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Objective: This study aims to evaluate the predictive efficacies of 6 established scoring systems for intravenous immunoglobulin (IVIG) resistance to Kawasaki disease (KD) in Chinese children. Methods: We retrospectively analyzed KD patients treated at cardiovascular medical ward in our institution between January 2020 and December 2022. Data were analyzed in 6scoring systems (Egami, Formosa, Harada, Kobayashi, Lan and Yang). Results: We recruited 763 KD patients in our study, including 60 IVIG-resistant cases (7.9%). Our study indicated that IVIG resistance KD patients represent a higher risk of developing coronary arterial lesions (CALs) (P < 0.001). In determining IVIG resistance, the sensitivity and specificity varied among scoring systems (Egami, 33.3% and 87.2%; Formosa, 91.7% and 42.0%; Harada, 76.7% and 42.8%; Kobayashi, 66.7% and 79.2%; Lan, 68.3% and 73.0%; Yang, 65.0% and 76.4%, respectively). Our study discovered that neutrophilic granulocyte percentage (NE%) ≥ 72.3% was an independent risk factor associated with IVIG resistance. Conclusion: The Kobayashi, Lan and Yang scoring systems were shown to be appropriate for determining IVIG resistance in Chinese KD patients. Meanwhile, more consideration should be considered for KD patients with high NE% to reduce IVIG resistance.

It was reported that circular RNA (circRNA) circSMARCA5, as a tumor-related molecule, could modulate development of cancers, including prostatic cancer and cervical cancer. Nevertheless, the essential function of circSMARCA5 in colon cancer has not yet been confirmed. We aimed to investigate the role of circSMARCA5 in colon cancer. CircSMARCA5 expression in tumor cells was detected using RT-qPCR. CCK-8, colony formation, flow cytometry and Transwell assays evaluated the influences of circSMARCA5 in colon cancer cells. RT-qPCR, prediction database and luciferase report assay were accomplished for revealing the correlation between circSMARCA5 and miR-552. After transfection with miR-552 mimic, colon cancer cell behaviors were re-evaluated. Wnt and YAP1 pathways were explored by western blot. Our data presented that circSMARCA5 was under-expressed in colon cancer tissues. Transfection with overexpressing circSMARCA5 plasmid restrained growth, migration and invasion of colon cancer cells. Besides, circSMARCA5 directly sponged to miR-552 and miR-552 up-regulation offset the effects of circSMARCA5 on SW480 and SW620 cells. Furthermore, circSMARCA5 inactivated Wnt and YAP1 pathways by inhibiting miR-552. Anti-tumor role of sircSMARCA5 was showed in colon cancer cells as sponging miR-552 and blocking Wnt and YAP1 pathways.

The imbalance between the anabolism and catabolism of the extracellular matrix (ECM) is of great importance to osteoarthritis (OA) development. Aberrant inflammatory responses and hypertrophic changes of chondrocytes are the main contributors to these metabolic disorders. In the present study, we found that Oroxylin A (ORA), a flavonoid compound derived from Oroxylum indicum, maintained ECM hemostasis of chondrocytes by Interleukin-1β (IL-1β) stimulation. Besides, it was demonstrated that IL-1β induced over-production of inflammatory mediators was attenuated by ORA treatment. Moreover, ORA could rescue IL-1β mediated hypertrophic alterations of chondrocytes. Mechanistically, ORA's protective effects were found to be associated with both NF-κB and Wnt/β-catenin signaling inhibition. Meanwhile, molecular docking analysis revealed that ORA could strongly bind to the inhibitor kappa B kinaseβ (IKKβ) and dishevelled, Dsh Homolog 2 (Dvl2), the upstream molecules of the NF-κB axis and β-catenin axis, respectively. In addition, ORA driven chondroprotective effects were also affirmed in a surgically induced OA mouse model. Taken together, the current study suggested that ORA might be a promising therapeutic option for the treatment of OA.

