Association between triglyceride glucose-body mass index and long-term adverse outcomes of heart failure patients with coronary heart disease.

BACKGROUND: The triglyceride glucose-body mass index (TyG-BMI) is recognized as a reliable surrogate for evaluating insulin resistance and an effective predictor of cardiovascular disease. However, the link between TyG-BMI index and adverse outcomes in heart failure (HF) patients remains unclear. This study examines the correlation of the TyG-BMI index with long-term adverse outcomes in HF patients with coronary heart disease (CHD). METHODS: This single-center, prospective cohort study included 823 HF patients with CHD. The TyG-BMI index was calculated as follows: ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2] × BMI. To explore the association between the TyG-BMI index and the occurrences of all-cause mortality and HF rehospitalization, we utilized multivariate Cox regression models and restricted cubic splines with threshold analysis. RESULTS: Over a follow-up period of 9.4 years, 425 patients died, and 484 were rehospitalized due to HF. Threshold analysis revealed a significant reverse "J"-shaped relationship between the TyG-BMI index and all-cause mortality, indicating a decreased risk of all-cause mortality with higher TyG-BMI index values below 240.0 (adjusted model: HR 0.90, 95% CI 0.86-0.93; Log-likelihood ratio p = 0.003). A distinct "U"-shaped nonlinear relationship was observed with HF rehospitalization, with the inflection point at 228.56 (adjusted model: below: HR 0.95, 95% CI 0.91-0.98; above: HR 1.08, 95% CI 1.03-1.13; Log-likelihood ratio p < 0.001). CONCLUSIONS: This study reveals a nonlinear association between the TyG-BMI index and both all-cause mortality and HF rehospitalization in HF patients with CHD, positioning the TyG-BMI index as a significant prognostic marker in this population.

Prognostic value of growth differentiation factor-15 in heart failure among whole ejection fraction phenotypes.

AIMS: The utility of growth differentiation factor-15 (GDF-15) in predicting long-term adverse outcomes in heart failure (HF) patients is not well established. This study explored the relationship between GDF-15 levels and adverse outcomes in HF patients across various ejection fraction (EF) phenotypes associated with coronary heart disease (CHD) and evaluated the added prognostic value of incorporating GDF-15 into the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score-based model. METHODS AND RESULTS: This single-centre cohort study included 823 HF patients, categorized into 230 (27.9%) reduced EF (HFrEF), 271 (32.9%) mid-range EF (HFmrEF), and 322 (39.1%) preserved EF (HFpEF) groups. The median age was 68.0 years (range: 56.0-77.0), and 245 (29.8%) were females. Compared with the HFrEF and HFmrEF groups, the HFpEF group had a higher GDF-15 concentration (P = 0.002) and a higher MAGGIC risk score (P < 0.001). We examined the associations between GDF-15 levels and the risks of all-cause mortality and HF rehospitalization using Cox regression models. The C-index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI) metrics were employed to assess the incremental prognostic value. During the 9.4 year follow-up period, 425 patients died, and 484 were rehospitalized due to HF. Multivariate Cox regression analysis revealed that elevated GDF-15 levels were significantly associated with an increased risk of all-cause mortality [hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.20-1.54; P < 0.001] and HF rehospitalization (HR = 1.75, 95% CI: 1.57-1.95; P < 0.001) across all HF phenotypes. This association remained significant when GDF-15 was treated as a categorical variable (high GDF-15 group: all-cause death: HR = 1.73, 95% CI: 1.40-2.14; P < 0.001; HF rehospitalization: HR = 3.37, 95% CI: 2.73-4.15; P < 0.001). Inclusion of GDF-15 in the MAGGIC risk score-based model provided additional prognostic value for all HF patients (Δ C-index = 0.021, 95% CI: 0.002-0.041; IDI = 0.011, 95% CI: 0.001-0.025; continuous NRI = 0.489, 95% CI: 0.174-0.629) and HF rehospitalization (Δ C-index = 0.034, 95% CI: 0.005-0.063; IDI = 0.021, 95% CI: 0.007-0.032; continuous NRI = 0.307, 95% CI: 0.147-0.548), particularly in the HFpEF subgroup. CONCLUSIONS: GDF-15 is identified as an independent risk factor for adverse outcomes in HF patients across the entire EF spectrum in the context of CHD. Integrating GDF-15 into the MAGGIC risk score-based model enhances its prognostic capability for adverse outcomes in the general HF population. This incremental prognostic effect was observed specifically in the HFpEF subgroup and not in other subgroups.

