver cancer(35.38%vs 0.62%)showed a higher prevalence of intracardiac metastasis.Overall survival was better for pericardial metastasis than for intracardiac metastasis patients(median survival:419 days vs 129 days,log-rank test P=0.0029).Cox proportional hazards model revealed that advanced age[hazard ratio(HR)=1.034,95%confidence interval(95%CI):1.011-1.057]and higher BNP and troponin levels(HR=1.011,95%CI:1.004-1.018)were associated with worse survival.Surgery significantly improved the survival rate of patients.The median survival time was 275 days for patients who did not undergo surgery and 708 days for those who had surgery(log-rank test P=0.0128)CONCLUSION Clinicians should consider CMT in the male lung or liver cancer patients with cardiac symptoms.Abnormal coagulation,impaired heart function,tumor location,and age are key prognostic factors for CMT.Surgical intervention is the preferred treatment option,as it significantly prolongs median survival.展开更多
Arrhythmogenic right ventricular cardiomyopathy(ARVC)is a progressive disease characterized by adipose and fibrous replacement of the myocardium.While elevated testosterone levels have been implicated in the pathologi...Arrhythmogenic right ventricular cardiomyopathy(ARVC)is a progressive disease characterized by adipose and fibrous replacement of the myocardium.While elevated testosterone levels have been implicated in the pathological process of ARVC,its exact contribution to cardiac fibrosis in ARVC remains unclear.In this study,we analyzed the potential contribution of gender-based differences on the distribution of the low-voltage area in an ARVC cohort undergoing an electrophysiological study,which was indicated by feature selection.Additionally,we established engineered cardiac spheroid models in vitro using patient-specific induced pluripotent stem cell(iPSC)-derived cardiomyocytes(iPSC-CMs)and iPSC-derived cardiac fibroblasts(icFBs).We elucidated the pathogenicity of abnormal splicing in the plakophilin-2(PKP2)gene caused by an intronic mutation.Additionally,pathogenic validation of the desmoglein-2(DSG2)point mutation further confirms the reliability of the models.Moreover,testosterone exacerbated the DNA damage in the mutated cardiomyocytes and further activated myofibroblasts in a chain reaction.In conclusion,we designed and constructed an in vitro three-dimensionally-engineered cardiac spheroid model of ARVC based on clinical findings and provided direct evidence of the fibrotic role of testosterone in ARVC.展开更多
Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria ...Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of B中央人民政府 in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cystatin C, with an Area under the ROC Curve of 0.864 and a cut-off value of 0.55 (p Conclusion: This study supports the superior utility of serum Cystatin C as an early detector of AKI in on-pump cardiac surgery patients compared to serum creatinine. Its ability to identify AKI several hours earlier may contribute to reduced morbidity, mortality, and healthcare costs. The findings underscore the significance of exploring novel biomarkers for improved post-cardiac surgery renal function assessment.展开更多
Thoracic ultrasound has attracted much interest in detecting pleural effusion or pulmonary consolidation after cardiac surgery.In 2016,Trovato reported,in the World Journal of Cardiology,the interest of using,in addit...Thoracic ultrasound has attracted much interest in detecting pleural effusion or pulmonary consolidation after cardiac surgery.In 2016,Trovato reported,in the World Journal of Cardiology,the interest of using,in addition to echocardiography,thoracic ultrasound.In this editorial,we highlight the value of assessing diaphragm function after cardiac surgery and interventional cardiology pro-cedures.Various factors are able to impair diaphragm function after such interventions.Diaphragm motion may be decreased by chest pain secondary to sternotomy,pleural effusion or impaired muscle function.Hemidiaphragmatic paralysis may be secondary to phrenic nerve damage complicating cardiac surgery or atrial fibrillation ablation.Diagnosis may be delayed.Indeed,respi-ratory troubles induced by diaphragm dysfunction are frequently attributed to pre-existing heart disease or pulmonary complications secondary to surgery.In addition,elevated hemidiaphragm secondary to diaphragm dysfunction is sometimes not observed on chest X-ray performed in supine position in the intensive care unit.Analysis of diaphragm function by ultrasound during the recovery period appears essential.Both hemidiaphragms can be studied by two complementary ultrasound methods.The mobility of each hemidiaphragms is measured by M-mode ultrasonography.In addition,recording the percentage of inspiratory thickening provides important information about the quality of muscle function.These two approaches make it possible to detect hemidiaphragm paralysis or dysfunction.Such a diagnosis is important because persistent diaphragm dysfunction after cardiac surgery has been shown to be associated with adverse respiratory outcome.Early respiratory physio-therapy is able to improve respiratory function through strengthening of the inspiratory muscles i.e.diaphragm and accessory inspiratory muscles.展开更多
It is estimated that approximately one in ten people over the age of 80 may suffer from cardiac amyloidosis(CA),a disease in which various aging-related factors,such as increased oxidative stress,can promote abnormal ...It is estimated that approximately one in ten people over the age of 80 may suffer from cardiac amyloidosis(CA),a disease in which various aging-related factors,such as increased oxidative stress,can promote abnormal protein folding and the formation of amyloid deposits in the heart.Over the long term,this tends to impair cardiac function,increasing the risk of developing cardiac conduction disorders,atrial fibrillation,thromboembolic events,heart failure(HF),and/or ventricular dysfunction.^([1,2])展开更多
Background: Heart failure is a chronic and severe condition that often results from various heart diseases. Cardiac rehabilitation (CR) is currently a crucial component in managing this condition. The aim was to asses...Background: Heart failure is a chronic and severe condition that often results from various heart diseases. Cardiac rehabilitation (CR) is currently a crucial component in managing this condition. The aim was to assess the effects of cardiac rehabilitation on physical capacity of heart failure patients. Methods: This was a cross-sectional study conducted from February 1, 2021, to June 30, 2023. We included all patients with heart failure who underwent cardiac rehabilitation. Data analysis was performed using SPSS software version 24.0, with a significance level set at p Results: The study included 87 heart failure patients, with a male-to-female ratio of 1.8. Mean age was 57.10 years (±11.75). Coronary artery disease was the primary cause of heart failure, accounting for 75.9% of cases. Atrial fibrillation was present in 4.7% of cases. Following cardiac rehabilitation, Left Ventricular Ejection Fraction increased from 40.15% to 49.48% (p = 0.001). Resting heart rate decreased significantly from 81.4 bpm to 68.3 bpm (p = 0.000), and the number of METS increased from 4.3 to 6.57 (+56.8%;p = 0.000). The mean distance covered in the 6-minute walk test significantly increased from 337.8 meters to 522.7 meters (p = 0.000), reflecting a gain of 183.5 meters. Moreover, the increase in the number of METS was more pronounced in females (p = 0.001), non-obese individuals (p = 0.000), non-diabetics (p = 0.001), non-sedentary individuals (p = 0.000), and non-smokers (p = 0.000). The study reported a low readmissions rate of 2.2% and a mortality rate of 1.1%. Conclusion: Our study demonstrates that cardiac rehabilitation is beneficial for black African heart failure patients, resulting in significant improvements in symptoms, physical and capacity.展开更多
