Safety and efficacy of minimal transcatheter aortic valve replacement: A systematic review and meta-analysis.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a preferred treatment for patients with highly critical aortic stenosis (AS), which is a difficult and complicated procedure, leaving a heavy economical burden on patients and national health insurance. Minimalist TAVR can simplify a part of the operation procedures, but the surgical efficacy and safety are still under debated. OBJECTIVES: Explore the effectiveness and safety of minimalist TAVR in the treatment of patients with aortic stenosis. METHODS: A systematic search of PubMed, Web of Science, and Embase databases was conducted for studies involving application of minimalist TAVR in patients with severe aortic stenosis, two researchers independently screened the literature, extracted data and Meta-analysis was performed using STATA 16.0 software. RESULTS: Nine studies, involving a total of 3,148 AS patients, were included. Minimalist TAVR has similar surgical success rates compared to standardized TAVR, intraoperative fluoroscopy time, dosage of contrast agent, and total operative time were superior to standard TAVR. Regarding surgical complications, the incidence of permanent pacemaker placement and moderate to severe paravalvular leakage were similar for both TAVR, the risk of major vascular complications and major bleeding events in the minimalist TAVR was significantly lower than the standard TAVR. The risk of overall death, stroke, and cardiovascular-related readmission within 30 days was similar in both procedures. CONCLUSION: Patients with severe aortic stenosis treated with minimalist TAVR have similar short-term efficacy as well as 30-day clinical outcomes to standard TAVR, while minimalist TAVR could reduce the risk of major vascular complications and bleeding complications.

The impact of early in-hospital use of PCSK9 inhibitors on cardiovascular outcomes in acute coronary syndrome patients: A systematic review and meta-analysis.

OBJECTIVE: To explore the safety and assess the cardiovascular impact of early in-hospital administration of PCSK9 inhibitors in patients with acute coronary syndrome (ACS). METHODS: A systematic search of PubMed, Web of Science, and Embase databases was conducted for studies involving the use of PCSK9 inhibitors in ACS patients from inception to October 2023. Two independent researchers screened the literature, extracted data, and assessed the risk of bias in the included studies. Meta-analysis was performed using STATA 16.0 software. RESULTS: Nine studies, encompassing a total of 2896 ACS patients, were included in the analysis. When compared to statin monotherapy, early administration of PCSK9 inhibitors during hospitalization for ACS proved effective in reducing the incidence of major adverse cardiovascular events (MACEs). This encompassed a decrease in coronary revascularization [Relative Risk (RR) = 0.78, 95% CI (0.62, 0.98), P < 0.05], recurrent ACS [RR = 0.62, 95% CI (0.42, 0.94), P < 0.05], readmissions due to unstable angina [RR = 0.71, 95% CI (0.59, 0.85), P < 0.01], and strokes [RR = 0.31, 95% CI (0.09, 1.04), P = 0.058]. There was no significant difference in the incidence of death between the two groups.The use of PCSK9 inhibitors notably hastened the reduction of LDL-C, TG, and Non HDL-C levels in the short term. Additionally, it increased HDL-C levels and the number of individuals meeting LDL-C compliance criteria. Importantly, the risk of adverse drug events, such as ALT increase >3xULN, allergies, and musculoskeletal pain, did not significantly elevate with PCSK9 inhibitor use. CONCLUSION: The early administration of PCSK9 inhibitors has been found to safely and effectively lower diverse lipid levels in patients with ACS. This reduction is associated with a noteworthy decrease in MACEs, encompassing revascularization, recurrent ACS, and hospital readmissions.

Advances in the study of ω-3 PUFA in heart failure / 中国临床药理学与治疗学

Free fatty acids, as important energy metabolism substrates for the heart, play an important role in various cardiovascular diseases; ω-3 PUFA, as an important branch of free fatty acids, has been confirmed by more and more researches to be closely related to cardiovascular diseases. Heart failure, as a common cardiovascular problem, seriously affects people's quality of life. Studies have shown that ω-3 PUFA plays a significant role in the development of heart failure. In this paper, we try to review the metabolism, pathogenesis and therapeutic significance of ω-3 PUFA in heart failure.

Construction of a Nomogram Prediction Model for Prognosis in Patients with Large Artery Occlusion-Acute Ischemic Stroke.

BACKGROUND: Patients with large artery occlusion-acute ischemic stroke (LAO-AIS) can experience adverse outcomes, such as brain herniation due to complications. This study aimed to construct a nomogram prediction model for prognosis in patients with LAO-AIS in order to maximize the benefits for clinical patients. METHODS: Retrospective analysis of 243 patients with LAO-AIS from January 2019 to January 2022 with medical history data and blood examination at admission. Univariate and multivariate analyses were conducted through binary logistic regression equation analysis, and a nomogram prediction model was constructed. RESULTS: Results of this study showed that hyperlipidemia (odds ratio [OR] = 2.849, 95% confidence interval [CI] = 1.100-7.375, P = 0.031), right cerebral infarction (OR = 2.144, 95% CI = 1.106-4.156, P = 0.024), D-Dimer>500 ng/mL (OR = 2.891, 95% CI = 1.398-5.980, P = 0.004), and neutrophil-lymphocyte ratio >7.8 (OR = 2.149, 95% CI = 1.093-4.225, P = 0.027) were independent risk factors for poor early prognosis in patients with LAO-AIS. In addition, hypertension (OR = 1.947, 95% CI = 1.114-3.405, P = 0.019), hyperlipidemia (OR = 2.594, 95% CI = 1.281-5.252, P = 0.008), smoking (OR = 2.414, 95% CI = 1.368-4.261, P = 0.002), D-dimer>500 ng/mL (OR = 3.170, 95% CI = 1.533-6.553, P = 0.002), and neutrophil-lymphocyte ratio >7.8 (OR = 2.144, 95% CI = 1.231-3.735, P = 0.007) were independent risk factors for poor long-term prognosis. The early prognosis nomogram receiver operating characteristic curve area under the curve value was 0.688 for the training set and 0.805 for the validation set, which was highly differentiated. The mean error was 0.025 for the training set calibration curve and 0.016 for the validation set calibration curve. Both the training and validation set decision curve analyses indicated that the clinical benefit of the nomogram was significant. The long-term prognosis nomogram receiver operating characteristic curve area under the curve values was 0.697 for the training set and 0.735 for the validation set, showing high differentiation. The mean error was 0.041 for the training set calibration curve and 0.021 for the validation set calibration curve. Both of the training and validation set decision curve analyses demonstrated a substantial clinical benefit of the nomogram. CONCLUSIONS: The nomogram prediction model based on admission history data and blood examination are easy-to-use tools that provide an accurate individualized prediction for patients with LAO-AIS and can assist in early clinical decisions and in obtaining an early prognosis.

