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Following percutaneous coronary intervention with stent placement to treat acute coronary syndromes, international clinical guidelines generally recommend dual antiplatelet therapy with aspirin plus a P2Y12receptor inhibitor for 12 months to prevent myocardial infarction and stent thrombosis. However, data on single antiplatelet therapy with a potent P2Y12inhibitor 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).

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.

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.

Long-term benefits of pulmonary artery denervation (PADN) for patients with combined precapillary and postcapillary pulmonary hypertension (CpcPH) secondary to left heart failure are unknown.

Percutaneous coronary intervention has become the main revascularization strategy for coronary artery disease. Compared with early percutaneous coronary angioplasty and the extensive clinical application of bare metal stents, drug-eluting stents can significantly reduce the stenosis caused by the elastic retraction of plaque and neoatherosclerosis (NA), but there is still a high incidence of in-stent restenosis (ISR), which restricts the clinical efficacy of stent implantation. In-stent neoatherosclerosis (ISNA), defined as atherosclerotic lesions in the neointima, is one of the main causes of late stent failure. ISNA plays an important role in stent thrombosis and ISR. The rate of target lesion revascularization and in-stent thrombosis is high when NA arises. Therefore, it is of great clinical significance to explore the occurrence of NA and its development mechanism after stent implantation to prevent ISR and improve stent implantation efficacy and associated clinical prognosis. In this article, we systematically reviewed the existing clinical research on ISNA and the role of optical coherence tomography in its evaluation.

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Aldehyde dehydrogenase 2 (ALDH2) rs671polymorphism is an established genetic risk of hypertension, diabetes, and coronary heart diseases in Asian population. Previous experimental data showed ALDH2regulated inflammation, a potential mechanism of heart failure with preserved ejection fraction (HFpEF). However, clinically, the association between ALDH2polymorphism and incidence of HFpEF remains unknown. In this prospective cross-sectional study, ALDH2genotyping was performed in 613 consecutive patients enrolled with cardiovascular diseases (CVDs), including hypertension, coronary heart diseases, and/or diabetes mellitus, with normal left ventricular ejection fraction (LVEF). HFpEF was diagnosed according to symptoms and/or signs of dyspnea, fatigue or ankle swelling, N-terminal pro-B-Type natriuretic peptide (NT pro-BNP ≥ 280 pg/mL), LVEF ≥ 50%, and at least one additional criterion: left atrial enlargement (left atrial diameter > 40 mm), diastolic dysfunction (E/E’ ≥ 13 or E’/A’ < 1) or concurrently with atrial fibrillation. Finally, of 613 patients with CVD, 379 patients (61.8%) were assigned to the wild-type ALDH2*1/*1 group and 234 patients (38.2%) to the mutation-type ALDH2*2group according to genotyping results. Sixty-nine patients (11.3%) were diagnosed with HFpEF. In ALDH2*2group, the occurrence of HFpEF was higher (15.4% vs. 8.7%, p= 0.011) than that in ALDH2*1/*1 group. Leukocyte count, the indicator of systemic inflammation, was significantly higher (6.9 ± 2.4 × 109/L vs. 6.5 ± 1.9 × 109/L, p= 0.010) in ALDH2*2 group compared to ALDH2*1/*1 group. In conclusion, ALDH2*2 variant is associated with the risk of HFpEF in patients with CVD. Increased systemic inflammation probably involved in this disease process.

ABSTRACTBackground:Echocardiographic right ventricular (RV) functional parameters and longitudinal peak systolic strain (LS) are important determinants of prognosis in patients with pulmonary arterial hypertension (PAH). Pulmonary artery denervation (PADN) has been shown to reduce pulmonary artery pressures (PAP) in PAH. Whether this results in improved RV function is unknown. We therefore sought to evaluate serial changes in RV function and clinical outcomes after PADN, and determine the role of baseline RV-LS as a prognostic tool.Methods:Between March 2014 and March 2016, 40 patients with PAH who underwent PADN were studied. RV function was evaluated at baseline, 1 week, 3 months, 6 months, and >1 year after PADN, and correlations between RV-LS, RV functional parameters, 6-minute walk distance (6MWD), and pulmonary vessel resistance (PVR) were examined. Receiver operating characteristic curve analysis was used to determine the optimal baseline RV-LS cutoff value to predict PADN responder status, and prognosis was assessed in these groups.Results:PADN resulted in sustained changes in PVR and RV-LS over time (mean follow-up of 763 ± 254 days). By multivariate analysis, baseline RV-LS was the only independent predictor of ∆mPAP (β = −0.736, p= 0.001) and ∆PVR (β = −0.076, p= 0.03), and significantly correlated with 6MWD (r= −0.586, p< 0.001) at the end of follow-up. Baseline RV-LS ≥ −11.3% had a sensitivity of 78.1% and a specificity of 75.0% for predicting non-responders to PADN. During follow-up there were 10 (25%) PAH-related events, including 4 (10%) cardiac deaths. PAH-related events after PADN were more frequent in patients with RV-LS ≥ −11.3% vs. < −11.3% (46.2% vs. 14.8%, p= 0.03).Conclusions:PADN results in sustained improvements in PVR and RV-LS. Baseline RV-LS is the strongest predictor of improved hemodynamic measures after PADN in patients with PAH, and is strongly associated with late 6MWD and prognosis. Specifically, baseline RV-LS ≥ −11.3% predicts non-responder status and PAH-related events after PADN, and thus may be useful to identify which PAH patients may benefit from the PADN procedure.

