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A dominating set of a graph G is a set S ⊆ V (G) such that every vertex in G is either in S or adjacent to a vertex in S. A dominating set S is a connected dominating set if the subgraph of G induced by S is connected. The minimum cardinality of a connected dominating set of G is the connected domination number , denoted by γ c (G). Zhuang showed that γ c (G) of a maximal outerplanar graph G is bounded by min { ⌊ n + k 2 ⌋ − 2 , ⌊ 2 (n − k) 3 ⌋ } (Zhuang, 2020), where k is the number of 2-degree vertices in G. In this paper, we give an algorithm for finding a connected dominating set of maximal outerplanar graphs and get an upper bound γ c (G) ≤ ⌊ n − k + x 2 ⌋ , where x is a counter in the algorithm and x ≤ k − 2. As a corollary, the result that γ c (G) ≤ ⌊ n − 2 2 ⌋ for a maximal outerplanar G is gotten directly. This results is better than the above known bound for 3 < k < n + 6 4 . In addition, we complement some analysis with simulations to evaluate the advantages of our results. [ABSTRACT FROM AUTHOR]

Background: Provisional stenting (PS) is the most common technique used to treat distal left main (LM) bifurcation lesions in patients with unprotected LM coronary artery disease undergoing percutaneous coronary intervention. The double kissing (DK) crush planned 2-stent technique has been shown to improve clinical outcomes in non-LM bifurcations compared with PS, and in LM bifurcations compared with culotte stenting, but has never been compared with PS in LM bifurcation lesions.Objectives: The authors sought to determine whether a planned DK crush 2-stent technique is superior to PS for patients with true distal LM bifurcation lesions.Methods: The authors randomized 482 patients from 26 centers in 5 countries with true distal LM bifurcation lesions (Medina 1,1,1 or 0,1,1) to PS (n = 242) or DK crush stenting (n = 240). The primary endpoint was the 1-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Routine 13-month angiographic follow-up was scheduled after ascertainment of the primary endpoint.Results: TLF within 1 year occurred in 26 patients (10.7%) assigned to PS, and in 12 patients (5.0%) assigned to DK crush (hazard ratio: 0.42; 95% confidence interval: 0.21 to 0.85; p = 0.02). Compared with PS, DK crush also resulted in lower rates of target vessel myocardial infarction I (2.9% vs. 0.4%; p = 0.03) and definite or probable stent thrombosis (3.3% vs. 0.4%; p = 0.02). Clinically driven target lesion revascularization (7.9% vs. 3.8%; p = 0.06) and angiographic restenosis within the LM complex (14.6% vs. 7.1%; p = 0.10) also tended to be less frequent with DK crush compared with PS. There was no significant difference in cardiac death between the groups.Conclusions: In the present multicenter randomized trial, percutaneous coronary intervention of true distal LM bifurcation lesions using a planned DK crush 2-stent strategy resulted in a lower rate of TLF at 1 year than a PS strategy. (Double Kissing and Double Crush Versus Provisional T Stenting Technique for the Treatment of Unprotected Distal Left Main True Bifurcation Lesions: A Randomized, International, Multi-Center Clinical Trial [DKCRUSH-V]; ChiCTR-TRC-11001213). [ABSTRACT FROM AUTHOR]

Background Evidences concerning the predictive value of baseline inflammatory biomarkers after drug-eluting stent (DES) placement are controversial, mainly because the use of statin was not precisely defined. Objectives The aim was to compare the differences between interleukin (IL)-6 and high-sensitivity C-reactive protein (hs-CRP) in predicting cardiovascular events 2 years after stenting in patients with unstable angina (UA) who had not received statin pretreatment. Methods There were 1,896 patients included in this study. The primary end-point was the occurrence of cardiac death or myocardial infarction (MI). Secondary endpoints included all-cause death, stent thrombosis (ST), target lesion revascularization (TLR), target vessel revascularization (TVR), or a composite of major adverse cardiac events (MACE) at 2 years after the procedure. Results During the median follow-up of 2.77 years, 96 patients experienced cardiac death (n = 37, 1.95%) or MIs (n = 70, 3.69%), 94 TLRs, 123 TVRs, 215 MACEs, and 21 definite or probable STs. In multivariable Cox proportional-hazards models and discrimination analysis, elevated IL-6 levels were superior to hs-CRP in predicting the occurrence not only of cardiac death or MI (HR 1.337, 95% CI 1.234-1.449, P < 0.001), but also of MACE and late-occurring definite/probable ST. Incorporation of IL-6 into conventional variables resulted in significantly increased c statistic for the prediction of end-points, with the exception of TLR and TVR. Conclusion Elevated IL-6 levels were independent predictors of cardiac death or MI, MACE, and late ST in patients with UA who had not received statin pretreatment, suggesting a role for IL-6 in the inflammatory risk assessment. Pathological studies have confirmed that atherosclerosis is a chronic inflammatory disease. Serum levels of high-sensitivity C-reactive protein (hs-CRP), matrix metalloproteinase, plasminogen activator inhibitor-1, the complement components C3a or C5a, and interleukin(IL)-6 were reported to provide strong and independent indications of the risk for future cardiovascular (CV) events, even among individuals who are thought to be free of vascular disease. (J Interven Cardiol 2014;27:142-154) [ABSTRACT FROM AUTHOR]

