Left ventricular thrombosis caused cerebral embolism during venoarterial extracorporeal membrane oxygenation support: A case report

BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.

Interaction between adolescent sleep rhythms and gender in an obese population

BACKGROUND The obesity rate of adolescents is gradually increasing,which seriously affects their mental health,and sleep plays an important role in adolescent obesity.AIM To investigate the relationship between sleep rhythm and obesity among adolescents and further explores the interactive effect of sleep rhythm and gender on adolescent obesity,providing a theoretical basis for developing interventions for adolescent obesity.METHODS Research data source Tianjin Mental Health Promotion Program for Students.From April to June 2022,this study selected 14201 students from 13 middle schools in a certain district of Tianjin as the research subject using the convenient cluster sampling method.Among these students,13374 accepted and completed the survey,with an effective rate of 94.2%.The demographic data and basic information of adolescents,such as height and weight,were collected through a general situation questionnaire.The sleep rhythm of adolescents was evaluated using the reduced version of the morningness-eveningness questionnaire.RESULTS A total of 13374 participants(6629 females,accounting for 49.56%;the average age is 15.21±1.433 years)were analyzed.Among them,the survey showed that 2942 adolescent were obesity,accounting for 22%and 2104 adolescent were overweight,accounting for 15.7%.Among them,1692 male adolescents are obese,with an obesity rate of 25.1%,higher than 18.9%of female adolescents.There is a statistically significant difference between the three groups(χ2=231.522,P<0.000).The obesity group has the smallest age(14.94±1.442 years),and there is a statistical difference in age among the three groups(F=69.996,P<0.000).Obesity rates are higher among individuals who are not-only-child,have residential experience within six months,have family economic poverty,and have evening-type sleep(P<0.05).Logistic regression analysis shows a correlation between sleep rhythm and adolescent obesity.Evening-type sleep rhythm can increase the risk of obesity in male adolescents[1.250(1.067-1.468)],but the effect on female obesity is not remarkable.Further logistic regression analysis in the overall population demonstrates that the interaction between evening-type sleep rhythm and the male gender poses a risk of adolescent obesity[1.122(1.043-1.208)].CONCLUSION Among adolescents,the incidence of obesity in males is higher than in females.Evening-type sleep rhythm plays an important role in male obesity but has no significant effect on female obesity.Progressive analysis suggests an interactive effect of sleep rhythm and gender on adolescent obesity,and the combination of evening-type sleep and the male gender promotes the development of adolescent obesity.In formulating precautions against adolescent obesity,obesity in male adolescents with evening-type sleep should be a critical concern.

The Systemic Immune Inflammatory Index Predicts No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention in Older Patients with STEMI

Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.

High Serum CEA and CYFRA21-1 Levels after a Two-Cycle Adjuvant Chemotherapy for NSCLC:Possible Poor Prognostic Factors

Objective The aim of this study was to test whether carcinoembryonic antigen(CEA) and cytokeratin 19 fragments(CYFRA21-1) can be used as a prognostic factor for non-small-cell lung cancer(NSCLC) after two cycles of adjuvant chemotherapy in NSCLC patients. Methods A total of 169 patients underwent at least two cycles of adjuvant chemotherapy.The serum levels of CEA and CYFRA21-1 were recorded after the second cycle of chemotherapy,and the patient follow-up was conducted.Overall survival(OS) and diseasefree survival(DFS) were used as the primary endpoint and the secondary endpoint,respectively. Results The high levels of CEA and CYFRA21-1 after two cycles of adjuvant chemotherapy were poor prognostic factors for OS,with risk ratios(RR) of 2.003 and 1.702,respectively.A high CEA level was a poor prognostic factor(RR 1.152) for DFS.The median survival time(MST) of the high CEA level group was 26 months,whereas that of the normal group was 61 months(P<0.0001).The median DFS time of the high CEA group and the normal group was 34 and 53 months,respectively(P<0.0001).The MST of the high CYFRA21-1 group and the normal group was 43 and 56 months,respectively(PO.0001). Conclusions The high serum levels of CEA or CYFRA21-1 after two cycles of adjuvant chemotherapy are poor prognostic factors for NSCLC patients.

