Comparation of quality of life in Chinese patients undergoing leadless versus conventional pacemaker implantation.

BACKGROUND: Leadless pacemakers are widely used, but the quality of life assessment of patients with leadless pacemakers is still unclear. HYPOTHESIS: Assume that leadless pacemakers can improve the patients' quality of life. METHODS: Total of 119 patients who received pacemaker implantation at Beijing Anzhen Hospital from January 2020 to March 2022 were selected, including 35 leadless pacemakers and 84 conventional pacemakers. The SF-36 questionnaire was used to evaluate quality of life at baseline, 1 month and 3 months after surgery. We also used a questionnaire consisted of 4 specific questions related to the implant procedure to assess the surgery. RESULTS: There were no differences in baseline characteristics between the two groups, except for age and oral anticoagulant treatment. There was no difference in baseline SF-36 scores. At the 3-month follow-up, patients in leadless pacemakers group were significantly better at physical function (63.63 vs 47.50, p = .000), role physical (60.20 vs 40.23, p = .000), bodily pain (65.57 vs. 61.69, p = .042), physical component summary (61.25 vs. 50.57, p = .000), vitality (56.26 vs 49.57, p = .001), social function (80.14 vs 74.70, p = .004), role emotional (76.14 vs. 71.42, p = .015), mental health (75.46 vs. 68.18, p = .000), mental component summary (72.00 vs. 65.97, p = .000), even after adjusting for clinical baseline and SF-36 baseline. Pacemaker-related discomfort and mobility limitations were significantly reduced in leadless pacemakers group. CONCLUSIONS: Leadless pacemakers is associated with better quality of life with less activity limitations due to surgical discomfort and less emotional distress. However, current use of leadless pacemakers in China is limited due to the high cost.

Inherited human c-Rel deficiency disrupts myeloid and lymphoid immunity to multiple infectious agents.

We studied a child with severe viral, bacterial, fungal, and parasitic diseases, who was homozygous for a loss-of-function mutation of REL, encoding c-Rel, which is selectively expressed in lymphoid and myeloid cells. The patient had low frequencies of NK, effector memory cells reexpressing CD45RA (Temra) CD8+ T cells, memory CD4+ T cells, including Th1 and Th1*, Tregs, and memory B cells, whereas the counts and proportions of other leukocyte subsets were normal. Functional deficits of myeloid cells included the abolition of IL-12 and IL-23 production by conventional DC1s (cDC1s) and monocytes, but not cDC2s. c-Rel was also required for induction of CD86 expression on, and thus antigen-presenting cell function of, cDCs. Functional deficits of lymphoid cells included reduced IL-2 production by naive T cells, correlating with low proliferation and survival rates and poor production of Th1, Th2, and Th17 cytokines by memory CD4+ T cells. In naive CD4+ T cells, c-Rel is dispensable for early IL2 induction but contributes to later phases of IL2 expression. The patient's naive B cells displayed impaired MYC and BCL2L1 induction, compromising B cell survival and proliferation and preventing their differentiation into Ig-secreting plasmablasts. Inherited c-Rel deficiency disrupts the development and function of multiple myeloid and lymphoid cells, compromising innate and adaptive immunity to multiple infectious agents.

Meta-Analysis of Radial Versus Femoral Artery Approach for Coronary Procedures in Patients With Previous Coronary Artery Bypass Grafting.

Cardiac catheterization through the radial artery approach (RA) has been shown to significantly reduce access-site complications compared with the femoral artery approach (FA) in many clinical settings. However, in the subset of patients with previous coronary artery bypass grafting (CABG), optimal vascular access site for coronary angiography and intervention is still a matter of debate. We aimed to perform a systematic review and meta-analysis of available studies comparing RA with FA in patients with previous CABG. Data were extracted by two independent reviewers; weighted mean differences and 95% confidence interval (CI) were calculated for continuous outcomes, whereas odds ratio (OR) and 95% CI were calculated for dichotomous outcomes. Summary statistics were calculated by random-effects model using Review Manager 5.3 software. The meta-analysis included 1 randomized and 8 nonrandomized studies, with a total of 2,763 patients. Compared with FA, RA required similar procedural time (mean difference 3.24 minutes, 95% CI -1.76 to 8.25, p = 0.20), fluoroscopy time (mean difference 0.62 minutes, 95% CI -0.83 to 2.07, p = 0.40), and contrast volume (mean difference -2.58 ml, 95% CI -18.36 to 13.20, p = 0.75) and was associated with similar rate of procedural failure (OR 1.32, 95% CI 0.63 to 2.80, p = 0.46), higher rate of crossover to another vascular access (OR 7.0, 95% CI 2.74 to 17.87, p <0.0001), and lower risk of access-site complications (OR 0.46, 95%CI 0.26 to 0.80, p = 0.006). In conclusion, the present meta-analysis suggests that in patients with previous CABG undergoing coronary procedures, RA, compared with FA, is associated with increased crossover rate but may reduce access-site complications.

Dendritic cell development-History, advances, and open questions.

Dendritic cells (DCs) are uniquely potent in orchestrating T cell immune response, thus they are indispensable immune sentinels. They originate from progenitors in the bone marrow through hematopoiesis, a highly regulated developmental process involving multiple cellular and molecular events. This review highlights studies of DC development-from the discovery of DCs as glass-adherent antigen presenting cells to the debate and resolution of their origin and lineage map. In particular, we summarize the roles of lineage-specific cytokines, the placement of distinct hematopoietic progenitors within the DC lineage and transcriptional programs governing DC development, which together have allowed us to diagram the current view of DC hematopoiesis. Important open questions and debates on the DC development and relevant models are also discussed.