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BACKGROUND: Ventricular tachycardia (VT) is the primary cause of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, the strategy for VT treatment in HCM patients remains unclear. This study is aimed to compare the effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy for sustained VT in patients with HCM. METHODS: A total of 28 HCM patients with sustained VT at 4 different centers between December 2012 and December 2021 were enrolled. Twelve underwent catheter ablation (ablation group) and sixteen received AAD therapy (AAD group). The primary outcome was VT recurrence during follow-up. RESULTS: Baseline characteristics were comparable between two groups. After a mean follow-up of 31.4 ± 17.5 months, the primary outcome occurred in 35.7% of the ablation group and 90.6% of the AAD group (hazard ratio [HR], 0.29 [95%CI, 0.10-0.89]; P = 0.021). No differences in hospital admission due to cardiovascular cause (25.0% vs. 71.0%; P = 0.138) and cardiovascular cause-related mortality/heart transplantation (9.1% vs. 50.6%; P = 0.551) were observed. However, there was a significant reduction in the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation in ablation group as compared to that of AAD group (42.9% vs. 93.7%; HR, 0.34 [95% CI, 0.12-0.95]; P = 0.029). CONCLUSIONS: In HCM patients with sustained VT, catheter ablation reduced the VT recurrence, and the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation as compared to AAD.
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Antiarrítmicos , Cardiomiopatia Hipertrófica , Ablação por Cateter , Recidiva , Taquicardia Ventricular , Humanos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/terapia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/cirurgia , Antiarrítmicos/uso terapêutico , Antiarrítmicos/efeitos adversos , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , Cardiomiopatia Hipertrófica/mortalidade , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica/cirurgia , Cardiomiopatia Hipertrófica/terapia , Resultado do Tratamento , Fatores de Tempo , Adulto , Estudos Retrospectivos , Fatores de Risco , Idoso , Frequência Cardíaca , ChinaRESUMO
BACKGROUND: Contiguity of ablation lesions is a critical determinant of success for paroxysmal atrial fibrillation (PAF) ablation. Evidence supports maintaining an inter-lesional distance (ILD) ≤ 6 mm during pulmonary venous isolation (PVI). Meanwhile, first-pass isolation (FPI) on PVI outcome in follow-up was not deeply studied. The impact of ILD and FPI on PAF ablation outcomes was investigated. METHODS: Consecutive PAF patients who underwent first-time antral PVI were recruited. Coordinates of ablation points were extracted from the electro-anatomical mapping system and analyzed using custom-developed software to determine the ILD. A gap is defined as ILD greater than 6 mm. FPI was defined as the achievement of PVI by encircling the ipsilateral veins while simultaneously recording their electrical activity using a multipolar catheter. The primary endpoint was freedom from documented atrial arrhythmias including AF, atrial tachycardia (AT), or atrial flutter (AFL) lasting longer than 30 s during follow-up. RESULTS: A total of 105 patients underwent first-time antral PVI. During 13.3 ± 0.6 months of follow-up, atrial arrhythmias recurrence was noted in 22.9% of the patients. Atrial arrhythmia recurrence was significantly higher in patients with more gaps (> 2) (37.0% versus 11.9%, P < 0.01), and the number of gaps was an independent predictor of AF/AT/AFL recurrence. (Hazard ratio [HR] 1.20, 95% CI 1.03-1.40, P = 0.02). The group with FPI for at least one ipsilateral pair of PVs exhibited a decreased number of gaps (2.0 versus 7.0, P < 0.01) and demonstrated a significant correlation with a reduction of recurrence (HR 0.26, 95% CI 0.09-0.71, P = 0.01). Among 16 patients who underwent repeat ablation, the number of gaps during the index PVI was associated with PV reconnection (PVR) (P < 0.01). CONCLUSIONS: Gaps created during PVI are a modifiable determinant of AF/AT/AFL recurrence, and avoidance of gaps is crucial to improve clinical outcomes of PAF ablation. In addition, FPI exhibited a strong predictive capability for clinical success in patients with PAF.
