Use of Three-dimensional Electroanatomic Mapping for Epicardial Access: Needle Tracking, Elctrographic Characteristics and Clinical Application

BACKGROUND AND AIMS

Pericardiocentesis is usually completed under fluoroscopy. The electroanatomic mapping (EAM) system allows visualizing puncture needle tip (NT) while displaying the electrogram recorded from NT, making it possible to obtain epicardial access (EA) independent of fluoroscopy. This study was designed to establish and validate a technique by which EA is obtained under guidance of 3-dimensional (3D) EAM combined with NT electrogram.

METHODS

3D shell of the heart was generated and the NT was made trackable in the EAM system. Unipolar NT electrogram was continuously monitored. Penetration into pericardial sac was determined by an increase in NT potential amplitude and an injury current. A long guidewire of which the tip was also visible in the EAM system was advanced to confirm EA.

RESULTS

EA was successfully obtained without complication in 13 pigs and 22 patients. In the animals, NT potential amplitude was 3.2± 1.0 mV when it was located in mediastinum, 5.2±1.6 mV when in contact with fibrous pericardium and 9.8±2.8 mV after penetrating into pericardial sac (all p≤0.001). In human subjects, it measured 1.54±0.40 mV, 3.61±1.08 mV and 7.15±2.88 mV respectively (all p<0.001). Fluoroscopy time decreased in every 4-5 cases (64±15, 23±17 and 0 second for animals 1-4, 5-8, 9-13 respectively, p=0.01; 44±23, 31±18; 4±7 seconds for patients 1-7, 8-14, 15-22 respectively, p<0.001). In 5 pigs and 7 patients, EA was obtained without X-ray exposure.

CONCLUSIONS

By tracking NT in the 3D EAM system and continuously monitoring the NT electrogram, it is feasible and safe to obtain EA with minimum or no fluoroscopic guidance.

Electron beam irradiation induced aggregation, structural and functional changes of soybean 11S globulin

This study investigated the effects of different irradiation doses of an electron beam (e-beam) (0, 2, 4, 6, 8, and 10 kGy) on the structure, emulsification, foaming, and rheological and gel properties of soybean 11S globulin. The irradiation treatment at 4 and 6 kGy significantly increased the solubility, surface hydrophobicity, disulfide bonding, and ζ-potential of 11S globulin, decreased the particle size of the protein solution, and effectively improved the emulsifying activity and foaming stability of the protein solution. Moreover, irradiation induced moderate cross-linking and aggregation of the proteins, thereby increasing the apparent viscosity and shear stress of the protein solution. In addition, the low-field NMR and microstructure analysis results revealed that protein gels formed a dense and homogeneous three-dimensional mesh structure after irradiation (6 kGy), along with increased content of bound water (T2b) and water not readily flowable (T21) and a decrease content of free water (T22). Overall, our results confirmed that e-beam irradiation could significantly improve the physicochemical properties of soybean 11S globulin. Our study thus provides a new technical means for the application of electron beam irradiation technology toward protein modification and broadens the high-value utilization of soybean 11S globulin in the food processing industry.

Effect of electron beam irradiation on the structural characteristics and functional properties of goat's milk casein

The effects of electron beam irradiation (EBI) at different doses (0, 2, 4, 6, 8, and 10 kGy) were investigated on the structural and functional properties of casein, including their interrelationship. A gradual reduction in the α-helix content of the secondary structure (as a stable structure) indicates that casein under EBI treatment mainly undergoes fragmentation and aggregation from a structural perspective. Furthermore, the hydrophobic group and tryptophan in the tertiary structure were exposed, which opened up the internal structure of the protein. In addition, a continuously increasing irradiation dose led to casein aggregation, as confirmed by electron microscopy. The structural changes affected its functional properties, such as solubility, emulsification, foaming, and rheological properties, all of which increased first and subsequently decreased. Finally, at irradiation doses of 4-6 kGy, casein was modified to exhibit optimal functional properties, which enhanced its food processing value and performance.

Incidence of cryoballoon expansion dislodgement during pulmonary vein isolation-An underappreciated frequent cause of incomplete isolation

BACKGROUND

Cryoballoon ablation for atrial fibrillation (AF) requires adequate contact between the pulmonary vein (PV) antrum and cryoballoon. The surge of intraballoon pressure during the initial phase of ablation may change the balloon's shape and compliance, resulting in balloon dislodgement and loss of PV occlusion. Without continuous monitoring, this phenomenon is often undetected but can be associated with incomplete PV isolation (PVI).

METHODS

Primary cryoablation of AF was performed in 15 patients. PV occlusion status pre- and post-freezing were analyzed with intracardiac echocardiography (ICE) and dielectric imaging-based occlusion tool (DIOT) to calculate the incidence of expansion dislodgement of cryoballoon.

RESULTS

A total of 105 cryoablation applications were performed on 57 veins, including three common ostiums of left pulmonary veins. In the evaluation of PV occlusion, both modalities reported consistent results in 86.7% of the assessments. Despite complete PV occlusion before ablation, peri-balloon leak after initiation of freezing was detected by ICE in 5/22 (22.7%) applications and by DIOT in 8/25 (32%) applications.

CONCLUSION

Incidence of expansion dislodgement of the cryoballoon was detected in one-fourth to one-third of cryoablation applications depending on the imaging modality used, which was clinically frequent and significant.

Designing a medical information diagnosis platform with IoT integration

In order to enhance the operational efficiency of the healthcare industry, this paper investigates a medical information diagnostic platform through the application of swarm and evolutionary algorithms. This paper begins with an analysis of the current development status of medical information diagnostic platforms based on Chat Generative Pre-trained Transformer (ChatGPT) and Internet of Things (IoT) technology. Subsequently, a comprehensive exploration of the advantages and disadvantages of swarm and evolutionary algorithms within the medical information diagnostic platform is presented. Further, the optimization of the swarm algorithm is achieved through reverse learning and Gaussian functions. The rationality and effectiveness of the proposed optimization algorithm are validated through horizontal comparative experiments. Experimental results demonstrate that the optimized model achieves favorable performance at the levels of minimum, average, and maximum algorithm fitness values. Additionally, preprocessing data in a 10 * 10 server configuration enhances the algorithm's fitness values. The minimum fitness value obtained by the optimized algorithm is 3.56, representing a 3 % improvement compared to the minimum value without sorting. In comparative experiments on algorithm stability, the optimized algorithm exhibits the best stability, with further enhancement observed when using sorting algorithms. Therefore, this paper not only provides a new perspective for the field of medical information diagnostics but also offers effective technical support for practical applications in medical information processing.

Chitosan/konjac glucomannan bilayer films: Physical, structural, and thermal properties

To overcome the limitations of chitosan (CS) and konjac glucomannan (KGM), the bilayer films of CS and KGM were prepared by layer-by-layer (LBL) casting method, and the effects of different mass ratios (i.e., C5: K0, C4:K1, C3:K2, C1:K1, C2:K3, C1:K4, and C0:K5) on the microstructures and physicochemical properties of bilayer films were examined to evaluate their applicability in food packaging. The results revealed that the bilayer films had uniform microstructures. When compared with pure films, the bilayer films displayed lower swelling degrees and water vapor permeability. However, the tensile tests revealed a reduction in the mechanical properties of the bilayer films, which was nonetheless superior to that of the pure KGM film. In addition, the intermolecular interactions between the CS and KGM layers were observed through FTIR and XRD analyses. Finally, TGA and DSC analyses demonstrated a decrease in the thermal stability of the bilayer films. Our cumulative results verified that CS-KGM bilayer films may be a promising material for use in food packaging and further properties of the bilayer films can be supplemented in the future through layer-by-layer modification and the addition of active ingredients.

Vertical variation in leaf functional traits of Parashorea chinensis with different canopy layers

Introduction

Canopy species need to shift their ecological adaptation to improve light and water resources utilization, and the study of intraspecific variations in plant leaf functional traits based at individual scale is of great significance for evaluating plant adaptability to climate change.

Methods

In this study, we evaluate how leaf functional traits of giant trees relate to spatial niche specialization along a vertical gradient. We sampled the tropical flagship species of Parashorea chinensis around 60 meters tall and divided their crowns into three vertical layers. Fourteen key leaf functional traits including leaf morphology, photosynthetic, hydraulic and chemical physiology were measured at each canopy layer to investigate the intraspecific variation of leaf traits and the interrelationships between different functional traits. Additionally, due to the potential impact of different measurement methods (in-situ and ex-situ branch) on photosynthetic physiological parameters, we also compared the effects of these two gas exchange measurements.

