Search

Due to advances in medical treatments, a substantial proportion of heart failure (HF) patients with reduced left ventricular ejection fraction (EF, HFrEF) have experienced partial or complete recovery of EF, termed HFrecEF, and markedly improved clinical outcomes. In the present study, we sought to investigate the relationship between glycemic control and the incidence of HFrecEF in hospitalized HFrEF patients with type 2 diabetes mellitus (T2DM).A total of 463 hospitalized T2DM patients with HFrEF were consecutively enrolled. Follow-up echocardiogram was performed after around 12 months. Patients who had an absolute EF improvement ≥10% and a second EF 40% were classified into HFrecEF, and those who did not meet these criteria were defined as persistent HFrEF.During the 12-month follow-up, 44.5% of T2DM patients developed HFrecEF. Patients with HFrecEF had significantly lower HbA1c level than those with persistent HFrEF (6.5% [IQR 5.8% ∼ 7.2%] vs. 6.7% [IQR 6.1% ∼ 7.8%], P = 0.003), especially in HF of an ischemic etiology. HbA1c levels were inversely correlated with changes in EF during follow-up. After multivariate adjustment, every 1% increase in HbA1c conferred a 17.4% (OR: 0.826 [95% CI 0.701-0.968]) lower likelihood of HFrecEF. Compared to patients with good glycemic control (HbA1c ≤ 6.2%), those with poor glycemic control (HbA1c 7.1%) had a 52.0% (OR: 0.480 [95% CI 0.281-0.811] decreased likelihood of HFrecEF.This study demonstrates that uncontrolled HbA1c level is associated with compromised development of HFrecEF in T2DM patients with HF, especially in those with an ischemic etiology.

This paper is concerned with the problem of adaptive event-triggered tracking control for a class of uncertain stochastic nonlinear systems in strict-feedback form. Firstly, with the help of fuzzy logic systems (FLSs) to approximate the unknown nonlinear functions, a robust fuzzy state observer is constructed to estimate all the unmeasurable states. Next, an adaptive output feedback controller which can adjust the variables on-line is designed by using the backstepping scheme. Concomitantly, in order to reduce the computation of communication process, a new event triggering condition involving the decreasing function of tracking errors is introduced. Moreover, the desired closed-loop stability of the resulting systems can be achieved by exploiting Lyapunov function analysis. Finally, simulation results verify the effectiveness of the proposed method.

This paper is concerned with the problem of adaptive asymptotic tracking fault-tolerant control (FTC) for uncertain nonlinear systems with actuator faults and event-triggered inputs. Firstly, fault-tolerant controller is designed to effectively compensate the unknown actuator failures by constructing the proper parameter updated laws. Then, the event-triggered strategy based on the relative threshold method is applied to the proposed adaptive fault-tolerant controller. Furthermore, it is proved that all the closed-loop signals are uniformly bounded and the tracking error can asymptotically converge to zero. Finally, the simulation results are given to demonstrate the effectiveness of the presented control scheme.

High-density lipoprotein (HDL) confers protection against cardiovascular disease partly attributable to its robust anti-oxidant activities, which is largely impaired in diabetic conditions. In this study, we analyzed the anti-oxidant activity of HDL, as represented by the arylesterase activity of paraoxonase 1 (PON1) in HDL particles, in 216 consecutive HF patients with (n = 79) or without (n = 137) type 2 diabetes, and age- and gender-matched 112 diabetic and 189 non-diabetic non-HF controls. We found arylesterase activity was significantly decreased in patients with than without HF, and was further decreased when comorbid with diabetes. After adjusting for conventional risk factors and apolipoprotein A-I levels, arylesterase activity remained correlated positively with left ventricular ejection fraction in diabetic (r = 0.325, P = 0.020) but not non-diabetic patients (r = 0.089, P = 0.415), and negatively with NT-proBNP and NYHA functional class in both subgroups. In regression analyses, a higher risk of HF was observed in diabetic than non-diabetic patients when having low arylesterase activities. In conclusion, our data demonstrate that impaired serum arylesterase activity in patients with HF is further reduced when comorbid with diabetes. The relationship of impaired arylesterase activity to HF is especially enhanced in diabetic patients.

The macromolecular organization in system composed of anionic poly(acrylic acid) (PAA) and cationic chitosan (Cs), with different degrees of deacetylation (DD), under extensive elongational flow, is described. Cs/PAA nanofibers were obtained, and polyelectrolyte complexation only occurred when fibers were immersed in fluid media of a certain pH. Assembled polyelectrolytes complexes formed a pH-triggered system, as demonstrated by reversible change of the swelling degree, by 3 orders of magnitude, and a change on the elastic modulus, by 2 orders of magnitude. Both the swelling degree and the elastic modulus proved sensitive to the DD of Cs. Rheological measurements showed that increased DD of Cs resulted in a decrease in viscosity of both pure Cs and precursor Cs/PAA solutions, attributed to repulsive interactions between ionized amino groups in Cs. At the same time, a DD-dependent change in balance between hydrogen bonding and ion-dipole interactions between the components in Cs/PAA, was responsible for the more pronounced viscosity decrease in these solutions.

