Exosome-drug conjugates delivery: a promising strategy for ameliorating the pharmacokinetic profile of artesunate.

Artesunate (ATS) is considered the most widely employed artemisnin derivative in the treatment of Plasmodium falciparum malaria. However, poor solubility and low bioavailability of ATS limit its further clinical application. Herein, we developed a new strategy based on the exosome (exo) - drug conjugation (EDC) using the milk-derived exosomes for ATS delivery. The Exo-ATS conjugates (EACs) which formed via a facile bio-conjugation of ATS to the exosomal surface, have been demonstrated to be able to not only boost the solubility and bioavailability of ATS but also enable a sustained-release of ATS from exosomes. Maximal improvement of 71.4-fold in the solubility of ATS was attained by EACs. The corresponding entrapment efficiency and drug loading capacities were found to be 90.3% and 73.9% for EACs, respectively. Further, in vivo pharmacokinetics study manifested that maximum 2.6-fold improved bioavailability of ATS was achieved by oral delivery of EACs. Moreover, EACs displayed a distinct sustained-release profile of maximum 36.2-fold prolonged half-life of ATS via intravenous delivery. We reported that for the first time the administration of EACs could be a potential drug delivery strategy aimed at ameliorating the pharmacokinetic profile of ATS based on our encouraging results and hoped that our work opened up a new avenue for the development of EDC delivery system.

Embedding Single Pd Atoms on NiGa Intermetallic Surfaces for Efficient and Selective Alkyne Hydrogenation.

Catalytic removal of alkynes is essential in industry for producing polymer-grade alkenes from steam cracking processes. Non-noble Ni-based catalysts hold promise as effective alternatives to industrial Pd-based catalysts but suffer from low activity. Here we report embedding of single-atom Pd onto the NiGa intermetallic surface with replacing Ga atoms via a well-defined synthesis strategy to design Pd1-NiGa catalyst for alkyne semi-hydrogenation. The fabricated Pd1Ni2Ga1 ensemble sites deliver remarkably higher specific mass activity under superb alkene selectivity of >96 % than the state-of-the-art catalysts under industry-relevant conditions. Integrated experimental and computational studies reveal that the single-atom Pd synergizes with the neighbouring Ni sites to facilitate the σ-adsorption of alkyne and dissociation of hydrogen while suppress the alkene adsorption. Such synergistic effects confer the single-atom Pd on the NiGa intermetallic with a Midas touch for alkyne semi-hydrogenation, providing an effective strategy for stimulating low active Ni-based catalysts for other selective hydrogenations in industry.

Atomic Design of Alkyne Semihydrogenation Catalysts via Active Learning.

Alkyne hydrogenation on palladium-based catalysts modified with silver is currently used in industry to eliminate trace amounts of alkynes in alkenes produced from steam cracking and alkane dehydrogenation processes. Intensive efforts have been devoted to designing an alternative catalyst for improvement, especially in terms of selectivity and catalyst cost, which is still far away from that as expected. Here, we describe an atomic design of a high-performance Ni-based intermetallic catalyst aided by active machine learning combined with density functional theory calculations. The engineered NiIn catalyst exhibits >97% selectivity to ethylene and propylene at the full conversion of acetylene and propyne at mild temperature, outperforming the reported Ni-based catalysts and even noble Pd-based ones. Detailed mechanistic studies using theoretical calculations and advanced characterizations elucidate that the atomic-level defined coordination environment of Ni sites and well-designed hybridization of Ni 3d with In 5p orbital determine the semihydrogenation pathway.

Novel roles of bovine milk-derived exosomes in skin antiaging.