Role of IL-17A in different stages of ischemic stroke.

Interleukin-17A (IL-17A) plays an important role in the progression of ischemic stroke. IL-17A mediates the endothelial inflammatory response, promotes water and sodium retention, and changes the electrophysiological structure of the atrium, accelerating the progression of ischemic stroke risk factors such as atherosclerotic plaques, hypertension, and atrial fibrillation. In the acute phase of ischemic stroke, IL-17A mediates neuronal injury through neutrophil chemotaxis to the site of injury, the induction of neuronal apoptosis, and activation of the calpain-TRPC-6 (transient receptor potential channel-6) pathway. During ischemic stroke recovery, IL-17A, which is mainly derived from reactive astrocytes, promotes and maintains the survival of neural precursor cells (NPCs) in the subventricular zone (SVZ), neuronal differentiation, and synapse formation and participates in the repair of neurological function. Therapies targeting IL-17A-associated inflammatory signaling pathways can reduce the risk of ischemic stroke and neuronal damage and are a new therapeutic strategy for ischemic stroke and its risk factors. In this paper, we will briefly discuss the pathophysiological role of IL-17A in ischemic stroke risk factors, acute and chronic inflammatory responses, and the potential therapeutic value of targeting IL-17A.

Relationship between epicardial adipose tissue measured by computed tomography and premature ventricular complexes originating from different sites.

AIMS: This study aims to explore the association between the features of epicardial adipose tissue (EAT) in different zones and premature ventricular complexes (PVCs) originating from different sites by computed tomography (CT). METHODS AND RESULTS: A total of 136 patients who underwent radiofrequency ablation for PVCs were incorporated in this study. One hundred and thirty-six matched controls were included in this study using the case-control method (1:1 matching). PVCs were classified into four subgroups: (1) right ventricular outflow tract (RVOT-PVCs), (2) non-RVOT of the right ventricle (RV-PVCs), (3) left ventricular outflow tract (LVOT-PVCs), and (4) non-LVOT of the left ventricle (LV-PVCs). The volume and density of EAT were quantified by CT. Patients with PVCs had a significantly higher volume and lower density of EAT than the controls (P < 0.001). The LVOT-PVCs and LV-PVCs had a higher left ventricle periventricular EAT volume (LV-EATv) proportion (P < 0.05). The right ventricle periventricular EAT volume (RV-EATv) proportion was higher in ROVT-PVCs and LVOT-PVCs (P < 0.05). RVOT-PVC patients had a higher volume ratio and a smaller density differential (P < 0.05). Patients with LVOT-PVCs had a lower volume ratio and the LV-PVCs showed a greater density differential (P < 0.05). CONCLUSION: Higher volume and lower density of EAT were significantly associated with frequent PVCs. The RVOT-PVC patients had a higher volume ratio and a smaller density differential. The LVOT-PVCs had a lower volume ratio and the LV-PVCs showed a greater density differential. These suggest a link between EAT structural properties and PVCs and a potential role for regional EAT in the development of PVCs.

Salinity significantly reduces plastic-degrading bacteria from rivers to oceans.

