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Background Mean arterial pressure (MAP) is a predictor of all-cause and cardiovascular disease (CVD) mortality in middle-aged population and elderly, but less evidence has been shown in young adults. Objectives We examined the associations of MAP with all-cause and CVD mortality in young adults aged between 18 and 40 years. Methods Data were from the National Health and Nutrition Examination Survey (1999–2006) and participants were followed up to 31 December 2015. MAP was categorised by quartiles. Multivariable Cox proportional hazards models and Kaplan-Meier survival curves were performed to estimate the association between MAP, all-cause and CVD mortality. Results There were a total of 8356 (4598 women (55.03%)) participants with the mean age of 26.63±7.01 years, of which 265 (3.17%) and 10 (0.12%) cases of all-cause and cardiovascular mortality occurred during a median follow-up duration of 152.96±30.45 months, respectively. There was no significant difference in the survival rate by MAP quartiles (p=0.058). When MAP was treated as a continuous variable, the multivariable adjusted HRs for all-cause and CVD mortality were 1.00 (95% CI 0.96 to 1.04; p=0.910) and 0.94 (95% CI 0.77 to 1.14; p=0.529), respectively. When using the lowest quartile (Q1) as referent, the adjusted HRs for all-cause mortality from Q2 to Q4 were 1.16 (95% CI 0.56 to 2.42), 1.06 (95% CI 0.48 to 2.32) and 0.91 (95% CI 0.37 to 2.24; p for tend was 0.749) after adjusting for potential confounders. Conclusion There was no significant association of MAP with all-cause and CVD mortality in young adults with a relatively short follow-up time.

Osteoarthritis (OA) is a clinical disease which seriously affects the quality of life of sufferers. Although the pathogenesis of OA has not been fully unraveled, it is may be due to increased levels of pro-inflammatory cytokines, activation of inflammation-related signaling pathways, and degradation of extracellular matrix. Osteoarthritis is characterized by chronic joint pain, swelling, stiffness, limited movement or joint deformity, all of which seriously affect the quality of life and health of the affected individuals. Myroside (Myr) is a polyphenolic hydroxyflavone glycoside extracted from the fruits, bark and leaves of myroside and other natural plants. It has many pharmacological properties, especially anti-inflammatory effects. In the present study, primary chondrocytes of IL-1β rats were used to simulate pathological environment of chondrocytes in OA, and to explore the effect of Myr on chondrocytes. It was found that Myr improved the viability and proliferation of chondrocytes, and also inhibited apoptosis in these cells. Moreover, Myr reduced the expressions of inflammatory factors, and inhibited inflammatory reactions in chondrocytes. These findings provide good experimental basis for the clinical application of Myr in the prevention and treatment of progressive degeneration of cartilage in OA.

Background Hand injury is commonly associated with multiple soft tissue defects. Polyfoliate flaps grafting is the optimal approach for multiple wounds.The feasibility of clinical using of free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand needs to be confirmed in clinical practice. Methods Fifteen patients with hand soft tissue defects that were repaired using free thoracodorsal artery polyfoliate perforator flaps from January 2015 to February 2018 was retrospectively analysed. The survival rate, the operative time, the appearance and sensory recovery of the flaps, and hand function were evaluated. Results The flaps of all 15 patients survived. Vascular crisis occurred in one patient, and the flap was saved after exploratory operation. The 15 patients were followed up for 12–26 months. Sensation in the flaps was partially recovered in all 15 patients. The wound in the donor area was closed directly with sutures. Mean score of scars at the donor site were assessed using the modified Vancouver scar scale (VSS) was 2.7. A puffed appearance in the recipient area was noted in four patients. To obtain a more satisfactory appearance, revision of the flap was performed once in these four patients. The Total Active Movement (TAM) evaluation system was used to assess the results, which were considered excellent in seven patients, good in six patients, fair in two patients, and poor in none of the patients. Ten of the 15 patients returned to their primary jobs. Conclusion Free thoracodorsal artery polyfoliate perforator flaps are appropriate for repairing multiple soft tissue defects in the hand, offer a satisfactory appearance, require a short operative time, and have little impact on the function and aesthetics of the donor site.

