The clinical use of remote parameter testing during cardiac implantable electronic devices implantation procedures: a single center, randomized, open-label, non-inferiority trial.

Background: A novel non-contact system for remote parameter testing and reprogramming offers an alternative method for assessing device parameters during cardiac implantable electronic devices (CIEDs) implantation without the need for physical contact with the manufacturer's clinical service technician. The safety and feasibility of using this system in CIEDs implantation procedures remains to be determined. Objective: Evaluate the safety and feasibility of remote parameter testing in CIEDs implantation procedures. Methods: A single center, randomized, open-label, non-inferiority trial (ChiCTR2200057587) was conducted to compare the two approaches for interrogating CIEDs during implantation procedures: routine interrogation performed by on-site technicians or remote interrogation performed by technicians using the 5G-Cloud Technology Platform. Patients aged ≥18 years and elected to receive CIEDs were eligible for inclusion. The primary endpoint was the completion rate of the parameter test. Safety and efficiency were evaluated in all randomly assigned participants. Results: A total of 480 patients were finally enrolled and were randomly assigned to routine group (n = 240) or remote group (n = 240). The primary endpoint was achieved by 100% in both groups (P = 0.0060 for noninferiority). The parameters of sensing, threshold, and impedance regarding the right atrium, right ventricle, and left ventricle had no statistical significance between the two groups (P > 0.05). Procedure time, parameter testing time, and both duration and dose of x-ray irradiation were not significantly different between the two groups (P > 0.05). Shut-open door frequency was significantly higher in the routine group than the remote group [6.00 (4.00, 8.00) vs. 0, P < 0.0001]. Notably, no clinical or technical complications were observed in the remote group. Conclusions: Remote parameter testing is safe and feasible across various devices implantation procedures. The utilization of remote parameter testing and reprogramming could represent an innovative approach to improve healthcare accessibility and unlock the full potential of secondary centers in managing CIEDs. The Registration Identification: ChiCTR2200057587.

Analysis of clinical characteristics of 617 patients with benign airway stenosis.

Introduction: Benign airway stenosis (BAS), namely airway narrowing caused by a variety of benign lesions, can lead to varying degrees of breathing difficulties and even death due to asphyxia. This study aimed to elucidate the clinical characteristics of BAS, including etiology, treatment and pathology, by analyzing the clinical data of BAS patients. Methods: A retrospective analysis was conducted using the clinical data of 617 BAS cases from January 2017 to December 2022. The pathological characteristics of the tissues were assessed by hematoxylin-eosin (H&E) and Masson's staining. Besides, protein expression levels were determined by immunohistochemistry (IHC). Results: A total of 617 patients were included (333 females [53.97%] and 284 males [46.03%]), with an average age of 48.93 ± 18.30 (range 14-87). Tuberculosis (n = 306, 49.59%) and trauma (n = 179, 29.02%) were the two leading etiologies of BAS, followed by airway foreign bodies (FB, n = 74, 11.99%), external compression (n = 25, 4.05%) and other etiologies (n = 33, 5.35%). Among 306 tuberculous tracheobronchial stenosis (TBTS) cases, most were females (n = 215, 70.26%), and TBTS mainly occurred in the left main bronchus (n = 97, 31.70%), followed by the right middle bronchus (n = 70 cases, 22.88%). The majority of TBTS patients (n = 259, 84.64%) were treated by interventional therapy. The condition of 179 BAS patients was ascribed to trauma, such as tracheal intubation (n = 92, 51.40%), tracheotomy (n = 69, 38.56%), injury (n = 15, 8.38%) and surgery (n = 3, 1.68%), which mostly took place in the trachea (n = 173, 96.65%). TAS patients mainly received interventional therapy (n = 168, 93.85%) and stent implantation (n = 47, 26.26%). The granulation tissues of BAS primarily featured inflammation, proliferation and fibrosis. IHC indicated the up-regulated expressions of transforming growth factor-ß1 (TGF-ß1), α-smooth muscle actin (α-SMA), collagen type I protein (COL-I) and vimentin, and the down-regulated expression of E-cadherin, which indicated fibrosis and epithelial-mesenchymal transition (EMT). Conclusion: Tuberculosis was the main etiology, and trauma was the secondary etiology. The granulation tissues of BAS were characterized by inflammation, fibrosis and probably EMT. Comprehensive interventional therapy is an effective method of treating BAS.

Cloud Follow-Up in Patients With Cardiovascular Implantable Electronic Devices: A Single-Region Study in China.

