Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and wide...Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.展开更多
Anomalous origin of the left coronary artery (AOLCA) from the right sinus of Valsalva constitutes a rare congenital coronary artery anomaly. Patients with an anomalous left main coronary artery face a significantly hi...Anomalous origin of the left coronary artery (AOLCA) from the right sinus of Valsalva constitutes a rare congenital coronary artery anomaly. Patients with an anomalous left main coronary artery face a significantly higher risk of sudden cardiac death compared to those with an anomalous right coronary artery. The anomalous coronary artery traversing between the ascending aorta and the pulmonary artery markedly heightens the risk of myocardial ischemia, arrhythmia, and sudden death. Symptomatic patients often exhibit a longer intramural course of the coronary artery, which may necessitate earlier intervention or influence the choice of surgical repair method. Surgical intervention is advocated for patients with this anomaly, even in the absence of symptoms. For anomalous aortic origin of a coronary artery from the opposite sinus of Valsalva with an intramural course, coronary unroofing is the preferred revascularization procedure. This report presents a case of AOLCA originating from the right sinus of Valsalva, treated surgically using the unroofing technique for the aortic intramural segment of the anomalous coronary artery traversing between the great vessels. The unroofing technique is recommended for treating AOLCA with an extensive intramural course that does not involve the commissure.展开更多
BACKGROUND The established cardiovascular risk factors cannot explain the overall risk of coronary artery disease(CAD),especially in women.Therefore,there is a growing need for the assessment of novel biomarkers to id...BACKGROUND The established cardiovascular risk factors cannot explain the overall risk of coronary artery disease(CAD),especially in women.Therefore,there is a growing need for the assessment of novel biomarkers to identify women at risk.The receptor for advanced glycation end products(RAGE)and its interaction with the advanced glycation end product(AGE)ligand have been associated with atherogenesis.The soluble fraction of RAGE(sRAGE)antagonizes RAGE signaling and exerts an antiatherogenic effect.AIM The study aim was to explore the association between plasma levels of sRAGE and CAD in nondiabetic postmenopausal women.METHODS This case-control study included 110 nondiabetic postmenopausal women who were enrolled in two groups.Group I included 55 angiographically proven CAD subjects with>50%stenosis in at least one of the major coronary arteries and Group II included 55 healthy control women who did not have CAD or had<50%stenosis of the coronary arteries.Stenosis was confirmed by invasive angiography.Plasma sRAGE was determined by an enzyme-linked immunosorbent assay.RESULTS We observed significantly lower plasma sRAGE concentrations in subjects with CAD vs healthy controls(P<0.05).Univariate and multivariate logistic regression analysis also revealed a significant correlation between plasma sRAGE levels and CAD(P=0.01).Multivariate odds ratios for CAD revealed that subjects with sRAGE concentrations below 225 pg/mL(lowest quartile)had a 6-fold increase in CAD prevalence independent of other risk factors.CONCLUSION Our findings indicated that low sRAGE levels were independently associated with CAD in nondiabetic postmenopausal women.Risk assessment of CAD in postmenopausal women can be improved by including sRAGE along with other risk factors.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)may contribute to delayed presentations of acute myocardial infarction.Delayed presentation with late reperfusion is often associated with an increased risk of mechanical c...BACKGROUND Coronavirus disease 2019(COVID-19)may contribute to delayed presentations of acute myocardial infarction.Delayed presentation with late reperfusion is often associated with an increased risk of mechanical complications and adverse outcomes.Inherent delays are possible as every patient who is acutely sick is being considered a potential case or a career of COVID-19.Also,standardized personal protective equipment precautions are established for all members of the team,regardless of pending COVID-19 testing which might further add to delays.AIM To compare performance measures and clinical outcomes of all patients who presented to our facility with ST elevation myocardial infarction(STEMI)during the COVID-19 pandemic to same time cohort from 2019.METHODS All patients who presented to our facility with STEMI during the pandemic were compared to a matched cohort during the