Background A simple clinical model that can predict all-cause mortality in the middle-aged and older adults in general population based on demographics and physical measurement indicators. The aim of this study was to develop a simple nomogram prediction model for all-cause mortality in middle-aged and elderly general population based on demographics and physical measurement indicators. Methods This was a prospective cohort study. We used data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES), which included adults aged ≥40 years with mortality status updated through 31 December 2015. Cox proportional hazards regression, nomogram and least absolute shrinkage and selection operator (LASSO) binomial regression model were performed to evaluate the prediction model in the derivation and validation cohort. Results A total of 13,026 participants (6,414 men, mean age was 61.59±13.80 years) were included, of which 6,671 (3,263 men) and 6,355 (3,151 men) were included in the derivation cohort and validation cohort, respectively. During an average follow-up period of 129.23±9.62 months, 4,321 died. We developed a 9-item nomogram mode included age, gender, smoking, alcohol intake, diabetes, hypertension, marriage status, education and poverty to income ratio (PIR). The area under the curve (AUC) was 0.842 and had good calibration. Internal validation showed good discrimination of the nomogram model with AUC of 0.849 and good calibration. Application of the LASSO regression model in the validation cohort also revealed good discrimination (AUC =0.854) and good calibration. A time-dependent and optimism-corrected AUC value for the model showed no significant relationship with the change of follow-up time. Conclusions A simple nomogram model, including age, gender, smoking, alcohol intake, diabetes, hypertension, marriage, education and PIR, could predict all-cause mortality well in middle-aged and elderly general population.

Background/Aims: Although it is widely acknowledged that atherosclerosis is mainly a chronic inflammatory process, in which both miR-29b and interleukin-6 (IL-6) play multifaceted roles, the association between miR-29b and IL-6 remains unknown. The aim of the present study was to explore the relationship between miR-29b and IL-6 and to test whether circulating levels of miR-29b and IL-6 could predict atherosclerosis. Methods: A total of 170 participants were divided into two groups according to carotid intima-media thickness (CIMT): study group (CIMT ≥ 0.9mm) and control group (CIMT < 0.9mm). Levels of circulating miR-29b and IL-6 were measured by quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. The association of miR-29b and IL-6 levels with CIMT was assessed using Spearman correlation analysis and multiple linear regression analysis. Results: The study group showed higher miR-29b levels (31.61 ± 3.05 vs. 27.91 ± 1.71 Ct, p < 0.001) and IL-6 levels (3.40 ± 0.67 vs. 2.99 ± 0.37 pg/ml, p < 0.001), compared with the control group. CIMT was positively correlated with miR-29b (r = 0.587, p < 0.001) and IL-6 (r = 0.410, p < 0.001), and miR-29b levels were also correlated with IL-6 (r = 0.242, p = 0.001). Multiple linear regression analysis also showed that CIMT was positively correlated with miR-29b and IL-6. After adjustment for age, body mass index, systolic blood pressure, total cholesterol and C-reactive protein, CIMT was still closely correlated with miR-29b and IL-6. The combination of miR-29b and IL-6 (AUC = 0.901, p < 0.001) offered a better predictive index for atherosclerosis than either miR-29b (AUC = 0.867, p < 0.001) or IL-6 (AUC = 0.747, p < 0.001) alone. Conclusion: Circulating levels of miR-29b and IL-6 may be independently correlated with subclinical atherosclerosis, and may serve as novel biomarkers for the identification of atherosclerosis.

Background— Few studies have investigated the safe limits of contrast to prevent contrast-induced nephropathy (CIN) based on hydration data. We aimed to investigate the relative safe maximum contrast volume adjusted for hydration volume in a population with a relatively low risk of CIN. Methods and Results— The ratios of contrast volume-to-creatinine clearance (V/CrCl) and hydration volume to body weight (HV/W) were determined in patients undergoing cardiac catheterization. Receiver–operator characteristic curve analysis based on the maximum Youden index was used to identify the optimal cutoff for V/CrCl in all patients and in HV/W subgroups. Eighty-six of 3273 (2.6%) patients with mean CrCl 71.89±27.02 mL/min developed CIN. Receiver–operator characteristic curve analysis indicated that a V/CrCl ratio of 2.44 was a fair discriminator for CIN in all patients (sensitivity, 73.3%; specificity, 70.4%). After adjustment for other confounders, V/CrCl >2.44 continued to be significantly associated with CIN (adjusted odds ratio, 4.12; P P 12 mL/kg). The best cutoff value for V/CrCl was 1.87 (sensitivity, 67.9%; specificity, 64.4%; adjusted odds ratio, 3.24; P =0.011) in the insufficient hydration subgroup (HV/W, ≤12 mL/kg; CIN, 1.32%) and 2.93 (sensitivity, 69.0%; specificity, 65.0%; adjusted odds ratio, 3.04; P =0.004) in the sufficient hydration subgroup (HV/W, >12 mL/kg; CIN, 5.00%). Conclusions— The V/CrCl ratio adjusted for HV/W may be a more reliable predictor of CIN and even long-term outcomes after cardiac catheterization. We also found a higher best cutoff value for V/CrCl to predict CIN in patients with a relatively sufficient hydration status, which may be beneficial during decision-making about contrast dose limits in relatively low-risk patients with different hydration statuses.

