Differential cognitive responses to guqin music and piano music in Chinese subjects： an event-related potential study

Objective To compare the cognitive effects of guqin （the oldest Chinese instrument） music and piano music. Methods Behavioral and event-related potential （ERP） data in a standard two-stimulus auditory oddball task were recorded and analyzed. Results This study replicated the previous results of culture-familiar music effect on Chinese subjects： the greater P300 amplitude in frontal areas in a culture-familiar music environment. At the same time, the difference between guqin music and piano music was observed in NI and later positive complex （LPC： including P300 and P500）： a relatively higher participation of right anterior-temporal areas in Chinese subjects. Conclusion The results suggest that the special features of ERP responses to guqin music are the outcome of Chinese tonal language environments given the similarity between Guqin＇s tones and Mandarin lexical tones.

Relationship between age of pregnant women with gestational diabetes mellitus and mode of delivery and neonatal Apgar score

BACKGROUND Gestational diabetes mellitus(GDM)refers to abnormal glucose tolerance during pregnancy,and it is often accompanied by obvious changes in glucose and lipid metabolism,and associated with adverse pregnancy outcomes.The incidence of fetal distress,polyhydramnios,puerperal infection,premature delivery,and macrosomia in pregnant women with GDM are higher than in those without GDM.AIM To analyze the relationship between age of pregnant women with GDM and mode of delivery and neonatal Apgar score.METHODS A total of 583 pregnant women with GDM who delivered in the Department of Obstetrics at our hospital between March 2019 and March 2022 were selected.Among them,377 aged<35 years were selected as the right age group and 206 aged>35 years were selected as the older group.The clinical data of the two groups were collected,and the relationship between age of the pregnant women with GDM and mode of delivery,maternal and neonatal outcomes,and neonatal Apgar score were compared.In the older group,159 women were classed as the adverse outcome group and 47 as the good outcome group according to whether they had adverse maternal and infant outcomes.The related factors of adverse maternal and infant outcomes were analyzed through logistic regression.RESULTS The number of women with assisted pregnancy,≤37 wk gestation,≥2 pregnancies,one or more deliveries,and no pre-pregnancy blood glucose screening in the older group were all higher than those in the right age group(P<0.05).The natural delivery rate in the right age group was 40.85%,which was higher than 22.33%in the older group(P<0.05).The cesarean section rate in the older group was 77.67%,which was higher than 59.15%in the right age group(P<0.05).The older group had a higher incidence of polyhydramnios and postpartum hemorrhage,and lower incidence of fetal distress than the right age group had(P<0.05).There was no significant difference in neonatal weight between the two groups(P>0.05).The right age group had higher Apgar scores at 1 and 5 min than the older group had(P<0.05).Significant differences existed between the poor and good outcome groups in age,education level,pregnancy mode,≤37 wk gestation,number of pregnancies,and premature rupture of membranes(P<0.05).Logistic regression showed that age,education level and premature rupture of membranes were all risk factors affecting the adverse outcomes of mothers and infants(P<0.05).CONCLUSION Delivery mode and Apgar score of pregnant women with GDM are related to age.Older age increases the adverse outcome of mothers and infants.

A Multicenter, Randomized, Double-Blind, and Placebo-Controlled Study of the Effects of Tongxinluo Capsules in Acute Coronary Syndrome Patients with High On-Treatment Platelet Reactivity

Background： High platelet reactivity （HPR） during clopidogrel treatment predicts postpercutaneous coronary intervention （PCI） ischemic events strongly and independently. Tongxinluo capsules （TCs） are a traditional Chinese medicine formulation used as antiplatelet treatment. However, its efficacy against HPR is not known. The aim of the present study was to evaluate the effects of TCs in acute coronary syndrome （ACS） patients with HPR. Methods： This multicenter, randomized, double-blind, placebo-controlled study prospectively analyzed 136 ACS patients with HPR who underwent PCI. The patients were enrolled from November 2013 to May 2014 and randomized to receive placebo or TCs in addition to standard dual antiplatelet therapy （DAPT） with aspirin and clopidogrel. The primary end points were the prevalence of HPR at 30 days and the mean change in P2YIz reaction units （PRUs） between baseline and 30 days. Survival curves were constructed with Kaplan-Meier estimates and compared by log-rank tests between the two groups. Results： Both groups had a significantly reduced prevalence of HPR at 30 days versus baseline, but the TC group, compared with the placebo group, had greater reduction （ 15.8% vs. 24.8%, P = 0.013）, especially among patients with one cytochrome P450 2C 19 loss of function （LOF） allele （χ2 = 2.931, P = 0.047）. The TC group also had a lower prevalence of HPR （33.3% vs. 54.2%, t - 5.284, P 0.022） and superior performance in light transmittance aggregometry and higher levels of high-sensitivity C-reactive protein （hsCRP）, but the composite prevalence ofischemic events did not differ significantly （χ2 = 1.587, P = 0.208）. Conclusions： In addition to standard DAPT with aspirin and clopidogrel, TCs further reduce PRU and hsCRP levels, especially in patients carrying only one LOF allele. The data suggest that TCs could be used in combination therapy for ACS patients with HPR undergoing PCI.

