Comparison of strategies for catheter ablation of left posterior fascicular ventricular tachycardia.

AIMS: Traditional ablation strategies including targeting the earliest Purkinje potential (PP) during left posterior fascicular (LPF) ventricular tachycardia (VT) or linear ablation at the middle segment of LPF during sinus rhythm are commonly used for the treatment of LPF-VT. Catheter ablation for LPF-VT targeting fragmented antegrade Purkinje (FAP) potential during sinus rhythm is a novel approach. We aimed to compare safety and efficacy of different ablation strategies (FAP ablation vs. traditional ablation) for the treatment of LPF-VT. METHODS AND RESULTS: Consecutive patients with electrocardiographically documented LPF-VT referred for catheter ablation received either FAP ablation approach or traditional ablation approach. Electrophysiological characteristics, procedural complications, and long-term clinical outcome were assessed. A total of 189 consecutive patients who underwent catheter ablation for LPF-VT were included. Fragmented antegrade Purkinje ablation was attempted in 95 patients, and traditional ablation was attempted in 94 patients. Acute ablation success with elimination of LPF-VT was achieved in all patients. Left posterior fascicular block occurred in 11 of 95 (11.6%) patients in the FAP group compared with 75 of 94 (79.8%) patients in the traditional group (P < 0.001). Fragmented antegrade Purkinje ablation was associated with significant shorter procedure time (94 ± 26 vs. 117 ± 23 min, P = 0.03) and fewer radiofrequency energy applications (4.1 ± 2.4 vs. 6.3 ± 3.5, P = 0.003) compared with the traditional group. One complete atrioventricular block and one left bundle branch block were seen in the traditional group. Over mean follow-up of 65 months, 89 (93.7%) patients in the FAP group and 81 (86.2%) patients in the traditional group remained free of recurrent VT off antiarrhythmic drugs (P = 0.157). CONCLUSION: Left posterior fascicular-ventricular tachycardia ablation utilizing FAP and traditional ablation approaches resulted in similar acute and long-term procedural outcomes. Serious His-Purkinje injury did occur infrequently during traditional ablation. The use of FAP ablation approach was associated with shorter procedure time and fewer radiofrequency energy applications, especially for non-inducible patients.

A comprehensive review of protein-based carriers with simple structures for the co-encapsulation of bioactive agents.

The rational design and fabrication of edible codelivery carriers are important to develop functional foods fortified with a plurality of bioactive agents, which may produce synergistic effects in increasing bioactivity and functionality to target specific health benefits. Food proteins possess considerable functional attributes that make them suitable for the delivery of a single bioactive agent in a wide range of platforms. Among the different types of protein-based carriers, protein-ligand nanocomplexes, micro/nanoparticles, and oil-in-water (O/W) emulsions have increasingly attracted attention in the codelivery of multiple bioactive agents, due to the simple and convenient preparation procedure, high stability, matrix compatibility, and dosage flexibility. However, the successful codelivery of bioactive agents with diverse physicochemical properties by using these simple-structure carriers is a daunting task. In this review, some effective strategies such as combined functional properties of proteins, self-assembly, composite, layer-by-layer, and interfacial engineering are introduced to redesign the carrier structure and explore the encapsulation of multiple bioactive agents. It then highlights success stories and challenges in the co-encapsulation of multiple bioactive agents within protein-based carriers with a simple structure. The partition, protection, and release of bioactive agents in these protein-based codelivery carriers are considered and discussed. Finally, safety and application as well as challenges of co-encapsulated bioactive agents in the food industry are also discussed. This work provides a state-of-the-art overview of protein-based particles and O/W emulsions in co-encapsulating bioactive agents, which is essential for the design and development of novel functional foods containing multiple bioactive agents.

Hybrid ablation procedure for the treatment of nonparoxysmal atrial fibrillation: A systematic review and meta-analysis.

