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Interleukin-5 (IL-5) was reported to participate in cardiovascular diseases, this study aimed to investigate the effects of IL-5 on cardiac remodeling. Mice were infused with angiotensin II (Ang II), and we found cardiac IL-5 expression was time- and dose-dependently decreased after Ang II infusion, and was mainly derived from cardiac macrophages. Additionally, the effects of IL-5 knockout on Ang II-induced cardiac remodeling were observed, and the results exhibited that IL-5 deficiency significantly increased the expression of cardiac hypertrophy markers, elevated myocardial cell cross-sectional areas, and worsened cardiac dysfunction in Ang II-infused mice. IL-5 deletion also promoted M2 macrophage differentiation and exacerbated cardiac fibrosis. Effects of IL-5 on cardiac remodeling and M2 macrophage differentiation were reversed by S31-201. IL-5 knockout significantly increased the Ang II-induced mRNA expression of cardiac hypertrophy markers in myocardial cells that were co-cultured with macrophages, and this effect was also reversed by S31-201. Similar trends in the mRNA levels of fibrosis markers were observed when cardiac fibroblasts and macrophages were co-cultured. Our study suggests that IL-5 deficiency promotes M2 macrophages differentiation and exacerbating cardiac remodeling by activating the STAT3 pathway in Ang II-infused mice. IL-5 may be a potential target for the clinical prevention of cardiac remodeling.

AIM Oxidative stress and the inflammatory response contribute to the progression of cardiovascular disease. The present study aimed to investigate whether the mitochondrial-derived peptide MOTS-c could alleviate H2O2-induced oxidative stress and inflammatory status in H9c2 cells through activation of nuclear factor erythroid 2-related Factor 2 (Nrf2)/antioxidative response element (ARE) and inhibition of the NF-κB pathway. METHODS Rat H9c2 cardiomyocytes were obtained, and 10, 20 or 50 μM MOTS-c was pretreated for 24 h before treatment with H2O2. Then, the cell was treated with 100 μM H2O2 for 1 h to induce oxidative stress. An inhibition model of sh-Nrf2 was constructed via a lentivirus expression system, and an activation model of NF-κB was achieved using phorbol 12-myristate-13-acetate (PMA). Cell viability was determined using a Cell Counting kit-8 assay. Relative measurement of relative protein and mRNA expression used western blotting and qRT-PCR, respectively. Intracellular reactive oxygen species (ROS) levels were detected using dichlorodihydrofluorescein diacetate, and malondialdehyde (MDA) and superoxide dismutase (SOD) levels were determined via commercial kits. The protein expression and distribution in the cells were visualized by immunofluorescence analysis. Enzyme-linked immunosorbent assay was used to detect the levels of inflammatory cytokines, including TNF-α, IL-6 and IL-1β. RESULTS We found that H2O2 treatment significantly decreased cell viability and the level of SOD, increased the levels of ROS and MDA, and upregulated the expression of inflammatory cytokines, including TNF-α, IL-6 and IL-1β, in H9c2 cells. The expression levels of Nrf2, HO-1 and NQO-1 were significantly downregulated in the H2O2, while the phosphorylation of NF-κBp65 was promoted by H2O2. However, pretreatment with MOTS-c significantly reversed H2O2-induced damage in H9c2 cells. Moreover, both inhibition of the Nrf2/ARE pathway and activation of the NF-κB pathway significantly decreased the effects of MOTS-c, suggesting that MOTS-c might play a role in alleviating oxidative damage via the Nrf2/ARE and NF-κB pathways. CONCLUSIONS Our investigation indicated that MOTS-c could protect against H2O2-induced inflammation and oxidative stress in H9c2 cells by inhibiting NF-κB and activating the Nrf2/ARE pathways.

