Macrophage CARD9 mediates cardiac injury following myocardial infarction through regulation of lipocalin 2 expression.

Immune cell infiltration in response to myocyte death regulates extracellular matrix remodeling and scar formation after myocardial infarction (MI). Caspase-recruitment domain family member 9 (CARD9) acts as an adapter that mediates the transduction of pro-inflammatory signaling cascades in innate immunity; however, its role in cardiac injury and repair post-MI remains unclear. We found that Card9 was one of the most upregulated Card genes in the ischemic myocardium of mice. CARD9 expression increased considerably 1 day post-MI and declined by day 7 post-MI. Moreover, CARD9 was mainly expressed in F4/80-positive macrophages. Card9 knockout (KO) led to left ventricular function improvement and infarct scar size reduction in mice 28 days post-MI. Additionally, Card9 KO suppressed cardiomyocyte apoptosis in the border region and attenuated matrix metalloproteinase (MMP) expression. RNA sequencing revealed that Card9 KO significantly suppressed lipocalin 2 (Lcn2) expression post-MI. Both LCN2 and the receptor solute carrier family 22 member 17 (SL22A17) were detected in macrophages. Subsequently, we demonstrated that Card9 overexpression increased LCN2 expression, while Card9 KO inhibited necrotic cell-induced LCN2 upregulation in macrophages, likely through NF-κB. Lcn2 KO showed beneficial effects post-MI, and recombinant LCN2 diminished the protective effects of Card9 KO in vivo. Lcn2 KO reduced MMP9 post-MI, and Lcn2 overexpression increased Mmp9 expression in macrophages. Slc22a17 knockdown in macrophages reduced MMP9 release with recombinant LCN2 treatment. In conclusion, our results demonstrate that macrophage CARD9 mediates the deterioration of cardiac function and adverse remodeling post-MI via LCN2.

Cardiac Computed Tomography to Guide the Selection of Better Display Angle of Cardiac Right Ventricular Pacing Electrode in Radiography.

BACKGROUND: Traditional radiography angles do not adequately reveal the shape and position of the right ventricular pacing electrode. OBJECTIVE: This study aimed to explore better radiography angles with the help of cardiac computed tomography (CT). METHODS: We analyzed the cardiac CT images of consecutive outpatients from 2018 to 2019. The right anterior oblique (RAO) 30° and the left anterior oblique (LAO) 40° were found to sufficiently display the shape and position of the right ventricular pacing electrode. RESULTS: A total of 214 consecutive outpatients were enrolled, whose average age was 55.0 ± 13.0 years, and 151 were male (70.6%). Through analyzing the cardiac CT images, the α angle (33.7° ± 6.1) and the γ angle (38.8° ± 8.0) were determined. Furthermore, we verified these angles in 48 patients after pacemaker implantation. The results showed that the ratio of the length of right ventricular electrode using the RAO α angle (≈30°) to the posterior-anterior position (PA position) was 1.099 ± 0.157 vs. 1.053 ± 0.182 (the ratio using the traditional RAO 45°) (P < 0.001). We observed that the relationship between the right ventricular active electrode and the ventricular septum was better identified using the LAO γ angle (≈40°) than the traditional 60° angle. CONCLUSION: With the help of cardiac CT, we found that RAO 30° could better show the shape and length of the right ventricular pacing electrode, and LAO 40° could better show the positional relationship between the pacing electrode and the ventricular septum.

Effectiveness of Baduanjin Exercise on Quality of Life and Psychological Health in Postoperative Patients With Breast Cancer: A Systematic Review and Meta-analysis.

