Evaluation of metoprolol standard dosing pathway in Chinese patients with acute coronary syndrome:a prospective multicenter single-arm interventional study

OBJECTIVE To evaluate the feasibility and tolerability of metoprolol standard dosing pathway(MSDP)in Chinese patients with acute coronary syndrome(ACS).METHODS In this multicenter,prospective,open label,single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals.A total of 998 hospitalized patients aged≥18 years and diagnosed with ACS were included.The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines.The primary endpoint was the percentage of patients achieving the target dose at discharge(V2).The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge(V4),and percentage of patients experiencing bradycardia(heart rate<50 beats/min),hypotension(blood pressure<90/60 mmHg)and transient cardiac dysfunction at V2 and V4.RESULTS Of the 998 patients,29.46%of patients achieved the target dose(≥95 mg/d)at V2.The total population was divided into two groups:target group(patients achieving the target dose at V2)and non-target group(patients not achieving the target dose at V2).There was significant difference in the reduction of heart rate from baseline to discharge in the two groups(-4.97±11.90beats/min vs.-2.70±9.47 beats/min,P=0.034).There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2(0 vs.0,P=1.000)and V4(0.81%vs.0.33%,P=0.715).There was no significant difference in the proportion of hypotension between the two groups at V2(0.004%vs.0.004%,P=1.000)and V4(0 vs.0.005%,P=0.560).No transient cardiac dysfunction occurred in two groups during the study.A total of five adverse events(1.70%)and one serious adverse event(0.34%)were related to the pathway in target group.CONCLUSIONS In Chinese ACS patients,the feasibility and tolerability of the MSDP have been proved to be acceptable.

胸腔镜下椎旁间隙置管镇痛在胸腔镜肺叶切除手术中的应用

目的评价胸腔镜下椎旁间隙置管持续椎旁神经阻滞在胸腔镜肺叶切除手术后镇痛中的应用价值。方法选取胸腔镜肺叶切除手术患者68例,根据置管方式不同分为实验组(胸腔镜下椎旁间隙置管镇痛组)35例和对照组(超声引导下椎旁间隙置管镇痛组)33例。置管成功后,两组均经导管注入0.5%罗哌卡因20 mL作为负荷量,术后以2 mL/h的速度持续泵入0.15%罗哌卡因。比较两组术后不同时间点的疼痛程度、镇痛副作用及肺部并发症发生情况。结果在静止状态及咳嗽时,两组术后2、4、6、8、12、24和48 h的视觉模拟评分(VAS)比较,差异均无统计学意义(P>0.05)。两组均有患者出现头晕嗜睡、恶心呕吐和低血压等镇痛相关副作用,但两组比较,差异无统计学意义(P>0.05)。两组肺部并发症比较,差异无统计学意义。没有观察到与麻醉镇痛相关的严重并发症。结论胸腔镜下椎旁间隙置管用于术后持续椎旁神经阻滞镇痛中,安全、有效、可行,且并发症发生率低,操作简单易学,无需超声设备辅助。

Real world effectiveness of PCSK-9 inhibitors combined with statins versus statins-based therapy among patients with very high risk of atherosclerotic cardiovascular disease in China(RWE-PCSK study)

BACKGROUND The efficacy and safety of proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors were confirmed by several clinical trials, but its effectiveness in routine clinical practice in China has not been evaluated. This study aims to describe the real world effectiveness of PCSK-9 inhibitors combined with statins compared with statins-based therapy among patients with very high risk of atherosclerotic cardiovascular disease(ASCVD).METHODS This is a multi-center observational study, enrolled patients from 32 hospitals who underwent percutaneous coronary intervention(PCI) from January to June in 2019. There are 453 patients treated with PCSK-9 inhibitors combined with statins in PCSK-9 inhibitor group and 2,610 patients treated with statins-based lipid lowering therapies in statins-based group. The lipid control rate and incidence of major adverse cardiovascular events(MACE) over six months were compared between two groups.A propensity score-matched(PSM) analysis was used to balance two groups on confounding factors. Survival analysis using Kaplan-Meier methods was applied for MACE.RESULTS In a total of 3,063 patients, 89.91% of patients had received moderate or high-intensity statins-based therapy before PCI, but only 9.47% of patients had low-density lipoprotein cholesterol(LDL-C) levels below 1.4 mmol/L at baseline. In the PSM selected patients, LDL-C level was reduced by 42.57% in PCSK-9 inhibitor group and 30.81%(P < 0.001) in statins-based group after six months. The proportion of LDL-C ≤ 1.0 mmol/L increased from 5.29% to 29.26% in PCSK-9 inhibitor group and 0.23% to 6.11% in statins-based group, and the proportion of LDL-C ≤ 1.4 mmol/L increased from 10.36% to 47.69% in PCSK-9 inhibitor group and 2.99% to 18.43% in statins-based group(P < 0.001 for both). There was no significant difference between PCSK-9 inhibitor and statins-based treatment in reducing the risk of MACE(hazard ratio = 2.52, 95% CI: 0.49-12.97, P = 0.250).CONCLUSIONS In the real world, PCSK-9 inhibitors combined with statins could significantly reduce LDL-C levels among patients with very high risk of ASCVD in China. The long-term clinical benefits for patients received PCSK-9 inhibitor to reduce the risk of MACE is still unclear and requires further study.

