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BACKGROUND: Polycystic ovary syndrome (PCOS) infertility has attracted great attention from researchers due to its high incidence. Numerous studies have shown that Chinese medicine is effective in treating this disease, but there is a wide variety of Chinese medicine therapies available, and there is a lack of comparative evaluation of the efficacy of various Chinese medicine combination therapies in the clinic, which requires further in-depth exploration. This study aims to evaluate the efficacy of a combined traditional Chinese medicine (TCM) therapy for the treatment of infertility with PCOS using network meta-analysis (NMA). METHODS: In PubMed, web of Science, Cochrane Library, Embase, China Knowledge Network, Wanfang Data, VIP Database, China Biomedical Literature Database (SinoMed) databases, searchs were conducted for information about the randomized controlled trials (RCTs) of combined TCM therapy for the treatment of infertility with PCOS. Quality evaluation was performed using the Cochrane 5.3 risk of bias assessment tool, and NMA using Stata 16.0. RESULTS: This study comprised 28 RCTs using 8 combined TCM therapies in total. The results of the NMA showed that moxibustionâ +â herbal, fire acupunctureâ +â herbal, acupunctureâ +â herbal, electroacupunctureâ +â herbal, and acupoint applicationâ +â herbal improved the clinical pregnancy rate better than acupuncture, herbal, and western medicines monotherapy (Pâ <â .05). Additionally, ear point pressureâ +â herbal enemaâ +â herbal, acupuncture and moxibustionâ +â herbal, fire acupunctureâ +â herbal, and acupunctureâ +â herbal improved the ovulation rate better than acupuncture, herbal, and western medicines monotherapy (Pâ <â .05). Moxibustionâ +â herbal, fire acupunctureâ +â herbal, and acupunctureâ +â herbal are the 3 most effective therapies for improving the clinical pregnancy rate. Fire acupunctureâ +â herbal, acupunctureâ +â herbal, and ear point pressureâ +â herbal enemaâ +â herbal are the 3 most effective therapies for improving the ovulation rate. CONCLUSION: The combined TCM therapy demonstrated better efficacy for the treatment of infertility with PCOS compared to acupuncture, herbal, and western medicines monotherapy. However, the optimal treatment therapy varied depending on the outcome indicators. Further large sample, high-quality, and standardized RCTs are needed to verify these findings.
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Infertilidade Feminina , Medicina Tradicional Chinesa , Síndrome do Ovário Policístico , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/terapia , Síndrome do Ovário Policístico/tratamento farmacológico , Feminino , Infertilidade Feminina/terapia , Infertilidade Feminina/etiologia , Infertilidade Feminina/tratamento farmacológico , Medicina Tradicional Chinesa/métodos , Terapia Combinada , Metanálise em Rede , Gravidez , Terapia por Acupuntura/métodos , Medicamentos de Ervas Chinesas/uso terapêutico , Taxa de GravidezRESUMO
Transpiration is a significant part of water cycle in forest ecosystems, influenced by meteorological factors and potentially constrained by soil moisture. We used Granier-type thermal dissipation probes to monitor xylem sap flow dynamics of three tree species (Quercus liaotungensis, Platycladus orientalis, and Robinia pseudoacacia) in a semi-arid loess hilly region, and to continuously monitor the key meteorological factors and soil water content (SWC). We established the SWC thresholds delineating soil moisture-limited and -unlimited sap flow responses to transpiration drivers. The results showed that mean sap flux density (Js) of Q. liaotungensis and R. pseudoacacia was significantly higher during period with higher soil moisture compared to lower soil moisture, while the difference in Js for P. orientalis between the two periods was not significant. We used an exponential saturation function to fit the relationship between the Js of each tree species and the integrated transpiration variable (VT) which reflected solar radiation and vapor pressure deficit. The difference in the fitting curve parameters indicated that there were distinct response patterns between Js and VT under different soil moisture conditions. There was a threshold in soil moisture limitation on sap flow for each species, which was identified as 0.129 m3·m-3 for Q. liaotungensis, 0.116 m3·m-3 for P. orientalis, and 0.108 m3·m-3 for R. pseudoacacia. Below the thresholds, Js was limited by soil moisture. Above these points, the normalized sensitivity index (NSI) for Q. liaotungensis and P. orientalis reached saturation, while that of R. pseudoacacia did not reach saturation but exhibited a significant reduction in moisture limitation. Among the three species, P. orientalis was the most capable of overcoming soil moisture constraints.
