Objective To evaluate the efficacy and safety of laser-assisted balloon angioplasty(LABA)in treating patients with infrapopliteal arterial occlusion complicated by critical limb ischemia(CLI).Methods The clinical data of patients with infrapopliteal artery occlusion complicated by CLI,who were admitted to the Fuwai Central China Cardiovascular Hospital to receive LABA(LABA group)or balloon angioplasty alone(BA group)between January 2019 and December 2021,were retrospectively analyzed.The incidence of perioperative complications and postoperative clinical efficacy were compared between the two groups.Results A total of 32 patients received LABA therapy and 40 patients received BA alone.The technical success rate,the postoperative ankle-brachial index(ABI),the numerical value of postoperative ABI value deducting preoperative ABI value,the postoperative 24-month continuous improvement rate of clinical symptoms and the primary patency rate of target vessels in the LABA group were remarkably higher than those in the BA group(all P＜0.05).No procedure-related target vessel perforation,amputation,or death occurred in both groups.No statistically significant differences in the target vessel dissection,distal embolism,remedial stenting,and postoperative 24-month amputation-free survival existed between the groups(all P＞0.05).Conclusion For the infrapopliteal arterial occlusion complicated by CLI,LABA therapy is clinically safe and effective,and its mid-term efficacy is superior to BA alone.

Objective To investigate the effect and mechanism of methyltransferase-like 3(METTL3)on the pro-liferation,migration,and secretion of inflammatory factors by synovial fibroblasts from rheumatoid arthritis(RA).Methods The expression of METTL3 in synovial tissue(SF)from 25 patients with rheumatoid arthritis and 25 pa-tients with osteoarthritis was detected by RT-qPCR and immunohistochemistry,respectively.The concentration of RNA m6A was detected by ELISA.RA synovial fibroblasts were isolated and cultured,and divided into NC(nor-mal control)group,hi-METTL3(overexpression of METTL3)group,si-METTL3(knock-down METTL3)group,and STM2457(METTL3 specific inhibitor)intervention group.Cell proliferation was detected by CCK-8 method.Apoptosis was detected by flow cytometry.And the concentrations of interleukin-6(IL-6),interleukin-17A(IL-17A),receptor activator of nuclear factor-kappa B ligand(RANKL),and osteoprotegerin(OPG)in the superna-tant of cell culture were detected by ELISA.Results Compared with synovial tissue of osteoarthritis,the expres-sion of mRNA m6A and METTL3 in synovial tissue of RA significantly increased(P<0.05).After overexpression of METTL3,the expression of m6A in synovial fibroblasts increased.The proliferation and migration abilities of SF in hi-METTL3 group were significantly improved,and their apoptosis did not change significantly.The secretion of cytokines IL-6 and RANKL of SF in hi-METTL3 group significantly increased,while the OPG significantly de-creased(P<0.05).After interfering with METTL3 expression,the expression of m6A in synovial fibroblasts de-creased.Cell proliferation and migration of SF in siMETTL3 group significantly decreased.The secretion of cyto-kines IL-6 and RANKL significantly decreased,and OPG significantly increased(P<0.05).After intervention with METTL3 inhibitor STM2457,the proliferation and migration of synovial fibroblasts were significantly reduced,and the secretion of cytokines IL-6 and RANKL significantly reduced,and OPG significantly increased(P<0.05).There was no significant difference in the expression of IL-17A among each group.Conclusion METTL3 may promote the proliferation and migration of RA synovial fibroblasts,enhance the expression of IL-6 and RANKL,and inhibit the expression of OPG through RNA m6A methylation modification.

Objective:To investigate the efficacy of excimer laser atherectomy (ELA) combined with drug-coated balloon (DCB) in the treatment of femoropopliteal arteriosclerosis obliterans (ASO) and its influencing factors.Methods:The clinical data of patients with femoropopliteal ASO treated by ELA combined with DCB from July 2019 to March 2022 were retrospectively analyzed, including technical success rate, ankle-brachial index(ABI), primary patency rate and freedom from target lesion revascularization (TLR) rate. Cox regression was applied to analyze the risk factors affecting the decline in the rate of primary patency and freedom from TLR.Results:All 82 patients were treated with ELA+DCB. The technical success was 91.5%. The post-operative ABI (0.73±0.13) was significantly higher than preoperative ABI (0.39±0.11) ( t=35.26, P<0.001). The 24-month cumulative primary patency and TLR-free rates were 64.1% and 76.8%, respectively. Lesion length>15 cm ( HR=2.57, P=0.047) and severe calcification ( HR=3.26, P=0.021) were associated with loss of primary patency. Having diabetes ( HR=5.24, P=0.010) and a single postoperative outflow tract ( HR=4.18, P=0.008) were associated with a decrease in TLR-free rates. Conclusions:ELA combined with DCB for femoropopliteal ASO is safe and has good intermediate efficacy. Lesion length>15 cm and severe calcification were independent risk factors for primary patency rate, and diabetes and a single postoperative outflow tract were independent risk factors for TLR-free rate.