BACKGROUND The Trial to Assess Chelation Therapy study found that edetate disodium (disodium ethylenediaminetetraacetic acid) chelation therapy significantly reduced the incidence of cardiac events in stable post-myocardial infarction patients, and a body of epidemiological data has shown that accumulation of biologically active metals, such as lead and cadmium, is an important risk factor for cardiovascular disease. However, limited studies have focused on the relationship between angiographically diagnosed coronary artery disease (CAD) and lead exposure. This study compared blood lead level (BLL) in Chinese patients with and without CAD. METHODS In this prospective, observational study, 450 consecutive patients admitted to Beijing Anzhen Hospital with suspected CAD from November 1, 2018, to January 30, 2019, were enrolled. All patients underwent coronary angiography, and an experienced heart team calculated the SYNTAX scores (SXscore) for all available coronary angiograms. BLLs were determined with atomic absorption spectrophotometry and compared between patients with angiographically diagnosed CAD and those without CAD. RESULTS In total, 343 (76%) patients had CAD, of whom 42% had low (0−22), 22% had intermediate (23−32), and 36% had high (≥ 33) SXscore. BLLs were 36.8 ± 16.95 μg/L in patients with CAD and 31.2 ± 15.75 μg/L in those without CAD (P = 0.003). When BLLs were categorized into three groups (low, middle, high), CAD prevalence increased with increasing BLLs (P < 0.05). In the multivariate regression model, BLLs were associated with CAD (odds ratio (OR): 1.023, 95% confidence interval (CI): 1.008−1.039; P = 0.0017). OR in the high versus low BLL group was 2.36 (95% CI: 1.29−4.42,P = 0.003). Furthermore, BLLs were independently associated with intermediate and high SXscore (adjusted OR: 1.050, 95% CI: 1.036–1.066; P < 0.0001). CONCLUSION BLLs were significantly associated with angiographically diagnosed CAD. Furthermore, BLLs showed excellent predictive value for SXscore, especially for complex coronary artery lesions.

Yi-Zi Zheng,1,2 Hong-Bin Qin,1 Zi-Zheng Li,1 He-Sheng Jiang,3 Greg Zhang,4 Shi-Wei Yang,5 Xian-Ming Wang,2 Yang-Chun Xu,1 Zhen-Han Deng,6 Guo-Wen Liu2 1Department of Thyroid and Breast Surgery, The People’s Hospital of Hechi, Hechi, Guangxi, People’s Republic of China; 2Department of Thyroid and Breast Surgery, Shenzhen Breast Tumor Research Center for Diagnosis and Treatment, National Standardization Center for Breast Cancer Diagnosis and Treatment, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, People’s Republic of China; 3Department of Surgery, Oregon Health & Science University, Portland, OR, USA; 4McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA; 5Teaching Office, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, People’s Republic of China; 6Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, People’s Republic of ChinaCorrespondence: Yang-Chun XuDepartment of Thyroid and Breast Surgery, The People’s Hospital of Hechi, Middle 455 Jinchengjiang Road, Hechi, 547000, Guangxi, People’s Republic of ChinaTel/Fax +86-778-2293900Email xuyangchun2010@163.comYi-Zi ZhengDepartment of Thyroid and Breast Surgery, Shenzhen Breast Tumor Research Center for Diagnosis and Treatment, National Standardization Center for Breast Cancer Diagnosis and Treatment, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, 3002 Sungang West Road, Shenzhen, 518035, Guangdong, People’s Republic of ChinaTel/Fax +86-755-83366388Email 14111230029@fudan.edu.cnPurpose: Ductal carcinoma in situ with microinvasion (DCISM) can be challenging to balance the risks of overtreatment versus undertreatment. We aim to identify prognostic factors in patients with DCISM and construct a nomogram to predict breast cancer-specific survival (BCSS).Materials and Methods: A retrospective cohort study of women diagnosed with DCISM from 1988 to 2015 who were identified in the Surveillance, Epidemiology and End Results database. Clinical variables and tumor characteristics were evaluated, and Cox proportional-hazards regression was performed. A nomogram was constructed from the multivariate logistic regression to combine all the prognostic factors to predict the prognosis of DCISM patients at 5 years, 10 years, and 15 years.Results: We identified 5438 total eligible breast cancer patients with a median and max survival time of 78 and 227 months, respectively. Here, patients with poorer survival outcomes were those diagnosed between 1988 and 2001, African-American race, under 40 years of age, higher tumor N stage, progesterone receptor-negative tumor, and received no surgery. The nomogram was constructed by the seven variables and passed the calibration and validation steps. The area under the receiver operating characteristic (ROC) curve (AUC) of both the training set and the validating set (5-year AUC: 0.77 and 0.88, 10-year AUC: 0.75 and 0.73, 15-year AUC: 0.72 and 0.65). Receiving chemotherapy was associated with a better BCSS (hazard ratio, HR=0.45, 95% confidence interval, 95% CI = 0.23– 0.89), especially in patients with estrogen receptor (ER) negative, progesterone receptor (PR) negative (HR = 0.35, 95% CI = 0.13– 0.97) and ER+PR-/ER-PR+ DCISM (HR = 0.07, 95% CI = 0.01– 0.59).Conclusion: Our current study is the first to construct nomograms of patients with DCISM which could help physicians identify breast cancer patients that more likely to benefit from more intensive treatment and follow-up. Chemotherapy might benefit patients with ER-PR- and ER+PR-/ER-PR+ DCISM.Keywords: breast cancer, ductal carcinoma in situ, microinvasion, nomogram, survival

