Real-world performance of indobufen versus aspirin after percutaneous coronary intervention: insights from the ASPIRATION registry.

BACKGROUND: Indobufen is widely used in patients with aspirin intolerance in East Asia. The OPTION trial launched by our cardiac center examined the performance of indobufen based dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). However, the vast majority of patients with acute coronary syndrome (ACS) and aspirin intolerance were excluded. We aimed to explore this question in a real-world population. METHODS: Patients enrolled in the ASPIRATION registry were grouped according to the DAPT strategy that they received after PCI. The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE) and Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding. Propensity score matching (PSM) was adopted for confounder adjustment. RESULTS: A total of 7135 patients were reviewed. After one-year follow-up, the indobufen group was associated with the same risk of MACCE versus the aspirin group after PSM (6.5% vs. 6.5%, hazard ratio [HR] = 0.99, 95% confidence interval [CI] = 0.65 to 1.52, P = 0.978). However, BARC type 2, 3, or 5 bleeding was significantly reduced (3.0% vs. 11.9%, HR = 0.24, 95% CI = 0.15 to 0.40, P < 0.001). These results were generally consistent across different subgroups including aspirin intolerance, except that indobufen appeared to increase the risk of MACCE in patients with ACS. CONCLUSIONS: Indobufen shared the same risk of MACCE but a lower risk of bleeding after PCI versus aspirin from a real-world perspective. Due to the observational nature of the current analysis, future studies are still warranted to further evaluate the efficacy of indobufen based DAPT, especially in patients with ACS. TRIAL REGISTRATION: Chinese Clinical Trial Register ( https://www.chictr.org.cn ); Number: ChiCTR2300067274.

A case of repeated in-stent restenosis of coronary artery as a primary manifestation of seronegative antiphospholipid antibody syndrome.

BACKGROUND: Antiphospholipid antibody syndrome (APS) is a multisystemic autoimmune disorder which affects many organs or systems; however, coronary artery is relatively less frequently involved. CASE PRESENTATION: A 65-year-old female with effort chest pain was hospitalized for unstable angina in Janurary, 2015. Coronary angiography revealed sub-total occlusion of proximal left anterior descending (LAD) coronary artery, where a drug-eluting stent was successfully deployed. The patient experienced multiple in-stent stenosis at LAD coronary artery and coronary artery bypass graft (CABG) surgery was advised. Subsequently, severe stenosis of left circumflex (LCX) coronary artery emerged, and the patient suffered persistent in-stent restenosis. Eventually, the patient was diagnosed with seronegative antiphospholipid antibody syndrome and salvaged by immunosuppressants. CONCLUSIONS: Repeated in-stent restenosis could be a primary manifestation of seronegative antiphospholipid antibody syndrome, and suppression of autoimmune activity and inflammation other than purely coronary revascularization might be a better option.

Sex-related association of modifiable risk factors with hypertension: A national cross-sectional study of NHANES 2007-2018.

OBJECTIVE: Sex difference is commonly observed in hypertension. We aimed to assess sex differences in the associations of modifiable lifestyle and metabolic risk factors with risk of hypertension. DESIGN: National cross-sectional population study. SETTING: Data from the 2007 to 2018 National Health and Nutrition Examination Survey. PARTICIPANTS: 7087 adults aged ≥30 years without a prior history of hypertension. PRIMARY AND SECONDARY OUTCOME MEASURES: Odds ratios and population attributable fraction (PAF) of hypertension associated with 10 modifiable risk factors: five lifestyle risk factors (current smoking, excess alcohol intake, poor diet, physical inactivity, and unhealthy sleep), and five metabolic risk factors (obesity, diabetes, dyslipidaemia, hyperuricemia, and chronic kidney disease) in women versus men. RESULTS: Compared with women, men had 84% increased risk of prevalence of hypertension. The sex difference in risk for hypertension is more evident in those aged <60 years (p for interaction <.001). For those aged <60 years the combination of lifestyle risk factors accounted for a PAF of 27.2% in men and 48.8% in women, and the combination of metabolic risk factors accounted for a PAF similarly in men (37.4%) and women (38.2%). For those aged ≥60 years, the PAF of lifestyle risk factors was similar between men and women and the metabolic risk factors accounted for a greater proportion in women (33.0% vs. 14.5% in men). CONCLUSIONS: Sex differences may exist in the relation and attribution of lifestyle and metabolic risk factors to hypertension, which may have implications for implementing sex-specific strategies to prevent hypertension.