Pericardial effusion or pericardial tamponade (PE/PT) is a relatively common complication of left atrial appendage closure (LAAC). However, delayed PE/PT is rare with limited data. The aim of the study was to analyze the incidence and clinical consequences of delayed PE/PT following LAAC.Patients with nonvalvular AF who were successfully implanted with LAAC devices from October 2014 to April 2021 were consecutively screened. Subjects experiencing delayed PE/PT after LAAC were included. All treatment sessions of the subjects were recorded in detail. After discharge, the patients were followed up for clinical outcomes.A total of 748 patients with successful LAAC [nitinol cage device (475 Watchman 2.5), nitinol plug device (131 ACP and 142 LAmbre)] were screened. Six patients experienced delayed PE/PT (1 Watchman, 2 ACP, 3 LAmbre). The incidence of delayed PE/PT was higher in patients with a nitinol plug device (1.8% vs. 0.2%, P = 0.027). Bloody PE only occurred in patients with a nitinol plug device (5/273, 1.8%). All the patients accepted pericardiocentesis and discontinuing antithrombotic medication, and none of the patients died or needed cardiac surgery. All patients were followed up for 810 (598, 1174) days after discharge. None of them developed constrictive pericarditis or thromboembolic or major bleeding events.Delayed PE/PT is rare but can occur, and the incidence of delayed bloody PE/PT for the nitinol plug device was higher than that for the nitinol cage device. The strategy of emergency pericardiocentesis combined with discontinuing antithrombotic medication may be effective for delayed bloody PE/PT.

The Watchman device is the most widely used occluder but is indicated in atrial fibrillation (AF) patients with a maximal left atrial appendage (LAA) orifice diameter between 17 and 31 mm. We aimed to compare the long-term safety and efficacy of left atrial appendage closure (LAAC) between patients with a small LAA (17 mm) and those with an indicated LAA (17-31 mm) measured by transesophageal echocardiography (TEE).A total of 369 AF patients treated with LAAC between March 2015 and February 2019 were included and divided into two groups based on the maximal LAA orifice diameter measured by TEE: small LAA group (n = 22) and indicated LAA group (n = 347). Periprocedural complications and long-term clinical outcomes were compared.The Watchman device was successfully implanted in all patients. Mean device compression was higher in the small LAA group. Four patients (1.2%) in the indicated LAA group experienced pericardial effusion, and none experienced pericardial effusion in the small LAA group. Device-related thrombus was detected in one (4.5%) patient in the small LAA group and five (1.4%) in the indicated LAA group (p = .310). After a mean follow-up period of 4.1 ± 1.6 years, one patient in the small LAA group (4.5%; 1.1/100 person-years) and four in the indicated LAA group (1.2%; 0.3/100 person-years) suffered an ischemic stroke (p = .266).The safety and efficacy of LAAC with the Watchman device were comparable between patients with small and indicated LAA orifice diameters measured by TEE.

Heart failure is a group of syndromes caused by various cardiac structural or functional disorders leading to impaired ventricular filling and (or) ejection capacity. Because of decreased ventricular systolic function and impaired ejection function, the amount of cardiac output cannot meet the body’s metabolic needs; organ and tissue blood perfusion is insufficient; at the same time, pulmonary circulation and (or) systemic circulation congestion; the clinical manifestations are mainly dyspnea and weakness but restricted physical activity and edema. Treatment of the disease should include preventing and delaying the onset of wails, relieving symptoms of clinical wails, improving its long-term prognosis, and reducing mortality. The aim of the study is to observe the efficacy and safety of Entresto in the treatment of left ventricular ejection fraction heart failure (HFpEF). Seventy-eight patients with HFpEF treated in our hospital from October 2017 to April 2018 were randomized into a treatment group (Entresto 50 mg + basic treatment, n = 39) and a control group (basic treatment, n = 39). The course of treatment was ten weeks. The levels of brain natriuretic peptide (BNP) and echocardiographic indicators (LVMI, LVEF, LVEDD, LVESD, E/E′ Ratio, E/A ratio, DT), 6-minute walking test (6MWD), and Minnesota Quality of Life Scale (MLHFQ) were analyzed before and after treatment. LVMI, LVEF, LVEDD, LVESD, E/E′ ratio, E/A ratio, DT, and BNP were all significantly improved in the Entresto group after treatment. In the control group, except for LVEDD, LVESD, the E/A ratio, and BNP, other indicators were significantly improved after treatment ( P < 0.05 ). Posttreatment, both groups had significantly improved 6MWD and MLHFQ scores ( P < 0.05 ). Differences in these parameters between the two groups were statistically significant ( P < 0.05 ). After treatment, the levels of NE, AngII, ALD, and MMP-9 in the two groups were decreased ( P < 0.05 ), with the lower lever in the treatment group ( P < 0.05 ). The effective rate was 76.92% in the control group and 94.87% in the Entresto group, and this rate difference was statistically significant ( P < 0.05 ). The number of patients re-hospitalized due to cardiovascular events was 2 (the Entresto group) vs. 7 (the control group) cases; worsening of heart failure was observed in 1 patient (the Entresto group) vs. 6 (the control group), and the difference between the two groups was statistically significant ( P < 0.05 ). However, the incidence of adverse reactions between the two groups was not statistically significant. Entresto can significantly improve left ventricular diastolic function in heart failure patients with preserved left ventricular ejection fraction and improve quality of life. This treatment is safe and effective and worthy of clinical application. This trail is registered with ChiCTR2000031486. This trial was approved by the Chinese Clinical Trial Registry (clinical trial number: ChiCTR2000031486). The registration number of this study is 2022-R008.

