Global trends in coronary artery disease and artificial intelligence relevant studies: a bibliometric analysis.

OBJECTIVE: Coronary artery disease (CAD) is a major global cause of death, greatly affecting life expectancy and quality of life for populations. With the advent of artificial intelligence (AI), there is new hope for accurately managing CAD. While recent studies have shown remarkable progress in AI and CAD research, there is a gap in comprehensive bibliometric analysis in this field. Therefore, this study aims to provide a thorough analysis of trends and hotspots in AI and CAD-related research utilizing bibliometrics. MATERIALS AND METHODS: Publications on AI and CAD relevant research from 2009 to 2023 were searched through the WoS core database (WoSCC). CiteSpace, VOSviewer and Excel 365 were used to conduct the bibliometric analysis. RESULTS: The bibliometric analysis included 1,248 publications, indicating a steady increase in AI and CAD-related publications annually. The United States of America (USA), China, and Germany were identified as the most influential countries in this field. Research institutions such as Cedars Sinai Med Ctr, Med Univ South Carolina, Harvard Med Sch and Capital Med Univ were the main contributors to research production. FRONT CARDIOVASC MED is the top-ranked journal, while J AM COLL CARDIOL emerged as the most cited journal. Schoepf, U. Joseph, Slomka, Piotr J., Berman, Daniel S. and Dey, Damini were the most prolific authors, while U. Rajendra Acharya was the most frequently co-cited author. Research related to the AI calculation of coronary flow reserve fraction and coronary artery calcification, based on coronary CT to identify CAD and cardiovascular risk, was a key research topic in this field. The potential link between cardiovascular risk stratification and radiomics is currently at the forefront of the field. CONCLUSIONS: This study is the first to use a bibliometric approach to visualize and analyze AI and CAD-related research. The findings provide insights into recent research trends and hotspots in the field and can serve as a reference for scholars to identify critical issues in this field.

Low expression of integrin signaling pathway genes is associated with abdominal aortic aneurysm: a bioinformatic analysis by WGCNA.

OBJECTIVE: An abdominal aortic aneurysm (AAA) is a potentially fatal disease associated with a high risk of rupture. AAA is pathologically distinguished by atherosclerotic thrombosis, immune cell infiltration, smooth muscle cell apoptosis, and extracellular matrix degradation. Given that there are no effective target treatments, once ruptured, AAA leads to high mortality with few long-term survivors. The goal of this study is to identify novel key pathways and hub genes involved in AAA formation with the aim of providing promising therapeutic targets for AAA. MATERIALS AND METHODS: The transcriptome sequencing matrix of GSE47472 and GSE57691 were obtained from the GEO database. These datasets were further merged for differential expression analysis, weighted gene co-expression network analysis (WGCNA), and functional enrichment analysis in R (v4.0.2). A co-expression network was constructed with Cytoscape (v3.8.0) to generate the top 30 hub genes. Hub Genes with high clinical traits and potential values were further verified using a receiver operating characteristic (ROC) curve and qPCR analysis. RESULTS: A total of 745 differentially expressed genes were screened and 14 gene co-expression modules were established. Among these 14 modules, pink modules with a total of 118 genes showed the strongest correlation with AAA pathogenesis. Subsequently, 78 genes associated with a highly relevant clinical trait and the top 30 hub genes were intersected to generate 22 genes. Gene ontology functional enrichment analysis of the 22 genes revealed abnormal expression of genes relating to cell-matrix adhesion and integrin-mediated signaling pathway. LAMA5, ITGA8, ITGA1, and FERMT2 were associated with the integrin-mediated signaling pathway and cell-matrix adhesion while ACTN1 and CX3CL1 were simply associated with the latter. Low expressions of LAMA5, ACTN1, ITGA8, ITGA1, and FERMT2 were further verified through qPCR in a mouse model of AAA. CONCLUSIONS: Low expression of partial genes in the integrin signaling pathway was implicated in the function loss of mediated cell-matrix adhesion, which may offer novel targets for therapeutic intervention against AAA.

