[Review and perspective of clinical research involving chest tightness variant asthma in China]

Chest tightness variant asthma (CTVA) was first reported and named by Chinese scholars in 2013. It is a new clinical type of asthma characterized by chest tightness as the only or primary symptom, without typical asthma manifestations such as recurrent wheezing and shortness of breath, and without wheezing sounds heard during lung auscultation. The overall epidemiological data on CTVA is currently unavailable. Its pathogenesis is similar to that of typical asthma, involving eosinophilic airway inflammation. Due to the lack of typical clinical manifestations, insufficient knowledge of this disease in some clinicians and some other reasons, CTVA is susceptible to misdiagnosis or missed diagnosis. Currently, the diagnostic criteria for CTVA are: chest tightness as the only or primary symptom, without typical asthma symptoms and signs such as wheezing and shortness of breath, and with any one of the objective indicators of variable airflow limitation. Effective anti-asthma treatment is required, and other diseases that cause chest tightness, such as cardiovascular, digestive, nervous, muscular, and mental diseases should be excluded. CTVA treatment follows that of typical asthma, but the specific treatment duration is uncertain and may require long-term management. Traditional Chinese medicine has shown some therapeutic effects on CTVA. Most CTVA patients have a good prognosis after active anti-asthma treatment. This paper analyzes and summarizes the research of CTVA in China from 2013 and provides new perspectives for further exploration of CTVA.

[Investigation on cognition, diagnosis and treatment status of chest tightness variant asthma among Chinese pediatricians]

Objective: To evaluate the awareness, diagnosis and treatment of chest tightness variant asthma (CTVA) among pediatricians in China. Methods: The survey was conducted by convenient sampling method. Pediatricians with professional title of attending physician and above from different grades hospitals in 30 provinces were invited to conduct online questionnaire surveys through WeChat, pediatricians scan QR codes to complete electronic questionnaires in the mini program from January 16th to February 4th, 2021. The contents of questionnaire included the awareness, diagnosis and treatment of CTVA, and comparing the differences between pediatricians in secondary hospitals and tertiary hospitals. Results: A total of 1 529 pediatricians participated in the survey, and 1 484 (97.06%) pediatricians completed the questionnaire and included in the analysis, including 420 males (28.30%). The awareness rate of CTVA among pediatricians was 77.83 % (1 155/1 484). Pediatricians in tertiary hospitals had higher rates of awareness of CTVA than pediatricians in secondary hospitals [81.86% (898/1 097) vs 66.41% (257/387), P<0.001] and had better execution of the guidelines [89.15% (978/1 097) vs 79.59% (308/387), P<0.001]. A total of 93.06 % (1 381/1 484) of pediatricians' first-line treatment included inhaled corticosteroids (ICS) for CTVA. Among them, a higher proportion of pediatricians in tertiary hospitals used ICS included regimens for first-line treatment of CTVA compared with pediatricians in secondary hospitals [94.90% (1 041/1 097) vs 87.86% (340/387), P<0.001]. The reported well control rate of CTVA was 32.08% (476/1 484), which was significantly lower in secondary hospitals than that in tertiary hospitals [17.31% (67/387) vs 37.28% (409/1 097), P<0.001]. Conclusion: Most pediatricians are well aware of CTVA, among which there is a certain gap in clinical practice between pediatricians in secondary hospitals and tertiary hospitals in terms of understanding, diagnosis, and treatment of CTVA.

Occupancy of orbitals and the quadrupole collectivity in 45Sc nucleus

In the present work, the Doppler Shift Attenuation method (DSAM) was used to analyze the observed lineshapes of transitions from excited states in ⁴⁵Sc, populated in the reaction ³⁶Ar + ¹²C at a beam energy of 145 MeV. The interpretation and comparison of the experimental results have been performed with large-scale shell model calculations, involving different interactions like: GX1A, GX1J, FPD6, KB3 and ZBM2. KB3 and FPD6 (present work) interactions in the negative parity states, and in positive parity states ZBM2 are most pre-eminent in reproducing the results, due to the large configuration space describing strong collective effects. Furthermore, the present work also looks at the details of the shell model helping in improving the understanding for the occupancy of orbitals. The present investigation suggests the observation of stronger collectivity for positive parity states over negative parity states with predicted enhanced collectivity of states in ⁴⁵Sc nucleus.

Prognostic Value of Four Preimplantation Malnutrition Estimation Tools in Predicting Heart Failure Hospitalization of the Older Diabetic Patients with Right Ventricular Pacing

OBJECTIVES

The prognostic value of preimplantation nutritional status is not yet known for older diabetic patients that received right ventricular pacing (RVP). The study aimed to investigate the clinical value of the four malnutrition screening tools for the prediction of heart failure hospitalization (HFH) in older diabetic patients that received RVP.

DESIGN

Retrospective observational cohort study.

SETTING AND PARTICIPANTS

This study was conducted between January 2017 and January 2018 at the Fuwai Hospital, Beijing, China, and included older (age ≥ 65 years) diabetic patients that received RVP for the first time Measurements: The Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Naples Prognostic Score (NPS), and the Controlling Nutritional Status (CONUT) score were used to estimate the preimplantation nutritional status of the patients. Univariate and multivariate Cox proportional hazard regression analyses were performed to investigate the association between preimplantation malnutrition and HFH.

RESULTS

Overall, 231 older diabetic patients receiving RVP were included. The median follow-up period after RVP was 53 months. HFH was reported for 19.9% of the included patients. Our results showed preimplantation malnutrition for 18.2%, 15.2%, 86.6% and 66.2% of the included patients based on the PNI, GNRI, NPS, and CONUT score, respectively. The cumulative rate of HFH during follow-up period was significantly higher for patients in the preimplantation malnutrition group based on the PNI (log-rank = 13.0, P = 0.001), GNRI (log-rank = 8.5, P = 0.01), and NPS (log-rank = 15.7, P < 0.001) compared to the normal nutrition group, but was not statistically significant for those in the preimplantation malnutrition group based on the CONUT score (log-rank = 2.7, P = 0.3). As continuous variables, all the nutritional indices showed significant correlation with HFH (all P < 0.05). However, multivariate analysis showed that only GNRI was independently associated with HFH (HR = 0.97, 95% CI: 0.937-0.997, P = 0.032). As categorical variables, PNI, GNRI, and NPS showed significant correlation with HFH. After adjustment of confounding factors, moderate-to-severe degree of malnutrition was an independent predictor of HFH based on the PNI (HR = 4.66, 95% CI: 1.03-21.00, P = 0.045) and GNRI (HR = 3.02, 95% CI: 1.02-9.00, P = 0.047).

CONCLUSION

Preimplantation malnutrition was highly prevalent in older diabetic patients that received RVP. The malnutrition prediction tools, PNI and GNRI, showed significant prognostic value in accurately predicting HFH in older diabetic patients with RVP.

[Initial clinical experience of left bundle branch pacing after transcatheter aortic valve implantation]

Objective: To investigate the efficacy and safety of left bundle branch pacing(LBBP) in patients after transcatheter aortic valve implantation (TAVI). Methods: This is a retrospective study. A total of 35 patients underwent TAVI and received pacemaker implantation from January 2018 to December 2020 in Beijing Fuwai Hospital were enrolled. Patients were divided into LBBP group (n=12) and right ventricular apex pacing (RVAP) group (n=23) according to the pacing position. The success rate of operation in LBBP group was calculated, and the occurrence of complications were observed, and the parameters of pacemaker were measured on the 3rd day and 1, 3 and 6 months after operation. The N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiographic and ECG indexes were compared between the two groups on the 3rd day and 1, 3, and 6 months after pacemaker implantation. Result: A total of 35 patients were included, The age was (76.4±7.7) years, including 19 males (54.3%). The procedure time ((86.58±17.10)min vs. (68.74±9.18)min, P<0.001) and fluoroscopy duration ((20.08±4.44)min vs. (17.00±2.26)min, P<0.001) were significantly longer in LBBP group compared with RVAP group. The operation success rate of LBBP group was 11/12. There was no serious operation related complications such as pneumothorax, hemothorax, electrode dislocation, infection, and lower limb bleeding. The patients were followed up for 7.43 (5.21, 9.84) months. The programmed parameters of pacemaker were in the ideal range and stable during follow-up. At 3 and 6 months after operation, the left ventricular ejection fraction in LBBP group was higher than that in RVAP Group (at 3 months: (60.75±2.89)% vs. (57.35±3.33)%, P=0.004; at 6 months: (63.17±3.33)% vs. (56.17±3.97)%, P<0.001), NT-proBNP values was lower in LBBP group than that in RVAP Group (at 3 months: 822 (607, 1 150)ng/L vs. 1 052 (902, 1 536)ng/L, P=0.006; at 6 months: 440 (330,679)ng/L vs. 783 (588, 1 023)ng/L, P=0.001). At 1, 3 and 6 months after operation, the QRS duration was shorter in LBBP group than that in RVAP group (1 month: 99 (97, 107)ms vs. 126(124, 130)ms, P<0.001; 3 months: 98(96, 105)ms vs. 129(128, 133)ms, P<0.001; 6 months: 96(94, 104)ms vs. 130(128, 132)ms, P<0.001). Conclusions: For patients with permanent pacemaker indications after TAVI, LBBP is feasible, safe and reliable. It could improve the cardiac function in the short term, the long-term effect of LBBP needs to be further observed.

