Conversion and outcome of dual antiplatelet therapy after bleeding in patients with acute coronary syndrome

Objective

To explore the conversion and outcome of antiplatelet therapy in patients with acute coronary syndrome (ACS) who have suffered bleeding after receiving aspirin combined with ticagrelor.

Methods

Patients who diagnosed with ACS and given aspirin 100 mg once daily combined with ticagrelor 90 mg twice daily for dual antiplatelet therapy (DAPT) were selected. The patients were divided into bleeding group and non-bleeding group according to whether bleeding events occurred within one year after DAPT. The bleeding group was divided into the next four groups according to the converted antiplatelet treatment strategy decided by the doctor and the patient. Patients in group A to D were treated with ticagrelor 90mg twice a day plus aspirin 0–50mgonce a day, ticagrelor 60mg twice a day plus aspirin 100mgonce a day, clopidogrel 75mgonce a day plus aspirin 100mg once a day and ticagrelor 90mg twice a day plus aspirin 100mg once a day, respectively. All patients were followed up for 1 year after DAPT. The primary outcome is change of bleeding degree by BARC. The secondary outcomes includes BARC bleeding, all-cause mortality and MACE.

Results

A total of 752 cases were enrolled, including 250 in the bleeding group and 502 in the non-bleeding group. The bleeding group was divided into four treatment groups, which were 63, 43, 38 and 95 cases among A, B, C and D group. There was a significant difference in the improvement of bleeding among the four groups. To be noted, patients in group A has the highest improvement rate of hemorrhage (65.1% vs 62.8% vs 47.4% vs 24.2%, P<0.01). There were no significant differences in the incidence of MACE and all-cause mortality (P>0.05). The incidence of major MACE in patients in the bleeding group was 14.4%, which was higher than that in the non-bleeding group (9.2%, P=0.03).The result of multivariate logistic regression analysis showed that female (OR=5.18, 95% CI: 1.61–16.65, P=0.006), low body weight (OR=7.73, 95% CI: 2.46–24.49, P<0.001) and low AA-induced maximum platelet aggregation rate (OR=2.72, 95% CI:1.09–6.84, P=0.033) were independent risk factors for hemorrhage.

Conclusion

Patients with acute coronary syndrome who have suffered bleeding after receiving aspirin combined with ticagrelor were at a higher risk of MACE than those who did not. Low-dose aspirin (0–50mg/d) combined with ticagrelor or even ticagrelor alone has the best effect on reducing bleeding without increasing the risk of ischemia. Female, low body mass and low AA-induced maximum platelet aggregation rate are independent risk factors for bleeding.

Funding Acknowledgement

Type of funding source: None

[Perceived organizational support and emotional stability modify the effect of depression tendency on burnout in doctors]

Objective: To explore and analyze the relationship between burnout, depression, perceived organizational support and emotional stability, as well as their interaction on burnout, so as to provide reference for improving the situation of burnout on doctors. Methods: By cluster random sampling, a cross-sectional survey of doctors in a municipal hospitals of Zhengzhou in June to August, 2015, Henan Province was conducted. The questionnaires of Maslach Burnout Inventory-General Survey (MBI-GS) , Perceived organizational support, Eysenck Personality Questionnair-Revission Short Scale of China (EPQ-RSC) and Center for Epidemiological Studies Depression Scale (CES-D) were used for questionnaire survey and analysis. Multiple regression analysis was used to explore the interaction of organizational support and emotional stability on depressive tendency and occupational burnout. Results: Among the 389 doctors, 147 were males and 242 were females. Age M (P(25), P(75)) was 33.0 (29.0, 40.0) years, and length of work M (P(25), P(75)) was 7.0 (4.0, 16.0) years. Burnout was positively correlated with depression tendency and emotional stability (r=0.571, 0.453, P<0.01) , while burnout was negatively correlated with perceived organizational support (r=-0.260, P<0.01) . The interaction among depression tendency, perceived organizational support and emotional stability was statistically significant (β=-0.002, P<0.05) , the independent effect on burnout is 1.0% (ΔR(2)=0.010) , the positive effect of emotional stability was the largest (β=0.550) , followed by the positive effect of depression tendency (β=0.494) . When the tendency of depression increased, the burnout of doctors with high perceived organizational support and emotional stability was higher than those with high perceived organizational support and emotional instability and those with low perceived organizational support (P<0.01) . Conclusion: Emotional stability is the main factor affecting the effect of depression tendency on doctors' burnout. Doctors with stable emotion and high perceived organizational support showed obvious changes in burnout when depression tendency increased, and showed stronger burnout.

