Prognostic relevance of ventricular arrhythmias in surgical patients with gastrointestinal tumors

BACKGROUND Individuals diagnosed with gastrointestinal tumors are at an increased risk of developing cardiovascular diseases.Among which,ventricular arrhythmia is a prevalent clinical concern.This suggests that ventricular arrhythmias may have predictive value in the prognosis of patients with gastrointestinal tumors.AIM To explore the prognostic value of ventricular arrhythmias in patients with gastrointestinal tumors receiving surgery.METHODS We retrospectively analyzed data from 130 patients undergoing gastrointestinal tumor resection.These patients were evaluated by a 24-h ambulatory electrocardiogram(ECG)at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to June 2020.Additionally,41 general healthy age-matched and sexmatched controls were included.Patients were categorized into survival and non-survival groups.The primary endpoint was all-cause mortality,and secondary endpoints included major adverse cardiovascular events(MACEs).RESULTS Colorectal tumors comprised 90%of cases.Preoperative ambulatory ECG monitoring revealed that among the 130 patients with gastrointestinal tumors,100(76.92%)exhibited varying degrees of premature ventricular contractions(PVCs).Ten patients(7.69%)manifested non-sustained ventricular tachycardia(NSVT).The patients with gastrointestinal tumors exhibited higher PVCs compared to the healthy controls on both conventional ECG[27(21.3)vs 1(2.5),P=0.012]and 24-h ambulatory ECG[14(1.0,405)vs 1(0,6.5),P<0.001].Non-survivors had a higher PVC count than survivors[150.50(7.25,1690.50)vs 9(0,229.25),P=0.020].During the follow-up period,24 patients died and 11 patients experienced MACEs.Univariate analysis linked PVC>35/24 h to all-cause mortality,and NSVT was associated with MACE.However,neither PVC burden nor NSVT independently predicted outcomes according to multivariate analysis.CONCLUSION Patients with gastrointestinal tumors exhibited elevated PVCs.PVCs>35/24 h and NSVT detected by 24-h ambulatory ECG were prognostically significant but were not found to be independent predictors.

Effects of NLRP3 Inflammasome Mediated Pyroptosis on Cardiovascular Diseases and Intervention Mechanism of Chinese Medicine

Activation of the NOD-like receptor protein 3(NLRP3)inflammasome signaling pathway is an important mechanism underlying myocardial pyroptosis and plays an important role in inflammatory damage to myocardial tissue in patients with cardiovascular diseases(CVDs),such as diabetic cardiomyopathy,ischemia/reperfusion injury,myocardial infarction,heart failure and hypertension.Noncoding RNAs(nc RNAs)are important regulatory factors.Many Chinese medicine(CM)compounds,including their effective components,can regulate pyroptosis and exert myocardium-protecting effects.The mechanisms underlying this protection include inhibition of inflammasome protein expression,Toll-like receptor 4–NF-κB signal pathway activation,oxidative stress,endoplasmic reticulum stress(ERS),and mixed lineage kinase 3 expression and the regulation of silent information regulator 1.The NLRP3 protein is an important regulatory target for CVD prevention and treatment with CM.Exploring the effects of the interventions mediated by CM and the related mechanisms provides new ideas and perspectives for CVD prevention and treatment.

Sleep conditions and quality of life among patients with ischemic heart disease after elective percutaneous coronary intervention

