Genome-based reclassification of Salipiger manganoxidans (Rajasabapathy et al. 2016) Wirth et al. 2018 as a later heterotypic synonym of Salipiger marinus (Lai et al. 2011) Wirth et al. 2018.

Salipiger manganoxidans VSW210T was compared with Salipiger marinus CK-I3-6T to examine the taxonomic relationship between the two type strains. In phylogenetic trees drawn using whole genome sequences and 16S rRNA gene sequences, S. manganoxidans VSW210T and S. marinus CK-I3-6T clade together and showed a 99.6 % 16S rRNA sequence similarity. The average amino acid identity (AAI), average nucleotide identity (ANIb and ANIm) and digital DNA-DNA hybridization (dDDH) values between S. manganoxidans VSW210T and S. marinus CK-I3-6T were below 97.5, 97.4, 98.4 and 85.1±2.5 %, respectively, all of which were greater than the species delineation threshold AAI value (95.5 %), ANI value (95-96 %) and dDDH value (70 %). Most phenotypic features between both species were almost identical, although there were some differences. The present results show that Salipiger manganoxidans is a later heterotypic synonym of Salipiger marinus.

Synthesis and Modulation of Low-Dimensional Transition Metal Chalcogenide Materials via Atomic Substitution.

In recent years, low-dimensional transition metal chalcogenide (TMC) materials have garnered growing research attention due to their superior electronic, optical, and catalytic properties compared to their bulk counterparts. The controllable synthesis and manipulation of these materials are crucial for tailoring their properties and unlocking their full potential in various applications. In this context, the atomic substitution method has emerged as a favorable approach. It involves the replacement of specific atoms within TMC structures with other elements and possesses the capability to regulate the compositions finely, crystal structures, and inherent properties of the resulting materials. In this review, we present a comprehensive overview on various strategies of atomic substitution employed in the synthesis of zero-dimensional, one-dimensional and two-dimensional TMC materials. The effects of substituting elements, substitution ratios, and substitution positions on the structures and morphologies of resulting material are discussed. The enhanced electrocatalytic performance and photovoltaic properties of the obtained materials are also provided, emphasizing the role of atomic substitution in achieving these advancements. Finally, challenges and future prospects in the field of atomic substitution for fabricating low-dimensional TMC materials are summarized.

The efficacy of progressive muscle relaxation training on cancer-related fatigue and quality of life in patients with cancer: A systematic review and meta-analysis of randomized controlled studies.

BACKGROUND: Cancer-related fatigue is one of the most common symptoms in cancer patients, usually accompanied by anxiety, depression and insomnia, which seriously affect patients' quality of life. Progressive muscle relaxation training is widely used for cancer-related fatigue, but the overall effect is unclear. OBJECTIVES: The aim of this study was to summarize the evidence on the effects of progressive muscle relaxation training on cancer-related fatigue and quality of life in cancer patients. DESIGN: Systematic review and meta-analysis. METHODS: Nine electronic databases (PubMed, Excerpta Medica Database (Embase), The Cochrane Library (Cochrane Central Register of Controlled Trials, CENTRAL), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP) and Wanfang Database) were explored for randomized controlled trials (RCTs) published before February 2023. This study was reported based on the PRISMA 2020 statement. The Cochrane Collaboration's risk of bias assessment tool was used for methodological assessment, and the GRADE pro online assessment tool was used for evidence evaluation. The data were analyzed with the Review Manager 5.4 software. RESULTS: Twelve studies involving 1047 patients were included. Meta-analysis showed that progressive muscle relaxation training plus routine nursing produced more positive effects than routine nursing in improving cancer-related fatigue [SMD = -1.06, 95 % CI -1.49, -0.62, P < 0.00001], anxiety [SMD = -1.09, 95 % CI -1.40, -0.77, P < 0.00001], depression [SMD = -1.43, 95 % CI -1.76, -1.10, P < 0.00001], and quality of sleep [MD = -1.41, 95 % CI -1.74, -1.08, P < 0.00001]. However, there was no significant difference in improving quality of life [SMD = 0.27, 95 % CI -0.62, 1.15, P = 0.55]. Progressive resistance exercise plus routine nursing improved cancer-related fatigue more than progressive muscle relaxation training plus routine nursing [SMD = 1.11, 95 % CI 0.43, 1.78, P = 0.001]. There was low certainty of evidence that progressive muscle relaxation training improved cancer-related fatigue and quality of sleep, and the evidence that improved quality of life, anxiety and depression was very low. CONCLUSION: Current evidence suggested that progressive muscle relaxation training has the potential to improve cancer-related fatigue, anxiety, depression and quality of sleep in patients with cancer and is a low-load, simple exercise worthy of recommendation for cancer patients in fatigue state. Future research should focus on improving the methodological quality of randomized controlled trials to enhance the persuasive evidence of progressive muscle relaxation training efficacy.

