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ObjectivesTo investigate prognostic significance of follow-up CT findings for initially medically treated type B aortic intramural hematoma (IMH).MethodsWe performed a retrospective pooled analysis of individual patient data, including baseline and follow-up CT characteristics. All enrolled patients were followed up for adverse aorta-related events, defined as a composite of aortic disease–related death and surgical or endovascular aortic repair.ResultsA total of 238 patients (73.9% men) were included, with a mean age of 58.1 ± 9.8 years. During follow-up, 83 patients (34.9%) experienced adverse aorta-related events, most of the events (83.1%) occurred within 1 month after follow-up CT imaging (n = 69). In the Cox regression model for predicting adverse aorta-related events, baseline maximal aortic diameter (MAD) (HR = 1.05, p = 0.008), ulcer-like projection (ULP) (HR = 2.47, p < 0.001), changes of maximal hematoma thickness (MHT) (HR = 1.22, p < 0.001), newly developed ULP (HR = 4.44, p < 0.001), and newly developed pleural effusion (HR = 2.46, p = 0.002) were powerful independent predictors. In combined predictive model for 1-month aortic events, baseline MHT ≥ 11.8 mm (OR = 4.39, p = 0.001), ULP (OR = 3.98, p < 0.001), changes of MHT (OR = 1.46, p < 0.001), newly developed ULP (OR = 9.27, p = 0.002), and newly developed pleural effusion (OR = 3.45, p = 0.015) were independent predictors. Besides, in patients with pleural effusion at baseline, resorption of pleural effusion was associated with adverse aorta-related events (HR = 0.36, p = 0.027) and 1-month aortic events (OR = 0.23, p = 0.026).ConclusionsFollow-up CT findings provide strong and incremental prognostic information for initially medically treated type B IMH, which are helpful for risk estimates and decisions-making.Key Points• Follow-up CT provides strong and incremental prognostic information for initially medically treated type B aortic intramural hematoma.• Follow-up CT is highly recommended for type B intramural hematoma in patients who did not receive urgent invasive therapy.• Follow-up CT is helpful for risk estimates and decisions-making.

Wind and sand control features are important tools for limiting desertification. Sand barriers are one of the oldest engineering measures used to reduce wind-sand hazards. Their efficacy and exact mechanism by which they work has remained a topic of scientific debate however. Sediment grain-size distributions can help constrain their utility and function. This research analyzed sediment grain size distributions in samples collected from areas around six different types of sand barriers installed along the southeastern margin of the Tengger Desert. Results were compared with sediment from a bare dune area (no barriers) used as a control. The barrier area samples contained high proportions of coarse sand and relatively low proportions of silty sand and very fine sand. Fine and medium sand were present but clay was not. The lower proportions of fine sand and higher proportions of coarse sand relative to bare dunes documented an effective reduction in aeolian transport by the barriers. Samples from the barrier areas also showed poorer sorting relative to bare dune areas. This appeared as lower kurtosis values and wider frequency distribution curves relative to those measured from bare dunes samples. The wider cumulative frequency curves for samples from the barrier areas likely reflects the higher proportion of coarse-grained material. The Straw/1.5 and PLA/1 barrier types hosted greater sediment accumulation than that observed for the other barrier types (Straw/1, PLA/1.5, Mixed/1 and Mixed/1.5). Sediment grain size distributions showed that the base and middle slope areas of the dune experienced deposition, while the top of the dunes experienced erosion. The Straw/1 barrier (straw installed as a 1 × 1 m grid) performed best in terms of installation costs and protective effects for the study area. This study demonstrates how sediment grain size distributions can be used as quantitative proxies for sand barrier performance in reducing desertification.