Background: Due to seriously imbalanced distribution of follow-up clinics in China, routine in-office visits are erratically attended by many cardiovascular implantable electronic device (CIED) patients. Meanwhile, remote monitoring is significantly underutilized. Novel tools to address the current predicament of routine in-office visits in China is urgently needed. Objectives: To assess the reliability and feasibility of cloud follow-up in CIED patients. Methods: A total of 325 CIED patients from 13 hospitals in Sichuan Province, China, were enrolled. Information on patients' sociodemographic and basic clinical characteristics was collected. All devices were tested and programmed with 5G-cloud follow-up platform in a real-time manner. All patients were surveyed about their acceptance of and preferences regarding cloud follow-up compared to routine in-office visits. Results: Compliance with routine in-office visits in this region was 60.6%. None of the patients were enrolled in remote monitoring services. Clinically important predictors of non-compliance were elderly age (≥75 years old), odds ratio (OR) 2.392 (95% confidence interval, 1.111-5.150); needing notification from a follow-up clinic, OR 2.518 (1.179-5.376); and being beyond 15 months post-implantation, OR 5.440 (2.563-11.543). All cloud follow-up sessions were performed safely and efficiently, without any adverse events. 292 (89.8%) patients preferred cloud follow-up for future device management. Conclusion: Compliance with routine in-office visits in this region has much room for improvement. Cloud follow-up addresses the limitations of an imbalanced distribution of follow-up clinics and geographic barriers for in-office CIED evaluation. Thus, cloud follow-up provides a potential solution to the current predicament of routine in-office visits in China.

Serum cortisol levels and adrenal gland size in patients with chronic obstructive pulmonary disease.

OBJECTIVE: To determine the clinical significance of serum Cortisol (Cor) levels and adrenal gland size in patients with chronic obstructive pulmonary disease (COPD). METHODS: We assigned 80 patients with COPD admitted to our hospital to an observation group, and 80 healthy individuals to a control group. Serum Cor, C-reactive protein (CRP) level, and adrenal gland size were measured. Patients with COPD were divided into several subgroups according to BODE (BMI, Obstruction, Dyspnea, Exercise capacity) indexes and forced expiratory volume in the first second (FEV1), and Cor levels and adrenal gland size were compared between subgroups. The Pearson Correlation was used to analyze correlations of adrenal gland size and Cor levels with partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), FEV1, forced vital capacity (FVC), and FEV1/FVC. After 30 days' follow-up, the patients were allocated into good-prognosis group and poor-prognosis group. The clinical value of Cor levels in predicting prognosis was estimated by the receiver operating characteristic (ROC) curve. RESULTS: Increased serum CRP levels were found in the observation group, while Cor levels and adrenal gland diameter were decreased (P<0.05 for each comparison). In the observation group, an increase in BODE index or decrease in FEV1 led to decreased Cor levels and adrenal gland diameter, as well as increased CRP levels (P<0.05, each comparison). Correlation analysis showed that adrenal gland diameter and Cor levels were positively correlated with PaO2, FEV1, FVC, and FEV1/FVC, but negatively correlated with PaCO2. The ROC curve indicated that Cor levels were valuable in predicting the prognosis (AUC>0.7, P<0.05). CONCLUSION: Cor levels and adrenal gland size are closely associated with the severity of COPD, and Cor levels are predictive of prognosis.

microRNA-1908-5p inhibits proliferation and promotes apoptosis by targeting PP5 in NSCLC.

MicroRNA-1908 is involved in the occurrence and development of various tumors. However, the mechanism of microRNA-1908-5p in the pathogenesis of non-small cell lung cancer (NSCLC) is not thoroughly studied. Protein phosphatase 5 catalytic subunit (PP5), a member of the protein phosphatase catalytic subunit family, may be a target of the microRNA-1908-5p. In order to further explore the mechanism of microRNA-1908-5p, real-time PCR was used to detect the expression of microRNA-1908-5p in non-small cell lung cancer tissues, and analyze the relationship between the expression of microRNA-1908-5p and clinical characteristics of lung cancer patients. The target of microRNA-1908-5p was predicted by bioinformatics and verified by Dual-luciferase assay. The effects of microRNA-1908-5p on the proliferation and apoptosis of lung cancer cells were examined at the cellular level. Nude mice tumorigenesis experiment was used to study the effect of microRNA-1908-5p on cancer cells. Western blot was used to detect the expression of related proteins. The results showed that the expression of microRNA-1908-5p in lung cancer tissues was significantly lower than that in adjacent tissues. The expression of microRNA-1908-5p in the non-metastatic lung cancer tissues was significantly higher than that in the metastatic lung cancer tissues, and the expression of microRNA-1908-5p was closely related to the survival rate of patients. Bioinformatics analysis combined with double luciferase assay showed that PP5 was a significant target of microRNA-1908-5p. Our results suggest that microRNA-1908-5p can regulate the pathogenesis of NSCLC by inhibiting PP5.