Identification of the key genes and mechanisms associated with transcatheter arterial chemoembolisation refractoriness in hepatocellular carcinoma

BACKGROUND Transcatheter arterial embolisation(TACE)is the primary treatment for intermediate-stage hepatocellular carcinoma(HCC)patients while some HCC cases have shown resistance to TACE.AIM To investigate the key genes and potential mechanisms correlated with TACE refractoriness in HCC.METHODS The microarray datasets of TACE-treated HCC tissues,HCC and non-HCC tissues were collected by searching multiple public databases.The respective differentially expressed genes(DEGs)were attained via limma R package.Weighted gene co-expression network analysis was employed for identifying the significant modules related to TACE non-response.TACE refractoriness-related genes were obtained by intersecting up-regulated TACE-associated and HCC-associated DEGs together with the genes in significant modules related to TACE nonresponse.The key genes expression in the above two pairs of samples was compared respectively via Wilcoxon tests and standard mean differences model.The prognostic value of the key genes was evaluated by Kaplan-Meier curve.Multivariate analysis was utilised to investigate the independent prognostic factor in key genes.Single-cell RNA(scRNA)sequencing analysis was conducted to explore the cell types in HCC.TACE refractoriness-related genes activity was calculated via AUCell packages.The CellChat R package was used for the investigation of the cell–cell communication between the identified cell types.RESULTS HCC tissues of TACE non-responders(n=66)and TACE responders(n=81),HCC(n=3941)and non-HCC(n=3443)tissues were obtained.The five key genes,DLG associated protein 5(DLGAP5),Kinesin family member 20A(KIF20A),Assembly factor for spindle microtubules(ASPM),Kinesin family member 11(KIF11)and TPX2 microtubule nucleation factor(TPX2)in TACE refractoriness-related genes,were identified.The five key genes were all up-regulated in the TACE non-responders group and the HCC group.High expression of the five key genes predicted poor prognosis in HCC.Among the key genes,TPX2 was an independent prognostic factor.Four cell types,hepatocytes,embryonic stem cells,T cells and B cells,were identified in the HCC tissues.The TACE refractoriness-related genes expressed primarily in hepatocytes and embryonic stem cells.Hepatocytes,as the providers of ligands,had the strongest interaction with embryonic stem cells that provided receptors.CONCLUSION Five key genes(DLGAP5,KIF20A,ASPM,KIF11 and TPX2)were identified as promoting refractory TACE.Hepatocytes and embryonic stem cells were likely to boost TACE refractoriness.

Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma

AIM: To compare radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA monotherapy in hepatocellular carcinoma (HCC). METHODS: We searched PubMed, Medline, Embase and Chinese databases (CBMdisc and Wanfang data) for randomized controlled trails comparing RFA plus TACE and RFA alone for treatment of HCC from January 2000 to December 2012. The overall survival rate, re-currence-free survival rate, tumor progression rate, and safety were analyzed and compared. The analysis was conducted on dichotomous outcomes and the standard meta-analytical techniques were used. Pooled odds ratios (ORs) with 95%CIs were calculated using either the fixed-effects or random-effects model. For each meta-analysis, the χ2 and I2 tests were first calculated to assess the heterogeneity of the included trials. For P<0.05 and I 2>50%, the assumption of homogeneity was deemed invalid, and the random-effects model wasused; otherwise, data were assessed using the fixed-effects model. All statistical analysis was conducted us-ing Review manager (version 4.2.2.) from the Cochrane collaboration. RESULTS: Eight randomized controlled trials were identified as eligible for inclusion in this analysis and included 598 patients with 306 treated with RFA plus TACE and 292 with RFA alone. Our data analysis indicated that RFA plus TACE was associated a sig-nificantly higher overall survival rate (OR 1-year=2.96, 95%CI: 1.84-7.74, P<0.001; OR 2-year=3.72, 95%CI: 1.24-11.16, P=0.02; OR 3-year=2.65, 95%CI: 1.81-3.86, P<0.001) and recurrence-free survival rate (OR 3-year=3.00, 95%CI: 1.75-5.13, P<0.001; OR 5-year=2.26, 95%CI: 1.43-3.57, P=0.0004) vs that of RFA alone. The tumor progression rate in patients treated with RFA alone was higher than that of RFA plus TACE (OR=0.60, 95%CI: 0.42-0.88, P=0.008) and there was no significant difference on major complications between two different kinds of treatment (OR=1.20, 95%CI: 0.31-4.62, P=0.79). Additionally, the meta-analysis data of subgroups revealed that the survival rate was significantly higher in patients with intermediate-and large-size HCC underwent RFA plus TACE than in those underwent RFA monotherapy; however, there was no significant difference between RFA plus TACE and RFA on survival rate for small HCC. CONCLUSION: The combination of RFA with TACE has advantages in improving overall survival rate, and pro-vides better prognosis for patients with intermediate-and large-size HCC.