Background/Purpose Left atrial appendage closure (LAAC) is conventionally guided by fluoroscopy and transesophageal echocardiography. We introduce an LAAC technique without fluoroscopy exposure using intracardiac echocardiography (ICE) and electroanatomic mapping system (EAMS) under local anesthesia. Methods Seven non-valvular atrial fibrillation patients who underwent LAAC with the LAmbre devices under the ICE and EAMS guidance were compared to 7 patients following the conventional approach by propensity score matching. ICE probe was advanced into the left atrium (LA) to guide sizing and device implantation following the orthogonal tri-axial technique (Axis-X: from left pulmonary veins [PVs] to LAA; Axis-Y: from right PV ostium to LAA; Axis-Z: from lower LA to LAA). Results The mean diameters of ostia and landing zone were 21.4 ± 3.9 mm and 20.4 ± 4.2 mm, respectively. LAmbre devices with a mean umbrella diameter of 23.7 ± 4.2 mm and cover disc diameter of 29.4 ± 3.6 mm were successfully implanted and acute complete LAA sealing without peri-device leak (PDL) were achieved in all cases. Neither fluoroscopy exposure nor contrast consumption was recorded. No procedure related complications were documented. The mean procedural time and PDLs at follow-ups were comparable to those in the conventional group. No stroke or thromboembolic events were documented. Conclusion The fluoroscopy exposure could be minimized, even to zero, in the ICEguided LAAC procedures feasibly and safely using LAmbre devices. The orthogonal triaxial technique is considered efficacious and safe for the procedures.

The balance of stoichiometric traits of organisms is crucial for nutrient cycling and energy flow in ecosystems. However, the impacts of different drivers on stoichiometric (carbon, C; nitrogen, N; and phosphorus, P) variations of organisms have not been well addressed. In order to understand how stoichiometric traits vary across trophic levels under different environmental stressors, we performed a mesocosm experiment to explore the impacts of warming (including +3 °C consistent warming above ambient and heat waves ranging from 0 to 6 °C), eutrophication, herbicide and their interactions on stoichiometric traits of organisms at different trophic levels, which was quantified by stable nitrogen isotopes. Results showed that herbicide treatment had no significant impacts on all stochiometric traits, while warming and eutrophication significantly affected the stoichiometric traits of organisms at lower trophic levels. Eutrophication increased nutrient contents and decreased C: nutrient ratios in primary producers, while the response of N:P ratios depended on the taxonomic group. The contribution of temperature treatments to stoichiometric variation was less than that of eutrophication. Heat waves counteracted the impacts of eutrophication, which was different from the effects of continuous warming, indicating that eutrophication impacts on organism stoichiometric traits depended on climate scenarios. Compared to environmental drivers, taxonomic group was the dominant driver that determined the variations of stoichiometric traits. Furthermore, the stoichiometric stability of organisms was strongly positively correlated with their trophic levels. Our results demonstrate that warming and eutrophication might substantially alter the stoichiometric traits of lower trophic levels, thus impairing the nutrient transfer to higher trophic level, which might further change the structure of food webs and functions of the ecosystems.

