Site of left axillary vein crossing the clavicle: an analysis with computed tomography venography as a guide for vein puncture for device implantation.

BACKGROUND: Blind axillary venous access is a convenient but technically difficult approach for cardiac rhythm device lead implantation. We try to explore whether there are rules on the axillary vein course to facilitate blind venous cannulation. METHODS: In a single-center, retrospective study, we included 155 patients who underwent computed tomography venography (CTV) examination of left axillary vein. All scans were reviewed for the relationship between left axillary vein and clavicle, vein steepness, and depth. Factors probably affecting above indicators were analyzed. RESULTS: The location of left axillary vein crossing the clavicle was mainly concentrated around the medial 1/3 of clavicle, with mean crossing location of the medial 1/3 of clavicle, which was not correlated with sex, age, abdominal subcutaneous fat thickness, upper thoracic kyphosis angle, or the angle between clavicle and anterior midline (P < 0.05). The average angle between axillary vein and horizontal line was 31.57 ± 11.72°, which was positively associated with age, whereas inversely associated with the angle between clavicle and anterior midline (P < 0.05). The proximal axillary vein ran more and more shallow until becoming the subclavian vein (P < 0.01); and it had a mean depth of 3 cm, which was significantly associated with abdominal subcutaneous fat thickness (P < 0.05). CONCLUSIONS: The left axillary vein and clavicle had a relatively fixed relationship that axillary vein commonly crossed the medial 1/3 of clavicle. The average angle between axillary vein and horizontal line was 31.57 ± 11.72°, associated with age and the clavicle course. The mean depth of proximal axillary vein was 3 cm, and patients with larger weight had a deeper position of axillary vein.

Clinical Evaluation of the Medium-Term Efficacy of Laparoscopic Sleeve Gastrectomy against Obstructive Sleep Apnea-Hypopnea Syndrome in Obese Patients.

Objective: This study was designed to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) for obstructive sleep apnea-hypopnea syndrome (OSAHS) in obese individuals and identify the related factors affecting its efficacy. Methods: The clinical and follow-up data of 37 obese patients with OSAHS who underwent LSG in the Laparoscopic Surgery Department of Zibo Central Hospital from January 2017 to July 2018 were analyzed retrospectively. The effect of this operation on patients' weight and OSAHS was studied, and the factors affecting weight and OSAHS were examined through univariate and multivariate logistic regression analysis. Results: Over 12 months of regular postoperative follow-up with the 37 patients, their body mass index (BMI) decreased, and the percentage of excess weight loss (EWL%) reached 73.2%. Additionally, the rate of successful OSAHS treatment reached 91.89%, and the apnea-hypopnea index (AHI) and lowest arterial oxygen saturation (LSaO2) increased significantly. Univariate logistic regression analysis showed that gender, weight, EWL%, and smoking affected the efficacy of LSG against OSAHS (P < 0.05). EWL% and smoking were independent factors that helped determine the efficacy of LSG against morbid obesity (P < 0.05). Conclusion: LSG can effectively help obese patients lose weight and show medium-term efficacy against OSAHS in obese people. Smoking and EWL% were found to be the factors determining the efficacy of LSG.

SKA3 promotes glioblastoma proliferation and invasion by enhancing the activation of Wnt/ß-catenin signaling via modulation of the Akt/GSK-3ß axis.

Spindle and kinetochore-related complex subunit 3 (SKA3) is a key modulator of the progression of multiple tumor types. However, the involvement of SKA3 in glioblastoma (GBM) has not been well studied. The current study aimed to explore the role of SKA3 expression and the potential function of the protein in GBM. Our data showed that SKA3 expression was significantly up-regulated in GBM. Functional assays demonstrated that the knockdown of SKA3 impeded the proliferation, colony formation and invasion of GBM cells, while SKA3 overexpression produced the opposite effects. Further investigation revealed that SKA3 overexpression enhanced the activation of Wnt/ß-catenin signaling, which was associated with the enhanced phosphorylation of Akt and glycogen synthase kinase-3ß (GSK-3ß). Notably, the inhibition of Akt markedly abrogated the SKA3 overexpression-induced promotion of Wnt/ß-catenin signaling in GBM cells. Further, the inhibition of Wnt/ß-catenin signaling markedly abrogated the SKA3 overexpression-induced promotion of tumor growth. In addition, the knockdown of SKA3 significantly retarded tumor formation and GBM progression in vivo. In summary, these data demonstrate that SKA3 exerts promotes tumor growth in GBM by enhancing the activation of Wnt/ß-catenin signaling via modulation of the Akt/GSK-3ß axis. This work highlights the pivotal role of SKA3/Akt/GSK-3ß/Wnt/ß-catenin signaling in the progression of GBM and suggests that SKA3 is an attractive therapeutic target with potential to be used to treat GBM.

