Abstract Background and Aims The association between the Triglyceride-Glucose index, an emerging marker of insulin resistance, and the risk of aortic stenosis remains unclear. The influence of Triglyceride-Glucose index on aortic stenosis may be mediated through plasma metabolites. To investigate the potential causal relationships between the Triglyceride-Glucose index, plasma metabolites, and aortic stenosis, we employed a two-sample Mendelian randomization approach. Methods We conducted univariable Mendelian randomization analyses to explore the associations between (i) the Triglyceride-Glucose index and aortic stenosis; (ii) plasma metabolites and aortic stenosis; and (iii) the Triglyceride-Glucose index and plasma metabolites. For significant associations identified through Mendelian randomization, a two-step MR analysis was employed to evaluate mediation effects. Results The genetically predicted Triglyceride-Glucose index is positively associated with aortic stenosis (OR 1.74, 95% confidence interval 1.41, 2.16). Following adjustments for multiple testing, there were 15 notable associations between genetically predicted metabolites and aortic stenosis. Additional analyses estimated the indirect effects of the TyG index on AS through these metabolites. Notably, the mediation effect of various metabolites was quantified: 1-arachidonoyl-gpc (20:4n6) exhibited a mediation effect of 0.06 (95% CI: 0.02 to 0.11, P = 4.38E-03); 1-stearoyl-2-arachidonoyl-gpc (18:0/20:4) had a mediation effect of 0.08 (95% CI: 0.03 to 0.12, P = 6.60E-04); 1-stearoyl-2-arachidonoyl-gpe (18:0/20:4) showed an effect of 0.12 (95% CI: 0.06 to 0.17, P = 6.58E-05); 1-palmitoyl-2-arachidonoyl-gpe (16:0/20:4) demonstrated a mediation effect of 0.07 (95% CI: 0.03 to 0.11, P = 8.75E-04); 1-palmitoyl-2-docosahexaenoyl-gpe (16:0/22:6) showed an effect of 0.09 (95% CI: 0.03 to 0.14, P = 1.26E-03); and 1-oleoyl-2-arachidonoyl-gpe (18:1/20:4) had an effect of 0.08 (95% CI: 0.03 to 0.13, P = 5.38E-04). Conclusion The genetically predicted Triglyceride-Glucose index is positively associated with the risk of aortic stenosis, and this relationship is partially mediated by specific metabolites.

Abnormalities in electrolyte balance are common following coronary artery bypass grafting (CABG) and are associated with adverse outcomes. The serum sodium-to-chloride ratio has emerged as a potential prognostic marker in critical illness, but its role in predicting short-term mortality after CABG remains unclear. This study explored the relationship between the serum sodium-to-chloride ratio and 30-day mortality following CABG, aiming to assess the predictive value of the sodium-to-chloride ratio for short-term mortality and provide insights for optimizing postoperative electrolyte management. A retrospective cohort study was carried out using the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, covering intensive care unit (ICU) admissions from 2008 to 2022 at the Beth Israel Deaconess Medical Center (BIDMC). The sodium-to-chloride ratio, measured within 24 h and divided into tertiles, was the exposure variable, while 30-day mortality was the outcome. Covariates included demographics, comorbid conditions, physiological scores, vital signs, and laboratory results. Multivariable Cox regression, restricted cubic splines (RCS), subgroup analyses, and doubly robust estimation (IPTW combined with Cox regression) were used to evaluate the independent association, dose–response relationship, and the robustness of the results. Patients in the highest tertile of sodium-to-chloride ratio had a significantly higher risk of 30-day mortality than those in the lowest tertile. In the fully adjusted model, each 0.01-unit increase in the sodium-to-chloride ratio was associated with a 6

