Assessment of Left Ventricular Longitudinal Systolic Function Using Global Tissue Motion Annular Displacement in Patients with Chronic Severe Aortic Regurgitation.

Background: In patients with chronic aortic regurgitation (AR), the left ventricle (LV) develops compensatory mechanisms to sustain its function. LV global longitudinal strain (GLS) is a key means to detect subclinical LV dysfunction, even when LV ejection fraction (LVEF) remains within the normal range. Compared to GLS, Tissue motion annular displacement (TMAD) is a simpler strain-based method to assess LV systolic function. This study investigated the correlation among TMAD parameters, LVEF, and GLS, and determined the diagnostic value and threshold of TMAD parameters for left ventricular systolic dysfunction. Methods: A prospective study was conducted at a single center. The case and control groups consisted of patients with chronic severe AR and healthy volunteers, respectively. Speckle-tracking echocardiography (STE) was used to assess the GLS and TMAD parameters in the apical 4-chamber and apical 2-chamber. Subsets of participants were analyzed for inter- and intra-observer variability and analysis time. A correlation analysis was performed among the TMAD parameters, LVEF, and GLS. Receiver operating characteristic curves and the area under the curves (AUCs) were used to evaluate the predictive value of the TMAD parameters for LVEF <50% and GLS > -18%. Results: This study involved 96 patients with severe chronic AR and 45 healthy volunteers. Compared to GLS, TMAD demonstrated superior intra- and inter-observer consistency and shorter average analysis time. Biplane global Midpt% showed the highest correlation with GLS and LVEF among all the TMAD parameters, with r values of 0.81 and 0.74, respectively. Furthermore, global Midpt% had AUCs of 0.89 and 0.92 for predicting LVEF< 50% and GLS > -18%, respectively. Conclusion: The TMAD global Midpt% has the potential to replace GLS in clinical practice and find wide applications.

Remote ischaemic preconditioning versus no remote ischaemic preconditioning for vascular and endovascular surgical procedures.

BACKGROUND: Despite advances in perioperative care, elective major vascular surgical procedures still carry a significant risk of morbidity and mortality. Remote ischaemic preconditioning (RIPC) is the temporary blocking of blood flow to vascular beds remote from those targeted by surgery. It has the potential to provide local tissue protection from further prolonged periods of ischaemia. However, the efficacy and safety of RIPC in people undergoing major vascular surgery remain unknown. This is an update of a review published in 2011.  OBJECTIVES: To assess the benefits and harms of RIPC versus no RIPC in people undergoing elective major vascular and endovascular surgery. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov to 1 April 2022. SELECTION CRITERIA: We included all randomised controlled trials that evaluated the role of RIPC in reducing perioperative mortality and morbidities in people undergoing elective major vascular or endovascular surgery. DATA COLLECTION AND ANALYSIS: We collected data on the characteristics of the trial, methodological quality, and the remote ischaemic preconditioning stimulus used. Our primary outcome was perioperative mortality, and secondary outcomes included myocardial infarction, renal impairment, stroke, hospital stay, limb loss, and operating time or total anaesthetic time. We analysed the data using random-effects models. For each outcome, we calculated the risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) based on an intention-to-treat analysis. In addition, we used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included 14 trials which randomised a total of 1295 participants (age range: 64.5 to 76 years; 84% male; study periods ranged from 2003 to 2019). In general, the included studies were at low to unclear risk of bias for most risk of bias domains. The certainty of evidence of main outcomes was moderate due to imprecision of results, moderate heterogeneity, or possible publication bias. We found that RIPC made no clear difference in perioperative mortality compared with no RIPC (RR 1.41, 95% CI 0.59 to 3.40; I2 = 0%; 10 studies, 965 participants; moderate-certainty evidence). Similarly, we found no clear difference between the two groups for myocardial infarction (RR 0.82, 95% CI 0.49 to 1.40; I2 = 7%; 11 studies, 1001 participants; moderate-certainty evidence), renal impairment (RR 1.07, 95% CI 0.62 to 1.86; I2 = 40%; 12 studies, 1054 participants; moderate-certainty evidence), stroke (RR 0.33, 95% CI 0.04 to 3.15; I2 = 0%; 4 studies, 392 participants; moderate-certainty evidence), limb loss (RR 0.74, 95% CI 0.05 to 10.61; I2 = 32%; 3 studies, 322 participants; low-certainty evidence), hospital stay (MD -0.94 day, 95% CI -1.95 to 0.07; I2 = 17%; 7 studies, 569 participants; moderate-certainty evidence), and operating time or total anaesthetic time (MD 5.76 minutes, 95% CI -3.25 to 14.76; I2 = 44%; 10 studies, 803 participants; moderate-certainty evidence).  AUTHORS' CONCLUSIONS: Overall, compared with no RIPC, RIPC probably leads to little or no difference in perioperative mortality, myocardial infarction, renal impairment, stroke, hospital stay, and operating time, and may lead to little or no difference in limb loss in people undergoing elective major vascular and endovascular surgery. Adequately powered and designed randomised studies are needed, focusing in particular on the clinical endpoints and patient-centred outcomes.

