Safety and efficacy of the Amplatzer amulet and watchman2.5 for left atrial appendage occlusion: a Systematic review and meta-analysis

BACKGROUND

Left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulation (OAC) to decrease the risk of stroke in patients with nonvalvular atrial fibrillation (NVAF); however, certain complications remain a concern. Amplatzer Amulet and Watchman are the two most popular used devices for preventing stroke in patients with NVAF. We assessed the safety and efficacy of LAAO using the Amplatzer Amulet and Watchman.

METHODS

A meta-analysis was conducted to compare the safety and efficacy outcomes associated with the use of the Amplatzer Amulet and Watchman 2.5. The Newcastle-Ottawa Scale has been utilized to assess the quality of study.

RESULTS

The meta-analysis includes seven studies involving 2,926 patients (1,418 patients with an amulet and 1,508 with a Watchman 2.5). Generally, adverse event rates for both systems were minimal. No significant differences between the two devices were found in safety (pericardial effusion, device embolization, and cardiac tamponade) or efficacy outcomes (death, TIA, stroke, major/minor bleeding, device leak, and thromboembolic events).

CONCLUSIONS

The data suggest LAAO is a safe procedure, regardless of which device was used. LAAO devices generally have low complication rates. Outcomes were comparable between the two groups with no significant differences in their safety or efficacy. This article is protected by copyright. All rights reserved.

Prostaglandin E1 reduces apoptosis and improves the homing of mesenchymal stem cells in pulmonary arterial hypertension by regulating hypoxia-inducible factor 1 alpha

Background

Pulmonary arterial hypertension (PAH) is associated with oxidative stress and affects the survival and homing of transplanted mesenchymal stem cells (MSCs) as well as cytokine secretion by the MSCs, thereby altering their therapeutic potential. In this study, we preconditioned the MSCs with prostaglandin E1 (PGE1) and performed in vitro and in vivo cell experiments to evaluate the therapeutic effects of MSCs in rats with PAH.

Methods

We studied the relationship between PGE1 and vascular endothelial growth factor (VEGF) secretion, B-cell lymphoma 2 (Bcl-2) expression, and C-X-C chemokine receptor 4 (CXCR4) expression in MSCs and MSC apoptosis as well as migration through the hypoxia-inducible factor (HIF) pathway in vitro. The experimental rats were randomly divided into five groups: (I) control group, (II) monocrotaline (MCT) group, (III) MCT + non-preconditioned (Non-PC) MSC group, (IV) MCT + PGE1-preconditioned (PGE1-PC) MSC group, and (V) MCT^{+PGE1+YC-1-PC}MSC group. We studied methane dicarboxylic aldehyde (MDA) levels, MSC homing to rat lungs, mean pulmonary artery pressure, pulmonary artery systolic pressure, right ventricular hypertrophy index, wall thickness index (%WT), and relative wall area index (%WA) of rat pulmonary arterioles.

Results

Preconditioning with PGE1 increased the protein levels of HIF-1 alpha (HIF-1α) in MSCs, which can reduce MSC apoptosis and increase the protein levels of CXCR4, MSC migration, and vascular endothelial growth factor secretion. Upon injection with ^PGE1-PCMSCs, the pulmonary artery systolic pressure, mean pulmonary artery pressure, right ventricular hypertrophy index, %WT, and %WA decreased in rats with PAH. ^PGE1-PCMSCs exhibited better therapeutic effects than ^non-PCMSCs. Interestingly, lificiguat (YC-1), an inhibitor of the HIF pathway, blocked the effects of PGE1 preconditioning.

Conclusions

Our findings indicate that PGE1 modulates the properties of MSCs by regulating the HIF pathway, providing insights into the mechanism by which PGE1 preconditioning can be used to improve the therapeutic potential of MSCs in PAH.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13287-022-03011-x.