A clinical strategy to improve the diagnostic performance of 3T non-contrast coronary MRA and noninvasively evaluate coronary distensibility: combination of diastole and systole imaging.

BACKGROUND: The clinical application of coronary MR angiography (MRA) combining diastole and systole imaging has never been described comprehensively in coronary artery disease (CAD) patients. We aimed to design an optimal non-contrast coronary MRA scan protocol combining diastolic and systolic imaging and to (1) evaluate its diagnostic performance for detecting significant coronary stenosis; (2) evaluate the feasibility of this protocol to noninvasively measure the coronary distensibility index (CDI). METHODS: From June 2021 to May 2022, 33 healthy volunteers and 91 suspected CAD patients scheduled for X-ray coronary angiography (CAG) were prospectively enrolled. 3T non-contrast water-fat coronary MRA was carried out twice at diastole and systole. Significant coronary stenosis was defined as a luminal diameter reduction of ≥ 50% using CAG as the reference and was evaluated as follows: (1) by coronary MRA in diastole alone; (2) by coronary MRA in systole alone; (3) by combined coronary MRA in diastole and systole. According to CAG, the patients were divided into significant CAD patients and non-significant CAD patients. The difference in CDI among participants was evaluated. RESULTS: Combined coronary MRA was completed in 31 volunteers and 76 patients. The per-patient sensitivity, specificity, and accuracy of combined coronary MRA were 97.5%, 83.3%, and 90.8%, respectively. Compared with single diastolic mode, combined coronary MRA showed equally high sensitivity but improved specificity on a per-patient basis (83.3% vs. 63.9%, adjusted P = 0.013). The CDI tested by coronary MRA decreased incrementally from healthy volunteers to non-significant and significant CAD patients. CONCLUSION: Compared with single-phase mode, 3 T non-contrast combined coronary MRA significantly improved specificity and may have potential to be a simple noninvasive method to measure CDI.

Exploring indicators of success in chronic total occlusion percutaneous coronary intervention with Stingray system-based antegrade dissection re-entry: Insights from retrospective analysis.

BACKGROUND: The predictors of success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) through antegrade dissection and re-entry (ADR) using the Stingray system (Stingray ADR) remain elusive, mainly owing to the lack of consecutive angiographic and procedural records of patients. OBJECTIVES: This study aimed to identify indicators that can determine the success of CTO PCI performed using the Stingray ADR technique. METHODS: The clinical data of 115 patients who underwent CTO PCI through Stingray ADR at the same cardiac center were retrospectively and consecutively collected. Multivariate logistic regression analysis was performed to investigate the indicators of the success of ADR attempts. RESULTS: The technical success rate of Stingray ADR in CTO PCI was 72.2%. The overall technical success rate of CTO recanalization was 78.3% in all CTO PCIs having used Stingray Low Profile balloon. Vessel calcification (odds ratio [OR]: 4.03; 95% confidence interval [CI]: 1.49-11.88; p = 0.008), and retrograde puncture indicator (OR: 4.89; 95% CI: 1.51-17.11; p = 0.009) were identified as independent positive predictors. Blunt/no stump proximal to the occlusion segment (OR: 0.22; 95% CI: 0.06-0.64; p = 0.009), decision time before Stingray ADR (per 1 h increase) (OR: 0.54; 95% CI: 0.31-0.92; p = 0.026), operation duration of Stingray ADR (per 10 min increase) (OR: 0.62; 95% CI: 0.40-0.94; p = 0.028), and puncture site at the intraplaque region (OR: 0.24; 95% CI: 0.06-0.84; p = 0.026) were identified as the four negative independent predictors. CONCLUSIONS: This study revealed independent predictors of the success of CTO PCI performed using the Stingray ADR technique. As for CTO characteristics, the presence of calcification in the CTO segment and a tapered stump proximal to the lesion site can facilitate successful Stingray ADR. As for the procedures, the success rate of Stingray ADR can be improved by initiating the technique decisively and promptly, operating the system quickly and accurately and creating a puncture in the distal cap region of CTO under retrograde guidance.

