Case report: Transapical transcatheter double valve-in-valve replacement of degenerated aortic and mitral bioprosthetic valves with limited radiopaque landmarks

A 67-year-old male patient who had undergone double valve replacement 11 years before presented with severe dyspnea to our department. The bioprosthetic aortic and mitral valves have failed. Because of the high risk of redo surgery. We perform a simultaneous transapical transcatheter valve-in-valve replacement of degenerated aortic and mitral bioprosthetic valves with limited radiopaque landmarks using the second-generation self-expanding J-valve. The post-operative course was stable and the patient was discharged on post-operative day eight

Preparation of pelargonic acid vesicles and sustained drug release

This study has selected the medium-chain saturated fatty acid pelargonic acid as the raw material for the first time, and added the surface catalyst Tween-80 to the aqueous solution to form pelargonic acid-Tween-80 composite vesicles by a surface tension method. The compound vesicle was used to encapsulate five heterocyclic drugs (ceftazolin sodium, chlorpromazine hydrochloride, gemcitabine hydrochloride, metronidazole, and isoniazid), all of which have disadvantages when used directly, and the effects of the vesicles on the five kinds of drugs was evaluated in terms of encapsulation rate and the in vitro sustained-release in a simulated artificial intestinal fluid environment. The results revealed that the pelargonic acid-Tween-80 composite vesicles exhibit an encapsulation efficiency above 45%, and that the encapsulated drugs achieve a cumulative release effect of 6-10 hours in a simulated artificial intestinal fluid environment, and the cumulative release rate is above 35%. This study proves that pelargonic acid-Tween-80 composite vesicles can be used as a carrier for encapsulated drugs, and this can extend the time of action of the drugs. This research illustrates the potential for application of pelargonic acid in the field of medicine

Transcatheter mitral valve replacement versus redo surgery for mitral prosthesis failure: A systematic review and meta-analysis

BackgroundTranscatheter mitral valve replacement (TMVR) has emerged as an alternative to redo surgery. TMVR compared with redo surgical mitral valve replacement (SMVR) in patients with mitral prosthesis failure remains limited. In this study, we performed a meta-analysis to assess the outcomes of TMVR (including valve-in-valve and valve-in-ring) versus redo surgery for mitral prosthesis failure.MethodsWe comprehensively searched the PubMed, Embase, and Cochrane library databases according to predetermined inclusion and exclusion criteria, and then we extracted data. We compared the outcomes of TMVR and redo SMVR for mitral prosthesis failure in terms of the in-hospital mortality, stroke, renal dysfunction, vascular complication, pacemaker implantation, exploration for bleeding, paravalvular leak, mean mitral valve gradient, 30-day mortality, and 1-year mortality.ResultsNine retrospective cohort studies and a total of 3,038 patients were included in this analysis. Compared with redo SMVR for mitral prosthesis failure, TMVR was associated with lower in-hospital mortality [odds ratios (OR): 0.44; 95% confidence interval (CI): 0.30–0.64; P < 0.001], stroke (OR: 0.44; 95% CI: 0.29–0.67; P = 0.0001), renal dysfunction (OR: 0.52; 95% CI: 0.37–0.75; P = 0.0003), vascular complication (OR: 0.58; 95% CI: 0.43–0.78; P = 0.004), pacemaker implantation (OR: 0.23; 95% CI: 0.15–0.36; P < 0.00001), and exploration for bleeding (OR: 0.24; 95% CI: 0.06–0.96; P = 0.04). Conversely, redo SMVR had lower paravalvular leak (OR: 22.12; 95% CI: 2.81–174.16; P = 0.003). There was no difference in mean mitral valve gradient (MD: 0.04; 95% CI: −0.47 to 0.55; P = 0.87), 30-day mortality (OR: 0.65; 95% CI: 0.36–1.17; P = 0.15), and 1-year mortality (OR: 0.96; 95% CI: 0.63–1.45; P = 0.84).ConclusionIn patients with mitral prosthesis failure, TMVR is associated with lower in-hospital mortality and lower occurrence of postoperative complications, except for paravalvular leak. TMVR offers a viable alternative to the conventional redo surgery in selected patients

