Association of acute glycemic parameters at admission with cardiovascular mortality in the oldest old with acute myocardial infarction

OBJECTIVES Stress-related glycemic indicators,including admission blood glucose(ABG),stress-hyperglycemia ratio(SHR),and glycemic gap(GG),have been associated with worse outcomes after acute myocardial infarction(AMI).However,data regarding their prognostic value in the oldest old with AMI are unavailable.Therefore,this study aimed to investigate the association of stress-related glycemic indicators with short-and long-term cardiovascular mortality(CVM)in the oldest old(≥80 years)with AMI.METHODS In this prospective study,a total of 933 consecutive old patients with AMI admitted to FuWai hospital(Beijing,China)were enrolled.On admission,ABG,SHR,and GG were assessed and all participants were classified according to their quartiles.Kaplan-Meier,restricted cubic splines(RCS),and multivariate Cox regression analyses were performed to evaluate the association between these glycemic indicators and CVM within 30 days and long-term follow-up.RESULTS During an average of 1954 patient-years of follow-up,a total of 250 cardiovascular deaths were recorded.Kaplan-Meier analyses showed the lowest CVM in quartile 1 of ABG and in quartile 2 of SHR and GG.After adjusting for potential covariates,patients in quartile 4 of ABG,SHR,and GG had a respective 1.67-fold(95%CI:1.03-2.69;P=0.036),1.80-fold(95%CI:1.16-2.79;P=0.009),and 1.78-fold(95%CI:1.14-2.79;P=0.011)higher risk of long-term CVM risk compared to those in the reference groups(quartile 1 of ABG and quartile 2 of SHR and GG).Furthermore,RCS suggested a J-shaped relationship of ABG and a Ushaped association of SHR and GG with long-term CVM.Additionally,we observed similar associations of these acute glycemic parameters with 30-day CVM.CONCLUSIONS Our data first indicated that SHR and GG consistently had a U-shaped association with both 30-day and longterm CVM among the oldest old with AMI,suggesting that they may be useful for risk stratification in this special population.

2023 China Guidelines for Lipid Management

Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of death among urban and rural residents in China,and elevated low-density lipoprotein cholesterol(LDL-C)is a risk factor for ASCVD.Considering the increasing burden of ASCVD,lipid management is of the utmost importance.In recent years,research on blood lipids has made breakthroughs around the world,hence a revision of China guidelines for lipid management is imperative,especially since the target lipid levels in the general population vary in respect to the risk of ASCVD.The level of LDL-C,which can be regarded as appropriate in a population without frisk factors,can be considered abnormal in people at high risk of developing ASCVD.As a result,the“Guidelines for the prevention and treatment of dyslipidemia”were adapted into the“China Guidelines for Lipid Management”(henceforth referred to as the new guidelines)by an Experts’committee after careful deliberation.The new guidelines still recommend LDL-C as the primary target for lipid control,with CVD risk stratification to determine its target value.These guidelines recommend that moderate intensity statin therapy in adjunct with a heart-healthy lifestyle,be used as an initial line of treatment,followed by cholesterol absorption inhibitors or/and proprotein convertase subtilisin/kexin type 9(PCSK9)inhibitors,as necessary.The new guidelines provide guidance for lipid management across various age groups,from children to the elderly.The aim of these guidelines is to comprehensively improve the management of lipids and promote the prevention and treatment of ASCVD by guiding clinical practice.

Chinese guideline for lipid management(2023):a new guideline rich in domestic elements for controlling dyslipidemia

Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of death among urban and rural residents in China,and elevated low-density lipoprotein cholesterol(LDL-C)is a causal risk factor for ASCVD.[1,2]Considering the increasing burden of ASCVD,lipid management is of the utmost importance.Within 7 years interval,Chinese guideline for lipid management(2023)(lipid guideline 2023)has simultaneously been published in both Chinese Journal of Cardiology,Chinese Circulation Journal in Chinese language and Frontiers in Pharmacology in English,which has widely been acclaiming at home and abroad.

