Postoperative Kinesiophobia in Patients with Acute Type A Aortic Dissection: A Cross-Sectional Study.

Background: This cross-sectional study explores postoperative kinesiophobia in patients with acute type A aortic dissection (AAAD), an understudied area. The occurrence of postoperative kinesiophobia and its relation to various factors were investigated. Methods: Patients diagnosed with AAAD and undergoing surgical treatment from January 2019 to December 2021 were selected through continuous sampling. Kinesiophobia levels were assessed using the Tampa Scale for Kinesiophobia Heart (TSK-SV-HEART). Univariate and multivariate regression analyses were employed to determine factors influencing kinesiophobia. Results: Out of 264 included patients, the mean postoperative kinesiophobia score was 38.15 (6.66), with a prevalence of 46.2%. Multivariate logistic regression revealed that education level, general self-efficacy, family care index, and facing style reduced kinesiophobia, while avoidance style and yielding style increased it. Conclusions: Postoperative kinesiophobia prevalence in AAAD patients is high and associated with diverse factors. Medical staff should remain vigilant to potential kinesiophobia during postoperative rehabilitation.

Sex-Based Differences in the Risk of Contrast-Induced Nephropathy and Clinical Outcomes in Patients Undergoing Coronary Angiography and/or Percutaneous Coronary Intervention.

Background: There is still controversial or limited evidence on whether sex differences exist in clinical characteristics, the risk of contrast-induced nephropathy (CIN), and other clinical outcomes of patients who received coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). The aim of this study was to characterize the effect of sex on clinical characteristics and outcomes of patients undergoing CAG and/or PCI. Methods: A total of 3,340 consecutive patients undergoing CAG and/or PCI from May 2017 to December 2022 were assessed in this retrospective study. Subgroup analyses by sex were performed. Clinical characteristics, treatments, the risk of CIN, and other clinical outcomes, including in-hospital and follow-up, were compared between females and males. Results: Females undergoing CAG and/or PCI tended to have an advanced age (65.8 versus 63.3 years, p < 0.001), a higher burden of complications, and received PCI less frequently compared with males (43.2% versus 64.2%, p < 0.001). After adjustment, female sex was associated with a higher incidence of CIN [adjusted odds ratio (aOR) 1.47; 95% CI 1.08-2.01; p = 0.015] and a higher all-cause readmission rate (aOR 1.26; 95%CI 1.02-1.56; p = 0.031). Meanwhile, females undergoing CAG alone demonstrated a higher risk of severe arrhythmia compared with males after controlling for potential confounders (aOR 1.52; 95% CI 1.12-2.04; p = 0.006). Conclusion: Sex disparities exist in the clinical characteristics, treatments, the risk of CIN, and other clinical outcomes among patients undergoing CAG and/or PCI. Female sex was identified as an independent predictor of risk for CIN, all-cause readmission rate, and severe arrhythmia.

Genomic insights into the modifications of spike morphology traits during wheat breeding.

Over the past century, environmental changes have significantly impacted wheat spike morphology, crucial for adaptation and grain yield. However, the changes in wheat spike modifications during this period remain largely unknown. This study examines 16 spike morphology traits in 830 accessions released from 1900 to 2020. It finds that spike weight, grain number per spike (GN), and thousand kernel weight have significantly increased, while spike length has no significant change. The increase in fertile spikelets is due to fewer degenerated spikelets, resulting in a higher GN. Genome-wide association studies identified 49,994 significant SNPs, grouped into 293 genomic regions. The accumulation of favorable alleles in these genomic regions indicates the genetic basis for modification in spike morphology traits. Genetic network analysis of these genomic regions reveals the genetic basis for phenotypic correlations among spike morphology traits. The haplotypes of the identified genomic regions display obvious geographical differentiation in global accessions and environmental adaptation over the past 120 years. In summary, we reveal the genetic basis of adaptive evolution and the interactions of spike morphology, offering valuable resources for the genetic improvement of spike morphology to enhance environmental adaptation.