Effect of Preoperative Nutritional Risk Screening on Postoperative Recovery in Patients with Laparoscopic-Assisted Radical Resection for Colorectal Cancer.

RESULTS: There were statistically significant differences in BMI, albumin, total cholesterol, and lymphocyte count between patients from the two groups (all P < 0.05). There was no difference in the incidence rate of postoperative complications between the two groups, but there was a statistically significant difference in the total number of complications (P < 0.05). There were no significant differences between the two groups regarding abdominal drainage volume, exhaust (flatus) time, hospitalization cost, morbidity, or 60 d readmission rate (all P > 0.05). However, patients with nutritional risk had higher postoperative blood transfusion volumes, albumin infusions, weight difference before and after surgery, and postoperative hospital stays than the nonnutritional risk group (all P < 0.05). Smoking, diabetes, and preoperative nutritional risk were the risk factors by the univariate and multivariate logistic regression analyses. CONCLUSIONS: The postoperative complication rate was increased, and the short-term efficacy was decreased in the preoperative nutritional risk group compared with those without nutritional risk.

Relay Rh(ii)/Pd(0) dual catalysis: synthesis of α-quaternary ß-keto-esters via a [1,2]-sigmatropic rearrangement/allylic alkylation cascade of α-diazo tertiary alcohols.

A relay Rh(ii)/Pd(0) dual catalysis that enables domino [1,2]-sigmatropic rearrangement/allylic alkylation of α-diazo tertiary alcohols is described. This transformation represents a highly efficient method for the one-pot synthesis of α-quaternary ß-keto-esters under mild conditions, in which two separate C-C σ-bonds at the carbenic center were formed in a straightforward manner.

Corrigendum to: Nicorandil alleviated cardiac hypoxia/reoxygenation-induced cytotoxicity via upregulating ketone body metabolism and ACAT1 activity.

[This corrects the article on p. 37 in vol. 23, PMID: 30627008.].

Incidence and predictors of left atrial thrombus in patients with atrial fibrillation prior to ablation in the real world of China.

BACKGROUND: The present study was to evaluate the value of CHADS2 and CHA2DS2VASC scores on predicting left atrial (LA) or left atrial appendage (LAA) thrombus in atrial fibrillation (AF) patients prior to ablation in the real world of China. METHODS AND RESULTS: A total of 397 patients with non-valvular AF were analyzed to determine the relationship between CHADS2 and CHA2DS2VASC scores and LA/LAA thrombus identified on transesophageal echocardiography prior to radiofrequency ablation(RFA). LA/LAA thrombus was present in 38 patients (9.6%). There was a strong association between higher CHADS2 score or CHA2DS2VASC score and LA/LAA thrombus. No thrombus was identified in patients with CHA2DS2VASC score of 0 regardless of anticoagulation status. However, LA/LAA thrombus was detected in 2.9% patients with CHADS2 score of 0 without adequate anticoagulation, while no thrombus was present in the patients with CHADS2 score of 0 with adequate anticoagulation. Univariate analysis showed that heart failure (LVEF＜50%), LA≥40 mm, diabetes mellitus, previous stroke or TIA, CAD, hypertension, inadequate anticoagulation therapy, CHADS2 score of ≥2 and CHA2DS2VASC score of ≥2 were significantly associated with LA/LAA thrombus. Multivariable Cox regression analysis demonstrated that CHA2DS2VASC score of ≥2 (p = 0.02) and previous stroke or TIA (p = 0.04) were independently associated with LA/LAA thrombus regardless of anticoagulation status. ROC curve analysis showed that higher CHADS2 score and CHA2DS2VASC score could be similarly used to predict the presence of LA thrombus. CONCLUSIONS: Both higher CHA2DS2VASC and CHADS2 scores were associated with LA/LAA thrombus in non-valvular AF patients prior to ablation. Although CHA2DS2VASC score and CHADS2 score had similar value to predict LA/LAA thrombus, CHA2DS2VASc score was better to identify low-risk patients for LA/LAA thrombus than CHADS2 score without anticoagulation. There will be a possibility of performing AF ablation or cardioversion in patients with a CHA2DS2VASC of 0 without TEE or anticoagulation therapy. The safety need to be verified by more multicentre randomized controlled clinical trails.