Background The age, creatinine levels, and the ejection fraction Ⅱ score(ACEF Ⅱ score) are significant indicators for assessing inflammation and predicting adverse outcomes following cardiac surgery. Our objective w...Background The age, creatinine levels, and the ejection fraction Ⅱ score(ACEF Ⅱ score) are significant indicators for assessing inflammation and predicting adverse outcomes following cardiac surgery. Our objective was to investigate the predictive value of the recently updated ACEF Ⅱ score concerning perioprative blood transfusion in adult patients undergoing cardiac surgery. Methods A retrospective review was conducted involving adults(≥18 years) who underwent cardiac surgery for heart disease between January 2019 and June 2019. The primary outcome measure was perioperative blood transfusion among adult patients. Multivariable logistic regression and receiver operation characteristic(ROC) analysis were applied to analyze the link between the ACEF Ⅱ score and perioperative blood transfusion. Results A total of 415 patients were included, participants were stratified into three groups based on their ACEF Ⅱ scores level: ACEF Ⅱ <0.666, 0.666 ≤ ACEF Ⅱ <0.950, and 0.950 ≤ ACEF II ≤4.781. Multivariable Logistic regression analysis indicated that a high ACEF Ⅱ score(OR: 3.59, 95% CI: 1.68-7.67, P<0.001) was independently associated with an increased risk of perioperative blood transfusion among adults undergoing cardiac surgery. Furthermore, the area under the receiver operating characteristic curve for predicting perioperative blood transfusion risk using the ACEF Ⅱ score was found to be 0.607. The Pearson correlation coefficient showed a direct and statistically significant positive correlation between ACEF Ⅱ score and perioperative blood transfusion(r=0.17, P<0.001). Conclusions In conclusion, our findings suggested that the ACEF Ⅱ score possessed significant predictive value regarding related to perioperative blood transfusions during cardiac surgical procedures in adult patients. The higher the ACEF Ⅱ score, the higher incidence of perioperative blood transfusions.展开更多
BACKGROUND Delayed sternal closure(DSC)can be a lifesaving approach for certain patients who have undergone cardiac surgery.The value of the type of prophylactic antibiotics in DSC is still debatable.AIM To investigat...BACKGROUND Delayed sternal closure(DSC)can be a lifesaving approach for certain patients who have undergone cardiac surgery.The value of the type of prophylactic antibiotics in DSC is still debatable.AIM To investigate clinical outcomes of different prophylactic antibiotic regimens in patients who had DSC after cardiac surgery.METHODS This was a retrospective observational single-center study.Fifty-three consecutive patients who underwent cardiac surgery and had an indication for DSC were included.Patients were subjected to two regimens of antibiotics:Narrow-spectrum and broad-spectrum regimens.RESULTS The main outcome measures were length of hospital and intensive care unit(ICU)stay,duration of mechanical ventilation,and mortality.Of the 53 patients,12(22.6%)received narrow-spectrum antibiotics,and 41(77.4%)received broad-spectrum antibiotics.The mean age was 59.0±12.1 years,without significant differences between the groups.The mean duration of antibiotic use was significantly longer in the broad-spectrum than the narrowspectrum group(11.9±8.7 vs 3.4±2.0 d,P<0.001).The median duration of open chest was 3.0(2.0-5.0)d for all patients,with no difference between groups(P=0.146).The median duration of mechanical ventilation was significantly longer in the broad-spectrum group[60.0(Δinterquartile range(IQR)170.0)h vs 50.0(ΔIQR 113.0)h,P=0.047].Similarly,the median length of stay for both ICU and hospital were significantly longer in the broadspectrum group[7.5(ΔIQR 10.0)d vs 5.0(ΔIQR 5.0)d,P=0.008]and[27.0(ΔIQR 30.0)d vs 19.0(ΔIQR 21.0)d,P=0.031].Five(9.8%)patients were readmitted to the ICU and 18(34.6%)patients died without a difference between groups.CONCLUSION Prophylactic broad-spectrum antibiotics did not improve clinical outcomes in patients with DSC post-cardiac surgery but was associated with longer ventilation duration,length of ICU and hospital stays vs narrow-spectrum antibiotics.展开更多
To improve the treatment effect of obstructive hypertrophic cardiomyopathy,this article focuses on the treatment of obstructive hypertrophic cardiomyopathy and conducts a comprehensive analysis of the disease.It highl...To improve the treatment effect of obstructive hypertrophic cardiomyopathy,this article focuses on the treatment of obstructive hypertrophic cardiomyopathy and conducts a comprehensive analysis of the disease.It highlights the limitations of traditional treatment methods and elaborates on interventional and surgical treatments.Additionally,this article compares the indications,risks,treatment effects,and costs of the two different treatment methods,providing a reference for doctors and patients in selecting clinical treatment plans.展开更多
BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and com...BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and comprehensive analysis of the long-term prognosis of survivors are vital.This scoping review summarized the representative prognostic scoring systems,aiming to help clinicians in selecting an appropriate scoring system to avoid unnecessary medical resource consumption and reduce ECMO-associated mortality.METHODS:A comprehensive search of multiple databases,including PubMed,Embase,and the Cochrane Library,was conducted.After removing duplicate studies,a full-text review was performed,and all studies that reported score systems before and/or after ECMO support were included.This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR)and has been registered with the Open Science Framework(osf.io/zp4ge).RESULTS:Among the 114 studies included,we identified three scores for patients receiving veno-venous ECMO(VV-ECMO),five scores for patients receiving veno-arterial ECMO(VA-ECMO),and three critical illness scores,which apply to both VV-and VA-ECMO conditions.All characteristics of these scoring systems,their advantages,and their limitations were summarized.CONCLUSION:The implementation of an ECMO scoring system helps to assess the condition of critically ill patients,predict outcome,and provide objective indicators to determine the optimal timing for ECMO intervention.Due to the limitations of the currently available scores,further efforts in improving and validating the ECMO scoring system are needed to achieve the goals of minimizing unnecessary consumption of medical resources and reducing mortality rates.展开更多
The advancement in extraterrestrial exploration has highlighted the crucial need for studying how the human cardiovascular system adapts to space conditions.Human development occurs under the influence of gravity,shie...The advancement in extraterrestrial exploration has highlighted the crucial need for studying how the human cardiovascular system adapts to space conditions.Human development occurs under the influence of gravity,shielded from space radiation by Earth’s magnetic field,and within an environment characterized by 24-hour day-night cycles resulting from Earth’s rotation,thus deviating from these conditions necessitates adaptive responses for survival.With upcoming manned lunar and Martian missions approaching rapidly,it is essential to understand the impact of various stressors induced by outer-space environments on cardiovascular health.This comprehensive review integrates insights from both actual space missions and simulated experiments on Earth,to analyze how microgravity,space radiation,and disrupted circadian affect cardiovascular well-being.Prolonged exposure to microgravity induces myocardial atrophy and endothelial dysfunction,which may be exacerbated by space radiation.Mitochondrial dysfunction and oxidative stress emerge as key underlying mechanisms along with disturbances in ion channel perturbations,cytoskeletal damage,and myofibril changes.Disruptions in circadian rhythms caused by factors such as microgravity,light exposure,and irregular work schedules,could further exacerbate cardiovascular issues.However,current research tends to predominantly focus on disruptions in the core clock gene,overlooking the multifactorial nature of circadian rhythm disturbances in space.Future space missions should prioritize targeted prevention strategies and early detection methods for identifying cardiovascular risks,to preserve astronaut health and ensure mission success.展开更多
BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-o...BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-old woman with severe MR,a left ventricular ejection fraction of 45%,and a small circumferential pericardial effusion underwent TEER of the mitral valve.After the placement of two MitraClips,the MR was assessed as mild to moderate.Within 10-20 minutes after the completion of the case,the patient was dyspneic and hypotensive despite volume resuscitation.Point-of-care ultrasound(POCUS)showed no changes in cardiac contractility,valve function,or the pericardial space.The right heart chambers appeared small with right atrial(RA)diastolic collapse.There was no evidence of venous congestion.Further exam showed a large right pleural fluid collection.Given the clinical scenario of dyspnea,hypotension,and diastolic RA collapse,low-pressure tamponade was suspected.A thoracentesis expelled 1200 mL of blood with immediate hemodynamic improvement.The patient made an uneventful recovery.CONCLUSION The application of POCUS is crucial for detecting,diagnosing,and properly managing cardiac dysfunction and procedural complications associated with TEER.While tamponade is classically associated with a pericardial effusion and vena caval plethora,their absence does not dismiss the suspicion or diagnosis of tamponade.This case highlights the value of POCUS in assessing low-pressure tamponade caused by a large,pressurized pleural effusion.Clinical suspicion,supported by POCUS findings,was confirmed by a thoracentesis that resulted in immediate hemodynamic improvement.展开更多
Background:Aortic atherosclerosis increases the risk of embolic events under extracorporeal circulation(ECC).To evaluate the hemodynamic impact of ECC on atheromatous plaques,an atherosclerosis animal model,which is a...Background:Aortic atherosclerosis increases the risk of embolic events under extracorporeal circulation(ECC).To evaluate the hemodynamic impact of ECC on atheromatous plaques,an atherosclerosis animal model,which is also eligible for ECC,is required.Methods:Twenty-nine New Zealand White rabbits received a pro-atherosclerotic diet(group diet,n=10),a pro-atherosclerotic diet and additional intraaortic balloon insufflation injury(group BI,n=9),or served as controls(n=10).After 3 or 6 months,aortic explants were analyzed by(immuno-)histology and RT-PCR.Results:Blood serum analyses revealed increased cholesterol-levels in groups diet and BI compared to controls(3 months:p=0.03 each,6 months:p<0.0001 each).Aortic inflammatory infiltration was significantly enhanced in groups diet(CD3 at 3 months:p<0.0001,6 months:p=0.02;CD68 at 3 months:p=0.01)and BI(CD3 at 3 months:p<0.0001,6 months:p=0.03;CD68 at 3 months:p=0.04,6 months:p=0.02).Increased intima hyperplasia occurred in both groups(p<0.0001 each).Macroscopic analyses after 3 and 6 months showed ubiquitous lumen-narrowing aortic plaques.Calcification of the intima and media was increased in groups diet(intima:p<0.0001 at 3 and 6 months;media at 3 months:p<0.0001,6 months:p=0.01)and BI(intima:p<0.0001 at 3 and 6 months;media at 3 months:p<0.0001,6 months:p=0.02).Extensive lipid accumulation was found in the intima in both treatment groups(p<0.0001 each).Conclusions:A rabbit model with high aortic calcific plaque burden—diet-induced with no implicit need of an additional intimal injury by an intraaortic balloon insufflation due to comparable outcome—exhibiting multiple pathophysiological aspects of human atherosclerosis has been designed and thoroughly characterized.It is suitable for use in future studies on the interaction between atherosclerotic plaques and the arterial blood flow under ECC.展开更多
Vein graft(VG)failure(VGF)is associated with VG intimal hyperplasia,which is characterized by abnormal accumulation of vascular smooth muscle cells(VSMCs).Most neointimal VSMCs are derived from pre-existing VSMCs via ...Vein graft(VG)failure(VGF)is associated with VG intimal hyperplasia,which is characterized by abnormal accumulation of vascular smooth muscle cells(VSMCs).Most neointimal VSMCs are derived from pre-existing VSMCs via a process of VSMC phenotypic transition,also known as dedifferentiation.There is increasing evidence to suggest that ginger or its bioactive ingredients may block VSMC dedifferentiation,exerting vasoprotective functions;however,the precise mechanisms have not been fully characterized.Therefore,we investigated the effect of ginger on VSMC phenotypic transition in VG remodeling after transplantation.Ginger significantly inhibited neointimal hyperplasia and promoted lumen(L)opening in a 3-month VG,which was primarily achieved by reducing ferroptotic stress.Ferroptotic stress is a pro-ferroptotic state.Contractile VSMCs did not die but instead gained a proliferative capacity and switched to the secretory type,forming neointima(NI)after vein transplantation.Ginger and its two main vasoprotective ingredients(6-gingerol and 6-shogaol)inhibit VSMC dedifferentiation by reducing ferroptotic stress.Network pharmacology analysis revealed that 6-gingerol inhibits ferroptotic stress by targeting P53,while 6-shogaol inhibits ferroptotic stress by targeting 5-lipoxygenase(Alox5),both promoting ferroptosis.Furthermore,both ingredients co-target peroxisome proliferator-activated receptor gamma(PPARγ),decreasing PPARγ-mediated nicotinamide adenine dinucleotide phosphate(NADPH)oxidase 1(Nox1)expression.Nox1 promotes intracellular reactive oxygen species(ROS)production and directly induces VSMC dedifferentiation.In addition,Nox1 is a ferroptosis-promoting gene that encourages ferroptotic stress production,indirectly leading to VSMC dedifferentiation.Ginger,a natural multi-targeted ferroptotic stress inhibitor,finely and effectively prevents VSMC phenotypic transition and protects against venous injury remodeling.展开更多
BACKGROUND Cholangiocarcinoma(CCA)is a heterogeneous group of aggressive malignancies arising from the biliary tree.Epidemiological data show an increase in the incidence of intrahepatic CCA in Western countries and a...BACKGROUND Cholangiocarcinoma(CCA)is a heterogeneous group of aggressive malignancies arising from the biliary tree.Epidemiological data show an increase in the incidence of intrahepatic CCA in Western countries and a stable or decrease in the incidence of extrahepatic CCA.There are conflicting results in literature regarding the trend of the incidence of gallbladder cancer.However,most studies refer to a time period before 2000.AIM To investigate the recent epidemiology of CCA and gallbladder cancer in Northeast Italy using regional data of hospital admissions.METHODS We performed a 17-year(2007-2023)retrospective analysis of hospital discharge records of the Veneto Region.During the period 10778 first hospital admissions for biliary tract cancers in the main or secondary diagnosis were recorded.Data were analyzed by theχ^(2)test for categorical data and the Student’s ttest for continuous data to assess differences in percentages and averages,respectively.Trends in the agestandardized hospitalization rate were evaluated using Joinpoint regression,estimating annual percentage changes(APC).RESULTS The total number of hospitalizations for biliary tract cancers remained stable over the past 17 years(186 hospitalizations/year for intrahepatic CCA,211 for extrahepatic CCA,and 237 for gallbladder cancer/unspecified biliary tract).Age-standardized hospitalization rates for intrahepatic and extrahepatic CCA decreased respectively from 4.9 cases to 3.4 per 100000 inhabitants(APC=-2.0,95%confidence interval:-3.2 to-0.7,P<0.001)and from 6.7 to 3.8 cases per 100000 inhabitants(APC=-3.2,95%confidence interval:-4.2 to-2.1,P<0.001).Instead,hospitalizations for gallbladder cancer remained stable,with an average rate of 5.5 per 100000 inhabitants.Overall,hospitalization rates for biliary tract cancers increased with age in both genders.CONCLUSION Our study reported a decreasing hospitalization rate for CCA and a stable trend for gallbladder cancer over a 17-year period,suggesting a change in the epidemiology of these tumors.展开更多