Microplastics (MPs) are found in rivers and offshore areas. However, there is a lack of detailed research on the changes of surface microbial species attached to MPs when MPs enter the sea. Moreover, no study has been conducted on changes to plastic-degrading bacteria during this process. In this study, using rivers and offshore in Macau, China as examples, bacterial diversity and bacterial species composition attached to surface water and MPs at four river sampling stations and four offshore sampling stations around Macau were studied. Plastic-degrading bacteria, plastic-related metabolic processes, and plastic-related enzymes were analyzed. The results showed that MPs-attached bacteria in rivers and offshore were different with the planktonic bacteria (PB). The proportion of major families on the surface of MPs continued to increase from rivers to estuaries. MPs could significantly enrich plastic-degrading bacteria both in rivers and offshore. The proportion of plastic-related metabolic pathways on the surface bacteria of MPs in rivers was higher than that in offshore waters. Bacteria on the surface of MPs in rivers may induce higher plastic degradation than offshore. Salinity significantly alters the distribution of plastic-degrading bacteria. MPs may degrade more slowly in the oceans, posing a long-term threat to marine life and human health.

CSAC-Net: Fast Adaptive sEMG Recognition through Attention Convolution Network and Model-Agnostic Meta-Learning.

Gesture recognition through surface electromyography (sEMG) provides a new method for the control algorithm of bionic limbs, which is a promising technology in the field of human-computer interaction. However, subject specificity of sEMG along with the offset of the electrode makes it challenging to develop a model that can quickly adapt to new subjects. In view of this, we introduce a new deep neural network called CSAC-Net. Firstly, we extract the time-frequency feature from the raw signal, which contains rich information. Secondly, we design a convolutional neural network supplemented by an attention mechanism for further feature extraction. Additionally, we propose to utilize model-agnostic meta-learning to adapt to new subjects and this learning strategy achieves better results than the state-of-the-art methods. By the basic experiment on CapgMyo and three ablation studies, we demonstrate the advancement of CSAC-Net.

Significant Gene Biomarker Tyrosine Kinase Non-receptor 2 Mediated Cell Proliferation and Invasion in Colon Cancer.

Objective: This study aimed to investigate the expression and biological functions of TNK2 and miR-125a-3p in colon cancer. Materials and methods: The expression of TNK2 and miR-125a-3p in colon cancer tissues was analyzed using data deposited on public databases including UALCAN and ONCOMINE. We verified their expression in colon cancer cell lines by RT-qPCR and western blotting. By regulating the expression of TNK2 and miR-125a-3p in colon cancer cells, their functions and potential mechanisms were explored. Results: TNK2 was overexpressed in colon cancer cell lines, and it was found to directly bind to miR-125a-3p, which was downregulated in these cell lines. Their expression affected the proliferation and invasion of colon cancer cells. Additionally, colon cancer patients with lower TNK2 expression had better prognoses than those with higher TNK2 expression. Conclusion: Our results indicated that TNK2 and miR-125a-3p play critical roles in colon cancer, and could also serve as biomarkers for the diagnosis and prognosis of this malignant disease.

High-dose intravenous vitamin C attenuates hyperinflammation in severe coronavirus disease 2019.

OBJECTIVE: High-dose intravenous vitamin C (HIVC) is a major concern when treating patients with coronavirus disease 2019 (COVID-19). The aim of this study was to assess the clinical efficacy of HIVC on hyperinflammation in patients with severe COVID-19. METHODS: This retrospective cohort study included hospitalized patients with severe COVID-19, a subset of whom was treated with HIVC. The medical records were screened for demographic data, laboratory findings, and medications, as well as initial and repeated values of multiple inflammatory markers for analysis. RESULTS: A high percentage of patients presented with hyperinflammation based on inflammatory marker levels above the upper limit of normal (high-sensitivity C-reactive protein, 80.1%; interleukin-6, 91.5%; and tumor necrosis factor-α, 67.4%). Eighty-five (36%) patients received HIVC therapy. After treatment with HIVC, the levels of inflammatory markers displayed a significant decrease compared with those of patients without HIVC. Furthermore, the percentages of reduction in inflammatory marker levels were higher in patients receiving HIVC compared with those in patients treated without HIVC. Stepwise multiple linear regression analysis revealed that HIVC was independently associated with percentages of reduction in levels of inflammatory markers. CONCLUSIONS: HIVC has the potential benefit of attenuating hyperinflammation by reducing inflammatory marker levels in patients with severe COVID-19.

