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BACKGROUND: Immune checkpoint inhibitor (ICI) has become a major breakthrough in the field of tumor therapy, leading to improved survival. This study evaluated the clinical and electrocardiographic characteristics of patients with ICI-related myocarditis. METHODS: Patients with ICI-related myocarditis were enrolled from 4 centers in China until September 2023. Demographic data (age, sex, comorbidity), types of ICI, clinical manifestations, electrocardiogram (ECG) and treatment were analyzed retrospectively. Arrhythmia and characteristics of ECG were compared according to prognosis and grading. RESULTS: A total of 29 participants (13 females with a median age of 63.25 years) with ICI-related myocarditis were enrolled. Lung cancer was the most, with a proportion of 31.03 % (9/29). The median time from the first administration of ICI to the diagnosis of myocarditis was 50 days. Camrelizumab was the main type of ICI (9/29). Most patients had non-specific symptoms, dyspnea (n = 16) and palpitation (n = 9) were common. The overall mortality rate was 37.93 % (11/29) with a median follow-up of 9(4,11) days. Compared with the survivors, P-wave abnormality was more common in participants who were dead (24.14 %vs6.90 %, p = 0.010). A total of 19 patients with severe ICI-related myocarditis were included in this study. The proportions of sinus tachycardia (34.48 %vs0.00 %, p = 0.005), premature ventricular complex (27.59 %vs0.00 %, p = 0.027) and atrioventricular block (34.48 %vs3.45 %, p = 0.044) were higher in severe ICI-related myocarditis. CONCLUSIONS: Clinical manifestations of ICI-related myocarditis usually lacked specificity. ECGs can be manifested as new-onset arrhythmias, ST-T segment changes, fragmented QRS complex, abnormal P wave, prolonged QTc interval and multilead low voltage.
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Background: Immune checkpoint inhibitors (ICI) are increasingly used in the first-line treatment of malignant tumors. There is increasing recognition of their cardiotoxicity and, in particular, their potential to lead to myocarditis. Cardiovascular magnetic resonance (CMR) can quantify pathological changes, such as myocardial edema and fibrosis. The purpose of this systematic review and meta-analysis was to examine the evidence for the roles of CMR in predicting prognosis in ICI-associated myocarditis. Methods: PubMed, Cochrane Library, and Web of Science databases were searched until October 2023 for published works investigating the relationship between CMR parameters and adverse events in patients with ICI-associated myocarditis. The analysis included studies reporting the incidence of late gadolinium enhancement (LGE), T1 values, T2 values, and CMR-derived left ventricular ejection fraction (LVEF). Odds ratios (OR) and weighted mean differences (WMD) were combined for binary and continuous data, respectively. Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Results: Five cohort studies were included (average age 65-68 years; 25.4% female). Of these, four studies were included in the meta-analysis of LGE-related findings. Patients with major adverse cardiovascular events (MACE) had a higher incidence of LGE compared with patients without MACE (OR = 4.18, 95% CI: 1.72-10.19, p = 0.002). A meta-analysis, incorporating data from two studies, showed that patients who developed MACE exhibited significantly higher T1 value (WMD = 36.16 ms, 95% CI: 21.43-50.89, p < 0.001) and lower LVEF (WMD = - 8.00%, 95% CI: -13.60 to -2.40, p = 0.005). Notably, T2 value (WMD = -0.23 ms, 95% CI: -1.86 to -1.39, p = 0.779) was not associated with MACE in patients with ICI-related myocarditis. Conclusions: LGE, T1 value, and LVEF measured by CMR imaging have potential prognostic value for long-term adverse events in patients with ICI-related myocarditis.