The protective effect of Veronica ciliata Fisch. Extracts on relieving oxidative stress-induced liver injury via activating AMPK/p62/Nrf2 pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Veronica ciliata Fisch. existed in various Tibetan medicine prescriptions, which was recorded to treat liver diseases in the Tibetan medicine roll of Chinese materia medica.

HYPOTHESIS/PURPOSE

The current study aimed to examine the effect of active constituents from V.ciliata relieving oxidative stress-mediated liver injury and clarify the underlying mechanism.

MATERIALS AND METHODS

tert-Butyl hydroperoxide (BHP) induced liver injury in mice model was established to evaluate the hepatoprotective effect of ethyl acetate extract of V. ciliata (EAFVC). Serum and liver indicators, as well as the histopathological change of liver were examined. Next, the constituents of EAFVC were separated and characterized by high-speed countercurrent chromatography (HSCCC) and Ultra performance liquid chromatography-mass spectrometer (UPLC-MS), respectively. Based on the above, the antioxidant activity of EAFVC and two fractions was evaluated using 2,2-Diphenyl-1-picrylhydrazyl (DPPH) and 2, 2'-azino-bis (3-ethylbenzothiazoli- ne-6-sulfonic acid) (ABTS) free radical scavenging assays. The hepatoprotective activity of EAFVC and its fractions/compounds attenuating ethanol-induced hepatocyte damage in BRL-3A cells was evaluated using the MTT method. The effect of the fraction and compounds with the strongest protective activity on ethanol-induced cytotoxicity, reactive oxygen species (ROS) accumulation, and glutathione (GSH) depletion was investigated. mRNA expression of nuclear factor-E2-related factor 2 (Nrf2) and nuclear factor of κB (NF-κB), as well as their downstream target genes, was determined by RT-qPCR. Finally, the potential mechanism of fraction 1 and luteolin on the AMPK/p62/Nrf2 signal pathway was studied using western blotting.

RESULTS

Firstly, EAFVC could relieve liver impairment induced by t-BHP in mice. Next, fraction 1 enriched with polyphenolic compounds and luteolin derived from EAFVC were screened to yield the highest hepatoprotective activity against ethanol-induced hepatocyte damage. Further study demonstrated that fraction 1 and luteolin relieved BRL-3A cells damage by decreasing the aspartate aminotransferase (AST), alanine transaminase (ALT) and lactate dehydrogenase (LDH) activities, ROS accumulation, as well as the depletion of GSH. Also, we determined that fraction 1 and luteolin suppressed inflammation and apoptosis of BRL-3A cells. The mechanistic studies indicated that fraction 1 could attenuate oxidative stress, inflammation, and apoptosis by activating AMPK phosphorylation, which promotes autophagy associated protein expression (LC3-B, Beclin1 and p62) as well as promote phosphorylation of p62 -dependent autophagic degradation of Keap1, to induce Nrf2 dissociation from Keap1 and translocate to nuclear. Nrf2 in the nuclear activate cytoprotective related genes to exert hepatoprotective function. Finally, we found that luteolin activated the protein expression of p-AMPK, p-p62, p62, Nrf2, and its downstream target genes.

CONCLUSIONS

This study clarified that fraction 1 enriched phenolic compounds could attenuate ethanol-induced liver injury in BRL-3A cells via activating AMPK/p62/Nrf2 pathway. Luteolin could serve as the major bioactive component in the therapeutic effect of fraction 1. These active constituents in V. ciliata could be used as the potential drugs targeted activation of AMPK or p62 for relieving oxidative stress-mediated liver disorders.

New α-Emitting Isotope ^{214}U and Abnormal Enhancement of α-Particle Clustering in Lightest Uranium Isotopes

A new α-emitting isotope ^{214}U, produced by the fusion-evaporation reaction ^{182}W(^{36}Ar,4n)^{214}U, was identified by employing the gas-filled recoil separator SHANS and the recoil-α correlation technique. More precise α-decay properties of even-even nuclei ^{216,218}U were also measured in the reactions of ^{40}Ar, ^{40}Ca beams with ^{180,182,184}W targets. By combining the experimental data, improved α-decay reduced widths δ^{2} for the even-even Po-Pu nuclei in the vicinity of the magic neutron number N=126 are deduced. Their systematic trends are discussed in terms of the N_{p}N_{n} scheme in order to study the influence of proton-neutron interaction on α decay in this region of nuclei. It is strikingly found that the reduced widths of ^{214,216}U are significantly enhanced by a factor of two as compared with the N_{p}N_{n} systematics for the 84≤Z≤90 and N<126 even-even nuclei. The abnormal enhancement is interpreted by the strong monopole interaction between the valence protons and neutrons occupying the π1f_{7/2} and ν1f_{5/2} spin-orbit partner orbits, which is supported by the large-scale shell model calculation.

Polyphenols from Penthorum chinense Pursh. Attenuates high glucose-induced vascular inflammation through directly interacting with Keap1 protein

ETHNOPHARMACOLOGICAL RELEVANCE

Penthorum chinense Pursh is used for promoting diuresis and alleviating "heat"-associated disorders, which were considered to be related to diabetic in Traditional Chinese Medicine (TCM).

AIMS OF THIS STUDY

Here, we aimed to evaluate the ability and underlying mechanism of the ethyl acetate fraction of Penthorum chinense Pursh stems (PSE) to inhibit vascular inflammation in high glucose (HG)-induced human umbilical vein endothelial cells (HUVEC cells).

MATERIALS AND METHODS

HUVEC cells were pre-treated with PSE following HG treatment. The cell viability, mitochondrial membrane potential (MMP), lactate dehydrogenase (LDH) levels, reactive oxygen species (ROS) generation were analyzed. Inflammatory, and antioxidant,-related proteins were analyzed using western blotting. Molecular docking and drug affinity targeting experiments (DARTS) were utilized to analyze and verify the binding of the Keap1 protein and polyphenols of PSE.

RESULTS

HG can significantly increase the activity of lactic dehydrogenase (LDH), destroy the mitochondrial membrane potential (MMP), and promote the generation of reactive oxygen species (ROS), while PSE treatment reversed these changes. Mechanistically, PSE inhibited NF-κB and inflammatory cytokines activation induced by HG through activating the expression of Nrf2 and its downstream antioxidant proteins Heme oxygenase-1 (HO-1), NAD (P)H Quinone Dehydrogenase 1 (NQO1), Glutamate cysteine ligase catalytic subunit (GCLC), Glutamate-cysteine ligase modifier (GCLM). Further study indicated that PSE activated Nrf2 antioxidant pathway mainly by the binding of primary polyphenols from PSE and the Keap1 protein.

CONCLUSION

Taken together, the present data highlight the health benefits of polyphenols from Penthorum chinense Pursh. regarding diabetes, proving it to be an important source of health care products. Besides, binding of the Keap1 protein may be an effective strategy to activate Nrf2 antioxidant pathway and prevent diabetes.