Clinical and neuroimaging features of enterovirus71 related acute flaccid paralysis in patients with hand-foot-mouth disease

Objective:To investigate clinical and neuroimaging features of enterovirus71(EV71) related acute flaccid paralysis in patients with hand-fool-mouth disease.Methods:Nine patients with acute flaccid paralysis met the criterion of EV71 induced hand-foot-mouth disease underwent spinal and brain MR imaging from May 2008 to Sep 2012.Results:One extremity flaccid was found in four cases(3 with lower limb,1 with upper limb),two limbs flaccid in three cases(2 with lower limbs,1 with upper limbs),and four limbs flaccid in two cases.Spinal MRI studies showed lesion with high signal in T2-weighted images(T2WI) and low signal T1-weighted images(T1WI) in the spinal cord of all nine cases,and the lesions were mainly in bilateral and unilateral anterior hom of cervical spinal cord and spinal cord below thoracic 9(T9) level.In addition,the midbrain,pons, and medulla,which were involved in 3 cases with brainstem encephalitis,demonstrated abnormal signal.Moreover,spinal cord contrast MRI studies showed mild enhancement in corresponding anterior hom of the involved side,and strong enhancement in its ventral root.Conclusions: EV71 related acute flaccid paralysis in patients with hand-foot-mouth disease mainly affected the anterior hom regions and ventral root of cervical spinal cord and spinal cord below T9 level. MR imaging could efficiendy show the characteristic pattern and extent of the lesions which correlated well with the clinical features.

Primary intestinal non-Hodgkin's lymphoma:A clinicopathologic analysis of 81 patients

AIM:To analyze the clinicopathologic features and the prognosis of primary intestinal lymphoma.METHODS:Patients were included in the study based on standard diagnostic criteria for primary gastrointesti-nal lymphoma,and were treated at Sun Yat-sen Univer-sity Cancer Centre between 1993 and 2008.RESULTS:The study comprised 81 adults.The most common site was the ileocaecal region.Twenty-two point two percent patients had low-grade B-cell lym-phoma.Fifty-one point nine percent patients had high-grade B-cell lymphoma and 25.9% patients had T-cell lymphoma.Most patients had localized disease.There were more patients and more early stage diseases in the latter period,and the origin sites changed.The ma-jority of patients received the combined treatment,andabout 20% patients only received nonsurgical therapy.The wverall survival and event-free survival rates after 5 years were 71.6% and 60.9% respectively.The mul-tivariate analysis revealed that small intestine and ileo-caecal region localization,B-cell phenotype,and normal lactate dehydrogenase were independent prognostic factors for better patient survival.Surgery based treat-ment did not improve the survival rate.CONCLUSION:Refined stratification of the patients according to the prognostic variables may allow indi-vidualized treatment.Conservative treatment may be an optimal therapeutic modality for selected patients.

Complications of high intensity focused ultrasound in patients with recurrent and metastatic abdominal tumors

AIM: To analyze the local and systemic complications of high intensity focused ultrasound (HIFU) for patients with recurrent and metastatic abdominal tumors.METHODS: From Aug 2001 to Aug 2004, 17 patients with recurrent and metastatic abdominal tumors were enrolled in this study. Real-time sonography was taken, and vital signs, liver and kidney function, skin burns, local reactions, and systemic effects were observed and recored before, during, and after HIFU. CT and MRI were also taken before and after HIFU.RESULTS: All 17 patients had skin burns and pain in the treatment region; the next common complication was neurapraxia of the stomach and intestines to variable degrees. The other local and systemic complications were relatively rare. Severe complications were present in two patients; one developed a superior mesenteric artery infarction resulting in necrosis of the entire small intestines, and the other one suffered from a perforation in terminal ileum due to HIFU treatment. CONCLUSION: Although HIFU is a one of noninvasive treatments for the recurrent and metastatic abdominal tumors, there are still some common and severe complications which need serious consideration.

Effectiveness of oral motor respiratory exercise and vocal intonation therapy on respiratory function and vocal quality in patients with spinal cord injury:a randomized controlled trial