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Background and aims: Postoperative atrial fibrillation (POAF) is a frequent complication following cardiac surgery and is associated with adverse clinical outcomes. Our study aimed at determining the clinical and echocardiographic predictors of POAF in patients with cardiac surgery and management of this group of patients may improve their outcome. Methods: We prospectively enrolled patients from the department of cardiovascular surgery in the Second Hospital of Tianjin Medical University from October 23, 2020 to October 30, 2022, without a history of atrial fibrillation. Cox regression was used to identify significant predictors of POAF. Results: A total of 217 patients (79 [36.41 %] were female, 63.96 ± 12.32 years) were included. 88 (40.55 %) patients met the criteria for POAF. Cox regression showed that preoperative left atrial diameter (LAD) (HR: 1.040, 95 % CI 1.008-1.073, p = 0.013) and postoperative QRS/LVEDD (HR: 0.398, 95 % CI 0.193-0.824, p = 0.013) and E/e' (HR: 1.029, 95 % CI 1.002-1.057ï¼p = 0.033) were predictors of POAF. Conclusion: Preoperative LAD and postoperative QRS/LVEDD and E/e' were predictors of POAF in patients undergoing cardiac surgery. Trial registration site: http://www.chictr.org.cn. Registration number: ChiCTR2200063344.
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Atrial fibrillation (AF) is the most common arrhythmia, and atrial fibrosis is a pathological hallmark of structural remodeling in AF. Prostaglandin I2 (PGI2) can prevent the process of fibrosis in various tissues via cell surface Prostaglandin I2 receptor (IP). However, the role of PGI2 in AF and atrial fibrosis remains unclear. The present study aimed to clarify the role of PGI2 in angiotensin II (Ang II)-induced AF and the underlying molecular mechanism. PGI2 content was decreased in both plasma and atrial tissue from patients with AF and mice treated with Ang II. Treatment with the PGI2 analog, iloprost, reduced Ang II-induced AF and atrial fibrosis. Iloprost prevented Ang II-induced atrial fibroblast collagen synthesis and differentiation. RNA-sequencing analysis revealed that iloprost significantly attenuated transcriptome changes in Ang II-treated atrial fibroblasts, especially mitogen-activated protein kinase (MAPK)-regulated genes. We demonstrated that iloprost elevated cAMP levels and then activated protein kinase A, resulting in a suppression of extracellular signal-regulated kinase1/2 and P38 activation, and ultimately inhibiting MAPK-dependent interleukin-6 transcription. In contrast, cardiac fibroblast-specific IP-knockdown mice had increased Ang II-induced AF inducibility and aggravated atrial fibrosis. Together, our study suggests that PGI2/IP system protects against atrial fibrosis and that PGI2 is a therapeutic target for treating AF.The prospectively registered trial was approved by the Chinese Clinical Trial Registry. The trial registration number is ChiCTR2200056733. Data of registration was 2022/02/12.
Subject(s)
Angiotensin II , Atrial Fibrillation , Atrial Remodeling , Epoprostenol , Mice, Inbred C57BL , Signal Transduction , Animals , Atrial Fibrillation/metabolism , Atrial Fibrillation/pathology , Atrial Fibrillation/chemically induced , Atrial Fibrillation/prevention & control , Mice , Humans , Male , Signal Transduction/drug effects , Atrial Remodeling/drug effects , Epoprostenol/metabolism , Fibrosis , Fibroblasts/metabolism , Fibroblasts/drug effects , Fibroblasts/pathology , Heart Atria/metabolism , Heart Atria/pathology , Heart Atria/drug effects , Iloprost/pharmacology , Receptors, Epoprostenol/metabolism , Receptors, Epoprostenol/genetics , FemaleABSTRACT
