Search

Background and Aims. The distal transradial access (dTRA) is a new puncture site for coronary catheterization. We sought to evaluate the feasibility, safety, and complication rates of using the dTRA for cardiac catheterization in Chinese patients. Methods. A total of 263 consecutive patients who underwent catheterization through the dTRA were enrolled. The primary endpoint of the study was the rate of conversion to another access site due to the impossibility of successful artery puncture or intubation. Secondary safety endpoints were the rates of bleeding-related complications and nerve disorders. Results. Among 263 patients, the puncture success rate was 96.2% (253/263). Eleven patients were successfully punctured, but the guide wire was difficult to advance. One patient had intubation failure, and the success rate of intubation was 91.6% (241/263). Two hundred thirty-three patients underwent puncture via the right dTRA, 5 patients underwent puncture via the left dTRA, and 3 patients underwent puncture via the bilateral dTRA. A total of 158 (65.6%) patients underwent coronary angiography, and 83 (34.4%) patients underwent percutaneous coronary intervention. After the procedure, only 2 (0.8%) patients had mild bleeding at the puncture site, 2 (0.8%) had a forearm hematoma, and no patient had a nerve disorder. Conclusions. DTRA has a low incidence of complications, making it a safe and effective technique for cardiac catheterization. [ABSTRACT FROM AUTHOR]

Background and Aims: The present study aimed to examine the association between big endothelin-1 (big ET-1) and long-term all-cause death in patients with coronary artery disease (CAD) and different glucose metabolism status.Methods and Results: We consecutively enrolled 8550 patients from January 2013 to December 2013. Patients were categorized according to both status of glucose metabolism status [Diabetes Mellitus (DM), Pre-Diabetes (Pre-DM), Normoglycemia (NG)] and big ET-1 levels. Primary endpoint was all-cause death. During a median of 5.1-year follow-up periods, 301 all-cause deaths occurred. Elevated big ET-1 was significantly associated with long-term all-cause death (adjusted HR: 2.230, 95%CI 1.629-3.051; p < 0.001). Similarly, patients with DM, but not Pre-DM, had increased risk of all-cause death compared with NG group (p < 0.05). When patients were categorized by both status of glucose metabolism and big ET-1 levels, high big ET-1 were associated with significantly higher risk of all-cause death in Pre-DM (adjusted HR: 2.442, 95% CI 1.039-5.740; p = 0.041) and DM (adjusted HR: 3.162, 95% CI 1.376-7.269; p = 0.007). The Kaplan-Meier curve indicated that DM patients with the highest big ET-1 levels were associated with the greatest risk of all-cause death (p < 0.05).Conclusions: The present data indicate that baseline big ET-1 levels were independently associated with the long-term all-cause death in DM and Pre-DM patients with CAD undergoing PCI, suggesting that big ET-1 may be a valuable marker in patients with impaired glucose metabolism. [ABSTRACT FROM AUTHOR]

Local information has significant contributions to visual sentiment analysis (VSA). Recent studies about local region discovery need manually annotate region location. Affective local information learning and automatic discovery of sentiment-specific region are still the challenges in VSA. In this paper, we propose an end-to-end VSA method for weakly supervised sentiment-specific region discovery. Our method contains two branches: an automatic sentiment-specific region discovery branch and a sentiment analysis branch. In the sentiment-specific region discovery branch, a region proposal network with multiple convolution kernels is proposed to generate candidate affective regions. Then, we design the multiple instance learning (MIL) loss to remove redundant and noisy candidate regions. Finally, the sentiment analysis branch integrates both holistic and localized information obtained in the first branch by feature map coupling for final sentiment classification. Our method automatically discovers sentiment-specific regions by the constraint of MIL loss function without object-level labels. Quantitative and qualitative evaluations on four benchmark affective datasets demonstrate that our proposed method outperforms the state-of-the-art methods. [ABSTRACT FROM AUTHOR]