Does False Lumen Thrombosis Lead to Better Outcomes in Patients with Aortic Dissection: A Meta-Analysis and Systematic Review.

OBJECTIVES: For a long time, the association of the false lumen status and the outcomes of patients suffering from aortic dissection has been unclear, so this review article aims to study whether the unobstructed of the false lumen is related to the outcome of patients suffering from aortic dissection. METHODS: We performed this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta Analyzes Protocols (PRISMA) statement 2009 and registered with PROSPERO (CRD42022381869). We searched PubMed, the Cochrane library, Web of Science and Embase to collect potential studies. The Newcastle-Ottawa Scale was used to assess the quality of the included studies. The main outcome is long-term survival. Data included in the study were summarized using the risk ratio or mean difference and 95% confidence interval. RESULTS: There were 16 trials, 2829 patients in total, with a mean age of 62.1 years. Compared with completely thrombosed false lumen, patent group has better long-term survival (risk ratio (RR), 0.88; 95% CI, 0.79 to 0.97; p = 0.01; I2 = 58%) and smaller yearly aortic growth rate (mean difference (MD), 1.03; 95% CI, 0.23 to 1.82; p = 0.01; I2 = 98%). In addition, patients with a patent false lumen had a lower risk of aortic event (RR, 0.81; 95% CI, 0.68 to 0.97; p = 0.02; I2 = 37%), but higher risk of aortic rupture (RR, 7.02; 95% CI, 2.55 to 19.3; p = 0.0002; I2 = 0) and hospital death (RR, 2.72; 95% CI, 1.45 to 5.08; p = 0.002; I2 = 0). CONCLUSION: Completely thrombosed of the false lumen is more beneficial to the long-term survival of patients with aortic dissection. And the risk of aortic rupture and hospital death in patients with patent false lumen is 7 times and 3 times that of patients with complete thrombosed false lumen. It is expected to provide individualized medical care for different types of patients according to different false lumen status to minimize death and related complications.

Impact of genetic and clinical factors on warfarin therapy in patients early after heart valve replacement surgery.

PURPOSE: Factors influencing responsiveness to warfarin at treatment onset time were not well identified in Chinese patients undergoing heart valve replacement. We sought to select the most relevant factors that associated with patient response to warfarin early after heart valve surgery. METHODS: In this observational study, 289 patients starting warfarin therapy early after heart valve replacement surgery were enrolled. CYP2C9 *1, *2, *3, and *5; VKORC1-1639 G>A, CYP4F2 V433M, and GGCX rs11676382 genotypes; clinical characteristics, response to therapy, and bleeding and thrombosis events were collected. The primary outcomes were the time to the first INR equal to or more than lower limit of therapeutic range and the warfarin dose requirements. Stepwise multiple linear regression was performed to develop a dosing algorithm to predict the warfarin dose requirements. RESULTS: The results of univariate analysis showed lone VKORC1-1639 G>A, CYP2C9 *1/*3, cefazolin, cefoperazone-sulbactam, increased BMI, Δhemoglobin, and white blood cell count could significantly affect patient responsiveness to warfarin in the initial period of anticoagulation. Multivariate analysis resulted in an equation: Accumulated warfarin doses (mg) = 17.068 VKORC1-1639 G>A - 4.261 hypertension + 0.593 BMI - 0.115 age - 4.852 CYP2C9 *1/*3 - 2.617 cefazolin - 4.902 cefoperazone-sulbactam - 4.537, which could explain 40.2% of the variability in warfarin dose needed to reach the first INR equal to or more than lower limit of therapeutic range. CONCLUSIONS: Both genetic and clinical factors contributed to anticoagulation effect of warfarin in the initial period of treatment. Our findings could provide a basis for the personalized management of warfarin use in the early stage of anticoagulation in northern Chinese patients.