Continuous regional arterial infusion for the treatment of severe acute pancreatitis: a meta-analysis

BACKGROUND： Continuous regional arterial infusion（CRAI） is a drug delivery system, which dramatically increases the drug concentration in the pancreas. Previous clinical and basic studies have demonstrated the possible therapeutic efficacy of CRAI for severe acute pancreatitis（SAP）. This meta-analysis of all published randomized controlled trials（RCTs） was conducted to assess the efficacy and safety of CRAI for the treatment of SAP. DATA SOURCES： Up to August 10, 2014, RCTs comparing CRAI with intravenous infusion for SAP in PubM ed, Embase, EBSCO, MEDLINE, Science Citation Index Expanded, Cochrane Library, China Academic Journals Full-Text Database, Chinese Biomedical Literature Database, and Chinese Scientific Journals Database were selected by two independent reviewers. The relative risk（RR） and their 95% confidence intervals（CI） for duration of elevated serum amylase and urine amylase, duration of abdominal pain, infection rate, incidence of complication, overall mortality, curative rate, hospital stay and details of subgroup analysis were extracted. Meta-analyses were made using the software Review Manager（RevM an version 5.10）.RESULTS： Six RCTs with 390 patients meeting the inclusion criteria were included in the final analysis. Compared with intravenous infusion route, CRAI significantly shortened the duration of elevated urine amylase（MD=-2.40, 95% CI=-3.20,-1.60; P〈0.00001） and the duration of abdominal pain（MD=-1.46, 95% CI=-1.94,-0.98; P〈0.00001）, decreased the incidence of complication（RR=0.35, 95% CI=0.15, 0.81; P=0.01） and overall mortality（RR=0.25, 95% CI=0.08, 0.78;P=0.02）, shortened the duration of hospital stay（MD=-10.36, 95% CI=-17.05,-3.68; P=0.002）, and increased the curative rate（RR=1.66, 95% CI=1.13, 2.46; P=0.01）. No mortality and catheter-related infections due to CRAI administration was reported in these studies. Subgroup analysis showed that the combination of drug administration via CRAI did not significantly improve the outcomes.CONCLUSION： CRAI is effective for the treatment of SAP, and the combination of drug administration via CRAI did not have a significant effect on the improvement of the outcomes.

Meta-analysis on clinical efficacy of Simiao Yong'an decoction in treatment of peripheral arterial occlusive diseases

Objective:To systematically evaluate the clinical efficacy and safety of Simiao Yong'an Decoction in the treatment of peripheral occlusive disease(PAOD).Methods:Eight randomized controlled clinical trials(RCT)of Simiao Yong'an Decoction in the treatment of PAOD were searched and screened from domestic and foreign databases(all from database construction to March 2020).The quality of the retrieved original studies was evaluated according to the evaluation criteria of Cochrane Handbook 5.1.0,and the included studies were meta-analyzed by RevMan5.3 software.Results:A total of 350 articles were retrieved,among which 14 studies met the inclusion criteria,with a total sample size of 1254 cases.The results of meta-analysis showed that:compared with conventional western Med,combined with Simiao Yong'an Decoction on the basis of western Med treatment can significantly improve the total clinical response rate of patients[RR=1.20,95%CI(1.14,1.27),P<0.00001],improve ankle brachial index(ABI)level[MD=0.79,95%CI(0.66,0.92),P<0.00001]and toe brachial index(TBI)level[RR=0.13,95%CI(0.10,0.16),P<0.00001],decreased c-reactive protein levels[MD=-8.55,95%CI(-8.99,-8.11),P<0.00001]and LDL levels[MD=-0.41,95%CI(-0.62,-0.19),P=0.0002],and increased HDL levels[MD=0.32(0.22,0.43),P<0.00001].There was no statistically significant difference in the incidence of adverse reactions[RR=0.50,95%CI(1.15,1.64),P=0.25].Conclusion:Simiao Yong'an Decoction combined with conventional western Med is more effective than conventional western Med in the treatment of PAOD.However,in view of the limitations of the quality of the analyzed literature,the positive results obtained in this study still need to be further verified by a large sample and multi-center clinical trial with a reliable research program.