Nicorandil alleviated cardiac hypoxia/reoxygenation-induced cytotoxicity via upregulating ketone body metabolism and ACAT1 activity.

To study the effect of nicorandil pretreatment on ketone body metabolism and Acetyl-CoA acetyltransferase (ACAT1) activity in hypoxia/reoxygenation (H/R)-induced cardiomyocytes. In our study, we applied H9c2 cardiomyocytes cell line to evaluate the cardioprotective effects of nicorandil. We detected mitochondrial viability, cellular apoptosis, reactive oxygen species (ROS) production and calcium overloading in H9c2 cells that exposed to H/R-induced cytotoxicity. Then we evaluated whether nicorandil possibly regulated ketone body, mainly ß-hydroxybutyrate (BHB) and acetoacetate (ACAC), metabolism by regulating ACAT1 and Succinyl-CoA:3-keto-acid coenzyme A transferase 1 (OXCT1) protein and gene expressions. Nicorandil protected H9c2 cardiomyocytes against H/R-induced cytotoxicity dose-dependently by mitochondria-mediated anti-apoptosis pathway. Nicorandil significantly decreased cellular apoptotic rate and enhanced the ratio of Bcl-2/Bax expressions. Further, nicorandil decreased the production of ROS and alleviated calcium overloading in H/R-induced H9c2 cells. In crucial, nicorandil upregulated ACAT1 and OXCT1 protein expressions and either of their gene expressions, contributing to increased production of cellular BHB and ACAC. Nicorandil alleviated cardiomyocytes H/R-induced cytotoxicity through upregulating ACAT1/OXCT1 activity and ketone body metabolism, which might be a potential mechanism for emerging study of nicorandil and other KATP channel openers.

Corrigendum to: Nicorandil alleviated cardiac hypoxia/reoxygenation-induced cytotoxicity via upregulating ketone body metabolism and ACAT1 activity

The affiliation of the second author, Lei Sen Han, should be corrected.

Nicorandil alleviated cardiac hypoxia/reoxygenation-induced cytotoxicity via upregulating ketone body metabolism and ACAT1 activity

To study the effect of nicorandil pretreatment on ketone body metabolism and Acetyl-CoA acetyltransferase (ACAT1) activity in hypoxia/reoxygenation (H/R)-induced cardiomyocytes. In our study, we applied H9c2 cardiomyocytes cell line to evaluate the cardioprotective effects of nicorandil. We detected mitochondrial viability, cellular apoptosis, reactive oxygen species (ROS) production and calcium overloading in H9c2 cells that exposed to H/R-induced cytotoxicity. Then we evaluated whether nicorandil possibly regulated ketone body, mainly β-hydroxybutyrate (BHB) and acetoacetate (ACAC), metabolism by regulating ACAT1 and Succinyl-CoA:3-keto-acid coenzyme A transferase 1 (OXCT1) protein and gene expressions. Nicorandil protected H9c2 cardiomyocytes against H/R-induced cytotoxicity dose-dependently by mitochondria-mediated anti-apoptosis pathway. Nicorandil significantly decreased cellular apoptotic rate and enhanced the ratio of Bcl-2/Bax expressions. Further, nicorandil decreased the production of ROS and alleviated calcium overloading in H/R-induced H9c2 cells. In crucial, nicorandil upregulated ACAT1 and OXCT1 protein expressions and either of their gene expressions, contributing to increased production of cellular BHB and ACAC. Nicorandil alleviated cardiomyocytes H/R-induced cytotoxicity through upregulating ACAT1/OXCT1 activity and ketone body metabolism, which might be a potential mechanism for emerging study of nicorandil and other K(ATP) channel openers.

Spontaneous scar-based reentrant atrial flutter: Electrophysiologic characteristics and ablation outcome in a retrospective analysis.

