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Background Arteriovenous fistulas, a major treatment for end-stage kidney disease, frequently require endovascular reinterventions to maintain haemodialysis function. Drug-coated angioplasty balloons (DCBs) were developed with the intention of reducing reintervention rates. The aim of this study was to perform a systematic review and meta-analysis of DCBs in the treatment of failing haemodialysis access. Methods Electronic databases were searched systematically to identify all relevant RCTs and any follow-up studies from RCTs. Pooled estimates of dichotomous outcomes were calculated using the odds ratio (OR) and 95 per cent confidence interval. Effect data are presented as summary hazard ratio and 95 per cent confidence interval. Results Some 19 studies from 18 RCTs and comprising 1898 patients were included in the meta-analysis. Compared with plain balloon angioplasty (PBA), DCB use was associated with higher target-lesion primary patency (HR 0.60, 95 per cent c.i. 0.45 to 0.79), access-circuit primary patency (HR 0.67, 0.56 to 0.80), and less target-lesion revascularization (TLR) within 6 months (OR 0.33, 0.23 to 0.47). No difference was observed between DCB and PBA in 12-month TLR (OR 0.62, 0.28 to 1.37). Mortality after DCB use was similar to that associated with PBA use at 6 months (OR 1.20, 0.65 to 2.21) and 12 months (OR 0.99, 0.66 to 1.49), and was higher at 24 months (23.1 versus 16.6 per cent), although the difference was not statistically significant (OR 1.53, 0.92 to 2.53). Conclusion Drug-coated balloon angioplasty of haemodialysis fistulas is associated with higher patency rates and lower rates of reintervention in the short to mid term. Although mortality rates appeared to be higher with drug-coated angioplasty at 24 months, this did not reach statistical significance.

Decoding human movement parameters from electroencephalograms (EEG) signals is of great value for human-machine collaboration. However, existing studies on hand movement direction decoding concentrate on the decoding of a single-hand movement direction from EEG signals given the opposite hand is maintained still. In practice, the cooperative movement of both hands is common. In this paper, we investigated the neural signatures and decoding of single-hand and both-hand movement directions from EEG signals. The potentials of EEG signals and power sums in the low frequency band of EEG signals from 24 channels were used as decoding features. The linear discriminant analysis (LDA) and support vector machine (SVM) classifiers were used for decoding. Experimental results showed a significant difference in the negative offset maximums of movement-related cortical potentials (MRCPs) at electrode Cz between single-hand and both-hand movements. The recognition accuracies for six-class classification, including two single-hand and four both-hand movement directions, reached 70.29%± 10.85% by using EEG potentials as features with the SVM classifier. These findings showed the feasibility of decoding single-hand and both-hand movement directions. This work can lay a foundation for the future development of an active human-machine collaboration system based on EEG signals and open a new research direction in the field of decoding hand movement parameters from EEG signals.

Objective The aim was to compare mid term outcomes between crossed limb (CL) and standard limb (SL) configuration in patients who underwent endovascular aortic aneurysm repair (EVAR). Methods This was a comparative cohort study. Eligible patients who underwent EVAR between September 2011 and March 2019 in a tertiary academic centre were included. Inverse probability of treatment weighting (IPTW) was used to balance the demographic, anatomical and operative baseline characteristics between the two groups. The primary outcome was adverse limb events including type IB endoleak (T1BEL), type III endoleak, and limb occlusion. Cox proportional hazards regression and marginal structural model were performed to compare time to event outcomes. Results The study included 729 patients (194 CL and 535 SL) with a median follow up of 34 months (interquartile range 16 – 62 months). The weighted analyses revealed no significant difference between CL and SL EVAR in terms of adverse limb events, type IA endoleak (T1AEL), type II endoleak (T2EL), re-intervention, and overall survival. In the subgroup analysis of large aneurysm sac, the CL configuration was associated with a significantly decreased risk of T1BEL (hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.12 – 0.78, p = .014). Similar results were also observed in the subgroup of tortuous iliac arteries (HR 0.30, 95% CI 0.11 – 0.81, p = .017). After stratification by severe neck angulation, no significant difference was found between CL and SL EVAR for T1AEL, but the CL configuration was associated with a significantly increased risk of re-intervention (HR 2.69, 95% CI 1.31 – 5.51, p = .007). In addition, a trend towards a higher risk of adverse limb events in the CL group with severely angulated proximal neck was observed. Conclusion CL configuration in EVAR is safe and may be associated with a lower risk of T1BEL in patients with a large aneurysm sac or tortuous iliac arteries. However, it should be applied cautiously to aneurysms with a severely angulated neck due to the potentially higher risk of re-intervention.

Currently, the clinical classification of the severity of renal artery stenosis (RAS) solely depends on the degree of stenosis. In addition, when the stenosis degree is between 50% and 70%, the clinical strategy is decided based on whether the RAS is hemodynamically significant. In this study, the influence of RAS morphological parameters on hemodynamics was numerically analyzed to provide a theoretical basis for clinical treatment.Idealized RAS models were established to investigate the hemodynamic effects of the stenosis length, asymmetric stenosis, and direction of the opening of the renal artery.The longer the stenosis length, the greater is the ratio of the low time-averaged wall shear stress (WSS) and high oscillatory shear index (OSI) area distal stenosis (when the stenosis area is the same). In addition, asymmetric stenosis leads to a significant increase in the ratio of the renal artery peak systolic velocity (R-PSV) and the abdominal aorta peak systolic velocity (A-PSV) when the stenosis area is 60-70%. Furthermore, the fraction flow reserve (FFR) of the RAS model with 12 mm stenosis length, upward eccentricity and upward direction of renal artery opening was approximately equal to the cumulative value of the influence of different stenosis morphologies on FFR.An assessment of the severity of RAS should consider the stenosis area and other morphological parameters, including the length and asymmetry of RAS as well as the direction of the opening of renal artery, particularly when the stenosis degree of RAS is between 50% and 70%.

BACKGROUND Infectious common femoral artery pseudoaneurysm caused by Klebsiella pulmonary infection is a relatively infrequent entity but is potentially life and limb threatening. The management of infectious pseudoaneurysm remains controversial. CASE SUMMARY We reported a 79-year-old man with previous Klebsiella pneumoniae pulmonary infection and multiple comorbidities who presented with a progressive pulsate mass at the right groin and with right lower limb pain. Computed tomography angiography showed a 6 cm × 6 cm × 9 cm pseudoaneurysm of the right common femoral artery accompanied by occlusion of the right superficial femoral artery and deep femoral artery. He underwent endovascular treatment (EVT) with stent–graft, and etiology of infectious pseudoaneurysm was confirmed. Then, 3-mo antibiotic therapy was given. One-year follow-up showed the stent–graft was patent and complete removal of surrounding hematoma. CONCLUSION The femoral artery pseudoaneurysm can be caused by Klebsiella pneumoniae deriving from the pulmonary infection. Moreover, this unusual case highlights the use of EVT and prolonged antibiotic therapy for infectious pseudoaneurysm.