In Japan, percutaneous coronary intervention (PCI) is a major therapeutic intervention for ischemic heart disease (IHD). Previous studies suggested that an association of the risk of IHD caused by sleep duration was related to factors closely associated with daily activities. However, in Japan, there is no study about this relationship objectively measured using the actigraphy in patients with IHD. Moreover, there is little reported data about sleep condition and early outcomes of patient’s Health-Related Quality of Life (QOL) after PCI. This study determines the correlations between sleep conditions and QOL (measured by SF36 version 2) of 25 patients with IHD who underwent elective PCI. Data were collected seven days after PCI using night-sleep condition. Using Spearman’s rank test, the results revealed positive correlation between vitality score and longest sleep duration (ρ = 0.43, p = 0.031): social functioning (SF) score and duration of night-time sleep (ρ = 0.42, p = 0.037);total sleep duration (ρ = 0.45, p = 0.026), and longest sleep duration (ρ = 0.44, p = 0.024);mental health score and longest sleep duration (ρ = 0.54, p = 0.006). However, negative correlation was found between physical functioning score and arousal during sleep (ρ = -0.44, p = 0.027). Sleep condition was significantly correlated with QOL. In particular, SF score was positively related to night-time sleep. This seems to indicate that SF score might be related to night-time sleep condition. Moreover, the longest sleep durations were correlated with the mental component summary. The results of the study suggest that not only the length of whole sleep durations leads to better QOL, but also the increase the amount of uninterrupted sleep.

Plasma HGF and OPN as Potential Biomarkers of Pulmonary Arterial Hypertension in Congenital Heart Disease

Objectives:Pulmonary arterial hypertension in congenital heart disease(PAH-CHD)is the most common type of PAH and increases morbidity and mortality in patients with CHD.Right heart catheterization(RHC)is the standard method to diagnose PAH.However,RHC is an invasive and complicated method with relatively high cost.Noninvasive,feasible,and cost-efficient methods are urgently needed.The objective of this study was to evaluate three potential biomarkers of PAH-CHD:Hepatocyte growth factor(HGF),osteopontin(OPN),and suppression of tumorigenicity 2(ST2).Methods:Plasma samples were collected from patients with CHD(n=46)and healthy individuals(n=22)and divided into four groups according to the severity of PAH.The levels of HGF,OPN,and ST2 were then analyzed using an enzyme-linked immunosorbent assay.Correlations between HGF,OPN,ST2,and clinical parameters of PAH-CHD were analyzed.Results:The plasma HGF levels in the moderate to the severe group were significantly higher than those in the mild group,nonPAH group,and healthy control group(p<0.05).Derived from a receiver operating characteristic(ROC)curve analysis,a cut-off value of 356.75 ng/ml for the HGF concentration was able to predict PAH-CHD with 53%sensitivity and 89%specificity.The HGF level was positively related to pulmonary arterial systolic pressure(PASP)(r=0.36,p<0.05)and pulmonary vascular resistance(PVR)(r=0.36,p<0.05).Plasma OPN levels in the mild group were significantly higher than other groups and positively correlated with the pulmonary-systemic shunt ratio(Qp/Qs)(r=0.33,p<0.05).There was no statistically significant between-group difference in plasma soluble ST2(sST2)levels.Conclusion:The plasma HGF level was elevated in PAH-CHD patients and can be used as a potential biomarker.The plasma OPN level was positively correlated with the Qp/Qs.

Generalization of integral inequalities and (c_1,c_1) stability of neutral differential equations with time-varying delays

A uniform stability analysis is developed for a type of neutral delays differential equations which depend on more general nonlinear integral inequalities. Many original investigations and results are obtained. Firstly, generations of two integral nonlinear inequalities are presented, which are very effective in dealing with the complicated integro-differential inequalities whose variable exponents are greater than zero. Compared with existed integral inequalities, those proposed here can be applied to more complicated differential equations, such as time-varying delay neutral differential equations. Secondly, the notions of (ω, Ω) uniform stable and (ω, Ω) uniform asymptotically stable, especially (c1, c1) uniform stable and (c1, c1) uniform asymptotically stable, are presented. Sufficient conditions on about (c1, c1) uniform stable and (c1, c1) uniform asymptotically stable of time-varying delay neutral differential equations are established by the proposed integral inequalities. Finally, a complex numerical example is presented to illustrate the main results effectively. The above work allows to provide further applications on the proposed stability analysis and control system design for different nonlinear systems. © 2017 Beijing Institute of Aerospace Information.

Aneurysm Resection and Vascular Reconstruction for True Aneurysm at the Initial Segment of Splenic Artery

The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography（CT） and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10–14 days after operation. A 1–14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery.

