Procedural Efficiency, Efficacy, and Safety of High-Power, Short-Duration Radiofrequency Ablation Delivered by STSF Catheter for Paroxysmal Atrial Fibrillation.

Objectives: To investigate the procedural efficiency, efficacy, and safety of high-power, short-term radiofrequency ablation delivered by the SmartTouch Surround Flow (STSF) catheter for paroxysmal atrial fibrillation (AF). Methods: We retrospectively analyzed a total of 72 patients who were admitted with paroxysmal AF, and who underwent radiofrequency catheter ablation (RFCA) for the first time. Of these patients, 36 cases underwent low-power, long-duration (LPLD, (30-35 W/20-40 s) pulmonary vein isolation (PVI) delivered by an SmartTouch (ST) catheter (control group), and the other 36 cases underwent high-power, short-duration (HPSD, (45-50 W/10-20 s) PVI delivered by a STSF catheter (study group). The baseline data, duration of PVI, procedural time, fluoroscopy time, the rate of first-pass isolation, irrigation perfusion, eschar and steam pop occurrences, intraoperative complications, and the rate of stable sinus rhythm maintenance following a blanking period of three months were analyzed between the two groups. Results: The isolation time of bilateral PVI and procedural time in the study group were markedly less than in controls (p < 0.01). The rate of first-pass isolation in the study group was significantly higher than in the control group (95.8% vs. 84.7%, p = 0.023), while the fluid perfusion in the study group was approximately 20% less than that in the control group (767 ± 171 vs. 966 ± 227 ml, p < 0.001). We observed no severe complications in any patients. The rate of freedom from AF recurrences following a blanking period of three months showed a tendency to be higher than in controls (93.9% vs. 87.1%, p = 0.348). Conclusions: The HPSD strategy delivered by the STSF catheter was superior to conventional LPLD ablation through the ST catheter with respect to efficiency, acute procedural effectiveness, short-term safety, and the risk of heart failure in patients with paroxysmal AF.

A Magic Filter Filled with Waste Plastic Shavings, Loofah, and Iron Shavings for Wastewater Treatment.

Integrated sewage treatment equipment has been widely used, but the commonly used fillers for wastewater treatment are not suitable in rural areas due to their price and performance issues. In this study, an integrated magic filter filled with waste fillers was proposed and established for wastewater treatment. The filter was composed of functional modules and an equipment room, and the fillers in each module can be taken out separately and changed arbitrarily according to the needs of specific treatment conditions. The fillers used include waste plastic shavings, loofah, and waste iron shavings, generated during the processing of plastic, crop, and steel. At the same time, a 91 d experiment was performed for real wastewater treatment, and a satisfactory removal performance was obtained, with average removal rates of COD, TP, NH4+-N, TN, and SS being 83.3%, 89.6%, 93.8%, 74.7%, and 94.0%, respectively. Through microscope observation, a large number of microorganisms were attached to the surface of the fillers, which was conducive to the simultaneous removal of nitrogen and phosphorus. The micro-electrolysis of waste iron shavings can produce Fe2+ and Fe3+, which would combine with PO43- to form Fe3(PO4)2 and FePO4 precipitates, enhancing the removal of phosphorus. In addition, the filled fillers have an excellent physical filtering effect, which can reduce the effluent SS. The magic filter achieves both the recycling of wastes and the treatment of wastewater.

PCSK9 inhibitor recaticimab for hypercholesterolemia on stable statin dose: a randomized, double-blind, placebo-controlled phase 1b/2 study.

BACKGROUND: Recaticimab (SHR-1209, a humanized monoclonal antibody against PCSK9) showed robust LDL-C reduction in healthy volunteers. This study aimed to further assess the efficacy and safety of recaticimab in patients with hypercholesterolemia. METHODS: In this randomized, double-blind, placebo-controlled phase 1b/2 trial, patients receiving stable dose of atorvastatin with an LDL-C level of 2.6 mmol/L or higher were randomized in a ratio of 5:1 to subcutaneous injections of recaticimab or placebo at different doses and schedules. Patients were recruited in the order of 75 mg every 4 weeks (75Q4W), 150Q8W, 300Q12W, 150Q4W, 300Q8W, and 450Q12W. The primary endpoint was percentage change in LDL-C from the baseline to end of treatment (i.e., at week 16 for Q4W and Q8W schedule and at week 24 for Q12W schedule). RESULTS: A total of 91 patients were enrolled and received recaticimab and 19 received placebo. The dose of background atorvastatin in all 110 patients was 10 or 20 mg/day. The main baseline LDL-C ranged from 3.360 to 3.759 mmol/L. The least-squares mean percentage reductions in LDL-C from baseline to end of treatment relative to placebo for recaticimab groups at different doses and schedules ranged from -48.37 to -59.51%. No serious treatment-emergent adverse events (TEAEs) occurred. The most common TEAEs included upper respiratory tract infection, increased alanine aminotransferase, increased blood glucose, and increased gamma-glutamyltransferase. CONCLUSION: Recaticimab as add-on to moderate-intensity statin therapy significantly and substantially reduced the LDL-C level with an infrequent administration schedule (even given once every 12 weeks), compared with placebo. TRIAL REGISTRATION: ClinicalTrials.gov , number NCT03944109.