same time period in 2019.STEMI with unknown time of symptom onset and inpatient STEMI patients were excluded.Primary outcome was major adverse cardiac events(MACE)in-hospital and up to 14 d after STEMI,including death,myocardial infarction,cardiac arrest,or stroke.Significant differences among groups for continuous variables were tested through ANOVA,using SYSTAT,version 13.Chi-square tests of association were used to compare patient characteristics among groups using SYSTAT.Relative risk scores and associated tests for significance were calculated for discrete variables using MedCalc(MedCalc Software,Ostend,Belgium).RESULTS There was a significantly longer time interval from symptom onset to first medical contact(FMC)in the COVID-19 group(P<0.02).Time to first electrocardiogram,door-to-balloon time,and FMC to balloon time were not significantly affected.The right coronary artery was the most common culprit for STEMI in both the cohorts.Over 60%of patients had one or more obstructive(>50%)lesion(s)remote from the culprit site.In-hospital and 14 d MACE were more prevalent in the COVID-19 group(P<0.01 and P<0.001).CONCLUSION This single academic center study in the United States suggests that there is a delay in patients with STEMI seeking medical attention during the COVID-19 pandemic which could be translating into worse clinical outcomes.展开更多
AIM: To investigate the impact of dual antiplatelet therapy (DAT) in patients on antivitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI).METHODS: Between February 2006 and February 2008, 138 con...AIM: To investigate the impact of dual antiplatelet therapy (DAT) in patients on antivitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI).METHODS: Between February 2006 and February 2008, 138 consecutive patients under chronic AVK treatment were enrolled in this registry. Of them, 122 received bare metal stent implantation and 16 received drug elutingstent implantation. The duration of DAT, on top of AVK treatment, was decided at the discretion of the clinician. Adequate duration of DAT was def ined according to type of stent implanted and to its clinical indication. RESULTS: The baseline clinical characteristics of patients reflect their high risk, with high incidence of comorbid conditions (Charlson score ≥ 3 in 89% of the patients). At a mean follow-up of 17 ± 11 mo, 22.9% of patients developed a major adverse cardiac event (MACE): 12.6% died from cardiovascular disease and almost 6% had an acute myocardial infarction. Major hemorrhagic events were observed in 7.4%. Adequate DAT was obtained in only 44% of patients. In the multivariate analysis, no adequate DAT and Charlson score were the only independent predictors of MACE (both P = 0.02). CONCLUSION: Patients on chronic AVK therapy represent a high risk population and suffer from a high MACE rate after PCI. An adequate DAT regimen and absence of comorbid conditions are strongly associated with better clinical outcomes.展开更多
BACKGROUND Apical hypertrophic cardiomyopathy(HCM)is considered to have a benign prognosis in terms of cardiovascular mortality.This serial case report aimed to raise awareness of ventricular fibrillation(VF)and sudde...BACKGROUND Apical hypertrophic cardiomyopathy(HCM)is considered to have a benign prognosis in terms of cardiovascular mortality.This serial case report aimed to raise awareness of ventricular fibrillation(VF)and sudden cardiac death(SCD)in apical HCM.CASE SUMMARY Here we describe two rare cases of apical HCM that presented with documented VF and sudden cardiac collapse.These patients were previously not recommended for primary prevention using implantable cardioverter-defibrillator(ICD)therapy based on current guidelines.However,both received ICD therapy for the secondary prevention of SCD.CONCLUSION These cases illustrate serious complications including VF and aborted sudden cardiac arrest in apical HCM patients who are initially not candidates for primary prevention using ICD implantation based on current guidelines.展开更多
This work identified the important role of matrix mechanical plasticity in mediating fibroblast activation.Many existing studies have highlighted the important effects of biochemical cues(e.g.,transforming growth fact...This work identified the important role of matrix mechanical plasticity in mediating fibroblast activation.Many existing studies have highlighted the important effects of biochemical cues(e.g.,transforming growth factor-β1)and mechanicalstiffness on fibroblast activation.Our results indicated that self-assembled collagen hydrogels showed high plasticity and in which fibroblasts remain undifferentiated.However,when we decreased the plasticity of collagen hydrogels by increasing covalent crosslinking,fibroblasts