Objective:To explore the related risk factors for systemic embolism (SE) in patients aged≥75 years with non-valvular atrial fibrillation (NVAF).Methods:A case-control study. NVAF patients aged≥75 years who were hospitalized at the First Affiliated Hospital of Xinjiang Medical University from October 2018 to October 2020 were divided into no SE ( n=1 127) and SE ( n=433) groups according to the occurrence of SE after NVAF. Multivariate logistic regression was used to analyze SE-related factors in patients with NVAF without anticoagulation treatment. Results:In the multivariate model, the following factors were associated with an increased risk of SE in patients with NVAF: history of AF≥5 years [odds ratio ( OR)=2.75, 95% confidence interval ( CI) 1.98-3.82, P<0.01], lipoprotein(a)>300 g/L ( OR=2.07, 95% CI 1.50-2.84, P<0.01), apolipoprotein (Apo)B>1.2 g/L ( OR=1.91, 95% CI 1.25-2.93, P=0.003), left ventricular ejection fraction (LVEF) of 30%-49% ( OR=2.45, 95% CI 1.63-3.69, P<0.01), left atrial diameter>40 mm ( OR=1.54, 95% CI 1.16-2.07, P=0.003), and CHA 2DS 2-VASc score≥3 ( OR=15.14, 95% CI 2.05-112.13, P=0.01). ApoAI>1.6 g/L was negatively correlated with the occurrence of SE ( OR=0.28, 95% CI 0.15-0.51, P<0.01). Conclusions:History of AF≥5 years, lipoprotein(a)>300 g/L, elevated ApoB, left atrial diameter>40 mm, LVEF of 30%-49%, and CHA 2DS 2-VASC score≥3 are independent risk factors for SE whereas ApoAI>1.6 g/L is a protective factor against SE in patients with NVAF.

Objective:To explore the correlation between intraoperative regional cerebral oxygen saturation(rScO 2) and nerve damage markers with postoperative neurological dysfunction(PND) in patients undergoing acute Stanford type A aortic dissection surgery. Methods:A total of 57 patients undergoing acute Stanford type A aortic dissection surgery under cardiopulmonary bypass(CPB) in the operating room of Henan Provincial Hospital from July 2020 to May 2021 were enrolled, regardless of gender, aged 35-64 years old, weighed 58.0-90.0 kg and with American Association of Anesthesiologists(ASA) classification status with Ⅱ-Ⅲ. A near infrared spectrometer(NIRS) was used to continuously monitor the bilateral rScO 2 of the patients during the surgery. Central venous blood was drawn 10 min before induction of anesthesia(T0), 10 min after induction of anesthesia(T1), immediately after CPB started(T2), when CPB ended(T3), at the end of the operation(T4), and when exiting ICU(T5), 1 day(T6), 2 days(T7) and 3 days(T8) after operation, and the levels of nerve injury marker S100 calcium binding protein(S100β protein) and neuron-specific enolase(NSE) in serum were measured. Follow up was performed on postoperative 3 to evaluate the occurrence of PND.The value of intraoperative rScO 2 and the concentrations serum S100β protein and NSE were compared between the PND group and the NND(NPND) group. The changes of intraoperative rScO 2 value, the concentrations of serum S100β protein and NSE between the PND group and NPND group were compared. The risk factors of PND and its correlation with the intraoperative rScO 2 value, and the concentrations of serum S100β protein and NSE were analyzed. The prognostic indicators of the two groups of patients were statistically analyzed. Results:Three patients were excluded from the study. A total of 12 patients(22.2%) developed PND(PND group), and 42 patients(77.8%) did not develop PND(NPND group) on postoperative 3 day. Compared with the NPND group, the minimum mean arterial pressure and the minimum rScO 2 during CPB were significantly decreased( P<0.05), the maximum da-rScO 2 during CPB was significantly increased( P<0.05), and duration of da-rScO 2>0.50, duration of da-rScO 2>0.40, duration of rScO 2 reduction >25%, rScO 2<0.50, rScO 2<0.40, during CPB were significantly prolonged( P<0.05) in the PND group. The levels of serum S100β and NSE in the PND group were significantly increased, compared with the NPND group at T2-8, respectively. Logistic regression analysis showed that the reduction of rScO 2 more than 25%( P=0.033), during of rScO 2<0.40( P=0.007) and duration of da-rScO 2>0.50( P=0.001) during CPB were risk factors of PND. Conclusion:Compared with the NPND group, the postoperative mechanical ventilation time, duration of ICU stay, postoperative hospital stay and PND recovery time were significantly prolonged( P<0.05), and the medical expenses were increased significantly( P<0.05) in the PND group. The duration of the reduction of rScO 2>25%, the duration of rScO 2<0.40 and the duration of da-rScO 2>0.50 during CPB are the risk factors of PND in patients with acute Stanford type A aortic dissection under CPB. Significantly increased levels of serum nerve injury markers S100β and NSE are related to the occurrence of PND. The occurrence of PND has a significant adverse effect on the early clinical prognosis of patients.