Results and discussion

In-situ measurements revealed that most leaf functional traits of individual-to-individual P. chinensis varied significantly at different canopy heights. Leaf hydraulic traits such as midday leaf water potential (MWP) and leaf osmotic potential (OP) were insignificantly correlated with leaf photosynthetic physiological traits such as maximal net assimilation rate per mass (A mass). In addition, great discrepancies were found between in-situ and ex-situ measurements of photosynthetic parameters. The ex-situ measurements caused a decrease by 53.63%, 27.86%, and 38.05% in A mass, and a decrease of 50.00%, 19.21%, and 27.90% in light saturation point compared to the in-situ measurements. These findings provided insights into our understanding of the response mechanisms of P. chinensis to micro-habitat in Xishuangbanna tropical seasonal rainforests and the fine scale adaption of different resultant of decoupled traits, which have implications for understanding ecological adaption strategies of P. chinensis under environmental changes.

Self-esteem buffers the stress sensitizing effect of childhood maltreatment on adolescent nonsuicidal self-injury

BACKGROUND

Adversity in childhood increases the risk of psychopathology, perhaps by influencing sensitivity to recent stressful life events (SLEs). However, little is known about the stress-sensitizing effect of childhood adversity on nonsuicidal self-injury (NSSI), whether stress sensitization exists in specific types of SLEs, and the stress-buffering effect of self-esteem. This study aimed to investigate whether exposure to child maltreatment increases adolescent's vulnerability to the effects of dependent and independent SLEs on later NSSI and whether self-esteem buffers this risk.

METHODS

We conducted a two-wave study with 18-month intervals. 601 Chinese adolescents completed self-report measures of child maltreatment, SLEs, self-esteem, and NSSI.

RESULTS

Results supported the stress sensitization hypothesis for child maltreatment regarding dependent SLEs, with dependent SLEs significantly predicting later NSSI only in maltreated adolescents. Moreover, self-esteem buffered the relationship between dependent SLEs and NSSI in maltreated adolescents but amplified the relationship in non-maltreated adolescents. In the maltreated group, dependent SLEs predicted increased NSSI only in those with low self-esteem. In contrast, in the control group, dependent SLEs were significantly associated with NSSI in individuals with high self-esteem.

LIMITATIONS

We did not collect information on the timing of exposure to child maltreatment. Future studies that assess child maltreatment during critical periods of development may be able to identify sensitive period in which maltreatment sensitizes individuals to stress in adolescents.

CONCLUSION

Findings provide preliminary evidence that child maltreatment has a stress-sensitizing effect on adolescent NSSI. Improving self-esteem may mitigate the associations between SLEs and NSSI in adolescents exposed to child maltreatment.

Reconsideration of the definition of blanking period and significance of early recurrences after catheter ablation of atrial fibrillation

PURPOSE OF REVIEW

Early recurrence of atrial tachyarrhythmia (ERAT) during blanking period (BP) is not uncommon after catheter ablation of AF. Current guidelines and consensus statements recommend conservative treatment of ERAT. This review summarized recent studies, underlying mechanism and clinical managements of ERAT, and proposed a reconsideration of the definition and clinical significance of BP.

RECENT FINDINGS

Recent studies have shown that the entity of ERAT in the very early phase of BP (i.e., first 4 weeks of the 3-month period) is different from those ERATs occurring late which is strongly associated with the late recurrence of atrial tachyarrhythmia. The optimal BP duration suggested by clinical observation ranges from 21 to 58 days. Using antiarrhythmic drugs and early electrical cardioversion are the effective management for ERAT, whereas re-ablation is a reasonable strategy although remains controversial.

SUMMARY

The definition of BP with a shorter duration, that is, 1 month instead of 3 months post AF ablation, is supported by the observations of latest clinical studies. Recurrent atrial tachyarrhythmia beyond the 1-month time frame is associated with higher risk of late recurrence and may warrant repeat ablation. A revisit to the guideline recommendation on management of ERAT is needed to change clinical practice.

Initial clinical experience of atrial fibrillation ablation guided by a cryoballoon-compatible, magnetic-based circular catheter

INTRODUCTION

The circular catheter compatible with current cryoballoon system for atrial fibrillation (AF) ablation is exclusively sensed by impedance-based electro-anatomical mapping (EAM) system, limiting the accuracy of maps. We aim to investigate the feasibility and safety of a magnetic-based circular mapping catheter for AF ablation with cryoballoon.

METHODS

Nineteen consecutive patients who underwent pulmonary vein isolation (PVI) with cryoballoon for paroxysmal or persistent AF were included. EAMs of left atrium (LA) created by the LASSOSTAR™NAV catheter (Lassostar map) before and after PVI were compared to that generated by a high-density mapping catheter (Pentaray map) from different aspects including structural similarity, PV angle, LA posterior wall (LAPW) and low voltage areas (LVAs), and the amplitude of far field electrograms (FFEs) recorded by catheters.

RESULTS

All patients had successful PVI without major complications. With similar mapping time and density, the LA volume calculated from the Pentaray map and Lassostar map were comparable. There were no significant differences in PV angle of all PVs and PW area (16.8 ± 3.2 vs. 17.1 ± 2.8, p = .516) between Pentaray map and Lassostar map. High structural similarity score was observed between two maps (0.783 in RAO/LAO view and 0.791 in PA view). Lassostar map detected lesser but not statistically significant extension of LVA (13.9% vs. 18.3%, p = .07). Amplitude of FFE was larger at the right superior PV on Lassostar map (0.21 ± 0.16 vs. 0.14 ± 0.11 mV, p = .041) compared to that on the Pentaray map.

CONCLUSION

In our initial experience, PVI with cryoballoon and magnetic-based circular LASSOSTAR™NAV catheter was safe and effective based on the accurate LA geometry it created.

Nonsynonymous SNPs within C7H15orf39 and NOS2 are associated with boar semen quality

Spermatogenesis is the developmental process that produces spermatozoa. The aim of this study was to investigate the single nucleotide polymorphisms (SNPs) within C7H15orf39 and NOS2 genes and to determine the correlations between two SNPs and semen quality in Duroc boars (n = 604). The polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP) method was used for genotyping the selected two nonsynonymous SNPs. The significant correlation was observed between two SNPs (rs80969873: g.58385473 G > A within C7H15orf39; rs325865291: g.44175445 G > A within NOS2) and semen traits in Duroc boars. This study indicates the SNPs in C7H15orf39 and NOS2 may be the potential molecular marker for improving the semen quality traits in Duroc boars.

Reciprocal associations between early maladaptive schemas and depression in adolescence: long-term effects of childhood abuse and neglect

BACKGROUND

Adolescent depression has grown to be a major social concern in China. During the coronavirus pandemic, the incidence of depression among Chinese adolescents increased substantially. More research is required to inform the prevention and intervention of adolescent depression in China. Depression is associated with Early Maladaptive Schemas (EMSs). Childhood abuse and neglect are distal antecedents of adolescent depression. It is not known how depression and EMSs interact in adolescence and how childhood abuse and neglect contribute to this relationship. This study aimed to examine the reciprocal relationships between depression and EMSs, as well as the long-term effects of childhood abuse and neglect on depression and EMSs during adolescence. The work also investigates gender differences in these mechanisms.

METHODS

Using a two-wave longitudinal design, we recruited 3,485 Chinese adolescents (Mage = 13.2; 43.2% females) from three Shanxi Province, China middle schools. All participants completed self-report questionnaires addressing childhood abuse and neglect, depression, and EMSs. Structural equation models examined reciprocal relationships between depression and EMS, as well as the effect of childhood abuse and neglect on depression and EMSs. Multi-group analysis addressed gender differences.

RESULTS

Results indicated that greater depression predicted more EMSs measured later, but EMSs did not predict subsequent depression. Childhood abuse and neglect had different effects on depression and EMSs during adolescence. Specifically, exposure to childhood abuse related to more severe depression and EMSs in adolescence and contributed to the perpetuation of EMSs by increasing depression. Exposure to childhood neglect showed a direct effect on depression and indirectly reinforced subsequent EMSs through depression. There were no gender differences.

CONCLUSION

These findings contribute to a better understanding of the emergence and course of depression in early adolescence, suggesting that childhood abuse and neglect are critical early risk factors. Additionally, depression plays a key role in promoting schema perpetuation among adolescents exposed to childhood maltreatment, providing important implications for relevant prevention and intervention in early adolescence.

