In-Hospital Outcomes of Acute Myocardial Infarction With Essential Thrombocythemia and Polycythemia Vera: Insights From the National Inpatient Sample.

Background Acute myocardial infarction (AMI) with essential thrombocythemia (ET) or polycythemia vera is rare, and there are scarce real-world data on its management and impact on in-hospital outcomes. Methods and Results Dates of current retrospective cohort study were obtained from the US National Inpatient Sample from October 2015 to 2019 for hospitalizations with AMI. The primary outcome was in-hospital mortality, and the secondary outcome was major adverse cardiac or cerebrovascular events, stroke, and bleeding; major adverse cardiac or cerebrovascular event was defined by a composite of all-cause mortality, stroke, and cardiac complications. Of the 2 871 934 weighted AMI hospitalizations, 0.27% were with ET and 0.1% were with polycythemia vera. Before propensity matching, AMI hospitalization with ET was associated with increased risk of in-hospital mortality (7.1% versus 5.7%; odds ratio [OR], 1.14 [95% CI, 1.04-1.24]), major adverse cardiac or cerebrovascular events (12.6% versus 9%; OR, 1.36 [95% CI, 1.26-1.45]), bleeding (12.7% versus 5.8%; OR, 2.28 [95% CI, 2.13-2.44]), and stroke (3.1% versus 1.8%; OR, 1.66 [95% CI, 1.46-1.89]). Polycythemia vera was associated with an increased risk of in-hospital mortality (7.8% versus 5.7%; OR, 1.21 [95% CI, 1.04-1.39]) and major adverse cardiac or cerebrovascular events (12.0% versus 9%; OR, 1.18 [95% CI, 1.05-1.33]). After propensity matching, ET was associated with increased risk of bleeding (12.6% versus 6.1%; OR, 2.22 [95% CI, 1.70-2.90]), and AMI with polycythemia vera was not associated with worse in-hospital outcomes. Conclusions AMI hospitalization with ET is associated with high bleeding risk before and after propensity score matching, particularly for hospitalizations treated with percutaneous coronary intervention. The management of AMI requires a multidisciplinary and patient-centered approach to ensure safety and improve outcomes.

Multivessel vs. culprit vessel-only percutaneous coronary intervention in ST-segment elevation myocardial infarction with and without cardiogenic shock.

Background: Early revascularization of the culprit vessel is the most effective treatment for reducing the risk of mortality from acute STEMI with and without cardiogenic shock. However, the most recent trends and impact of multivessel percutaneous coronary intervention (PCI) during the index hospitalization on in-hospital outcomes are unknown. Methods: The National Inpatient Sample was queried from October 2015 to 2019 for hospitalizations with STEMI. The impact of multivessel PCI on in-hospital outcomes of patients with and without cardiogenic shock was evaluated. Results: Of 624,605 STEMI hospitalizations treated with PCI, 12.5% were complicated by cardiogenic shock. Among hospitalizations without cardiogenic shock, 15.7% were treated by multivessel PCI, which declined from 20.8% in 2015 to 13.9% in 2019 (P trend < 0.001). Multivessel and culprit-only PCI had similar rates of In-hospital mortality (2.4 vs. 2.3%, p = 0.027) and major adverse cardiac and cerebrovascular events (MACCE; 7.4 vs. 7.2%, p = 0.072). Among hospitalizations with cardiogenic shock, 22.1% were treated by multivessel PCI, which declined from 29.2% in 2015 to 19.4% in 2019 (P trend < 0.001). Multivessel PCI was associated with higher rates of in-hospital mortality (30.9 vs. 28.4%, p < 0.001) and MACCE (39.9 vs. 36.5%, p < 0.001) than culprit-only PCI. Conclusion: The frequency of multivessel PCI for STEMI with and without cardiogenic shock is declining. Multivessel PCI is associated with worse in-hospital outcomes for STEMI with cardiogenic shock but not for STEMI without cardiogenic shock.

Characteristics of OGTT and Correlation Between the Insulin to C-Peptide Molar Ratio, HOMA-IR, and Insulin Antibodies in T2DM Patients.

