Unique Approach for Isolating Rat Bone Marrow Neutrophils with Comparable Capacity.

The primary aim of this research was to develop a reliable and efficient approach for isolating neutrophil extracellular traps (NETs) from rat bone marrow. This effort arose due to limitations associated with the traditional method of extracting NETs from peripheral blood, mainly due to the scarcity of available neutrophils for isolation. The study revealed two distinct methodologies for obtaining rat neutrophils from bone marrow: a streamlined one-step procedure that yielded satisfactory purification levels, and a more time-intensive two-step process that exhibited enhanced purification efficiency. Importantly, both techniques yielded a substantial quantity of viable neutrophils, ranging between 50 to 100 million per rat. This efficiency mirrored the results obtained from isolating neutrophils from both human and murine sources. Significantly, neutrophils derived from rat bone marrow exhibited comparable abilities to secrete NETs when compared with neutrophils obtained from peripheral blood. However, the bone marrow-based method consistently produced notably larger quantities of both neutrophils and NETs. This approach demonstrated the potential to obtain significantly greater amounts of these cellular components for further downstream applications. Notably, these isolated NETs and neutrophils hold promise for a range of applications, spanning the realms of inflammation, infection, and autoimmune diseases.

Bio-Bentall and hybrid arch frozen elephant trunk repair for acute type A aortic dissection with malperfusion.

The extent of repair in patients with acute type A aortic dissection is often determined by factors such as entry tear location, aortic anatomy, malperfusion and team expertise. The hybrid arch frozen elephant trunk, which has become an established technique to extend the distal acute type A aortic dissection repair, is particularly useful in malperfusion; however, it remains technically challenging and is associated with increased duration of circulatory arrest and risks of spinal cord ischaemia. Proximal dissection flap extension often determines repairability versus replacement of the aortic root. We present a case report highlighting the proximal and distal extent of repair in a patient with a known ascending aortic aneurysm presenting with an acute type A aortic dissection, with malperfusion, undergoing a successful bio-Bentall procedure and hybrid arch frozen elephant trunk repair.

Predictability alters information flow during action observation in human electrocorticographic activity.

The action observation network (AON) has been extensively studied using short, isolated motor acts. How activity in the network is altered when these isolated acts are embedded in meaningful sequences of actions remains poorly understood. Here we utilized intracranial electrocorticography to characterize how the exchange of information across key nodes of the AON-the precentral, supramarginal, and visual cortices-is affected by such embedding and the resulting predictability. We found more top-down beta oscillation from precentral to supramarginal contacts during the observation of predictable actions in meaningful sequences compared to the same actions in randomized, and hence less predictable, order. In addition, we find that expectations enabled by the embedding lead to a suppression of bottom-up visual responses in the high-gamma range in visual areas. These results, in line with predictive coding, inform how nodes of the AON integrate information to process the actions of others.

Dual-layer spectral computed tomography aortography using a seventy-five-percent-reduced iodine dose protocol and multiparameter spectral imaging: comparison with conventional computed tomography imaging.