Association between CYP2C19*2/*3Polymorphisms and Coronary Heart Disease

This study sought to explore the relationship between cytochrome P450 2C19(CYP2C19)*2/*3 polymorphisms and the development of coronary heart disease(CHD),and to evaluate the influence of the single nucleotide polymorphisms(SNPs)on the occurrence of adverse clinical events in CHD patients.A total of 231 consecutive patients candidate for percutaneous coronary intervention genotyped for CYP2C19*2(681G>A)and*3(636G>A)polymorphisms were enrolled.The adverse clinical events were recorded during a follow-up period of 14 months.The incidence of CHD,according to coronary angiography,was significantly higher(P=0.025)in CYP2C19*2 carriers group.Stepwise binary logistic regression analysis revealed that among factors that potentially influenced the presence of CHD(age>60 years,gender,BMI,etc.),CYP2C19*2 carriers(OR 1.94,95%CI:1.08-3.50,P=0.028)and male gender(OR 2.74,95%CI:1.58-4.76,P=0.001)were independent predictors,which were associated with the presence of CHD.The follow-up results showed that the incidence of adverse cardiovascular events within 14 months of discharge was significantly higher in the CYP2C 19*2 carriers than in the non-carriers(21.6%vs.6.3%,P=0.019).The results of the multivariate Cox proportional hazards model showed that CYP2C19*2 loss-of-flinction was the only independent factor which predicted the coronary events during the follow-up period of 14 months(OR=3.65,95%CI:1.09-12.25,P=0.036).The adverse impact of CYP2C19*2 polymorphisms was found not only in the risk of the presence of CHD,but also in the adverse cardiovascular events in CHD patients during the follow-up period of 14 months.However the same influence was not found in CYP2C19*3 mutation in Chinese Han population.

Ultrasound-guided Thrombin Injection:An Alternative Treatment for Femoral Artery Pseudoaneurysm with Better Efficiency and Safety

The aim of this study was to evaluate the efficiency and safety of ultrasound-guided thrombin injection on femoral pseudoaneurysm （FPA） as compared to ultrasound-guided local oppression. Eleven cases of FPA were enrolled and 7 cases received ultrasound-guide thrombin injection （injection group）, and the remaining 4 cases were treated with local oppression （oppression group）. Efficiency and safety were analyzed by ultrasound and subsequent follow-up. The results showed that 1 case relapsed in oppression group while no relapse occurred in thrombin injection group. Ultrasound-guided thrombin injection is better for treatment of FPA in terms of effectiveness and safety.

Influence of increased epicardial adipose tissue volume on 1-year in-stent restenosis in patients who received coronary stent implantation

Epicardial 脂肪质的织物(吃) 显著地与冠的动脉粥样硬化患者匾，心脏的事件和冠的心疾病的临床的预后的形成和作文被联系。但是，是否增加了吃免职可以影响 in-stent 狭窄(ISR ) 的发生当前是不清楚的。这研究把冠的计算断层摄影术 angiography ( CCTA )用作一个平均数调查是否增加了吃体积与为怀疑的冠的动脉疾病的评估经历了64片 CCTA 检查的 364 个病人全部的 ISR.MethodsA 被联系，并且随后第一次经历了经皮的冠的干预(一种总线标准)，然后为一年里的 ISR 检查的接受冠的 angiography ( CA )后续，回顾地在这研究被包括。吃体积被 CCTA 检查测量。CA 后续在 9 和 15 个月之间被获得。ISR 作为 stent 片断或 peri-stent 片断变窄的 50% 钠直径是 dened。吃体积有或没有 ISR 在病人之间被比较， ISR 的另外的著名预言者是 compared.ResultsEAT 没有 ISR ，体积 signicantly 与那些相比与 ISR 在病人被增加( 154.5 ?潃据畬楳湯??汥敤汲?华??千瀠瑡敩瑮?楷桴???瑳条摥倠?洠杩?戠?湡漠瑰浩污猠牴瑡来?獡潳楣瑡摥眠瑩?敲畤散?潬杮琭牥?慣摲慩?敤瑡?牯??潣灭牡摥眠瑩?湯?楴敭倠?猠牴瑡来?