Meta-analysis of the impact of hyperuricemia on contrast agent-related acute kidney injury after percutaneous coronary intervention

Objective:To evaluate the impact of hyperuricemia on the occurrence of contrast agentrelated acute kidney injury after percutaneous coronary intervention.Methods:Retrieve PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang,and VIP databases,and publish articles on the correlation between hyperuricemia and contrast agent-related acute kidney damage after percutaneous coronary intervention from the establishment of the database to August 162023.Two researchers independently conducted literature screening and data extraction to evaluate the bias risk of inclusion in the study,and conducted metaanalysis using Review Manager 5.4 software.Results:A total of 12 articles were included,including 11676 patients.The meta-analysis results showed that compared with patients without hyperuricemia,patients with hyperuricemia had a higher risk of developing PC-AKI,with an incidence rate of 22.3%.Hyperuricemia was a risk factor for the occurrence of PCAKI(OR=2.03,95%CI:1.58-2.61);Patients with hyperuricemia have a higher risk of death after PC-AKI,with a mortality rate of 7.5%.Hyperuricemia is a risk factor for early death in PC-AKI patients(OR=2.33,95%CI:1.81-3.00);The probability of CRRT treatment after PCAKI in patients with hyperuricemia is higher,at 3.14%.Hyperuricemia is an influencing factor for CRRT treatment in PC-AKI patients(OR=7,95%CI:2.83-17.30).Conclusion:Existing research evidence suggests that the presence of hyperuricemia is an independent risk factor for the occurrence of PC-AKI,and it significantly increases the hospital mortality rate and the risk of renal replacement therapy in PC-AKI patients.

Impacts of Transportation Arteries on Land Use Patterns in Urbanrural Fringe: A Comparative Gradient Analysis of Qixia District, Nanjing City, China

Integrated transportation and land use studies are of major interest to planners because they consider the interaction between transportation development and land use change. Quantifying the impact of transport infrastructure on land use change is necessary for evaluating the role of transportation development in the process of land use and land cover change in the urban-rural fringe. Taking Qixia District of Nanjing City, Jiangsu Province, China as a typical urban-rural fringe area, this paper analyzes the patterns and characteristics of land use change along three major transportation arteries using land use data from 2000 and 2008. We examine the spatial differentiation and gradient of land use pattern around railway, expressway, and highway corridors to investigate whether land use change in the urban-rural fringe is related to distance from transportation arteries and to clarify the varying impacts of different forms of transport infrastructure on land use patterns. We find that construction land generally tends to be located close to major transportation arteries, and that railways have the most obvious influence on land use change in the urban-rural fringe, while the impact of expressways was not significant. We conclude that there exists a causal relationship between the presence of transportation arteries and land use change in the urban-rural fringe, but this relationship varies across different types of linear transport infrastructure.