The aim of this paper is to identify the volatility function in Dupire’s equation from given option prices. This inverse problem is formulated as an infinite-dimensional minimization problem with PDE constraints. The computational cost of solving the discretized problem on a fine discretization level is expensive. A multi-grid method is proposed to explore the hierarchical structures of discretized problems on different levels. Computational examples are presented to demonstrate the efficiency of our method.

Objective This study aimed to evaluate the relationship between coronary collateralization and in-stent restenosis (ISR) in stable coronary artery disease patients with chronic total occlusion (CTO) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. Methods The degree of coronary collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded according to Rentrop classification in 216 patients with stable angina undergoing successful DES based PCI for CTO. Univariable and multivariable logistic regression analyses were performed to assess the potential factors related to angiographic ISR during follow-up. Results Despite similar number of diseased coronary arteries, good collateralization (Rentrop score 2 or 3) was more frequently associated with right coronary artery occlusion (60%), whereas poor collaterals (Rentrop score 0 or 1) occurred more often in left anterior descending artery occlusion (40%). Despite similar number of CTO intervened, stent length was longer in patients with good collateralization (59±27mm vs 47±23mm, p =0.001). At mean 18months, the rate of ISR did not significantly differ between patients with good collateralization and those with poor collateralization (12.7% vs 20.2%, p =0.148). At multivariable analysis, age (OR 1.058, 95%CI 1.015–1.104, p =0.008), history of diabetes mellitus (OR 2.382, 95%CI 1.109–5.116, p =0.026) and reference CTO vessel diameter (OR 0.219, 95% CI 0.051–0.951, p =0.043) were independent risk factors for ISR while Rentrop collateral grade (OR 0.795, 95% CI 0.365–1.732, p =0.414) was not associated with ISR. Conclusions The occurrence of ISR after successful DES based PCI for CTO may be not influenced by coronary collateralization.

Mimecan/osteoglycin is identified as an emerging biomarker of coronary atherosclerosis. We investigated whether and to what extent serum mimecan reflects angiographic coronary collateralization in patients with stable coronary artery disease and chronic total occlusion.Serum levels of mimecan were determined in 559 consecutive patients with stable angina and angiographic total occlusion of at least one major coronary artery. The degree of collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded as poor (Rentrop score of 0 or 1) or good coronary collateralization (Rentrop score of 2 or 3).Serum mimecan was significantly higher in patients with poor collateralization than in those with good collateralization, and correlated inversely with Rentrop score (adjusted Spearmen's r = -0.443, p 0.001). The prevalence of poor coronary collaterals increased stepwise from the lowest to the highest quartile of serum mimecan (OR 2.140, 95% CI 1.793-2.555; p for trend 0.001). After adjusting for age, gender, traditional risk factors for coronary artery disease, history of myocardial infarction, severity of coronary artery disease, renal function and C-reactive protein, serum mimecan (per SD) remained an independent determinant for poor collateralization (OR 2.674, 95% CI 2.057-3.475, p 0.001). The diagnostic value of mimecan (per SD) for detecting poor collateralization was consistent when the patients were specified by gender, age, body mass index, presence or absence of hypertension and diabetes, and status of renal function (OR 2.075-6.932, p interaction ≥ 0.059).Increased serum mimecan is associated with poor angiographic coronary collateralization in patients with chronic total occlusion.

Conductive elastomeric materials of multi-walled carbon nanotube (MWCNT) filled thermoplastic vulcanizate (TPV) based on polypropylene (PP)/ethylene-propylene-diene rubber (EPDM) blends were fabricated via different processing procedures, i.e., one-step and two-step methods, to control strain sensitivity aiming at applications from strain sensors to stretchable conductors. The phase size of cross-linked EPDM could be effectively tuned and the average diameter of EPDM particles was 550 nm for one-step TPV and 230 μm for two-step TPV. Uniform dispersion of MWCNTs in two-step TPV and serious aggregations of MWCNTs in one-step TPV were observed. Both TPVs showed excellent strain-resistance repeatability for 50 tensile and recovery cycles. The one-step-TPV showed a potential to be used as strain sensor due to a high gauge factor (GF) of 1004 at a strain of 100%, while the resistance for the two-step TPV composite was independent with strain even at a strain of 200%, resulting in a stretchable conductor with excellent resistance memory effect. The different strain sensitivity can be explained by the orientation of PP matrix. Moreover, the two-step TPV showed much lower electrical conductivity percolation threshold, 0.65 wt.%. This work provided a simple route to tune the strain sensitivity of MWCNTs filled TPVs based on PP/EPDM blends for applications from strain sensors to highly stretchable conductor through different processing procedures to control the morphologies and MWCNT dispersion.