The Pan-Immune Inflammation Value at Admission Predicts Postoperative in-hospital Mortality in Patients with Acute Type A Aortic Dissection.

Purpose: The inflammatory response of the body is intimately linked to the quick onset and high in-hospital mortality of Acute Type A Aortic Dissection (ATAAD). The purpose of the study was to examine the connection between in-hospital mortality in patients with ATAAD upon admission and the Pan-Immune-Inflammation Value (PIV). Patients and Methods: 308 patients who were diagnosed with ATAAD between September 2018 and October 2021 at Fujian Provincial Center for Cardiovascular Medicine had their clinical data retrospectively examined. PIV was assessed at the time of study population admission, with in-hospital mortality serving as the main outcome measure. Patients were divided into two groups, the high PIV group (PIV > 1807.704) and the low PIV group (PIV < 1807.704), based on the PIV ROC curve and the best threshold of the Youden index. The clinical results of the two groups were then compared. Results: Among ATAAD patients, postoperative in-hospital mortality was higher in the high PIV group (54.7% vs 10.6%, P < 0.001), and the high PIV group had significantly higher rates of postoperative acute kidney injury, acute liver insufficiency, and gastrointestinal hemorrhage (P < 0.05). Additionally, the high PIV group's ICU stays lasted longer than the low PIV group's (P < 0.05). The results of multifactorial logistic regression analysis, which controlled for other variables, indicated that the mechanical ventilation time (OR = 1.860, 95% CI: 1.437, 2.408; P < 0.001), the high PIV group (> 1807.704) (OR = 1.939, 95% CI: 1.257, 2.990; P = 0.003), the cardiopulmonary bypass time (OR = 1.011, 95% CI: 1.004, 1.018; P = 0.002), and the white blood cell count (OR = 1.188, 95% CI: 1.054, 1.340; P = 0.005) were independent risk factors for postoperative in-hospital mortality in ATAAD patients. Conclusion: Postoperative death in ATAAD patients was independently predicted by high PIV levels at admission. Patients should be informed about their preoperative inflammatory status and actively participate in prompt clinical decision-making and treatment.

Predictive value of inflammatory prognostic index for contrast-induced nephropathy in patients undergoing coronary angiography and/or percutaneous coronary intervention.

The purpose of this study was to investigate the relationship between Inflammatory Prognostic Index (IPI) levels and Contrast-Induced Nephropathy (CIN) risk and postoperative clinical outcomes in patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). A total of 3,340 consecutive patients who underwent CAG and/or PCI between May 2017 and December 2022 were enrolled in this study. Based on their baseline IPI levels, patients were categorized into four groups. Clinical characteristics and postoperative outcomes were compared among these groups. In-hospital outcomes focused on CIN risk, repeated revascularization, major bleeding, and major adverse cardiovascular events (MACEs), while the long-term outcome examined the all-cause readmission rate. Quartile analysis found a significant link between IPI levels and CIN risk, notably in the highest quartile (P < 0.001). Even after adjusting for baseline factors, this association remained significant, with an adjusted Odds Ratio (aOR) of 2.33 (95%CI 1.50-3.64; P = 0.001). Notably, baseline IPI level emerged as an independent predictor of severe arrhythmia, with aOR of 0.50 (95%CI 0.35-0.69; P < 0.001), particularly driven by the highest quartile. Furthermore, a significant correlation between IPI and acute myocardial infarction was observed (P < 0.001), which remained significant post-adjustment. For patients undergoing CAG and/or PCI, baseline IPI levels can independently predict clinical prognosis. As a comprehensive inflammation indicator, IPI effectively identifies high-risk patients post-procedure. This study underscores IPI's potential to assist medical professionals in making more precise clinical decisions, ultimately reducing mortality and readmission rates linked to cardiovascular disease (CVD).

