Surgical Correction of Coronary Artery Ectasia Combining Congenital Coronary Artery Fistula

Background:Coronary artery ectasia(CAE)complicated with concomitant congenital coronary artery fistula(CCAF)is rare.This study characterizes the clinical characteristics of CAE combining CCAF,and reports a single-institution experience with surgical correction of CAE combining CCAF.Methods:A total of 24 symptomatic patients(8 males,median 52.5 years old)who underwent surgical correction of CAE combining CCAF in this center were reviewed.Based on the size of ectatic segment,the CAE were classified as a giant CAE(>20 mm,n=14)and a non-giant CAE(≤20 mm,n=10).Individualized surgical approaches were chosen.The patients were followed up for a median of 3.8 years.Results:The overwhelming majority of CAEs were solitary,and only 4.2%of CAEs were associated with multiple lesions.CAEs were predominantly located in the right coronary artery with predilection to women more than to men(2:1).95.8%of patients with the CCAF had single fistula defect.The right atrium was the most frequent drainage site(33.3%)followed by the left ventricle(25.0%).Surgical mortality was 4.2%.All 22 follow-up patients survived with recovery from symptoms and New York Heart Association(NYHA)functional class I-II.In 10 patients with non-giant CAEs undergoing closure of fistula alone,favorable in-hospital outcomes were recorded,but residual fistula(one patient)and acute inferior wall myocardial infarction related to intracoronary thrombosis(one patient)were observed at follow-up.In 11 patients with giant CAEs undergoing aneurysm resection plus distal bypass grafting at the time of closure of fistula,favorable in-hospital outcomes and encouraging midterm results were recorded.Additionally,in 3 patients with giant CAEs undergoing closure of fistula plus aneurysmal plication,adverse events occurred,including surgical death related to rupture of the ectatic segment(one patient),perioperative myocardial infarction caused by acute thromboembolism(one patient),nonfatal inferior wall myocardial infarction related to intracoronary thrombosis(one patient)at follow-up.Conclusion:Individualized surgical approaches based on the size and the location of ectatic coronary artery as well as fistula should be offered to symptomatic patients with CAE combining CCAF.

Role of chemokines in the hepatocellular carcinoma microenvironment and their translational value in immunotherapy

The difficulty of early diagnosis,high tumor heterogeneity,and high recurrence and metastasis rates lead to an unsatisfactory treatment status for hepatocellular carcinoma(HCC).HCC is a typical inflammation-driven tumor.Chronic inflammation allows nascent tumors to escape immunosurveillance.Chemokines are small,soluble,secreted proteins that can regulate the activation and trafficking of immune cells during inflammation.Several studies have shown that various chemokines with overarching functions disrupt the immune microenvironment during the initiation and progression of HCC.The dysregulated chemokine network in HCC contributes to multiple malignant processes,including angiogenesis,tumor proliferation,migration,invasion,tumor low response,and resistance to immune therapy.Here,we summarize the current studies focusing on the role of chemokines and their receptors in the HCC immune microenvironment,highlighting potential translational therapeutic uses for modulating the chemokine system in HCC.

基于图像内容的物品推荐

摘 要:针对物品推荐技术中存在的目标用户和相似用户均未标记的物品无法预测以及未考虑用户已购买情况等问题,提出了一种基于图像内容的物品推荐方法。该方法提取物品图像的颜色、形状和纹理特征来表示物品,通过图像内容间的相似性和用户相似性完成了对目标用户未标记物品兴趣度的预测,并引入用户兴趣度因子来反映用户已购买的情况对用户兴趣的影响,最终根据用户购买项目的静态特征给出推荐结果。在自建的物品图像数据集上,用文中方法与基于用户的协同过滤技术、基于项目的协同过滤技术以及two-way三种方法进行对比试验,实验结果表明,该方法具有良好的物品推荐品质。

The switch triggering the invasion process:Lipid metabolism in the metastasis of hepatocellular carcinoma

In humans,the liver is a central metabolic organ with a complex and unique histological microenvironment.Hepatocellular carcinoma(HCC),which is a highly aggressive disease with a poor prognosis,accounts for most cases of primary liver cancer.As an emerging hallmark of cancers,metabolic reprogramming acts as a runaway mechanism that disrupts homeostasis of the affected organs,including the liver.Specifically,rewiring of the liver metabolic microenvironment,including lipid metabolism,is driven by HCC cells,propelling the phenotypes of HCC cells,including dissemination,invasion,and even metastasis in return.The resulting formation of this vicious loop facilitates various malignant behaviors of HCC further.However,few articles have comprehensively summarized lipid reprogramming in HCC metastasis.Here,we have reviewed the general situation of the liver microenvironment and the physiological lipid metabolism in the liver,and highlighted the effects of different aspects of lipid metabolism on HCC metastasis to explore the underlying mechanisms.In addition,we have recapitulated promising therapeutic strategies targeting lipid metabolism and the effects of lipid metabolic reprogramming on the efficacy of HCC systematical therapy,aiming to offer new perspectives for targeted therapy.

Association between CYP2C9, VORC1, VDR, and APOE genotypes on warfarin maintenance and response during initial anticoagulation for Chinese patients with heart valve replacement

To the,Editor:For patients with mechanical and bioprosthetic heart valve replacement,vitamin K antagonist(VKA)therapy is recommended according to guidelines.Effective and safe therapywith warfarin requires continuous monitoring of prothrombin time and international normalized ratio(INR)levels to adjust the dose of warfarin.

Repetitive transcranial magnetic stimulation causes significant changes of chemical substances in the brain of rabbits with experimental intracerebral hemorrhage

More and more studies have reported the use-fulness of repetitive transcranial magnetic stimulation(rTMS)in the treatment of stroke patients.This article is to explore if rTMS can cause changes of such chemical substances as N-acetylaspartate(NAA),choline(Cho)and creatine(Cr)in the surrounding area of experimental intracerebral hematoma of rabbits.A total of 36 rabbits were randomly divided into 3 groups:a control group(group A),a sham rTMS group(group B)and an rTMS group(group C).The experimental intracerebral hemor-rhage(ICH)was induced by intracerebral injection of self-body blood of the animals in groups B and C,while those of the group A serving as controls were injected with nor-mal saline.The rabbits of groups B and C were treated with sham and real rTMS,respectively,but those of group A were not.The contents of chemical substances including NAA,Cho and Cr in the perihematomal brain tissues were measured by using lH-magnetic resonance spectro-scopy(1H-MRS)12 hours,72 hours,1 week and 2 weeks after the experimental ICH was induced.The results show that the contents of NAA,Cr and NAA/Cr ratio were decreased significantly,but Cho,Cho/Cr increased signifi-cantly in groups B and C(P,0.01)as compared against those in group A.A comparison between the groups B and C revealed that the contents of NAA,Cr,NAA/Cr were higher,but Cho and Cho/Cr were significantly lower in group C than those in group B(P,0.01).It is concluded that rTMS could result in changes of the chemical sub-stance contents in perihematomal brain tissues,which leads to neuroprotective effects in the brain.