It is thought that carbamylated modification plays a crucial role in the development and progression of cardiovascular disease (CVD) in patients with end-stage renal disease (ESRD). However, information on the biological effects of carbamylated high-density lipoprotein (C-HDL) in ESRD is poor. The present study investigated the carbamylation level of HDL in ESRD and the effects of C-HDL on endothelial repair properties. HDL was isolated from healthy control subjects ( n = 22) and patients with ESRD ( n = 30). The carbamylation level of HDL was detected using ELISA. Isolated C-HDL for use in tissue culture experiments was carbamylated in vitro to a similar extent to that observed in ESRD. Human arterial endothelial cells were treated with C-HDL or native HDL to assess their migration, proliferation, and angiogenesis properties. HDL-associated paraoxonase 1 activity was also determined by spectrophotometry assay. Compared with healthy control subjects, the carbamylation level of HDL in ESRD patients was increased and positively correlated with blood urea concentration. In vitro, C-HDL significantly inhibited migration, angiogenesis, and proliferation in endothelial cells. Mechanistic studies revealed that HDL-associated paraoxonase 1 activity was decreased and negatively correlated with the carbamylation level of HDL in ESRD patients. In addition, C-HDL suppressed the expression of VEGF receptor 2 and scavenger receptor class B type I signaling pathways in endothelial cells. In conclusion, the present study identified a significantly increased carbamylation level of HDL in ESRD. Furthermore, C-HDL inhibited endothelial cell repair functions.

Background There is increasing interest in percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Periprocedural myocardial injury (PMI) post CTO PCI is not uncommon, but true incidence and implications of PMI are not well understood. Objectives This study aimed to investigate risk factors for PMI post CTO PCI and its implications for the 1-year clinical outcome of a Chinese population. Methods Baseline characteristics, procedure features, and major adverse cardiac events (MACE) at 1 year were assessed in 629 consecutive patients who underwent CTO PCI. PMI was diagnosed as an elevation of creatine kinase MB ≥3 times ULN 12–24 hr post procedure. Multivariate analysis was performed to determine the correlates of PMI and MACE at 1-year follow-up. Results In total, PMI was detected in 115 patients (18.3%). Compared with patients without PMI, those with PMI had a higher percentage of previous coronary artery bypass grafting (CABG), right coronary occlusion and side branch occlusion, and technical success was lower in the PMI group (90.4% vs. 96.7%, P = 0.003). One-year MACE-free survival was reduced in the PMI group (87.8% vs. 95.9%, P = 0.001). The final TIMI flow 0–1 (OR 2.23, 95%CI 1.06–4.87, P = 0.02), side branch occlusion (OR 2.67, 95%CI 1.19–7.11, P = 0.009), retrograde PCI (OR 1.35, 95%CI 1.10–2.74, P = 0.04), and history of prior CABG (OR 2.41, 95%CI 1.38–5.91, P = 0.01) were independent risk factors for the occurrence of PMI. Conclusions In this unique Chinese cohort, PMI post CTO PCI was associated with several clinical and angiographic factors and exerts an adverse effect on 1-year clinical outcomes. © 2016 Wiley Periodicals, Inc.

A new method of using ion chromatograph (IC) to test chloride in the cement was introduced in this paper. The accuracy and precision of the new developed method was also analyzed. The advantages compared with existing methods were pointed out that this method is not only quicker but also more accurate and more green environmental.

Glycated albumin (GA) and the endogenous secretory receptor for advanced glycation endproducts (esRAGE) may modulate risk related to atherosclerosis. We tested the hypothesis that elevated GA and reduced esRAGE in serum are associated with adverse clinical outcomes in patients with type 2 diabetes and stable coronary artery disease (CAD).We determined GA and esRAGE serum levels in 576 consecutive patients with type 2 diabetes and stable CAD undergoing sirolimus-eluting stent (SES)-PCI. The primary endpoint was the incidence of major adverse cardio-cerebral events (MACCE) including cardiac death, non-fatal myocardial infarction, and non-fatal stroke during a 2-year follow-up. The secondary endpoint was the occurrence of clinically driven repeat revascularization during a 2-year follow-up. The prognostic value of GA and esRAGE was determined with the Cox-proportional hazard model after adjustment for covariates.A total 40 patients (6.9%) experienced MACCE, and 108 (18.8%) patients underwent repeat coronary revascularization during the follow-up. Serum GA (HR=1.22, 95% CI 1.16-1.28; HR=1.15, 95% CI 1.11-1.19, respectively; for both p0.001) and esRAGE (HR=0.60, 95% CI 0.40-0.87; HR=0.75, 95% CI 0.61-0.92, respectively; for both p0.01) levels remained independent predictors of the primary and secondary endpoints after adjustment for possible confounders.Serum GA and esRAGE are novel predictors of long-term clinical outcomes in patients with type 2 diabetes and stable CAD. Increased serum GA and decreased esRAGE are associated with a poor prognosis in such patients.