Galactic halo age estimated from LAMOST DR4 and Gaia DR1

The stellar halo is one of the major components in the Milky Way. Research on its age can provide critical constraints on the origin of the stellar halo and further on the formation of our Galaxy.So far, different approaches and samples have been used to estimate the age of the Galactic halo. In our previous paper, we carefully selected 63 field halo turn-off stars within 1 kpc from the literature using a kinematic approach, then estimated the age of the halo. In this following work, we not only update the data from LAMOST DR4 and Gaia DR1, but also try a different method to select a clean halo sample by combining the metallicity and orbital parameters. Then we compare this halo turn-off sample with the GARSTEC model in the B-V vs. metallicity plane. After Monte Carlo simulations are performed, the age is estimated to be 10.5±1.4 Gyr, highly consistent with our previous result and other studies. However,due to the limited common sources between LAMOST DR4 and Gaia DR1, the final sample in this paper is still quite small. The estimated age will be more robust with the much larger Gaia DR2.

Binary Star Fractions from the LAMOST DR4

Stellar systems composed of single, double, triple or higher-order systems are rightfully regarded as the fundamental building blocks of the Milky Way. Binary stars play an important role in formation and evolution of the Galaxy. Through comparing the radial velocity variations from multiepoch observations, we analyze the binary fraction of dwarf stars observed with LAMOST. Effects of different model assumptions, such as orbital period distributions on the estimate of binary fractions,are investigated. The results based on log-normal distribution of orbital periods reproduce the previous complete analyses better than the power-law distribution. We find that the binary fraction increases with Teff and decreases with [Fe/H]. We first investigate the relation between α-elements and binary fraction in such a large sample as provided by LAMOST. The old stars with high [α/Fe] dominate with a higher binary fraction than young stars with low [α/Fe]. At the same mass, earlier forming stars possess a higher binary fraction than newly forming ones, which may be related with evolution of the Galaxy.

X-ray activity from different types of stars

X-ray emission is an important indicator of stellar activity.In this paper,we study stellar Xray activity using the XMM-Newton and LAMOST data for different types of stars.We provide a sample including 1259 X-ray-emitting stars,of which 1090 have accurate stellar parameter estimations.Our sample size is much larger than those used in previous works.We find a bimodal distribution of the X-ray to optical flux ratio(log(fX/fV)) for G and K stars.We interpret that this bimodality is due to two subpopulations with different coronal heating rates.Furthermore,using the full widths at half maxima calculated from Hα and Hβ lines,we show that these stars in the inactive peaks have smaller rotational velocities.This is consistent with the magnetic dynamo theory that presumes stars with low rotational velocities have low levels of stellar activity.We also examine the correlation between log(fX/fV) and luminosity of the excess emission in the Hα line,and find a tight relation between the coronal and chromospheric activity indicators.

An active M star with X-ray double flares disguised as an ultra-luminous X-ray source

Here we present research on an ultra-luminous X-ray source （ULX） candidate 2XMM J 140229.91＋542118.8. The X-ray light curves of this ULX candidate in M 101 exhibit features of a flare star. More importantly, the Chandra light curve displays unusual X-ray double flares, which is comprised of two close peaks. The X-ray （0.3-11.0 keV） flux of the first peak was derived from the two-temperature APEC model as ～ 1.1 ±0.1× 10-12 ergcm-2 s-1. The observed flux at its first peak increased by about two orders of magnitude in X-ray as compared to quiescence. The slope of the second fast decay phase is steeper than the slope of the first fast decay phase, indicating that the appearance of a second flare accelerated the cooling of the first flare in a way we do not understand yet. We also observed its optical counterpart using a 2.16 m telescope administered by National Astronomical Observatories, Chinese Academy of Sciences. By optical spectral fitting, it is confirmed to be a late type dMe2.5 star. According to the spectral type and apparent magnitude of its optical counterpart, we estimate the photometric distance to be ～ 133.4 ±14.2 pc. According to the X-ray spectral fitting, a possible explanation is provided. However, more similar close double flares are needed to confirm whether this accelerated cooling event is a unique coincidence or a common physical process during double flaring.