Clinical prediction models of fractional flow reserve: an exploration of the current evidence and appraisal of model performance.

BACKGROUND: Invasive fractional flow reserve (FFR) is a standard indicator of coronary stenoses' hemodynamic severity. Clinical prediction models (CPMs) may help differentiate ischemic from non-ischemic lesions without using a pressure wire but by integrating related variables. This approach differs from that of physics-based models. However, it is not yet known which CPMs are the most reliable at detecting hemodynamic significance. METHODS: A systematic review was performed of relevant publications that developed or validated any FFR CPMs from inception to April 2019 in the PubMed, EMBASE, and Cochrane Library databases by two independent authors. The risk of bias and applicability were assessed using the prediction model risk of the bias assessment tool (PROBAST). RESULTS: A total of 11 unique CPMs and 5 subsequent external validation studies were identified. The prevalence of hemodynamically significant lesions (FFR ≤0.80) across the studies had a median of 37.1% (range: 20.7-68.0%). Lesion length, percent diameter stenosis, and minimal lumen diameter were the three most frequently used variables in the CPMs. Of the 11 FFR CPMs, 9 (82%) exhibited strong discrimination [area under the curve (AUC) >0.75], and 5 (45%) had been subject to external validation; however, calibration was only available for 3 models (27%). There was a high degree of applicability; however, none of the studies was assessed as having a low risk of bias. A CPM was identified that had undergone rigorous validation and calibration: the DILEMMA score (three validations; median AUC, 0.83). CONCLUSIONS: Almost half of the existing FFR CPMs had been externally validated. Due to their good discrimination abilities, these FFR CPMs are useful tools that could reduce the need for invasive hemodynamic measurements. Future research that adheres to methodological guidelines should be undertaken to develop high-quality models in this setting. (PROSPERO registration number: CRD42019125011).

Hyper-Inflammatory Response Involves in Cardiac Injury Among Patients With Coronavirus Disease 2019.

BACKGROUND: Inflammation can facilitate development of coronavirus disease 2019 (COVID-19) and cardiac injury is associated with worse clinical outcomes. However, data are relatively scarce on the association between hyper-inflammatory response and cardiac injury among COVID-19 patients. METHODS: The study was designed based on severe and critically ill patients with COVID-19. Information on clinical characteristics and laboratory examinations was collected from the electronic medical records and analyzed. RESULTS: There were 32.4% (n = 107) of patients with cardiac injury. The median age was 67 years, and 48.8% (n = 161) of patients were men. Hypertension was the most common in 161 (48.8%) patients, followed by diabetes (16.7%, n = 55) and coronary heart disease (13.3%, n = 44). Compared to cases without cardiac injury, those with cardiac injury were older, had higher proportions of coronary heart disease, and leukocyte counts, significantly elevated concentrations of N-terminal pro-B-Type natriuretic peptide, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, interleukin-2 receptor (IL-2R), IL-6, and IL-8, but lower lymphocyte counts. A significant positive correlation was observed between high-sensitivity troponin I and inflammatory cytokines. Logistic regression analysis showed that hs-CRP, TNF-α and IL-6 were independent risk factors for cardiac injury. CONCLUSIONS: Cardiac injury was associated with elevated levels of inflammatory cytokines among severe and critically ill patients with COVID-19, suggesting that hyper-inflammatory response may involve in cardiac injury.

MiR-15a Functions as a Diagnostic Biomarker for Coronary Artery Disease.