The Effects of Dietary Silybin Supplementation on the Growth Performance and Regulation of Intestinal Oxidative Injury and Microflora Dysbiosis in Weaned Piglets

Oxidative stress is the major incentive for intestinal dysfunction in weaned piglets, which usually leads to growth retardation or even death. Silybin has caught extensive attention due to its antioxidant properties. Herein, we investigated the effect of dietary silybin supplementation on growth performance and determined its protective effect on paraquat (PQ)-induced intestinal oxidative damage and microflora dysbiosis in weaned piglets. In trial 1, a total of one hundred twenty healthy weaned piglets were randomly assigned into five treatments with six replicate pens per treatment and four piglets per pen, where they were fed basal diets supplemented with silybin at 0, 50, 100, 200, or 400 mg/kg for 42 days. In trial 2, a total of 24 piglets were randomly allocated to two dietary treatments with 12 replicates per treatment and 1 piglet per pen: a basal diet or adding 400 mg/kg silybin to a basal diet. One-half piglets in each treatment were given an intraperitoneal injection of paraquat (4 mg/kg of body weight) or sterile saline on day 18. All piglets were euthanized on day 21 for sample collection. The results showed that dietary supplementation with 400 mg/kg silybin resulted in a lower feed conversion ratio, diarrhea incidence, and greater antioxidant capacity in weaned piglets. Dietary silybin enhanced intestinal antioxidant capacity and mitochondrial function in oxidative stress piglets induced by PQ. Silybin inhibited mitochondria-associated endogenous apoptotic procedures and then improved the intestinal barrier function and morphology of PQ-challenged piglets. Moreover, silybin improved intestinal microbiota dysbiosis induced by the PQ challenge by enriching short-chain fatty-acid-producing bacteria, which augmented the production of acetate and propionate. Collectively, these findings indicated that dietary silybin supplementation linearly decreased feed conversion ratio and reduced diarrhea incidence in normal conditions, and effectively alleviated oxidative stress-induced mitochondrial dysfunction, intestinal damage, and microflora dysbiosis in weaned piglets.

Longitudinal Evaluation of the Neurosequential Model of Therapeutics with Adoptive Families in Tennessee

PURPOSE

This study evaluated effectiveness of the Neurosequential Model of Therapeutics (NMT) with adoptive families who received post adoption services in Tennessee.

METHODS

Researchers obtained a sample of 552 families who received post adoption services in the U.S. state of Tennessee. Most families (77%) had adopted children through public child welfare services. A quasi-experimental design examined wellbeing outcomes for an NMT group (n = 319) versus a services-as-usual (SAU) group (n = 233) in intent-to-treat analyses. Then, the SAU group was contrasted to an NMT subgroup that had high adherence to the NMT model (n = 109) in an analysis of treatment-on-the-treated.

RESULTS

Intent-to-treat models indicated no differences on outcomes between the NMT and SAU groups. However, the results of treatment-on-the-treated analyses showed slightly greater reduction on the Behavior Problems Index over time for the NMT with high adherence group as compared to SAU.

DISCUSSION AND CONCLUSION

Adoptive families may face challenges that could be addressed through developmentally sensitive, trauma-informed services, such as NMT. The results of this study suggest that the NMT might benefit adoptive families if greater attention is paid to implementation adherence, or fidelity.

State Child Maltreatment Policies and Disparities in Substantiation: A Study of State-Administered Child Welfare Systems in the U.S

Although several studies have examined child and family factors associated with substantiation, less research has explored the role of state child maltreatment policies in substantiating cases of alleged maltreatment. In parallel, there is growing pressure to reduce racial/ethnic disproportionality and disparities across the span of a child welfare case. We examined the relationship between state child maltreatment policies and substantiation, with child race/ethnicity as a moderator of this relationship. Data came from the 2019 National Child Abuse and Neglect Data System (NCANDS) and the State Child Abuse and Neglect (SCAN) Policy Database. Using a series of multi-level binary logistic models, we calculated the odds of substantiation based on child characteristics (e.g., child age, number of types of alleged maltreatment) and state policies (e.g., state definitions of maltreatment that include exposure to domestic violence, harsh punishment). Approximately 17% of the variance in substantiation occurs between states. Although we did not find a direct effect of state policy on substantiation, there were significant interaction terms, in that inclusion of exposure to domestic violence, harsh punishment, or educational neglect in state policy was more strongly associated with substantiation for children of color than white children. Implications for policy and research are explored.

Identification of Human Ventricular Tachycardia Demarcated by Fixed Lines of Conduction Block in a 3-Dimensional Hyperboloid Circuit

BACKGROUND

The circuit boundaries for reentrant ventricular tachycardia (VT) have been historically conceptualized within a 2-dimensional (2D) construct, with their fixed or functional nature unresolved. This study aimed to examine the correlation between localized lines of conduction block (LOB) evident during baseline rhythm with lateral isthmus boundaries that 3-dimensionally constrain the VT isthmus as a hyperboloid structure.

METHODS

A total of 175 VT activation maps were correlated with isochronal late activation maps during baseline rhythm in 106 patients who underwent catheter ablation for scar-related VT from 3 centers (42% nonischemic cardiomyopathy). An overt LOB was defined by a deceleration zone with split potentials (≥20 ms isoelectric segment) during baseline rhythm. A novel application of pacing within deceleration zone (≥600 ms) was implemented to unmask a concealed LOB not evident during baseline rhythm. LOB identified during baseline rhythm or pacing were correlated with isthmus boundaries during VT.

RESULTS

Among 202 deceleration zones analyzed during baseline rhythm, an overt LOB was evident in 47%. When differential pacing was performed in 38 deceleration zones without overt LOB, an underlying concealed LOB was exposed in 84%. In 152 VT activation maps (2D=53, 3-dimensional [3D]=99), 69% of lateral boundaries colocalized with an LOB in 2D activation patterns, and the depth boundary during 3D VT colocalized with an LOB in 79%. In VT circuits with isthmus regions that colocalized with a U-shaped LOB (n=28), the boundary invariably served as both lateral boundaries in 2D and 3D. Overall, 74% of isthmus boundaries were identifiable as fixed LOB during baseline rhythm or differential pacing.

CONCLUSIONS

The majority of VT circuit boundaries can be identified as fixed LOB from intrinsic or paced activation during sinus rhythm. Analysis of activation while pacing within the scar substrate is a novel technique that may unmask concealed LOB, previously interpreted to be functional in nature. An LOB from the perspective of a myocardial surface is frequently associated with intramural conduction, supporting the existence of a 3D hyperboloid VT circuit structure. Catheter ablation may be simplified to targeting both sides around an identified LOB during sinus rhythm.

Expression of m6A Regulator Genes can Facilitate the Diagnosis of Chronic Heart Failure

BACKGROUND

RNA N6-methyladenosine (m6A) is the most common type of modification in eukaryotic mRNA. The relationship between m6A modification and disease has been studied extensively, but there have been few studies on chronic heart failure (CHF). This study investigated a possible role for m6A in the diagnosis of CHF.

METHODS

Seven candidate m6A regulators (writers: WTAP and ZC3H13; readers: YTHDF3, FMR1, IGFBP1, and ELAVL1; eraser: FTO) were identified using a random forest (RF) model and the GSE5406 dataset from the Gene Expression Omnibus database. A nomogram model was developed to predict the risk of CHF, while consensus clustering methodology assigned CHF samples into two m6A patterns (cluster A and cluster B) according to the 7 candidate m6A regulators. Principal component analysis was used to calculate an m6A score for each sample and to quantify m6A patterns.

RESULTS

Decision curve analysis and the nomogram model were used to obtain predictions that may be of clinical use. Patients in cluster B had higher m6A scores than patients in cluster A. Cluster B patients also had higher expression levels (ELs) of IL-4, IL-5, IL-10 and IL-13 than patients in cluster A, whereas cluster A patients had a higher EL for IL-33. The m6A cluster B pattern likely represents the ischemic heart failure (HF) disease group.

CONCLUSION

m6A regulators are important in the pathogenesis of CHF associated with ischemic and idiopathic dilated cardiomyopathy, and may prove useful for the diagnosis and treatment of CHF.

Risk Factors for Left Ventricular Thrombus Formation in Patients with Dilated Cardiomyopathy

BACKGROUND

 Left ventricular thrombus (LVT) is a common complication of dilated cardiomyopathy (DCM), causing morbidity and mortality.

METHODS

 This study retrospectively analyzed patients with DCM from January 2002 to August 2020 in Beijing Anzhen Hospital. Clinical characteristics were compared between the LVT group and the age and sex 1:4 matched with the LVT absent group. The receiver operator characteristic (ROC) curve was plotted to evaluate the diagnostic value of D-dimer predicting LVT occurrence in DCM.

RESULTS

 A total of 3,134 patients were screened, and LVT was detected in 72 (2.3%) patients on echocardiography. The patients with LVT had higher D-dimer, fibrinogen, and lower systolic blood pressure than those without LVT. The ejection fraction (EF) was lower and left ventricular end-systolic diameter was larger in the LVT group. Severe mitral regurgitation (MR) was more common in the LVT absent groups. The prevalence of atrial fibrillation was lower in the LVT group. The ROC curve analysis yielded an optimal cut-off value of 444 ng/mL DDU (D-dimer units) for D-dimer to predict the presence of LVT. Multivariable binary logistic regression analysis revealed that EF (OR = 0.90, 95% CI = 0.86-0.95), severe MR (OR = 0.19, 95% CI = 0.08-0.48), and D-dimer level (OR = 15.4, 95% CI = 7.58-31.4) were independently associated with LVT formation.

CONCLUSION

 This study suggested that elevated D-dimer levels (>444 ng/mL DDU) and reduced EF were independently associated with increased risk of LVT formation. Severe MR could decrease the incidence of LVT.