Incidence of pocket hematoma after electrophysiological device placement：dual antiplatelet therapy versus low-molecular-weight heparin regimen

BackgroundGiven 要求双 antiplatelet 的病人的增加的数字(弹跳) 治疗和 electrophysiological 设备(EPD ) 放置， perioperative antiplatelet 管理是当前的挑战。在这研究，我们在经历的病人在 EPD 放置以后调查了袖珍 hematoma 形成的发生弹跳治疗或其他的 low-molecular-weight 肝磷脂(LMWH ) regimen.MethodsThis 临床的观察学习从 2010 年 7 月被执行到 2012 年 7 月。总共， 171 个病人在满足包括标准以后在分析被注册。这些病人被划分成二个组：86 个病人被对待与弹跳治疗在设备培植，和 DAP 治疗的时候被中止 5 ～ 7 天并且在另外的 85 个病人在设备培植前用 enoxaparin 代替了。腺苷磷酸盐(自动数据处理) 调停了血小板聚集和 arachidonic 导致酸的血小板聚集外科手术前地被测试。我们把在二个组和袖珍 hematoma 开发的协会之间的袖珍 hematoma 的发生与调停自动数据处理的血小板聚集和 arachidonic 作比较在继续的病人的袖珍 hematoma 的导致酸的血小板 aggregation.ResultsThe 发生弹跳在用 LMWH 代替了双 antiplatelet 政体的病人是比那低的(3.49%对16.47%分别地；X 2= 6.66， P <；0.01 ) 。在继续的病人之中弹跳治疗，没有袖珍 hematomas，在有袖珍 hematomas 的病人的调停自动数据处理的血小板聚集抑制的率在病人比那高。没有经历的病人弹跳或 enoxaparin 治疗得了袖珍感染， thromboembolic 事件，或另外的严肃的复杂并发症。多重逻辑回归分析表明那 LMWH 治疗是为袖珍 hematoma 的发展的一个独立风险因素(RR = 0.054， 95%CI = 0.012-0.251 ) 。而且，经历 LMWH 治疗的病人比是弹跳对待 individuals.ConclusionContinuance 的多半更是 5.1 褶层开发袖珍 hematomas 弹跳治疗不在 EPD 以后增加袖珍 hematoma 形成的风险放置。

Surface Modification of Polycarbonate Urethane by Covalent Linkage of Heparin with a PEG Spacer

Heparin was grafted onto polycarbonate urethane (PCU) surface via a three-step procedure utilizing α, ωdiamino-poly(ethylene glycol) (APEG, M n =2 000) as a spacer. In the first step, isocyanate functional groups were introduced onto PCU surface by the treatment of hexamethylene diisocyanate (HDI) in the presence of di-n-butyltin dilaurate (DBTDL) as a catalyst. In the second step, APEG was linked to the PCU surface to obtain the APEG conjugated PCU surface (PCU-APEG). In the third step, heparin was covalently coupled with PCU-APEG in the presence of N-hydroxysuccinimide (NHS) and 1-ethyl-3-(3-dimethylamidopropyl) carbodiimide (EDAC). The amount of heparin (1.639 μg/cm 2 ) covalently immobilized on the PCU-APEG surface was determined by the toluidine blue method. The modified surface was characterized by water contact angle, attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), X-ray photoelectron spectroscopy (XPS), and atomic force microscopy (AFM). The hemocompatibility was preliminarily studied by platelet adhesion test. The results indicated that heparin was successfully grafted onto the PCU surface, and meanwhile the hydrophilicity and hemocompatibility of the modified PCU surface were improved significantly compared with the blank PCU surface.