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Transpiração Vegetal , Solo , Árvores , Água , Solo/química , Água/metabolismo , Água/análise , Árvores/crescimento & desenvolvimento , Árvores/fisiologia , Árvores/metabolismo , China , Quercus/fisiologia , Quercus/crescimento & desenvolvimento , Quercus/metabolismo , Ecossistema , Robinia/fisiologia , Robinia/crescimento & desenvolvimento , Robinia/metabolismo , Florestas , Xilema/fisiologia , Xilema/metabolismo , Exsudatos de Plantas/metabolismoRESUMO
OBJECTIVE: To explore the effect and mechanism of Dahuang Zhechong Pill (DHZCP) on liver fibrosis. METHODS: Liver fibrosis cell model was induced by transforming growth factor-ß (TGF-ß) in hepatic stellate cells (HSC-T6). DHZCP medicated serum (DMS) was prepared in rats. HSC-T6 cells were divided into the control (15% normal blank serum culture), TGF-ß (15% normal blank serum + 5 ng/mL TGF-ß), DHZCP (15% DMS + 5 ng/mL TGF-ß), DHZCP+PDTC [15% DMS + 4 mmol/L ammonium pyrrolidine dithiocarbamate (PDTC)+ 5 ng/mL TGF-ß], and PDTC groups (4 mmol/L PDTC + 5 ng/mL TGF-ß). Cell activity was detected by cell counting kit 8 and levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß, IL-6, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the cell supernatant were determined by enzyme-linked immunosorbnent assay. Western blot was used to measure the expressions of p38 mitogen-activated protein kinase/nuclear factor kappa B/transforming growth factor-ß1 (p38 MAPK/NF-κ B/TGF-ß1) pathway related proteins, and the localization and expressions of these proteins were observed by immunofluorescence staining. RESULTS: DHZCP improves the viability of cells damaged by TGF-ß and reduces inflammatory cytokines and ALT and AST levels in the supernatant of HSC-T6 cells induced with TGF-ß (P<0.05 or P<0.01). Compared with the TGF-ß group, NF-κ B p65 levels in the DHZCP group were decreased (P<0.05). p38 MAPK and NF-κ B p65 levels in the DHZCP+PDTC were also reduced (P<0.01). Compared with the TGF-ß group, the protein expression of Smad2 showed a downward trend in the DHZCP, DHZCP+PDTC, and PDTC groups (all P<0.01), and the decreasing trend of Samd3 was statistically significant only in DHZCP+PDTC group (P<0.01), whereas Smad7 was increased (P<0.05 or P<0.01). CONCLUSION: DHZCP can inhibit the process of HSC-T6 cell fibrosis by down-regulating the expression of p38 MAPK/NF-κ B/TGF-ß1 pathway.
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BACKGROUND: Acute respiratory distress syndrome (ARDS) is a severe respiratory condition characterized by a high mortality rate, the management of which relies on supportive care and a profound understanding of its pathophysiology. Heparin, with its anticoagulant and potential anti-inflammatory properties, offers a new therapeutic opportunity for the treatment of ARDS. METHODS: In this retrospective cohort study, we examined the MIMIC-IV database for ARDS patients who received prophylactic heparin within the first 72 h of ICU admission. Employing propensity score matching and inverse probability weighting (IPW) analysis, we evaluated the impact of early heparin use on patient outcomes, focusing on mortality rates. RESULTS: Patients who received prophylactic heparin had a significantly lower in-hospital mortality rate compared to those who did not (13.55% vs 17.93%, HR = 0.71, 95% CI: 0.54-0.93, P = 0.012). This result remained significant after propensity score matching (12.75% vs 17.93%, HR = 0.65, 95% CI 0.47-0.90, P = 0.010). Analysis using five different statistical models indicated that early use of heparin significantly reduced the in-hospital mortality rate, with HR = 0.669 (95% CI 0.487-0.919, P = 0.013) in the doubly robust model without balanced covariates; HR = 0.705 (95% CI 0.515-0.965, P = 0.029) with all covariates considered; HR = 0.660 (95% CI 0.491-0.888, P = 0.006) in the propensity score (IPW) model; HR = 0.650 (95% CI 0.470-0.900, P = 0.010) in the propensity score matching model; and HR = 0.706 (95% CI 0.536-0.930, P = 0.013) in the multivariate Cox regression model. Secondary outcomes indicated that heparin use was also associated with reduced mortality rates at 60 days, and 90 days. CONCLUSION: This research highlights that early prophylactic administration of heparin may substantially lower mortality in ARDS patients. These findings underscore the potential of heparin as a key component in the management of ARDS, offering a new perspective and novel strategies for clinical treatment.
