Clinical analysis of left atrial appendage occlusion for stroke prevention in elderly patients with atrial fibrillation / 中华内科杂志

To evaluate the efficacy and safety of left atrial appendage occlusion (LAAO) in patients with atrial fibrillation (AF) over 75 years. A total of 82 patients with AF who underwent LAAO successfully in Beijing Anzhen Hospital from March 2014 to March 2019 were divided into two groups according to age: the elderly group (aged>75 years) and the young group (aged ≤75 years). Risk of perioperative complications and incidence of ischemic stroke and major bleeding during follow-up were retrospectively analyzed. The results showed that there were no significant differences in procedure-related ischemic stroke(0 vs.1.6%, P=0.768) and major bleeding (0 vs.1.6%, P=0.768) during perioperative period between the two groups. No complications as death or pericardial tamponade occurred in the two group. During a (25.9±15.9) months period of followed up, ischemic stroke event rate was 3.6/100 person-years in the elderly group and 4.9/100 person-years in the young group, respectively. Major bleeding event rate was 2.5/100 person-years in the elderly group and 0/100 person-years in the young group, respectively. Compared with the expected ones, the relative risk reduction (RRR) of stroke in the elderly group was more profound than that in the young group (32.0% vs. 25.0%), while the risk of major bleeding in the young group was significantly lower than that in the elderly group (RRR 100% vs. 56.9%). Therefore, LAAO might be suitable for stroke prevention in the elderly AF patients.

Single-cell atlas of a non-human primate reveals new pathogenic mechanisms of COVID-19

Stopping COVID-19 is a priority worldwide. Understanding which cell types are targeted by SARS-CoV-2 virus, whether interspecies differences exist, and how variations in cell state influence viral entry is fundamental for accelerating therapeutic and preventative approaches. In this endeavor, we profiled the transcriptome of nine tissues from a Macaca fascicularis monkey at single-cell resolution. The distribution of SARS-CoV-2 facilitators, ACE2 and TMRPSS2, in different cell subtypes showed substantial heterogeneity across lung, kidney, and liver. Through co-expression analysis, we identified immunomodulatory proteins such as IDO2 and ANPEP as potential SARS-CoV-2 targets responsible for immune cell exhaustion. Furthermore, single-cell chromatin accessibility analysis of the kidney unveiled a plausible link between IL6-mediated innate immune responses aiming to protect tissue and enhanced ACE2 expression that could promote viral entry. Our work constitutes a unique resource for understanding the physiology and pathophysiology of two phylogenetically close species, which might guide in the development of therapeutic approaches in humans. Bullet pointsO_LIWe generated a single-cell transcriptome atlas of 9 monkey tissues to study COVID-19. C_LIO_LIACE2+TMPRSS2+ epithelial cells of lung, kidney and liver are targets for SARS-CoV-2. C_LIO_LIACE2 correlation analysis shows IDO2 and ANPEP as potential therapeutic opportunities. C_LIO_LIWe unveil a link between IL6, STAT transcription factors and boosted SARS-CoV-2 entry. C_LI

Relationship between admission blood glucose and in-hospital adverse events of elderly patients with non-ST-segment elevation myocardial infarction combined with multi-organ dysfunction in emergency department / 中国综合临床

Objective To investigate the relationship between admission blood glucose and in-hospital adverse events of elderly patients with non-ST-segment elevation myocardial infarction(NSTEMI) combined with multi-organ dysfunction in emergency department,and to assess the prognostic value.Methods Fifty-one geriatric patients with NSTEMI combined with multi-organ dysfunction were selected and divided into the experimental group (26 cases) and control group (25 cases),depending on whether they had adverse events in hospital.After the propensity score matching was used to reduce confounding effects,the difference in admission blood glucose between the two groups was compared.According to the ROC curve,the predictive value of immediate admission blood glucose to the incidence of adverse events during hospitalization was detected.Results After propensity score matching,admission blood glucose of the experimental group ((10.35±4.06) mmol/L) was higher than that of the control group ((7.05±2.45) mmol/L),and this difference was statistically significant (t=2.869,P<0.01).The area under the ROC curve for adverse events during hospitalization was 0.758 (P<0.01),and it may reach the best prognostic value when we choose 8.025mmol/L as the critical value.Under this condition,the sensitivity was 0.765 and specificity was 0.765.Conclusion For geriatric patients with NSTEMI combined with multi-organ dysfunction in emergency department,admission blood glucose is a risk factor for in-hospital adverse event,and the risk is high when admission blood glucose is over 8.025mmol/L.