bluuebunny/crossref_metadata_2025 huggingface dataset:
Electrical Muscle Stimulation for the Conservative Management of Female Pelvic Floor Muscle Dysfunction: A Scoping Review
Authors: Guitar Nicole A. , Akbari Priyanshi S , Dzieduszycki Christina , Konduros Kristi , Asmani Hessa , Dufour Sinéad
Published: November 2024

Background: Electrical muscle stimulation (EMS) is a conservative management tool for the treatment of pelvic floor dysfunctions (PFDs). The aim of this review was to scope, summarize and critically evaluate available research investigating the impact of various modes of EMS on PFDs in females. Methods: Joanna Briggs Institute methodology for scoping reviews was used with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Three databases were searched. Articles published in English that included female participants living with pelvic floor muscle dysfunction where EMS was used as a conservation care intervention were included in the review. Included studies were analyzed following Arksey and O’Malley’s framework. The Cochrane Risk of Bias Tool for randomized trials was used to assess risk of bias for the randomized controlled trials (RCTs), and Hawker and Payne’s quality appraisal criteria was used to appraise the data from the other included papers systematically. Results: A total of 37 studies, including 20 RCTs were included. A favorable impact, across various outcomes, was found across trials which investigated different types of EMS with varying protocols. The heterogenous nature of intervention protocols limited the ability to apply any statistical or meta-analyses. EMS demonstrates a positive effect for improving outcomes related to PFDs in adult women. Included studies support the use of EMS for stress, urgency and mixed urinary incontinence. All versions of EMS studied were found to provide significant improvements, which included them being used as a sole intervention or as an adjunct intervention. High intensity forms of EMS were consistently found to require shorter intervention times. Conclusions: EMS demonstrates improvement across outcomes for PFDs among adult women. In particular, the results of this review suggest that EMS may be particularly useful in women living with stress urinary incontinence (SUI) or who those are unable to perform voluntary muscle contractions when pelvic floor muscle training is attempted. Further research related to more novel versions of high intensity EMS approaches is needed.
NUF2 Promotes Breast Cancer Metastasis via Activating Wnt/β-Catenin Pathways
Authors: AiErken Nijiati , Wang Xidi , Wang Jiamei , Ma Weisen , Cui Lingfei , Zhang Mingxia , Ma Weifeng , Liu Dongwei
Published: November 2024

Background: Breast cancer is the most common malignancy and the leading cause of cancer death among women. NDC80 kinetochore complex component (NUF2) is demonstrated to implicate the progression of human cancer. But the role of NUF2 in breast cancer progression is unclear. Here, we aimed to study the role and regulatory mechanisms of NUF2 in breast cancer metastasis. Methods: Immunohistochemistry was used to determine UNF2 expression in clinical samples. Transwell assas were used to determine the role of NUF2 in breast cancer migration and invasion. Animal model in vivo was used to determine the rold of NUF2 in breast cancer metastasis. Results: NUF2 was upregulated significantly in breast cancer tissues and cells. Worse prognosis was noted in patients with high NUF2 levels compared with that in patients with low NUF2 levels. NUF2 overexpression markedly enhanced, while NUF2 knockdown inhibited, breast cancer cell invasion and migration. Mechanistically, NUF2 was observed to upregulate Wnt/β-catenin signaling pathway activity. The promoting effect of NUF2 on cell migration and invasion were blocked by inhibition of the Wnt/β-catenin pathway. Conclusions: We revealed that NUF2 promotes breast cancer progression via activating Wnt/β-catenin signaling, suggesting that NUF2 might be a new potential target for breast cancer treatment.
Regulatory T-cells: The Face-off of the Immune Balance
Authors: Singer Mahmoud , Elsayed Ahmed M. , Husseiny Mohamed I.
Published: November 2024

Regulatory T-cells (Tregs) play a crucial role in maintaining immune homeostasis, ensuring a balanced immune response. Tregs primarily operate in an antigen-specific fashion, facilitated by their distinct distribution within discrete niches. Tregs have been studied extensively, from their point of origin in the thymus origin to their fate in the periphery or organs. Signals received from antigen-presenting cells (APCs) stimulate Tregs to dampen inflammation. Almost all tumors are characterized by a pathological abundance of immune suppression in their microenvironment. Conversely, the lack thereof proves detrimental to immunological disorders. Achieving a balanced expression of Tregs in relation to other immune compartments is important in establishing an effective and adaptable immune tolerance towards cancer cells and autoantigens. In the context of cancer, it is essential to decrease the frequency of Tregs to overcome tumor suppression. A lower survival rate is associated with the presence of excessive exhausted effector immune cells and an increased frequency of regulatory cells. However, when it comes to treating graft rejection and autoimmune diseases, the focus lies on immune tolerance and the transfer of Tregs. Here, we explore the complex mechanisms that Tregs use in human disease to balance effector immune cells.
Ratio of AT and GC Pairs in the Zones of Open States Genesis in DNA Molecules
Authors: Dorohova Anna , Lyasota Oksana , Svidlov Alexander , Anashkina Anastasia , Tekutskaya Elena , Dzhimak Stepan , Drobotenko Mikhail
Published: November 2024