This study employs an integrative approach combining single-cell RNA sequencing (scRNA-seq), spatial transcriptomics (ST), and bulk RNA sequencing to investigate the complex cellular and molecular dynamics following myocardial infarction (MI). Quality control, batch correction, dimensionality reduction, clustering, and annotation were performed on scRNA and ST data. The Milo tool was used to analyze differential cell abundance. Developmental trajectory inference was conducted using the Monocle2 algorithm, and cell-cell communication was explored using CellPhoneDB and NicheNet. SCENIC analysis identified active transcription factors (TFs) in macrophage subtypes. Additionally, deconvolution was used to assess the spatial distribution of cell types. The functional roles of different myocardial regions were explored through cell communication patterns. Mouse MI and ischemia-reperfusion (I/R) models were established by ligating the left anterior descending (LAD) coronary artery. Molecular changes were analyzed using RT-qPCR, Western blot, immunohistochemistry and immunofluorescence. In vitro, AC16 cardiomyocytes (CMs) and THP-1-derived M2 macrophages were subjected to oxygen-glucose deprivation/reoxygenation (OGD/R) and co-culture experiments to study TREM2-mediated effects. Cell viability and apoptosis were assessed using CCK-8 and flow cytometry, respectively. The study identified dynamic changes in the proportions of immune cell types at different time points post-MI. ST revealed distinct immune cell infiltration patterns in the infarct, border, and remote zones, with macrophages progressively infiltrating the infarct region over time. Functional enrichment analysis highlighted key pathways involved in inflammation, cell proliferation, and extracellular matrix remodeling across different cardiac regions. The study also identified Trem2high macrophages as key players in tissue repair. SCENIC analysis uncovered TFs regulating macrophage subtypes, emphasizing their roles in immune regulation and tissue reconstruction. Finally, cell-cell communication analysis revealed complex signaling networks influencing immune responses and tissue repair. Our results demonstrated that the expressions of Trem2 were significantly increased in the IZ groups in the MI and I/R model, and co-culture with TREM2-overexpressing M2 macrophages significantly enhanced the proliferative capacity and reduced apoptosis in AC16 CMs under OGD/R conditions, indicating a critical role of Trem2 in the I/R response and CMs survival. This comprehensive analysis provides a detailed map of the cellular and molecular landscape post-MI, highlighting the temporal and spatial dynamics of immune cells and their regulatory networks.

Myocardial ischemia-reperfusion (I/R) injury is a major cause of heart damage, linked to disrupted ATP metabolism and oxidative stress. While m6A RNA methylation regulates various cellular processes, its role in modulating I/R injury and ATP hydrolysis remains unclear. In this study, we demonstrate that both in vivo (rat I/R model) and in vitro (H/R-treated cardiomyocytes) models exhibit increased m6A modification levels during I/R injury. Among key m6A regulators, RBM15 is significantly upregulated in ischemic heart tissue. Functional assays reveal that RBM15 directly modulates the m6A methylation of Entpd1 (CD39), enhancing its expression and activity. Overexpression of RBM15 promotes ATP hydrolysis, resulting in increased adenosine production. These molecular changes collectively mitigated oxidative stress, reduced inflammation, and decreased apoptosis, resulting in improved cardiac function, smaller infarct sizes, and less cell death in the I/R model. These protective effects are reversed by CD39 inhibitor (sodium polyoxotungstate, POM-1), confirming the pivotal role of CD39 in this pathways. Mechanistically, RBM15 also activates the AMPK and AKT/ERK/GSK3β signaling pathway by increasing phosphorylation levels, further contributing to cardioprotection. In summary, RBM15-mediated m6A methylation enhances CD39 expression, facilitating extracellular ATP hydrolysis and exerting protective effects against myocardial I/R injury, highlighting its potential as a therapeutic target.

Previous studies reported that the use of natriuretic peptides (NPs) can effectively decrease arrhythmias. However, there is a lack of clinical evidence that recombinant human brain natriuretic peptide (rh-BNP) inhibits postoperative atrial fibrillation (POAF). This cohort aims to assess the effect of rh-BNP on POAF. This study retrospectively reviewed patients who underwent isolated coronary artery bypass grafting from January 2018 to January 2021. Patients were divided into 2 groups according to whether they received rh-BNP therapy within 5 days after surgery. A total of 1153 patients met the inclusion and exclusion criteria, of which 54 received rh-BNP therapy within 5 days. After propensity score matching, 53 patients were treated with rh-BNP, and 148 patients were not treated with rh-BNP. The incidence of POAF was lower in rh-BNP group than non-rh-BNP group (18.9% vs. 37.2%, odds ratio = 0.393, 95% confidence interval, 0.183-0.845, P = 0.017). There was no significant difference in the occurrence of ventricular arrhythmia (P = 0.4), hypotension (P = 0.763), and the risk of death (P = 0.14). rh-BNP could significantly reduce the occurrence of POAF after coronary artery bypass grafting, and rh-BNP did not increase the risk of ventricular arrhythmia, hypotension, and death. Accordingly, rh-BNP could be a potential safe medicine for preventing POAF.