Numerical study on the performance of mixed flow blood pump with superhydrophobic surface.

To meet the clinical status of the wide application of percutaneous mechanical circulatory support, this paper selects the mixed flow blood pump applied with superhydrophobic surface as the research object. The Navier slip model was used to simulate the slip characteristics of superhydrophobic surface, and the effects of the blade wrap angle and the superhydrophobic surface on the performance of the mixed flow blood pump are studied by numerical simulation. The results show that (1) considering the head, hydraulic efficiency, and hemolysis index of the blood pump, the optimal value of the blade wrap angle of the mixed flow blood pump in this paper is 60°. (2) The hydraulic efficiency of the blood pump with superhydrophobic surface is improved, and the maximum growth rate is about 13.9%; superhydrophobic surface can reduce the hemolysis index of blood pump under various working conditions, and the maximum reduction rate of hemolysis index of blood pump is 22.9%. (3) The variation trends of blood pump head, hydraulic efficiency, and hemolysis index with the increased rotating speed before and after setting superhydrophobic slip boundary conditions are the same as their original variation trends.

A Novel Parallel Wire-based Antegrade Dissection Re-entry Technique for Failed Retrograde Attempt of Coronary Chronic Total Occlusions with Risk Nomogram Analysis.

BACKGROUND: Rapid development in coronary chronic total occlusion (CTO) interventional techniques and devices have achieved a greater success rate with favorable outcomes. Antegrade dissection re-entry (ADR) technique is an important CTO crossing strategy and a desirable approach for long CTOs with good distal landing zone. However, unsuccessful procedures in contemporary CTO-percutaneous coronary intervention (PCI) remain, especially in lesions with non-interventional collaterals. METHOD: Based on a single center experience, a hybrid interventional algorithm, parallel wire-based ADR (PW-ADR) combines the advantages of parallel wire technique (PWT) and device-based ADR to target CTO lesions with failed retrograde approach. A retrospective analysis of patients who underwent PW-ADR was performed. A risk nomogram was created to identify patients at high risk for technical failure. RESULTS: A total of 57 patients treated with PW-ADR were ultimately included in the present study. A total of 46 (80.7%) cases achieved technical success and procedural success, with low incidence of in-hospital complications or 1-year major adverse cardiac events (MACE). The risk nomogram identified 3 predictor variables associated with technical failure of PW-ADR, including tortuous vessel, J-CTO score, and times of antegrade coronary angiography (CAG) during ADR, with promising accuracy (AUROC 0.947). CONCLUSION: The novel hybrid CTO-PCI algorithm, PW-ADR, provided an alternative interventional approach for complex CTO lesions with a promising success rate. The risk nomogram served as a prompter for high-risk cases, which may warrant a change in treatment strategy.

The present study reported a new hybrid-PCI strategy with a promising success rate for the treatment of CTO from a single center experience, over last 5 years. A retrospective analysis of patients who underwent PW-ADR was performed. A risk nomogram was created to identify patients at high risk for technical failure. 80.7% of patients treated with PW-ADR were achieved technical success and procedural success, with low incidence of in-hospital complications or 1-year MACE in the present study. A total of 3 predictor variables were identified to be associated with technical failure of PW-ADR, including tortuous vessel, J-CTO score, and times of antegrade CAG during ADR. This prediction tool may allow early identification of more complex and difficult CTO cases that require a timely switch in strategic approach or termination of the procedure to avoid unnecessary surgical risk.

Long-term clinical outcomes of drug-coated balloon for the management of chronic total occlusions.