Background and purpose:Patients are at risk of developing periprocedural myonecrosis after percutaneous coronary intervention (PCI). We investigated whether the use of the platelet glycoprotein (GP) IIb/IIIa receptor inhibitor tirofiban could reduce periprocedural myocardial infarction (PMI) in pati

Stanniocalcin (STC), first isolated from the corpuscles of stannius of teleost fishes, was originally known for its regulation on calcium/phosphate transport. Increasing evidence demonstrates that STCs display the important function in some physiological and pathological behaviors such as calcium regulation, oxidative stress, anti-inflammation, angiogenesis, ischemia reperfusion, nerve diseases, etc. Moreover, STCs are implicated in the development and progression of multiple malignancies through promoting cell growth, proliferation, invasion, metastasis, and apoptotic escape. Some studies have shown that NF-κB upregulates STC expression, thereby activating the downstream HIF-1/ERK1/2 signaling pathway, enhancing the transcriptional activity of tumor-related factors (MMP-2/9, cyclinD1, Bcl-2, N-cadherin, etc) and contributing to tumorigenesis. Here, this brief review describes recent progress of STCs in mammalians, focused mainly on their critical functions in cancer.

Recently, a melt penetrating process in which a first polymer melt is rapidly penetrated by a second polymer melt has been realized on our home-made multi-melt multi-injection molding (MMMIM) machine. Although great deformation can be provided by the rapid melt penetration process, it has been found that hardly any oriented crystalline structures can be kept and formed due to the quick chain relaxation at high temperatures. In the present work, lightly cross-linked structures were introduced to prolong the relaxation time of linear high density polyethylene (HDPE) molecular chains. The hierarchical structures of MMMIM samples were characterized by scanning electron microscopy (SEM), polarized light microscopy (PLM) and two-dimensional small angle X-ray scattering (2D-SAXS). It was found that the melt penetrating process promoted the formation of cylindritic crystalline structures in the subskin layer, whereas only isotropic spherulites were formed in the subskin layer of the corresponding conventional injection molding (CIM) sample. From linear to lightly cross-linked macromolecular chain structures, a transition from cylindritic structures composed of banded-spherulites along the flow direction towards shish–kebab-like structures was observed in the subskin layer of the MMMIM samples, and also the distances between two nuclei decreased as well as the orientation degree increased gradually in the transition layer. These results indicate that lightly cross-linked HDPE structures with longer relaxation times are beneficial to keep the point-like nuclei along the flow direction and are helpful for the transition to shish–kebab-like structures with thread-like nuclei. Modified models are proposed to interpret the mechanism of the formation of shish–kebab-like structures under the melt penetrating of samples with lightly cross-linked structures.

The high-density polyethylene (HDPE)/polyamide 6 (PA6) in situ microfibrillar composites (HAM-C) were fabricated by the “extrusion-hot stretch-quenching” technique, in which PA6 microfibrillar had diameters lying in the range 0.55 to 1.05 μm. Then the HAM-C and pure HDPE were processed by multi-melt multi-injection molding (MMMIM). The effect of PA6 in situ microfibrillar and secondary melt penetration on the crystalline morphologies and mechanical properties was investigated using a variety of characterization techniques including differential scanning calorimetry (DSC), rheological experiments, scanning electron microscopy (SEM), synchrotron two-dimensional small-angle X-ray scattering (SAXS), and tensile testing. It was found that PA6 microfibrillar not only acted as a heterogeneous nucleation agent, but also prolonged the relaxation time of HDPE matrix by suppressing the mobility of HDPE molecular chains. It was revealed, from observing the morphologies, that the presence of PA6 microfibrillar not only facilitated the formation of transcrystalline superstructures on its surface, but also induced much more oriented crystals nearby as a result of the amplified local shear field. Furthermore, SAXS results confirmed that the degree of orientation of the injection-molded HAM-C part (HAM-M) was largely enhanced. Finally, the tensile testing showed that the tensile strength and Young’s modulus of the HAM-M sample were enhanced by 38.8 and 54.6 %, respectively, when compared with pure HDPE parts. This work provides a promising way to tailor the crystalline structure of the injection-molded parts.

The effect of viscosity ratio (ηcore/ηskin) on the crystalline morphologies of the bars molded by multi-melt multi-injection molding (MMMIM) was investigated by fixing a kind of high density polyethylene (HDPE) with a high molecular weight as the skin material and tuning the viscosity ratio by the viscosities of different core melts. The hierarchical morphologies and mechanical properties were investigated by PLM, SEM, 2D-WAXS and tensile testing. It was found that higher viscosity ratio facilitated the interaction between the skin and core melts ascribed to greater chain entanglement, and induced a higher degree of molecular orientation accompanied by improved mechanical properties.