This study investigated the changes in the structural and functional properties of various adlay starch-based polymers that occur during low moisture extrusion. The water absorption index, water solubility index, color, and morphological, pasting, and thermal properties of the adlay flours were investigated. Extrusion significantly decreased their contents (starch > protein > fiber > lipids). The color of the adlay flour darkened after extrusion, primarily due to the Maillard reaction and caramelization. Scanning electron microscopy revealed various cracks, pits, and holes on the surface of the extruded flour without defatting for both the extruded brown adlay and the extruded polished adlay. Extrusion caused molecular degradation of the extruded starch, decreasing its swelling power in hot water. The ΔH values (0.19-0.71 J/g) of the extrudates revealed that the starch granules were not fully gelatinized. These results provide a theoretical basis for further explorations of the interactions of adlay macromolecules by extrusion.

Objectives: Cross-limb stent grafts for endovascular aneurysm repair (EVAR) are often employed for abdominal aortic aneurysms (AAAs) with significant aortic neck angulation. Neck angulation may be coronal or sagittal; however, previous hemodynamic studies of cross-limb EVAR stent grafts (SGs) primarily utilized simplified planar neck geometries. This study examined the differences in flow patterns and hemodynamic parameters between crossed and non-crossed limb SGs at different spatial neck angulations.Methods: Ideal models consisting of 13 cross and 13 non-cross limbs were established, with coronal and sagittal angles ranging from 0 to 90°. Computational fluid dynamics (CFD) was used to capture the hemodynamic information, and the differences were compared.Results: With regards to the pressure drop index, the maximum difference caused by the configuration and angular direction was 4.6 and 8.0%, respectively, but the difference resulting from the change in aneurysm neck angle can reach 27.1%. With regards to the SAR-TAWSS index, the maximum difference caused by the configuration and angular direction was 7.8 and 9.8%, respectively, but the difference resulting from the change in aneurysm neck angle can reach 26.7%. In addition, when the aneurysm neck angle is lower than 45°, the configuration and angular direction significantly influence the OSI and helical flow intensity index. However, when the aneurysm neck angle is greater than 45°, the hemodynamic differences of each model at the same aneurysm neck angle are reduced.Conclusion: The main factor affecting the hemodynamic index was the angle of the aneurysm neck, while the configuration and angular direction had little effect on the hemodynamics. Furthermore, when the aneurysm neck was greatly angulated, the cross-limb technique did not increase the risk of thrombosis.

Background Covered stent has become one of the mainstream therapies for aortoiliac obstructive disease (AIOD), with higher patency rate compared to bare metal stent. Covered balloon-expandable (CBE) stent can be placed more accurately with higher radial support force, while covered self-expanding (CSE) stent has greater elasticity and higher trackability. However, there is no level I evidence regarding the comparison safety and efficacy between the CSE stent and CBE stent in AIOD up to date. Therefore, this study aims to compare the efficacy and safety of CBE stent (BARD®LIFESTR`EAM™) and CSE stent (GORE® VIABAHN™) in AIOD. Methods This trial is a prospective, single center, paralleled, non-inferiority, randomized controlled trial. A total of 106 patients will be enrolled and these patients will be randomized to either the CBE stent group or CSE stent group. The primary end point of the study is occurrence of Target Lesion Revascularization (TLR) at 12 months after the intervention. Discussion To our knowledge, the NEONATAL trial is the first RCT to compare CBE and CSE stent in AIOD patients. The results of clinical trials may contribute to establishing a strategic guideline for choosing the optimal type of covered stent in treatment of AIOD patients. Trial registration: ChiCTR2100046734; Registered on 27 May, 2021 in Chinese Clinical Trials Registry.

Background: Current evidence regarding gender difference in retroperitoneal liposarcoma (RLPS) is scarce, we sought to investigate whether gender may affect prognosis after primary resection of RLPS.Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to identify RLPS patients from January 1973 to December 2015. Multivariate cox proportional hazards analysis was adopted to generate adjusted hazard ratio (AHR) and 95% confidence intervals (CI) of survival outcomes.Results: In total, 2108 RLPS patients, including 971 women and 1137 men, were identified, with a median follow-up of 45.0 (17.0-92.0) months. The 5-year and 10-year overall survival rates were 50.5% and 31.5% for men, and 60.4% and 42.5% for women. The 5-year and 10-year disease-specific survival rates for men and women were 71.5%, 57.3% and 76.3%, 62.1%, respectively. We found men were associated with an increased risk of all-cause mortality (AHR 1.3, 95%CI 1.0-1.6, P=.017) but not disease-specific mortality (AHR 1.2, 95%CI 0.9-1.6, P=.246). The subgroup analyses revealed that men were associated with an increased risk of all-cause mortality in patients with low-grade tumors (AHR 1.8, 95%CI 1.3-2.5) or patients received non-radical resection (AHR 1.6, 95%CI 1.2-2.1). Besides, in the subgroup of low-grade tumors, men were also associated with an increased risk of disease-specific mortality (AHR 2.0, 95%CI 1.2-3.3).Conclusion: Men may have worse survival after primary resection of RLPS compared with women, especially in patients with low-grade tumors or patients received non-radical resection. Gender-based disparities may deserve more attention in patients with RLPS.

Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for acute liver injury caused by overuse of acetaminophen (APAP). Caveolin-1 (CAV1), a regulator of hepatic energy metabolism and oxidative stress, was found to have a protective effect against NAFLD in our previous study. However, it remains unclear whether CAV1 has a protective effect against APAP-induced hepatotoxicity in NAFLD. The aim of this study was to determine whether CAV1 inhibits oxidative stress through the AMPK/Nrf2/HO-1 pathway to protect the liver from fat accumulation exacerbated by APAP in NAFLD. In this study, seven-week-old C57BL/6 male mice (18–20 g) were raised under similar conditions for in vivo experiment. In vitro, L02 cells were treated with A/O (alcohol and oleic acid mixture) for 48 h, and APAP was added at 24 h for further incubation. The results showed that the protein expression of the AMPK/Nrf2 pathway was enhanced after CAV1 upregulation. The effects of CAV1 on fat accumulation, ROS, and the AMPK/Nrf2 anti-oxidative pathway were reduced after the application of CAV1-siRNA. Finally, treatment with compound C (an AMPK inhibitor) prevented CAV1 plasmid-mediated alleviation of oxidative stress and fat accumulation and reduced the protein level of Nrf2 in the nucleus, demonstrating that the AMPK/Nrf2/HO-1 pathway was involved in the protective effect of CAV1. These results indicate that CAV1 exerted a protective effect against APAP-aggravated lipid deposition and hepatic injury in NAFLD by inhibiting oxidative stress. Therefore, the upregulation of CAV1 might have clinical benefits in reducing APAP-aggravated hepatotoxicity in NAFLD.

BackgroundThe appropriate surgical procedure for early-stage retroperitoneal sarcoma (RPS) is unclear. Thus, we used a national database to compare the outcomes of radical and non-radical resection in patients with early stage RPS.MethodsThis retrospective study included 886 stage I RPS patients from 2004 to 2015 in the SEER database. Outcomes were compared using the multivariate Cox proportional hazards models and the results were presented as adjusted hazards ratio (AHR) with corresponding 95% confidence intervals (95%CIs). Propensity score-matched analyses were also performed for sensitive analyses.ResultsFor the 886 stage I RPS patients, 316 underwent radical resection, and 570 underwent non-radical resection, with a median follow-up of 4.58 (2.73-8.35) years. No difference was observed in overall mortality (AHR 0.84, 95%CI 0.62-1.15; P = 0.28) or RPS-specific mortality (AHR 0.88, 95%CI 0.57-1.36; P = 0.56) between groups. The results were similar in propensity score-matching analyses. However, subgroup analysis revealed that radical resection was associated with significantly decreased risks of overall mortality in male (AHR 0.61, 95%CI 0.38-0.98; P = 0.04) and in patients with radiotherapy (AHR 0.56, 95%CI 0.32-0.98; P = 0.04).ConclusionRadical resection did not improve midterm survival outcomes compared with non-radical resection in overall patients with early stage RPS. However, male patients or patients who received radiotherapy might benefit from radical resection with improved overall survival.