Background: There is an assumption about the presence of a specific nucleotides sequence in DNA molecule, which contributes to the genesis of open states (OS). In addition, it would be logical to assume that OS zones should form in DNA regions with a large proportion of Adenine-Thymine (AT) pairs, since they contain fewer hydrogen bonds than Guanine- Cytosine (GC) base pairs. However, studies have shown that in areas rich in AT pairs, the probability of open states will not always be higher. Methods: In this work, for two genes containing different numbers of regions with a large AT pairs proportion, we calculated the ratio of AT and GC pairs in the OS zones. For calculations, we used a coarse-grained angular mechanical DNA model. Results: It has been established that small OS zones can appear on any part of the DNA molecule. They mainly consist of AT pairs, but as the size of OS zones increases, the content of AT pairs in them decreases. Conclusions: The occurrence of long-length OS zones is “tied” to regions of the DNA molecule with a large proportion of AT pairs; if there are several such areas, then, depending on the magnitude of the torque, OS zones can arise in different areas of the gene. Thus, the genesis probability of large OS zones in a DNA segment depends not only on the “strength” of the nucleotide sequence of this area, but also on the factors determining the dynamics of DNA.
Effects of Arginine Vasopressin on Hippocampal Myelination in an Autism Rat Model: A RNA-seq and Mendelian Randomization Analysis
Authors: Bao Xingxing , Zhou Bo , Wen Min
Published: November 2024

Background: To explore the therapeutic role of arginine vasopressin (AVP) and its possible mechanisms in autism. Methods: Mid-trimester pregnant rats treated with valproate on embryonic day 12.5 and their offspring were selected as autism model. The autism rats were randomly assigned to autism group and AVP treatment group that given AVP by inhalation per day from postnatal days 21 to 42. The changes in social behavior and the hippocampus transcriptome were compared, and the hub genes were confirmed by quantitative real-time polymerase chain reaction (qPCR) and Mendelian randomization (MR). Results: 403 genes were found to be differentially expressed in the autism model, with the majority of these genes being involved in oligodendrocyte development and myelination. Only 11 genes associated with myelination exhibited statistically significant alterations following AVP treatment when compared to the autism group. Gene set enrichment, expression patterns, and weighted gene co-expression network analysis (WGCNA) analysis consistently indicated that the biological processes of oligodendrocyte development and myelination were markedly enriched in the autism group and exhibited improvement following treatment. The variation trend of various nerve cells demonstrated a notable increase in the proportion of oligodendrocytes and oligodendrocyte precursor cells in the autism group, which subsequently exhibited a significant decline following treatment. Five hub genes (MBP, PLIP, CNP, GFAP, and TAOK1) were verified by qPCR. Finally, MR studies have confirmed a causal relationship between hippocampal myelination-related gene expression and the risk of autism. Conclusions: AVP could markedly enhance social interaction abilities in the autism rat model, possibly due to the significantly improved hippocampus oligodendrocytes development and myelination.
HDL Cholesterol-Associated Shifts in the Expression of Preselected Genes Reveal both Pro-Atherogenic and Atheroprotective Effects of HDL in Coronary Artery Disease
Authors: Dergunov Alexander D. , Nosova Elena V. , Rozhkova Alexandra V. , Vinogradina Margarita A. , Baserova Veronika B. , Popov Mikhail A. , Limborska Svetlana A. , Dergunova Liudmila V.
Published: November 2024

Background: The associations of high-density lipoprotein (HDL) level and functionality with lipid metabolism, inflammation, and innate immunity in coronary artery disease (CAD) remain controversial. The differential expression of a set of genes related to HDL metabolism (24 genes) and atherogenesis (41 genes) in peripheral blood mononuclear cells (PBMC) from CAD and control patients with varied HDL cholesterol (HDL-C) levels was compared. Methods: 76 male patients 40–60 years old with CAD diagnosed by angiography and 63 control patients were divided into three groups with low, normal (1.0–1.4 mM), and increased HDL-C levels. Transcript levels were measured by real-time PCR. The differentially expressed genes (DEGs) and associated metabolic pathways were analyzed for three groups, with prevalent CAD as an outcome. Results: The common feature was the increased odds ratio values for liver X receptor (LXR) gene expression for three patient groups. CAD patients with low HDL-C possessed 24 DEGs with lower expression of genes involved in cholesterol efflux, and down-regulated SREBF1 and ABCG1 are suggested as gene signatures. CAD patients with normal HDL-C possessed nine DEGs with down-regulated ITGAM and ALB as gene signatures. CAD patients with increased HDL-C possessed 19 DEGs with down-regulated APOA1 and HMGCR as gene signatures. With gene expression signatures, one standard deviation higher average gene expressions were associated with 5.1-, 48.8-, and 38.9-fold fewer CAD cases for three patient groups. As HDL-C increased in CAD patients, the expression of ABCG1, CUBN, and HDLBP genes increased, while the expression of HMGCR and NPC2 genes, involved in cholesterol synthesis and trafficking, decreased. The expression of CD14, CD36, S100A8, S100A9, S100A12, TLR5, TLR8, and VEGFA genes, involved in angiogenesis and inflammation mainly via nuclear factor-κB (NF-κB), decreased. Conclusions: The increased accumulation of cholesteryl ester in PBMC from patients with low HDL-C was suggested. This assumption contrasts with the suggested accumulation of free cholesterol in PBMC from patients with increased HDL-C, concomitant with suppression of cholesterol synthesis and traffic to the plasma membrane, and with an inflammatory state controlled by depressed CD36-mediated and upregulated apoE-mediated immunometabolic signaling. Gene signatures may be used for the diagnosis, prognosis, and treatment of CAD in dependence on HDL-C levels.
Interplay of Reactive Oxygen Species (ROS) and Epigenetic Remodelling in Cardiovascular Diseases Pathogenesis: A Contemporary Perspective
Authors: Al-Awar Amin , Hussain Shafaat
Published: November 2024

