[Characteristics of alveolar bone loss in severe periodontitis and consideration of rehabilitation with implant]

Severe periodontitis is the main cause of tooth loss in adults, with varying degrees of horizontal and vertical alveolar bone loss. In view of the complex alveolar bone defect, a suitable surgery planning should be made on the basis of fully nuderstanding the characteristics of alveolar bone defect in severe periodontitis and the key points of bone augmentation technique, so as to choose an appropriate method for reconstruction of alveolar bone and complete the implantation and restoration to ensure the integrity of dentition, which are important for the long-term stability of periodontal health. Based on clinical experiences and literature review, we summarizes the characteristics of alveolar bone loss in patients with severe periodontitis and the timing of implant placement after bone augmentation surgery, in order to provide reference for implant treatment of severe periodontitis.

[Structural Analysis of the 5'-Flanking Region of Human Alpha-Fetoprotein Encoding Gene]

Alpha fetoprotein (AFP) is a growth factor and a signaling molecule that promotes the development of HCC. However, the mechanism of the awakening of AFP in course of HCC progression remains unclear. We have studied the structure of AFP 5'-flanking regulatory sequence using dual-luciferase reporter vectors with fragments of this region. Reporter constructs were transfected into HepG2 and PLC hepatoma cell lines. The AFP 5'-flanking regulatory sequence between -1871 and -1004 bp was promoting gene transcription, while the effects of the sequence between -1004 and -667 bp were small. The fragment located between positions -667 and -448 bp inhibited the transcriptional activity of the AFP gene, while the fragment located between -448 and -287 bp promoted expression of AFP. The effects of the adjacent promoter sequence were small. A variety of transcription factor binding sites were mapped.

Left atrial appendage mechanical dispersion assessed by speckle-tracking echocardiography as a determinant of left atrial appendage stasis in patients with non-valvular atrial fibrillation

Background

We sought to investigate the relationship of left atrial appendage (LAA) mechanical dispersion (MD) with LAA dense spontaneous echo contrast (SEC) or thrombus, and to compare its usefulness in the identification of thrombogenesis with left atrial (LA) MD or LA/LAA strain parameters in patients with nonvalvular atrial fibrillation (AF).

Methods

We conducted a cross-sectional study of 493 consecutive patients with AF (median age 65, male 66.9%) who underwent echocardiography prior to catheter ablation. We measured the LAA and LA global longitudinal strain (GLS) using speckle-tracking echocardiography (STE). LAA MD and LA MD was defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval.

Results

Patients with LAA dense SEC/thrombus (n=70) had significantly higher LAA MD than controls (n=423) (median 14.20% vs 9.35%). Areas under the receiver-operating curve for CHA2DS2-VASc score plus LAA MD, LAA GLS or LA GLS were comparable (0.830, 0.843 and 0.809) and superior to that combined with LA MD (0.762, all p<0.01). Multivariable analysis showed that LAA MD was an independent determinant of LAA dense SEC/thrombus in four different models (Odds ratio, 1.23–1.24; P<0.001), and provided additional diagnostic value over clinical and standard echocardiographic parameters. Whereas LA MD was not independently associated with LAA dense SEC/thrombus and had no incremental predictive value.

Conclusion

LAA mechanical dispersion provided incremental information over conventional risk factors in the identification of LAA dense SEC or thrombus in AF patients and is superior to LA mechanical dispersion.

Funding Acknowledgement

Type of funding sources: None.

Comparison of left atrial and atrial appendage mechanics to stratify the risk of left atrial/atrial appendage stasis in patients with non-valvular atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial appendage (LAA) and left atrial (LA) dysfunction are associated with the presence of thrombus and spontaneous echo contrast (SEC) within LAA. However, the role of LAA mechanical dispersion (MD) in contributing to thrombogenesis has not been fully addressed and compared with LA MD or LA/LAA GLS. We sought to investigate the relationship of LAA MD with LAA dense SEC or thrombus, and to compare its additional value with other LA/LAA mechanical parameters in patients with nonvalvular atrial fibrillation (AF).

Methods

We conducted a cross-sectional study of 493 consecutive patients with AF (median age 65, male 66.9%) who underwent echocardiography prior to catheter ablation. Of these, 70(14.2%) patients had dense SEC or thrombus in LAA. We measured the LAA and LA longitudinal strain using speckle-tracking echocardiography (STE). LAA MD and LA MD was defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval.

Results

Patients with LAA dense SEC/thrombus (n=70) had significantly higher LAA MD (median 14.20% (11.60%,16.80%) vs 9.35 % (6.23%,12.07%)) than controls (n = 423). Areas under the receiver-operating curve (AUC) for CHA2DS2-VASc score plus LAA MD, LAA GLS or LA GLS were comparable (0.843,0.830 and 0.809) and superior to that combined with LA MD (0.762, p<0.01). Multivariable analysis showed that LAA MD was an independent determinant of LAA dense SEC/thrombus in four different models (Odds ratio, 1.23-1.24; P < 0.001), and provided additional diagnostic value over clinical and standard echocardiographic parameters. Whereas LA MD was not significantly associated with LAA dense SEC/thrombus and had no incremental predictive value.

Conclusion

LAA mechanical dispersion provided incremental information over conventional risk factors in the identification of LAA dense SEC or thrombus in AF patients and is superior to LA mechanical dispersion.

Residual SYNTAX score in relation to culprit-plaque characteristics and cardiovascular risk in acute myocardial infarction:an optical coherence tomography study

Introduction

The residual SYNTAX score (rSS) as the SYNTAX remaining after completion of percutaneous coronary intervention (PCI) was proved to be related to poor outcomes.

Purpose

This study aimed to investigate the association of culprit-plaque morphology with rSS and the predictive value of rSS for major adverse cardiac events (MACE) in patients with ST-segment elevation myocardial infarction (STEMI).

Methods

A total of 274 STEMI patients undergoing preintervention optical coherence tomography examination were included and divided into 3 groups – rSS=0 (n=72), 0<rss≤8>8 (n=68). Baseline clinical data and culprit-plaque characteristics were compared. MACE was defined as the composite of all-cause death, recurrence of myocardial infarction (MI), stroke and unplanned revascularization of any coronary artery.