Changes in the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios before and after percutaneous coronary intervention and their impact on the prognosis of patients with acute coronary syndrome.

OBJECTIVES: This study aimed to prospectively observe the changes in the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) before and after percutaneous coronary intervention (PCI) and their impact on the prognosis of patients with acute coronary syndrome (ACS). METHODS: Blood samples from 205 patients with ACS were collected at admission and at 24h and 30 days post-PCI to observe changes in the complete blood count. The Cox multivariate regression model was used to analyze the factors influencing major adverse cardiac events (MACE) after PCI in patients with ACS. A receiver operating characteristic (ROC) curve was used to evaluate the predictive value of inflammation indicators for MACE after PCI. RESULTS: Following PCI, NLR and PLR first increased postoperatively and then decreased within 30 days after PCI. Cox multivariate regression analysis showed that NLR and PLR at 24h post-PCI and acute ST-segment elevation myocardial infarction were independent influencing factors for the incidence of MACE after PCI. The ROC curve analysis showed that the NLR at 24h post-PCI was a better predictor of the incidence of MACE. The NLR at 24h post-PCI was significantly correlated with the number and length of implanted stents and operation duration. CONCLUSIONS: After PCI, patients with ACS had an increased neutrophil proportion and NLR. The NLR at 24h post-PCI was a better predictor of the incidence of postoperative MACE.

Mechanical creep instability of nanocrystalline methane hydrates.

Mechanical creep behaviors of natural gas hydrates are of importance for understanding the mechanical instability of gas hydrate-bearing sediments on Earth. Limited by the experimental challenges, intrinsic creep mechanisms of nanocrystalline methane hydrates remain largely unknown yet at the molecular scale. Herein, using large-scale molecular dynamics simulations, mechanical creep behaviors of nanocrystalline methane hydrates are investigated. It is revealed that mechanical creep responses are greatly dictated by internal microstructures of crystalline grain size and external conditions of temperature and static stress. Interestingly, a long steady-state creep is observed in nanocrystalline methane hydrates, which can be described by a modified constitutive Bird-Dorn-Mukherjee model. Microstructural analysis shows that deformations of crystalline grains, grain boundary diffusion and grain boundary sliding collectively govern the mechanical creep behaviors of nanocrystalline methane hydrates. Furthermore, structural transformation also appears to be important in their mechanical creep behaviors. This study provides new insights into understanding the mechanical creep scenarios of gas hydrates.

Uric acid aggravates myocardial ischemia-reperfusion injury via ROS/NLRP3 pyroptosis pathway.

BACKGROUND: The NOD-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome activation-mediated pyroptosis pathway has been linked to myocardial ischemia-reperfusion (MI/R) injury. This study explored whether uric acid (UA) aggravates MI/R injury through NLRP3 inflammasome-mediated pyroptosis. METHODS: In vivo, a mouse MI/R model was established by ligating the left coronary artery, and a mouse hyperuricemia model was created by intraperitoneal injection of potassium oxonate (PO). Then, the myocardial infarction (MI) size; terminal deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL) immunofluorescence; and serum levels of lactate dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB), and UA, as well as the expression level of pyroptosis-related protein and caspase-3 in heart tissues, were measured. Separately, primary mouse cardiomyocytes were cultured in vitro to create a hypoxia/reoxygenation (H/R) model. We then compared cardiomyocytes viability, TUNEL immunofluorescence, and the levels of LDH, reactive oxygen species (ROS), and pyroptosis-related protein and caspase-3 in cardiomyocytes. RESULTS: In vivo, the MI area, levels of CK-MB and LDH, rate of cell death, and pyroptosis-related protein and the expression of caspase-3 were significantly higher in the MI/R group than in the sham group, and high UA levels worsened these changes. In vitro, cardiomyocytes viability was significantly downregulated, and the levels of ROS, LDH, pyroptosis-related protein, caspase-3, and the rate of cardiomyocyte death were significantly higher in the H/R + UA group compared with the HR group. Administration of an NLRP3 inflammasome inhibitor and ROS scavenger reversed these effects. CONCLUSION: UA aggravates MI/R-induced activation of the NLRP3 inflammatory cascade and pyroptosis by promoting ROS generation, while inflammasome inhibitors and ROS scavengers partly reverse the injury.

