Safety and efficacy of Cox-Maze procedure for atrial fibrillation during mitral valve surgery: a meta-analysis of randomized controlled trials.

BACKGROUND: Cox-Maze procedure is currently the gold standard treatment for atrial fibrillation (AF). However, data on the effectiveness of the Cox-Maze procedure after concomitant mitral valve surgery (MVS) are not well established. The aim of this study was to assess the safety and efficacy of Cox-Maze procedure versus no-maze procedure n in AF patients undergoing mitral valve surgery through a systematic review of the literature and meta-analysis. METHODS: A systematic search on PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Clinical Trials (Cochrane Library, Issue 02, 2017) databases were performed using three databases from their inception to March 2023, identifying all relevant randomized controlled trials (RCTs) comparing Cox-Maze procedure versus no procedure in AF patients undergoing mitral valve surgery. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Nine RCTs meeting the inclusion criteria were included in this systematic review with 663 patients in total (341 concomitant Cox-Maze with MVS and 322 MVS alone). Across all studies with included AF patients undergoing MV surgery, the concomitant Cox-Maze procedure was associated with significantly higher sinus rhythm rate at discharge, 6 months, and 12 months follow-up when compared with the no-Maze group. Results indicated that there was no significant difference between the Cox-Maze and no-Maze groups in terms of 1 year all-cause mortality, pacemaker implantation, stroke, and thromboembolism. CONCLUSIONS: Our systematic review suggested that RCTs have demonstrated the addition of the Cox-Maze procedure for AF leads to a significantly higher rate of sinus rhythm in mitral valve surgical patients, with no increase in the rates of mortality, pacemaker implantation, stroke, and thromboembolism.

Sivelestat in Patients at a High Risk of Postoperative Acute Lung Injury After Scheduled Cardiac Surgery: A Prospective Cohort Study.

Background: Sivelestat, a neutrophil elastase inhibitor, is specifically developed to mitigate the occurrence of acute lung injury (ALI) in individuals who are undergoing cardiovascular surgery. However, its impact on patients who are at a heightened risk of developing ALI after scheduled cardiac surgery has yet to be determined. In order to address this knowledge gap, we undertook a study to assess the efficacy of sivelestat in protecting the lungs of these patients. Methods: We conducted a prospective cohort study involving 718 patients who were at high risk of developing postoperative acute lung injury (ALI) and underwent scheduled cardiac surgery between April 25th, 2022, and September 7th, 2023. Among them, 52 patients received sivelestat (administered at a dosage of 0.2mg/kg/h for 3 days), while 666 patients served as controls, not receiving sivelestat. The control conditions were the same for all patients, including ventilation strategy, extubating time, and fluid management. Subsequently, a propensity-score matched cohort was established, consisting of 40 patients in both the sivelestat and control groups. The primary outcome measure encompassed a composite of adverse outcomes, including 30-day mortality, ALI, acute respiratory distress syndrome (ARDS), and others. Secondary outcomes assessed included pneumonia, ventricular arrhythmias, mechanical ventilation (MV) time, and more. Results: After conducting propensity matching in our study, we observed that there were no significant differences in 30-day mortality between the sivelestat and control groups (0% vs 2.5%, P=0.32). However, the use of sivelestat exhibited a significant reduction in the incidence of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) compared to the control group (0% vs 55%, P<0.01), pneumonia (0 vs 37.5%, P<0.01), MV time (median:8 hours, IQR:4-14.8 hours vs median: 15.2 hours, IQR:14-16.3 hours, P<0.01). Compared to the control group, the sivelestat could significantly decrease white cell count (P<0.01), neutrophile percentage (P<0.01) and C-reactive protein (P<0.01) in the period of postoperative 5 days. Conclusion: The prophylactic administration of sivelestat has shown promising results in reducing the occurrence of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in patients with a heightened risk of developing these conditions after elective cardiac surgery. Our study findings indicate that sivelestat may provide protective effects by suppressing inflammation triggered by neutrophil activation, thereby safeguarding pulmonary function. Registration: ChiCTR2200059102, https://www.chictr.org.cn/showproj.html?proj=166643.

Short and mid-term effects of modified release technique in rheumatic mitral valve repair.