Singing,as a method of combining respiratory function exercise and vocal intonation therapy,provides a new direction for respiratory function exercise in patients with spinal cord injury.This randomized controlled trial investigated the effects of oral motor respiratory exercise and vocal intonation therapy on respiratory function and vocal quality in patients with spinal cord injury.Among 31 included patients with spinal cord injury,18 completed the treatment.These 18 patients were randomly assigned to undergo music therapy(intervention group,30 min/d,5 times a week,for a total of 12 weeks;n=9,7 males and 2 females;30.33±11.74 years old)or normal respiratory training(control group,n=9;8 males and 1 female;34.78±11.13 years old).Both patient groups received routine treatment concurrently.Before and at 6 and 12 weeks after intervention,a standard respiratory function test,a voice test,the St.George's Respiratory Questionnaire,and a quality of life questionnaire were administered.The results showed that the inspiratory capacity,forced expiratory volume in 1 second,forced vital capacity,maximal mid-expiratory flow rate,sing-loud pressure level,and sustained note length were significantly increased in the intervention group compared with the control group.The St.George's Respiratory Questionnaire and quality of life results of patients in the intervention group were significantly superior to those in the control group.These findings suggest that oral motor respiratory exercise and vocal intonation therapy,as respiratory training methods in music therapy,are effective and valuable for improving respiratory dysfunction and vocal quality in patients with spinal cord injury.This study was approved by the Ethics Committee of China Rehabilitation Research Center(approval No.2019-78-1)on May 27,2019 and was registered with the Chinese Clinical Trial Registry(registration number:Chi CTR1900026922)on October 26,2019.

Comparison of walking quality variables between incomplete spinal cord injury patients and healthy subjects by using a footscan plantar pressure system

The main goal of spinal cord rehabilitation is to restore walking ability and improve walking quality after spinal cord injury(SCI). The spatiotemporal parameters of walking and the parameters of plantar pressure can be obtained using a plantar pressure analysis system. Previous studies have reported step asymmetry in patients with bilateral SCI. However, the asymmetry of other parameters in patients with SCI has not been reported. This was a prospective, cross-sectional study, which included 23 patients with SCI, aged 48.1 ± 14.5 years, and 28 healthy subjects, aged 47.1 ± 9.8 years. All subjects underwent bare foot walking on a plantar pressure measurement device to measure walking speed and spatiotemporal parameters. Compared with healthy subjects, SCI patients had slower walking speed, longer stride time and stance time, larger stance phase percentage, and shorter stride length. The peak pressures under the metatarsal heads and toe were lower in SCI patients than in healthy subjects. In the heel, regional impulse and the contact area percentage in SCI patients were higher than those in healthy subjects. The symmetry indexes of stance time, step length, maximum force, impulse and contact area were increased in SCI patients, indicating a decline in symmetry. The results confirm that the gait quality, including spatiotemporal variables and plantar pressure parameters, and symmetry index were lower in SCI patients compared with healthy subjects. Plantar pressure parameters and symmetry index could be sensitive quantitative parameters to improve gait quality of SCI patients. The protocols were approved by the Clinical Research Ethics Committee of Shengjing Hospital of China Medical University(approval No. 2015 PS54 J) on August 13, 2015. This trial was registered in the ISRCTN Registry(ISRCTN42544587) on August 22, 2018. Protocol version: 1.0.

Association of serum lipoprotein(a) level with the severity and prognosis of calcific aortic valve stenosis: a Chinese cohort study

Background There was a causal relationship between elevated lipoprotein(a)[Lp(a)]levels and increased risk of calcific aortic valve stenosis(CAVS)in whites and blacks.The present study aimed to investigate whether Lp(a)levels were associated with aortic stenosis(AS)severity and clinical events in Chinese patients.Methods Levels of serum Lp(a)were measured in 652 patients with CAVS,whom all underwent baseline echocardiographic examination.The clinical endpoint was defined as a composite of aortic valve replacement(AVR)and cardiac death.Results Patients in the tertile 3 of Lp(a)had a higher percentage of severe AS compared with those in the tertile 1 and 2 of Lp(a)(46.2%vs.33.9%,P=0.005).Moreover,the top tertile of Lp(a)was an independent predictor of severe AS(OR=1.78,95%CI:1.18-2.66,P=0.006).However,there was no significant association between tertile 3 of Lp(a)and clinical events(hazard ratio:0.73;95%CI:0.43-1.24;P=0.239)in the multivariate Cox regression analysis during a mean follow-up time of 3.16±2.74 years.Conclusions Elevated Lp(a)level was an independent predictor of severe AS by echocardiography in the Chinese population,but was not associated with the increased risk of AVR and cardiac death,suggesting that Lp(a)levels might be helpful in the risk stratification of patients with CAVS.