Objective:To study the role and preliminary molecular mechanism of TRIM24 regulating macrophage polarization in viral myocarditis(VM).Methods:VM mouse model was established by Coxsackie virus B3(CVB3),and expression of TRIM24 in myocardial tissue was detected.Cardiac inflammation level and polarization phenotype of cardiac infiltrating macrophages in a murine model of cardiac TRIM24 inhibition were detected in vivo.A polarization model of mouse bone marrow-derived macrophages(BMDMs)in vitro was established to observe the role of TRIM24 inhibition in polarizing BMDMs to M1 and M2,as well as its effects on phagocy-tosis and bactericidal function of BMDMs.Effects of TRIM24 inhibition on total STAT6 protein level and phosphorylation were investi-gated.Results:TRIM24 was significantly highly expressed in myocardial tissue of VM mice(P<0.001).Inhibition of TRIM24 expres-sion in myocardium had an attenuating effect on VM and promoted polarization of cardiac infiltrating macrophages to M2.TRIM24 was significantly down-regulated in vitro during the polarization of BMDMs toward M2(P<0.01).Inhibition of TRIM24 expression signifi-cantly promoted macrophage polarization toward M2 type and inhibited polarization toward M1 type,accompanied by a significant increase in STAT6 phosphorylation levels(P<0.01).Conclusion:TRIM24 regulates macrophage M2 polarization via activation of STAT6 signaling pathway to attenuate VM.

Electrocardiogram (ECG) signal is an important basis for the diagnosis of arrhythmia and myocardial infarction. In order to further improve the classification effect of arrhythmia and myocardial infarction, an ECG classification algorithm based on Convolutional vision Transformer (CvT) and multimodal image fusion was proposed. Through Gramian summation angular field (GASF), Gramian difference angular field (GADF) and recurrence plot (RP), the one-dimensional ECG signal was converted into three different modes of two-dimensional images, and fused into a multimodal fusion image containing more features. The CvT-13 model could take into account local and global information when processing the fused image, thus effectively improving the classification performance. On the MIT-BIH arrhythmia dataset and the PTB myocardial infarction dataset, the algorithm achieved a combined accuracy of 99.9% for the classification of five arrhythmias and 99.8% for the classification of myocardial infarction. The experiments show that the high-precision computer-assisted intelligent classification method is superior and can effectively improve the diagnostic efficiency of arrhythmia as well as myocardial infarction and other cardiac diseases.
Humans ; Electrocardiography ; Heart Diseases ; Myocardial Infarction/diagnostic imaging* ; Algorithms ; Electric Power Supplies

Objective:To investigate the risk factors for retrograde type A dissection (RTAD) associated with thoracic endovascular aortic repair (TEVAR) which provided the basis for clinical risk stratification and treatment decision.Methods:The clinical data of 1 688 patients with thoracic aortic disease who underwent TEVAR in our center from January 2004 to December 2019 were retrospectively analyzed. The pathological classification included aortic dissection (1 592 cases) and other thoracic aortic diseases (96 cases). Univariate analysis and categorical multiple logistic regression analysis were used to explore the risk factors for the development of RTAD during or after TEVAR.Results:A total of 18 cases of RTAD were found, with an overall incidence of 1.1% (18/1 688), all of which occurred in aortic dissection group. After adjusting for confounding factors, multivariate logistic regression analysis showed that the incidence of RTAD was significantly decreased(OR=0.27,95%CI 0.07-0.96, P=0.043) when the oversize of stentgraft was 11%-20%, the oversize of stentgraft was ≤10% as the control group, and the difference was statistically significant( P<0.05). The ascending aorta diameter was <40 mm as the control group, and there was no significant difference in the incidence of RTAD between the ≥40 mm group and the control group(OR=2.71,95%CI 0.94-7.84, P=0.065). Conclusions:Aortic dissection is more likely to develop RTAD than other thoracic aortic diseases. A proper stentgraft oversizing ratio could reduce the probability of RTAD. That is to say that a too low stentgraft oversizing ratio is not recommended.