OBJECTIVE: Repair or replacement remains debatable in rheumatic heart disease. To regain optimal mean transvalvular pressure gradients and end-diastolic peak flow velocity, the modified release technique combined peeling in the anterior leaflet and separated the shortened chordal. In the end, the short and mid-term outcomes of the modified release technique were evaluated. METHODS: We retrospectively analyzed a series of 128 patients with rheumatic mitral stenosis, from January 2018 to July 2021 in our center. All patients undergoing mitral valve repair were using the modified release technique. The effect of mitral valve repair was evaluated by intraoperative transesophageal echocardiography and postoperative transthoracic echocardiography. RESULTS: All the 128 patients successfully repaired the mitral valve. The intraoperative transesophageal echocardiography showed trivial or mild regurgitation. The aortic valve was repaired without obvious regurgitation in 12 cases, 5 cases received an aortic valve replacement, 89 cases underwent tricuspid annuloplasty. There were no blood transfusions in most patients, no deaths nor complications during peri-operation, also, no deaths and adverse events were observed during the follow-up period from 3 to 42 months. During the follow-up, 122 cases had no mitral valve regurgitation and 2 cases of moderate regurgitation, 4 cases of mild to moderate regurgitation. The mean peak flow velocity was 1.2 ± 0.3 m / s, no new-onset stenosis occurred. CONCLUSION: Modified release technique is safe and feasible. Its durability is acceptable in the short and mid-term, with no new-onset stenosis during the follow-up.

Nuciferine improves cardiac function in mice subjected to myocardial ischemia/reperfusion injury by upregulating PPAR-γ.

Ischemic heart disease and myocardial infarction contribute to the leading cause of death in worldwide. The prevention and management of myocardial ischemia/reperfusion (I/R) injury is an essential part of coronary heart disease surgery and is becoming a major clinical problem in the treatment of ischemic heart disease. Nuciferine has potent anti-inflammatory and antioxidative stress effects, but its role in myocardial ischemia-reperfusion (I/R) is unclear. In this study, we found that nuciferine could reduce the myocardial infarct size in a mouse myocardial ischemia-reperfusion model and improve cardiac function. Furthermore, nuciferine could effectively inhibit hypoxia and reoxygenation (H/R) stimulated apoptosis of primary mouse cardiomyocytes. In addition, nuciferine significantly reduced the level of oxidative stress. The peroxisome proliferator-activated receptor gamma (PPAR-γ) inhibitor GW9662 could reverse the protective effect of nuciferine on cardiomyocytes. These results indicate that nuciferine can inhibit the apoptosis of cardiomyocytes by upregulating PPAR-γ and reducing the I/R-induced myocardial injury in mice.

Measurements of Intrinsic Capacity in Older Adults: A Scoping Review and Quality Assessment.

OBJECTIVES: This review summarizes the measurements of intrinsic capacity in 5 domains across different studies and evaluates the quality of research papers. DESIGN: Scoping review of papers written in English and Chinese published in peer-reviewed journals. SETTING AND PARTICIPANTS: The intrinsic capacity of older adults was assessed using the multidomain structure (Cognition, Locomotion, Psychological, Sensory and Vitality) proposed by the World Health Organization. METHODS: We searched PubMed, MEDLINE, and Web of Science for papers in English, and CNKI, CBM for papers written in Chinese published until September 13, 2022. Both cross-sectional and cohort studies of multidomain measurements of intrinsic capacity were included. Three independent reviewers appraised the quality of studies, and Cohen's kappa was calculated to determine interrater reliability. Data were listed by author, year, setting, country, age range and number of participants, measurement and calculation of intrinsic capacity, and data acquisition method. RESULTS: We included 53 studies. Twenty-one studies were of high quality, 31 studies were of moderate quality, and 1 study was of low quality. Measurements of intrinsic capacity and derivation of the summative index score were heterogeneous. Intrinsic capacity was usually assessed in 4 or 5 domains. Sensory was the most frequently overlooked domain or subdivided into vision and hearing in some studies. Indicators of vitality were the most heterogeneous. We also found consistency in heterogeneous measurements. The most common measurements of cognition, locomotion, and psychological capacity were the Mini-Mental State Examination, Short Physical Performance Battery, and Geriatric Depression Scale respectively. Self-reported questionnaires were commonly adopted in sensory domain. The Mini-Nutritional Assessment and grip strength were the most measured indicators of vitality. CONCLUSIONS AND IMPLICATIONS: The focus on capacity and disease should be balanced to better promote healthy aging in older adults. Heterogeneity of intrinsic capacity measurements underscores the need for consensus about standardized measurements and calculation procedures.