Background Sirolimus-eluting stents (SES) with a biodegradable polymer coating have demonstrated promising results but have not been compared to SES with a durable polymer in high-risk patients. We compared the efficacy of these 2 stent types in patients with acute myocardial infarction (STEMI). Methods One thousand one hundred ninety-two STEMI patients were randomized to receive SES coated with biodegradable (n = 596) or durable polymer (n = 596). The study end-point was the composite of major adverse cardiac events (MACE) including all-cause death, recurrent myocardial infarction (MI), or target lesion revascularization (TLR) at 1-year follow-up. Secondary end-points included individual components of primary end-point and stent thrombosis. Results Compared with durable polymer SES, the noninferiority of SES with biodegradable polymer coating was established by an absolute risk difference of 0.9% in the primary end-point (12.4% vs. 13.3%, P = 0.67) and an upper limit of one-sided 95% confidence interval (CI) of 2.96% (P for noninferiority = 0.001). Rate of death, recurrent MI, and TLR were 7.9% and 8.6% (HR: 0.92; 95% CI: 0.61–1.38, P = 0.67), 2.9% and 3.5% (HR: 0.80; 95% CI: 0.42–1.54, P = 0.51), and 2.0% and 3.2% (HR: 0.62; 95% CI: 0.30–1.30, P = 0.20) in the biodegradable polymer SES and durable polymer SES group at 1-year clinical follow-up, respectively. Despite similar rates of 30-day ARC definite/probable stent thrombosis, late stent thrombosis (stent thrombosis occurring beyond 30 days) was lower with biodegradable polymer SES (0.7% vs. 2.2%, P = 0.028). Conclusions In patients undergoing primary PCI for STEMI, the use of biodegradable polymer SES was associated with noninferior 1-year rates of MACE compared with durable polymer SES. (J Interven Cardiol 2014;27:131–141)

The morphology distribution of a model polymer blend, polystyrene (PS)/polyethylene (PE), molded by multimelt multi-injection molding (MMMIM) process was studied by scanning electronic microscopy and polarizing light microscopy. An unusual double skin/core morphology was observed. The minor phase, PS, showed highly deformed morphology in both the skin layer near the mold wall and the core layer near the skin/core layer's interface. Meanwhile, in the regions that highly deformed PS phase showed, highly ordered cylindritic crystal structures of PE are also formed. As we all know the driving force and the basic prerequisite to deform the dispersed droplet and form the oriented crystal structure is the shear field. So an attempt was made to correlate the dispersed phase morphology, crystalline morphologies, and shear rate. The shear rate, estimated via the capillary number, across the thickness of the parts molded by MMMIM was bimodal. Even if the coalescence and relaxation of the dispersed phase during and after mold filling cannot be ignored, both the highly dispersed PS domains and the highly ordered crystal structure of PE showed in the regions with the maximum calculated shear rate, which is consistent with the generally accepted theories that strong shear flow is favorable to the formation of the oriented structures. POLYM. ENG. SCI., 54:2345–2353, 2014. © 2013 Society of Plastics Engineers

Background Glycated albumin (GA) has been shown to be a better indicator than glycosylated hemoglobin A1c (HbA1c) in terms of severity of renal impairment in patients with type 2 diabetes mellitus (T2DM). This study aimed to determine whether elevated serum GA levels are associated with an increased risk for contrast-induced acute kidney injury (CI-AKI) and worse clinical outcome in patients with T2DM and at least moderate renal insufficiency (RI) undergoing coronary angiography. Methods Serum levels of fasting blood glucose (FBG), HbA1c and GA were measured in 1030 patients with T2DM and moderate to severe RI (eGFR 15–59mL/min/1.73m 2 ). CI-AKI was defined as ≥25% increase in serum creatinine within 72h after the procedure. Receiver-operating characteristic curve was constructed to assess the predictive value of GA, HbA1c and FBG for CI-AKI. Multivariable logistic regression model was developed to identify risk factors for CI-AKI, and Kaplan–Meier curve analysis was used to compare the rates of dialysis and major adverse cardiac events (MACE) during one-year follow-up. Results The overall rate of CI-AKI was 11.1%. GA was significantly higher in patients with CI-AKI than in those without, and correlated positively with changes of renal function after the procedure. After adjusting for age, sex, left ventricular ejection fraction, multi-vessel disease, type and volume of contrast media, FBG, and HbA1c, GA remained an independent risk factor for CI-AKI. GA≥21% was associated with increased rates of dialysis and MACE during one-year follow-up in patients with or without CI-AKI. Conclusions Increased GA level serves as a valuable risk factor for CI-AKI and indicates poor one-year clinical outcome in patients with T2DM and moderate to severe RI.