Image-based computational models have been used for vulnerable plaque progression and rupture predictions,and good results have been reported.However,mechanisms and predictions for plaque erosion are underinvestigated...Image-based computational models have been used for vulnerable plaque progression and rupture predictions,and good results have been reported.However,mechanisms and predictions for plaque erosion are underinvestigated.Patient-specific fluid-structure interaction(FSI)models based on optical coherence tomography(OCT)follow-up data from patients with plaque erosion and who received conservative antithrombotic treatment(using medication,no stenting)to identify risk factors that could be used to predict the treatment outcome.OCT and angiography datawere obtained from10 patientswho received conservative antithrombotic treatment.Five participants had worse outcomes(WOG,stenosis severity≥70%at one-year follow-up),while the other five had better outcomes(BOG,stenosis severity<70%at one-year follow-up).Patient-specific 3D FSI models were constructed to obtain morphological and biomechanical risk factor values(a total of nine risk factors)for comparison and prediction.A logistic regressionmodel was used to identify optimal predictors with the best treatment outcome prediction accuracies.Our results indicated that the combination of wall shear stress(WSS),lipid percent,and thrombus burden was the best group predictor according to the mean area under the curve(AUC)of 0.96(90%confidence interval=(0.85,1.00)).WSS was the best single predictor withmean AUC=0.70(90%confidence interval=(0.20,1.00)).Thrombus burden was the only risk factor showing statistically significant group difference,suggesting its crucial role in the outcomes of conservative anti-thrombotic therapy.This pilot study indicated that integratingmorphological and biomechanical risk factors could improve treatment outcome prediction accuracy in patients with plaque erosion compared to predictions using single predictors.Large-scale patient studies are needed to further validate our findings.展开更多
Background:The National Chest Pain Center Program(NCPCP)is a nationwide,quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China.The benefits of chest pain ...Background:The National Chest Pain Center Program(NCPCP)is a nationwide,quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China.The benefits of chest pain center(CPC)accreditation on acute coronary syndrome have been demonstrated.However,there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection(AAD).Methods:We conducted a retrospective observational study of patients with AAD from 1671 hospitals in China,using data from the NCPCP spanning the period from January 1,2016 to December 31,2022.The patients were divided into 2 groups:pre-accreditation and post-accreditation admissions.The outcomes examined included in-hospital mortality,misdiagnosis,and Stanford type A AAD surgery.Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes.Furthermore,we stratified the hospitals based on their geographical location(Eastern/Central/Western regions)or administrative status(provincial/non-provincial capital areas)to assess the impact of CPC accreditation on AAD patients across various regions.Results:The analysis encompassed a total of 40,848 patients diagnosed with AAD.The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis(12.1%vs.16.3%,P<0.001 and 2.9%vs.5.4%,P<0.001,respectively)as well as a notably higher rate of Stanford type A AAD surgery(61.1%vs.42.1%,P<0.001)compared with the pre-accreditation group.After adjusting for potential covariates,CPC accreditation was associated with substantially reduced risks of in-hospital mortality(adjusted OR=0.644,95%CI 0.599-0.693)and misdiagnosis(adjusted OR=0.554,95%CI 0.493-0.624),along with an increase in the proportion of patients undergoing Stanford type A AAD surgery(adjusted OR=1.973,95%CI 1.797-2.165).Following CPC accreditation,there were significant reductions in in-hospital mortality across various regions,particularly in Western regions(from 21.5%to 14.1%).Moreover,CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities(adjusted OR:0.607 vs.0.713).Conclusion:CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.展开更多
Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by re...Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging,which significantly complicates their recovery process.To date,no study has investigated burns as a potential risk factor for frailty.This study aimed to determine the short-term prevalence of frailty among burn survivors’months after injury and compare it with that of the general population.Methods:A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury(RE-ENERGIZE)trial,an international randomized-controlled trial involving 1200 burn injury patients with partial-or full-thickness burns.Participants who did not complete the 36-Item Short Form Health Survey(SF-36)questionnaire were excluded.Data for the general population were obtained from the 2022 National Health Interview Survey(NHIS).Frailty was assessed using the FRAIL(Fatigue,Resistance,Ambulation,Illness,Loss of weight)scale.Due to lack of data on loss of weight,for the purposes of this study,malnutrition was used as the fifth variable.Illness and malnutrition were based on admission data,while fatigue,resistance,and ambulation were determined from post-discharge responses to the SF-36.The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status.Within the burn group,patients were divided into different subgroups based on their frailty status,and the differences in their(instrumental)activities of daily living(iADL and ADL)were compared.A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.Results:Out of the 1200 burn patients involved in the study,600 completed the required questionnaires[follow-up time:(5.5±2.3)months]and were matched to 1200 adults from the general population in the U.S.In comparison to the general population,burn patients exhibited a significantly higher likelihood of being pre-frail(42.3%vs.19.8%,P<0.0001),or frail(13.0%vs.1.0%,P<0.0001).When focusing on specific components,burn patients were more prone to experiencing fatigue(25.8%vs.13.5%,P<0.0001),limited resistance(34.0%vs.2.7%,P<0.0001),and restricted ambulation(41.8%vs.3.8%,P<0.0001).Conversely,the incidence rate of illness was observed to be higher in the general population(1.2%vs.2.8%,P=0.03),while no significant difference was detected regarding malnutrition(2.3%vs.2.6%,P=0.75).Furthermore,in comparison with robust burn patients,it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL.The frail cohort reported the most pronounced limitation.Conclusions:Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury.Burn survivors experience compromised fatigue,resistance,and ambulation,while rates of illness and malnutrition were lower or unchanged,respectively.These results underscore the critical need for early identification of frailty after a burn injury,with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists,community physicians,physiotherapists,nutritionists,and social workers.This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.展开更多
Heart rate variability （HRV） refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV ha...Heart rate variability （HRV） refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV has been shown to be effective as a predictor of risk after myocardial infarction and an early warning sign of diabetic neuropathy, and in the cardiology setting is now recognized to be a useful tool for risk-stratification after hospital admission and after discharge. Recent evidences suggest that HRV analysis might predict complications even in patients undergoing cardiac surgery, and the present review summarizes the importance of HRV analysis in adult cardiac surgery and the perspectives for HRV use in current clinical practice. Although future larger studies are warranted before HRV can be included into daily clinical practice in adult cardiac surgery, HRV is a novel tool which might detect autonomic instability in the early postoperative phase and during hospital stay, thus predicting or prompt-diagnosing many of the post-operative complications.展开更多
文摘Cardiac resynchronization therapy(CRT)reduces heart failure(HF)hospitaliz-ations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch(LBB)block.Biventricular pacing(BVP)is considered the gold standard for achieving CRT;however,approximately 30%–40%of patients do not respond to BVP-CRT.Recent studies have demonstrated that LBB pacing(LBBP)produces remarkable results in CRT.In this meta-analysis,LBBP-CRT showed better outcomes than conventional BVP-CRT,including greater QRS duration reduction and left ventricular ejection fraction improvement,along with consistently lower pacing thresholds on follow-up.Additionally,there was a grea-ter reduction in New York Heart Association class and brain natriuretic peptide levels.This study contributes to the growing body of encouraging data on LBBP-CRT from recent years.With ongoing technological advancements and increasing operator expertise,the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.