Facial expression recognition (FER) in the wild is a very challenging problem due to different expressions under complex scenario (e.g., large head pose, illumination variation, occlusions, etc.), leading to suboptimal FER performance. Accuracy in FER heavily relies on discovering superior discriminative, emotion‐related features. In this paper, we propose an end‐to‐end module to disentangle latent emotion discriminative factors from the complex factors variables for FER to obtain salient emotion features. The training of proposed method contains two stages. First of all, emotion samples are used to obtain the latent representation using a variational auto‐encoder with reconstruction penalization. Furthermore, the latent representation as the input is thrown into a disentangling layer to learn a set of discriminative emotion factors through the attention mechanism (e.g., a Squeeze‐and‐Excitation block) that encourages to separate emotion‐related factors and nonaffective factors. Experimental results on public benchmark databases (RAF‐DB and FER2013) show that our approach has remarkable performance in complex scenes than current state‐of‐the‐art methods. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of different guidewires on stent coating integrity in jailed wire technique (JWT) for bifurcation treatment.Background: JWT is commonly adopted to protect side branch in provisional one-stent strategy for coronary bifurcation lesions. However, this technique may cause defects in stent coatings. The degree of coating damage caused by different types of jailed wires remains unknown.Methods: A fluid model with a bifurcation was established to mimic the condition in vivo. One-stent strategy was performed with three types of guidewire (nonpolymer-jacketed wire, intermediate polymer-jacketed wire, and full polymer-jacketed wire) tested for JWT. Scanning electron microscopy (SEM) was used to evaluate stent coating integrity and wire structure. The degrees of coating defects were recorded as no, slight, moderate, and severe defects.Results: A total of 27 samples were tested. Analyses of SEM images showed a significant difference in the degree of coating damage among the three types of wire after the procedure of JWT (P < 0.001). Nonpolymer-jacketed wire could inevitably cause a severe defect in stent coatings, while full polymer-jacketed wire caused the least coating damages. Besides, there were varying degrees of coil deformation in nonpolymer-jacketed wires, while no surface damage or jacket shearing was observed in full polymer-jacketed wires.Conclusions: Although nonpolymer-jacketed wire has long been recommended for JWT, our bench-side study suggests that full polymer-jacketed wire may be a better choice. Further clinical studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Background: It is ill‐defined which factors affect the prognosis of patients with recanalized chronic total occlusion (CTO). This study sought to investigate predictors for adverse outcome in such a cohort with long‐time follow‐up. Methods: From 2010 to 2013, patients with successfully recanalized CTO were included. The primary endpoint was a composite of all‐cause death, myocardial infarction or target vessel revascularization (TVR). The secondary endpoints were TVR and target lesion revascularization (TLR). Results: A total of 1987 patients were enrolled and 1806 (90.6%) subjects completed 5‐year follow‐up. Multivariate Cox analysis revealed that age ≥ 75 years (HR,1.70; 95% CI, 1.09‐2.64; P =.02), left ventricular ejection fraction <40% (HR, 1.94; 95% CI, 1.02‐3.69; P =.04) and residual SYNTAX score (HR, 1.02; 95% CI, 1.01‐1.04; P =.01) were predictors for the primary endpoint. Non‐LAD CTO (HR, 1.82; 95% CI, 1.23‐2.70; P <.01), J‐CTO score (HR, 1.31; 95% CI, 1.11‐1.54; P <.01) and residual SYNTAX score (HR, 1.02; 95% CI, 1.00‐1.04; P =.04) were independently related to TVR. Non‐LAD CTO, high J‐CTO score and residual SYNTAX score was also correlated with TLR. Conclusions: Advanced age, left ventricular dysfunction and residual SYNTAX score were predictors for composite cardiovascular events in patients with CTO after revascularization. Those with non‐LAD CTO, high J‐CTO and residual SYNTAX score had higher risk for revascularization. [ABSTRACT FROM AUTHOR]