Background: Computed tomography angiography (CTA) is the recommended diagnostic and follow-up imaging modality for acute aortic dissection (AD). However, the high-contrast medium burden associated with repeated CT aortography follow-ups remains a significant concern. This prospective study aimed to assess whether an ultra-low contrast dose (75% cutoff) aortic CTA protocol on dual-layer spectral CT could achieve comparable image quality with the full dose protocol. We also investigated the image quality of the virtual noncontrast (VNC) images derived from the ultra-low dose protocol. Methods: This study included 37 consecutive patients who were referred to aortic CTA from May 2022 to August 2022. The enrolled patients underwent full-dose contrast CTA and ultra-low dose (reduced to 25% of conventional) contrast CTA on dual-layer spectral CT in 1 day. Virtual monochromatic images (VMIs) were reconstructed with 40 and 70 keV. The VNC images were reconstructed for both protocols. Objective image quality evaluation, recorded as signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs), was compared between the groups using 1-way analysis of variance and post hoc analysis with Bonferroni correction. Subjective image quality was also compared between the groups. Finally, VNC images derived from the low-dose (VNClow) and full-dose (VNCfull) protocols were compared to the true noncontrast (TNC) images. Results: Neither CNR nor SNR was lower for the 40-keV images reconstructed from the ultra-low dose group compared to the conventional images. Both were significantly higher than those of the 70-keV images. Regarding subjective image quality, vessel enhancement was not significantly different between the 40-keV VMI and full-dose images [ascending aorta (AAO): 4.37±0.46 vs. 4.57±0.48, P=0.096; brachiocephalic arteries: 4.34±0.45 vs. 4.51±0.49, P=0.152; abdominal aortic side branch: 4.42±0.48 vs. 4.51±0.49, P=0.480]. The VNClow images were similar to the TNC images but significantly different from the VNCfull images (P<0.001). Conclusions: Ultra-low contrast aortic CTA with a 75%-reduced iodine dose using dual-layer spectral CT and the derived VNC achieved image quality comparable to that of conventional CTA and TNC images.

A Metabolomics-Based Study on NMDAR-Mediated Mitochondrial Damage through Calcium Overload and ROS Accumulation in Myocardial Infarction.

BACKGROUND: Coronary artery disease is a leading public health problem. However, the mechanisms underlying mitochondrial damage remain unclear. The present study verified and explored the novel mechanisms underlying ischemic injury based on a metabolomic analysis. METHODS: Mouse models of acute myocardial infarction were established, and serum samples were collected for targeted liquid chromatography with tandem mass spectrometry analysis. Based on metabolomic analyses, the N-methyl-d-aspartic acid receptor (NMDAR)-related calcium transporting signaling pathway was selected. Primary cardiomyocyte cultures were used, and N-methyl-d-aspartic acid (NMDA) was used as an agonist to confirm the role of NMDAR in ischemic injury. In addition, Bax, Bcl-2, mitochondrial calcium, potential, and mitochondrial reactive oxygen species accumulation were used to explore the role of NMDAR in mitochondrial damage-induced apoptosis. RESULTS: Glutamate-related metabolism was significantly altered following in acute myocardial infarction. NMDA induces apoptosis under hypoxic conditions NMDAR was translocated to the mitochondrial-related membrane after activation, and its mitochondrial expression was significantly increased (p < 0.05). Mitochondrial damage-induced apoptosis was significantly inhibited by a selective NDMAR antagonist (p < 0.05), while Bax expression was remarkably decreased and Bcl-2 expression was increased (p < 0.05). To further explore the mechanism of NMDAR, mitochondrial calcium, membrane potential, and reactive oxygen species were detected. With NMDAR inhibition under hypoxic conditions, mitochondrial morphology and function were preserved (p < 0.05). CONCLUSIONS: Our metabolomic study identified NMDAR as a promising target. In conclusion, our study provides solid data for further studies of the role of NMDAR in cardiovascular diseases and a promising target to interfere with apoptosis in acute myocardial infarction.

Adherence, belief, and knowledge about oral anticoagulants in patients with bioprosthetic heart valve replacement: a cross-sectional study.