Protective effects of n-Butanol extract and iridoid glycosides of Veronica ciliata Fisch. Against ANIT-induced cholestatic liver injury in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Veronica ciliata Fisch. is a traditional medical herb that present in more than 100 types of Tibetan medicine prescriptions, most of which are used for liver disease therapy. Iridoid glycosides have been identified as the major active components of V.ciliata with a variety of biological activities.

AIMS OF THE STUDY

The aim of this study is to explore the protective effect and potential mechanism of n-Butanol extract (BE) and iridoid glycosides (IG) from V.ciliata against ɑ-naphthyl isothiocyanate (ANIT)-induced hepatotoxicity and cholestasis in mice.

MATERIALS AND METHODS

Mice were intragastrically (i.g.) given BE and IG at different dose or positive control ursodeoxycholic acid (UCDA) once a day for 14 consecutive days, and were treated with ANIT to cause liver injury on day 12th. Serum levels of hepatic injury markers and cholestasis indicators, liver index and liver histopathology were measured to evaluate the effect of BE and IG on liver injury caused by ANIT. The protein levels of tumor necrosis factor-α (TNF-α), nuclear factor kappa B(NF-κB), interleukin-6 (IL-6), Na+/taurocholate cotransporting polypeptide (NTCP), bile salt export pump (BSEP), multidrug resistance-associated protein 2 (MRP2), and the levels of oxidative stress indicators in liver tissue were investigated to reveal the underlying protective mechanisms of BE and IG against ANIT-induced hepatotoxicity and cholestasis.

RESULTS

The n-Butanol extract (BE) and iridoid glycosides (IG) isolated from V.ciliata significantly decreased serum level of cholestatic liver injury markers aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (GGT), total bile acid (TBA), total bilirubin (TBIL), and direct bilirubin (DBIL) in ANIT-treated mice. Histopathology of the liver tissue showed that pathological damages were relieved upon BE and IG treatment. Meanwhile, the results indicated BE and IG notably restored relative liver weights, inhibited oxidative stress induced by ANIT through increasing hepatic level of superoxide dismutase (SOD), reduced glutathione (GSH), catalase (CAT) and decreasing hepatic content of malondialdehyde (MDA). Western blot revealed that BE and IG inhibited the expression of pro-inflammatory factors TGF-α, IL-6 and NF-κB. Furthermore, the decreased protein expression of bile acid transporters NTCP, BSEP, MRP2 were upregulated by BE and IG in a dose-dependent manner.

CONCLUSION

The results have demonstrated that BE and IG exhibited a dose-dependently protective effect against ANIT-induced liver injury with acute intrahepatic cholestasis in mice, which might be related to the regulation of oxidative stress, inflammatory response and bile acid transport. In addition, these findings pointed out that iridoid glycosides as main active components of V.ciliata play a critical role in hepatoprotective effect of V.ciliata.

Phytochemical characterization and hepatoprotective effect of active fragment from Adhatoda vasica Nees. against tert-butyl hydroperoxide induced oxidative impairment via activating AMPK/p62/Nrf2 pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Adhatoda vasica Nees., which existed in a large; number of Tibetan medicine prescriptions for hepatopathy, used as an adjuvant to treat liver diseases.

HYPOTHESIS/PURPOSE

Oxidative stress is the key player in the development and progression of liver pathogenesis. In recent years, research is increasingly being focused on exploitation of the active components from medicinal plants to combat the liver oxidative injury. In our study, we aimed to screen the active principles from A. vasica and clarify whether they could relieve oxidative damage induced by tert-Butyl hydroperoxide (t-BHP) and its potential mechanism via activating AMPK/p62/Nrf2 pathway.

MATERIALS AND METHODS

Ultra performance liquid chromatography (UPLC) was adopted for analysis of chemical composition in the extracts. Furthermore, the antioxidant activity of the fractions was evaluated using DPPH, ABTS and reducing power assay. Along with this, the compounds in this fraction with highest antioxidant activity were analyzed using UPLC-MS. Based on this, the condition for extracting flavonoids of this subfraction was optimized via response surface method. CCK-8 assay was used to detect cell viability. Detection kits were used to measure the activity changes of AST, ALT, LDH and CAT as well as MDA and GSH levels induced by t-BHP. Detection of reactive oxygen species (ROS) production was used DCFH-DA probe. DAPI staining and flow cytometry was used to detect cell apoptosis. In terms of the mechanistic studies, the expression of proteins involved in AMPK/p62/Nrf2 pathway was measured using western blotting.

RESULTS

Eventually, 70% ethanol extract from leaf of A. vasica was chosen due to its highest active components compared with other extracts. Further, ethyl acetate fraction derived from 70% ethanol extract in A. vasica (AVEA) possess highest ability for scavenging DPPH and ABTS free radicals as well as strongest reducing power than other fractions. Chemical composition analysis showed that AVEA contained 17 compounds, including 1 quinazoline alkaloid, 12 flavonoid-C-glycosides and 4 flavonoid-O-glycosides. In addition, the conditions (ratio of solid-liquid 1:14, the concentration of ethanol 73%, and the temperature 65 °C) were selected to enrich the flavonoids in AVEA. Furthermore, AVEA could attenuate t-BHP induced hepatocyte damage via increasing the cell viability, restoring abnormal the activities of AST, ALT, LDH and CAT as well as the levels of MDA and GSH. ROS fluorescence intensity was reduced by AVEA. Meanwhile, it could inhibit the cell apoptosis of BRL 3 A cells, as evidenced by restoration of cell morphology and decreasing the number of apoptotic cells. Further mechanistic studies indicated AVEA could promote p-AMPK expression to further induce autophagy adaptor-p62 protein expression, which could autophagic degradation of Keap1, leading to Nrf2 release and translocation into nucleus to induce antioxidant genes (HO-1, NQO-1, GCLC and GCLM) expression.

CONCLUSION

In our study, AVEA was first to screen as the active fraction in A. vasica with alkaloids and abundant flavones. Moreover, the fraction potentiates its beneficial aspect by displaying the protective role on relieving t-BHP induced oxidative stress and activating AMPK/p62/Nrf2 pathway. AVEA helps maintain the redox homeostasis of hepatic cells and could be considered as an effective candidate against oxidative stress related liver disorders.

[The value of intraoperative cerebral oxygen saturation in predicting postoperative neurocognitive dysfunction in elderly patients with mild cognitive impairment]

Objective: To evaluate the value of intraoperative cerebral oxygen saturation in predicting postoperative neurocognitive dysfunction (PND) in elderly patients with mild cognitive impairment. Methods: A total of 210 cases of lumbar decompression, bone grafting and fusion surgery under general anesthesia were collected in the Third Central Hospital of Tianjin from June, 2019 to January, 2020, either sex, aged 65-75 year, BMI 19.5-32.5 kg/m(2), ASA physical status Ⅱ or Ⅲ, preoperative comorbidities with mild cognitive impairment. MoCA and MMSE were used to evaluate the cognitive function of patients 1 day before the operation, 7 days and 3 monthes after operation. PND group (n=38) and non-PND group (n=172) were selected according to postoperative MMSE and MoCA scale scores and the diagnostic criteria of PND. Heart rate (HR) , mean arterial pressure (MAP), pulse oxygen saturation (SpO(2)), bispectral index (BIS), cerebral tissue oxygen saturation (SctO(2), average left and right brain SctO(2) were recorded) were recorded pre-anesthetic (T(0)), ten minutes of anesthesia(T(1)), twenty minutes of anesthesia (T(2)), thirty minutes into the operation (T(3)), one hour into the operation (T(4)), end of the surgery (T(5)), and leave the PACU (T(6)). SctO(2) at time point T(0) was the base value of SctO(2), and the maximum percentage drop in SctO(2) from the base value was calculated (SctO(2max)%). Results: The incidence of PND was 18% (38/210) in 210 elderly patients undergoing surgery. The age of PND group and non-PND group was (71.0±2.1) and (67.8±2.0) years old, and the PACU time was (57±5) and (46±8) min, respectively. Compared with the non-PND group, the age of the PND group was higher (t=2.600, P<0.05) and the PACU time was longer (t=3.039, P<0.05). At the time points T(3), T(4), T(5) and T(6), SctO(2) in the PND group was (62±10) %, (60±11) %, (64±12) % and (66±10)%, respectively, lower than that in the non-PND group (67±60) %, (68±6) %, (69±5) % and (70±7)%, respectively, and the difference was statistically significant (t=3.369, 4.906, 3.787, 2.516, all P<0.05).The MoCA and MMSE scores of the PND group were (22.9±1.2) and (24.1±1.2) points, respectively, 1 day before surgery; and the MoCA and MMSE scores of the PND group were reduced to (20.8±1.2) and (21.3±0.7) points, respectively, 7 days after surgery, with statistically significant differences (t=3.523, 5.675, all P<0.05). MoCA and MMSE scores 7 days after surgery in the non-PND group were (22.4±1.3) and (23.1±1.6) points, respectively. Compared with the non-PND group, MoCA and MMSE scores 7 days after surgery in the PND group were reduced (t=2.630, 3.108, all P<0.05). The critical value of intraoperative SctO(2max)% was 13.74%, the area under the curve of PND was predicted to be 0.907 (95%CI: 0.819-0.995), sensitivity and specificity were 88.9% and 88.5%, respectively. Conclusion: SctO(2max)%>13.74% can be used as an indicator to predict PND occurrence in elderly patients with mild cognitive impairment during lumbar surgery.

