[Efficacy and safety of extracorporeal membrane oxygenation-supported percutaneous coronary intervention in chronic coronary total occlusion patients with reduced left ventricular ejection fraction]

Objective: To investigate the feasibility and safety of extracorporeal membrane oxygenation (ECMO)-supported percutaneous coronary intervention (PCI) in chronic coronary total occlusion (CTO) patients with reduced left ventricular ejection fraction (LVEF). Methods: The CTO patients with LVEF≤35% and undergoing CTO-PCI assisted by ECMO in the General Hospital of Northern Theater Command from December 2018 to March 2022 were enrolled in this study. The post-procedure complications, changes of LVEF from pre-procedure to post-procedure during hospitalization, and the incidence of all-cause mortality and changes of LVEF after discharge were assessed. Results: A total of 17 patients aged (59.4±11.8) years were included. There were 14 males. The pre-procedure LVEF of these patients were (29.00±4.08)%. Coronary angiography results showed that there were 29 CTO lesions in these 17 patients. There was 1 in left main coronary artery, 7 in left anterior descending artery, 11 in left circumflex artery, and 10 in right coronary artery. ECMO was implanted in all patients before procedure. Among 25 CTO lesions attempted to cross, 24 CTO were successfully implanted with stents. All patients underwent successful PCI for at least one CTO lesion. The number of drug-eluting stents implantation per patient were 4.6±1.3. After procedure, there were 8 patients with hemoglobin decreased>20 g/L, and 1 patient with ECMO-access-site related bleeding. The LVEF value at a median duration of 2.5 (2.0-5.5) days after procedure significantly increased to (38.73±7.01)% (P<0.001 vs. baseline). There were no in-hospital deaths. Patients were followed up for 360 (120, 394) days after discharge, 3 patients died (3/17). The LVEF value was (41.80±7.32)% at 155 (100, 308) days after discharge, which was significantly higher than the baseline value (P<0.001). Conclusion: The results of present study demonstrate that it is feasible, efficient and safe to perform ECMO)-supported CTO-PCI in CTO patients with reduced LVEF.

[The efficacy and safety of ticagrelor versus clopidogrel in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention]

Objective: To compare the efficacy and safety of ticagrelor and clopidogrel in elderly Chinese patients with acute coronary syndrome (ACS) underwent percutaneous coronary intervention (PCI) in the real world. Methods: This study is a post-hoc analysis of a single center, retrospective cohort study. Between March 2016 and March 2018, elderly (age≥65) ACS patients who underwent PCI in the General Hospital of Northern Theater Command were included in the study. The patients were grouped according to P2Y₁₂ receptor inhibitor. The primary endpoints of this study were ischemic events during the 2-year follow-up, which were defined as the composite of cardiac death, myocardial or stroke. The secondary efficiency endpoints included all-cause death and BARC 2, 3, 5 bleeding events. Results: A total of 4 022 elderly (mean age: (71.5±5.3) years) ACS patients were included in this study. Based on the choice of P2Y₁₂ receptor inhibitor, patients were divided into clopidogrel (n=3 201) and ticagrelor (n=821) groups. Incidences of ischemic events (3.2% (26/821) vs. 5.6% (179/3 201), P=0.005) at 2 years were significantly lower in ticagrelor group compared to clopidogrel group. BARC 2, 3, 5 bleeding events (1.7% (14/821) vs. 1.6% (52/3 201), P=0.818) were comparable between the two groups. The incidence of all-cause death (1.5% (12/821) vs. 4.1% (132/3 201), P=0.005) were also lower in the ticagrelor group compared to the clopidogrel group. Clinical outcomes were consistent after adjusting for confounding factors, the incidence of ischemic events (HR= 0.637, 95%CI 0.409-0.991, P=0.046) and all-cause mortality (HR=0.402, 95%CI 0.213-0.758, P=0.005) was significantly lower in the ticagrelor group compared with the clopidogrel group. Risk of BARC 2, 3, 5 bleeding events were similar between the two groups (HR=0.957, 95%CI 0.496-1.848, P=0.897). Conclusion: In real-world clinical practice, for elderly patients with ACS undergoing PCI, ticagrelor use might reduce the incidence of long-term ischemic events and all-cause death without increasing the risk of bleeding.