Objective:To investigate the association between abnormal left atrial appendage function and thrombotic events in patients with non-valvular atrial fibrillation, and the independent risk factors affecting left atrial appendage function.Methods:Patients with non-valvular atrial fibrillation, who visited the Atrial Fibrillation Center of the First Affiliated Hospital of Xinjiang Medical University from June 1, 2019 to June 1, 2021, were selected. According to left atrial appendage flow velocity (LAAFV), they were divided into normal left atrial appendage function group (297 patients with LAAFV ≥ 40 cm/s) and abnormal left atrial appendage function group (85 patients with LAAFV<40 cm/s). Baseline data and transesophageal echocardiography images were collected from all the patients. The occurrence of thrombotic events was recorded. Univariate and multivariate unconditional logistic regression analyses were conducted to investigate the correlation between abnormal left atrial appendage function and the occurrence of thrombotic events.Results:There were significant differences in gender, type of atrial fibrillation, CHA 2DS 2-VASc score, anticoagulant therapy, total cholesterol, low-density lipoprotein cholesterol, international normalized ratio (INR), left atrial diameter, proportion of patients with right atrial enlargement, left ventricular ejection fraction, inner diameter, sum of inner diameter, depth, and sum of depth of all angles of the left atrial appendage, and incidence of thrombotic events between the two groups (all P<0.05). After adjusting for confounders, multivariate unconditional logistic regression analyses showed that abnormal left atrial appendage function was closely associated with thrombotic events (β=1.168 P=0.002), and left atrial diameter ( OR=1.084, 95% CI 1.019-1.153, P=0.011) and persistent atrial fibrillation ( OR=2.323, 95% CI 1.226-4.403, P=0.010) were independent risk factors affecting left atrial appendage function. Conclusions:Abnormal left atrial appendage function is closely associated with thrombosis. The left atrial diameter and persistent atrial fibrillation were independent risk factors affecting left atrial appendage function.

Objective:To observe and investigate the effect of HIF-2α in the process of neovascularization of proliferative diabetic retinopathy (PDR).Methods:Retrospective clinical study. From July 2014 to July 2015, 60 eyes of 57 PDR patients diagnosed in Ophthalmology Department of Affiliated Hospital of Qingdao University were included in the study. Twenty-eight eyes of 27 patients received intravitreal injections of 0.5 mg ranibizumab (0.05 ml) at 2-7 days before surgery (ranibizumab group) and other 32 eyes of 30 patients did not (group without ranibizumab). Eighteen eyes of 18 patients with epiretinal membranes were included as controls. Pathological specimens of PDR fibrovascular membrane and premacular membrane were obtained during vitrectomy. The immunohistochemical staining and real-time PCR (RT-PCR) were used to detecting the expression of HIF-2α, Dll4 and VEGF. Kruskal-wallis test was used to compare the expression differences of correlation factors between groups. Spearman correlation analysis was used to analyze the relationship between the two variables.Results:The immunohistochemical staining revealed that there were positive expression of HIF-2α, Dll4 and VEGF in all PDR membranes, regardless of the injection of the ranibizumab. The levels of HIF-2α, Dll4 and VEGF protein in the group without ranibizumab were higher than those of the ranibizumab group ( t=4.36, 6.01, 4.82; P=0.000, 0.008, 0.016). RT-PCR showed that the differences of the mRNA expression of HIF-2α, Dll4 and VEGF were all statistically significant among the PDR patients and controls ( H=18.81,19.60, 20.50; P=0.000, 0.000, 0.000). The expression of HIF-2α, Dll4 and VEGF in the PDR membranes was higher than that of epiretinal membranes from non-diabetic patients. In the PDR patients,the expression of HIF-2α, Dll4 and VEGF of the group without ranibizumab was higher than that of the ranibizumab group. The spearman correlation analysis showed that the expression of mRNA between HIF-2α and Dll4, HIF-2α and VEGF were both significantly correlated ( r=0.95, 0.87; P<0.05). Conclusions:The expression of HIF-2α in the PDR membranes was higher than that of the controls. It is positively correlated with the expression of the DLL4 and VEGF.