Predictors of early left ventricular dysfunction after mitral valve replacement for rheumatic valvular disease.

OBJECTIVE: The purpose of this study was to determine the predictors of early left ventricular (LV) dysfunction in patients with rheumatic heart disease (RHD) after mitral valve replacement (MVR). We examined echocardiographic and nonechocardiographic predictors. METHODS: This study included 571 patients receiving MVR for RHD from 2012 to 2017. Their baseline characters, preoperative examination, operation data, and postoperative echocardiography were collected retrospectively. Univariate and multivariate logistic regression were used to evaluate the predictors of early LV dysfunction after MVR. The LV dysfunction was defined as left ventricular end-ejection fraction (LVEF) <50%. The interaction model was further performed to calculate interaction effects between predictors selected by logistic regression. RESULTS: In the 571 patients, 164 (28.7%) had early LV dysfunction after the operation, but only 94 (16.5%) had a preoperative LVEF <50%. Significant differences between two groups (LVEF ≥50% or LVEF <50%) were finally revealed in LV end-diastolic dimension, preoperative atrial fibrillation (AF), preoperative LVEF <50%, and the white blood cell (WBC) count measured after admission (>10 × 109 L -1 ) in the multivariate logistic regression. Corresponding odds ratios (ORs) were 1.06, 1.82, 3.63, and 2.64, respectively. Diabetes, lesion type, LV end-systolic dimension, aspartate transaminase, alanine transaminase, and serum creatinine were statistically significant (P < .05) in univariate logistic regression, with matched ORs 2.45, 1.66/0.65, 1.07, 2.50, 1.83, and 2.90, respectively. However, these variables were not significant anymore in the multivariate logistic model. Besides, the OR of early postoperative LV dysfunction increased to 7.00 when preoperative AF, preoperative LVEF <50%, and WBC >10 × 109 L-1 were all present. CONCLUSIONS: The preoperative LV dysfunction, a large LV volume, AF and over-normal WBC could independently predict postoperative LV dysfunction.

Compressed Fixation Combined with Vacuum-Assisted Closure for Treating Acute Injury of the Heel Fat Pad.

BACKGROUND Treating acute injury of the heel fat pad is different from treating common soft tissue damage. Due to the paucity of literature on the topic, we described our initial experience treating acute injury of the heel fat pad to determine the ideal treatment method. MATERIAL AND METHODS A total of 53 patients with acute injury of the heel fat pad admitted to our hospital were selected for the study and were randomly divided into 2 groups: the compressed fixation combined with vacuum-assisted closure group and the only reimplanted and sewn group. Twenty-seven of the heel fat pads were compressed and fixed using a flat, hard piece of plastic and hollow screws; then, they were covered with a vacuum-assisted closure device. The other 27 were only sewn without tension. The clinical results were evaluated according to the American Orthopedic Foot and Ankle Society hindfoot score and the British Medical Research Council function evaluation criteria RESULTS In the compressed fixation combined with vacuum-assisted closure group, flaps of 12 feet with retrograde avulsion injury survived successfully. Partial flap necrosis occurred in 8 feet. Seven feet underwent repair using the neurocutaneous vascular resupinated island flap. Results were excellent or good for 74% of patients according to the AOFS. However, in the only reimplanted and sewn group, results were excellent or good for 44% of patients according to the AOFS. CONCLUSIONS Compressed fixation with vacuum-assisted closure is effective for treating acute injury of the heel fat pad, with high success rates and good utility.