BACKGROUND: Over the past decade, immune checkpoint inhibitors (ICIs) have significantly transformed cancer treatment. However, ICIs inevitably may cause a spectrum of immune-related adverse events, among which cardiovascular toxicity, particularly myocarditis, while infrequent, has garnered increasing attention due to its high fatality rate. METHODS: We conducted a multicenter retrospective study to characterize ICI-associated cardiovascular adverse events. Logistic regression was performed to explore the risk factors for the development of myocarditis and severe myocarditis. Receiver operating characteristic curves were conducted to assess the diagnostic abilities of cardiac biomarkers to distinguish different cardiovascular toxicities, and the performance and calibration were evaluated using Hosmer-Lemeshow test. RESULTS: Forty-four patients were identified, including thirty-five myocarditis, five heart failure, three arrhythmias, and one myocardial infarction. Compared with other patients, myocarditis patients had higher cardiac troponin-I (cTnI) levels (p < 0.001), higher creatine kinase levels (p = 0.003), higher creatine kinase isoenzyme-MB (CK-MB) levels (p = 0.013), and shorter time to the incidence of adverse cardiovascular events (p = 0.022) after ICI treatment. Twenty-one patients (60%) were classified as severe myocarditis, and they presented higher cardiac troponin I (cTnI) levels (p = 0.013), higher N-terminal pro-B-type natriuretic peptide levels (p = 0.031), higher creatine kinase levels (p = 0.018), higher CK-MB levels (p = 0.026), and higher neutrophil to lymphocyte ratio (NLR) levels (p = 0.016) compared to non-severe myocarditis patients after ICI treatment. Multivariate logistic regression showed that CK-MB (adjusted odds ratio [OR]: 1.775, 95% confidence interval [CI]: 1.055-2.984, p = 0.031) was the independent risk factor of the development of ICI-associated myocarditis, and cTnI (adjusted OR: 1.021, 95% CI: 1.002-1.039, p = 0.03) and NLR (adjusted OR: 1.890, 95% CI: 1.026-3.483, p = 0.041) were the independent risk factors of ICI-associated severe myocarditis. The receiver operating characteristic curve showed an area under curve of 0.785 (95% CI: 0.642 to 0.928, p = 0.013) for CK-MB, 0.765 (95% CI: 0.601 to 0.929, p = 0.013) for cTnI, and 0.773 for NLR (95% CI: 0.597 to 0.948, p = 0.016). CONCLUSIONS: Elevated CK-MB after ICI treatment is the independent risk factor for the incidence of ICI-associated myocarditis, and elevated cTnI and NLR after ICI treatment are the independent risk factors for the development of ICI-associated severe myocarditis. CK-MB, cTnI, and NLR demonstrated a promising predictive utility for the identification of ICI-associated myocarditis and severe myocarditis.
Subject(s)
Immune Checkpoint Inhibitors , Myocarditis , Humans , Male , Retrospective Studies , Female , Immune Checkpoint Inhibitors/adverse effects , Myocarditis/chemically induced , Myocarditis/epidemiology , Myocarditis/diagnosis , Middle Aged , Aged , Risk Factors , Biomarkers/blood , Neoplasms/drug therapy , Troponin I/blood , ROC Curve , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/epidemiology , Creatine Kinase, MB Form/blood , Natriuretic Peptide, Brain/blood , Heart Failure/chemically inducedABSTRACT
Background: Insufficient clinicians' auscultation ability delays the diagnosis and treatment of valvular heart disease (VHD); artificial intelligence provides a solution to compensate for the insufficiency in auscultation ability by distinguishing between heart murmurs and normal heart sounds. However, whether artificial intelligence can automatically diagnose VHD remains unknown. Our objective was to use deep learning to process and compare raw heart sound data to identify patients with VHD requiring intervention. Methods: Heart sounds from patients with VHD and healthy controls were collected using an electronic stethoscope. Echocardiographic findings were used as the gold standard for this study. According to the chronological order of enrollment, the early-enrolled samples were used to train the deep learning model, and the late-enrollment samples were used to validate the results. Results: The final study population comprised 499 patients (354 in the algorithm training group and 145 in the result validation group). The sensitivity, specificity, and accuracy of the deep-learning model for identifying various VHDs ranged from 71.4 to 100.0%, 83.5-100.0%, and 84.1-100.0%, respectively; the best diagnostic performance was observed for mitral stenosis, with a sensitivity of 100.0% (31.0-100.0%), a specificity of 100% (96.7-100.0%), and an accuracy of 100% (97.5-100.0%). Conclusions: Based on raw heart sound data, the deep learning model effectively identifies patients with various types of VHD who require intervention and assists in the screening, diagnosis, and follow-up of VHD.