Objective:To evaluate the effect of remote ischemic preconditioning (RIPC) combined with postconditioning (RIPostC) on postoperative pulmonary complications in elderly patients undergoing thoracoscopic radical surgery for lung cancer.Methods:Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 65-79 yr, with height 155-180 cm, weighing 45-80 kg, were divided into 2 groups ( n=40 each) by the random number table method: control group (group C) and RIPC combined with RIPostC group (group R). RIPC was induced by 3 cycles of 5 min ischemia (cuff inflation to 200 mmHg) followed by 5 min reperfusion (cuff deflation to 0 mmHg) though applying a mercury sphygmomanometer adult cuff to the right upper extremity at 30 min before one-lung ventilation and 30 min before the end of one-lung ventilation in group R. The adult cuff was only bound to the right upper extremity without inflation and deflation in group C. The occurrence of pulmonary complications was recorded within 72 h after operation in both groups.The Quality of Recovery-15 score was used to assess the early postoperative quality of recovery on 1 and 2 days after operation.The number of white blood cells and neutrophils and percentage of neutrophils were recorded at 1 day before surgery and 1 and 3 days after surgery.The postanesthesia care unit stay time and hospital stay time were recorded. Results:Compared with group C, the incidence of pulmonary complications was significantly decreased within 72 h after operation, Quality of Recovery-15 scores were increased at 1 and 2 days after operation, the number of white blood cells and neutrophils and percentage of neutrophils were decreased at 1 and 3 days after operation, and the postanesthesia care unit stay time and postoperative hospital stay time were shortened in group R ( P<0.05). Conclusion:RIPC combined with RIPostC can decrease the risk of postoperative pulmonary complications and is helpful for early postoperative rehabilitation in elderly patients undergoing thoracoscopic radical surgery for lung cancer.

In order to solve the problem that the early onset of paroxysmal atrial fibrillation is very short and difficult to detect, a detection algorithm based on sparse coding of Riemannian manifolds is proposed. The proposed method takes into account that the nonlinear manifold geometry is closer to the real feature space structure, and the computational covariance matrix is used to characterize the heart rate variability (RR interval variation), so that the data is in the Riemannian manifold space. Sparse coding is applied to the manifold, and each covariance matrix is represented as a sparse linear combination of Riemann dictionary atoms. The sparse reconstruction loss is defined by the affine invariant Riemannian metric, and the Riemann dictionary is learned by iterative method. Compared with the existing methods, this method used shorter heart rate variability signal, the calculation was simple and had no dependence on the parameters, and the better prediction accuracy was obtained. The final classification on MIT-BIH AF database resulted in a sensitivity of 99.34%, a specificity of 95.41% and an accuracy of 97.45%. At the same time, a specificity of 95.18% was realized in MIT-BIH NSR database. The high precision paroxysmal atrial fibrillation detection algorithm proposed in this paper has a potential application prospect in the long-term monitoring of wearable devices.
Algorithms ; Atrial Fibrillation ; Databases, Factual ; Electrocardiography ; Humans ; Wearable Electronic Devices

Objective: To evaluate the effects of remote ischemic preconditioning (RIPC) on occurrence of postoperative delirium in elderly patients undergoing radical mastectomy. Methods: Sixty elderly patients, aged 65-78 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective radical mastectomy, were allocated into 2 groups (n=30 each) using a random number table method: control group (group C) and RIPC group.Three cycles of 5-min ischemia/5-min reperfusion induced by a blood pressure cuff placed on the upper arm of the right upper arm served as RIPC treatment at 5 min after induction of anesthesia in RIPC group.The blood pressure cuff was only placed on the upper arm of the right upper arm without inflation and deflation in group C. Jugular bulb venous blood samples were obtained at 10 min before anesthesia induction (T₀) and 1, 12, 24, 48 and 72 h after the end of operation (T_1-5) for determination of S-100β protein and neuron-specific enolase (NSE) concentrations in serum.The occurrence of delirium within 72 h after operation was estimated using Confusion Assessment Method for the Intensive Care Unit.The occurrence of hypotension, sinus bradycardia and reintubation was recorded.The Quality of Recovery-15 (QoR-15) was used to evaluate the early postoperative quality of recovery at 1 and 2 days after operation. Results: Compared with group C, the concentrations of S-100β protein and NSE in serum and incidence of delirium within 72 h after operation were significantly decreased at T₁-T₅, and the Quality of Recovery-15 scores were increased at 1 and 2 days after operation in group RIPC (P<0.05). There was no significant difference in the duration of delirium or incidence of hypotension, sinus bradycardia and reintubation between the two groups (P>0.05). Conclusion RIPC can decrease the development of postoperative delirium and is helpful for the early postoperative recovery of elderly patients undergoing radical mastectomy.