文摘BACKGROUND Cardiac metastatic tumors(CMTs)are rare yet pose significant medical concerns.Clinical studies on CMT are limited,particularly those involving multicenter data analysis.AIM To systematically analyze the etiology,sources,classification,treatment,and prognosis of CMT.METHODS A total of 226 CMT patients from two centers(2013 to 2023)were reviewed,and 153 tumor patients from China Health and Retirement Longitudinal Study were used as controls.The survival rates of 96 CMT patients were tracked through medical records and telephone follow-ups.Logistic regression and survival analyses were conducted to characterize CMT.RESULTS CMTs were predominantly male(67.26%vs 39.47%,P<0.001).Intracardiac metastasis patients had worse heart and coagulation function than pericardial metastasis patients(prothrombin time:13.90 vs 13.30,P=0.002),D-dimer levels(2.16 vs 0.85,P=0.001),B-type natriuretic peptide(BNP)levels(324.00 vs 136.50,P=0.004),and troponin levels(5.35 vs 0.03,P<0.001)).Lung and liver cancers were the predominant primary tumor types in CMT.Patients with lung cancer(76.40%vs 30.77%)and thymoma(7.45%vs 1.54%)exhibited a higher prevalence of pericardial metastasis,while those with liver cancer(35.38%vs 0.62%)showed a higher prevalence of intracardiac metastasis.Overall survival was better for pericardial metastasis than for intracardiac metastasis patients(median survival:419 days vs 129 days,log-rank test P=0.0029).Cox proportional hazards model revealed that advanced age[hazard ratio(HR)=1.034,95%confidence interval(95%CI):1.011-1.057]and higher BNP and troponin levels(HR=1.011,95%CI:1.004-1.018)were associated with worse survival.Surgery significantly improved the survival rate of patients.The median survival time was 275 days for patients who did not undergo surgery and 708 days for those who had surgery(log-rank test P=0.0128)CONCLUSION Clinicians should consider CMT in the male lung or liver cancer patients with cardiac symptoms.Abnormal coagulation,impaired heart function,tumor location,and age are key prognostic factors for CMT.Surgical intervention is the preferred treatment option,as it significantly prolongs median survival.
基金supported by the National Natural Science Foundation of China(Nos.82370322 to CC,82200352 to FZ,82300352 to YZ,22275034 to HX,and 82070343 to MLC)the Natural Science Foundation of Jiangsu Province of China(Nos.BK20220710 to FZ and BK20230733 to YZ)Postgraduate Research&Practice Innovation Program of Jiangsu Province(No.JX13414086 to HYC).
文摘Arrhythmogenic right ventricular cardiomyopathy(ARVC)is a progressive disease characterized by adipose and fibrous replacement of the myocardium.While elevated testosterone levels have been implicated in the pathological process of ARVC,its exact contribution to cardiac fibrosis in ARVC remains unclear.In this study,we analyzed the potential contribution of gender-based differences on the distribution of the low-voltage area in an ARVC cohort undergoing an electrophysiological study,which was indicated by feature selection.Additionally,we established engineered cardiac spheroid models in vitro using patient-specific induced pluripotent stem cell(iPSC)-derived cardiomyocytes(iPSC-CMs)and iPSC-derived cardiac fibroblasts(icFBs).We elucidated the pathogenicity of abnormal splicing in the plakophilin-2(PKP2)gene caused by an intronic mutation.Additionally,pathogenic validation of the desmoglein-2(DSG2)point mutation further confirms the reliability of the models.Moreover,testosterone exacerbated the DNA damage in the mutated cardiomyocytes and further activated myofibroblasts in a chain reaction.In conclusion,we designed and constructed an in vitro three-dimensionally-engineered cardiac spheroid model of ARVC based on clinical findings and provided direct evidence of the fibrotic role of testosterone in ARVC.
文摘Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of B中央人民政府 in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cystatin C, with an Area under the ROC Curve of 0.864 and a cut-off value of 0.55 (p Conclusion: This study supports the superior utility of serum Cystatin C as an early detector of AKI in on-pump cardiac surgery patients compared to serum creatinine. Its ability to identify AKI several hours earlier may contribute to reduced morbidity, mortality, and healthcare costs. The findings underscore the significance of exploring novel biomarkers for improved post-cardiac surgery renal function assessment.
文摘Thoracic ultrasound has attracted much interest in detecting pleural effusion or pulmonary consolidation after cardiac surgery.In 2016,Trovato reported,in the World Journal of Cardiology,the interest of using,in addition to echocardiography,thoracic ultrasound.In this editorial,we highlight the value of assessing diaphragm function after cardiac surgery and interventional cardiology pro-cedures.Various factors are able to impair diaphragm function after such interventions.Diaphragm motion may be decreased by chest pain secondary to sternotomy,pleural effusion or impaired muscle function.Hemidiaphragmatic paralysis may be secondary to phrenic nerve damage complicating cardiac surgery or atrial fibrillation ablation.Diagnosis may be delayed.Indeed,respi-ratory troubles induced by diaphragm dysfunction are frequently attributed to pre-existing heart disease or pulmonary complications secondary to surgery.In addition,elevated hemidiaphragm secondary to diaphragm dysfunction is sometimes not observed on chest X-ray performed in supine position in the intensive care unit.Analysis of diaphragm function by ultrasound during the recovery period appears essential.Both hemidiaphragms can be studied by two complementary ultrasound methods.The mobility of each hemidiaphragms is measured by M-mode ultrasonography.In addition,recording the percentage of inspiratory thickening provides important information about the quality of muscle function.These two approaches make it possible to detect hemidiaphragm paralysis or dysfunction.Such a diagnosis is important because persistent diaphragm dysfunction after cardiac surgery has been shown to be associated with adverse respiratory outcome.Early respiratory physio-therapy is able to improve respiratory function through strengthening of the inspiratory muscles i.e.diaphragm and accessory inspiratory muscles.
文摘It is estimated that approximately one in ten people over the age of 80 may suffer from cardiac amyloidosis(CA),a disease in which various aging-related factors,such as increased oxidative stress,can promote abnormal protein folding and the formation of amyloid deposits in the heart.Over the long term,this tends to impair cardiac function,increasing the risk of developing cardiac conduction disorders,atrial fibrillation,thromboembolic events,heart failure(HF),and/or ventricular dysfunction.^([1,2])
文摘Background: Heart failure is a chronic and severe condition that often results from various heart diseases. Cardiac rehabilitation (CR) is currently a crucial component in managing this condition. The aim was to assess the effects of cardiac rehabilitation on physical capacity of heart failure patients. Methods: This was a cross-sectional study conducted from February 1, 2021, to June 30, 2023. We included all patients with heart failure who underwent cardiac rehabilitation. Data analysis was performed using SPSS software version 24.0, with a significance level set at p Results: The study included 87 heart failure patients, with a male-to-female ratio of 1.8. Mean age was 57.10 years (±11.75). Coronary artery disease was the primary cause of heart failure, accounting for 75.9% of cases. Atrial fibrillation was present in 4.7% of cases. Following cardiac rehabilitation, Left Ventricular Ejection Fraction increased from 40.15% to 49.48% (p = 0.001). Resting heart rate decreased significantly from 81.4 bpm to 68.3 bpm (p = 0.000), and the number of METS increased from 4.3 to 6.57 (+56.8%;p = 0.000). The mean distance covered in the 6-minute walk test significantly increased from 337.8 meters to 522.7 meters (p = 0.000), reflecting a gain of 183.5 meters. Moreover, the increase in the number of METS was more pronounced in females (p = 0.001), non-obese individuals (p = 0.000), non-diabetics (p = 0.001), non-sedentary individuals (p = 0.000), and non-smokers (p = 0.000). The study reported a low readmissions rate of 2.2% and a mortality rate of 1.1%. Conclusion: Our study demonstrates that cardiac rehabilitation is beneficial for black African heart failure patients, resulting in significant improvements in symptoms, physical and capacity.