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Cadmium (Cd) is detrimental to plant growth and threatens human health. Here, we investigated the potential for remediation of Cd-contaminated soil with high copper (Cu) background using Cd hyperaccumulator ecotype (HE) Sedum alfredii. We assessed effects of Cu on Cd accumulation, compartmentation and translocation in HE S. alfredii, and compared with those in a related non-accumulator ecotype (NHE). We found that Cu supply significantly induced Cd accumulation in roots and shoots of long-term soil-cultivated HE S. alfredii. A large fraction of root Cd was accumulated in the organelles, but a small fraction was stored in the cell wall. Importantly, Cu addition reduced Cd accumulation in the cell wall and the organelles in root cells. Furthermore, leaf cell capacity to sequestrate Cd in the organelles was greatly improved upon Cu exposure. We also found that genes involving metal transport and cell wall remodeling were distinctly regulated to mediate Cd accumulation in HE S. alfredii. These findings indicate that Cu-dependent decrease of root cell-wall-bound Cd, and stimulation of efflux/influx of organelle Cd transport in root and leaf cells plays a role in the dramatic Cd hyperaccumulation expressed in naturally survived HE S. alfredii.
Subject(s)
Sedum , Soil Pollutants , Humans , Cadmium/pharmacology , Copper/pharmacology , Plant Roots/chemistry , Soil , Soil Pollutants/analysis , Biodegradation, EnvironmentalABSTRACT
BACKGROUND: This meta-analysis evaluated long-term efficacy and safety of cryoballoon ablation (CB) of atrial fibrillation (AF). METHODS: PubMed, Cochrane Library, and Web of Science were searched until July 31, 2023, for published works investigating efficacy and safety of CB of AF in which mean/median follow-up time was not less than 36 months. Safety was assessed by adverse events. Efficacy was assessed by AF recurrence, defined as any atrial arrhythmias lasting more than 30 s. RESULTS: A total of 19 clinical studies were included. After an average of 58.1 months of follow-up, the overall AF recurrence rate was about 37%. The predictors of recurrence were duration of AF (HR 1.00; 95% CI [1.00 â¼ 1.01]), early recurrence of atrial fibrillation (HR 3.96; 95%CI [1.12 â¼ 14.02]), left atrial diameter (HR 1.04; 95%CI [1.02 â¼ 1.06]), and persistent AF (HR1.47; 95% CI [1.19 â¼ 1.82]). In terms of safety, the incidence of transient phrenic paralysis (PNP) was the highest, about 3%; followed by vascular complications (about 2%); pseudoaneurysm, permanent PNP, and all-cause death was (about 1%); and pericardial effusion and stroke / TIA was very low. CONCLUSION: CB is associated with low rates of severe complications and reasonable success rates.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Cryosurgery , Pulmonary Veins , Humans , Cryosurgery/adverse effects , Treatment Outcome , Pulmonary Veins/surgery , Recurrence , Catheter Ablation/adverse effectsABSTRACT
Digital inclusive finance eases credit constraints on innovative small and medium-sized enterprises which contributes to urban green technology innovation in China. Government intervention plays an essential role in the development of digital inclusive finance. Based on the panel data of 243 cities in China from 2011 to 2019, this paper empirically examines the relationship between digital inclusive finance and urban green technology innovation as well as the intrinsic mechanism of government intervention. The findings show that, even after a series of robustness tests, digital inclusive finance can promote the quantity and quality of green technology innovation. In terms of its mechanism, digital inclusive finance can empower green technology innovation by complementing traditional financial development and stimulating green consumption, both in terms of supply and demand. At the same time, in the dynamic process of digital financial inclusion from low to high, the development of traditional finance and green consumption level on the marginal promotion of green technology innovation continues to strengthen. The nonlinear relationship test reveals that there is a significant double threshold effect on the positive impact of digital inclusive finance on urban green technology innovation with the evolution of government intervention. The innovation incentive effect of digital financial inclusion will be marginal decreasing with the increase of government intervention. Further considering the heterogeneity of urban geographic location and environmental regulation, it is found that digital financial inclusion promotes green technology innovation more in eastern and high-environmental regulation cities. Based on the above research conclusions, this paper argues that while developing digital inclusion finance, government support policies should be adjusted promptly to constantly stimulate the "Metcalfe's law" effect of digital inclusive finance enabling green technology innovation.