showed a significant fibrotic response as reflected by the increasedα-SMA expression.Since the material systems we constructed have low and the same initial modulus,this process is stiffness independent.Although it has been reported that covalently crosslinked hydrogels are more difficult to degrade and matrix degradability has an important impact on cell behaviors,no significant changes of fibroblast activation were observed when proteases were broadly inhibited in our experiments.Importantly,the hydrogels we constructed showed similar plastic behaviors under creep and recovery tests compared to native normal and fibrotic tissues.These highlight the importance of matrix plasticity in mimicking the mechanical microenvironment of native fibrotic tissues.Mechanistically,we found that the enhanced fibroblast activation in low plastic matrix is mediated through integrin-actin pathway and nuclear localization of YAP.In high plastic collagen,matrix cannot provide effective resistance to actin contraction because of the rupture of weak crosslinks and the slippage of local fibers.On the contrary,in low plastic collagen,deformation energy can be stored in the network due to the existence of strong covalent crosslinks,thus enabling the build-up of cell traction and the formation of a robust cell-matrix interaction.Experiments of inhibiting or promoting cytoskeletal contractility and CGMD simulation both verified the above points.Our results clarify plasticity changes on the development of fibrotic diseases and highlight plasticity as an important mechanical cue in understanding cell-matrix interactions.展开更多
The coronavirus disease 2019(COVID-19)pandemic has had a tremendous adverse impact on the global health system,public sector,and social aspects.It is unarguably the worst pandemic of the century.However,COVID-19 manag...The coronavirus disease 2019(COVID-19)pandemic has had a tremendous adverse impact on the global health system,public sector,and social aspects.It is unarguably the worst pandemic of the century.However,COVID-19 management is a mystery in front of us,and an authentic treatment is urgently needed.Various repurposed drugs,like ivermectin,remdesivir,tocilizumab,baricitinib,etc.,have been used to treat COVID-19,but none are promising.Antibody therapy and their combinations are emerging modalities for treating moderate COVID-19,and they have shown the potential to reduce hospitalisations.One antibody monotherapy,bamlanivimab,and two cocktails,casirivimab/imdevimab and bamlanivimab/esterivimab,have received authorization for emergency use by the United States Food and Drug Administration for the treatment of mild COVID-19 in high risk individuals.The European Emergency has made similar recommendations for use of the drug in COVID-19 patients without oxygen therapy.This brief review will focus on monoclonal antibodies and their combination cocktail therapy in managing COVID-19 infection.展开更多
Background: Transesophageal echocardiography(TEE) gui-ded cardioversion to restoration of sinus rhythm is a therapeutic option in patients with atrial fibrillation(AF). Anticoagulation at the time of and after cardiov...Background: Transesophageal echocardiography(TEE) gui-ded cardioversion to restoration of sinus rhythm is a therapeutic option in patients with atrial fibrillation(AF). Anticoagulation at the time of and after cardioversion is necessary to prevent formation of new thrombus during atrial stunning period. We aimed to evaluate the efficacy and safety to TEE guided cardioversion with low molecular weight heparin(LMWH)in patients with atrial fibrillation. Methods: We followed up 208 patients with persistent AF(mean age: 65.5±10.2 years) who were attempted TEE guided cardioversion. LMWH were used as an anticoagulant and warfarin therapy was continued. Results: Cardioversion were performed in 183 patients. Sinus rhythm restored in 144 patients(78.7%). Mean follow up duration was 155 days. No cardiac death occurred. In the early follow up period(within 30 day) one thromboembolic event(0.54%) occurred in a patient who was cardioverted. Two patients who had not been cardioverted because of left atrial thrombus presented embolic stroke, one in early and another in late followup period. All embolic complications occurred in patients who had been taking warfarin and whose INR level was subtherapeutic at the time of stroke. Sinus rhythm was maintained in 64%and total hemorrhagic complications occurred in 4.8%of the patients in long-term follow-up. Conclusion: TEE guided cardioversion with a short-term anticoagulation protocol using low molecular weight heparin is a safe and effective method in restoring and maintaining sinus rhythm and enables us to make earlier cardioversion in atrial fibrillation.展开更多