Alcoholic fatty liver (AFL) is a disease characterized by the abnormal structure and dysfunction of hepatocytes caused by long-term, excessive drinking. Acetaminophen (APAP) is a commonly used painkiller, but it can aggravate lipid deposition in the liver and cause liver injury when used in fatty liver disease. Here, we investigated the effect of caveolin-1 (CAV-1), an intracellular stent protein, on the pathogenesis of APAP aggravated lipid deposition in AFL mice. This study shows that lipid accumulation was more severe in APAP groups than in alcohol-treated mice. The CAV-1 stent-like domain (CSD, 82–101 amino acids of caveolin-1), used to upregulate CAV-1 expression, could reduce lipid accumulation and activate autophagy in AFL mice treated with APAP. The levels of CAV-1 and autophagy-related proteins (LC3-II/I and Beclin-1) had decreased, whereas SREBP-1c had increased in A/O (alcohol and oleic acid) and APAP-co-treated L02 cells. CAV-1 small interfering RNA and CAV1-overexpressing plasmid were separately transfected into A/O and APAP co-treated L02 cells. When CAV-1 was downregulated, the levels of Pink-1, Parkin, and autophagy-related proteins (LC3-II/I and Beclin-1) were decreased, whereas SREBP-1c was increased. The opposite trend was observed when CAV-1 was overexpressed. The results show that CAV-1 reduced lipid accumulation in L02 cells and activated Pink-1/Parkin-related mitophagy. This study highlights the positive role of CAV-1 in APAP-increased lipid accumulation under the AFL status and provides a new understanding of the function of CAV-1 in the liver through mitophagy associated with the Pink-1/Parkin pathway.

This meta-analysis was conducted to investigate whether compression stockings were necessary after endovenous thermal ablation of varicose veins.Electronic databases, including MEDLINE, EMBASE, and the Cochrane Library database, were searched from inception to 10 March 2021 to identify all the related trials.Random or fixed effects models were used to generate pooled mean difference (MD) or standardised mean difference (SMD) for continuous data, risk ratios (RRs) for dichotomous data, and related 95% confidence intervals (95% CIs). The quality of evidence was graded with a specific tool (GRADEpro GDT) from the GRADE working group.A total of seven randomised controlled trials (RCTs) comprising 1 146 patients were included in this meta-analysis. Wearing compression stockings was correlated with lower post-operative pain scores from a 0 to 100 mm visual analogue scale (MD -8.00; 95% CI -12.01 - -3.99; p.001). No difference was observed between wearing compression stockings or not in quality of life (SMD 0.45; 95% CI 0.14 - 1.04), major complications (RR 0.64; 95% CI 0.26 -1.59), target vein occlusion rates (RR 0.99; 95% CI 0.96 - 1.02), or time to return to work (MD -0.43; 95% CI 1.06 - 0.19).After endovenous thermal ablation of varicose veins, wearing compression stockings was not associated with a better outcome except for mild pain relief. Post-operative compression stockings may be unnecessary after endovenous thermal ablation.

Rationale: Endovascular treatment (EVT) is considered a preferred procedure of superficial femoral artery (SFA) pseudoaneurysm in recent years. However, heterotopic ossification (HO) after SFA pseudoaneurysm is a rare occurrence, that may cause late stent–graft fracture. Patient concerns: A 58-year-old male who underwent EVT for SFA pseudoaneurysm 8 years ago presented with a progressive mass at the right thigh and claudication. Computed tomography angiography (CTA) showed fracture and occlusion of stent–graft, which was compressed by the deep femoral artery (DFA) pseudoaneurysm and a bone-like body. Diagnosis: According to the CTA images, the stent–graft was fractured and occluded, accompanied by DFA pseudoaneurysm. Interventions and outcomes: Debridement and arterial reconstruction were performed. Pathological analysis showed that the bone-like body was derived from HO. CTA at one-year follow-up showed that the prosthetic vessel was patent and previous hematoma disappeared. Conclusions: This report demonstrates that residual hematoma can induce HO, which may result in late stent fracture, and it should thus be removed timely. Patients with SFA pseudoaneurysm who have undergone EVT should be followed up regularly.

Background: Obstructive sleep apnea-hypopnea syndrome (OSAHS) can impact multiple organ systems in children. Objectives: To investigate the effects of OSAHS on T-lymphocyte subgroups and natural killer (NK) cell activity in the peripheral blood of affected children. Methods: A total of 85 children with OSAHS were enrolled into an experimental group (OSAHS) and 76 healthy children were placed in a control group (CON) to compare peripheral blood levels of CD3+, CD4+, CD8+, and NK cell activity using flow cytometry. Meanwhile, their polysomnography results were monitored to analyze the correlation between T-lymphocyte subgroups/NK cell activity and lowest pulse oxygen saturation (LSaO2)/apnea-hypopnea index (AHI). Results: Compared to the CON group, the CD3+ percentage in the OSAHS group showed no significant difference (65.98 ± 6.54 vs 64.36 ± 5.32; P > 0.05), but the CD4+ percentage, CD4+/CD8+ ratio, and NK cell activity decreased markedly (33.52 ± 3.04 vs 35.26 ± 3.68,1.29 ± 0.14 vs 1.43 ± 0.26, and 11.47 ± 4.58 vs 12.69 ± 2.36, respectively; P < 0.05). In addition, the CD8+ percentage increased significantly (26.18 ± 4.76 vs 24.36 ± 2.32; P < 0.05). Linear regression analysis indicated that the CD3+ percentage was not related to LSaO2/AHI (P > 0.05), but the CD4+ and CD8+ percentages, CD4+/CD8+ ratio, and NK cell activity were linearly related to LSaO2 and AHI (P < 0.05). Conclusions: OSAHS can affect the cellular immunity of children. The AHI and LSaO2 may be involved in cellular immunity function.

Objective The aim of the present study was to demonstrate the clinical outcomes of intentional coverage of the celiac artery (CA) during thoracic endovascular aneurysm repair (TEVAR). Methods The MEDLINE, EMBASE, and Cochrane Library databases were searched for studies reporting coverage of CA during TEVAR. The methodologic quality of the included studies was assessed using the Moga score and Newcastle-Ottawa scale. A random effects model was used to pool the estimates. A meta-analysis was performed with investigation of the following outcomes: visceral ischemia, spinal cord ischemia (SCI), stroke, endoleak, reintervention, 30-day mortality, and 1-year mortality. Results A total of 10 studies with 171 patients were included. The summary estimate rate of visceral ischemia events was 4.2% (95% confidence interval [CI], 0.9-8.9%; I2 = 4.1%). The incidence of stroke and SCI was 0.2% (95% CI, 0%-3.4%; I2 = 0%) and 3% (95% CI, 0.3%-7.4%; I2 = 6.1%). The rate of endoleak during the follow-up period was 24.1% (95% CI, 14.3%-35.1%; I2 = 20.0%). The reintervention rate was 13.6% (95% CI, 4.4%-25.7%; I2 = 66.0%). The 30-day and 1-year mortality were 2.9% (95% CI, 0.3%-7.2%; I2 = 6.2%) and 15.2% (95% CI, 7.8%-23.9%; I2 = 0%). Conclusions Among the patients with complex thoracic aortic pathologies deemed at high risk for open reconstruction, TEVAR with intentional coverage of the CA is a safe and feasible option to extend the distal sealing zone with acceptable rates of visceral ischemia, SCI, type II endoleak from the CA, and 30-day mortality.