BACKGROUND: Hybrid ablation combines the advantages of surgical and catheter ablation. Many studies have explored the efficiency and safety of hybrid ablation in patients with nonparoxysmal AF. METHODS: We systematically searched for prospective controlled trials that compared hybrid ablation with catheter/surgical ablation in PubMed, Web of Science, Wiley Library, and CNKI. Our main assessment indicators included maintenance of sinus rhythm (SR) without antiarrhythmic drugs for more than 12 months, major adverse events (MAEs), procedure time and fluoroscopy time. RESULTS: Of 1214 identified studies, five were eligible and were included in our analysis (N = 451 participants). The pooled results showed that hybrid ablation was more effective in maintaining SR than a single procedure (surgical ablation or catheter ablation) (OR = 2.52, 95% confidence interval [CI]: 1.63-3.89, p < .001). Little significant heterogeneity was revealed (p = .32 for heterogeneity, I2  = 14%). More MAEs occurred in the hybrid group than in the single procedure group (OR = 7.47, 95% CI: 1.90-29.41, p = .004; I2  = 0%). Two trials reported the procedure and fluoroscopy times, and the procedure time for hybrid ablation was significantly longer than that of a single procedure (mean difference = 107.42, 95% CI: 88.62 to 126.22, p < .001; I2  = 82%). There was no significant difference in fluoroscopy time between the 2 groups (mean difference = -1.00, 95% CI: -5.37 to 3.36, p = .65; I2  = 12%). CONCLUSIONS: Hybrid ablation was more effective than catheter ablation and was as effective as surgical ablation in patients with nonparoxysmal AF. Meanwhile, hybrid ablation, especially concomitant hybrid ablation, increases the incidence of MAEs and prolongs the procedure time.

Acute changes of left ventricular function during surgical revascularization by 3D speckle tracking.

BACKGROUND: Detecting early impact of coronary artery bypass grafting (CABG) on left ventricular (LV) function is important because such measures may contribute to meaningful improvement in clinical outcomes. We aimed to gain knowledge about acute changes of LV performance during surgical revascularization using three-dimensional speckle tracking echocardiography (3D STE). METHODS: Thirty-five patients scheduled for CABG surgery who underwent intraoperative transesophageal echocardiography (TEE) were enrolled (mean age 68.9 ± 7.3 years). TEE was performed before and after surgery, as well as before and after grafting. 3D LV ejection fraction (LVEF), tissue motion annular displacement (TMAD) of the mitral valves, 3D global longitudinal strain (GLS), global circumferential strain (GCS), twist, and torsion were quantified. Regional longitudinal strain (LS) was calculated based on coronary perfusion territories in a 16-segment LV model. RESULTS: Despite the absence of change in TMAD and 3D LVEF, 3D GLS (-18.6 ± 4.3% at baseline vs -16.0 ± 4.0% after surgery, P = .01) was significantly decreased, followed with no significant effect on GCS, twist, and torsion during surgery. 3D GLS correlated significantly with 3D LVEF (r between -0.34 and -0.51, P < .05 for all) under the whole operation. Territorial LS did not increase immediately after surgery. CONCLUSION: 3D speckle tracking imaging allows for detailed and direct evaluation of myocardial deformation, though impaired LV longitudinal function is still apparent immediately after surgery. GLS is more sensitive to an acute reduction in LV function than conventional parameters, which can be potentially useful for serial monitoring of functional recovery.

In vitro remodeling and structural characterization of degradable polymer scaffold-based tissue-engineered vascular grafts using optical coherence tomography.

Non-destructive imaging strategies to monitor long-term cultures is essential for vascular engineering. The goal of this study is to investigate whether optical coherence tomography (OCT) can be a suitable approach to monitor the long-term remodeling process of biodegradable polymeric scaffold-based tissue-engineered vascular grafts (TEVG) after pulsatile stimulation and to observe polymeric scaffold degradation during bioreactor cultivation. In the present study, a perfusion system driven by a ventricular assist device was provided for a three-dimensional culture system as a pulsatile force. We characterized the structural features of wall thickness and polyglycolic acid degradation based on optical signal attenuation using catheter-based OCT. Scanning electron microscopy confirmed morphological changes. Also, polymer degradation and the detection of different types of collagen was visualized after 4 weeks of culture by means of polarized microscopy. Findings on OCT imaging correlated with those on histological examination and revealed the effects of pulsatile stimulation on the development of engineered vessels. This finding demonstrated that real-time imaging with OCT may be a promising tool for monitoring the growth and remodeling characterization of TEVG and provide a basis to promote the ideal and long-term culture of vascular tissue engineering.