Aims: To investigate adherence to oral anticoagulants among patients after mechanical heart valve (BHV) replacement and further examine the mediating role of medication belief in the relationship between knowledge and medication adherence. Background: The number of patients who undergo BHV replacement has increased in recent years. Short-term anticoagulant therapy is recommended for patients after BHV replacement. However, little is known about adherence to oral anticoagulant therapy and the underlying mechanisms among patients with BHV replacement. Methods: A cross-sectional study was conducted between September 2022 and November 2022. A convenience sample of 323 patients who underwent BHV replacement was recruited from a tertiary public hospital in Southwest China. Data were collected by using the 8-item Morisky Medication Adherence Scale, Beliefs about Medicines Questionnaire-specific, and the Knowledge of Anticoagulation Questionnaire. The mediation model was tested by Hayes's PROCESS macro. The STROBE checklist was used. Results: Approximately 17.3% of participants had low adherence, 47.1% had medium adherence, and only 35.6% reported high adherence to oral anticoagulants. Knowledge and necessity beliefs were positively related to medication adherence, while concern beliefs were negatively correlated with medication adherence. Medication belief mediated the relationship between knowledge and adherence to oral anticoagulants. Conclusion: Patients with BHV replacement demonstrated relatively low adherence to oral anticoagulant therapy. Efforts to enhance medication adherence should consider improving patients' knowledge and medication beliefs.

Interaction between neutrophil extracellular traps and cardiomyocytes contributes to atrial fibrillation progression.

Atrial fibrillation (AF) is a frequent arrhythmia associated with cardiovascular morbidity and mortality. Neutrophil extracellular traps (NETs) are DNA fragments with cytoplasm proteins released from neutrophils, which are involved in various cardiovascular diseases. To elucidate the role of NETs in AF, we investigated the effect of NETs on AF progression and the secretion of NETs in AF. Results showed that: NETs induced the autophagic apoptosis of cardiomyocytes, and NETs also led to mitochondrial injury by promoting mitochondrial depolarization and ROS production. Ongoing tachy-pacing led to the structural loss of cardiomyocytes and provided potent stimuli to induce NETs secretion from neutrophils. In the meanwhile, increased Ang II in AF facilitated NETs formation through the upregulation of AKT phosphorylation, while it could not directly initiate NETosis as the autophagy was not induced. In vivo, DNase I was administrated to abrogate NETs formation, and AF-related fibrosis was ameliorated as expected. Correspondingly, the duration of the induced AF was reduced. Our study addresses the formation mechanism of NETs in AF and demonstrates the lethal effects of NETs on cardiomyocytes through the induction of mitochondrial injury and autophagic cell death, which comprehensively describes the positive feedback comprised of NETs and stimuli secreted by cardiomyocytes that sustains the progression of AF and AF related fibrosis.

Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis.

BACKGROUND: Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). DESIGN: Meta-analysis with meta-regression and systematic review. SETTING: Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase. INTERVENTIONS: All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes. RESULT: Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I2 = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I2 = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I2 = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time. CONCLUSION: The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic.

The effect of postoperative anticoagulation on acute aortic dissection: a systematic review and meta-analysis.

Background and aim: The evolution of the false lumen after the repair of acute aortic dissection has been linked to numerous adverse clinical outcomes, including increased late mortality and a higher risk of reoperation. Despite the widespread use of chronic anticoagulation in patients who have undergone repair for acute aortic dissection, the effects of this therapy on false lumen evolution and its subsequent consequences are yet to be fully understood. This meta-analysis aimed to investigate the impact of postoperative anticoagulation on patients with acute aortic dissection. Methods: In PubMed, Cochrane Libraries, Embase, and Web of Science, we performed a systematic review of nonrandomized studies, comparing outcomes with postoperative anticoagulation vs. non-anticoagulation on aortic dissection. We investigated the status of false lumen (FL), aorta-related death, aortic reintervention, and perioperative stroke in aortic dissection patients with anticoagulation and non-anticoagulation. Results: After screening 527 articles, seven non-randomized studies were selected, including a total of 2,122 patients with aortic dissection. Out of these patients, 496 received postoperative anticoagulation while 1,626 served as controls. Meta-analyses of 7 studies revealed significantly higher FL patency in Stanford type A aortic dissection (TAAD) postoperative anticoagulation with an OR of 1.82 (95% CI: 1.22 to 2.71; Z = 2.95; I²=0%; P = 0.93). Moreover, there was no statistically significant difference between the two groups in aorta-related death, aortic reintervention, and perioperative stroke with an OR of 1.31 (95% CI: 0.56 to 3.04; Z = 0.62; I² = 0%; P = 0.40), 0.98 (95% CI: 0.66 to 1.47; Z = 0.09; I² = 23%; P = 0.26), 1.73 (95% CI: 0.48 to 6.31; Z = 0.83; I² = 8%; P = 0.35), respectively. Conclusions: Postoperative anticoagulation was associated with higher FL patency in Stanford type A aortic dissection patients. However, there was no significant difference between the anticoagulation and non-anticoagulation groups in terms of aorta-related death, aortic reintervention, and perioperative stroke.