Aims: This study sought to report the 10-year clinical outcomes of patients who underwent unprotected left main (LM) percutaneous coronary intervention (PCI) in a large centre.Methods and Results: A total of 913 consecutive patients who underwent unprotected LM PCI from January 2004 to December 2008 at Fu Wai Hospital were retrospectively analysed; the mean age was 60.0 ± 10.9 years, females accounted for 22% of patients, diabetes was present in 27.7% of patients, and an LM bifurcation lesion occurred in 82.9% of patients. During the median follow-up of 9.7 years, major adverse cardiac or cerebrovascular events (MACCEs) occurred in 25.6% (234) of patients, and the rates of all-cause death, myocardial infarction, and stroke were 14.9%, 11.0%, and 7.1%, respectively. Cardiac death occurred in only 7.9% of patients. The estimated event rate was 41.9% for death/myocardial infarction/any revascularization and 45.9% for death/MI/stroke/any revascularization. Definite/probable stent thrombosis occurred in 4.3% (39) of patients. According to the subgroup analysis, IVUS-guided PCI was associated with less long-term MACCEs. Further multivariate analysis identified that age and LVEF<40% were the only independent predictors for 10-year death. Age, LVEF<40%, creatinine clearance, and incomplete revascularization were independent predictors for death/MI, while a two-stent strategy, diabetes, a transradial approach, and the use of bare metal stents (BMSs) or first-generation drug-eluting stents (DESs) were not.Conclusions: Unprotected LM PCI in a large cohort of consecutive patients in a single large centre demonstrated favourable long-term outcomes up to 10 years even with the use of BMSs and first-generation of DESs. [ABSTRACT FROM AUTHOR]

Background and Aim: To explore the prevalence of unknown diabetes (DM) or prediabetes (pre-DM) in "nondiabetic" patients and its association with 2-year clinical outcomes after primary percutaneous coronary intervention (PCI).Methods and Results: 5202 consecutive "nondiabetic" patients who underwent primary PCI at Fuwai Hospital from January to December 2013 were prospectively enrolled. The patients were grouped according to their glycemia status: unknown DM (HbA1c ≥ 47 mmol/L; FPG≥ 7.0 mmol/L), pre-DM (HbA1c 39-47 mmol/L; FPG: 5.6-6.9 mmol/L) and normoglycemia (NG, HbA1c < 39 mmol/L; FPG < 5.6 mmol/L). The main endpoint was 2-year major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, and target vessel revascularization. A total of 905 patients had unknown DM, and 3407 patients had pre-DM. Unknown DM and pre-DM were associated with aging (p < 0.001); a greater proportion of hypertension (p < 0.001), previous myocardial infarction (p < 0.001), and chronic kidney disease (p = 0.004). During the 2-year follow-up, the rate of MACE was significantly higher in the unknown DM and pre-DM groups than in the NG group (8.1% vs. 5.8% vs. 4.1%, respectively, p = 0.001). Multivariate analyses demonstrated that unknown DM was associated with a 1.9-fold higher event risk compared to NG (95% CI: 1.2-2.8).Conclusions: The prevalence of abnormal glucose metabolism was high in "nondiabetic" Chinese PCI patients. Patients with unknown DM and pre-DM had higher event risks than those with NG. In "nondiabetes" patients requiring PCI, routine assessment of HbA1c and FPG appears to be of value to identify patients with an increased event risk. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the platelet reactivity in real-world patients with different chronic kidney disease (CKD) stages after percutaneous coronary intervention (PCI), and to examine whether high residual platelet reactivity (HRPR) is associated with higher incidence of adverse cardiovascular events in a 2-year follow up. A total of 10 724 consecutive patients receiving DAPT with aspirin and clopidogrel after PCI throughout 2013 were enrolled. We applied modified thromboelastography (mTEG) in 6745 patients. Kaplan–Meier analysis and Cox proportional regression analysis were applied to illustrate end points for patients. The prevalence of HRPR for adenosine diphosphate (ADP) was higher in patients with CKD3-5 than patients with CKD1-2 (47.0% vs. 37.3%, p = 0.002), but not for arachidonic acid (AA). No significant difference was observed for MACCE between patients with or without HRPR for ADP (HR 1.004, 95%CI: 0.864–1.167, p = 0.954). Patients with HRPR for ADP was associated with less bleeding events than patients without HRPR for ADP (HR 0.795, 95%CI: 0.643–0.982, p = 0.034). In this large cohort of real-world patients after PCI, the deterioration of renal function was linked to HRPR for ADP. HRPR was not associated with MACCE in patients with CKD in a 2-year follow up. Bleeding risks were significantly lower in PCI patients with versus without HRPR for ADP. [ABSTRACT FROM AUTHOR]