Thoracoscopic left atrial appendage (LAA) occlusion is an alternative treatment for stroke prevention in patients with atrial fibrillation. Prospective study comparing thoracoscopic LAA occlusion and warfarin therapy is still lacking. The goal of this prospective cohort study was to assess the safety and efficacy of thoracoscopic LAA occlusion for stroke prevention in patients with nonvalvular atrial fibrillation compared with long-term warfarin therapy. Four hundred and ninety-two nonvalvular atrial fibrillation patients were enrolled. Two hundred and fifty-seven patients were treated with thoracoscopic LAA occlusion and 235 with long-term warfarin therapy. At 24 months, the rate of the first efficacy endpoint (composite of stroke, systemic embolism, and death) was 0.018 in the surgical group versus 0.043 in the warfarin group (p = 0.033). The rate of the second efficacy endpoint (stroke and systemic embolism excluding the first 7 days after procedure) was 0.010 versus 0.034 (p = 0.019). The rate of the first safety endpoint of bleeding was 0.016 versus 0.044 (p = 0.022). In conclusion, this study showed that thoracoscopic LAA occlusion was superior to warfarin for stroke prevention. The surgical group also had significantly lower bleeding risk. The incidence of surgical complications was low, and all occurred in hospital without causing serious outcomes.

Background To investigate the effects of hypertension on the prevalence of acute coronary syndrome (ACS) and the severity of coronary artery disease in young women in northern China. Methods A retrospective analysis was performed on 840 young female patients (age Results The prevalence of ACS was higher in the hypertension group compared with the control group (80.9% vs. 36.5%, P < 0.05). The rates of hyperlipidemia (37.1% vs. 14.9%), hypercholesterolemia (8.6% vs. 3.4%), hyperuricemia (18.4% vs. 7.2%), and hyperhomocysteinemia (10.9% vs. 3.9%) were all significantly higher in the hypertensives compared with controls (all P < 0.05). The hypertension group had higher rates of overweight (63.7% vs. 29.5%), family history of early coronary heart disease (15.2% vs. 5.5%), smoking (5.5% vs. 4.3%), menopause (4.7% vs. 1.7%), and type 2 diabetes (24.2% vs. 8.9%) compared with the control group (all P < 0.05). Double branch lesions of coronary artery in hypertension and control groups were 14.1% and 5.7%, respectively (P < 0.05). Further, hypertensive patients with ACS had higher number (1.67 ± 1.05 vs. 1.41 ± 0.85) and longer (24.44 ± 6.97 vs. 22.85 ± 7.80 mm) stents implantation than the control group (P < 0.05). Conclusions Hypertension is the main risk factor of ACS in young women in northern China. Young women with hypertension have more risk factors for atherosclerotic cardiovascular disease.

Background: Ductal carcinoma in situ with microinvasion (DCISM) can be challenging to balance the risks of overtreatment versus undertreatment. We aim to identify prognostic factors in patients with DCISM and construct a nomogram to predict breast cancer-specific survival (BCSS).Methods: Women diagnosed with DCISM were selected from the Surveillance, Epidemiology and End Results database (1998-2015). Clinical variables and tumor characteristics were evaluated and Cox proportional-hazards regression model was performed. A nomogram was con­structed from the multivariate logistic regression model to combine all the prognostic factors to predict the prognosis of DCISM patients at 5 years, 10 years, and 15 years. Results: We identified 5,438 total eligible breast cancer patients with a median and max survival time of 78 and 227 months, respectively. Here, patients with poorer survival outcomes were those diagnosed between 1988-2001, African-American race, under 40 years of age, higher tumor N stage, progesterone receptor-negative tumor, and received no surgery (all P < 0.05). The nomogram was constructed by the seven variables and passed the calibration and validation steps. The area under the receiver operating characteristic (ROC) curve (AUC) of both the training set and the validating set (5-year AUC: 0.77 and 0.88, 10-year AUC: 0.75 and 0.73, 15-year AUC: 0.72 and 0.65) demonstrated excellent reliability and robust performance.Conclusion: Our current study is the first to construct nomograms of patients with DCISM which could help physicians identify breast cancer patients that more likely to benefit from more intensive treatment and follow-up.