Randomized prospective evaluation of same-day discharge after cryoballoon ablation of atrial fibrillation: results of the EASY PVI study

BACKGROUND

With advancements in technology and ablation techniques, catheter ablation for the treatment of atrial fibrillation (AF) has become safer with time. In the past, standard-of-care recommended overnight stay for outpatient procedures. As safety has improved and procedure times have shortened, some centers have allowed for same-day discharge. We report the results of a multi-center, randomized clinical trial investigating the safety of same-day discharge post-cryoballoon ablation.

METHODS

Patients with paroxysmal atrial fibrillation underwent pulmonary vein isolation (PVI) with the Medtronic Arctic Advance cryoballoon at 3 US centers. Six hours after the procedure, patients were randomized to either stay overnight or be discharged same day.

RESULTS

A total of 49 patients were enrolled. Two patients were withdrawn prior to randomization. One patient chose to withdraw after randomization. Of the 22 patients randomized to same-day discharge and the 23 patients randomized the overnight stay, no significant adverse outcomes were reported in either group. Occurrence of adverse events did not differ significantly between the two groups. Procedure time and fluoroscopy time did not significantly differ between groups.

CONCLUSIONS

This is the first randomized trial examining the safety of same-day discharge post-cryoballoon ablation. Based on our results, same-day discharge following cryoballoon ablation for paroxysmal AF is a safe option following uncomplicated ablation for PVI. Operators should use their discretion in selecting patients for same-day discharge.

[Relationships between hypertensive disorders in pregnancy and obstructive sleep apnea syndrome]

Objective: To investigate the impact of obstructive sleep apnea syndrome (OSAS) on pregnancy outcomes, especially the relationship between OSAS and hypertensive disorders in pregnancy (HDP). Methods: A total of 228 pregnant women with high risk of OSAS who underwent sleep monitoring during pregnancy in Peking University People's Hospital from January 2021 to April 2022 were collected by reviewing their medical records for retrospective analysis. According to the diagnosis of OSAS, the pregnant women were divided into OSAS group (105 cases) and non-OSAS group (123 cases). The non-parametric Mann-Whitney U test, χ2 test or Fisher's exact test were used to compare the general data and maternal and fetal outcomes between the two groups, and the occurrence of each type of HDP was further compared. Results: (1) Compared with the non-OSAS group, the median pre-pregnancy body mass index (23.6 vs 27.6 kg/m2) and the proportion of snoring [28.9% (33/114) vs 59.2% (61/103)] in the OSAS group were higher, and the differences were both statistically significant (both P<0.001). (2) The incidence of HDP [67.6% (71/105) vs 39.0% (48/123)] and gestational diabetes mellitus [GDM; 40.0% (42/105) vs 26.8% (33/123)] of pregnant women in the OSAS group were higher than those in the non-OSAS group, and the median delivery week was shorter than that in the non-OSAS group (38.4 vs 39.0 weeks). The differences were all statistically significant (all P<0.05). Between-group differences for the delivery way, postpartum hemorrhage, the rate of intensive care unit admission, preterm birth, small for gestational age infants, neonatal asphyxia, the rate of neonatal intensive care unit admission, newborn birth weight and the proportion of umbilical artery blood pH<7.00 were not statistically significant (all P>0.05). (3) Compared with the non-OSAS group, the incidence of chronic hypertension [11.4% (14/123) vs 22.9% (24/105)] and chronic hypertension with superimposed pre-eclampsia [11.4% (14/123) vs 30.5% (32/105)] were higher in the OSAS group, and the differences were both statistically significant (both P<0.01). Conclusion: OSAS is related to HDP (especially chronic hypertension and chronic hypertension with superimposed pre-eclampsia) and GDM, which could provide a practical basis for the screening, diagnosis and treatment of OSAS in pregnant women at high risk.

Prospective prescription review system correlated with more rational PPI medication use, better clinical outcomes and reduced PPI costs: experience from a retrospective cohort study

INTRODUCTION

Proton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs.

METHODS

A retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10-2020.09) and a postintervention group (2020.10-2021.09). To reduce the bias of patients' baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs.

RESULTS

A total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05).

CONCLUSION

The implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use.

Vasovagal Responses to Human Monomorphic Ventricular Tachycardia: Hemodynamic Implications From Sinus Rate Analysis

BACKGROUND

Factors determining hemodynamic stability during human ventricular tachycardia (VT) are incompletely understood.

OBJECTIVES

The purposes of this study were to characterize sinus rate (SR) responses during monomorphic VT in association with hemodynamic stability and to prospectively assess the effects of vagolytic therapy on VT tolerance.

METHODS

This is a retrospective analysis of patients undergoing scar-related VT ablation. Vasovagal responses were evaluated by analyzing sinus cycle length before VT induction and during VT. SR responses were classified into 3 groups: increasing (≥5 beats/min, sympathetic), decreasing (≥5 beats/min, vagal), and unchanged, with the latter 2 categorized as inappropriate SR. In a prospective cohort (n = 30) that exhibited a failure to increase SR, atropine was administered to improve hemodynamic tolerance to VT.

RESULTS

In 150 patients, 261 VT episodes were analyzed (29% untolerated, 71% tolerated) with median VT duration 1.6 minutes. A total of 52% of VT episodes were associated with a sympathetic response, 31% had unchanged SR, and 17% of VTs exhibited a vagal response. A significantly higher prevalence of inappropriate SR responses was observed during untolerated VT (sustained VT requiring cardioversion within 150 seconds) compared with tolerated VT (84% vs 34%; P < 0.001). Untolerated VT was significantly different between groups: 9% (sympathetic), 82% (vagal), and 32% (unchanged) (P < 0.001). Atropine administration improved hemodynamic tolerance to VT in 70%.

CONCLUSIONS

Nearly one-half of VT episodes are associated with failure to augment SR, indicative of an under-recognized pathophysiological vasovagal response to VT. Inappropriate SR responses were more predictive of hemodynamic instability than VT rate and ejection fraction. Vagolytic therapy may be a novel method to augment blood pressure during VT.

The effectiveness and safety of eyelid defect reconstruction after sebaceous carcinoma of the eyelid surgery: A protocol for systematic review and meta-analysis

INTRODUCTION

Sebaceous carcinoma of the eyelid is the third most common eyelid malignancy, after basal cell carcinoma and squamous cell carcinoma. It is highly malignant and potentially aggressive. Surgical excision is currently the best treatment option for this condition. Patients often require reconstruction surgery to repair eyelid defects to achieve normal eyelid function and appearance. However, no comprehensive systematic review has assessed the efficacy and safety of eyelid defect reconstruction. This protocol was developed to conduct a systematic review and meta-analysis to evaluate evidence related to the efficacy and safety of reconstruction.

METHODS

We will systematically search the Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure, WanFang Database, and Chinese Biomedical Literature Database from their inception to February 2023 for studies on eyelid defect reconstruction. We will identify other potential studies using multiple methods such as manual searching. The outcomes were eyelid function, eyelid morphology, patient satisfaction, recurrence rate, metastasis rate, tumor-related mortality, and adverse events. Two researchers will independently screen titles and abstracts, identify full-text studies for inclusion, extract data, and appraise the risk of bias in the included studies. A meta-analysis will be conducted using Review Manager 5.4 and R software. The certainty of evidence will be appraised by grading of recommendations, assessment, development, and evaluation system.

RESULTS

This full-text will adhere to the preferred reporting items for systematic reviews and meta-analyses statement to ensure clarity and completeness of reporting in all phases of the systematic review.

DISCUSSION

This study provides evidence of the efficacy and safety of reconstruction methods for sebaceous carcinoma of the eyelid.

State Policies on Child Maltreatment and Racial Disproportionality

Over the past several decades researchers have documented disproportionality for Black families across multiple decision-making points within the child welfare system. Yet, few studies have examined how specific state policies may impact disproportionality across decision points. The racial disproportionality index (RDI) was calculated for Black children in each state and Washington DC (N = 51) based on the proportion of children who were received a referral to CPS, a substantiated investigation, or entered foster care. A series of bivariate analyses (one-way ANOVAs; independent sample t-tests) were used to explore the relationship between the RDI and these decision points. Further analyses were conducted between the RDI and state policies (e.g., child maltreatment definitions, mandated reporting, and alternative response). Our results suggest there is an overrepresentation of Black children in CPS across the three decision points. This overrepresentation continues with specific state policies such as a state using harsh punishment in their definition of child maltreatment. Recommendations are provided for policy and research, including a suggestion for further exploration of state policies and county-level disproportionality indexes.