Purpose: The purpose of our study was to analyze the characteristics of OGTT and the correlation between the insulin to C-peptide molar ratio (ICPR), HOMA-IR and insulin antibodies (IAs) in T2DM patients. Patients and Methods: A total of 77 T2DM patients were included and divided into the IA+ group (25 patients) and IA- group (52 patients). The values of serum glucose, insulin, and C-peptide testing during 2-h OGTT were summarized comparatively, and ROC was made to analyze the predictive value of ICPR for IAs. Results: At each time point of OGTT, there was no significant difference in serum glucose and C-peptide changes (p>0.05). Serum insulin levels in positive patients were elevated or not at different time points of the OGTT but ICPR was significantly different (P<0.05) in the two groups. Spearman correlation coefficient analysis showed that the presence of insulin antibodies was correlated with ICPR, but not with HOMA-IR, and ICPR-2h had a better prediction capacity (AUC=0.735, the optimal cutoff-point=0.11, Se=0.760, Sp=0.635). Conclusion: T2DM patients with IAs showed no difference in serum glucose and serum C-peptide changes, but elevated or not insulin levels on the OGTTs, compared with negative patients. ICPR-2h can be a preliminary diagnostic index to timely predict IAs in T2DM patients.

Impact of the PEAR1 polymorphism on clinical outcomes in Chinese patients receiving dual antiplatelet therapy after percutaneous coronary intervention.

Background: Patients might still experience major adverse cardiovascular events even with dual antiplatelet therapy after percutaneous coronary intervention. Our study aimed to explore the impact of gene polymorphism on clinical outcomes in one-year follow-up. Methods: A total of 171 patients treated with dual antiplatelet therapy after percutaneous coronary intervention from April to December 2020 in the first hospital of Jilin University enrolled in this study. Results: PEAR1 genetic polymorphisms was associated with the arachidonic acid (AA) and adenosine diphosphate (ADP) platelet aggregation. Hyperglycemia was associated with the rate of major adverse cardiovascular events. PEAR1 GA+AA genetic genetic polymorphisms is associated with hyperglycemia. Conclusion:PEAR1 GG is a risk factor for AA and ADP platelet aggregation. Hyperglycemia can effect the one-year outcome. PEAR1 GA+AA genetic polymorphisms are associated with hyperglycemia.

Functional comparison of different jailed balloon techniques in treating non-left main coronary bifurcation lesions.

BACKGROUND: There is a paucity of data comparing functional difference between active jailed balloon technique (A-JBT) and conventional jailed balloon technique (C-JBT) in treating non-left main coronary bifurcation lesions (CBLs). METHODS: In this retrospective cohort study, we consecutively enrolled 232 patients with non-left main CBLs who underwent percutaneous coronary intervention (PCI) using JBTs between January 2018 and March 2019. Among them, 191 patients entered the final analysis with 12-months angiographic follow-up. We stratified patients into A-JBT group (130 patients) and C-JBT group (61 patients). The functional analysis by Murray law-based quantitative flow ratio (µQFR) and Seattleanginaquestionnaire (SAQ) were performed to compare the two techniques. RESULTS: Compared with C-JBT group, A-JBT group observed a lower abrupt (0.8% vs. 11.1%, p = 0.002) and final SB occlusion (0 vs. 7.9%, p = 0.005). Meanwhile, A-JBT group had a significantly higher µQFR of side branch (SB) both post-PCI and 12-months follow-up (median [interquartile range (IQR)]: 0.91 (0.86-0.96) vs. 0.82 (0.69-0.92), p < 0.001; median [IQR]: 0.95 (0.89-0.98) vs. 0.85 (0.74-0.93), p < 0.001) than C-JBT group. Besides, A-JBT group gained a µQFR improvement at follow-up period compared with post-PCI data (median [IQR]: 0.95 [0.89-0.98] vs. 0.91[0.86-0.96] of SB, p < 0.001) and a higher SAQ scores at 12-months follow-up compared with C-JBT group (p < 0.001). CONCLUSIONS: Compared with C-JBT, A-JBT provided excellent SB protection during MV stenting and improved the SB functional blood flow as well as the angina relief even after 12 months.