Comparison of electrical characteristics between atrial and ventricular side His-bundle pacing in bradycardia patients

Background

His-bundle pacing (HBP) is recognized as the most physiological way of pacing but with less study focused on electrical characteristics in different site.

Purpose

We aimed to evaluate the differences of pacing and echocardiographic parameters between atrial and ventricular side His-bundle pacing.

Methods

Patients who successfully underwent HBP implantation from September 2018 to August 2019 were retrospectively analyzed. All patients were assigned to atrial-side HBP (aHBP) group or ventricular-side HBP (vHBP) group according to the location of the His-bundle pacing lead, which was confirmed by two methods including postoperative echocardiography and visualization of tricuspid valve annulus (TVA). The pacing and echocardiographic parameters were compared between two groups during the procedure and at 3-month follow-up.

Results

A total of 71 bradycardia patients who successfully underwent HBP implantation and confirmed lead position were included. Among them, twenty-seven were assigned to aHBP group and the other 44 were assigned to vHBP group with no significant differences in baseline clinical characteristics between two groups. During the procedure, the proportion of selective HBP was significantly higher (77.8% vs. 11.4%; P&lt;0.01) and the intra-procedural HV intervals was significantly longer (50.85±6.53 ms vs. 42.95±6.02 ms, P&lt;0.01) in aHBP group than in vHBP group. The capture threshold in vHBP group was significantly lower than in aHBP group at implantation (0.92±0.22 V/1.0ms vs. 1.05±0.26 V/1.0ms, P=0.03) and remain significantly difference after 3-month follow-up (0.98±0.23 V/1.0ms vs. 1.15±0.44 V/1.0ms, P=0.03). The R-wave amplitude was significantly higher in vHBP group than in aHBP group at implantation (5.82±2.52 mV vs. 3.74±1.81 mV, P&lt;0.01), and these differences still persisted during follow-up (5.88±2.51 mV vs. 3.67±1.61 mV, P&lt;0.01). During 3-month follow-up, an increase in the capture threshold &gt;1 V/1.0ms was seen in 2 cases in aHBP group while all patients remained stable in vHBP group. One patient developed a pocket hematoma in aHBP group compared to none in vHBP group. None of deterioration of tricuspid regurgitation and other procedure-related complications were observed during 3-month follow-up.

Conclusions

Ventricular side His-bundle pacing can achieve favourable pacing parameters including a lower pacing threshold and a higher R-wave amplitude than atrial side His-bundle pacing, which may be an ideal pacing strategy for patients in need of ventricular pacing.

Funding Acknowledgement

Type of funding source: None

Periodic repolarization dynamics for prediction of mortality: a systematic review and meta-analysis

Background

Prediction of death is the philosopher's stone of arrhythmology. The electrophysiology has proven to be an important tool to predict the risk of death. Periodic repolarization dynamics (PRD) is a novel electrocardiographic marker that indicates the sympathetic effect on repolarization. PRD qualifies the low-frequency oscillations of cardiac repolarization instability using high-resolution 12 channel 24-h Holter recording. Several studies showed that PRD was an independent predictor of all-cause mortality and cardiac mortality. However, the prediction value of PRD has not been established.

Purpose

To evaluate the prediction value of PRD as an approach of risk stratification that selects patients at a higher risk of death.

Methods

We conducted electronic searches of MEDLINE (PubMed), Embase, Cochrane Register of Controlled Trials (CENTRAL), Science Citation Index Expanded, WHO International Clinical Trials Registry platform (ICTRP) and ClinicalTrials.gov from inception to January 9th, 2020. We also screened for relevant abstracts from conferences including ACC Annual Scientific Sessions, ESC Congress and Annual Congress of the EHRA for the last five years (2014–2019). The primary outcome was all-cause mortality and secondary outcome was cardiac mortality. We included study with large sample size while more than one study were found based on the same originated population. We extracted data from included studies and reported pooled outcomes as hazard ratios (HRs) with 95% confidential intervals (CI) for time-to-event outcomes using DerSimonian-Laird random-effects model. We did statistical analyses using Stata version 12.0 and R version 3.6.1.

Results

5 studies including 6758 patients met all selection criteria for our meta-analysis. Follow-up period ranged from 20.4 to 75.1 months. Among 5 studies, 3 studies considered PRD as dichotomous variable and the cut-off value was 5.75 deg2, while 2 studies considered PRD as continuous variable and coefficient was expressed in standardized units (increase per standard deviation). We did subgroup analysis according to the type of variable because of heterogeneity. There was a significant higher risk of all-cause mortality in PRD ≥5.75 deg2 patients compared with PRD &lt;5.75 deg2 patients (HR 2.37, 95% CI 1.77–3.17). As for continuous variable, increased PRD was a predictor for all-cause death (HR 1.28, 95% CI 1.14–1.42) (Figure). The cardiac mortality was significantly increased in patients with PRD ≥5.75 deg2 vs PRD &lt;5.75 deg2 (HR 3.06, 95% CI 1.66–5.65). Increased PRD was associated with cardiac mortality in continuous variable subgroup (HR 1.34, 95% CI 1.21–1.48) (Figure).

Conclusion

Our findings suggest PRD is a significant predictor of all-cause mortality and cardiac mortality. PRD provides new additional electrophysiological indicator for risk stratification until further investigations are available.

Funding Acknowledgement

Type of funding source: None

A prognostic nomogram for event-free survival in patients with atrial fibrillation before cardiac resynchronization therapy

Background

Atrial fibrillation (AF), one of the most common comorbidities with heart failure (HF), is associated with worse prognosis in HF patients receiving cardiac resynchronization therapy (CRT). However, there is still no convenient tool to evaluate and identify patients with high risk of mortality and hospitalization due to heart failure in CRT candidates with AF.

Methods

We included 152 consecutive patients with AF for CRT in our hospital from January 2009 to July 2019. Multivariate Cox regression was applied to derive a nomogram, using multiple imputation for missing values and backward stepwise regression for variable selection.

Results

Five predictors were incorporated in the nomogram, including N-terminal pro brain natriuretic protein (NTproBNP) &gt;1745pg/mL, history of syncope, previous pulmonary hypertension (PHP), moderate or severe tricuspid regurgitation (TR), thyroid stimulating hormone (TSH) &gt;4mIU/L. Concordance index (0.70, 95% CI 0.62–0.77), corrected concordance index (0.67, 95% CI 0.59–0.74) and calibration curve showed optimal discrimination and calibration of the established nomogram. Significant difference of overall event-free survival was recognized by the nomogram-derived scores in patients with high risk (&gt;50 points), intermediate risk (21–50 points) and low risk (0–20 points) before CRT.

Conclusion

Our nomogram may be an applicable tool for early risk stratification among CRT candidates with AF.

Nomogram and risk stratification

Funding Acknowledgement

Type of funding source: None

Diagnostic accuracy of computed tomography colonography in patients at high risk for colorectal cancer: a meta-analysis

AIM

The aim was to explore the diagnostic value of computed tomographic colonography (CTC) compared with conventional colonoscopy in individuals at high risk for colorectal cancer.