Intracranial human recordings reveal association between neural activity and perceived intensity for the pain of others in the insula.

Based on neuroimaging data, the insula is considered important for people to empathize with the pain of others. Here, we present intracranial electroencephalographic (iEEG) recordings and single-cell recordings from the human insula while seven epilepsy patients rated the intensity of a woman's painful experiences seen in short movie clips. Pain had to be deduced from seeing facial expressions or a hand being slapped by a belt. We found activity in the broadband 20-190 Hz range correlated with the trial-by-trial perceived intensity in the insula for both types of stimuli. Within the insula, some locations had activity correlating with perceived intensity for our facial expressions but not for our hand stimuli, others only for our hand but not our face stimuli, and others for both. The timing of responses to the sight of the hand being hit is best explained by kinematic information; that for our facial expressions, by shape information. Comparing the broadband activity in the iEEG signal with spiking activity from a small number of neurons and an fMRI experiment with similar stimuli revealed a consistent spatial organization, with stronger associations with intensity more anteriorly, while viewing the hand being slapped.

Alleviation of cardiac fibrosis using acellular peritoneal matrix-loaded pirfenidone nanodroplets after myocardial infarction in rats.

Myocardial fibrosis (MF) in the remote myocardium is a feature at the micoscopic level of pathological remodeling after myocardial infarction (MI). Although pirfenidone (PFD), an antifibrotic agent, is commonly used to inhibit fibrosis in multiple organs, its clinical use is limited because of the high doses required for favorable therapeutic outcomes and various side effects. Nanodrug technology has allowed for delayed quantitative drug release and reduced the amount of medication required, improving the treatment strategy for MF. In this study, we investigated the possible therapeutic effect of peritoneal matrix-loaded pirfenidone nanodroplets (NDs) on MI fibrosis. The results showed that the Perfluoropentane-Pirfenidone@Nanodroplets-Polyethylene glycol 2000 (PFP-PFD@NDs-PEG) described in this study was successfully synthesized and demonstrated a high potential for the targeted treatment of MI. The total duration of pirfenidone release from PFP-PFD@NDs-PEG was increased by loading it into an acellular peritoneal matrix (APM). Additionally, pirfenidone inhibited the transformation of cardiac fibroblasts into cardiac myofibroblasts in vitro and reduced the synthesis and secretion of collagen I and collagen III by cardiac myofibroblasts. The combination of the APM with pirfenidone nanodroplets achieved a slow drug release and showed excellent therapeutic effects on fibrosis in MI rats. Our study confirmed the feasibility and synergistic effectiveness of the APM combined with pirfenidone nanodroplets in the treatment of fibrosis in MI rats. Moreover, our technique offers a great potential for applying nanomedicine in other biomedical fields.

Ataxia telangiectasia mutated: The potential negative regulator in platelet-derived growth factor-BB promoted proliferation of pulmonary arterial smooth muscle cells.