Radiotherapy-induced isolated left main coronary artery disease presenting with cardiogenic shock: A case report.

RATIONALE: Mediastinal radiotherapy is a common practice for treating breast cancer and Hodgkin's lymphoma. Radiotherapy causes cardiovascular damage and has attracted increasing attention, particularly among Hodgkin's lymphoma patients, as they receive a higher dose of radiation. PATIENT CONCERNS: A 36-year-old woman with a past medical history of Hodgkin's lymphoma presented with persistent chest pain for 3 hours. She experienced exertional chest pain 1 month before when she was climbing stairs, which disappeared after a few minutes with rest, but recurred with a similar level of exertion. Three hours before admission to the emergency room, the chest pain persisted and was accompanied by diaphoresis and dyspnea. DIAGNOSIS: Cardiogenic shock caused by radiotherapy-induced left main coronary artery disease. INTERVENTIONS: Urgent angiography revealed left main coronary artery stenosis. Intravascular ultrasonography showed diffuse fibrous proliferation in the left main coronary artery. Hemodynamic instability was resolved after drug-eluting stent implantation. OUTCOMES: The patient was discharged uneventfully 5 days after the procedure, with a prescription for dual antiplatelet and statin therapy. She was asymptomatic with good exercise tolerance at the 3-month follow-up. CONCLUSION: Radiotherapy-induced isolated left main coronary artery disease is a rare complication of cancer radiotherapy and can occur years or decades after treatment. Fibrous proliferation is a characteristic pathologic change in the exposed coronary arteries.

Reasons for lesion uncrossability as assessed by intravascular ultrasound.

OBJECTIVES: The purpose of the current study was to use intravascular ultrasound (IVUS) to clarify anatomical and morphological lesion characteristics of uncrossable lesions. BACKGROUND: Uncrossable lesions are not always severely calcified. The prevalence of uncrossable lesions that are nonseverely calcified as well as other mechanisms for uncrossability has not been well clarified. METHODS: A total of 252 de novo uncrossable lesions in native coronary arteries that underwent either rotational or orbital atherectomy due to inability of any balloon to cross the lesion and 38 lesions with severe calcium in which IVUS crossed preatherectomy were included. Severe calcium is defined as maximum arc of calcium ≥270°. RESULTS: Severe calcification was absent in 16% of uncrossable lesions, 83% of which had a significant vessel bend. Compared with crossable lesions with severe calcium, uncrossable lesions with severe calcium more often had a bend in the vessel (71% vs. 21%, p < 0.001) and a longer length of continuous severe calcium (median length of calcium ≥270° 3.8 mm vs. 1.9 mm, p = 0.001). Other than severe calcium (especially long continuous calcium) or a bend in the vessel, anatomical factors associated with uncrossabilty were aorto-ostial lesion location and small vessels. CONCLUSIONS: Uncrossable lesions are not always severely calcified. The interaction of lesion morphology (continuous long and large arcs of calcium) and vessel geometry (bend in the vessel or ostial lesion location) affect lesion crossability.

Intravascular Ultrasound-Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions.

[Figure: see text].

Trend and Impact of Concomitant CABG and Multiple-Valve Procedure on In-hospital Outcomes of SAVR Patients.

Background: The trends of concomitant CABG and multiple-valve procedures and their impact on in-hospital outcomes in the context of transcatheter aortic valve replacement are unexplored. Methods: This was a retrospective cohort study using the administrative database of the U.S. national inpatient sample from 2012 to 2018 to identify patients who underwent SAVR with or without concomitant CABG and/or multiple-valve procedures. Results: During the study period, a total of 75,763 representing 378,815 patients underwent SAVR nationwide were identified, of whom 42,993 (55.1%) experienced isolated SAVR, 27,133 (34.8%) underwent concomitant CABG, 5,637 (7.2%) underwent multiple-valve procedures, and 2,298 (2.9%) underwent both concomitant CABG and multiple-valve procedures. The rate of multiple-valve procedures increased from 6.1% in 2012 to 9.2% in 2018 (P < 0.001 for trend). In-hospital mortality was 2.1, 3.9, 7.3, and 11.2% for isolated SAVR, SAVR with CABG, SAVR with multiple-valve procedures, and SAVR with CABG and multiple-valve procedures, respectively. After propensity matching, compared to isolated SAVR, the risk ratio for in-hospital mortality associated with concomitant CABG was 1.54 (CI 1.39-1.70). In multiple-valve procedures, it was 2.36 (CI 1.97-2.83), and in concomitant CABG and multiple-valve procedures, it was 2.92 (CI 2.29-3.73). Conclusions: The proportion of patients receiving multiple-valve procedures is increasing. While concomitant CABG moderately increased in-hospital mortality, multiple-valve procedures dramatically increased in-hospital mortality and complications, even after propensity score matching.