OBJECTIVES: This study aims to compare the clinical outcomes of patients with de novo chronic total occlusion (CTO) lesions treated by hybrid strategy and drug-coated balloons (DCB)-only strategy. BACKGROUNDS: DCBs have been used as an alternative to or in combination with drug-eluting stents in CTO lesions. However, the clinical impact of DCB treatment on CTO lesion remains uncertain. METHODS: We retrospectively enrolled 154 patients with de novo CTO lesions treated by DCB, including 57 cases in hybrid group and 97 cases in DCB-only group. RESULTS: The lesions in hybrid group were more complicated than those in DCB-only group as shown by higher J-CTO score, and therefore higher percentage of retrograde approach, more IVUS guidance, more CTO guidewires, and longer procedural time were demonstrated. Although the percentage of non-flow-limiting dissection and residual stenosis of more than 30% were lower in hybrid group, TIMI flow grade, satisfactory and acceptable recanalization rate were not significantly different between two groups. During a median follow-up was 470 days, the incidence of target lesion revascularization (TLR), myocardial infarction and cardiac death was 11.0%, 1.3% and 1.9%, respectively. The long-term TLR-free survival was comparable between hybrid and DCB-only groups. By multivariate analysis, DCB length and age were predictors of TLR. CONCLUSION: DCB treatment appears effective and safe in selected de novo CTO lesions during long-term follow up. The recanalization results and long-term outcomes are comparable between hybrid and DCB-only group despite more complicated lesions in hybrid group.

Retrograde Approach via Ipsilateral Septal Collateral Channel in Percutaneous Coronary Intervention for Coronary Chronic Total Occlusion: A Single-Center Experience.

Background: The septal collateral channel (CC) is the preferred channel in retrograde percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). However, reports on the utilization of the ipsilateral septal CC are limited. Objective: To evaluate the feasibility and safety of the ipsilateral septal CC in retrograde CTO PCI. Methods: Twenty-five patients with successful wire CC tracking via the ipsilateral septal CC in retrograde CTO PCI were retrospectively analyzed. All procedures were performed by experienced CTO operators. Procedures were divided into the left descending coronary artery (LAD)-septal-LAD group and the LAD-septal-left circumflex coronary artery (LCX) group. Procedural complications and in-hospital outcomes were ascertained. Results: Both groups were similar with respect to risk factors and angiographic characteristics of the CTO, except for the collateral tortuosity (86.7% vs 20%, p=0.002). The success rate of microcatheter CC tracking was 96%. Both technical success and procedural success rates were 92%. Procedural complications were found in one case (septal perforation, 4%), which happened in the LAD-septal-LAD group (p=0.250). One postoperative adverse event (Q-wave myocardial infarction, 4%) was observed before discharge. Conclusion: The retrograde approach via the ipsilateral septal CC was feasible, with high success rates and acceptable complications, in the hands of experienced operators.

Benefits of biological nitrification inhibition of Leymus chinensis under alkaline stress: the regulatory function of ammonium-N exceeds its nutritional function.

Introduction: The production of root exudates with biological nitrification inhibition (BNI) effects is a strategy adopted by ammonium-N (NH4+-N) tolerant plant species that occur in N-limited environments. Most knowledge on BNI comes from plant species that occur in acidic soils. Methods: Here, combining field sampling and laboratory culture, we assessed the BNI-capacity of Leymus chinensis, a dominant grass species in alkaline grasslands in eastern Asia, and explored why L. chinensis has BNI ability. Results and discussion: The results showed that L. chinensis has strong BNI-capacity. At a concentration of 1 mg mL-1, L. chinensis' root exudates inhibited nitrification in soils influenced by Puccinellia tenuiflora by 72.44%, while DCD only inhibited it by 68.29%. The nitrification potential of the soil of L. chinensis community was only 53% of the P. tenuiflora or 41% of the Suaeda salsa community. We also showed that the supply of NH4+-N driven by L. chinensis' BNI can meet its requirements . In addition, NH4+-N can enhance plant adaptation to alkaline stress by regulating pH, and in turn, the uptake of nitrate-N (NO3--N). We further demonstrated that the regulatory function of NH4+-N is greater than its nutritional function in alkaline environment. The results offer novel insights into how L. chinensis adapts to high pH and nutrient deficiency stress by secreting BNIs, and reveal, for the first time, differences in the functional roles of NH4+-N and NO3--N in growth and adaptation under alkaline conditions in a grass species.