[Key data elements for clinical management and outcomes of patients with coronary artery disease: definitions from Coronary Artery Disease and Creative Antithrombotic Clinical Research Collaboration (CardiaCare)]

Objective: To develop a set of data elements and standardized definitions of Coronary Artery Disease and Creative Antithrombotic Clinical Research Collaboration (CardiaCare), aiming to facilitate the exchange of disparate data sources, enhance the abilities to support multicenter researches, and subsequently ensure the databases use under standardized process and criteria. Methods: The Cardiacare writing committee members reviewed data elements and definitions from published guidelines, clinical trials, databases, and standardized documents, then determined the data elements and standardized definitions, which should be included in CardiaCare. The writing committee also considered the specific domestic clinical management strategies during the establishment of Cardiacare. The resulting documents provide a series of key data elements and standardized definitions used in the management of coronary artery disease patients. Key data elements from CardiaCare could be sorted by clinical management flowsheet and outcome from hospitalization to long-term follow-up. Results: The Cardiacare standardized set comprised 864 data elements from admission to post-hospital follow-up visit. There were 8 tables in the documents, including demographic and admission information (23 elements), medical history and risk factors (102 elements), clinical presentations and diagnosis (22 elements), diagnostic and laboratory tests (111 elements), interventional diagnosis and treatment (118 elements), pharmacological therapy (213 elements), clinical outcomes (161 elements), and special subpopulations (114 elements: 87 elements for transcatheter valve replacement and 27 elements with cardiac rehabilitation). Conclusions: The Cardiacare standardized data elements set could provide support for real-world clinical research in consecutive data collection and databases mining. A wider applicability in various settings of CardiaCare needs to be explored further.

The sources and mechanisms of bioactive ingredients in coffee

Coffee bioactive components include caffeine, chlorogenic acids (CGAs), trigonelline, tryptophan alkaloids, diterpenes and other secondary metabolites. During roasting, coffee metabolites undergo complex Maillard reactions, producing melanoidins and other degradation products, the most controversial among which is acrylamide, an ingredient widely found in baked food and listed as a second class carcinogen. Green and roasted coffee ingredients have good biological activities for the prevention of cardiovascular disease, and antibacterial, anti-diabetic, neuroprotection, and anti-cancer activities. To better understand the relationship between coffee ingredients and human health, and to effectively use the active ingredients, it is essential to understand the sources of coffee active ingredients and their mechanisms of action in the organism. This paper systematizes the available information and provides a critical overview of the sources of coffee active ingredients and the mechanisms of action in vivo or in vitro, and their combined effects on common human diseases.

[Value of SYNTAX revascularization index on evaluating the long-term prognosis of coronary artery disease patients with biodegradable polymer drug-eluting stents implantation]

Objective: To explore the value of SYNTAX revascularization index (SRI) on evaluating the long-term prognosis of coronary artery disease (CAD) patients implanted with biodegradable polymer drug-eluting stents (BP-DES) and define the best threshold of SRI for predicting all-cause mortality in these patients. Methods: Data used in this study derived from the I-LOVE-IT 2 trial (evaluate safety and effectiveness of the Tivoli DES and the Firebird DES for treatment of coronary). I-LOVE-IT 2 trial was a prospective, multicenter, randomized, assessor-blinded, non-inferiority study. A total of 1 829 patients implanted with BP-DES were divided into 3 groups, namely SRI=100% group (n=963), 50%≤SRI<100% group (n=527) and SRI<50% group (n=339). The primary endpoint was 48-month patient-oriented composite endpoint (PoCE), a composite of all-cause mortality, myocardial infarction(MI), stroke, and/or any revascularization. The secondary endpoints were components of PoCE and definite/probable stent thrombosis at 48 months. The receiver operating characteristic curve was used to investigate the best cut-off point of SRI for 48-month all-cause mortality. The Cox regression analysis was used to identify independent predictors of the all-cause death and PoCE at 48 months. Results: Incidence of PoCE at 48 months was significantly lower in SRI=100% group than patients with 50%≤SRI<100%(17.34% (167/963) vs. 22.20% (117/527), P<0.05) and SRI<50% (17.34% (167/963) vs. 24.78% (84/339), P<0.05). Comparing with SRI=100% group, the patients with 50%≤SRI<100% suffered higher rates of all MI (7.78% (41/527) vs. 4.26% (41/963), P<0.05) and target vessel MI (6.45% (34/527) vs. 4.26% (41/963), P<0.05); patients with SRI<50% had higher rates of all-cause mortality (5.90% (20/339) vs. 3.12% (30/963), P<0.05) and any revascularization (14.16% (48/339) vs. 3.12% (30/963), P<0.05). The receiver operating characteristic curve analysis showed that the SRI=65% was the best cut-off point to predict the all-cause mortality at 48 months (area under the curve was 0.58, sensitive was 0.47, specificity was 0.70). Meanwhile, SRI<65% was an independent predictor of 48-month all-cause mortality (HR=2.06, 95%CI 1.25-3.38) and PoCE (HR=1.34, 95%CI 1.09-1.66). Conclusions: SRI serves as a good index for predicting long-term prognosis and SRI<65% is an independent predictor of 48-month PoCE and all-cause mortality for CAD patients with BP-DES implantation. Meanwhile, SRI≥65% might be a reasonable threshold of incomplete revascularization.