Arterial Imaging in Digital Gangrenes Associated with Scleroderma-Spectrum Disorders

Objectives: Digital refractory gangrene is rarely found in collagen diseases, including systemic sclerosis and is possibly caused by similar underlying vascular damage in peripheral arterial disease (PAD) such as arteriosclerosis obliterans (ASO) and/or thromboangiitis obliterans (TAO) by unclarified mechanisms other than vasculitis and thrombosis. This study evaluated the radiological imaging in patients with digital gangrene associated with collagen disease and compared the images with those of PAD based on the results of laboratory and histopathological examinations. Methods: Angiography, MR angiography and/or CT angiography were performed on 6 patients with refractory gangrene or extensive ulcers accompanied by scleroderma-spectrum disorders;3 with diffuse systemic sclerosis, 1 with limited systemic sclerosis, 1 with overlap syndrome and 1 with Sj?gren’s syndrome. Results: Although the vascular alterations in collagen diseases were similar to those in PAD, the abnormal image findings (occlusion or stenosis of the arteries with smooth vessel walls) found in collagen diseases did not include atheromatous plaque, which are worm-like vessels that are characteristic of those observed in PAD. Conclusions: Some cases of digital gangrene seen in collagen diseases show similar vascular imaging patterns to those of PAD and comprehensive examinations including arterial imaging can be useful for the diagnosis of these unrecognized vascular changes other than vasculitis or digital thrombosis.

Sevoflurane Versus Propofol for Myocardial Protection in Patients Undergoing Coronary Artery Bypass Grafting Surgery: a Meta-analysis of Randomized Controlled Trials

Objective To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods Electronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardium in adult patients undergoing CABG surgery. Two authors independently extracted patients' perioperative data, including patients' baseline characteristics, surgical variables, and outcome data. For continuous variables, treatment effects were calculated as weighted mean difference (WMD) and 95% confidential interval (CI). For dichotomous data, treatment effects were calculated as odds ratio (OR) and 95% CI. Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity (Q test P<0.05). Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects. Publication bias was explored through visual inspection of funnel plots of the outcomes. Statistical significance was defined as P<0.05. Results Our search yielded 13 studies including 696 patients, and 402 patients were allocated into sevoflurane group and 294 into propofol group. There was no significant difference in postoperative mechanical ventilation time, inotropic support, mortality, myocardial infarction, and atrial fibrillation between the two groups (all P>0.05). Patients randomized into sevoflurane group had higher post-bypass cardiac index (WMD=0.39, 95% CI: 0.18 to 0.60, P=0.0003), lower troponin I level (WMD=-0.82, 95% CI:-0.87 to-0.85, P=0.0002), lower incidence of myocardial ischemia (OR=0.37, 95% CI: 0.16 to 0.83, P=0.02), shorter ICU and hospital stay length (WMD=-10.99, 95% CI:-12.97 to-9.01, P<0.00001; WMD=-0.78, 95% CI:-1.00 to-0.56, P<0.00001, respectively). Conclusion This meta-analysis has found some evidence showing that sevoflurane has better myocardial protection than propofol in CABG surgery.

Transradial Versus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China： A Retrospective Analysis

在老病人比较在 transradial 干预( TRI )和 transfemoral 干预( TFI )之间的医院费用和临床的结果的目的在我们识别了的 65 years.Methods 上使在 Fuwai 医院里经历了经皮的冠的干预(一种总线标准)的在 65 年变老的 1229 个病人变老，中国北京，在1月1日和2010年12月31日之间。全部的医院费用和在里面医院结果在 TRI 和 TFI 之间被比较。一个反的概率 weighting (IPW ) 模型被介绍控制经历了 TRI 的潜在的 biases.Results 病人更年轻，不太经常女性、更可能为单个容器的损害收到一种总线标准、不太可能为 ostial 损害经历过程。TRI 与一 CNY7495 节省花费被联系(95%CI：CNY4419-10 420 ) 。如此的差别被更低的一种总线标准相关的费用主要驾驶。TRI 病人有停留的更短的长度(1.9 天， 95%CI：1.1-2.7 天) ，更短的 procedural 以后停留(0.7 天， 95%CI：0.3-1.1 天) ，并且更少主要不利心脏的事件(调整机会比率 = 0.47， 95%CI：0.31-0.73 ) 。在在 TRI 和 TFI 之间的一种总线标准以后的流血的发生没有统计意义(P > 0.05 ) 。在在病人的 TRI 的使用在 65 年变老的尖锐心肌的梗塞，急性冠的症候群，和稳定的 angina.Conclusion 的临床上相关的亚群一致的仍然是的如此的差别与显著地减少的医院费用和更多的有利临床的结果被联系。