The effect of prognostic nutritional index on diabetic patients with myocardial infarction.

BACKGROUND: The prognostic nutritional index (PNI), a simple and comprehensive predictor of nutritional and immunological health, is connected to cancer and cardiovascular disease. The effects of PNI on myocardial infarction (MI) in individuals with diabetes remain unclear. Thus, we aim to investigate the correlation of PNI with predictive outcomes in this specific population group to inform therapeutic decision-making. METHODS: This prospective observational study included 417 diabetic patients with MI who underwent coronary angiography intervention at Fujian Medical University Union Hospital from May 2017 to May 2020. We collected follow-up and prognostic data from these patients at 6, 12, 18, and 24 months post-procedure via outpatient visits or phone interviews. The main focus of the study was on major adverse cardiovascular events (MACE) in the two years after surgery. Based on the median PNI, patients were categorized into two groups: high PNI (H-PNI) and low PNI (L-PNI). Data were analyzed using IBM SPSS 25.0. Kalpan-Meier survival curves and Cox proportional hazards regression analysis were utilized to examine the associations between preoperative PNI and the prognosis of diabetic patients with MI. RESULTS: In the study, 417 participants were observed for two years. Of these patients, 159 (38.1%) had MACE. According to the Kaplan-Meier curves, patients in the L-PNI group had more MACE than those in the H-PNI group (log-rank p < 0.001) and had a heightened susceptibility to all categories of MACE. After adjusting for confounding variables, the corrected hazard ratio for developing unstable angina in the L-PNI group was 2.55 (95% CI 1.57-4.14, p < 0.001). CONCLUSION: Low PNI levels are associated with MACE after coronary angiography intervention in diabetic patients with myocardial infarction. This highlights the prognostic value of PNI and broadens its potential use in larger populations. TRIAL REGISTRATION: Not applicable.

Compilation of a self-management assessment scale for postoperative patients with aortic dissection.

Objective: The aim of this research was to compile a self-management assessment scale for patients with aortic dissection (AD). The questionnaire is useful in making the patient aware of the need for post-operative care in order to contribute to improving the outcome and quality of life. Methods: The initial version of the "postoperative self-management assessment scale for patients with aortic dissection" was developed using the Delphi expert consultation method based on qualitative research results, consultation of self-management-related literature, reference to the existing self-management scale, and self-efficacy theory, combined with the disease characteristics of AD. By using the convenience sampling method, a total of 201 patients with AD who had undergone surgery were selected as the research participants. The initial version of the scale was used for follow-up investigation, and the scale entries were evaluated and exploratory factor analysis carried out to form the formal version of the "postoperative self-management assessment scale for patients with aortic dissection." A total of 214 patients with AD after surgery were selected as the research participants. The formal version of the scale was used for follow-up investigation, and its reliability and validity were evaluated. Results: The formal version of the scale had 6 dimensions and 35 entries. The Cronbach's α coefficient for the total scale was 0.908, the split-half reliability was 0.790, and the test-retest reliability after 2 weeks was 0.471. The content validity index of the total scale was 0.963. Exploratory factor analysis yielded six common factors, and the cumulative contribution rate of variance was 66.303%. Confirmatory factor analysis showed that except for the incremental fit index, Tucker-Lewis index, and comparative fit index >0.85, slightly lower than 0.90, χ 2/df <3, root mean square of approximation <0.08, parsimonious goodness-of-fit index, and parsimonious normed fit index >0.50; all other model fitting requirements were satisfied, indicating that the model fitting was acceptable. Conclusion: We compiled the postoperative self-management assessment scale for patients with AD, which has demonstrated excellent reliability and validity and can be used as a tool to evaluate the postoperative self-management level in patients with aortic dissection.

Unconventional human CD61 pairing with CD103 promotes TCR signaling and antigen-specific T cell cytotoxicity.