Mechanism of balloon burst during transcatheter aortic valve replacement pre-dilatation: Image observation and validation by finite element analysis.

BACKGROUND: Balloon burst during transcatheter aortic valve replacement (TAVR) is serious complication. This study pioneers a novel approach by combining image observation and computer simulation validation to unravel the mechanism of balloon burst in a patient with bicuspid aortic valve (BAV) stenosis. METHOD: A new computational model for balloon pre-dilatation was developed by incorporating the element failure criteria according to the Law of Laplace. The effects of calcification and aortic tissue material parameters, friction coefficients, balloon types and aortic anatomy classification were performed to validate and compare the expansion behavior and rupture mode of actual balloon. RESULTS: Balloon burst was dissected into three distinct stages based on observable morphological changes. The mechanism leading to the complete transverse burst of the non-compliant balloon initiated at the folding edges, where contacted with heavily calcified masses at the right coronary sinus, resulting in high maximum principal stress. Local sharp spiked calcifications facilitated rapid crack propagation. The elastic moduli of calcification significantly influenced balloon expansion behavior and crack morphology. The simulation case of the calcific elastic modulus was set at 12.6 MPa could closely mirror clinical appearance of expansion behavior and crack pattern. Furthermore, the case of semi-compliant balloons introduced an alternative rupture mechanism as pinhole rupture, driven by local sharp spiked calcifications. CONCLUSIONS: The computational model of virtual balloons could effectively simulate balloon dilation behavior and burst mode during TAVR pre-dilation. Further research with a larger cohort is needed to investigate the balloon morphology during pre-dilation by using this method to guide prosthesis sizing for potential favorable outcomes.

Angiography and optical coherence tomography derived shear stress: are they equivalent in my opinion?

Advances in image reconstruction using either single or multimodality imaging data provide increasingly accurate three-dimensional (3D) patient's arterial models for shear stress evaluation using computational fluid dynamics (CFD). We aim to evaluate the impacts on endothelial shear stress (ESS) derived from a simple image reconstruction using 3D-quantitative coronary angiography (3D-QCA) versus a multimodality reconstruction method using optical coherence tomography (OCT) in patients' vessels treated with bioresorbable scaffolds. Seven vessels at baseline and five-year follow-up of seven patients from a previous CFD investigation were retrospectively selected for a head-to-head comparison of angiography-derived versus OCT-derived ESS. 3D-QCA significantly underestimated the minimum stent area [MSA] (-2.38mm2) and the stent length (-1.46 mm) compared to OCT-fusion method reconstructions. After carefully co-registering the region of interest for all cases with a sophisticated statistical method, the difference in MSA measurements as well as the inability of angiography to visualise the strut footprint in the lumen surface have translated to higher angiography-derived ESS than OCT-derived ESS (1.76 Pa or 1.52 times for the overlapping segment). The difference in ESS widened with a more restricted region of interest (1.97 Pa or 1.63 times within the scaffold segment). Angiography and OCT offer two distinctive methods of ESS calculation. Angiography-derived ESS tends to overestimate the ESS compared to OCT-derived ESS. Further investigations into ESS analysis resolution play a vital role in adopting OCT-derived ESS.

Constraints on the maintenance of wild Taxus cuspidata populations based on regression conservation.