TNC Accelerates Hypoxia-Induced Cardiac Injury in a METTL3-Dependent Manner.

Cardiac fibrosis and cardiomyocyte apoptosis are reparative processes after myocardial infarction (MI), which results in cardiac remodeling and heart failure at last. Tenascin-C (TNC) consists of four distinct domains, which is a large multimodular glycoprotein of the extracellular matrix. It is also a key regulator of proliferation and apoptosis in cardiomyocytes. As a significant m6A regulator, METTL3 binds m6A sites in mRNA to control its degradation, maturation, stabilization, and translation. Whether METTL3 regulates the occurrence and development of myocardial infarction through the m6A modification of TNC mRNA deserves our study. Here, we have demonstrated that overexpression of METTL3 aggravated cardiac dysfunction and cardiac fibrosis after 4 weeks after MI. Moreover, we also demonstrated that TNC resulted in cardiac fibrosis and cardiomyocyte apoptosis after MI. Mechanistically, METTL3 led to enhanced m6A levels of TNC mRNA and promoted TNC mRNA stability. Then, we mutated one m6A site "A" to "T", and the binding ability of METTL3 was reduced. In conclusion, METTL3 is involved in cardiac fibrosis and cardiomyocyte apoptosis by increasing m6A levels of TNC mRNA and may be a promising target for the therapy of cardiac fibrosis after MI.

Device-based antegrade dissection re-entry versus parallel wire techniques for the percutaneous revascularization of coronary chronic total occlusions.

BACKGROUND: Device-based antegrade dissection re-entry (ADR) and parallel wire technique (PWT) are two important techniques in the antegrade approach in percutaneous coronary intervention (PCI) of chronic total occlusion (CTO). The study is aimed to compare the procedural and mid-term outcomes between device-based ADR using the CrossBoss/Stingray system and PWT in CTO PCI. METHODS: Data was retrospectively collected from consecutive patients who underwent CTO PCI using device-based ADR or PWT. CTO due to in-stent restenosis were excluded. RESULTS: A total of 273 patients were included in the study (n = 55 in device-based ADR group, n = 218 in PWT group). Baseline characteristics were similar across groups except for higher prevalence of prior PCI and lower level of lipid profile in the ADR group. Moreover, although patients in the ADR group showed higher contrast volume (441.6 ± 162.4 mL vs. 361.5 ± 142.1 mL, p < 0.001), more intravascular ultrasound guidance (50.9% vs. 22.9%, p < 0.001), more guidewires used (4.6 ± 1.4 vs. 3.4 ± 1.2, p < 0.001) and higher troponin T level after PCI (0.167 vs. 0.087, p = 0.004), the technical success, procedural success and in-hospital complications were similar between the two groups. During a median follow-up of 1 year, the ADR group showed no difference in major adverse cardiac events (MACE, including all cause death, nonfatal myocardial infarction, and ischemia driven target vessel revascularization) (7.3% vs. 14.7%, p = 0.150) as compared with the PWT group. CONCLUSIONS: In the documented center, the use of device-based ADR for CTO PCI showed no difference in in-hospital complications and mid-term MACE as compared with PWT, despite higher procedure complexity in ADR group.

Differential eco-physiological performance to declining groundwater depth in Central Asian C3 and C4 shrubs in the Gurbantunggut Desert.