[Covered airway stent loaded with (125)I seeds for tracheal adenoid cystic carcinoma: a clinical observation of 8 cases]

Objective: To explore the efficacy and safety of the covered airway stent loaded with (125)I seeds for the treatment of tracheal adenoid cystic carcinoma (TACC). Methods: We retrospectively reviewed the clinical data from 8 patients with TACC who had received placement of the covered stent loaded with (125)I seeds between December 2014 and July 2017 in the endoscopic center of the Second Affiliated Hospital of Xiamen Medical College. We compared the difference in the dyspnea index, the diameter of the airway lumen, and the lesion surrounding the airway wall before and after treatment. The complications were also recorded during follow-up. Results: Eight patients underwent successful placement of a total of 11 radioactive stents (2 straight-type stents, 2 L-shape stents, and 7 Y-shape stents, all loaded a total of 243 radioactive particles). Displacement of stents took place within 2 weeks in 2 patients, who were managed with re-stenting and fixation. No further displacement occurred during follow-up. The median time to stent removal was 2.9(interquartile range: 2.3,3.0) months. After stent placement, the dyspnea index was significantly decreased compared with pre-treatment level (mean: 0.1 vs. 3.4, t=8.881, P<0.001). Bronchoscopic re-assessment showed that the residual tumor within the airway was detected in only one patient and that the tumor completely disappeared in the remaining 7 patients. Treatment with stents loaded with radioactive particles yielded smooth and pale airway mucosa with formation of partial scar formation. Chest computed tomography re-assessment demonstrated significantly larger luminal diameter than that before treatment (mean: 13.1 mm vs. 3.3 mm, t=-7.839, P<0.001). The airway wall thickness was notably reduced after treatment (mean: 4.3 mm vs. 14.4 mm, t=7.620, P<0.001). The lesions surrounding the airway wall completely disappeared in 7 patients and decreased for more than 50% in a single patient. The median duration of follow-up was 28.0(interquartile range: 24.8,31.5) months. Recurrence of tumor was documented in a single case within 2 years. Six patients did not experience recurrence within the 2-year follow-up period. No death or severe complications were recorded during follow-up. Conclusion: The (125)I radioactive stent is effective for dilating the stenotic airway and ameliorating the symptoms, and thus might be an effective and safe method for the treatment of TACC. Further studies that explore the efficacy of stents loaded with (125)I particles are needed.

[A multicenter randomized prospective study of concurrent chemoradiation with 60 Gy versus 50 Gy for inoperable esophageal squamous cell carcinoma]

Objective: To determine whether 60 Gy is superior to standard 50 Gy for definitive concurrent chemoradiation(CCRT) in esophageal squamous cell carcinoma (ESCC) using modern radiation technology in a phase Ⅲ prospective randomized trial. Methods: From April 2013 to May 2017, 331 patients from 22 hospitals who were pathologically confirmed with stage ⅢA-ⅣA ESCC were randomized to 60 Gy or 50 Gy with random number table. Total of 305 patients were analyzed, including 152 in 60 Gy group and 153 in 50 Gy group. The median age was 63 years, 242(79.3%) males and 63(20.7%) females. The median length of primary tumor was 5.6 cm. The clinical characteristics between two groups were comparable. All patients were delivered 2 Gy per fraction, 5 fractions per week. Concurrent weekly chemotherapy with docetaxel (25 mg/m(2)) and cisplatin (25 mg/m(2)) and 2 cycles consolidation chemotherapy with docetaxel (70 mg/m(2)) and cisplatin (25 mg/m(2), d1-3) were administrated. The primary endpoint was local/regional progression-free survival (LRPFS). The data were compared with Pearson chi-square test or Fisher's exact test. Results: At a median follow-up of 27.3 months, the disease progression rate was 37.5% (57/152), 43.8% (67/153) in the high and standard-dose group, respectively (χ(2)=1.251, P=0.263). The 1, 2, 3-year LRPFS rate was 75.4%, 56.8%, 52.1% and 74.2%, 58.4%, 50.1%, respectively (HR: 0.95, 95%CI: 0.69-1.31, P=0.761). The 1, 2, 3-year overall survival rate was 84.1%, 64.8%, 54.1% and 85.4%, 62.9%, 54.0%, respectively (HR: 0.98, 95%CI: 0.71-1.38, P=0.927). The 1, 2, 3-year progression-free survival rate was 70.8%, 54.2%, 48.5% and 65.5%, 51.9%, 45.1%, respectively (HR: 0.93, 95%CI: 0.68-1.26, P=0.621). The incidence rates in toxicities between the two groups were similar except for higher rate of severe pneumonitis in high dose group (χ(2)=11.596, P=0.021). Conclusions: The efficacy in disease control is similar between 60 Gy and 50 Gy using modern radiation technology concurrent with chemotherapy for ESCC. The 50 Gy should be recommended as the regular radiation dose with CCRT for ESCC.