BACKGROUND: Exosomes are small vesicles released from cells and are found in various mammalian biological fluids, such as bovine milk, which has been employed in skincare for many years, apart from its dairy applications. In addition, exosomes have been recognized as vehicles for intercellular communication. AIMS: In this study, we aimed to investigate the novel effects of bovine milk-derived exosomes (MK-Exo) on antiaging in human skin. METHODS: Initially, MK-Exo were co-cultured with keratinocytes and fibroblasts; subsequent analysis involved qPCR and western blotting to assess induced gene expression. Subsequently, MK-Exo were topically applied to the facial skin of 31 female volunteers twice daily for 28 days. The functions were evaluated after conducting safety assessments in vivo. RESULTS: Purified MK-Exo demonstrated the ability to be taken up directly by keratinocytes and fibroblasts in vitro, resulting in the upregulation of natural factors associated with skin moisturization, including filaggrin (FLG), aquaporin 3 (AQP3), and CD44 in keratinocytes, as well as hyaluronidase (HAS2) in fibroblasts. Concurrently, MK-Exo promoted fibroblast cell migration and restored the expression of type I and III collagen (Col I and Col III) following exposure to ultraviolet radiation. Furthermore, phototoxicity, photoallergy, repeated skin irritation, skin allergy, and patch tests confirmed the safety of MK-Exo for skin application. Finally, we elucidated the roles of MK-Exo in preserving moisture and reducing wrinkles in humans. CONCLUSION: Our findings unveil the novel contributions of MK-Exo to human skin aging, presenting a new avenue in the field of skincare.

Beam management optimization for V2V communications based on deep reinforcement learning.

Intelligent connected vehicles have garnered significant attention from both academia and industry in recent years as they form the backbone of intelligent transportation and smart cities. Vehicular networks now exchange a range of mixed information types, including safety, sensing, and multimedia, due to advancements in communication and vehicle technology. Accordingly, performance requirements have also evolved, prioritizing higher spectral efficiencies while maintaining low latency and high communication reliability. To address the trade-off between communication spectral efficiency, delay, and reliability, the 3rd Generation Partnership Project (3GPP) recommends the 5G NR FR2 frequency band (24 GHz to 71 GHz) for vehicle-to-everything communications (V2X) in the Release 17 standard. However, wireless transmissions at such high frequencies pose challenges such as high path loss, signal processing complexity, long pre-access phase, unstable network structure, and fluctuating channel conditions. To overcome these issues, this paper proposes a deep reinforcement learning (DRL)-assisted intelligent beam management method for vehicle-to-vehicle (V2V) communication. By utilizing DRL, the optimal control of beam management (i.e., beam alignment and tracking) is achieved, enabling a trade-off among spectral efficiency, delay, and reliability in complex and fluctuating communication scenarios at the 5G NR FR2 band. Simulation results demonstrate the superiority of our method over the 5G standard-based beam management method in communication delay, and the extended Kalman Filter (EKF)-based beam management method in reliability and spectral efficiency.

Mixed Plastics Wastes Upcycling with High-Stability Single-Atom Ru Catalyst.

Mixed plastic waste treatment has long been a significant challenge due to complex composition and sorting costs. In this study, we have achieved a breakthrough in converting mixed plastic wastes into a single chemical product using our innovative single-atom catalysts for the first time. The single-atom Ru catalyst can convert ∼90% of real mixed plastic wastes into methane products (selectivity >99%). The unique electronic structure of Ru sites regulates the adsorption energy of mixed plastic intermediates, leading to rapid decomposition of mixed plastics and superior cycle stability compared to traditional nanocatalysts. The global warming potential of the entire process was evaluated. Our proposed carbon-reducing process utilizing single-atom catalysts launches a new era of mixed plastic waste valorization.

Intraduodenal Delivery of Exosome-Loaded SARS-CoV-2 RBD mRNA Induces a Neutralizing Antibody Response in Mice.

Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has presented numerous challenges to global health. Vaccines, including lipid-based nanoparticle mRNA, inactivated virus, and recombined protein, have been used to prevent SARS-CoV-2 infections in clinics and have been immensely helpful in controlling the pandemic. Here, we present and assess an oral mRNA vaccine based on bovine-milk-derived exosomes (milk-exos), which encodes the SARS-CoV-2 receptor-binding domain (RBD) as an immunogen. The results indicate that RBD mRNA delivered by milk-derived exosomes can produce secreted RBD peptides in 293 cells in vitro and stimulates neutralizing antibodies against RBD in mice. These results indicate that SARS-CoV-2 RBD mRNA vaccine loading with bovine-milk-derived exosomes is an easy, cheap, and novel way to introduce immunity against SARS-CoV-2 in vivo. Additionally, it also can work as a new oral delivery system for mRNA.

MiR-141-3p promotes malignant progression in prostate cancer through AlkB homolog 5-mediated m6A modification of protein arginine methyltransferase 6.