To clarify the key factors constraining the maintenance of wild Taxus cuspidata populations and to develop conservation strategies and technical links for current populations, we investigated the renewal status and distribution patterns of wild T. cuspidata populations in the main distribution areas of China. We analyzed the effects of stand factors and human disturbance on population renewal and maintenance. The results showed that the overall regeneration of wild T. cuspidata populations was poor. The basal diameter and height class structure of renewed individuals showed an unhealthy state. 19% of the area was well regenerated. There were three types of regeneration, including poor regeneration with few adult trees, poor regeneration with many adult trees, and good regeneration with few adult trees. The communities in which T. cuspidata was found could be classified into Abies nephrolepis + Tilia amurensis forest, spinney forest, and Picea jezoensis var. microsperma + A. nephrolepis forest. The renewal number of A. nephrolepis + T. amurensis forest was significantly higher than that of spinney forest. Increased stand density and moderate human disturbance contributed to the regeneration of T. cuspidata. The regenerating T. cuspidata seedlings increased significantly when stand density increased from low to medium. The number of regenerating populations in moderately disturbed habitats was significantly higher than those in lightly disturbed habitats. Human disturbance and habitat were currently critical constraints to maintaining and regenerating wild T. cuspidata populations. The conservation of T. cuspidata should consider current status of population regeneration in each habitat patch to develop corresponding in situ conservation and regression conservation measures and focus on the influence of critical factors such as disturbances and habitat conditions.

Wnt/ß-catenin signalling pathway in breast cancer cells and its effect on reversing tumour drug resistance by alkaloids extracted from traditional Chinese medicine.

Breast cancer is a high-risk disease with a high mortality rate among women. Chemotherapy plays an important role in the treatment of breast cancer. However, chemotherapy eventually results in tumours that are resistant to drugs. In recent years, many studies have revealed that the activation of Wnt/ß-catenin signalling is crucial for the emergence and growth of breast tumours as well as the development of drug resistance. Additionally, drugs that target this pathway can reverse drug resistance in breast cancer therapy. Traditional Chinese medicine has the properties of multi-target and tenderness. Therefore, integrating traditional Chinese medicine and modern medicine into chemotherapy provides a new strategy for reversing the drug resistance of breast tumours. This paper mainly reviews the possible mechanism of Wnt/ß-catenin in promoting the process of breast tumour drug resistance, and the progress of alkaloids extracted from traditional Chinese medicine in the targeting of this pathway in order to reverse the drug resistance of breast cancer.

Investigation of In Situ Vibration During Wire and Arc Additive Manufacturing.

Wire and arc additive manufacturing (WAAM) is becoming a promising technique due to its high deposition rate and low cost. However, WAAM faces challenges of coarse grains. In this study, a novel in situ vibration method was proposed to suppress these imperfections of WAAM. Temperature and vibration distributions were explored first, and the optimized parameters were utilized for manufacturing low-carbon steel parts. The results revealed that after the vibration, the average grain size in fine grain zone was reduced from 9.8 to 7.1 µm, and that in coarse grain zone was declined from 10.6 to 7.4 µm, respectively. No large deformation occurred due to the low temperature. Grain refining was attributed to more dendrite fragments induced by excessive stress at the roots of dendrites. The refined grains enhanced mechanical strength of the parts in both X and Z directions and improved the average hardness. After the vibration, the ultimate tensile strength and yield strength were increased to 522.5 and 395 MPa, which represented an increase of 10% and 13.8%, respectively. The average hardness was improved to 163 HV, which was an increase of 10.1%.

Angiography-Based Superficial Wall Strain of De Novo Stenotic Coronary Arteries: Serial Assessment of Vessels Treated with Bioresorbable Scaffold or Drug-Eluting Stent.

OBJECTIVES: This study sought to present an angiography-based computational model for serial assessment of superficial wall strain (SWS, dimensionless) of de-novo coronary stenoses treated with either bioresorbable scaffold (BRS) or drug-eluting stent (DES). BACKGROUND: A novel method for SWS allows the assessment of the mechanical status of arteries in-vivo, which may help for predicting cardiovascular outcomes. METHODS: Patients with arterial stenosis treated with BRS (n = 21) or DES (n = 21) were included from ABSORB Cohort B1 and AIDA trials. The SWS analyses were performed along with quantitative coronary angiography (QCA) at pre-PCI, post-PCI, and 5-year follow-up. Measurements of QCA and SWS parameters were quantified at the treated segment and adjacent 5-mm proximal and distal edges. RESULTS: Before PCI, the peak SWS on the 'to be treated' segment (0.79 ± 0.36) was significantly higher than at both virtual edges (0.44 ± 0.14 and 0.45 ± 0.21; both p < 0.001). The peak SWS in the treated segment significantly decreased by 0.44 ± 0.13 (p < 0.001). The surface area of high SWS decreased from 69.97mm2 to 40.08mm2 (p = 0.002). The peak SWS in BRS group decreased to a similar extent (p = 0.775) from 0.81 ± 0.36 to 0.41 ± 0.14 (p < 0.001), compared with DES group from 0.77 ± 0.39 to 0.47 ± 0.13 (p = 0.001). Relocation of high SWS to device edges was often observed in both groups after PCI (35 of 82 cases, 41.7 %). At follow-up of BRS, the peak SWS remained unchanged compared to post-PCI (0.40 ± 0.12 versus 0.36 ± 0.09, p = 0.319). CONCLUSION: Angiography-based SWS provided valuable information about the mechanical status of coronary arteries. Device implantation led to a significant decrease of SWS to a similar extent with either polymer-based scaffolds or permanent metallic stents.