C-arm Lipiodol CT in transcatheter arterial chemoembolization for small hepatocellular carcinoma

AIM:To investigate the value of C-arm Lipiodol computed tomography(CT) for intra-procedural hepatocellular carcinoma(HCC) lesion detection during transcatheter arterial chemoembolization(TACE).METHODS:Forty patients(37 male,3 female;mean age,52.6 ± 12.5 years,age range:25-82 years) diagnosed with HCC were enrolled in this study.All patients underwent 64-slice CT 1-2 wk before TACE.During the procedure,hepatic angiography was performed first.Following diagnostic embolization with Lipiodol injected into the hepatic artery,a C-arm CT scan was immediately conducted(C-arm Lipiodol CT).If new HCC lesions were confirmed,gelfoam particles were super-selectively injected into the tumor-nourishing blood vessel.A Lipiodol CT scan was performed 7-14 d after TACE.All images acquired from 64-slice CT,digital subtraction angiography(DSA),C-arm Lipiodol CT and Lipiodol CT were retrospectively reviewed by four radiologists and the number of detected lesions in each examination was counted,respectively.The results of Lipiodol CT were taken as the diagnostic reference.Alpha-fetoprotein values were examined both before and after TACE.This study only takes into account the lesions that were not found or were considered suspicious on 64-slice CT before TACE.RESULTS:Preprocedural 64-slice CT detected a total of 13 suspicious lesions in the 40 patients.DSA detected ten definite and four suspicious lesions.C-arm Lipiodol CT detected 71 lesions in total and Lipiodol CT confirmed 67 lesions with a diameter range of 3-12 mm.Four false-positive lesions,which were detected by C-arm Lipiodol CT,were considered to be hepatic artery-portal vein fistulas.The average alpha-fetoprotein values before and after TACE were significantly different(452.3 ± 192.6 ng/m L vs 223.8 ± 93.2 ng/m L;P = 0.039).CONCLUSION:C-arm Lipiodol CT has a higher diagnostic sensitivity for small HCC lesions.This technique may help physicians make intraproceduraldecisions to provide patients with earlier treatment.

Relationship of lipid and lipoprotein ratios with coronary severity in patients with new on-set coronary artery disease complicated with type 2 diabetics

BackgroundDiabetes mellitus (DM ) 与冠的动脉疾病(CAD ) 被联系前进。尽管以前的研究与 CAD 表明了类脂化合物和脂蛋白比率的协会，没有数据有关在类脂化合物和脂蛋白比率和在糖尿病患者的新发作 CAD 的严厉之间的关系当前是可得到的。因此，现在的学习的目的有新发作 CAD 的 380 个连续 T2DM 病人是在与类型 2 DM (T2DM ).MethodsA 在病人预言 CAD 的严厉调查类脂化合物和脂蛋白比率的实用性全部的在现在的学习被注册。然后，他们根据 Gensini 被分类进三个组分数(GS ) tertiles。在类脂化合物和脂蛋白比率之间的关系当前使用了， GS 与到 apoA 的 apolipoprotein B 是自然转变木头的 GS ( lnGS )的 investigated.ResultsPositive 关联--我比率( apoB/apoA-I )， non-high-density 脂蛋白胆固醇到 apoA --我比率( non-HDL-C/apoA-I )，并且低密度的脂蛋白胆固醇到 apoA --我比率( LDL-C/apoA-I )被发现( r = 0.18 ， 0.13 ， 0.12 ，分别地所有 P &#x0003c ；0.05 ) 。Multivariate 逻辑分析为高 GS 作为最强壮的预言者显示了 apoB/apoA-I (或 = 5.67， 95% CI：1.45-23.92， P = 0.003 ) 。在操作 apoB/apoA-I 的典型曲线的接收装置下面的区域是 0.63 (95% CI：0.60-0.66， P = 0.001 ) 为预言高 GS。apoB/apoA-I 的最佳的截止值预言高 GS 与 61.2% 的敏感和 62.1%.ConclusionsLipid 和脂蛋白比率的特性是 0.72 可能为在 T2DM 病人预言新发作 CAD 的严厉是有用的，并且 apoB/apoA-I 在这张人口作为最重要的预言者出现。

Effects of Pitavastatin on Lipoprotein Subfractions and Oxidized Low-density Lipoprotein in Patients with Atherosclerosis