Objective: To study the role of ataxia telangiectasia mutated (ATM) in the platelet-derived growth factor (PDGF)-BB-induced proliferation of pulmonary arterial smooth muscle cells (PASMCs) through reactive oxygen species (ROS) formation. Methods: Primary cultures of PASMCs were treated with different concentrations of PDGF-BB or exogenous hydrogen peroxide (H2O2). The activation level of ATM and the proliferation level of PASMCs were measured by immunofluorescence staining and Cell Counting Kit-8, respectively. Moreover, NADPH oxidase 2 (NOX2) and intracellular H2O2 were detected under the stimulation of different levels of PDGF-BB by Western blot and dihydroethidium staining. Results: Both the control group and 50 ng/ml of the PDGF-BB group showed significantly higher levels of phosphorylation ATM compared to other groups (P < 0.05). With the ATM inhibitor, 50 ng/ml of the PDGF-BB group showed further increased proliferative level compared to the 10 ng/ml (P < 0.05). Both the levels of NOX2 and H2O2 showed dose-dependent manners under PDGF-BB stimulation (P < 0.05). ATM could be activated by H2O2 upon a dose-dependent way, except for the 500 µM H2O2 group. Under 200 µM H2O2 stimulation, proliferation level decreased significantly (P < 0.05), while no significant difference was shown with the addition of ATM inhibitor (P > 0.05). Conclusion: Our study first established ROS-induced ATM activation in PDGF-BB-stimulated proliferation of PASMCs. Inhibition of ATM had promoted effects on the proliferation of PASMCs under the excessive levels of PDGF-BB and H2O2. Our study might provide a novel promising target for the treatment of pulmonary arterial hypertension (PAH).

Bone marrow is the preferred source for isolation of rat neutrophils and the subsequent acquisition of neutrophil extracellular traps.

Background: Neutrophil extracellular traps (NETs) are a network structure with DNA as skeleton scaffolding a wide range of antimicrobial proteins, which have been shown to contribute to the pathogenesis, persistence, and progression of many chronic inflammatory diseases. The method for isolation of human or mouse NETs has been well-established. However, in some diseases such as atrial fibrillation, the model can only be established in rats. While most related studies isolate rat neutrophils from the peripheral blood, which is insufficient for further acquisition of NETs. Despite the consumptiveness of rat peripheral blood neutrophil isolation, bone-marrow deprived neutrophil is rarely employed and has not been compared to peripheral neutrophil with its NETs secreting capability. Methods: In the current study, a different bone-marrow-oriented strategy was described and conducted. Based on centrifugal program settings, a one-step method and a two-step method was developed and compared. The purity of the isolated neutrophils was determined by Wright's staining and the viability was detected by flow cytometry. NETosis is the specialized cell death of neutrophils accompanied with NETs formation and its degree of rat neutrophils was analyzed by phase contrast microscopy, fluorescence microscopy, and Celigo whole view analysis. The Picogreen dsDNA Assay Kit was used to determine the concentration of NETs obtained from the NET-rich supernatants. The levels of secreted NETs in rat peripheral blood and bone marrow were compared. Results: Approximately 0.5×108-1×108 neutrophils could be obtained from the bone marrow of a single rat, with viability above 90%, which was comparable to that of neutrophils isolated from humans and mice. The final concentration of NETs obtained from the supernatant ranged from 8-12 µg/mL. The secretion of NETs from bone marrow-derived neutrophils showed a similar trend to polymorphonuclear (PMN) leukocytes. In addition, the extrusion of the intracellular matrix was incomplete during NETosis, and rat NETs showed weak cross-linking capability for forming large-scale net-like structures. Conclusions: The bone marrow-oriented strategy for isolating rat neutrophils is accessible and repeatable. NETs formation capability is similar between rat bone-marrow and peripheral blood neutrophils.

Appropriate Timing of Coronary Artery Bypass Graft Surgery for Acute Myocardial Infarction Patients: A Meta-Analysis.