Background. Data comparing different doses of non-vitamin K antagonist oral anticoagulants (NOACs) regarding resolution of left atrial appendage thrombus (LAAT) in patients with nonvalvular atrial fibrillation (AF) are scarce. This study aimed to investigate the safety and efficacy of standard-dose versus low-dose NOACs in patients with nonvalvular AF and LAAT. Methods. Patients with nonvalvular AF who underwent transesophageal echocardiography (TEE) before interventional procedures for the detection of LAAT and treated with NOACs from October 2014 to September 2020 in Ningbo First Hospital were retrospectively screened. The study population was divided into two groups according to the doses of NOACs: standard-dose group (dabigatran 150 mg, twice daily; rivaroxaban 20 mg, once daily) and low-dose group (aged ≥75 years, body weight

Atrial fibrosis occurs frequently with structural heart disease and is considered as a major cause of arrhythmia. Microarray-based profiling predicted the differential expression of SPP1 in atrial fibrosis. Herein, we aimed to analyze the role of shRNA-mediated SPP1 knockdown in the progression of atrial fibrosis as well as the downstream mechanism. In vivo model in mice and in vitro HL-1 cell model of atrial fibrosis were developed by the angiotensin II (Ang II) method, where SPP1 expression was validated by RT-qPCR. Gain- and loss-of-function experiments were performed in Ang II-induced mice and HL-1 cells to evaluate the effect of the SPP1/TGF-β/SREBP2/PCSK9 axis on cell viability, apoptosis, collagen production and mitochondrial DNA (mtDNA) damage in atrial fibrosis. Expression of SPP1, TGF-β, SREBP2 and PCSK9 was increased in Ang II-induced mice and HL-1 cells. Silencing of SPP1 inhibited the occurrence of atrial fibrosis, as reflected by attenuated cell viability and collagen production as well as increased cell apoptosis. Conversely, upregulated SPP1 enhanced atrial fibrosis, which was related to upregulation of TGF-β. In addition, TGF-β elevated the expression of SREBP2, which promoted mtDNA damage and the consequent atrial fibrosis by augmenting the expression of PCSK9. This study uncovers previously unrecognized pro-fibrotic activities of SPP1 in atrial fibrosis, which is achieved through activation of the TGF-β/SREBP2/PCSK9 signaling pathway and promotion of mtDNA damage.

Background/Purpose: Experience in procedures combining left atrial appendage (LAA) closure (LAAC) and catheter ablation (CA) was scarce in Chinese nonvalvular atrial fibrillation (AF) patients with high risks for stroke and bleeding. We aimed to investigate the efficacy and safety of the combination therapy with LAAC and AF CA in a single procedure based on the multicenter data and medium-term follow-up results. Methods: A total of 122 AF patients with a mean CHA2DS2-VASc score of 4.3 ± 1.4 and HAS-BLED score of 3.3 ± 1.0 were enrolled. The Watchman (n = 83) devices were implanted either before or after AF ablations in the same procedure, while the Amplatzer Cardiac Plug (ACP, n = 39) devices were implanted immediately after CA. AF recurrence and transesophageal echocardiography results were evaluated. Results: All devices were successfully implanted and acute complete LAA occlusions were achieved in 115 (94.3%) of patients. Neither acute nor chronic peri-device leaks greater than 5 mm were detected. Oral anticoagulation was held in all patients but two with asymptomatic device-related thrombi, which were resolved after prolonged anticoagulation. AF-free success rate without antiarrhythmic drugs was 76.2% after a mean follow-up of 11.5 ± 6.8 months. No serious complications were observed during the follow-up. Conclusion: The combination therapy with LAAC and AF ablation in a single procedure was efficacious and safe in the Chinese symptomatic AF population with high risk for stroke and bleeding. Keywords: Atrial fibrillation, Catheter ablation, Left atrial appendage closure, Oral anticoagulation