Blood pressure assessment with in-ear photoplethysmography.

Objective. In this study, we aimed to estimate blood pressure (BP) from in-ear photoplethysmography (PPG). This novel implementation provided an unobtrusive and steady way of recording PPG, whereas previous PPG measurements were mostly performed at the wrist, finger, or earlobe.Methods. The time between forward and reflected PPG waves was very short at the ear site. To minimize errors introduced by feature extraction, a multi-Gaussian decomposition of in-ear PPG was performed. Both hand-crafted and whole-based features were extracted and the best combination of features was selected using a backward-search wrapper method and evaluated by the Akaike information criteria. Hemodynamic parameters such as compliance and inertance were estimated from a four-element Windkessel (WK4) model, which was used to pre-classify PPG signals and generate different BP estimation algorithms. Calibration was done by using previous measurements from the same class. To validate this novel approach, 53 subjects were recruited for a one-month follow-up study, and 17 subjects were recruited for a two-month follow-up study. Calibrated systolic BP estimation accuracy was significantly improved with inertance-based pre-classification, while diastolic BP showed less improvement.Results. With proper feature selection, pre-classification and calibration, we have achieved a mean absolute error of 5.35 mmHg for SBP estimation, compared to 6.16 mmHg if no pre-classification was carried out. The performance did not deteriorate in two months, showing a decent BP trend-tracking ability.Conclusion. The study demonstrated the feasibility of in-ear PPG to reliably measure BP, which represents an important technological advancement in terms of unobtrusiveness and steadiness.

Correlation Between Immune Lymphoid Cells and Plasmacytoid Dendritic Cells in Human Colon Cancer.

Background: Innate lymphoid cells (ILCs), so far studied mostly in mouse models, are important tissue-resident innate immune cells that play important roles in the colorectal cancer microenvironment and maintain mucosal tissue homeostasis. Plasmacytoid dendritic cells (pDCs) present complexity in various tumor types and are correlated with poor prognosis. pDCs can promote HIV-1-induced group 3 ILC (ILC3) depletion through the CD95 pathway. However, the role of ILC3s in human colon cancer and their correlation with other immune cells, especially pDCs, remain unclear. Methods: We characterized ILCs and pDCs in the tumor microenvironment of 58 colon cancer patients by flow cytometry and selected three patients for RNA sequencing. Results: ILC3s were negatively correlated, and pDCs were positively correlated, with cancer pathological stage. There was a negative correlation between the numbers of ILC3s and pDCs in tumor tissues. RNA sequencing confirmed the correlations between ILC3s and pDCs and highlighted the potential function of many ILC- and pDC-associated differentially expressed genes in the regulation of tumor immunity. pDCs can induce apoptosis of ILC3s through the CD95 pathway in the tumor-like microenvironment. Conclusions: One of the interactions between ILC3s and pDCs is via the CD95 pathway, which may help explain the role of ILC3s in colon cancer.

Left coronary artery calcification patterns after coronary bypass graft surgery: An in-vivo optical coherence tomography study.