Aldosterone-producing adenomas (APA) is one of the causative factors of primary aldosteronism. Previous studies have suggested that there are somatic CTNNB1 mutations in APA, but the specific mechanism of CTNNB1 mutation in APA tumorigenesis and aldosterone secretion remains unclear. In the present study, human adrenocortical carcinoma cell line H295 R was used to establish stable CTNNB1 knockdown cell lines. Cell proliferation and aldosterone secretion of H295 R cells in response to angiotensin Ⅱ (Agn Ⅱ) were analyzed. We found that CTNNB1 knockdown reduced β-catenin expression and inhibited proliferation of H295 R cells. CTNNB1 knockdown inhibited Wnt/β-catenin signaling pathway and downregulated expression of downstream genes including axin 2, lymphoid enhancer binding factor 1 ( LEF1), and cyclin D1. In addition, CTNNB1 knockdown decreased responses of H295 R cells to Agn Ⅱ and decreased aldosterone secretion. Our findings suggest that CTNNB1 knockdown can inhibit H295 R cell proliferation and decrease aldosterone secretion in the responses of H295 R cells to Ang II through inhibiting Wnt/β-catenin signaling pathway, indicating that targeting Wnt/β-catenin signaling pathway may be an important approach to decrease aldosterone secretion in the treatment of aldoster-producing adenomas.

To investigate the long-term clinical value of prostate 125I brachytherapy (BT) combined with maximal androgen blockade (MAB) in the treatment of metastatic prostate cancer (mPCa).We retrospectively analyzed the clinical data on 173 cases of mPCa treated by MAB (n = 126) or BT+MAB (n = 47) from December 2011 to December 2016 and followed up for 6－76 (44.17 ± 19.73) months. We compared the PSA level, prostate volume, IPSS, progression-free survival, and the rates of 3- and 5-year overall survival between the two groups.After treatment, the minimum PSA level was significantly lower in the BT+MAB than in the MAB group ［3.77 ± 4.14］ vs ［5.96 ± 7.01］ ng/ml, P = 0.046) and the time to reach the minimum level was shorter in the former than in the latter (［5.19 ± 2.83］ vs ［6.52 ± 3.34］ mo, P = 0.016). The prostate volume was markedly reduced in both of the groups at 1, 3 and 5 years after treatment as compared with the baseline, even more significantly in the BT+MAB than in the MAB group (P0.01), though with no statistically significant difference between the two groups before treatment (P = 0.307). The IPSS was remarkably decreased in both of the groups at 1 and 3 years (P0.01) but showed no significant difference at 5 years after treatment as compared with the baseline (P0.05) or between the two groups before and after treatment (P0.05). The progression-free survival was obviously longer in the BT+MAB than in the MAB group (［37.29 ± 15.73］ vs ［29.41 ± 14.37］ mo, P = 0.011), and the rates of 3- and 5-year overall survival were higher in the former than in the latter (74.60% and 60.70% vs 62.60% and 51.50%, P = 0.227 and P = 0.356). Kaplan-Meier survival curves showed no statistically significant difference in the overall survival between the two groups (P = 0.105).Both MAB and BT+MAB are effective therapies for mPCa, but the latter can achieve a longer progression-free survival.

The association between cardiovascular risk factors (CVRFs) and characteristics of coronary plaque in young patients has remained to be fully elucidated. Therefore, the present study sought to determine the association between CVRFs and phenotypes of culprit coronary plaques revealed by optical coherence tomography (OCT) in young patients with stable coronary heart disease (CHD) and acute coronary syndrome (ACS). OCT imaging pullback was performed at corresponding sites on 123 lesions in 123 young patients (age, 36±7 years), including those with stable CHD and ACS. Patients with analyzable OCT images were classified as having thin-cap fibroatheromas (TCFAs), plaque rupture, macrophage accumulation, calcified nodule, vasa vasorum, cholesterol crystal and erosion. TCFAs were more prevalent in patients with metabolic syndrome (MetS) than in those without MetS (P=0.020). Plaque rupture was more common in smokers than in non-smokers (P=0.002). Multivariate analysis indicated that MetS was independently associated with TCFAs (P=0.041) and smoking was independently associated with plaque rupture (P=0.006). Young patients with MetS were demonstrated to have more extensive TCFAs and young smokers had a higher prevalence of culprit plaque rupture.

We propose a transmitted-type guided-mode resonance (GMR) image system to display refractive index (RI) distribution over the GMR structure using phase values obtained by the five-step phase shift interferometry. The primary result shows that this system can obtain a phase image corresponding to two area with two different material RIs, 1.0 (air) and 1.4 (polymer), respectively, on the GMR device surface and their phase difference is 140°.