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The design of earth-abundant and highly efficient bifunctional electrocatalysts for hydrogen evolution and oxygen evolution reactions (HER/OER) is crucial for hydrogen production through overall water splitting. Herein, we report a novel nanostructure consisting of vertically oriented CoP hierarchical nanosheet arrays with in situ-assembled carbon skeletons on a Ti foil electrode. The novel Zeolitic Imidazolate Framework-67 (ZIF-67) template-derived hierarchical nanosheet architecture effectively improved electrical conductivity, facilitated electrolyte transport, and increased the exposure of the active sites. The obtained bifunctional hybrid exhibited a low overpotential of 72 mV at 10 mA cm-2 and a small Tafel slope of 65 mV dec-1 for HER, and an improved overpotential of 329 mV and a Tafel slope of 107 mV dec-1 for OER. Furthermore, the assembled C@CoP||C@CoP electrolyzer showed excellent overall water splitting performance (1.63 V) at a current density of 10 mA cm-2 and superior durability. This work provides a structure engineering strategy for metal-organic framework (MOF) template-derived hybrids with outstanding electrocatalytic performance.
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OBJECTIVE: To estimate the prevalence and risk factors associated with tuberculosis (TB) among people living with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) in China. METHODS: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. After the literature was screened based on the inclusion and exclusion criteria, STATA® version 17.0 software was used for the meta-analysis. The heterogeneity among study data was assessed using I2 statistics. Subgroup analysis and meta-regressions were performed to further explore the source of heterogeneity. RESULTS: A total of 5241 studies were retrieved. Of these, 44 studies were found to be eligible. The pooled prevalence of HIV/TB co-infection was 6.0%. The risk factors for HIV/TB co-infection included a low CD4+ T cell count, smoking, intravenous drug use and several other sociodemographic and clinical factors. Bacillus Calmette-Guérin (BCG) vaccination history was a protective factor. CONCLUSION: A high prevalence of TB was observed among people living with HIV/AIDS in China. Low CD4+ T cell count, smoking, and intravenous drug use were the primary risk factors for HIV/TB co-infection, whereas BCG vaccination history was a protective factor. Checking for TB should be prioritized in HIV screening and healthcare access. SYSTEMATIC REVIEW REGISTRATION: Registered on PROSPERO, Identifier: CRD42022297754.
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Síndrome da Imunodeficiência Adquirida , Coinfecção , Tuberculose , Humanos , Vacina BCG , Coinfecção/epidemiologia , Prevalência , Fatores de Risco , Tuberculose/epidemiologia , China/epidemiologiaRESUMO
The brain metabolic changes caused by the interruption of blood supply are the initial factors of brain injury in ischemic stroke. Electroacupuncture (EA) pretreatment has been shown to protect against ischemic stroke, but whether its neuroprotective mechanism involves metabolic regulation remains unclear. Based on our finding that EA pretreatment significantly alleviated ischemic brain injury in mice by reducing neuronal injury and death, we performed a gas chromatography-time of flight mass spectrometry (GC-TOF/MS) to investigate the metabolic changes in the ischemic brain and whether EA pretreatment influenced these changes. First, we found that some glycolytic metabolites in the normal brain tissues were reduced by EA pretreatment, which may lay the foundation of neuroprotection for EA pretreatment against ischemic stroke. Then, 6[Formula: see text]h of cerebral ischemia-induced brain metabolic changes, especially the enhanced glycolysis, were partially reversed by EA pretreatment, which was manifested by the brain levels of 11 of 35 up-regulated metabolites and 18 of 27 down-regulated metabolites caused by cerebral ischemia significantly decreasing and increasing, respectively, due to EA pretreatment. A further pathway analysis showed that these 11 and 18 markedly changed metabolites were mainly involved in starch and sucrose metabolism, purine metabolism, aspartate metabolism, and the citric acid cycle. Additionally, we found that EA pretreatment raised the levels of neuroprotective metabolites in both normal and ischemic brain tissues. In conclusion, our study revealed that EA pretreatment may attenuate the ischemic brain injury by inhibiting glycolysis and increasing the levels of some neuroprotective metabolites.