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Urban air pollution is a critical public health challenge in low-and-middle-income countries (LMICs). At the same time, LMICs tend to be data-poor, lacking adequate infrastructure to monitor air quality (AQ). As LMICs undergo rapid urbanization, the socio-economic burden of poor AQ will be immense. Here we present a globally scalable two-step deep learning (DL) based approach for AQ estimation in LMIC cities that mitigates the need for extensive AQ infrastructure on the ground. We train a DL model that can map satellite imagery to AQ in high-income countries (HICs) with sufficient ground data, and then adapt the model to learn meaningful AQ estimates in LMIC cities using transfer learning. The trained model can explain up to 54% of the variation in the AQ distribution of the target LMIC city without the need for target labels. The approach is demonstrated for Accra in Ghana, Africa, with AQ patterns learned and adapted from two HIC cities, specifically Los Angeles and New York.
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Poluição do Ar , Imagens de Satélites , Humanos , Cidades , Aprendizado de Máquina , GanaRESUMO
Nanocapsules are polymeric nanoparticles encased in a polymeric coating composed of a predominantly non-ionic surfactant, macromolecules, phospholipids, and an oil core. Lipophilic drugs have been entrapped using various nanocarriers, including lipid cores, likely lipid nanocapsules, solid lipid nanoparticles, and others. A phase inversion temperature approach is used to create lipid nanocapsules. The PEG (polyethyleneglycol) is primarily utilised to produce nanocapsules and is a critical parameter influencing capsule residence time. With their broad drug-loading features, lipid nanocapsules have a distinct advantage in drug delivery systems, such as the capacity to encapsulate hydrophilic or lipophilic pharmaceuticals. Lipid nanocapsules, as detailed in this review, are surface modified, contain target-specific patterns, and have stable physical and chemical properties. Furthermore, lipid nanocapsules have target-specific delivery and are commonly employed as a marker in the diagnosis of numerous illnesses. This review focuses on nanocapsule synthesis, characterisation, and application, which will help understand the unique features of nanocapsules and their application in drug delivery systems.
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Nanocápsulas , Nanocápsulas/química , Sistemas de Liberação de Medicamentos , Polímeros/química , Tensoativos/química , Lipídeos/química , Portadores de Fármacos/químicaRESUMO
A conjunctival foreign-body (FB) granuloma may result following trauma with synthetic and non-synthetic materials including organic and non-organic objects. Children usually manifest with FB granulomas that develop due to inoculation of FBs from soft toys, blankets or woollen clothes. Encapsu- lation of these FBs following a granulomatous inflammatory response results in a nodular swelling in the conjunctiva. Reports of a wooden FB granuloma in the conjunctiva in children are anecdotal. A 5-year-old boy suffered an un- witnessed direct ocular trauma to his left eye (OS) with a wooden arrow while playing. He developed redness and nodular swelling at the inferotemporal aspect of the OS without any visual complaints. The diagnosis of a wooden FB granuloma is a challenge to ophthalmologists and may go undetected in children who neglect their symptoms. It characteristically presents as a unilateral conjunctival nodule. Surgical excision is the definitive management. However, spontaneous extrusion of the FB might be observed due to protective blinking and tearing mechanisms in the eye.
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Corpos Estranhos no Olho , Granuloma de Corpo Estranho , Humanos , Masculino , Pré-Escolar , Granuloma de Corpo Estranho/diagnóstico , Granuloma de Corpo Estranho/etiologia , Granuloma de Corpo Estranho/cirurgia , Corpos Estranhos no Olho/cirurgia , Corpos Estranhos no Olho/diagnóstico , Corpos Estranhos no Olho/complicações , Doenças da Túnica Conjuntiva/etiologia , Doenças da Túnica Conjuntiva/cirurgia , Doenças da Túnica Conjuntiva/diagnóstico , Túnica Conjuntiva/patologia , Túnica Conjuntiva/cirurgia , Madeira , Remissão EspontâneaRESUMO
In 2003, the United States saw an epidemic of monkeypox that was later traced back to rodents of West Africa infected with the monkeypox virus (MPXV). Disease in the United States seemed less severe than the smallpox-like disease in the Democratic Republic of the Congo (DRC). In this study, researchers analyzed data from Central Africa: two distinct MPXV clades were confirmed by sequencing the genomes of MPXV isolates from Western Africa, the United States, and Central Africa. By comparing open reading frames across MPXV clades, scientists can infer which virus proteins might account for the observed variation in pathogenicity in humans. Monkeypox can be prevented and controlled with a better understanding of MPXV's molecular etiology and epidemiological and clinical features. In light of the current outbreaks worldwide, we provide updated information on monkeypox for medical professionals in this review.
