Predictive value of SYNTAX score II for clinical outcomes in octogenarian undergoing percutaneous coronary intervention

Objective To evaluate the predictive value of SYNTAX Score II （SS-II） for percutaneous coronary intervention （PCI） in octogenarian （≥ 80 years old） undergoing PCI. Methods ＆ Results Data from three consecutive years of octogenarian undergoing PCI from Ruijin Hospital （Shanghai, China） was retrospectively collected （n = 308）. Follow up clinical data at one year including all cause mortality, cardiac mortality and main adverse cardiovascular and cerebrovascular events （MACCE） were collected. Patients were stratified according to tertiles of SS-II for PCI： SS-II 〈 26 （n = 104）, SS-II： 27-31 （n = 102）, SS-II 〉 31 （n = 102）. After adjustment for confounding factors, SS-II for PCI was an independent risk factors for all cause mortality （odds ratio： 2.77, 95% CI： 1.13-8.06; P = 0.04）. Kaplan-Meier curves showed higher event rates for all cause mortality and cardiac mortality in higher tertile of SS-II for PCI （Log-Rank test P = 0.002 and P = 0.001, respectively）. SSdl for PCI predicted one year mortality in octogenarian population undergoing PCI. Conclusions In octogenarian, SS-II which incorporated clinical variables with angiographic anatomy variable was suitable in risk stratifying and predicting clinical outcomes at one year.

Cutaneous metastasis from esophageal squamous cell carcinoma:A case report

BACKGROUND Esophageal cancer is a common cause of cancer-related death worldwide.Cutaneous metastasis of esophageal squamous cell carcinoma is rare,particularly in diffuse skin metastasis.CASE SUMMARY In this case report,we describe an 82-year-old male who was diagnosed with esophageal squamous cell carcinoma.The tumor was staged as T4N3M1(Stage IVB).The pathological findings revealed poorly differentiated squamous cell carcinoma of the esophagus.Four months after diagnosis,the patient began chemotherapy,and symptoms were relieved after four cycles of chemotherapy.After that,the patient returned home without a systematic physical examination.One year after diagnosis,the patient realized that the skin of the abdominal wall was hard and rough without pain,and the color became darker than normal skin.Thirteen months after diagnosis,a biopsy of the patient’s abdominal lesion revealed that the skin metastasis was derived from the esophagus.Then the patient received two cycles of apatinib combined with docetaxel,but the abdominal lesion worsened.Two cycles of nivolumab were administered,but the patient eventually died of multiple organ failure.CONCLUSION This report highlights cutaneous metastasis as a late and untreatable metastasis of esophageal cancer.

Clinical Utility of the Ratio Between Circulating Fibrinogen and Fibrin （ogen） Degradation Products for Evaluating Coronary Artery Disease in Type 2 Diabetic Patients

Background:We investigated whether and to what extent the ratio between circulating fibrinogen (Fg) and its degradation products (FDP)reflects the severity of coronary artery disease (CAD) in type 2 diabetic patients.Methods:Plasma levels of Fg and FDP were determined,and Fg/FDP ratio was calculated in 344 consecutive patients with type 2 diabetes and chest pain on exertion undergoing coronary angiography.The severity of CAD was evaluated by the number of significant CAD (＞50％ luminal diameter narrowing) and Gensini score.Results:Plasma Fg was higher,but Fg/FDP ratio was lower in patients with significant CAD (n =255) compared with those without (n =89),due to a disproportionate increase in FDP.Fg and FDP correlated positively,while Fg/FDP ratio negatively,with the number of diseased coronary arteries and the tertile of Gensini score (all P values for trend ＜ 0.01).After adjusting for age,sex,risk factors for CAD,lipid profiles,glycosylated hemoglobin A1c,creatinine,leukocyte count,and high-sensitivity C-reactive protein,Fg/FDP ratio remained an independent determinant for multivessel coronary disease (MVD) (odds ratio [OR],0.869; 95％ confidence interval [CI],0.788-0.958,P =0.005) and high tertile of Gensini score (OR,0.797,95％ CI,0.682-0.930,P =0.004).The area under the curve of Fg/FDP ratio was larger than that of Fg for predicting the presence of MVD (0.647 vs.0.563,P =0.048) and Gensini score ≥ 30 (0.656 vs.0.53 8,P =0.026).Conclusions:Elevated plasma Fg and FDP level and reduced Fg/FDP ratio are associated with presence of CAD,and Fg/FDP ratio is superior to Fg in reflecting severe coronary atherosclerosis for patients with type 2 diabetes.