It has been demonstrated that pitavastatin can significantly reduce low-density lipoprotein(LDL)cholesterol(LDL-C),but its impact on lipoprotein subfractions and oxidized low-density lipoprotein(oxLDL)has not been determined.The aim of the present study was to investigate the potential effects of pitavastatin on subfractions of LDL and high-density lipoprotein(HDL)as well as oxLDL in untreated patients with coronary atherosclerosis(AS).Thirty-six subjects were enrolled in this study.O f them,18 patients with AS were administered pitavastatin 2 mg/day for 8 weeks and 18 healthy subjects without therapy served as controls.The plasma lipid profile,lipoprotein subfractions and circulating oxLDL were determined at baseline and 8 weeks respectively.The results showed that pitavastatin treatment indeed not only decreased LDL-C,total cholesterol(TC),triglycerides(TG)and apolipoprotein B(ApoB)levels,and increased HDL cholesterol(HDL-C),but also reduced the cholesterol concentration of all of the LDL subfractions and the percentage of intermediate and small LDL subfractions.Meanwhile,pitavastatin could decrease plasma oxLDL levels.Furthermore,a more close correlation was found between oxLDL and LDL-C as well as LDL subfractions after pitavastatin treatment.We concluded that a moderate dose of pitavastatin therapy not only decreases LDL-C and oxLDL concentrations but also improves LDL subfractions in patients with AS.

Clinical features of coronary artery ectasia in the elderly

ObjectiveTo 与冠的动脉 ectasia (CAE ) 在老病人调查发生，成像和临床的特征 .MethodsA 回顾的分析与 CAE 在病人上被进行经历了在 2006 年 1 月和 2012 年 12 月之间的冠的 angiography。根据年龄，注册病人被划分成二个组(老组，年龄 ≥；65 年；非老的组，年龄 <；65 年) 。临床的特征，成像特征和二个组的 5 年的幸存率是在老病人的 CAE 的 compared.ResultsThe 流行是 0.33% 。在老组的病人被发现有女性的显著地更高的比例(30.1% 对 10.1% ， P <；0.001 ) ，三容器的疾病(60.5% 对 45.2% ， P = 0.003 ) 并且局部性的 ectasia (55.0% 对 40.2% ， P = 0.003 ) 。另外，身体团索引(20.90 ±；2.71 kg/m 2 对 22.31 ±；2.98 kg/m 2, P <；0.001 ) 并且当前的吸烟者的百分比(45.0% 对 64.6% ， P <；0.001 ) 在老组是显著地更低的。累积幸存曲线与非老的组相比在老组在后续表明了减少的 5 年的累积幸存(88.0% 对 96.0% ， P = 0.002 ) 。但是免费幸存率没能显示出二之间的重要差别的 5 年的事件组织(31.0% 对 35.0% ， P = 0.311 ) 在老病人的 CAE 的 .ConclusionThe 流行是 0.33% ，它关于 CAE 病人的全部数字的 1/3。在之间有重要差别老并且有 CAE 的非老的病人以冠的动脉疾病冒险因素和冠的动脉 ectatic 特征。CAE 可能与增加的死亡风险被联系在老。

Effect of Intracoronary Infusion of Bone Marrow Mononuclear Cells or Peripheral Endothelial Progenitor Cells on Myocardial Ischemia-reperfusion Injury in Mini-swine

Objective To simulate and assess the clinical effect of intracoronary infusion of bone marrow mononuclear cells or peripheral endothelial progenitor cells on myocardial reperfusion injury in mini-swine model.Methods Twenty-three mini-swine with myocardial reperfusion injury were used as designed in the study protocol.About(3.54±0.90)×108 bone marrow mononuclear cells(MNC group,n=9) or(1.16± 1.07)×107 endothelial progenitor cells(EPC group,n=7) was infused into the affected coronary segment of the swine.The other mini-swine were infused with phosphate buffered saline as control(n=7).Echocardio-graphy and hemodynamic studies were performed before and 4 weeks after cell infusion.Myocardium infarction size was calculated.Stem cell differentiation was analyzed under a transmission electromicroscope.Results Left ventricular ejection fraction dropped by 0% in EPC group,2% in MNC group,and 10% in the control group 4 weeks after cell infusion,respectively(P<0.05).The systolic parameters increased in MNC and EPC groups but decreased in the control group.However,the diastolic parameters demonstrated no significant change in the three groups(P>0.05).EPC decreased total infarction size more than MNC did(1.60±0.26 cm2 vs.3.71±1.38 cm2,P<0.05).Undermature endothelial cells and myocytes were found under transmission electromicroscope.Conclusions Transplantation of either MNC or EPC may be beneficial to cardiac systolic function,but might not has obvious effect on diastolic function.Intracoronary infusion of EPC might be better than MNC in controlling infarction size.Both MNC and EPC may stimulate angiogenesis,inhibit fibrogenesis,and differentiate into myocardial cells.