Cancer remains one of the leading causes of mortality worldwide, leading to increased interest in utilizing immunotherapy strategies for better cancer treatments. In the past decade, CD103+ T cells have been associated with better clinical prognosis in patients with cancer. However, the specific immune mechanisms contributing toward CD103-mediated protective immunity remain unclear. Here, we show an unexpected and transient CD61 expression, which is paired with CD103 at the synaptic microclusters of T cells. CD61 colocalization with the T cell antigen receptor further modulates downstream T cell antigen receptor signaling, improving antitumor cytotoxicity and promoting physiological control of tumor growth. Clinically, the presence of CD61+ tumor-infiltrating T lymphocytes is associated with improved clinical outcomes, mediated through enhanced effector functions and phenotype with limited evidence of cellular exhaustion. In conclusion, this study identified an unconventional and transient CD61 expression and pairing with CD103 on human immune cells, which potentiates a new target for immune-based cellular therapies.

Association Between Remnant Cholesterol and Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography and/or Percutaneous Coronary Intervention.

Contrast-induced nephropathy (CIN) is an acute renal complication that can occur after the use of iodinated contrast media. Remnant cholesterol (RC) is one of the markers of atherosclerotic cardiovascular disease risk. We evaluated the impact of RC on CIN and clinical outcomes after coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Consecutive patients (n = 3332) undergoing CAG and/or PCI were assessed in this retrospective study. Patients were divided into four groups based on baseline RC levels. In the quartile analysis, RC were associated with a higher risk of CIN, especially when RC ≤0.20 or ≥0.38 mmol/L (P < .05). However, after adjustment, the association of RC with CIN was not significant. There was a significant correlation between RC and repeated revascularization in patients undergoing PCI (P < .001) and driven primarily by the highest quartile level. After adjustment, this remained statistically significant (adjusted odds ratio (aOR) 4.06; 95% CI 2.10-7.87; P < .001). This is the first large study to show a possible association between RC and the risk of CIN after CAG and/or PCI; however, this finding was not further confirmed after adjustment. The complex clinical risk profile of patients, rather than RC itself, may contribute to the risk of CIN in this high-risk subgroup.

Blood-urea-nitrogen-to-serum-albumin ratio in predicting the value of patients with contrast-induced nephropathy for coronary heart disease.

BACKGROUND: The blood-urea-nitrogen (BUN)-to-serum-albumin (ALB) ratio (BAR) has been identified as a novel indicator of both inflammatory and nutritional status, exhibiting a correlation with adverse cardiovascular outcomes. This study aims to investigate the potential predictive value of BAR levels at admission for the development of CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). METHODS: Retrospective data were collected from patients who were admitted and underwent CAG or PCI between January 2018 and December 2022 at the Cardiac Medical Center of Union Hospital of Fujian Medical University, and the patients were divided into CIN and non-CIN groups. The BAR was computed by dividing the BUN count by the ALB count. Using multiple variable logistic regression, risk variables associated with the development of CIN were found. RESULTS: A total of 156 patients developed CIN (7.78%). The development of CIN was predicted by a BAR ratio > 4.340 with a sensitivity of 84.0% and a specificity of 70.2%, according to receiver operating characteristic (ROC) analysis. BAR, female gender, diuretic use, and statin medication use were found to be independent predictors of CIN using multifactorial analysis. CONCLUSIONS: When patients are receiving CAG/PCI, BAR is a simple-to-use marker that can be used independently to predict the presence of CIN.

A Predictive Nomogram for Intensive Care-Acquired Weakness after Cardiopulmonary Bypass.