OBJECTIVES: We sought to evaluate the severity and patterns of calcifications in the left main coronary artery (LMCA) and proximal segments of left anterior descending coronary artery (LAD) and left circumflex artery (LCX) using optical coherence tomography (OCT) in patients with and without prior coronary artery bypass grafting (CABG). BACKGROUND: CABG may accelerate upstream calcium development. METHODS: OCT images (n = 76) of the LMCA bifurcation from either the LAD or LCX in 76 patients with at least one patent left coronary graft, on average 7.0 ± 5.6 years post-CABG, were compared with 148 OCT images in propensity-score-matched non-CABG controls. RESULTS: Minimum lumen areas in the LMCA, LAD, and LCX in post-CABG patients were smaller than non-CABG controls. Maximum calcium arc and thickness as well as calcium length were greater in the LMCA and LCX, but not in the LAD in post-CABG patients versus non-CABG controls. Calcium located at the carina of a bifurcation, calcified nodules (CN), thin intimal calcium, and lobulated calcium were more prevalent in post-CABG patients. After adjusting for multiple covariates, prior CABG was an independent predictor of calcification at the carina of a bifurcation (odds ratio [OR] 5.77 [95% confidence interval, CI: 1.5-21.6]), thin intimal calcium (4.7 [1.5-14.4]), and the presence of a CN (15.60 [3.2-76.2]). CONCLUSIONS: Prior CABG is associated with greater amount of calcium in the LMCA and the proximal LCX, as well as higher prevalence of atypical calcium patterns, including CN, thin or lobulated calcium, and calcifications located at the carina of a bifurcation, compared with non-CABG controls.

Temporal Trends and Outcomes of Percutaneous and Surgical Aortic Valve Replacement in Patients With Atrial Fibrillation.

Objectives: The aim of this study was to evaluate the temporal trends of transcatheter aortic valve replacement (TAVR) in severe aortic stenosis (AS) patients with atrial fibrillation (AF) and to compare the in-hospital outcomes between TAVR and surgical aortic valve replacement (SAVR) in patients with AF. Background: Data comparing TAVR to SAVR in severe AS patients with AF are lacking. Methods: National inpatient sample database in the United States from 2012 to 2016 were queried to identify hospitalizations for severe aortic stenosis patients with AF who underwent isolated aortic valve replacement. A propensity score-matched analysis was used to compare in-hospital outcomes for TAVR vs. SAVR for AS patients with AF. Results: The analysis included 278,455 hospitalizations, of which 124,910 (44.9%) were comorbid with AF. Before matching, TAVR had higher in-hospital mortality than SAVR (3.1 vs. 2.2%, p < 0.001); however, there was a declining trend during the study period (Ptrend < 0.001). After matching, TAVR and SAVR had similar in-hospital mortality (2.9 vs. 2.9%, p < 0.001) and stroke. TAVR was associated with lower rates of acute kidney injury, new dialysis, cardiac complications, acquired pneumonia, sepsis, mechanical ventilation, tracheostomy, non-routine discharge, and shorter length of stay; however, TAVR was associated with more pacemaker implantation and higher cost. Of the patients receiving TAVR, the presence of AF was associated with an increased rate of complications and increased medical resource usage compared to those without AF. Conclusions: In-hospital mortality and stroke for TAVR and SAVR in AF, AS are similar; however, the in-hospital mortality in TAVR AF is declining and associated with more favorable in-hospital outcomes.

Dynamic changes of innate lymphoid cells in acute ST-segment elevation myocardial infarction and its association with clinical outcomes.

An increasing body of evidence has implicated the innate immune system in the causation of acute ST-segment elevation myocardial infarction (STEMI). Innate lymphoid cells (ILCs) are newly identified members of the lymphoid lineage that are important effectors of innate immunity. The role of ILCs in STEMI has not been explored. We characterized the ILCs present in peripheral blood of 176 STEMI patients and 52 controls. Patients were followed up for up to 23 months. Flow cytometry showed that the proportion of total ILCs and ILC1s were significantly increased compared with controls; contrary to ILC1s, the proportion of ILC2s among total ILCs decreased significantly during the acute phase of STEMI. ILC1s percentage was an independent predictor of major adverse cardiovascular events (MACE). On multivariate Cox regression, the 3rd tertile of ILC1s was associated with a higher MACE rate compared with the 1st tertile (hazard ratio: 2.26; 95% confidence interval 1.56-3.27; P = 0.014). RNA-sequencing (RNA-Seq) revealed increased expressions of interferon-γ, tumor necrosis factor-α, vascular cell adhesion molecule 1 (VCAM1), and matrix metallopeptidase 9. Moreover, as active factors secreted by ILC1s, levels of interleukin (IL)-12 and IL-18 were significantly increased in STEMI patients. Increased ILC1s in patients with STEMI was associated with poor outcomes. Our findings suggest that ILC1s may play an important role in STEMI.

