Growth differentiation factor 15 predicts cardiovascular events in stable coronary artery disease

BACKGROUND Growth differentiation factor 15(GDF-15)has been explored as a potential biomarker for various inflammatory diseases and cardiovascular events.This study aimed to assess the predictive role of GDF-15 levels in cardiovascular events and all-cause mortality,considering traditional risk factors and other biomarkers.METHODS A prospective study was conducted and 3699 patients with stable coronary artery disease(CAD)were enrolled into the research.Baseline GDF-15 levels were measured.Median follow-up was 3.1 years during the study.We analyzed clinical variables and several biomarkers.Multivariable Cox regression analysis was performed to evaluate prognostic performance of GDF-15 levels in predicting myocardial infarction(MI),heart failure,stroke,cardiovascular death,and non-cardiovascular death.RESULTS Baseline GDF-15 levels for 3699 patients were grouped by quartile(≤1153,1153-1888,1888-3043,>3043 ng/L).Higher GDF-15 levels were associated with older age,male gender,history of hypertension,and elevated levels of N-terminal pro Btype natriuretic peptide(NT-pro BNP),soluble suppression of tumorigenesis-2(sST2),and creatine(each with P<0.001).Adjusting for established risk factors and biomarkers in Cox proportional hazards models,a 1 standard deviation(SD)increase in GDF-15 was associated with elevated risk of clinical events[hazard ratio(HR)=2.18,95%confidence interval(CI):(1.52-3.11)],including:MI[HR=2.8395%CI:(1.03-7.74)],heart failure[HR=2.7195%CI:(1.18-6.23)],cardiovascular and non-cardiovascular death[HR=2.48,95%CI(1.49-4.11)]during the median follow up of 3.1 years.CONCLUSIONS Higher levels of GDF-15 consistently provides prognostic information for cardiovascular events and all cause death,independent of clinical risk factors and other biomarkers.GDF-15 could be considered as a valuable addition to future risk prediction model in secondary prevention for predicting clinical events in patient with stable CAD.

Effect of exogenous hydrogen sulfide in the nucleus tractus solitarius on gastric motility in rats

BACKGROUND Hydrogen sulfide(H2S)is a recently discovered gaseous neurotransmitter in the nervous and gastrointestinal systems.It exerts its effects through multiple signaling pathways,impacting various physiological activities.The nucleus tractus solitarius(NTS),a vital nucleus involved in visceral sensation,was investigated in this study to understand the role of H2S in regulating gastric function in rats.AIM To examine whether H2S affects the nuclear factor kappa-B(NF-κB)and transient receptor potential vanilloid 1 pathways and the neurokinin 1(NK1)receptor in the NTS.METHODS Immunohistochemical and fluorescent double-labeling techniques were employed to identify cystathionine beta-synthase(CBS)and c-Fos co-expressed positive neurons in the NTS during rat stress.Gastric motility curves were recorded by inserting a pressure-sensing balloon into the pylorus through the stomach fundus.Changes in gastric motility were observed before and after injecting different doses of NaHS(4 nmol and 8 nmol),physiological saline,Capsazepine(4 nmol)+NaHS(4 nmol),pyrrolidine dithiocarbamate(PDTC,4 nmol)+NaHS(4 nmol),and L703606(4 nmol)+NaHS(4 nmol).RESULTS We identified a significant increase in the co-expression of c-Fos and CBS positive neurons in the NTS after 1 h and 3 h of restraint water-immersion stress compared to the expressions observed in the control group.Intra-NTS injection of NaHS at different doses significantly inhibited gastric motility in rats(P<0.01).However,injection of saline,first injection NF-κB inhibitor PDTC or transient receptor potential vanilloid 1(TRPV1)antagonist Capsazepine or NK1 receptor blockers L703606 and then injection NaHS did not produce significant changes(P>0.05).CONCLUSION NTS contains neurons co-expressing CBS and c-Fos,and the injection of NaHS into the NTS can suppress gastric motility in rats.This effect may be mediated by activating TRPV1 and NK1 receptors via the NF-κB channel.