Background We investigated whether an additional intracoronary tirofiban bolus administration following upstream intravenous treatment could further improve myocardial reperfusion and clinical outcome in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods A total of 453 eligible STEMI patients were randomly allocated to intracoronary bolus administration of tirofiban (10μg/kg; n=229) or saline (10mL; n=224) during primary PCI, followed by intravenous tirofiban infusion (0.15μg/kg/min) for 24–36h. Serum levels of P-selectin, vWF, CD40L and serum amyloid A (SAA) in the coronary sinus were measured before and after intracoronary bolus administration. The primary endpoint was ST-segment resolution (STR) at 90min after the procedure. Second endpoints included corrected TIMI frame count (cTFC), left ventricular volumes and ejection fraction (EF), and major adverse cardiac events (MACE) at 30-day and 6-month follow-up. Results Intracoronary tirofiban administration resulted in a higher rate of completed STR (59.0% vs. 44.6%, P=0.002), lower cTFC (21.6±5.4 vs. 23.7±7.8, P=0.048), and significantly reduced coronary sinus levels of P-selectin, vWF, CD40L and SAA. Patients treated with intracoronary tirofiban had a trend toward less MACE at 30days (3.1% vs. 6.7%, P=0.072). At 6months, left ventricular end-systolic volume was smaller, EF was higher and MACE-free survival was improved (96.1% vs. 90.6%, P=0.020) in the intracoronary tirofiban group. Conclusions An additional intracoronary tirofiban bolus administration following upstream intravenous treatment reduces coronary circulatory platelet activation and inflammatory process, and significantly improves myocardial reperfusion and left ventricular function as well as 6-month MACE-free survival for STEMI patients undergoing primary PCI.

OBJECTIVE To investigate whether glycation level of apoprotein (apo)A-I is associated with coronary artery disease (CAD) and plaque progression in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Among 375 consecutive type 2 diabetic patients undergoing quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS), 82 patients with nonsignificant stenosis (luminal diameter narrowing RESULTS Relative intensity of apoA-I glycation by densitometry was increased, and serum LCAT activity was decreased stepwise across groups control, I, and II. These two measurements were associated with the number of diseased coronary arteries and extent index in group II. During 1-year follow-up, QCA detected 45 patients with plaque progression in 159 subjects, and IVUS found 38 patients with plaque progression in 127 subjects. Baseline relative intensity of apoA-I glycation was significantly increased in patients with plaque progression compared with those without, with values associated with changes in QCA and IVUS measurements. Multivariable regression analysis revealed that baseline relative intensity of apoA-I glycation was an independent determinant of CAD and plaque progression in type 2 diabetic patients. CONCLUSIONS ApoA-I glycation level is associated with the severity of CAD and coronary artery plaque progression in type 2 diabetic patients.

The formation of a hybrid shish-kebab (HSK) structure with different degrees of lamellar orientations was first observed in the solution crystallization of polyethylene (PE) in the presence of carbon nanofibers (CNFs). In this study, PE crystal lamellae were periodically decorated on the surface of CNFs and were aligned approximately perpendicular to the long axes of the CNFs, forming aligned hybrid shish-kebab nanostructures. More importantly, the fascinating structure was directly formed in all regions of the injection molded bars of HDPE/CNF composites, via a gas-assisted injection molding (GAIM), instead of the shell–core structure. In the GAIM process, an intense shear was imposed onto the melt during the melt second flow and drove PE chains to orient along the axes of the CNFs. Then the entropy penalty for PE chains deposited on the CNF surface was drastically decreased. Although the attractive van der Waals interactions were weak, the oriented PE chains could successfully adsorb on the CNF surface due to the decrease of the entropy penalty, therewith the underlayer coating was formed along the axis based on a two-dimensional mode for early nucleation on the CNF surface. Subsequently, subglobules appeared on the ordered structure, which could be regarded as the crystal nucleus. Finally, the oriented PE chains began to epitaxially grow from the subglobules with a folded-chain shape to decrease the polymer surface energy and grew perpendicular to the CNFs long axis, abiding by the “soft epitaxy” crystallization mechanism regardless of strict lattice matching.

Objectives: This study aimed to compare the value of serum glycated albumin (GA) level versus glycated hemoglobin A1c (HbA1c) for evaluating the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). Methods: Serum GA and blood HbA1c levels were measured in 829 consecutive T2DM patients with or without angiographically documented significant CAD (≥70% diameter stenosis). Results: Serum GA levels were higher in diabetic patients with significant CAD than in those without (20.57 ± 4.23 vs. 19.00 ± 4.48%; p < 0.001), but HbA1c was similar in the two groups (7.74 ± 1.34 vs. 7.51 ± 1.37% p > 0.05). Compared to HbA1c, GA correlated more closely with the sum of significant stenotic lesions (r = 0.275, p < 0.001 and r = 0.092, p = 0.019) and the extent index (r = 0.375, p < 0.001 and r = 0.091, p = 0.019). The area under the curve of GA was larger than that of HbA1c for detecting the presence of significant CAD (0.637 vs. 0.568; p = 0.046) and 3-vessel disease (0.620 vs. 0.536; p = 0.039). GA, but not HbA1c, was independently associated with significant CAD. Conclusions: Serum GA level is a better indicator than HbA1c for evaluating the presence and severity of CAD and predicting major adverse cardiac events in patients with T2DM.