Objective To observe the influence of human umbilical cord mesenchymal stem cells (hUCMSC) transplanted into the tail vein of diabetic rats on apoptosis of retinal neurons and the retinal expression level of glial fibrillary acidic protein (GFAP).Methods Seventy clean male Sprague-Dawley rats were randomly divided into the normal control group (group A),diabetes mellitus (DM) only group (group B),DM + balanced salt solution (BSS) group (group C),DM + hUCMSC group (group D),with 10 rats in each group.DM rats were induced by intraperitoneal injection of streptozotocin.Apoptosis of retinal cells was assayed by dUTP nick end labeling.Immunohistochemistry and Western blot was performed to detect the retinal expressions of GFAP in rats.Results Compared with group A,large numbers of apoptotic cells could be found in the retinal ganglion cell layer (GCL) and inner nuclear layer (INL) of group B and group C,however the apoptotic cells in group D were significantly reduced than group B and C.The expression of GFAP was mainly located in the retinal GCL and retinal nerve fibre layer (RNFL) in group A,throughout the inner plexiform layer (IPL) in group B and C,only distributed in RNFL and GCL in group D.It was obvious that the expression of GFAP in group B and C was higher than group A.Compared with group B and C,the expression of GFAP in group D was significantly reduced.The difference of GFAP expression among the 4 groups was significant (F=79.635,P＜0.05).Conclusion hUCMSC could inhibit the apoptosis of retinal cells and activation of glial cells in early DM rats.

Objective To observe the effect of macular retinal thickness (CMT) on the long-term visual prognosis after intravitreal injection of Conbercept combined with retinal laser photocoagulation for macular edema (ME) secondary to branch retinal vein occlusion (BRVO).Methods A retrospective non randomized controlled study.Forty-one patients (41 eyes) of ischemic BRVO secondary ME were included in the study.Among them,there were 23 males (23 eyes) and 18 females (18 eyes).The average age was (56.49±8.94) years.The best corrected visual acuity (BCVA) and optical coherence tomography were performed.The mean logMAR BCVA was 0.82±0.41,and the mean CMT was (512.61 ± 185.32) μrn.According to the CMT reduction value at 1 month after treatment,the eyes were divided into no response group and response group,each has 15 patients of 15 eyes and 26 patients of 26 eyes respectively.The age and sex composition of the two groups were not statistically significant (t=-0.298,-1.708;P=0.767,0.096),and the difference of frequency of injection was statistically significant (t=3.589,P=0.010),and there was no statistical difference between the patients with logMAR BCVA and CMT (t=2.056,-1.876;P=0.460,0.070).The average follow-up was 8 months.The logMAR BCVA on 6 months after treatment was defined as long term vision.The changes of long term vision and CMT on 1 and 6 months of two groups after treatment were observed.Pearson correlation analysis showed that the correlation between long-term vision and age,logMAR BCVA before treatment,CMT before treatment,frequency of injection,and CMT value decreased 1 month after treatment.The correlation of long-term visual acuity with age,sex,logMAR BCVA before treatment,CMT before treatment,number of drugs before treatment,CMT reduction at 1 month after treatment,integrity of ellipsoid band and integrity of external membrane (ELM) were analyzed by multiple regression analysis.Results On 1 month after treatment,the CMT of the eyes was lower than that before treatment (231.48± 177.99) μm,and the average integrity of ELM and ellipsoid were 0.56±0.50 and 0.41 ±0.50 respectively.On 6 months after treatment,the average logMAR BVCA of the eyes was 0.48 ± 0.34.The results of Pearson correlation analysis showed that the long-term vision was positively correlated with the logMAR BCVA before treatment and the number of CMT reduction and the number of drug injection at 1 month after treatment (P＜0.05);there was no correlation with age and CMT before treatment (P＞0.05).The results of multiple regression analysis showed that the long-term vision was associated with logMAR BVCA before treatment,CMT reduction,ELM integrity,and the number of times of injection (P＜0.05),and no correlation with age,sex,CMT before treatment and the integrity of the ellipsoid (P＞0.05).On the 6 months after treatment,the logMAR BCVA in the non-response group and the response group were 0.86±0.23 and 0.26±0.14,and the average CMT was respectively (398.93±104.87) and (255.15 ± 55.18) μrn,and the average injection times were respectively (2.53 ± 1.46) and (1.31 ± 0.74) times.The average logMAR BCVA,CMT and injection times of the two groups were statistically significant (t=10.293,5.773,3.589;P=0.000,0.000,0.001).No complications related to drug or intravitreal injection occurred in all patients.Conclusion The long-term vision of ME secondary to BRVO after intravitreal injection of Conbercept combined with retinal laser photocoagulation was associated with the decrease of CMT and the integrity of the ELM after 1 month of treatment,no correlation was found between CMT and ellipsoid integrity before treatment.