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Objective:To compare the clinical effect of transaxillary non-inflatable endoscopic surgery and traditional open thyroid surgery in the treatment of PTC. Methods:A retrospective analysis was performed on 342 patients with PTC treated in the Otorhinolaryngology Department of Qilu Hospital of Shandong University from December 2020 to December 2022. There were 73 males and 269 females, aged 16-72 years, who underwent unilateral non-inflatable transaxillary endoscopic thyroid surgeryï¼endoscopic groupï¼ and unilateral traditional open thyroid surgeryï¼open groupï¼. There were 108 patients in the endoscopic group and 234 in the open group. Results:The endoscopic group was lower in ageï¼37.1±9.4 vs 43.5±11.2ï¼ years and BMIï¼23.4±3.4 vs 25.7±3.8 ï¼kg/m² than that in the open group, and the difference was statistically significantï¼t was 5.53, 5.67 respectively, P<0.01ï¼. There was no significant difference in hospitalization days between the two groupsï¼P>0.05ï¼. The logarithmic curve of the operation time showed a smooth downward trend, and the overall operation time of the endoscopic group was relatively consistent. There was no significant difference in intraoperative blood loss between the endoscopic groupï¼13.3±3.2ï¼ mL and the open groupï¼14.7±6.3ï¼ mLï¼P>0.05ï¼, but the operation timeï¼130.1±37.9ï¼ min was longer than that in the open groupï¼57.4±13.7ï¼ min, and the difference was statistically significantï¼t=19.40, P<0.01ï¼. There was no significant difference in complications such as temporary recurrent laryngeal nerve injury within 3 days after operation between the two groupsï¼P>0.05ï¼. The aesthetic satisfaction score of the surgical incision and the incision concealment effect score in the endoscopic group were higher than those in the open group, and the difference was statistically significantï¼P<0.05ï¼. Conclusion:Compared with traditional open thyroidectomy, transaxillary non-inflatable endoscopic thyroidectomy has more advantages in the concealment and aesthetics of postoperative incision. Although the former has longer operation time and more drainage, it is still a safe and feasible surgical method with good postoperative clinical effect.
Subject(s)
Thyroid Neoplasms , Male , Female , Humans , Thyroid Neoplasms/surgery , Retrospective Studies , Neck , Thyroidectomy/methods , Endoscopy/methodsABSTRACT
BACKGROUND: Early identification of modifiable risk factors is essential for the prevention of frailty. This study aimed to explore the causal relationships between a spectrum of genetically predicted risk factors and frailty. METHODS: Univariable and multivariable Mendelian randomisation (MR) analyses were performed to explore the relationships between 22 potential risk factors and frailty, using summary genome-wide association statistics. Frailty was accessed by the frailty index. RESULTS: Genetic liability to coronary artery disease (CAD), type 2 diabetes mellitus (T2DM), ischaemic stroke, atrial fibrillation and regular smoking history, as well as genetically predicted 1-SD increase in body mass index, systolic blood pressure, diastolic blood pressure, low-density lipoprotein cholesterol, triglycerides, alcohol intake frequency and sleeplessness were significantly associated with increased risk of frailty (all p<0.001). In addition, there was a significant inverse association between genetically predicted college or university degree with risk of frailty (beta -0.474; 95% CI (-0.561 to -0.388); p<0.001), and a suggestive inverse association between high-density lipoprotein cholesterol level with risk of frailty (beta -0.032; 95% CI (-0.055 to -0.010); p=0.004). However, no significant causal associations were observed between coffee consumption, tea consumption, serum level of total testosterone, oestradiol, 25-hydroxyvitamin D, C reactive protein or moderate to vigorous physical activity level with frailty (all p>0.05). Results of the reverse directional MR suggested bidirectional causal associations between T2DM and CAD with frailty. CONCLUSIONS: This study provided genetic evidence for the causal associations between several modifiable risk factors with lifetime frailty risk. A multidimensional approach targeting these factors may hold a promising prospect for prevention frailty.