PURPOSE: Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB. METHODS: Baseline characteristics, preoperative laboratory data, and intra- and postoperative variables of 473 patients after CPB were determined in this prospective cohort study. Lower limb muscles on bedside ultrasound images were compared 1 day before and 7 days after CPB. Risk factors were assessed using logistic regression models. RESULTS: Approximately 50.95% of the patients developed ICUAW after CPB. The body mass index (BMI), New York Heart Association (NYHA) class, lactate, albumin, aortic clamping time, operation time, and acute physiological and chronic health evaluation II were determined as independent risk factors. The average absolute error of coincidence was 0.019; the area under the curve, sensitivity, and specificity were 0.811, 0.727, and 0.733, respectively, for the predictive nomogram. CONCLUSION: A high BMI, poor NYHA class, preoperative high serum lactate, low serum albumin, long surgical duration, aortic clamping, and high acute physiological and chronic health evaluation II score are risk factors for ICUAW after CPB. This robust and easy-to-use nomogram was developed for clinical decision-making.

A family intervention to prevent postoperative delirium in patients undergoing cardiac valve surgery: A randomized controlled study.

BACKGROUND: Multiple guidelines recommend that families be involved in the care of ICU patients, which has been widely used in ICU delirium management in recent years. Postoperative delirium (POD) occurs frequently after cardiac surgery and is associated with poor outcomes; however, the effects of family intervention on this group are rarely studied. OBJECTIVES: This study aimed to investigate the effects of family intervention on the incidence of POD and the ICU prognoses of patients undergoing cardiac valve surgery. METHODS: This was a two-group, single-blind, randomized controlled trial involving 80 patients undergoing cardiac valve surgery, with 40 patients in each group. The control group received routine ICU visits, and the experimental group implemented a family intervention that instructed family caregivers to participate in delirium management during ICU visits. The occurrence of POD, ICU stay, mechanical ventilation time of patients; as well as the anxiety, depression, and satisfaction levels of family caregivers were compared between the two groups. RESULTS: The incidence of POD and ICU stay of patients were significantly lower in the experimental group compared to the control group (P < 0.05). The anxiety and depression incidence of family caregivers in the experimental group was lower than those of the control group (P < 0.05), and satisfaction scores were higher than those of the control group (P < 0.05). CONCLUSIONS: Family intervention has the potential to reduce the incidence of POD in patients undergoing cardiac valve surgery, shorten ICU stays, reduce the incidence of anxiety and depression in family caregivers, and improve their satisfaction. These findings suggest that family intervention could be incorporated into routine nursing practice.

Durability and cross-reactive immune memory to SARS-CoV-2 in individuals 2 years after recovery from COVID-19: a longitudinal cohort study.

BACKGROUND: SARS-CoV-2-specific adaptive immunity more than 1 year after initial infection has not been well characterised. The aim of this study was to investigate the durability and cross-reactivity of immunological memory acquired from natural infection against SARS-CoV-2 in individuals recovered from COVID-19 2 years after infection. METHODS: In this longitudinal cohort study, we recruited patients who had recovered from laboratory-confirmed COVID-19 and were discharged from Jinyintan Hospital (Wuhan, China) between Jan 7 and May 29, 2020. We carried out three successive follow-ups between June 16 and Sept 3, 2020 (6 months), Dec 16, 2020, and Feb 7, 2021 (1 year), and Nov 16, 2021, and Jan 10, 2022 (2 years), in which blood samples were taken. We included participants who did not have re-infection or receive a SARS-CoV-2 vaccination (infected-unvaccinated), and participants who received one to three doses of inactivated vaccine 1-2 years after infection (infected-vaccinated). We evaluated the presence of IgG antibodies, neutralising antibodies, and memory B-cell and memory T-cell responses against the prototype strain and delta and omicron variants. FINDINGS: In infected-unvaccinated participants, neutralising antibody titres continually declined from 6-month to 2-year follow-up visits, with a half-life of about 141·2 days. Neutralising antibody responses to omicron sublineages (BA.1, BA.1.1, BA.2, BA.4/5, BF.7, BQ.1, and XBB) were poor. Memory B-cell responses to the prototype strain were retained at 2 years and presented cross-reactivity to the delta and omicron BA.1 variants. The magnitude of interferon γ and T-cell responses to SARS-CoV-2 were not significantly different between 1 year and 2 years after infection. Multifunctional T-cell responses against SARS-CoV-2 spike protein and nucleoprotein were detected in most participants. Recognition of the BA.1 variant by memory T cells was not affected in most individuals. The antibody titres and the frequencies of memory B cells, but not memory T cells, increased in infected-vaccinated participants after they received the inactivated vaccine. INTERPRETATION: This study improves the understanding of the duration of SARS-CoV-2-specific immunity without boosting, which has implications for the design of vaccination regimens and programmes. Our data suggest that memory T-cell responses primed by initial viral infection remain highly cross-reactive after 2 years. With the increasing emergence of variants, effective vaccines should be introduced to boost neutralising antibody and overall T-cell responses to newly emerged SARS-CoV-2 variants. FUNDING: Chinese Academy of Medical Sciences, National Natural Science Foundation of China, Fundamental Research Funds for the Central Universities for Peking Union Medical College, Beijing Natural Science Foundation, UK Medical Research Council.