To evaluate the effect of frailty assessed by the modified Frailty Index (mFI) on major adverse cardiac and cerebrovascular events (MACCE) in the elderly patients after endovascular aortic aneurysm repair (EVAR).This was a retrospective cohort study of elderly patients who underwent EVAR in a tertiary hospital. The main exposure was frailty status assessed by the mFI. The primary outcomes were 30-day and long-term MACCE. The predictive ability of the mFI was compared with the Revised Cardiac Risk Index (RCRI) using net reclassification improvement (NRI) and integrated discrimination improvement (IDI) statistics.Of 749 participants, 134 (17.89%) were identified as frail and 185 (24.70%) as prefrail. Thirteen patients (1.74%) were lost in follow-up after surgery, and the median length of follow-up was 32.00 months (range, 15.00-59.25 months). Frailty was associated with a significantly increased risk of 30-day MACCE (adjusted odds ratio OR, 14.53; 95% confidence interval [CI], 4.59-46.04; P .0001) and longer intensive care unit stay (adjusted odds ratio, 2.43; 95% CI, 1.17-5.07; P = .0176). As for long-term outcomes, both frailty and prefrailty were associated significantly increased risks of MACCE after EVAR (prefrail: adjusted hazard ratio [HR] 1.71; 95% CI, 1.12-2.61; frail: adjusted HR, 3.37; 95% CI, 1.86-6.10). When considering death as a competing risk, we also observed a significant association between frailty and cardiac and cerebrovascular events (adjusted HR, 2.95; 95% CI, 1.06-8.15). In addition, frailty was associated with a significantly increased risk of all-cause mortality (adjusted HR, 1.93; 95% CI, 1.28-2.90). Compared with the RCRI, the mFI had better discrimination in predicting 30-day MACCE (IDI: 0.225; 95% CI, 0.018-0.431; P = .033; NRI: 0.225; 95% CI, 0.023-0.427; P = .029) and long-term MACCE (IDI: 0.056; 95% CI, 0.018-0.128; P = .013; NRI: 0.237; 95% CI, 0.136-0.359; P .001).Frailty assessed by the mFI may serve as a useful predictor of both short-term and long-term MACCE in elderly patients after EVAR, with improved discrimination and reclassification abilities compared with the RCRI.

Decoding human motor intention from electroencephalograms (EEG) signals is valuable for developing intelligent driver-assistive systems. However, existing studies about human motion decoding from EEG signals are only focused on one main movement task without considering the influence of other movement tasks. In this work, we explore the decoding of right-hand movement direction from EEG signals in the presence of a left-hand movement. A corresponding experimental paradigm was designed. The phase-locking value (PLV), amplitude in the time domain, and spectrum energy in the frequency domain from different frequency bands were used as classification features, respectively, and linear discrimination analysis (LDA) was used as a classifier to decode movement direction of the right hand. Experimental results showed that the decoding model based on the amplitude in the delta band performed best with a mean accuracy of 73.01% for the left-and-right direction pair, showing the feasibility of movement direction decoding of a single hand from EEG signals under a movement of the other hand.

Objective The aim of our systematic review and meta-analysis was to demonstrate the clinical outcomes of open surgical repair (OSR) and endovascular aneurysm repair (EVAR) for infective native aortic aneurysms (INAAs). Methods MEDLINE, Embase, and Cochrane Databases were searched for articles reporting OSR and/or EVAR repair of INAA. The methodological quality of included studies was assessed by the Newcastle-Ottawa scale and Moga-Score. Random-effects models were used to calculate the pooled measures. Results A total of 34 studies were included, with 22 studies reporting OSR alone, 6 studies reporting EVAR alone and 6 comparative studies for INAAs. The pooled estimates of infection-related complications (IRCs) were 8.2% (95% CI 4.9%-12.2%) in OSR cohort and 23.2% (95% CI 16.1%-31.0%) in EVAR cohort. EVAR was associated with a significantly increased risk of IRCs compared with OSR during follow-up (OR 1.9, 95% CI 1.0-3.7). As for survival outcomes, the summary estimate rate of all cause 30-day, 3-month and 1-year mortality in OSR cohort were 11.7% (95% CI 7.7%-16.1%), 21.6% (95%CI 16.3%-27.4%) and 28.3% (95% CI 20.5%-36.7%; I2=50.47%), respectively. For EVAR cohort, the summary estimate rate of all cause 30-day, 3-month and 1-year mortality were 4.9% (95% CI 1.1%-10.4%), 9.4% (95% CI 2.7%-18.7%) and 22.2% (95% CI 12.4%-33.7%), respectively. EVAR was associated with a significantly decreased of 30-day mortality (OR 0.2, 95% CI 0.1-0.6). However, no difference was found between EVAR and OSR in 3-month (OR 0.2, 95% CI 0-1.1), 1-year all-cause mortality (OR 0.4, 95% CI 0.1-1.1) or aneurysm-related mortality (OR 1.4, 95% CI 0.5-3.9). Moreover, no difference of incidence of reintervention was observed (OR 2.6, 95% CI 0.9-7.7; I2=53.7%) between two groups. Conclusions EVAR could provide better short-term survival than OSR in patients with INAAs. However, patients undergoing EVAR suffered from higher risks of IRCs. EVAR could be considered as an alternative for low-risk patients with well-controlled infections or patients considered high-risk for open reconstruction.

Background Few studies investigated the effects of sublingual immunotherapy (SLIT) on the peripheral regulatory T cells (Tregs)/Th17 ratio. Objective To investigate the effectiveness of SLIT in children with allergic rhinitis (AR) and the effects on the Tregs/Th17 ratio. Methods This was a retrospective study of children who were treated for AR between April 2017 and March 2018 at one hospital. The patients were grouped according to the treatments they received: SLIT + pharmacotherapy vs pharmacotherapy alone. Results Eighty children (51 boys and 29 girls; 40/group) were included. The visual analog scale (VAS) and medication scores at 1 year in the SLIT + pharmacotherapy group were 2.70 ± 1.08 and 1.1 ± 0.8, respectively, which were lower than at baseline (7.7 ± 1.2 and 3.6 ± 1.0, respectively) (both Ps < 0.05). For the pharmacotherapy group, the VAS score was decreased at 1 year vs baseline (3.3 ± 1.2 vs 7.4 ± 1.0; P < 0.05), but the medication score did not change (P > 0.05). In the SLIT + pharmacotherapy group, the Treg percentage increased, while the Th17 percentage decreased at 1 year (both Ps < 0.01). The percentages of Tregs and Th17s did not change in the pharmacotherapy group (both Ps > 0.05). Conclusions SLIT + pharmacotherapy can increase the Treg percentage and decrease the Th17 percentage in the peripheral blood of children with AR.