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Lesões Encefálicas , Isquemia Encefálica , Eletroacupuntura , AVC Isquêmico , Traumatismo por Reperfusão , Acidente Vascular Cerebral , Camundongos , Animais , Eletroacupuntura/métodos , Neuroproteção , Isquemia Encefálica/metabolismo , Metabolômica , Traumatismo por Reperfusão/prevenção & controle , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
Stroke is a fatal neurological disease, which seriously threatens human health and life. Ischemic stroke (IS) is the most common type of stroke in clinic. Its pathogenesis is very complex, mainly caused by nerve damage caused by brain blood supply disorder. Previous studies have confirmed that natural products play important roles in improving neurological disorders. Furthermore, our previous results also suggested that Shenxiong Tongmai granule, a clinically used herbal medicines' prescription, has a good ameliorating effect on IS. In the present study, we found that Monomethyl lithospermate (MOL), a constituent of Shenxiong Tongmai granule, significantly improved the neurological damage in middle cerebral artery occlusion (MCAO) rats. MOL can significantly improve the neurological deficit score of MCAO rats, and improve the damage of hippocampal neurons caused by ischemia-reperfusion (IR). At the same time, we also found that MOL could reduce the level of oxidative stress in the brain tissues of MCAO rats. Furthermore, the oxygen and glucose deprivation/Reoxygenation (OGD/R)-induced SHSY-5Y cell model was established in vitro to investigate the pharmacological activity and molecular mechanisms of MOL in improving the nerve injury of IS rats. The results showed that MOL could increase the cell viability of SHSY-5Y cells, inhibit the mitochondrial membrane potential (MMOP) collapse and suppress apoptosis. In addition, MOL also ameliorated the elevated oxidative stress level caused by OGR/R treatment in SHSY-5Y cells. Further mechanistic studies showed that MOL could activate the PI3K/AKT pathway via promoting the phosphorylation of PI3K and AKT in MCAO rats and OGR/R-induced SHSY-5Y cells, which could be partially blocked by addition of PI3K/AKT pathway inhibitor of LY294002. Taken together, our current study suggested that MOL exerts a protective effect against neural damage caused by IS in vivo and in vitro by activating the PI3K/AKT pathway.
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Using DC3 high-resolution dendrometer and Granier-type thermal dissipation probes, we measured stem diameter micro-variations and xylem sap flow of two typical forestation species, Quercus liaotungensis and Robinia pseudoacacia, for a growing season in the loess hilly region of China. The main environmental factors (soil water content, solar radiation, air temperature and relative humidity) were monitored. The linkage between diameter micro-variations and transpiration water use were analyzed with respect to their responses to environmental factors. The results showed that the variations in stem diameter and sap flux density of both species had obvious diurnal rhythms. The maximum daily shrinkage was positively correlated with daily sap flux density. The micro-variation of stem diameter at the daily scale was affected by transpiration during the day. The maximum daily shrinkage of stem diameter was positively correlated and well fitted with transpiration driving factors (solar radiation, vapor pressure deficit, and the integrated variable VT). The difference in slopes of regression curves suggested that the daily variation of stem diameter in Q. liaotungensis was greater and more sensitive to meteorological factors than that in R. pseudoacacia. The sap flux densities of both tree species were higher during the period with relatively higher soil water content than that with lower soil water content. The difference of maximum daily diameter shrinkage between different soil water conditions was statistically significant in Q. liaotungensis, but not in R. pseudoacacia. These differences may be related to water use strategies, including transpiration regulation and stem water replenishment.