An optical coherence tomography and endothelial shear stress study of a novel bioresorbable bypass graft.

Endothelial shear stress (ESS) plays a key role in the clinical outcomes in native and stented segments; however, their implications in bypass grafts and especially in a synthetic biorestorative coronary artery bypass graft are yet unclear. This report aims to examine the interplay between ESS and the morphological alterations of a biorestorative coronary bypass graft in an animal model. Computational fluid dynamics (CFD) simulation derived from the fusion of angiography and optical coherence tomography (OCT) imaging was used to reconstruct data on the luminal anatomy of a bioresorbable coronary bypass graft with an endoluminal "flap" identified during OCT acquisition. The "flap" compromised the smooth lumen surface and considerably disturbed the local flow, leading to abnormally low ESS and high oscillatory shear stress (OSI) in the vicinity of the "flap". In the presence of the catheter, the flow is more stable (median OSI 0.02384 versus 0.02635, p < 0.0001; maximum OSI 0.4612 versus 0.4837). Conversely, OSI increased as the catheter was withdrawn which can potentially cause back-and-forth motions of the "flap", triggering tissue fatigue failure. CFD analysis in this report provided sophisticated physiological information that complements the anatomic assessment from imaging enabling a complete understanding of biorestorative graft pathophysiology.

Efficacy and safety of sacubitril/valsartan vs. valsartan in patients with acute myocardial infarction: A meta-analysis.

Background: The angiotensin-receptor neprilysin inhibitor (ARNI) sacubitril/valsartan was shown to be superior to the angiotensin receptor blocker (ARB) valsartan in terms of reversing heart failure classification (NYHA classification), reducing N-terminal pro-brain natriuretic peptide (NT-proBNP) level and cardiovascular mortality in many studies. Yet, the efficacy of ARNI did not come from patients with acute myocardial infarction (AMI). Methods: We searched databases for research published from inception to July 29, 2022, that reported cardiac reverse remodeling (CRR) or security indices. Two reviewers independently screened literature, extracted data, and assessed the risk of bias. Nine studies enrolling 1,369 patients were included to perform a meta-analysis. There were 716 patients in the ARNI group and 653 in the ARB group. Results: ARNI outperformed ARBs in terms of CRR indices, with striking changes in left ventricular ejection fraction (EF) (MD: 4.12%, 95%CI: 2.36, 5.88, P < 0.0001), diameter (MD: -3.40 mm, 95%CI: -4.30, -2.94, P < 0.00001, I 2 = 0%) and left atrial diameter (MD: -2.41 mm, 95%CI: -3.85, -0.97, P = 0.001, I 2 = 0%), other indices there showed no significant improvements. The incidences of major adverse cardiac events (RR: 0.47, 95%CI: 0.34-0.65, P < 0.00001, I 2 = 0%), the heart failure (RR: 0.37, 95%CI: 0.23-0.61, P < 0.0001, I 2 = 0%), readmission (RR: 0.54, 95%CI: 0.36-0.80, P = 0.003, I 2 = 29%) in the sacubitril/valsartan group were lower than the ARB group, while the incidences of cardiac death (RR: 0.56, 95%CI: 0.28, 1.09, P = 0.09), the myocardial infarction (RR: 0.83, 95% CI: 0.39, 1.77, P = 0.63), adverse side effects (RR: 1.67, 95% CI: 0.89, 3.13, P = 0.11) showed no difference. Conclusion: This research indicated that early initiation of sacubitril/valsartan in patients after AMI was superior to ARBs in reducing the risks of major adverse cardiac events, heart failure, readmission, and enhancing left ventricular EF, decreasing diameter, left atrial diameter. As for the other outcomes (the incidences of cardiac death, myocardial infarction, and adverse side effects), sacubitril/valsartan demonstrated no obvious advantage over ARBs. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier [CRD42022307237].