[Association between dietary vitamin A intake and gestational diabetes mellitus in the first trimester].

Objective: To investigate the relationship between dietary vitamin A intake and its sources in the first trimester and gestational diabetes mellitus (GDM). Methods: A prospective study was conducted to select women at 6-14 weeks of gestation in an obstetric clinic of a maternal and child health care medical institution in Chengdu in 2017. The types and quantities of food during the first trimester were collected by 3-day 24-hour dietary recalls. Dietary vitamin A intake was calculated based on the Chinese Food Composition Table (2018), and it was divided into animal and plant vitamin A intakes according to its food sources. An oral glucose tolerance test was performed at 24-28 weeks of gestation to diagnose GDM according to the Chinese guidelines for diagnosis and treatment of gestational diabetes mellitus (2014). According to the estimated average requirement (EAR) and recommended nutrient intake (RNI), dietary vitamin A intake was divided into low-level group (RNI). Animal and plant vitamin A intakes were divided into four groups (Q1-Q4) according to the quartile method, respectively. The association between dietary vitamin A intake, its different sources of vitamin A intake and GDM in the first trimester was analyzed by log-binomial regression models. Results: A total of 1 298 valid samples were finally included. The average dietary vitamin A intake, animal and plant vitamin A intakes in the first trimester were 341.1 (227.8-501.0) µgRAE/d, 139.3 (69.6-195.3) µgRAE/d and 184.2 (99.4-301.1) µgRAE/d, respectively. After adjusting for confounding factors, log-binomial regression analysis showed that the risk of GDM in high-level group of dietary vitamin A intake was lower than that in low-level group [RR (95%CI):0.53 (0.36-0.80)]. Pregnant women in the highest quartile of animal vitamin A intake had a lower risk of GDM than those in the lowest quartile [RR (95%CI):0.66 (0.47-0.95)]. No relationship between plant vitamin A intake and GDM was found. Conclusion: Dietary vitamin A intake in the first trimester is associated with the occurrence of GDM, and higher intake than RNI may reduce the risk of GDM. Higher vitamin A intake from animal-derived food is associated with decreased risk of GDM.

The perioperative complications and short-term death in endovascular treatment for acute stroke induced by extracranial carotid occlusion: a systematic review and a meta-analysis.

OBJECTIVE: Endovascular treatment (EVT) has been demonstrated superior to pharmacological thrombolysis in acute ischemic stroke (AIS) induced by extracranial internal carotid artery occlusion. This paper aims to summarize clinical evidence about EVT and assess its efficacy and safety on acute extracranial carotid occlusion. MATERIALS AND METHODS: We systematically reviewed all studies that reported endovascular therapy as carotid stenting, stent retriever, aspiration, and angioplasty for acute extracranial carotid occlusion. Literature retrieval was performed in PubMed, Embase, and Cochrane library, dated from January 1st, 2005 to December 31st, 2020. The primary endpoint was a favorable outcome rate. Major secondary endpoints were SICH incidence, 90-day mortality rate, and complications. Meta-analysis and subgroup analysis were conducted to identify predictors for prognosis. This systematic review has been registered in PROSPERO (CRD42020181154) on July 18, 2020. RESULTS: 10 studies with 620 patients were included in total. Endovascular approach presented a favorable outcome rate of 0.47 (0.37, 0.56), an acceptable 90-day mortality rate of 0.16 (0.13, 0.19), and a mild SICH rate of 0.07 (0.05, 0.10). Age and NIHSS at admission were negatively associated with favorable outcome, with odds ratio of 0.95 (0.92, 0.98) and 0.74 (0.62, 0.88) respectively. Lower age (p=0.049) and aspiration thrombectomy (p=0.041) predicted less SICH events. In subgroup in which time window > 6 hours, endovascular therapy presented similar encouraging results, with favorable outcome rate of 0.59 (0.51, 0.66), 90-day mortality rate of 0.11 (0.07, 0.17), and SICH rate of 0.04 (0.02, 0.09). CONCLUSIONS: EVT can effectively improve neurological function and reduce 90-day mortality for acute extracranial carotid occlusion patients without increasing the risk of symptomatic intracranial hemorrhage. Endovascular therapy is safe to perform from 6 to 24 hours after symptom onset.