Cardiovascular diseases (CVDs) continue to be the leading cause of mortality worldwide, necessitating the development of novel therapies. Despite therapeutic advancements, the underlying mechanisms remain elusive. Reactive oxygen species (ROS) show detrimental effects at high concentrations but act as essential signalling molecules at physiological levels, playing a critical role in the pathophysiology of CVD. However, the link between pathologically elevated ROS and CVDs pathogenesis remains poorly understood. Recent research has highlighted the remodelling of the epigenetic landscape as a crucial factor in CVD pathologies. Epigenetic changes encompass alterations in DNA methylation, post-translational histone modifications, adenosine triphosphate (ATP)-dependent chromatin modifications, and noncoding RNA transcripts. Unravelling the intricate link between ROS and epigenetic changes in CVD is challenging due to the complexity of epigenetic signals in gene regulation. This review aims to provide insights into the role of ROS in modulating the epigenetic landscape within the cardiovascular system. Understanding these interactions may offer novel therapeutic strategies for managing CVD by targeting ROS-induced epigenetic changes. It has been widely accepted that epigenetic modifications are established during development and remain fixed once the lineage-specific gene expression pattern is achieved. However, emerging evidence has unveiled its remarkable dynamism. Consequently, it is now increasingly recognized that epigenetic modifications may serve as a crucial link between ROS and the underlying mechanisms implicated in CVD.
Avicularin Treatment Ameliorates Ischemic Stroke Damage by Regulating Microglia Polarization and its Exosomes via the NLRP3 Pathway
Authors: Shi Yan , Yang Yufeng , Liu Juntong , Zheng Jinling
Published: November 2024

Background: Avicularin (AL), an ingredient of Banxia, has anti-inflammatory properties in cerebral disease and regulates polarization of macrophages, but its effects on ischemic stroke (IS) damage have not been studied. Methods: In vivo, AL was administered by oral gavage to middle cerebral artery occlusion/reperfusion (MCAO/R) C57BL/6J mice in doses of 1.25, 2.5, and 5 mg/kg/day for seven days, and, in vitro, AL was added to treat oxygen-glucose deprivation (OGD)-BV2 cells. Modified neurological severity score, Triphenyltetrazolium chloride (TTC) staining, brain-water-content detection, TdT-mediated dUTP nick-end labeling (TUNEL) assay, flow cytometry, immunofluorescence assay, Enzyme linked immunosorbent assay (ELISA), and Western-blot analysis were used to investigate the functions and mechanism of the effect of AL treatment on IS. The exosomes of AL-treated microglia were studied by transmission electron microscope (TEM), nanoparticle tracking analyzer (NTA), and Western-blot analysis. Results: AL treatment reduced the neurological severity score, infarct volume, brain-water content, neuronal apoptosis, and the release of inflammatory factors, that were induced by MCAO/R. Notably, M2 microglia polarization was promoted but M1 microglia polarization was inhibited by AL in the ischemic penumbra of MCAO/R mice. Subsequently, anti-inflammatory and polarization-regulating effects of AL were verified in vitro. Suppressed NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome activation was found in the ischemic penumbra of animal and Oxygen-Glucose Deprivation/Reoxygenation (OGD/R) cells treated with AL, as evidenced by decreasing NLRP3-inflammasome-related protein and downstream factors. After AL treatment, the anti-apoptosis effect of microglial exosomes on OGD/R primary cortical neurons was increased. Conclusion: AL reduce inflammatory responses and neuron death of IS-associated models by regulating microglia polarization by the NLRP3 pathway and by affecting microglial exosomes.
Lentivirus-Mediated Missense Mutation in HtrA1 Leads to Activation of the TGF-β/Smads Pathway and Increased Apoptosis of Mouse Brain Microvascular Endothelial Cells via the Oxidative Stress Pathway
Authors: Song Shi-na , Li Hui-juan , Liang Jian-lin , Ren Qian-qian , Li Chang-xin , Xu Sui-yi
Published: November 2024

Background: The aim of this study was to investigate the possible molecular mechanisms underlying cerebral small vessel disease caused by a missense mutation in the high-temperature serine peptidase A1 gene, HtrA1 (NM_002775.4, Exon4, c.905G>A, p.Arg302Gln). Stable strain models were constructed using wild-type and mutant HtrA1 overexpression lentiviral vectors to infect mouse brain microvascular endothelial cells (bEnd.3 cells). Methods: HtrA1 mRNA and protein expression were analyzed by Western blot and quantitative real-time polymerase chain reaction. Western blot technique was also used to evaluate the expression of transforming growth factor (TGF)-β/Smads-related signaling pathway proteins and the oxidative stress pathway protein nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4). The level of reactive oxygen species (ROS) was evaluated using dichloro-dihydro-fluorescein diacetate (DCFH-DA) fluorescent probes. Results: HtrA1 mRNA and protein expression levels were found to be decreased in mutant cells, whereas the levels of ROS, the TGF-β/Smads proteins, and the caspase3 and cleaved-caspase3 apoptotic proteins were increased. Conclusions: Lentivirus-mediated missense mutation in HtrA1 leads to activation of the TGF-β/Smads pathway and to increased apoptosis of mouse brain microvascular endothelial cells via the oxidative stress pathway. Further in vivo studies are required to explore the connections between different signaling pathways in animals, and to identify potential molecular targets for clinical therapy.
Anterograde versus Retrograde Effects of Damage to Identified Learning and Memory Systems during Acquisition, Retention, and Re-Acquisition of an Instrumental Visual Discrimination Task: Dorsal Striatum, Perirhinal Cortex, and Hippocampus
Authors: McDonald Robert J. , Kopp Joelle , Zelinski Erin L. , Sutherland Robert J. , Lehmann Hugo , Sparks Fraser , Hong Nancy S.
Published: November 2024