Dietary Supplementation with Different Types of Potassium and Magnesium during Late Gestation and Lactation Modulates the Reproductive Performance, Antioxidant Capacity, and Immune Function of Sows

The objective of this study was to investigate the effects of dietary supplementation with different types of potassium and magnesium on the reproductive performance, antioxidant capacity, and immunity of sows. Forty-five Landrace × Yorkshire sows at the late gestation stage (85 d) were randomly assigned to three groups (n = 15). Sows in the control group (CON), potassium chloride and magnesium sulfate group (PM), and potassium-magnesium sulfate group (PMS) were fed with a basal diet, a basal diet supplemented with magnesium sulfate (0.20%) and potassium chloride (0.15%), or a basal diet supplemented with potassium-magnesium sulfate (0.45%), respectively. The results showed that dietary supplementation with PMS did not yield significant effects on the reproductive performance compared with the CON group (p > 0.05). However, it significantly elevated the level of insulin-like growth factor 1 (IGF-1) in plasma and immunoglobulin A (IgA) in colostrum (p < 0.05). Furthermore, PMS significantly augmented the activities of catalase (CAT) and superoxide dismutase (SOD) while reducing the levels of malondialdehyde (MDA) in comparison to the CON group (p < 0.05). Compared with the PM group, the PMS group significantly reduced the incidence rate of intrauterine growth restriction (IUGR) (p < 0.05) and significantly decreased the concentration of the proinflammatory cytokine (TNF-α) level in plasma (p < 0.05). These results indicated that dietary supplementation with PMS during late gestation could enhance sows' antioxidant capacity and the IgA level in colostrum. These findings will provide a theoretical reference for the use of magnesium and potassium in sow production to improve sows' health.

[Evolution and progress of surgical intervention strategies for acute pancreatitis]

Acute pancreatitis is one of the common surgical acute abdominal diseases. Since people first recognized acute pancreatitis in the middle of the nineteenth century, a diversified minimally invasive treatment model with standardization has been formed today. According to the main line of surgical intervention of acute pancreatitis treatment,this period can be roughly divided into five stages:exploration stage, conservative treatment stage, pancreatectomy stage, debridement and drainage of the pancreatic necrotic tissue stage, and minimally invasive treatment as the first choice led by the multidisciplinary team mode stage. Throughout history, the evolution and progress of surgical intervention strategies for acute pancreatitis cannot be separated from the progress of science and technology, the update of treatment concepts and the further understanding of the pathogenesis. This article will summarize the surgical characteristics of acute pancreatitis treatment at each stage to explain the development of surgical treatment of acute pancreatitis,to help investigate the development of surgical treatment of acute pancreatitis in the future.

The synergistic hydration mechanism and environmental safety of multiple solid wastes in red mud-based cementitious materials

Red mud (RM) is a solid waste material with high alkalinity and low cementing activity component. The low activity of RM makes it difficult to prepare high-performance cementitious materials from RM alone. Five groups of RM-based cementitious samples were prepared by adding steel slag (SS), grade 42.5 ordinary Portland cement (OPC), blast furnace slag cement (BFSC), flue gas desulfurization gypsum (FGDG), and fly ash (FA). The effects of different solid waste additives on the hydration mechanisms, mechanical properties, and environmental safety of RM-based cementitious materials were discussed and analyzed. The results showed that the samples prepared from different solid waste materials and RM formed similar hydration products, and the main products were C-S-H, tobermorite, and Ca(OH)₂. The mechanical properties of the samples met the single flexural strength criterion (≥ 3.0 MPa) for first-grade pavement brick in the Industry Standard of Building Materials of the People's Republic of China-Concrete Pavement Brick. The alkali substances in the samples existed stably, and the leaching concentrations of the heavy metals reached class III of the surface water environmental quality standards. The radioactivity level was in the unrestricted range for main building materials and decorative materials. The results manifest that RM-based cementitious materials have the characteristics of environmentally friendly materials and possess the potential to partially or fully replace traditional cement in the development of engineering and construction applications and it provides innovative guidance for combined utilization of multi-solid waste materials and RM resources.

Association of shift work and dietary inflammatory potential with all-cause death among us hypertensive population: national health and nutrition examination study, 2005-2010

BACKGROUND & AIMS

The individual effect of working schedule on survival in the hypertensive population has not been adequately studied. Shiftworkers are also prone to unhealthy lifestyles like pro-inflammatory diet. Therefore, we assessed the effect of shift work and its joint association with dietary inflammatory potential on mortality risk among the large US nationally representative sample of adult hypertensive population.

METHODS

Data were from a nationally representative prospective cohort among US hypertensive population (n = 3680; weighted population, 54,192,988). The participants were linked to the 2019 public-access linked mortality archives. The working schedule were self-reported using the Occupation Questionnaire Section. Dietary inflammatory index (DII) scores were equally calculated using the 24-hour dietary recall (24 h) interviews. Multivariable Cox proportional hazards regression models were used to estimate hazard ratio and 95% confidence intervals (95%CI) for survival of hypertension individuals by work schedule and dietary inflammatory potential. The joint effect of work schedule and dietary inflammatory potential was then examined.

RESULTS

Among the 3680 hypertension individuals (39.89% female [n = 1479] and 71.42% white [n = 1707]; weighted mean [SE] age, 47.35 [0.32] years), 592 individuals reported shift work status. 474 (10.76%) reported shift work status with pro-inflammatory dietary pattern (DII scores > 0). 118 (3.06%) reported shift work status with anti-inflammatory dietary pattern (DII scores < 0). 646 (19.64%) reported a non-shift working schedule with anti-inflammatory dietary pattern, while 2442 (66.54%) reported non-shift working schedule with pro-inflammatory dietary pattern. After a median follow-up of 11.67 years (140 months), 317 deaths (cardiovascular diseases (CVD), 65; cancer, 104) were registered. Cox regression analysis showed that shift work was associated with higher risk of all-cause mortality (hazard ratio [HR], 1.48; 95% CI, 1.07-2.06) compared with non-shift workers. In the joint analysis, shift work status combined with pro-inflammatory dietary pattern was associated with the highest all-cause mortality risk. Moreover, adopting the anti-inflammatory diet significantly attenuates the deleterious effect of shift work on mortality risk.

CONCLUSIONS

In this large representative sample of adults with hypertension in the U.S., the combination of shift work status with pro-inflammatory dietary pattern was highly prevalent and was associated with the highest risks of death from all causes.

Prospective randomized comparison between upgraded '2C3L' vs. PVI approach for catheter ablation of persistent atrial fibrillation: PROMPT-AF trial design

BACKGROUND

In randomized studies, the strategy of pulmonary vein antral isolation (PVI) plus linear ablation has failed to increase success rates for persistent atrial fibrillation (PeAF) ablation when compared with PVI alone. Peri-mitral reentry related atrial tachycardia due to incomplete linear block is an important cause of clinical failures of a first ablation procedure. Ethanol infusion (EI) into the vein of Marshall (EI-VOM) has been demonstrated to facilitate a durable mitral isthmus linear lesion.

OBJECTIVE

This trial is designed to compare arrhythmia-free survival between PVI and an ablation strategy termed upgraded '2C3L' for the ablation of PeAF.

STUDY DESIGN

The PROMPT-AF study (clinicaltrials.gov 04497376) is a prospective, multicenter, open-label, randomized trial using a 1:1 parallel-control approach. Patients (n = 498) undergoing their first catheter ablation of PeAF will be randomized to either the upgraded '2C3L' arm or PVI arm in a 1:1 fashion. The upgraded '2C3L' technique is a fixed ablation approach consisting of EI-VOM, bilateral circumferential PVI, and 3 linear ablation lesion sets across the mitral isthmus, left atrial roof, and cavotricuspid isthmus. The follow-up duration is 12 months. The primary end point is freedom from atrial arrhythmias of >30 seconds, without antiarrhythmic drugs, in 12 months after the index ablation procedure (excluding a blanking period of 3 months).

CONCLUSIONS

The PROMPT-AF study will evaluate the efficacy of the fixed '2C3L' approach in conjunction with EI-VOM, compared with PVI alone, in patients with PeAF undergoing de novo ablation.

Efficiency and safety of high-power ablation guided by Lesion size index: An ex vivo porcine heart study

BACKGROUND

Although Lesion size index (LSI) has been reported to highly predict radiofrequency lesion size in vitro, its accuracy in lesion size and steam pop estimation has not been well investigated for every possible scenario.

METHODS

Initially, radiofrequency ablations were performed on porcine myocardial slabs at various power, CF, and time settings with blinded LSI. Subsequently, radiofrequency power at 20, 30, 40, 50, and 60 W was applied at CF values of 5, 10, 20, and 30 g to reach target LSIs of 4, 5, 6, and 7. Lesion size and steam pops were recorded for each ablation.

RESULTS

Lesion size was positively correlated with LSI regardless of power settings (p < 0.001). The linear correlation coefficients of lesion size and LSI decreased at higher power settings. At high power combined with high CF settings (50 W/20 g), lesion depth and LSI showed an irrelevant correlation (p = 0.7855). High-power ablation shortened ablation time and increased the effect of resistive heating. LSI could predict the risk of steam pops at high-power settings with the optimal threshold of 5.65 (sensitivity, 94.1%; specificity, 46.1%). The ablation depth of the heavy heart was shallower than that of the light heart under similar ablation settings.

CONCLUSIONS

LSI could predict radiofrequency lesion size and steam pops at high power settings in vitro, while synchronous high power and high CF should be avoided. Lighter hearts require relatively lower ablation settings to create appropriate ablation depth.