Background: Some clinical studies have demonstrated that the proton pump inhibitor (PPI) could decrease clopidogrel platelet response and increase major adverse cardiovascular events (MACE) in white or black subjects. However, that remains to be determined in Chinese patients. In this study, we sought to determine whether there could be an increased risk for developing MACE after concomitant use of dual antiplatelet therapy (DAT) and a PPI in Chinese patients treated with percutaneous coronary intervention (PCI) and stenting. Methods: This study was a 5-year, single-center, retrospective cohort analysis of eligible patients (n = 6188) who received DAT and a PPI concomitantly (defined as PPI users) before discharge and/or 12-month follow-up after discharge as compared with those who received DAT alone (also defined as non-PPI users, n = 1465). The incidence of recurrent MACE, such as myocardial infarction (MI), definite stent thromboses (ST), or cardiovascular death, was compared between the PPI users and non-users. Results: PPI users had a significantly higher incidence of the MACE than non-users (13.9% vs. 10.6%; adjusted HR: 1.33; 95% CI: 1.12 – 1.57, P = 0.007). Stratified analysis revealed that concurrent use of DAT and a PPI was associated with a significantly increased risk for developing ST compared with DAT alone (1% vs. 0.4%; adjusted HR: 2.66, 95% CI: 1.16 – 5.87, P = 0.012). However, there were no significant differences in the risk of MI, cardiovascular death and other adverse events, regardless of combination of clopidogrel and a PPI. Conclusions: The study further suggests that concomitant use of DAT and a PPI may be associated with an increased risk for developing MACE, in particular definite ST, in Chinese PCI patients after discharge as compared with use of DAT alone. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The current study aimed at determining the best cutoff value of angiographic and intravascular ultrasound (IVUS) parameters for defining fractional flow reserve (FFR) <0.8 in patients with single coronary artery lesion. Background: The correlation between angiographic or IVUS variables and FFR in patients with single coronary artery lesions has not been studied yet. Methods: Quantitative coronary analysis and IVUS and FFR measurements were used in 323 patients with a single lesion. The best angiographic and IVUS cutoff values and their predictive value for FFR<0.8 were compared using area under the receiver–operator characteristic curve (AUC). Results: FFR<0.8 was in 54.2%. Minimal lumen area (MLA), plaque burden (PB), lesion length (LL) and lesion at left anterior descending artery (LAD) were four predictors of FFR<0.8. LL had less value in predicting FFR<0.8. The cutoff values of PB and MLA for FFR<0.8 were 72.7% and 2.97mm2. MLA and PB had similar high diagnostic value for vessel size≥3mm (cutoff values: 3.02mm2 and 80.7%), proximal LAD lesion (cutoff values: 3.04mm2 and 76.5%) and unstable angina (2.82mm2 and 71.9%). Combination of MLA (2.82mm2) and PB (80.6%) had increased diagnostic value for distal LAD lesion. Only PB (71%) had higher diagnostic value for diabetic patients. MLA and PB could not predict FFR<0.8 for vessel size<3mm, and non-LAD lesion. Conclusion: Best cutoff value of MLA and PB for FFR<0.8 in patients with a single lesion is patient-, vessel size- and lesion location-oriented. PB has strengthened diagnostic accuracy for diabetic patients. [Copyright &y& Elsevier]

Objectives: This study was designed to test the safety and efficacy of pulmonary artery (PA) denervation (PADN) for patients with idiopathic PA hypertension (IPAH) not responding optimally to medical therapy. Background: Baroreceptors and sympathetic nerve fibers are localized in or near the bifurcation area of the main PA. We previously demonstrated that PADN completely abolished the experimentally elevated PA pressure responses to occlusion of the left interlobar PA. Methods: Of a total of 21 patients with IPAH, 13 patients received the PADN procedure, and the other 8 patients who refused the PADN procedure were assigned to the control group. PADN was performed at the bifurcation of the main PA, and at the ostial right and left PA. Serial echocardiography, right heart catheterization, and a 6-min walk test (6MWT) were performed. The primary endpoints were the change of PA pressure (PAP), tricuspid excursion (Tei) index, and 6MWT at 3 months follow-up. Results: Compared with the control group, at 3 months follow-up, the patients who underwent the PADN procedure showed significant reduction of mean PAP (from 55 ± 5 mm Hg to 36 ± 5 mm Hg, p < 0.01), and significant improvement of the 6MWT (from 324 ± 21 m to 491 ± 38 m, p < 0.006) and of the Tei index (from 0.7 ± 0.04 to 0.50 ± 0.04, p < 0.001). Conclusions: We report for the first time the effect of PADN on functional capacity and hemodynamics in patients with IPAH not responding optimally to medical therapy. Further randomized study is required to confirm the efficacy of PADN. (First-in-Man Pulmonary Artery Denervation for Treatment of Pulmonary Artery Hypertension [PADN-1] study; chiCTR-ONC-12002085) [ABSTRACT FROM AUTHOR]