Deep brain stimulation in the globus pallidus externa promotes sleep

The basal ganglia, a network of subcortical structures, play a critical role in movements, sleep and mental behavior. Basal ganglia disorders such as Parkinson's disease and Huntington's disease affect sleep. Deep brain stimulation (DBS) to treat motor symptoms in Parkinson's disease can ameliorate sleep disturbances. Our series of previous studies lead the hypothesis that dopamine, acting on D2 receptors on the striatopallidal terminals, enhances activity in the globus pallidus externa (GPe) and promotes sleep. Here, we tested if DBS in the GPe promotes sleep in rats. We found that unilateral DBS (180 Hz at 100 μA) in the GPe in rats significantly increased both non-rapid eye movement and rapid eye movement sleep compared to sham DBS stimulation. The EEG power spectrum of sleep induced by DBS was similar to that of the baseline sleep, and sleep latency was not affected by DBS. The GPe is potentially a better site for DBS to treat both insomnia and motor disorders caused by basal ganglia dysfunction.

Quantification of Phase Values of Cerebral Microbleeds in Hypertensive Patients Using ESWAN MRI

PURPOSE

The presence of cerebral microbleeds (CMBs) may have predictive and diagnostic value for cerebrovascular diseases. The purpose of our study was to measure the phase values (PVs) of CMBs by phase maps.

METHODS

We retrospectively analyzed 75 patients with hypertension who had CMBs using enhanced T2*-weighted angiography (ESWAN). The PVs of CMBs were measured and documented. The mean PVs of CMBs were correlated with demographic features and the grade of white matter lesions for seven brain regions.

RESULTS

A total of 275 CMBs were found. Their mean PV was - 1.39 ± 0.29 radians. The mean PV of CMBs in seven brain regions was significantly lower than that of red nucleus and substantia nigra of healthy controls (P <  .05). The mean PV of CMBs in the basal ganglia gray matter was significantly lower than that of the brainstem, subcortical white matter, and cerebellum (P < 0.05). In subcortical white matter, the PVs were significantly lower in patients with hypertension < 10 years than for those patients with hypertension ≥ 10 years (P < 0.05). In basal ganglia gray matter, the PVs were significantly lower in men than in women (P < 0.05). There was no significant correlation between the PVs of CMBs and the demographic features addressed or the grade of white matter lesions.

CONCLUSIONS

Measurement of the PV of phase maps using ESWAN sequence provides quantitative information for detection of CMBs. The measurement data reported herein will provide a reference for a longitudinal study of CMBs in the future.

Modafinil exerts a dose-dependent antiepileptic effect mediated by adrenergic α1 and histaminergic H1 receptors in mice

Epilepsy is characterized by neuronal hyperexcitability and hypersynchronization. Disruption of electroencephalographically (EEG) synchronized epileptiform discharges may be a possible therapy for epilepsy. In the present study, to clarify the role of EEG desynchronization on epilepsy, we investigated the effect of modafinil, a potent wake-promoting substance with EEG desynchronization activity, on epilepsy in mice and clarified the receptors involved in the suppression of seizure caused by maximal electroshock (MES) and pentylenetetrazol (PTZ) kindling models. Modafinil given at 22.5, 45, and 90 mg/kg, i.p. significantly decreased the incidence of tonic hindleg extension in MES seizure models, and protected against PTZ-induced convulsive behaviors in a dose-dependent manner. In addition, modafinil at 180 mg/kg exerted an antiepileptic effect in the MES model; however, at the same dosage it increased the seizure stage in the PTZ-kindling model. The antiepileptic effect in both MES and PTZ models was antagonized by the adrenergic alpha(1) receptor antagonist terazosin, but not by the adrenergic alpha(2) receptor antagonist yohimbine or by dopaminergic receptor antagonists, SCH-23390 (for D(1) receptors) and haloperidol (for D(2) ones). Pyrilamine, a histaminergic H(1) receptor antagonist, counteracted the antiepileptic action of modafinil in the PTZ induced-kindling model, but not in the MES seizure model. Taken together, the present findings indicate that modafinil exerted its antiepileptic effect via adrenergic alpha(1) and histaminergic H(1) receptors, and might be of potential use in the treatment of epilepsy.