Analysis of serum calcium change trajectories and prognostic factors in patients with acute type A aortic dissection.

OBJECTIVES: This study aimed to analyze the correlation between serum calcium changes and short-term prognosis of patients with acute type A aortic dissection. METHODS: Patients who underwent acute type A aortic dissection surgery at Fujian Heart Medical Center between June 2019 and June 2021 were retrospectively analyzed. RESULTS: A total of 383 patients were enrolled. According to the changing track of serum calcium in patients after acute type A aortic dissection, three potential category tracks were determined: high-level (n = 85), medium-level (n = 259), and continuous low-level groups (n = 39). Using the medium-level group as the control, regression analysis showed that poor prognosis risk was increased in the group with continuous low serum calcium (odds ratio = 2.454, P < 0.05) and in the group with continuous low serum calcium > 48 h (odds ratio = 3.595, P < 0.05). Age (odds ratio = 1.063, P < 0.001), body mass index (odds ratio = 1.138, P < 0.05), hypertension (odds ratio = 3.697, P < 0.05), and the highest lactic acid within 72 h after surgery(odds ratio = 1.093, P < 0.05) were independent risk factors for poor prognosis after aortic dissection. CONCLUSION: Continuous low serum calcium was an independent predictor of poor prognosis in patients with acute type A aortic dissection.

Influence of Impaired Hydration Status on Postoperative in-Hospital Death in Patients with Acute Type A Aortic Dissection.

Background: The hydration state of the body is getting more and more attention from researchers. The purpose of this study is to investigate the relationship between impaired hydration status and postoperative hospitalization death in patients with A AAD. Methods: From January 2019 to October 2021, the clinical data of 299 patients undergoing A AAD surgery were retrospectively analyzed. Patients were divided into normal hydration group, imminent dehydration group and current dehydration group according to the dehydration standard at admission. Univariate and multivariate logistic regression analysis were used to determine the independent risk factors for in-hospital death of patients with A AAD. Results: Postoperative in-hospital death in A AAD patients was significantly more common in the imminent and current dehydration groups (>295mmol/L) (26.7% vs 11.9%; P=0.001). The length of ICU stay was significantly longer in the impending and current dehydration groups (P<0.05). After controlling for other factors by multivariate logistic regression analysis, the results showed that the group of impending and current dehydration (>295) (OR=3.61, 95% confidence interval [CI]: 1.61-8.06; P=0.002), CRRT (OR=10.55, 95%[CI]: 3.59-31.01; P<0.001), lactic acid (OR=1.25, 95%[CI]: 1.13-1.38; P<0.001), CAD (OR=5.27, 95%[CI]: 1.12-24.80; P=0.035) was an independent risk factor for in-hospital death in A AAD patients. Albumin (OR=0.92, 95%[CI]: 0.85-0.99; P=0.040) is a protective factor. Conclusion: The presence of high serum osmotic pressure on admission of A AAD patients can independently predict postoperative death, and the impaired body hydration status should be paid attention to.