The mechanisms of milder clinical symptoms of COVID-19 in children compared to adults.

In stark contrast to adult patients, children who contract Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) typically manifest milder symptoms or remain asymptomatic. However, the precise underlying mechanisms of this pathogenesis remain elusive. In this review, we primarily retrospect the clinical characteristics of SARS-CoV-2 infection in children, and explore the factors that may contribute to the typically milder clinical presentation in pediatric Coronavirus Disease 2019 (COVID-19) patients compare with adults patients with COVID-19. The pathophysiological mechanisms that mitigate lung injury in children are as follows: the expression level of ACE2 receptor in children is lower; the binding affinity between ACE2 receptors and viral spike proteins in children was weaker; children have strong pre-activated innate immune response and appropriate adaptive immune response; children have more natural lymphocytes; children with COVID-19 can produce higher levels of IgM, IgG and interferon; children infected with SARS-CoV-2 can produce lower levels of IL-6 and IL-10; children have fewer underlying diseases and the lower risk of worsening COVID-19; children are usually exposed to other respiratory viruses and have an enhanced cross-reactive immunity. Comprehending the relative contributions of these processes to the protective phenotype in the developing lungs can help in the diagnosis, treatment and research pertaining to children with COVID-19.

Enabling extracorporeal ultrasound imaging with the da Vinci robot for transoral robotic surgery: a feasibility study.

PURPOSE: Transoral robotic surgery (TORS) is a challenging procedure due to its small workspace and complex anatomy. Ultrasound (US) image guidance has the potential to improve surgical outcomes, but an appropriate method for US probe manipulation has not been defined. This study evaluates using an additional robotic (4th) arm on the da Vinci Surgical System to perform extracorporeal US scanning for image guidance in TORS. METHODS: A stereoscopic imaging system and da Vinci-compatible US probe attachment were developed to enable control of the extracorporeal US probe from the surgeon console. The prototype was compared to freehand US by nine operators in three tasks on a healthy volunteer: (1) identification of the common carotid artery, (2) carotid artery scanning, and (3) identification of the submandibular gland. Operator workload and user experience were evaluated using a questionnaire. RESULTS: The robotic US tasks took longer than freehand US tasks (2.09x longer; p = 0.001 ) and had higher operator workload (2.12x higher; p = 0.004 ). However, operator-rated performance was closer (avg robotic/avg freehand = 0.66; p = 0.017 ), and scanning performance measured by MRI-US average Hausdorff distance provided no statistically significant difference. CONCLUSION: Extracorporeal US scanning for intraoperative US image guidance is a convenient approach for providing the surgeon direct control over the US image plane during TORS, with little modification to the existing operating room workflow. Although more time-consuming and higher operator workload, several methods have been identified to address these limitations.

Risk factors and nomogram construction for predicting women with chronic pelvic pain:a cross-sectional population study.

Background: Chronic pelvic pain (CPP) in women is a critical challenge. Due to the complex etiology and difficulties in diagnosis, it has a greatly negative impact on women's physical and mental health and the healthcare system. At present, there is still a lack of research on the related factors and predictive models of chronic pelvic pain in women. Our study aims to identify risk factors associated with chronic pelvic pain in women and develop a predictive nomogram specifically tailored to high-risk women with CPP. Materials and methods: From May to October 2022, trained interviewers conducted face-to-face questionnaire surveys and pelvic floor surface electromyography assessments on women from community hospitals in Nanjing. We constructed a multivariate logistic regression-based predictive model using CPP-related factors to assess the risk of chronic pelvic pain and create a predictive nomogram. Both internal and external validations were conducted, affirming the model's performance through assessments of discrimination, calibration, and practical applicability using area under the curve, calibration plots, and decision curve analysis. Results: 1108 women were recruited in total (survey response rate:1108/1200), with 169 (15.3 %) being diagnosed as chronic pelvic pain. Factors contributing to CPP included weight, dysmenorrhea, sexual dysfunction, urinary incontinence, a history of pelvic inflammatory disease, and the surface electromyography value of post-baseline rest. In both the training and validation sets, the nomogram exhibited strong discrimination abilities with areas under the curve of 0.85 (95 % CI: 0.81-0.88) and 0.85 (95 % CI: 0.79-0.92), respectively. The examination of the decision curve and calibration plot showed that this model fit well and would be useful in clinical settings. Conclusions: Weight, dysmenorrhea, sexual dysfunction, history of urinary incontinence and pelvic inflammatory disease, and surface electromyography value of post-baseline rest are independent predictors of chronic pelvic pain. The nomogram developed in this study serves as a valuable and straightforward tool for predicting chronic pelvic pain in women.