Objective For thoraco-abdominal aortic aneurysms (TAAA), it is unclear whether it is better to perform hybrid repair in one (single) or two stages (staged). This study aimed to compare the clinical outcomes of single vs. staged hybrid repair of TAAA. Methods The Medline, Embase, and Cochrane Databases (1 January 1994 to 11 May 2020) were searched for studies on hybrid repair of TAAA. Cohort studies and case series reporting outcomes of single and staged hybrid repair of TAAA were eligible for inclusion. The Newcastle–Ottawa scale and an 18 item tool were used to assess the risk of bias. The primary outcome was 30 day mortality, and the secondary outcomes included post-operative complications, overall survival, and other mid term events. A random effects model was used to calculate pooled estimates. Results A total of 37 studies was included in the meta-analysis. The quality assessment of the included studies suggested low or moderate risk of bias. The pooled estimates for aneurysm rupture and death during stage interval were 2% (95% CI 0%–4%, I2 = 0%) and 4% (95% CI 2%–7%, I2 = 0%), respectively. Single repair was associated with a significantly higher 30 day risk of death when compared with patients who completed staged procedures successfully (OR 2.64, 95% CI 1.36–5.12, I2 = 0%). Staged repair also had lower incidence of major adverse cardiac events (MACE) (single: 10%, 95% CI 5%–16%; staged: 2%, 95% CI 0%–5%) and intestinal complications (single: 15%, 95% CI 8%–25%; staged: 3%, 95% CI 1%–6%). For mid term outcomes, single and staged repair had comparable 12 month overall survival, aneurysm related mortality, rate of re-intervention, and graft patency. Conclusion Two stage hybrid repair may represent a better choice for patients with controlled risk of aneurysm rupture, because it can provide lower 30 day mortality risks, MACE, and intestinal complications, as well as comparable mid term outcomes. Randomised controlled trials are needed to ascertain the effect of repair staging in patients for elective TAAA.

Objective To evaluate the quality of published evidence of all frailty tools in major vascular surgery and to determine the effect of frailty on short and long-term outcomes after vascular procedures. Methods MEDLINE, Embase, Cochrane Database and Scopus (updated on May 12, 2018) were searched for studies evaluating the effect of frailty in vascular surgery and data were extracted from the included studies. A modified Newcastle-Ottawa scale was used to assess the quality of the included studies. The impact of frailty on outcomes was expressed as odds ratios (OR) or hazard ratios (HR) using a random effects model. Results A total of 22 cohort studies and one RCT were included. Overall frailty was found to be associated with a significantly increased risk of 30 day mortality in patients who underwent vascular surgery (OR 3.83, 95% CI 3.08–4.76), with similar effects in both patients who underwent abdominal aortic aneurysm (AAA) repair (OR 5.15, 95% CI 3.91–6.77) and lower extremity revascularisation (OR 3.29, 95% CI 2.53–4.28). Functional status remained the only tool with high quality of evidence predicting 30 day mortality after vascular surgery (OR 4.49, 95% CI 3.81–5.30). As for long-term outcomes, frailty was associated with a significantly increased risk of long-term all cause mortality in the overall studied population (HR 2.22, 95% CI 1.81–2.73), as well as in patients with AAA repair (HR 2.10, 95% CI 1.59–2.79) and lower extremity revascularisation (HR 2.46, 95% CI 1.73–3.49). Central muscle mass was found to be the only tool with moderate quality of evidence predicting long-term survival after major vascular surgery (HR 2.48, 95% CI 1.76–3.49). Other single domain tools were generally scored as low quality, and the modified Frailty Index was the only multi-domain tool with moderate quality while others were scored as low or very low. Conclusion Frailty, assessed by functional status, can predict short-term mortality in elderly patients after vascular surgery; while central muscle mass may help determine long-term survival in abdominal aortic repair. As frailty is associated with both worse short and long-term outcomes, frailty assessment may be considered in patients scheduled for vascular surgery.

Objective The aim of our study was to compare percutaneous vascular interventions (PVI) versus bypass surgeries (BSX) in patients with critical limb ischemia (CLI). Background Previous relevant reviews with limited numbers of included studies did not strictly confine the inclusion criteria to CLI, also involving patients with severe claudication, which may introduce bias in the decision-making of CLI revascularization. Current treatment strategies for CLI still remain controversial. Methods We performed a meta-analysis of all available randomized controlled trials and observational clinical studies comparing PVI with BSX in CLI patients. Primary endpoints included overall survival, amputation-free survival, 30-day mortality, and major adverse cardiovascular and cerebrovascular events. Results We identified 45 cohorts and 1 RCT in over 20,903 patients. In overall population, PVI reduced the risks of 30-day mortality [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.51-0.95), major adverse cardiovascular and cerebrovascular events (OR 0.42, 95% CI 0.29-0.61), and surgical site infection (OR 0.31, 95% CI 0.19-0.51), but increased the risks of long-term all-cause mortality [hazard ratio (HR) 1.16, 95% CI 1.05-1.27) and primary patency failure (HR 1.31, 95% CI 1.08-1.58). When compared with autogenous BSX, PVI was also associated with additional increased risks of long-term death or amputation (HR 1.41, 95% CI 1.02-1.94) and secondary patency failure (HR 1.51, 95% CI 1.17-1.95). In patients with infrapopliteal lesions, we found PVI had inferior primary patency (HR 1.39, 95% CI 1.10-1.75) compared with BSX. Conclusion For patients in good physical condition with long life-expectancy, BSX may represent a better choice compared with PVI, particularly when autogenous bypass is available. While enhanced perioperative care for cardiovascular events and surgical site should be considered in patients underwent BSX to achieve comparable short-term outcomes provided by PVI.

The popliteal artery has complex deformations such as axial shortening, bending, squeezing and twisting, as well as specific positions across the knee joint. Up to now there is a high incidence of in-stent restenosis (ISR) after the stent treatment of the popliteal artery. This paper aimed to design a new type of popliteal artery stent -- cross-helical stent.to meet its deformation characteristics. The finite element analysis (FEA) method was used to test the mechanical properties of six stents with different winding height ratios of axial shortening, bending, plate extrusion, and torsional deformation. The results showed that the stents performance was affected by the ratio of winding height, the larger the winding height ratio, the worse the compliance, the worse the axial compressibility, but the better the radial support. And when the stent is torsional, the greater the winding height ratio is, the greater the stress is. In additon, the maximum stress was also related to the direction of torsion deformation, and the stress when the helix has the same direction with the torsion direction of the stent are was greater than that when the helix direction and torsion direction are opposite. Moreover, when the winding height ratio is 3:5, the performance of the stent is better, not only has better flexibility, its radial force, axial compression, and torsional deformation are better. It is concluded that the new cross-helical stent can adapt to the special deformation of popliteal artery and has good mechanical properties.