METHOD

PubMed, Embase, the Cochrane Library and the Web of Science were searched by two independent reviewers for potentially eligible studies published up to 31 October 2018 that were based on a per-patient analysis. stata, meta-disc and revman were used to perform this meta-analysis. A random-effect model was used, and a subgroup analysis was conducted to explore the sources of heterogeneity.

RESULTS

A total of 14 full-text articles, involving 3578 patients, were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the area under the summary receiver operating characteristic curve of CTC for detecting polyps ≥ 6 mm were 0.87 (95% CI 0.83-0.90), 0.90 (95% CI 0.86-0.93), 9.08 (95% CI 6.28-13.13), 0.14 (95% CI 0.11-0.18) and 0.94 (95% CI 0.92-0.96), respectively. For polyps ≥ 10 mm, the pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of CTC were 0.91 (95% CI 0.86-0.94), 0.98 (95% CI 0.95-0.99), 40.36 (95% CI 19.16-85.03), 0.90 (95% CI 0.06-0.14) and 0.98 (95% CI 0.96-0.99), respectively.

CONCLUSION

In this meta-analysis, CTC had high diagnostic accuracy for detecting polyps ≥ 6 mm and ≥ 10 mm in patients at high risk of developing colorectal cancer and it had a higher sensitivity and specificity for detecting polyps ≥ 10 mm than polyps ≥ 6 mm. However, the results should be used cautiously due to the significant heterogeneity.

Activation of p62-Keap1-Nrf2 Pathway Protects 6-Hydroxydopamine-Induced Ferroptosis in Dopaminergic Cells

Parkinson's disease (PD) is a common neurodegenerative disorder primarily caused by the death of dopaminergic neurons in the substantia nigra pars compacta (SNpc). However, the manner of death of dopaminergic neurons remains indistinct. Ferroptosis is a form of cell death involving in the iron-dependent accumulation of glutathione depletion and lipid peroxide. Besides, previous studies indicated that ferroptosis might be involved in the death of dopaminergic neurons. In this study, we aim to explore the protective effect of the p62-Keap1-Nrf2 pathway against 6-hydroxydopamine (6-OHDA)-induced ferroptosis in dopaminergic cells. Firstly, our results demonstrated that 6-OHDA-induced ferroptosis could be observed in vivo zebrafish and in vitro human dopaminergic cell line (SH-SY5Y cells) model. Moreover, ferroptosis induced by 6-OHDA mitigates in SH-SY5Y cells upon ferrostatin-1 (Fer, an inhibitor of ferroptosis) treatment via upregulating the protein expression of glutathione peroxidase 4 (GPX4). Then, we found that high p62/SQSTM1 (p62) expression could protect SH-SY5Y cells against ferroptosis through promoting Nrf2 nuclear transfer and upregulating the expression of the antioxidant protein heme oxygenase-1 (HO-1). Ultimately, high p62 expression activates the Nrf2/HO-1 signaling pathway through binding to Kelch-like ECH-associated protein 1 (Keap1). Collectively, the activation of the p62-Keap1-Nrf2 pathway prevents 6-OHDA-induced ferroptosis in SH-SY5Y cells, targeting this pathway in combination with a pharmacological inhibitor of ferroptosis can be a potential approach for PD therapy.

Short-Lived α-Emitting Isotope ^{222}Np and the Stability of the N=126 Magic Shell

A new, very short-lived neutron-deficient isotope ^{222}Np was produced in the complete-fusion reaction ^{187}Re(^{40}Ar,5n)^{222}Np, and observed at the gas-filled recoil separator SHANS. The new isotope ^{222}Np was identified by employing a recoil-α correlation measurement, and six α-decay chains were established for it. The decay properties of ^{222}Np with E_{α}=10016(33)  keV and T_{1/2}=380_{-110}^{+260}  ns were determined experimentally. The α-decay systematics of Np isotopes is improved by adding the new data for ^{222}Np, which validates the N=126 shell effect in Np isotopes. The evolution of the N=126 shell closure is discussed in the neutron-deficient nuclei up to Np within the framework of α-decay reduced width.

MicroRNA-95-3p promoted the development of prostatic cancer via regulating DKK3 and activating Wnt/β-catenin pathway

OBJECTIVE

Previous studies have shown that microRNA-95-3p (miR-95-3p) plays a crucial role in multiple human cancers except for prostatic cancer (PCa). Therefore, the function of miR-95-3p was investigated in PCa in the present work.

PATIENTS AND METHODS

The expression of miR-95-3p was measured by Real Time-quantitative Polymerase Chain Reaction (RT-qPCR) assay. Western blot assay was used to examine the protein expression of epithelial-mesenchymal transition (EMT) markers. In addition, the function of miR-95-3p was detected through MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) and transwell assays. Dual Luciferase assay was applied to confirm the relationship between miR-95-3p and dickkopf-3 (DKK3). The tumor growth was observed through xenograft tumor formation assay.

RESULTS

The upregulation of miR-95-3p was detected in PCa tissues and cell lines, which predicted poor prognosis of PCa patients. Moreover, miR-95-3p promoted cell proliferation, migration and invasion in PCa by targeting DKK3 and activating the Wnt/β-catenin pathway. MiR-95-3p also promoted the tumor growth of PCa in vivo. Besides that, downregulation of DKK3 was identified in PCa and low DKK3 expression predicted poor prognosis of PCa patients.

CONCLUSIONS

MiR-95-3p promoted the development of PCa via targeting DKK3 and activating the Wnt/β-catenin pathway.

Phenols fragment of Veronica ciliata Fisch. ameliorate free radical-induced nonalcoholic fatty liver disease by mediating PI3K/Akt signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Veronica ciliata Fisch. is used in numerous of Tibetan medicine prescriptions because of its hepatoprotective effect.

AIMS OF THIS STUDY

Here, we aimed to investigate the hepatoprotective effect and mechanism of phenolic fraction (PF) of V. ciliata Fisch. on liver injury induced by free radical.

MATERIALS AND METHODS

BRL 3A cells were pre-treated with PF and luteolin (Lut) following tert-butyl hydroperoxide (t-BHP) treatment. The cell viability, lactate dehydrogenase (LDH) levels, reactive oxygen species (ROS) generation, apoptosis, cell cycle and autophagy were analyzed. Apoptotic, inflammatory, and autophagy,- related proteins were analyzed using Western blotting. The combination of molecular docking and drug affinity targeting experiments (DARTS) were first utilized to analysis the target protein of Lut.

RESULTS

PF effectively suppressed t-BHP-induced apoptosis caused by mitochondrial dysfunction, which were associated with inhibiting ROS generation. Further investigation indicated that PF significantly suppressed apoptosis, inflammation, and autophagy by regulating the expression of related proteins. The results of molecular docking and drug affinity targeting experiments (DARTS) revealed that PI3K was the target protein of PF and Lut. Further studies have shown that PF relieved liver injury induced by t-BHP via suppressing phosphorylated expression of PI3K.

CONCLUSION

Our results indicate that PF effectively protect against hepatotoxicity induced by t-BHP through inhibiting the abnormal activation of PI3K-Akt signaling pathway and highlight the health benefits of PF regarding oxidative stress, proving it to be an important source of bioactive compounds associated with Nonalcoholic fatty liver disease (NAFLD).

A new adaptation for in vitro co-culture of single porcine parthenogenetic embryos using feeder cells

Feeder cells can promote cell proliferation and help overcome the developmental arrest of early embryos by producing growth factors. The objective of this study was to evaluate the effects of feeder cells on the development of all single porcine parthenogenetic embryos in vitro. Firstly, we showed that the cleavage and blastocyst formation rate of all single procine parthenogenetic embryos co-cultured with feeder cells increased in contrast to those cultured without feeder cells (p⟨0.05). However, no statistically significant differences were observed between the blastocyst formation rate in the embryos co-cultured with 3 different kinds feeder cells namely oviduct epithelial feeder cells, granulose feeder cells and porcine fetal fibroblast feeder cells (p>0.05). Secondly, highly significant differences were observed between the cleavage and blastocyst formation rate (p⟨0.05) when the embryos were co-cultured with oviduct epithelial feeder cells in different volume drops ranging from 3 to 20 μL and the cleavage rate were the highest when cultured in 5 μL drops. Thirdly, the tempospacial pattern of the development of single embryos co-cultured with oviduct epithelial feeder cells was consistent with that of traditional multi-embryo culture, indicating that the co-culturing does not affect the developmental competence of the porcine parthenogenetic embryos. Finally, highly significant differences were observed between the cleavage and blastocyst formation rate with and without zona pellucida in vitro (p⟨0.05). In this study, a new adaption of in vitro co-culture of single porcine parthenogenetic embryos using feeder cells has been successfully established and this will facilitate further investigations to discover the mechanistic mode of developmental arrest of porcine embryos.