To investigate the influence of albuminuria on clinical outcomes in patients with type 2 diabetes mellitus (T2DM) after elective pecutaneous coronary intervention. We observed 407 patients with T2DM after elective percutaneous coronary intervention (PCI). Patients were divided into three groups

The initial 85 patients who successfully underwent percutaneous mitral valvuloplasty (PMV) with the Inoue balloon catheter at the Guangdong Cardiovascular Institute between November 1985 and November 1988 had a mean follow-up period of 5 +/- 1 year (range 43 to 79 months). Before and after PMV and at follow-up, mean diastolic mitral gradients by the catheter method were 17.5 +/- 6.2, 3.1 +/- 3.3 and 3.3 +/- 3.4 mm Hg, respectively (p0.001 before vs after PMV and before vs follow-up; and p0.05 after PMV vs follow-up). Mean diastolic mitral gradients by the Doppler method were 18 +/- 6, 8 +/- 5 and 9 +/- 5 mm Hg, respectively (p0.001 before vs after PMV and before vs follow-up; and p0.05 after PMV vs follow-up). Mean diastolic mitral gradients by the Doppler method were 18 +/- 6, 8 +/- 5 and 9 +/- 5 mm Hg, respectively (p0.001 before vs after PMV and before vs follow-up; and p0.05 after PMV vs follow-up). Mitral valve areas by the echo-Doppler method were 1.1 +/- 0.3, 2.0 +/- 0.4 and 1.8 +/- 0.5 cm2, respectively (p0.001 before vs after PMV and before vs follow-up; and p0.05 after PMV vs follow-up). Phonocardiographic and vectorcardiographic studies, and cardiopulmonary exercise testing showed significant improvement after PMV and at follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous balloon valvuloplasty has been the accepted first-line treatment for congenital pulmonic stenosis in children. Its efficacy in adolescents and adults is less well defined.Between December 1985 and July 1995 we performed percutaneous pulmonic valvuloplasty with a single Inoue balloon catheter in 53 adolescent or adult patients 13 to 55 years of age (mean [+/- SD], 26 +/- 11). Follow-up studies were performed 0.2 to 9.8 years after the procedure (mean, 6.9 +/- 3.1) by Doppler echocardiography (in all the patients) and by cardiac catheterization and angiography (in nine patients).After balloon valvuloplasty, the systolic pressure gradient across the pulmonic valve decreased from 91 +/- 46 mm Hg to 38 +/- 32 mm Hg (P0.001), and the diameter of the pulmonic-valve orifice increased from 8.9 +/- 3.6 mm to 17.4 +/- 4.6 mm (P0.001). In the nine patients catheterized at follow-up, the systolic gradient decreased from 107 +/- 48 mm Hg before valvuloplasty to 50 +/- 29 mm Hg after valvuloplasty and to 30 +/- 16 mm Hg at follow-up (P0.001 for the comparison of the gradient before and after valvuloplasty; P0.001 for the comparison before valvuloplasty and at follow-up; and P0.05 for the comparison after valvuloplasty and at follow-up). In the same nine patients, the diameter of the pulmonic valve, as measured by right ventricular angiography, increased from 8.3 +/- 1.4 mm before valvuloplasty to 17.2 +/- 2.0 mm after valvuloplasty (P0.001) and to 18.4 +/- 1.4 mm at follow-up (P = 0.08). Incompetence of the pulmonic valve was noted in 7 of the 53 patients (13 percent) after balloon valvuloplasty, but it had disappeared at follow-up in all of them.Patients with congenital pulmonic stenosis who present in late adolescence or adult life can be treated with percutaneous balloon valvuloplasty with excellent short-term and long-term results that are similar to those in young children.