BACKGROUND/PURPOSE Anticoagulant therapy is suggested within 45 days after Watchman device implantation for stroke prevention in patients with atrial fibrillation (AF). A previous study demonstrated that non-vitamin K antagonist oral anticoagulants (NOACs) were a feasible peri- and postprocedural alternative to warfarin. The present study aimed to compare the safety and efficacy of using different anticoagulants (low-dose NOACs vs. warfarin) within 45 days after Watchman device implantation in a Chinese population. METHODS Patients with successful Watchman device implantation from October 2014 to June 2020 were included. All patients received anticoagulants within 45 days after the procedure, and those patients were divided into three groups according to the type of postprocedural anticoagulants. Transesophageal echocardiography follow-up was performed 45 days post procedure to assess residual flow and the occurrence of device-related thrombus (DRT). RESULTS A total of 368 patients were enrolled in the study. The study population was divided into three groups: the warfarin group (n = 77), the dabigatran group (n = 165) and the rivaroxaban group (n = 126). Periprocedural major bleeding was higher in the warfarin group (2.6% vs. 0% vs. 0%, P = 0.043), while minor bleeding was comparable among the groups (3.9% vs. 1.2% vs. 0.8%, P = 0.230). No periprocedural transient ischemic attack/stroke occurred. At follow-up, the incidence of DRT was higher in the warfarin group than in the other groups (4.2% vs. 0.6% vs. 0.8%; P = 0.116), but the difference was not statistically significant. The rates of thromboembolic and bleeding events were similar in the three groups. CONCLUSION The safety and efficacy of low-dose dabigatran and rivaroxaban were comparable to those of warfarin within 45 days after Watchman device implantation in a Chinese population.

IntroductionMultiple algorithms based on 12-lead ECG measurements have been proposed to identify the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) locations from which ventricular tachycardia (VT) and frequent premature ventricular complex (PVC) originate. However, a clinical-grade machine learning algorithm that automatically analyzes characteristics of 12-lead ECGs and predicts RVOT or LVOT origins of VT and PVC is not currently available. The effective ablation sites of RVOT and LVOT, confirmed by a successful ablation procedure, provide evidence to create RVOT and LVOT labels for the machine learning model.MethodsWe randomly sampled training, validation, and testing data sets from 420 patients who underwent successful catheter ablation (CA) to treat VT or PVC, containing 340 (81%), 38 (9%), and 42 (10%) patients, respectively. We iteratively trained a machine learning algorithm supplied with 1,600,800 features extracted via our proprietary algorithm from 12-lead ECGs of the patients in the training cohort. The area under the curve (AUC) of the receiver operating characteristic curve was calculated from the internal validation data set to choose an optimal discretization cutoff threshold.ResultsThe proposed approach attained the following performance: accuracy (ACC) of 97.62 (87.44–99.99), weighted F1-score of 98.46 (90–100), AUC of 98.99 (96.89–100), sensitivity (SE) of 96.97 (82.54–99.89), and specificity (SP) of 100 (62.97–100).ConclusionsThe proposed multistage diagnostic scheme attained clinical-grade precision of prediction for LVOT and RVOT locations of VT origin with fewer applicability restrictions than prior studies.

Background: Left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulation for thromboembolic prevention in patients with atrial fibrillation (AF). Left atrial (LA) catheter ablation (CA) in patients with LAAO devices has not been well investigated. Here, we report on the safety and efficacy of LA CA in patients with nitinol cage or plug LAAO devices. Methods: A total of 18 patients (aged 67 ± 11 years; 14 males; 5 paroxysmal AF) with LAAO devices (nitinol cage, n = 10; nitinol plug, n = 8) and symptomatic LA tachyarrhythmias were included. Periprocedural and follow-up data were assessed. Results: A total of 20 LA CA procedures were performed at a median of 130 (63, 338) days after LAAO. The strategy of CA consisted of circumferential pulmonary vein isolation (n = 16), linear lesions (n = 14) and complex fractionated atrial electrogram ablation (n = 6). No major adverse events occurred periprocedurally. Repeated transesophageal echocardiography showed no device-related thrombus, newly developed peridevice leakage or device dislodgement. After a median follow-up period of 793 (376, 1090) days, four patients (22%) experienced LA tachyarrhythmias recurrence and two received redo LA CA. No patients suffered stroke or major bleeding events during follow-up. Conclusions: LA CA in patients with LAAO devices (either nitinol cages or nitinol plugs) seems to be safe and efficient in our single-center experience.

Given the lack of quantifiable evaluation criteria for the quality supervision and control in the existing power cable industry, insufficient research on the correlation of production indexes in the production process, and low timeliness in the analysis and processing of massive multi-source production data, the video monitoring model and data-driven process quality evaluation strategy model under the edge computing framework were constructed. Next, all the production data and test data in the cable production procedures were captured using edge nodes, and the factory-side data was cleansed, processed, and analyzed. The cable manufacturing quality was evaluated through edge computing, and the business process was arranged based on the edge computing results, so as to improve the cable product quality and finally optimize the total value chain of production in the whole cable industry.