BACKGROUND: The present study aimed to explore the diagnostic value of miR-15a in coronary artery disease (CAD). METHODS: After recruiting all the participants, peripheral blood samples were obtained according to the instructions. miR-15a expression was evaluated using real-time quantitative polymerase chain reaction (RT-qPCR) and IL-6, TNF-α, and hs-CRP expressions were detected using ELISA kits. RESULTS: The results elucidated a significantly decreased expression of miR-15a in peripheral blood samples from CAD patients compared to non-CAD controls (p < 0.01). Meanwhile, miR-15a expression was negatively correlated with LDL-C and Gensini score (p = 0.0059, 0.0243, respectively). Moreover, miR-15a expression was negatively correlated with inflammatory cytokines IL-6, TNF-α, and hs-CRP (p = 0.0009, 0.0178, 0.0005, respectively). The receiver operating curve (ROC) curve analysis demonstrated that miR-15a was a promising biomarker for early diagnosis of CAD with an area under the curve (AUC) of 0.9368. CONCLUSIONS: The present study elucidated a decreased miR-15a expression in CAD patients and showed negative correlations with LDL-C, Gensini score, and inflammatory cytokines. miR-15a may serve as a promising biomarker for early diagnosis of CAD.

CircRHOT1 mediated cell proliferation, apoptosis and invasion of pancreatic cancer cells by sponging miR-125a-3p.

Pancreatic cancer patients are asymptomatic at early stages and leading to late diagnoses. Additionally, pancreatic cancer easily metastasizes and is resistant to radiotherapy and chemotherapy. Therefore, it is critical to understand the underlying molecular mechanisms involved in pancreatic cancer to develop more efficient diagnostic and treatment strategies. In this study, we demonstrated that circRHOT1 was overexpressed in pancreatic cancer tissues and cell lines, and it was found to directly bind to miR-125a-3p, acting as an endogenous sponge to inhibit its activity. Knockdown of circRHOT1 expression significantly inhibited proliferation as well as invasion, and it promoted apoptosis of pancreatic cancer cells via the regulation of E2F3 through the targeting of miR-125a-3p. Taken together, our results showed that circRHOT1 plays critical roles in regulating the biological functions of pancreatic cancer cells, suggesting that circRHOT1 may serve as a potential diagnostic marker and therapeutic target for patients with pancreatic cancer.

Association between plasma fibroblast growth factor 23 and left ventricular mass index in patients with Takayasu arteritis.

INTRODUCTION/OBJECTIVES: Fibroblast growth factor (FGF23) is an endocrine hormone that can be induced by inflammation and plays a role in the pathogenesis of cardiac abnormalities. Few studies have reported plasma FGF23 levels in patients with Takayasu arteritis (TAK). We hypothesized that the production of FGF23 in TAK is associated with abnormal cardiac mass. METHOD: Forty-seven patients diagnosed with TAK and 52 age- and gender-matched healthy controls were included in this observational study. Plasma FGF23 was detected by human enzyme-linked immunosorbent assay. Multivariable linear regression analyses were performed to examine the association between FGF23 and left ventricular mass index (LVMI). RESULTS: Patients with TAK had higher plasma FGF23 than healthy controls [121.8 (84.5-168.8) vs. 86.7 (70.5-101.1) RU/ml, P < 0.001]. Patients with higher FGF23 concentrations were more likely to be females (100.0% vs. 75.0%, P = 0.01), angiographic type V (69.6% vs. 33.3%, P = 0.013), heart failure (43.5% vs. 12.5%, P = 0.018), and have higher LVMI [126.3 (81.1-177.7) vs. 85.9 (69.7-114.3) g/m2, P = 0.041]. Plasma FGF23 was significantly associated with LVMI in TAK patients [ß = 0.402, 95% confidence interval (CI) 0.032-0.301, P = 0.016], after adjusting for age, gender, disease duration, angiographic type (angiographic type V vs. non-angiographic type V), the presence of cardiovascular events and hypertension, and serum N-terminal pro-B-type natriuretic peptide in the multivariate linear regression. Age (ß = - 0.399, P = 0.016) and the presence of angiographic type V (ß = 0.376, P = 0.018) were identified to be significant determinants of plasma FGF23 in patients with TAK. CONCLUSIONS: Plasma FGF23 was elevated in patients with TAK and was associated with LVMI. FGF23 may participate in the development of abnormal cardiac mass in patients with TAK.Key Points• Plasma FGF23 was elevated in patients with TAK.• FGF23 was significantly associated with LVMI in TAK.• Age and the presence of angiographic type V were determinants of plasma FGF23 in patients with TAK.