Background and aims Familial hypercholesterolemia (FH) is an autosomal dominant disease with widespread global prevalence that partially accounts for the high prevalence of premature coronary heart disease. Although the majority of research on FH has focused on single heterozygous LDLR mutations, there have been limited reports of double LDLR mutations on the same chromosome. The aim of this study was to gain insight into the clinical consequences of the presence of multiple mutations in the LDLR gene. Methods DNA from two clinical homozygous FH patients and their relatives was analysed using targeted exome sequencing and DNA resequencing. Functional characterization of novel variants was performed by Western blot, flow cytometry and confocal microscopy. Results Proband 1 carried p.Q12X, NTDA (p.N276T and c.892delA) mutations in LDLR , and Proband 2 carried c.971delG, GSDN (p.G77S + D601N). Results showed that p.Q12X, c.892delA, and c.971delG are non-functional LDLR variants. Conversely, N276T and G77S are non-pathogenic variants. Interestingly, while D601N alone only slightly diminishes LDLR activity, its co-presence with the non pathogenic p.G77S mutation results in a more strongly pathogenic variant with LDLR activity reduced by 40%. One of the double mutants, NTDA, is as non functional as c.892delA alone. The other double mutant, GSDN, is more severe than either of the component single mutants. Conclusions An early gene screening and laboratory functional verification of LDLR activity is of vital importance to enable a definite FH diagnosis. Functional verification is also necessary for prenatal and postnatal care in patients with FH.

Aims/Introduction The impact of body mass index on mortality among patients with diabetes remains controversial. Therefore, we carried out a meta-analysis of pertinent studies. Materials and Methods We searched OVID/MEDLINE, EMBASE and Cochrane databases for all reported studies, which investigated the relationship between body mass index and mortality in patients with diabetes. Summary estimates of hazard ratios (HRs) were obtained with a random effects model. Univariate meta-regressions were carried out. Results A total of 20 studies including 250,016 patients with diabetes were identified. The results of the present study showed a significantly reduced risk of all-cause mortality in overweight patients (HR 0.82, 95% CI: 0.74–0.91, P < 0.0001, and I2 = 91.6%) as compared with normal weight patients. The survival benefits of obesity were only observed in the elderly patients (HR 0.69, 95% CI: 0.63–0.75, P < 0.0001, and I2 = 50.4%), but not in the younger patients (HR 1.01, 95% CI: 0.84–1.20, P = 0.96, I2 = 80.1%). Furthermore, the beneficial prognostic impacts on overweight (coefficient = 0.030, P = 0.041) and obesity (coefficient = 0.032, P = 0.010) were attenuated with clinical follow-up duration. Conclusions The present meta-analysis showed a significantly lower risk of all-cause mortality in overweight patients with diabetes compared with normal weight patients. However, the survival benefits of obesity were only observed among the elderly patients.

Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease, and optical coherence tomography (OCT) provides detailed microstructural information. The current study was designed to test the hypothesis that markers of plaque vulnerability derived from OCT could predict CAV progression after heart transplantation (HTx).In 34 consecutive patients (median 3.1 years from HTx), intravascular ultrasound (IVUS) and OCT were performed in the left anterior descending artery (LAD) during routine annual coronary angiography. The presence of vulnerability markers, such as lipid pools, thin-cap fibroatheroma, macrophages and microchannels, was assessed in 100 consecutive frames of OCT in 20-mm segments of proximal LAD. The total number of appearances of vulnerable markers was defined as the vulnerability score (VS). Plaque volume (PV) was measured in the same study segment using IVUS at baseline and at 1-year follow-up, and the association between the baseline VS and the subsequent change in percent PV (PV / vessel volume × 100 [%PV]) was evaluated.Follow-up IVUS study was conducted after 12.5 ± 1.3 months. The mean VS was 59.9 ± 44.6. Compared with the initial %PV, the follow-up %PV increased in the study segment (25.6 ± 13.7% to 31.8 ± 17.5%, p0.001). The correlations between baseline VS and Δ%PV were significant in the study segment (r = 0.757, p0.001). On multivariable analysis, only the VS correlated significantly with Δ%PV.Our results demonstrate that the markers of plaque vulnerability in OCT can predict the progression of CAV. Therefore, in patients with HTx, OCT may aid in determining prognosis and guiding therapy related to CAV.

There is increasing evidence implying that the early and functionally highly active circulating endothelial progenitor cell (CEPC) phenotype (CD34-/CD133+/KDR+) with osteogenic potential (OCN+) might link between vascular atherosclerotic calcification and mechanisms of bone metabolism. We sought to evaluate the early OCN+ CEPC counts as an independent biomarker for the severity of coronary artery disease (CAD).Peripheral blood samples were drawn from 593 patients undergoing clinically indicated coronary angiography. CAD severity was assessed by the presence of significant coronary artery stenosis (CAS) as well as an ordinal categorical variable. Subjects were followed for all-cause death over a median follow-up of 40months.OCN+ early CEPC counts (square-root transformed) were independently associated with the presence of significant CAS [odds ratio (OR) per standard deviation (SD) increment: 1.389, 95% confidence interval [CI]: 1.131 to 1.707, p=0.002). Similar association was observed with an increase in levels of CAS (OR: 1.353, 95% CI: 1.157 to 1.582, p0.001). There was a weak tendency between OCN+ early CEPC counts and all-cause mortality (p=0.090), whereas the highest decile of OCN+ early CEPC counts had a 2.991-fold increased risk of all-cause death (p=0.047).We demonstrate for the first time an independent, significant, and strong correlation between OCN+ early CEPC counts and CAD severity. Additionally, very high numbers of OCN+ early CEPC tend to be linked to the risk of all-cause mortality.