In the cable insulation crosslinking production process, the process quality is determined by multiple processes and multiple related process variables, and there are complex autocorrelation and cross-correlation among these process variables. In this paper, different process variables are studied. By implementing statistical process control on a univariate, single value control chart (I) and moving range control chart ( M ¯ R ) are drawn, and process capability CP is analyzed to find variables with weak process capability for improvement. At the same time, based on the background of the continuous development of the Internet of Things and big data technology, this paper evaluates the complex autocorrelation and cross-correlation between the overall process variables, adopts the multivariate statistical process control technology, and combines the multivariate HOTELLING T2 control chart and MEWMA control chart to reflect the statistical characteristics of multiple variables, thus avoiding misjudgment or omission of process quality monitoring model. By studying the setting of cable production process parameters and quality standards, combined with the application of complete multivariate statistical process control (MSPC) around the evaluation results, process, and technical requirements, this research can provide effective guidance for the cable insulation crosslinking production process

Necroptosis is a new type of cell death. However, the role of necroptosis in LPS-related cardiomyocyte damage has not been fully understood. The aim of our study is to explore the molecular mechanism underlying inflammation-mediated cardiomyocyte necroptosis. H9C2 cardiomyocyte cell line was treated with LPS. Then, cell viability and necroptosis were measured through qPCR and ELISA. Pathway analysis was performed to verify whether Ripk3/Pgam5 signaling pathway is implicated into the regulation of cardiomyocyte necroptosis. The results demonstrated that LPS reduced cardiomyocyte viability and activated necroptosis. At the molecular levels, oxidative stress and inflammation were triggered by LPS and these alterations may contribute to the activation of necroptosis. Finally, we found that Ripk3/Pgam5 signaling pathway was activated by LPS in cardiomyocyte and this signaling pathway may explain the regulatory mechanism underlying LPS-mediated necroptosis. Altogether, our results demonstrated that septic cardiomyopathy is associated with an activation of necroptosis through the Ripk3/Pgam5 signaling pathway.

Transmural lesions (TLs) are the crucial point for radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients. Previous studies have reported that complete positive unipolar electrogram (UP-EGM) after ablation is associated with transmural lesions. However, UP-EGM patterns may differ in different regions of continuous circular lesions (CCLs) around the pulmonary vein ostia after ablation. We aimed to analyze the different UP-EGM patterns in different CCL regions after ablation and the effectiveness of UP-EGM guided RFCA in paroxysmal atrial fibrillation (PAF). A total of 43 patients with PAF (aged 59 ± 11 years; 65% male) were consecutively included. Pulmonary vein isolation was achieved by contiguous point-by-point RFCA. UP-EGM was recorded by the ablation catheter. Both CCLs were divided into six regions. Two points were randomly chosen from each region to analyze UP-EGM type after ablation. All the patients were followed for atrial arrhythmias recurrence. All pulmonary veins were isolated with complete bidirectional block. A total of 1032 RFCA points with complete positive UP-EGM were collected. UP-EGM morphology after ablation was divided into four different types defined as R, rR′, Rr′, and M. M patterns mostly appeared in anterosuperior (65%) and roof (49%) regions of left CCLs. In the remaining regions, the percentage of non-M patterns (R, rR′, and Rr′) ranged from 63% in posteroinferior regions of right CCLs to 88% in anteroinferior regions of right CCLs. After a mean follow-up time of 19 months, 37 (86%) patients remained in sinus rhythm. Most (72%) UP-EGM types after ablation are non-M patterns. Pulmonary vein isolation guided by UP-EGM with a complete positive pattern in PAF patients is reliable.