Circulating miR-130 is a potential bio signature for early prognosis of acute myocardial infarction.

BACKGROUND: As distinctive leading reasons of death globally, acute myocardial infarction (AMI). Accounts for major death ratio, caused by coronary artery disease (CAD). Its diagnosis relies on the presenting clinical symptoms, electrocardiograms (ECGs), and levels of circulating biomarkers. Recent studies have implicated microRNAs (miRNAs) in the pathogenesis of many diseases, including AMI. The present study inquire into feature value of miR-130 in AMI patients. METHODS: levels of expression of miR-130 in patient plasma, considered through simultaneous quantitative polymerase chain reaction (qRT-PCR). The method used for determining Plasma cardiac troponin I (cTnI) & creatine kinase-MB(CK-MB) degree set on by enzyme-linked immunosorbent assay (ELISA). The diagnostic value of miR-130 was measured using a receiver operating characteristic (ROC) curve. RESULTS: Plasma miR-130, cTnI, and CK-MB levels exist remarkably inflated in the AMI classification in comparison with control category (P<0.05). MiR-130 expression peaked 6 hours after disease onset, earlier than cTnI and CK-MB. The level of expression of miR-130 6 hours after disease onset was positively correlated with cTnI and CK-MB levels 12 hours after onset. The optimal cut-off point for miR-130 in peripheral blood, sensitivity, and specificity were 1.58 ng/mL, 82.5% and 77.5%, respectively. The area under curve (AUC) was 0.922. CONCLUSIONS: These results indicate that circulating miR-130 holds great promise as an effective biomarker for diagnosing AMI earlier.

Pulmonary Artery Involvement in Patients with Takayasu Arteritis.

OBJECTIVE: This study was performed to explore the clinical manifestations and longterm prognosis in patients with Takayasu arteritis (TA) with pulmonary artery involvement (PAI). METHODS: The medical records of 194 patients with TA who underwent traditional catheter angiography or computed tomography of pulmonary artery from 2009 to 2016 were retrospectively reviewed. The clinical manifestations, angiographic features, and mortality of 128 patients with TA with PAI were further analyzed. RESULTS: Patients with TA with PAI had a higher risk of pulmonary hypertension (PH) than patients with TA alone (61.7% vs 7.6%, p < 0.001). Patients with PAI and PH more frequently developed dyspnea, hemoptysis, and lower limbs edema (all p < 0.05) than those without PH. Patients with PH also had a higher incidence of bilateral PAI (84.8% vs 34.7%, p < 0.001) and a higher pulmonary artery obstruction index [23 (interquartile range 20-27) vs 10 (6-15), p < 0.001]. Left heart disease was presented in 39 (30.5%) patients with TA with PAI. During the median followup of 38 (21-58) months, 19 and 2 deaths occurred among patients with and without PH, respectively. Among patients with PAI, the mortality rate was 7 times higher in patients with than without PH (p = 0.009). Independent predictors of mortality were the disease duration (p = 0.047), New York Heart Association class III/IV (p = 0.019), right ventricular systolic dysfunction (p = 0.019), and respiratory failure (p = 0.007). CONCLUSION: Patients with TA with PAI have a higher risk of developing PH than patients with TA alone. The presence of PH in patients with PAI increases the risk of early mortality.