Changes in the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios before and after percutaneous coronary intervention and their impact on the prognosis of patients with acute coronary syndrome

OBJECTIVES: This study aimed to prospectively observe the changes in the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) before and after percutaneous coronary intervention (PCI) and their impact on the prognosis of patients with acute coronary syndrome (ACS). METHODS: Blood samples from 205 patients with ACS were collected at admission and at 24h and 30 days post-PCI to observe changes in the complete blood count. The Cox multivariate regression model was used to analyze the factors influencing major adverse cardiac events (MACE) after PCI in patients with ACS. A receiver operating characteristic (ROC) curve was used to evaluate the predictive value of inflammation indicators for MACE after PCI. RESULTS: Following PCI, NLR and PLR first increased postoperatively and then decreased within 30 days after PCI. Cox multivariate regression analysis showed that NLR and PLR at 24h post-PCI and acute ST-segment elevation myocardial infarction were independent influencing factors for the incidence of MACE after PCI. The ROC curve analysis showed that the NLR at 24h post-PCI was a better predictor of the incidence of MACE. The NLR at 24h post-PCI was significantly correlated with the number and length of implanted stents and operation duration. CONCLUSIONS: After PCI, patients with ACS had an increased neutrophil proportion and NLR. The NLR at 24h post-PCI was a better predictor of the incidence of postoperative MACE.

Effect of stress hyperglycaemia on monocyte chemoattractant protein-1 levels and the short-term prognosis of patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

The present study prospectively investigated the effect of blood glucose level at admission on monocyte chemoattractant protein-1 levels at different time points before and after primary percutaneous coronary intervention, and the postoperative 1-year prognosis of patients with acute ST-segment elevation myocardial infarction. The 146 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention were divided into three groups: Group 1, non-diabetic, non-hyperglycemic group; group 2, stress hyperglycemia group; and group 3, diabetic group. Serum monocyte chemoattractant protein-1 levels before and after percutaneous coronary intervention (PCI), and the incidence of major adverse cardiovascular events 1-year post PCI were observed. The increase in monocyte chemoattractant protein-1 levels 24 h after percutaneous coronary intervention, compared with those before percutaneous coronary intervention, was significantly correlated with the blood glucose level at admission. Furthermore, the 1-year postoperative major adverse cardiovascular events rates were significantly higher in groups 2 and 3 compared with group 1. Logistic regression analysis demonstrated that a high blood glucose level at admission, diabetes, and high preoperative monocyte chemoattractant protein-1 levels were risk factors for major adverse cardiovascular events 1-year post-percutaneous coronary intervention. Stress hyperglycemia and diabetes may contribute to high monocyte chemoattractant protein-1 levels and prolonged inflammation. These symptoms are associated with poor prognosis of acute ST-segment elevation myocardial infarction in patients undergoing primary percutaneous coronary intervention.

Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio are Associated with Lower Extremity Vascular Lesions in Chinese Patients with Type 2 Diabetes.