[Association between dietary glycemic load during first trimester and the risk of gestational diabetes mellitus: a prospective study].

Objective: To explore the effects of dietary glycemic load (GL) during first trimester on the risk of gestational diabetes mellitus (GDM). Methods: A prospective study was conducted among healthy women with singleton pregnancy at 8-14 weeks of gestation in a maternity out-patient clinic of maternal-and-child health care institution in Chengdu, Sichuan province. Information on dietary intake during the first trimester was collected through a 3-day 24-hour dietary recall. Glycemic index (GI) values were obtained from China Food Composition Tables (Standard Edition) and International Tables of Glycemic Index and Glycemic Load Values (2008). Dietary GL and GLs of staple foods were calculated based on GI values and the amount of carbohydrate consumed per day. Diagnostic criteria of GDM was followed the Guidelines for Diagnosis and Treatment of Pregnancy Diabetes in China (2014), and used on participants who underwent an oral glucose tolerant test during 24-28 weeks of gestation. Log-binomial regression models were used to explore the associations between both quartiles of dietary GL, GLs of staple foods and the risks of GDM,respectively. Results: The medians of dietary GL and GL of staple foods were 145.70 (113.23-180.85) and 121.05 (89.08-155.70), respectively. The median GL of both rice and tubers were 73.14 (43.89-107.50) and 3.43 (0.00-9.84), respectively. After adjusting for the age at pregnancy, pre-pregnancy body mass index and other confounding factors, results of log-binomial regressions analysis showed that when compared with the lowest quartile of dietary GL group, the third and highest quartiles of dietary GL groups increased the risk of GDM (RR=1.47, 95%CI: 1.20-1.80; RR=1.31, 95%CI: 1.04-1.64), respectively. Compared with the lowest quartile of GL of staple foods, the third and highest quartiles of GL of staple foods groups also increased the risk of GDM (RR=1.28, 95%CI: 1.04-1.58; RR=1.27, 95%CI: 1.02-1.60), respectively. The third and highest quartiles of GL of rice groups increased the risk of GDM (RR=1.30, 95%CI: 1.06-1.59; RR=1.28, 95%CI: 1.03-1.59), respectively, than the lowest quartile of GL of rice group. When compared with the lowest quartile of GL of tubers group, the highest quartile of GL of tubers group increased the risk of GDM (RR=1.30, 95%CI: 1.09-1.54). However, we did not notice the effects of wheat GL and coarse grain GL on the risk of GDM. Conclusions: A positive association was found between dietary glycemic load and the risk of GDM. Higher dietary glycemic load, especially in rice and tubers during first trimester, seemed to have increased the risk of GDM.

[Application of gastric pull up and complex laryngotracheal flap to reconstruct the circumferencial defect after resection of the hypopharyngeal and cervical esophageal cancers].