SARS-CoV-2 mutations affect antigen processing by the proteasome to alter CD8+ T cell responses.

Mutations within viral epitopes can result in escape from T cells, but the contribution of mutations in flanking regions of epitopes in SARS-CoV-2 has not been investigated. Focusing on two SARS-CoV-2 nucleoprotein CD8+ epitopes, we investigated the contribution of these flanking mutations to proteasomal processing and T cell activation. We found decreased NP9-17-B*27:05 CD8+ T cell responses to the NP-Q7K mutation, likely due to a lack of efficient epitope production by the proteasome, suggesting immune escape caused by this mutation. In contrast, NP-P6L and NP-D103 N/Y mutations flanking the NP9-17-B*27:05 and NP105-113-B*07:02 epitopes, respectively, increased CD8+ T cell responses associated with enhanced epitope production by the proteasome. Our results provide evidence that SARS-CoV-2 mutations outside the epitope could have a significant impact on proteasomal processing, either contributing to T cell escape or enhancement that may be exploited for future vaccine design.

Gut microbiota changes in patients with hypertension: A systematic review and meta-analysis.

Hypertension is a major public health issue worldwide. The imbalance of gut microbiota is thought to play an important role in the pathogenesis of hypertension. The authors conducted the systematic review and meta-analysis to clarify the relationship between gut microbiota and hypertension through conducting an electronic search in six databases. Our meta-analysis included 19 studies and the results showed that compared with healthy controls, Shannon significantly decreased in hypertension [SMD = -0.13, 95%CI (-0.22, -0.04), p = .007]; however, Simpson [SMD = -0.01, 95%CI (-0.14, 0.12), p = .87], ACE [SMD = 0.18, 95%CI (-0.06, 0.43), p = .14], and Chao1 [SMD = 0.11, 95%CI (-0.01, 0.23), p = .08] did not differ significantly between hypertension and healthy controls. The F/B ratio significantly increased in hypertension [SMD = 0.84, 95%CI (0.10, 1.58), p = .03]. In addition, Shannon index was negatively correlated with hypertension [r = -0.12, 95%CI (-0.19, -0.05)], but had no significant correlation with SBP [r = 0.10, 95%CI (-0.19, 0.37)] and DBP [r = -0.39, 95%CI (-0.73, 0.12)]. At the phylum level, the relative abundance of Firmicutes [SMD = -0.01, 95%CI (-0.37, 0.34), p = .94], Bacteroidetes [SMD = -0.15, 95%CI (-0.44, 0.14), p = .30], Proteobacteria [SMD = 0.25, 95%CI (-0.01, 0.51), p = .06], and Actinobacteria [SMD = 0.21, 95%CI (-0.11, 0.53), p = .21] did not differ significantly between hypertension and healthy controls. At the genus level, compared with healthy controls, the relative abundance of Faecalibacterium decreased significantly [SMD = -0.16, 95%CI (-0.28, -0.04), p = .01], while the Streptococcus [SMD = 0.20, 95%CI (0.08, 0.32), p = .001] and Enterococcus [SMD = 0.20, 95%CI (0.08, 0.33), p = .002] significantly increased in hypertension. Available evidence suggests that hypertensive patients may have an imbalance of gut microbiota. However, it still needs further validation by large sample size studies of high quality.

The Effect of Onset Time on In-Hospital Mortality in Patients with Acute Type A Aortic Dissection of Different Gender: A Retrospective Cohort Study.