Subject(s)
Brain Ischemia , Coronary Artery Disease , Diabetes Mellitus, Type 2 , Frailty , Stroke , Humans , Diabetes Mellitus, Type 2/genetics , Smoking/adverse effects , Genome-Wide Association Study , Frailty/epidemiology , Frailty/genetics , Risk Factors , Mendelian Randomization Analysis , CholesterolABSTRACT
In the shallow-water waveguide environment, the tonal signals radiated by moving targets carry modal interference and Doppler shift information. The modal interference can be used to obtain the time of the closest point of approach (tCPA) and the ratio of the range at the closest point of approach to the velocity of the source (rCPA/v). However, parameters rCPA and v cannot be solved separately. When tCPA is known, the rCPA and the v of the target can be obtained theoretically by using the Doppler information. However, when the Doppler frequency shift is small or at a low signal-to-noise ratio, there will be a strong parametric coupling between rCPA and v. In order to solve the above parameter coupling problem, a target motion parameter estimation method from tonal signals with a single hydrophone is proposed in this paper. The method uses the Doppler and modal interference information carried by the tonal signals to obtain two different parametric coupling curves. Then, the parametric coupling curves can be used to estimate the two motion parameters. Simulation experiments verified the rationality of this method. The proposed method was applied to the SWellEx-96 and speedboat experiments, and the estimation errors of the motion parameters were within 10%, which shows the method is effective in its practical applications.
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Estimation of modal wavenumbers is important for inference of geoacoustic properties and data-driven matched field processing in shallow water waveguides. This paper introduces a deep neural network called combining physical informed neural network (CPINN) for modal wavenumber estimation using a vertical linear array (VLA). Note that the sound field recorded by a VLA can be expressed as a linear superposition of finite modal depth functions, and the differential equations satisfied by the modal depth functions are related to the corresponding modal wavenumbers. CPINN can estimate the modal wavenumbers by introducing the proxies of the modal depth functions and constraining them to satisfy the corresponding differential equations. The performance of the CPINN is evaluated by simulated data in a noisy shallow water environment. Numerical results show that, when compared with the previous methods, CPINN does not need to know the exact horizontal distance between the sound source and the VLA. Moreover, CPINN can estimate the modal wavenumbers at the VLA position in the case where the range segment traversed by the source, i.e., the aperture in the range direction, is smaller than the maximum modal cycle distance and in a range-dependent waveguide.
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Copper acquisition and subsequent delivery to target proteins are essential for many biological processes. However, the cellular levels of this trace element must be controlled because of its potential toxicity. The COPT1 protein rich in potential metal-binding amino acids functions in high affinity copper uptake at the plasma membrane of Arabidopsis cells. The functional role of these putative metal-binding residues is largely unknown. Through truncations and site-directed mutagenesis, we identified His43, a single residue within the extracellular N-terminal domain as absolutely critical for copper uptake of COPT1. Substitution of this residue with leucine, methionine or cysteine almost inactivated transport function of COPT1, implying that His43 fails to serves as a copper ligand in the regulation of COPT1 activity. Deletion of all extracellular N-terminal metal-binding residues completely blocked copper-stimulated degradation but did not alter the subcellular distribution and multimerization of COPT1. Although mutation of His43 to alanine and serine retained the transporter activity in yeast cells, the mutant protein was unstable and degraded in the proteasome in Arabidopsis cells. Our results demonstrate a pivotal role for the extracellular residue His43 in high affinity copper transport activity, and suggest common molecular mechanisms for regulating both metal transport and protein stability of COPT1.