Shellfish polysaccharides: A comprehensive review of extraction, purification, structural characterization, and beneficial health effects.

Global food systems are currently facing great challenges, such as food sources, food safety, and environmental crises. Alternative nutritional resources have been proposed as part of the solution to meeting future global food demand. In the natural resources, shellfish are the major component of global aquatic animals. Although most studies focus on the allergy, toxin, and contamination of shellfish, it is also a delicious food to the human diet rich in proteins, polysaccharides, minerals, and omega-3. Among the functional ingredients, shellfish polysaccharides possess nutritional and medicinal values that arouse the great interest of researchers. The selection of the extraction approach and the experimental condition are the key factors that influence the extraction efficiency of shellfish polysaccharides. Importantly, the purification of crude polysaccharides comprises the enrichment of shellfish polysaccharides and isolation of fractions, also resulting in various structural characteristics and physicochemical properties. Chemical modification is also an efficient method to further improve the biological activities of shellfish polysaccharides. This review summarizes the extraction, purification, structural characterization, and chemical modification methods for shellfish polysaccharides. Additionally, the beneficial health effects of shellfish polysaccharides are highlighted, with an emphasis on their potential mechanism. Finally, current challenges and perspectives on shellfish polysaccharides are also spotlighted.

A study on the structure-functionality relationship of Solenaia oleivora protein under high-intensity ultrasonication processing.

Solenaia oleivora is a valuable freshwater mussel endemic to China with a high content of high-quality proteins, but the lack of structural information and limited functionality of Solenaia oleivora proteins constrained their application in the food industry. This study investigates the changes in structural characteristics and functionality of Solenaia oleivora protein under ultrasound processing at power from 200 to 600 W. The ultrasound treatment caused increased contents of ß-turn and α-helix, and the exposure of interior hydrophobic groups, resulting in the increased hydrophobicity by around 3 folds. The ultrasound treatment could significantly decrease particle size and increase surface charges of Solenaia oleivora proteins, facilitating the increase of hydrosolubility from 10.2% to 81.7%. These structural changes and increased hydrosolubility contributed to the enhancement of emulsifying and foaming properties, and in vitro digestibility. The results suggested that the ultrasound-treated Solenaia oleivora proteins possessed the potential as an alternative protein in food applications.

Chromosome-level genome assembly of the freshwater mussel Sinosolenaia oleivora (Heude, 1877).

Sinosolenaia oleivora (Bivalve, Unionida, Unionidae), is a near-endangered edible mussel. In 2022, it was selected by the Ministry of Agriculture and Rural Affairs as a top-ten aquatic germplasm resource, with potential for industrial development. Using Illumina, PacBio, and Hi-C technology, a high-quality chromosome-level genome of S. oleivora was assembled. The assembled S. oleivora genome spanned 2052.29 Mb with a contig N50 size of 20.36 Mb and a scaffold N50 size of 103.57 Mb. The 302 contigs, accounting for 98.41% of the total assembled genome, were anchored into 19 chromosomes using Hi-C scaffolding. A total of 1171.78 Mb repeat sequences were annotated and 22,971 protein-coding genes were predicted. Compared with the nearest ancestor, a total of 603 expanded and 1767 contracted gene families were found. This study provides important genomic resources for conservation, evolutionary research, and genetic improvements of many economic traits like growth performance.

PD-1 inhibitors-associated myocarditis in non-small cell lung cancer patients.