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Mpox , Animais , Humanos , Mpox/epidemiologia , Monkeypox virus/genética , Saúde Global , Proteínas Virais/genética , RoedoresRESUMO
INTRODUCTION: Esthesioneuroblastoma and sinonasal neuroendocrine carcinoma (SNEC) are the most common histological subtypes of non-squamous Sinonasal Tumors. A multidisciplinary approach is preferred for locally advanced unresectable esthesioneuroblastoma and SNEC. METHODS: From June 2010 to October 2021, 59 patients with esthesioneuroblastoma and SNEC received NACT. NACT consists of 2-3 cycles of Etoposide-Platinum based chemotherapy. Depending upon response and performance status, subsequent therapy was planned. SPSS descriptive statistics were performed for analysis. Kaplan Meir methods were used for the estimation of Progression Free Survival (PFS) and Overall Survival (OS). RESULTS: 45 (76.3 %) Esthesioneuroblastoma and 14 (23.7 %) SNEC patients received NACT. The median age of the population was 45 years (range 20-81 years). The majority of patients received 2-3 cycles of Platinum (Cisplatin or Carboplatin) + Etoposide as NACT. 28 patients (47.5%) underwent surgery and 20 patients (33.9%) received definitive chemoradiotherapy after NACT. The most common grade 3 or above adverse events were anemia (13.6%), neutropenia (27.1), and hyponatremia (45.8%). At the time of analysis, the median PFS was 56 months (95% CI 31 months to 77 months), and the median OS was 70 months (95% CI 56 months to 86 months). The most common late toxicities noticed were metabolic syndrome (42.4%), hyperglycemia (39%), nasal bleeding (33.9%), hypertension (17%), dyslipidemia (8.5%), and hypothyroidism (5.1%). CONCLUSION: The study shows that NACT is safe, and can be easily delivered without any life-threatening toxicities, with a favorable response and improved survival in this subset of patients.
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Carcinoma Neuroendócrino , Estesioneuroblastoma Olfatório , Neoplasias Nasais , Neoplasias dos Seios Paranasais , Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Terapia Neoadjuvante/métodos , Estesioneuroblastoma Olfatório/tratamento farmacológico , Etoposídeo/uso terapêutico , Estudos Retrospectivos , Cisplatino , Carcinoma Neuroendócrino/tratamento farmacológico , Neoplasias dos Seios Paranasais/patologia , Cavidade Nasal/patologia , Neoplasias Nasais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
Cancer is the leading cause of human disease and death worldwide, accounting for 7.6 million deaths per year and projected to reach 13.1 million by 2030. Many phytochemicals included in traditional medicine have been utilized in the management of cancer. Conventional chemotherapy is generally known to be the most effective treatment of metastatic cancer but these cancerous cells might grow resistant to numerous anticancer drugs over time that resulting in treatment failure. This review tried to portray the advancement in the anticancer and chemopreventive effects of several phytochemicals and some of its members encapsulated in the nano-based delivery system of the drug. It comprises the issue associated with limited use of each phytoconstituents in human cancer treatment are discussed, and the benefits of entrapment into nanocarriers are evaluated in terms of drug loading efficiency, nanocarrier size, release profile of the drug, and in vitro and/or in vivo research and treatment testing, such as cytotoxicity assays and cell inhibition/viability.