Background Polymer-free sirolimus- and probucol-eluting stents ( Real Dual drug-eluting stents [ DES]) is as effective as first-generation DES in treating coronary artery stenosis. It is unknown whether sirolimus-eluting stents containing biodegradable polymer ( Excel) would be superior to real Dual DES. This study aimed to investigate the difference in target vessel revascularization ( TVR) at 12 months in patients with coronary artery disease treated by the implantation of Dual DES or Excel stents. Methods Three hundred and forty-six patients with de novo coronary artery disease were recruited from six centers in China and randomly assigned to either the Dual DES or the Excel group. The primary endpoint was the occurrence of TVR at 12 months. The secondary endpoint was angiographic in-stent restenosis and late lumen loss at 13 months. Stent thrombosis ( ST) served as the safety endpoint. Dual anti-platelet therapy ( DAPT) was prescribed for 6 months. Results Clinical follow-up for 12 months and repeat angiography at 13 months were available in 100% and >90% of patients, respectively. The ISR and in-stent late loss were significantly different between the Excel (3.1%, 0.09 ± 0.11 mm) and the Dual DES (19.5%, 0.36 ± 0.32 mm, P < 0.001, P < 0.001, respectively) groups. The TVR (3.5%) in the Excel group was significantly less than in the Dual DES group (13.9%, P = 0.001). The ST rate beyond 12 months in the Dual DES group was 0%, and this was 1.2% in the Excel group ( P = 0.499). Conclusions The Excel stent was statistically superior to the Dual DES in terms of restenosis, late loss, and TVR for long lesions. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to investigate the difference in major adverse cardiac event (MACE) at 1-year after double kissing (DK) crush versus Culotte stenting for unprotected left main coronary artery (UPLMCA) distal bifurcation lesions. Background: DK crush and Culotte stenting were reported to be effective for treatment of coronary bifurcation lesions. However, their comparative performance in UPLMCA bifurcation lesions is not known. Methods: A total of 419 patients with UPLMCA bifurcation lesions were randomly assigned to DK (n = 210) or Culotte (n = 209) treatment. The primary endpoint was the occurrence of a MACE at 1 year, including cardiac death, myocardial infarction, and target vessel revascularization (TVR). In-stent restenosis (ISR) at 8 months was secondary endpoint, and stent thrombosis (ST) served as a safety endpoint. Patients were stratified by SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) and NERS (New Risk Stratification) scores. Results: Patients in the Culotte group had significant higher 1-year MACE rate (16.3%), mainly driven by increased TVR (11.0%), compared with the DK group (6.2% and 4.3%, respectively; all p < 0.05). ISR rate in side branch was 12.6% in the Culotte group and 6.8% in the DK group (p = 0.037). Definite ST rate was 1.0% in the Culotte group and 0% in the DK group (p = 0.248). Among patients with bifurcation angle ≥70°, NERS score ≥20, and SYNTAX score ≥23, the 1-year MACE rate in the DK group (3.8%, 9.2%, and 7.1%, respectively) was significantly different to those in the Culotte group(16.5%, 20.4%, and 18.9%, respectively; all p < 0.05). Conclusions: Culotte stenting for UPLMCA bifurcation lesions was associated with significantly increased MACEs, mainly due to the increased TVR. (Double Kissing [DK] Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing Double-Stent Techniques; ChiCTR-TRC-00000151) [Copyright &y& Elsevier]

SUMMARY Objective: This study aimed to compare the acute effects of nicardipine and esmolol on hemodynamic and endothelial shear stress (ESS) in patients with unstable angina (UA) and moderate coronary stenosis (MCS). Background: Nicardipine and esmolol exhibit cardioprotection via different mechanisms. However, their acute effects on hemodynamic and ESS are still unknown. Methods: One-hundred sixteen patients with UA and MSC were randomly divided into nicardipine (n = 59) and esmolol (n = 57) groups. Drugs were injected as a bolus followed by continuous infusion to achieve the steady states defined as the mean blood pressure (MBP) reduced by ≥10% or a heart-rate change by ≥15 bpm, lasting for at least 10 min. The aortic pressure (AP), EKG, blood velocity, right atrial pressure, distal coronary pressure (DCP), systolic time (ST), isovolumetric diastolic time (IVDT), speed filling time (SFT), and ESS were simultaneously calculated at baseline and steady states. Results: Both drugs significantly reduced blood pressure and rate-pressure load. Infusion of nicardipine was associated with negative remodeling of the distal segment ( P= 0.005). Esmolol, rather than nicardipine, increased minimal lumen diameter ( P= 0.040), prolonged SFT (0.34 ± 0.03 s vs. 0.41 ± 0.03 s, P < 0.001), reduced DCP ( P < 0.001) and increased blood velocity (33.65 ± 1.07 cm/s vs. 43.36 ± 1.25 cm/s, P < 0.001) at SFT stages, with increased blood-flow ( P < 0.001). Both drugs increased downstream ESS. Esmolol significantly reversed abnormally increased ESS ( P < 0.001) and increased upstream ESS compared with nicardipine ( P < 0.001). Conclusion: Beyond a similar reduction of AP, patients with UA and MCS could benefit more from the reduction of heart rate induced by esmolol (ChiCTR-TRC-10000964). [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to investigate the difference in major adverse cardiac events (MACE) at 12 months in patients with coronary bifurcation lesions after double kissing double crush (DK crush) or provisional stenting (PS) techniques. Background: Provisional side branch (SB) stenting is preferable to DK crush because it has been associated with fewer complications. It is unknown which strategy would provide the best results. Methods: From April 2007 to June 2009, 370 unselected patients with coronary bifurcation lesions from 7 Asian centers were randomly assigned to either the DK or the PS group. Additional SB stenting in PS was required if final results were suboptimal. The primary end point was the occurrence of MACE at 12 months, including cardiac death, myocardial infarction, or target vessel revascularization (TVR). Secondary end point was the angiographic restenosis at 8 months. Results: There were 3 procedural occlusions of SB in the PS group. At 8 months, angiographic restenosis rates in the main vessel and SB were significantly different between the DK (3.8% and 4.9%) and the PS groups (9.7% and 22.2%, p = 0.036 and p < 0.001, respectively). Additional SB stenting in the PS group was required in 28.6% of lesions. TVR was 6.5% in the DK group, occurring significantly less often than in the PS group (14.6%, p = 0.017). There were nonsignificant differences in MACE and definite stent thrombosis between the DK (10.3% and 2.2%) and PS groups (17.3%, and 0.5%, p = 0.070 and p = 0.372, respectively). Conclusions: DK crush was associated with a significant reduction of TLR and TVR in this unselected patient population. However, there was no significant difference in MACE between DK and the PS groups. (Randomized Study on DK Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions; ChicTR-TRC-00000015) [Copyright &y& Elsevier]