SPAG6 c.900 T>C affects boar semen quality and blood-testis barrier function by creating a new splice acceptor site

Sperm associated antigen 6 (SPAG6) acts as a scaffolding protein in the center of the flagellar axoneme and has an impact on the maturation of the motility of mammalian sperm flagella and the maintenance of sperm structure. In our previous research, SPAG6 c.900 T>C in exon 7 and exon 7 skipped transcript was identified by analyzing RNA-seq data of testicular tissues from 60 day (sexually immature) and 180 day (sexually mature) Large White boars. Herein, we found porcine SPAG6 c.900 T>C to be associated with semen quality traits in Duroc, Large White and Landrace pigs. SPAG6 c.900 C can generate a new splice acceptor site, inhibit the occurrence of SPAG6 exon 7 skipping to a certain extent, thereby promote the growth of Sertoli cells and maintain the normal blood-testis barrier function. This study provides new insights into the molecular regulation of spermatogenesis and a new genetic marker for the improvement of semen quality in pigs.

Successful ablation of a right epicardial accessory pathway via the right ventricular diverticulum in a patient with Wolff-Parkinson-White syndrome

INTRODUCTION

We describe one rare case of successful ablation of a right epicardial accessory pathway (AP) via the right ventricular diverticulum in a patient with Wolff-Parkinson-White syndrome.

METHODS

A 42-year-old woman being referred to the hospital for a catheter ablation of a Wolf-Parkinson White syndrome. Earliest activation was shown to be present in the region of the tricuspid annulus. However, ablation had no effect on the AP.

RESULTS

We decided to do a selected angiography, in which a big diverticulum near to the right tricuspid annulus was shown to be present. Ablation in this region successfully repressed the AP without any recurrences within a follow-up period of 12 months.

CONCLUSTION

The ventricular diverticulum mediated AP is a novel variant of pre-excitation. It can serve as an anatomical substrate of supraventricular tachycardia, and can be ablated endocardially using an irrigation tip catheter within the diverticulum. This article is protected by copyright. All rights reserved.

Study on hydration mechanism and environmental safety of thermal activated red mud-based cementitious materials

Red mud (RM) cementitious materials were prepared with the thermally, thermoalkali- or thermocalcium-activated RM, steel slag (SS), and other additives. The effects of different thermal RM activation methods on the cementitious material hydration mechanisms, mechanical properties, and environmental risks were discussed and analyzed. The results showed that the hydration products of different thermally activated RM samples were similar with the main products being C-S-H, tobermorite, and Ca(OH)₂. Ca(OH)₂ was mainly present in thermally activated RM samples, and the tobermorite was mainly produced by samples prepared with thermoalkali- and the thermocalcium-activated RM. The mechanical properties of the samples prepared by thermally and thermocalcium-activated RM had early-strength properties, while the thermoalkali-activated RM samples were similar to the late-strength type of cement properties. The average flexural strength of thermally and the thermocalcium-activated RM samples at 14 days were 3.75 MPa and 3.87 MPa respectively, whereas, the 1000 °C thermoalkali-activated RM samples only at 28 days was 3.26 MPa; the above data could reach the single flexural strength (3.0 MPa) of the first-grade pavement blocks of the building materials industry standard of the People's Republic of China-concrete pavement blocks (JC/T446-2000). The optimal preactivated temperature for different thermally activated RM was different; the optimal preactivated temperature for both thermally and thermocalcium-activated RM was 900 °C, and the flexural strength was 4.46 MPa and 4.35 MPa, respectively. However, the optimal preactivated temperature of thermoalkali activated RM at 1000 °C. The 900 °C thermally activated RM samples had better solidified effects for heavy metal elements and alkali substances. 600~800℃ thermoalkali activated RM samples had better solidified effects for heavy metal elements. Different temperatures of thermocalcium-activated RM samples showed different solidified effects on different heavy metal elements, which may be due to the influence of thermocalcium activation temperature on the structural changes of the hydration products of the cementitious samples. In this study, three thermal RM activation methods were proposed, and the co-hydration mechanism and environmental risk study of different thermally activated RM and SS were further elucidated. This not only provides an effective method for the pretreatment and safe utilization of RM, but also facilitates the synergistic resource treatment of solid waste and further promotes the research process of replacing part of traditional cement with solid waste.

Visualization and mapping of the right phrenic nerve by intracardiac echocardiography during atrial fibrillation ablation

OBJECTIVE

This study aimed to evaluate the feasibility of real-time visualization and mapping of the right phrenic nerve (RPN) by using intracardiac echocardiography (ICE) during atrial fibrillation (AF) ablation.

BACKGROUND

RPN injury is a complication associated with the ablation of AF. Multiple approaches are currently being used to prevent and detect RPN injuries. However, none of these approaches can directly visualize the RPN in real-time during the ablation procedure.

METHODS AND RESULTS

The RPN was detected using ICE. The RPN and its adjacent structures were analysed. The relationship between the RPN's distance from the superior vena cava (SVC) and its pacing capture threshold was quantified. The safety of SVC isolation guided by the ICE-visualized RPN was evaluated. Thirty-eight people were enrolled in this study. The RPN was visualized by ICE in 92% of patients. It ran through the space between the SVC and the mediastinal pleura and had a 'straw'-like appearance upon ICE imaging. The course of the RPN was close to the SVC (minimum 1.0 ± 0.4 mm) and the right superior pulmonary vein (minimum 14.1 ± 7.3 mm). There was a positive linear correlation between the RPN's capture threshold and its distance from the SVC (Spearman's correlation coefficient = 0.728, < 0.001). SVC isolation was guided by the RPN; none of the patients developed an RPN injury.

CONCLUSIONS

RPN can be visualized by ICE in most patients, thus providing a novel approach for the real-time detection of RPN during AF ablation.

Impact of GBA variants on longitudinal freezing of gait progression in early Parkinson's disease

BACKGROUND

Freezing of gait (FOG) is a common disabling gait disturbance among patients with Parkinson's disease (PD), but the influence of genetic variants on the incidence of FOG has been poorly studied to date.

OBJECTIVES

We aimed to evaluate the association of GBA variants with the risk of FOG development in a large early PD cohort.

METHODS

This study included 371 early PD patients from the Parkinson's Progression Markers Initiative (PPMI) who were divided into a GBA variant carrier group (GBA-PD group, n = 44) and an idiopathic PD group without GBA variants (iPD group, n = 327). They were followed up for up to 5 years to examine the progression of FOG. The cumulative incidence of FOG and risk factors for FOG were assessed using Kaplan‒Meier and Cox regression analyses.

RESULTS

At baseline, the GBA-PD group had lower CSF β-amyloid 1-42 (Aβ₄₂) levels and more severe motor and nonmotor symptoms than the iPD group. During the 5-year follow-up, the GBA-PD group had a higher incidence of FOG than the iPD group, and the FOG progression rate was related to GBA variant severity. In the multivariable Cox model without CSF Aβ₄₂, GBA variants were significant predictors of future FOG, and the association remained significant after adding CSF Aβ₄₂ to the model. In the subgroup analyses, the effect of GBA variants was not observed in the "low-level" group. However, in the "high-level" group, GBA variants independently increased the risk of FOG, and this association was stronger than the association with CSF Aβ₄₂.

CONCLUSION

GBA variants are novel genetic risk factors for future FOG development in early PD patients. This association seemed to be mediated by both Aβ-dependent pathways and Aβ-independent pathways.

Gallbladder disease is associated with the risk of cardiovascular disease among Uyghurs in Xinjiang: a prospective cohort study

BACKGROUND

Gallbladder disease (GBD) can increase the risk of cardiovascular disease (CVD). However, GBD has rarely been reported in the less developed, rural areas of Xinjiang. This study aimed to determine the prevalence of GBD and incidence of CVD in a prospective cohort study in rural Xinjiang. Moreover, the study aimed to explore the association between GBD and CVD within this cohort.

METHODS

The study cohort included 11,444 Uyghur adults in Xinjiang, 3^rd division, from the 51st Mission. Study groups were classified according to whether GBD was present or absent at baseline. The occurrence of CVD was the end event. Demographic, anthropometric, and biochemical data were recorded, and the incidence of CVD in the GBD and non-GBD groups analysed. Cox proportional hazards regression models were used to assess the association between GBD and CVD and factors associated with their incidence. Several subgroup analyses were performed to assess CVD incidence in different subgroups. The interaction between GBD and cardiometabolic risk factors, and subsequent risk of developing CVD, was evaluated.

