New predictors of in-stent restenosis in patients with diabetes mellitus undergoing percutaneous coronary intervention with drug-eluting stent

Background Percutaneous coronary intervention （PCI） had become the major therapeutic procedure for coronary artery disease （CAD）, but the high rate of in-stent restenosis （ISR） still remained an unsolved clinical problem in clinical practice. Increasing evidences suggested that diabetes mellitus （DM） was a major risk factor for ISR, but the risk predictors of ISR in CAD patients with DM had not been well characterized. The aim of this study was to investigate the clinical and angiographic characteristic predictors significantly associated with the occurrence of ISR in diabetic patients following coronary stenting with drug-eluting stent （DES）. Methods A total of 920 patients with diabetes who diagnosed CAD and underwent coronary DES implantation at Beijing Anzhen Hospital in China were consecutively enrolled from January 2012 to December 2012. Of these, 440 patients underwent the second angiography within ≥ 6 months due to the progression of treated target lesions. Finally, 368 of these patients who met the inclusion and exclusion criteria were followed up by angiography after baseline PCI. According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group （n = 74） and the non-ISR group （n = 294）. The independent predictors of ISR in patients with DM were explored by multivariate Cox＇s proportional hazards regression models. Results A total of 368 patients （260 women and 108 men） with a mean ages of 58.71 ± 10.25 years were finally enrolled in this study. Of these, ISR occurred in 74/368 diabetic patients （20.11%） by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly higher serum very low density lipoprotein cholesterol （VLDL-C）, triglyceride （TG） and uric acid （UA） levels, more numbers of target vessel lesions, higher prevalence of multi-vessel disease, higher SYNTAX score, higher rate of previous but lower rate of drinking compared with patients in the non-ISR group. The independent predictors of ISR in patients with DM after DES implantation included VLDL-C （HR = 1.85, 95% CI： 1.24-2.77, P = 0.002）, UA （per 50 μmol/L increments, HR = 1.19, 95% CI： 1.05 1.34, P = 0.006）, SYNTAX score （per 5 increments, HR = 1.34, 95% CI： 1.03-1.74, P = 0.031） and the history ofPCI （HR = 3.43, 95% CI： 1.57-7.80, P = 0.003） by the multivariate Cox＇s proportional hazards regression analysis. Conclusions The increased serum VLDL-C and UA level, higher SYNTAX score and the history of previous PCI were independent predictors of ISR in patients with DM after coronary DES implantation. It provided new evidence for physi- cians to take measures to lower the risk oflSR for the better management of diabetic patients after PCI.

Elevated IL-37 levels in the plasma of patients with severe coronary arterycalcification

Background Coronary artery calcification （CAC） is a predictor of cardiovascular events and plaque burden and is closely associatedwith chronic inflammation. Intedeukin （IL）-37 is a newly discovered member of the IL-1 family and is considered an anti-inflammatorycytokine. Our recent study on mice indicated that IL-37 could attenuate atherosclerosis and vascular calcification, which suggests that IL-37could be associated with the development of atherosclerosis and related diseases. The aim of this study was to investigate if IL-37 plays arole in the progression of CAC in patients. Methods Two hundred participants with suspected cardiovascular disease were recruited. Thelevels of plasma IL-37, osteoprotegerin （OPG）, hypersensitive C-reactive protein （hsCRP） together with other biochemical parameters weremeasured, and a coronary calcium assessment was carried out by multi-detector row CT. A score of 〈 10 AU （Agatston units） denotes anabsence of CAC, a score of 11-100 AU denotes mild CAC, 101-400 denotes moderate CAC, and 〉 400 AU denotes severe CAC. ResultsOur initial data showed that there were no apparent differences in plasma IL-37 levels among patients with or without mild or moderate CAC.However, IL-37 levels were significantly increased in patients with severe CAC （P 〈 0.001）. Similar results were observed for plasma OPGand hsCRP levels. When IL-37 levels in patients with severe calcification were compared with that in all of the other non-severe CAC groups,it became apparent that there was a significant positive correlation between IL-37 level and severe CAC （r = 0.360, P 〈 0.001; OR = 1.033）using Spearrnan＇s correlation and binary logistic regression analysis. Conclusions This study demonstrates that the anti-inflammatory cy-tokine IL-37 is associated with high coronary calcium levels, suggesting that IL-37 expression may be caused by the activation ofinf/amma-tion and that IL-37 might become a predictor of severe CAC in the future, which requires further investigation.