Journal Article Corrected proof Rare cardiac foreign body: acupuncture needle-penetrated heart Get access Yikang Wang, Yikang Wang Department of cardiovascular surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 266003, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Qing Chang Qing Chang Department of cardiovascular surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao 266003, China Corresponding author. E-mail: changqing20671@qdu.edu.cn https://orcid.org/0000-0003-4122-3705 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal - Cardiovascular Imaging, jead134, https://doi.org/10.1093/ehjci/jead134 Published: 09 June 2023 Article history Published: 09 June 2023 Corrected and typeset: 22 June 2023

Objective Using the nomogram to intuitively predict atrial fibrillation after coronary artery bypass grafting. Identify high-risk patients with atrial fibrillation and provide preoperative protective therapy. Methods A total of 397 patients that underwent coronary artery bypass grafting were consecutively enrolled. Independent predictors of patients were analyzed by multivariate logistic regression. Two nomograms were constructed to predict postoperative atrial fibrillation. Results The incidence of postoperative atrial fibrillation in this study was 29% (115/397). Multivariate Logistic showed that Age, Operative Time > 4 h, Left Atrial Diameter > 40 mm, Mean Arterial Pressure, Body Mass Index > 23 kg/m 2 , Insulins, and Statins were independently associated with atrial fibrillation after isolated coronary artery bypass grafting. The nomogram of postoperative atrial fibrillation in patients was constructed using total predictor variables (AUC = 0.727, 95% CI 0.673–0.781). The model was internally validated (AUC = 0.701) by K-fold Cross-validation resampling (K = 5, Times = 400). To make an early intervention, the intraoperative information of the patients was excluded. Only 6 variables before surgery were used to establish the brief nomogram to predict postoperative atrial fibrillation (AUC = 0.707, 95% CI 0.651–0.764). The brief model was internally validated (AUC = 0.683) by resampling with K-fold Cross-validation resampling. Conclusions These two nomograms could be used to predict patients at high risk for atrial fibrillation after isolated coronary artery bypass grafting.

BACKGROUND:Postoperative atrial fibrillation (POAF) after cardiac surgery is a common complication. We aimed to investigate the impact of serum uric acid level (UA) on the POAF of patients undergoing coronary artery bypass grafting (CABG).METHODS:A retrospective cohort study of patients undergoing CABG at the Hospital between January 2019 and December 2019 was performed. Hyperuricemia (HUA) was defined as serum UA levels >420 µmol/l in men and>360 µmol/l in women. The included patients were divided into the HUA group (103) and the normal UA group (306) based on serum uric acid levels before surgery. POAF was defined as atrial fibrillation that occurred within 7 days of cardiac surgery. We use COX regression analysis and Kaplan-Meier curves (log-rank test) for statistical analysis.RESULTS:The incidence of HUA was 25.2% (103/409). The rate of POAF was 28.61%. Univariate COX regression analysis showed the risk of POAF occurrence. It was revealed that UA was an independent predictor of POAF (HR=1.493, 95% CI1.007-2.212, P = 0.046). Kaplan-Meier curves showed that high serum UA was associated with the occurrence of POAF (P = 0.034). Moreover, age (HR=1.05, 95%CI 1.024-1.076, P < 0.001), AD (HR=1.567, 95%CI .015-2.42, P = 0.043), and CCB (HR=0.647, 95%CI 0.424-0.988, P = 0.044) also were independent predictors of POAF.CONCLUSIONS:Preoperative UA level was significantly associated with POAF. Higher serum UA was an independent risk factor for POAF.

Cryoprotectants are crucial factors in cell cryopreservation. Trehalose (Tre), a nontoxic, nonreducing, and natural disaccharide, has the potential to protect cells as a cryoprotectant. As an inducer of autophagy, Tre can influence the development of many diseases and may also have an effect on cell cryopreservation through this mechanism. In this study, human aortic endothelial cells were preserved in different cryopreservation fluids with or without dimethyl sulfoxide and Tre was added. Subsequently, the expression of the main autophagy-related genes LC3, BECN, and P62, cell death and apoptosis, and the proliferation rate were measured in different groups after cryopreservation. Our data showed that Tre can improve the expression of the autophagy-related genes LC3 and BECN and reduce the expression of P62. Dead/alive staining and flow cytometry showed that cell death and cell apoptosis were reduced during cryopreservation with Tre. In addition, the cell proliferation rate after thawing was increased in the Tre group when compared with others. These results all indicated that there might be a connection between Tre-triggered autophagy and the protective role of Tre in cell cryopreservation. Furthermore, strategies to regulate autophagy to reduce apoptosis in this process should be investigated in future research.

