The effectiveness and safety of the RESTORE R drug-eluting balloon versus a drug-eluting stent for small coronary vessel disease： study protocol for a multi-center, randomized, controlled trial

bjective Small coronary vessel disease （disease affecting coronary vessels with main branch diameters of 〈 2.75 mm） is a common and intractable problem in percutaneous coronary intervention （PCI）. This study was designed to test the theory that the effectiveness and safety of drug-eluting balloons for the treatment of de novo lesions in small coronary vessels are non-inferior to those of drug-eluting stents. Methods We designed a prospective, multicenter, randomized, controlled clinical trial aiming to assess the effectiveness and safety of the RESTORE R （Cardionovum, Bonn, Germany） drug-eluting balloon （DEB） versus the RESOLUTE R （Medtronic, USA） drug-eluting stent （DES） in the treatment of small coronary vessel disease. This trial started in August 2016. A total of 230 patients with a reference vessel diameter （RVD） 〉 2.25 mm and 〈 2.75 mm were randomly assigned to treatment with a DEB or a DES at a 1：1 ratio. The study was also designed to enroll 30 patients with an RVD 〉 2.00 mm and 〈 2.25 mm in the tiny vessel cohort. Results The key baseline data include demographic characteristics, relative medical history, baseline angiographic values and baseline procedural characteristics. The primary endpoint is in-segment diameter stenosis at nine months after the index procedure. Secondary endpoints include acute success, all-cause death, myocardial infarction, target vessel revascularization, target lesion revascularization and stent thrombosis. Conclusions The study will evaluate the clinical efficacy, angiographic outcomes, and safety of DEBs compared to DESs in the treatment of de novo coronary artery lesions in small vessels.

Safety and efficacy of frequency-domain optical coherence tomography in evaluating and treating intermediate coronary lesions

AIM To establish whether frequency-domain optical coherence tomography(FD-OCT) is safe and effective in the evaluation and treatment of angiographicallyintermediate coronary lesions(ICL) METHODS Sixty-four patients with 2-dimensional quantitativecoronary angiography(2D-QCA) demonstrating ICL were included. OCT imaging was performed. According to predetermined OCT criteria, patients were assigned to either of 2 groups: OCT-guided percutaneous coronary intervention(PCI) or OCT-guided optimal medical therapy(OMT). The primary efficacy endpoint was to demonstrate the superiority and higher accuracy of FD-OCT compared to 2D-QCA in evaluating stenosis severity in patients with ICL. The primary safety endpoint was the incidence of 30-d major adverse cardiac events(MACE). Secondary endpoints included MACE at 12 mo and other clinical events.RESULTS Analysis of the primary efficacy endpoint demonstrates that 2D-QCA overestimates the stenosis severity of ICL in both the OCT-guided PCI and OMT groups, proving FD-OCT to be superior to and more precise than 2D-QCA in treating this subset of lesions. The primary safety endpoint was fully met with the incidence of 30-d MACE being nil in both the OCT-guided PCI and OCTguided OMT groups. Incidences of secondary endpoints were found to be low in both arms, the only exception being the relatively high incidence of recurrent episodes of angina which was, however, very similar in the 2 groups.CONCLUSION FD-OCT is safe and effective in the evaluation and treatment of ICL. Larger studies are needed to firmly establish the efficacy and safety of FD-OCT in treating ICL across all coronary artery disease population subgroups.

Increased index of microcirculatory resistance in older patients with heart failure with preserved ejection fraction

