Intravascular ultrasound guided retrograde guidewire true lumen tracking technique for chronic total occlusion intervention

Chronic total occlusion （CTO） occurs in approximately 20% known coronary atherosclerotic lesions, and CTO intervention has become a most challenging work. Although retrograde techniques have been applied and significantly increased the success rate of CTO intervention, there are still some CTOs that cannot be opened.

Nicotine Concentration in Leaves of Flue-cured Tobacco Plants as Affected by Removal of the Shoot Apex and Lateral Buds

It is believed that the nicotine concentration in tobacco is closely correlated with the amount of nitrogen （N） supplied. On the other hand, N uptake mainly occurs at the early growth stage, whereas nicotine concentration increases at the late growth stage, especially after removing the shoot apex. To identify the causes of the increased nicotine concentration in tobacco plants, and to compare the effects of different ways of mechanical wounding on nicotine concentration, field experiments were carried out in Fuzhou, Fujian Province in 2003 and 2004. Excision of the shoot apex had almost no influence on N content in the plant; however, it caused dramatic increases in nicotine concentration in leaves, especially in the middle and upper leaves. An additional increase of the nicotine concentration was obtained by removal of axillary buds. The wounding caused by routine leaf harvests, however, did not change the leaf nicotine concentration, and neither did reducing leaf harvest times. The present results revealed no direct relationship between N supply and nicotine concentration in tobacco leaves, and indicate that not all kinds of mechanical wounding were capable of stimulating nicotine synthesis in tobacco plants. Since nicotine production is highly dependent on the removal of apical meristems and hence on the major sources of auxin in the plant, and application of 1-naphthylacetic acid onto the cut surface of the stem after removing the shoot apex markedly decreased the nicotine concentration in different leaves and the total nicotine content in the plant, the results suggest that decreased auxin supply caused by removal of the shoot apex as a kind of mechanical wounding might regulate nicotine synthesis in the roots of tobacco plants.

Intensified Antiplatelet Treatment Reduces Major Cardiac Events in Patients with Clopidogrel Low Response： A Meta-analysis of Randomized Controlled Trials

Background：Clopidogrel low response （CLR） is an independent risk factor of adverse outcomes in patients undergoing percutaneous coronary intervention （PCI）,and intensified antiplatelet treatments （IAT） guided by platelet function assays might overcome laboratory CLR.However,whether IAT improves clinical outcomes is controversial.Methods：Relevant trials were identified in PubMed,the Cochrane Library,and the Chinese Medical Journal Network databases from their establishment to September 9,2014.Trials were screened using predefined inclusion criteria.Conventional meta-analysis and cumulative meta-analysis were performed using the Review Manager 5.0 and STATA 12.0 software programs.Results：Thirteen randomized controlled trials involving 5111 patients with CLR were recruited.During a follow-up period of 1-12 months,the incidences of cardiovascular （CV） death,nonfatal myocardial infarction （MI）,and stent thrombosis were significantly lower in the IAT arm than in the conventional antiplatelet treatment arm （relative risk [RR] =0.45,95% confidence interval [CI]：0.36-0.57,P 〈 0.000,01）,whereas bleeding was similar between the two arms （RR =1.05,95% CI：0.86-1.27,P =0.65）.Conclusions：IAT guided by platelet function assays reduces the risk of CV death,nonfatal MI,and stent thrombosis （ST） without an increased risk of bleeding in patients undergoing PCI and with CLR.

A correlation between acute kidney injury and myonecrosis after scheduled percutaneous coronary intervention

Slight elevations in cardiac troponin I and T are frequently observed after percutaneous coronary inter- vention （PCI）. Contrast-induced acute kidney injury （CI-AKI） is a complex syndrome induced by exposure to in- travascular contrast media （CM）. Currently, the relationships between the CM, pre-existing kidney insufficiency, CI-AKI and myonecrosis after elective PCI are unclear. To investigate the relationship between CI-AKI and post-procedural myonecrosis （PMN） after PCI, we analyzed 327 non-ST-segment elevation acute coronary syndrome subjects un- dertaking elective PCI. The levels of cardiac troponins （cTns）, cTnl and cTnT, at baseline and on at least one occasion 18-24 h after PCI were measured. We also recorded serum levels of creatinine （SCr） and the urine albumin：creatinine ratio （ACR） before coronary angiography, and 24-48 h and 48-72 h after contrast administration. A post-procedure increase in cTns was detected in 16.21% （53/327） of subjects with cTns levels 〉99th to 5x99th percentile upper ref- erence limit （URL）. Twenty-seven patients （8.26%） developed CI-AKI. CI-AKI occurred more often in subjects with PMN than in those without PMN （20.8% versus 5.8%, respectively, /〉=-0.001）. Multiple logistic regression analysis revealed that pre-existing microalbuminuria （MA） was an important independent predictor of PMN （OR： 3.31; 95% CI： 1.26-8.65, P=0.01）. However, there was no correlation between the incidence of CI-AKI and PMN （OR： 2.38; 95% CI： 0.88-6.46, P=-0.09）. We conclude that pre-existing MA was not only an important independent predictor of CI-AKI but also of PMN.