A systematic review and meta-analysis of the safety and efficacy of uterine artery embolization vs. surgery for symptomatic uterine fibroids

Purpose: The aim of this study was to systematically review the safety and efficacy of uterine artery embolization(UAE) versus surgery for symptomatic uterine fibroids. Materials and Methods: An electronic search of the Cochrane Library, PubMed, Embase and Web of Science databases was conducted from their inception to May 2017 for randomized controlled trials(RCTs) that assessed UAE versus surgery for the treatment of symptomatic uterine fibroids. The references of the included studies were also retrieved. Two reviewers independently screened the studies based on the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality. The meta-analysis was conducted using RevMan 5.3 software. Results: A total of seven RCTs involving 859 patients were included. The results of the meta-analysis showed a shorter hospital stay and recovery time for UAE as compared to surgery. Surgery was not reported to be better for improving health-related quality of life in any of the included studies. There were no significant differences in patient satisfaction(1-2 and 5 years), and intra-procedural complications or major complications(1 year). However, the rates of minor complications(1 year) and further interventions(2 and 5 years) were significantly higher in patients who underwent UAE rather than surgery. The rates of pregnancy and live births were significantly lower among patients who underwent UAE than surgery. Conclusion: UAE is safe and effective, and has the advantages of shorter hospital stay and recovery time as compared to surgery. However, UAE has the risk of re-intervention, and lower pregnancy and live birth rates.

A Meta-analysis of the Biomarkers Associated with Coronary Artery Lesions Secondary to Kawasaki Disease in Chinese Children

The biomarkers associated with coronary artery lesions （CAL） secondary to Kawasaki disease （KD） in Chinese children were investigated by using Meta-analysis. We searched documents published from January 1997 to December 2009 from medical electronic databases. According to inclusion and exclusion criteria, eligible full-text papers were identified. We conducted a comprehensive quantitative analysis by using Stata10.0 statistical software package to assess the heterogeneity among the documents, calculated the summary effect and analyze publication bias and sensitivity. A total of 92 documents and 16 biomarkers were identified. All documents were case-control studies, and included 2398 patients in CAL group and 5932 patients in non-CAL （NCAL） group. The Meta-analysis showed that the levels of platelet count, platelet hematocrit （PCT）, neutrophils count, platelet distribution width （PDW）, mean platelet volume （MPV）, erythrocyte sedimentation rate （ESR）, cardiac troponin Ⅰ （cTnI）, and endothelin-1 （ET-1） in CAL group were significantly higher than those in NCAL group, and serum albumin （Alb） and hemoglobin （Hb） levels were significantly lower in CAL group （all P〈0.05）. White blood cell （WBC） count, serum sodium, matrix metalloproteinase 9 （MMP-9）, total cholesterol （TC）, hematocrit （HCT） and CD3＋T lymphocytes percentage had no statistically significant difference between the two groups. In conclusion, our results indicated that the 10 biomarkers including platelet count, neutrophils count, PCT, PDW, MPV, ESR, cTnI, ET-1, Alb and Hb were associated with CAL, and may be involved in the pathogenesis of CAL. The biomarkers of WBC count, serum sodium, MMP-9, TC, HCT, and CD3＋T lymphocytes percentage bore no relationship with the development of CAL among Chinese children with KD.

Quantitative Analysis of the Tomographic Technetium－99m MIBI （^（99m）Tc－MIBI） Myocardial Bullseye Display： Application to Diag

In this study, the 99mTc-MIBI myocardial bullseye display of 31 healthy persons and 34 patients with myocardial ischemia and 17 patients with myocardial infarction were analyzed quantitatively, and compared with the results of myocardial tomography analysis and qualitative bullseye analysis. The sensitivities of the three methods were 88.2%, 91.2 % and 94.1 % respectively (P>0.05),and the specificities were 93. 5%, 83, 9% and 83. 9% respectively (P<0.05).On the other hand, the quantitative analysis obviously outperformed the other two methods in the detection of ischemic segments of myocardium near infarction zone (P<0. 01). The quantitative analysis of 99mTc-MIBI myocardial bullseye (quantitative bullseye) was an objective, specific and sensitive method for diagnosis of coronary artery disease.