Objective:To explore the optimal match degree between thoracolumbar kyphosis (TLK) and lower lumbar lordosis (LLL) in adult spinal deformity (ASD) after correction surgery.Methods:Data of 119 ASD patients (male: 28, female: 91), belonging to the Affiliated Hospital of Jining Medical University (19 cases), the Affiliated Hospital of Shandong University of Traditional Chinese Medicine (11 cases), and the First Medical Center of Chinese PLA General Hospital (89 cases) were reviewed and documented from March 2019 to March 2020. All patients (age, 64.48±8.88 years; range, 45-79 years) underwent the surgical procedure of thoracolumbar fusion with instrumentations were followed up over 24 months (51.68±15.60 months; range, 24-87 months) after surgery. Postoperative proximal interface failure, Oswestry disability index (ODI) score and Scoliosis Research Society-22 (SRS-22) score were recorded for all patients. The immediate match of TLK to LLL postoperatively was calculated as follows: TLM=TLK/LLL. The data of those individuals with excellent improvements in the ODI (>50%) at the final follow-up were recorded and analyzed. Then the mean value and the 95% CI of TLM in those individuals were calculated. All participants were subdivided into three groups according to the 95% CI value of TLM. After the receiver operating characteristic curve (ROC) analyzing, the area under the ROC curve (AUC) was the best cutoff value of TLM. The association of proximal junctional failure (PJF) developing with the abnormal TLM postoperatively was analyzed with logistic regression, and the odds ratio (OR) was calculated. Results:62 patients had significant improvements in ODI (>50%) at the final follow-up, and the mean TLM in those individuals was 0.41 [95% CI (0.2, 0.5)]. All patients were divided into three groups: TLM<0.2 (35 cases), 0.2≤TLM≤0.5 (48 cases) and TLM>0.5 (36 cases). The preoperative TLK (13.87°±16.61°) and T 1 pelvic angle (19.69°±10.55°) in the those patients with TLM<0.2 were the smallest, and those were the largest in those with TLM>0.5 (30.59°±16.68°, 28.30°±14.46°). The individuals with TLM<0.2 still had the smallest TLK (2.89°±1.78°), however, those with TLM>0.5 had the largest TLK (17.13°±12.13°) and the smallest LLL (-26.16°±11.02°) accordingly. Additionally, the ODI and SRS-22 for those with 0.2≤TLM≤0.5 at the final follow-up were the best ( P<0.05). ROC curve analysis results showed that the best cutoff value of TLM was 0.4 (sensitivity=78.9%, specificity=76.2%; AUC=0.802, 95% CI (0.708, 0.896) , P<0.001). During the follow-up after orthopedic surgery, there were 19 patients with postoperative proximal junction failure, including 16 patients in the mismatched group (6 patients in the TLM<0.2 group, 10 patients in the TLM>0.5 group) and 3 patients in the matched group (0.2≤TLM≤0.5 group), with the incidence of 23% (16/71) and 6% (3/48), respectively. The difference was statistically significant (χ 2=5.66, P=0.017). Thoracolumbar mismatch was significantly associated with proximal borderline failure after orthosis [ OR=4.35, 95% CI (1.196, 15.924)]. Conclusion:The abnormal correction in thoracolumbar kyphosis and lower lumbar lordosis may result in mismatch between thoracolumbar segments, which would undermine the quality of life, and increase the incidence of proximal junctional failure developing in those ASD patients underwent long-fusion surgeries. The match between TLK and LLL should be 0.2 to 0.5.