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Antineoplásicos/uso terapêutico , Sistemas de Liberação de Fármacos por Nanopartículas/química , Nanopartículas/química , Neoplasias/tratamento farmacológico , Compostos Fitoquímicos/química , Animais , Antineoplásicos/farmacologia , Linhagem Celular Tumoral , Humanos , Lipossomos/química , Nanocápsulas/química , Nanosferas/químicaRESUMO
High spatial resolution information on urban air pollution levels is unavailable in many areas globally, partially due to high input data needs of existing estimation approaches. Here we introduce a computer vision method to estimate annual means for air pollution levels from street level images. We used annual mean estimates of NO2 and PM2.5 concentrations from locally calibrated models as labels from London, New York, and Vancouver to allow for compilation of a sufficiently large dataset (~250k images for each city). Our experimental setup is designed to quantify intra and intercity transferability of image-based model estimates. Performances were high and comparable to traditional land-use regression (LUR) and dispersion models when training and testing on images from the same city (R2 values between 0.51 and 0.95 when validated on data from ground monitoring stations). Like LUR models, transferability of models between cities in different geographies is more difficult. Specifically, transferability between the three cities i.e., London, New York, and Vancouver, which have similar pollution source profiles were moderately successful (R2 values between zero and 0.67). Comparatively, performances when transferring models trained on these cities with very different source profiles i.e., Accra in Ghana and Hong Kong were lower (R2 between zero and 0.21) suggesting the need for local calibration with local calibration using additional measurement data from cities that share similar source profiles.
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Oxidized low-density lipoprotein (ox-LDL) induces endothelial cell apoptosis and dysfunction. Statins are drugs that are clinically used to lower serum cholesterol levels, and they have been shown to exert vascular protective effects. In the present study, human umbilical vein endothelial cells were transfected with scramble control siRNA or siRNA specific for glutathione peroxidase (GPx)4 or cystine-glutamate antiporter (xCT). MTT, Matrigel and Transwell assays were used to evaluate cell proliferation, tube formation and migration, respectively. The levels of TNF-α, IL-α, 4-hydroxynonenal, GPx4 and xCT expression were detected by western blot analysis. It was demonstrated that ox-LDL promoted cytokine production and reduced the proliferation, migration and angiogenesis of endothelial cells. It was also observed that ox-LDL decreased GPx4 and xCT expression and induced ferroptosis. Furthermore, the inhibition of ferroptosis by deferoxamine mesylate attenuated ox-LDL-induced endothelial cell dysfunction and restored ox-LDL-decreased GPx4 and xCT expression. Consistent with these results, GPx4 and xCT knockdown by siRNA transfection aggravated ox-LDL-induced endothelial cell dysfunction and inhibition of proliferation. To the best of our knowledge, the present study was the first to discover that fluvastatin may protect endothelial cells from ox-LDL-induced ferroptosis and dysfunction. Furthermore, knockdown of GPx4 and xCT expression blunted the protective effects of fluvastatin on ox-LDL-treated endothelial cells. These data indicated a novel function of fluvastatin in the protection of endothelial cells from ox-LDL-induced ferroptosis, the mechanism of which involves the regulation of GPx4 and xCT.
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Natural hazards including floods can trigger catastrophic failures in interdependent urban transport network-of-networks (NoNs). Population growth has enhanced transportation demand while urbanization and climate change have intensified urban floods. However, despite the clear need to develop actionable insights for improving the resilience of critical urban lifelines, the theory and methods remain underdeveloped. Furthermore, as infrastructure systems become more intelligent, security experts point to the growing threat of targeted cyber-physical attacks during natural hazards. Here we develop a hypothesis-driven resilience framework for urban transport NoNs, which we demonstrate on the London Rail Network (LRN). We find that topological attributes designed for maximizing efficiency rather than robustness render the network more vulnerable to compound natural-targeted disruptions including cascading failures. Our results suggest that an organizing principle for post-disruption recovery may be developed with network science principles. Our findings and frameworks can generalize to urban lifelines and more generally to real-world spatial networks.