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Transpiração Vegetal , Robinia , China , Estações do Ano , Solo , Árvores , Água/análiseRESUMO
BACKGROUND: High power shorter duration (HPSD) ablation seen to increase efficacy and safety treating of atrial fibrillation (AF); however, comparative data between HPSD and low power longer duration (LPLD) ablation are limited. HYPOTHESIS: We thought that HPSD might bring more clinical benefits. The aim of this meta-analysis was to evaluate the clinical benefits of HPSD in patients with AF. METHODS: The Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPSD and LPLD ablation. RESULTS: Ten trials with 2467 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first-pass pulmonary vein isolation (PVI) (risk ratio [RR]: 1.20; 95% confidence interval [CI]: 1.10-1.31, P < .001) and recurrence of atrial arrhythmias (RR: 0.73; 95% CI: 0.58-0.91, P = .005). Additionally, HPSD could reduce procedural time (weighted mean difference [WMD]: -42.93; 95% CI, -58.10 to -27.75, P < .001), ablation time (WMD: -21.01; 95% CI: -24.55 to -17.47, P < .001), and fluoroscopy time (WMD: -4.11; 95% CI: -6.78 to -1.45, P < .001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44-1.30, P = .31) and (RR: 0.57; 95% CI: 0.21-1.51, P = .26). CONCLUSIONS: HPSD was safe and efficient for treating AF. Compared with LPLD, HPSD was associated with advantages of procedural features, higher first-pass PVI and reducing recurrence of atrial arrhythmias. Moreover, major complications and ETI were similar between two groups.
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Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Sistema de Condução Cardíaco/fisiopatologia , Veias Pulmonares/cirurgia , Fibrilação Atrial/fisiopatologia , Humanos , Recidiva , Resultado do TratamentoRESUMO
Recently, low-dimensional organic-inorganic hybrid metal halide perovskites acting as single-component white-light emitting materials have attracted extensive attention, but most studies concentrate on hybrid lead perovskites. Herein, we present two isomorphic zero-dimensional (0D) hybrid cadmium perovskites, (HMEDA)CdX4 (HMEDA=hexamethylenediamine, X=Cl (1), Br (2)), which contain isolated [CdX4 ]2- anions separated by [HMEDA]2+ cations. Under UV light excitation, both compounds display broadband bluish white-light emission (515â nm for 1 and 445â nm for 2) covering the entire visible light spectrum with sufficient photophysical stabilities. Remarkably, compound 2 shows a high color rendering index (CRI) of 83 enabling it as a promising candidate for single-component WLED applications. Based on the temperature-dependent, powder-dependent and time-resolved PL measurements as well as other detailed studies, the broadband light emissions are attributed to self-trapped excitons stemming from the strong electron-phonon coupling.
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The mitochondrial alternative pathway (AP) represents an important photoprotective mechanism for the chloroplast, but the temperature sensitivity of its photoprotective role is unknown. In this study, using the aox1a Arabidopsis mutant, the photoprotective role of the AP was verified under various temperatures, and the mechanism underlying the temperature sensitivity of the AP's photoprotective role was clarified. It was observed that the photoprotective role of the AP increased with rising temperature but was absent at low temperature. The photoprotective role of the AP was severely reduced under non-photorespiratory conditions. Disturbance of the AP inhibited the conversion of glycine to serine in mitochondria, which may restrain upstream photorespiratory metabolism and aggravate photoinhibition. With rising temperatures, photorespiration accelerated and the restraint of photorespiration caused by disturbance of the AP also increased, determining the temperature sensitivity of the AP's photoprotective role. We also verified that not only the AP but also the cytochrome pathway in mitochondria contributes to photoprotection by maintaining photorespiration.
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Arabidopsis/fisiologia , Mitocôndrias/metabolismo , Arabidopsis/efeitos dos fármacos , Arabidopsis/genética , Clorofila A/metabolismo , Temperatura Baixa , Glicina/metabolismo , Temperatura Alta , Luz , Metacrilatos/farmacologia , Proteínas Mitocondriais/genética , Mutação , NADP/metabolismo , Oxirredutases/genética , Fotossíntese , Folhas de Planta/fisiologia , Proteínas de Plantas/genética , Serina/metabolismo , Tiazóis/farmacologiaRESUMO
The clinical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in prior coronary artery bypass graft (pCABG) patients have been investigated; however, the results are inconsistent.The present meta-analysis compared the clinical outcomes of CTO PCI in patients with and without prior CABG (nCABG). The endpoints included technical success, procedural success, all-cause mortality, myocardial infarction (MI), major bleeding, coronary perforation, pericardial tamponade, emergency CABG, and vascular access complication.A total of 7 studies comprising of 11099 patients were included in this meta-analysis. The results showed that compared to nCABG patents, pCABG patients were associated with lower technical success (82.3% versus 87.8%; OR, 0.60; 95% CI, 0.53-0.68; Pâ<â.00001; Iâ=â0%) and procedural success (80.4% versus 86.2%; OR, 0.61; 95% CI, 0.53-0.70; Pâ<â.00001; Iâ=â10%); a higher risk of all-cause mortality (OR, 2.95; 95% CI, 1.56-5.57; Pâ=â0.0008; Iâ=â0%), MI (OR, 2.30; 95% CI, 1.40-3.80; Pâ=â.001; Iâ=â5%), and coronary perforation (OR, 2.16; 95% CI, 1.51-3.08; Pâ<â0.0001; Iâ=â52%). On the other hand, the risk of pericardial tamponade (OR, 0.42; 95% CI, 0.15-1.18; Pâ=â.10; Iâ=â21%), major bleeding (OR, 1.51; 95% CI, 0.90-2.53; Pâ=â.11; Iâ=â0%), vascular access complication (OR, 1.50; 95% CI, 0.93-2.41; Pâ=â.10; Iâ=â0%), and emergency CABG (OR, 0.99; 95% CI, 0.25-3.91; Pâ=â.99; Iâ=â0%) was similar in both groups.Compared to nCABG patients, pCABG patients had lower CTO PCI success rates, higher rates of in-hospital mortality, MI, and coronary perforation, and similar risk of pericardial tamponade and vascular complication rates.