WOXs are a class of plant-specific transcription factors that play key roles in plant growth and stress responses. However, the mechanism by which WOXs influence adventitious root development in Rosa hybrida remains unclear. In this study, RcWOX gene family in rose was identified and phylogenetically analyzed using bioinformatics analysis. A total of 381 RcWOX gene members were localized on seven chromosomes except of nine members. The main cis -acting elements involved in hormonal, light, developmental, and abiotic stress responses were identified in the promoters of RcWOX genes, suggesting their regulation by these signals. Nine RhWOX genes had significant different expression during rooting process of rose. RhWOX331 , RhWOX308 , RhWOX318 were positive with the formation of rose roots. RhWOX331 was positively involved in the formation of adventitious root primordia, which gene coding a transcription factor localized in the nucleus. The HOX conserved domain in the protein contributed to the self-activating activity of RhWOX331. We obtained genetically modified Arabidopsis to validate the function of RhWOX331 . Overexpression of RhWOX331 gene alleviated the inhibition of root length of A. thaliana primary roots by high concentration of IBA and NPA, and significantly increased the number of lateral roots on the primary roots, as well as the height of A. thaliana plants. Additionally, RhWOX331 promoted adventitious root formation in A. thaliana and mitigated hormonal inhibition by exogenous 6-BA, NPA, and GA 3 . The RhWOX331 promoter contained cis-acting elements such as ABRE, Box 4 and CGTCA-motif et.al. GUS activity analysis showed that the gene acted at the cotyledon attachment site. Taken together, these studies identified a significant expansion of the RcWOX gene family, inferred roles of certain branch members in adventitious root formation, elucidated the function of RhWOX331 in adventitious root initiation, and laid the foundation for further research on the function of WOX gene family in roses.

There are limited data assessing statin therapy in patients with nonobstructive coronary plaque on coronary computed tomography angiography (CCTA). Two hundred six consecutive patients with mild noncalcified plaque on CCTA were enrolled in this multicenter prospective observational study. Subjects were divided into 3 groups according to subsequent statin therapy: intensive statin therapy (n = 55), moderate statins (n = 85), and no statin (n = 66). Serial scans were performed after a median interval of 18 months. Low-attenuation plaque (LAP) volume, total plaque volume, and percent plaque volume were measured. The LAP volume, total plaque volume, and percent plaque volume showed significant regression among intensive-statin compared with no-statin group (annualized changes: −7.1 ± 13.1 vs 0.9 ± 12.7 mm3, P< .001; −16.4 ± 35.0 vs 12.3 ± 32.4 mm3, P< .001; and −6.2% ± 11.8% vs 3.5% ± 12.1%, P< .001, respectively). Progression of LAP volume, total plaque volume, and percent plaque volume was retarded among moderate-statin compared with no-statin group (annualized changes: −2.8 ± 7.6 vs 0.9 ± 12.7 mm3, P= .041; −0.1 ± 25.6 vs 12.3 ± 32.4 mm3, P= .014; and −1.8% ± 11.2% vs 3.5% ± 12.1%, P= .006, respectively). On multivariable model predicting change in total plaque volume, higher baseline LAP volume, moderate statin therapy, and intensive statin therapy were each independent predictors of plaque regression (standardized coefficients: baseline LAP volume −0.36, P< .001; moderate statin −0.21, P= .004; intensive statin −0.36, P< .001, respectively). This study suggests that statin treatment can retard progression and even induce regression of mild noncalcified coronary plaque. Patients with greater baseline LAP volume are more likely to benefit from statin therapy.

Background Both bicuspid aortic valve (BAV) and bovine aortic arch (BA) are considered as markers of thoracic aortic disease (TAD). But the association between them is not yet clear. This study aimed to explore the potential association of BAV and BA with TAD. Methods The study involved 449 participants who underwent their first aortic valve replacement in Fuwai Hospital from June 2017 to March 2018. All patients underwent multidetector computed tomography and echocardiography before surgery. The clinical characteristics were recorded to analyze the association between BAV, BA, and TAD. The univariate and multivariate logistic regression analyses were applied to identify the risk factors for TAD. Results BA accounted for 79.8% of the arch variants and was the most common aortic arch branching variant. BAV was present in 52.6% of the patients with BA and 38.1% of the patients with normal arch (NA). Among the 185 patients in the BAV subgroup, 50 had BA and 135 had NA. No significant differences were found in BAV anatomical phenotype, aortopathy phenotype, and valve function between BA and NA. The multivariate analysis showed that the presence of BAV and male sex were the risk predictors of TAD. BA was not a risk factor for TAD in either univariate or multivariate analysis. Conclusions The proportion of BAV in patients with BA was significantly higher than that of NA, but the BAV phenotype and aortopathy were not related to BA. BAV was a risk factor for TAD, whereas BA was not associated with TAD.