BACKGROUND: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are inflammatory markers used for prediction of chronic complications of diabetes. Lower extremity arterial disease (LEAD) is one of chronic complications of type 2 diabetes mellitus (T2DM). The correlation between NLR, PLR, and lower extremity vascular lesions was investigated in subjects with T2DM to determine the best predictive marker for LEAD. METHODS: Three hundred thirty-five patients with T2DM (199 males and 136 females; age 54.12 ± 14.07 years) were enrolled. Blood differential counts and anklebrachial index (ABI) were assessed. Patients were divided into the LEAD group (ABI ≤ 0.9, n = 236) and non-LEAD group (ABI > 0.9, n = 99), and NLR and PLR were compared between the two groups. The independent risk factors for LEAD were analyzed using a logistic regression model. Receiver operating characteristic (ROC) curve analysis was used to assess the optimal cutoff values of PLR and NLR for prediction of LEAD. RESULTS: NLR and PLR in the LEAD group were significantly increased compared to non-LEAD group patients. Univariate analyses identified that NLR was positively correlated with age, glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), and 2-hours postprandial glucose levels. PLR was positively correlated with age, duration of T2DM, HbA1c, TG, TC, and LDL, but negatively correlated with diastolic blood pressure and fasting C-peptide levels. Binary logistic regression analysis identified that age, total number of white blood cells, PLR, and TC were significant and independent factors of diabetic LEAD. Moreover, ROC curve analysis showed that NLR and PLR were both predictive markers of LEAD in diabetes, and that the area under the PLR curve was larger than NLR. CONCLUSIONS: NLR and PLR are positively correlated with LEAD in diabetes. PLR was superior to NLR as a predictor of LEAD in diabetes.

Association of coronary artery disease with toll-like receptor 4 genetic variants: A meta-analysis.

BACKGROUND: Toll-like receptor 4 (TLR4) plays an important role in the formation of coronary atherosclerotic plaque and the pathogenesis of coronary artery disease (CAD). OBJECTIVES: The aim of the study was to conduct a meta-analysis assessing the relationship between 2 common genetic variants in the TLR4 gene (rs4986790 and rs4986791) and susceptibility to CAD. MATERIAL AND METHODS: A systematic search of Web of Science, Embase, Scopus, PubMed, and Wanfang Med Online was undertaken. Case-control studies assessing the association of rs4986790 and rs4986791 with CAD risk were included. The odds ratio (OR) and 95% confidence interval (CI) were used as the metric of choice for the evaluation of risk. RESULTS: The literature search generated 427 studies, of which 14 met the inclusion criteria, for a total of 13,927 participants. Our meta-analysis revealed a significant association between rs4986791 and CAD risk in Asians using the dominant model (CT + TT vs CC: OR = 0.35, 95% CI = 0.21-0.56, p < 0.001), heterozygote contrast (CT vs CC: OR = 0.32, 95% CI = 0.19-0.57, p < 0.001) and allele contrast (T vs C: OR = 0.38, 95% CI = 0.25- 0.58, p < 0.001). No significant association between rs4986791 and CAD was observed among Caucasians. For rs4986790, the results provided no evidence of an association with CAD risk. CONCLUSIONS: Our analysis suggests that rs4986791 is negatively associated with CAD risk in Asians but not in Caucasians. No association between rs4986790 and CAD risk was found.

Methylophiopogonanone A suppresses ischemia/reperfusion-induced myocardial apoptosis in mice via activating PI3K/Akt/eNOS signaling pathway.

AIM: The dried tuber root of Ophiopogon japonicus has been used in the traditional Chinese medicine for treatment of myocardial ischemia and thrombosis. In this study we investigated the effects of methylophiopogonanone A (MO-A), a major homoisoflavonoid in Ophiopogon japonicus, on myocardial ischemia/reperfusion (I/R) injury. METHODS: Mice were pretreated with MO-A (10 mg·kg(-1)·d(-1), po) for 2 weeks and then subjected to transient occlusion of the left anterior descending coronary artery. Cardiac function was evaluated, and the infarct size and apoptosis index were assessed. The mechanisms underlying the cardio-protection of MO-A were analyzed in H9C2 rat cardiomyocytes subjected to hypoxia/reoxygenation (H/R). The cell viability and apoptosis were evaluated; apoptotic and relevant signaling proteins were analyzed. NO levels in the culture medium were assessed. RESULTS: In I/R mice, pretreatment with MO-A significantly reduced the infarct size (by 60.7%) and myocardial apoptosis (by 56.8%), and improved cardiac function. In H9C2 cells subjected to H/R, pretreatment with MO-A (10 µmol/L) significantly decreased apoptosis and cleaved caspase-3 expression, elevated the Bcl-2/Bax ratio and restored NO production. Furthermore, pretreatment with MO-A markedly increased the activation of PI3K/Akt/eNOS pathway in H9C2 cells subjected to H/R, and the protective effects of MO-A were abolished in the presence of the PI3K inhibitor wortmannin (100 nmol/L). CONCLUSION: MO-A attenuates I/R-induced myocardial apoptosis in mice via activating the PI3K/Akt/eNOS signaling pathway.