Resources in water-limited ecosystems are highly variable and unpredictable, and the maintenance of functional diversity among coexisting species is a crucial ecological strategy through which plants mitigate environmental stress. The comparison of differential eco-physiological responses among co-occurring plants in harsh environments could help provide deep insights into the coexistence mechanisms of competing species. Two coexisting desert shrubs with different photosynthetic pathways (Haloxylon ammodendron and Tamarix ramosissima) were selected in the Gurbantunggut Desert located in northwest China. This study detected variations in the water sources, photosynthetic parameters, stem water status, and non-structural carbohydrates of the two shrubs at three sites with different groundwater table depths during the growing seasons of 2015 and 2016 to identify distinct eco-physiological performances in coexisting plants with different functional types under fluctuating water conditions. The water sources of H. ammodendron shifted from soil water to groundwater, while T. ramosissima extracted water mainly from deep soil layers at both sites. Significant reductions in carbon assimilation and stomatal conductance in H. ammodendron with deeper groundwater table depth were detected during most drought periods, but no significant decreases in transpiration rate were detected with declining groundwater table depth. For T. ramosissima, all of these gas exchange parameters decreased with the progression of summer drought, and their relative reduction rates were larger compared with those of H. ammodendron. The stem water status of H. ammodendron deteriorated, and the relative reduction rates of water potential increased with deeper groundwater, whereas those of T. ramosissima did not differ with greater groundwater depth. These findings indicated that prolonged drought would intensify the impact of declining groundwater depth on the eco-physiology of both shrubs, but the extent to which the shrubs would respond differed. The two shrubs were segregated along the water-carbon balance continuum: the C3 shrub T. ramosissima maximized its carbon fixation at an enormous cost of water, while greater carbon fixation was achieved with far greater water economy for H. ammodendron. These results demonstrated that the two shrubs prioritized carbon gain and water loss differently when faced with limited water sources. These mechanisms might mitigate competitive stress and enable their coexistence.

Establishing a signature based on immunogenic cell death-related gene pairs to predict immunotherapy and survival outcomes of patients with hepatocellular carcinoma.

Immunogenic cell death (ICD) is a type of regulated cell death (RCD) triggered by various stresses that are involved in activating the immune system against cancer in immunocompetent hosts. However, no previous study has investigated the regulation of ICD-related gene pairs involved in hepatocellular carcinoma (HCC). A prognostic signature composed of 8 ICD-related gene pairs was generated that was capable of reliably separating patients with HCC into low- and high-risk subgroups with differing overall survival rates. Significant correlations were observed between risk score and surgical procedure, vascular tumor cell type, recurrence status, tumor status, and stages. The risk score was confirmed to be an independent prognostic factor for HCC and subsequently was employed to construct a prognostic nomogram. Low-risk patients were characterized by higher levels of immune cell infiltration, lower stromal and immune scores, higher tumor purity, higher expression of most immune checkpoints, and higher tumor mutational burden (TMB), revealing different levels of immunological functional pathways between different risk HCC patient cohorts. Furthermore, immunophenoscore (IPS) and Tumor Immune Dysfunction and Exclusion (TIDE) scores demonstrated that patients in the low-risk group are more likely to be sensitive to immunotherapy. In conclusion, the signature conducted by ICD-related gene pairs is a promising biomarker for the prediction of HCC patient outcomes and immunotherapeutic responses.

Numerical study on the performance of centrifugal blood pump with superhydrophobic surface.

AIM: In order to reduce the blood damage of an artificial heart pump and optimize its hydraulic performance, a centrifugal blood pump with superhydrophobic characteristics is proposed in this study. METHODS: To study the influence of superhydrophobic surface characteristics on the performance of centrifugal blood pumps, the Navier slip model is used to simulate the slip characteristics of superhydrophobic surfaces, which is realized by the user defined function of ANSYS fluent. The user defined functions with different values of slip length are verified by two benchmark solutions of laminar flow and turbulence in the pipeline. The blood pump model adopts the designed centrifugal blood pump, and its head, hydraulic efficiency and hemolysis index are calculated. The Navier slip boundary condition (a constant slip-length of 50 µm) is applied to the walls of the blood pump impeller and a volute at different positions, and the influence of the superhydrophobic surface on the performance of the blood pump at the design point Q = 6 L/min was compared and analyzed. RESULTS: The results show that the centrifugal blood pump model used in this paper has good blood compatibility and meets the design requirements; the superhydrophobic surface can significantly reduce the scalar shear stress in the blood pump. At the design point, when the slip length is 50 µm, the mass-average scalar shear stress in the impeller area and the volute area reduction rate is about 5.9%, the hydraulic efficiency growth rate is about 3.8%, the hemolysis index reduction rate is about 18.4%, and the pressure head changes little with a growth rate of 0.3%. CONCLUSIONS: Centrifugal blood pumps with superhydrophobic surfaces can improve the efficiency of blood pumps and reduce hemolysis. Based on these encouraging results, vitro investigations for actual blood damage would be practicable.

