Apoptosis and fibrosis play a vital role in myocardial infarction (MI) induced tissue injury. Although microRNAs have been the focus of many studies on cardiac apoptosis and fibrosis in MI, the detailed effects of miR-26a is needed to further understood. The present study demonstrated that miR-26a was downregulated in ST-elevation MI (STEMI) patients and oxygen-glucose deprivation (OGD)-treated H9c2 cells. Downregulation of miR-26a was closely correlated with the increased expression of creatine kinase, creatine kinase-MB and troponin I in STEMI patients. Further analysis identified that ataxia-telangiectasia mutated (ATM) was a target gene for miR-26a based on a bioinformatics analysis. miR-26a overexpression effectively reduced ATM expression, apoptosis, and apoptosis-related proteins in OGD-treated H9c2 cells. In a mouse model of MI, the expression of miR-26a was significantly decreased in the infarct zone of the heart, whereas apoptosis and ATM expression were increased. miR-26a overexpression effectively reduced ATM expression and cardiac apoptosis at Day 1 after MI. Furthermore, we demonstrated that overexpression of miR-26a improved cardiac function and reduced cardiac fibrosis by the reduced expression of collagen type I and connective tissue growth factor (CTGF) in mice at Day 14 after MI. Overexpression of miR-26a or ATM knockdown decreased collagen I and CTGF expression in cultured OGD-treated cardiomyocytes. Taken together, these data demonstrate a prominent role for miR-26a in linking ATM expression to ischemia-induced apoptosis and fibrosis, key Chiang-Wen Lee and Mao-Shin Lin contributed equally to this work.features of MI progression. miR-26a reduced MI development by affecting ATM expression and could be targeted in the treatment of MI.

SynopsisNovel regular network polyester films were prepared from benzenetricarboxylic acids of trimesic (Y) and trimellitic (Z) acids, and glycols of ethylene (2G), tetramethylene (4G), and hexamethylene (6G) glycols. Prepolymers prepared by melt polycondensation for a short period within 1 h were cast from a DMF solution and successively post-polymerized a t various temperatures and times t o form a network. The resultant films were transparent, flexible, and insoluble in any solvents. Distortion temperature measured by a penetration mode of thermomechanical analysis (TMA) increased with increasing post-polymerization time and temperature, and leveled out at 222, 168, 125 and 75"C, for the 2GY, 2GZ, 4GY, and 6GY films, respectively. Temperatures close to 400°C a t which the probe had completely penetrated corresponded t o the thermal decomposition temperature of these films. Two broad but strong peaks in the x-ray diffraction curves appears for the 2GY, 4GY, and 6GY, suggesting the formation of some ordered supramolecular structure owing t o the regular network formed by symmetrical trimesic acid moiety, and the intensity of diffraction peaks became higher with increasing length of the methylene chain of the glycol monomer. Densities of the 2GY and 2GZ films decreased with increasing post-polymerization time and temperature. Tensile strength and Young's modulus increased and elongation decreased with increasing network formation. These tensile properties was affected by the chemical structure of the network films.

Background Carotid artery stenosis (CAS) is a common cause of ischemic stroke, and the early detection of CAS may improve patient outcomes. Carotid Doppler ultrasound is commonly used to diagnose CAS. However, it is costly and may not be practical for regular screening practice. This article presents a novel noninvasive and noncontact detection technique using video‐based motion analysis (VMA) to extract useful information from subtle pulses on the skin surface to screen for CAS. Methods and Results We prospectively enrolled 202 patients with prior carotid Doppler ultrasound data. A short 30‐second video clip of the neck was taken using a commercial mobile device and analyzed by VMA with mathematical quantification of the amplitude of skin motion changes in a blinded manner. The first 40 subjects were used to set up the VMA protocol and define cutoff values, and the following 162 subjects were used for validation. Overall, 54% of the 202 subjects had ultrasound‐confirmed CAS. Using receiver operating characteristic curve analysis, the area under the curve of VMA‐derived discrepancy values to differentiate patients with and without CAS was excellent (area under the curve, 0.914 [95% CI, 0.874–0.954]; P <0.01). The best cutoff value of VMA‐derived discrepancy values to screen for CAS was 5.1, with a sensitivity of 87% and a specificity of 87%. The diagnostic accuracy was consistently high in different subject subgroups. Conclusions A simple and accurate screening technique to quickly screen for CAS using a VMA system is feasible, with acceptable sensitivity and specificity.