Results

There was a significant difference in the prevalence of plaque ruptures, lipid-rich plaques, and calcification among the three groups (plaque rupture: 44.4% versus 59.0% versus 64.7%, lowest to highest rSS, p=0.04; lipid-rich plaque: 40.3% versus 54.5% versus 69.1%, lowest to highest rSS, p=0.003; calcification: 38.9% versus 52.5% versus 61.8%, lowest to highest rSS, p=0.024). Multivariate logistic regression analysis indicated that rSS>8 was an independent predictor for plaque rupture (OR: 2.21, 95% CI: 1.19–4.19, P=0.013). During a mean follow-up of 2.2 years, MACE occurred in 47 (17.2%) patients. In fully adjusted analyses, rSS was independently associated with MACE (HR: 1.06, 95% CI: 1.02–1.10, P=0.005); patients with rSS >8 had higher MACE risk compared to rSS=0 (HR: 2.68, 95% CI: 1.11–6.5, P=0.029).

Conclusion

In STEMI patients, culprit-plaque morphology was significantly correlated with rSS, and elevated rSS was independently associated with cardiovascular risk.</rss≤8>

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences OCT findingsSurvival curves according to rSS

[Characteristics of the alveolar bone defects evaluated by cone-beam CT in periodontitis patients with orthodontic treatment history of Angle class Ⅱ malocclusion]

Objective: To evaluate the levels of alveolar bone defects by using cone-beam CT in periodontitis patients with history of orthodontic treatment and to find the special tooth positions, sites and periodontitis stages of alveolar bone defects, so as to provide reference for the formulation of clinical personalized diagnosis and treatment plans. Methods: Thirty patients who were diagnosed as Angle class Ⅱ malocclusion, treated by using labial fixed orthodontic appliances and also diagnosed as periodontitis (orthodontic group) were recuited from January 2009 to June 2019 at the School and Hospital of Stomatology, China Medical University in the present study. They were aged (27.0±5.4) years old (ranged 18-41 years old). Another 60 periodontitis patients without a history of orthodontic treatment matched according to age, gender and severity of periodontitis were selected as control group (non-orthodontic group). They were aged (26.7±5.2) years old (ranged 18-41 years old). Cone-beam CT images were used to measure the heights of the alveolar bone defects at each tooth position of the patients. The difference in the heights of the alveolar bone defects between the orthodontic group and the non-orthodontic group at the same position of the maxillary and mandibular alveolar bones were compared. The specificities of the defect heights in different positions of the maxillary and mandibular alveolar bones and different sites of the same tooth position were analyzed among orthodontic group. The specificities of the different tooth positions of the maxillary and mandibular alveolar bones of the different periodontitis stages among orthodontic group were compared. Results: The heights of the alveolar bone defects in the maxillary canine area and molar area, the mandibular incisor area, the canine area and the premolar area in the orthodontic group were higher than that in the non-orthodontic group, and the differences were statistically significant (P<0.05). In orthodontic group, the most severe teeth in the maxillary and mandibular alveolar bone defects were the canine areas [(3.75±1.00), (3.83±1.10) mm]. Secondly, the more severe tooth positions of the maxillary alveolar bone height defects were the molar area [(3.67±0.84) mm] and the incisor area [(3.39±0.83) mm] and the more severe tooth positions of the mandibular alveolar bone defects were the incisor area [(3.73±1.42) mm] and the molar area [(3.54±0.81) mm]. The height of the alveolar bone defect in the mandibular incisor area was greater than that in the maxillary (P<0.05). The bone defect in the maxillary molar area was severer than that of the mandibular area (P<0.05). The alveolar bone defects in the buccal and lingual sides were mostly larger than that of the mesial and distal sides both in maxillary and mandibular positions except for the maxillary incisor area(P<0.05). The most severe alveolar bone defect position changed with the periodontitis stage. The most severe tooth position of the maxillary in stage Ⅰ periodontitis was in the molar area [(3.26±0.63) mm], whereas the incisor area was the most severe tooth of the mandible [(3.14±1.04) mm]. In addition, among maxillary incisor area, canine area, premolar area, molar area, the most severe alveolar bone defect height was the canine area in stage Ⅱ, Ⅲ, Ⅳ mandibular (P<0.05). Conclusions: In periodontitis patients with a history of orthodontic treatment, the height of the alveolar bone defect was specific to the tooth positions and sites. With the periodontitis stage changing, the most severe defect position changed in both maxillary and mandibular alveolar bones. It is recommended to pay more attention to the alteration of alveolar bone in periodontitis patients with a history of orthodontic treatment and give timely targeted treatment plans.

[The variation of serum uric acid levels among patients with myocardial infarction treated with ticagrelor and the association between serum uric acid and platelet reactivity]