Carvedilol suppresses ventricular arrhythmia in a pressure over-load rabbit model through relieving transmural dispersion of repolarization with long-term administration

Objective: To investigate the effects of carvedilol (CVD) on transmural dispersion of repolarization(TDR) and arrhythmia in pressure over-load rabbits. Methods: Left ventricular hypertrophied(LVH) rabbit models were established by pressure over-load; All animal models were assigned into CVD group or LVH group randomly. The action potentials of endocardium, epicardium and transmural ECG of arterially perfused left ventricular preparations were recorded concurrently. Action potential duration (APD), TDR, ventricular arrhythmia and ultrasonic parameters, ratio of LVM to body weight (LVMI) were compared correspondingly. The stable plasma concentration of carvedilol in CVD group was detected by HPLC. APD, TDR and arrhythmia of LVH models were compared just preor post-perfusion with stable concentration of CVD. Results: In Contrast with values in LVH group, LVEFof CVD group were significantly elevated while the LVMI was remarkably reduced, TDRs were significantly shortened, and ratio of ventricular arrhythmia was lowered remarkably. No significant difference of APD, TDR and ratio of arrhythmia was found pre- or post-perfusion at stable plasma concentration of CVD. Conclusion: CVD can ameliorate the structure and function of pressure over-load ventricles; CVD contributes to the improvement of ventricular arrhythmia associated with its long-term effect on APD,TDR shortening ,whereas has nothing to do with its transient function on ionic channel blockade.

No association between low-dose reserpine use and depression in older hypertensive patient: result of a multicenter, cross-sectional study

Background Reserpine is currently used by millions of Chinese hypertensive patients, in spite of the continued concern of its depressogenic effect, even when used in low dose. This study aimed to investigate the association between low-dose reserpine use and depression in older Chinese hypertensive patient. Methods In this cross-sectional, case-control study, we recruited patient aged 60 years or over who had regularly taken one or two tables of “compound reserpine and triamterene tablets (CRTTs)” for more than one year (reserpine user) from 26 community health centers located in 10 provinces in China. For each patient who took CRTTs, we selected an age (within five years) and sex matched hypertensive patient who had never taken any drugs containing reserpine (non-reserpine user) as control. Depressive symptoms were evaluated using a Chinese depression scale adapted from the Zung Self-Rating Depression Scale. Demographic, clinical data and laboratory examination results within six months were collected. Results From August 2018 to December 2018, 787 reserpine user and 787 non-reserpine user were recruited. The mean age of all study subjects was 70.3 years, with about equal numbers of males and females. The mean depression score was 40.4 in reserpine users and 40.6 in non-reserpine users (P = 0.7). The majority of study subject had a depression score < 53 (87.6% in reserpine users and 88.2% in non-reserpine users, respectively). There were no significant differences in the prevalence of mild, moderate or severe depression in reserpine users and non-reserpine users. Conclusions There is no association between low-dose reserpine use and depression in older hypertensive patient. The role of reserpine in the treatment and control of hypertension should be reconsidered;and further studies, especially randomized, controlled clinical trials to compare efficacy and safety of reserpine and other widely recommended anti-hypertensive agents are needed.

Lactobacillus levels and prognosis of patients with acute myocardial infarction

OBJECTIVE To explore the relationship between Lactobacillus and prognosis of acute myocardial infarction(AMI)patients treated by percutaneous coronary intervention(PCI)and its correlation with clinical parameters.METHODS Consecutive patients with AMI in the coronary care unit of Tianjin Chest Hospital in China who received emergency PCI between July 2017 and December 2018 were enrolled.Subjects’fecal 16 S r DNA gene sequencing data were analyzed and subjects were categorized into low,medium and high level groups according to stool Lactobacillus measurements.The primary endpoints were major adverse cardiac events.Cox regression analysis was used to analyze the relationship between Lactobacillus and prognosis.Spearman correlation analysis and trend tests were used to assess the relationship between Lactobacillus and the clinical indicators.RESULTS The data of 254 patients were included in the analysis.Mean age was 65.90±11.56 years,and 152 patients(59.84%)were male.Follow-up time was 652(548.25-753.00)days.Multivariate Cox regression analysis showed a significantly lower risk of major adverse cardiac events in patients with Lactobacillus>7.1 copies/g[adjusted hazard ratio(HR)=0.216,95%CI:0.094-0.493,P<0.001]compared to patients with Lactobacillus≤3.6 copies/g.Statistically significant differences were shown in ST-segment elevation myocardial infarction(STEMI)(HR=0.217,95%CI:0.085-0.551,P=0.001).Lactobacillus was a protective factor for male smokers aged over 60 years whose brain natriuretic peptide was over 1,000 pg/m L.Spearman correlation analysis showed that Lactobacillus correlated negatively with white blood cells,neutrophils,high-sensitivity C-reactive protein,Troponin T,creatine kinase,creatine kinase-MB and brain natriuretic peptide(downward trend),and correlated positively with left ventricular ejection fraction(upward trend).CONCLUSIONS This study is the first to reveal the correlation between Lactobacillus and inflammation and myocardial damage after STEMI.STEMI patients,especially male smokers aged over 60 years with severe impairment of cardiac function,have better outcomes with high levels of Lactobacillus,suggesting new therapeutic strategies for improving the prognosis and quality of life of AMI patients.