Prostate cancer (PCa) is one of the leading causes of cancer-related death in males worldwide and exploring more reliable biomarkers for PCa is essential for the diagnosis and therapeutics for the disease. Although the functions of miR-141-3p and AlkB homolog 5 (ALKBH5) were identified in some cancers, whether they were involved in the development of PCa remains unclear. In this study, reverse transcription-quantitative polymerase chain reaction unveiled that the expression of ALKBH5 was reduced in PCa tissues and was negatively correlated with miR-141-3p. ALKBH5 attenuated the malignant development of PCa through suppressing the growth, migration, invasion, and sphere formation abilities of PCa cells. In addition, the luciferase activity assay identified that ALKBH5 was corroborated as a downstream target of miR-141-3p. Moreover, miR-141-3p expression was boosted in PCa tissues and cells and inhibition of miR-141-3p suppressed the tumor growth of PCa in vivo. Moreover, ALKBH5 was confirmed to suppress protein arginine methyltransferase 6 (PRMT6) expression through N6-methyladenosine (m6A) modification. We further identified that miR-141-3p-modulated PRMT6 level through mediating ALKBH5. Furthermore, PRMT6 level was positively correlated with miR-141-3p level and negatively associated with ALKBH5 level. Finally, rescue assays also uncovered that miR-141-3p aggravated PCa development by regulating PRMT6. In conclusion, miR-141-3p accelerated the malignant progression of PCa through ALKBH5-mediated m6A modification of PRMT6, which might offer a novel insight into the role of miR-141-3p and ALKBH5 in the treatments of PCa patients.

Increasing the Distance of Adjacent Palladium Atoms for Configuration Matching in Selective Hydrogenation.

Precisely tailoring the distance between adjacent metal sites to match adsorption configurations of key species for the targeted reaction pathway is a great challenge in heterogeneous catalysis. Here, we report a proof-of-concept study on the atomically sites-tailored pathway in Pd-catalyzed acetylene hydrogenation, i.e., increasing the distance of adjacent Pd atoms (dPd-a-Pd ) for configuration matching in acetylene semi-hydrogenation against coupling. dPd-a-Pd is identified as a structural descriptor for describing the competitiveness for reaction pathways, and the increased dPd-a-Pd prefers the semi-hydrogenation pathway due to simultaneously promoted C2 H4 desorption and the destabilized transition state of the C2 H3 * coupling. Spectroscopic, kinetics and electronic structure studies reveal that increasing dPd-a-Pd to 3.31 Šdelivers superior selectivity and stability due to energy matching and appropriate hybridization of Pd 4d with In 2s and, especially, 2p orbitals.

Mechanism driven design of trimer Ni1Sb2 site delivering superior hydrogenation selectivity to ethylene.

Mechanism driven catalyst design with atomically uniform ensemble sites is an important yet challenging issue in heterogeneous catalysis associated with breaking the activity-selectivity trade-off. Herein, a trimer Ni1Sb2 site in NiSb intermetallic featuring superior selectivity is elaborated for acetylene semi-hydrogenation via a theoretical guidance with a precise synthesis strategy. The trimer Ni1Sb2 site in NiSb intermetallic is predicted to endow acetylene reactant with an adequately but not excessively strong σ-adsorption mode while ethylene product with a weak π-adsorption one, where such compromise delivers higher ethylene formation rate. An in-situ trapping of molten Sb by Ni strategy is developed to realize the construction of Ni1Sb2 site in the intermetallic P63/mmc NiSb catalysts. Such catalyst exhibits ethylene selectivity up to 93.2% at 100% of acetylene conversion, significantly prevailing over the referred Ni catalyst. These insights shed new lights on rational catalyst design by taming active sites to energetically match targeted reaction pathway.

Study on the Correlation between the Prevalence of Venous Thromboembolism in Kazak Pregnant and Lying-In Women in Xinjiang.