There has been a long-lasting controversy about whether higher BMI is associated with worse perioperative outcomes of laparoscopic colorectal surgery. Recently, a number of newly published investigations have made it possible to draw a quantitative conclusion.We conducted this comprehensive meta-analysis to clarify the exact effect that BMI imposes on perioperative outcome of laparoscopic colorectal surgery.We systematically searched MEDLINE, Embase, and Cochrane Library databases to identify all relevant studies.Comparative studies in English that investigated perioperative outcome of laparoscopic colorectal surgery for patients with different BMIs were included. Quality of studies was evaluated by using the Newcastle-Ottawa Scale.The risk factor of interest was BMI.Effective sizes were pooled under a random-effects model to evaluate preoperative, intraoperative, and postoperative outcomes.A total of 43 studies were included. We found that higher BMI was associated with significantly longer operative time (p0.001), greater blood loss (p = 0.01), and higher incidence of conversion to open surgery (p0.001). Moreover, BMI was a risk factor for overall complication rates (p0.001), especially for ileus (p = 0.02) and events of the urinary system (p = 0.03). Significant association was identified between higher BMI and risk of surgical site infection (p0.001) and anastomotic leakage (p = 0.02). Higher BMI might also led to a reduced number of harvest lymph nodes for patients with colorectal cancer (p = 0.02). The heterogeneity test identified no significant cross-study heterogeneity, and the results of cumulative meta-analysis, sensitivity analysis, and the publication bias test verified the reliability of our study.Most studies included were retrospectively designed.Body mass index is a practical and valuable measurement for the prediction of the perioperative outcome of laparoscopic colorectal surgery. Higher BMI is associated with worse perioperative outcome. More accurate conclusions, with more precise cutoff values, can be achieved by future well-designed prospective investigations.

We present an electroencephalogram (EEG) signals-based method to distinguish intentional and unintentional hand movements by using the optimized linear discriminant analysis (LDA) algorithm by combining the particle swarm optimization (PSO) with the traditional LDA. We design a novel experimental paradigm to validate the proposed method. Experimental results of seven participants show that the proposed method perform well. Furthermore, the performance of the PSO-LDA algorithm which is 86.4% are better than that of the traditional LDA algorithm. This work advances the field of hand movement recognition and gives some insights into the study on human-robot interaction.

Non-alcoholic fatty liver disease (NAFLD) is the most burgeoning chronic liver disease worldwide whose pathogenesis is complex and controversial. Here, we investigated the impact of caveolin-1 (CAV1), a scaffolding protein of caveolae for lipid homeostasis and endocytosis, on the pathogenesis of NAFLD. CAV1 and caveolae play crucial roles in the regulation of autophagy and hepatic energy metabolism. However, it remains unclear whether CAV1 could affect hepatic lipid metabolism by regulating autophagy. In this study, results showed that the expressions of CAV1 and autophagy-related proteins (Beclin1 and LC3-II/Ⅰ) were decreased, while the level of p62 was increased in HFD (high-fat diet) fed mice liver and in A/O (alcohol and oleic acid mixture) treated L02 cells, compared to the corresponding controls. In vivo study, upregulation of CAV1 with CAV1 scaffolding domain peptides (CSD, amino acids 82–101 of caveolin-1) could alleviate lipid accumulation and promote autophagy in NAFLD mice. In vitro study, CAV1 overexpression plasmid and its small interfering RNA were cultured with A/O treated L02 cells respectively. The results also demonstrated that CAV1 reduced lipid accumulation and promoted autophagy in L02 cells. Treatment with chloroquine, an inhibitor of autophagic degradation, abrogated CAV1 plasmid-mediated alleviation of lipid accumulation. Mechanistically, the inhibition of Akt/mTOR pathway was involved in the protective role of CAV1 in autophagy induction and lipid metabolism in NAFLD. Together, these results provided novel perception into the function of CAV1 in liver through autophagy and emphasized its positive role in NAFLD.

© 2019, Mary Ann Liebert, Inc., publishers 2019. Impaired skin wounds represent a significant and growing complication associated with type II diabetes and effective clinical strategies to reproducibly induce wound resolution do not exist. As a class of secreted nonstructural matrix proteins that modulate many cellular aspects of skin healing, matricellular proteins could represent a novel mechanism to promote skin healing. Based on their role in the regulation of the proliferative phase of healing, we hypothesized that local delivery of periostin and CCN2 could suppress inflammation and progress wounds into the proliferative and remodeling phases of repair. Using electrospinning, scaffolds composed of collagen type I and periostin or CCN2 were fabricated. Delivery of periostin/collagen and CCN2/collagen electrospun scaffolds increased excisional wound closure rates in a murine db/db diabetic model compared with collagen alone or untreated wounds. Reduced neutrophil infiltration was evident in the presence of periostin/collagen and CCN2/collagen scaffolds, concomitant with an increase in mesenchymal cell infiltration versus empty and collagen scaffolds alone at day 7. Microarray analysis demonstrated scaffold-dependent upregulation of gene clusters associated with wound contraction, cell differentiation, and suppression of PPARγsignaling at day 7; however, no changes in mRNA levels of extracellular matrix genes were observed compared with controls. At day 11, significantly increased vascularization of the wound bed was evident. Local delivery of periostin- and CCN2-based biomaterials may represent a novel strategy to induce the proliferative phase of repair and correction of the healing process in impaired skin wounds. Nonhealing skin wounds remain a significant burden on health care systems, with diabetic patients 20 times as likely to undergo a lower extremity amputation due to impaired healing. Novel treatments that suppress the proinflammatory signature and induce the proliferative and remodeling phases are needed clinically. We demonstrate that the addition of periostin and CCN2 in a scaffold form increases closure rates of full-thickness skin wounds in diabetic mice, concomitant with enhanced angiogenesis. Our results demonstrate the efficacy of periostin- and CCN2-containing biomaterials to stimulate wound closure, which could represent a novel method for the treatment of diabetic skin wounds.

Rationale: Malignant peripheral nerve sheath tumors (MPNSTs) are rare sarcomas arising from peripheral nerves. MPNSTs are uncommon in the head and neck, and various clinical manifestation often make the diagnosis challenging. Patient concerns: A 67-year-old female was referred for evaluation of repetitive syncope with a massive mass in the neck. Preoperative evaluation revealed potential neuroendocrine activity of the mass and enhanced computed tomography showed carotid artery was involved. Diagnosis: According to the preoperative imaging, intraoperative finding and postoperative pathological examination, the diagnosis of left neck MPNST involving left carotid arteries was made. Interventions: Volume expansion therapy with phenoxybenzamine started one week before surgery. Complete surgical resection of the mass was performed and pathological analysis suggested the diagnosis of MPNST. The postoperative radiotherapy was not given due to her poor nutrition. Outcomes: This patient recovered well after surgery and no sign of recurrence was noted at 2-year follow-up. Lessons: Though the involvement of carotid artery with neuroendocrine activity is rare in sporadic MPNST, preoperative scanning of blood and urine catecholamine is crucial for intraoperative hemodynamic stability, especially when carotid artery is involved.

The present research aimed to explore the effects of endogenous proteins and lipids on the physicochemical properties of adlay seed starch. Endogenous proteins and lipids were selectively removed. Morphological images indicated that protein bodies closely surrounded starch granules and served as a “robust rampart” toward starch gelatinization. Removal of protein led to increases in swelling power, crystallinity, gelatinization enthalpy, peak viscosity, breakdown viscosity and the starch hydrolysis degree and caused decreases in gelatinization temperature, setback viscosity, apparent viscosity and viscoelastic moduli. In addition, removal of lipids contributed to increases in gelatinization enthalpy, peak viscosity, setback viscosity, apparent viscosity, viscoelastic moduli and the starch hydrolysis degree and a decrease in gelatinization temperature. After the removal of proteins and lipids, adlay seed flour exhibited its lowest thermal stability. Overall, the role of endogenous proteins in physicochemical changes is more crucial than that of endogenous lipids. This study will be helpful to understand the interaction between starch and proteins/lipids in the adlay seed matrix and to facilitate the development of more palatable and healthier adlay seed foods.