Objectives: To compare the impact of ticagrelor or clopidogrel on serum uric acid levels among patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and further evaluate the effects of variation of serum uric acid levels on platelet reactivity. Methods: STEMI patients who admitted to Fuwai Hospital from April 2017 to January 2020, and underwent primary PCI and discharged alive with aspirin and ticagrelor or clopidogrel were included in this study. Patients were divided into ticagrelor group and clopidogrel group. The baseline clinical data were collected. Serum uric acid and creatinine levels at baseline and 30 days post-PCI were measured. Light transmittance aggregometry was used to assess maximum aggregation rate induced by adenosine diphosphate and arachidonic acid. The changes of serum uric acid and creatinine were compared between the two groups. Multivariate logistic regression was performed to evaluate independent related factors for rise in the uric acid levels, and the effect of variation of serum uric acid level on platelet reactivity was analyzed. Results: A total of 967 patients were included, the age was (59.4±12.1) years, and 163 case were female. There were 550 cases in ticagrelor group (56.9%) and 417 cases in clopidogrel group (43.1%). Baseline serum uric acid and creatinine levels were similar between the 2 groups. At 30 days, the serum uric acid level [(347.2±96.5) mmol/L vs. (341.2±105.3) mmol/L, P=0.009] and absolute [46.4 (-2.4, 88.1) mmol/L vs. 25.0 (-21.9, 73.0) mmol/L, P=0.001] and percentage [13.2 (-0.01, 29.0) % vs. 7.9 (-5.7, 25.0) %, P=0.007] increase in the serum uric acid levels were significantly higher in ticagrelor group than in clopidogrel group. The level of serum creatinine at 30 days was significantly lower in ticagrelor group than in clopidogrel group [(89.7±21.3) μmol/L vs. (94.4±43.9) μmol/L, P<0.05], whereas there were no differences in absolute [8.0 (-1.4, 16.6) μmol/L vs. 7.8 (-2.0, 16.6) μmol/L] and percentage [10.5 (-1.7%, 22.6%) vs. 9.8 (-2.4%, 22.1%)] change in the serum creatinine between the 2 groups (all P>0.05). Logistic regression analysis showed that, after adjusting for confounding factors, ticagrelor therapy was an independent related factor of serum uric acid elevation (OR=1.582, 95% CI:1.023-2.447, P=0.039). The variation of the serum uric acid levels did not affect platelet aggregation and the percentage of high platelet reactivity in both groups. Conclusions: Ticagrelor use is related to a significant increase in the serum uric acid levels at 30 days post-PCI in this patient cohort. The variations in the uric acid levels do not increase the percentage of high platelet reactivity in STEMI patients treated with ticagrelor or clopidogrel.

Endoscopic mucosal resection versus endoscopic submucosal dissection for colorectal laterally spreading tumors: a meta-analysis

OBJECTIVE

to assess the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of colorectal laterally spreading tumors (LSTs).

METHODS

a systematic literature search was performed in PubMed, Embase, the Cochrane Library, CNKI and WANFANG databases. The related references were selected according to certain inclusion and exclusion criteria. The Cochrane Collaboration's Revman 5.3 software was used for data analysis.

RESULTS

a total of 12 studies were included in the analysis. The total number of lesions was 3,062 (EMR: 1,906; ESD: 1,156). The en-bloc resection rate of ESD was 95 % (1,098/1,156), which was significantly higher than that of EMR (42.8 %, 815/1,906) (OR = 0.07, 95 % CI [0.02, 0.07], p < 0.00001). The complete resection rate of ESD was 93.2 % (109/117), which was significantly higher than that of EMR as well (71.9 %, 92/128) (OR = 0.12, 95 % CI [0.05, 0.29], p < 0.00001). The bleeding rate showed no significant difference between EMR and ESD (4.2 % vs 3.5 %) (OR = 1.04, 95 % CI [0.68, 1.60], p = 0.85). The perforation rates of EMR and ESD were 1.8 % and 2.4 %, respectively, which displayed a significant difference (OR = 0.56, 95 % CI [0.32, 0.97], p = 0.04). Nevertheless, the recurrence rate of EMR was significantly higher than that of ESD (15.9 % vs 0.5 %) (OR = 23.06, 95 % CI [11.11, 47.85], p < 0.00001).

CONCLUSIONS

endoscopic resection of LSTs is safe and effective. As compared with EMR, ESD has higher en-bloc and complete resection rates but a lower recurrence rate. Therefore, ESD is highly recommended for the treatment of LSTs.

[Prevalence and risk factors of pterygium in Han and Yugur populations in Gansu Province, China]

Objective: To investigate the prevalence and risk factors of pterygium in Han and Yugur populations aged 40-79 years in Gansu Province, China. Methods: This was a cross-sectional study. A multistage cluster sampling method with urbanization level-based stratification was employed. Multiple logistic regression analysis was performed to evaluate the risk factors of pterygium. Results: A total of 4 193 people (1 840 males, 2 353 females; 3 035 Hans, 1 158 Yugurs) aged over 40 in Gansu Province were included in the study. Among them, 391 patients (9.3%) were found to have pterygium. The prevalence of pterygium adjusted for age and sex was 9.3%. The prevalence rates of Han and Yugur participants were 8.8% (267 patients) and 10.7% (124 patients), respectively, and there was no significant difference between them (χ²=3.629, P=0.057). Multivariate regression analysis showed that the risk factors of pterygium included age (OR=3.66, 95%CI: 2.26-5.92), length of residence in the countryside (OR=2.18, 95%CI: 1.41-3.38), and education level (OR=0.49, 95%CI: 0.29-0.83). In the Han group, the risk factors of pterygium were age (OR=3.84, 95%CI: 2.18-6.78) and length of rural residence (OR=2.02, 95%CI: 1.23-3.33), and a higher level of education (OR=0.36, 95%CI: 0.20-0.66) was a protective factor. Older age (OR=3.11, 95%CI: 1.13-8.59) and rural residential length ratio (OR=3.28, 95%CI: 1.09-9.88) were risk factors for pterygium in Yugur population. Conclusions: The overall prevalence of pterygium in Han and Yugur populations aged over 40 in Gansu Province, China was 9.3%, with no significant difference between the two nationalities. Older age and rural residency increased the incidence of pterygium, and a higher education level was a protective factor for pterygium.(Chin J Ophthalmol, 2020, 56:600-607).

[Associations between postprocedural D-dimer, hs-CRP, LDL-C levels and prognosis of acute myocardial infarction patients treated by percutaneous coronary intervention]