Delicate and Independent Manipulation of Dynamic Fluorescence Behavior of Polymer Nanoparticles Based on a Core-Shell Strategy.

Fluorescent polymer nanomaterials with dynamic fluorescence properties hold great potential in many advanced applications, including but not limited to information encryption, adaptive camouflage, and biosensors. The key to improving the application value of materials is to establish an accurate control strategy for dynamic fluorescence behavior. Herein, we develop a core-shell engineering strategy to precisely and independently manipulate the dynamic fluorescence behavior through the shell polymeric matrix. The core-shell fluorescent polymer nanoparticles (CS-FPNPs) are constructed through a sequential process of miniemulsion polymerization and seeded emulsion polymerization. Taking advantage of the core-shell structure, the rigid core matrix ensures the strong initial emission of AIE units, while the photoisomerization behavior of spiropyrane (SP) units is delicately and independently regulated by the rigidness of the shell matrix. Thereby, CS-FPNPs exhibit bright time-dependent reversible dynamic fluorescence behavior under alternating UV/vis irradiation. Benefited from the excellent processability and film formation ability, we have successfully applied CS-FPNPs to dynamic decorative painting, warning labels, and dynamic QR code security. Impressively, the fluorescence manipulation strategy based on core-shell engineering allows the independent regulation of specific luminescent units in complicated emission systems to accurately embody designed emission behavior.

One-year performance of biorestorative polymeric coronary bypass grafts in an ovine model: correlation between early biomechanics and late serial Quantitative Flow Ratio.

OBJECTIVES: This study aimed to investigate the impact of mechanical factors at baseline on the patency of a restorative conduit for coronary bypass grafts in an ovine model at serial follow-up up to 1 year. METHODS: The analyses of 4 mechanical factors [i.e. bending angle, superficial wall strain and minimum and maximum endothelial shear stress (ESS)] were performed in 3D graft models reconstructed on baseline (1-month) angiograms frame by frame by a core laboratory blinded for the late follow-up. The late patency was documented by Quantitative Flow Ratio (QFR®) that reflects the physiological status of the graft. The correlation between 4 mechanical factors and segmental QFR (△QFR) were analysed on 10 equal-length segments of each graft. RESULTS: A total of 69 graft geometries of 7 animals were performed in the study. The highest △QFR at 12 months was colocalized in segments of the grafts with the largest bending angles at baseline. Higher △QFR at 3 months were both at the anastomotic ends and were colocalized with the highest superficial wall strain at baseline. High baseline ESS was topographically associated with higher △QFR at the latest follow-up. Correlations of minimum and maximum ESS with △QFR at 3 months were the strongest among these parameters (ρ = 0.30, 95% CI [-0.05 to 0.56] and ρ = 0.27, 95% CI [-0.05 to 0.54], respectively). CONCLUSIONS: Despite the limited number of grafts, this study suggests an association between early abnormal mechanical factors and late flow metrics of the grafts. The understanding of the mechanical characteristics could help to improve this novel conduit.

Preparation of quaternized chitosan/Ag composite nanogels in inverse miniemulsions for durable and antimicrobial cotton fabrics.

It is an urgent task to exploit effective antimicrobial agents due to the rise of drug-resistant pathogens. Herein, antimicrobial quaternized chitosan/Ag composite nanogels (QCS/Ag CNGs) with tunable properties were fabricated through inverse miniemulsion technique with a high encapsulation efficiency of NH2-Ag nanoparticles (NPs). The QCS/Ag CNGs possess superior broad-spectrum antimicrobial activity and low biotoxicity, via synergistic sterilization of Ag NPs and QCS. Furthermore, the NH2-Ag NPs were chemically linked to the QCS matrix through Schiff base reactions, and the QCS/Ag CNGs have reactive groups, making it possible to obtain durable antibacterial cotton fabrics. Thus, QCS/Ag CNGs modified cotton fabrics exhibited laundering durability of antimicrobial effect after 100 washing cycles without sacrificing other inherent properties of cotton fabrics. Our study provides a facile and controllable method to construct polymer/inorganic CNGs to address the urgent need for antibacterial agents/fabrics.

Usability of Fantom Encore® scaffold in non-complex bifurcations-Analysis in bench models.

