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Hepatocellular carcinoma surveillance: current practice and future directions
No full textHepatocellular carcinoma (HCC) is among the leading causes of cancer incidence and mortality worldwide. Surveillance of individuals with cirrhosis or other conditions that confer a high risk of HCC development is essential for early detection and improved overall survival. Biannual ultrasonography with or without alpha-fetoprotein is widely recommended as the standard method for HCC surveillance, but it has limited sensitivity in early disease and may be inadequate in certain individuals. This review article will provide a comprehensive overview of the current landscape of HCC surveillance, including the rationale and indications for HCC surveillance, standard methods for HCC surveillance, and their strengths/limitations. Alternative surveillance methods such as the role of cross-sectional imaging, emerging circulating biomarkers, as well as the problem of under-utilization of HCC surveillance and surveillance-related harms will also be discussed in this review
Pre-operative and post-operative atrial fibrillation in patients undergoing SAVR/TAVR
No full textAtrial fibrillation (AF) is a common preoperative comorbidity and post-operative complication associated with cardiac surgery and is recognized as a significant predictor of adverse clinical outcomes. This review aims to highlight the current literature regarding the incidence, risk factors, and outcomes of atrial fibrillation in patients undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) procedures. A literature search of relevant articles was conducted via PubMed, Medline, and EMBASE. Pre-existing AF is seen in 6.3%-35.2% of SAVR patients and 15.7%-48.9% of TAVR patients and is associated with increased risk of mortality (OR = 2.2) and stroke (OR = 5.9). Postoperative AF (POAF) is more common after SAVR and in patients with hemodynamic instability. The rates for POAF range from 11.1%-84% following SAVR and range from 3.0%-55.6% following TAVR. In-hospital mortality (7.8% vs. 3.4%; P < 0.01) and stroke (4.7% vs. 2.0%; P < 0.01) are higher in the POAF group. POAF can be prevented via prophylactic antiarrhythmic medications and atrial pacing. Therapeutic anticoagulation is recommended as it reduces the risk of thrombotic complications following SAVR and TAVR procedures in the setting of POAF. Compared to those not on anticoagulant therapies, patients on anticoagulation have decreased rates of stroke (1.7% vs. 5.5%) and fewer 30-day thrombotic complications (3% vs. 40%). These preventive measures are essential as POAF is associated with more thromboembolic events, longer hospital stays, and higher overall morbidity and mortality rates
Reduced myocardial perfusion is common among subjects with ischemia and no obstructive coronary artery disease and heart failure with preserved ejection fraction: a report from the WISE-CVD continuation study
No full textAim: Women with evidence of ischemia and no obstructive coronary artery disease (INOCA) have an increased risk of major adverse cardiac events, including heart failure with preserved ejection fraction (HFpEF). To investigate potential links between INOCA and HFpEF, we examined pathophysiological findings present in both INOCA and HFpEF.Methods: We performed adenosine stress cardiac magnetic resonance imaging (CMRI) in 56 participants, including 35 women with suspected INOCA, 13 women with HFpEF, and 8 reference control women. Myocardial perfusion imaging was performed at rest and with vasodilator stress with intravenous adenosine. Myocardial perfusion reserve index was quantified as the ratio of the upslope of increase in myocardial contrast at stress vs. rest. All CMRI measures were quantified using CVI42 software (Circle Cardiovascular Imaging Inc). Statistical analysis was performed using linear regression models, Fisher’s exact tests, ANOVA, or Kruskal-Wallis tests.Results: Age (P = 0.007), Body surface area (0.05) were higher in the HFpEF group. Left ventricular ejection fraction (P = 0.02) was lower among the INOCA and HFpEF groups than reference controls after age adjustment. In addition, there was a graded reduction in myocardial perfusion reserve index in HFpEF vs. INOCA vs. reference controls (1.5 ± 0.3, 1.8 ± 0.3, 1.9 ± 0.3, P = 0.02), which was attenuated with age-adjustment.Conclusion: Reduced myocardial perfusion reserve appears to be a common pathophysiologic feature in INOCA and HFpEF patients
Nucleic acid functionalized extracellular vesicles as promising therapeutic systems for nanomedicine
No full textExtracellular vesicles (EVs), as natural carriers, are regarded as a new star in nanomedicine due to their excellent biocompatibility, fascinating physicochemical properties, and unique biological regulatory functions. However, there are still some challenges to using natural EVs, including poor targeting ability and the clearance from circulation, which may limit their further development and clinical use. Nucleic acid has the functions of programmability, targeting, gene therapy, and immune regulation. Owing to the engineering design and modification by integrating functional nucleic acid, EVs offer excellent performances as a therapeutic system in vivo. This review briefly introduces the function and mechanism of nucleic acid in the diagnosis and treatment of diseases. Then, the strategies of nucleic acid-functionalized EVs are summarized and the latest progress of nucleic acid-functionalized EVs in nanomedicine is highlighted. Finally, the challenges and prospects of nucleic acid-functionalized EVs as a promising diagnostic system are proposed