Objective: To evaluate the efficacy of gastric pull-up and complex laryngotracheal flap in reconstruction for circumferencial defects after resection of hypopharyngeal and cervical esophageal cancers. Methods: A total of 163 cases (152 males, 11 females) with circumferencial defect after resection of hypopharyngeal and cervical esophageal cancers received reconstructive surgeries by gastric pull-up (42 cases) and complex laryngo-tracheal flaps (121 cases), of them 115 cases simultaneously underwent unilateral neck dissection and 20 cases had bilateral neck dissection. Postoperative radiotherapy was used in 67 cases, with a dosage of 40-60 Gy. Results: There were 127 (77.9%) cases with positive metastatic lymph nodes. Of 42 patients with gastric pull-up reconstruction, 39 cases (92.8%) recovered the function of oral swallowing after operation, and 8 cases with cervical esophageal cancer recovered the functions of oral swallowing and speech after gastroesophageal anastomosis reconstruction. There were 3 (7.1%) cases died of surgery and 8 cases with surgical complications. Reconstruction of upper digestive tract with combined laryngotracheal flap was successful in all 121 cases, with recovered oral swallowing function after operation. No patient died of surgery but 24 cases had complications, mainly pharynx skin fistula or wound infection, which were cured by conservative treatments. The 1-, 3- and 5-year survival rates for 163 patients were 69.8%, 50.5% and 34.3%, respectively. The independent factors for prognosis included T4 (P<0.001) and N+ (P=0.042). Conclusions: The complex of laryngotracheal flap with pectoralis major myocutaneous flap is suitable for most advanced hypopharyngeal cancer after resection of the tumor and reconstruction of circumferencial defect. It is simple technology, low and slight complication rate. The minority is not suitable for the application of pectoralis major myocutaneous flap can be used instead of free anterolateral thigh flap. Gastric pull-up for reconstruction of upper digestive tract is suitable for most patients with cervical esophageal cancer and hypopharyngeal carcinoma invading the cervical esophagus who are not suitable for laryngotracheal flap reconstruction, with good swallowing function after surgery. However, it is prudent to choose operative indications because of serious surgical trauma and risks for complications.

[The clinical characteristics and treatment strategies of differentiated thyroid carcinoma in adolescents and children].

Objective:To study the clinical characteristics and treatment strategies of differentiated thyroid carcinoma in adolescents and children.Method:From 1983 to 2014, total 2936 patients with the thyroid cancer were collected in our hospital, among which there were 85 patients of adolescents and children with 61 female and 24 male. The age was from 9 to 21 years old (median 18.3 years). There were 12 cases less than 14 years.The pathologic diagnoses were papillary carcinoma 76 cases and follicular carcinoma 9 cases. The clinical material, history of disease, clinical presentation, TNM classification, histopathological features, treatment method, and the final follow-up results were analyzed and studied. Result:Overall survival rate was 100%, follow-up from 0.5 to 31 years(medium 10.9 years), 10 year progression free survival rate was 87.1%. There was no mortality and 8(9.4%)cases occurred recurrence,who followed by surgery and resumed finally. There were 20 cases found extrathyroid extention, including 8 cases less than 14 years and 12 cases older than 15 years. The extrathyroid extention rate was significantly higher in cases of lower years(66.7%)than other group(16.4%)(P<0.01). Forty-nine(57.6%) cases were found lymphanods metastases, among them ≤14 years metastases rate 92.0%（11/12）significantly more than ≥15 years metastases rate 52.1%(38/73) (P<0.05). Three patients suffered with pulmonary metastases and all of them were ≤14 years patients. All of 85 patients were received surgery treatment included total, subtotal and oneside thyroidectomy. The neck lymph nodes were underwent modefied, radical or no neck dissection. Fifteen patients were received 131I therapy postoperatively, the dosage was 50～170 mCi. All of 85 patients were received TSH suppression therapy. 13 cases(15.3%) occurred complications,such as laryngeal recurrent nerve paralysis and hypoparathyroidism commonly. Conclusion:Majority of thyroid cancer for adolescents and children are papillary and follicular carcinoma. The histopathologic feature has significant invasion beyond thyroid capsula, and metastasis to the lymphanods and distante area,especially ≤14 years patients significant more than ≥15 years. The prognosis is favorable, it is few death from thyroid cancer. The treatment means is surgery to resect all of the disease, sometimes should perform total or neartotal thyroidectomy if there are distant metastasis and extensive invasion. It should pay attention to preserve the function of recurrent laryngeal nerve and parathyroid gland. Most of them can be performed unilateral lobectomy if the tumor located oneside thyroid gland. The lymphanode metastasis should be undertaken modified neck dissection, make effort to avoid radical neck dissection. It should be carful to use 131I internal radiation therapy and avoid the excessive treatment.