Comparison of the Efficacy of Drug-eluting Stents Versus Bare-metal Stents for the Treatment of Left Main Coronary Artery Disease

treatment of left main coronary artery （LMCA） disease in select patients. However, it is unclear whether drug-eluting stents （DESs） have better outcomes in patients with LMCA disease compared with bare-metal stent （BMS） during long-term follow-up in Chinese populations. Methods： From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups： 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events （MACEs）, including cardiovascular （CV） death, myocardial infarction （MI）, and target lesion revascularization （TLR） at 5 years postimplantation. Results： Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE （19.4% vs. 31.8%, P = 0.022）, CV death （7.0% vs. 14.7%, P = 0.045）, and MI （5.4% vs. 12.4%, P = 0.049） than the BMS group. There were no significant differences in the rate of TLR （10.9% vs. 17.8%, P = 0.110） and stent thrombosis （4.7% vs. 3.9%, P = 0.758）. The rates of MACE （80.6% vs. 68.2%, P = 0.023）, CV death （93.0% vs. 85.3%, P - 0.045）, TLR （84.5% vs. 72.1%, P = 0.014）, and MI （89.9% vs. 80.6%, P = 0.029） free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and M1 were 0.41 （95% confidence interval [C/l： 0.21-0.63, P = 0.029） and 0.29 （95% CI： 0.08-0.92, P = 0.037）, respectively. Conelusions： DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.

Safety and Necessity of Antiplatelet Therapy on Patients Underwent Endovascular Aortic Repair with Both Stanford Type B Aortic Dissection and Coronary Heart Disease

Background： Acute aortic dissection is known as the most dangerous aortic disease, with management and prognosis determined as the disruption of the medial layer provoked by intramural bleeding. The objective of this study was to evaluate the safety and necessity of antiplatelet therapy on patients with Stanford Type B aortic dissection （TBAD） who underwent endovascular aortic repair （EVAR）. Methods： The present study retrospectively analyzed 388 patients with TBAD who underwent EVAR and coronary angiography. The primary outcomes were hemorrhage, death, endoleak, recurrent dissection, myocardial infarction, and cerebral infarction in patients with and without aspirin antiplatelet therapy at 1 month and 12 months. Results： Of those 388 patients, 139 （35.8%） patients were treated with aspirin and 249 （64.2%） patients were not treated with aspirin. Patients in the aspirin group were elderly （57.0 ± 10.3 years vs. 52.5 ± 11.9 years, respectively, χ2 = 3.812, P 〈 0.001） and had more hypertension （92.1% vs. 83.9%, respectively, χ2 = 5.191, P = 0.023） and diabetes （7.2% vs. 2.8%, respectively, χ2 = 4.090, P = 0.043） than in the no-aspirin group. Twelve patients （aspirin group vs. no-aspirin group; 3.6% vs. 2.8%, respectively, χ2 = 0.184, P = 0.668） died at 1-month follow-up, while the number was 18 （4.6% vs. 5.0%, respectively, χ2 = 0.027, P = 0.870） at 12-month follow-up. Hemorrhage occurred in 1 patient （Bleeding Academic Research Consortium [BARC] Type 2） of the aspirin group, and 3 patients （1 BARC Type 2 and 2 BARC Type 5） in the no-aspirin group at 1-month follow-up （ χ2 = 0.005, P = 0.944）. New hemorrhage occurred in five patients in the no-aspirin group at 12-month follow-up. Three patients in the aspirin group while five patients in the no-aspirin group had recurrent dissection for endoleak at 1-month follow-up （2.3% vs. 2.2%, respectively, χ2 = 0.074, P = 0.816）. Four patients had new dissection in the no-aspirin group at 12-month follow-up （2.3% vs. 3.8%, respectively, χ2 = 0.194, P = 0.660）. Each group had one patient with myocardial infarction at 1-month follow-up （0.8% vs. 0.4%, respectively, χ2 = 0.102, P = 0.749） and one more patient in the no-aspirin group at 12-month follow-up. No one had cerebral infarction in both groups during the 12-month follow-up. In the percutaneous coronary intervention （PCI） subgroup, 44 （31.7%） patients had taken dual-antiplatelet therapy （DAPT, aspirin ＋ clopidogrel） and the other 95 （68.3%） patients had taken only aspirin. There was no significant difference in hemorrhage （0% vs. 1.1%, respectively,χ2 = 0.144, P = 0.704）, death （4.8% vs. 4.5%, respectively, χ2 = 0.154, P = 0.695）, myocardial infarction （2.4% vs. 0%, respectively,χ2 = 0.144, P = 0.704）, endoleak, and recurrent dissection （0% vs. 3.4%, respectively, χ2 = 0.344, P = 0.558） between the two groups at 12-month follow-up. Conclusions： The present study indicated that long-term oral low-dose aspirin was safe for patients with both TBAD and coronary heart disease who underwent EVAR. For the patients who underwent both EVAR and PCI, DAPT also showed no increase in hemorrhage, endoleak, recurrent dissection, death, and myocardial infarction.