Impact of Subintimal Plaque Modification on Reattempted Chronic Total Occlusions Percutaneous Coronary Intervention.

BACKGROUND: Predictors of success in reattempted chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures remain obscure, mainly owing to the lack of consecutive angiograms and procedural records of initial attempts in the same cohort. OBJECTIVES: This study sought to investigate the factors predicting the success of reattempted CTO PCI procedures. METHODS: A total of 208 consecutive patients who underwent a failed CTO PCI attempt and received reattempted procedure at the same cardiac center were retrospectively analyzed. Predictors of the success of reattempted procedures were evaluated. RESULTS: The overall technical success rate of reattempted CTO PCI procedures was 71.2%. Subintimal plaque modification (SPM) was implemented in 35 (16.8%) procedures in initial attempts. The reattempted technical success rate was 93.3% in cases in which SPM with guidewire (GW) crossing was achieved in the initial attempt; however, the success rate was 55.0% for procedures involving SPM without GW crossing. SPM with GW crossing (OR: 11.21; 95% CI: 1.31-96.16; P = 0.028), referral to high-volume operators (OR: 2.38; 95% CI: 1.14-4.98; P = 0.021), and a bidirectional approach (OR: 2.31; 95% CI: 1.12-4.79; P = 0.024) were positive independent predictors of technical success in the subsequent reattempt. The time interval for reattempt (per 90-day increment) was negatively correlated with the technical success of the reattempted procedures (OR: 0.85; 95% CI: 0.73-0.98; P = 0.030). CONCLUSIONS: This study identified independent predictors of success in reattempted CTO PCI procedures. SPM with GW crossing achieved in the initial attempt is associated with a higher success rate in the subsequent reattempt.

Role of CD4 + T and CD8 + T Lymphocytes-Mediated Cellular Immunity in Pathogenesis of Chronic Obstructive Pulmonary Disease.

This work was to explore the changes of T lymphocyte subsets in peripheral blood of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) (AECOPD) and the role of cellular immunity mediated in the disease process. Eighty-six patients with AECOPD who visited Qingdao Hiser Medical Center from June 2020 to December 2021 and 30 healthy people (controls) who underwent health examination in the same period were selected. The differences of pulmonary function (PF), arterial blood gas (ABG), blood routine inflammatory indexes, T lymphocyte and T lymphocyte subsets were compared between the two groups, and the correlation between T lymphocyte subsets and each index was analyzed. There were clear differences in PF, ABG, and PB inflammation indexes between AECOPD patients and the controls (P <0.05). Compared with the controls, the CD4 + and CD4 +/CD8 + ratio in PB of AECOPD group were obviously decreased, and the CD8 + level was clearly increased (P <0.05); Th1 of CD4 + cell subsets and Tc1 of CD8 + cell subsets were significantly increased, while Th2 of CD4 + cell subsets and Tc2 of CD8 + cell subsets were obviously decreased (P <0.05). However, CD4+ was significantly positively correlated with lung function indexes, and significantly negatively correlated with neutrophils/lymphocytes and high-sensitivity C-reactive protein (P <0.05) and significantly positively correlated with Hs-CRP (P <0.05). In summary, CD4+ and CD8+ T lymphocytes were involved in the occurrence and occurrence of AECOPD, the decrease of CD4+ and the increase of CD8+ may promote the deterioration of COPD.

Necroptosis-associated classification combined with tumor microenvironment characteristic analysis of cutaneous melanoma.