Background: The goal of these experiments was to determine which learning and memory system(s) were necessary for the retention of visual discriminations and subsequent acquisition of a second problem. The dorsal striatum should be involved in the acquisition and expression of this task based on previous work implicating this region in instrumental learning and memory processes. The perirhinal cortex has been implicated in learning and memory processes associated with visual information like objects, and pictures and may also play a role in the acquisition and/or retention of visual discriminations. As there is no clear spatial/relational component to the task, the hippocampus should not be involved. Methods: Rats were trained on a two-choice visual discrimination task to criterion performance after which they received lesions to portions of the dorsal striatum (dorso-medial or dorso-lateral striatum) and medial temporal lobe (perirhinal cortex or hippocampus). After surgical recovery, the rats were tested for retention of the original discrimination, followed by training on a second problem on the same task. Results: The results showed that dorsal medial striatal lesions produced a retrograde deficit on picture discrimination, but dorsal lateral striatum lesions did not. Neither dorsal striatal lesion produced a deficit on acquisition of a second problem. Perirhinal cortex did not seem to make an essential contribution to the retention of the original discrimination or acquisition of the second problem. Surprisingly, subjects with hippocampal damage were severely impaired but eventually re-learned the discrimination. Damage to the hippocampus had no impact on acquisition of a second problem. Conclusions: Taken together, the results of the present experiments show that the dorsomedial striatum and the hippocampus may support performance on this instrumental task if intact during acquisition but is not required for acquisition of a new problem. The implications of this pattern of results for our understanding of the organization of learning and memory in mammals is discussed.
Insular Epilepsy: Functions, Diagnostic Approaches, and Surgical Interventions
Authors: Ekman Felix R. , González-Martínez Jorge A.
Published: November 2024

Epilepsy, a chronic neurological disorder characterized by recurrent seizures, affects a significant portion of the global population, with drug-resistant epilepsy (DRE) presenting a major treatment challenge. Insular epilepsy, originating from this complex region, exhibits a broad range of symptoms, making diagnosis particularly difficult. Advanced imaging techniques and invasive procedures like stereoelectroencephalography (SEEG) are often crucial for accurately localizing the epileptogenic zone. Surgical resection remains the primary treatment for DRE, with recent advancements in microsurgical techniques and neuroimaging improving outcomes. Additionally, minimally invasive approaches like laser interstitial thermal therapy (LITT) and radiofrequency thermocoagulation (RFTC) offer promising alternatives.
The Modulatory Effect of Exogenous Orienting on Audiovisual Emotional Integration: An ERP Study
Authors: Li Shengnan , Li Yueying , Li Ruizhi , Li Yan , Wu Jinglong , Yang Weiping , Zhang Zhilin
Published: November 2024

Background: In this study, we explored the interplay between exogenous orienting attention and emotional audiovisual integration (AVI) via electroencephalography (EEG). Methods: We designed a 2 (cue validity: valid, invalid) × 3 (emotion types: happiness, neutral and sadness) × 3 (modality: visual, auditory, audiovisual) discrimination task on the basis of the cue–target paradigm. Twenty-two participants (average age: 21.71 ± 1.84 years; 13 females, 9 males) were enrolled in this experiment. Participants were asked to respond to three emotional stimuli presented in different modalities by pressing a corresponding key. Results: The results indicated faster responses to multisensory stimuli than to unisensory stimuli and to the valid cue condition than to the invalid cue condition, which indicated multisensory advantage and cueing effect occurred. In addition, happiness stimuli induced the fastest response compared with neutral and sadness emotion stimuli. EEG findings indicated a reduction in audiovisual integration induced by valid exogenous orienting in the frontal, central and parietal lobe regions. Moreover, neutral emotional stimuli elicited greater audiovisual integration than stimuli expressing happiness and sadness did. Conclusions: Overall, valid exogenous cues and emotional processing decreased audiovisual integration. The present study sheds light on how exogenous attention modulates emotional audiovisual integration and highlights the complex interactions among attention, sensory processing, and the emotional context in multisensory perception.
Metabolic Consequences of Advanced Chronic Heart Failure and its Modification by Implantation of a Durable Left Ventricular Assist Device
Authors: Hlaváček Daniel , Haluzík Martin , Mahrík Jakub , Popivnyak Ganna , Kasperová Barbora J. , Ivák Peter
Published: November 2024