Lower incidence of new-onset severe conduction disturbances after transcatheter aortic valve implantation with bicuspid aortic valve in patients with no baseline conduction abnormality: a cross-sectional investigation in a single center in China

BackgroundWith technological advancements, the incidence of most transcatheter aortic valve implantation (TAVI)-related complications, with the exception of conduction disturbances, has decreased. Bicuspid aortic valve (BAV) is also no longer considered a contraindication to TAVI; however, the effect of BAV on postoperative conduction disturbances after TAVI is unknown.MethodsWe collected information on patients who met the indications for TAVI and successfully underwent TAVI at our center between January 2018 and January 2021. Patients with preoperative pacemaker implantation status or conduction disturbances (atrioventricular block, bundle branch block, and intraventricular block) were excluded. Based on imaging data, the patients were categorized into the BAV group and the tricuspid aortic valve (TAV) group. The incidence of new perioperative conduction disturbances was compared between the two groups.ResultsA total of 187 patients were included in this study, 64 (34.2%) of whom had BAV. The incidence of third-degree block in the BAV group was 1.6%, which was lower than that (13.0%) in the TAV group (P < 0.05). Multivariate logistic regression results showed that the risk of third-degree conduction disturbances was 15-fold smaller in the BAV group than that in the TAV group [relative risk (RR) = 0.067, 95% CI = 0.008–0.596, P < 0.05]. The risk of other blocks in the BAV group was about half of that in the TAV group (RR = 0.498, 95% CI = 0.240–1.032); however, the difference was not statistically significant (P > 0.05).ConclusionThe present study found that patients with BAV had a lower rate of third-degree conduction disturbances after TAVI than patients with TAV

A novel Fas ligand plays an important role in cell apoptosis of Crassostrea hongkongensis: molecular cloning, expression profiles and functional identification of ChFasL

BackgroundApoptosis regulates normal development, homeostasis, immune tolerance and response to environmental stress by eliminating unwanted or diseased cells, and plays a key role in non-specific immunity of invertebrates. The exogenous pathway mediated by death receptors and death ligands is a very important pathway for cell apoptosis. Death ligands are mainly members of the tumour necrosis factor (TNF) family, of which FasL is an important member. The deep involvement of FasL in vertebrates cell apoptosis and immunity has been reported many times, but there is limited research on the FasL gene in shellfish, and its functional importance in oyster cell apoptosis and immunity remains unclear.MethodsThe full length of ChFasL was identified and cloned based on the genome of Crassostrea hongkongensis. Quantitative PCR was used to detect the relative expression of ChFasL in different developmental stages and tissues, as well as the changes of relative expression in hemocytes after bacterial infection. The expression position of ChFasL in HEK293T cells was also located by subcellular localization, and the effect of increased recombinant protein content on the activity of reporter genes p53 and p21 was studied by dual-fluorescence reporter gene. Finally, the changes of apoptosis rate in hemocytes after ChFasL silencing was identified by RNA interference technology.ResultsWe identified a novel FasL gene from C. hongkongensis and named it ChFasL. We found that ChFasL has potential N-linked glycosylation site, a transmembrane domain and a TNF region, which was a typical characteristics of TNF family. ChFasL was expressed in all developmental stages of larvae and in all tissues of oysters. After stimulation by V. alginolyticus or S. haemolyticus, its relative expression in hemocytes increased significantly, suggesting that ChFasL was deeply engaged in the immune response process of C. hongkongensis to external microbial stimulation. The results of subcellular localization showed that ChFasL was mainly distributed in the cytoplasm of HEK293T cells. With the overexpression of the recombinant protein pcDNA3 1- ChFasL, the activity of p53 and p21 significantly increased, showing a positive regulatory effect. Moreover, after dsRNA successfully reduced the relative expression of ChFasL, the apoptosis rate of hemocytes was significantly lower than that the dsGFP group.ConclusionThese results comprehensively confirmed the important role of ChFasL in the apoptosis process of C. hongkongensis, which provided the basis and premise for the in-depth understanding of the immune function of apoptosis in molluscs, and also contributed to the research on the pathogenic death mechanism and disease resistance breeding of marine bivalves