Objective: To investigate the association between postprocedural D-dimer, high sensitivity C-reactive protein(hs-CRP) and low-density lipoprotein-cholesterol(LDL-C) and outcomes of acute myocardial infarction (AMI) patients treated by percutaneous coronary intervention(PCI), in order to clarify the impacts of thrombotic, inflammatory and cholesterol risks on long-term prognosis. Methods: Patients with AMI who underwent emergency PCI from January 2010 to June 2017 in Fuwai Hospital with complete baseline data were enrolled. Patients were stratified into four groups according to quartiles of D-dimer, hs-CRP and LCL-C. Cox regression was used to analyze the relationship between these biomarkers and prognosis. Restricted cubic spline (RCS) was used to characterize the continuous association between risk of all-cause death and biomarkers. The primary outcome was all-cause death. Results: A total of 3 614 patients were included in the analysis. The age was (59.2±12.0) years old, and 2 845 (78.7%) were male and 3 161 (87.5%) patients were diagnosed as ST-segment elevation myocardial infarction. The follow-up time was 652 (414, 1 880) days. Survival analysis showed that postprocedural D-dimer and hs-CRP were significantly associated with all-cause mortality (all P<0.05). Cox regression with multiple adjustments showed that patients with D-dimer≥580 μg/L presented higher risk of all-cause death (HR=2.03, 95%CI 1.22-3.38, P=0.006), compared to patients with D-dimer<220 μg/L. RCS analysis showed that risk of all-cause death was stably high when D-dimer reached 500 μg/L. Multivariable Cox regression also showed that patients with hs-CRP<2.74 mg/L (HR=1.86, 95%CI 1.10-3.15, P=0.020)or hs-CRP≥11.99 mg/L (HR=2.14, 95%CI 1.35-3.40, P=0.001) presented higher mortality compared to patients whose hs-CRP was 2.74-7.18 mg/L. RCS analysis indicated a J-shaped relation between hs-CRP and mortality, as greater risk of death was observed when hs-CRP was lower than 2 mg/L or higher than 10 mg/L. LDL-C was not associated with outcomes (all P>0.05). Conclusions: Postprocedural D-dimer is significantly associated with long-term prognosis of AMI patients treated by PCI. Patients with extremely high or low levels of hs-CRP presents worse outcomes. Intensive and tailored antithrombotic or anti-inflammatory therapies should be considered for patients with increased thrombotic risk and those with extremely high or low inflammatory risk.

[Long-term outcomes of patients with ST-elevation myocardial infarction undergoing early versus late delayed percutaneous coronary intervention using drug-eluting stents]

Objective: To compare the long-term outcomes in ST-elevation myocardial infarction (STEMI) patients who underwent early or late delayed percutaneous coronary intervention (PCI) using drug-eluting stents (DES). Methods: This study was a retrospective, observational and single-center study. Consecutive STEMI patients (n=977), who admitted to Fuwai Hospital in 2013 and underwent successful selective PCI using drug-eluting stents (DES) within 3 to 35 days after symptom onset were enrolled and divided into the early delayed PCI (3-14 d) group (n=495) and the late delayed PCI (15-35 d) group (n=482). General clinical data of the patients and related data of coronary angiography and interventional therapy were collected, and the endpoint events were followed up. The primary endpoint was 2-year major adverse cardiac and cerebrovascular events (MACCE) including cardiac death, recurrent myocardial infarction, definite or probable stent thrombosis and ischemic stroke. The secondary endpoint was 2-year ischemia-driven target vessel revascularization. The incidence of endpoint events of the two groups was compared, and it was compared again after the primary baseline characteristics such as age and gender were matched by the propensity scoring method at a 1∶1 ratio. Results: A total of 910 (93.1%) patients who underwent delayed PCI were transferred from other hospitals, and 292 (29.9%) patients received thrombolysis before PCI. The time interval before PCI was 14 (10, 20) days. The incidence of 2-year MACCE (3.0%(15/495) vs. 2.3%(11/482), P=0.468) and ischemia-driven target vessel revascularization (3.8%(19/495) vs. 5.0%(24/482), P=0.385) were similar between the two groups. The incidence of 2-year MACCE (3.3%(15/453 vs. 2.4%(11/453), P=0.426) and ischemia-driven target vessel revascularization (4.2% (19/453) vs. 4.9%(22/453), P=0.632) were also similar between the two groups after matching propensity score. Conclusion: The long-term clinical outcomes after early delayed PCI using DES is statistically equivalent to those of late delayed PCI using DES for STEMI patients who missed the time window for emergency PCI.

[Effect of nonoperative periodontal treatment on changes of schneiderian membrane thickness of maxillary sinus in the chronic periodontitis patients using cone-beam CT]

Objective: To analysis the effect of nonoperative periodontal treatment on morphological changes of the schneiderian membrane of maxillary sinus in the chronic periodontitis patients by using oro-maxillaofacial cone-beam CT (CBCT) in order to provide the foundation in the diagnosis and treatment of maxillary sinusitis caused by chronic periodontitis. Methods: Totally 30 chronic periodontitis patients with schneiderian membrane thickening [(40.0±5.6) years old (ranged 26-55 years old), 18 males and 12 females] were randomly recruited in Department of Periodontics, School of Stomatology, China Medical University from June 2014 to December 2016. All patients were scanned by CBCT. The probing depth (PD), clinical attachment loss (CAL), plaque index (PLI) and bleeding index (BI) of the maxillary first and second premolars and molars were recorded. All patients received systematic nonoperative periodontal treatment. After six months, patients were reviewed, periodontal indexes and CBCT scanning were recorded. The thickness of the schneiderian membrane of maxillary sinus were analyzed by the software of CBCT. The changes of clinical parameters, parameter dimensional values of membrane thickness before and after treatment were statistically compared by t test. Results: In 30 chronic periodontitis patients, there was no statistically significant difference in the dimension and length of the maxillary sinus mucosa between the right and the left (P>0.05). The dimension of the mucosal thickening was positively correlated with PD and CAL values, and the correlation was statistically significant (P<0.05). Totally 58 maxillary sinus showed mucosal thickening. There were 20 mild thickening cases, and the dimension of mucosal thickening 6 months after treatment [(1.1±0.6) mm] was significantly lower than that before treatment [(2.5±0.7) mm] (P<0.05). There were 30 moderate thickening cases and the dimension of mucosal thickening 6 months after treatment [(2.3±0.6) mm] was significantly lower than that before treatment [(5.8±0.5) mm] (P<0.01). There were 8 severe thickening cases and the dimension of mucosal thickening 6 months after treatment [(4.2±0.4) mm] was also significantly lower than that before treatment [(11.2±1.8) mm] (P<0.01). The periodontal indexes of patients with mild, moderate and severe mucosal thickening in maxillary sinus showed statistically significant difference after treatment compared with before treatment (P<0.05). Conclusions: Nonoperative periodontal treatment has a positive therapeutic significance for improving the schneiderian membrane thickening of maxillary sinus.

