Impact of main vessel calcification on procedural and clinical outcomes of bifurcation lesion undergoing provisional single-stenting intervention: a multicenter, prospective, observational study

Background Few data on the combined effects of bifurcation and calcification on coronary artery disease(CAD)patients undergoing percutaneous coronary intervention(PCI)are available.This study evaluated the impact of main vessel(MV)calcification on the procedural and long-term outcomes in patients with CAD who underwent provisional single stent PCI.Methods This is a multicenter,prospective,observational study.Patients with bifurcation lesions were enrolled at 10 PCI centers in China from January 2015 to December 2017.Intravascular ultrasound or optical coherence tomography was performed in all patients to evaluate the MV calcification.Patients were treated with provisional single stent strategy using drug eluting stents and followed-up at 1 month,6 months and 12 months after discharge by telephone contact or outpatient visit.Repeated coronary imaging was performed within one year.We compared the procedural success rates in MV and in side branch(SB),and target lesion failure(TLF),defined as a composite of cardiac death,non-fatal myocardial infarction,definite or possible stent thrombosis and target lesion revascularization between patients with and without MV calcification.Results A total of 185 subjects were enrolled according to the inclusion and exclusion criteria of this study.MV calcification was detected in 119(64.3%,calcification group)and not found in 66(35.7%,non-calcification group)patients.The angiographic success rate of MV was 95.8%in the calcification group and 97.0%in the non-calcification group(P=0.91);the angiographic success rate of SB was 32.8%in the calcification group and 53.0%in the non-calcification group(P<0.05).During the one-year follow-up period,TLF occurred in 14(11.8%)patients in the calcification group and in 13(19.7%)in the non-calcification group{P=0.31).Multivariate regression analysis showed the same result(HR=1.23,95%CI:0.76-1.52,P=0.47).Calcification on group had higher recurrent angina than non-calcification group(13.51%vs.17.65%,P<0.05).Conclusions In patients with coronary bifurcation lesion treated with provisional one stent approach,calcification of MV is associated with lower SB procedural success rate,it could increase recurrence of angina;however,it was not associated with an increased risk of TLF.

Fc effector of anti-Aβ antibody induces synapse loss and cognitive deficits in Alzheimer’s disease-like mouse model

Passive immunotherapy is one of the most promising interventions for Alzheimer’s disease(AD).However,almost all immune-modulating strategies fail in clinical trials with unclear causes although they attenuate neuropathology and cognitive deficits in AD animal models.Here,we showed that Aβ-targeting antibodies including their lgG1 and lgG4 subtypes induced microglial engulfment of neuronal synapses by activating CR3 or FcγRIIb via the complex of Aβ,antibody,and complement.Notably,anti-Aβantibodies without Fc fragment,or with blockage of CR3 or FcγRIIb,did not exert these adverse effects.Consistently,Aβ-targeting antibodies,but not their Fab fragments,significantly induced acute microglial synapse removal and rapidly exacerbated cognitive deficits and neuroinflammation in APP/PS1 mice post-treatment,whereas the memory impairments in mice were gradually rescued thereafter.Since the recovery rate of synapses in humans is much lower than that in mice,our findings may clarify the variances in the preclinical and clinical studies assessing AD immunotherapies.Therefore,Aβ-targeting antibodies lack of Fc fragment,or with reduced Fc effector function,may not induce microglial synaptic pruning,providing a safer and more efficient therapeutic alternative for passive immunotherapy for AD.

Clinical,Neuroimaging,and Pathological Analyses of 13 Chinese Leigh Syndrome Patients with Mitochondrial DNA Mutations