In order to reveal the correlation between the prevalence of venous thromboembolism in Kazak pregnant and lying-in women in Xinjiang, the polymorphisms in the promoter region and coding region of the TAFI gene and the interaction of environmental factors are investigated. In this study, determination and analysis of anticoagulation indexes are conducted. The activity of antithrombin III and protein C is measured by chromogenic substrate method, and the activity of protein S is measured by coagulation method. Besides, the detection of APC-R is performed by APC-APTT method. The experimental results show that the prevalence rate of hereditary thrombophilia + DVT among Kazak pregnant women in Xinjiang is 33.8%, and the prevalence rates of AT-III deficiency, PC deficiency, PS deficiency, APCR, and Hcy are 17.5%, 16.7%, 22.0%, 23.7%, and 26.8%, respectively. Also, the genotype frequency and allele frequency distribution of each group are in line with Hardy-Weinberg equilibrium (P > 0.05). The comparison result indicates that the gene frequency has reached a genetic balance and is representative of the population. It is clearly evident that the polymorphisms of prothrombin gene rs3136447 and rs5896 may be associated with hereditary thrombophilia in Xinjiang Kazaks.

Biopsy Forceps-Assisted Loop Snare Technique for Complex Retrieval of Inferior Vena Cava Filter.

INTRODUCTION: Severe tilt with embedded hooks is a common obstacle to successful inferior vena cava (IVC) filter retrieval. METHODS: Disposal biopsy forceps were used to remodel the filter hook in the center position to release the embedded hook from the caval wall. RESULTS: The biopsy forceps-assisted loop snare technique was successfully used to retrieve filters with hooks embedded in the IVC wall. CONCLUSION: The biopsy forceps-assisted loop snare technique we present here offers a new solution for the complex retrieval of IVC filters. This technique may prove useful in cases where standard techniques at filter retrieval fail.

The Distance From the Primary Intimal Tear to the Left Subclavian Artery Predicts Thoracic Aortic Enlargement After Thoracic Endovascular Aortic Repair of Type B Aortic Dissection: A Retrospective Cohort Study.

PURPOSE: The purpose of this study was to evaluate the association between the distance from the primary intimal tear (PIT) to the left subclavian artery (LSA) (PIT-LSA distance) and the risk of aortic enlargement after thoracic endovascular aortic repair (TEVAR). METHODS: This is a retrospective cohort study. A total of 228 patients were reviewed from the database of the Registry Of type B aortic dissection with the Utility of STent graft (ROBUST) study performed from January 1, 2011, to December 31, 2016. Of them, 196 patients were eligible for analysis. The PIT-LSA distance was defined as the length from the distal edge of the LSA orifice to the proximal edge of the PIT along the centerline of the true lumen. According to the border between zone 3 and zone 4 of the Ishimaru classification, patients were divided into group A (n = 117, PIT-LSA distance ≤ 2 cm) and group B (n = 79, PIT-LSA distance > 2 cm). Thoracic aortic enlargement (TAE) was defined as a thoracic aortic volume increase of ≥20%. Multivariate Cox regression was used to estimate the association between the PIT-LSA distance and risk of TAE after TEVAR. RESULTS: The mean age was 52.3 ± 11.6 years, and 88.8% of patients were male. There were no significant differences between groups in demographic and baseline characteristics. The PIT-LSA distance was 1.1 cm (range, -1.6 to 2.0 cm) in group A, and 2.9 cm (range, 2.1-12.6 cm) in group B. TAE occurred in 27 patients in group A, and 6 in group B. The mean follow-up was 12.4 months (range, 0.10-83.1 months) in group A, and 12.63 months (range, 0.10-82.77 months) in group B. The cumulative 12- and 24-month rates of freedom from TAE were 79.0% and 71.3% in group A, versus 92.5% and 92.5% in group B, respectively. Multivariate Cox regression analysis revealed that the PIT-LSA distance was an independent predictor of TAE after TEVAR (adjusted hazard ratio, 0.66; 95% confidence interval, 0.48-0.90; p = 0.009). CONCLUSION: Patients with a more proximal PIT location have a higher incidence of thoracic aortic enlargement after TEVAR. The location of the PIT in relation to the LSA can be used to identify patients who need closed surveillance after TEVAR or early preemptive intervention.

Expression and role of interleukin-1ß and associated biomarkers in deep vein thrombosis.