Real-Time QCM-D Monitoring of the Adsorption-Desorption of Expansin on Lignin

Expansin has nonhydrolytic disruptive activity and synergistically acts with cellulases to enhance the hydrolysis of cellulose. The adsorption-desorption of expansin on noncellulosic lignin can greatly affect the action of expansin on lignocellulose. In this study, three lignins with different sources (kraft lignin (KL), sodium lignin sulfonate (SLS), and enzymatic hydrolysis lignin (EHL)) were selected as the substrates. The real-time adsorption-desorption of Bacillus subtilis expansin (BsEXLX1) on lignins was monitored using quartz crystal microgravimetry with dissipation (QCM-D). The effects of temperature and Tween 80 on the adsorption-desorption behaviors were also investigated. The results show that BsEXLX1 exhibited high binding ability on lignin and achieved maximum adsorption of 283.2, 273.8, and 266.9 ng cm^-2 at 25 °C on KL, SLS, and EHL, respectively. The maximum adsorption decreased to 148.2-192.8 ng cm^-2 when the temperature increased from 25 to 45 °C. Moreover, Tween 80 competitively bound to lignin and significantly prevented expansin adsorption. After irreversible adsorption of Tween 80, the maximum adsorption of BsEXLX1 greatly decreased to 33.3, 37.2, and 10.3 ng cm^-2 at 25 °C on KL, SLS, and EHL, respectively. Finally, a kinetic model was developed to analyze the adsorption-desorption process of BsEXLX1. BsEXLX1 has a higher adsorption rate constant (k_A) and a lower desorption rate constant (k_D) on KL than on SLS and EHL. The findings of this study provide useful insights into the adsorption-desorption of expansin on lignin.

[Differences in efficacy between drug-eluting beads transbronchial arterial chemoembolization combined with systemic chemotherapy and systemic chemotherapy alone for unresectable lung squamous cell carcinoma]

Objective: To investigate the differences in efficacy between drug-eluting beads transbronchial arterial chemoembolization (DEB-BACE) combined with systemic chemotherapy and systemic chemotherapy alone for unresectable lung squamous cell carcinoma. Methods: Totally 60 cases of unresectable lung squamous cell carcinoma undergoing systemic chemotherapy in Yancheng Third People Hospital were retrospectively selected as the research object. According to patients' wishes, they were divided into chemotherapy-only group (group A) and combined treatment group (group B). Group A received gemcitabine combined with cisplatin chemotherapy. DEB-BACE was applied in the first half, and systemic chemotherapy was administered in the second half (starting 3 d after BACE). The first half and the second half of the chemotherapy dose were 1/2 of the drug dose in the chemotherapy alone group. The short-term efficacy, incidence of toxic side effects, peripheral blood T lymphocyte subsets, serum vascular endothelial growth factor (VEGF) levels, and survival time were compared between the two groups. Results: After 2 cycles of treatment, the total effective rates of group A and group B were 50.0% (15/30) and 76.7% (23/30) (P<0.05), the incidence of nausea and vomiting (63.3% vs 20.0%), decreased appetite (76.7% vs 43.3%), hair loss (86.7% vs 40.0%), and bone marrow suppression (40.0% vs 10.0%) in group A were higher than in group B (all P<0.05). After 2 cycles of treatment, the levels of CD3(+), CD4(+)and CD4(+)/CD8(+)in the two groups were higher than before treatment (group A: 47.7%±6.6% vs 52.3%±7.7%, 31.5%±4.9% vs 34.7%±5.8%, 1.05±0.24 vs 1.18±0.32; group B: 49.2%±7.0% vs 62.0%±14.0%,29.2%±5.5% vs 42.2%±7.3%, 1.07±0.26 vs 1.39±0.42; all P<0.05), while the level of CD8(+)was lower than before treatment (group A: 30.4%±5.4% vs 24.5%±4.8%; group B: 29.5%±4.1% vs 21.1%±4.5%; all P<0.05). The CD3(+), CD4(+), and CD4(+)/CD8(+) levels in group A were lower than those in group B (P<0.05), while CD8(+)level was higher than in group B (P<0.05). After 2 cycles of treatment, the VEGF levels in the two groups were lower than before treatment (group A: (423±85) vs (352±64) ng/L; group B: (404±114) vs (296±66) ng/L; P<0.05), and the VEGF level in group A was higher than that in group B (P<0.05). The 1-year survival rates of groups A and B were 54.9% and 77.9%, and the 2-year survival rates were 17.2% and 41.7% (Log rank χ(2)=4.750, P=0.029). Conclusion: DEB-BACE combined with systemic chemotherapy is superior to systemic chemotherapy in the treatment of unresectable lung squamous cell carcinoma. It can reduce toxic and side effects, improve immune function and prolong survival time, which is worthy of clinical application.