Genomic Analyses Reveal Demographic History and Temperate Adaptation of the Newly Discovered Honey Bee Subspecies Apis mellifera sinisxinyuan n. ssp.

Studying the genetic signatures of climate-driven selection can produce insights into local adaptation and the potential impacts of climate change on populations. The honey bee (Apis mellifera) is an interesting species to study local adaptation because it originated in tropical/subtropical climatic regions and subsequently spread into temperate regions. However, little is known about the genetic basis of its adaptation to temperate climates. Here, we resequenced the whole genomes of ten individual bees from a newly discovered population in temperate China and downloaded resequenced data from 35 individuals from other populations. We found that the new population is an undescribed subspecies in the M-lineage of A. mellifera (Apis mellifera sinisxinyuan). Analyses of population history show that long-term global temperature has strongly influenced the demographic history of A. m. sinisxinyuan and its divergence from other subspecies. Further analyses comparing temperate and tropical populations identified several candidate genes related to fat body and the Hippo signaling pathway that are potentially involved in adaptation to temperate climates. Our results provide insights into the demographic history of the newly discovered A. m. sinisxinyuan, as well as the genetic basis of adaptation of A. mellifera to temperate climates at the genomic level. These findings will facilitate the selective breeding of A. mellifera to improve the survival of overwintering colonies.

Single administration of intra-articular bupivacaine in arthroscopic knee surgery: a systematic review and meta-analysis.

BACKGROUND: Single administration of intra-articular (IA) bupivacaine for pain relief after arthroscopic knee surgery is effective, but its active duration and dose-response relationship is unclear. We conducted this meta-analysis to summarize all published randomized controlled trials (RCTs), thus providing the most recent information on the safety and efficacy of single-administration IA bupivacaine for pain relief after arthroscopic knee surgery, and to determine whether a dose-response relationship exists. METHODS: A systematic electronic literature search (through April 2014) was conducted to identify those RCTs that addressed the safety and efficacy of a single administration of IA bupivacaine for pain management after arthroscopic knee surgery. Subgroup analysis was conducted to determine changes in visual analog scale (VAS) scores at seven postoperative time points. Meta-regression and subgroup analyses were carried out to assess the effects of various treatment factors on efficacy and to evaluate the dose-response relationship of bupivacaine. Weighted mean differences or relative risks were calculated and pooled using a random-effects model. RESULTS: Twenty-eight trials involving 1,560 patients who underwent arthroscopic knee surgery met the inclusion criteria. The trials were subject to medium risk of bias. VAS scores at 2, 4, 6, 12, and 24 h postoperatively were significantly lower, the number of patients requiring supplementary analgesia was smaller, and the time to first request for analgesia was longer in the IA bupivacaine group than in the placebo group. The analgesic effect of single-administration IA bupivacaine may be associated with the effect of concomitant administration of epinephrine and concentration of bupivacaine, and no dose-response relationship was identified. No significant difference in side effects was detected between groups. CONCLUSIONS: Current evidence shows that the use of single-administration IA bupivacaine is effective for postoperative pain management in patients undergoing arthroscopic knee surgery, with satisfactory short-term safety. Low-dose administration of IA bupivacaine 0.5% combined with epinephrine adjuvant in clinical practice should be performed. Additional high-quality RCTs with longer follow-up periods are required to examine the safety of single-administration IA bupivacaine.

Understanding the spatial disparity in socio-economic recovery of coastal communities following typhoon disasters.