目的 探讨术前甘油三酯-葡萄糖指数(TyG)对冠状动脉搭桥患者术后急性肾损伤(AKI)的预测价值.方法 回顾性分析自2019年7月至2020年12月于青岛大学附属医院西海岸院区行单纯冠状动脉搭桥术的139例患者的临床资料.根据AKI情况将患者分为AKI组(n=28)与非AKI组(n=111).收集患者的一般资料、临床特征、术前血常规与生化指标、手术类型及手术相关因素.绘制受试者工作特征(ROC)曲线分析TyG预测患者术后AKI的效能.采用单因素及多因素Logistic回归分析探讨冠状动脉搭桥术后AKI的危险因素.结果 AKI组糖化血红蛋白、空腹血糖、TyG、血管紧张素、转化酶抑制剂与胰岛素应用比例高于非AKI组,两组比较,差异有统计学意义(P<0.05).ROC曲线分析结果显示,TyG的最佳截断值为8.855,其对应的灵敏度和特异性分别为61.3％和67.9％,曲线下面积为0.628.Logistic回归分析结果显示,TyG、外周血管疾病、血管紧张素转化酶抑制剂、胰岛素为术后AKI的危险因素(危险比=3.949、18.805、5.538、7.714,P<0.05).结论 术前TyG>8.855是接受冠状动脉搭桥术患者术后急性肾损伤的独立预测因子,有助于早期识别术后AKI的高危人群.

Aim    Endothelial progenitor cells (EPCs) play important roles in heart valve replacement surgery. Up-regulation of Grb2‑associated binder 1 (Gab1) promotes hepatocyte growth factor (HGF) - induced endothelial progenitor cell proliferation and migration. This study aimed to investigate the effects of up-regulation of Gab1 in hepatocyte growth factor-induced EPCs in tissue-engineered heart valves (TEHV).Material and methods    Fresh porcine aortic valves were placed in 1 % Triton X-100 and trypsin buffer for decellularization. EPCs in the control group were cultured normally, whereas those in the experimental group were both HGF stimulated and transfected with adenovirus containing the Gab1 gene. Cells in the two groups were seeded onto the decellularized valve scaffolds and cultured for 3 or 7 days. TEHV were analyzed by HE and AB-PAS staining.Results    By day 3, the experimental group had formed confluent endothelial monolayers on top of the decellularized valves, on the basis of by HE staining and AB-PAS staining. One week later, the control group showed a imperfect endothelial layer.Conclusion    HGF-induced EPCs overexpressing Gab1 can endothelialize the decellularized matrix and create functional TEHV, which may then be preconditioned in a bioreactor before clinical implantation.

Background: Acute kidney injury (AKI) is a common complication of coronary artery bypass grafting (CABG) that results in worse prognosis. Studies have shown that recombinant human brain natriuretic peptide (rh-BNP) reduces renal injury. However, its treatment effects for AKI in patients underwent cardiac surgery are unclear. This study sought to explore the efficacy of rh-BNP in patients with AKI after bypass surgery. Methods: This study included patients with AKI diagnosed within 4 days after CABG during the period January 2016 to December 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The clinical characteristics and outcomes were collected. Patients were divided into BNP and non-BNP groups according to whether rh-BNP was injected intravenously after the operation. Multivariable logistic regression was adjusted the confounding effects between clinical characteristics and rh-BNP. Propensity score matching (PSM) was used to perform a sensitivity analysis. Results: A total of 395 patients, including 56 and 339 patients in the BNP and non-BNP groups, respectively, were included in this study. The decreasing trend of postoperative serum creatinine levels (P<0.001) and postoperative urine volume (P=0.001) within 4 days of surgery were independent associated with rh-BNP. From PSM, 175 patients, including 44 and 131 patients in the BNP and non-BNP groups, respectively, were included in this study. The decreasing trend of postoperative serum creatinine levels in the BNP group was significantly stronger than that in the non-BNP group (0.04 +/- 0.28 vs. -0.16 +/- 0.36, P=0.001). The postoperative urine volume within 4 days of surgery of the BNP group was higher than that of the non-BNP group (11.3 +/- 2.8 vs. 9.11 +/- 2.66, P<0.001). The cumulative dosage of diuretics after the procedure did not differ between the BNP and non-BNP groups {60 [40, 80] vs. 60 [40, 120], P=0.852}. Conclusions: Rh-BNP can reduce creatinine levels and increases postoperative urine volume to improve renal function in patients.