Mechanical Analysis of Multi-Component Tissues

Collagen is the major structural fiber found in mammalian tissues. It is a protein in the form of a triple-helix which is found in several subfamilies, the most abundant of which is the fiber forming group containing Types I, II and III. Type I collagen is found in tendons, skin, cornea, bone, lung and vessel walls. This collagen is thought to give rise to the high tensile strengths of collagen fibers in tissues;in addition, it is actively involved in other physiologic processes such mechanotransduction. However, the non-linear mechanical behavior and viscoelasticity of collagen fibers make analysis of the mechanical properties of tissues complicated. Mechanistically, during mechanical loading, a tensional increase in the D period is observed with increasing strain that is associated with: 1) molecular elongation at the triple-helical level of structure;2) increases in the gap distance between the end of one triple-helix and the start of the next one in the microfibril;and 3) molecular slippage. In this paper, we discuss the relationship between collagen hierarchical structure and its non-linear mechanical properties. Using vibrational analysis and optical coherence tomography, it is hoped that the mechanical properties of collagenous tissues can be studied in vivo in order to better understand tissue mechanics and to be better able to offer early diagnosis and differentiation of different disease states.

Effect of blood gas analysis in patients with bed rest and blood sampling through the dorsal artery:A meta-analysis

目的:系统评价经足背动脉采血在卧床患者血气分析中的应用效果。方法:检索PubMed、中国知网、万方数据库及维普数据库中关于经足背动脉采血在血气分析中的应用效果的随机对照试验(RCTs)。2名评价者独立对文献进行检索及筛选、提取相关数据,并对纳入文献的方法学质量进行评价后,采用RevMan5.3软件行Meta分析。结果:最终纳入12项随机对照试验,共计1696例患者。经Meta分析,经足背动脉穿刺使卧床患者动脉穿刺一次成功情况提高[Z=5.78,95%CI(1.90,3.66),P<0.001],减少血肿发生[Z=4.27,95%CI(0.19,0.54),P<0.001],减少误穿静脉的发生[Z=4.60,95%CI(0.08,0.36),P<0.001],减少青紫发生[Z=2.84,95%CI(0.23,0.81),P<0.008]差异均有统计学意义。结论:足背动脉穿刺可以提高对卧床患者动脉穿刺时一次成功的情况,减少血肿、误穿静脉及青紫的发生,可在临床推广。

Neural plasticity secondary to carpal tunnel syndrome: a pseudo-continuous arterial spin labeling study

Conventional neuroimaging techniques cannot truly reflect the change of regional cerebral blood flow in patients with carpal tunnel syndrome.Pseudo-continuous arterial spinning labeling(pCASL)as an efficient non-invasive neuroimaging technique can be applied to directly quantify the neuronal activities of individual brain regions that show the persistent symptoms owing to its better spatial resolution and increased signal-to-noise ratio.Therefore,this prospective observational study was conducted in 27 eligible female carpal tunnel syndrome,aged 57.7±6.51 years.Psychometric tests,nerve conduction studies and pCASL neuroimaging assessment were performed.The results showed that the relevant activated brain regions in the cortical,subcrotical,and cerebral regions were correlated with numbness,pain,functionality,median nerve status and motor amplitude of median nerve(K=21–2849,r=–0.77–0.76,P<0.05).There was a tendency of pain processing which shifted from the nociceptive circuitry to the emotional and cognitive one during the process of chronic pain caused by carpal tunnel syndrome.It suggests the necessity of addressing the ignored cognitive or emotional state when managing patients with carpal tunnel syndrome.Approval for this study was obtained from the Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West,China(HKU/HA HKW IRB,approval No.UW17-129)on April 11,2017.This study was registered in Clinical Trial Registry of The University of Hong Kong,China(registration number:HKUCTR-2220)on April 24,2017.