TGFβ-induced metabolic reprogramming during epithelial-to-mesenchymal transition in cancer

Metastasis is the most frequent cause of death in cancer patients. Epithelial-to-mesenchymal transition (EMT) is the process in which cells lose epithelial integrity and become motile, a critical step for cancer cell invasion, drug resistance and immune evasion. The transforming growth factor-β (TGFβ) signaling pathway is a major driver of EMT. Increasing evidence demonstrates that metabolic reprogramming is a hallmark of cancer and extensive metabolic changes are observed during EMT. The aim of this review is to summarize and interconnect recent findings that illustrate how changes in glycolysis, mitochondrial, lipid and choline metabolism coincide and functionally contribute to TGFβ-induced EMT. We describe TGFβ signaling is involved in stimulating both glycolysis and mitochondrial respiration. Interestingly, the subsequent metabolic consequences for the redox state and lipid metabolism in cancer cells are found to be in favor of EMT as well. Combined we illustrate that a better understanding of the mechanistic links between TGFβ signaling, cancer metabolism and EMT holds promising strategies for cancer therapy, some of which are already actively being explored in the clinic.

Phytochemical composition, isolation and hepatoprotective activity of active fraction from Veronica ciliata against acetaminophen-induced acute liver injury via p62-Keap1-Nrf2 signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Veronica ciliata Fisch, a traditional Tibetan medicine, used to cure hepatitis and existed in lots of Tibetan medicine prescriptions owing to its hepatoprotective activity.

AIMS OF THIS STUDY

In this study, we are aimed to systematically analysis and isolate the chemical constituents of the ethyl acetate fraction from V. ciliata (EAFVC), and test the hepatoprotective effect and mechanism of EAFVC and its compounds on attenuating the liver injury induced by acetaminophen (APAP) in vivo and vitro.

MATERIALS AND METHODS

UPLC-PDA-ESI-MS method was established for the analysis of the components in EAFVC, which was further separated using multiple chromatographic techniques. The MS, ¹H and ¹³C NMR were applied to elucidate their structures. UPLC-PDA method was applied for the simultaneous quantification of major compounds of EAFVC. Furthermore, the protective effect of the EAFVC was determined using APAP-induced acute hepatotoxicity in mice and BRL-3A cells model, respectively. In addition, the hepatoprotective activity of two main compounds in EAFVC on relieving APAP-induced liver injury was further evaluated. Finally, we have some concerns about the protective mechanism of EAFVC via enzyme-linked immunosorbent assay (ELISA), reactive oxygen species (ROS) detection, quantitative real-time PCR (qPCR), western blot analysis and molecular docking.

RESULTS

Thirteen compounds were successfully identified using UPLC-PDA-ESI-MS for the first time. Meanwhile, other twelve compounds were separated from EAFVC. Eventually, twenty-five compounds were successfully identified from the EAFVC. Among these compounds, fourteen compounds (3, 8, 10, 14-17, 19-25) were separated from V.ciliata for the first time. In addition, UPLC-PDA analysis method was first to establish for simultaneous determination of the main compounds (1, 2, 4, 5, 7, 9, 12). Further assay indicated that the liver injury in mice induced by APAP showed a significant reversal by EAFVC, as evidenced by reducing the activities of liver function enzymes, suppressing the lipid peroxidation as well as increasing the serum total antioxidant capacity (T-AOC) and the activities of antioxidant enzymes. Pathological sections showed that the liver in the high dose has significant improvement in mice. In vitro experiment also showed that EAFVC elevate the viability, inhibiting the activities of liver function enzymes as well as the generation of ROS of BRL-3A cells. In addition, Catalposide and verproside could reverse the low cell viability of BRL-3A cells induced by APAP. The mechanism research in vitro demonstrated that EAFVC could promote the mRNA and protein expression of heme oxygenase-1 (HO-1), NAD(P) H dehydrogenase quinone 1 (NQO-1) and catalytic or modify subunit of glutamate-cysteine ligase (GCLC/GCLCM) via enhancing nuclear factor-E2-related factor 2 (Nrf2) and p62/SQSTM1 (p62) expression in protein level. Molecular docking results demonstrated that catalposide and verproside have strong affinity to the kelch-like ECH-associated protein-1(Keap1) Kelch domain.

CONCLUSION

This research is the first to clarify the substance basis of the hepatoprotective activity of the EAFVC and provide the further scientific data for the traditional use of this Tibetan Medicine. EAFVC is valuable to be further investigated as active preparations for application in liver protection via activating p62- Keap1-Nrf2 pathway.

P3803New predictive score for clinical prognosis in non-ischemic cardiomyopathy patients with cardiac resynchronization therapy

Objective

To derive and validate a prediction score for clinical prognosis in non-ischemic cardiomyopathy (NICM) patients receiving cardiac resynchronization therapy (CRT).

Methods

A cohort of 422 consecutive NICM patients with CRT were retrospectively enrolled from January 2010 to December 2017, randomly categorized into the derivation group (n=338) and the validation group (n=84). Primary endpoint defined as all-cause death and heart transplantation. A new score was established based on the β coefficients of each risk factor.

Results

High sensitive C-response protein [hazard ratio (HR):1.081, 95% confidence interval (CI): 1.029–1.134 P=0.002], left atrial diameter (HR: 1.056, 95% CI: 1.020–1.093, P=0.002), non-LBBB (HR: 1.793, 95% CI: 1.131–2.844, P=0.013), N-terminal pro-B-type natriuretic peptide per 100 pg/ml (HR: 1.018, 95% CI: 1.007–1.030, P=0.002), were independent predictors for primary endpoint. A new prediction score, HALP score, showed significant difference of primary endpoint among different risk groups (log-rank test, all P<0.01) by Kaplan-Meier curve; Compared with three prior models, HALP scores had adequate discrimination [AUC: 0.738 (95% CI: 0.680–0.794)] and good calibration for all caused death and heart transplantation.

Table 1. Predictors of all-cause mortality and heart transplantation risk by uni- and multivariate Cox proportional hazards models in deviation datasets Variables Univariate Multivariate HR (95% CI) P-value HR (95% CI) P-value Age 0.992 (0.972–1.012) 0.423 Sex (male) 1.821 (1.091–3.041) 0.022 Non-LBBB 2.260 (1.438–3.552) <0.001 1.793 (1.131–2.844 0.013 Type of device (CRT-D) 1.592 (1.009–2.512) 0.046 Atrial Fibrillation 1.797 (1.055–3.062) 0.031 NYHA function class IV 1.878 (1.105–3.191) 0.020 AST 1.014 (1.000–1.027) 0.045 HS-CRP 1.106 (1.055–1.160) <0.001 1.081 (1.029–1.134) 0.002 NT-proBNP per100 1.029 (1.020–1.039) <0.001 1.018 (1.007–1.030) 0.002 Big Endothelin-1 1.973 (1.350–2.882) <0.001 Creatinine 1.007 (1.001–1.013) 0.015 Uric acid 1.001 (1.000–1.003) 0.144 LA 1.084 (1.051–1.117) <0.001 1.056 (1.020–1.093) 0.002 LVFE 0.975 (0.950–1.000) 0.054 LVEDD 1.032 (1.011–1.053) 0.003

Figure 1. Comparison of different scores

Conclusion

HALP score system may be an effective model for clinical prognostics in NICM patients with CRT.

Acknowledgement/Funding

None

P6017Permanent left bundle branch area pacing for atrioventricular block: feasibility, safety and acute effect

Background

Left bundle branch area pacing (LBBAP), lacks adequate evaluation for AVB.