RESULTS

Prevalence of GBD in the study cohort was 10.29%. After a median follow-up of 4.92 years, the cumulative incidence of CVD in the study cohort was 10.49%, 8.43% in males and 12.65% in females. CVD incidence was higher in the GBD group (34.04% vs. 7.78%, HR = 4.96, 95% CI: 4.40-5.59). After multivariate adjustment, the risk of CVD remained higher in the GBD group (HR = 2.89, 95% CI: 2.54-3.29). Subgroup analyses showed male sex, smoking, alcohol consumption, lack of exercise, and abnormal renal function were all associated with increased risk of CVD. Moreover, the risk of CVD was markedly higher in GBD combined with cardiometabolic risk factors (hypertension, T2DM, dyslipidaemia, overweight, and abdominal obesity), than in cardiometabolic risk factors alone and this was higher in the GBD group than in the non-GBD group regardless of whether cardiometabolic risk factors were combined.

CONCLUSION

GBD is an important independent risk factor for CVD development. Awareness of these associations will raise concerns among clinicians about the risk of cardiovascular disease in patients with GBD.

Analysis of Risk Factors Related to the Efficacy of Foramen Ovale Closure as a Therapy for Migraine

This study aimed to monitor the incidence of migraine non-remission after percutaneous patent foramen ovale (PFO) closure and to discuss relevant risk factors. Recently, evidence of a relationship between the presence of PFO and migraines has been found, and PFO closure has been pointed out as a possible treatment for migraineurs.A retrospective analysis was conducted, which involved 139 patients diagnosed with PFO and associated migraine who underwent percutaneous PFO closure in The First Affiliated Hospital of Zhengzhou University from October 2019 to April 2021. All the considered patients were evaluated using the Headache Impact Test (HIT-6™) and classified with a score higher than 55 points before closure. The HIT-6™ score was re-evaluated 1-6 months after the intervention. HIT-6™ ≤ 55 was defined as headache remission (n = 93) and > 55 as headache non-remission (n = 46). A logistic regression model was developed to identify the risk factors of headache non-remission after PFO closure.The incidence of headache non-remission after PFO closure was 33.09%. Statistically significant differences were observed between the two groups as regards age and serum phosphorus level (P < 0.05). History of smoking, atrial fibrillation, absolute lymphocyte count, platelet-to-lymphocyte ratio, and interventricular septal thickness were identified as independent risk factors for headache non-remission following PFO closure, which were statistically significant (P < 0.05).

Black women's experiences with professional accompaniment at prenatal appointments

U.S. public health statistics report dismal Black infant and maternal mortality rates. Prenatal care alone, while essential, does not reduce such disparities.

OBJECTIVES

The purpose of the study was to explore Black women's experiences when a perinatal support professional (PSP) accompanies them to prenatal medical appointments.

DESIGN

This research used a phenomenological approach, using data from in-depth individual interviews to explore the essence of 25 Black women's experiences.

RESULTS

We identified three major themes from the data that together, show that PSPs served as communication bridges for their clients. Clients said their PSPs helped them to understand and feel seen and heard by their medical providers during their prenatal appointments. The third theme was the deep level of trust the clients developed for their PSPs which made the first two themes possible. PSPs' intervention resulted in reduced stress and uncertainty in medical interactions and increased women's trust in their providers' recommendations.

CONCLUSIONS

Including a trusted, knowledgeable advocate like a PSP may be an important intervention in improving Black women's prenatal care experiences, reducing stress associated with medical interactions, and ultimately reducing pregnancy-related health disparities.

Coassisted carbonization with HCOOK/(HCOO)2Ca for the fabrication of bamboo-derived oxygen-doped porous carbons exhibiting high-performance sorption of diethyl phthalate from aqueous solutions

Porous carbons are excellent sorbents for removing organic pollutants. Green conversion of biowaste into advanced porous carbons is crucial for industrialized production and practical applications, which, however, have rarely been investigated. This study develops a coassisted carbonization method for the preparation of porous carbons with the environmentally friendly agents HCOOK and (HCOO)₂Ca for the first time. The bamboo waste-derived hydrochar was transformed into oxygen-doped porous carbons, which displayed a large surface area and pore volume, abundant oxygen content, graphene structure and many surface functional groups. These properties contributed to the extremely high sorption of large quantities of diethyl phthalate, which reached 761 mg g^-1. Surface adsorption, including pore filling, hydrogen bonding, and π-π stacking, rather than partitioning, was the main sorption process. Therefore, this study provides a sustainable and promising route for the preparation of porous carbons that can be applied in the efficient removal of organic pollutants.

Chenodeoxycholic Acid (CDCA) Promoted Intestinal Epithelial Cell Proliferation by Regulating Cell Cycle Progression and Mitochondrial Biogenesis in IPEC-J2 Cells

Chenodeoxycholic acid (CDCA), a primary bile acid (BA), has been demonstrated to play an important role as a signaling molecule in various physiological functions. However, the role of CDCA in regulating intestinal epithelial cell (IEC) function remains largely unknown. Herein, porcine intestinal epithelial cells (IPEC-J2) were used as an in vitro model to investigate the effects of CDCA on IEC proliferation and explore the underlying mechanisms. IPEC-J2 cells were treated with CDCA, and flow cytometry and transcriptome analysis were adopted to investigate the effects and potential molecular mechanisms of CDCA on the proliferation of IECs. Our results indicated that adding 50 μmol/L of CDCA in the media significantly increased the proliferation of IPEC-J2 cells. In addition, CDCA treatment also hindered cell apoptosis, increased the proportion of G0/G1 phase cells in the cell cycle progression, reduced intracellular ROS, and MDA levels, and increased mitochondrial membrane potential, antioxidation enzyme activity (T-AOC and CAT), and intracellular ATP level (p < 0.05). RNA-seq results showed that CDCA significantly upregulated the expression of genes related to cell cycle progression (Cyclin-dependent kinase 1 (CDK1), cyclin G2 (CCNG2), cell-cycle progression gene 1 (CCPG1), Bcl-2 interacting protein 5 (BNIP5), etc.) and downregulated the expression of genes related to mitochondrial biogenesis (ND1, ND2, COX3, ATP6, etc.). Further KEGG pathway enrichment analysis showed that CDCA significantly enriched the signaling pathways of DNA replication, cell cycle, and p53. Collectively, this study demonstrated that CDCA could promote IPEC-J2 proliferation by regulating cell cycle progression and mitochondrial function. These findings provide a new strategy for promoting the intestinal health of pigs by regulating intestinal BA metabolism.

Preparation and characterization of octenyl succinic anhydride-modified ginkgo seed starch with enhanced physicochemical and emulsifying properties

A quick preparation of octenylsuccinylated (OS)-ginkgo seed starch was proposed by lipase-coupling esterification within 30 min, and the physicochemical and emulsifying properties of OS-ginkgo seed starch were evaluated. High-performance liquid chromatography results revealed that ginkgolic acid in ginkgo seed starch was too low to be detected, which improved the biosafety and application range of OS-ginkgo seed starch. The degree of substitution (DS) of OS-ginkgo starch varied from 0.006 to 0.0169 depending on the lipase concentration increased from 0% to 1% (w/w, based on the volume of starch solution), and the reaction efficiency obtained the highest value of 68.5% at the lipase concentration of 1%. Fourier transform infrared spectra of OS-ginkgo seed starch confirmed ester carbonyl splicing in the starch molecular with the characteristic peaks at 1722 and 1567 cm^-1 . Scanning electron microscopy observations revealed that the esterification occurred mainly in the amorphous regions with slight morphological modification. X-ray diffractions suggested that no crystal change occurred on the starch granule. The thermal analysis revealed that OS-ginkgo seed starch showed a lower temperature and endothermic enthalpy for gelatinization, and presented enhanced and DS-dependent emulsifying properties and in vitro antidigestion properties. PRACTICAL APPLICATION: Results indicated that OS-ginkgo seed starch prepared by lipase-coupling esterification would be an alternative emulsion stabilizer for encapsulation and delivery of hydrophobic components. This study would provide an alternative method for the efficient and economical production of OS-ginkgo seed starch, thereby broadening its application in commercial exploitation.

Effect of Dronedarone in the Treatment of Atrial Fibrillation in the Asian Population: Post Hoc Analysis of the ATHENA Trial

PURPOSE

Limited data are available on the impact of dronedarone treatment in Asian patients with atrial fibrillation (AF) or atrial flutter (AFL). This post hoc analysis evaluated the efficacy and safety of dronedarone compared with placebo in populations from Asian and non-Asian regions randomized in the ATHENA trial (A Placebo-Controlled, Double-blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg BID for the Prevention of CV Hospitalization or Death From Any Cause in Patients With AF/AFL).

METHODS

Time to first hospitalization for cardiovascular events or death from any cause (primary outcome) and time to first AF/AFL event recurrence (secondary outcome) were analyzed by Kaplan-Meier curves and Cox proportional hazards regression.

FINDINGS

The risk of experiencing the primary composite outcome was significantly lower in the dronedarone-treated patients in both the Asian (hazard ratio = 0.541; 95% CI, 0.320-0.914]) and non-Asian (hazard ratio = 0.768; 95% CI, 0.696-0.848) populations than in the placebo-treated patients. The median time to the first AF/AFL event recurrence was longer in the dronedarone-treated population than in the placebo-treated populations: 183 vs 92 days (P = 0.165) in the Asian population and 534 vs 196 days (P < 0.001) in the non-Asian population. Treatment-emergent adverse events in Asian (81.2% vs 78.4%) and non-Asian (71.4% vs 68.7%) populations and serious treatment-emergent adverse events in Asian (14.3% vs 15.7%) and non-Asian (20.3% vs 21.5%) patients were comparable in patients taking dronedarone compared with those taking placebo.