Objective To investigate the effect of viral myocarditis serum exosomal miR-320 on apoptosis of cardiomyocytes and its mechanism. Methods The model of viral myocarditis mice was established by intraperitoneal injection of Coxsackie virus B3. Serum exosomes were extracted by serum exosome extraction kit and co-cultured with cardiomyocytes. The uptake of exosomes by cardiomyocytes was detected by laser confocal microscopy. Cardiomyocytes were transfected with miR-320 inhibitor or mimic, and the expression level of miR-320 was detected by real-time quantitative PCR. Flow cytometry was used to detect cardiomyocyte apoptosis rate, and the expression levels of B cell lymphoma 2 (Bcl2) and Bcl2-related X protein (BAX) were tested by Western blot analysis. The prediction of miR-320 target genes and GO and KEGG enrichment analysis were tested by online database. The relationship between miR-320 and its target gene phosphoinositide-3-kinase regulatory subunit 1(Pik3r1) was examined by luciferase reporter gene. The effect of miR-320 on AKT/mTOR pathway protein was detected by Western blot analysis. Results Viral myocarditis serum exosomes promoted cardiomyocyte apoptosis, and increased the level of BAX while the level of Bcl2 was decreased. miR-320 was significantly up-regulated in myocardial tissue of viral myocarditis mice, and both pri-miR-320 and mature of miR-320 were up-regulated greatly in cardiomyocytes. The level of miR-320 in cardiomyocytes treated with viral myocarditis serum exosomes was significantly up-regulated, while transfection of miR-320 inhibitor counteracted miR-320 overexpression and reduced apoptosis rate caused by exosomes. Pik3r1 is the target gene of miR-320, and its overexpression reversed cardiomyocyte apoptosis induced by miR-320 up-regulation. The overexpression of miR-320 inhibited AKT/mTOR pathway activation. Conclusion Viral myocarditis serum exosome-derived miR-320 promotes apoptosis of mouse cardiomyocytes by inhibiting AKT/mTOR pathway by targeting Pik3r1.
Mice ; Animals ; Myocytes, Cardiac ; Phosphatidylinositol 3-Kinase/metabolism* ; Proto-Oncogene Proteins c-akt/metabolism* ; Myocarditis/pathology* ; Exosomes/metabolism* ; bcl-2-Associated X Protein/metabolism* ; MicroRNAs/metabolism* ; TOR Serine-Threonine Kinases/metabolism* ; Apoptosis/genetics*

Objective:To explore the clinical application value of personalized positioning using a cervical collar combined with a vacuum pad in the Cyberknife radiosurgery for cervical spine metastases.Methods:This study enrolled 68 patients with cervical spine metastases to be treated with Cyberknife stereotactic radiotherapy for cervical spines. These patients consisted of 41 males and 27 females, aged from 43 to 78 years (average: 51.5 years). They were divided into groups A, B, and C using the random number table method. The patient positioning in these groups was achieved using a cervical collar combined with a vacuum pad (personalized positioning), a vacuum pad, and a small head mold, respectively. After the first treatment, the comfort levels of the positioning molds during treatment were investigated. After radiotherapy, the average deviations in translational and rotational directions, the minimum tolerance distance (dxAB), the minimum rotational deviation angle (drAB), the proportion of false nodes, and the comfort level of the three positioning method were acquired for analysis.Results:The three groups showed statistically significant differences in the inf-sup, left-right, ant-post, pitch, roll, and yaw directions during the first treatment ( F = 7.13, 2.56, 3.41, 4.21, 2.71, 8.14, P < 0.05). Compared with groups B and C, Group A had significantly lower dxAB, drAB, and the proportion of false nodes, showing statistically significant differences ( F = 5.06, 4.31, 3.30, P < 0.05). Furthermore, patients in groups A and B felt more comfortable with the positioning molds than those in Group C ( χ2 = 12.46, P < 0.05), with no statistically significant differences between groups A and B ( P > 0.05). Conclusions:For patients with cervical spine metastases undergoing Cyberknife radiosurgery for cervical spines, the personalized positioning using a cervical collar combined with a vacuum pad can improve the accuracy and safety of Cyberknife spinal tracking while remaining the comfort level.

【Objective】 To investigate the prevalence of occult hepatitis C virus infection (OCI) in Shaanxi blood donors and characterize the occult hepatitis C virus in this cohort. 【Methods】 Between July and September of 2019, 112, 117, 46, and 75 blood samples were obtained from eligible donors, alanine aminotransferase (ALT) elevated donors(ALT>50 U/L), hepatitis B virus surface antigen (HBsAg) positive donors, and anti-hepatitis C virus (anti-HCV) positive donors, respectively. Peripheral blood lymphocytes (PBMCs) were isolated from all the samples. HCV 5′UTR was amplified from total RNA of PBMCs using reverse transcription nested PCR (RT-Nested PCR) to detect the infection status of OCI in blood donors. HCV RNA core/E2 region was amplified from HCV RNA positive samples with RT-Nested PCR to determine HCV genotypes and subtypes via sequencing. 【Results】 Two (2.67%, 2/75) cases of OCI were identified in anti-HCV positive samples, 1(0.85%, 1/117) case of OCI was identified in abnormal ALT samples, and all OCI were genotyped as 1b. OCI was not found in HBsAg positive and eligible blood donors. 【Conclusions】 Our findings suggest that OCI does exist among Shaanxi blood donors and that ALT may be useful in diagnosing OCI.