Objective To observe the effect of Delta-like ligand 4 (Dll-4) on the pathological structure of retina in early diabetic rats (DM) and its relationship with vascular endothelial growth receptor-2 (VEGFR-2).Methods A total of 70 male Sprague-Dawley rats were randomly divided into normal group and DM group,with 10 and 60 rats in each group,respectively.The rats of DM group was induced by intraperitoneal injection of streptozotocin to established DM model.The rats with blood glucose recovery and death were excluded,and the final 60 rats were included in the statistics.Rats in the normal group were injected with an equal volume of citric acid-sodium citrate buffer.Rats in the DM group were divided into DM 1 month (DM lm) group,DM 2 months (DM 2m) group,DM 3 months (DM 3m) group and DM 3m + Anti group,DM 3m + phosphate buffer solution (PBS) group by random number table method,and 10 rats in each group.In the DM 3m+Anti group,4 μl ofantiDll-4 polyclonal antibody was injected into the vitreous cavity,and the antibody concentration was 0.25 mg/ml.The DM 3m+PBS group was intravitreally injected with an equal volume of PBS.Five days after the injection,the rats were sacrificed.Rats in the DM 3m group and the normal group were not treated,and were sacrificed 3 months after the model was established.The structure and microvascular changes of the retina were observed by hematoxylin-eosin staining,and the total thickness of the retina was measured.The expression of Dll-4 and VEGFR-2 in the retina was detected by immunohistochemistry and fluorescence quantitative polymerase chain reaction (PCR).One-way analysis of variance was used to compare the expression of Dll-4 and VEGFR-2 in the retina of each group.The least significant difference t test was used to compare the two groups.Results Light microscopy showed that the retinal ganglion cells layer in the DM 3m group were obviously edematous,the inner and outer nuclear layers were thinner,the number of cells was reduced,the arrangement was disordered,the edema of outer plexiform layer was obvious,and the microvessels were abnormally dilated.In the DM 3m+Anti group,the edema of outer plexiform layer was lessened than that of the DM 3m group,and the other layers were not significantly different from the DM 3m group.Compared with the normal group,the total retinal thickness of the DM 3m group,the DM 3m+Anti group and the DM 3m+PBS group increased (t=5.596,3.290,4.286;P=0.000,0.008,0.002).Immunohistochemical staining showed that a small amount of Dl14 was positively expressed in the retinal ganglion cell layer of the normal group;a small amount of VEGFR-2 was positively expressed in the ganglion cell layer and the inner and outer nuclear layers.The positive expression of Dll-4 and VEGFR-2 in retinal vascular endothelial cells of DM 3m group increased significantly.The expression of Dll-4 was significantly decreased in the retinal layers and vascular endothelial cells ofDM 3m+Anti group,while the expression of VEGFR-2 was significantly increased.There was no significant difference between the positive expression of Dll4 and VEGFR-2 in the DM 3m+PBS group and the DM 3m group.The results of real-time PCR showed that the relative expression of Dll-4 and VEGFR-2 mRNA in the DM 3m group was significantly higher than that in the normal group (t=6.705,20.871;P＜0.05).Compared with DM 3m group,the relative expression of Dll-4 mRNA in DM 3m+Anti group decreased,and the relative expression of VEGFR-2 mRNA increased (t=2.681,3.639;P＜0.05).The relative expressions of Dll-4 and VEGFR-2 mRNA in the DM 3m+PBS group and DM 3m group were not statistically significant (t=0.513,0.657;P＜0.05).Conclusions The expression of Dll-4 in retinal vascular endothelial cells is gradually increased during the early retinopathy of DM rats.The expression of Dll-4 is inhibited,the expression of VEGFR-2 is up-regulated,and the plexus edema is alleviated.