Survival prediction with score model based on clinical characteristics in advanced HCC patients receiving oxaliplatin-containing regimens

A score model based on clinical characteristics in advanced hepatocellular carcinoma (HCC) patients treated with systemic chemotherapy of oxaliplatin-containing regimens was established to evaluate progression-free survival (PFS) and overall survival (OS). Thirty HCC patients eligible for radical resection were involved in the retrospective study, and these were divided into the good response group (complete response (CR)/partial response (PR) and the poor response group (stable disease (SD)/progression disease (PD). The median PFS and OS were compared in the two groups. PFS and OS combined with clinical characteristics were evaluated by univariate and multivariate analyses. The score model was defined with 1 score for each characteristic, and score model cut-off values were determined by the receiver operating characteristic curve (ROC) which describes treatment response. The median PFS was 10 and 2 months (p<0.001), and the median OS was 13 and 4 months (p=0.011) for the CR/PR and SD/PD groups, respectively. The score of 1 was the optimal cutoff value, with sensitivity ranging from 52.6 to 63.2% and specificity from 81.8 to 100% (AUC= 0.773, p=0.014). The median PFS for good and poor response groups was 9 months and 1month (p<0.001) and the median OS was 22 and 3months at p<0.001, respectively. Patients with scores above 1 had poor response, with median 3 months OS and 1 month PFS, and patients with scores of 0 and 1 established good response, with median 22 months OS and 9 months PFS, respectively.

[Trend of clinical features in patients with acute coronary syndrome undergoing emergent percutaneous coronary intervention]

Objective: To investigate the clinical features and change trend of patients with acute coronary syndrome(ACS) undergoing emergent percutaneous coronary intervention(PCI). Methods: In this retrospective study, we retrieved all medical records of 4 907 ACS patients who underwent emergent PCI in Fuwai hospital from January 1,2010 to December 31,2016. We analyzed the clinical features and change trend in these patients. According to clinical diagnosis, patients were grouped as ST-elevated myocardial infarction(STEMI) group (3 719 cases) and NSTE-ACS group (patients with non-STEMI and unstable angina, 1 188 cases). Results: The ACS patients were aged (59.5±11.8) years old. There were 3 772 males and 1 135 females. The annual number of ACS patients underwent emergent PCI increased from 412 patients in 2010 to 1 067 patients in 2016. The number of NSTE-ACS patients increased from 11.4% (47/412) in 2010 to 26.5% (283/1 067) in 2016. Compared with STEMI group, patients in NSTE-ACS group were significantly older ((61.2±10.9) years old vs. (58.9±12.1) years old,P<0.01).The percent of female patients (30.1% (358/1 188) vs. 20.9% (777/3 719), P < 0.01), history of hypertension (69.1% (821/1 188) vs. 60.4% (2 248/3 719,P <0.01), previous PCI (25.8% (307/1 188) vs. 12.4% (461/3 719), P <0.01), and previous coronary artery bypass grafting (3.0% (36/1 188) vs. 1.0% (37/3 719), P <0.01) were all significantly higher in NSTE-ACS group than in STEMI group. On the other hand, NSTE-ACS patients presented less chronic renal failure (2.9% (35/1 188) vs. 4.3% (173/3 719), P <0.05) and hepatic dysfunction (8.5% (101/1 188) vs. 13.3% (495/3 719), P<0.01) as compared to ACS patients. In coronary angiography, NSTE-ACS patients had a higher prevalence of left-main disease (14.0% (166/1 188) vs. 7.8% (291/3 719), P<0.012 5) and triple vessel disease (47.8% (568/1 188) vs. 43.5% (1 619/3 719), P<0.012 5). There were no differences in prevalence of diabetes mellitus (31.9% (1 187/3 719) vs. 34.8% (414/1 188),P>0.05) and acute renal failure (0.1% (38/3 719) vs. 0.6% (7/1 188),P>0.05) between STEMI group and NSTE-ACS group. Conclusions: This single center retrospective analysis reveals that there is an increasing trend of NSTE-ACS patients from 2010 to 2016. Furthermore, there are more high-risk clinical characteristics in NSTE-ACS patients than in STEMI patients.

[Contemporary use of ticagrelor in patients with acute coronary syndrome after discharge]

Objective: To investigate the degree and determinants of using ticagrelor among discharged patients with acute coronary syndrome (ACS). Methods: Patients with ACS in Fuwai hospital who were given ticagrelor after discharge between Jan. 2015 to Jun. 2015 were analyzed.The clinical characteristics and adherence to ticagrelor of these patients were collected by reviewing the electronic medical records and telephone interview.Date were statistically-analyzed. Results: Among all screened 404 patients, 158 (39.1%) patients prematurely stopped ticagrelor within 12 months, while 119(29.5%) patients switched from ticagrelor to clopidogrel.Unavailable locally (34.8%), economic reasons (17.7%) and hemorrhagic events (18.4%) were the main causes of the premature discontinuation of ticagrelor.Univariate analysis showed left main disease (P=0.04) and the frequency of outpatient follow-up (P<0.01) as relative factors for prematurely stopping ticagrelor outside hospital after discharge.Multivariate analysis revealed medical insurance payment (OR 1.79, 95%CI 1.03-3.11) and the frequency of outpatient follow-up (OR 0.61, 95%CI 0.43-0.86) as independent predictors of prematurely stopping ticagrelor outside hospital.Prematurely stopping ticagrelor has no significant effect on the ischemic events (myocardial infaction or stroke) (P=0.76). Conclusion: Social cinditions is the main factor for the persistence to ticagrelor among ACS patients after dischcrge.Medical insurance payment and low frequency of outpatient follow-up were independent predictors of prematurely stopping ticagrelor and it may not have impact on ischemic events.