BACKGROUND: Although the research on gender in acute type A aortic dissection (AAAD) patients has increased in recent years, the results are still controversial. The effect of time of onset on in-hospital mortality in patients with AAAD of different gender is unclear. The purpose of this study was to investigate the effect of onset time on in-hospital mortality of patients with AAAD of different gender. METHODS: In this retrospective observational study, patients with AAAD were selected from June 2013 to March 2020. Patients' information was extracted from electronic medical records. Based on the onset time, the patients were categorized into four groups: group one (00:00-05:59), group two (6:00-11:59), group three (12:00-17:59), and group four (18:00-23:59). RESULTS: A total of 760 subjects were included in our study. There were 591 (77.8%) males and 169 (22.2%) females. In male patients, 79 cases died, in female patients, 19 cases died (p < 0.05). We conducted subgroup analysis according to gender, univariate Cox regression analysis of male patients showed that compared with the patients at onset time of 0:00-5:59, patients at onset time of 12:00-17:59 and 18:00-23:59 were associated with an increased risk of in-hospital mortality. Multivariate Cox regression analysis of male patients showed that the onset time of 18:00-23:59 remained as the significant risk factor of in-hospital mortality of male patients hazard ratio (HR) = 4.396 (p < 0.05). CONCLUSIONS: This analysis demonstrated that in-hospital mortality of AAAD patients was similar in different genders. In male patients, the onset time of 18:00-23:59 was significantly associated with an increased risk of in-hospital mortality.

Engineering immunosuppressive drug-resistant armored (IDRA) SARS-CoV-2 T cells for cell therapy.

Solid organ transplant (SOT) recipients receive immunosuppressive drugs (ISDs) and are susceptible to developing severe COVID-19. Here, we analyze the Spike-specific T-cell response after 3 doses of mRNA vaccine in a group of SOT patients (n = 136) treated with different ISDs. We demonstrate that a combination of a calcineurin inhibitor (CNI), mycophenolate mofetil (MMF), and prednisone (Pred) treatment regimen strongly suppressed the mRNA vaccine-induced Spike-specific cellular response. Such defects have clinical consequences because the magnitude of vaccine-induced Spike-specific T cells was directly proportional to the ability of SOT patients to rapidly clear SARS-CoV-2 after breakthrough infection. To then compensate for the T-cell defects induced by immunosuppressive treatment and to develop an alternative therapeutic strategy for SOT patients, we describe production of 6 distinct SARS-CoV-2 epitope-specific ISD-resistant T-cell receptor (TCR)-T cells engineered using the mRNA electroporation method with reactivity minimally affected by mutations occurring in Beta, Delta, Gamma, and Omicron variants. This strategy with transient expression characteristics marks an improvement in the immunotherapeutic field and provides an attractive and novel therapeutic possibility for immunosuppressed COVID-19 patients.

Effect of timing of enteral nutrition initiation on poor prognosis in patients after cardiopulmonary bypass: A prospective observational study.

OBJECTIVES: Current guidelines recommend that enteral nutrition (EN) be implemented as early as possible in patients after cardiopulmonary bypass (CPB), but the optimal time to initiate EN remains controversial. Therefore, the aim of this study was to investigate the effect of timing of EN initiation on poor prognosis in patients after CPB. METHODS: This was a prospective observational study with patients who underwent CPB in a tertiary hospital from September 1, 2021, to January 31, 2022. The patients were divided into three groups according to the timing of EN initiation: <24 h, 24 to 48 h, and >48 h. Unconditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals to identify independent risk factors for poor prognosis. RESULTS: The study included 579 patients, of whom 255 patients had EN initiated at <24 h (44%), 226 at 24 to 48 h (39%), and at >48 h (17%). With EN <24 h as a reference, multivariate logistic analysis showed that EN 24 to 48 h (OR, 1.854, P = 0.008) and EN >48 h (OR, 7.486, P <0.001) were independent risk factors for poor prognosis after CPB. Age (OR, 1.032, P = 0.001), emergency surgery (OR, 10.051; P <0.001), surgical time (OR, 1.006; P <0.001), and sequential organ failure assessment score (OR, 1.269; P = 0.001) also increased the risk for poor prognosis after CPB. CONCLUSIONS: Compared with early EN <24 h, EN 24 to 48 h and EN >48 h increased the risk for poor prognosis in patients after CPB.