文摘Background The age, creatinine levels, and the ejection fraction Ⅱ score(ACEF Ⅱ score) are significant indicators for assessing inflammation and predicting adverse outcomes following cardiac surgery. Our objective was to investigate the predictive value of the recently updated ACEF Ⅱ score concerning perioprative blood transfusion in adult patients undergoing cardiac surgery. Methods A retrospective review was conducted involving adults(≥18 years) who underwent cardiac surgery for heart disease between January 2019 and June 2019. The primary outcome measure was perioperative blood transfusion among adult patients. Multivariable logistic regression and receiver operation characteristic(ROC) analysis were applied to analyze the link between the ACEF Ⅱ score and perioperative blood transfusion. Results A total of 415 patients were included, participants were stratified into three groups based on their ACEF Ⅱ scores level: ACEF Ⅱ <0.666, 0.666 ≤ ACEF Ⅱ <0.950, and 0.950 ≤ ACEF II ≤4.781. Multivariable Logistic regression analysis indicated that a high ACEF Ⅱ score(OR: 3.59, 95% CI: 1.68-7.67, P<0.001) was independently associated with an increased risk of perioperative blood transfusion among adults undergoing cardiac surgery. Furthermore, the area under the receiver operating characteristic curve for predicting perioperative blood transfusion risk using the ACEF Ⅱ score was found to be 0.607. The Pearson correlation coefficient showed a direct and statistically significant positive correlation between ACEF Ⅱ score and perioperative blood transfusion(r=0.17, P<0.001). Conclusions In conclusion, our findings suggested that the ACEF Ⅱ score possessed significant predictive value regarding related to perioperative blood transfusions during cardiac surgical procedures in adult patients. The higher the ACEF Ⅱ score, the higher incidence of perioperative blood transfusions.
文摘BACKGROUND Delayed sternal closure(DSC)can be a lifesaving approach for certain patients who have undergone cardiac surgery.The value of the type of prophylactic antibiotics in DSC is still debatable.AIM To investigate clinical outcomes of different prophylactic antibiotic regimens in patients who had DSC after cardiac surgery.METHODS This was a retrospective observational single-center study.Fifty-three consecutive patients who underwent cardiac surgery and had an indication for DSC were included.Patients were subjected to two regimens of antibiotics:Narrow-spectrum and broad-spectrum regimens.RESULTS The main outcome measures were length of hospital and intensive care unit(ICU)stay,duration of mechanical ventilation,and mortality.Of the 53 patients,12(22.6%)received narrow-spectrum antibiotics,and 41(77.4%)received broad-spectrum antibiotics.The mean age was 59.0±12.1 years,without significant differences between the groups.The mean duration of antibiotic use was significantly longer in the broad-spectrum than the narrowspectrum group(11.9±8.7 vs 3.4±2.0 d,P<0.001).The median duration of open chest was 3.0(2.0-5.0)d for all patients,with no difference between groups(P=0.146).The median duration of mechanical ventilation was significantly longer in the broad-spectrum group[60.0(Δinterquartile range(IQR)170.0)h vs 50.0(ΔIQR 113.0)h,P=0.047].Similarly,the median length of stay for both ICU and hospital were significantly longer in the broadspectrum group[7.5(ΔIQR 10.0)d vs 5.0(ΔIQR 5.0)d,P=0.008]and[27.0(ΔIQR 30.0)d vs 19.0(ΔIQR 21.0)d,P=0.031].Five(9.8%)patients were readmitted to the ICU and 18(34.6%)patients died without a difference between groups.CONCLUSION Prophylactic broad-spectrum antibiotics did not improve clinical outcomes in patients with DSC post-cardiac surgery but was associated with longer ventilation duration,length of ICU and hospital stays vs narrow-spectrum antibiotics.
文摘To improve the treatment effect of obstructive hypertrophic cardiomyopathy,this article focuses on the treatment of obstructive hypertrophic cardiomyopathy and conducts a comprehensive analysis of the disease.It highlights the limitations of traditional treatment methods and elaborates on interventional and surgical treatments.Additionally,this article compares the indications,risks,treatment effects,and costs of the two different treatment methods,providing a reference for doctors and patients in selecting clinical treatment plans.
基金Natural Sciences Foundation of Gansu(No.23JRRA0972No.25RCKA013)+4 种基金Natural Sciences Foundation of Fujian(No.2022J05105)Science and Technology Planning Project of Chengguan District(No.2022RCCX0023)Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital(No.CY2022-MS-A03)Talent Introduction Plan of the Lanzhou University Second Hospital(No.YJRCKYQDJ-2021-02)Major Scientific Research Project on Health and Medical Science and Technology Innovation in Gansu Province(No.GSWSQNPY2024-13).
文摘BACKGROUND:Extracorporeal membrane oxygenation(ECMO)is an effective measure for saving the lives of critically ill patients.Prompt identification of the risk factors for mortality among patients receiving ECMO and comprehensive analysis of the long-term prognosis of survivors are vital.This scoping review summarized the representative prognostic scoring systems,aiming to help clinicians in selecting an appropriate scoring system to avoid unnecessary medical resource consumption and reduce ECMO-associated mortality.METHODS:A comprehensive search of multiple databases,including PubMed,Embase,and the Cochrane Library,was conducted.After removing duplicate studies,a full-text review was performed,and all studies that reported score systems before and/or after ECMO support were included.This protocol adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews(PRISMA-ScR)and has been registered with the Open Science Framework(osf.io/zp4ge).RESULTS:Among the 114 studies included,we identified three scores for patients receiving veno-venous ECMO(VV-ECMO),five scores for patients receiving veno-arterial ECMO(VA-ECMO),and three critical illness scores,which apply to both VV-and VA-ECMO conditions.All characteristics of these scoring systems,their advantages,and their limitations were summarized.CONCLUSION:The implementation of an ECMO scoring system helps to assess the condition of critically ill patients,predict outcome,and provide objective indicators to determine the optimal timing for ECMO intervention.Due to the limitations of the currently available scores,further efforts in improving and validating the ECMO scoring system are needed to achieve the goals of minimizing unnecessary consumption of medical resources and reducing mortality rates.
基金supported by the National Natural Science Fund for Distinguished Young Scholars of China(82125004).
文摘The advancement in extraterrestrial exploration has highlighted the crucial need for studying how the human cardiovascular system adapts to space conditions.Human development occurs under the influence of gravity,shielded from space radiation by Earth’s magnetic field,and within an environment characterized by 24-hour day-night cycles resulting from Earth’s rotation,thus deviating from these conditions necessitates adaptive responses for survival.With upcoming manned lunar and Martian missions approaching rapidly,it is essential to understand the impact of various stressors induced by outer-space environments on cardiovascular health.This comprehensive review integrates insights from both actual space missions and simulated experiments on Earth,to analyze how microgravity,space radiation,and disrupted circadian affect cardiovascular well-being.Prolonged exposure to microgravity induces myocardial atrophy and endothelial dysfunction,which may be exacerbated by space radiation.Mitochondrial dysfunction and oxidative stress emerge as key underlying mechanisms along with disturbances in ion channel perturbations,cytoskeletal damage,and myofibril changes.Disruptions in circadian rhythms caused by factors such as microgravity,light exposure,and irregular work schedules,could further exacerbate cardiovascular issues.However,current research tends to predominantly focus on disruptions in the core clock gene,overlooking the multifactorial nature of circadian rhythm disturbances in space.Future space missions should prioritize targeted prevention strategies and early detection methods for identifying cardiovascular risks,to preserve astronaut health and ensure mission success.