BACKGROUND: The understanding of spontaneous scar-based reentrant atrial arrhythmia is limited. We aim to characterize the electrophysiologic and mapping features of spontaneous scar-based atrial flutter (AFL) and outcomes of catheter ablation. METHODS: Consecutive patients with a diagnosis of AFL who underwent catheter ablation from January 2012 to June 2015 were screened. Scars were detected in 12 patients and were included in this study. All had negative coronary angiography. These patients were divided into right AFL (seven patients) and left AFL groups (five patients) based on electrophysiologic mappings. RESULTS: Compared to patients with right AFL, the size of right atrium (RA) was smaller and left atrium (LA) was larger in the left AFL group. The proportion of the scar area was 11.1 ± 11.7 % in the RA AFL group and 7.8 ± 2.8 % in the LA AFL group. The difference was significant (P = 0.001). The acute success rates of ablation were 85.7% and 100%, respectively, in patients with right and left AFL (P = 0.304). During the follow-up, expansion of the scar area was noted in three patients with recurrent right AFL. No scar expansion was noted in one patient with recurrent left AFL. In addition, three patients with right AFL required permanent pacemaker implantation for sinus node dysfunction, and no one required pacemaker in patients with left AFL. CONCLUSIONS: Spontaneous scar could serve as substrate for AFL in RA or LA. Compared to left AFL, there was a higher rate of recurrence and pacemaker implantation in patients with right AFL.

A Simple Method to Differentiate Atrioventricular Node Reentrant Tachycardia from Orthodromic Reciprocating Tachycardia.

Discrimination between atrioventricular node reentry tachycardia (AVNRT) and orthodromic reciprocating tachycardia (ORT) during an electrophysiological study is sometimes challenging. This study aimed to investigate if the difference in the local VA (ventricle-atrium) interval during ventricular entrainment pacing and during tachycardia (DVA, defined as the shortest local VA interval of coronary sinus [CS] during entrainment minus the shortest local VA interval of CS during tachycardia) was different in patients with AVNRT and patients with ORT.Diagnoses of AVNRT or ORT through a concealed accessory pathway (AP) were made according to conventional electrophysiological criteria and ablation results. Entrainment by right ventricular (RV) pacing was performed in each patient before ablation and patients with successful entrainment were included in the study. The DVA was compared between patients with AVNRT and patients with ORT. The DVA in patients with AVNRT was significantly longer than that in patients with ORT (120 ± 20 versus 5.7 ± 9; P < 0.001). In each patient with AVNRT of slow-fast type, fast-slow type, and slow-slow type, the DVA was more than 48 ms. In each patient with ORT using a left free wall accessory pathway (AP), right free wall AP, and septal AP, the DVA was less than 20 ms.DVA was found to be a rapid, useful test in distinguishing patients with AVNRT from those with ORT.

Frequency spectra analysis suggests outcomes in patients with paroxysmal atrial fibrillation.

BACKGROUND AND AIM: The purpose of this study was to determine the role of dominant frequency (DF) and organised index (OI) in outcomes of pulmonary vein (PV) isolation for paroxysmal atrial fibrillation (AF). METHODS: OI and DF of electrograms in coronary vein (CS) during AF were obtained by frequency spectra analysis in 60 patients with paroxysmal AF who underwent PV isolation. Based on the results of 12 months follow up, 14 patients with recurrent AF were included in group 1 and 46 patients with sinus rhythm were included in group 2. RESULTS: In group 1, no spectral component was reduced by PV isolation. Spectral components were reduced by PV isolation in 23 patients in group 2. The changes of DF after PV isolation was significantly different between groups 1 and 2 (1.2 ± 1.2 vs. 2.4 ± 1.3, p = 0.01); the increment of OI after PV isolation in group 1 was significantly lower than in group 2 (9 ± 13% vs. 22 ± 17%, p = 0.02. CONCLUSIONS: A decrease in DF and an increase in OI after PV isolation may suggest a better clinical outcome.

Effect of fat pad ablation on the spatial and temporal stability of complex fractionated atrial electrogram in acetylcholine-induced atrial fibrillation.