Background: Acute kidney injury (AKI) is a common complication after cardiac surgery. It is closely related to poor perioperative glycemic control. We aimed to explore the relationship between preoperative hemoglobin A1c (HbA1c) levels and cumulative postoperative insulin usage and AKI after off-pump coronary artery bypass grafting (OPCABG). Method: The included a total of 284 patients undergoing isolated OPCABG from 2018 to 2020. According to KDIGO's diagnostic criteria, patients were divided into the AKI group and the non-AKI group. Methods included ① increase in SCr by ≥0.3 mg/dl (≥26.5 µmol/l) within 48 hours; ② increase in SCr to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; ③ urine volume <0.5 ml/kg/hour for 6 hours. Results: Fifty-one patients (17.9%) had postoperative AKI. HbA1c levels (non-AKI group 6.1 (5.8, 7.1) vs. the AKI group 7.1 (5.9, 8.6) (P = 0.014, cut-off=7.2, AUC=0.61, sensitivity 49%, specificity 76.4%) and postoperative insulin usage (non-AKI group 16.0 (4.0, 36.0) vs. the AKI group 56.0 (11.0, 132.0), P < 0.001, cut-off=39.5, AUC=0.673, sensitivity 60.8%, specificity 76.8%) were different between the two groups. Multivariate logistic regression analysis showed that HbA1c > 7.2% (OR=2.869, P = 0.04) and postoperative insulin usage > 39.5 U (OR=7.548, P < 0.001) were independently associated with AKI. Conclusions: HbA1c levels and cumulative postoperative insulin usage could be used as independent predictors for AKI after OPCABG. Postoperative insulin usage is more predictive than preoperative HbA1c levels.

Background Several human diseases are associated with aberrant expression of regulators involved in N6-methyladenosine (m6A) RNA modification. However, their role in aortic valve calcification (AVC) is largely unknown. The aim of this study was to determine the general expression pattern and potential function of m6A regulators in AVC by bioinformatics methods. Methods We obtained AVC datasets from the Gene Expression Omnibus (GEO). The identification of m6A-related differentially expressed genes (DEGs) and the Consensus Clustering method was performed to type AVC individuals based DEGs. Then, we quantified the effect of typing by principal component analysis (PCA). Next, we performed the weighted gene co-expression network analysis (WGCNA) and identified the main modules as well as functional analysis. Additionally, the key genes were screened by protein-protein interaction network (PPIN) analysis and identifying important genes of important modules. We again typed AVC individuals by the same method using key genes. Finally, we evaluated the link between key genes and immune infiltration. Results We discovered that METTL14, ZC3H13, FTO, FMR1, HNRNPA2B1, HNRNPC, LRPPRC, YTHDC1, YTHDC2, and YTHDF1 expression levels decreased considerably in AVC tissues. Based on 10 genes, we typed 240 AVC samples as clusters A and B. We assessed the immune cell content in 240 samples using Cell-type Identification by Estimating Relative Subsets of RNA Transcripts (CIBERSORT) and found that B cell memory, CD8 T cells, T follicular helper cells, monocytes, M0 macrophages, resting dendritic cells (DCs), and interleukin-10 (IL-10) were concentrated in the cluster A group. Additionally, based on the important WGCNA modules, we identified 7 key genes. Next, 240 samples were retyped based on 7 key genes; we found that T cells CD8, T cells CD4 memory activated, T cells follicular helper, and macrophages M1 were significantly increased in gene cluster-1. Finally, we performed functional enrichment of gene cluster-typed samples, showing potential functional differences between different types. Conclusions Our study provides a review of the m6A regulators’ expression pattern and functional importance in human AVC. The data from this study might serve as a significant resource for future mechanistic and therapeutic investigations into the role of critical m6A regulators in AVC.