BACKGROUND: Baduanjin exercise is a traditional Chinese Qigong exercise. This study aimed to investigate the effects of Baduanjin exercise on the quality of life and psychological status of postoperative patients with breast cancer. METHODS: A systematic review and meta-analysis were conducted. Eight databases were searched from inception to December 15, 2021, restricting the language to English and Chinese. RevMan5.3 software was employed for data analysis. This study was registered in PROSPERO, number CRD 42020222132. RESULTS: A total of 7 randomized controlled trials (RCTs) with 450 postoperative breast cancer patients with or without Baduanjin exercise were collected. Compared with the group without Baduanjin, those who practiced Baduanjin showed significant improvement in quality of life (WMD = 5.70, 95% CI 3.11-8.29, P < .0001). Subgroup analysis showed significant improvement in physical (WMD = 1.83, 95% CI 1.13-2.53, P < .00001) and functional well-being (WMD = 1.58, 95% CI 0.77-2.39, P = .0001), which were measured by the functional assessment of cancer therapy-breast (FACT-B). Subgroup analysis also showed that role-physical (WMD = 11.49, 95% CI 8.86-14.13, P < .00001) and vitality (WMD = 8.58, 95% CI 5.60-11.56, P < .00001) were significantly increased, as measured by a 36-item Short Form survey (SF-36). In terms of psychological health, Baduanjin exercise reduced patients' anxiety (WMD = -8.02, 95% CI -9.27 to -6.78, P < .00001) and depression (WMD = -4.45, 95% CI -5.62 to -3.28, P < .00001). CONCLUSIONS: Baduanjin is an effective exercise, which can significantly improve the quality of life and psychological health of breast cancer patients after operation.

Vertebral and carotid artery aneurysms and polyarthritis in a patient with Takayasu arteritis: A case report.

Takayasu arteritis (TA) is a common autoimmune disease in the clinical setting. However, vertebral artery aneurysms caused by TA are rarely reported. We herein describe a 28-year-old man with multiple vertebral artery aneurysms and carotid artery aneurysms caused by TA, which showed typical wall thickening and lumen dilation with a "string of beads" appearance by Doppler ultrasound and radiology. Previous studies have shown that most TA-associated vertebral artery lesions are stenosis, occlusion, and dissection of the intracranial part of the artery. In this case, TA mainly affected the cervical segment of the vertebral artery (the intracranial segment was not obviously involved), and the main manifestations were aneurysms and occlusion. This case provides more information for further understanding of TA-associated vertebral artery lesions.

Recent approaches to His-Purkinje system pacing.

OBJECTIVE: Physiologic cardiac pacing is a novel technique which has been largely popularized in recent decades. His bundle pacing (HBP) has been long considered the most physiologic pacing method; however, with the widespread implementation of this method, its disadvantages have become apparent. In this context, left bundle branch pacing (LBBP)-directly engaged in the His-Purkinje system-has been foreseen as the best pacing method to mimic physiologic activation patterns. This review aimed to summarize recent approaches to physiologic cardiac pacing. DATA SOURCES: This review included fully peer reviewed publications up to July 2018, found in the PubMed database using the keywords "His bundle branch pacing," "right ventricular pacing," and "physiologic pacing." STUDY SELECTION: All selected articles were in English, with no restriction on study design. RESULTS: The HBP has been studied worldwide, and is currently considered the most physiologic pacing method. However, it has disadvantages, such as high pacing threshold, unsatisfactory sensing and long procedure times, among others. Although LBBP is theoretically superior to HBP, the clinical relevance of this difference remains under debate, as few large randomized clinical trials with LBBP have been published. CONCLUSIONS: Although HBP indeed appears to be the most physiologic pacing method, it has certain shortcomings, such as high pacing threshold, difficult implantation due to specific anatomic features, and others. Further studies are required to clarify the clinical significance of LBBP.

Ultrasound bio-microscopy for measurement of coronary artery flow and estimation of infarct size in a mouse model of acute myocardial infarction.

Ultrasound bio-microscopy was used to measure hemodynamic changes in the left main coronary artery after myocardial infarction (MI), and its usefulness in estimating infarct size was evaluated. MI was induced by left anterior descending artery ligation. Diastolic peak velocity (Vd), mean flow velocity (Vmean) and the velocity-time integral (VTI) were measured 2 and 6 h after MI. Serum troponin I levels were assayed 2, 6 and 12 h after MI. At 2 h, Vmean and VTI significantly differed between mice that underwent low and high left anterior descending artery ligation; Vd, Vmean and VTI were correlated with infarct size (r = -0.557, -0.693 and -0.672, respectively; all p < 0.01). Infarct size was more strongly correlated with 2-h ultrasound bio-microscopy measurements than with 2-h serum troponin I level. Measurement of coronary artery blood flow by ultrasound bio-microscopy may be useful for early estimation of infarct size in mice.

Knockout of CD8 delays reendothelialization and accelerates neointima formation in injured arteries of mouse via TNF-α inhibiting the endothelial cells migration.