Analysis of 28 trace elements in the blood and serum antioxidant status in chickens under arsenic and/or copper exposure

This study aimed to evaluate the 28 trace elements in the blood and serum antioxidant status in chickens under arsenic (As) and/or copper (Cu) exposure. A total of 200 1-day-old male Hy-Line chickens were fed either a commercial diet (C-group) or arsenic trioxide (30 mg/kg) and/or cupric sulfate (300 mg/kg) for 90 days. The 28 trace element levels in the blood were analyzed by inductively coupled plasma mass spectrometry (ICP-MS). The concentrations of As in the blood of chickens were elevated approximately 17.15-fold, 2.30-fold, and 13.37-fold in the As-group, Cu-group, and As + Cu-group, respectively, at 90 days. The concentrations of Cu did not change in the As-group and increased approximately 29.53 and 23.37% in the Cu-group and As + Cu-group, respectively, at 90 days. Moreover, As exposure caused ion profile disorders in the blood, including increased concentrations of Na, Mg, Si, K, Cr, Fe, and Se and reduced B, Ca, Ti, V, Mn, Co, Ni, Zn, Sr, and Mo. Cu exposure increased the contents of Mg, Si, Ca, Ti, V, Cr, Mn, Fe, Co, Zn, and Se and decreased the content of B, Ca, Al, Ni, and Mo. As + Cu exposure increased the contents of Mg, Si, Cr, Fe, Zn, and Se and decreased the content of B, Ca, Ti, Co, Ni, Sr, and Mo. Moreover, As and/or Cu exposure induced oxidative stress in the blood of chickens. In conclusion, the results indicated that the mixture of As and Cu caused a synergistic effect via disturbing homeostasis of trace elements and oxidative stress in the blood of chickens.

Assessment of arsenic trioxide toxicity on cock muscular tissue: alterations of oxidative damage parameters, inflammatory cytokines and heat shock proteins

To evaluate the toxicity of arsenic trioxide (As₂O₃) in the muscular tissues (wing, thigh and pectoral) of birds, 72 one-day-old Hy-line cocks were selected and randomly divided into four groups. They were fed either a commercial diet or an arsenic-supplemented diet containing 7.5, 15 or 30 mg/kg As₂O₃. The experiment lasted for 90 days and the samples of muscular tissues were collected at 30, 60 and 90 days. The results showed that As₂O₃ exposure significantly lowered the activities of antioxidant enzymes (catalase (CAT), glutathione peroxidase (GSH-Px)) and inhibition ability of hydroxyl radicals (OH) and increased the malondialdehyde (MDA) contents. Furthermore, the mRNA levels of inflammatory cytokines (tumor necrosis factor-α (TNF-α), nuclear factor-kappa B (NF-κB), cyclooxygenase-2 (COX-2), inducible NO synthase (iNOS), prostaglandin E synthase (PTGEs)) and heat shock proteins (HSPs) in muscular tissue were significantly upregulated in the As₂O₃ exposure groups. The results indicated that As₂O₃ exposure resulted in oxidative damage, induced the inflammatory response, and influenced the mRNA levels of HSPs in muscular tissue of cocks. Additionally, the results suggested that HSPs possibly resisted due to the As₂O₃ exposure-induced oxidative stress and inflammatory response, which provided a favorable environment and played protective roles in the muscular tissues of cocks. The information presented in this study is helpful to understand the mechanism of As₂O₃ toxicity in bird muscular tissues.

Assessment of 28 trace elements and 17 amino acid levels in muscular tissues of broiler chicken (Gallus gallus) suffering from arsenic trioxide

The contents of 28 trace elements, 17 amino acid were evaluated in muscular tissues (wings, crureus and pectoralis) of chickens in response to arsenic trioxide (As₂O₃). A total of 200 one-day-old male Hy-line chickens were fed either a commercial diet (C-group) or an As₂O₃ supplement diet containing 7.5mg/kg (L-group), 15mg/kg (M-group) or 30mg/kg (H-group) As₂O₃ for 90 days. The elements content was analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Under As₂O₃ exposure, the concentration of As were elevated 8.87-15.76 fold, 7.93-15.63 fold and 5.94-12.45 fold in wings, crureus and pectoralis compared to the corresponding C-group, respectively. 19 element levels (lithium (Li), magnesium (Mg), aluminum (Al), silicon (Si), kalium (K), vanadium (V), chromium (Cr), manganese (Mn), nickel (Ni), copper (Cu), selenium (Se), strontium (Sr), molybdenum (Mo), cadmium (Cd), tin (Sn), antimony (Sb), barium (Ba), mercury (Hg) and lead (Pb), 9 element levels (K, Co, Ni, Cu, As, Se, Sr, Sn, Ba and Hg) and 4 element levels (Mn, cobalt (Co), As, Sr and Ba) were significantly increased (P < 0.05) in wing, crureus and pectoralis, respectively. 2 element levels (sodium (Na) and zinc (Zn)), 5 element levels (Li, Na, Si, titanium (Ti and Cr), 13 element levels (Li, Na, Mg, K, V, Cr, iron (Fe), Cu, Zn, Mo, Sn, Hg and Pb) were significantly decreased (P < 0.05) in wing muscle, crureus and pectoralis, respectively. Additionally, in crureus and pectoralis, the content of total amino acids (TAA) was no significant alterations in L and M-group and then increased approximately 10.2% and 7.6% in H-group, respectively (P < 0.05). In wings, the level of total amino acids increased approximately 10% in L-group, whereas it showed unchanged in M and H-group compared to the corresponding C-group. We also observed that significantly increased levels of proline, cysteine, aspartic acid, methionine along with decrease in the tyrosine levels in muscular tissues compared to the corresponding C-group. In conclusion, the residual of As in the muscular tissues of chickens were dose-dependent and disrupts trace element homeostasis, amino acids level in muscular tissues of chickens under As₂O₃ exposure. Additionally, the response (trace elements and amino acids) were different in wing, thigh and pectoral of chick under As₂O₃ exposure. This study provided references for further study of heavy metal poisoning and may be helpful to understanding the toxicological mechanism of As₂O₃ exposure in muscular tissues of chickens.

Critical values in hematology of 862 institutions in China

INTRODUCTION

A national survey on critical values in hematology of China laboratories was conducted to determine the current practice and assess the quality indicators so as to obtain a quality improvement.