OBJECTIVE: Present bench study aimed to evaluate whether technical characteristics of Fantom Encore® bioresorbable scaffold (BRS) allow to perform proximal optimization/side branch dilation/proximal optimization (POT-SB-POT) technique, as an adequate solution for bifurcation percutaneous coronary intervention. METHODS: Two Fantom Encore® BRS platforms (small with 3.0 mm nominal diameter, n = 7; and large with 3.5 mm nominal diameter, n = 7) were evaluated in bench models, which were designed according to Finet-law and fitted to nominal scaffold diameter in the distal main branch (MB) and fitted to indicated maximal expansion capacity in the proximal main branch (MB). Results were evaluated by (a) fluoroscopy, (b) optical coherence tomography (OCT) and (c) micro-computed tomography (µCT). RESULTS: All procedures were performed according to the protocol. Careful review of the fluoroscopic loops by an independent operator did not reveal any strut fracture or major deformation. By OCT the overall rate of perfectly apposed struts in the bifurcation area was 15 ± 6% after SB opening, that increased significantly but remained low with 22 ± 9% after final POT (p = .001). Compared to SB ballooning alone, significant benefit of final POT was found in rate of perfect apposition in the proximal MB (15 ± 12% vs. 26 ± 15%, respectively; p = .017) and at the abostial side of polygon of confluence (7 ± 9% vs. 16 ± 13%, respectively; p = .005). µCT analysis revealed a single strut fracture in one case with the small platform, while four cases showed single or multiple strut fractures with the large platform. CONCLUSION: The mechanical characteristics of the device are not suitable for use of Conventional techniques for bifurcation PCI such as POT-SB-POT. The use of Fantom Encore® BRS for bifurcation PCI with relevant SB should not be encouraged.

Bench test and in vivo evaluation of longitudinal stent deformation during proximal optimisation.

BACKGROUND: While radial stent deformation has been thoroughly investigated, data on longitudinal deformation are scarce. AIMS: The aim of the study was to describe longitudinal stent deformation associated with the proximal optimisation technique (POT). METHODS: Longitudinal stent deformation was assessed by bench testing and by clinical evaluation. Bench testing was performed in silicone models using 3.00 (n=15) and 3.50 mm (n=14) stent platforms. After deployment, stents were sequentially post-dilated in the proximal main branch up to 5.50 mm, in increments of 0.50 mm, in order to simulate a spectrum of overexpansion. Stent length was redefined by optical coherence tomography (OCT) after each step. Clinical data were collected retrospectively from OCT-guided bifurcation percutaneous coronary intervention cases. RESULTS: In bench tests, POT has led to significant stent elongation in all cases. The magnitude of elongation was comparable between the 3.00 and the 3.50 mm stent platforms, with 0.86±0.74 mm vs 0.86±0.73 mm, respectively (p=0.71), per 0.5 mm overexpansion. For 3.00 mm stent platforms, maximal elongation was 4.31±1.47 mm after up to 5.5 mm overexpansion. For 3.50 mm platforms, maximal elongation was 2.87±0.94 mm after up to 5.5 mm overexpansion. Thirty-six clinical cases were analysed, of which 22 (61%) were performed in the distal left main. Post-dilation was performed with 0.98±0.36 mm absolute overexpansion, resulting in 2.22±1.35 mm elongation, as compared to nominal stent length. CONCLUSIONS: Overexpansion by POT results in proximal stent elongation. This has to be considered once the stent length is selected and the stent is positioned, especially in the left main stem, where proximal overexpansion is marked and accurate ostial landing is critical.

Effects of sacubitril/valsartan on cardiac reverse remodeling and cardiac resynchronization in patients with acute myocardial infarction.