BackgroundPatients often experience postoperative nausea and vomiting (PONV) after catheter ablation of atrial fibrillation (AF) because of the use of opioids for anaesthesia and analgesia during the procedure. Some clinical trials have demonstrated that acupuncture-assisted anaesthesia (AAA) reduces opioid consumption and prevents PONV. Although several studies have been conducted on AAA, its safety and efficacy in AF catheter ablation remain unclear due to small sample sizes and a paucity of methodologically rigorous designs. Therefore, this trial was designed to evaluate the safety and efficacy of AAA in reducing PONV and morphine hydrochloride consumption during catheter ablation.MethodsThis single-centre, patient-blinded, randomised, non-penetrating sham-controlled trial will be conducted in China. A total of 100 patients will be randomly assigned to the AAA and conventional anaesthesia (CA) groups in a ratio of 1:1. The patients will receive AAA or CA plus sham acupuncture during catheter ablation and will be followed up for 30 days. The primary outcomes include the total amount of morphine hydrochloride consumed during catheter ablation and PONV within the first 24 hours after the procedure. The secondary outcomes include pain, nausea and vomiting, anxiety, patient’s ability to cope during catheter ablation, AF recurrence and quality of life, as assessed using the numeric rating scale. Adverse events will be recorded and their influence will be analysed at the end of the trial.DiscussionThis study will help in evaluating the safety and efficacy of AAA applied for AF catheter ablation in reducing opioid doses during the procedure and the occurrence of PONV.Ethics and disseminationThe study has been approved by the Medical Ethics Committee of Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine. The results of the study will be published in peer-reviewed journals and presented at conferences if possible.Trial registration numberChiCTR 2100042646; Chinese Clinical Trial Registry.

IntroductionCurrent guidelines recommend moderate-intensity lipid lowering (low-density lipoprotein cholesterol, LDL-C of <2.6 mmol/L or 30%–49% reduction from the baseline) for patients with intermediate 10-year atherosclerotic cardiovascular disease (ASCVD) risk. The effects of intensive lipid lowering (LDL-C of <1.8 mmol/L) on coronary atherosclerotic plaque phenotype and major adverse cardiovascular events (MACE) in adults with both non-obstructive coronary artery disease (CAD) and low to intermediate 10-year ASCVD risk remain uncertain.Methods and analysisIntensive Lipid-lowering for Plaque and Major Adverse Cardiovascular Events in Low to Intermediate 10-year ASCVD Risk Population is a multicentre, randomised, open-label, blinded endpoint clinical trial. Inclusion criteria are as follows: (1) patients with the age of 40–75 years within 1 month of coronary CT angiography (CCTA) and coronary artery calcium score (CACS) evaluation; (2) population with low to intermediate 10-year ASCVD risk (<20%) and (3) patients with non-obstructive CAD (stenosis <50%) using CCTA. 2900 patients will be randomly assigned to the intensive lipid lowering (LDL-C of <1.8 mmol/L or ≥50% reduction from the baseline) or the moderate-intensity lipid lowering (LDL-C of<2.6 mmol/L or 30%–49% reduction from the baseline) group in a 1:1 ratio. The primary endpoint is MACE (composite of all-cause death, non-fatal MI, non-fatal stroke, any revascularisation and hospitalisation for angina) within 3 years after enrolment. The secondary endpoints are changes in coronary total plaque volume (mm3), plaque burden (%), plaque composition (mm3, %), high-risk plaque characteristics detected using CCTA and CACS determined using CT.Ethics and disseminationEthics committee approval for this study was obtained from the review boards of Fuwai Hospital (No.2022-1787) and all other study sites. Written informed consent will be obtained from all participants. The results of this study will be published in peer-reviewed journals and reported at international conferences.Trial registration numberNCT05462262.