Objective To assess the safety and efficacy of multifunctional catheter of 5F Tiger I in coronary angiography versus Judkins approach via the right radial artery pathway. Methods 200 patients were selected from Department of Cardiology, Nanjing First Hospital of Nanjing Medical University from April to October 2007, including 123 males and 77 females, aged (58 ± 8) years. They were randomized into two groups (n = 100). The informed consent was obtained from all subjects. All patients underwent coronary angiography via the right radial artery pathway using standard Judkins catheters (Cordis Corporation, Miami, U. S. ) and 5F Tiger I catheters (Terumo Corporation, Tokyo, Japan). 6F Judkins L (JL) 3. 5 and Judkins R (JR) 3. 5 were used as first choice catheters in one group, if catheter tip size was not suitable, 6F JL4. 0 , JR4. 0 and other catheters might be used. 5F Tiger I catheters were used in the other group. If the left or right coronary artery angiography failed or did not achieve the target site, Tiger I catheter intubation failed and replaced by Judkins or other catheters. Success rate of left and right coronary artery angiography, total procedure time, total fluoroscopic time, usage amount of contrast, incidence of complication correlating with catheter in angiography procedure, and cost of catheter were observed. Results The success rate of Tiger I catheter in left and right coronary artery angiographies via the right radial artery pathway was 94% ,and that of Judkins catheter was 100% (P <0. 05). Total procedure time was (318. 3 ± 47. 9) s in Judkins catheter group and (318.5 ±49.0) s in Tiger I catheter group (P >0. 05). Total fluoroscopic time was (1. 8 ±0. 9) mm in Judkins catheter group and (1.9 ± 0.6) min in Tiger I catheter group (P >0.05). Usage amount of contrast was (42. 6 ±6. 4) ml in Judkins catheter group and (34. 2 ±5. 0) ml in Tiger I catheter group (P <0. 05). Incidence of complication correlating with catheter in angiography procedure was zero in both two groups. Judkins catheters cost (530. 4 ± 51. 2) Yuan, and Tiger I catheter cost (260 ± 0) Yuan. Biocompatibility of material and host No platelet disorder, local inflammation or general malaise were found in any patients undergoing coronary artery angiography by Tiger I and Judkins catheters. Conclusion Tiger I catheter is effective and safe in coronary angiography via the right radial artery pathway with no specific biocompatibility problems. Judkins catheter is better than Tiger I catheter in the success rate of coronary angiographies, but Tiger I catheter is superior to Judkins catheter in reducing usage amount of contrast and cost of catheters, the two catheters have no difference in proccessing time and fluoroscopic time. [ABSTRACT FROM AUTHOR]

Abstract: Backgrounds: The potential role of hydration in prevention of contrast-induced nephropathy (CIN) still remains to be unclear. Methods: Nine-hundred and thirty-six patients scheduled for percutaneous coronary intervention (PCI) were enrolled into the present study, and divided into normal (serum creatinine<1.5 mg/dl) and abnormal (serum creatine≥1.5 mg/dl) groups according to their baseline serum concentration of creatinine. Each group was further randomly divided into two subgroups: hydration and nonhydration. All patients in abnormal group took twice orally loading dose of 1200 mg acetylcysteine (ATLS) at 12 h before scheduled time for coronary angiogram and immediately after procedure. Creatinine concentration was remeasured at the time of admission (just before catheterization), every day for the following three days. The primary end point during 6-month follow-up included clinical driven revascularization (either PCI or CABG), death from all causes, and requiring emergency renal-replacement therapy. Results: The incidence of CIN was more commonly in abnormal group that in normal group (6.52% vs. 37.68%, p <0.001). Hydration had potentials in prevention of CIN only in patients with elevated baseline concentration of creatinine. Multivariate analysis demonstrated that the following variables remained to be significant factors correlating with CIN: age≥70 years (odds ration [OR] 5.27, 95% confidence interval [CI] 1.94 to 13.07, p =0.0007), contrast volume≥320 ml (OR 3.26, 95% CL 2.14 to 7.58, p =0.01), diabetes mellitus (OR 9.86, 95% CL 5.38 to 31.67, p <0.0001), and peripheral arterial disease (OR 11.25, 95% CL 5.12 to 43.19, p <0.0001). Patients with CIN in abnormal group had worse clinical outcomes, compared to patients with CIN in normal group. Conclusion: Patients with CIN and preexisting renal insufficiency had worse clinical outcomes. Hydration with 0.45% sodium chloride alone had no potential effect on the occurrence of CIN in patients with normal renal function. Combination of hydration with ATLS could reduce the incidence of CIN in patients at high risk. [Copyright &y& Elsevier]

Abstract: Accurate estimates of the surface area of burns are important for initial fluid resuscitation and prognosis of burn victims. The area of the surface of the open hand is often used to estimate the area of a burn. Although it is accepted that hand surface area is generally equal to 1% of total body surface area among Caucasians, this ratio has not been verified for Chinese people. We used two-dimensional projection to estimate the hand surface areas of Chinese adults. The area of the palm was 0.44% of total body surface area among men and 0.42% among women. The area of the hand, including that of the thumb and fingers, was 0.76% of total body surface area among men and 0.73% among women. We conclude that the ratio between hand and total body surface area among Chinese adults differs from the ratio among Caucasians, and suggest an adjustment of the ratio for use with Chinese people. [Copyright &y& Elsevier]