Subject(s)
Arabidopsis Proteins , Arabidopsis , Arabidopsis/metabolism , Arabidopsis Proteins/genetics , Arabidopsis Proteins/metabolism , Histidine/genetics , Histidine/metabolism , Membrane Transport Proteins/genetics , Copper Transport Proteins/metabolism , Copper/chemistry , Copper Transporter 1/metabolism , Biological Transport , Protein StabilityABSTRACT
The long-term risk of incident atherosclerotic cardiovascular diseases (ASCVD) among cancer patients remains incompletely defined. This study aimed to evaluate the long-term ASCVD risk in cancer patients compared with the noncancer population. This was a prospective population-based study using data from the Kailuan cohort, 6204 individuals with newly diagnosed cancer, free of ASCVD, were matched in a 1:1 ratio to noncancer controls for age (±1) and sex, from June 2006 to December 2020. Multivariable competing risk analyses were performed to evaluate the association between cancer diagnosis and risk of incident ASCVD events (including myocardial infarction, ischemic stroke, heart failure, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention). During a median follow-up of 5.3 (1.7, 9.7) years, 1019 incident ASCVD events were observed. Compared to participants without cancer, there was a similar risk for incident ASCVD events among cancer patients within the first few years after cancer diagnosis, and the risk declined over time. Overall, cancer patients showed lower risks of incident ASCVD compared to the noncancer patients over the long term, with a hazard ratio (95% confidence interval) of 0.52 (0.45-0.60) for composite ASCVD events, 0.43 (0.35-0.53) for ischemic stroke, 0.63 (0.42-0.95) for myocardial infarction, 0.63 (0.48-0.83) for heart failure, and 0.82 (0.60-1.11) for coronary revascularization. Baseline level of low-density lipoprotein cholesterol, fasting blood glucose, blood pressure, and high-sensitivity C-reactive protein could independently predict the incident ASCVD among the study population. Subgroup analyses according to cancer types revealed a significantly lower risk of ASCVD events among patients with digestive cancer or respiratory cancer compared with noncancer controls, but not for urologic or genital cancer. Multiple sensitivity analyses yielded similar results to the primary analysis. Long-term ASCVD risk among cancer survivors is not increased compared with the noncancer individuals, probably driven by a favorable profile of baseline risk factor in cancer population.
Subject(s)
Atherosclerosis , Cardiovascular Diseases , Heart Failure , Ischemic Stroke , Myocardial Infarction , Neoplasms , Humans , Cardiovascular Diseases/epidemiology , Prospective Studies , Atherosclerosis/etiology , Myocardial Infarction/epidemiology , Ischemic Stroke/complications , Heart Failure/complications , Neoplasms/epidemiology , Neoplasms/complicationsABSTRACT
Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events including myocarditis, whilst improving cancer-related outcomes. There is thus a clinical need to identify electrocardiographic manifestations of ICI-related myocarditis to guide clinical management. PubMed was searched for clinical studies and case reports describing electrocardiographic changes in patients with ICI-related myocarditis. A total of 6 clinical studies and 79 case reports were included. This revealed a range of presentations for patients on ICIs, including supraventricular arrhythmias, ventricular arrhythmias and heart block, and new changes of ST-T segment unrelated to coronary artery disease, ST-segment elevation or depression and T-wave abnormalities. Several patients showed low voltages in multiple leads and new onset Q-wave development. Patients with ICI-related myocarditis may develop new arrhythmia and ST-T changes, and infrequently low voltages in multiple leads.