A Review on N-Doped Biochar for Oxidative Degradation of Organic Contaminants in Wastewater by Persulfate Activation.

The Persulfate-based advanced oxidation process is the most efficient and commonly used technology to remove organic contaminants in wastewater. Due to the large surface area, unique electronic properties, abundant N functional groups, cost-effectiveness, and environmental friendliness, N-doped biochars (NBCs) are widely used as catalysts for persulfate activation. This review focuses on the NBC for oxidative degradation of organics-contaminated wastewater. Firstly, the preparation and modification methods of NBCs were reviewed. Then the catalytic performance of NBCs and modified NBCs on the oxidation degradation of organic contaminants were discussed with an emphasis on the degradation mechanism. We further summarized the detection technologies of activation mechanisms and the structures of NBCs affecting the PS activation, followed by the specific role of the N configuration of the NBC on its catalytic capacity. Finally, several challenges in the treatment of organics-contaminated wastewater by a persulfate-based advanced oxidation process were put forward and the recommendations for future research were proposed for further understanding of the advanced oxidation process activated by the NBC.

The role of peripheral blood eosinophil counts in acute Stanford type A aortic dissection patients.

Background: Acute Stanford-A aortic dissection (AAAD) is a devastating cardiovascular condition with high mortality, therefore identifying risk prognosis factors is vital for the risk stratification of patients with AAAD. Here, we investigated peripheral blood eosinophil (EOS) counts in patients with AAAD and their possible biological implications. Methods: We performed a single center retrospective cohort study. From 2011 to 2021, a total of 1,190 patients underwent AAAD surgery. Patients were categorized first by death and then admission EOS counts (0.00 × 109/L or >0.00 × 109/L). Demographics, laboratory data, and outcomes were analyzed using standard statistical analyses. Ascending aorta specimens were used for western blotting and histological assessments. Results: Death group patients had lower EOS counts than the non-death group (P = 0.008). When patients were stratified using mean blood EOS counts: 681 patients had low (0.00 × 109/L) and 499 had high (>0.00 × 109/L) counts. Patients with low EOS counts at admission were more likely to have a higher mortality risk (P = 0.017) and longer treatment in the intensive care unit (ICU) days (P = 0.033) than patients with normal EOS counts. Also, the five blood coagulation items between both groups showed significantly different (P < 0.001). Hematoxylin & eosin-stained cross-sections of the ascending aorta false lumen showed that EOSs were readily observed in thrombi in the false lumen of the aorta. Conclusions: Peripheral blood EOS counts may be involved in thrombosis and could be an effective and efficient indicator for the diagnosis, evaluation, and prognosis monitoring of patients with AAAD.

Research on the Relationship Model between Professional Identity and Life Meaning of Clinical Medical Freshmen based on Artificial Intelligence Medical Image Detection.

Objective: To understand the current situation of professional identity and life significance of clinical medical freshmen in a university in Xinjiang, analyze its influencing factors, find out the influencing factors and causes, and intervene and improve them. Provide the public with better medical and health management services, so that people can independently and effectively predict and prevent diseases; at the same time, it can also guide people to make more correct and wise choices in uncomfortable situations. Methods: A questionnaire survey was conducted on 793 freshmen majoring in clinical medicine with the college students' professional identity questionnaire and the Chinese version of the meaning in life scale (C-MLQ). Results: The freshmen total score of professional identity was (97.48 ± 12.21). The total score of meaning in life was (53.26 ± 7.15), and the meaning in life and the professional identity were significantly positively correlated (r = 0.467, P < 0.01). Students with first choice, only child, urban living, and parents with a high educational level scored higher in their professional identity (P < 0.05). First choice (ß = -0.11, P < 0.001), place of residence (ß = -0.07, P=0.03), father's education level (ß = 0.08, P=0.04), family monthly income (ß = -0.09, P=0.02), and the presence of meaning in life (ß = 0.54, P < 0.001) are the influencing factors of students' professional identity. Both professional identity and meaning in life have important relationship with the mental health of medical students. In the development of modern medicine, finding personal career orientation and goals helps to establish a correct outlook on life, values, and the world. It has a positive impact on the development of personal physical and mental health. Conclusion: The professional identity and life meaning of clinical medical freshmen are at the upper middle level, which can be improved through medical education and other measures. The joint efforts of society, schools, families, and individual students are needed to improve the professional identity of medical students.