Introduction: In 2014, the PARADIGM-HF trial (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) has shown that sacubitril/valsartan can reduce the risk of hospitalization and death from cardiovascular causes more effectively than enalapril (an ACEI) in heart failure patients with reduced ejection fraction (HFrEF). Similarly, the PARADIGM-HF trial (Comparison of Sacubitril-Valsartan vs. Enalapril on Effect on NT-proBNP in Patients Stabilized from an Acute Heart Failure Episode) came to similar conclusions and extended the PARADIGM-HF trial results in 2019. Since then, numerous new studies have provided further insight in HFrEF, sacubitril/valsartan can reduce N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, increase left ventricular ejection fraction (LVEF), reverse ventricular remodeling, and reduce other non-fatal manifestations of clinical deterioration as compared to ACEI/ARB. However, few trials have compared the effects of these drugs in patients shortly after AMI. Therefore, it is necessary to further explore the clinical efficacy and safety of sacubitril/valsartan vs. valsartan in patients with AMI. Methods: We conducted an open-label, prospective, randomized controlled trial to determine the superiority in ameliorating ventricular remodeling and preventing of heart failure in patients with AMI after percutaneous coronary intervention (PCI), 148 patients were randomly assigned (85 to sacubitril/valsartan and 63 to valsartan). Results: LAV, LVDV, and LVSV were all decreased in the sacubitril/valsartan group when compared with before treatment, but there was no difference between the sacubitril/valsartan group and the valsartan group. In addition, compared with before treatment in the sacubitril/valsartan group, the heart global work index (GWI) and the global work efficiency (GWE) increased, while the heart global wasted work (GWW) decreased. Patients in the sacubitril/valsartan group have similar MACE and adverse side effects to those in the valsartan group. Conclusion: Sacubitril/valsartan has the same performance as valsartan in inhibiting ventricular remodeling and preventing heart failure after PCI in patients with AMI, and its clinical application is safe. It provides a clinical foundation for the application of sacubitril/valsartan in patients with AMI.

Angiography-Based 4-Dimensional Superficial Wall Strain and Stress: A New Diagnostic Tool in the Catheterization Laboratory.

A novel method for four-dimensional superficial wall strain and stress (4D-SWS) is derived from the arterial motion as pictured by invasive coronary angiography. Compared with the conventional finite element analysis of cardiovascular biomechanics using the estimated pulsatile pressure, the 4D-SWS approach can calculate the dynamic mechanical state of the superficial wall in vivo, which could be directly linked with plaque rupture or stent fracture. The validation of this approach using in silico models showed that the distribution and maximum values of superficial wall stress were similar to those calculated by conventional finite element analysis. The in vivo deformation was validated on 16 coronary arteries, from the comparison of centerlines predicted by the 4D-SWS approach against the actual centerlines reconstructed from angiograms at a randomly selected time-point, which demonstrated a good agreement of the centerline morphology between both approaches (scaling: 0.995 ± 0.018 and dissimilarity: 0.007 ± 0.014). The in silico vessel models with softer plaque and larger plaque burden presented more variation in mean lumen diameter and resulted in higher superficial wall stress. In more than half of the patients (n = 16), the maximum superficial wall stress was found at the proximal lesion shoulder. Additionally, in three patients who later suffered from acute coronary syndrome, the culprit plaque rupture sites co-localized with the site of highest superficial wall stress on their baseline angiography. These representative cases suggest that angiography-based superficial wall dynamics have the potential to identify coronary segments at high-risk of plaque rupture and fracture sites of implanted stents. Ongoing studies are focusing on identifying weak spots in coronary bypass grafts, and on exploring the biomechanical mechanisms of coronary arterial remodeling and aneurysm formation. Future developments involve integration of fast computational techniques to allow online availability of superficial wall strain and stress in the catheterization laboratory.

Delayed pericardial effusion after left atrial appendage closure with the LAmbre device: Importance of a fully open umbrella.

INTRODUCTION: We aimed to investigate whether a modified implantation method facilitating a fully open umbrella can reduce the pericardial effusion/pericardial tamponade (PE/PT) rate after left atrial appendage closure (LAAC) with the LAmbre device compared with the conventional method (CM) in patients with non-valvular atrial fibrillation (NVAF). METHODS AND RESULTS: Patients with NVAF who received either isolated LAAC or combined catheter ablation and LAAC using the LAmbre device at the First Affiliated Hospital of Wenzhou Medical University from January 2018 to December 2019 were enrolled. CM was used for device implantation in the initial 59 patients, while a modified method (MM) was used in the remaining 165 patients. Successful implantation was achieved in 98.3% of patients in the CM group and 98.8% in the MM group. A higher rate of a fully open umbrella (98.8% vs. 69%, p < .001), less requirement for recapture (46% vs. 62.1%, p = .036), and a lower incidence of delayed PE/PT (1.2% vs. 8.6%, p = .005) were found in the MM group compared with the CM group. All of the five delayed PT events occurred in patients with combined treatment. An umbrella that was not fully open was the only factor associated with delayed PE/PT events in a multivariable Cox model. CONCLUSIONS: LAAC with the LAmbre device using an MM significantly increases the rate of a fully open umbrella and decreases the requirement for recapture and the incidence of delayed PE/PT. This method is more effective in patients with combined treatment.