New open cluster candidates discovered in the XSTPS-GAC survey

The Xuyi Schmidt Telescope Photometric Survey of the Galactic Anti-center（XSTPS-GAC）is a photometric sky survey that covers nearly 6000 deg^2 towards the Galactic Anti-center（GAC） in the g,r,i bands. Half of its survey field is located on the Galactic Anti-center disk,which makes XSTPSGAC highly suitable to search for new open clusters in the GAC region. In this paper,we report new open cluster candidates discovered in this survey,as well as properties of these open cluster candidates,such as age,distance and reddening,derived by isochrone fitting in the color-magnitude diagram（CMD）.These open cluster candidates are stellar density peaks detected in the star density maps by applying the method from Koposov et al. Each candidate is inspected in terms of its true color image composed from three XSTPS-GAC band images. Then its CMD is checked,in order to identify whether the central region stars have a clear isochrone-like trend differing from background stars. The parameters derived from isochrone fitting for these candidates are mainly based on three band photometry of XSTPS-GAC.Moreover,when these new candidates are able to be seen clearly in 2 MASS data,their parameters are also derived based on the 2 MASS（J-H,J） CMD. There are a total of 320 known open clusters rediscovered and 24 new open cluster candidates discovered in this work. Furthermore,the parameters of these new candidates,as well as another 11 previously known open clusters,are properly determined for the first time.

The age of the halo as determined from halo field stars

The age of the Galactic halo is a critical parameter that can constrain the origin of the stellar halo. In general, the Galactic stellar halo is believed to be very old. However, different independent measurements and techniques based on various types of stars are required so that the age estimates of the Galactic halo are accurate, robust, and reliable. In this work, we provide a novel approach to determine the age of the halo with turn-off stars. We first carefully select 63 field halo turn-off stars from the literature. Then, we compare them with the GARSTEC model, which takes the process of atomic diffusion into account in the B - V vs. metallicity plane. Finally, we run Monte Carlo simulations to consider the uncertainty of the color index and obtain the age of 10.5 ± 1.5 Gyr. This result is in agreement with previous studies. Future works are needed to collect more turn-off samples with more accurate photometry to reduce the uncertainty of the age.

Protein-coding genes combined with long noncoding RNA as a novel transcriptome molecular staging model to predict the survival of patients with esophageal squamous cell carcinoma

Background:Esophageal squamous cell carcinoma(ESCC)is the predominant subtype of esophageal carcinoma in China.This study was to develop a staging model to predict outcomes of patients with ESCC.Methods:Using Cox regression analysis,principal component analysis(PCA),partitioning clustering,Kaplan-Meier analysis,receiver operating characteristic(ROC)curve analysis,and classification and regression tree(CART)analysis,we mined the Gene Expression Omnibus database to determine the expression profiles of genes in 179 patients with ESCC from GSE63624 and GSE63622 dataset.Results:Univariate cox regression analysis of the GSE63624 dataset revealed that 2404 protein-coding genes(PCGs)and 635 long non-coding RNAs(lncRNAs)were associated with the survival of patients with ESCC.PCA categorized these PCGs and lncRNAs into three principal components(PCs),which were used to cluster the patients into three groups.ROC analysis demonstrated that the predictive ability of PCG-lncRNA PCs when applied to new patients was better than that of the tumor-node-metastasis staging(area under ROC curve[AUC]:0.69 vs.0.65,P<0.05).Accord-ingly,we constructed a molecular disaggregated model comprising one lncRNA and two PCGs,which we desig-nated as the LSB staging model using CART analysis in the GSE63624 dataset.This LSB staging model classified the GSE63622 dataset of patients into three different groups,and its effectiveness was validated by analysis of another cohort of 105 patients.Conclusions:The LSB staging model has clinical significance for the prognosis prediction of patients with ESCC and may serve as a three-gene staging microarray.