Fermatean Hesitant Fuzzy Prioritized Heronian Mean Operator and Its Application in Multi-Attribute Decision Making

In real life,incomplete information,inaccurate data,and the preferences of decision-makers during qualitative judgment would impact the process of decision-making.As a technical instrument that can successfully handle uncertain information,Fermatean fuzzy sets have recently been used to solve the multi-attribute decision-making(MADM)problems.This paper proposes a Fermatean hesitant fuzzy information aggregation method to address the problem of fusion where the membership,non-membership,and priority are considered simultaneously.Combining the Fermatean hesitant fuzzy sets with Heronian Mean operators,this paper proposes the Fermatean hesitant fuzzy Heronian mean(FHFHM)operator and the Fermatean hesitant fuzzyweighted Heronian mean(FHFWHM)operator.Then,considering the priority relationship between attributes is often easier to obtain than the weight of attributes,this paper defines a new Fermatean hesitant fuzzy prioritized Heronian mean operator(FHFPHM),and discusses its elegant properties such as idempotency,boundedness and monotonicity in detail.Later,for problems with unknown weights and the Fermatean hesitant fuzzy information,aMADM approach based on prioritized attributes is proposed,which can effectively depict the correlation between attributes and avoid the influence of subjective factors on the results.Finally,a numerical example of multi-sensor electronic surveillance is applied to verify the feasibility and validity of the method proposed in this paper.

Novel biomarkers for cardiovascular risk prediction

Cardiovascular disease （CVD） is the leading cause of death and disability worldwide. The primary prevention of CVD is dependent upon the ability to identify high-risk individuals long before the development of overt events. This highlights the need for accurate risk strati- fication. An increasing number of novel biomarkers have been identified to predict cardiovascular events. Biomarkers play a critical role in the definition, prognostication, and decision-making regarding the management of cardiovascular events. This review focuses on a variety of promising biomarkers that provide diagnostic and prognostic information. The myocardial tissue-specific biomarker cardiac troponin, high- sensitivity assays for cardiac troponin, and heart-type fatty acid binding proteinall help diagnose myocardial infarction （MI） in the early hours following symptoms. Inflammatory markers such as growth differentiation factor-15, high-sensitivity C-reactive protein, fibrinogen, and uric acid predict MI and death. Pregnancy-associated plasma protein A, myeloperoxidase, and matrix metalloproteinases predict the risk of acute cor- onary syndrome. Lipoprotein-associated phospholipase A2 and secretory phospholipase A2 predict incident and recurrent cardiovascular events. Finally, elevated natriuretic peptides, ST2, endothelin-1, mid-regional-pro-adrenomedullin, copeptin, and galectin-3 have all been well validated to predict death and heart failure following a MI and provide risk stratification information for heart failure. Rapidly develop- ing new areas, such as assessment ofmicro-RNA, are also explored. All the biomarkers reflect different aspects of the development ofather- osclerosis.

Protective effect of heme oxygenase-1 on Wistar rats with heart failure through the inhibition of inflammation and amelioration of intestinal micro- circulation

Background Myocardial infarction （MI） has likely contributed to the increased prevalence of heart failure （HF）. As a result of re- duced cardiac function, splanchnic blood flow decreases, causing ischemia in villi and damage to the intestinal barrier. The induction of heme oxygenase-1 （HO-1） could prevent, or lessen the effects of stress and inflammation. Thus, the effect and mechanism thereof of HO-1 on the intestines of rats with HF was investigated. Methods Male Wistar rats with heart failure through ligation of the left coronary artery were identified with an left ventricular ejection fraction of 〈 45% through echocardiography and then divided into various experimental groups based on the type of peritoneal injection they received [MI： saline; MI ＋ Cobalt protoporphyrin （CoPP）： CoPP solution; and MI ＋ Tin mesoporphyrin IX dichloride （SnMP）： SnMP solution]. The control group was comprised of rats without coronary ligation. Echocardiogra- phy was performed before ligation for a baseline and eight weeks after ligation in order to evaluate the cardiac function of the rats. The bac- terial translocation （BT） incidence, mesenteric microcirculation, amount of endotoxins in the vein serum, ileum levels of HO- 1, carbon oxide （CO）, nitric oxide （NO）, intedeuldn （IL）-10, turnour necrosis factor-et （TNF-ct）, and the ileum morphology were determined eight weeks after the operation. Results The rats receiving MI ＋ CoPP injections exhibited a recovery in cardiac function, an amelioration of mesenteric microcirculation and change in morphology, a lower BT incidence, a reduction in serum and ileac NO and TNF-ct levels, and an elevation in ileac HO-1, CO, and interleukin-10 （[L-10） levels compared to the MI group （P 〈 0.05）. The rats that received the MI ＋ SnMP injections exhibited results inverse to the MI （P 〈 0.05） group. Conclusions HO-1 exerted a protective effect on the intestines of rats with HF by inhibiting the inflammation and amelioration of microcirculation through the CO pathway. This protective effect could be independent from the recovery of cardiac function.