Objective To study the coronary microvascular function in older patients with heart failure with preserved ejection fraction (HFpEF) using an invasive pressure–temperature sensor guidewire. Methods Patients undergoing echocardiography and cardiac catheterization examinations for exertional dyspnea and a positive stress test were retrospectively enrolled from January 2014 to November 2017, and were allocated into the control group or HFpEF group. The HFpEF group was secondary divided into two groups according to the age of 65 years. Comparing the clinical features and values obtained in examinations between the three groups, multivariate regression analysis was used to analyze the predictors of left ventricle end diastolic pressure (LVEDP). Results There were 87 patients enrolled in this study. The older HFpEF patients (n = 32) were more likely to be female;and had the most comorbidities, such as diabetes mellitus, atrial fibrillation, and chronic kidney dysfunction (CKD) with a low estimated glomerular filtration rate (eGFR), and had a similar hypertensive prevalence as the adult HFpEF group (n = 24), whose mean LVEDP and index of microcirculatory resistance (IMR) were highest in comparison to the adult HFpEF patients and controls (n = 31). The coronary flow reserve (CFR) in the older HFpEF and adult HFpEF groups was similarly reduced. In the regression analysis, the IMR linearly correlated to LVEDP, and was the only independent predictor of LVEDP. Conclusions An increased IMR and reduced CFR were characteristics of microvascular dysfunction in older HFpEF patients. The IMR independently had a positive linear correlation with LVEDP. Microvascular rarefaction might be a subsequent pathological progression in the development of HFpEF.

Why a mosquito leg possesses superior load-bearing capacity on water:Experimentals

Mosquitoes possess the striking ability to walk on water because each of their legs has a huge water supporting force（WSF） that is 23 times their body weight.Aiming at a full understanding of the origins of this extremely large force,in this study,we concentrate on two aspects of it：the intrinsic properties of the leg surface and the active control of the initial stepping angle of the whole leg.Using a measurement system that we developed ourselves,the WSFs for the original leg samples are compared with those whose surface wax and microstructures have been removed and with those of a different stiffness.The results show that leg f exibility plays a dominant role over surface wax and microstructures on the leg surface in creating the supporting force.Moreover,we discuss the dependence relationship between the maximum WSF and the initial stepping angle,which indicates that the mosquito can regulate this angle to increase or decrease the WSF during landing or takeoff.These finding are helpful for uncovering the locomotion mechanism of aquatic insects and for providing inspiration for the design of microfluids miniature boats,biomimetic robots,and microsensors.

Epigenetic role of N^6-methyladenosine(m^6A)RNA methylation in the cardiovascular system

As the most prevalent and abundant transcriptional modification in the eukaryotic genome,the continuous and dynamic regulation of N^6-methyladenosine(m^6 A)has been shown to play a vital role in physiological and pathological processes of cardiovascular diseases(CVDs),such as ischemic heart failure(HF),myocardial hypertrophy,myocardial infarction(MI),and cardiomyogenesis.Regulation is achieved by modulating the expression of m^6 A enzymes and their downstream cardiac genes.In addition,this process has a major impact on different aspects of internal biological metabolism and several other external environmental effects associated with the development of CVDs.However,the exact molecular mechanism of m^6 A epigenetic regulation has not been fully elucidated.In this review,we outline recent advances and discuss potential therapeutic strategies for managing m^6 A in relation to several common CVD-related metabolic disorders and external environmental factors.Note that an appropriate understanding of the biological function of m^6 A in the cardiovascular system will pave the way towards exploring the mechanisms responsible for the development of other CVDs and their associated symptoms.Finally,it can provide new insights for the development of novel therapeutic agents for use in clinical practice.

Nano-silver induced ceramic coloring via control of glaze interface and phase separation

As a kind of rare materials,nano-silver has broad application prospects in the fields of catalysis,medical treatment,new energy and so on.However,there are few reports on the systematic research of nano-silver in ceramic glazes.In this work,different color ceramic glazes were produced by tuning the nano-silver content and optimizing the firing process.The crystalline phase composition,micro-morphology and elemental distribution of fired glazes were analyzed and discussed in depth.The elemental composition and distribution of the samples were studied.The surface of the glazes with varying Ag contents fired under the reducing atmosphere exhibited blue-white.And the blue color is attributable to Rayleigh scattering that may arise because the phase-separation structures existed in glazes.Interestingly,the color of the ceramic glazes with varying Ag contents changed to golden-yellow when the ceramic glazes were fired under the air atmosphere.Golden-yellow color of the samples fired under the air atmosphere is mainly attributable to the silver nanoparticles,though Ag^(+) may be existed in the glazes.