Robust blood pressure estimation from finger photoplethysmography using age-dependent linear models.

OBJECTIVE: This work aims to develop an efficient and robust age-dependent multiple linear regression (MLR) model to estimate blood pressure (BP) from a single-source photoplethysmography (PPG) and biometrics, which could be embedded in the microcontroller of pulse oximeters. APPROACH: Hemodynamic features were extracted from the PPG signal using its waveform, derivatives, and biometrics. Whole-based, feature-based, and fusion models were evaluated and compared for different age groups. Their performance was tested using 1086 subjects with a leave-one-subject-out cross-validation. The improvement by adding biometrics and the long-term calibration effect were investigated in detail. The relative importance of each feature was compared between different age groups and the implication was discussed. MAIN RESULTS: The fusion model achieved the best performance in subjects with well-defined PPG features, whereas the feature-based method was better suited for subjects with damped signals. Adding age significantly improved both systolic BP (SBP) and diastolic BP (DBP) estimation accuracy for older subjects (> 50 years old) with well-defined features, while it only improved diastolic BP accuracy for older subjects with damped signals. For younger subjects (≤ 50 years old), the contribution of age was very small. A simple subtraction of subject-specific calibration factors significantly reduced biometric-related errors, which also improved the linearity of BP estimation. The relative importance analysis of input features suggests that separate models are indeed necessary for different age groups with different signal qualities, especially for DBP estimation in older subjects. SIGNIFICANCE: This study shows a reasonable BP estimation accuracy with age-dependent MLR models, which may help to equip current pulse oximeters with additional functionalities.

Vaccination with CD47 deficient tumor cells elicits an antitumor immune response in mice.

Cancer cells are poorly immunogenic and have a wide range of mutations, which makes them unsuitable for use in vaccination treatment. Here, we show that elimination of CD47, a ligand for the myeloid cell inhibitory receptor SIRPα, from tumor cells by genetic deletion or antibody blocking, significantly improves the effectiveness of the immune response to tumour cells. In both solid and hematopoietic mouse tumor models, vaccination with tumor cells or tumor antigen-expressing cells, that lack CD47 or were pre-coated with anti-CD47 antibodies, achieved an antitumor immune response. The efficacy of this approach was synergistically enhanced when used in combination with anti-PD-1 antibodies. The induction of antitumor responses depends on SIRPα+CD11c+ DCs, which exhibit rapid expansion following introduction of CD47-deficient tumor cells. Our results indicate that CD47-deficient whole tumor cells can induce antitumor responses.

An Unobtrusive and Calibration-free Blood Pressure Estimation Method using Photoplethysmography and Biometrics.

We introduce a novel paradigm to unobtrusively and optically measure blood pressure (BP) without calibration. The algorithm combines photoplethysmography (PPG) waveform analysis and biometrics to estimate BP, and was evaluated in subjects with various age, height, weight and BP levels (n = 1249). In the young population (<50 years old) with low, medium and high systolic blood pressures (SBP, <120 mmHg; 120-139 mmHg; ≥140 mmHg), the fitting errors are 6.3 ± 7.2, -3.9 ± 7.2 and -20.2 ± 14.2 mmHg for SBP respectively; In the older population (>50 years old) with the same categories, the fitting errors are 12.8 ± 9.0, 0.5 ± 8.2 and -14.6 ± 11.5 mmHg for SBP respectively. A simple personalized calibration reduces fitting errors significantly (n = 147), and good peripheral perfusion helps to improve the fitting accuracy. In conclusion, PPG may be used to calculate BP without calibration in certain populations. When calibrated, it shows great potential to serially monitor BP fluctuation, which can bring tremendous economic and health benefits.

pDC Activation by TLR7/8 Ligand CL097 Compared to TLR7 Ligand IMQ or TLR9 Ligand CpG.