文摘BACKGROUND The use of percutaneous transcatheter edge-to-edge repair(TEER)for mitral regurgitation(MR)has increased,including an increased application to older,frailer,and higher risk patients.CASE SUMMARY A 74 year-old woman with severe MR,a left ventricular ejection fraction of 45%,and a small circumferential pericardial effusion underwent TEER of the mitral valve.After the placement of two MitraClips,the MR was assessed as mild to moderate.Within 10-20 minutes after the completion of the case,the patient was dyspneic and hypotensive despite volume resuscitation.Point-of-care ultrasound(POCUS)showed no changes in cardiac contractility,valve function,or the pericardial space.The right heart chambers appeared small with right atrial(RA)diastolic collapse.There was no evidence of venous congestion.Further exam showed a large right pleural fluid collection.Given the clinical scenario of dyspnea,hypotension,and diastolic RA collapse,low-pressure tamponade was suspected.A thoracentesis expelled 1200 mL of blood with immediate hemodynamic improvement.The patient made an uneventful recovery.CONCLUSION The application of POCUS is crucial for detecting,diagnosing,and properly managing cardiac dysfunction and procedural complications associated with TEER.While tamponade is classically associated with a pericardial effusion and vena caval plethora,their absence does not dismiss the suspicion or diagnosis of tamponade.This case highlights the value of POCUS in assessing low-pressure tamponade caused by a large,pressurized pleural effusion.Clinical suspicion,supported by POCUS findings,was confirmed by a thoracentesis that resulted in immediate hemodynamic improvement.
基金German Heart Foundation/German Foundation of Heart Research。
文摘Background:Aortic atherosclerosis increases the risk of embolic events under extracorporeal circulation(ECC).To evaluate the hemodynamic impact of ECC on atheromatous plaques,an atherosclerosis animal model,which is also eligible for ECC,is required.Methods:Twenty-nine New Zealand White rabbits received a pro-atherosclerotic diet(group diet,n=10),a pro-atherosclerotic diet and additional intraaortic balloon insufflation injury(group BI,n=9),or served as controls(n=10).After 3 or 6 months,aortic explants were analyzed by(immuno-)histology and RT-PCR.Results:Blood serum analyses revealed increased cholesterol-levels in groups diet and BI compared to controls(3 months:p=0.03 each,6 months:p<0.0001 each).Aortic inflammatory infiltration was significantly enhanced in groups diet(CD3 at 3 months:p<0.0001,6 months:p=0.02;CD68 at 3 months:p=0.01)and BI(CD3 at 3 months:p<0.0001,6 months:p=0.03;CD68 at 3 months:p=0.04,6 months:p=0.02).Increased intima hyperplasia occurred in both groups(p<0.0001 each).Macroscopic analyses after 3 and 6 months showed ubiquitous lumen-narrowing aortic plaques.Calcification of the intima and media was increased in groups diet(intima:p<0.0001 at 3 and 6 months;media at 3 months:p<0.0001,6 months:p=0.01)and BI(intima:p<0.0001 at 3 and 6 months;media at 3 months:p<0.0001,6 months:p=0.02).Extensive lipid accumulation was found in the intima in both treatment groups(p<0.0001 each).Conclusions:A rabbit model with high aortic calcific plaque burden—diet-induced with no implicit need of an additional intimal injury by an intraaortic balloon insufflation due to comparable outcome—exhibiting multiple pathophysiological aspects of human atherosclerosis has been designed and thoroughly characterized.It is suitable for use in future studies on the interaction between atherosclerotic plaques and the arterial blood flow under ECC.
基金supported by grants from the Natural Science Foundation of Shandong Province,China(Grant Nos.:ZR2019ZD28 and ZR2022QH008)the National Natural Science Foundation of China(Grant Nos.:82270301 and 82200465)+1 种基金China Postdoctoral Science Foundation(Grant No.:2023M731842)Shandong Postdoctoral Science Foundation,China(Grant No.:SDCX-ZG-202203013).
文摘Vein graft(VG)failure(VGF)is associated with VG intimal hyperplasia,which is characterized by abnormal accumulation of vascular smooth muscle cells(VSMCs).Most neointimal VSMCs are derived from pre-existing VSMCs via a process of VSMC phenotypic transition,also known as dedifferentiation.There is increasing evidence to suggest that ginger or its bioactive ingredients may block VSMC dedifferentiation,exerting vasoprotective functions;however,the precise mechanisms have not been fully characterized.Therefore,we investigated the effect of ginger on VSMC phenotypic transition in VG remodeling after transplantation.Ginger significantly inhibited neointimal hyperplasia and promoted lumen(L)opening in a 3-month VG,which was primarily achieved by reducing ferroptotic stress.Ferroptotic stress is a pro-ferroptotic state.Contractile VSMCs did not die but instead gained a proliferative capacity and switched to the secretory type,forming neointima(NI)after vein transplantation.Ginger and its two main vasoprotective ingredients(6-gingerol and 6-shogaol)inhibit VSMC dedifferentiation by reducing ferroptotic stress.Network pharmacology analysis revealed that 6-gingerol inhibits ferroptotic stress by targeting P53,while 6-shogaol inhibits ferroptotic stress by targeting 5-lipoxygenase(Alox5),both promoting ferroptosis.Furthermore,both ingredients co-target peroxisome proliferator-activated receptor gamma(PPARγ),decreasing PPARγ-mediated nicotinamide adenine dinucleotide phosphate(NADPH)oxidase 1(Nox1)expression.Nox1 promotes intracellular reactive oxygen species(ROS)production and directly induces VSMC dedifferentiation.In addition,Nox1 is a ferroptosis-promoting gene that encourages ferroptotic stress production,indirectly leading to VSMC dedifferentiation.Ginger,a natural multi-targeted ferroptotic stress inhibitor,finely and effectively prevents VSMC phenotypic transition and protects against venous injury remodeling.
文摘BACKGROUND Cholangiocarcinoma(CCA)is a heterogeneous group of aggressive malignancies arising from the biliary tree.Epidemiological data show an increase in the incidence of intrahepatic CCA in Western countries and a stable or decrease in the incidence of extrahepatic CCA.There are conflicting results in literature regarding the trend of the incidence of gallbladder cancer.However,most studies refer to a time period before 2000.AIM To investigate the recent epidemiology of CCA and gallbladder cancer in Northeast Italy using regional data of hospital admissions.METHODS We performed a 17-year(2007-2023)retrospective analysis of hospital discharge records of the Veneto Region.During the period 10778 first hospital admissions for biliary tract cancers in the main or secondary diagnosis were recorded.Data were analyzed by theχ^(2)test for categorical data and the Student’s ttest for continuous data to assess differences in percentages and averages,respectively.Trends in the agestandardized hospitalization rate were evaluated using Joinpoint regression,estimating annual percentage changes(APC).RESULTS The total number of hospitalizations for biliary tract cancers remained stable over the past 17 years(186 hospitalizations/year for intrahepatic CCA,211 for extrahepatic CCA,and 237 for gallbladder cancer/unspecified biliary tract).Age-standardized hospitalization rates for intrahepatic and extrahepatic CCA decreased respectively from 4.9 cases to 3.4 per 100000 inhabitants(APC=-2.0,95%confidence interval:-3.2 to-0.7,P<0.001)and from 6.7 to 3.8 cases per 100000 inhabitants(APC=-3.2,95%confidence interval:-4.2 to-2.1,P<0.001).Instead,hospitalizations for gallbladder cancer remained stable,with an average rate of 5.5 per 100000 inhabitants.Overall,hospitalization rates for biliary tract cancers increased with age in both genders.CONCLUSION Our study reported a decreasing hospitalization rate for CCA and a stable trend for gallbladder cancer over a 17-year period,suggesting a change in the epidemiology of these tumors.