Nontoxic Black Phosphorus Quantum Dots Inhibit Insulin Amyloid Fibrillation at an Ultralow Concentration

Amyloid are protein aggregates formed by cross β structures assemblies. Inhibiting amyloid aggregation or facilitating its disassembly are considered to be two major effective therapeutic strategies in diseases involving peptide or protein fibrillation such Alzheimer's disease or diabetes. Using thioflavin-T fluorescence, far-UV circular dichroism spectroscopy, and atomic force microscopy, we found nontoxic and biocompatible black phosphorus quantum dots (BPQDs) appear to have an exceptional capacity to inhibit insulin aggregation and to disassemble formed mature fibrils, even at an ultralow concentration (100 ng/mL). The inhibition of fibrillation persists at all stages of insulin aggregation and increases PC12 cells survival when exposed to amyloid fibrils. Molecular dynamics simulations suggest that BPQDs are able to stabilize the α-helix structure of insulin and obliterate the β-sheet structure to promote the fibril formation. These characteristics make BPQDs be promising candidate in preventing amyloidosis, disease treatment, as well as in the storage and processing of insulin.

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BPQDs inhibit insulin amyloid fibrillation at an ultralow concentration

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BPQDs can depolymerize protofibrils and even mature fibers

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BPQDs inhibit aggregation mainly by van der Waals' force and hydrophobic interaction

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BPQDs are biocompatible and can reduce insulin fibrils-induced cytotoxicity

Comprehensive meta-analysis reveals an association of the HLA-DRB1*1602 allele with autoimmune diseases mediated predominantly by autoantibodies

The human leukocytes antigen (HLA)-DRB1*16:02 allele has been suggested to be associated with many autoimmune diseases. However, a validation of the results of the different studies by a comprehensive analysis of the corresponding meta data is lacking. In this study, we performed a meta-analysis of the association between HLA-DRB1*16:02 allele with various autoimmune disorders. Our analysis shows that HLA-DRB1*16:02 allele was associated with systemic lupus erythematosus, anti-N-Methyl-d-Aspartate receptor (NMDAR) encephalitis, Graves' disease, myasthenia gravis, neuromyelitis optica and antibody-associated systemic vasculitis with microscopic polyangiitis (AASV-MPA). However, no such association was found for multiple sclerosis, autoimmune hepatitis type 1, rheumatoid arthritis, type 1 diabetes and Vogt-Koyanagi-Harada syndrome. Re-analysis of the studies after their categorization into autoantibody-dependent and T cell-dependent autoimmune diseases revealed that the HLA-DRB1*16:02 allele was strongly associated with disorder predominantly mediated by autoantibodies (OR = 1.93; 95% CI = 1.63-2.28, P = 1.95 × 10^-14) but not with those predominantly mediated by T cells (OR = 1.08; 95% CI = 0.87-1.34, P = .474). In addition, amino acid sequence alignment of common HLA-DRB1 subtypes demonstrated that HLA-DRB1*16:02 carries a unique motif of amino acid residues at position 67-74 which encodes the third hypervariable region. Taken together, the distinct pattern of disease association and the unique amino acid sequence of the third hypervariable region of the HLA-DRB1 provide some hints on how HLA-DRB1*16:02 is involved in the pathogenesis of autoimmune diseases.