Peroxisome Proliferator-activated Receptor-γ2 Pro12Ala and C-689T Polymorphisms and Haplotypes Affect the Profiles of Coronary Heart Disease in Diabetic Chinese People

Objectives Peroxisome proliferator-activated receptor-γ2（PPARγ2） variant Pro12Ala was demonstrated with risk of coronary heart disease （CHD） and type 2 diabetes mellitus （T2DM）. Another variant C-689T in the promoter was reported with lower receptor activity but lack of reports on association between C-689T and CHD or T2DM. Methods A total of 351 subjects without CHD and T2DM （controls） and 125 patients with CHD and T2DM （cases） were enrolled in our case-control study. Polymerase chain reaction-restricted fragments length polymorphism （PCR-RFLP） was used to detect Pro12Ala and C-689T polymorphisms. And effects on CHD merged with T2DM of the two polymorphisms were analyzed in individual and haplotype analyses. Results In the study, Pro12Pro, Pro12Ala and Ala12Ala genotype frequencies were 92.9%, 6.8% and 0.3% in controls; 92.8%, 7.2% and 0.0% in cases respectively whilst CC, CT and TT genotype frequencies were 93.4%, 6.3% and 0.3% in controls; 92.8%, 7.2% and 0.0% in cases respectively. Pro12Ala and C-689T polymorphisms were in strong linkage disequilibrium （D＇=0.81, P=0.000） and the observed haplotype frequency of Pro-C, Pro-T, Ala-C and Ala-T was 0.957, 0.006, 0.008 and 0.028 respectively. No significant associations were detected between the two polymorphisms and CHD merged with T2DM in either individual or haplotype analyses. In subjects with obesity [body mass index （BMI）≥25 kg/m^2], we found that both Pro12Ala and C-689T polymorphisms were associated with BMI. In haplotype analyses, we found that Pro12Ala and C-689T haplotypes had associations with systolic blood pressure in total population, with BMI, waist circle and total cholesterol（TC） in obesity subgroup and with fasting blood glucose and TC in males. Conclusions PPARγ2 Pro12Ala and C-689T polymorphisms and haplotypes affect the profiles of CHD merged with T2DM in Chinese Han people.

Progresses in the research of Danhong Injection against the cardial ischemia-referfusion injury

Researches in the field of the myocardial ischemia-reperfusion injury are attracting the attentions of clinicians for the treatments that protect cardiac muscle cells from being injured can not only help the patients get recovery but also keep them in health. By clearing the free radicals and reducing calcium overload of myocardial cell, treatments with Danhong Injection will help myocardial cells survive from inflammatory reactions which are triggered by ischemia reperfusion so as that endothelial function will be improved and myocardial cell apoptosis will be inhibited. In all, Danhong Injection is an ideal medicine for protecting myocardial cell against ischemia reperfusion injury.

A review on function of the Naoxintong Capsule in anti atherosclerosis and protection of vascular endothelium

Atherosclerosis(As) is the common pathological basis of cardiovascular and cerebrovascular diseases, it starts with the injury of vascular endothelial. The Naoxintong Capsule, a modern patent traditional Chinese medicine, is composed of Huangqi, Danshen, Quanxie, Shuizhi and other sixteen herbs. It is extensively used to treat coronary heart disease, stroke and other cardiovascular and cerebrovascular diseases, with the activity of anti-coagulation, anti-inflammatory, protecting endothelial cells, anti-atherogenic and plaque stabilization.

Lyophilized recombinant human brain natriuretic peptide for chronic heart failure:Effects on cardiac function and inflammation