Lower extremity deep vein thrombosis (DVT) is a common peripheral vascular disease, in which inflammation plays an important role. The aim of the present study was to investigate the expression and role of inflammatory factors in DVT. A rat model of venous thrombosis of the lower extremities was established through venous ligation surgery. The rats were examined at 2, 8, 24, 48 and 72 h after the induction of inferior venous stenosis and compared with control and sham surgery groups. The serum levels of interleukin-1ß (IL-1ß), tissue factor (TF) and xanthine oxidase (XOD) were measured using ELISAs. The morphology of the DVT tissue was observed by hematoxylin and eosin staining. Circulating endothelial cells (CECs) in peripheral blood were counted by flow cytometry. Reverse transcription-quantitative PCR and western blotting were used to detect mRNA and protein expression, respectively. The serum levels of IL-1ß, TF and XOD exhibited no significant differences between the control and sham surgery groups. However, those in the rat model of DVT presented an upward trend from 2 to 24 h and peaked at 24 h, with a significant difference from the respective levels in the control and sham surgery groups. The histopathological analysis revealed the presence of red and mixed thrombi in the rats 2-48 h following the induction of inferior venous stenosis group with inflammatory cell infiltration in the vascular wall. Thrombus formation was evident after 72 h. While significant difference was observed in the number of CECs in the peripheral blood between the control and sham surgery groups, the number of peripheral blood CECs in the rats with inferior venous stenosis group increased from 8 to 72 h, with significant differences among these groups. The mRNA levels of IL-1ß, TF, XOD and NF-κB in the tissues peaked at 24 h, with significant differences compared with those in the control and sham surgery groups. In addition, the protein expression level of NF-κB increased from 2 to 72 h. In conclusion, these results suggest that the high expression of IL-1ß, TF, XOD and NF-κB may promote thrombus formation.

Role and Mechanism of mir-5189-3p in Deep Vein Thrombosis of Lower Extremities.

BACKGROUND: This study is to investigate the role and mechanism of mir-5189-3p in deep vein thrombosis (DVT) in lower extremity. METHODS: The blood samples were collected from Kazakh patients with DVT in lower extremity and were subjected to microRNA sequencing. Bioinformatics were used to identify mir-5189-3p and its target genes. Dual luciferase reporter assay was used to determine the regulatory effect of mir-5189-3p on JAG1. SD rats were randomly divided into normal control, DVT model, hsa-miR-5189-3p mimics and hsa-miR-5189-3p negative control groups. HE staining was used to observe the pathological changes. TUNEL method was used to observe apoptosis. Western blot was used to detect Bax and Bcl-2 protein expression. Real-time quantitative PCR was used to detect JAG1, Notch1 and Hes1 mRNA. RESULTS: The target of Has-miR-5189-3p was JAG1. Co-transfection of miR-5189-3p mimics and pmirGLO/JAG1 wild-type plasmid induced significantly decreased luciferase activity. In hsa-miR-5189-3p mimics and hsa-miR-5189-3p negative control groups, there were more nucleated cells in the thrombus tissues, and the organization degree obviously increased. Signs of blood flow recanalization were observed. The apoptosis of hsa-miR-5189-3p mimics and hsa-miR-5189-3p negative control groups was lower than that in DVT model group. Furthermore, mir-5189-3p mimics significantly increased the mRNA levels of JAG1, Notch1 and Hes1. Additionally, mir-5189-3p mimics significantly increased Bcl-2 while decreased Bax protein. CONCLUSIONS: mir-5189-3p could inhibit apoptosis and promote thrombus organization in DVT possibly via Notch signaling pathway. Mir-5189-3p can be used as a potential target for DVT treatment.

Power-Consumption Outage in Beyond Fifth Generation Mobile Communication Systems.

One of the biggest problems facing future mobile systems beyond 5G (B5G) is the energy dissipation of mobile devices at high data rates. The heat generated by these devices can impact the performance as a result of a new type of outage called power-consumption outage. In this article, we propose a general definition of the power-consumption outage and describe its three features. Based on the heat transfer model in smartphones, the power-consumption outage probability is analyzed. Specifically, we derive the joint outage probability of channel and power-consumption outages in relation to the signal-to-noise ratio (SNR), communication duration, and initial temperature of the smartphone-back-plate. The joint outage probability is then used to obtain the upper bound of the maximum receiving rate of a typical smartphone. Furthermore, we propose and analyze the impact on the capacity of the power-consumption outage. Simulation results show that the power-consumption outage probability increases with an increase of SNR and with extension of the communication duration. The upper bound of the maximum receiving rate of a smartphone decreases with an extension of communication duration. Considering the joint outage probability, simulation results show that the outage capacities, i.e., channel and power-consumption outages, decrease with an increase of SNR after reaching a given capacity threshold.