A Qualitative Study of Clinical Teachers' Expectations for the Role of Nursing Postgraduates Based on Intelligent Data Analysis.

Objective: To deeply understand the role expectation of clinical teachers for nursing master's degree graduates and use the crowd portrait intelligent data analysis system to assist in enrollment. Methods: Retrospective analysis was used to group nursing postgraduates and observe and statistically analyze the passing rate of basic course examination, subject achievement, graduation thesis, and graduation passing rate within three years. Results: The passing rates of the observation indexes of the double compliance group, the compliance system group, the compliance teacher group, and the double noncompliance group decreased in turn. It can be said that the system design can provide effective suggestions for the enrollment of nursing postgraduates. If the enrollment is carried out according to the system suggestions, the overall level of postgraduates can be improved, and their role expectations can be met. Conclusion: This paper was aimed at studying the advantages of using intelligent data systems to assist in enrollment, which can not only improve the overall level of nursing graduate students but also meet the role expectations of clinical teachers, systematically arrange practical teaching, and promote the development of relevant software systems.

Targeting NRF2 to suppress ferroptosis in brain injury.

Brain injury is accompanied by serious iron metabolism disorder and oxidative stress. As a novel form of regulated cell death (RCD) depending on lipid peroxidation caused by iron overload, ferroptosis (FPT) further aggravates brain injury, which is different from apoptosis, autophagy and other traditional cell death in terms of biochemistry, morphology and genetics. Noteworthy, transcriptional regulator NRF2 plays a key role in the cell antioxidant system, and many genes related to FPT are under the control of NRF2, including genes for iron regulation, thiol-dependent antioxidant system, enzymatic detoxification of RCS and carbonyls, NADPH regeneration and ROS sources from mitochondria or extra-mitochondria, which place NRF2 in the key position of regulating the ferroptotic death. Importantly, NRF2 can reduce iron load and resist FPT. In the future, it is expected to open up a new way to treat brain injury by targeting NRF2 to alleviate FPT in brain.

Ferroptosis-relevant mechanisms and biomarkers for therapeutic interventions in traumatic brain injury.

Traumatic brain injury (TBI) is one of the most significant health care problems worldwide, causing disability and death especially among young individuals. Although a large range of agents and therapies have been proved beneficial to lesions post-TBI to some extent, effective treatments have not been translated to the clinic. As a newly discovered form of iron-dependent regulated cell death, ferroptosis has been implicated in TBI. In this review, we update the current state of knowledge related to second injuries post-TBI, including ferroptosis, oxidative stress, mitochondrial dysfunction, neuroinflammation and so on, which often lead to chronic symptoms and long-term disability. This review systematically summarizes the latest progress in the pathophysiological mechanisms of TBI, with a focus on providing references for proposing new multi-molecular targets for comprehensive therapeutic strategies based on ferroptosis-relevant mechanisms. In addition, biomarkers are essential diagnostic and prognostic tools in TBI. Several biomarkers associated with the outcome of TBI have been listed in this article, such as Pde10a, MDA, UCH-L1, S100A9, S100B, ALDOC, ACSL4, MBP and F2-Isoprostane. Therefore, the understating of ferroptosis-relevant mechanisms and biomarkers may contribute to development of promising therapies for TBI clinical trials.

Magnetic resonance imaging and magnetic resonance venography features in heat stroke: a case report.