Objective. To identify fatty acid metabolism-related biomarkers of aortic valve calcification (AVC) using bioinformatics and to research the role of immune cell infiltration for AVC. Methods. The AVC dataset was retrieved from the Gene Expression Omnibus database. R package is used for differential expression genes analysis and weighted gene coexpression analysis. The differentially coexpressed genes were identified by the Venn diagram, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses of differentially coexpressed genes. Functions closely related to AVC were identified by GO and KEGG enrichment analyses of differentially coexpressed genes. Genes related to fatty acid metabolism were retrieved from the Molecular Signatures Database (MSigDB) database. After removing duplicate genes, least absolute shrinkage and selection operator (LASSO) regression analysis, support vector machine recursive feature elimination (SVM-RFE), and random forest were applied to recognize biomarkers related to fatty acid metabolism in AVC. The CIBERSORT tool was used to analyze infiltration of immune cells in normal and AVC samples. Correlations between biomarkers and immune cells were calculated. Finally, HIBCH-related pathway was predicted by single-gene gene set enrichment analysis (GSEA). Results. 2416 differentially expressed genes and one coexpression module were identified. A total of 1473 differentially coexpressed genes were acquired. GO and KEGG enrichment analyses demonstrated that differentially coexpressed genes were closely related to fatty acid metabolism. LASSO regression analysis, SVM-REF, and random forest revealed that 3-hydroxyisobutyryl-CoA hydrolase (HIBCH) was a biomarker of fatty acid metabolism-related genes in AVC. Significant high levels of memory B cells were found in AVC than normal samples, while activated natural killer (NK) cells were significantly low in AVC than normal samples. A significantly positive relevance was observed between HIBCH and activated NK cells, regulatory T cells, monocytes, naïve B cells, activated dendritic cells, resting memory CD4 T cells, resting NK cells, and CD8 T cells. A significantly negative relevance was observed between HIBCH and activated memory CD4 T cells, memory B cells, neutrophils, gamma delta T cells, M0 macrophages, and plasma cells. The single-gene GSEA results suggest that HIBCH may work through the inhibition of multiple immune-related pathways. Conclusion. HIBCH is closely relevant to immune cell infiltration in AVC and could be applied as a diagnostic marker for AVC.

OBJECTIVE:A set of cardiac MRI short-axis image dataset is constructed, and an automatic segmentation based on an improved SegNet model is developed to evaluate its performance based on deep learning techniques. METHODS:The Affiliated Hospital of Qingdao University collected 1354 cardiac MRI between 2019 and 2022, and the dataset was divided into four categories: for the diagnosis of cardiac hypertrophy and myocardial infraction and normal control group by manual annotation to establish a cardiac MRI library. On the basis, the training set, validation set and test set were separated. SegNet is a classical deep learning segmentation network, which borrows part of the classical convolutional neural network, that pixelates the region of an object in an image division of levels. Its implementation consists of a convolutional neural network. Aiming at the problems of low accuracy and poor generalization ability of current deep learning frameworks in medical image segmentation, this paper proposes a semantic segmentation method based on deep separable convolutional network to improve the SegNet model, and trains the data set. Tensorflow framework was used to train the model and the experiment detection achieves good results. RESULTS:In the validation experiment, the sensitivity and specificity of the improved SegNet model in the segmentation of left ventricular MRI were 0.889, 0.965, Dice coefficient was 0.878, Jaccard coefficient was 0.955, and Hausdorff distance was 10.163 mm, showing good segmentation effect. CONCLUSION:The segmentation accuracy of the deep learning model developed in this paper can meet the requirements of most clinical medicine applications, and provides technical support for left ventricular identification in cardiac MRI.

Background: Calcific aortic valve stenosis (CAVS) is a common valvular heart disease, but there are limited reports on the construction of prediction models for CAVS. This study aimed to investigate the risk factors for CAVS and construct a predictive model for CAVS based on its common clinical features.Methods: Patients with CAVS who underwent surgical treatment in our hospital from 2016 to 2020 and those who underwent physical examination during the same period were retrospectively studied and placed in the CAVS group and normal group based on the area of aortic valve orifice less than or more than 3 cm2. A total of 548 patients were included in this study, including 106 CAVS patients and 442 normal patients. Subjects were randomly divided into training and validation sets at a 7:3 ratio. The features were dimensionally reduced using the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm in the training set, and the optimal clinical features were selected. The independent predictors of patients with CAVS were determined by univariate and multivariate logistic regression, and nomogram was constructed. The calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to evaluate the model in both the training set and the validation set.Results: In this study, 11 independent predictors were distinguished by multivariate logistic regression analysis: history of hypertension, history of carotid atherosclerosis, age, diastolic blood pressure, C-reactive protein, direct bilirubin, alkaline phosphatase, low-density lipoprotein (LDL), lipoprotein(a) [Lp(a)], uric acid, and cystatin C. A nomogram was constructed using the above indicators. The model was well-calibrated and showed good discrimination and accuracy [the area under the curve (AUC) =0.981] in the training set, with a sensitivity of 91.89% and a specificity of 95.48%. More importantly, the nomogram displayed a good performance in the validation set (AUC =0.955, 95% CI: 0.925-0.985), with a sensitivity of 93.75% and a specificity of 84.09%. Additionally, DCA revealed that the nomogram had high clinical practicability.Conclusions: This study successfully established a risk prediction model for CAVS based on 11 conveniently accessible clinical indicators, which might easily be used for individualized risk assessment of CAVS.