Subject(s)
Coronary Artery Disease , Myocarditis , Humans , Immune Checkpoint Inhibitors/adverse effects , Myocarditis/chemically induced , Myocarditis/diagnosis , Electrocardiography , Arrhythmias, CardiacABSTRACT
Emerging proof shows that abnormal lipometabolism affects invasion, metastasis, stemness and tumor microenvironment in carcinoma cells. However, molecular markers related to lipometabolism have not been further established in breast cancer. In addition, numerous studies have been conducted to screen for prognostic features of breast cancer only with RNA sequencing profiles. Currently, there is no comprehensive analysis of multiomics data to extract better biomarkers. Therefore, we have downloaded the transcriptome, single nucleotide mutation and copy number variation dataset for breast cancer from the TCGA database, and constructed a riskScore of twelve genes by LASSO regression analysis. Patients with breast cancer were categorized into high and low risk groups based on the median riskScore. The high-risk group had a worse prognosis than the low-risk group. Next, we have observed the mutated frequencies and the copy number variation frequencies of twelve lipid metabolism related genes LMRGs and analyzed the association of copy number variation and riskScore with OS. Meanwhile, the ESTIMATE and CIBERSORT algorithms assessed tumor immune fraction and degree of immune cell infiltration. In immunotherapy, it is found that high-risk patients have better efficacy in TCIA analysis and the TIDE algorithm. Furthermore, the effectiveness of six common chemotherapy drugs was estimated. At last, high-risk patients were estimated to be sensitive to six chemotherapeutic agents and six small molecule drug candidates. Together, LMRGs could be utilized as a de novo tumor biomarker to anticipate better the prognosis of breast cancer patients and the therapeutic efficacy of immunotherapy and chemotherapy.
Subject(s)
Breast Neoplasms , Biomarkers, Tumor/genetics , Breast Neoplasms/drug therapy , Breast Neoplasms/genetics , DNA Copy Number Variations , Female , Humans , Immunologic Factors , Immunotherapy , Nucleotides , Prognosis , Tumor Microenvironment/geneticsABSTRACT
BACKGROUND: Narrower retinal arterioles and wider retinal venules have been associated with the incidence of heart failure (HF). However, whether they are predictive of the prognosis of heart failure (HF) is unclear. We aimed to explore the role of retinal vessel calibers in predicting long-term clinical outcomes of HF. METHODS: This is a prospective, single-center, observational study that surveyed patients in a tertiary referral hospital for the treatment of HF. Retinal vessel caliber was graded using retinal photography. The primary endpoint was the composite endpoint of HF rehospitalization and mortality at 12 months. RESULTS: There were 55 patients with chronic HF included in the final analysis. At 12 months, the cumulative incidence of the primary endpoint, HF rehospitalization, and mortality tended to be higher with the widening of the central retinal venular equivalent (CRVE) (p for non-linearity = 0.059) and was significantly increased when CRVE reached a cut-off value (283 µm) (p = 0.011) following adjustment for age, sex, etiology of HF, and diabetes. No association between the central retinal arteriolar equivalent (CRAE) and arteriolar-to-venular caliber ratio (AVR) was found with the clinical outcome in both univariable and multivariable Cox regression. CRAE, CRVE, and AVR had no relationship with the concentration of the N-terminal pro-B-type natriuretic peptide. In addition, CRVE was not associated with cardiac diastolic and systolic function. CONCLUSIONS: When the retinal venular caliber widens to a certain point, the composite incidence of HF rehospitalization and mortality significantly increase, suggesting retinal vessel caliber imaging may provide insight into the development of HF.
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Experimental data indicate that in a sloped area, the value of ß abruptly changes before and after a given source arrives at the closest point of approach to the hydrophone, which has not been previously reported. The adiabatic approximation is employed to explain the above abrupt change in ß, and it is found that the azimuthal variance in the sound path is the reason for this phenomenon. Simulations are performed to confirm the model and experimental data, and perfect agreement is achieved. This work suggests that ß should be carefully set in related applications in a sloped area.
Subject(s)
Sound Localization , Sound , Sound SpectrographyABSTRACT
Estimation of modal wavenumbers is important for inference of geoacoustic properties and matched field processing in shallow water waveguides. However, it is challenging in a range-dependent environment, because modal content varies locally in response to changes in the environment. Moreover, the scales of the spatial variations in the waveguide may be on the same order as the range aperture required for resolvability of the individual modes. To this end, high-resolution (HR) wavenumber estimation methods have been widely used. In this paper, the matrix pencil and MUSIC algorithms are generalized to geometry involving a synthetic horizontal aperture (SHA) formed by a towed acoustic source and a fixed full-spanning vertical line array (VLA). The performance of the proposed methods is evaluated by simulated data in a noisy shallow water environment. Numerical results show that, when compared with the previous methods, the proposed methods significantly outperform the previous methods in terms of aperture requirement.