Pathological differentiation of suspected cases of pentastomiasis in China

We report nine cases of suspected pentastomiasis from China, and propose that diagnosis of this rare parasitic disease should be made aetio-pathologically, subaetio-pathologically, and presumptively. In none of our cases' lesions we could find either a whole or part of an embedded nymph; hence, no aetio-pathologic diagnosis of pentastomid infection was established. In three cases, subaetio-pathologic diagnoses of pentastomiasis were made upon the discovery of a peculiar set of relics from lesions, namely two pairs of circumoral hooks of pentastomid from lesions. In one of these three cases, an extra scissors-like image indicating a longitudinal section of a hook of the embedded pentastomid nymph, probably Linguatula serrata, was found. In the other six cases, none of the relics of the aetiological agents were found, and our diagnoses were made presumptively by a series of relatively specific pathologic features, i.e. pearly lesions over the peritoneal surface of the abdominal cavity under the serosa of the intestinal wall or under the capsules of liver and spleen. They tend to be uniquely protuberant, sometimes linked by a short thin stalk to the surface. The hyalinization and calcification of these centrally caseated granulomatous nodules tend to be concentric and targetoid in appearance. Tuberculosis, the most easily confused condition, was easily ruled out pathohistologically. We believe that there is a need for presumptive pathologic diagnosis of human pentastomid infection not only in China, but worldwide.

Two triterpenoid saponins from Pterocephalus bretschneidri

Two new triterpenoid saponins, named bretschnosides A and B, were isolated from the roots of Pterocephalus bretschneidri. On the basis of chemical degradation and spectroscopic evidence, the structures of bretschnosides A and B were shown to be 3-O-alpha-L-rhamnopyranosyl(1-->3)- beta-D-xylopyranosyl(1-->3)-alpha-L-rhamnopyranosyl(1-->2)-beta-D- xylopyranosyl oleanolic acid 28-O-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranoside 4 and 3-O-alpha-D-glucopyranosyl(1-->3)-beta-D-xylopyranosyl(1-->3)-alpha-L- rhamnopyranosyl(1-->2)-beta-D-xylopyranosyl oleanolic acid 28-O-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranoside 6, respectively.

Triterpenoid saponins from Pterocephalus hookeri

Four new triterpenoid saponins, named hookerosides A-D, were isolated from Pterocephalus hookeri. Based on chemical and spectral evidence, their structures were determined as 3-O-beta-D-glucopyranosyl(1-->4)-beta-D-xylopyranosyl(1-->3)-alpha-L- Rhamnopyranosyl(1-->2)-beta-D-xylopyranosyl oleanolic acid 28-O-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranoside, 3-O-beta-D-xylopyranosyl(1-->4)-beta-D-glucopyranosyl(1-->4)-beta-D- xylopyranosyl(1-->3)-alpha-L-rhamnopyranosyl(1-->2)-beta-D-xylopyranosyl oleanolic acid 28-O-beta-D-glucopyranosyl(1-->6)-beta-D-glucopyranoside, 3-O-alpha-L-rhamnopyranosyl(1-->2)-beta-D-xylopyranosyl(1-->4)-beta-D- glucopyranosyl(1-->4)-beta-D-xylopyranosyl(1-->3)-alpha-L-rhamnopyranosy l(1-->2 ) beta-D-xylopyranosyl oleanolic acid 28-O-beta-D-glucopyranosyl(1-->6)-beta-glucopyranoside and oleanolic acid 3-O-alpha-L-rhamnopyranosyl(1-->2)-beta-D- xylopyranosyl(1-->4)-beta-D-glucopyranosyl(1-->4)-beta-D-xylopyranosyl(1 -->3)- alpha-L-rhamnopyranosyl(1-->2)-beta-D-xylopyranoside, respectively.