The increasing risk of climate change in the Anthropocene underscores the importance and urgency of enhancing resilience to climate-related disasters. However, the assessment of resilience to disasters with traditional statistical data is spatially inexplicit and timeliness inadequate, and the determinants of resilience remain unclear. In this study, we employed spatially detailed daily nighttime light images to assess socio-economic disturbance and track near real-time recovery of coastal communities in Southeast China following super typhoon Meranti. Furthermore, we constructed a "exposure-sensitivity-adaptive capacity" framework to explore the role of key factors in shaping spatiotemporal patterns of recovery. Our case study showed a significant spatial disparity in socio-economic recovery in the post-typhoon period. Low-urbanized areas recovered relatively rapidly with the weakest socio-economic disturbance they suffered, and middle-urbanized areas experienced the slowest recovery despite the disruption being moderate. Remarkably, high-urbanized areas were the most severely impacted by the typhoon but recovered fast. The exposure to hazard, socio-economic sensitivity, and adaptive capacity in communities explained well the spatial disparity of resilience to the typhoon. Maximum wind speed, percentage of the elderly, and percentage of low-income population significantly negatively correlated with resilience, whereas commercial activity intensity, spatial accessibility of hospitals, drainage capacity, and percentage of green open space showed significantly positive relationships with resilience. Notably, the effects of key factors on resilience were spatially heterogeneous. For instance, maximum wind speed exhibited the strongest influence on resilience in middle-urbanized areas, while the effect of commercial activity intensity was most pronounced in low-urbanized areas. Conversely, spatial accessibility of hospitals and drainage capacity showed the strongest influence in high-urbanized areas. Our study highlights the necessity of linking post-disaster recovery with intensity of hazard, socio-economic sensitivity, and adaptive capacity to understand community resilience for better disaster risk reduction.

The spatial configuration of buildings: A vital consideration impossible to ignore in regulating urban land surface temperature? Evidence from 35 Chinese cities.

Land urbanization not only efficiently met the requirements of social development but also brought severe heating effects, especially the changes in Land Surface Temperature (LST). The effects of building density on LST and driving relation of the configuration of buildings remain poorly understood over large areas. Using Landsat 8 satellite imagery acquired from the summer of 2019, this study quantified the heating effects (k) of building density on LST across 35 cities in China, and further analyzed the driving relation of the configuration of buildings such as the size, shape, and spatial distribution on k. Here the regression analysis results showed that the building density had a significant relationship with LST, and the k varied from 1.10 to 7.27 amount of the different cities. The size and aggregation distribution of buildings were the main positive drivers for the effects of building density on LST, and the shape of buildings was not obviously related to the k-value. The results of thermal environment simulation showed that the major reason might be that the close spatial relationship reduced the heat exchange between buildings and the atmosphere, resulting in higher LST. These conclusions will provide an important reference for urban planning and design.

Segmentation of pancreatic tumors based on multi-scale convolution and channel attention mechanism in the encoder-decoder scheme.

BACKGROUND: Computer-aided diagnosis is of great significance to improve the diagnostic accuracy of pancreatic cancer that has an insidious course and does not have obvious symptoms at first. However, segmentation of pancreatic cancer is challenging because the tumors vary in size with the smallest tumor having a size of about 0.5 c m $cm$ in diameter, and most of them have irregular shapes and unclear boundaries. PURPOSE: In this study, we developed a deep learning architecture Multi-Scale Channel Attention Unet (MSCA-Unet) for pancreatic tumor segmentation and collected CT images of 419 patients from The Affiliated Hospital of Qingdao University and a public dataset. We embedded the multi-scale network into the encoder to extract semantic information at different scales and the decoder to provide supplemental information to overcome the loss of information in the upsampling and the drift of the localized tumor due to the upsampling and skip connections. METHODS: We adopted the channel attention unit after the multi-scale convolution to emphasize the informative channels, which was observed to have the effects of accelerating the positioning process, reducing false positives, and improving the accuracy of outlining very small, irregular pancreatic tumors. RESULTS: Our results show that our network outperformed the other current mainstream segmentation networks and achieved a Dice index of 68.03%, a Jaccard of 59.31%, and an FPR of 1.36% on the private dataset Task-01 without data pre-processing. Compared with the other pancreatic tumor segmentation networks on the public dataset Task-02, our network produced the best Dice index, 80.12%, with the assistance of the data pre-processing scheme. CONCLUSIONS: This study strategically utilizes the multi-scale convolution and channel attention mechanism of the architecture to provide a dedicated network for segmentation of small and irregular pancreatic tumors.