基金supported in part by National Sciences Foundation of China grants 11972117a Jiangsu Province Science and Technology Agency under grant number BE2016785+4 种基金support from Natural Science Foundation of China(81827806 and 62135002)support from Natural Science Foundation of China(81722025)Key R&D Project of Heilongjiang Province grant 2022ZX06C07support from the Natural Science Foundation of Shandong Province under grant number ZR2024QA110Shandong Province Medical Health Science and Technology Project(Nos.202425020256,and 202403010254).
文摘Image-based computational models have been used for vulnerable plaque progression and rupture predictions,and good results have been reported.However,mechanisms and predictions for plaque erosion are underinvestigated.Patient-specific fluid-structure interaction(FSI)models based on optical coherence tomography(OCT)follow-up data from patients with plaque erosion and who received conservative antithrombotic treatment(using medication,no stenting)to identify risk factors that could be used to predict the treatment outcome.OCT and angiography datawere obtained from10 patientswho received conservative antithrombotic treatment.Five participants had worse outcomes(WOG,stenosis severity≥70%at one-year follow-up),while the other five had better outcomes(BOG,stenosis severity<70%at one-year follow-up).Patient-specific 3D FSI models were constructed to obtain morphological and biomechanical risk factor values(a total of nine risk factors)for comparison and prediction.A logistic regressionmodel was used to identify optimal predictors with the best treatment outcome prediction accuracies.Our results indicated that the combination of wall shear stress(WSS),lipid percent,and thrombus burden was the best group predictor according to the mean area under the curve(AUC)of 0.96(90%confidence interval=(0.85,1.00)).WSS was the best single predictor withmean AUC=0.70(90%confidence interval=(0.20,1.00)).Thrombus burden was the only risk factor showing statistically significant group difference,suggesting its crucial role in the outcomes of conservative anti-thrombotic therapy.This pilot study indicated that integratingmorphological and biomechanical risk factors could improve treatment outcome prediction accuracy in patients with plaque erosion compared to predictions using single predictors.Large-scale patient studies are needed to further validate our findings.
基金supported by the National Key Research and Development Program of China(2023YFC2506500,2021YFC2500500)the Program of Shanghai Academic Research Leader(22XD1423300)the National Natural Science Foundation of China(T2288101,82370357,82100470)。
文摘Background:The National Chest Pain Center Program(NCPCP)is a nationwide,quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China.The benefits of chest pain center(CPC)accreditation on acute coronary syndrome have been demonstrated.However,there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection(AAD).Methods:We conducted a retrospective observational study of patients with AAD from 1671 hospitals in China,using data from the NCPCP spanning the period from January 1,2016 to December 31,2022.The patients were divided into 2 groups:pre-accreditation and post-accreditation admissions.The outcomes examined included in-hospital mortality,misdiagnosis,and Stanford type A AAD surgery.Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes.Furthermore,we stratified the hospitals based on their geographical location(Eastern/Central/Western regions)or administrative status(provincial/non-provincial capital areas)to assess the impact of CPC accreditation on AAD patients across various regions.Results:The analysis encompassed a total of 40,848 patients diagnosed with AAD.The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis(12.1%vs.16.3%,P<0.001 and 2.9%vs.5.4%,P<0.001,respectively)as well as a notably higher rate of Stanford type A AAD surgery(61.1%vs.42.1%,P<0.001)compared with the pre-accreditation group.After adjusting for potential covariates,CPC accreditation was associated with substantially reduced risks of in-hospital mortality(adjusted OR=0.644,95%CI 0.599-0.693)and misdiagnosis(adjusted OR=0.554,95%CI 0.493-0.624),along with an increase in the proportion of patients undergoing Stanford type A AAD surgery(adjusted OR=1.973,95%CI 1.797-2.165).Following CPC accreditation,there were significant reductions in in-hospital mortality across various regions,particularly in Western regions(from 21.5%to 14.1%).Moreover,CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities(adjusted OR:0.607 vs.0.713).Conclusion:CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.
基金supported by the U.S.Department of Defense(W81XWH-09-2-0194 for the pilot phase)the Canadian Institutes of Health Research(MCT-94834 for the pilot phase and 14238 for the definitive phase).
文摘Background:With advancements in burn treatment and intensive care leading to decreased mortality rates,a growing cohort of burn survivors is emerging.These individuals may be susceptible to frailty,characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging,which significantly complicates their recovery process.To date,no study has investigated burns as a potential risk factor for frailty.This study aimed to determine the short-term prevalence of frailty among burn survivors’months after injury and compare it with that of the general population.Methods:A post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury(RE-ENERGIZE)trial,an international randomized-controlled trial involving 1200 burn injury patients with partial-or full-thickness burns.Participants who did not complete the 36-Item Short Form Health Survey(SF-36)questionnaire were excluded.Data for the general population were obtained from the 2022 National Health Interview Survey(NHIS).Frailty was assessed using the FRAIL(Fatigue,Resistance,Ambulation,Illness,Loss of weight)scale.Due to lack of data on loss of weight,for the purposes of this study,malnutrition was used as the fifth variable.Illness and malnutrition were based on admission data,while fatigue,resistance,and ambulation were determined from post-discharge responses to the SF-36.The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status.Within the burn group,patients were divided into different subgroups based on their frailty status,and the differences in their(instrumental)activities of daily living(iADL and ADL)were compared.A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.Results:Out of the 1200 burn patients involved in the study,600 completed the required questionnaires[follow-up time:(5.5±2.3)months]and were matched to 1200 adults from the general population in the U.S.In comparison to the general population,burn patients exhibited a significantly higher likelihood of being pre-frail(42.3%vs.19.8%,P<0.0001),or frail(13.0%vs.1.0%,P<0.0001).When focusing on specific components,burn patients were more prone to experiencing fatigue(25.8%vs.13.5%,P<0.0001),limited resistance(34.0%vs.2.7%,P<0.0001),and restricted ambulation(41.8%vs.3.8%,P<0.0001).Conversely,the incidence rate of illness was observed to be higher in the general population(1.2%vs.2.8%,P=0.03),while no significant difference was detected regarding malnutrition(2.3%vs.2.6%,P=0.75).Furthermore,in comparison with robust burn patients,it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL.The frail cohort reported the most pronounced limitation.Conclusions:Our findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury.Burn survivors experience compromised fatigue,resistance,and ambulation,while rates of illness and malnutrition were lower or unchanged,respectively.These results underscore the critical need for early identification of frailty after a burn injury,with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists,community physicians,physiotherapists,nutritionists,and social workers.This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.
文摘Heart rate variability （HRV） refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV has been shown to be effective as a predictor of risk after myocardial infarction and an early warning sign of diabetic neuropathy, and in the cardiology setting is now recognized to be a useful tool for risk-stratification after hospital admission and after discharge. Recent evidences suggest that HRV analysis might predict complications even in patients undergoing cardiac surgery, and the present review summarizes the importance of HRV analysis in adult cardiac surgery and the perspectives for HRV use in current clinical practice. Although future larger studies are warranted before HRV can be included into daily clinical practice in adult cardiac surgery, HRV is a novel tool which might detect autonomic instability in the early postoperative phase and during hospital stay, thus predicting or prompt-diagnosing many of the post-operative complications.