One-year Outcomes in Patients with ST-segment Elevation Myocardial Infarction Caused by Unprotected Left Main Coronary Artery Occlusion Treated by Primary Percutaneous Coronary Intervention

Background： Very few data have been reported for ST-segment elevation myocardial infarction （STEMI） caused by unprotected left main coronary artery （ULMCA） occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention （PCI）. The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion. Methods： From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion （ULMCA-STEMI） who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI （NSTEMI） caused by ULMCA lesion （U LMCA-NSTEMI） who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events （MACEs） in-hospital, at 1 month, and at 1 year. Results： Compared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥Ⅲ （21.2% vs. 3.5%,χ^2= 36.253, P 〈 0.001 ） and cardiac arrest （8.3% vs. 3.5%, χ^2= 5.529, P = 0.019）. For both groups, the proportions of one-year cardiac death in the patients with a post-procedure thrombolysis in myocardial infarction （TIMI） flow grade〈3 were significantly higher than those in the patients with a TIMI flow grade of 3 （STEMI group： 51.7% [ 15/29] vs. 4.1% [ 14/343], P 〈 0.001 ; NSTEM I group： 33.3% [3/9] vs. 13.6% [3/221], P = 0.001; respectively]. Landmark analysis showed that the patients in STEM I group were associated with higher risks of MACE （16.7% vs. 9.1%, P 0.009） and cardiac death （5.4% vs. 1.3%, P- 0.011 ） compared with NSTEMI patients at I month. Meanwhile, in patients with ULMCA, the landmark analysis for incidences of MACE and cardiac death was similar between the STEMI and NSTEMI （all P=0.72） in the intervals of 1-12 months. However, patients who were diagnosed with STEMI or NSTEMI had no significant difference in reinfarction （all P 〉 0.05） and TVR （all P〉 0.05） in the intervals of 0-1 rnonth as well as 1 month to 1 year. The results of Cox regression analysis showed that the differences in the independent predictors for MACE included the variables of Killip class ≥ Ⅲ and intra-aortic balloon pump support for the STEMI patients and the variables of previous MI, ULMCA distal bifurcation, and 2-stent for distal ULMCA lesions for the NSTEMI patients. Conclusions： Compared to the NSTEMI patients, the patients with STEMI and ULMCA lesions still remain at a much higher risk for adverse events at I year, especially on I month. Ira successthl PCI procedure is performed, the 1-year outcomes in those patients might improve.