New sights on the impact of spatial composition of production factors for socioeconomic recovery in the post-epidemic era: a case study of cities in central and eastern China.

The COVID-19 pandemic led to a sharp economic contraction. A comprehensive understanding of the relationship between the spatial composition of production factor (SCPF) and socioeconomic recovery is still missing. Here, we applied the contrasting status of nitrogen dioxide (NO2) concentrations in cities in central and eastern China as natural laboratories. From the perspective of the spatial composition of land (SCL) and the dependence on the inflow population (DIP), four quantifiable indicators (resilience, impact, sensitivity, recovery speed) were used to analyze the adaptability of SCPF to the epidemic lockdown. The results indicate that appropriate SCPF is a prerequisite for a complete "land-population-industry" nexus. The built-up area proportion is below 74.38%, with higher adaptability to epidemic shocks. The range of rural built-up proportion conducive to economic recovery is 10.18%-15.18%. The proportions of various land types inside the city's defense unit should also be constrained. Similarly, DIP is advocated to be maintained below 17.5%. For urban-rural fringe areas, the response to epidemic prevention and socioeconomic recovery are rapid. This observation-driven study indicated that COVID-19 is a shocking reminder for policymakers, to improve the socioeconomic recovery ability from the spatial composition of production factor perspective in the post-COVID-19 era.

Simultaneously tackling ecological degradation and poverty challenges: Evidence from desertified areas in northern China.

Developing sustainable environmental policies in ecologically fragile and deeply impoverished areas is a global challenge. Desertification has caused serious environmental and socioeconomic issues. It is important to reveal the mechanisms of environmental policies when balancing desertification control and poverty alleviation. This study used comparative analysis and trend analysis methods and assessed the policy performances of national key ecological functional areas (NKEFAs) for desertified areas in northern China from 2005 to 2020. Two factors have been fully analyzed: desertification and poverty. The results indicate that adaptive adjustments of the NKEFA policy play an essential role in eradicating the vicious cycle of "degradation-poverty". Although the improvements in ecological quality were not obvious, its trends changed substantially from decreasing to increasing. The proportions of desert control and socioeconomic improvement were more optimistic in the NKEFAs than in non-NKEFAs (e.g., expansion: 0.41% < 4.67%; improvement: 7.63% > 5.48%). The overall ecological benefit of the adjustment was 0.25%, which experienced a trend of declining first and then rising. The ecological and socioeconomic benefits of the first adjustment were - 0.96% per year and 2.1% per year, respectively. Then, the ecological and socioeconomic benefits of the second policy adjustment were 2.51% per year and 3.2% per year, respectively. The potential mechanism of the NKEFA policy effect is adaptive adjustments that are based on the complexity and variability of the issue. The results contribute to simultaneously tackling ecological degradation and poverty challenges and facilitating sustainable development.

A perception of the nexus "resistance, recovery, resilience" of vegetations responded to extreme precipitation pulses in arid and semi-arid regions: A case study of the Qilian Mountains Nature Reserve, China.

Unprecedented pulses of extreme precipitation due to climate change are causing significant stresses and impacts on regional and even global ecosystems. However, the relationship of vegetation response to this disturbance is unclear, such as phase characteristics, extent, timing, and degree. We summarize the nexus between vegetation resistance, recovery, and resilience under three stages of extreme precipitation pulses: duration, lagging, and post-disturbance, and then construct a pragmatic scheme to quantify and validate this complex relationship based on precipitation and Normalized Difference Vegetation Index (NDVI) data for the Qilian Mountains Nature Reserve (QMNR) from 2000 to 2020. The results show that the four extreme precipitation pulses were spring 2010 (118.98 mm), summer 2007 (312.25 mm), autumn 2010 (109.74 mm), and winter 2018 (6.84 mm). Extreme precipitations had a significant effect on vegetation in at least 98.5 % of the area, and there was also a two-month time lag effect. Specifically, the percentage of negative vegetation resistance in the face of four seasons of extreme precipitation pulses was 18.3 %, 2.0 %, 15.4 %, and 21.7 %, respectively, compared to negative recovery rates of 4.8 %, 11.9 %, 17.8 % and 10.2 % respectively, resilience was even more severe, with 20.1 %, 10.9 %, 16.1 % and 16.3 % of vegetation failing to rebound to normal levels within two months. The negative resistance, negative recovery, and weak resilience of vegetation under short-term extreme precipitation pulses are approximately 4.8, 3.7, and 5.3 times more fierce than long-term vegetation degradation. A total of 62 % of the four seasonal areas of severe negative resistance, severe negative recovery, and weak resilience were located in areas of moderate and significant steepness, which confirms that extreme precipitation pulses cause serious degradation of vegetation. Response of vegetation under extreme precipitation pulses is perceived, quantified, and validated in this study, which is essential for addressing climate change.