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Ponte de Artéria Coronária/estatística & dados numéricos , Oclusão Coronária/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Tamponamento Cardíaco/etiologia , Hemorragia/etiologia , Humanos , Infarto do Miocárdio/etiologia , Estudos Observacionais como Assunto , Projetos de Pesquisa , Fatores de Risco , Metanálise como AssuntoRESUMO
Although many methods and new therapeutic drugs have been developed, the overall survival rate and long-term survival rate of patients with gastric cancer (GC) are still not satisfactory. In this study, we investigated the effects of microRNA miR-133a-3p and transcription factor FOXP3 on proliferation and autophagy of GC cells and their interactions. Our results showed that knockdown of FOXP3 increased the proliferation and autophagy of GC cells. The relationship between FOXP3 and autophagy has not been reported previously. In addition, FOXP3 could directly bind the promoter region of TP53 and inhibit its expression. miR-133a-3p increased the proliferation and autophagy via decreasing the protein level of FOXP3 by targeting its 3'-UTR. Our research provides new insights into the development of GC and provides new ideas and theoretical basis for the clinical treatment of GC and the development of new drug targets.
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Autofagia , Proliferação de Células , Fatores de Transcrição Forkhead/metabolismo , Regulação Neoplásica da Expressão Gênica , MicroRNAs/metabolismo , Neoplasias Gástricas/metabolismo , Regiões 3' não Traduzidas , Biomarcadores Tumorais/metabolismo , Linhagem Celular Tumoral , Citoplasma/metabolismo , Humanos , Regiões Promotoras GenéticasRESUMO
PURPOSE: Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) vs. radiofrequency (RF) ablation in elderly patients (> 75 years old). The present study aimed to compare the costs and clinical outcomes in elderly patients using these two strategies. METHODS: Elderly patients with symptomatic drug-refractory paroxysmal/short-lasting persistent AF were included in the study. Pulmonary vein isolation (PVI) was performed in all patients. RESULTS: A total of 324 elderly patients were included (RF,176; CB-2,148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs. 135.1 ± 9.9 min, P < 0.001; 53.7 ± 8.9 vs. 65.1.9 ± 9.0 min, P < 0.001) but marked fluoroscopy utilization (22.1 ± 3.3 vs. 18.5 ± 3.6 min, P < 0.001). Complications occurred in 3.3% (CB-2) and 6.2% (RF) of patients with no significant different (p = 0.307). The length of stay after ablation was shorter, but the costs were higher in the CB-2 group (1.94 vs. 2.53 days, P < 0.001 and 91,132.6 ± 3723.5 vs. 81,149.4 ± 6824.1 CNY, P < 0.001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia (ERAA) was lower in the CB-2 group (14.2 vs. 23.3%, P = 0.047), but the long-term success rate was similar between two groups. CONCLUSIONS: CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, as well as lower ERAA, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long-term success is similar between the two groups.