Background Infarct-artery (IRA) microvascular obstruction (MVO) is associated with diastolic dysfunction (DD) in STEMI patients. However, association between nonIRA MVO and DD in STEMI patients remains unknown. We hypothesized that revascularized STEMI patients with IRA and nonIRA MVO (IRA + nonIRA+), compared to those without nonIRA MVO (IRA + nonIRA-), have worse DD at presentation and long-term follow-up. Methods 87 IRA-revascularized STEMI patients had cardiac magnetic resonance imaging (MRI) [to evaluate MVO] and TTE (to evaluate diastolic function) within 1 week of presentation. Diastolic function was re-assessed by TTE at 3.97 ± 3.24 years. Baseline and follow-up DD prevalence and grade were studied in IRA + nonIRA + vs. IRA + nonIRA- MVO patients. Results 54 (62%) patients were IRA + nonIRA+ and 33 (38%) IRA + nonIRA-at baseline. IRA + nonIRA + patients had higher DD frequency at baseline (40.7 vs. 6.1%, p = 0.006) and follow-up (50.0 vs. 13.0%, p = 0.05). Only IRA + nonIRA + patients had increase in mitral medial E/e’ (20.0%, p = 0.043) and trend towards increase in mitral E/A (31.1%, p = 0.063) at follow-up. IRA + nonIRA + patients had greater left atrial volume index increase (23.7%, p = 0.032 vs. 15.5%, p = 0.029) and smaller prolongation in deceleration time (15.4%, p = 0.018 vs. 18.7%, p = 0.044) at follow-up compared to IRA + nonIRA-. Grade 1 DD increased (60.9–73.9%) and combined grades 2/3 decreased (30.4–13.0%) at follow-up in IRA + nonIRA-patients. In contrast, grade 1 DD decreased (77.8–61.1%) and combined grades 2/3 increased (8.3–22.2%) at follow-up in IRA + nonIRA + patients. Conclusion Concurrent IRA and nonIRA MVO in revascularized STEMI patients is associated with higher DD prevalence and worse DD grade on long-term follow-up.

OBJECTIVE: To study the clinical effect of psychological and behavioral intervention combined with biofeedback in the treatment of preschool children with attention deficit hyperactivity disorder (ADHD). METHODS: Sixty children each with inattentive, hyperactive/impulsive or combined type ADHD were enrolled. According to the intervention measure, they were randomly divided into 4 groups:control, psychological and behavioral intervention, biofeedback treatment and comprehensive treatment (psychological and behavioral intervention + biofeedback). Attention concentration time and impulse/hyperactivity and hyperactivity index scores of the Conners Parent Symptom Questionnaire (PSQ) were evaluated after 4 months of treatment. RESULTS: The attention concentration time increased in all types children with ADHD after psychological and behavioral intervention, biofeedback treatment or comprehensive treatment (P < 0.05). In children with inattentive ADHD, hyperactive/impulsive ADHD or combined-type ADHD, biofeedback or comprehensive treatment reduced the impulse/hyperactivity index score (P < 0.05). In children with inattentive or combined-type ADHD, psychological and behavioral intervention or comprehensive treatment reduced the hyperactivity index score (P < 0.05). In children with hyperactive/impulsive ADHD, biofeedback treatment, psychological and behavioral intervention or comprehensive treatment reduced the hyperactivity index score (P < 0.05). CONCLUSIONS: In children with ADHD, psychological and behavioral intervention combined with biofeedback treatment can improve the attention concentration and impulsive/hyperactive and hyperactive symptoms. The treatment strategies are slightly different for children with different types of ADHD.

Background FFR of deferred PCI lesions can predict future cardiovascular events. However, the prognostic utility of FFR remains unclear in diabetic patients in view of the potential impact of the diffuse nature of vascular disease process. We aimed to study the relation between fractional flow reserve (FFR) values and long-term outcomes of diabetic and non-diabetic patients with deferred percutaneous coronary intervention (PCI). Methods Patients with FFR assessment and deferred PCI (n=630) were enrolled and stratified according to diabetes mellitus (DM) status and FFR values. Patients were followed over a median of 39months. Cox proportional hazard regression models were used to analyze the association between clinical endpoints and clinical factors such as DM and FFR. Results In non-diabetics (n=450), higher FFR values were associated with less cardiovascular events (hazard ratio (HR) for death and myocardial infarction (MI) [95% confidence interval (CI)], 0.61[0.44 to 0.86] per 0.1 increase in FFR, p=0.007; HR for revascularization [95%CI], 0.66[0.49 to 0.9] per 0.1 increase in FFR, p=0.006). In diabetics (n=180), there was no difference in death and MI across the range of FFR values. Among those patients with an FFR >0.85, diabetics had a more than two-fold higher risk of death and MI than non-diabetics (HR [95% CI], 2.20 [1.19 to 4.01], p=0.015). Conclusion Among non-diabetic patients with deferred PCI, a higher FFR was associated with lower rates of death, MI and revascularization. On the contrary in diabetic patients with deferred revascularization, FFR was not able to differentiate the risk of cardiovascular events.

