The value of left atrial longitudinal strain in evaluating left atrial appendage spontaneous echo contrast in non-valvular atrial fibrillation.

Background: Spontaneous echo contrast (SEC) observed in transesophageal echocardiography (TEE) is a reliable predictor of the risk of future ischemic stroke in patients with non-valvular atrial fibrillation (NVAF). Left atrial strain globally reflects atrial function, remodeling and distensibility. The left atrial appendage (LAA) is a myogenic remnant of the left atrium, which can actively relax and contract. The left atrial appendage (LAA) is an important part of releasing the pressure of the left atrium. The key role of the left atrium is to regulate the left ventricular filling pressure, act as a reservoir for pulmonary venous return during ventricular contraction, and act as a conduit, transferring blood to the Left ventricle during early ventricular diastole. The purpose of this study was to explore the relationship between left atrial function and left atrial appendage spontaneous echo contrast (LAASEC). Methods: A retrospective study of 338 patients with non-valvular AF was conducted. Two-dimensional speckle-tracking echocardiography provided the following metrics of LA strain: LA strain during the reservoir phase (LASr), LA strain during the conduit phase (LAScd). LA or LAA has the dense SEC of more than grade 3, which is defined as mud like change or pre thrombosis. Results: Patients with level 3 SEC (n = 81) has lower LASr than those with lower grades of SEC (n = 257) (7.20 ± 3.70 vs. 17.48 ± 8.67, P < 0.001). Multivariate logistic regression model showed that the type of atrial fibrillation (persistent∼), increased heart rate, decreased LASr were independently associated with the dense LAASEC (OR (CI 95%), 5.558 (1.618-19.09), 1.016 (1.006-1.026) 0.002, 1.224 (1.085-1.381), both P < 0.01). Venn Diagram showed that lower CHADVASC2 score groups had dense SEC cases. Receiver operating characteristic (ROC) curve was used for analyzing results and selecting cut off values. The cut off point for LASr < 8.85% and CHADVASC2 score was >2 scores with sensitivity and specificity were 79% and 85%. Conclusion: Lower LASr is independently associated with the dense LAASEC in NVAF and has incremental values superior to clinical scores. The decrease of LASr may be a potential non-invasive parameter for evaluating the higher risk of LAA thrombosis.

The novel left atrial appendage strain parameters are associated with thrombosis risk in patients with non-valvular atrial fibrillation.

OBJECTIVES: We sought to explore a novel left atrial appendage (LAA) strain parameter which could represent the cumulative adverse impact of chronic Atrial fibrillation (AF) on the LAA function, and the relationship between the LAA strain parameter and thrombosis risk in patients with non-valvular AF. METHODS: We enrolled 268 patients with non-valvular AF and 58 sinus rhythm subjects who underwent transesophageal echocardiography in the study. LAA longitudinal strain amplitude (LAA LSA) was defined as the sum of the value of the maximum positive peak strain (LAA PLS) and the absolute value of the minimum negative peak strain (LAA NLS). Dense spontaneous echo contrast (SEC) was defined as grade 3 or 4 SEC. RESULTS: Compared to sinus rhythm group, the global LAA strain parameters were significantly lower in paroxysmal AF (n = 148), and the lowest of them were found in persistent AF (n = 120), which suggested that the global LAA strain parameters could evaluate LAA function in sinus rhythm, paroxysmal AF and persistent AF. Compared with patients in AF without SEC/thrombus (n = 113), the regional and global LAA strain parameters were significantly depressed in AF with SEC/thrombus (n = 155). Multivariate logistic regression analyses showed that LAA global LSA (OR 0.768; 95% CI:0.569, 0.970; p = 0.027) was an independent predicter of the SEC/thrombus. Compared with patients in AF without dense SEC or thrombus (n = 210), the regional and global LAA strain parameters were significantly impaired in the patients with dense SEC/thrombus(n = 58). LAA global LSA (AUC 0.884) had the best predictable accuracy for dense SEC or thrombus, and outperformed LAA PLS, LAA NLS, CHA2DS2-VASc score and conventional LAA functional parameters that have been used in the evaluation blood flow stasis in LAA. LAA LSA showed excellent interobserver and intra-observer agreement beyond LAA PLS and LAA NLS. CONCLUSION: The novel LAA strain parameters, which were feasible and reproducible parameters for evaluation LAA mechanic function, had good predictive accuracy for blood flow stasis in LAA beyond conventional LAA functional parameters.

Syncope as the initial symptom in a patient with nasopharyngeal carcinoma: a case report.

BACKGROUND: A high prevalence of nasopharyngeal carcinoma (NPC) has been found in China, but it rarely occurs with syncope. Studies have demonstrated that syncope due to NPC may be related to carotid sinus syndrome, glossopharyngeal irritation, and parapharyngeal and retropharyngeal space lesions. Such patients require evaluation by nasopharyngoscopy and head magnetic resonance imaging/computed tomography. There is no known single effective treatment for these patients. Various interventions may be considered in an effort to relieve syncope, including vasoconstrictive drugs, cardiac pacemaker implantation, radiotherapy and chemotherapy, and surgical resection. CASE PRESENTATION: This case report describes a 56-year-old man who developed recurrent syncope with atrial fibrillation, a long RR interval, and hypotension. A single chamber pacemaker was fitted, but it failed to relieve the symptom. Cranial magnetic resonance imaging and pathological tests led to a final diagnosis of NPC. After six courses of chemotherapy and 35 sessions of radiotherapy, the patient became asymptomatic. However, he died from a massive uncontrolled hemorrhage in the nasopharynx two years later. CONCLUSIONS: This case brings attention to the fact that syncope can be a symptom of NPC. Due to the insidiously malignant nature of this cancer, when a patient presents with syncope, clinicians should bear in mind this connection, albeit a rare one. There are at least two ways of treating NPC-associated syncope, but there is disagreement about which is the most effective.