A S-Shaped Association of Distal Oversizing Ratio with Distal Stent-Graft-Induced New Entry Following Thoracic Endovascular Aortic Repair for Stanford B Aortic Dissection.

BACKGROUND: This study was performed to evaluate the nonlinear association of the distal oversizing ratio with distal stent-graft-induced new entry (dSINE) following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) and to find the optimal value of the distal oversizing ratio for prevention strategy of dSINE. METHODS: Total of 177 patients who underwent TEVAR for TBAD from the Registry Of type B aortic dissection with the Utility of STent graft were retrospectively investigated. Patients were stratified into two groups on the median distal oversizing ratio: lower group (≤16%, n = 88) and higher group (>16%, n = 89). The Kaplan-Meier method was used to estimate the cumulative incidence of dSINE. The multivariate Cox proportional hazards model was used to identify the association of the distal oversizing ratio with dSINE. Restricted cubic smoothing spline plots and two-piecewise regression were used to analyze the possible nonlinear association. RESULTS: Eleven patients developed dSINE (6.21%) during the median follow-up time of 12.37 months (interquartile range, 8.07-18.17 months). An S-shaped association of the distal oversizing ratio with dSINE was identified. When the distal oversizing ratio was ≤40%, the risk of dSINE increased with distal oversizing ratio, and the risk of dSINE was highest when the distal oversizing ratio reached 40% (adjusted HR, 1.09; 95% CI, 1.02-1.17; P = 0.011). A larger distal oversizing ratio over 40% did not generate a greater risk of dSINE (adjusted HR, 0.95; 95% CI, 0.87-1.05; P = 0.455). CONCLUSIONS: This study substantiated previous findings that the dSINE was associated with the increasing distal oversizing ratio. We also found an S-shaped association between the distal oversizing ratio and dSINE after TEVAR for TBAD. The distal oversizing ratio of 40% can be used for stratified management of patients who underwent TEVAR for TBAD.

Expression profile of circular RNAs in cystic echinococcosis pericystic tissue.

OBJECTIVE: The aim of the present study was to investigate the expression profiles of circular RNAs (circRNAs) in the pericystic tissue of patients with cystic echinococcosis (CE). PATIENTS AND METHODS: CircRNA expression profiles were obtained by circRNA microarray of four matched pairs of pericystic tissues affected by CE and adjacent normal liver tissues. qRT-PCR was used to validate the differential expression of some circRNAs identified by the microarray analysis. The potential functions of the differentially expressed circRNAs in the CE pericystic tissues were predicted by bioinformatic analysis. RESULTS: Compared with the adjacent normal liver tissues, 177 circRNAs were upregulated and 166 circRNAs were downregulated in CE pericystic tissues based on a ≥2.0-fold change. The top 10 upregulated circRNAs were hsa_circRNA_001654,hsa_circRNA_103361,hsa_circRNA_001490,hsa_circRNA_104310,hsa_circRNA_100395,hsa_circRNA_102485,hsa_circRNA_001459,hsa_circRNA_104193,hsa_circRNA_400043, and hsa_circRNA_006773; The top 10 downregulated circRNAs were hsa_circRNA_400633,hsa_circRNA_404974,hsa_circRNA_068482 ,hsa_circRNA_100974,hsa_circRNA_049637,hsa_circRNA_404798,hsa_circRNA_400064,hsa_circRNA_004045,hsa_circRNA_101379, and hsa_circRNA_016771;The circRNA-seq results for 15 selected differentially expressed circRNAs were validated by qRT-PCR. The qRT-PCR analysis showed that hsa_circRNA_006773, hsa_circRNA_049637, hsa_circRNA_104349, and hsa_circRNA_406281 were differentially expressed in CE pericystic tissues when compared with their expression in the adjacent normal liver tissues. Interestingly, 319 miRNAs and 52 mRNAs were predicted to be adsorbed by these four differentially expressed circRNAs. Gene Ontology analysis revealed that these circRNAs may be involved in the response to organic cyclic compounds and endogenous stimuli and in cellular organismal processes. CONCLUSION: Differential expression of circRNAs may be associated with the development and progression of CE, and these circRNAs might be useful as biomarkers for prognosis prediction and as treatment targets.