IMPLICATION

Efficacy and tolerability of dronedarone were consistent in the Asian population compared with the non-Asian population in the ATHENA trial. These finding may aid Asian health care professionals to select the appropriate first-line treatment for Asian patients with AF/AFL.

Bundle branch block and nonspecific intraventricular conduction delay prevalence using Chinese nationwide survey data

Objective

We aimed to determine the prevalence of and the factors associated with intraventricular conduction disturbance in the Chinese population.

Methods

Electrocardiographic data from 42,031 people were retrospectively analysed. The weighted prevalences of left bundle branch block (LBBB), right bundle branch block (RBBB), bifascicular block and nonspecific intraventricular conduction delay (NS-IVCD) were calculated. The independently associated factors were determined using logistic regression analysis.

Results

The weighted prevalence for Chinese people older than 45 years was 0.17% for LBBB, 2.16% for RBBB and 0.44% for NS-IVCD. The weighted prevalence for RBBB combined with left anterior fascicular block was 0.17%, and 0.05% for RBBB combined with left posterior fascicular block. There were significant differences in the weighted prevalences of RBBB and NS-IVCD between men and women. The weighted prevalence of LBBB and RBBB increased markedly with increasing age. Age and diabetes were independent factors associated with LBBB, compared with age and sex for RBBB and sex and coronary artery disease for NS-IVCD.

Conclusions

This study provided reliable data for the weighted prevalence of and factors associated with LBBB, RBBB and NS-IVCD in Chinese adults.

Outcome of catheter ablation for paroxysmal atrial fibrillation in patients with stable coronary artery disease

BACKGROUND

Atrial fibrillation (AF) and stable coronary artery disease (SCAD) frequently coexist. This study aimed to assess the long-term outcome of catheter ablation in patients with paroxysmal AF and SCAD.

METHODS

In total, 12104 patients with paroxysmal AF underwent catheter ablation in the Chinese Atrial Fibrillation Registry between 2011 and 2019 were screened. A total of 441 patients with SCAD were matched with patients without SCAD in a 1:4 ratio. The primary endpoint was AF recurrence after single ablation. The composite secondary endpoints were thromboembolism, coronary events, major bleeding, all-cause death. RESULTS;: Over a mean follow-up of 46.0±18.9 months, the recurrence rate in patients with SCAD was significantly higher after a single ablation (49.0% vs. 41.9%, P = 0.03). The very late recurrence rate of AF in the SCAD group was also significantly higher than that in the control group (38.9% vs. 31.2%;P = 0.04). In multivariate analysis, adjusted with the female, smoking, duration of AF, previous thromboembolism, COPD, and statins, SCAD was independently associated with AF recurrence (adjusted HR, 1.19 [1.02-1.40], P = 0.03). The composite secondary endpoints were significantly higher in the SCAD group (12.70% vs. 8.54%, P = 0.02), mainly due to thromboembolism events (8.16% vs. 4.41%, P<0.01).

CONCLUSIONS

SCAD significantly increased the risk of recurrence after catheter ablation of paroxysmal AF. The incidence of thromboembolic events after catheter ablation of paroxysmal AF in the patients with SCAD was significantly higher than that in those without SCAD. This article is protected by copyright. All rights reserved.

Lambl's excrescence and the safety of radiofrequency ablation for atrial fibrillation

BACKGROUND

Lambl's excrescences (LEs) are excrescences with an extremely low incidence, mainly ultrasound diagnosed. Increasingly, LEs are detected by transesophageal echocardiography before catheter ablation, which raises safety concerns on whether LEs were associated with an embolism event during or after ablation, but clinical data are still lacking.

METHODS AND RESULTS

We consecutively recruited 8081 patients with atrial fibrillation who underwent radiofrequency catheter ablation in Beijing Anzhen Hospital from Jan 1, 2017 to Dec 31, 2019. Total 21 patients (0.3%) were diagnosed as LEs with an average age of 70.8 ± 8.9 years, and 38.1% were male. Persistent atrial fibrillation (PeAF) and paroxysmal atrial fibrillation (PAF) accounted for 57.1% (12 cases) and 42.9% (nine cases), respectively. LEs were mostly frequently observed on the aortic valve (18 cases, 75%) and mitral valve (six cases, 25%). Precisely, the noncoronary cusp is ranked first in terms of the LEs presence (seven cases, 29.2%), followed by the right coronary cusp (six cases, 25.0%), the left coronary cusp (five cases, 20.8%), the anterior mitral valve (four cases, 16.7%), and the posterior mitral valve (two cases, 8.3%). During the ablation for LEs patients, the average procedure time was 96.0 ± 22.4 min; the average fluoroscopy time was 4.2 ± 0.8 min; the average total ablation time was 20.6 ± 5.6 min; and the mean hospital stay was 3.3 ± 0.6 days. No patients suffered from serious complications during the procedure. Furthermore, no cardiovascular event was observed during a follow-up of 19.1 ± 11.8 months.

CONCLUSIONS

There was no clear association between LEs with intraoperative embolism events or cardiovascular events during the follow-up period.

BCL2-associated athanogene 6 exon24 contributes to testosterone synthesis and male fertility in mammals

Objectives

BCL2‐associated athanogene 6 (BAG6) plays critical roles in spermatogenesis by maintaining testicular cell survival. Our previous data showed porcine BAG6 exon24‐skipped transcript is highly expressed in immature testes compared with mature testes. The objective of this study is to reveal the functional significance of BAG6 exon24 in mammalian spermatogenesis.

Materials and Methods

CRISPR/Cas9 system was used to generate Bag6 exon24 knockout mice. Testes and cauda epididymal sperm were collected from mice. TMT proteomics analysis was used to discover the protein differences induced by Bag6 exon24 deletion. Testosterone enanthate was injected into mice to generate a high‐testosterone mice model. H&E staining, qRT‐PCR, western blotting, vector/siRNA transfection, immunofluorescence, immunoprecipitation, transmission electron microscopy, TUNEL and ELISA were performed to investigate the phenotypes and molecular basis.

Results

Bag6 exon24 knockout mice show sub‐fertility along with partially impaired blood‐testis barrier, increased apoptotic testicular cell rate and abnormal sperm morphology. Endoplasmic reticulum stress occurs in Bag6 exon24‐deficient testes and sterol regulatory element‐binding transcription factor 2 is activated; as a result, cytochrome P450 family 51 subfamily A member 1 expression is up‐regulated, which causes a high serum testosterone level. Additionally, serine/arginine‐rich splicing factor 1 down‐regulates BAG6 exon24‐skipped transcripts in porcine Sertoli cells by binding to 35–51 nt on BAG6 exon24 via its N‐terminal RNA‐recognition domain.

Conclusions

Our findings reveal the critical roles of BAG6 exon24 in testosterone biosynthesis and male fertility, which provides new insights into the regulation of spermatogenesis and pathogenesis of subfertility in mammals.

Evaluation of salt tolerance of oat cultivars and the mechanism of adaptation to salinity

Soil salinity is a threat to agricultural production worldwide. Oat (Avena sativa L.) is an irreplaceable crop in areas with fragile ecological conditions. However, there is a lack of research on salt tolerance evaluation of oat germplasm resources. Therefore, the purpose of this work was to evaluate the salt tolerance of oat cultivars and investigate the mechanism of salt-tolerant oat cultivars' adaptation to salinity. Salt tolerance of 100 oat cultivars was evaluated, and then two salt-tolerant cultivars and two salt-sensitive cultivars were used to compare their physiological responses and expression patterns of Na⁺- and K⁺-transport-related genes under salinity. Principal component analysis and membership function analysis had good predictability for salt tolerance evaluation of oat and other crops. The 100 oat cultivars were clustered into three categories, with three salt tolerance levels. Under saline condition, salt-tolerant cultivars maintained higher growth rate, leaf cell membrane integrity, and osmotic adjustment capability via enhancing the activities of antioxidant enzymes and accumulating more osmotic regulators. Furthermore, salt-tolerant cultivars had stronger capability to restrict root Na ⁺ uptake through reducing AsAKT1 and AsHKT2;1 expression, exclude more Na⁺ from root through increasing AsSOS1 expression, compartmentalize more Na ⁺ into root vacuoles through increasing AsNHX1 and AsVATP-P1 expression, and absorb more K⁺ through increasing AsKUP1 expression, compared with salt-sensitive cultivars. The evaluation procedure developed in this work can be applied for screening cereal crop cultivars with higher salt tolerance, and the elucidated mechanism of oat adaptation to salinity lays a foundation for identifying more functional genes related to salt tolerance.