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Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , China/epidemiologia , Feminino , Humanos , Masculino , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Recidiva , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
BACKGROUND: Several studies have evaluated the long-term clinical outcomes of periprocedural myocardial injury for chronic total occlusions patients. However, the results of these studies were inconsistent. To determine whether the periprocedural myocardial injury has adverse effects on long-term clinical outcomes in chronic total occlusion patients undergoing percutaneous coronary intervention. METHODS: We searched Cochrane Library, PubMed, and Embase for eligible articles from their date of inception up to March 2019. Long-term clinical outcomes included major adverse cardiac events, all-cause death, cardiac death, myocardial infarction, and target vessel revascularization. Odds ratios with 95% confidence intervals were calculated as summary statistics by using Review Manager software. RESULTS: A total of 8 observational studies involving 5879 chronic total occlusions patients were included in this meta-analysis. These results of this meta-analysis indicated that periprocedural myocardial injury was associated with a higher risk of major adverse cardiac events (odds ratio, 1.94; 95% confidence interval, 1.22-3.08; P = 0.005), a higher risk of all-cause death (odds ratio, 1.30; 95% confidence interval, 1.02-1.64; P = 0.03), a higher risk of cardiac death (odds ratio, 2.59; 95% confidence interval, 1.41-4.78; P = 0.002), a higher risk of myocardial infarction (odds ratio, 3.07; 95% confidence interval, 1.90-4.98; P < 0.00001), and a higher risk of target vessel revascularization (odds ratio, 2.07; 95% confidence interval, 1.35-3.16; P=0.0008) than non-periprocedural myocardial injury. CONCLUSION: Periprocedural myocardial injury was associated with significantly increased risk of major adverse cardiac events, all-cause death, cardiac death, myocardial infarction, and target vessel revascularization in chronic total occlusion patients undergoing percutaneous coronary intervention at long-term follow-up.
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Oclusão Coronária/cirurgia , Complicações Intraoperatórias/epidemiologia , Mortalidade , Infarto do Miocárdio/epidemiologia , Isquemia Miocárdica/epidemiologia , Miocárdio , Intervenção Coronária Percutânea , Doenças Cardiovasculares/mortalidade , Doença Crônica , Humanos , Revascularização Miocárdica/estatística & dados numéricos , Razão de Chances , Período Perioperatório , Prognóstico , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: The ThermoCool Smarttouch Surroundflow catheter (STSFc) is an advanced catheter, which integrating contact force sensing and surroundflow technology. However, comparative data between STSFc and contact force sensing catheter (Thermocool SmartTouch catheter [STc]) are limited. HYPOTHESIS: We thought that STSFc might bring more clinical benefits. The aim of this meta-analysis was to compare the safety and efficiency between the STSFc and the STc for treatment of atrial fibrillation (AF). METHODS: The Medline, PubMed, Embase, and Cochrane Library databases were searched for studies comparing STSFc and STc. RESULTS: Four trials involving 727 patients were included in the study. Pool-analyses demonstrated that, as compared STc ablation, STSFc ablation was more beneficial in terms of procedural times (standard mean difference [SMD]: -0.22; 95% confidence interval [CI], -0.37 to -0.07, P = .005) and irrigation fluid volume (SMD: -1.94; 95% CI, -2.65 to -1.22, P < .0001). There was no significant difference between STSFc and STc (risk ratio [RR]: 1.02; 95% CI: 0.86 to 1.21, P = .79) for free from AF. Evidence of complications were low and similar for both groups (RR: 0.83; 95% CI: 0.19-3.55, P = .80). Additionally, patients administered STSFc ablation tended to have shorter fluoroscopic times (SMD: -0.20; 95% CI, -0.63-0.23, P = .21). CONCLUSIONS: STSFc ablation was associated with reducing procedural times and irrigation fluid volume. Further, STSFc ablation tended to shorten fluoroscopic times. Therefore, STSFc ablation would be a better choice for AF patients especially in patients with heart failure.