The Number of Preoperative Abdominal False Lumen-perfused Small Branches Is Related to Abdominal Aortic Remodeling after Thoracic Endovascular Aortic Repair for Type B Aortic Dissection.

BACKGROUND: Abdominal aortic enlargement (AAE) is a commonly seen complication after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). This study assessed the relationship between preoperative abdominal false lumen-perfused small branches (pre-AFLSBs) and risk of AAE after TEVAR for TBAD extending through the abdominal aorta. METHODS: One hundred and eighty-four patients with TBAD who had been treated by TEVAR at 4 hospitals in China were stratified in accordance with median pre-AFLSBs: ≤8 (group A) and >8 (group B). AAE was defined as ≥20% increase in abdominal total aortic volume, measured using imaging software featuring centerline analysis, on most recent postoperative computed tomography angiography relative to preoperative examination. Multivariable Cox proportional hazard regression was used to evaluate the relationship between the number of pre-AFLSBs and the risk of AAE after TEVAR. RESULTS: At median 12.4 months imaging follow-up, AAE was present in 65 patients at higher cumulative rate (log-rank test P < 0.001) in group B, which had more frequent partially thrombosed or patent abdominal false lumen than group A at 6-12 months (P < 0.01) and 12-24 months (P = 0.03) of follow-up. In a multivariable Cox proportional hazard regression model, the number of pre-AFLSBs was independently associated with risk of AAE after TEVAR (hazard ratio [for one increase], 1.10; 95% confidence interval, 1.00-1.21; P = 0.04) after adjustment for age, gender, dissection chronicity, Society for Vascular Surgery risk score, preoperative maximum descending aortic diameter, false lumen status of the abdominal aorta, numbers of false lumen-perfused visceral arteries, abdominal intimal larger tears, and preoperative abdominal intimal small tears, and dissection length and descending aortic length ratio. CONCLUSIONS: The number of pre-AFLSBs was positively associated with the risk of AAE after TEVAR for TBAD extending through the abdominal aorta.

Dissection length-to-descending thoraco-abdominal aorta length ratio predicts abdominal aortic enlargement after thoracic endovascular aortic repair for type B aortic dissection involving the abdominal aorta.

OBJECTIVES: This study was performed to assess the association between the dissection length-to-descending thoraco-abdominal aorta length ratio (LLR) and abdominal aortic enlargement (AAE) (≥20% increase in total abdominal aortic volume) after thoracic endovascular aortic repair (TEVAR) in patients with type B aortic dissection. METHODS: We retrospectively analysed data from 184 consecutive patients with type B aortic dissection who underwent TEVAR from January 2011 to December 2016 at 4 hospitals as part of the Registry Of type B aortic dissection with Utility of STent graft study. Preoperative and postoperative computed tomography angiography images were reviewed to assess the LLR and AAE. Patients were stratified into tertiles according to the pre-TEVAR LLR: 0.7 to <1.0 (n = 61), 1.0 to <1.2 (n = 61) and 1.2 to <1.6 (n = 62). The thoracic and abdominal aorta were divided by the celiac trunk. The cumulative incidence of AAE was estimated using the Kaplan-Meier method. A multivariable Cox proportional hazards model was used to assess the independent association between the preoperative LLR and the post-TEVAR risk of AAE. The nonlinear relationship between the LLR and the risk of post-TEVAR AAE was fitted by the restricted cubic smoothing spline, and the inflection point on the fitting curve was determined using a piecewise linear regression model. RESULTS: Baseline demographics, clinical features, preoperative anatomic characteristics and implanted devices were similarly distributed among the pre-TEVAR LLR tertile groups. At 24 months post-TEVAR, the estimated cumulative incidence of AAE significantly differed (P < 0.01) by LLR tertile group: 0.10 [95% confidence interval (CI) 0.00-0.21], 0.65 (95% CI 0.45-0.78) and 0.67 (95% CI 0.40-0.82), respectively. The pre-TEVAR LLR was an independent predictor of post-TEVAR AAE [hazard ratio (per unit increase) 1.03, 95% CI 1.01-1.04] following a nonlinear relationship with an inflection point at LLR = 1.0. CONCLUSIONS: The risk of post-TEVAR AAE is highest when the length of the dissection is greater than or equal to the length of the descending aorta (LLR ≥ 1.0).