[Effects of selenium supplement on atherogenesis of ApoE-knockout mice fed high fat diet].

OBJECTIVE: To investigate the effects of selenium supplement on atherogenesis and endothelial function in ApoE-knockout mice fed high fat diet. METHODS: ApoE-knockout mice fed with selenium-deficient and high fat diet were randomly allocated into 3 groups based on random number table including control group (not supplied with sodium selenite, n=10), low dosage selenium supplement group (supplied water with 0.1 mg/L sodium selenite, n=10) and high dosage selenium supplement group (supplied water with 0.2 mg/L sodium selenite, n=10). After 15 weeks, the following values were measured: the concentrations of selenium in heart and liver, the levels of serum lipid, the parameters of antioxidant function including activities of superoxide dismutase(SOD) and glutathion peroxidase (GSH-Px) and malondialdehyde (MDA) level in serum, the parameters of endothelial function including serum nitric oxide (NO), endothelin 1(ET-1), and vascular endothelial growth factor (VEGF) levels, and ET-1 and VEGF levels in aorta roots. The atherosclerotic lesions in aorta roots were analyzed with oil red O staining. RESULTS: (1) The selenium concentrations in heart and liver were significantly higher in high dosage and low dosage selenium supplement groups compared to control group (both P<0.05). (2) The levels of triglyceride, total cholesterol, low density lipoprotein cholesterol, very low density lipoprotein cholesterol and high-density lipoprotein cholesterol were similar among groups (all P>0.05). (3) The activity levels of serum SOD were significantly higher in low dosage ((113.8±12.5)U/ml) and high dosage selenium supplement group ((152.3±11.3)U/ml) compared to control group ((90.7±10.7)U/ml, all P<0.05). The activity levels of serum GSH-Px were significantly higher in low dosage ((53.9±7.2)U/ml) and high dosage ((69.6±8.7)U/ml) selenium supplement groups than that of control group ((36.4±5.6)U/ml, all P<0.05). The serum MDA levels in low dosage ((4.73±1.05)nmol/ml) and high dosage ((4.13±1.21)nmol/ml) selenium supplement groups were significantly lower than that of control group ((5.97±1.08)nmol/ml, all P<0.05). (4) The serum NO concentrations in low dosage ((61.5±12.8)µmol/L) and high dosage ((79.0±14.6)µmol/L)selenium supplement groups were significantly higher than that of control group((42.7±9.1)µmol/L, all P<0.05). The concentrations of serum ET-1 in low dosage ((52.8±6.3)ng/L)and high dosage ((46.3±4.7)ng/L)selenium supplement groups were significantly lower than that of control group((72.2±6.3)ng/L, P<0.05). The concentrations of serum VEGF in low dosage ((97.4±16.5)ng/L)and high dosage ((83.5±22.0)ng/L)selenium supplement groups were significantly lower than that of control group((125.8±18.6)ng/L, P<0.05). The expression levels of ET-1 and VEGF in aorta roots among low dosage and high dosage selenium supplement groups were significantly lower compared to control group (all P<0.05). (5) The plaque area of aorta roots in low dosage ((0.95±0.19)×10(5) µm(2))and high dosage selenium supplement ((0.75±0.15)×10(5) µm(2)) groups were significantly smaller than that of control group((1.13±0.23)×10(5) µm(2)), and the plaque area in high dosage selenium supplement group was significantly smaller than in low dosage selenium supplement group (P<0.05). CONCLUSION: Supplement of selenium can attenuate atherogenesis in ApoE-knockout mice fed high fat diet, which is possibly mediated via reducing lipid peroxidation and improving endothelial functions.