Analysis of in situ Transcriptomes Reveals Divergent Adaptive Response to Hyper- and Hypo-Salinity in the Hong Kong Oyster, Crassostrea hongkongensis

Crassostrea hongkongensis, a commercially valuable aquaculture species dwelling in estuaries along the coast of the South China Sea, is remarkable for its eurysalinity traits that enable its successful colonization of diverse osmotic niches ranging from near freshwater to seawater. In order to elucidate how this oyster copes with coastal waters with immense salinity differences, we performed in situ transcriptomic analysis (RNA-seq) to characterize the global expression patterns of oysters distributed across naturally formed salinity gradients in Zhenhai Bay along the northern coast of the South China Sea. Principal component analysis reveals distinct expression profiles of oysters living in the extreme conditions of hypo-salinity and hyper-salinity. Compared with the situation of optimal salinity for oyster growth, hypo-salinity mainly regulated expression of genes involved in FoxO and oxytocin signaling, tight junction and several immune pathways, while hyper-salinity altered gene expression implicated in amino acid metabolism, AMPK and PI3K-AKt signaling pathways, demonstrating the complexity and plasticity of transcriptomic expression underpinning oyster eurysalinity. Furthermore, the expression patterns of several genes correlated with salinity gradients reveals the fine-tuned coordination of molecular networks necessary for adaptive homeostasis in C. hongkongensis. In conclusion, a striking capacity and distinct patterns of transcriptomic expression contribute to eurysalinity adaptation in C. hongkongensis, which provides new mechanistic insights into the adaptive plasticity and resilience of marine mollusks

Comparison of the Biochemical Composition and Nutritional Quality Between Diploid and Triploid Hong Kong Oysters, Crassostrea hongkongensis

This study is the first systematic comparison of the biochemical composition and nutritional quality between diploid and triploid Hong Kong oysters, Crassostrea hongkongensis. Results showed that in the reproductive season, the glycogen content in five tissues (gill, mantle, adductor muscle, labial palps and gonad) was significantly higher (P < 0.05) in triploids than in diploids, with odds ratios (ORs) of 96.26, 60.17, 72.59, 53.56, and 128.52%, respectively. In the non-reproductive phase, significant differences in glycogen content (P < 0.05) between diploid and triploid oysters existed only in gill and gonad. In both diploid and triploid Hong Kong oysters, quantitative real-time PCR analysis of the glycogen synthesis gene (ChGS) and glycogen phosphorylase gene (ChGP) showed that the gene expression patterns matched the pattern of variation in glycogen content. Moreover, in both the reproductive and the non-reproductive phases, triploid Hong Kong oysters had a well balance of essential amino acids and were thus a well source of high-quality protein. Surprisingly, in both phases, significantly higher (P < 0.05) percentages of four essential fatty acids (α-linolenic acid, linoleic acid, eicosapentaenoic acid, and docosahexaenoic acid) were observed in triploids than in diploids. Additionally, the ratio of n-3/n-6 polyunsaturated fatty acids (PUFAs) was much higher in triploids than that in diploids. Variations in Biochemical composition were consistent with the relative expression of the citrate synthase gene (ChCS) and the α-ketoglutarate dehydrogenase gene (ChKD), which are key enzyme genes of the tricarboxylic acid cycle. Overall, the triploid Hong Kong oyster has a better nutritional value and taste than the diploid in terms of glycogen content, protein quality and fatty acid content