Objectives: This study analyzed a large sample to explain the association of baseline smoking state with long-term prognosis of coronary artery disease (CAD) patients who underwent percutaneous coronary intervention (PCI).Background: Data is limited up to now regarding whether smoker's paradox exists in Chinese population.Methods: A total of 10724 consecutive cases were enrolled from January to December 2013. 2-year clinical outcomes were evaluated among current smokers and nonsmokers. Major adverse coronary event (MACCE) included all-cause death, revascularization, myocardial infarction (MI), and stroke.Results: Current smokers and nonsmokers accounted for 57.1% and 42.9%, respectively. Current smokers were presented with predominant male sex, lower age, and less comorbidities. The rates of 2-year all-cause death were not significantly different among two groups. But the rate of stroke and bleeding was significantly higher in nonsmokers than in current smokers (1.6% and 1.1%, P=0.031; 7.2% and 6.1%, P=0.019). The rate of revascularization was significantly higher in current smokers than in nonsmokers (9.1% and 8.0%, P=0.037). Multivariable Cox regression indicated that, compared with nonsmokers, current smokers were not independently associated with all endpoints (all P>0.05).Conclusions: 2-year all-cause death, MACCE, MI, revascularization, stroke, ST, and bleeding risk were similar between current smokers and nonsmokers in CAD patients undergoing PCI. [ABSTRACT FROM AUTHOR]

Objectives: We aim to present a new way to introduce reverse wire in crusade microcatheter-facilitated reverse wire technique to solve markedly angulated bifurcated lesions.Background: Markedly angulated coronary bifurcation lesions are still one of the considerable challenges of treatment with percutaneous coronary intervention especially with severe proximal stenosis. Microcatheter-facilitated reverse wire technique improved the efficacy of crossing a guide wire to such an extremely angulated complex targeted vessel. However, there has been a debate regarding what kind of curve was the best to introduce reverse guide wire in this technique.Methods: We analyzed 7 patients who were admitted to Fuwai Hospital and underwent antegrade wiring which failed. Crusade microcatheter-facilitated reverse wire technique with simple short tip one round curve was used successfully to solve in all 7 bifurcation lesions. We investigated the bifurcation lesion's characteristics and details of the reverse wire technique procedures.Results: All 7 bifurcations exhibit both a smaller take-off angle and a larger carina angle and severe proximal significant stenosis. After having suitable size of balloon predilation, reverse wire with simple short distal one curve was delivered to distal segment of targeted vessel successfully. We performed all PCI procedures without any complications and no major adverse cardiac event was observed during hospitalization.Conclusions: In solving markedly angulated bifurcated lesions, especially with severe proximal stenosis, crusade microcatheter-facilitated reverse wire technique with simple short tip one curve is an effective and safe way of wiring. [ABSTRACT FROM AUTHOR]