Background: Immune checkpoint inhibitors (ICIs)-associated myocarditis remains a rare but fatal adverse event. The authors sought to provide a comprehensive clinical description of ICI-associated myocarditis by analyzing symptoms, laboratory indicators, imaging features, and management of ICI-associated myocarditis in patients with non-small cell lung cancer (NSCLC). Methods: A retrospective study was conducted to analyze 14 ICI-associated myocarditis cases and 45 control patients to clarify clinical features of ICI-associated myocarditis. Detailed laboratory tests and imaging examinations were performed in 14 cases, and the rescue process and follow-up after the onset of myocarditis were recorded. Results: A total of 14 (2.08%) NSCLC patients developed ICI-related myocarditis, with a median time of onset of 34 days (interquartile range, 12 to 146 days) after ICI initiation. The most common concurrent adverse events in cases were myositis (P<0.001) and peripheral neuritis (P<0.001). Among cases, cardiac troponin I (cTnI) levels were abnormally elevated in 92% of patients, and electrocardiogram (ECG) showed abnormal in all cases. Steroid therapy was used in 92.9% of patients with ICI-associated myocarditis, of which the response rate to steroids was 76.9% and the mortality rate was 7.1%. A dose of 1 g/d of glucocorticoid supplemented by immunoglobulin was observed to be effective for severe myocarditis. Conclusions: Early identification and treatment are essential for managing myocarditis caused by ICI. Routine monitoring of cTnI level and ECG is most sensitive for the early diagnosis of ICI-related myocarditis. High-dose of glucocorticoids can effectively relieve the symptoms of ICI-associated myocarditis and stabilize the condition, especially for fulminant myocarditis.

Synthesis, characterization, and anticancer activity of protamine sulfate stabilized selenium nanoparticles.

Selenium nanoparticles (SeNPs) have attracted much recent interest as nutraceuticals, while they face great challenges, such as poor stability and low cellular uptake efficiency. This study introduced a facile approach to synthesizing protamine sulfate (PS) functionalized selenium nanoparticles (PS-SeNPs) by using PS as a surface decorator. The monodisperse spherical PS-SeNPs with a particle size of 130 nm and a ζ-potential of +31 mV were ligated with PS through Se-N, Se-O bonds, and physical adsorption, which exhibits excellent physical stability against pH, temperature, and storage time. The positive surface charge of PS-SeNPs contributed to the enhancement of cellular uptake efficiency by endocytosis, which was 3-times higher than bare SeNPs. Compared to SeNPs (IC50 = 17.675 µg/mL), PS-SeNPs could dramatically inhibit the proliferation of HepG2 cells with an IC50 value of 5.507 µg/mL, as reflected by the induction of apoptosis, S phase arresting, overproduction of intracellular ROS, and depolarization of mitochondria membrane. Overall, these results demonstrated the great potential of PS-SeNPs that can be applied as a functional ingredient in foods and nutraceuticals.

Towards transcervical ultrasound image guidance for transoral robotic surgery.

PURPOSE: Trans-oral robotic surgery (TORS) using the da Vinci surgical robot is a new minimally-invasive surgery method to treat oropharyngeal tumors, but it is a challenging operation. Augmented reality (AR) based on intra-operative ultrasound (US) has the potential to enhance the visualization of the anatomy and cancerous tumors to provide additional tools for decision-making in surgery. METHODS: We propose a US-guided AR system for TORS, with the transducer placed on the neck for a transcervical view. Firstly, we perform a novel MRI-to-transcervical 3D US registration study, comprising (i) preoperative MRI to preoperative US registration, and (ii) preoperative to intraoperative US registration to account for tissue deformation due to retraction. Secondly, we develop a US-robot calibration method with an optical tracker and demonstrate its use in an AR system that displays anatomy models in the surgeon's console in real-time. RESULTS: Our AR system achieves a projection error from the US to the stereo cameras of 27.14 and 26.03 pixels (image is 540[Formula: see text]960) in a water bath experiment. The average target registration error (TRE) for MRI to 3D US is 8.90 mm for the 3D US transducer and 5.85 mm for freehand 3D US, and the TRE for pre-intra operative US registration is 7.90 mm. CONCLUSION: We demonstrate the feasibility of each component of the first complete pipeline for MRI-US-robot-patient registration for a proof-of-concept transcervical US-guided AR system for TORS. Our results show that trans-cervical 3D US is a promising technique for TORS image guidance.