Carotid artery stenting versus carotid endarterectomy in the treatment of symptomatic and asymptomatic carotid stenosis: a systematic review and meta-analysis

Purpose: To evaluate the short-term and intermediate-to long-term efficacy and safety of carotid artery stenting(CAS) compared with carotid endarterectomy(CEA). Materials and Methods: The published literature was electronically searched for randomized controlled trials(RCTs) between CAS and CEA for the treatment of carotid stenosis performed from January 2000 to January 2017. The short-term and intermediate-to long-term outcomes were evaluated. Results: We identified 10 RCTs including 7,183 participants with symptomatic or asymptomatic carotid stenosis. Our meta-analysis found different results between the patients with and those without symptoms. In patients with symptomatic carotid stenosis, the total stroke incidence in the CAS group was significantly higher than that in the CEA group within the 30-day periprocedural period(p<0.001); however, the myocardial infarction incidence in the CAS group was significantly lower than that in the CEA group(p<0.05). There was no significant difference between the two groups in the mortality within 30 days post-procedure, but the intermediate-to long-term incidence of stroke or death in the CAS group was higher than that of the CEA group(p<0.05). In contrast, for asymptomatic patients, there were no significant differences between the CAS and CEA groups in the short-and intermediate-to long-term outcomes. Conclusion: For patients with symptomatic carotid stenosis, CEA is associated with an increased risk of myocardial infarction, whereas CAS is correlated with an increased risk of procedurally related strokes. However, for patients with asymptomatic carotid stenosis, no significant difference was found in the efficacy or safety between CAS and CEA.

Algorithm-based arterial blood sampling recognition increasing safety in point-of-care diagnostics

AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample dating.METHODS Blood pressure information obtained from a patient monitor was fed as a real-time data stream to an experimental medical framework. This framework was connected to an analytical application which observes changes in systolic, diastolic and mean pressure to determine anomalies in the continuous data stream. Detection was based on an increased mean blood pressure caused by the closing of the withdrawal three-way tap and an absence of systolic and diastolic measurements during this manipulation. For evaluation of the proposed algorithm, measured data from animal studies in healthy pigs were used.RESULTS Using this novel approach for processing real-time measurement data of arterial pressure monitoring, the exact time of blood withdrawal could be successfully detected retrospectively and in real-time. The algorithm was able to detect 422 of 434(97%) blood withdrawals for blood gas analysis in the retrospective analysis of 7 study trials. Additionally, 64 sampling events for other procedures like laboratory and activated clotting time analyses were detected. The proposed algorithm achieved a sensitivity of 0.97, a precision of 0.96 and an F1 score of 0.97.CONCLUSION Arterial blood pressure monitoring data can be used toperform an accurate identification of individual blood samplings in order to reduce sample mix-ups and thereby increase patient safety.

Screen for Coronary Artery Disease Specific Genetic Expression by Representational Differential Analysis

Objective To screen coronaryartery disease (CAD) specific expressions and clone their genes. Method Blood samples were collected from CAD and non - CAD patients at the end of coronary angiography. mRNA from samples was isolated and converted into cDNA. After ligated with specific linkers, the cDNA was amplified with complementary primers. PCR products from CAD samples were named as tester; the ones from non - CAD samples were named as driver. With different ratio of tester to driver (1 : 100,1: 1, 000, and 1: 10, 000), they were mixed, denatured, and renatured. Single strand cD-NA was eliminated by Mung bean nuclease. Double strand cDNA presented only in tester was amplified, ligated in vector pUC19 and pUC53, and transformed into E. coll DH5a. Strains with inserted cDNA fragments were picked up based on blue and white selection. Insertions were screened by endonuclease digestion and DNA sequencing. Results were compared with DNA sequences of GeneBank. Results: After the selection with representational differential analysis, CAD specific cDNA fragments with different sizes (about 1kb, 0. 75kb, and 0. 6kb) were cloned. Among them, two fragments from unknown genes were identified. One presented a 43. 3 % similarity with part of the rattus norvegicus lipocortin gene. Another presented a 45. 4 % similarity with part of the human polynucleotide kinase 3' - phosphatase gene. Conclusion There are at least two CAD specific - ex- pressions from unknown genes that were partially similar to lipocortin and polynucleotide kinase 3'- phos-phatase genes, respectively. Expression of these genes might affect the formation and progression of plaque within coronary artery.