Aloe-derived vesicles enable macrophage reprogramming to regulate the inflammatory immune environment.

Introduction: Bacterial pneumonia poses a significant global public health challenge, where unaddressed pathogens and inflammation can exacerbate acute lung injury and prompt cytokine storms, increasing mortality rates. Alveolar macrophages are pivotal in preserving lung equilibrium. Excessive inflammation can trigger necrosis in these cells, disrupting the delicate interplay between inflammation and tissue repair. Methods: We obtained extracellular vesicle from aloe and tested the biosafety by cell viability and hemolysis assays. Confocal microscopy and flow cytometry were used to detect the uptake and internalization of extracellular vesicle by macrophages and the ability of extracellular vesicle to affect the phenotypic reprogramming of macrophages in vitro. Finally, we conducted a clinical feasibility study employing clinical bronchoalveolar lavage fluid as a representative model to assess the effective repolarization of macrophages influenced by extracellular vesicle. Results: In our study, we discovered the potential of extracellular vesicle nanovesicles derived from aloe in reprograming macrophage phenotypes. Pro-inflammatory macrophages undergo a transition toward an anti-inflammatory immune phenotype through phagocytosing and internalizing these aloe vera-derived extracellular vesicle nanovesicles. This transition results in the release of anti-inflammatory IL-10, effectively curbing inflammation and fostering lung tissue repair. Discussion: These findings firmly establish the immunomodulatory impact of aloe-derived extracellular vesicle nanovesicles on macrophages, proposing their potential as a therapeutic strategy to modulate macrophage immunity in bacterial pneumonia.

Polyethylene film mulching enhances the microbial carbon-use efficiency, physical and chemical protection of straw-derived carbon in an Entisol of the Loess Plateau.

The global use of agricultural polyethylene mulches has emerged as a widespread farming practice, however, its effects on the fate and dynamics of crop straw-derived C in soil microbial biomass C (MBC), aggregate-associated and chemical recalcitrance-related C fractions are rarely assessed in situ. A two-year field experiment using 13C-labeled maize stem was carried out to quantify the allocation and dynamics of straw-C in an Entisol with and without plastic mulching. The results indicated that across the treatments, from 49.2% to 56.4% of straw-13C was released as CO2-C, from 34.9% to 43.1% was sequestrated as SOC pool, and from 6.7% to 9.7% remained undecomposed at the end of the experiment. Compared to non-mulching, plastic mulching significantly decreased the straw-derived CO2-C emissions by 14.6%, partially owing to the increased incorporation of straw-C into SOC pool. Across the treatments, the straw-derived MBC ranged from 14.4 to 147.9 mg 13C kg-1; and plastic mulching increased straw-derived MBC and microbial C use efficiency (CUE) of straw residue by 41.2% and 35.2% compared with non-mulching, respectively. The allocation dynamics of straw-C in each soil aggregate followed a sustained upward trend with time, while a significantly higher straw-C was incorporated into both macro- (> 0.25 mm) and micro-aggregates (0.25-0.053 mm) with plastic mulching. Compared to the non-mulching, plastic mulching enhanced the inclusion of straw-13C in the chimerically more stable C fraction, especially at the late experimental period. We conclude that crop straw return combined with plastic mulching could improve SOC sequestration by enhancing microbial CUE, physical and chemical protection of straw-derived C in this dryland cropping system.

The virtual water content of major grain crops and virtual water flows between regions in China.

BACKGROUND: The disproportionate distribution of arable land and water resources has become a bottleneck for guaranteeing food security in China. Virtual water and virtual water trade theory have provided a potential solution to improve water resources management in agriculture and alleviate water crises in water-scarce regions. The present study evaluates the green and blue virtual water content of wheat, maize and rice at the regional scale in China. It then assesses the water-saving benefits of virtual water flows related to the transfer of the three crops between regions. RESULTS: The national average virtual water content of wheat, maize and rice were 1071 m(3) per ton (50.98% green water, 49.02% blue water ), 830 m(3) per ton (76.27% green water, 23.73% blue water) and 1294 m(3) per ton (61.90% green water, 38.10% blue water), respectively. With the regional transfer of wheat, maize and rice, virtual water flows reached 30.08 Gm(3) (59.91% green water, 40.09% blue water). Meanwhile, China saved 11.47 Gm(3) green water, while it consumed 7.84 Gm(3) more blue water than with a no-grain transfer scenario in 2009. CONCLUSION: In order to guarantee food security in China, the government should improve water productivity (reduce virtual water content of crops) during the grain production process. Meanwhile, under the preconditions of economic feasibility and land-water resources availability, China should guarantee the grain-sown area in southern regions for taking full advantage of green water resources and to alleviate the pressure on water resources.