Heart failure (HF) is a clinical syndrome characterized by the inability of the heart to provide adequate perfusion to tissues and organs, resulting in typical symptoms such as fatigue, dyspnea, dyspepsia, or swelling due to decreased cardiac output. With its increasing prevalence, heart failure has become one of the leading causes of morbidity and mortality worldwide, imposing a significant burden on the population by reducing long-term life expectancy and raising hospital costs. Indeed, over 20 million people worldwide suffer from heart failure, with a 5-year mortality rate of 60–70%. As heart failure progresses, various structural and metabolic changes occur within the myocardium and organ systems. In the past two decades, therapeutic options for heart failure patients have significantly expanded. In addition to novel pharmacological treatment, advanced surgical methods such as heart transplantation (HTx) and the implantation of durable left ventricular assist devices (LVADs) are available for patients with end-stage heart failure. This review discusses the pathophysiological aspects and metabolic consequences of heart failure and metabolic changes, as well as the benefits and challenges of implanting a left ventricular assist device. Furthermore, future targets for heart failure diagnostics and therapy will be highlighted.
Challenges and Innovations in Postoperative Care for Acute Type A Aortic Dissection: The Role of Structured Surveillance and Virtual Wards
Authors: Pruna-Guillen Robert , Ghosh Laerke , Mastracci Tara M. , Kapil Vikas , Lopez-Marco Ana , Oo Aung ,   on behalf the of the rest of the aortic dissection surgical team at Barts Heart Centre (London, UK)
Published: November 2024

Acute Type A aortic dissection (ATAAD) represents a life-threatening medical emergency that requires emergent surgical repair. Despite improvement in surgical techniques and perioperative management, ATAAD remains associated with high early mortality and postoperative complications. A structured and individualized postoperative surveillance program is essential, not only for improving survival rates but also for identifying risk factors necessitating reintervention and enhancing the quality of life. Comprehensive postoperative care should address both medical monitoring and psychological support to meet the holistic needs of ATAAD survivors. In real-world settings adherence to guideline-directed imaging surveillance (GDIS) is poor, leading to underestimation of reintervention rates. A comprehensive aortic service should include GDIS, clinical assessments, cardiovascular risk management, and psychological support. Since August 2022, a virtual ward has been implemented in our department to facilitate remote monitoring, ensuring tight blood pressure control and early detection of complications.
Effect of Salt Substitution on Cardiac Structure and ECG Parameters in Middle-aged and Elderly Hypertensive Patients
Authors: Che Li , Zhang Ying , Chen Xia , Du Haiqing , Song Wei , Jiang Yinong
Published: November 2024

Background: Salt substitution (SS) has been found to reduce blood pressure (BP). However, the impact of SS on cardiac structure, as assessed through ultrasonic cardiogram (UCG) and electrocardiograms (ECG), remains poorly understood. This study aims to evaluate the effects of SS on cardiac structure and ECG parameters. Methods: This 12-month prospective, multi-center, randomized, double-blind study involved hypertensive patients aged 50 to 70 years with office systolic BP (SBP) ranging from 140 to 180 mmHg and diastolic BP (DBP) ranging from 90 to 110 mmHg. A total of 352 patients were enrolled and equally randomized to either the normal salt (NS) group or SS group. Office BP measurements (OBPM) were obtained at baseline and at 3, 6, and 12 months, while home BP measurements (HBPM) were recorded at baseline, 3, 6, 9, and 12 months. Fasting blood, UCG, and ECG parameters were obtained at baseline and at the end of the study. Results: Of the 352 enrolled patients, 322 completed the study. In the SS group, the reductions in systolic OBPM, HBPM, and diastolic HBPM were significantly greater than those in the NS group. Notable cardiac parameter changes included a reduction in QT dispersion (QTd) by –5 ms (–10, 5) in the NS group and –5 ms (–15, 0) in the SS group (p = 0.001); the T wave peak-to-end (Tp-e) value was 0 ms (–5, 10) and –5 ms (–10, 0) (p < 0.001), respectively; and Tp-e/QT was 0 (–0.01, 0.02) and –0.02 (–0.04, 0) (p < 0.001), respectively. Additionally, left atrial diameter (LAD) was 0 mm (–1, 1) and –1 mm (–2, 1) (p < 0.001), and the change in left ventricular mass (LVM) was –2 g (–17.75, 11) and –7 g (–18, 6) (p = 0.035), respectively. Conclusions: This study demonstrates that SS not only significantly decreased LAD and LVM, indicating a significant effect on cardiac structure, but also improves UCG parameters, including reductions in QTd, Tp-e, and Tp-e/QT. These findings highlight the potential of SS as a beneficial intervention in managing cardiac risks in hypertensive patients. Clinical Trial Registration: ChiCTR1800019727. (https://www.chictr.org.cn/showproj.html?proj=31036).
The Correlation between Preoperative Average Heart Rate and Postoperative Recurrence in Patients with Paroxysmal Atrial Fibrillation Undergoing Transcatheter Radiofrequency Ablation
Authors: Feng Xiu , Yang Ling , Yang Zhenni , Miao Yuxia , Gong Mingxia , Meng Jun , Xu Min
Published: November 2024