Colorectal adenomas and MAFLD: a cross-sectional study in a Hispanic screening cohort
No full textAims: Prior evidence demonstrates an association between non-alcoholic fatty liver disease (NAFLD) and colorectal adenomas (CRA) risk. However, information using the new definition of the disease [i.e., metabolic dysfunction-associated fatty liver disease (MAFLD)] is scarce. We aimed to assess the relationship between MAFLD and CRA risk.Methods: We conducted a cross-sectional study including patients from three university centers in Chile who underwent a colonoscopy for colorectal cancer screening and abdominal imaging study. We obtained sociodemographic and clinical data, and we performed univariate and multivariable regression analyses.Results: In total, 895 patients were included; 42% were male, the mean age was 59.9 ± 9.3 years, and 37.8% (338) had CRA. Patients harboring polyps were predominantly males (48.2% vs. 38.2%, P = 0.002), older (61.6 ± 8.7 years vs. 58.9 ± 9.5 years, P < 0.001), and exhibited a higher body weight than controls [75 (66-88) kg vs. 72 (63-82.3) kg, P = 0.002]. Fifty-six percent of patients showed hepatic steatosis in imaging studies and 54.4% met MAFLD diagnostic criteria. The adenoma detection rate was higher in the MAFLD group compared to controls (46.4% vs. 27.5%, P < 0.001). In the multivariable analysis, MAFLD was significantly associated with the presence of CRA (odds ratio = 2.32; 95%CI: 1.68-3.19, P < 0.0001). There were no statistically significant differences of histopathological characteristics of the adenomas according to the presence of MAFLD.Conclusion: The present study shows that, in Chilean Hispanic subjects, MAFLD is associated with an increased risk of CRA. This information may be useful to design specific screening colonoscopy recommendations in MAFLD patients
Biomedical DNA hydrogels
No full textDue to considerable progress in DNA nanotechnology, DNA is gaining significant attention as a programmable building block for the next generation of soft biomaterials. DNA has been used as either a single component to form all-DNA hydrogels or a crosslinker or functional entity to form hybrid DNA hydrogels through physical interactions or chemical reactions. The formed hydrogels exhibit adequate biocompatibility, convenient programmability, tunable multifunctionality and the capability of precise molecular recognition, making them an irreplaceable polymeric platform for interfacing with biology. Responsive DNA hydrogels that are prepared through the hybridization of DNA sticky ends, the formation of i-motifs, enzymatic ligation and enzymatic polymerization are commonly reported nowadays and can undergo disassembly induced by various triggers, including alterations in ionic strength, pH, temperature and biomolecules. These hydrogels are envisioned for applications in drug delivery and biosensing. This perspective assesses the most recent and important developments in this emerging class of biomedically useful DNA hydrogels
Polarization boosted catalysis: progress and outlook
No full textPolarization has a significant impact on chemical reactions, as demonstrated by recent research of photo-/electrocatalytic water splitting, electrocatalytic CO2 reduction, water treatment, dye degradation and so on. This review summarizes the fundamental influence of polarization on the physical/chemical properties of catalysts and discusses polarization-dependent catalytic processes. Based on the research progress of polarization-modulated chemical reactions, we draw the conclusion that the control of polarization can be used to adjust the reactivity and selectivity of various catalytic reactions by tuning the miscellaneous fundamental properties of polarized catalysts. At the end of the review, the future research challenges are also discussed, including the ultrafast reversal of polarization, the magnetic-field control of chemical reactions through the magnetoelectric effect and in-plane polarization
Atomistic engineering of Ag/Pt nanoclusters for remarkably boosted mass electrocatalytic activity
No full textIt is of vital importance to boost the intrinsic activity and augment the active sites of expensive and scarce platinum-based catalysts for advancing a variety of electrochemical energy applications. We herein report a mild electrochemical bottom-up approach to deposit ultrafine, but stable, Pt8Ag4 alloy clusters on carbon nanotubes (CNTs) by elaborately designing bimetallic organic cluster precursors with four silver and eight platinum atoms coordinated with µ,σ-bridged ethynylpyridine ligands, i.e., [Ag4(C24H16N4Pt)8(BF4)4]. The Pt8Ag4 cluster/CNT hybrids present impressively high platinum mass activity that is threefold that of commercial Pt/C toward the hydrogen evolution reaction, as a result of the cooperative contributions from the Ag atoms that enhance the intrinsic activity and the CNT supports that increase the activity sites. The present work affords an attractive avenue for engineering and stabilizing Pt-based nanoclusters at the atomic level and represents a promising strategy for the development of high-efficiency and durable electrocatalysts
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