Percutaneous Ventricular Restoration Therapy Using the Parachute Device in Chinese Patients with Ischemic Heart Failure： Three-Month Primary End-point Results of PARACHUTE China Study

Background： The primary cause of ischemic heart failure （HF） is myocardial infarction （MI） resulting in left ventricle （LV） wall motion abnormality secondary to ventricular remodeling. A prospective, nonrandomized study conducted in China was designed to assess safety and efficacy of the percutaneous ventricular restoration therapy using Parachute device （CardioKinetix, lnc., CA, USA） in ischemic HF patients as a result of LV remodeling after anterior wall M1. Methods： Thirty-one patients with New York Heart Association （NYHA） Class I1, I11 ischemic HF, ejection traction between 15% and 40%, and dilated akinetic or dyskinetic anterior-apical wall without the need to be revascularized were enrolled from seven sites in China from October to December 2014. The Parachute device was implanted through femoral artery. All patients received low-dose aspirin and anticoagulation with warfarin tbr at least 12 months postdevice implantation. The primary end-point was the assessment of efficacy as measured by the reduction in LV end-systolic volume index （LVESVI） against baseline LVESVI at 3 months postdevice implantation, determined by the echocardiography and measured by echocardiography core laboratory. Quality of life was assessed using EQ-SD and visual analog scale （VAS）. For quantitative data comparison, paired t-test （normality data） and signed-rank test （abnormality data） were used： application of signed-rank test was tbr the ranked data comparison. Results： A change in LVESVI as measured by echocardiography from the preimplant baseline to 3-month postdevice implantation revealed a statistically significant reduction from 77.5 ~ 20.0 ml/m-＇ to 53,1 ~ 17.0 ml/m-＂ （P 〈 0.0001 ）, The trial met its primary end-point. Of the 31 patients, the procedural success was 96.8%. Overall, NYHA HF class assessment results showed an improvement of more than halfa class at 3 months （P 〈 0.001 ）. Quality of life assessed by the VAS value increased 11.5 points （P 〈 0.01 ）, demonstrating improvement at 3 months.Conclusion： The favorable outcomes observed in the high-risk patients provide reassuring safety and efficacy data to support adoption of this technology as a therapeutic option for ischemic HF patients. Trial Registration： ClinicalTrials.gov, NCT02240940; https：// clinicaltrials.gov/ct2/show/NCT02240940.

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Objective： Coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease. We sought to determine which clinical and angiographic variables are associated with collateral development in patients with stable angina and chronic total coronary occlusion. Methods： Demographic variables, biochemical measurements, and angiographic findings were collected from 478 patients with stable angina and chronic total coronary occlusion. The presence and extent of collaterals supplying the distal aspect of a total coronary occlusion from the contra-lateral vessel were graded from 0 to 3 according to the Rentrop scoring system. Results： Low （Rentrop score of 0 or 1） and high （Rentrop score of 2 or 3） coronary collateralizations were detected in 186 and 292 patients, respectively. Despite similar age, cigarette smoking, and medical treatment, patients with low collateralization were female in a higher proportion and less hypertensive, and had higher rates of type 2 diabetes and dyslipidemia than those with high coUateralization （for all comparisons, P〈0.05）. In addition, patients with low collateralization exhibited more single-vessel disease, less right coronary artery occlusion, more impaired renal function, and higher serum levels of high-sensitivity C-reactive protein （hsCRP） compared with those with high col- lateralization. Multivariate analysis revealed that age of 〉65 years, female gender, diabetes, no history of hypertension dyslipidemia, moderate to severe renal dysfunction, single-vessel disease, and elevated hsCRP levels were inde- pendently associated with low coronary collateralization. Conclusions： Coronary collateralization was reduced in almost 40% of stable angina patients with chronic total occlusion, which was related to clinical and angiographic factors. The impact of coronary collateralization on outcomes after revascularization needs further investigation.

Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention

Objective:Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods:Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results:Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as:P/(1 P)=exp( 2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions:The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.

Hierarchical Crystalline Structures Induced by Temperature Profile in HDPE Bars during Melt Penetration Process

The hierarchical crystalline morphologies and orientation structures across the thickness direction in high-density polyethylene （HDPE） molded bars were investigated via a novel melt-penetrating processing method named multi-melt multi-injection molding （M3IM）. The samples with various mold temperatures （20, 40 and 60 ℃） were prepared, and the effects of the external temperature profile on the evolution of crystalline microstructures were studied. With scanning electron microscopy （SEM）, the transition of crystalline morphology from ring-banded structure to oriented lamellae was observed with decreasing mold temperature, and the oriented lamellae were formed at the sub-skin layer of the samples at the lowest mold temperature, which was further testified by differential scanning calorimetry （DSC）. With the decline of mold temperature, the degree of orientation, obtained from two-dimensional small angle X-ray scattering （2D-SAXS）, was increased and long periods rose a little. Thus, decreasing mold temperature was beneficial to the formation of orientation structures because the relaxation of chains was weakened.