Background: Atrial fibrillation (AF) is the most common persistent arrhythmia, with increasing incidence worldwide. Transcatheter radiofrequency ablation (RFA) represents a first-line therapy for paroxysmal atrial fibrillation (PAF), although the long-term recurrence rate of AF remains relatively high. This study aimed to investigate the relationship between the average heart rate (AHR) on a dynamic electrocardiogram before transcatheter RFA and the postoperative recurrence of AF in patients with PAF. Methods: A retrospective analysis was conducted on patients with PAF who experienced primary transcatheter RFA. Relevant clinical indicators, dynamic electrocardiograms, and echocardiography were collected from the enrolled patients before ablation. Multivariate logistic regression analysis examined the relationship between the preoperative AHR and postoperative recurrence of AF in patients with PAF. Results: This study included 224 patients with PAF who were scheduled for transcatheter RFA. Based on the AHR in sinus rhythm state on the dynamic electrocardiogram before ablation, the patients were divided into three groups: low, medium, and high heart rate. The recurrence rates of AF after ablation for the three groups were 14.667%, 8.108%, and 4.000%, respectively. After adjusting for confounding factors, postoperative AF recurrence risk gradually decreased with an increase in preoperative AHR (odds ratio: 0.849, 95% confidence interval: 0.729–0.988, p = 0.035). This trend remained statistically significant even after adjusting for the three categorical variables of AHR (odds ratio = 0.025, 95% confidence interval: 0.001–0.742, p = 0.033). The curve fitting analysis indicated a linear and negative correlation between the preoperative AHR and postoperative AF recurrence risk in patients with PAF. Conclusions: In patients with PAF who experienced their primary transcatheter RFA, there was a linear and negative correlation between the AHR in sinus rhythm state on the preoperative dynamic electrocardiogram and the risk of postoperative AF recurrence.
Successful Percutaneous Coronary Intervention for Chronic Total Occlusion in Left Ventricular Systolic Dysfunction Patients with and without Diabetes Mellitus
Authors: Wu Xi , Li Qin , Wu Mingxing , Huang Haobo , Liu Zhe , Huang He , Wang Lei
Published: November 2024

Background: Diabetes mellitus (DM) and left ventricular (LV) systolic dysfunction are common in patients who receive percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study aimed to investigate the clinical outcomes of LV systolic dysfunction patients who had successful PCI for CTO over two years, with or without DM. Methods: This cohort included 185 patients with LV systolic dysfunction undergoing successful PCI for CTO. A comparative analysis was performed on individual data and clinical outcomes among patients with and without DM after a two-year follow-up. Results: DM was identified in 99 (53.5%) patients who exhibited a higher incidence of chronic kidney disease (CKD), elevated serum creatinine levels, increased hemoglobin A1c, and reduced estimated glomerular filtration rates (p < 0.05). Patients with diabetes also experienced increased multi-vessel disease, a higher number of lesions per patient, as well as elevated multicenter chronic total occlusion registry in Japan (J-CTO) and Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores (p < 0.05). During the two-year follow-up, the DM group showed a greater occurrence of major adverse cardiovascular events (MACEs) compared with the non-DM group (24.2% versus 12.8%, p < 0.001). The DM group also had higher rates of all-cause mortality (9.1% versus 3.5%, p < 0.002), cardiac death (8.1% versus 1.2%, p < 0.001), and target vessel revascularization (18.2% versus 7.1%, p < 0.001). Multivariable logistic regression analysis demonstrated that the presence of DM is not an independent predictor of MACEs (hazard ratio (HR): 0.58; 95% confidence interval (CI): 0.32 to 1.03; p = 0.260). Moreover, the multi-vessel disease (HR: 1.69; 95% CI: 1.21 to 2.36; p = 0.002), CKD (HR: 1.38; 95% CI: 1.08 to 1.78; p = 0.011) and complete revascularization (HR: 0.36; 95% CI: 0.14 to 0.88; p = 0.026) had a significant association with MACEs. Conclusions: In patients with LV systolic dysfunction who underwent successful CTO-PCI, those with diabetes exhibited a higher trend toward the incidence of MACEs over two years.
Xuebijing Injection Alleviates the Inflammatory Response in Patients with Venous-Arterial Extracorporeal Membrane Oxygenation: A Prospective Randomized Controlled Study
Authors: Yuan Zhiyong , Liu Ying , Wang Fuhua , Han Xiaoning , Dong Zhenhui , Xing Jinyan , Chang Xiaotian
Published: November 2024

Background: Both acute myocardial infarction (AMI) and its salvage treatment, venoarterial-extracorporeal membrane oxygenation (VA-ECMO), may lead to the production of proinflammatory cytokines and further aggravate tissue damage. Xuebijing (XBJ) may modulate cytokine production involved in the inflammatory response. We aimed to determine the efficacy of XBJ in cardiogenic shock patients on VA-ECMO. Methods: This was a prospective, randomized trial carried out in an intensive care unit of a tertiary teaching hospital. Patients with cardiogenic shock after acute myocardial infarction undergoing percutaneous coronary intervention (PCI) with VA-ECMO support were randomly divided into a Xuebijing group and a control group. Cytokines, inflammatory factors and left ventricular ejection fraction (LVEF) were compared between the groups. Results: 41 patients were enrolled in the study, with 21 in the Xuebijing group and 20 in the control group. 28 (68.3%) were male, and the average age was 64.71 ± 8.18 years old. There was no difference in APACHEII (acute physiology and chronic health evaluation II) score, LVEF, or cytokine and inflammatory factors collected before extracorporeal membrane oxygenation (ECMO) between the two groups. The levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in the Xuebijing group were lower than those in the control group in the first 24 hours, 48 hours and 72 hours after ECMO (p < 0.05). The LVEF in the Xuebijing group was higher than that of the control group at 48 hours (31.57 ± 3.43 vs. 28.35 ± 4.42, p = 0.013). This trend persisted at 72 hours. The duration of ECMO support in the Xuebijing group was 5.57 ± 2.11 days, which was shorter than that in the control group (p = 0.033). Conclusions: Xuebijing injection can reduce the inflammatory response and improve cardiac function in patients with acute myocardial infarction treated with VA-ECMO to a certain extent. Clinical Trial Registration: Chinese Clinical Trial Registry (ChiCTR), ChiCTR2100054069, Registered 8, December 2021, https://www.chictr.org.cn/showproj.html?proj=142869.
Thromboembolism in Patients with Cancer: A Practical Guide to Recurrent Events
Authors: Kozhukhov Sergey , Dovganych Nataliia
Published: November 2024