BACKGROUND: Heat stroke (HS) is a critical illness that can cause multiple organ dysfunction, including damage to the central nervous system (CNS), which can be life-threatening in severe cases. Brain lesions in patients with HS who present with CNS damage have been rarely reported before, and they usually vary in different cases, hence, patients with such lesions may present a clinical challenge in terms of diagnosis and management. Cerebral venous thrombosis (CVT) is a rare cause of stroke that mostly affects young individuals and children. The pathogenesis of brain damage caused by HS is complex, and CVT may be involved in the pathogenesis of HS with CNS damage. In this manuscript, we have reported a case of a patient with HS having CVT with symmetrical lesions in the bilateral putamen, posterior limb of the internal capsule, external capsule, insular lobe, and subcortical white matter in the brain. CASE PRESENTATION: We encountered a 48-year-old man who presented with HS in the summer season. During admission, he had a high body temperature and was in coma and shock. Then, he developed rhabdomyolysis syndrome, acute kidney and liver damage, electrolyte imbalance, and acid-base balance disorders, and his D-dimer level was elevated. After several days of anti-shock treatment, the patient's level of consciousness improved. However, he experienced a decline in vision. Cerebral magnetic resonance imaging (MRI) showed symmetrical lesions in the bilateral posterior limb of the internal capsule, putamen, external capsule, insula, and subcortical white matter, and cerebral magnetic resonance venography (MRV) showed the development of CVT. Therefore, anti-coagulation treatment was provided. After timely clinical intervention, the symptoms of the patient gradually improved. CONCLUSIONS: This case showed that HS can cause CVT. Therefore, cerebral MRI findings in HS must be assessed; in addition, early MRV can help in the diagnosis of the disease, which can effectively improve prognosis.

Application of Biochar Derived From Pyrolysis of Waste Fiberboard on Tetracycline Adsorption in Aqueous Solution.

In this study, biochars derived from waste fiberboard biomass were applied in tetracycline (TC) removal in aqueous solution. Biochar samples were prepared by slow pyrolysis at 300, 500, and 800°C, and were characterized by ultimate analysis, Fourier transform infrared (FTIR), scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), Brunauer-Emmett-Teller (BET), etc. The effects of ionic strength (0-1.0 mol/L of NaCl), initial TC concentration (2.5-60 ppm), biochar dosage (1.5-2.5 g/L), and initial pH (2-10) were systemically determined. The results present that biochar prepared at 800°C (BC800) generally possesses the highest aromatization degree and surface area with abundant pyridinic N (N-6) and accordingly shows a better removal efficiency (68.6%) than the other two biochar samples. Adsorption isotherm data were better fitted by the Freundlich model (R 2 is 0.94) than the Langmuir model (R 2 is 0.85). Thermodynamic study showed that the adsorption process is endothermic and mainly physical in nature with the values of ΔH 0 being 48.0 kJ/mol, ΔS 0 being 157.1 J/mol/K, and ΔG 0 varying from 1.02 to -2.14 kJ/mol. The graphite-like structure in biochar enables the π-π interactions with a ring structure in the TC molecule, which, together with the N-6 acting as electron donor, is the main driving force of the adsorption process.

Pyrolysis of palm kernel shell with internal recycling of heavy oil.

This paper investigated pyrolysis of palm kernel shell in a proposed reactor, which is characterized by internal recycling of heavy oil between a heavy oil sorption zone and pyrolysis zone. The internal recycling of heavy oil favors conversion of heavy oil to char, gas, and light oil. Compared with the product distribution from the conventional pyrolysis without heavy oil recycling, the yields of char, gas, and GC/MS detectable organic compounds increase from 34.8, 15.2, and 9.8 wt%-(dry feedstock) to 38.5, 19.0, and 16.9 wt%-(dry feedstock), respectively, with the help of internal recycling of heavy oil. The increases in the char and gas yields are interestingly found to be nearly equivalent. Furthermore, the yields of acetic acid and phenol in the resulting bio-oil can be as high as 10.1 and 2.7 wt%-(dry feedstock), and the outputs of 2-methylfuran, 2,6-dimethoxyphenol, and H2 are increased by around 37, 7, and 4 times, respectively.

Effects of Water Content and Particle Size on Yield and Reactivity of Lignite Chars Derived from Pyrolysis and Gasification.

Water inside coal particles could potentially enhance the interior char⁻steam reactions during pyrolysis and gasification. This study aims to examine the effects of water contents on the char conversion during the pyrolysis and gasification of Shengli lignite. The ex-situ reactivities of chars were further analyzed by a thermo gravimetric analyzer (TGA). Under the pyrolysis condition, the increase in water contents has monotonically decreased the char yields only when the coal particles were small (<75 µm). In contrast, the water in only large coal particles (0.9⁻2.0 mm) has clearly favored the increase in char conversion during the gasification condition where 50% steam in argon was used as external reaction atmosphere. The waved reactivity curves for the subsequent char⁻air reactions were resulted from the nature of heterogeneity of char structure. Compared to the large particles, the less interior char⁻steam reactions for the small particles have created more differential char structure which showed two different stages when reacting with air at the low temperature in TGA.