BACKGROUND The efficacy and safety of combining left atrial appendage closure (LAAC) plus atrial fibrillation (AF) catheter ablation (CA) in a single procedure has been established, but the optimal combination strategy has not been thoroughly elucidated to date. OBJECTIVE We aimed to investigate the impact of different combination strategies on clinical outcomes. METHODS Eighty-two consecutive patients with symptomatic AF (mean CHA2 DS2 -VASc score 4.4 ± 1.4, mean HAS-BLED score 3.5 ± 1.0) were enrolled. LAAC with the Watchman device was performed either before (occlusion-first group, N = 52) or after (ablation-first group, N = 30) CA. Procedural and clinical data were retrospectively analyzed to evaluate the advantages of each strategy. RESULTS Complete device occlusions were achieved in 92.3% and 90.0% of patients, respectively (P = 0.719). Neither acute nor chronic peridevice leak greater than 5 mm was detected. Oral anticoagulants were held in all patients, except two (one in each group) with asymptomatic device-related thrombi. AF-free success rates were comparable between groups with a mean follow-up of 11.2 ± 7.3 months (75.0% vs. 70.0%, log-rank P = 0.311). The new peridevice leak rate was significantly lower in the occlusion-first group (7.7% vs. 26.7%, P = 0.019). Multivariate logistic regression demonstrated that the combination strategy was independently associated with the new peridevice leak (P = 0.025, OR 13.3). CONCLUSIONS Both occlusion-first and ablation-first strategies were efficacious and safe as combined procedures in patients with nonvalvular AF; however, the occlusion-first strategy was associated with lower new peridevice leak rates at follow-up.

Surface-enhanced Raman spectroscopy (SERS) is a very sensitive and selective technique for detecting surface species. Recently, SERS has been increasingly employed in the study of biological macromolecules, from DNA and peptides to whole proteins, and cells. However, visible laser sources usually employed in SERS detections always lead to photochemical reactions as well as intensive fluorescence emission from the biological samples. A way to avoid these questions is the employment of near infrared (NIR) laser excitation; thus, it demands the appropriate designs of NIR-SERS substrates in order to obtain the maximum enhancement of the Raman signals from biological analytes. In this work, we demonstrate the fabrication of a new NIR-SERS substrate of polyvinyl alcohol (PVA) coating Ag nanofilms (PVA-coating Ag nanofilm) using a simple and low-cost microwave strategy. The experimental data show that, the plasmon resonance band of the PVA-coating Ag nanofilm is in the region of 400–900 nm, and the maximum center is at ∼780 nm, which matches well with the 785 nm laser excitation employed in this work. With the NIR-SERS detections of hematin and hemoglobin molecules adsorbed on this PVA-coating Ag nanofilm, one can see that the NIR-SERS activity and spectroscopy reproducibility of this NIR-SERS substrate are all perfect. By using of the tested molecule of hematin, the PVA-coating Ag nanofilm shows a high enhancement factor (EF) of ∼10 7 . As the fabrication process of this NIR-SERS substrate is very simple and inexpensive, this method may be used in large-scale preparation of SERS substrates that have been widely applied in Raman analysis. Especially, this PVA-coating Ag nanofilm can also be served as a novel NIR-SERS substrate in biochemical analysis due to its good NIR characteristics.

Display Omitted Totally, 32 and 55 modules were obtained from the PPI networks of normal and HCM, respectively.A total of 5 modules were differential attractors.Proteasome, ribosome and oxidative phosphorylation were the significant pathways. BackgroundOur study was designed to identify the differential attractor modules related with hypertrophic cardiomyopathy (HCM) by integrating clustering-based on maximal cliques algorithm and Attract method. MethodsWe firstly recruited the HCM-related microarray data from ArrayExpress database. Next, proteinprotein interaction (PPI) networks of normal and HCM were constructed and re-weighted using spearman correlation coefficient (SCC). Then, maximal cliques were found from the PPI networks through the clustering-based on maximal cliques approach. Afterwards, highly overlapped cliques were eliminated or merged according to the interconnectivity, and then modules were obtained. Subsequently, we used Attract method to identify differential attractor modules, following by the pathway enrichment analyses for genes in differential attractor modules. ResultsAfter removing the cliques with nodes less than or equal to 4, 926 and 1118 maximal cliques in normal and HCM PPI networks were obtained for module analysis. Then, we obtained 32 and 55 modules from the PPI networks of normal and HCM, respectively. By comparing with normal condition, there were 5 module pairs with the same or similar gene composition. Significantly, based on attract method, we found that these 5 modules were differential attractors. Pathway enrichment analyses indicated that proteasome, ribosome and oxidative phosphorylation were the significant pathways. ConclusionsProteasome, ribosome and oxidative phosphorylation might play pathophysiological roles in HCM.