Background The COVID-19 pandemic was well controlled in Taiwan until an outbreak in May 2021. Telemedicine was rapidly implemented to avoid further patient exposure and to unload the already burdened medical system. Objective To understand the effect of COVID-19 on the implementation of video-based virtual clinic visits during this outbreak, we analyzed the logistics of prescribing medications and patient flow for such virtual visits at a tertiary medical center. Methods We retrospectively collected information on video-based virtual clinic visits and face-to-face outpatient visits from May 1 to August 31, 2021, from the administrative database at National Taiwan University Hospital. The number of daily new confirmed COVID-19 cases in Taiwan was obtained from an open resource. Results There were 782 virtual clinic visits during these 3 months, mostly for the departments of internal medicine, neurology, and surgery. The 3 most common categories of medications prescribed were cardiovascular, diabetic, and gastrointestinal, of which cardiovascular medications comprised around one-third of all medications prescribed during virtual clinic visits. The number of virtual clinic visits was significantly correlated with the number of daily new confirmed COVID-19 cases, with approximately a 20-day delay (correlation coefficient 0.735; P<.001). The patient waiting time for video-based virtual clinic visits was significantly shorter compared with face-to-face clinic visits during the same period (median 3, IQR 2-6 min vs median 20, IQR 9-42 min; rank sum P<.001). Although the time saved was appreciated by the patients, online payment with direct delivery of medications without the need to visit a hospital was still their major concern. Conclusions Our data showed that video-based virtual clinics can be implemented rapidly after a COVID-19 outbreak. The virtual clinics were efficient, as demonstrated by the significantly reduced waiting time. However, there are still some barriers to the large-scale implementation of video-based virtual clinics. Better preparation is required to improve performance in possible future large outbreaks.

BACKGROUND The COVID-19 pandemic was well controlled in Taiwan, until an outbreak in May 2021. Telemedicine was rapidly implemented to avoid further patient exposure and to unload the already burdened medical system. OBJECTIVE To understand the effect of COIVD-19 on the implementation of virtual clinic during this outbreak, we analyzed the logistics of medication prescription and patient flow for video-based virtual clinic visits in a tertiary medical center. METHODS We retrospectively collected information on video-based virtual clinic visits and face-to-face outpatient visits from May 1st to August 31st 2021 from the administrative database at the National Taiwan University Hospital. The number of daily new confirmed COVID-19 cases in Taiwan was obtained from an open resource. RESULTS There were 782 virtual clinic visits during these 3 months. These visits were mostly for the internal medicine, neurology and surgery departments. The 3 most common categories of medications prescribed were cardiovascular, diabetic and gastrointestinal. Cardiovascular medications comprised around one third of the total medications prescribed during this period in our virtual clinic. The number of virtual clinic visits was significantly correlated with the number of daily new confirmed COVID-19 cases, with approximately a 20-day delay (correlation coefficient 0.735, P<.001). The patient waiting time for video-based virtual clinic visits was significantly shorter compared with face-to-face clinic visits during the same period (median 3 [IQR 2-6] min vs median 20 [IQR 9-42] min, ranksum P<.001). Although the time saved was appreciated by patients, online payment with direct delivery of medication without the need to visit a hospital was still the major concern among patients. CONCLUSIONS Our data showed that video-based virtual clinics can be implemented rapidly after a COVID-19 outbreak. Video-based virtual clinics were efficient, as demonstrated by the significantly reduced waiting times. However, there are still some barriers to large scale implementation of video-based virtual clinics. Better preparation is required to improve our performance in possible future large outbreaks. CLINICALTRIAL n/a

BACKGROUND The association between short-term exposure to ambient air pollution and blood pressure has been inconsistent, as reported in the literature. OBJECTIVE This study aimed to investigate the relationship between short-term ambient air pollution exposure and patient-level home blood pressure (HBP). METHODS Patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital were enrolled as the study population. HBP was measured by patients or their caregivers. Hourly meteorological data (including temperature, relative humidity, wind speed, and rainfall) and ambient air pollution monitoring data (including CO, NO₂, particulate matter with a diameter of &lt;10 µm, particulate matter with a diameter of &lt;2.5 µm, and SO₂) during the same time period were obtained from the Central Weather Bureau and the Environmental Protection Administration in Taiwan, respectively. A stepwise multivariate repeated generalized estimating equation model was used to assess the significant factors for predicting systolic and diastolic blood pressure (SBP and DBP). RESULTS A total of 253 patients and 110,715 HBP measurements were evaluated in this study. On multivariate analysis, demographic, clinical, meteorological factors, and air pollutants significantly affected the HBP (both SBP and DBP). All 5 air pollutants evaluated in this study showed a significant, nonlinear association with both home SBP and DBP. Compared with demographic and clinical factors, environmental factors (meteorological factors and air pollutants) played a minor yet significant role in the regulation of HBP. CONCLUSIONS Short-term exposure to ambient air pollution significantly affects HBP in patients with chronic cardiovascular disease.