Background Statins improve arterial stiffness in patients with coronary artery disease （CAD）.Hypertension is a predominant contributor of arterial stiffening.However,the influence of hypertension on the effect of st...Background Statins improve arterial stiffness in patients with coronary artery disease （CAD）.Hypertension is a predominant contributor of arterial stiffening.However,the influence of hypertension on the effect of statins for improving arterial stiffness in CAD patients has seldom been investigated.Therefore,in this study,we investigated the relationships between statin use and arterial stiffness in normotensive and hypertensive CAD patients.Methods Brachial-ankle pulse wave velocity （ba-PWV） was measured in 437 patients,including 220 hypertensive CAD patients （121 used statins,99 did not） and 217 normotensive CAD patients （105 used statins,112 did not）.The normotensive and hypertensive CAD patients were matched according to age,sex,and body mass index （BMI）.Results In the normotensive and hypertensive CAD patients,lipid profiles were significantly improved in the statin group compared with the non-statin group.No significant differences in the administered statins （i.e.,atorvastatin,simvastatin,rosuvastatin,and pravastatin） and statin therapy duration were found between normotensive and hypertensive CAD patients （all P＞0.05）.No significant correlation of ba-PWV and statin therapy duration was found in all CAD patients,normotensive CAD patients,or hypertensive CAD patients （all P＞0.05）.ba-PWV in the statin group was significantly lower than that in the non-statin group in normotensive CAD patients （（1331.68±167.52） cm/s vs.（1468.61±244.54） cm/s,P=0.002） but not in hypertensive CAD patients （P＞0.05）.In multiple linear regression analyses,statin therapy was significantly associated with ba-PWV after adjusting for confounding variables in normotensive CAD patients （P=0.018） but not in hypertensive CAD patients （P＞0.05）.Conclusions Statins may significantly improve arterial stiffness in CAD patients,and hypertension may probably influence the effectiveness of statin therapy in improving arterial stiffness in this population.Further studies are required to investigate the effect of statins on arterial stiffness in normotensive and hypertensive CAD patients.展开更多
Background Noninvasive cardiac imaging is now central to the diagnosis and management of patients with moderate probability for coronary artery disease. The aim of this study was to assess the impact of stress myocard...Background Noninvasive cardiac imaging is now central to the diagnosis and management of patients with moderate probability for coronary artery disease. The aim of this study was to assess the impact of stress myocardial perfusion single photon emission computerized tomography （SPECT） on in-hospital coronary angiography and revascularization for such patients. Methods Between January 2005 and June 2007, 1053 consecutive in-hospital patients （423 women,展开更多
基金supported by European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement(No.101028929)BJFis supported by National Heart Foundation of Australia Postdoc-toral Fellowship(No.106588)+1 种基金BG is supported by Australian Government Research Training Program ScholarshipDPLis supported by Clive Kearon Award,McMaster University.Additional funding information can be found in Supplemen-tary Funding.
文摘Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.
文摘Anomalous origin of the left coronary artery (AOLCA) from the right sinus of Valsalva constitutes a rare congenital coronary artery anomaly. Patients with an anomalous left main coronary artery face a significantly higher risk of sudden cardiac death compared to those with an anomalous right coronary artery. The anomalous coronary artery traversing between the ascending aorta and the pulmonary artery markedly heightens the risk of myocardial ischemia, arrhythmia, and sudden death. Symptomatic patients often exhibit a longer intramural course of the coronary artery, which may necessitate earlier intervention or influence the choice of surgical repair method. Surgical intervention is advocated for patients with this anomaly, even in the absence of symptoms. For anomalous aortic origin of a coronary artery from the opposite sinus of Valsalva with an intramural course, coronary unroofing is the preferred revascularization procedure. This report presents a case of AOLCA originating from the right sinus of Valsalva, treated surgically using the unroofing technique for the aortic intramural segment of the anomalous coronary artery traversing between the great vessels. The unroofing technique is recommended for treating AOLCA with an extensive intramural course that does not involve the commissure.