目的 探讨术中左心耳封闭对患有心房颤动并接受二尖瓣置换术的患者的影响.方法 选取青岛大学附属医院自2014年1月至2018年7月收治的507例患有心房颤动并接受二尖瓣置换术的患者为研究对象.根据二尖瓣置换术术中对左心耳的处理方式不同,将患者分入A组(n=298)和B组(n=209),B组进行了左心耳封闭,A组未进行.比较两组患者的手术相关资料、围术期指标及随访数据,采用COX比例风险模型分析影响预后的危险因素,并绘制Kaplan-Meier无卒中事件累积生存曲线.结果 B组患者手术时间、体外循环时间、升主动脉阻断时间长于A组,差异均有统计学意义(P<0.05).术后1个月,B组患者左房内径、左室舒张内径小于A组,差异均有统计学意义(P<0.05).B组患者术后住院时间短于A组,差异有统计学意义(P<0.05).B组患者随访期间脑卒中事件发生率、死亡率低于A组,差异均有统计学意义(P<0.05).术前颈内动脉或椎动脉狭窄、年龄≥65岁、左房血栓是术后脑卒中的独立风险因素(P<0.05),术中封闭左心耳是预防术后脑卒中的保护因素(P<0.05).糖尿病、既往脑梗死病史、嗜酒史是术后死亡的独立风险因素(P<0.05),术中封闭左心耳是预防术后死亡的保护因素(P<0.05).B组患者无卒中事件累积生存率高于A组(P<0.05).结论 对患有心房颤动并接受二尖瓣置换术的患者进行术中左心耳封闭能够安全、有效地降低术后脑卒中风险和死亡率.

Trehalose is a disaccharide molecule consisting of two molecules of glucose. Industrially, trehalose is derived from corn starch and utilized as a drug. This study aims to examine whether the integration of nanoparticle-encapsulated trehalose to the Ice-Free Cryopreservation (IFC) method for preserving heart valves has better cell viability, benefits to protect the extracellular matrix (ECM), and reduce immune response after storage. For the experiment to be carried out, we obtained materials, and the procedures were carried out in the following manner. The initial step was the preparation of hydroxyapatite nanoparticles, followed by precipitation to acquire Apatite colloidal suspensions. Animals were obtained, and their tissue isolation and grouping were done ethically. All samples were then divided into four groups, Control group, Conventional Frozen Cryopreservation (CFC) group, IFC group, and IFC + T (IFC with the addition of 0.2 M nanoparticle-encapsulated Trehalose) group. Histological analysis was carried out via H&E staining, ECM components were stained with Modified Weigert staining, and the Gomori Ammonia method was used to stain reticular fibers. Alamar Blue assay was utilized to assess cell viability. Hemocompatibility was evaluated, and samples were processed for immunohistochemistry (TNFα and IL-10). Hemocompatibility was quantified using Terminal Complement Complex (TCC) and Neutrophil elastase (NE) as an indicator. The results of the H&E staining revealed less formation of extracellular ice crystals and intracellular vacuoles in the IFC + T group compared with all other groups. The CFC group’s cell viability showed better viability than the IFC group, but the highest viability was exhibited in the IFC + T group (70.96 ± 2.53, P < 0.0001, n = 6). In immunohistochemistry, TNFα levels were lowest in both IFC and IFC + T group, and IL-10 expression had significantly reduced in IFC and IFC + T group. The results suggested that the nanoparticle encapsulated trehalose did not show significant hemocompatibility issues on the cryopreserved heart valves.