Identifying diagnostic and prognostic biomarkers is crucial for improved guidance of the treatment of renal cell carcinoma (RCC). Amyloid β precursor-like protein 2 (APLP2) has been determined to serve an important role in the progression of a number of cancer types. However, the expression and significance of APLP2 in RCC remains unknown. In the present study, it was determined that the expression of APLP2 protein (n=10) and mRNA (n=8) expression was significantly decreased in clear cell RCC (CCRCC) tissues compared with that in matched normal renal tissues. The expression level of APLP2 was significantly associated with high Fuhrman grade, high pT stage, and presence of distant metastasis and lymph node metastasis (P<0.05). Multivariate analysis demonstrated that the expression of APLP2 was a significant independent predictor of disease-specific survival in renal cell carcinoma (P=0.026). Notably, APLP2 expression was significantly associated with disease-specific survival (P<0.001). APLP2 may be used to potentially predict patient prognosis, and to guide clinical diagnosis and treatment in CCRCC. [ABSTRACT FROM AUTHOR]

Summary: Aim: To evaluate the incidence, predictors, and outcomes of postdischarge gastrointestinal bleeding (GIB) in patients underwent percutaneous coronary intervention (PCI) in a 2‐year follow‐up study. Methods and Results: All consecutive patients who underwent PCI throughout 2013 were enrolled. Multivariable cox proportional hazards regression were used to identify predictors of postdischarge GIB and 2‐year major adverse cardiovascular and cerebrovascular events (MACCE). Among 10 637 enrolled patients, postdischarge GIB events occurred in 123 (1.1%) patients at a median time of 329 days (interquartile range: 191‐504 days). Predictor of postdischarge GIB included renal dysfunction and use of ticagrelor. There was no significant association between postdischarge GIB and MACCE (7.3% vs 12.0%, P = .092). Among whole population, 310 (2.91%) patients had dual antiplatelet therapy (DAPT) cessation. DAPT cessation was strongly associated with 2‐year mortality (21.6% vs 0.4%, P < .001). Conclusion: In this large cohort of real‐world patients after PCI, postdischarge GIB was not significantly associated with MACCE up to 2 years of follow‐up but lead to an increase in DAPT cessation, and DAPT cessation was strongly associated with 2‐year mortality. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the expression of amyloid precursor protein in bladder cancer, and to study its role in malignant bladder cancer cell behaviors. Methods: Immunohistochemistry and western blotting analysis were used to detect the amyloid precursor protein level in bladder cancer tissues and cell lines. The effect of amyloid precursor protein on bladder cancer cell proliferation, migration, invasion and cell cycle was evaluated by using small interfering ribonucleic acid. The levels of RAS, RAF, MEK, phosphorylated MEK, extracellular regulated protein kinases, phosphorylated extracellular regulated protein kinases, protein kinase B and phosphorylated protein kinase B were determined by western blot after amyloid precursor protein knockdown. The effect of amyloid precursor protein on the extracellular regulated protein kinases pathway was further evaluated using extracellular regulated protein kinases pathway agonist, ceramide C6. Results: The expression of amyloid precursor protein was significantly increased in the human bladder cancer tissues compared with matched normal bladder tissues. The overexpression of amyloid precursor protein was significantly associated with tumor stage, tumor size, histological grade and lymph node metastasis. The proliferation, migration and invasion of human bladder cancer cells were significantly inhibited by the silencing of amyloid precursor protein. In addition, knockdown of amyloid precursor protein arrested the cell cycle progression of bladder cancer cells in the G2/M phase. Mechanistic analysis showed that knockdown of amyloid precursor protein significantly decreased the phosphorylation of extracellular regulated protein kinases. Ceramide C6 could rescue the malignant bladder cancer cell behaviors inhibited by the silencing of amyloid precursor protein. Conclusions: Amyloid precursor protein is upregulated in bladder cancer, and might be closely associated with bladder cancer cell growth and survival. Amyloid precursor protein could potentially be used as a therapeutic target for bladder cancer treatment. [ABSTRACT FROM AUTHOR]