益气活血化瘀汤联合曲安奈德及532nm氩激光治疗BRVO继发黄斑水肿

目的:观察益气活血化瘀汤联合曲安奈德及532nm氩激光治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿(ME)的临床疗效。方法:选取2014-01/2016-08我院收治的BRVO继发ME患者80例80眼,根据治疗方式不同分为对照组与观察组每组40例40眼,对照组采用玻璃体腔注射曲安奈德联合532nm氩激光光凝治疗,观察组在对照组基础上加用益气活血化瘀汤治疗,均测定治疗前,治疗1wk,1、3mo患者最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)、眼压,比较两组患者视力、ME及症状(视物变形、出血、渗出等)改善情况,并发症发生率及治疗3mo后复发率。结果:观察组治疗后不同时间BCVA优于对照组,CMT低于对照组(P<0.05);两组治疗不同时间眼压比较无差异(P>0.05);观察组ME改善效果优于对照组,视物变形、出血渗出吸收情况均优于对照组(P<0.05),两组并发症发生情况比较无差异(P>0.05),治疗后3mo观察组无复发,对照组复发3眼,复发病例均予激光光凝治疗后改善。结论:益气活血化瘀汤联合曲安奈德及532nm氩激光治疗BRVO继发ME疗效肯定,可改善视力,减轻黄斑水肿,促进眼底出血渗出吸收,且安全性高。

Nursing Based on Syndrome Differentiation Combined with Auricular Plaster Therapy in Alleviating Insomnia

Objective:To observe the effect of auricular point pressing combined with nursing based on syndrome differentiation in the treatment of insomnia patients.Methods:Totally 92 patients with insomnia were randomly divided into the observation groupgiven auricular point pressing combined with nursing care based on syndrome differentiation and the control group treated with auricular point pressing alone.The improvement of Pittsburgh Sleep Quality Index(PSQI),TCM Syndrome Score and nursing satisfaction were compared between the 2 groups.Results:The time effect of PSQI total score and 6 factors in both groups were statistically significant(P<0.05).The time effect,interaction effect and inter-group effect of subjective sleep quality,PSQI total score were statistically significant(P<0.05);the 4 inter-group factors of sleep quality,sleep latency,sleep duration and daytime function were statistically significant(P<0.05).The total score of TCM syndromes in the observation group was lower than that in the control group(P<0.05),and the satisfaction rate in the observation group higher than that in the control group(80.43%vs.60.86%,P<0.05).Conclusion:Auricular point pressing combined withnursing based on syndrome differentiation can effectively improve the sleep quality of insomnia patients,and has significant advantages in improving TCM syndromes,as well as gained higher nursing satisfaction from patients.

Characterization and Visible Light Photocatalytic Activity of Cucurbit[n]urils/CdS-MoS_(2)

In order to reduce the impact of CdS photogenerated electron-hole recombination on its photocatalytic performance,a narrow band gap semiconductor MoS_(2) and organic macromolecular cucurbit[n]urils(Q[n])were used to modify CdS.Q[n]/CdS-MoS_(2)(n=6,7,8)composite photocatalysts were synthesized by hydrothermal method.Infrared spectroscopy,X-ray diffraction,X-ray photoelectron spectroscopy,field emission scanning electron microscopy,ultraviolet-visible and photoluminescence spectrum were used to characterize the structure,morphology and optical properties of the products,and the catalytic degradation of the solutions of methylene blue,rhodamine B and crystal violet by Q[n]/CdS-MoS_(2) composite catalyst was investigated.The results showed that the Q[n]played a regulatory role on the growth and crystallization of CdS-MoS_(2) particles,Q[n]/CdS-MoS_(2)(n=6,7,8)formed flower clusters with petal-like leaves,the flower clusters of petal-like leaves increased the surface area and active sites of the catalyst,the Q[n]/CdS-MoS_(2) barrier width decreased,the electron-hole pair separation efficiency was improved in the Q[6]/Cds-MoS_(2).Q[n]makes the electron-hole pair to obtain better separation and migration.The Q[6]/CdS-MoS_(2) and Q[7]/CdS-MoS2 have good photocatalytic activity for methylene blue,and the catalytic process is based on hydroxyl radical principle.

Association of serum complement C1q with cardiovascular outcomes among patients with acute coronary syndrome undergoing percutaneous coronary intervention

OBJECTIVE To determine the association of serum complement C1q levels with cardiovascular outcomes among patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI),and evaluate the value of C1q modified by high-sensitivity C-reactive protein(hs-CRP)levels as an independent predictor.METHODS As a single-center prospective observational study,we analyzed 1701 patients who had received primary or elective PCI for ACS at Beijing Anzhen Hospital,Capital Medical University,Beijing,China between June 1,2016 and November 30,2017.The associations of C1q modified by hs-CRP with major adverse cardiovascular events(MACE)were determined in survival analysis.RESULTS Patients with the lowest C1q tertile had the highest cumulative risk of MACE(log-rank P=0.007).In fully adjusted Cox regression models,stratifying the total population according to hs-CRP dichotomy,C1q was significantly associated with MACE in patients with hs-CRP levels less than 2 mg/L but not in those with 2 mg/L or more(P_(interaction)=0.02).In patients with hs-CRP levels less than 2 mg/L,with the lowest C1q tertile as reference,the risk of MACE was reduced by 40.0%in the middle C1q tertile[hazard ratio(HR)=0.600,95%CI:0.423–0.852,P=0.004]and by 43.9%in the highest C1q tertile(HR=0.561,95%CI:0.375–0.840,P=0.005).CONCLUSIONS Serum complement C1q is significantly associated with cardiovascular outcomes in patients with ACS undergoing PCI,only when hs-CRP levels are less than 2 mg/L.This finding implicates the usefulness of C1q for the risk stratification in ACS patients with reduced systemic inflammation.