OBJECTIVE: Delayed or impaired reendothelialization is a major cause of stent thrombosis in the interventional treatment of coronary heart disease. T cells are involved in neointima formation of injured arteries. However, the regulated mechanism of reendothelialization and the role of CD8 T cell in reendothelialization are unclear. METHODS AND RESULTS: Immunofluorescence staining showed that CD8 positive cells were increased in wire injured femoral artery of mice. On day 21 after injury, elastin staining showed that knockout of CD8 (CD8(-/-)) significantly increased intimal thickness and a ratio of intima to media by 1.8 folds and 1.9 folds respectively in injured arteries. Evans blue staining showed that knockout of CD8 delayed the reendothelialization area on day 7 after injury (18.8±0.5% versus 42.1±5.6%, p<0.05). In vitro, a migration assay revealed that CD8(-/-) T cells co-cultured with WT macrophages significantly inhibited the migration of the endothelial cells (ECs); compared to CD4(+) T cells, and CD8(+) T cells could promote the ECs migration. Furthermore, real-time PCR analysis showed that knockout of CD8 increased the level of tumor necrosis factor α (TNF-α) in injured arteries and cytometric bead cytokine array showed that TNF-α was elevated in cultured CD8(-/-) T cells. Finally, a wound-healing assay showed that recombinant TNF-α significantly inhibited the migration of ECs. CONCLUSION: Our study suggested that CD8(+) T cells could promote the reendothelialization and inhibit the neointima formation after the artery wire injury, and this effect is at least partly dependent on decreasing TNF-α production promoting ECs migration.

[The relationship between ankle brachial index and all-cause and cardiovascular disease mortality in Chinese metabolic syndrome male cohort].

OBJECTIVE: Ankle brachial index (ABI) is thought to be an efficient means of objectively assessing the potency of lower extremity arterial system. This study is aimed to evaluate the relationship between ABI and cardiovascular disease CVD mortality in Chinese male patients with metabolic syndrome (MS). METHODS: 1224 Chinese male patients with MS were selected from Beijing and Shanghai and the baseline examinations were carried out. All the participants were divided into 2 main groups: ABI < or = 0.9 (n = 268) and ABI 0.9 - 1.4 (n = 956). and they were followed up for (13.2 +/- 2.7) months. RESULTS: As to baseline characteristics, age, systolic blood pressure (SBP), hypertensive disease and diabetes mellitus morbidity and smoking history had significant difference between the 2 groups (P < 0.05 or P < 0.01). All-cause mortality and CVD mortality decreased gradually while the ABI increased from 0.4 to 1.4. With Cox regression analysis, relative ratio (RR) value of all-cause mortality and CVD mortality also showed the decreasing trend with the rising of ABI. CONCLUSION: In Chinese male patients with MS, ABI is one of the most important parameters in indicating possible prognosis and foreseeing all-cause and CVD mortality. Male subjects with relatively old age, higher systolic blood pressure, hypertensive disease and diabetes mellitus morbidity, smoking history may be associated with lower ABI (< or = 0.9) and relatively higher all-cause and CVD mortality. Our results suggest the urgent need for frequent measurement of the ABI in clinical practice before diagnosing peripheral artery disease and making therapeutic decision, especially in some high-risk population such as male patients with MS.

[The relation between post-acute coronary syndrome anxiety and serum levels of inflammatory factors].

OBJECTIVE: To explore the role of inflammatory factors (interleukin-6, tumor necrosis factor alpha, high sensitive C reactive protein) in the pathogenesis of anxiety after acute coronary syndrome (ACS) by investigating the serum levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNFalpha) and high sensitive C reactive protein (hsCRP). METHODS: Serum IL-6, TNFalpha and hsCRP levels were measured in 105 ACS patients within 7 days after onset of the event. Symptoms of anxiety were evaluated by self-reporting standardized questionnaire, using a validated Chinese version of Hospital Anxiety and Depression Scale (HADS-A)-Anxiety Subscale (7 items) within 72 hours of the event. Demographic and clinical data including cardiac risk factors were recorded. RESULTS: The median of TNFalpha was lower in the anxious patients with ACS than that of non-anxious ones (44.55 vs 61.70, P = 0.004). Neither the levels of hsCRP nor the levels of IL-6 were found to be different between the groups with anxiety and without. CONCLUSION: Anxiety after ACS does not increase the inflammatory reaction in the ACS patients.