Plasmacytoid dendritic cells (pDCs) express high levels of the toll-like receptors (TLRs) TLR7 and TLR9. In response to TLR7 and TLR9 ligands, pDCs are primary producers of type I interferons. Our previous study demonstrated that pDCs activated by the TLR7 ligand imiquimod (IMQ) and the TLR9 ligand CpG A can kill breast cancer cells in vitro and inhibit tumor growth in vivo. Moreover, we observed a distinctive morphological, phenotypic change in pDCs after activation by IMQ and CpG A. However, the effect of other TLR7 and TLR9 ligands on pDCs remains less understood. In this study, we treat pDCs with the TLR7 ligand IMQ, TLR7/8 ligands (CL097 and CL075), and three TLR9 ligands (different types of CpGs). The size of pDCs increased significantly after activation by TLR7, or TLR7/8 ligands. TLR7, TLR7/8, and TLR9 ligands similarly modulated cytokine release, as well as protein expression of pDC markers, costimulatory molecules, and cytotoxic molecules. Interestingly, TLR7/8 ligands, especially CL097, induced stronger responses. These results are relevant to the further study of the role and mechanism of pDC-induced antitumor effects and may aid in the development of a new strategy for future tumor immunotherapy.

Nonobstructive coronary artery myocardial infarction complicated by heart failure, ventricular aneurysm, and incessant ventricular arrhythmia: A case report.

RATIONALE: Myocardial infarction with nonobstructive coronary artery (MINOCA) is one of the common causes of cardiac related death. While patients with MINOCA usually do not need coronary artery intervention treatments, the prognosis could be worsened if the condition is not appropriately managed. This report describes a case of MINOCA patient suffered with multiple complications. PATIENT CONCERNS: A 63-year-old female was admitted to the emergency department with acute onset of chest pain, electrocardiogram showed ST segment elevation in precordium leads. DIAGNOSIS: Emergency coronary artery angiogram no significant coronary artery stenosis being observed. The diagnosis of MINOCA was established. She subsequently developed ventricular thrombus, heart failure, and ventricular arrhythmia. INTERVENTIONS: The patient's ventricular tachycardia (VT) was refractory to different treatments. Due to the presence of a ventricular thrombus, epicardial ablation was performed but the VT recurred. The patient was then successfully treated with an implantable cardioverter defibrillator and surgical removal of the ventricular aneurysm. OUTCOMES: The patient was free of events during the 3-month follow-up period after the surgery. LESSONS: MINOCA can occur with multiple complications, and surgical removal of a ventricular aneurysm can successfully recover the cardiac geometry during contraction leading to an improvement of the left ventricular bump function, as well as the removal of the potentially pathological loci of the VT.

Hypercholesterolemia induces T cell expansion in humanized immune mice.

Emerging data suggest that hypercholesterolemia has stimulatory effects on adaptive immunity and that these effects can promote atherosclerosis and perhaps other inflammatory diseases. However, research in this area has relied primarily on inbred strains of mice whose adaptive immune system can differ substantially from that of humans. Moreover, the genetically induced hypercholesterolemia in these models typically results in plasma cholesterol levels that are much higher than those in most humans. To overcome these obstacles, we studied human immune system-reconstituted mice (hu-mice) rendered hypercholesterolemic by treatment with adeno-associated virus 8-proprotein convertase subtilisin/kexin type 9 (AAV8-PCSK9) and a high-fat/high-cholesterol Western-type diet (WD). These mice had a high percentage of human T cells and moderate hypercholesterolemia. Compared with hu-mice that had lower plasma cholesterol, the PCSK9-WD mice developed a T cell-mediated inflammatory response in the lung and liver. Human CD4+ and CD8+ T cells bearing an effector memory phenotype were significantly elevated in the blood, spleen, and lungs of PCSK9-WD hu-mice, whereas splenic and circulating regulatory T cells were reduced. These data show that moderately high plasma cholesterol can disrupt human T cell homeostasis in vivo. This process may not only exacerbate atherosclerosis, but also contribute to T cell-mediated inflammatory diseases in the hypercholesterolemia setting.