[Study on feasibility of enhanced recovery after surgery combined with mobile microendoscopic discectomy-transforaminal lumbar interbody fusion in the treatment of lumbar spondylolisthesis]

Objective: To explore the feasibility of enhanced recovery after surgery (ERAS) combined with mobile microendoscopic discectomy-transforaminal lumbar interbody fusion (MMED-TLIF) in the treatment of lumbar spondylolisthesis and its influence on postoperative rehabilitation. Methods: From October 1 2014 to July 1 2016 , a cohort of 52 patients with lumbar spondylolisthesis who received the program of ERAS-MMED-TLIF were retrospectively reviewed in Department of Minimally Invasive Spine Surgery, Tianjin Hospital.The primary outcomes include the operation time, intraoperative blood loss, length of hospital stay, VAS score (low back pain and leg pain) and Oswestry Disability Index (ODI) at different follow-up time and complication.The height of intervertebral space and fusion rate were also recorded as radiographic indicators. Results: All cases had an average follow-up of 12 months. The mean operative time was (115±30) min with a mean blood loss of (100±35) ml.Compared with preoperative condition, VAS score of low back pain (6.3±3.3 vs 3.5±2.3, P<0.05), VAS score of leg pain (7.1 ± 4.2 vs 3.1 ± 2.6, P<0.05) and the ODI disability index score (43.5±9.6 vs 20.9±7.3, P<0.05) at the postoperative 24 h were decreased and the difference was statistically significant.The mean hospitalized time were (4.9±1.3) days with mean postoperative hospital stay (2.1±1.2) days.Fusion rate was 92.31% (48/52) at the last follow-up time. Conclusion: ERAS combined with MMED-TLIF is feasible in the treatment of lumbar spondylolisthesis, which can significantly reduce intraoperative bleeding, shorten the total length of stay and postoperative hospital stay, improve postoperative pain and promote rapid rehabilitation of patients after operation without increasing the operation time and influencing the long-term effect, it can be applied in clinical practice.

Augmentation of autophagy by atorvastatin via Akt/mTOR pathway in spontaneously hypertensive rats

Autophagy is activated in hypertension-induced cardiac hypertrophy. However, the mechanisms and significance of an activated autophagy are not clear. This study was designed to determine the role of atorvastatin (ATO) in cardiac autophagy and associated benefits on cardiac remodeling and left ventricular function in spontaneously hypertensive rats (SHRs). Twenty-eight male SHRs at 8 weeks of age were randomized to treatment with vehicle (saline solution; SHR+V) or ATO (SHR+ATO; 50 mg kg(-1) per day) for 6 or 12 months. Age-matched male Wistar-Kyoto (WKY) rats were used as normotensive controls. Cardiac magnetic resonance was used to evaluate cardiac function and structure. Compared with WKY rats, SHRs showed significant left ventricle (LV) dysfunction, remodeling and increases in cardiomyocyte size, which were all attenuated by 6 and 12 months of ATO treatment. Compared with WKY rats, autophagy was activated in the hearts of SHRs and this effect was amplified by chronic ATO treatment, particularly following 12 months of treatment. Protein expression levels of microtubule-associated protein-1 light chain 3-II and beclin-1, the biomarkers of an activated cardiac autophagy, were significantly elevated in ATO-treated versus vehicle-treated SHRs and control WKY rats. Cardiac Akt and phosphorylated mammalian target of rapamycin (mTOR) expression were also increased in the hearts of SHR versus WKY rats, and this effect was attenuated by ATO treatment. These findings suggest that ATO-mediated improvements in LV function and structure in SHRs may be, in part, through its regulation of cardiac autophagy via the Akt/mTOR pathway.

Maggot debridement therapy for the treatment of diabetic foot ulcers: a meta-analysis

OBJECTIVE

To assess the potential efficacy of maggot debridement therapy (MDT) compared with standard care for diabetic foot ulcers (DFUs).