Objective The comparison between paclitaxel-coated balloon (PCB) angioplasty and plain balloon angioplasty (PBA) for hemodialysis (HD) access stenosis or occlusion has not been well investigated. The objectives of this systematic review and meta-analysis were to compare all-cause mortality, HD access primary patency, and circuit primary patency after endovascular maintenance procedures using PCB angioplasty vs PBA. Methods MEDLINE, Embase, and Cochrane Databases were systematically searched to identify all the relevant studies on paclitaxel-coated devices for stenosis or thrombosis of HD access. A random effects model was applied to pool the effect measures. Dichotomous data were presented using an odds ratio (OR). Effect data were presented using pooled hazard ratio (HR) with 95% confidence interval (CI). Results A total of 16 studies were included in this meta-analysis, 12 randomized controlled trials and 4 cohort studies involving 1086 patients who underwent endovascular treatment for HD access stenosis or occlusion. All-cause mortality rates at 6, 12, and 24 months after intervention were similar between the PCB and PBA groups (6 months: OR, 1.06 [95% CI, 0.38-2.96; P = .907; I2 = 19.2%]; 12 months: OR, 1.20 [95% CI, 0.66-2.16; P = .554; I2 = 0%]; 24 months: OR, 1.43 [95% CI, 0.83-2.45; P = .195; I2 = 0%]). There was a significant improvement of primary patency in the PCB group compared with the PBA group (HR, 0.47; 95% CI, 0.33-0.69; P Conclusions This systematic review and meta-analysis demonstrated that PCB angioplasty is associated with significantly improved primary patency of arteriovenous fistula and central venous stenosis for HD access maintenance, with no evidence of increasing all-cause mortality based on short-term and midterm follow-up. Further large cohort study is needed to investigate long-term mortality.

Matrix metalloproteinase (MMP) promoter polymorphisms are considered to play roles in the aetiology of endometriosis and adenomyosis, however, the evidence available are inconsistent. We aimed to systematically review the asscociation between MMP-1 -1607 1G/2G MMP-2 -735 C/T, MMP-3 -1171 5A/6A and MMP-9 -1562 C/T polymorphisms and the risk of endometriosis and adenomyosis. A systemic search was conducted in Ovid, PubMed, Chinese National Knowledge Infrastructure and ChineseWanfang Database.We used the pooled odds ratio (OR) and their corresponding 95% confidence interval (CI) to calculate the statistical power. Besides, we evaluated the quality of individual studies based on Newcastle-Ottawa scale. A total of 13 papers with 18 studies conformed to our inclusion criteria. We observed a significant association between MMP-1 -1607 1G/2G polymorphism and the susceptibility of endometriosis and adenomyosis under recessive model (OR = 1.25, 95%CI = 1.03-1.53, P = 0.03). While no significant association was found in MMP-2 -735 C/T, MMP-3 -1171 5A/6A and MMP-9 -1562 C/T polymorphisms. This systemic review and meta-analysis suggested that theMMP-1 -1607 1G/2G polymorphism might play an important role in the risk of endometriosis and adenomyosis. Further, more well-designed and large-scale studies regarding gene-gene and gene-environment interactions are needed in the future.

Background: KN026 is a bispecific antibody simultaneously targeting the extracellular domains II and IV of the human HER2. It blocks both ligand-dependent and ligand-independent HER2 signaling pathway. The IgG1 Fc fragment of KN026 binds FcRγIIIa mediates potent ADCC and inhibits tumor cell proliferation. Aim: The goal of the present work is to predict efficacious doses for KN026 using a translational tumor growth inhibition modeling approach based on tumor growth and KN026 exposure data from mouse, followed by a population PK analysis based on KN026 concentration data from patients in a first-in-human (FIH) clinical trial. Methods: A tumor growth inhibition model was developed to fit tumor volume time course data from NCI-N87 and Calu-3 xenografts. A translational tumor growth inhibition model was next developed by adjusting the tumor growth component to more realistically reflect tumor growth dynamics as reported in HER2-positive breast cancer patients. Model parameters intrinsic to KN026 efficacy (Emax, EC50) were assumed constant across species. To determine the target concentration, simulations were performed for different initial tumor volumes and tumor doubling time in humans under different KN026 exposures. Next, intensively sampled pharmacokinetics data from 20 patients in a FIH trial of KN026 were used to develop the human population PK model. KN026 concentration-time profiles in humans were then simulated across a variety of candidate dosing regimens and compared with the projected target concentration from translational tumor growth inhibition modeling. Recommended efficacious doses and dosing schedules were predicted if steady state trough concentration from more than 90% simulated subjects achieve the target concentration. Results: A tumor growth inhibition model adequately described the data from xenograft models. To build the translational tumor growth inhibition model, a literature-documented tumor growth equation more relevant to the observed tumor growth dynamics in breast cancer patients was used to replace the growth component in formula 1 originally fitted to mouse data. Simulation results from the translational tumor growth inhibition model show that tumor stasis can be achieved at the KN026 trough concentration lower than 20 μg/mL. More aggressive tumors will take longer time to achieve tumor stasis under the same given concentration. A two-compartment PK model incorporating body weight as a covariate on both volume of distribution and clearance describes human PK data well. Efficacious steady state dose levels were predicted to be 20 mg/kg Q2W and 30 mg/kg Q3W. Loading doses with a higher frequency were predicted to have the advantage of maximizing initial tumor killing. Conclusions: The use of the modeling and simulation approach to aid decision in drug development has become a popular tool. Here we present a translational PK-PD modeling framework incorporating preclinical tumor growth data and clinical PK data to inform dose selection strategy for KN026 in patients with HER2-positive solid tumors. Furthermore, simulation results suggest that loading doses with higher dosing frequency will likely be beneficial. These model predictions will be further validated by emerging PK and efficacy data from ongoing clinical trials of KN026. Citation Format: Dongmei Ji, Yuan Xiong, Jing Yang, Pilin Wang, Jiarong Wang, Fei Yang, Junfang Xu. Using translational tumor growth inhibition modeling approach and population PK analysis to predict efficacious doses for KN026, a HER2 bispecific antibody [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3022.

Women face distinctive challenges when they receive endovascular aneurysm repair (EVAR) treatment, and according to the previous studies, sex differences in outcomes after EVAR for infrarenal abdominal aortic aneurysm (AAA) remains controversial. This study aimed to compare the short-term and long-term outcomes between women and men after EVAR for infrarenal AAA.We conducted a comprehensive systematic review and meta-analysis of all available studies reporting sex differences after EVAR for infrarenal AAA, which were retrieved from the MEDICINE, Embase, and Cochrane Database. The pooled results were presented as odds ratios (ORs) for dichotomous data and hazard ratios for time-to-event data using a random effect model.Thirty-six cohorts were included in this meta-analysis. The pooled results showed that women were associated with a significantly increased risk of 30-day mortality (crude OR, 1.67; 95% confidence interval [CI], 1.50-1.87; P .001; adjusted OR, 1.73; 95% CI, 1.32-2.26; P .001), in-hospital mortality (OR, 1.90; 95% CI, 1.43-2.53; P .001), limb ischemia (OR, 2.44; 95% CI, 1.73-2.43; P .001), renal complications (OR, 1.73; 95% CI, 1.12-2.67; P = .028), cardiac complications (OR, 1.68; 95% CI, 1.01-2.80; P = .046), and long-term all-cause mortality (hazard ratio, 1.23; 95% CI, 1.09-1.38; P = .001) compared with men; however, no significant sex difference was observed for visceral/mesenteric ischemia (OR, 1.62; 95% CI, 0.91-2.88; P = .098), 30-day reinterventions (OR, 1.37; 95% CI, 0.95-1.98; P = .095), late endoleaks (OR, 1.18; 95% CI, 0.88-1.56; P = .264), and late reinterventions (OR, 1.05; 95% CI, 0.78-1.41; P = .741). In the intact AAA subgroup, women had a significantly increased risk of visceral/mesenteric ischemia (OR, 1.85; 95% CI, 1.01-3.39; P = .046) and an equivalent risk of cardiac complications (OR, 1.64; 95% CI, 0.85-3.17; P = .138) compared with men.Compared with male sex, female sex is associated with an increased risk of 30-day mortality, in-hospital mortality, limb ischemia, renal complications, cardiac complications, and long-term all-cause mortality after EVAR for infrarenal AAA. Women should be enrolled in a strict and regular long-term surveillance after EVAR.