Hyperbaric oxygen therapy attenuates neuropathic hyperalgesia in rats and idiopathic trigeminal neuralgia in patients.

BACKGROUND: Neuropathic pain after nerve injury is severe and intractable, and current drug and non-drug therapies offer very limited pain relief. Hyperbaric oxygen (HBO 2) has been clinically used for protection of the nervous system after acute injury. We investigated whether HBO 2 treatment could prevent and/or attenuate neuropathic pain in animals and in patients. METHODS: Mechanical allodynia and thermal hyperalgesia and neurochemical alterations of neuropathic pain were analysed in male, adult, Sprague-Dawley rats with sciatic nerve injury. Clinical trials were conducted in patients with idiopathic trigeminal neuralgia. RESULTS: Repetitive HBO 2 treatment [a combination of pressure at 3 atmosphere absolute (ATA) and pure oxygen] greatly inhibited behavioural signs of neuropathic pain manifested as thermal hyperalgesia and mechanical allodynia. Such an HBO 2 treatment also inhibited nerve injury-induced induction of c-Fos and activation of astrocytes and increased phosphorylation of NR2B receptor and the subsequent Ca 2+-dependent signals in rats. Neither high pressure (up to 3 ATA) nor pure oxygen alone resulted in analgesic effect. In clinical trials, one course of HBO 2 therapy (10 consecutive days) produced a rapid-onset, dose-dependent and long-lasting analgesic effects evidenced by the decreased doses of carbamazepine required for keeping patient pain at a minimum and decreased scores of visual analogue scales, which was used for patient's self-evaluation. CONCLUSIONS: These findings support that HBO 2 therapy is an effective approach for treating neuropathic pain in both animals and human beings and suggest that neural protection, anti-inflammation and inhibition of nerve injury-induced altered neural activity may contribute to the analgesic effect of HBO 2 therapy.

Ethical selection on liver transplantation and abandoning treatment for hepatocellular carcinoma in China.

Orthotopic liver transplantation (OLT) has evolved in China over three decades, emerging as the mainstay treatment for hepatocellular carcinoma (HCC). Some Chinese transplantation centers have begun offering OLT for selected patients with HCC exceeding Milan criteria. However, this still remains a controversial subject. In this article, we have weighed arguments for and against OLT for advanced HCC. Meanwhile, the development of OLT for HCC in China has raised problems, mainly focused on ethical and moral concerns. Postmodern philosophy and ethics, particularly the life value theory, shall be the theoretical support to the concept of abandoning treatment. In China, ethical selection for OLT and abandoning treatment for HCC must be made justly and prudently.

[Influence of burn shock on the prognosis of burn wound sepsis in mice].

The influence of burn shock on the prognosis of burn wound sepsis was investigated in mice. Mice with full-thickness burn of 13% TBSA was injected subcutaneously under the burned area immediately after burning with 0.2ml P. aeruginosa (1 x 10(3)CFU/ml) or 0.2 ml K. pneumoniae (5 x 10(3)CFU/ml). The survival rate in P. aeruginosa burn wound sepsis was 49% in resuscitation group (n = 53) on 7 postburn day and 17% in non-resuscitation group (n = 24) (P < 0.01). The mean survival time in dead mice of resuscitation group (n = 27) was 4.2 +/- 1.7 days and 2.5 +/- 0.6 days in that of non-resuscitation group (n = 20) (p < 0.01). The survival rate in K. pneumoniae burn wound sepsis was 69% in resuscitation group (n = 26) on 7 postburn day and 15% in non-resuscitation group (n = 13) (P < 0.01). The mean survival time in dead mice of resuscitation group (n = 8) was 5 +/- 1.35 days and 2.1 +/- 0.3 days in that of non-resuscitation group (n = 11) (p < 0.01). These results indicated that burn shock might increase the mortality of burn wound sepsis and resuscitation could improve the prognosis of burn wound sepsis.