METHODS

Laboratories participating were asked to submit the general information, the practice of critical value reporting, and the status of timeliness of critical value reporting.

RESULTS

A total of 862 laboratories submitted the results. The majority of participants have included white blood cell count, blood platelet count, hemoglobin, prothrombin time, and activated partial thromboplastin time in their critical value lists. Many sources are used for establishing a critical value policy, and some of the laboratories consult with clinicians. The unreported critical value rate, late critical value reporting rate, and clinically unacknowledged rate in China are relatively low, and the median of critical value reporting time is 8-9 minutes.

CONCLUSION

There exists a wide variety for critical value reporting in hematology in China. Laboratories should establish a policy of critical value reporting suited for their own situations and consult with clinicians to set critical value lists. Critical values are generally reported in a timely manner in China, but some measures should be taken to further improve the timeliness of critical value reporting.

A compliant and biomimetic three-layered vascular graft for small blood vessels

Engineering a small diameter vascular graft with mechanical and biological properties comparable to living tissues remains challenging. Often, current devices lead to thrombosis and unsatisfactory long-term patency as a result of poor blood compatibility and a mismatch between the mechanical properties of the living tissue and the implanted biomaterial. Addressing all these requirements is essential to produce scaffolds able to survive throughout the life of the patient. For this purpose, we fabricated a novel three-layered vascular graft by combining electrospinning and braiding. Mirroring the structure of human blood vessels, the proposed device is composed of three layers: the intima, the media, and the adventitia. The intima and media layers were obtained by sequentially electrospinning silk fibroin (SF) and poly(L-lactide-co-ε-caprolactone), with ratios selected to match the mechanical properties of the native tissue. For the outer layer, the adventitia, SF yarns were braided on top of the electrospun tubes to create a structure able to withstand high pressures. Compliance, Young's modulus and deformability of the obtained scaffold were similar to that of human blood vessels. Additionally, cytocompatibility of the two layers, media and intima, was assessed in vitro by analysing cell metabolic activity and proliferation of endothelial cells and smooth muscle cells, respectively. Furthermore, heparin functionalization of the scaffolds led to improved anticoagulant properties upon incubation in whole blood. The obtained results indicate a potential application of the herewith designed three-layered construct as a vascular graft for small diameter blood vessel engineering.

Assessment of arsenic trioxide in the heart of Gallus gallus: alterations of oxidative damage parameters, inflammatory cytokines, and cardiac enzymes

The aim of this study was to assess the effects of arsenic trioxide (As₂O₃) in the chicken heart, and 72 1-day-old male Hy-line chickens were fed either a commercial diet (C group) or an arsenic supplement diet containing 7.5 mg/kg (L group), 15 mg/kg (M group), or 30 mg/kg (H group) As₂O₃ for 90 days. The results showed that exposure to As₂O₃ merely lowered (P < 0.05) the activities of catalase (CAT) and glutathione peroxidase (GSH-Px) in M and H groups at 90 days, significantly downregulated the inhibition ability of hydroxyl radicals (OH·), and upregulated (P < 0.05) the contents of malondialdehyde (MDA) in As₂O₃ exposure groups at 30, 60, and 90 days. Meanwhile, the messenger RNA levels of inflammatory cytokines (tumor necrosis factor-α (TNF-α), nuclear factor-kappa B (NF-κB), cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), and prostaglandin E synthase (PTGEs)) significantly increased (P < 0.05) in As₂O₃ exposure groups at 30, 60, and 90 days, and histological and ultrastructural damage was observed in As₂O₃ exposure groups. Additionally, As₂O₃-induced cardiac enzyme (aspartate transaminase (AST), creatine kinase (CK), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), and α-hydroxybutyrate dehydrogenase (α-HBDH)) levels increased (P < 0.05) at 90 days. These findings suggested that As₂O₃ exposure led to oxidative stress, inflammatory response, and histological and ultrastructural damage and altered the levels of cardiac enzymes in chicken heart tissues. This result may be helpful for further studies on the toxicological mechanisms of As₂O₃ in the chicken heart.

Dynamics of self-organized driven particles with competing range interaction

Nonequilibrium self-organized patterns formed by particles interacting through competing range interaction are driven over a substrate by an external force. We show that, with increasing driving force, the preexisted static patterns evolve into dynamic patterns either via disordered phase or depinned patterns or via the formation of nonequilibrium stripes. Strikingly, the stripes are formed either in the direction of the driving force or in the transverse direction, depending on the pinning strength. The revealed dynamical patterns are summarized in a dynamical phase diagram.

Escape of quantum particles from an open cavity

A negative ion irradiated by a laser provides a coherent source of electrons propagating out from the location of the negative ion. The total escape rates of the electrons when the negative ion is placed inside an open cavity in the shape of a wedge are studied. It is shown that the wedge induces significant oscillations in the total escape rates because of quantum interference effects. In particular, it is shown that, for a wedge with an opening angle of π/N, where N is an arbitrary positive integer, there are (2N-1) induced oscillations in the rates. As a demonstration, the case for a wedge with an opening angle π/5 is calculated and analyzed in detail.

CTL responses to regulatory proteins Tat and Rev in HIV-1 B'/C virus-infected individuals

OBJECTIVE

To characterize HIV-1 specific CTL responses to regulatory proteins Tat and Rev in HIV-B'/C virus-infected ART-naive individuals.

METHODS

HIV-1-specific CTL responses were analyzed by IFN-gamma ELISPOT assay using overlapping peptides spanning the consensus sequences of HIV-1 clade C Tat and Rev proteins. Statistical analysis and graphical presentation were performed using SIGMAPLOT 10.0 and SIGMASTAT 3.5. For samples with a positive response, the magnitude of CTL responses was compared between HIV-1 C proteins by Wilcoxon rank sum test, and the significance threshold was P<0.05.

RESULTS

Tat and Rev were frequently recognized, with 23% and 52% of the tested individuals having detectable responses to these proteins, respectively. Several immunodominant regions were detected in Rev. No significant correlation was observed between the magnitude and breadth of CTL responses to regulatory proteins and the control of virus replication in this study.