Short-term Rosuvastatin Treatment for the Prevention of Contrast-induced Acute Kidney Injury in Patients Receiving Moderate or High Volumes of Contrast Media： A Sub-analysis of the TRACK-D Study

Background:Current randomized trials have demonstrated the effects of short-term rosuvastatin therapy in preventing contrast-induced acute kidney injury (CIAKI).However,the consistency of these effects on patients administered different volumes of contrast media is unknown.Methods:In the TRACK-D trial,2998 patients with type 2 diabetes and concomitant chronic kidney disease (CKD) who underwent coronary/peripheral arterial angiography with or without percutaneous intervention were randomized to short-term (2 days before and 3 days after procedure) rosuvastatin therapy or standard-of-care.This prespecified analysis compared the effects of rosuvastatin versus standard therapy in patients exposed to (moderate contrast volume [MCV],200-300 ml,n =712) or (high contrast volume [HCV],≥300 ml,n =220).The primary outcome was the incidence of CIAKI.The secondary outcome was a composite of death,dialysis/hemofiltration or worsened heart failure at 30 days.Results:Rosuvastatin treatment was associated with a significant reduction in CIAKI compared with the controls (2.1％ vs.4.4％,P =0.050) in the overall cohort and in patients with MCV (1.7％ vs.4.5％,P =0.029),whereas no benefit was observed in patients with HCV (3.4％ vs.3.9％,P =0.834).The incidence of secondary outcomes was significantly lower in the rosuvastatin group compared with control group (2.7％ vs.5.3％,P =0.049) in the overall cohort,but it was similar between the patients with MCV (2.0％ vs.4.2％,P =0.081) or HCV (5.1％ vs.8.8％,P =0.273).Conclusions:Periprocedural short-term rosuvastatin treatment is effective in reducing CIAKI and adverse clinical events for patients with diabetes and CKD after their exposure to a moderate volume of contrast medium.

Correlation between Sex and Prognosis of Acute Aortic Dissection in the Chinese Population

Background： The prevalence, presentation, management, and prognosis of coronary heart disease differ according to sex. Greater understanding on the differences between men and women with acute aortic dissection （AAD） is needed. We aimed to investigate whether sex disparities are found in patients with AAD, and to study sex differences in complications, mortality in-hospital, and tong-term. Methods： We included 884 patients enrolled in our institute between June 2002 and May 2016. Considering psychosocial factors, treatments, and the outcomes in men versus those in women with AAD, we explored the association of sex with psychosocial characteristics and mortality risk. For categorical variables, significant differences between groups were assessed with the Chi-square test or Fisher＇s exact test, and continuous parameters were assessed with Student＇s t-test. Univariate and stratified survival statistics were computed using Kaplan-Meier analysis. Results： A total of 884 patients （76.1% male, mean age 51.4 ± 11.8 years） were inchidcd in this study. There were fewer current smokers in female compared with male （ 17.5% vs. 67.2%,χ^2= 160.06, P〈 0.05）. The percentage of men who reported regular alcohol consumption was significantly higher than that in women （40.6% vs. 3.8%, χ^2== 100.18, P 〈 0.05）. About 6.2% （55 of 884） of patients with AAD died before vascular or endovascular surgery was performed, 34.4% （304 of 884） of patients underwent surgical procedures, and 52.7% （466 of 884） and 12.8% （113 of 884） of patients received endovascular treatment and medication, Postoperative mortality similar （6.0% vs. 5.6%, respectively, χ^2= 0.03, P = 0.91） between men and women. Follow-up was completed in 653 of 829 patients （78.8%）. Adjustment for age, history of coronary disease, hypertension, smoking and drinking, Type A and use of beta-blocker, angiotensin II receptor blockers, angiotensin converting enzyme （ACE） inhibitor, calcium-channel blockers and statins by multivariate logistic regression analysis suggested that age （odds ratios [ORs], 1.04; 95% confidence interval [CI], 1.01-1.07; P 〈 0.05）, using of calcium-channel blockers （OR, 0.37： 95% CI, 0.18-0.74; P 〈 0.05）, at discharge were independent predictors of late mortality, ACE inhibitors （OR, 1.91： 95% CI, 1.03-3.54： P = 0.04） was independent risk factor of late mortality.Conclusions： In Chinese with AAD, sex is not independently associated with long-term clinical outcomes. Age, the intake of calcium-channel blockers at discharge might help to improve long-term otitcomes.