Necroptosis is a mode of programmed cell death that overcomes apoptotic resistance. The accurate prognosis of cutaneous melanoma is complicated to predict due to tumor heterogeneity. Necroptosis contributes to the regulation of oncogenesis and cancer immunity. We comprehensively investigated different necroptosis patterns by the non-negative matrix factorization (NMF) clustering analysis and explored the relationships among necroptosis patterns, infiltered immune cells, and tumor microenvironment (TME) scores. Two different necroptosis patterns were identified, and the two clusters could predict prognosis and immune landscape. A four-gene signature was successfully constructed and validated its predictive capability of overall survival (OS) in cutaneous melanoma patients. The prognostic value of the signature was further enhanced by incorporating other independent prognostic factors such as age and clinicopathological stages in a nomogram-based prediction model. Patients with lower risk scores tended to have better OS, higher TME score, immune checkpoints, immunophenoscore (IPS), and lower Tumor Immune Dysfunction and Exclusion (TIDE), which indicated better responses to immunotherapy. In addition, the pigmentation score of the high-risk group was visibly higher than those of the low-risk group. In conclusion, the necroptosis-related signature indicated favorable predictive performance in cutaneous melanoma patients, which provides guidance for immunotherapy and provide novel insights into precision medicine.

Clinical impact of pretreatment albumin-globulin ratio in patients with colorectal cancer: A meta-analysis.

BACKGROUND: Accumulating evidence have revealed that pretreatment albumin to globulin ratio (AGR) may be a predictor of prognosis among patients with colorectal cancer (CRC). However, these findings are inconsistent. The aim of the present study was to investigate the prognostic value of pretreatment AGR in CRC. METHODS: A systematic meta-analysis was conducted by searching MEDLINE, EMBASE, and Cochrane Library databases. RESULTS: A total of 9 studies with 7939 patients were finally included. Low pretreatment AGR was associated with worse overall survival (pooled hazard ratio [HR]: 2.07, 95% CI: 1.60-2.67, P < .001) and disease-free survival/progress-free survival (pooled hazard ratio [HR]: 2.10, 95% confidence interval [CI]: 1.34-3.31, P = .001). Subgroup analyses revealed that the pooled correlation did not alter these results. Moreover, low pretreatment AGR were associated with elderly patients, tumor diameter (≥50 mm), tumor node metastasis stage (III-IV), depth of tumor (T3-4), and CA19-9 (>37 U/mL). CONCLUSION: The present meta-analysis suggests that low pretreatment AGR was associated with advanced clinicopathological features and worse prognosis, suggesting AGR is a useful prognostic biomarker for CRC patients.

Different drivers of soil C accumulation in aggregates in response to altered precipitation in a semiarid grassland.

Soil carbon (C) stabilization partially depends on its distribution within soil structural aggregates, and on the physicochemical processes of C within these aggregates. Changes in precipitation can alter the size distribution of aggregate classes within soils, and C input and output processes within these aggregates, which have potential consequences for soil C storage. However, the mechanisms underlying C accumulation within different aggregates under various precipitation regimes remain unclear. In this study, we conducted a 3-year field manipulation experiment to test the effects of a gradient of altered precipitation (-70%, -50%, -30%, 0%, +30%, and +50% amounts compared with ambient rainfall) on soil aggregate distribution and C accumulation in aggregates (53-250 µm, microaggregates; < 53 µm, silt and clay fractions) in a meadow steppe of northeastern China. Our results revealed that the distribution of soil microaggregates decreased along the precipitation gradient, with no detectable discrepant responses with respect to soil C accumulation within the microaggregates to precipitation treatments. In contrast, higher precipitation amounts coupled with a greater proportion of silt and clay fractions enhanced the accumulation of soil C. Importantly, structural equation models revealed that the pathways by which changes in precipitation control the accumulation of soil C varied across aggregate size fractions. Plant biomass was the main direct factor controlling the accumulation of C within soil microaggregates, whereas soil aggregate distribution and enzyme activities strongly interacted with soil C accumulation in the silt and clay fractions. Our findings imply that identifying how plant and soil aggregate properties respond to precipitation changes and drive C accumulation among soil particles will enhance the ability to predict responses of ecosystem processes to future global change.