A 63-year-old male was admitted with subacute anterior ST-elevation myocardial infarction. Cardiac catheterization revealed a subtotal occlusion in the proximal and middle part of left anterior descending coronary artery. Subacute stent thrombosis (SAT) occurred recurrently until the last stent deployment solved the problem of the uncovered artery and distal-stent edge dissection. The patient's SYNTAX score was 19, and percutaneous coronary intervention (PCI) was performed. Unfortunately, SAT occurred recurrently after drug eluting stent implantation. What reason should be responsible for the recurrent SAT, clopidogrel hyporesponse or mechanical factors? All anti-platelet therapy has been tried, but adenosine diphosphate (ADP)-induced platelet aggregation remained hyporesponsive to clopidogrel. The patient has been symptom-free at follow-ups since the fourth PCI solved the problem of the uncovered artery and distal-stent edge dissection.

This Letter proposes the use of a thin-film tunable bandpass filter (TTBF) as an accurate absorption spectral shift detector in surface plasmon resonance (SPR) sensors. The passband central wavelength of the TTBF can be tuned by changing the incident angle. A single TTBF is required to filter two passbands with central wavelengths on the falling and rising curves of the SPR absorption spectrum. The spectral shift can then be converted to the differential intensity change of these two TTBF output beams using the differential detectors to eliminate the common-mode noise. This method can perform a high-resolution sensing for the refractive index change in the SPR sensor surface without using high-performance spectrometers. A grating-coupled SPR sensor was used in the experiment system and achieved a detection resolution of 6.99 × 10 − 6 refractive index unit.

Objective The aim is to evaluate the association between baseline platelet count (PC) and severe adverse outcomes following percutaneous coronary intervention (PCI) in current real-world practice. Methods A total of 18,788 patients underwent PCI with drug-eluting stents constituted the study population. Patients were categorized as having low (< 150 × 1000/µL), normal (150–300 × 1000/µL), and high (≥ 300 × 1000/µL) baseline PC. The primary endpoints included in-hospital and follow-up all-cause mortality. The secondary endpoint was major bleeding requiring a blood transfusion. Results In-hospital mortality rates for patients with low, normal, and high baseline PC were 0.6%, 0.4%, and 0.4%, respectively (P = 0.259). Similarly, mortality rates during long-term follow-up (median 23.8 months) for patients with low, normal, and high baseline PC were 0.9%, 0.6%, and 0.7%, respectively (P = 0.079). After multivariate adjustment, patients with low or high baseline PC tended to have similar risks for both in-hospital and follow-up mortality compared with the normal group. Subgroup analyses failed to demonstrate an independent prognostic value of baseline PC in specific population groups except patients who undwent transfemoral PCI. There was also no significant difference in the incidence of major bleeding requiring a blood transfusion in the low, normal, and high groups (0.5%, 0.3%, and 0.3%, respectively; P = 0.320). After multivariate adjustment, low or high baseline PC did not significantly increase the risk of major bleeding. Conclusion There is no significant association between baseline PC and severe adverse outcomes following PCI in current real-world practice.

To investigate the effect of ATO on the proportion of Treg in the peripheral blood of patients with severe aplastic anemia (SAA) in vitro.The peripheral blood of 20 newlydiagnosed patients were collected, and the peripheral blood monomuclear cells (PBMNC) were extracted. After the PBMNC were treated with ATO of different concentrotions (0, 1, 2.5 and 5 µmol/L) for 96 hours, the proportion of CD44ATO significantly increased the proportion of Treg (P0.01) at the concentration of 2.5 and 5 µmol/L, and the rising degree of Treg proportion improved with the increasing ATO concentration(r= 0.524). Treg proportion increased at a concentration of 1 µmol/L, but without statistical significance (P0.05). At 1(P0.05), 2.5(P0.01) and 5 µmol/L(P0.01), ATO significantly up-regulated the expression of Foxp3 mRNA, and the increase of Foxp3 mRNA positively and linearly correlated with the increase of Treg cell-frequency(r=0.523). ATO significantly reduced the levels of IFN-γ (at ATO 1,2.5 and 5 µmol/L, P0.01), IL-4 (at ATO 2.5 µmol/L, P0.01; at ATO 5 µmol/L, P0.01) and IL-17(at ATO 2.5 µmol/L, P0.05; at ATO 5 µmol/L, P0.01). ATO had no significant effect on TGF-β1 at 1(P0.05) and 2.5 µmol/L (P0.05), but significantly reduced TGF-β1 level at 5 µmol/L (P0.05).ATO can mediate the immune regulation through up-regulating the proportion of Treg in peripheral blood of patients with SAA and reducing the levels of IFN-γ, IL-4 and IL-17.