Summary: The boomerang flap originates from the dorsolateral aspect of the proximal phalanx of an adjacent digit and is supplied by the retrograde blood flow through the vascular arcades between the dorsal and palmar digital arteries. To provide sensation of the boomerang flap for finger pulp reconstruction, the dorsal sensory branch of the proper digital nerve and the superficial sensory branch of the corresponding radial or ulnar nerve are included within the skin flap. After transfer of the flap to the injured site, epineural neurorrhaphies are done between the digital nerves of the pulp and the sensory branches of the flap. We used this sensory flap in five patients, with more than 1 year follow-up, and all patients achieved measurable two-points discrimination. The boomerang flap not only preserves the proper palmar digital artery but also provides an extended and innervated skin paddle. It seems to be an alternative choice for one-stage reconstruction of major pulp defect. [Copyright &y& Elsevier]

Sixty-nine patients who underwent primary percutaneous coronary intervention within 12 hours after onset of acute myocardial infarction were randomized to receive intracoronary injection of autologous bone marrow mesenchymal stem cell or standard saline. Several imagining techniques demonstrated that bone marrow mesenchymal stem cells significantly improved left ventricular function. [Copyright &y& Elsevier]

Dual antiplatelet therapy (DAPT) for 12 months is the standard of care after coronary stenting in patients with acute coronary syndrome (ACS). The aim of this individual patient-level meta-analysis was to summarise the evidence comparing DAPT de-escalation to ticagrelor monotherapy versus continuing DAPT for 12 months after coronary drug-eluting stent implantation. A systematic review and individual patient data (IPD)-level meta-analysis of randomised trials with centrally adjudicated endpoints was performed to evaluate the comparative efficacy and safety of ticagrelor monotherapy (90 mg twice a day) after short-term DAPT (from 2 weeks to 3 months) versus 12-month DAPT in patients undergoing percutaneous coronary intervention with a coronary drug-eluting stent. Randomised trials comparing P2Y 12 inhibitor monotherapy with DAPT after coronary revascularisation were searched in Ovid MEDLINE, Embase, and two websites (www.tctmd.com and www.escardio.org) from database inception up to May 20, 2024. Trials that included patients with an indication for long-term oral anticoagulants were excluded. The risk of bias was assessed using the revised Cochrane risk-of-bias tool. The principal investigators of the eligible trials provided IPD by means of an anonymised electronic dataset. The three ranked coprimary endpoints were major adverse cardiovascular or cerebrovascular events (MACCE; a composite of all-cause death, myocardial infarction, or stroke) tested for non-inferiority in the per-protocol population; and Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding and all-cause death tested for superiority in the intention-to-treat population. All outcomes are reported as Kaplan–Meier estimates. The non-inferiority was tested using a one-sided α of 0·025 with the prespecified non-inferiority margin of 1·15 (hazard ratio [HR] scale), followed by the ranked superiority testing at a two-sided α of 0·05. This study is registered with PROSPERO (CRD42024506083). A total of 8361 unique citations were screened, of which 610 records were considered potentially eligible during the screening of titles and abstracts. Of these, six trials that randomly assigned patients to ticagrelor monotherapy or DAPT were identified. De-escalation took place a median of 78 days (IQR 31–92) after intervention, with a median duration of treatment of 334 days (329−365). Among 23 256 patients in the per-protocol population, MACCE occurred in 297 (Kaplan–Meier estimate 2·8%) with ticagrelor monotherapy and 332 (Kaplan–Meier estimate 3·2%) with DAPT (HR 0·91 [95% CI 0·78–1·07]; p=0·0039 for non-inferiority; τ2<0·0001). Among 24 407 patients in the intention-to-treat population, the risks of BARC 3 or 5 bleeding (Kaplan–Meier estimate 0·9% vs 2·1%; HR 0·43 [95% CI 0·34–0·54]; p<0·0001 for superiority; τ2=0·079) and all-cause death (Kaplan–Meier estimate 0·9% vs 1·2%; 0·76 [0·59–0·98]; p=0·034 for superiority; τ2<0·0001) were lower with ticagrelor monotherapy. Trial sequential analysis showed strong evidence of non-inferiority for MACCE and superiority for bleeding among the overall and ACS populations (the z-curve crossed the monitoring boundaries or the required information size without crossing the futility boundaries or approaching the null). The treatment effects were heterogeneous by sex for MACCE (p interaction=0·041) and all-cause death (p interaction=0·050), indicating a possible benefit in women with ticagrelor monotherapy, and by clinical presentation for bleeding (p interaction=0·022), indicating a benefit in ACS with ticagrelor monotherapy. Our study found robust evidence that, compared with 12 months of DAPT, de-escalation to ticagrelor monotherapy does not increase ischaemic risk and reduces the risk of major bleeding, especially in patients with ACS. Ticagrelor monotherapy might also be associated with a mortality benefit, particularly among women, which warrants further investigation. Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale. [ABSTRACT FROM AUTHOR]