文摘BACKGROUND The established cardiovascular risk factors cannot explain the overall risk of coronary artery disease(CAD),especially in women.Therefore,there is a growing need for the assessment of novel biomarkers to identify women at risk.The receptor for advanced glycation end products(RAGE)and its interaction with the advanced glycation end product(AGE)ligand have been associated with atherogenesis.The soluble fraction of RAGE(sRAGE)antagonizes RAGE signaling and exerts an antiatherogenic effect.AIM The study aim was to explore the association between plasma levels of sRAGE and CAD in nondiabetic postmenopausal women.METHODS This case-control study included 110 nondiabetic postmenopausal women who were enrolled in two groups.Group I included 55 angiographically proven CAD subjects with>50%stenosis in at least one of the major coronary arteries and Group II included 55 healthy control women who did not have CAD or had<50%stenosis of the coronary arteries.Stenosis was confirmed by invasive angiography.Plasma sRAGE was determined by an enzyme-linked immunosorbent assay.RESULTS We observed significantly lower plasma sRAGE concentrations in subjects with CAD vs healthy controls(P<0.05).Univariate and multivariate logistic regression analysis also revealed a significant correlation between plasma sRAGE levels and CAD(P=0.01).Multivariate odds ratios for CAD revealed that subjects with sRAGE concentrations below 225 pg/mL(lowest quartile)had a 6-fold increase in CAD prevalence independent of other risk factors.CONCLUSION Our findings indicated that low sRAGE levels were independently associated with CAD in nondiabetic postmenopausal women.Risk assessment of CAD in postmenopausal women can be improved by including sRAGE along with other risk factors.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)may contribute to delayed presentations of acute myocardial infarction.Delayed presentation with late reperfusion is often associated with an increased risk of mechanical complications and adverse outcomes.Inherent delays are possible as every patient who is acutely sick is being considered a potential case or a career of COVID-19.Also,standardized personal protective equipment precautions are established for all members of the team,regardless of pending COVID-19 testing which might further add to delays.AIM To compare performance measures and clinical outcomes of all patients who presented to our facility with ST elevation myocardial infarction(STEMI)during the COVID-19 pandemic to same time cohort from 2019.METHODS All patients who presented to our facility with STEMI during the pandemic were compared to a matched cohort during the same time period in 2019.STEMI with unknown time of symptom onset and inpatient STEMI patients were excluded.Primary outcome was major adverse cardiac events(MACE)in-hospital and up to 14 d after STEMI,including death,myocardial infarction,cardiac arrest,or stroke.Significant differences among groups for continuous variables were tested through ANOVA,using SYSTAT,version 13.Chi-square tests of association were used to compare patient characteristics among groups using SYSTAT.Relative risk scores and associated tests for significance were calculated for discrete variables using MedCalc(MedCalc Software,Ostend,Belgium).RESULTS There was a significantly longer time interval from symptom onset to first medical contact(FMC)in the COVID-19 group(P<0.02).Time to first electrocardiogram,door-to-balloon time,and FMC to balloon time were not significantly affected.The right coronary artery was the most common culprit for STEMI in both the cohorts.Over 60%of patients had one or more obstructive(>50%)lesion(s)remote from the culprit site.In-hospital and 14 d MACE were more prevalent in the COVID-19 group(P<0.01 and P<0.001).CONCLUSION This single academic center study in the United States suggests that there is a delay in patients with STEMI seeking medical attention during the COVID-19 pandemic which could be translating into worse clinical outcomes.