IMPLANTATION OF AUTOLOGOUS BONE MARROW MONONUCLEAR CELLS INTO ISCHEMIC MYOCARDIUM ENHANCES CORONARY CAPILLARIES AND SYSTOLIC FUNCTION IN MINISWINE

Objective To investigate the therapeutic effectiveness of intracoronary implantation of autologous bone marrow mononuclear cells (BM-MNC) in miniswine model of reperfused myocardial infarction. Methods Sixteen miniswine myocardial ischemic reperfusion injury models made by ligation of the distal one third segment of left anterior descending artery for 90 minutes were randomized into 2 groups. In BM-MNC group (n = 9), (3.54±0.90)×108 BM-MNC were intracoronary injected, and in the control group (n = 7), phosphate buffered saline was injected by the same way. Echocardiographic and hemodynamic results, vessel density, and myocardial infarction size were evaluated and compared before and 4 weeks after cell transplantation. Results In BM-MNC group, there were no differences between before and 4 weeks after transplantation in aspects of left ventricular ejection fraction (LVEF), interventricular septal thickness, left ventricular lateral and anterior septal wall thickness, cardiac output, or +dp/dtmax. In control group, LVEF, interventricular septal thickness, left ventricular lateral and anterior septal wall thickness, cardiac output, and +dp/dtmax decreased significantly 4 weeks after transplantation (P < 0.05). Left ventricular end-diastolic pressure and –dp/dtmax did not change significantly before and after cell transplantation in both groups. Capillary density in BM-MNC group was greater than that in control group [(13.39 ± 6.96)/high power field vs. (3.50 ± 1.90)/high power field, P < 0.05]. Infarction area assessed by tetrazolium red staining and the infarction percentage decreased in BM-MNC group compared with those in control group (P < 0.05). Conclusions Transplantation of BM-MNC into myocardium with ischemic reperfusion injury increases capillary density and decreases infarction area. It has significantly beneficial effect on cardiac systolic function rather than on diastolic function.

Establishment and identification of induced pluripotent stem cells in liver cancer patients

Objective:To induce pluripotent stem(IPS)cells from fibrocytes that are separated from liver cancer patients.Methods:The fibrocytes were reprogrammed to IPS cells by lentiviral vector,stained and identified by immunohistochemistry.Results:The IPS cells were successfully established from fibrocytes after infection,and IPS cell clones formed in round shape under a microscopy.The induction rate was 0.013%±0.007%.No tumor formed at the back of nude mice within 8 weeks after the inoculation of cell clone.However,tetatoma appeared in nude mice within 1 week after IPS inoculation.A few tumors formed in nude mice within 4 weeks after the inoculation of cell clones.However,subcutaneous tumors formed within 1 week after IPS inoculation.The induced IPS cells showed three germ layers in tetatoma.Nanog and OCT4 in the induced IPS cells showed hypomethylation.SSEA-A,TRA-1-6-,TRA-1-81 and Nanog were highly expressed in the induced IPS cells,indicating the IPS cells possessed the similar ability as the stem cells.Conclusion:The IPS cells of liver cancer patients can be established effectively from fibrocytes and can be cultured stably in vitro,which provides an approach for the treatment of intermediate or advanced stage liver cancer.