Cancer patients have an increased risk of venous thromboembolism (VTE), and VTE is the second most common cause of death among them. Anticoagulation plays a key role in the treatment of cancer-associated thrombosis (CAT). Low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) are effective and generally safe options for cancer-associated VTE. However, those patients have a 10–20% risk of VTE recurrence in spite of using anticoagulants. The main reasons for recurrent VTE (rVTE) can be non-compliance, inadequate dosing of anticoagulants, thrombocytopenia and malignancy progression. Despite the publication of major guidelines regarding the management of CAT, the treatment of patients with rVTE is undefined. Treatment options for rVTE include bridging to LMWH in cases of oral anticoagulants use, LMWH dose escalation, and sometimes considering inserting a vena cava filter. This review paper summarizes the management of cancer-associated VTE, risk factors for rVTE and the treatment algorithm of rVTE.
Technique and Preliminary Results of Sole-echocardiography-guided Tricuspid Transcatheter Edge-to-edge Repair without the Use of Fluoroscopy
Authors: Gao Manchen , Shi Hao , Wang Cheng , Meng Hong , Wang Jiande , Zhu Da , Luo Zhiling , Wang Chuangshi , Li Ziping , Chang Junke , Zhang Fengwen , Pan Xiangbin , Wang Shouzheng
Published: November 2024

Background: Tricuspid transcatheter edge-to-edge repair (T-TEER) has emerged as an attractive option for severe tricuspid regurgitation (TR). To avoid the radiation exposure for both patients and medical staff, we propose a sole-echocardiography-guided method for T-TEER. The purpose of this article was to investigate the feasibility of sole-echocardiography-guided T-TEER. Methods: This was a retrospective observational study, including 43 patients who underwent sole-echocardiography-guided T-TEER at two medical centers in China between June 2022 and September 2023. Clinical and echocardiographic data were collected at baseline, discharge and 6-month follow-up. Results: Patients enrolled in this study were elderly (71.6 ± 8.2 years) with significant comorbidities, 67.4% had baseline massive or torrential TR and 76.7% were classified as New York Heart Association (NYHA) functional class III/IV. All patients achieved successful device implantation, and no severe device-related complications or mortality occurred during the follow-up period. Significantly reduced TR and reversed right ventricular remodeling were observed at 6-month follow-ups. Patients classified as NYHA functional class I/II increased from 23.3% at baseline to 81.4% at 6-month follow-up (p < 0.001). Conclusions: Sole-echocardiography-guided T-TEER has a low incidence of complications and can effectively reduce TR. It is feasible to substitute conventional fluoroscopy and echocardiography guidance for echocardiography guidance alone. Further large-scale randomized controlled trials are needed to validate the safety, efficacy and patient benefits of this technique.
Safety and Efficacy of Pulse Field Ablation in the Treatment of Atrial Fibrillation and Its Comparison with Traditional Thermal Ablation: A Systematic Review and Meta-Analysis
Authors: Gong Aobo , Li Wentao , Li Fanghui , Tong Yao , Cao Ying , Zeng Rui
Published: November 2024

Background: The purpose of this meta-analysis was to evaluate the efficacy and safety of pulsed field ablation (PFA) and to compare it with the efficacy and safety of traditional thermal ablation in patients with atrial fibrillation (AF). Methods: PubMed, Web of Science, and Embase were searched for randomized or observational studies exploring the efficacy and safety of PFA and comparing PFA with traditional thermal ablation in patients with AF. Results: A total of 4437 patients from 16 studies that only included PFA as the ablation method and 1792 patients from 9 comparing PFA to traditional thermal ablation were included in the final analysis. In studies that considered PFA alone, the freedom from atrial arrhythmia recurrence was 0.80 (95% confidence interval [CI] 0.76–0.84), and the incidence of periprocedural complications was 0.03 (95% CI 0.02–0.05). In comparative studies, there was no significant difference in the freedom from atrial arrhythmia recurrence (odds ratio (OR) 1.24, 95% CI 0.90–1.72) and the incidence of periprocedural complications (OR 0.74, 95% CI 0.37–1.48) of PFA compared to that of traditional thermal ablation. In the subgroup with a follow-up period less than 12 months, PFA had higher freedom from atrial arrhythmia recurrence rate compared to thermal ablation (OR 2.19, 95% CI 1.14–4.20). Conclusions: PFA is a safe and effective catheter ablation method that is not inferior to the traditional and well-established thermal ablation. It can be used as a treatment of choice for patients with AF. The PROSPERO registration: CRD42023473026, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=473026.
STEMI Antithrombotic Therapy: The Evolving Role of P2Y12 Inhibitor Pretreatment in Contemporary Practice
Authors: Tommasino Antonella , Fiorentini Vincenzo , Mattaroccia Giulia , Scoccia Alessandra , Barbato Emanuele
Published: November 2024