Propofol can Protect Against the Impairment of Learning-memory Induced by Electroconvulsive Shock via Tau Protein Hyperphosphorylation in Depressed Rats

Objective To explore the possible neurophysiologic mechanisms of propofol and N-methyl-Daspartate(NMDA) receptor antagonist against learning-memory impairment of depressed rats without olfactory bulbs. Methods Models of depressed rats without olfactory bulbs were established. For the factorial design in analysis of variance, two intervention factors were included: electroconvulsive shock groups(with and without a course of electroconvulsive shock) and drug intervention groups [intraperotoneal(ip) injection of saline, NMDA receptor antagonist MK-801 and propofol. A total of 60 adult depressed rats without olfactory bulbs were randomly divided into 6 experimental groups(n=10 per group): ip injection of 5 ml saline; ip injection of 5 ml of 10 mg/kg MK-801; ip injection of 5 ml of 10 mg/kg MK-801 and a course of electroconvulsive shock; ip injection of 5 ml of 200 mg/kg propofol; ip injection of 5 ml of 200 mg/kg propofol and a course of electroconvulsive shock; and ip injection of 5 ml saline and a course of electroconvulsive shock. The learning-memory abilities of the rats was evaluated by the Morris water maze test. The content of glutamic acid in the hippocampus was detected by high-performance liquid chromatography. The expressions of p-AT8Ser202 in the hippocampus were determined by Western blot analysis. Results Propofol, MK-801 or electroconvulsive shock alone induced learning-memory impairment in depressed rats, as proven by extended evasive latency time and shortened space probe time. Glutamic acid content in the hippocampus of depressed rats was significantly up-regulated by electroconvulsive shock and down-regulated by propofol, but MK-801 had no significant effect on glutamic acid content. Levels ofphosphorylated Tau protein p-AT8Ser202 in the hippocampus was up-regulated by electroconvulsive shock but was reduced by propofol and MK-801 alone. Propofol prevented learning-memory impairment and reduced glutamic acid content and p-AT8Ser202 levels induced by electroconvulsive shock. Conclusion Electroconvulsive shock might reduce learning-memory impairment caused by protein Tau hyperphosphorylation in depressed rats by down-regulating glutamate content.

Targeting CC Chemokine Ligand 2 (CCL2) for Cancer Skeletal Metastasis

Prostate, breast, and lung cancer preferentially metastasize to bone resulting in bone lesions and thus high mortality. However, the

Effects of Pemetrexed and Docetaxel Combined with Cisplatin in the Treatment of Non-small Cell Lung Cancer