Assuntos
Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Ablação por Cateter/instrumentação , Irrigação Terapêutica/instrumentação , Transdutores de Pressão , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Ablação por Cateter/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Temperatura , Irrigação Terapêutica/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Lead-related complication is an important drawback of trans-venous implantable cardioverter-defibrillators (TV-ICD). The subcutaneous ICD (S-ICD) was developed to overcome ICD lead associated complications; however, whether the S-ICD confers enhanced clinical benefits compared with TV-ICD remains unclear. The present systematic review and meta-analysis aimed to assess TV-ICD and S-ICD for safety, efficacy, and in-hospital outcomes in the prevention of sudden cardiac death (SCD) in patients not requiring pacing. METHODS: The Medline, PubMed, EmBase, and Cochrane Library databases were searched for studies comparing TV-ICD and S-ICD. RESULTS: A total of 9 eligible studies, including 5 propensity-matched case-control, 3 retrospective, and 1 cross-sectional studies were identified, assessing 7361 patients in all. Pool analyses demonstrated that SICD were associated with lower lead-related complication rates [odds ratio (OR)â=â0.13; 95% confidence interval [CI] 0.05-0.33; Iâ=â0%], and S-ICD was more beneficial in terms of reducing ICD shocks [ORâ=â0.48; 95% CI 0.32-0.72, Iâ=â4%]. In addition, the patients administered S-ICD tend to have shorter length of hospital stay after implantation (SMDâ=â-0.06; 95% CI -0.11 to 0.00, Iâ=â0%) and reduce total complication rates (ORâ=â0.72; 95% CI 0.50-1.03; Iâ=â18%), non-decreased quality of life (QoL). Moreover, both devices appeared to perform equally well with respect to infection rate and death. CONCLUSIONS: Available overall data suggested that S-ICD is associated with reducing lead-related complications, ICD shocks. In addition, S-ICD has tendency to shorten hospitalization and reduce total complications, although the difference is no significant. Equivalent death rate, infection, and QoL were found between 2 groups. Therefore, S-ICD could be considered an alternative approach to TV-ICD in appropriate patients for SCD prevention.
Assuntos
Doenças Cardiovasculares/terapia , Desfibriladores Implantáveis , Desfibriladores Implantáveis/efeitos adversos , Falha de Equipamento , Humanos , Complicações Pós-OperatóriasRESUMO
Graphene oxide (GO) membranes have the potential to be next-generation membranes. However, the GO layer easily swells in water and risks shedding during the long-term filtration. Organic GO interlayer organic cross-linking agent was not resistant to oxidation, which limits the application scope of GO membrane. In this study, an inorganic cross-linked GO membrane was prepared via the reaction of sodium tetraborate and GO hydroxyl groups, and a -B-O-C- cross-linking bond was detected by X-ray photoelectron spectroscopy (XPS). Additionally, a new atomic force microscope scratch method to evaluate the cross-linking force of a nanoscale GO layer was proposed. It showed that the critical destructive load of the inorganic cross-linked GO membrane increased from 8 to 80 nN, which was a 10-fold increase from that of the nonlinked sample. During the NaOH/sodium dodecyl sulfate (SDS) destructive wash tests, morphology, flux and retention rate of inorganic cross-linked GO remained stable while the comparative membranes showed significant destruction. At the same time, based on the better oxidation resistance, organic membrane fouling was effectively controlled by the introduction of trace ·OH radicals. This study provides a new perspective for GO membrane preparation, interlayer cross-linking force testing and membrane fouling control.
Assuntos
Grafite , Boratos , Filtração , Membranas Artificiais , ÓxidosRESUMO
Some refractory organic matters or soluble microbial products remained in the effluents of refractory organic wastewater after biological secondary treatment and need an advanced treatment before final disposal. Graphene oxide (GO) was known to have potential to be the next generation membrane material. The functional organics/inorganic salts separation GO membrane preparation and application in wastewater advanced treatment could reduce energy or chemicals consumption and avoid organics/inorganic salts mixed concentrate waste problems after nanofiltration or reverse osmosis. In this study, we developed a novelty GO membrane aiming at advanced purification of organic matters in the secondary effluents of refractory organic wastewater and avoiding the organics/inorganic salts mixed concentrate waste problem. The influence of preparation conditions including pore size of support membrane, the number of GO layers and the applied pressure was investigated. It was found that for organics/inorganic salts mixture separation membrane preparation, the rejection and flux would achieve balance for the support membrane at a pore size of ~0.1µm and the number of GO layers of has an optimization value (~10 layers). A higher assemble pressure (~10bar) contributed to the acquisition of a higher rejection efficiency and lower roughness membrane. This as prepared GO membrane was applied to practical secondary effluent of a chemical synthesis pharmaceuticals wastewater. A good organic matter rejection efficiency (76%) and limited salt separation (<14%) was finally obtained. These results can promote the practical application of GO membrane and the resourcelized treatment of industrial wastewater.