Aim: To investigate the impact of diabetic status on 2-year clinical outcomes in Chinese patients undergoing contemporary percutaneous coronary intervention (PCI) treatment. Methods and Results: A total of 10 724 consecutive patients underwent PCI at Fu Wai Hospital were prospectively collected. Two-year clinical outcomes were compared between patients with and without diabetes mellitus (DM). Diabetic patients had more baseline clinical risks and more extensive coronary disease. During 2-year follow-up, the rates of all-cause death, myocardial infarction (MI), revascularization, and major adverse cardiac events (MACE) were significantly higher in DM group. After multivariable-adjusted Cox regression analysis, DM was an independent risk factor for MACE but not for the individual components of MACE. After performing propensity score matching, rates of all-cause death, MI, revascularization, stroke, stent thrombosis, and MACE were not significantly different between the 2 groups, and DM was not predictive of MACE and any clinical adverse outcomes. Conclusions: Diabetic patients who underwent PCI had worse prognosis including death and repeat revascularization during 2-year follow-up, but DM was not an independent risk factor for adverse clinical outcomes. [ABSTRACT FROM AUTHOR]

The role of cystatin C (Cys-C) in tumorigenesis and progression of bladder urothelial tumors (BUT) is still indefinite. We retrospectively collected the clinical information from the records of 425 BUT patients. Pretreatment serum Cys-C levels were compared across the various groups. Then we subgroup the patients with GFR ≥ 90 mg/min/1.73 m2, to exclude the effects of lower renal function on cystatin C. No statistically significant differences in the levels of serum Cys-C were found among the tumor characteristics (all P>0.05). In conclusion, circulating Cys-C was not a reliable predictor for clinicopathological characteristics of BUT patients. [ABSTRACT FROM AUTHOR]

In this paper, we numerically investigate the effects of porosity on hemodynamics using a seepage outlet boundary condition. The results with the porosities and are compared. The comparison of the results shows that there are identical pressure, velocity and wall shear stress distributions in the artery zone; however, the velocities and wall shear stresses in the microcirculation zone with are almost as twice as those with . This work suggests that the porosity changes do not provoke variations in the artery zone, but they lead to the differences of the velocities and wall shear stresses in the microcirculation zone. The results may be the explanation of syndrome X. [ABSTRACT FROM AUTHOR]

Background: In recent years, most drug-eluting stents (DESs) were domestically produced in China, but how domestic DESs perform compared to imported DESs was still unknown.Methods: A total of 9011 consecutive cases with DESs implantation in a single center throughout 2013 were prospectively collected. Two-year clinical outcomes were evaluated between patients implanted with imported and domestic DESs.Results: During 2-year follow-up, the rates of all-cause death, cardiac death, myocardial infarction, stroke, and stent thrombosis were not significantly different between two groups. However, the rate of revascularization was significantly higher in domestic DES group, shown as higher rates of overall revascularization, target vessel revascularization (TVR), and target lesion revascularization (TLR) (9.7% vs 6.4%, P < 0.001; 5.6% vs 3.2%, P < 0.001; 4.5% vs 2.2%, P < 0.001, respectively). Accordingly, major adverse cardiac events (MACE) rate was significantly higher in domestic DES group (12.1% vs 8.5%, P < 0.001). Multivariable Cox regression analysis indicated that domestic DES was an independent risk factor of MACE (HR [95%CI]: 1.22 [1.05-1.41]), overall revascularization (HR [95%CI]: 1.29 [1.09-1.53]), TVR (HR [95%CI]: 1.54 [1.22-1.94]), and TLR (HR [95%CI]: 1.85 [1.41-2.42]). After propensity score matching, the rates of overall revascularization, TVR, and TLR were still significantly higher in domestic DES group, and domestic DES was still predictive of overall revascularization, TVR, and TLR in multivariate Cox regression analysis.Conclusions: Domestic DESs showed the same safety as imported DESs in this real-world cohort. But, patients implanted with domestic DESs had a higher risk of revascularization than imported DESs. [ABSTRACT FROM AUTHOR]