Purpose

We aimed to assess the feasibility, safety, and acute clinical outcomes of permanent LBBAP in patients with AVB.

Methods

We retrospectively recruited AVB patients with indication for ventricular pacing who had underwent LBBAP from May to Sep. 2018. ECG characteristics, pacing parameters, echocardiographic parameters and adverse events were evaluated during follow-up. Successful LBBAP was defined as the paced QRS morphology of RBBB pattern and QRSd less than 130ms.

Results

A total of 33 patients were involved in this study (mean age: 55.1±18.5 years; 66.7% male, 48.4% with bundle branch block,BBB). LBBAP was successfully performed in 90.9% (30/33) of all patients. The mean capture threshold of LBBAP was 0.76±0.26 V/0.4 ms during the procedure and 0.64±0.20 V/0.4ms at 3-month follow-up. The paced QRSd was 112.8±10.9 ms during the procedure and 116.8±10.4ms at 3-month follow-up. Baseline left or right BBB was corrected by LBBAP (153.3±27.8 ms vs. 122.2±9.9 ms) with a success rate of 68.7% (11/16). One ventricular septal lead perforation occurred soon after the procedure and LBBAP was successfully repeated by lead revision. Cardiac function and left ventricular synchronization at three-month follow-up presented slightly improvement as compared with baseline.

Table 1. Complications and changes in pacing parameters within 3 months after LBBAP Pacing parameters LBBAP (N=30) During the procedure Before discharge 3-month follow up Sensing amplitude, mV 14.4±5.1 15.8±11.7 14.6±4.6 Pacing threshold@0.4ms, V 0.76±0.26 0.59±0.16 0.64±0.20 Pacing impedance, Ω 691.7±133.8 588.0±79.3 554.7±93.7 Paced QRSd at 3.0V@0.4 ms output, ms 112.8±10.9 114.4±14.2 116.8±10.4 VP, % NA NA 79.4±24.6 Complications, n (%) 1 (3.3) 0 (0.0) 0 (0.0) Infection, n (%) 0 (0.0) 0 (0.0) 0 (0.0) Septal perforation, n (%) 1 (3.3) 0 (0.0) 0 (0.0) Dislodgement, n (%) 0 (0.0) 0 (0.0) 0 (0.0) QRSd, QRS duration; VP, ventricular pacing percentage.

Figure 1. Characteristics of LBBAP

Conclusion

Permanent LBBAP yielded stable threshold, narrow QRSd and preserved left ventricle synchrony with few complications. Our preliminary results indicate that LBBAP holds promise as an attractive physiological pacing strategy for AVB.

[Association of serum albumin level and clinical outcomes among heart failure patients receiving cardiac resynchronization therapy]

Objective: To assess the relationship between serum albumin level and clinical outcome in heart failure (HF) patients receiving cardiac resynchronization therapy (CRT). Methods: In this retrospective cohort study, 357 consecutive chronic heart failure patients receiving CRT between January 2010 and December 2015 were enrolled and divided into two groups based on pre-CRT serum albumin (albumin≥40 g/L, n=244; albumin<40 g/L, n=113). Clinical outcomes were defined as all-cause mortality (including heart transplantation) and rehospitalization due to worsening HF.Baseline characteristics were compared and all-cause mortality (including heart transplantation) and rehospitalization due to worsening heart failure (HF) were analyzed using Kaplan-Meier curves.Prognostic value of albumin level was evaluated in Cox proportional-hazards regression models. Results: Over a median follow-up time of 21 months, 45 patients (12.6%) died, 4 patients (1.1%) underwent heart transplantation and 100 patients (28.0%) were rehospitalized due to worsening HF. HF patients with pre-CRT albumin<40 g/L were related with worse NYHA function class, lower HDL-C level and ACEI/ARB use compared to HF patients with pre-CRT albumin≥40 g/L. Kaplan-Meier analyses evidenced lower survival rate in HF patients (log-rank test: P=0.000 4, χ(2)=12.60) and higher rehospitalization rate due to worsening HF (log-rank test: P=0.009, χ(2)=6.82) in HF patients with pre-CRT albumin<40 g/L.Multivariate Cox analyses indicated that serum pre-CRT albumin <40 g/L was an independent risk factor for all-cause mortality (HR=2.019, 95%CI 1.125-3.622, P=0.018) and HF rehospitalization (HR=1.517, 95%CI 1.014-2.270, P=0.043). Conclusion: Pre-CRT serum albumin level is associated with the severity of heart failure in CRT recipients.Patients with lower pre-CRT albumin level face increased risk of all-cause mortality and HF rehospitalization in chronic heart failure patients receiving cardiac resynchronization.

Comparison of two series of non-invasive instruments used for the skin physiological properties measurements: the DermaLab® from Cortex Technology vs. the series of detectors from Courage & Khazaka

BACKGROUND/PURPOSE

The detectors from Courage & Khazaka and DermaLab^® from Cortex Technology were two series of the most commonly used non-invasive instruments for the skin physiological properties measurements. The aim of this study is to reveal the differences and correlations in measuring skin color, hydration, transepidermal water loss (TEWL), sebum and elasticity on the forearm or faces between two commercially available series of instruments.

METHODS

30 subjects were enrolled to be measured by the two series of instruments. The measurements by each series were performed on the left/right side of the body randomly. The hydration, sebum, elasticity and TEWL measurements were performed on different sites.

RESULTS

Positive correlations were found in the values of skin color, hydration, TEWL, sebum and visco-elasticity detected by the two series. The values related to skin firmness measured by the two instruments were statistically negative correlated. Contrary to the results in measuring the skin color, the detectors from Courage & Khazaka presented lower values of variation in measuring skin hydration and TEWL than those from DermaLab^® .

CONCLUSION

The two series have significant correlations.The differences of the two series can be due either to differences in the design of the probe or left/right part of the body.

Eosinophil differentiation in the bone marrow is promoted by protein tyrosine phosphatase SHP2

SHP2 participates in multiple signaling events by mediating T-cell development and function, and regulates cytokine-dependent granulopoiesis. To explore whether and how SHP2 can regulate bone-marrow eosinophil differentiation, we investigate the contribution of SHP2 in the bone-marrow eosinophil development in allergic mice. Blockade of SHP2 function by SHP2 inhibitor PHPS-1 or conditional shp2 knockdown by adenovirus-inhibited bone-marrow-derived eosinophil differentiation in vitro, with no detectable effects on the apoptosis of eosinophils. Furthermore, SHP2 induced eosinophil differentiation via regulation of the extracellular signal-regulated kinase pathway. Myeloid shp2 conditional knockout mice (LysM^creshp2^flox/flox) failed to induce eosinophilia as well as airway hyper-responsiveness. The SHP2 inhibitor PHPS-1 also alleviated eosinophilic airway inflammation and airway hyper-responsiveness, accompanied by significantly reduced levels of systemic eosinophils and eosinophil lineage-committed progenitors in allergic mice. We demonstrate that inhibition of eosinophil development is SHP2-dependent and SHP2 is sufficient to promote eosinophil formation in vivo. Our data reveal SHP2 as a critical regulator of eosinophil differentiation, and inhibition of SHP2 specifically in myeloid cells alleviates allergic airway inflammation.

Rapid isolation and purification of phorbol esters from Jatropha curcas by high-speed countercurrent chromatography

In this work, a high-speed countercurrent chromatography (HSCCC) method was established for the preparation of phorbol esters (PEs) from Jatropha curcas. n-Hexane-ethyl acetate-methanol-water (1.5:1.5:1.2:0.5, v/v) was selected as the optimum two-phase solvent system to separate and purify jatropha factor C1 (JC1) with a purity of 85.2%, as determined by HPLC, and to obtain a mixture containing four or five PEs. Subsequently, continuous semipreparative HPLC was applied to further purify JC1 (99.8% as determined by HPLC). In addition, UPLC-PDA and UPLC-MS were established and successfully used to evaluate the isolated JC1 and PE-rich crude extract. The purity of JC1 was only 87.8% by UPLC-UV. A peak (a compound highly similar to JC1) was indentified as the isomer of JC1 by comparing the characteristic UV absorption and MS spectra. Meanwhile, this strategy was also applied to analyze the PE-rich crude extract from J. curcas. It is interesting that there may be more than 15 PEs according to the same quasi-molecular ion peaks, highly similar sequence-specific fragment ions, and similar UV absorption spectrum.