Objective Coverage of the left subclavian artery (LSA) is often required to achieve complete proximal sealing during thoracic endovascular aortic repair. However, whether LSA revascularization should be performed remains controversial. Methods MEDLINE, Embase, and Cochrane databases were systematically searched to identify all the relevant studies. A random-effects model was applied to pool the effect measures. Dichotomous data were presented using an odds ratio (OR). Results There were 32 studies included for qualitative analysis and 31 studies for quantitative analysis. We found that patients who underwent LSA revascularization had a significantly decreased risk of spinal cord ischemia (OR, 0.62; 95% confidence interval [CI], 0.41-0.92; P = .02; I2 = 0%), cerebrovascular accident (OR, 0.63; 95% CI, 0.42-0.95; P = .03; I2 = 22%), and left upper extremity ischemia (OR, 0.18; 95% CI, 0.09-0.36; P Conclusions Revascularization of the LSA is associated with decreased risks of cerebrovascular accident, spinal cord ischemia, and left upper limb ischemia in thoracic endovascular aortic repair with LSA coverage at the cost of higher local complications, such as possible vocal cord paresis.

PB1F2 is a proapoptotic protein encoded by an alternative reading frame in the influenza A virus. Its accumulation accelerates mitochondrial fragmentation by decreasing the mitochondrial membrane potential following translocation into the mitochondrial inner membrane space, but the mechanistic underpinnings remain unclear. Herein, the PB1F2 from HK97 was expressed and purified in soluble form. The interaction between PB1F2 and the mitochondrial membrane were investigated using three membrane mimics, liposomes, bicelles, and nanodiscs. We show that the interactions between PB1F2 and membrane mimics depend on lipid type and are time- and dose-dependent. The primary membrane target of PB1F2 is phosphatidylcholine, the lipid that forms the major component of mitochondrial inner membranes. PB1F2 disrupts the integrity of lipid membranes by forming micelle-like PB1F2-lipid assemblies.

Objective Spontaneous isolated celiac artery dissection (SICAD) and spontaneous isolated superior mesenteric artery dissection (SISMAD) represent the major types of spontaneous visceral artery dissection. However, no quantitative meta-analysis of SICAD and SISMAD is available. The aim of our study was to pool current evidence concerning basic profiles, treatment strategies, long-term adverse events, and morphologic changes of lesioned vessels in SICAD and SISMAD patients. Methods We searched the MEDLINE, Embase, Scopus, and Cochrane Databases (January 1, 1946-September 21, 2017) for studies of SICAD and SISMAD. Related cohort studies or case series with sample size larger than 10 were included. Two reviewers independently extracted and summarized the data. A random-effects model was used to calculate pooled estimates. Results In total, 43 studies were included. An estimated 8% (95% confidence interval [CI], 0.01-0.21) symptomatic SICAD and 12% (95% CI, 0.06-0.19) symptomatic SISMAD patients with initial conservative management required secondary intervention during follow-up, whereas none of the asymptomatic patients treated conservatively required secondary intervention. As for morphologic changes during follow-up, a higher proportion of SICAD patients (64%; 95% CI, 0.47-0.80) achieved complete remodeling compared with SISMAD patients (25%; 95% CI, 0.19-0.32), and an estimated 6% (95% CI, 0.00-0.16) of SICAD and 12% (95% CI, 0.05-0.20) of SISMAD patients had morphologic progression. Overall, the pooled estimate of long-term all-cause mortality was 0% (95% CI, 0.00-0.03) in SICAD and 1% (95% CI, 0.00-0.02) in SISMAD. When stratified by symptoms, symptomatic patients were associated with a significantly increased probability of accomplishing complete remodeling (odds ratio, 3.95; 95% CI, 1.31-11.85) compared with asymptomatic patients. Conclusions Initial conservative treatment is safe for asymptomatic SICAD or SISMAD patients. Symptomatic patients managed conservatively have relatively high occurrence of late secondary intervention, which may require closer surveillance, especially in SISMAD because of a lower rate of remodeling.

The aim of the present study was to determine the effect of S-phase kinase-associated protein 2 (Skp2) and cyclin-dependent kinase inhibitor p27kinase-interacting protein 1 (p27kip1) protein expression on the occurrence and development of hypopharyngeal squamous cell carcinoma. The protein expression levels of Skp2 and p27kip1 were detected in 42 hypopharyngeal squamous cell carcinoma and 15 normal hypopharyngeal mucous membrane specimens using the an immunohistochemical PV-9000 two-step method. The expression levels of Skp2 protein were significantly different in hypopharyngeal squamous cell carcinomas and normal hypopharyngeal mucous membranes (61.90 vs. 26.67%; P

Background/Aims: IL-1β creates persistent pulmonary inflammation accompanied by elevated transforming growth factor β (TGF-β levels and is associated with abnormal elastogenesis, which is observed in bronchopulmonary dysplasia (BPD). Although progress has been made in this field, the mechanisms underlying this process remain only partially understood. Methods: We assessed aberrant elastin localization-associated signaling in mouse pups exposed to 85% O2 treated with either IL-1Ra or 1D11, using morphometric analyses, quantitative RT-PCR, immunostaining, and ELISA. We also evaluated the derivation of elastin-producing cells using dual marker tracking. The regulatory mechanisms of IL-1β were investigated in vitro in lung epithelial and mesenchymal cells. Results: Elevated levels of IL-1β, αvβ6 and TGF-β1 were each associated with aberrant elastin production in O2-exposed lungs. IL-1Ra abolished TGF-β1 activation and αvβ6 upregulation, which occurred as a result of exposure to hyperoxia, whereas 1D11 had no discernible effect on the expression of either αvβ6 or IL-1β even following O2-exposure, suggesting that IL-1β was initially induced. Additionally, double staining revealed the presence of epithelium-derived elastin-producing cells, which was confirmed via in vitro IL-1β stress-induced epithelial-mesenchymal transformation (EMT) morphological and molecular marker changes, which may explain the altered lung elastin deposition and defective septation observed in BPD. Conclusions: These data support the hypothesis that IL-1β was initially induced by hyperoxia; αvβ6 subsequently interacted with and activated TGF-β1, acting as an epithelial/mesenchymal signaling molecule that contributed to excessive alveolar elastogenesis, the primary pathological feature of BPD.