We aim to check if serum levels of receptor for advanced glycation endproduct (RAGE) ligands S100B, S100A6 and S100P were related to myocardial injury in acute coronary syndrome (ACS).Serum levels of S100B, S100A6, S100P, and soluble RAGE (sRAGE) were analyzed in 882 patients. Based upon clinical and laboratory findings, they were assigned into control (n=251), stable angina (n=211), and ACS (n=420). To verify clinical data of ACS, forty Sprague-Dawley rats were subjected to cardiac ischemia-reperfusion (I/R) injury by occluding proximal (large infarct size; n=20) or distal (small infarct size; n=20) left anterior descending coronary artery, and another 20 rats were in sham-operation group. The expressions of S100B, S100A6, S100P and RAGE in the myocardium were analyzed.Serum levels of S100B, S100A6 and S100P were higher in ACS group than in stable angina and control groups, and sRAGE levels were higher in ACS patients versus controls (all p0.01). S100B and S100P levels correlated significantly with CK-MB and troponin I levels in ACS group (all p0.05). In multivariable regression analysis, S100B, S100A6, S100P and conventional risk factors were independently associated with ACS. In animal models, the expressions of S100B, S100A6 and S100P were closely related to infarct size (all p0.05).This study indicates that serum levels of S100B, S100A6 and S100P are associated with ACS, and serum levels and myocardial expression of these proteins are related to infarct size.

Background— Traditional reperfusion options for patients with acute ST-segment elevation myocardial infarction (STEMI) presenting to non-primary percutaneous coronary intervention (PPCI)-capable hospitals generally include onsite fibrinolytics or emergency transfer for PPCI. A third option, involving interventionalist transfer, was examined in the REVERSE-STEMI study. Methods and Results— A total of 334 patients with acute STEMI who presented to 5 referral hospitals with angiographic facilities but without interventionalists qualified for PPCI were randomized to receive PPCI with either an interventionalist- (n=165) or a patient-transfer (n=169) strategy. The primary end point of door-to-balloon (D2B) time and secondary end points of left ventricular ejection fraction and major adverse cardiac events (MACE) at 1-year clinical follow-up were compared between the 2 groups. Compared with the patient-transfer strategy, the interventionalist-transfer strategy resulted in a significantly shortened D2B time (median, 92 minutes versus 141 minutes; P P P P =0.019). Multivariate Cox proportional hazards modeling revealed that the interventionalist-transfer strategy was an independent factor for reduced risk of composite MACE (hazard ratio, 0.63; 95% CI, 0.45 to 0.88; P =0.003). Conclusions— The interventionalist-transfer strategy for PPCI may be effective in improving the care of patients with STEMI presenting to a non-PPCI-capable hospital, particularly in a congested cosmopolitan region where patient transfers could be prolonged. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00713557.

We sought to examine if polymorphisms in the promoter region of YKL-40 gene (CHI3L1) are associated with serum YKL-40 levels and coronary artery disease (CAD) in Chinese patients.Three single nucleotide polymorphisms (SNPs) (-329GA, rs10399931; -247CT, rs10399805; -131GC, rs4950928) in the CHI3L1 promoter were determined in 213 consecutive patients with angiographically documented CAD (luminal diameter stenosis ≥50%) and 248 normal controls. Coronary cumulative obstruction score and number of diseased vessels represent the severity of CAD. Serum YKL-40 levels were assessed using an ELISA kit.Patients with CAD had remarkably higher serum YKL-40 levels compared to controls (p0.001). There was no difference in the allele, genotype and haplotype distribution of these three SNPs between controls and CAD patients. The minor alleles of CHI3L1-329GA and -131GC were significantly associated with decreased serum YKL-40 levels in both controls (p = 0.001 and p0.001, respectively) and CAD patients (p = 0.007 and p0.001, respectively), whereas CHI3L1-247CT had no appreciable effect. None of these genetic variants and haplotypes was associated with severity of angiographic CAD.CHI3L1-329GA and -131GC polymorphisms are associated with serum YKL-40 levels, but not with the prevalence or severity of CAD.

This cross-sectional study aimed at evaluating the possible association of serum levels of glycated albumin (GA) and endogenous secretory RAGE (esRAGE) with angiographically significant coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM) and non-diabetic patients.Serum levels of GA, esRAGE, and inflammatory markers were measured in 1320 patients undergoing coronary angiography from three large districts in Shanghai. Patients were divided into four groups based on the presence/absence of T2DM and of significant CAD (diameter stenosisor=70%).Serum levels of GA, high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 were significantly higher and, in contrast, serum esRAGE levels were lower in patients with both T2DM and significant CAD than in all other groups (all P0.01), whereas there were no significant differences in GA and esRAGE levels between non-diabetic patients with CAD and those without. Serum GA and esRAGE levels correlated with angiographic CAD severity (P=0.031 and P=0.001), extent (both P0.001) and number of diseased coronary arteries (both P0.001) in diabetic CAD patients. At multivariable regression analysis, male gender, age, hypertension, cigarette smoking, HDL-C, lipoprotein (a), GA, esRAGE, hsCRP and TNF-alpha were all independent determinants of significant CAD in diabetic patients. Moreover, male gender, age, hypertension, lipoprotein (a), GA and esRAGE remained independently associated with three-vessel disease.Patients with T2DM and CAD feature elevated serum GA and decreased serum esRAGE levels. Here serum GA and esRAGE levels are associated with angiographic extent and severity of CAD.