Mustard tuber wastewater is characterized by high salinity and high organic content that is potentially detrimental to the biological treatment system and affects the treatment efficiency accordingly. The experiment used the integrated bioreactor to reduce much of the organics in mustard tuber wastewater, and found the influence of organic loading rate on effluent chemical oxygen demand (COD) and phosphate (PO4 (3-) -P). Results showed that under the condition of 10-15 °C, 6 mg/L of dissolved oxygen, the reduction value of COD removal rate in anaerobic and aerobic area was 14.5% and 31.7% when the organic loading rate increased from 2.0 to 4.0 kg COD/m(3) /day. Therefore, an integrated bioreactor should take 2.0 kg COD/m(3) /day organic loading rate in mustard wastewater treatment if the effluent is expected to meet the third level of "Integrated Wastewater Discharge Standard" (GB 8978-1996).

Objective Optimal antithrombotic strategy for patients with concomitant coronary artery disease and atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is still controversial, and the role of novel antithrombotic agents has nerve been tested. Therefore, the aim of this study is to evaluate and overall safety and efficacy profile of the combination of rivaroxaban and ticagrelor in this particular population. Design The RT-AF study is an open-label, randomized, active-controlled, multicenter clinical trial with up to 420 subjects enrolled in 5 centers. Eligible patients, who have a history or new onset paroxysmal, persistent, or permanent non-valvular AF, referred to the study centers with indications for PCI will be randomly assigned to receive triple therapy (including warfarin, clopidogrel and aspirin) or dual therapy (rivaroxaban and ticagrelor). All subjects will have clinical follow-up at discharge, at 30 days, 6 months and 12 months. The primary end point is major or clinically relevant non-major bleeding events at 12 months. The major secondary end point is the composite efficacy outcome of death, myocardial infarction, stent thrombosis and ischemic stroke. Conclusion The study will be sufficiently powered to provide data primarily regarding the safety of dual therapy with rivaroxaban and ticagrelor over the traditional triple therapy in patients with AF undergoing PCI at 12 months. It will also provide important information regarding the efficacy of the two different antithrombotic regimens. (ClinicalTrials.gov identifier: NCT02334254 ).

Soil erosion on newly engineered landforms severely threatens the ecological security of construction sites and their surrounding areas. A field scouring-erosion experiment was conducted on a typical spoil heap along the Shenmu–Fugu Expressway in China to investigate the processes of soil erosion by simulated runoff. A 2.5 × 12 m2 runoff plot with 72.7% gradient was established on the spoil heap. Clean water was applied at the top of the plot with five different inflow rates of 0.167 × 10− 3, 0.25 × 10− 3, 0.33 × 10− 3, 0.417 × 10− 3 and 0.5 × 10− 3 m3/s to simulate surface runoff processes. The variation of sediment concentration was greatly influenced by gravitational erosion which occurred at the critical inflow rates ranging from approximately 0.33 × 10− 3 to 0.417 × 10− 3 m3/s. The process of sediment yield on the spoil heap, in terms of sediment transport rate, was characterized by three stages: abruption, fluctuation and stabilization. The spatial distribution of sediment yield in different slope segments at different inflow rates showed two trends: steady decreasing and drastically fluctuated decreasing. The flow over the spoil heap belonged to supercritical flow and the critical inflow rate controlling the transformation from transitional flow to turbulent flow for rill flow was between 0.33 × 10− 3 and 0.417 × 10− 3 m3/s. Statistically, power, exponential and logarithmic-linear equations can be used to describe the interrelations of main hydraulic parameters including flow velocity, Reynolds Number, Froude Number and Darcy–Weisbach roughness coefficient. The three forms of equations were also appropriate for describing sediment concentration in relation to the hydraulic parameters mentioned. Slope length was more significant than inflow rate in affecting hydraulic parameters, which showed an exponential relation with the increase in distance from the top of the plot for all the parameters except Reynolds Number. Stream power was the best hydrodynamic parameter to simulate the changing trend of soil detachment rate. As for different control equations, mechanic parameters and energy parameters had some relative advantages in depicting the dynamic processes of sheet erosion and rill erosion, respectively.