Background: Currently, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are commonly used in the treatment of coronary atherosclerotic heart disease. But the optimal timing for CABG after acute myocardial infarction (AMI) is still controversial. The purpose of this article was to evaluate the optimal timing for CABG in AMI. Methods: We searched the PubMed, Embase, and Cochrane library databases for documents that met the requirements. The primary outcome was in-hospital mortality. The secondary outcomes were perioperative myocardial infarction (MI) incidence and cerebrovascular accident incidence. Results: The search strategy produced 1,742 studies, of which 19 studies (including data from 113,984 participants) were included in our analysis. In total, 14 studies compared CABG within 24 h with CABG late 24 h after AMI and five studies compared CABG within 48 h with CABG late 48 h after AMI. The OR of in-hospital mortality between early 24 h CABG and late 24 h CABG group was 2.65 (95%CI: 1.96 to 3.58; P < 0.00001). In the undefined ST segment elevation myocardial infarction (STEMI)/non-ST segment elevation myocardial infarction (NSTEMI) subgroup, the mortality in the early 24 h CABG group (OR: 3.88; 95%CI: 2.69 to 5.60; P < 0.00001) was significantly higher than the late 24 h CABG group. Similarly, in the STEMI subgroup, the mortality in the early 24 h CABG group (OR: 2.62; 95% CI: 1.58 to 4.35; P = 0.0002) was significantly higher than that in the late 24 h CABG group. However, the mortality of the early 24 h CABG group (OR: 1.24; 95%CI: 0.83 to 1.85; P = 0.29) was not significantly different from that of the late 24 h CABG group in the NSTEMI group. The OR of in-hospital mortality between early 48 h CABG and late 48 h CABG group was 1.91 (95%CI: 1.11 to 3.29; P = 0.02). In the undefined STEMI/NSTEMI subgroup, the mortality in the early 48 h CABG group (OR: 2.84; 95%CI: 1.31 to 6.14; P < 0.00001) was higher than the late 48 h CABG group. The OR of perioperative MI and cerebrovascular accident between early CABG and late CABG group were 1.38 (95%CI: 0.41 to 4.72; P = 0.60) and 1.31 (95%CI: 0.72 to 2.39; P = 0.38), respectively. Conclusion: The risk of early CABG could be higher in STEMI patients, and CABG should be delayed until 24 h later as far as possible. However, the timing of CABG does not affect mortality in NSTEMI patients. There was no statistical difference in perioperative MI and cerebrovascular accidents between early and late CABG.

NETs promote pathogenic cardiac fibrosis and participate in ventricular aneurysm formation after ischemia injury through the facilitation of perivascular fibrosis.

Fibrosis has been widely investigated in acute phase of myocardial infarction (MI). However, the mechanism of sustained fibrosis after MI hasn't been elucidated, which eventually gives rise to ventricular aneurysm (VA) formation chronic while lethal. Neutrophil as vital cell facilitating the fibrotic repair after acute MI may not project its effect to chronic phase unless neutrophil extracellular traps (NETs) were secreted and accumulating. The aim of this study was to investigate whether NETs contribute to the sustained fibrosis and VA formation after MI. We identified NETs in ventricular aneurysm of patients. Accordingly, NETs increased in peripheral blood of VA patients. Moreover, in rat VA NETs were also identified. Stimulated by NETs, the migration of fibroblast was enhanced and the differentiation of cardiac myofibroblast was initiated. Smad, MAPK and RhoA signaling pathways were activated by NETs incubation. And additional deposition with DNase I to disrupt NETs and abrogated NETs induced fibrosis both in vivo and vitro. These results collectively demonstrate a novel profibrotic role for NETs in chronic cardiac fibrosis and VA formation.

Postoperative Coronary Artery Spasm After Mitral Valve Replacement and Cox-Maze IV Procedure: A Case Report.