Construction of Polygonatum sibiricum Polysaccharide Functionalized Selenium Nanoparticles for the Enhancement of Stability and Antioxidant Activity.

Although selenium nanoparticles (SeNPs) have attracted great attention due to their potential antioxidant activity and low toxicity, the application of SeNPs is still restricted by their poor stability. A combination of polysaccharides and SeNPs is an effective strategy to overcome the limitations. In this study, Polygonatum sibiricum polysaccharide (PSP) was used as a stabilizer to fabricate SeNPs under a simple redox system. Dynamic light scattering, transmission electron microscopy, energy dispersive X-ray, ultraviolet-visible spectroscopy, Fourier transform infrared, and X-ray photoelectron spectrometer were applied to characterize the synthesized PSP-SeNPs. The stability and the antioxidant activity of PSP-SeNPs were also investigated. The results revealed that the zero-valent and well-dispersed spherical PSP-SeNPs with an average size of 105 nm and a negative ζ-potential of -34.9 mV were successfully synthesized using 0.1 mg/mL PSP as a stabilizer. The prepared PSP-SeNPs were stable for 30 days at 4 °C. The decoration of the nanoparticle surface with PSP significantly improved the free radical scavenging ability of SeNPs. Compared to the H2O2-induced oxidative stress model group, the viability of PC-12 cells pretreated with 20 µg/mL PSP-SeNPs increased from 56% to 98%. Moreover, PSP-SeNPs exhibited a higher protective effect on the H2O2-induced oxidative damage on PC-12 cells and lower cytotoxicity than sodium selenite and SeNPs. In summary, these results suggest the great potential of PSP-SeNPs as a novel antioxidant agent in the food or nutraceuticals area.

Progress in the Surface Functionalization of Selenium Nanoparticles and Their Potential Application in Cancer Therapy.

As an essential micronutrient, selenium participates in numerous life processes and plays a key role in human health. In the past decade, selenium nanoparticles (SeNPs) have attracted great attention due to their excellent functionality for potential applications in pharmaceuticals. However, the utilization of SeNPs has been restricted by their instability and low targeting ability. Since the existing reviews mainly focused on the applications of SeNPs, this review highlights the synthesis of SeNPs and the strategies to improve their stability and targeting ability through surface functionalization. In addition, the utilization of functionalized SeNPs for the single and co-delivery of drugs or genes to achieve the combination of therapy are also presented, with the emphasis on the potential mechanism. The current challenges and prospects of functionalized SeNPs are also summarized. This review may provide valuable information for the design of novel functionalized SeNPs and promote their future application in cancer therapy.

Synthesis, characterization, and biological evaluation of novel selenium-containing chitosan derivatives.

Though great efforts have been made to develop selenium polysaccharides with unique properties using HNO3-Na2SeO3 methods, the Se content is still low due to the poor esterification efficiency of H2SeO3. Herein, selenodiacetic acid (SA) was introduced into chitosan (CS) to synthesize O-selenodiacetyl chitosan (OSAC) and chitosan-ammonium selenodiacetate (CASA) by covalent and non-covalent interaction, respectively. The obtained CS derivatives were characterized by UV-vis, FTIR, 1H NMR, XPS, TGA, and XRD spectra, and the OSAC and CASA showed high Se content up to 15,720 ± 475 and 26,363 ± 698 µg/g. The OSAC and CASA demonstrated increased antioxidant activities compared to the CS in DPPH and ABTS free radical scavenging assays. Moreover, they exhibited a potent anticancer effect on HepG2 cells with the IC50 values of 0.918 and 1.459 µg/mL. Taken together, this study provides a promising strategy for the design of novel selenium polysaccharides with high Se content and greater biological activity.

Chitosan/zein bilayer films with one-way water barrier characteristic: Physical, structural and thermal properties.