Prevention of neointimal formation after angioplasty using tetramethylpyrazine-coated balloon catheters in a rabbit iliac artery model.

BACKGROUND: Restenosis remains a clinical problem; drug-coated balloons (DCBs) have demonstrated high efficiency in this situation. DCBs prevent neointimal hyperplasia by inhibiting cell proliferation and migration. Tetramethylpyrazine (TMP) is a traditional Chinese medicine originally isolated from the rhizome of Ligusticum Walliichii, which can inhibit platelet aggregation and smooth muscle cell proliferation. We hypothesized that TMP-coated balloons (TCB) could reduce neointimal hyperplasia through the NF-κB signalling pathway. METHODS: Twenty-one New-Zealand White rabbits (2.5-3.0 kg, male) were fed high-fat diets; 36 bilateral iliac artery stenosis models were successfully established by balloon straining. Rabbits were randomly treated with TCB (n=20) or plain balloons (PBA, n=16) (3 died during model construction). Angiographies were recorded at baseline, the immediate period, and 4 weeks later. Animals were euthanized and arteries collected for histological analysis and immunohistochemical staining. Protein expression of proliferating cell nuclear antigen (PCNA) and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) p65 of the vessel samples were analyzed using Western blotting. RESULTS: No difference existed in the baseline lesion characteristics or procedural results. Angiographic follow-up was successfully performed on 18 rabbits (TCB: n=20, PBA: n=16), except for 3 deaths related to the operation. Treatment with TCB was superior to that with PBA, with lower late lumen loss (0.45±0.23 vs. 0.84±0.17 mm, P<0.01). Pathological analysis confirmed the efficiency of TCB through decreasing the area stenosis rate compared with PBA (46.48%±8.22% vs. 75.24%±6.10%, P<0.01). As determined by Western blotting, significant reductions occurred in PCNA and NF-κB p65 protein intensity in the TCB group versus the PBA group (all P<0.01). TCB efficiently mitigated restenosis in the rabbit iliac artery model. CONCLUSIONS: This study elucidated that TCB could restrain intimal hyperplasia of vessels by inhibiting the activation of the NF-κB pathway to reduce inflammatory response and decrease the rate of cell proliferation through suppressing PCNA expression.

Malnutrition status in patients of very advanced age with nonvalvular atrial fibrillation and its impact on clinical outcomes.

BACKGROUND AND AIMS: Malnutrition is associated with adverse outcomes in patients with chronic disease. We screened malnutrition among patients of very advanced age with nonvalvular atrial fibrillation (AF) by malnutrition scores and investigated the associations between malnutrition and clinical outcomes. METHODS AND RESULTS: This retrospective observational study included 461 patients aged ≥80 years with nonvalvular AF. Malnutrition was screened using the Controlling Nutritional Status (CONUT), Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI) scores. The primary endpoints were composite events, including thromboembolic events and all-cause death. Malnutrition was present in 62.9%, 5.0%, and 21.9% of patients according to the CONUT, PNI, and GNRI scores, respectively. During a median 27-month follow-up, 130 (28.2%) patients had composite events. Kaplan-Meier curves revealed that patients with moderate to severe malnutrition had the worst clinical outcomes (log-rank P < 0.05 for all scores). Multivariate Cox proportional hazards analysis showed that moderate to severe malnutrition was an independent predictor of composite events [hazard ratio (HR): 2.051, 95% confidence interval (95%CI): 1.143-3.679, P = 0.016 for CONUT score; HR: 3.374, 95%CI: 1.898-5.998, P < 0.001 for PNI score; HR: 2.254, 95%CI: 1.381-3.679, P = 0.001 for GNRI score]. Addition of the CONUT or GNRI score to a baseline prediction model for composite events significantly improved the net reclassification improvement and integrated discrimination improvement (all P < 0.05). CONCLUSION: Moderate to severe malnutrition was an independent predictor of adverse outcomes among patients of very advanced age with nonvalvular AF. Screening for malnutrition might provide useful information regarding prognosis and risk stratification.