Following percutaneous coronary intervention with stent placement to treat acute coronary syndromes, international clinical guidelines generally recommend dual antiplatelet therapy with aspirin plus a P2Y 12 receptor inhibitor for 12 months to prevent myocardial infarction and stent thrombosis. However, data on single antiplatelet therapy with a potent P2Y 12 inhibitor earlier than 12 months after percutaneous coronary intervention for patients with an acute coronary syndrome are scarce. The aim of this trial was to assess whether the use of ticagrelor alone, compared with ticagrelor plus aspirin, could reduce the incidence of clinically relevant bleeding events without an accompanying increase in major adverse cardiovascular or cerebrovascular events (MACCE). In this randomised, placebo-controlled, double-blind clinical trial, patients aged 18 years or older with an acute coronary syndrome who completed the IVUS-ACS study and who had no major ischaemic or bleeding events after 1-month treatment with dual antiplatelet therapy were randomly assigned to receive oral ticagrelor (90 mg twice daily) plus oral aspirin (100 mg once daily) or oral ticagrelor (90 mg twice daily) plus a matching oral placebo, beginning 1 month and ending at 12 months after percutaneous coronary intervention (11 months in total). Recruitment took place at 58 centres in China, Italy, Pakistan, and the UK. Patients were required to remain event-free for 1 month on dual antiplatelet therapy following percutaneous coronary intervention with contemporary drug-eluting stents. Randomisation was done using a web-based system, stratified by acute coronary syndrome type, diabetes, IVUS-ACS randomisation, and site, using dynamic minimisation. The primary superiority endpoint was clinically relevant bleeding (Bleeding Academic Research Consortium [known as BARC] types 2, 3, or 5). The primary non-inferiority endpoint was MACCE (defined as the composite of cardiac death, myocardial infarction, ischaemic stroke, definite stent thrombosis, or clinically driven target vessel revascularisation), with an expected event rate of 6·2% in the ticagrelor plus aspirin group and an absolute non-inferiority margin of 2·5 percentage points between 1 month and 12 months after percutaneous coronary intervention. The two co-primary endpoints were tested sequentially; the primary superiority endpoint had to be met for hypothesis testing of the MACCE outcome to proceed. All principal analyses were assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov , NCT03971500 , and is completed. Between Sept 21, 2019, and Oct 27, 2022, 3400 (97·0%) of the 3505 participants in the IVUS-ACS study were randomly assigned (1700 patients to ticagrelor plus aspirin and 1700 patients to ticagrelor plus placebo). 12-month follow-up was completed by 3399 (>99·9%) patients. Between month 1 and month 12 after percutaneous coronary intervention, clinically relevant bleeding occurred in 35 patients (2·1%) in the ticagrelor plus placebo group and in 78 patients (4·6%) in the ticagrelor plus aspirin group (hazard ratio [HR] 0·45 [95% CI 0·30 to 0·66]; p<0·0001). MACCE occurred in 61 patients (3·6%) in the ticagrelor plus placebo group and in 63 patients (3·7%) in the ticagrelor plus aspirin group (absolute difference –0·1% [95% CI –1·4% to 1·2%]; HR 0·98 [95% CI 0·69 to 1·39]; p non-inferiority <0·0001, p superiority =0·89). In patients with an acute coronary syndrome who had percutaneous coronary intervention with contemporary drug-eluting stents and remained event-free for 1 month on dual antiplatelet therapy, treatment with ticagrelor alone between month 1 and month 12 after the intervention resulted in a lower rate of clinically relevant bleeding and a similar rate of MACCE compared with ticagrelor plus aspirin. Along with the results from previous studies, these findings show that most patients in this population can benefit from superior clinical outcomes with aspirin discontinuation and maintenance on ticagrelor monotherapy after 1 month of dual antiplatelet therapy. The Chinese Society of Cardiology, the National Natural Scientific Foundation of China, and the Jiangsu Provincial & Nanjing Municipal Clinical Trial Project. For the Mandarin translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Intravascular ultrasound-guided percutaneous coronary intervention has been shown to result in superior clinical outcomes compared with angiography-guided percutaneous coronary intervention. However, insufficient data are available concerning the advantages of intravascular ultrasound guidance for patients with an acute coronary syndrome. This trial aimed to investigate whether the use of intravascular ultrasound guidance, as compared with angiography guidance, improves the outcomes of percutaneous coronary intervention with contemporary drug-eluting stents in patients presenting with an acute coronary syndrome. In this two-stage, multicentre, randomised trial, patients aged 18 years or older and presenting with an acute coronary syndrome at 58 centres in China, Italy, Pakistan, and the UK were randomly assigned to intravascular ultrasound-guided percutaneous coronary intervention or angiography-guided percutaneous coronary intervention. Patients, follow-up health-care providers, and assessors were masked to random assignment; however, staff in the catheterisation laboratory were not. The primary endpoint was target vessel failure, a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularisation at 1 year after randomisation. This trial is registered at ClinicalTrials.gov , NCT03971500 , and is completed. Between Aug 20, 2019 and Oct 27, 2022, 3505 patients with an acute coronary syndrome were randomly assigned to intravascular ultrasound-guided percutaneous coronary intervention (n=1753) or angiography-guided percutaneous coronary intervention (n=1752). 1-year follow-up was completed in 3504 (>99·9%) patients. The primary endpoint occurred in 70 patients in the intravascular ultrasound group and 128 patients in the angiography group (Kaplan-Meier rate 4·0% vs 7·3%; hazard ratio 0·55 [95% CI 0·41–0·74]; p=0·0001), driven by reductions in target vessel myocardial infarction or target vessel revascularisation. There were no significant differences in all-cause death or stent thrombosis between groups. Safety endpoints were also similar in the two groups. In patients with an acute coronary syndrome, intravascular ultrasound-guided implantation of contemporary drug-eluting stents resulted in a lower 1-year rate of the composite outcome of cardiac death, target vessel myocardial infarction, or clinically driven revascularisation compared with angiography guidance alone. The Chinese Society of Cardiology, the National Natural Scientific Foundation of China, and Jiangsu Provincial & Nanjing Municipal Clinical Trial Project. For the Mandarin translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Epicardial adipose tissue (EAT) is a metabolically active organ which generates inflammatory cytokines. Thickness of EAT is associated with onset and development of heart failure with preserved ejection fraction (HFpEF). However, it is still unclear the specific mechanisms and pharmacological targets on EAT induced inflammation in HFpEF. A two-hit protocol with western diet and Nω-nitrol-arginine methyl ester (L-NAME) was used to establish HFpEF mouse model. In HFpEF mice, inflammatory biomarkers, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β and von willebrand factor (vWF) elevated in myocardium compared to control. Inflammatory cell infiltration in myocardium was increased. In HFpEF mice, inflammasome-mediated pyroptosis pathway was activated in the EAT. Suppression of pyroptosis-related protein gasdermin D (GSDMD) in cultured EAT could lower cardiomyocyte inflammation and autophagy. Furthermore, spironolactone and rosuvastatin, the two-hit anti-inflammatory agents, reduced NLR family pyrin domain containing 3 (NLRP3)/GSDMD pyroptosis in EAT and autophagy in myocardium of HFpEF mouse. The combination treatment also enhanced exercise tolerance and appeased inflammatory injuries in HFpEF mice. Pyroptosis signaling is involved in EAT-myocardium axis in mouse model of HFpEF. Targeting adipocyte-derived inflammation in EAT bears potential to treatment HFpEF. • Epicardial adipose tissue is a metabolically active organ which generates inflammatory cytokines. • In HFpEF mouse model, an epicardial adipose tissue-myocardium axis was established, and pyroptosis signaling mediate the effect of adipose tissue on myocardium. • Suppressing pyroptosis is a novel concept and strategy for the treatment of HFpEF. [ABSTRACT FROM AUTHOR]