Background:Leigh syndrome (LS)is a rare disease caused by mitochondrial defects and has high phenotypic and genotypic heterogeneity. We analyzed the clinical symptoms,neuroimaging,muscular histopathology,and genotypes of 13 Chinese LS patients with mitochondrial DNA (mtDNA)mutations. Methods:Mutations in mtDNA were identified by targeted sequencing.The brain imaging features on magnetic resonance imaging (MRI) were analyzed.The levels of lactate in fasting blood and cerebrospinal fluid (CSF)were routinely tested.The levels of urinary organic acids,plasma amino acids,and acylcamitines were examined with gas chromatography-mass spectrometry and tandem mass spectrometry. The histopathological traits of skeletal muscles were analyzed under microscope. Results:Among 13 patients,mutations ofMT-NDs (n =8)and MT-ATP6(n =4)genes were most common.Strabismus (8/13),muscle weakness (8/13),and ataxia (5/13)were also common,especially for the patients with late-onset age after 2 years old.However,respiratory distress was common in patients with early-onset age before 2 years old.The most frequently affected brain area in these patients was the brain stem (12/13),particularly the dorsal part of midbrain,followed by basal ganglia (6/13),thalamus (6/13),cerebellum (5/13), and supratentorial white matter (2/13).Besides,the elevated lactate levels in CSF (6/6)were more common than those in serum (7/13). However,the analysis of abnormal plasma amino acid and urinary organic acid showed limited results (0/3and 1/4,respectively).Muscular histopathology showed mitochondrial myopathy in the three late-onset patients but not in the early-onset ones. Conclusions:Noninvasive genetic screening is recommended for mtDNA mutations in MT-NDs and MT-ATP6 genes in patients with ophthalmoplegia,muscle weakness,ataxia,and respiratory disorder.Furthermore,the lactate detection in CSF and the brain MRI scanning are suggested as the diagnosis methods for LS patients with mtDNA mutations.

Variation characteristic of drilling force and influence of cutting parameter of SiCp/Al composite thin-walled workpiece

In this paper,the variation characteristic of the drilling force,and the influences of cutting speed,feed rate,and workpiece thickness on the drilling force,were eval・uated when drilling a silicon carbide particle reinforced aluminum matrix(SiCp/Al)composite thin-walled workpiece with a high volume fraction.Under the condition that the workpiece thickness was less than the drill tip height,three characteristic stages of drilling force variation were proposed.The results indicate that there is a sign币cant difference between the variations in the drilling force when drilling a thin-walled workpiece compared to thick-walled workpiece.When the chisel edge drills out the lower surface of the workpiece,there is an abrupt decrease in the thrust forces of the thin-walled and thick-walled workpieces.In addition,there is an abrupt decrease in the torque of the thick-walled workpiece,whereas that of the thinwalled workpiece increases.According to the thickness of the thin-walled workpiece,the instant of the abrupt decrease in the thrust force may lead or lag behind the theoretical instant at which the chisel edge reaches the lower surface of the workpiece without deformation.When drilling a thin-walled hole,the cutting speed has a slight influence on the thrust force,and there is a slight increase in the torque in accordance with an increase in the cutting speed.The thrust force and torque increase in accordance with an increase in the feed rate.When drilling a thinwalled workpiece with a thickness of 1 mm,the critical thickness of workpiece cracking decreases in accordance with an increase in the cutting speed,and increases in accordance with an increase in the feed rate.When drilling a thin-walled workpiece with a thickness of 0.5 mm,the concave deformation of the workpiece and the critical thickness of the workpiece cracking increase in accordance with an increase in the feed rate.However,the increment in the critical thickness of the workpiece cracking is less than that in the concave deformation of the workpiece.

Reply to “Phenotypic and Genotypic Peculiarities in Chinese Patients with Leigh Syndrome”

To the Editor: We really appreciate the readers5 interest and comments about our article, and to have the opportunity to make an explanation[1].

Myotonic Dystrophy Type I with Syringomyelia in a Young Patient

Myotonic dystrophy type 1 (DM1) is the most common disease causing muscle weakness and atrophy in adults,[1]The prevalence of DM1 in China is not clear.DM1 is an autosomal dominant genetic disorder associated with the cytosine-thymine-guanine (CTG) repeat expansion in 3'untranslated region in dystrophia myotonica-protein kinase (DMPK) gene on chromosome 19q13.3.In DM1, CTG pathological repeat numbers are more than 50.The size of CTG repeat expansion is associated with the time of clinical phenotypes onset and severity.[1-3] The coexistence of DM1 and syringomyelia is rare.Here, we report DM1 coexisting with syringomyelia in a Chinese male patient.