CONCLUSION

Tat and Rev can serve as targets for HIV-1-specific CTL, and several immunodominant regions are detectable in Rev. Further characterization of epitopes and their role in virus control may shed light on pathogenesis of HIV-1 natural infection and also be useful for the design and testing of candidate vaccines.

Threshold law for escaping from the Hénon-Heiles system

We report a theoretical study of the escape rates of the Hénon-Heiles system above threshold. An analytic formula for the escape rate as a function of energy is presented. We also simulated the escaping process by following the motions of a large number of particles. Two algorithms are employed to solve the equations of motion. One is the Runge-Kutta-Fehlberg method, and another is a recently proposed fourth order symplectic method. Our simulations show the escape of Hénon-Heiles system follows exponential laws. We extracted the escape rates from the time dependence of particle numbers in the Hénon-Heiles potential. The extracted escape rates agree with the analytic result. Close to threshold we find the rate alpha(DeltaE) can be written as a series expansion, the first term of this expansion is 4/3DeltaE.

Starch properties of mutant rice high in resistant starch

As the staple food of over half the world's population, hot cooked rice high in resistant starch (RS) is of particular interest, which will have greater impact in the dietary prevention of diabetes and hyperlipidemia. A mutant rice high in RS in hot cooked rice, described as RS111, was comparatively studied with the wild type and common rice. Despite obviously low RS content in the raw milled rice, the RS content in the hot cooked rice of mutant RS111 was significantly higher than that of the wild type and common rice and, correspondingly, in vitro starch hydrolysis by porcine pancreatic alpha-amylase tends to be incomplete with low hydrolysis extent for the cooked mutant rice high in RS. Obvious differences in physicochemical properties, starch granule morphology, pasting properties, thermal properties, and X-ray diffraction pattern were observed among the mutant RS111, wild type, and common indica rice. The high-RS mutant was characterized by significantly higher apparent amylose content and crude lipid content, higher percentage of oval-shaped granules and bigger oval size, reduced paste viscosity, and low onset temperature, peak temperature, final temperature, enthalpy of gelatinization, and crystallinity.

As2O3 induces apoptosis of the human B lymphoma cell line MBC-1

OBJECTIVE

To see how arsenic trioxide (As2O3) affects proliferation of the human B lymphoma cell line MBC-1.

METHODS

We studied the effect of As2O3 on MBC-1 cells and its mechanism by morphological observation, flow cytometry assay and DNA gel electrophoresis.

RESULTS

As2O3 could upregulate p53 gene expression at protein level, inducing cell apoptosis and inhibiting the proliferation of MBC-1 cells. Upregulation of p53 expression appears to be important in the apoptosis of MBC-1 cells.

CONCLUSIONS

As2O3 can inhibit the proliferation of MBC-1 cells by upregulating p53 gene expression, thus inducing apoptosis.

DNA-dependent protein kinase activity correlates with Ku70 expression and radiation sensitivity in esophageal cancer cell lines

We investigated the relationship between DNA-dependent protein kinase (DNA-PK) activity and radiation sensitivity using 14 esophageal cancer cell lines, TE 1-14. DNA-PK activities differed significantly among the cell lines. The highest DNA-PK activity observed in TE-8 was more than two times higher than the lowest DNA-PK activity observed in TE-5. Significant correlation was observed between DNA-PK activity and D0 (r = 0.766; P = 0.0008). Western blots analysis revealed a significant correlation between DNA-PK activity and Ku70 expression, suggesting that the regulation in DNA-PK activity was associated with Ku70 expression. The data suggest that the measurement of DNA-PK activity and/or Ku70 expression may provide a useful way to predict radiation sensitivity.

A phosphatidylinositol 3-kinase inhibitor wortmannin induces radioresistant DNA synthesis and sensitizes cells to bleomycin and ionizing radiation

ATM and DNA-dependent protein kinase catalytic subunit (DNA-PKcs) have been shown to have sequences homologous to the catalytic domains of mammalian phosphatidylinositol 3-kinase (PI3-kinase). In order to determine the contribution of ATM and DNA-PKcs to the increased sensitivity of cells to DNA-damaging agents observed in the presence of PI3-kinase inhibitors, we examined the effects of a PI3-kinase inhibitor, wortmannin, on cellular sensitivity to bleomycin (BLM), mitomycin C (MMC), X-irradiation and ultraviolet (UV)-irradiation using 2 human tumor cell lines (T98G and A172), a human fibroblast cell line (LM217), an ataxia telangiectasia (AT) cell line (AT3BISV), a scid murine cell line (SCF) and a control murine cell line (CBF). Wortmannin sensitized all of the cells, including AT3BISV and SCF, to BLM and X-irradiation, but not to MMC or UV-irradiation. Hypersensitivity to BLM and X-irradiation and normal sensitivity to MMC and UV-irradiation are characteristic phenotypes of both AT and scid mice. DNA-dependent protein kinase (DNA-PK) activity was suppressed by wortmannin to 45-65% of the control values in all of the cells except SCF, in which DNA-PK activity was not detected. Wortmannin also induced radioresistant DNA synthesis, which is a cellular phenotype of AT, in T98G and SCF cells, but did not change the DNA synthesis rates after X-irradiation in AT3BISV. Our data suggest that wortmannin decreases the activities of both the ATM protein and DNA-PK, indicating that it might be of use as a sensitizing agent for radiotherapy and chemotherapy.

Quantitative morphological study of Langerhans cells by computerized image analysis

ATPase-stained normal and topical nitrogen mustard treated Langerhans cells (LC) in guinea pig epidermis were studied quantitatively and morphologically by computerized image analysis. Significant correlation and linear regression were found between the perimeter and square root of its area for both cytoplasm and nucleus; a theoretical basis was thus given for morphological identification of LC. The directly measured and derived geometric parameters indicated not only substantial alteration of cytoplasm morphology of post-treated LC such as cytoplasmatosis and dendrites reduction but also a potential change of nuclear size and functional status. We conclude that quantitative morphological analysis is an objective, precise and practical method for LC research.