The purpose of this study was to compare the clinical effects of pemetrexed and docetaxel combined with cisplatin in the treatment of patients with non-small cell lung cancer.A total of 58 patients with non-small cell lung cancer who were enrolled between January 2017 and January 2018 were enlisted into a randomized digital table.29 patients who have received treatment with combined pemetrexed and cisplatin were assigned to the pemetrexed group,whereas for the other 29 patients which were treated with docetaxel and cisplatin combined,were assigned to the docetaxel group to verify the calculated clinical treatment efficiency of the patients with non-small cell lung cancer,soluble vascular cell adhesion molecule 1(SVCAM-1),and activated leukocyte cell adhesion molecule-1(alCAM-1)concentrations and to evaluate the quality of life scores of the patients after half a year as well as the incidences of adverse reactions following the treatments provided.The differences in SVCAM-1 and alCAM-1 concentrations and incidence of adverse reactions in patients with non-small cell lung cancer in the docetaxel group as compared with patients in the pemetrexed group after the treatments were statistically significant(P<0.05)where the calculations were performed with data sets gathered from and between the two groups.In addition,SVCAM-1 and alCAM-1 concentrations in patients in both pemetrexed group and docetaxel group demonstrated significant differences in concentrations before and after the treatments were provided,P<0.05.The comparative studies of the effects of the treatments on the quality of life scores and clinical treatment efficiency between the two groups after half a year,P>0.05,demonstrated no analytical significance.Both pemetrexed combined with cisplatin and docetaxel in combination with cisplatin as forms of treatments demonstrated significant effects in patients with non-small cell lung cancer.However,based on our study,it was found that the combined treatment involving pemetrexed and cisplatin can further reduce adverse reactions and thus is worthy of clinical application.

Real world effectiveness of PCSK-9 inhibitors combined with statins versus statins-based therapy among patients with very high risk of atherosclerotic cardiovascular disease in China(RWE-PCSK study)

BACKGROUND The efficacy and safety of proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors were confirmed by several clinical trials, but its effectiveness in routine clinical practice in China has not been evaluated. This study aims to describe the real world effectiveness of PCSK-9 inhibitors combined with statins compared with statins-based therapy among patients with very high risk of atherosclerotic cardiovascular disease(ASCVD).METHODS This is a multi-center observational study, enrolled patients from 32 hospitals who underwent percutaneous coronary intervention(PCI) from January to June in 2019. There are 453 patients treated with PCSK-9 inhibitors combined with statins in PCSK-9 inhibitor group and 2,610 patients treated with statins-based lipid lowering therapies in statins-based group. The lipid control rate and incidence of major adverse cardiovascular events(MACE) over six months were compared between two groups.A propensity score-matched(PSM) analysis was used to balance two groups on confounding factors. Survival analysis using Kaplan-Meier methods was applied for MACE.RESULTS In a total of 3,063 patients, 89.91% of patients had received moderate or high-intensity statins-based therapy before PCI, but only 9.47% of patients had low-density lipoprotein cholesterol(LDL-C) levels below 1.4 mmol/L at baseline. In the PSM selected patients, LDL-C level was reduced by 42.57% in PCSK-9 inhibitor group and 30.81%(P < 0.001) in statins-based group after six months. The proportion of LDL-C ≤ 1.0 mmol/L increased from 5.29% to 29.26% in PCSK-9 inhibitor group and 0.23% to 6.11% in statins-based group, and the proportion of LDL-C ≤ 1.4 mmol/L increased from 10.36% to 47.69% in PCSK-9 inhibitor group and 2.99% to 18.43% in statins-based group(P < 0.001 for both). There was no significant difference between PCSK-9 inhibitor and statins-based treatment in reducing the risk of MACE(hazard ratio = 2.52, 95% CI: 0.49-12.97, P = 0.250).CONCLUSIONS In the real world, PCSK-9 inhibitors combined with statins could significantly reduce LDL-C levels among patients with very high risk of ASCVD in China. The long-term clinical benefits for patients received PCSK-9 inhibitor to reduce the risk of MACE is still unclear and requires further study.