The future of remote ECG monitoring systems

Remote ECG monitoring systems are becoming commonplace medical devices for remote heart monitoring. In recent years, remote ECG monitoring systems have been applied in the monitoring of various kinds of heart diseases, and the quality of the transmission and re- ception of the ECG signals during remote process kept advancing. However, there remains accompanying challenges. This report focuses on the three components of the remote ECG monitoring system： patient （the end user）, the doctor workstation, and the remote server, reviewing and evaluating the imminent challenges on the wearable systems, packet loss in remote transmission, portable ECG monitoring system, pa- tient ECG data collection system, and ECG signals transmission including real-time processing ST segment, R wave, RR interval and QRS wave, etc. This paper tries to clarify the future developmental strategies of the ECG remote monitoring, which can be helpful in guiding the research and development of remote ECG monitoring.

Enhanced strength and toughness in 40CrNiMo steels by austempering below martensite start temperature

The austempering above and below martensite transition temperature(M_(s))was employed in a medium-carbon low-alloy 40CrNiMo steel,and the bainite and martensite multiphase microstructures with different volume fractions were obtained.Here,the effect of pre-existing martensite on subsequent transformation of bainite microstructure and mechanical properties is focused and researched.The microstructure with a volume fraction of pre-existing martensite(V_(PM)),bainite(V_(B)),and martensite/austenite(V_(M/A))constituents of approximately 28%,46%,and 26%,respectively could be obtained by austenitizing below M_(s)(280℃)for 1 h,and an optimum combination of strength,ductility,and impact toughness(yield strength of 1420 MPa,ultimate tensile strength of 1795 MPa,total elongation of 7.9%,and V-notch impact value of 37 J)was achieved.The considerable enhancement of mechanical properties in the sample austenitized below M_(s)is mainly ascribed to the formation of the pre-existing martensite,resulting in an effective reduction in the size of the bainite plates and martensite/austenite constituents.

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.

Early diagnosis of acute kidney injury in aged patients undergoing percutaneous coronary intervention

In aged patients, acute kidney injury （AKI） is a common clinical complication after percutaneous coronary intervention （PCI）, highlighting the need for timely and certain diagnosis of this disease. A single centre, nested case-control study was conducted, which assessed the usefulness of urinary liver-type fatty acid-binding protein （uL-FABP）, neutrophil gelatinase-associated lipocalin （uNGAL）, and kidney injury molecule-1 （uKIM-1） for early detection of AKI. One hundred and thirty-two patients at or over 60 years old undergoing PCI were included.

Advances in monoclonal antibody application in myocarditis

Monoclonal antibodies have become a part of daily preparation technologies in many laboratories. Attempts have been made to apply monoclonal antibodies to open a new train of thought for clinical treatments of autoimmune diseases, inflammatory diseases, cancer, and other immune-associated diseases. This paper is a prospective review to anticipate that monoclonal antibody application in the treatment of myocarditis, an inflammatory disease of the heart, could be a novel approach in the future. In order to better understand the current state of the art in monoclonal antibody techniques and advance applications in myocarditis, we, through a significant amount of literature research both domestic and abroad, developed a systematic elaboration of monoclonal antibodies, pathogenesis of myocarditis, and application of monoclonal antibodies in myocarditis. This paper presents review of the literature of some therapeutic aspects of monoclonal antibodies in myocarditis and dilated cardiomyopathy to demonstrate the advance of monoclonal antibody application in myocarditis and a strong anticipation that monoclonal antibody application may supply an effective therapeutic approach to relieve the severity of myocarditis in the future. Under conventional therapy, myocarditis is typically associated with congestive heart failure as a progressive outcome, indicating the need for alternative therapeutic strategies to improve long-term results. Reviewing some therapeutic aspects of monoclonal antibodies in myocarditis, we recently found that monoclonal antibodies with high purity and strong specificity can accurately act on target and achieve definite progress in the treatment of viral myocarditis in rat model and may meet the need above. However, several issues remain. The technology on how to make a higher homologous and weak immunogenic humanized or human source antibody and the treatment mechanism of monoclonal antibodies may provide solutions for these open issues. If we are to further stimulate progress in the area of clinical decision support, we must continue to develop and refine our understanding and use of monoclonal antibodies in myocarditis.

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.

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.