BACKGROUND Chronic heart failure(CHF)is a serious and prevalent condition characterized by impaired cardiac function and inflammation.Standard therapy for CHF has limitations,prompting the exploration of alternative treatments.Recombinant human brain natriuretic peptide(BNP)has emerged as a potential therapy,with evidence suggesting that it can improve cardiac function and reduce inflammation in patients with CHF.However,further research is required to determine the efficacy and safety of lyophilized recombinant human BNP in CHF patients and its impact on microinflammatory status.This study aimed to investigate the effects of lyophilized recombinant human BNP therapy on CHF patients’cardiac function and microinflammatory status.AIM To investigate the effects of freeze-dried recombinant human BNP therapy on cardiac function and microinflammatory status in patients with CHF.METHODS In total,102 CHF patients admitted to our hospital from January 2021 to January 2022 were randomly assigned to control and observation groups(n=51 patients/group).The control patients were treated with standard HF therapy for 3 d,whereas the observational patients were injected with the recombinant human BNP for 3 d.Clinical efficacy,inflammatory factor levels,myocardial damage,cardiac function before and after the treatment,and adverse reactions during treatment were compared between the two groups.RESULTS The overall clinical efficacy was higher in the observation group than in the control group.Compared with baseline,serum hypersensitive C-reactive protein,N-terminal proBNP,and troponin I level,and physical,emotional,social,and economic scores were lower in both groups after treatment,with greater reductions in levels and scores noted in the observation group than in the control group.The overall incidence of adverse reactions in the observation group was not significantly different compared with that in the control group(P>0.05).CONCLUSION Freeze-dried recombinant human BNP therapy can improve heart function and enhance microinflammatory status,thereby improving overall quality of life without any obvious side effects.This therapy is safe and reliable.

Application and Exploration of Big Data Mining in Clinical Medicine

Objective： To review theories and technologies of big data mining and their application in clinical medicine. Data Sources： Literatures published in English or Chinese regarding theories and technologies of big data mining and the concrete applications of data mining technology in clinical medicine were obtained from PubMed and Chinese Hospital Knowledge Database from 1975 to 2015. Study Selection： Original articles regarding big data mining theory/technology and big data mining＇s application in the medical field were selected. Results： This review characterized the basic theories and technologies of big data mining including fuzzy theory, rough set theory, cloud theory, Dempster-Shafer theory, artificial neural network, genetic algorithm, inductive learning theory, Bayesian network, decision tree, pattern recognition, high-performance computing, and statistical analysis. The application of big data mining in clinical medicine was analyzed in the fields of disease risk assessment, clinical decision support, prediction of disease development, guidance of rational use of drugs, medical management, and evidence-based medicine. Conclusion： Big data mining has the potential to play an important role in clinical medicine.

Endovascular pseudoaneurysm repair after distal pancreatectomy with celiac axis resection

Erosive hemorrhage due to pseudoaneurysm is one of the most life-threatening complications after pancreatectomy.Here,we report an extremely rare case of rupture of a pseudoaneurysm of the common hepatic artery(CHA)stump that developed after distal pancreatectomy with en block celiac axis resection(DP-CAR),and was successfully treated through covered stent placement.The patient is a 66-year-old woman who underwent DP-CAR after adjuvant chemoradiotherapy for locally advanced pancreatic body cancer.She developed an intra-abdominal abscess around the remnant pancreas head 31 d after the surgery,and computed tomography(CT)showed an occluded portal vein due to the spreading inflammation around the abscess.Her general condition improved after CT-guided drainage of the abscess.However,19 d later,she presented with melena,and CT showed a pseudoaneurysm arising from the CHA stump.Because the CHA had been resected during the DP-CAR,this artery could not be used as the access route for endovascular treatment,and instead,we placed a covered stent via the inferior pancreaticoduodenal artery originating from the superior mesenteric artery.After stent placement,cessation of bleeding and anterograde hepatic artery flow were confirmed,and the patient recovered well without any further complications.CT angiography at the 6-mo follow-up indicated the patency of the covered stent with sustained hepatic artery flow.To our knowledge,this is the first reported case of endovascular repair of a pseudoaneurysm that developed after DP-CAR.

Identification of prophylaxis and treatment for hospitalized patients associated with venous thromboembolism

To the Editor:Venous thromboembolism(VTE)is a collective term consisting of deep venous thrombosis(DVT)and pulmonary embolism(PE).It is a major worldwide health concern as it affects 5%to 15%of hospitalized patients.Various predisposing factors for VTE occurrence include cancer,surgery,prolonged immobilization,fracture,paralysis,oral contraceptive use,and hereditary coagulopathies.