Prognostic Outcome of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis: A Systematic Review and Meta-Analysis.

Background: Left bundle branch block (LBBB) is a common complication of the transcatheter aortic valve replacement (TAVR), and its impact on prognosis is controversial. Methods: A comprehensive electronic search was conducted in databases (PubMed, Embase, Cochrane Library, and The Web of Science), from the date of database establishment till March 2021, to screen for studies on new-onset LBBB after TAVR. We next performed a meta-analysis to evaluate the effect of new-onset LBBB after TAVR on patient prognosis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 17 studies, including 9205 patients, were eligible for our analysis. Patients with new-onset LBBB had elevated all-cause mortality risk verses patients without new-onset LBBB, during all follow ups. The relevant data are as follows: 30-day (RR:1.71; 95%CI:1.27-2.29; P < 0.001), 1-year (RR:1.31; 95%CI:1.12-1.52; P < 0.001), and 2-year (RR:1.31; 95%CI:1.09-1.56; P = 0.003) follow ups. Likewise, new-onset LBBB patients also experienced increased cardiovascular mortality, compared to non-new-onset LBBB patients, but only in the 1-year follow up (RR:1.49; 95%CI:1.23-1.82; P < 0.001). Hospitalization for heart failure was dramatically elevated in patients with new-onset LBBB verses non-new-onset LBBB, in all follow ups. The relevant data are as follows: 30-day (RR:1.56; 95%CI:1.13-2.12; P = 0.007), 1-year (RR:1.35; 95%CI:1.08-1.68; P = 0.007), and 2-year (RR:1.49; 95%CI:1.21-1.84; P < 0.001). Similarly, new-onset LBBB patients had higher PPI risk than non-new-onset LBBB patients, in all follow ups. The relevant data are as follows: 30-day (RR:3.05; 95%CI:1.49-6.22; P = 0.002), 1-year (RR:2.15; 95%CI:1.52-3.03; P < 0.001), and 2-year (RR:2.52; 95%CI:1.68-3.78; P < 0.001). Conclusion: Patients with new-onset LBBB have worse prognosis after TAVR than those without new-onset LBBB. Recognition of the adverse effects of post-TAVR new-onset LBBB can lead to the development of new strategies that enhance clinical outcomes. Systematic Trial Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197224, identifier: 19722.

Impact of Chronic Kidney Disease on the Prognosis of Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis: A Meta-Analysis of 133624 Patients.

PURPOSE: The impact of chronic kidney disease (CKD) on the prognosis of transcatheter aortic valve replacement (TAVR) remains unclear. The purpose of this meta-analysis was to assess the impact of CKD and different stages of CKD on prognosis in patients undergoing TAVR. METHODS: As of June 2020, we performed a comprehensive literature search on relevant studies using PubMed, Embase, Cochrane Library, and Web of Science. Subsequently, we pooled the risk ratio (RR) of individual studies via random effects to analyze heterogeneity, quality assessment, and publication bias. RESULTS: A total of 20 studies, involving 133624 patients, were eligible for analysis. Patients with CKD had higher all-cause mortality at 30 days (RR: 1.39, 95% confidence interval [CI]: 1.31-1.47, P <0.001), 1 year (RR: 1.36, 95% CI: 1.24-1.49, P <0.001), and 2 years (RR: 1.2, 95% CI: 1.05-1.38, P = 0.009) of follow-up. Moreover, they also had higher acute kidney injury (AKI) (RR: 1.38, 95% CI: 1.16-1.63, P <0.001) and bleeding (RR: 1.33, 95% CI: 1.18-1.50, P <0.001) at 30 days. CKD3 alone also increased all-cause mortality at follow-ups. Risk of all-cause mortality increased with severity of CKD for stages 3, 4, and 5 at follow-up. CONCLUSION: Patients with CKD are at an increased risk of all-cause mortality, AKI, and bleeding events after TAVR. Moreover, the mortality risk rises with increasing severity of CKD.