Background: Coronary computed tomography angiography (CCTA) is an established first-line test in the investigation of patients with suspected coronary artery disease (CAD), while the perivascular fat attenuation index (FAI) derived from CT seems to be a feasible and efficient tool for the identification of ischemia. The association between the FAI and lesion-specific ischemia as assessed by fractional flow reserve (FFR) remains unclear. Methods: In a total of 261 patients, 294 vessels were assessed for CCTA stenosis, vessel-specific FAI, lesion-specific FAI, and plaque characteristics. The diagnostic accuracies of each parameter and the combined approach were analyzed via the receiver operating characteristic curve (ROC) with FFR as the reference standard. The determinants of FAI were statistically analyzed. Results: The cutoff values of vessel-specific FAI and lesion-specific FAI scores calculated according to the Youden index were −70.97 and −73.95 HU, respectively. No significant differences were noted between them; however, they exhibited a strong correlation. No significant differences were noted between the area under the curve (AUC) scores of vessel-specific FAI (0.677), lesion-specific FAI (0.665), and CCTA (0.607) (p > 0.05 for all) results. The addition of two FAI measures to the CCTA showed improvements in the discrimination (AUC) and reclassification ability (relative integrated discrimination improvement (IDI) and category-free net reclassification index (NRI)), vessel-specific FAI (AUC, 0.696; NRI, 49.6%; IDI, 5.9%), and lesion-specific FAI scores (AUC, 0.676; NRI, 43.3%; IDI, 5.4%); (p < 0.01 for all). Multivariate analysis revealed that low-attenuation plaque (LAP) volume was an independent predictor of two FAI measures. Conclusion: The combined approach of adding vessel-specific FAI or lesion-specific FAI scores could improve the identification of ischemia compared with CCTA alone. The LAP volume was the independent risk factor for both tools.

Progression of coronary artery calcification (CAC) was significantly associated with all-cause mortality, and high coronary artery calcium score (CACS) portends a particularly high risk of cardiovascular events. But how often one should rescan is still an unanswered question. Preliminary screening by testing circulating biomarker may be an alternative before repeat computed tomography (CT) scan. The aim of this study was to investigate the value of big endothelin-1 (bigET-1), the precursor of endothelin-1 (ET-1), in predicting the severity of CAC. A total of 428 consecutively patients who performed coronary computed tomography angiography (CCTA) due to chest pain in Fuwai Hospital were included in the study. The clinical characteristics, CACS, and laboratory data were collected, and plasma bigET-1 was detected by enzyme-linked immunosorbent assay (ELISA). The bigET-1 was positively correlated with the CACS (r = .232, P < .001), and the prevalence of CACS >400 increased significantly in the highest bigET-1 tertile than the lowest tertile. Multivariate analysis showed that bigET-1was the independent predictor of the presence of CACS >400 (odds ratio [OR] = 1.721, 95% confidence interval [CI], 1.002-2.956, P = .049). The receiver operating characteristic (ROC) curve analysis showed that the optimal cutoff value of bigET-1 for predicting CACS >400 was 0.38 pmol/L, with a sensitivity of 59% and specificity of 68% (area under curve [AUC] = 0.65, 95% CI, 0.58-0.72, P < .001). The present study demonstrated that the circulating bigET-1 was valuable in the assessment of the severity of CAC.

Objective We performed this meta-analysis to determine which stent among everolimus eluting stents (EES), sirolimus eluting stents (SES) and paclitaxel eluting stents (PES) should be preferred for the treatment of DM patients. Methods A systematic search of publications about randomized controlled trials (RCTs) focused on diabetic patients received EES, SES or PES was conducted. We evaluated the following indicators: target vessel revascularization (TVR), target lesion revascularization (TLR), late luminal loss (LLL), stent thrombosis (ST), myocardial infarction (MI), all-cause mortality and cardiac mortality. Results EES showed obvious advantages over SES for DM patients, as it induced the lowest rate of target vessel revascularization and target lesion revascularization (TLR) ( p  = 0.04). In addition, EES induced lower in-segment LLL than PSE and SES and lower in-stent LLL than PES in DM patients (all p  < 0.05). Moreover, EES effectively reduced all-cause mortality compared to SES (RR = 0.71, 95% CI: 0.52–0.99, p  = 0.04) and MI rates compared to PES (RR = 0.44, 95% CI: 0.26–0.73, p  = 0.0002). Furthermore, EES could reduce the ST rate compared with both SES (RR = 0.53, 95% CI: 0.28–0.98, p  = 0.04) and PES (RR = 0.18, 95% CI: 0.07–0.51, p  = 0.001). Conclusion Among those three types of stents, EES should be the first recommended stent for DM patients.