OBJECTIVE: The objective of this study was to investigate the effect of selective fat pad ablation on the spatial and temporal stability of the complex fractionated atrial electrogram (CFAE) in acetylcholine (ACh)-induced atrial fibrillation (AF). METHODS AND RESULTS: ACh was applied to fat pads in 10 dogs. Effective refractory periods (ERPs) at 5 different sites, AF inducibility and AF duration were obtained before and after fat pad ablation. During the first two induced AFs, the number of sites with continuous CFAEs and the duration of continuous CFAEs at every site were measured before and after fat pad ablation. The average ERP was shortened by ACh application (138 14 vs 100 15 ms, P < 0.001) and increased after fat pad ablation (100 +/- 15 vs. 115 +/- 14 ms, P < 0.001). AF inducibility (76 +/- 9% vs. 4 +/- 6%, P < 0.001) and AF duration (56 +/- 11 vs. 187 +/- 56 s, P = 0.01) increased after ACh application compared to baseline; while fat pad ablation reduced AF inducibility (76% +/- 9% vs. 54% +/- 6%, P < 0.001) and AF duration (187 +/- 56 vs. 144% +/- 35 s, P = 0.015). The percentage of sites with continuous CFAE decreased after fat pad ablation compared with that before fat pad ablation (24% vs. 82%, P < 0.001). On average, fat pad ablation reduced the duration of continuous CFAEs (188 +/- 63 vs. 139 +/- 31 s, P < 0.001). CONCLUSION: Selective fat pad ablation can affect the spatial and temporal stability of CFAEs in ACh-induced atrial fibrillation in dogs.

Different properties of complex fractionated atrial electrograms during atrial fibrillation.

AIMS: The aim of the present study was to investigate various properties of complex fractionated atrial electrograms (CFAEs) in different models of atrial fibrillation. METHODS: Fifteen dogs were divided into three groups (five dogs/group): group 1 (pacing-induced atrial fibrillation group), group 2 (100 mM Ach-induced atrial fibrillation group), group 3 (500 mM Ach-induced atrial fibrillation group). Five sites from the left atrium in each dog were used as recording sites. Electric stimulations were used to induce atrial fibrillation. Effective refractory period (ERP) of each recording site and atrial fibrillation inducibility index were obtained at baseline and following sustained atrial tachypacing for 4 h (group 1) or acetylcholine (Ach) application (groups 2 and 3). During the first induced atrial fibrillation, recording sites with CFAEs were identified and domain frequency of CFAE was obtained. RESULTS: ERPs decreased significantly compared to baseline in all groups (P < 0.001). There was no significant difference in decrements of ERPs at each site after pacing in group 1 (P = 0.646); in groups 2 and 3, significant differences were found in decrements of ERPs following Ach application when each site was compared (P < 0.05). Atrial fibrillation inducibility index increased in all groups compared to baseline (P < 0.05). During the first induced atrial fibrillation, CFAEs were recorded at all sites. There was no significant difference of domain frequencies in group 1 when each site was compared (P = 0.509), but significant differences in domain frequencies were found in groups 2 and 3 when each site was compared (P < 0.05). CONCLUSION: We identified that various characteristics of CFAEs may exist in different experimental models of atrial fibrillation. This may indicate different mechanisms of CFAEs.

Electrophysiological characteristics of the Marshall potential in dogs.

BACKGROUND: The electrophysiological characteristics of the Marshall potential is important in ligament of Marshall (LOM) ablation. METHODS AND RESULTS: Marshall potential was recorded under sinus rhythm and left atrial appendage (LAA) pacing and in the first randomly selected 5 dogs (Group 1), LOM ablation was performed. Histological examination was performed in the remaining 10 dogs, which were subdivided according to the results (Groups 2, 3). During LAA pacing in Group 2, the AM interval was prolonged or shortened, whereas in Group 3 it was prolonged (125+/-9 vs 80+/-6 ms, P=0.043, when the pacing rate =350) (126+/-9 vs 80+/-6 ms, P=0.0442, when the pacing rate =450). The Marshall potential was separated from the atrial electrogram by LAA pacing in Groups 2 and 3. There was no significant difference in the AM interval during sinus rhythm and right atrial appendage pacing. CONCLUSIONS: Marshall potential has different forms on electrograms, including a prolonged AM interval, which presents with LAA pacing. This finding might be useful in LOM ablation.