Background We assessed the possible association of glycated albumin (GA) and circulatory adhesion molecules with diffuse coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). Methods Six hundred and two consecutive patients with CAD, based upon angiographic features and presence or absence of T2DM, were categorized as Group I (296 patients with non-diffuse CAD but no T2DM), Group II (138 patients with diffuse CAD but no T2DM), Group III (78 patients with non-diffuse CAD and T2DM) and Group IV (90 patients with diffuse CAD and T2DM). Serum levels of glycated albumin, adhesion molecules, endogenous secretory receptor of advanced glycation end products (esRAGE) and inflammatory factors were determined. Results Serum levels of GA, hsCRP, sVCAM-1, sICAM-1 and sE-selectin were increased, while esRAGE levels were decreased in diabetic patients than in non-diabetic patients (all P

We investigated the impact of glycated albumin (GA) and endogenous secretory receptor for advanced glycation end products (esRAGE) and RAGE polymorphisms on occurrence of in-stent restenosis (ISR) in Chinese patients with type 2 diabetes.Four hundred nineteen patients with diabetes were divided, based upon the presence or absence of coronary artery disease (CAD) and ISR, into Group I (205 patients without CAD), Group II (128 patients with CAD but without ISR) and Group III (86 patients with ISR). One hundred fifty-two normal subjects were served as controls. Serum concentrations of GA and esRAGE were measured, and RAGE polymorphisms (-374TA, -429TC and G82S) were analyzed.Serum GA concentration was higher and, in contrast, esRAGE concentration was lower in Group III than in the other groups (P0.05). These two protein concentrations correlated closely with loss index (all P0.01), and were independent risk factors for ISR in diabetic patients (P=0.01 and P=0.025, respectively). However, there were no differences in the allele and genotype frequencies in the 3 polymorphisms of RAGE gene between groups.Increased GA and decreased esRAGE concentrations, but not -374TA, -429TC and Gly82Ser polymorphisms of RAGE gene, are associated with ISR in Chinese patients with type 2 diabetes.

Background and aims In-stent restenosis (ISR) remains a major limitation of percutaneous coronary intervention despite improvements in stent design and pharmacological agents, whereas the mechanism of ISR has not been fully clarified. In the present study, we sought to investigate the potential association of serum soluble TREM-1 (sTREM-1) levels with the incidence of ISR. The role of TREM-1 was evaluated in cultured vascular smooth muscle cells (VSMCs). Methods Out of 1683 patients undergoing coronary intervention and follow-up coronary angiography after approximately one year, 130 patients were diagnosed with ISR, and 150 gender- and age-matched patients with no ISR were randomly included as controls. Levels of sTREM-1 were determined by ELISA. The role of TREM-1 signaling in the activation of VSMCs was tested. Results Serum sTREM-1 concentrations were significantly elevated in patients with than without ISR. Multivariable logistic regression analysis showed that sTREM-1, besides conventional factors, was independently associated with the incidence of ISR. Evident expression of TREM-1 in VSMCs was detected in the neointimal and medial layers of stenotic lesions of mouse carotid ligation models. In cultured VSMCs, expression of TREM-1 was significantly induced upon exposure to lipopolysaccharide. Blocking of TREM-1 with a synthetic inhibitory peptide LP17 dramatically inhibited, whereas TREM-1-activating antibody promoted cellular inflammation, proliferation and migration in VSMCs. Conclusions These data suggest that TREM-1 is a predictive biomarker of ISR and an important mediator of cellular inflammation, migration, and proliferation in VSMCs. Pharmacological inhibition of TREM-1 may serve as a promising approach to attenuate the progression of ISR.

Recently, a melt-penetrating process in which the first melt suffered from only one direction penetrating action was achieved by our home-made multi-melt multi-injection molding (MMMIM). In this work, a high-density polyethylene (HDPE) melt was penetrated by a high-speed second HDPE melt via an MMMIM instrument. It was found that hierarchically oriented crystalline structures were generated in the melt-penetrating sample along the thickness, investigated by SEM, synchrotron 2D-WAXD and 2D-SAXS; however, only isotropic spherulites were formed in non-melt-penetrating samples. 2D-WAXD/2D-SAXS results demonstrated that in the melt-penetrating sample, the degree of orientation in the subskin layer was larger than that in other layers, and confirmed the existence of the shish–kebab structures.