基金Supported by An EAPCI grant in Interventional Cardiology (to Brugaletta S)
文摘AIM: To investigate the impact of dual antiplatelet therapy (DAT) in patients on antivitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI).METHODS: Between February 2006 and February 2008, 138 consecutive patients under chronic AVK treatment were enrolled in this registry. Of them, 122 received bare metal stent implantation and 16 received drug elutingstent implantation. The duration of DAT, on top of AVK treatment, was decided at the discretion of the clinician. Adequate duration of DAT was def ined according to type of stent implanted and to its clinical indication. RESULTS: The baseline clinical characteristics of patients reflect their high risk, with high incidence of comorbid conditions (Charlson score ≥ 3 in 89% of the patients). At a mean follow-up of 17 ± 11 mo, 22.9% of patients developed a major adverse cardiac event (MACE): 12.6% died from cardiovascular disease and almost 6% had an acute myocardial infarction. Major hemorrhagic events were observed in 7.4%. Adequate DAT was obtained in only 44% of patients. In the multivariate analysis, no adequate DAT and Charlson score were the only independent predictors of MACE (both P = 0.02). CONCLUSION: Patients on chronic AVK therapy represent a high risk population and suffer from a high MACE rate after PCI. An adequate DAT regimen and absence of comorbid conditions are strongly associated with better clinical outcomes.
文摘BACKGROUND Apical hypertrophic cardiomyopathy(HCM)is considered to have a benign prognosis in terms of cardiovascular mortality.This serial case report aimed to raise awareness of ventricular fibrillation(VF)and sudden cardiac death(SCD)in apical HCM.CASE SUMMARY Here we describe two rare cases of apical HCM that presented with documented VF and sudden cardiac collapse.These patients were previously not recommended for primary prevention using implantable cardioverter-defibrillator(ICD)therapy based on current guidelines.However,both received ICD therapy for the secondary prevention of SCD.CONCLUSION These cases illustrate serious complications including VF and aborted sudden cardiac arrest in apical HCM patients who are initially not candidates for primary prevention using ICD implantation based on current guidelines.
基金financially supported by the National Natural Science Foundation of China ( 11872298, 11602191,11532009,11621062)the China Postdoctoral Science Foundation ( 2018M631141)the Fundamental Research Funds for the Central Universities ( Z201811336)
文摘This work identified the important role of matrix mechanical plasticity in mediating fibroblast activation.Many existing studies have highlighted the important effects of biochemical cues(e.g.,transforming growth factor-β1)and mechanicalstiffness on fibroblast activation.Our results indicated that self-assembled collagen hydrogels showed high plasticity and in which fibroblasts remain undifferentiated.However,when we decreased the plasticity of collagen hydrogels by increasing covalent crosslinking,fibroblasts showed a significant fibrotic response as reflected by the increasedα-SMA expression.Since the material systems we constructed have low and the same initial modulus,this process is stiffness independent.Although it has been reported that covalently crosslinked hydrogels are more difficult to degrade and matrix degradability has an important impact on cell behaviors,no significant changes of fibroblast activation were observed when proteases were broadly inhibited in our experiments.Importantly,the hydrogels we constructed showed similar plastic behaviors under creep and recovery tests compared to native normal and fibrotic tissues.These highlight the importance of matrix plasticity in mimicking the mechanical microenvironment of native fibrotic tissues.Mechanistically,we found that the enhanced fibroblast activation in low plastic matrix is mediated through integrin-actin pathway and nuclear localization of YAP.In high plastic collagen,matrix cannot provide effective resistance to actin contraction because of the rupture of weak crosslinks and the slippage of local fibers.On the contrary,in low plastic collagen,deformation energy can be stored in the network due to the existence of strong covalent crosslinks,thus enabling the build-up of cell traction and the formation of a robust cell-matrix interaction.Experiments of inhibiting or promoting cytoskeletal contractility and CGMD simulation both verified the above points.Our results clarify plasticity changes on the development of fibrotic diseases and highlight plasticity as an important mechanical cue in understanding cell-matrix interactions.
文摘The coronavirus disease 2019(COVID-19)pandemic has had a tremendous adverse impact on the global health system,public sector,and social aspects.It is unarguably the worst pandemic of the century.However,COVID-19 management is a mystery in front of us,and an authentic treatment is urgently needed.Various repurposed drugs,like ivermectin,remdesivir,tocilizumab,baricitinib,etc.,have been used to treat COVID-19,but none are promising.Antibody therapy and their combinations are emerging modalities for treating moderate COVID-19,and they have shown the potential to reduce hospitalisations.One antibody monotherapy,bamlanivimab,and two cocktails,casirivimab/imdevimab and bamlanivimab/esterivimab,have received authorization for emergency use by the United States Food and Drug Administration for the treatment of mild COVID-19 in high risk individuals.The European Emergency has made similar recommendations for use of the drug in COVID-19 patients without oxygen therapy.This brief review will focus on monoclonal antibodies and their combination cocktail therapy in managing COVID-19 infection.