Lung ultrasound in diagnosis of acute heart failure: A protocol for systematic review and meta-analysis.

BACKGROUND: Lung ultrasound has been used more and more in clinical diagnosis of acute heart failure (AHF) in recent years. The purpose of this paper is to evaluate the diagnostic value of lung ultrasound in AHF by meta-analysis. METHODS: PubMed, Cochrane Library, Web of Science, and Embase were searched. The time limit for retrieval is from the establishment to October 2022. According to the criteria, the literatures were screened and the relevant data was extracted. Efficacy of lung ultrasound in AHF was evaluated using Stata Version 16.0, (Stata Corp, College Station, TX). RESULTS: This study will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study conducted a systematic review of relevant studies, which aims to systematically evaluate the diagnostic value of lung ultrasound in AHF.

Facile synthesis of a high efficiency and durability L-citrulline flame retardant for cotton.

A novel flame retardant (FR), the ammonium salt of citrulline-penta (methylphosphonic acid) (ACPMPA) based on L-citrulline was synthesized, and its structure was characterized by 13C, 1H, and 31P nuclear magnetic resonance (NMR) spectroscopy. The ACPMPA flame retardant molecule contains five ammonium salts of phosphorus acid and one ammonium salt of carboxylic acid, which allowed the covalent attachment of ACPMPA onto cellulose via -P=O(-O-C) and -COOC bonds. The results showed that the treated cotton fabrics had very high flame retardance and excellent durability. The limiting oxygen index (LOI) of cotton fabric treated with 35%-ACPMPA reached 49.2% and only decreased to 34.2% after 50 laundry cycles. Vertical flame tests also demonstrated that the treated cotton fabric acquired good flame retardance. The thermogravimetry (TG) and TG-IR results showed that the treated cotton left more residues and released almost no flammable volatiles at high temperatures. The cone calorimetry results showed that the treated cotton released less heat than pure cotton. Scanning electron microscopy (SEM) and X-ray diffraction (XRD) results demonstrated that the structure of the treated cotton fabric was almost unchanged, and no free formaldehyde was detected, indicating that the treated cotton was safe. The treated cotton fabric also retained good tensile strength and whiteness.

A high molecular weight formaldehyde-free polymer flame retardant made from polyvinyl alcohol for cellulose.

Polyvinyl alcohol and phosphoric acid were used as primary raw materials to synthesize a polyvinyl alcohol/ammonium phosphate flame retardant (PVAAP) for cotton fabrics. The limiting oxygen index of the cotton fabric treated with 24% PVAAP was 42.1. After 50 standard laundry cycles, the limiting oxygen index remained relatively high (26.3), suggesting that the 24% PVAAP can be used as a durable flame retardant. The vertical flammability test of the cotton fabric treated with PVAAP exhibited no afterflame and afterglow. The cone calorimetry test indicated that the peak of the heat release rate and total heat release of the cotton fabric treated with 24% PVAAP were significantly lower than those of the control cotton. Thermogravimetric and thermogravimetric-infrared spectroscopy revealed that the initial decomposition temperature of the PVAAP-treated fabric was substantially lower than that of the control fabric, and more residual carbon was generated. The PVAAP altered the thermal decomposition pathway of the treated cotton. The X-ray diffraction patterns and scanning electron microscopy images suggested that the PVAAP treatment did not change the structure of the fibers.