Pharmacokinetics, safety and tolerability of triflusal and its main active metabolite HTB in healthy Chinese subjects

Triflusal presents comparable antiplatelet activity to aspirin while presenting a more favourable safety profile, and is used in the treatment of thrombosis. The study aimed to evaluate the pharmacokinetics and safety of triflusal and its major metabolite 2-(hydroxyl)-4-(trifluoromethyl)- benzoic acid (HTB) in healthy Chinese subjects.30 healthy subjects were recruited in this randomized, single-center, and open-label, parallel, single ascending doses (300, 600, 900 mg) and multiple doses (600 mg, once daily for 7 days) study. Plasma samples were analyzed with a validated liquid chromatography tandem mass spectrometry (LC/MS/MS) method. Safety was assessed by adverse events, ECG, laboratory testing, and vital signs.Triflusal was safe and well tolerated. After single-dose administration, triflusal was rapidly absorbed with a mean Tmax of 0.55-0.92 h and a mean t1/2 kel of 0.35-0.65 h, HTB was absorbed with a mean Tmax of 2.35-3.03 h and a mean t1/2 kel of 52.5-65.57 h. Cmax and AUC for triflusal and HTB were approximately dose proportional over the 300-900 mg dose range. In the steady state, the accumulation index (R) indicated that the exposure of triflusal increased slightly with repeated dosing, and the exposure of HTB increased obviously. 3 adverse events certainly related to the investigational drugs occurred in the multiple-dose phase.Following oral dosing under fasting condition, triflusal is promptly absorbed and rapidly depleted from the systemic circulation. HTB is quickly generated from triflusal and slowly eliminated. Triflusal accumulates slightly in the body. HTB plasma concentration builds up progressively toward steady-state.

Impact of MTHFR polymorphisms on methylation of MGMT in glioma patients from Northeast China with different folate levels

Hypomethylation of the O6-methylguanine-DNA-methyltransferase (MGMT) promoter in glioma cells has been associated with temozolomide resistance. S-adenosylmethionine (SAM), which is produced during folate metabolism, is the main source of methyl groups during DNA methylation. As a key enzyme during folate metabolism, polymorphisms of 5,10-methylenetetrahydrofolate reductase (MTHFR) may regulate folate end-products. We investigated the effect of typical polymorphisms of MTHFR (C677T and A1298C) on MGMT methylation based on different serum folate levels in patients with glioma from Northeast China. A total of 275 patients with glioma and 329 without malignant tumors were tested. Serum folate concentration was assayed by using the electrochemiluminescence immunoassay. MTHFR polymorphisms were detected by Taqman-Fluorescence quantitative polymerase chain reaction (PCR). Methylation-specific PCR was used to assess MGMT methylation. The constituent ratio of glioma patients below the serum folate biological reference value was significantly higher than that of the control population (P < 0.001). In patients with oligodendroglioma and glioblastoma, heterozygotes for the A1298C mutation were found in higher frequency than homozygotes or wild types (oligodendroglioma, P < 0.001; glioblastoma, P < 0.01). When grouped by the median or biological reference value of serum folate, only homozygotes for C677T with low levels of folate were significantly associated with decreased methylation of MGMT (median, P < 0.001; biological reference value, P = 0.036). These data suggest that, in combination with a negative folate balance in glioma patients, T/T genotypes in MTHFR C677T may be associated with MGMT demethylation.

Pharmacokinetics, pharmacodynamics, and safety of landiolol hydrochloride in healthy Chinese subjects

OBJECTIVE

Landiolol is an ultra-short-acting β-blocker that appears to be more cardioselective and less toxic than esmolol. The main objective of this study was to investigate the pharmacokinetics, pharmacodynamics, and safety of landiolol hydrochloride in healthy Chinese volunteers.

METHODS

We set 2-dose regimen (L and H groups) [L (low): 0.125 mg/kg/min (1 min) loading→0.02 mg/kg/min (20 min) continuous, H (high): 0.25 mg/kg/min (1 min) loading→0.04 mg/kg/min (20 min) continuous]. 20 healthy subjects of either sex were allocated randomly to the L and H groups (n=10, and 10). Blood samples were collected over 1 h after continuous infusion and were determined using a validated liquid chromatography/mass spectrometry (LC/MS/MS) assay. The safety of landiolol hydrochloride was assessed by adverse events recording, 12-lead ECG findings, physical examination, laboratory testing, and vital signs.

RESULTS

The main pharmacokinetic parameters of landiolol hydrochloride in healthy Chinese subjects were as follows: doses of 2 groups (L and H); Cmax of 400±110 and 731±246 ng/mL; C21min of 327±109 and 508±141 ng/mL; Tmax of 10.1±6.5 and 6.2±5.7 min; t1/2 of 4.7±1.6 and 6.5±1.7 min. Landiolol hydrochloride was safe. There were no adverse events in any subject. The heart rates and blood pressures of subjects administered landiolol hydrochloride decreased, but no clinically significant changes were observed.

CONCLUSION

The concentration of landiolol hydrochloride rapidly reached steady state levels, and rapidly dissipated after completion of administration. Landiolol hydrochloride appears to have rapid onset and short action.

Distant lymph nodes serve as pools of Th1 cells induced by neonatal BCG vaccination for the prevention of asthma in mice

BACKGROUND

Neonatal Bacillus Calmette-Guérin (BCG) vaccination induces vigorous T-helper type 1 (Th1) responses and inhibits allergy-related airway dysfunction, but the exact mechanisms remain unclear. The objective of this study was to address where the Th1 cells induced by neonatal BCG vaccination are generated and stored, and how they are recruited into the inflamed airway for the prevention of allergen-induced airway inflammation.

METHODS

We vaccinated neonatal C57BL/6 mice with BCG in a mouse model of asthma and analyzed the expression and function of Th1 cells in vivo and in vitro.

RESULTS

BCG vaccination-induced Th1 cells in the local inguinal lymph nodes (ILN) migrated into the lungs upon inhaled ovalbumin (OVA) challenge in OVA-sensitized mice. These CD4(+) T cells in the ILN exhibited potentials of activation, proliferation and cytokine secretion and expressed high levels of CXCR3. Adoptive transfer of CD4(+) T cells from BCG-treated ILN significantly decreased allergic airway responses. In addition, the protective effect of BCG vaccination against allergic airway inflammation was lost upon the excision of the ILN.

CONCLUSIONS

These data demonstrate that ILN serves as a 'weapon' pool of Th1 cells following BCG vaccination, and these cells are ready for the migration into the inflamed lungs upon the allergen challenge, thereby inhibiting allergen-induced airway disorder.

Serum concentrations of resistin and adiponectin and their relationship to insulin resistance in subjects with impaired glucose tolerance

OBJECTIVES

This study measured the serum concentrations of resistin and adiponectin in Chinese subjects with impaired glucose tolerance (IGT) and investigated their association with insulin resistance, metabolic parameters and circulating inflammatory markers.

METHODS

A total of 124 subjects participated in the study (44 with IGT and 80 with normal glucose tolerance [NGT]). Fasting serum concentrations of lipids, glucose, insulin and adipocytokines (resistin, adiponectin, leptin, tumour necrosis factor-α [TNF-α], interleukin-6 and C-reactive protein) were measured.

RESULTS

Serum resistin concentrations were similar in the IGT and NGT groups but were significantly higher in overweight/ obese IGT subjects than in those of normal weight. Serum adiponectin concentrations were significantly lower in the IGT group than in the NGT group. In the IGT group, resistin was positively correlated with age, body mass index and TNF-α, and adiponectin was correlated positively with high-density lipoprotein cholesterol and negatively with TNF-α and waist/hip ratio.

CONCLUSIONS

Circulating resistin is unlikely to be a major mediator of glucose tolerance in humans but it may have an inflammatory role in IGT. The data support the theory that circulating adiponectin has an anti-inflammatory and anti-insulin resistance function.