Chitosan (C) and zein (Z) were used to develop bilayer films with a characteristic one-way water barrier using a layer-by-layer (LBL) casting method. The effects of mass ratios (C:Z1:1, C:Z1:2, C:Z1:3, C:Z3:1, C:Z2:1) on the microstructure and physicochemical properties of bilayer films were investigated. Bilayer films had uniform microstructures, and C:Z = 1:3 showed a firmer structure as the Z aggregates were distributed in the continuous phase of C. The intermolecular interactions between the C and Z layers were observed using FTIR and XRD analysis. TGA demonstrated that adding Z layer enhanced the thermal stability of C films. LBL coating gave the C/Z bilayer film an increased elongation and tensile strength, as well as a decreased water vapor and oxygen permeability, especially for C:Z = 1:3 which had better properties. The results suggested that C and Z bilayer films may be a promising material for food packaging with the desired water resistance.

Changes in left atrial appendage orifice following percutaneous left atrial appendage closure using three-dimensional echocardiography.

Percutaneous left atrial appendage (LAA) occlusion is increasingly performed in patients with atrial fibrillation and long-term contraindications for anticoagulation. Our aim was to evaluate the effects of LAA occlusion with the Watchman device on the geometry of the LAA orifice and assess its impact on the adjacent left upper pulmonary vein (LUPV) hemodynamics. We included 50 patients who underwent percutaneous LAA occlusion with the Watchman device and had acceptable three-dimensional transesophageal echocardiography images of LAA pre- and post-device placement. We measured offline the LAA orifice diameters in the long axis, and the minimum and maximum diameters, circumference, and area in the short axis view. Eccentricity index was calculated as maximum/minimum diameter ratio. The LUPV peak S and D velocities pre- and post-procedure were also measured. Patients were elderly (mean age 76 ± 8 years), 30 (60%) were men. There was a significant increase of all LAA orifice dimensions following LAA occlusion: diameter 1 (pre-device 18.1 ± 3.2 vs. post-device 21.5 ± 3.4 mm, p < 0.001), diameter 2 (20.6 ± 3.9 vs. 22.1 ± 3.6 mm, p < 0.001), minimum diameter (17.6 ± 3.1 vs. 21.3 ± 3.4 mm, p < 0.001), maximum diameter (21.5 ± 3.9 vs. 22.4 ± 3.6 mm, p = 0.022), circumference (63.6 ± 10.7 vs. 69.6 ± 10.5 mm, p < 0.001), and area (3.1 ± 1.1 vs. 3.9 ± 1.2 cm2, p < 0.001). Eccentricity index decreased after procedure (1.23 ± 0.16 vs. 1.06 ± 0.06, p < 0.001). LUPV peak S and D velocities did not show a significant difference (0.29 ± 0.15 vs. 0.30 ± 0.14 cm/s, p = 0.637; and 0.47 ± 0.19 vs. 0.48 ± 0.20 cm/s, p = 0.549; respectively). LAA orifice stretches significantly and it becomes more circular following LAA occlusion without causing a significant impact on the LUPV hemodynamics.

The characterization and biological activities of synthetic N, O-selenized chitosan derivatives.

Synthetic selenium polysaccharides with potential bioactivity have drawn great interest due to the SeO bonds existing in the structure. Herein, N, O-selenized N-(2-carboxyethyl) chitosan (sNCCS) was synthesized through carboxyethylation and selenylation. Various characterizations were performed to identify the structure of sNCCS, indicating that SeO bonds were formed both at the C-6 hydroxyl groups and the introduced C-2 carboxyethyl groups. The highest yield and selenium content of all sNCCS reached 84.5% and 1.553 mg/g, respectively. In vitro evaluation exhibited that sNCCS has excellent bile acid binding capacity, which was 1.63, 2.00, and 2.55-fold higher than that of N-(2-carboxyethyl) chitosan (NCCS). Moreover, it was found that higher selenium content could significantly enhance the antioxidant properties of sNCCS. Importantly, no obvious cytotoxic effect had been observed on Caco-2 cells. Taken together, sNCCS with desirable biological activity and non-cytotoxicity might be considered as an effective ingredient in the fields of food or medicine.