Clinical Characteristics of Patients with Drug-induced Liver Injury

Background： Drug is all important cause of liver injury and accounts for up to 40% of instances offidminant hepatic failure. Drug-induced liver injury （DILl） is increasing while the diagnosis becomes more difficult. Though many drugs may cause DILl, Chinese herbal medicines have recently emerged as a major cause due to their extensive use in China. We aimed to provide drug safety information to patients and health carets by analyzing the clinical and pathological characteristics of the DILl and the associated drug types. Methods： A retrospective analysis was conducted in 287 patients diagnosed with DILl enrolled in our hospital from January 2011 to December 2015. The categories of causative drugs, clinical and pathological characteristics were reviewed. Results： Western medicines ranked as the top cause of DILl, accounting for 163 out of the 287 DILl patients （56.79%） in our study. Among the Western medicine, antituberculosis drugs were the highest cause （18.47%, 53 patients） of DILl. Antibiotics （18 patients, 6.27%） and antithyroid （18 patients, 6.27%） drugs also ranked among the major causes of DILl. Chinese herbal medicines are another major cause of DILl, accounting for 36.59% of cases （105 patients）. Most of the causative Chinese herbal medicines were those used to treat osteopathy, arthropathy, dermatosis, gastropathy, leukotrichia, alopecia, and gynecologic diseases. Hepatocellular hepatitis was prevalent in DILl, regardless of Chinese herbal medicine or Western medicine-induced DILI. Conclusions： Risks and the rational use of medicines should be made clear to reduce the occurrence of DILl. For patients with liver injury of unknown origin, liver tissue pathological examination is recommended for further diagnosis.

Coaxial Fe_(2)O_(3)/TiO_(2)nanotubes for enhanced photo-Fenton degradation of electron-deficient organic contaminant

Coaxial Fe_(2)O_(3)/TiO_(2)nanotubes(Fe_(2)O_(3)/TiO_(2)NTs)were prepared by two anodic oxidation processes.The synthesized Fe_(2)O_(3)/TiO_(2)NTs catalysts showed high photocatalytic activity in heterogeneous photo-Fenton system.With the help of Fe_(2)O_(3)/TiO_(2)NTs,4-nitrophenol(10 mg·L^(-1),50 ml),a typical electron-deficient organic contaminant,can be completely removed by adding only0.4 mmol·L^(-1)of H_(2)O_(2)under irradiation.Investigation results clarify that the calculated position of Fe_(2)O_(3)/TiO_(2)NTs valence band is at 2.944 eV,its potential is higher than the potential of OH~-/·OH(2.800 eV),thereby ensuring the generation of·OH.Meanwhile,the transformation of photogenerated electrons from the conduction band of TiO_(2)to Fe_(2)O_(3)accelerates the reduction of Fe^(3+)to Fe^(2+).The unstable Fe^(2+)can be oxidized by H_(2)O_(2)to produce high yields of·OH.Therefore,both the coaxial heterojunction and fast Fe^(2+)/Fe^(3+)conversion provide abundant·OH to effective attack the electron-deficient benzene ring passivated by the nitro group.Thus,surface-catalyzed degradation of 4-nitrophenol can be carried out step by step.This work contributes a detailed understanding of charge transfer in semiconductor composites and degradation of organic contaminants.

A high-throughput strategy for rapid synthesis and characterization of Ni-based superalloys

This study developed a new high-throughput strategy,designated as hot-isostatic-pres sing-based microsynthesis approach(HIP-MSA),to optimize high-performance nickel-based superalloys in a rapid,efficient,and cost-effective manner.A specific honeycomb-array structure containing 106 discrete cells was designed and optimized using finite element analysis(FEA)and then applied to create a combinatorial library consisting of 106 Ni-based superalloys with various Co,Nb and Ta concentrations.By integration with high-throughput characterization tools,extensive composition and phase structure data were collected quickly and efficiently.In the superalloys with higher amounts of Nb and Ta,the detrimentalηphase displaying needle-like morphology was observed,and its content(wt%)increased drastically with Ta and Nb contents increasing.However,the increase of Co addition in those alloys was confirmed to be surprisingly beneficial by significantly suppressing the formation ofηphase that was induced by high Nb and Ta contents.The zero-phasefraction(ZPF)line ofηphase was established,which is critical to design superalloy chemistry for superior micros tructural stability at high-temperature service conditions.