The Initial Tangent of the Femoral Arterial Pressure Increase Is an Estimate of Left Ventricular Contractility in Patients Undergoing Cardiacsurgery

Purpose: Assessment of contractile function is a major challenge in patients with left ventricular dysfunction, especially during cardiac surgery. The initial tangent of the femoral arterial pressure increase (tanin) has recently been described to be an estimate of left ventricular (LV) contractility. To confirm these findings tanin was compared to various indices of LV performance in patients undergoing cardiac surgery. Methods: Data from 17 patients were evaluated retrospectively. Myocardial performance was estimated by the echocardiographic indices ejection fraction (EF), shortening fraction (FS), circumferential fiber shortening velocity (Vcf), the parameters of pulse contour analysis area under the curve (AUC) and tanin. Measurements were taken before and after cardiopulmonary bypass (CPB). Results: Tanin increased significantly (813 ± 216 mmHg/s vs. 1490 ± 450 mmHg/s, p < 0.05) after CPB, as well as Vcf (0.89 ± 0.14 circ/s vs. 1.47 ± 0.27 circ/s, p < 0.05) and EF (65% ± 7% vs. 74% ± 6%, p < 0.05). FS did not change (40.7% ± 7% vs. 46.5% ± 5%, p = 0.30). AUC significantly dropped after CPB (435 ± 54 mmHg*s vs. 263 ± 27 mmHg*s). Tanin and Vcf correlated strongly (r = 0.70, p < 0.001), while tanin showed only weak correlation with EF (r = 0.36, p = 0.037). There was no significant correlation with FS (r = 0.31, p = 0.079). Tanin and AUC correlated inversely (r = -0.62, p < 0.001). Conclusions: While showing little or no correlation with EF and FS respectively, tanin correlated well with the less preload-dependent parameter Vcf, thus suggesting that tanin may be used as an easily accessible estimate of LV contractility during cardiac surgery.

Bioinformatics Analysis of the Regulatory lncRNA–miRNA–mRNA Network and Drug Prediction in Patients with Pulmonary Arterial Hypertension

Objective:Pulmonary arterial hypertension(PAH)is a cardiovascular disease caused by primary proliferative lesions in pulmonary arterioles.Competing endogenous RNAs(ceRNAs)have been reported to act as sponges for microRNAs(miRNAs).To date,however,the mechanisms underlying ceRNA involvement in PAH have not been investigated.This study aimed to construct a PAH-related ceRNA network to further explore the mechanisms of PAH.Methods:A probe reannotation was conducted to identify the long non-coding RNAs(lncRNAs)and messenger RNAs(mRNAs)involved in PAH.Based on the reannotation results,the“limma”package was used to identify the differentially expressed genes(DEGs)and lncRNAs.The miRcode database was used to predict the lncRNA–miRNA interactions.Then,the mRNAs targeted by the miRNAs were predicted by using TargetScan,miRTarBase,and miRDB.Based on the above interactions,a ceRNA network was constructed,which was mapped and visualized with Cytoscape 3.6.1 software.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed using the database.To predict possible drugs or molecules that may mitigate PAH,C-Map analysis was applied to find relevant molecular compounds that can reverse the expression of DEGs in cell lines.Results:The ceRNA network consisted of 174 nodes and 304 links,which included 10 lncRNAs,23 miRNAs,and 53 mRNAs.The hub genes of the ceRNA network for PAH included hsa-miR-17-5p,hsa-miR-20b-5p,MEG3,HCP5,hsa-miR-27a-3p,hsa-miR-107,hsa-miR-142-3p,hsa-miR-363-3p,hsa-miR-301b-3p,and hsa-miR-23b-3p.Calprotectin,irinotecan,and medrysone were found to be the 3 significant compounds.Conclusion:This study found that hsa-miR-17-5p,hsa-miR-20b-5p,MEG3,HCP5,hsa-miR-27a-3p,hsa-miR-107,hsa-miR-142-3p,hsa-miR-363-3p,hsa-miR-301b-3p,and hsa-miR-23b-3p maybe the underlying biomarkers and targets for diagnosis and treatment of PAH.