Multidisciplinary diagnosis and treatment of acute myocardial infarction with cardiogenic shock caused by anomalous aortic origin of a coronary artery: a case report / 中国综合临床

Anomalous aortic origin of a coronary artery is a rare abnormal coronary artery development disease, which affects myocardial blood perfusion in the absence of significant coronary artery stenosis. Such patients have a high risk of sudden death, and their disease progresses rapidly, and their clinical manifestations are easily confused with myocardial diseases. We report a case of a 13-year-old young patient whose diagnosis was confirmed, the condition was stabilized at an early stage, and the abnormal coronary structure was corrected by coronary decapitation through a multidisciplinary combination of cardiology, cardiac surgery, ICU, and imaging. This article focuses on the diagnosis and treatment of these patients.

Role of ferroptosis in dorsal root gangions in neuropathic pain in rats / 中华麻醉学杂志

Objective:To evaluate the role of ferroptosis in the dorsal root gangions in neuropathic pain (NP) in rats.Methods:Thirty-two healthy male Sprague-Dawley rats, aged 6-8 weeks, weighing 180-220 g, were randomized into 4 groups ( n=8 each) using a random number table method: sham operation group (Sham group), NP group, NP+ solvent control group (NP+ Veh group), and NP+ liproxstatin-1 (Lip-1) group (NP+ Lip group). NP was induced by chronic constrictive injury (CCI) to sciatic nerve in anesthetized animals.In NP+ Lip group, liproxstatin-1 (diluted to 10 μg/μl in DMSO) 30 μl was intrathecally injected for 3 consecutive days after surgery.NP+ Veh group received intrathecal injection of DMSO 30 μl for 3 consecutive days after surgery.Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured at 3 days before surgery and on days 1, 3, 5, 7 and 10 after surgery.Rats were sacrificed after the end of pain threshold measurement on day 10 after surgery, and DRGs of the lumbar segment (L 3-5) on the left side were removed for determination of the levels of iron ion, reactive oxygen species (ROS), malondialdehyde (MDA), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD), expression of glutathione peroxidase 4 (GPX4) and acyl-CoA synthetase long-chain family member 4 (ACSL4) (by Western blot), and expression of ACSL4 in each nerve cells of DRGs (by immunofluorescence) and for microscopic examination of the ultrastructure of mitochondria in DRGs (by transmission electron microscopy). Results:Compared with Sham group, MWT was significantly decreased and TWL was shortened at T 2-6, levels of iron ions, ROS and MDA in DGRs were increased, activities of SOD and GSH-Px were decreased, ACSL4 expression was up-regulated, GPX4 expression was down-regulated, and ACSL4 expression in astrocytes and Schwann cells of DRGs was up-regulated in NP group ( P<0.05). Compared with NP group, MWT was significantly increased and TWL was prolonged at T 3-6, levels of iron ions, ROS and MDA in DGRs were decreased, activities of SOD and GSH-Px were increased, ACSL4 expression was down-regulated, GPX4 expression was up-regulated, and ACSL4 expression in astrocytes and Schwann cells of DRGs was down-regulated ( P<0.05), and no significant change was found in the parameters mentioned above in NP+ Veh group ( P>0.05). The results of electron microscopy showed that collapsed mitochondrial cristae and membrane rupture were found in astrocytes and Schwann cells of DRGs in NP group, and the number of collapsed mitochondrial cristae and membrane rupture was significantly decreased in NP + Lip group when compared with NP group. Conclusions:The ferroptosis in DRGs is involved in NP in rats.

Clinical study of effect of ezetimibe combined with statins on residual lipoprotein cholesterol and MACE events in patients undergoing emergency intervention with acute coronary syndrome / 中国临床药理学与治疗学

AIM: To investigate the effect of ezetimibe combined with statins on residual lipoprotein-cholesterol (RLP-C) levels and major cardiovascular adverse events (MACE) in patients with acute coronary syndrome (ACS) after emergency intervention (PCI). METHODS: A total of 90 hospitalized patients with ACS and undergoing emergency PCI were randomly divided into two groups: 48 patients in the control group received atorvastatin, and 42 patients in the study group were additionally treated with ezetimibe. RLP-C level before and after treatment was detected. The occurrence of MACE events and adverse drug events during the treatment were obtained through regular follow-up. RESULTS: Compared with the control group, the level of RLP-C in the study group was significantly decreased (P<0.05), the incidence of MACE were significantly decreased (P<0.05), and adverse drug events were not increased. CONCLUSION: The combination therapy of ezedemibe and statins can reduce RLP-C level and MACE in ACS patients undergoing emergency PCI with less adverse reactions, which is worthy of promotion and application.