METHOD

A meta-analysis was performed on the evidence for MDT for DFUs. Databases, including PubMed, Web of Science, the Cochrane Library, EMbase, EBSCOhost, Springer Link, ScienceDirect and Ovid-Medline, were electronically searched for randomised controlled trials, case-control studies and controlled clinical trials, up to 31 December 2012, and relevant references of the included articles were also manually searched. The literature was screened, the data were extracted and the methodological quality of the included studies was assessed. Meta-analyses were performed on the included data, for the outcomes healing rate, time to healing, incidence of infection, amputation rate and antibiotic-free days or antibiotics usage.

RESULTS

Overall, four studies comparing MDT with standard therapy on a total of 356 participants were included. The results of meta-analyses suggested that the MDT group was significantly superior to the control group in the percentage of DFUs to achieve full healing (RR=1.8, 95%CI=1.07; 3.02; p=0.03), amputation rate (RR=0.41, 95%CI=0.20; 0.85; p=0.02), time to healing (RR=-3.70, 95%CI=-5.76; -1.64; p=0.0004) and number of antibiotic-free days (126.8 ± 30.3 days vs 81.9 ± 42.1 days; p=0.001); however, collated differences in incidence of infection after intervention revealed no evidence of a difference between the MDT and control groups (RR=0.82, 95%CI=0.65; 1.04, p=0.10).

CONCLUSION

Although MDT may be a scientific and effective therapy in treatment of DFUs, the evidence is too weak to routinely recommend it for treatment. Large studies and sample sizes are needed to assess the efficacy and safety of MDT in the treatment of DFUs.

DECLARATION OF INTEREST

There were no external sources of funding for this study. The authors have no conflicts of interest to declare with regard to this work or its contents. X. Tian and X.M. Liang contributed equally to this work.

Valve replacement in pediatric patients: a single center experience

BACKGROUND

Reconstructive surgery is the primary goal in pediatric patients with valve disease. However, in cases with irreparable valve lesions, valve replacement is the only option. This study aimed to retrospectively analyze the clinical experience of heart valve prosthesis replacement in children.

METHODS

Between January 1990 and July 2009, 35 pediatric patients (16 boys, 19 girls) underwent mechanical valve replacement in Shandong University Qilu Hospital. The ages ranged from 2.5 to 14 years (mean, (8.8 ± 3.8) years) and body weight varied from 11 to 37 kg (mean, (22.1 ± 5.2) kg). Mechanical valve replacement was performed because of congenital heart disease in 23 patients, rheumatic disease in ten patients and infective endocarditis in two patients. St. Jude bileaflet mechanical valves were implanted in all the 35 patients including mitral valve replacement (MVR) in 18, aortic valve replacement (AVR) in 12, tricuspid valve replacement (TVR) in two, AVR and MVR in two and MVR and TVR in one. The size of the prostheses ranged between 19 and 27 mm. All patients received long-term anticoagulation treatment with sodium warfarin, aiming to maintain an international normalized ratio between 1.5 to 2.0. Follow-up was performed in all the patients with a total follow-up of 119.4 patient-years.

RESULTS

The operative mortality was 8.57% (3/35). One patient, who underwent cardiac debridement and AVR, died 2 hours after being admitted to the intensive care unit because of severe low cardiac output syndrome and ventricular fibrillation. Two patients died of cardiogenic shock and renal failure during initial hospitalization after the operation. One patient who received replacement of a tricuspid valve developed complete heart block requiring temporary pacing and recovered sinus rhythm 4 days later. Thirty-two patients survived and their cardiac function was in New York Heart Association (NYHA) class I to class II when discharged. Late events included hemorrhage and endocarditis. Two patients required reoperation. No late deaths occurred during the follow-up.

CONCLUSIONS

Mechanical valve replacement remains an acceptable treatment option in children when the valve reparation is impossible or unsuccessful. The operative mortality and incidence of any valve-related events such as endocarditis, reoperation, thromboembolism or anticoagulation-related bleeding are acceptable.

[Expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule in cardiac allografts and significance thereof: experiment with rats]

OBJECTIVE

To investigate the expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in allograft with chronic rejection (CR) after heart transplantation.

METHODS

Seventy-two SD rats receiving transplantation of the heats of 71 Wistar rats were divided into 4 equal groups: Group A, undergoing heterotopic cervical heart transplantation (transplanted with donor's heart subcutaneously at the neck) and receiving none intervention, and with the transplanted hearts taken out 3 d after transplantation to the end of CR; Group B, injected intravenously with the splenocytes (SPCs) of the donors on day 0, injected with cyclophomide (CP) on d2, transplanted with the donor hearts on d15, with the transplanted hearts taken out 15 - 120 days after transplantation; Group C, transplanted with the donor's heart and injected intraperitoneally with cyclosporine A (Cs A) 10 mg/kg every other day for 8 - 10 times, and with the transplanted hearts taken out 60 d after transplantation to the end of CR; and Group D, injected intravenously with the SPCs of the donors on day 0, injected with CP on d2, transplanted with the donor hearts on d15, with the transplanted hearts taken out 150 - 420 days after transplantation. Immunohistochemical method was used to detect the expression of ICAM-1 and VCAM-1 in the allografts.

RESULTS

The cardiac allograft survival time of Group B was the longest. Less ICAM-1 and VCAM-1 expression and lymphocyte infiltration were observed in SPC and CP-pretreated group. Reversely, protein expression levels of ICAM-1 and VCAM-1 were both high and significant lymphocyte infiltration was seen in Groups B and D. There was no significant difference in the expression of ICAM-1 and VCAM-1 between Groups A and C (P > 0.05).

CONCLUSION

The expression levels of ICAM-1 and VCAM-1 are associated with the occurrence and development of rejection and have positive correlation with the severity of graft rejection. Determination of ICAM-1 and VCAM-1 can predict the function of allograft and provide evidence for early diagnosis and prevention of CR.

[Distribution of bromo[methylene-3H]acetamide in Oncomelania snails, carps, and mice]

Bromoacetamide show a high molluscicidal effect, low toxicity to fish and good solubility in water. It is a promising molluscicide. The present paper reported the distribution of bromo[methylene-3H]acetamide in Oncomelania snails, carps, and mice. Radioactivity in animals was measured by liquid scintillation counting. In Oncomelania snails the radioactivity gradually increased with exposure time and drug concentration. The highest level was found in the head-foot, reaching 12.5 x 10(3) dpm.mg-1 after exposure to the drug for 24 h, whereas the levels in liver and other tissue were 3.0 x 10(3) and 3.8 x 10(3) dpm.mg-1 respectively. Carps absorbed bromo[methylene-3H] acetamide similarly as in Oncomelania snails, but the levels in tissues were less than those in Oncomelania snails. Bromo[methylene-3H]acetamide 0.5 ml (1.4 mumol.L-1) was given ig to mice. Blood samples of 3 mice were collected at 0.5, 1, 3, 6, 12, 24 and 96 h after ig. The peak levels was found within 12 h and then declined gradually.

Mode of action of the molluscicide bromoacetamide

1. Uptake of bromoacetamide was found to be upgraded with exposure time (6, 12, 24 hr) and drug concentration (0.1, 0.5, 1.0 ppm). 2. Bromoacetamide was also absorbed by carp and mice, but drug concentration was markedly lower than in snails. Drug clearance from carp as well as from mice is more rapid than that of snails. 3. The ultrastructure of hepatopancreas cells are markedly influenced by bromoacetamide, including swelling of mitochondria and splitting of cristae. This finding is correlative in a decrease in action of enzymes located in mitochondria (ornithine carbamyl-transferase, citric acid synthase). 4. Oxygen uptake and glucose uptake, as well as urea excretion, are reduced and glycogen reserve are decreased.