PTEN-induced putative kinase 1 regulates mitochondrial quality control and is essential for the maturation of human induced pluripotent stem cell-derived cardiomyocytes

Human induced pluripotent stem cell-derived cardiomyocytes(hiPSC-CMs)have attracted attention in the field of regenerative medicine due to their potential ability to repair damaged hearts.However,the immature phenotype of these cells limits their clinical application.Cardiomyocyte maturation is accompanied by changes in mitochondrial quality.PTEN-induced putative kinase 1(PINK1)has been linked to mitochondrial quality control.However,whether the changes in mitochondrial quality in hiPSC-CMs are associated with PINK1,and the impact of PINK1 on hiPSC-CMs development are not clear.In this study,we found that knockdown of PINK1 in hiPSC-CMs resulted in mitochondrial fragmentation and impaired mitochondrial functions such as mitophagy and mitochondrial biogenesis.PINK1 deletion also inhibited the maturation of hiPSC-CMs,reverting them to a naive structural and functional state.We found that restoring the mitochondrial structure did not completely rescue the mitochondrial dysfunction caused by PINK1 deletion,while activation of PINK1 kinase activity using kinetin promoted mitochondrial fusion,increased the mitochondrial membrane potential and ATP production,and maintained the development and maturation of hiPSC-CMs.In conclusion,PINK1 regulates the mitochondrial structure and function of hiPSC-CMs,and is essential for the maturation of hiPSC-CMs.

Experimental drugs for treatment of autoimmune myocarditis

Objective To review the experimental drugs for the treatment of autoimmune myocarditis.Data sources The literatures published in English about different kinds of experimental drugs based on different therapeutic mechanisms for the treatment of autoimmune myocarditis were obtained from PubMed from 2002 to 2013.Study selection Original articles regarding the experimental drugs for treatment of autoimmune myocarditis were selected.Results This study summarized the effects of the experimental drugs for the treatment of autoimmune myocarditis,such as immunomodulators and immunosuppressants,antibiotics,Chinese medicinal herbs,cardiovascular diseases treatment drugs,etc.These drugs can significantly attenuate autoimmune myocarditis-induced inflammation and fibrosis,alleviate autoimmune myocarditis-triggered overt lymphocyte proliferation,and meanwhile reduce Th1 cytokines （IFN-γ and IL-2） and increase Th2 cytokines （IL-4 and IL-10）.Conclusion This study summarized recent advances in autoimmune myocarditis treatment and further proposes that traditional Chinese medicine and immune regulators will play important roles in the future.

Computed Tomography Angiography in Diagnosis and Treatment of Splenic Artery Aneurysm

Splenic artery aneurysm, without obvious symptoms, is a direct threat to the patient＇s life, once it ruptures as hemorrhagic shock.Imaging examinations have been the main diagnostic methods of splenic artery aneurysm, including ultrasound, computed tomography （CT）, magnetic resonance imaging, and digital subtraction angiography （DSA）.Although various inspective methods have their own advantages and disadvantages, abdominal CT examination is the most comprehensively applied method in clinical settings.The representative images of splenic artery aneurysm from a relatively large number of patients examined by CT are presented in this study.

PGC-1α promotes mitochondrial respiration and biogenesis during the differentiation of hiPSCs into cardiomyocytes

Although it is widely accepted that human induced pluripotent stem cell-derived cardiomyocytes(hiPSC-CMs)are readily available,robustly reproducible,and physiologically appropriate human cells for clinical applications and research in the cardiovascular field,hiPSC-CMs cultured in vitro retain an immature metabolic phenotype that limits their application,and little is known about the underlying molecular mechanism controlling mitochondrial metabolic maturation during human induced pluripotent stem cells(hiPSCs)differentiation into cardiomyocytes.In this study,we found that peroxisome proliferator-activated receptor g coactivator-1α(PGC-1α)played an important role in inducing mitochondrial biogenesis and establishing oxidative phosphorylation(OXPHOS)during the cardiac differentiation of hiPSCs.Knocking down PGC-1α by siRNA impaired mitochondrial respiration,while upregulating PGC-1α by ZLN005 promoted mitochondrial biosynthesis and function by regulating the expression of downstream genes involved in mitochondrial dynamics and oxidative metabolism in hiPSCCMs.Furthermore,we found that estrogen-related receptor a(ERRa)was required for the induction of PGC-1α stimulatory effects in hiPSC-CMs.These findings provide key insights into the molecular control of mitochondrial metabolism during cardiac differentiation and may be used to generate more metabolically mature cardiomyocytes for application.