Multidrug resistance protein 3 ( MPR3), encoded by the ATP-binding cassette, subfamily C ( CFTR/ MRP), member 3 ( ABCC3) gene, functions as an important drug efflux transporter. The ABCC3 -211 C/ T polymorphism is associated with decreased MRP3 mRNA expression, and low MRP3 mRNA expression is associated with increased clopidogrel response in patients. The aim of the present study was to determine whether the -211 C/ T polymorphism is associated with altered antiplatelet effects and clinical outcomes in clopidogrel-treated patients., A subcohort of 249 patients not carrying the CYP2C19* 2, * 3 or * 17 variant was identified from a total of 617 consecutive clopidogrel-treated patients undergoing percutaneous coronary intervention and then categorized into three groups on the basis of their ABCC3 -211 C/ T genotype. Baseline data, clinical characteristics and DNA samples were collected for all patients. Light transmittance aggregometry was used to determine ADP-induced maximum platelet aggregation ( MPA) in blood samples obtained from patients on Day 3 after starting daily clopidogrel maintenance doses. Genotyping of CYP2C19* 2, * 3 and * 17 variants and the ABCC3 -211 C/ T polymorphism was performed using matrix-assisted laser desorption ionization time-of-flight ( MALDI- TOF) mass spectrometry. The primary clinical end-point was a definite stent thrombosis ( ST) episode, whereas secondary end-points were other major adverse cardiovascular events within 12 months after stenting., There were no differences in MPA values according to ABCC3 -211 C/ T genotype. A multiple linear regression model revealed that the ABCC3 -211 C/ T polymorphism was not independently associated with ADP-induced MPA measurements; a multiple logistic regression model revealed that carrying the ABCC3 -211 C allele was not associated with the risk of developing an ST event in clopidogrel-treated patients not harbouring CYP2C19* 2, * 3 and * 17 variants., In conclusion, the ABCC3 -211 C/ T polymorphism seems not to be associated with altered antiplatelet effects and clinical outcomes in clopidogrel-treated patients. [ABSTRACT FROM AUTHOR]

Background and objectives: A large number of clinical studies have well demonstrated that the loss-of-function variant allele CYP2C19*2 is associated with attenuated response to clopidogrel and increased risk of developing stent thrombosis (ST) in white or black patients with stenting. However, similar association studies on the effect of the CYP2C19*2 and *3 variants on maximum platelet aggregation (MPA) and the risk of cardiovascular events are currently unavailable for the Chinese patients. This work was aimed at assessing the impact of the CYP2C19 *2 and *3 variants on the antiplatelet effects and adverse cardiovascular events in clopidogrel-treated Chinese patients undergoing percutaneous coronary intervention (PCI). Methods: The study population consisted of 617 patients undergoing PCI. Genotypes were determined using MALDI/TOF-MS. MPA was measured by light transmittance aggregometry. The clinical end-point was the 1-year incidence of adverse cardiovascular events, including ST. Results: Carriers of CYP2C19 heterozygous (*1/*2, or *1/*3; n = 278) and mutant homozygous (*2/*2, *2/*3, or *3/*3, n = 80) genotypes had significantly higher MPA values than noncarriers (*1/*1; n = 259; P = 0.036 and 0.007 respectively). Moreover, the presence of the CYP2C19*2 or *3 mutant allele was significantly associated with an increased risk of developing ST, with the higher risk of ST being seen in patients homozygous for the CYP2C19*2 or *3 variant allele than in noncarriers (OR, 13.58; 95% CI, 1.49-123.31; P = 0.012). Furthermore, multivariate analysis revealed an independent association of the presence of CYP2C19*2 and/or *3 variant alleles with greater MPA values ( P = 0.001) and increased risk of ST (OR, 11.67; 95% CI, 1.21-78.83; P = 0.022). However, there was no significant influence of CYP2C19*2 and *3 on the risk of developing other adverse cardiovascular events. Conclusions: Carriage of the loss-of-function genetic variants CYP2C19*2 and *3 is significantly associated with attenuated platelet response to clopidogrel and an increased risk of ST in Chinese patients treated with stenting. [ABSTRACT FROM AUTHOR]

This report describes the management of a charcoal burn involving deep tissues at different anatomic sites. The closure of burn wounds should be considered as a functional and cosmetic outcome whenever possible. Our aim should be to get the soft tissue of the early burned wound closed. A satisfactory result can be achieved if both the functional anatomy and the aesthetic outcome can be kept in mind while planning the management. [Copyright &y& Elsevier]