The P2Y12 receptor plays a central role in platelet activation, secretion, and procoagulant activity. The CURE (clopidogrel in unstable angina to prevent recurrent events) trial, conducted in 2001, was the first to effectively demonstrate the benefit of dual anti-aggregation therapy with aspirin and clopidogrel in patients with acute coronary syndromes (ACS) undergoing invasive treatment. Since then, the field of interventional cardiology has changed considerably. The introduction of drug-eluting stents (DES) and the development of new, potent P2Y12 inhibitors such as ticagrelor, prasugrel and cangrelor have revolutionized the treatment of ACS. Nevertheless, ST-elevation myocardial infarction (STEMI) remains a critical condition that requires rapid and effective intervention. The use of P2Y12 receptor antagonists as part of the pretreatment strategy is an interesting topic to optimize outcomes in STEMI patients. This review summarizes the existing evidence on the efficacy and safety of pretreatment with P2Y12 receptor antagonists in STEMI, and emphasizes the importance of making pretreatment decisions based on individual clinical characteristics. The review also looks to the future, pointing to the potential role of artificial intelligence (AI) in improving STEMI diagnosis and treatment decisions, suggesting a future where technology could improve the accuracy and timeliness of care for STEMI patients.
The Predictive and Prognostic Value of the Systemic Immune-Inflammation Index for Congestive Heart Failure
Authors: Zheng Zhihao , Shi Shanshan , Liu Zechen , Song Yanjun , Chang Zhen’ge , Cui Kongyong , Song Chenxi , Li Jia , Dou Kefei
Published: November 2024

Background: The systemic immune-inflammatory index (SII), calculated by (platelet count × neutrophil count)/lymphocyte count, is a novel biomarker with predive and prognostic value in numerous diseases. However, the relationship between SII and congestive heart failure (CHF) is not clear. This study aims to document the association of SII with the prevalence of CHF in the whole population and the long-term prognosis in CHF patients. Methods: This study included 57,500 participants in the National Health and Nutritional Examination Surveys, who were categorized into 3 categories based on their SII levels. A cross-sectional study was conducted to examine the relationship between SII and CHF prevalence in the whole population, followed by a prospective longitudinal study with a 5.4-year follow-up period for CHF patients to assess the predictive significance of SII for CHF. The main focus of the longitudinal study was on all-cause death as the primary outcome, with cardiovascular (CV) death as the secondary outcome. Associations were estimated using multivariate logistic regression and Cox proportional hazards models. The dose-response relationship was assessed with the restricted cubic spline (RCS) analysis. Results: In the cross-sectional analysis, there were 1927 (3.35%) participants diagnosed with CHF. The high SII group showed a significantly higher prevalence of CHF than the low SII group (odds ratio (OR) 1.24, 95% confidence interval (CI): 1.05, 1.45). In the longitudinal analysis, 882 all-cause deaths including 379 CV deaths were collected among CHF patients, and high SII was associated with a significant increase in the risk of all-cause death (hazard ratio (HR) 1.44; 95% CI: 1.14, 1.81) and CV death (HR 1.31; 95% CI: 1.08, 1.58). RCS confirmed the positive correlation of SII with the prevalence of CHF in the whole population, as well as the mortality risk in CHF patients. Conclusions: This study is the first to reveal that high SII was related to a high prevalence of CHF and a poor prognosis in CHF patients. These findings underscore the potential role of SII in the prevention and management of CHF.
Prognostic Influence of Lung Compliance in Patients with Cardiogenic Shock and Invasive Mechanical Ventilation
Authors: Rusnak Jonas , Schupp Tobias , Weidner Kathrin , Ruka Marinela , Egner-Walter Sascha , Schmitt Alexander , Akin Muharrem , Tajti Péter , Mashayekhi Kambis , Ayoub Mohamed , Behnes Michael , Akin Ibrahim
Published: November 2024

Background: There is limited data regarding the influence of lung compliance on the outcome of patients with cardiogenic shock (CS). Thus, a registry study was conducted to assess the prognostic influence of lung compliance in invasively ventilated patients with CS. Methods: Hospital records for consecutive invasively ventilated CS-patients from June 2019 to May 2021 were collected into a prospective registry. Our study evaluated the prognostic influence of lung compliance on 30-day all-cause mortality. Statistical analyses comprised t-tests, analysis of variance (ANOVA), Kruskal-Wallis-tests, Spearman’s correlation, Kaplan-Meier survival analyses, and Cox regression. Results: A total of 141 patients with CS requiring invasive mechanical ventilation were included. Stratification by quartiles revealed that patients with the lowest lung compliance (≤23.8 mL/cmH2O) experienced the highest mortality rates (77.1% vs. 66.7% vs. 48.6% vs. 51.4%; log-rank p = 0.018) both overall and among the subgroup of CS-patients with cardiac arrest (80% vs. 74% vs. 53% vs. 59%; log-rank p = 0.037). After stratifying by the median, patients with lung compliance <30.4 mL/cmH2O demonstrated a significantly higher 30-day all-cause mortality compared to those above this threshold (71.8% vs. 50.0%; log-rank p = 0.007) for both the overall cohort and the cardiac arrest subgroup (77.2% vs. 55.9%; log-rank p = 0.008). Multivariable adjustment confirmed that lung compliance <30.4 mL/cmH2O was significantly associated with increased 30-day all-cause mortality in the entire cohort (hazard ratio [HR] = 1.698; 95% CI 1.085–2.659; p = 0.021). Notably, this association was not significant in CS-patients with cardiac arrest (HR = 1.523; 95% CI 0.952–2.438; p = 0.080). Additionally, those with lung compliance below the median experienced fewer ventilator-free days (p = 0.003). Conclusions: In invasively ventilated CS-patients, low lung compliance was associated with higher all-cause mortality and fewer ventilator-free days at 30 days. Clinical Trial Registration: NCT05575856, https://clinicaltrials.gov/study/NCT05575856.