Between November 1985 and December 1991, percutaneous balloon mitral valvuloplasty (PBMV) with the Inoue balloon catheter (Toray Marketing & Sales [America], Inc., New York, N.Y.) was performed in 53 patients with rheumatic mitral stenosis and associated mild to moderate aortic regurgitation. Mean left atrial pressure was 22.5 +/- 8.6 mm Hg and 9.7 +/- 5.5 mm Hg before and after PBMV, respectively (p < 0.001). The mean diastolic mitral gradient as determined by the catheter method decreased from 18.7 +/- 11.4 mm Hg to 2.1 +/- 3.1 mm Hg (p < 0.001). The echocardiographic mitral valve area was 1.0 +/- 0.2 cm2, 2.0 +/- 0.6 cm2, and 1.9 +/- 0.5 cm2, before and after PBMV and at follow-up (p < 0.001 before PBMV vs after PBMV and at follow-up). The mean diastolic mitral gradient as determined by two-dimensional and Doppler echocardiography was 19.3 +/- 8.4 mm Hg, 5.2 +/- 4.1 mm Hg, and 6.6 +/- 3.3 mm Hg, before and after PBMV and at follow-up, respectively (p < 0.001). The phonocardiographic interval between the Q wave and the mitral component of the first heart sound was 85.2 +/- 15.2 msec, 74.2 +/- 13.4 msec, and 72.3 +/- 15.7 msec before and after PBMV and at follow-up (p < 0.001 before PBMV vs after PBMV and at follow-up). The phonocardiographic interval between the aortic second sound and opening snap was 73.4 +/- 18.1 msec, 88.7 +/- 9.6 msec, and 92.1 +/- 11.7 msec before and after PBMV and at follow-up (p < 0.001 before PBMV vs after PBMV and at follow-up). The voltage of P loop in the frontal plane of the vectorcardiogram was 0.25 +/- 0.04 mV, 0.21 +/- 0.04 mV, and 0.20 +/- 0.03 mV before and after PBMV and at follow-up (p < 0.001 before PBMV vs after PBMV and at follow-up). The New York Heart Association classification improved from class II in 26 patients and class III in 27 patients before PBMV to class I in 48 patients and class II in five patients after PBMV. These hemodynamic, noninvasive, and clinical results were not significantly different from those that were obtained in 112 patients with mitral stenosis without associated aortic regurgitation, who were studied during the same period in our cardiac catheterization laboratory. It was concluded that patients with rheumatic mitral stenosis are suitable candidates for PBMV whether or not they have associated aortic regurgitation of mild to moderate degree.

The first 71 patients with rheumatic mitral stenosis who successfully underwent single rubber-nylon balloon (Inoue balloon) percutaneous mitral valvuloplasty (PMV) from November 1985 to August 1988 had a mean follow-up period of 27.1 ± 11.6 months (range, 14 to 48 months). Functional status before PMV was New York Heart Association (NYHA) functional class IV in two, class III in 38, and class II in 31. Pre and post PMV and follow-up mean diastolic mitral gradient by catheter method was 17.5 ± 6.9, 2.7 ± 3.5, and 3.3 ± 3.4 mm Hg ( p p > 0.05 post PMV versus follow-up). By Doppler method the mean diastolic gradient was 17.4 ± 5.5, 8.5 ± 4.7, and 9.2 ± 4.1 mm Hg, respectively ( p p > 0.05 post PMV versus follow-up). Mitral valve area was 1.12 ± 0.26, 2.04 ± 0.41, and 1.92 ± 0.45 cm 2 , respectively ( p > 0.001 pre versus post PMV and pre PMV versus follow-up; and p > 0.05 post PMV versus follow-up). The phonocardiographic and vectorcardiographic studies and cardiopulmonary exercise testing showed significant improvement after PMV and at follow-up. At follow-up the NYHA functional class was I in 57 patients, class II in 13, and class III in one patient with severe mitral valve calcification and subvalvular fusion, in whom restenosis occurred 18 months after PMV. Thus single rubber-nylon balloon PMV can achieve very good short-term and long-term results in relieving symptomatic rheumatic mitral stenosis. Patients with severe mitral calcification and subvalvular fusion do not appear to be good candidates for PMV.