文摘Background: Transesophageal echocardiography(TEE) gui-ded cardioversion to restoration of sinus rhythm is a therapeutic option in patients with atrial fibrillation(AF). Anticoagulation at the time of and after cardioversion is necessary to prevent formation of new thrombus during atrial stunning period. We aimed to evaluate the efficacy and safety to TEE guided cardioversion with low molecular weight heparin(LMWH)in patients with atrial fibrillation. Methods: We followed up 208 patients with persistent AF(mean age: 65.5±10.2 years) who were attempted TEE guided cardioversion. LMWH were used as an anticoagulant and warfarin therapy was continued. Results: Cardioversion were performed in 183 patients. Sinus rhythm restored in 144 patients(78.7%). Mean follow up duration was 155 days. No cardiac death occurred. In the early follow up period(within 30 day) one thromboembolic event(0.54%) occurred in a patient who was cardioverted. Two patients who had not been cardioverted because of left atrial thrombus presented embolic stroke, one in early and another in late followup period. All embolic complications occurred in patients who had been taking warfarin and whose INR level was subtherapeutic at the time of stroke. Sinus rhythm was maintained in 64%and total hemorrhagic complications occurred in 4.8%of the patients in long-term follow-up. Conclusion: TEE guided cardioversion with a short-term anticoagulation protocol using low molecular weight heparin is a safe and effective method in restoring and maintaining sinus rhythm and enables us to make earlier cardioversion in atrial fibrillation.
文摘Background Statins improve arterial stiffness in patients with coronary artery disease （CAD）.Hypertension is a predominant contributor of arterial stiffening.However,the influence of hypertension on the effect of statins for improving arterial stiffness in CAD patients has seldom been investigated.Therefore,in this study,we investigated the relationships between statin use and arterial stiffness in normotensive and hypertensive CAD patients.Methods Brachial-ankle pulse wave velocity （ba-PWV） was measured in 437 patients,including 220 hypertensive CAD patients （121 used statins,99 did not） and 217 normotensive CAD patients （105 used statins,112 did not）.The normotensive and hypertensive CAD patients were matched according to age,sex,and body mass index （BMI）.Results In the normotensive and hypertensive CAD patients,lipid profiles were significantly improved in the statin group compared with the non-statin group.No significant differences in the administered statins （i.e.,atorvastatin,simvastatin,rosuvastatin,and pravastatin） and statin therapy duration were found between normotensive and hypertensive CAD patients （all P＞0.05）.No significant correlation of ba-PWV and statin therapy duration was found in all CAD patients,normotensive CAD patients,or hypertensive CAD patients （all P＞0.05）.ba-PWV in the statin group was significantly lower than that in the non-statin group in normotensive CAD patients （（1331.68±167.52） cm/s vs.（1468.61±244.54） cm/s,P=0.002） but not in hypertensive CAD patients （P＞0.05）.In multiple linear regression analyses,statin therapy was significantly associated with ba-PWV after adjusting for confounding variables in normotensive CAD patients （P=0.018） but not in hypertensive CAD patients （P＞0.05）.Conclusions Statins may significantly improve arterial stiffness in CAD patients,and hypertension may probably influence the effectiveness of statin therapy in improving arterial stiffness in this population.Further studies are required to investigate the effect of statins on arterial stiffness in normotensive and hypertensive CAD patients.
文摘Background Noninvasive cardiac imaging is now central to the diagnosis and management of patients with moderate probability for coronary artery disease. The aim of this study was to assess the impact of stress myocardial perfusion single photon emission computerized tomography （SPECT） on in-hospital coronary angiography and revascularization for such patients. Methods Between January 2005 and June 2007, 1053 consecutive in-hospital patients （423 women,