BACKGROUND Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common cardiac conditions with poor outcomes and high mortality risks which can be improved through early intervention. Telehealth services, which allow for remote monitoring of patient conditions, has been proven to improve health management of chronic diseases, but its effects on MR and TR progression are unknown. OBJECTIVE We aimed to explore whether patients with telehealth services have less MR and TR progression compared with a control group. We also aimed to identify predictors of MR and TR progression. METHODS This single-center retrospective study conducted at National Taiwan University Hospital in Taiwan compared MR and TR progression (defined as either progression to ≥ moderate MR/TR or MR/TR progression by ≥ 2 grades during the study period) between the telehealth and control groups. All patients had a minimum of 2 transthoracic echocardiograms at least 6 months apart; baseline mild-moderate MR/TR or lower; and no prior surgeries on the mitral or tricuspid valve. Telehealth patients were defined as those who had received telehealth service for at least 28 days within 3 months of baseline. Basic demographics, baseline blood pressure measurements, prescribed medication, and Charlson comorbidity index (CCI) score components were obtained for all patients. RESULTS A total of 1,081 patients (226 in the telehealth group and 855 in the control group) were included in study analyses. The telehealth group showed significantly lower baseline systolic blood pressure (p<0.001), higher CCI (p=0.015), higher prevalence of prior myocardial infarction (p=0.01) and heart failure (p <0.001), higher beta blocker(p=0.028) and diuretic (p=0.041) use, and lower nitrate use (p=0.044). Both groups showed similar cardiac remodeling conditions at baseline. Telehealth was found to be neutral for both MR (hazard ratio [HR], 1.10; 95% confidence interval [CI] 0.80-1.52; p=0.52) and TR (HR, 1.27; 95% CI 0.92-1.74; p=0.14) progression. Predictors for MR progression ≥ moderate included older age, female sex, diuretic use, larger left atrial (LA) dimension, left ventricular end-diastolic dimension (LVEDD), LV end-systolic dimension (LVESD), and lower LV ejection fraction (LVEF). Predictors of TR progression ≥moderate included older age, female sex, diuretic use, presence of atrial fibrillation (AFib), LA dimension, LVESD, and lower LVEF; statin use was protective. CONCLUSIONS This is the first study to assess the association between telehealth and progression of MR or TR. Telehealth patients, who had more comorbidity, displayed similar MR and TR progression versus control patients, indicating that telehealth may slow MR and TR progression. Determinants of MR and TR progression included easy-to-measure traditional echo parameters of cardiac function, older age, female sex, and AFib, which can be incorporated into a telehealth platform and advanced alert system to improve patient outcomes through personalized care.

BACKGROUND Patients with peripheral artery disease (PAD) are at high risk for major cardiovascular events (MACE), including myocardial infarction, stroke, and hospitalization for heart failure. We have previously shown the clinical efficacy of a 4th-generation synchronous telehealth program for some patients, but the costs and cardiovascular benefits of the program for PAD patients remain unknown. OBJECTIVE The telehealth program is now widely used by higher-risk cardiovascular patients to prevent further cardiovascular events. This study investigated whether patients with PAD would also have better cardiovascular outcomes after participating in the 4th-generation synchronous telehealth program. METHODS This was a retrospective cohort study. We screened 5062 patients with cardiovascular diseases who were treated at National Taiwan University Hospital and then enrolled 391 patients with the diagnosis of PAD. Of these patients, 162 took part in the telehealth program, while 229 did not and thus served as control patients. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to mitigate possible selection bias. Follow-up outcomes included heart failure hospitalization (HFH), acute coronary syndrome (ACS), stroke, and all-cause readmission during the 1-year follow-up period and through the last follow-up. RESULTS The mean follow-up duration was 3.1 ± 1.8 years for the patients who participated in the telehealth program and 3.2 ± 1.8 years for the control group. The telehealth program patients exhibited lower risk of ischemic stroke than the control group in the first year after IPTW (0.9% vs. 3.5%; hazard ratio [HR] 0.24, 95% CI 0.07–0.80). The 1-year composite endpoint of vascular accident, including acute coronary syndrome and stroke, was also significantly lower in the telehealth program group after IPTW (2.4% vs. 5.2%; [HR] 0.46, 95% CI 0.21–0.997). At the end of the follow-up, the telehealth program group continued to exhibit a significantly lower rate of ischemic stroke than the control group after IPTW (0.9% vs. 3.5%; [HR] 0.52, 95% CI 0.28–0.93). Furthermore, the medical costs of the telehealth program patients were not higher than those of the control group, whether in terms of outpatient, emergency department, hospitalization, or total costs. CONCLUSIONS The PAD patients who participated in the 4th-generation synchronous telehealth program exhibited lower risk of ischemic stroke events over both mid- and long-term follow-up periods. However, larger scale and prospective randomized clinical trials are needed to confirm our findings.