The nose is the central part of the face, and constitutes the most prominent projection in facial geometry. This report presents five cases that sustained a chemical burn injury with associated facial mutilation resulting from contact with strong acids. The chemical burn affected the nasal architecture after inflicting a burn injury to the face. Applying bone deriving from a split skull procedure for the nasal projection restoration and the augmentation of the dorsal nose is a feasible undertaking, and the overall result appears satisfactory.A retrospective survey of cases admitted to our clinic from January 1999 to December 2001, inclusively was undertaken and is described below. Split calvarial bone graft procedure for the nasal tip projection reconstruction was performed for five patients, all of whom had sustained chemical burns following assault by strong acid. The disfiguration of the nasal anatomical structure was due to healing from deep burn wounds. The tip became blunt and less protruberant following the arising of cicatricial tightness of the surrounding tissue. Strength and resistance to scar contraction are the first considerations for such implantation when attempting to correct the nasal tip projection. The five female patients sustained a severe chemical burn which involved a surface area ranging from 25 to 60% of total body surface area. The facial mutilation was noted simultaneously with the determination of the extent of the burning injury. A severe burn scar is the typical sequel following a deep chemical burn. Nasal tip projection was restored and a nasal dorsum augmentation procedure with a split calvarial bone graft under an “open” method was used. This particular surgical procedure was able to be used in order to improve the nasal tip projection and resist surrounding scar contracture. The three-dimensional surface structure of the face became more prominent subsequent to the administration of this procedure. [Copyright &y& Elsevier]

Heart failure (HF) with preserved ejection fraction (HFpEF) is now the most common form of HF and has been reported to be closely related to diabetes. Accumulating evidence suggests that HFpEF patients exhibit cardiac fibrosis. This study investigates whether direct targeted inhibition of the activation of cardiac fibroblasts (CFs), the main effector cells in cardiac fibrosis, improves diabetes-induced HFpEF and elucidates the underlying mechanisms. Twenty-week-old db/db mice exhibited HFpEF, as confirmed by echocardiography and hemodynamic measurements. Proteomics was performed on CFs isolated from the hearts of 20-week-old C57BL/6 and db/db mice. Bioinformatic prediction was used to identify target proteins. Experimental validation was performed in both high glucose (HG)-treated neonatal mouse CFs (NMCFs) and diabetic hearts. TAX1 binding protein 1 (TAX1BP1) was identified as the most significantly differentially expressed protein between 20-week-old C57BL/6 and db/db mice. TAX1BP1 mRNA and protein were markedly downregulated in CFs from diabetic hearts and HG-cultured NMCFs. Overexpression of TAX1BP1 profoundly inhibited HG/diabetes-induced NF-κB nuclear translocation and collagen synthesis in CFs, improved cardiac fibrosis, hypertrophy, inflammation and HFpEF in diabetic mice. Mechanistically, signal transducer and activator of transcription 3 (STAT3), which is phosphorylated and translocated from the cytoplasm into the nucleus under hyperglycemic conditions, bound to TAX1BP1 promoter and blocked TAX1BP1 transcriptional activity, consequently promoting NF-κB nuclear translocation and collagen synthesis in CFs, aggravating cardiac fibrosis, hypertrophy and inflammation, leading to HFpEF in db/db mice. Taken together, our findings demonstrate that targeting regulation of STAT3-TAX1BP1-NF-κB signaling in CFs may be a promising therapeutic approach for diabetes-induced HFpEF. Hyperglycemia-induced sustained STAT3 phosphorylation in cardiac fibroblasts, leading to nuclear translocation, strengthened its binding to the TAX1BP1 promoter and markedly blocked TAX1BP1 promoter transcription activity, leading to TAX1BP1 downregulation and subsequent NF-κB activation; these effects promoted collagen synthesis, cardiac fibrosis, hypertrophy, and inflammation and eventually led to HFpEF. [Display omitted] • Hyperglycemia-induced STAT3 phosphorylation promotes TAX1BP1 downregulation in CFs. • TAX1BP1 downregulation promotes NF-κB nuclear translocation and CF activation. • CF activation contributes to cardiac fibrosis, hypertrophy, inflammation and HFpEF. • Dysregulation of STAT3-TAX1BP1-NF-κB signaling leads to cardiac remodeling and HFpEF. [ABSTRACT FROM AUTHOR]

Coronary artery bypass surgery has been the accepted treatment for left main coronary artery disease for over 50 years. Balloon angioplasty was later used then abandoned because of deaths likely due to restenosis or thrombotic occlusion. However, rapid innovations in drug-eluting stent designs leading to more biocompatible thin strut platforms with optimal drug elution profiles and further advances in modern pharmacotherapy involving potent P2Y12 inhibitors combined with utilization of intracoronary imaging and physiologic assessment for procedural planning and optimization have transformed percutaneous interventions into successful alternatives to coronary artery bypass graft surgery (CABG) in selected LM anatomic territories. Herein, we provide an evidence-based practical guide on how to approach and perform LM percutaneous interventions (PCI). [ABSTRACT FROM AUTHOR]

Heart failure (HF) is the end‐stage syndrome for most cardiac diseases, and the 5‐year morbidity and mortality of HF remain high. Malignant arrhythmia is the main cause of sudden death in the progression of HF. Recently, bridging integrator 1 (BIN1) was discovered as a regulator of transverse tubule function and calcium signalling in cardiomyocytes. BIN1 downregulation is linked to abnormal cardiac contraction, and it increases the possibility of malignant arrhythmias preceding HF. Because of the detectability of cardiac BIN1 in peripheral blood, BIN1 may serve as a predictor of HF and may be useful in therapy development. However, the mechanism of BIN1 downregulation in HF and how BIN1 regulates normal cardiac function under physiological conditions remain unclear. In this review, recent progress in the biological studies of BIN1‐related cardiomyocytes and the effect of cardiac dysfunction and malignant arrhythmia will be discussed. [ABSTRACT FROM AUTHOR]