Association between increased arterial stiffness measured by brachial-ankle pulse wave velocity and cardiovascular events in patients with Takayasu's arteritis.

OBJECTIVES: This study aims to investigate the association between arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) and cardiovascular events (CVEs) in patients with Takayasu's arteritis (TAK). METHODS: A total of 240 TAK patients, who underwent baPWV measurement, were included in the study. The primary outcome was CVEs, which was defined as presently or previously diagnosed with myocardial infarction, unstable angina, congestive heart failure, aortic aneurysm/dissection, cerebral infarction/transient ischaemic attack (TIA), or cerebral haemorrhage. RESULTS: A total of 74 (30.8%) patients with CVEs were included in the present cohort. Compared with the patients without CVEs, those with CVEs had a higher prevalence of hyperlipidaemia (HL), smoking history, active stage, angiographic type V, renal dysfunction (RDF), higher baPWV and high sensitive C-reactive protein (hs-CRP) level (all, p<0.05). The multivariate logistic regression analysis showed that HL (OR: 2.465, 95%CI: 1.308-4.648, p=0.005), smoking history (OR: 4.764, 95%CI: 1.623-13.985, p=0.004), baPWV (OR: 1.132, 95%CI: 1.063-1.204, p<0.001), and hs-CRP (OR: 1.111, 95%CI: 1.040-1.188, p=0.002) were independently associated with the presence of CVEs. The multiple linear regression analysis revealed that age (ß=0.100, p=0.002), mean blood pressure (ß=0.071, p<0.001), angiographic type V (ß=3.681, p<0.001) and RDF (ß=1.800, p=0.048) were independently correlated with baPWV. CONCLUSIONS: Increased baPWV was independently associated with CVEs in patients with TAK. Age, angiographic type V, mean blood pressure and RDF were the strongest determinants for baPWV in TAK. BaPWV may be a potential maker to predict CVEs in patients with TAK.

Single or dual antiplatelet therapy after transcatheter aortic valve replacement: an updated systemic review and meta-analysis.

BACKGROUND: Although current guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel as an antiplatelet strategy after transcatheter aortic valve replacement (TAVR), it is not based on clinical evidence. Here we aim to review updated evidence systemically and assess safety and efficacy of the two antiplatelet regimens. METHODS: PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to retrieve studies involving single antiplatelet therapy (SAPT) versus DAPT after TAVR. We screened the records and extracted the data from publications independently. Relative risks (RRs) and the corresponding 95% confidence intervals (CIs) were used to compare the efficacy and safety of SAPT with that of DAPT in fixed-effects model with Mantel-Haenszel method. The quality of evidence was assessed by the scoring system, GRADE (Grading of Recommendations Assessment, Development, and Evaluation). RESULTS: A total of 2,489 patients from 8 studies were enrolled in this meta-analysis. Compared with DAPT, SAPT was associated with a lower all-cause mortality (RR =0.57; 95% CI, 0.36-0.89; P=0.014) and major/life-threatening bleeding (RR =0.62; 95% CI, 0.50-0.76; P=0.000) in 30 days. Furthermore, there was no significant difference found between SAPT and DAPT group in terms of 30-day stroke (RR =0.85; 95% CI, 0.45-1.63; P=0.631) and death beyond 3 months (RR =0.96; 95% CI, 0.81-1.15; P=0.664). CONCLUSIONS: This meta-analysis suggests that compared with DAPT, SAPT after TAVR is more likely to lead to a decline of 30-day mortality along with the reduced risk of bleeding and no increased risk of stroke. However, more clinical data and evidence from randomized controlled trials are warranted to clarify the optimal post-TAVR antiplatelet strategy.