Association of invasive treatment and lower mortality of patients ≥ 80 years with acute myocardial infarction: a propensity-matched analysis

Objective To investigate whether invasive strategy was associated with lower mortality in Chinese patients ≥ 80 years with acute myocardial infarction (AMI). Methods We used retrospective data from our center between 2013 and 2017. During a median of 17.4 (interquartile range: 7.3–32.3) months follow-up, 120 deaths were recorded among 514 consecutive patients ≥ 80 years with AMI. The patients were divided into two groups: invasive treatment group (IT group, n = 269) and conservative treatment group (CT group, n = 245), which were also then compared with propensity score matching. Results High mortality was found in CT group compared with that in the IT one. Cox proportional hazard regression analysis showed that invasive treatment was associated with lower mortality of patients ≥ 80 years. Moreover, the results revealed that the patients in IT group had lower in-hospital mortality (3.35% vs. 9.39%, P = 0.005). Besides, the Kaplan-Meier analysis revealed that the mortality was significantly lower in IT group compared with that in CT group using entire and propensity-matched cohort analysis (P < 0.001, respectively). Conclusions Our data suggested that IT appeared to be associated with lower mortality in Chinese patients ≥ 80 years with AMI, which consists with previous studies in spite of either ST elevated myocardial infarction (STEMI) or non-STEMI (NSTEMI) patients.

Extraesophageal saline enhances endoscopic ultrasonography to differentiate esophagus and adjacent organs

AIM:To distinguish between the esophagus and adjacent organs using extraesophageal saline injection(ESI) in a canine model.METHODS:ESI was performed through the esophagus under the guidance of linear-array endoscopic ultrasonography(EUS).Approximately 15 mL of methylene blue saline(0.5%) was then injected through each of the extraesophageal puncture points using a 22 G needle.Radial EUS examinations were conducted before and after ESI.EUS images of the trachea,tracheal bifurcation,arcus aortae and thoracic aorta were recorded.Vital signs were monitored during the ESI procedure and EUS examination.The dogs were then sacrificed for exploratory thoracotomy.RESULTS:No obvious fluctuation in vital signs or serious adverse events occurred during the ESI procedure.On EUS imaging,an apparent hypoechoic area outside the esophagus,which separated the esophagus and adjacent organs,was visualized.The adventitious of the esophagus and adjacent organs were easily distinguished.The findings of subsequent exploratory thoracotomy confirmed the EUS findings:obvious accumulation of a blue liquid in the extraesophageal tissues,as well as in the esophageal-thoracic aorta space,esophageal-arcus aortae space and esophageal-tracheal space.CONCLUSION:The esophagus and adjacent organs were successfully separated by ESI,and extraesophageal saline acted as an effective ultrasonic contrast agent.

Dyslipidemia in rat fed with high-fat diet is not associated with PCSK9-LDL-receptor pathway but ageing

BACKGROUND: Obesity is associated with unfavorable alternations in plasma lipid profile and a broad spectrum of cardio-metabolic disorders。 Proprotein convestase subtilisin kexin type 9 (PCSK9) is a novel circulating protein that promotes hypercholesterolemia by decreasing hepatic low lipoprotein density receptor (LDLR) protein。 However, the relationship between PCSK9 concentration and lipid profile in an obesity condition has less been investigated。 OBJECTIVE: To examine the changes of plasma PCSK9 concentration in a rat model fed with high fat diet (HFD) and its correlation to lipid profile, body weight and ageing。 METHODS: Twenty male Sprague Dawley (SD) rats were divided into two groups, control group (fed with normal pellet for 4 weeks), and high-fat diet group (fed with 3% cholesterol enrich diet for 4 weeks)。 Blood samples of rats were obtained before and at days 14, 21, and 28 in both groups。 The body weight, plasma metabolic parameters (glucose, lipid profile) and PCSK9 were determined at indicated time points。 RESULTS: The body weights were significantly increased in rats fed with HFD compared to that in rats with normal pellets at day 28。 Additionally, total cholesterol (TC), triglyceride (TG), and low density lipoprotein cholesterol (LDL-C) levels in rat fed with HFD were also higher than that in rats fed with control diet while decreased high density lipoprotein cholesterol (HDL-C) levels were found in rats with HFD at day 28。 More interesting, there were no differences of plasma PCSK9 concentrations as well as hepatic expression of LDLR between the two groups at day 28。 CONCLUSIONS: Although the body weight and LDL-C were significantly increased in rats fed with HFD at 4 weeks, there were no differences of changes in plasma PCSK9 concentration and LDLR expression of liver tissue in both groups at baseline and day 28, suggesting that dyslipidemia in the rat model with HFD appears not to be associated with PCSK9-LDLR pathway but ageing。