BACKGROUND: Few cases have been reported about coronary artery spasm after a mitral valve replacement and concomitant Cox-Maze IV procedure. We report the case of an adult male who developed right coronary artery (RCA) spasm after a mitral valve replacement with tricuspid valve repair and Cox-Maze IV procedure. CASE REPORT: A 66-year-old male, complaining of progressive exertional shortness of breath, was diagnosed with severe mitral stenosis, moderate tricuspid regurgitation, complete right bundle branch block, and persistent atrial fibrillation (AF) in our clinic. The patient underwent elective mitral valve replacement, tricuspid valve repair, and Cox-Maze IV procedure. Four hours after surgery, a 12-lead electrocardiogram (ECG) showed progressive elevation of ST-segment in the avF and III leads and Troponin-T was over 7000 pg/mL. After one hour, Troponin-T increased to over 10000 pg/mL, and ECG still showed persisted ST-segment elevation in inferior leads. Emergent angiography was performed, and intra-coronary administration of nitroglycerin completely relieved the spasm. CONCLUSION: Potential risks of coronary injury after valvular surgery and Cox-Maze IV procedure need further aggressive investigation and postoperative ischemia should prompt an emergent coronary angiography to identify the cause and apply immediate therapy.

Actin-granule formation is an additional step in cardiac myofibroblast differentiation.

BACKGROUND: Atrial fibrillation is the most common and long-lasting cardiac arrhythmia, and profoundly effects the daily lives of patients. The pathogenesis and persistence of atrial fibrillation is closely related to the cardiac fibroblast and its myofibroblast differentiation as increased collagen synthesis and migration capability. Thus better understanding of myofibroblast differentiation is essential for the prevention and treatment of atrial fibrillation. METHODS: Cardiac fibroblasts were isolated from neonatal rats and its actin structure was analyzed by immunofluorescence staining. Myofibroblast differentiation was induced by Angiotensin II (Ang II) and ROCK signaling related proteins were determined by western blot. Fasudil and Ricolinostat were employed to abrogate ROCK signaling and their effects on myofibroblast differentiation were assessed by IF microscopy and Celigo Image Cytometry. RESULTS: Stress actin fibers similar to actin filaments in myofibroblast differentiation are regulated by ROCK signaling, and our results also suggested Guanine nucleotide exchange factor-H1 (GEF-H1) phosphorylation could be induced by Ang II. In addition, Fasudil could down-regulate RhoA, GEF-H1, and phosphorylated GEF-H1 to inhibit ROCK signaling and further reduce Col I expression and the myofibroblast proportion. CONCLUSIONS: An individual phase characterized by actin-granule formation was identified in cardiac myofibroblast differentiation. In the meanwhile, myofibroblast differentiation and its F-actin assembly could be detained in this phase by Fasudil abrogating the ROCK signaling pathway.

Transcatheter Aortic Valve Implantation With J-Valve: 2-Year Outcomes From a Multicenter Study.

BACKGROUND: We report the 2-year follow-up outcomes of the J-Valve in the treatment of either aortic stenosis (AS) or pure aortic insufficiency (AI) from a multicenter study. METHODS: From March 2014 to October 2016, 107 patients with either AS (n = 63) or pure AI (n = 44) were enrolled in a trial and were treated by transcatheter aortic valve implantation with the J-Valve system. All patients except 1 completed a 2-year clinical and echocardiographic follow-up (follow-up rate of 99%). The procedural and clinical outcomes were presented according to Valve Academic Research Consortium-2 criteria. RESULTS: The success rate of the device was 91.5%. All-cause mortality was 4.7% and 10.3% at 30 days and 2 years, respectively. Echocardiographic follow-up showed mild prosthetic valve regurgitation in 1.0% and 6.8% of patients at 30 days and 2 years, respectively. No patient showed more than mild aortic prosthetic regurgitation. At the 2-year follow-up, 97.6% of patients had mild or less than mild paravalvular leak and 99.8% of patients experienced notable improvement in heart failure symptoms (at least 1 NYHA level reduction). We found no major differences in echocardiographic and clinical follow-up between AS and AI, except for a significantly higher transvalvular gradient in the AS cohort (P = .01). CONCLUSIONS: This study demonstrated good midterm outcomes of transcatheter aortic valve implantation with the J-Valve system in the treatment of patients with either AS or AI. It suggests that the J-Valve system is a promising alternative therapy in high-risk patients.