Retrospective analysis of diffuse interstitial lung disease in 10 hospitals in Tianjin

Objective:To investigate the constituent ratio and clinical features of diffuse interstitial lung disease(DILD)in Tianjin,and to identify the existing problems of its diagnosis and treatment.Methods:Data of all patients diagnosed as DILD in ten comprehensive hospitals in Tianjin from 2003 to 2009 was collected.The disease constituent ratio of DILD to all kinds of diseases in the respiration department or in the whole hospital,the clinical manifestation,lung function,the result of blood gas analysis,and biopsy were analyzed.Results:A total of 804 DILD patients were included in the study aged(69.28±12.09)years with a male/female ratio of 1.32.The disease constituent ratios of DILD were 4.52‰in respiratory department and 0.31‰in the whole hospital in 2003,which increased to 35.9‰and 1.51‰respectively in 2009.Reticular abnormality(43.1%),ground glass(25.6%)and honeycombing(11.4%)were the predominant imaging manifestations.26.7%patients’lung function were tested,and 10.3%had diffusion function tests.Most patients presented with hypoxemia,and the average oxygenation index was(281±98.3)mmHg.Only 4.0%of patients underwent bronchoalveolar lavage,and 3.5%had pathologic data.Conclusion:The disease constituent ratio of DILD increased progressively from 2003 to 2009.A definite diagnosis of DILD demands cooperation of physicians,radiologists and pathologists.Doctors should attach more importance on lung function test,bronchoalveolar lavage and biopsy.

Twin peaks of in-hospital mortality among patients with STEMI across five phases of COVID-19 outbreak in China:a nation-wide study

Lockdown and re-opening may become cyclical due to the recurrent waves of the COVID-19 epidemic.Few studies have examined temporal trends and determinants of in-hospital mortality among patients with ST-segment elevation myocardial infarction(STEMI),a life-threatening condition that requires emergency medical care.Using nation-wide data before,during and after the Wuhan lockdown,we aimed to depict temporal patterns and major determinants of STEMI in-hospital mortality in China across five time periods of the COVID-19 epidemic.We analyzed the data of 283,661 STEMI patients who were admitted to 4,487 chest-pain-centers across China,from January 1,2019 to May 31,2020.Compared with the period before the lockdown,STEMI in-hospital mortality increased by 25%(OR 1.25,95%CI 1.16–1.34)during Early Lockdown,by 12%(OR 1.12,95%CI 1.03–1.22)during Later Lockdown,by 35%(OR 1.35,95%CI 1.21–1.50)during Early Lift,and returned to pre-COVID risk(OR 1.04,95%CI 0.95–1.14)during Later Lift.For each time-period,we observed a clear mortality gradient by timing and types of revascularization procedure.In conclusion,the COVID-19 epidemic had a significant adverse impact on STEMI in-hospital mortality,with bimodal peaks during early lockdown and early lift periods and clear mortality gradients by timing and types of revascularization procedure,independent of the time periods.

Long-term effect of a large dose of iodinated contrast in patients with mild thyroid dysfunction:a prospective cohort study

Background:More than 75 million procedures with intravascular iodine-based contrast media(ICM)are performed worldwide every year,and some patients undergoing these procedures do not have normal thyroid function.The long-term effects of ICM in patients with mild thyroid dysfunction(TD)are unclear.Methods:This prospective cohort study was conducted in China.Patients with stable angina pectoris with total triiodothyronine(TT3)reduction,normal thyroid-stimulating hormone,and reverse triiodothyronine(rT3)were enrolled and divided into high-dose(≥100 mL ICM)and low-dose groups(<100 mL ICM).We dynamically investigated the trends in thyroid function,rT3,and thyroid antibodies one year after ICM exposure.Results:A total of 154 patients completed 6 months of follow-up and 149 completed 1 year of follow-up.Thyroglobulin antibody(TGAB)levels were elevated in 41(26.6%)patients before ICM exposure,11(7.1%)of whom also had elevated thyroid peroxidase antibody levels.Transient subclinical TD occurred 6 months after ICM exposure;75.5%(34/45)of post-operative TD occurred in the high-dose group.One patient developed severe hypothyroidism with myxedema,requiring drug intervention 1 year after ICM exposure.The level of rT3 showed no statistically significant changes during post-operative follow-up(P=0.848).The TGAB level decreased at 6th month(P<0.001),but increased at 1 year after ICM exposure(P=0.002).Conclusions:Patients with T3 reduction are at a risk of transient subclinical TD and hypothyroidism after a single large dose of ICM.Follow-up of this population at 9-12 months after ICM exposure is warranted.