Three-dimensional printing of black phosphorous/polypyrrole electrode for energy storage using thermoresponsive ink

Three-dimensional (3D) printing techniques bring the possibility of making electronic devices in any desired shape and dimensions. Here, we report on a printable black phosphorous nanosheet/polypyrrole composite ink for constructing a high-performance supercapacitor (SC) electrode. The printed BPNS/PPy electrode shows a good energy storage performance with a specific capacitance of up to 417 F g^-1 and an excellent cycling stability.

Zwitterionic Peptide Enhances Protein-Resistant Performance of Hyaluronic Acid-Modified Surfaces

A convenient and efficient approach for the surface modification of antifouling materials is highly desirable in numerous applications like affinity-based biosensors. Herein, we fabricated a hybrid antifouling coating on Au surfaces, with thiolated hyaluronic acid (HA) being chemically adsorbed to Au surfaces by the "graft to" approach, followed by a self-assembly of a smaller zwitterionic peptide named p-EK to obtain HA/p-EK-modified surfaces. The real-time sensorgrams of surface plasmon resonance biosensor manifested the successful modification of HA and p-EK on Au surfaces, indicating that there were some bare Au substrates on the HA-modified surfaces for peptide binding. The obtained HA/p-EK surfaces exhibited high hydrophilicity with a water contact angle of 9°. Quartz crystal microbalance and surface plasmon resonance experiments verified that further grafting the zwitterionic p-EK peptide on HA-modified surfaces could enhance the antifouling performance by one time. The improved protein resistance could be mainly contributed by the modification of the zwitterionic peptide that shields the exposed Au substrates from interacting with protein foulings. This strategy by grafting a smaller zwitterionic peptide might provide a novel way to achieve an enhanced protein-resistant performance of the macromolecular coating obtained by the "graft to" surface modification approach.

Polydopamine-Assisted Surface Coating of MIL-53 and Dodecanethiol on a Melamine Sponge for Oil-Water Separation

A superhydrophobic and superoleophilic porous composite was successfully prepared via a polydopamine-assisted surface coating of MIL-53(Fe) and 1-dodecanethiol (DDT) on a melamine formaldehyde (MF) sponge. The as-prepared sponge composite (MIL-DDT@MF) has a high water contact angle (WCA) of 151.8°, which is probably attributed to both the rough surface derived from in situ growth of MIL-53 nanocrystals and the low surface energy due to grafting of hydrophobic 1-dodecanethiol. The MIL-DDT@MF sponge can effectively absorb oil or organic solvent with an absorption capacity of up to 54.1 (for petroleum) to 120.2 (for chloroform) times its own weight. In addition, the MIL-DDT@MF sponge retained a high absorption capacity and maintained approximately 78% of its original value after 50 cycles of reuse. Moreover, the MIL-DDT@MF sponge can selectively absorb the oil/organic solvent from water and achieve continuous oil-water separation. The separation efficiency of n-hexane, dichloromethane, and crude oil from water or seawater can reach above 95%. The superhydrophobic and superoleophilic MIL-DDT@MF sponge has potential as a promising absorbent for treatment of oily wastewater.

Natural variation at OsCERK1 regulates arbuscular mycorrhizal symbiosis in rice

The symbiotic interaction between arbuscular mycorrhizal fungi (AMF) and land plants is essential for efficient nutrient acquisition and utilisation. Our understanding of key processes controlling the AMF colonisation in rice is still limited. Dongxiang wild rice (DY) exhibited a stronger colonisation with Rhizophagus irregularis than the rice cultivar Zhongzao 35 (ZZ35). Chromosome segment substitution lines were constructed and the OsCERK1 gene from DY was mapped. Transgenic plants in the japonica rice Zhonghua 11 (ZZ11) were constructed to compare root colonisation by AMF. Chromosome single-segment substitution lines containing OsCERK1^DY showed higher phosphorus content and grain yield relative to ZZ35. Four amino acids substitutions were identified among the OsCERK1 haplotypes of DY, ZZ35 and ZH11 and two of these were in the second lysine-motif domain, which is essential for the differences of AMF colonisation level among rice varieties. Heterologous expression of OsCERK1^DY in ZH11 significantly enhanced AMF colonisation and increased resistance against the pathogenic fungi Magnaporthe oryzae. Notably, the OsCERK1^DY haplotype was absent from 4660 cultivated rice varieties. We conclude that OsCERK1 is a key gene affecting the symbiotic interaction with AMF and OsCERK1^DY has the biotechnological potential to increase rice phosphorus acquisition and utilisation efficiency for sustainable agriculture.