Successful treatment of accessory breast cancer with endocrine therapy

Accessory breast cancers in males are extremely rare, and only a few cases have been reported in the literature. In this paper, an 87-year-old male patient was diagnosed with an accessory breast cancer by means of computed tomography （CT）, magnetic reso- nance imaging （MRI）, positron emission tomography- computed tomography （PET-CT）, and immuno- histochemistry based on needle biopsy, and has un- dergone successful resection and postoperative ad- juvant endocrine therapy. He was the oldest male patient with an accessory breast cancer reported in the Chinese Hospital Knowledge Database and PubMed literature from 1975 to 2015.

Effect of Losartan on the Cardiac and Renal Function in Patients With Chronic Heart Failure

Objectives To explore the effect of losartan on cardiac and renal function in patients with chronic heart failure (CHF). Methods Sixty-five patients with CHF were divided into two groups using a randomized, control and single blind method: losartan group (n=30) and convention group (n=35), with a treatment course of 8 weeks for both groups. The concentrations of cystatin C (cys C) in serum, microamount albumin (MA) in urine were measured by immunoturbidimetry. The concentration of aquaporin-2(AQP-2)was determined by enzyme-linked-immunosorbent assay (ELISA) and the heart contractile function was measured by echocardiography before and after treatment respectively. Results Comparing with routine treatment group, left ventricular end-diastolic dimension (LVEDd) decreased significantly, while left ventricular ejection fraction(LVEF)and left ventricular fractional shortening (LVFS) increased significantly in losartan group. The levels of cys C in serum and MA, AQP-2 in urine were significantly lower in losartan group than in routine treatment group. Conclusion Losartan can improve cardiac and renal function in patients with CHF.

Development of nano t-PA gene coating stent and its preventive effect on dog coronary artery stent thrombosis

Background The regulation of t-PA gene is the essence and core of thrombosis. Therefore, the present study aimed to prepare nano t-PA gene coated stent and to observe its effect on coronary stent thrombosis in dogs.Methods Highly expressed t-PA gene plasmid was constructed and albumin nano t-PA gene coating stent was prepared. The major branch vessels of dog coronary artery were pre-expanded with a 3.0 mm×20 balloon with 8-10 atmospheric pressure. 10 dogs of the control group were implanted with bare metal stent; while 12 dogs of the experimental group were implanted with nano t-PA gene coating stent. Both groups were not given anti-coagulation treatments. Blood samples were taken for t-PA and D-dimer before the operation, at 1,2,4 and 8 weeks after operation. Pathological analysis found thrombosis in the cavity and the hyperplasia of the intima. t-PA expression was detected by immunohistochemical indirectly, and the thickness of the intima of the section cross was directly measured by morphometry. Liver, heart, kidneys and lung were taken for pathological observation. Results All experimental animals survived at postoperative 8 weeks. Vascular stent thrombosis was seen in 10 cases of the control group with the thrombosis rate of 100%; while was seen in 2 cases among 12 cases of the experimental group with the thrombosis rate was 16.67%（P=0.00087）. Immunohistochemical staining showed that the positive t-PA gene transfection of the experimental group was mainly distributed on the surface of hyperplasia intima, and vascular wall t-PA expression of the control group was negative. Positive t-PA signal was not found in the liver,heart, kidneys and lung. Conclusion Nano t-PA gene vector coating stent can effectively express t-PA in vascular wall and effectively prevents stent thrombosis.