Introduction:Despite the clinical benefits to intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI), most patients with coronary artery disease undergo angiography-guided PCI alone in real world.Hypothesis:We sought to investigate the procedural characteristics of IVUS-guided PCI and their clinical outcomes, as compared with angiography-guided PCI.Methods:This was a cohort study using patient-level data from IVUS-XPL and ULTIMATE clinical trials. A total of 2,848 patients with 3,872 native coronary lesions were included and procedural characteristics assessed by quantitative coronary angiography (QCA) were compared between IVUS and angiography guidance.Results:Stent-to-reference vessel diameter ratio (i.e., QCA stent sizing) was greater (1.11±0.16 vs 1.07±0.14, p<0.001) and high-pressure post-dilation was more frequently performed (83.7% vs 75.4%, p<0.001) with IVUS guidance, whereas residual stent edge dissections were more frequent in lesions treated with IVUS guidance (4.6% vs 0.7%, p<0.001). Given the dissection risk, optimal QCA stent sizing for IVUS guidance was a stent-to-QCA reference vessel diameter ratio ≥1.1 to <1.3. Among 1,424 patients (1,969 lesions) treated with angiography guidance, QCA stent sizing <1.0 was observed in 651 (33.1%) lesions while QCA stent sizing ≥1.1 to <1.3 was observed in only 526 (26.7%) lesions. Under angiography guidance, patients with both QCA stent sizing ≥1.1 to <1.3 and high-pressure post-dilation (235/1,424, 16.5%) had a lower risk of 3-year target lesion failure compared with others (hazard ratio=0.532, 95% confidence interval=0.293-0.966, p=0.038).Conclusions:IVUS-guided PCI resulted in larger QCA-assessed stent sizing and more frequent post-dilation with high-pressure inflations. These procedures may further improve long-term clinical outcomes in patients undergoing PCI without IVUS.

Pulmonary hypertension (PH) predicts poor outcome in patients with left heart disease. A 62-year-old man was referred for heart failure associated with ischemic cardiomyopathy. He received a diagnosis of combined postcapillary and precapillary PH secondary to left heart disease on the basis of hemodynamic parameters. After the pulmonary artery denervation procedure was performed, hemodynamic parameters were markedly improved, which resulted in a significant increase in functional capacity.

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This study was designed to determine whether CES1A−816AC polymorphism could be associated with altered clopidogrel response. Recruited patients were pretreated with 300 mg clopidogrel loading dose before undergoing percutaneous coronary intervention for stenting and genotyped with CYP2C192, 3, or 17, and CES1A−816AC, respectively. Adenosine diphosphate–induced maximum platelet aggregation (MPA) was determined on day 3 after initiation of daily clopidogrel maintenance doses. The clinical primary end point was the 1-year incidence of definite stent thrombosis (ST). Multivariable linear regression revealed that the CES1A−816AC polymorphism was independently associated with MPA measures with an absolute value of 6.76. Of 617 patients, a subcohort of 249 patients not carrying CYP2C192, 3, or 17were categorized into 3 groups based on the −816AC genotype. The median MPA value was lower in 125 carriers of the −816C variant than in 124 noncarriers (21.5 vs. 31.7, P= 0.001). The 1-year definite ST occurred in 7 patients in that subcohort, and only 1 ST case was one of carriers of the −816 AA that was associated with higher MPA values. The CES1A−816C would be used to predict greater platelet response to clopidogrel than the CES1A−816A in percutaneous coronary intervention–treated patients not carrying CYP2C19variants.

Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) for the treatment of coronary bifurcation lesions (CBLs) is still technically demanding, mainly because of higher rates of both acute and chronic complication as compared with non-CBLs. Although provisional stenting (PS) is considered as the preferred strategy for most of the CBLs, a systematic two-stent technique (double kissing [DK] crush) should be considered in patients with complex left main (LM)-CBLs or non–LM-CBLs stratified by the DEFINITION criteria. Intracoronary imaging and/or physiologic evaluation should be used to optimize CBLs intervention. PCI with DES for the treatment of CBLs is technically demanding, mainly because of higher rates of both acute and chronic complication as compared with non-CBLs. PS is a default strategy for most of the CBLs. Double kissing (DK) crush is associated with better clinical outcomes compared with PS in patients with complex LM-CBLs or non–LM-CBLs stratified by the DEFINITION criteria. Intracoronary imaging and/or physiologic evaluation are useful tools to guide the treatment of CBLs. The use of drug-coated balloons in CBLs needs further data to support the clinical benefits.

Ginsenoside Rg1, an important and active ingredient of Panax ginseng, has been shown to exert cardioprotective effects in vivo. The present study aimed to test the hypothesis that ginsenoside Rg1 attenuates cardiac dysfunction in a transverse aortic constriction (TAC)–induced left ventricular hypertrophy in vivo via proangiogenic and antifibrotic effects.

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).

The ability of a plant to maintain an ionic homeostasis is crucial in plant salt tolerance. Direct evidence based on data from the non-invasive measurement of ion fluxes would not only offer new insight about the function of the transporter but also provide a whole plant approach for dissecting salt adaptation mechanisms. Here, we review some reports using the ion-selective microelectrodes to characterize the net ion fluxes of tissues or cells.

The effect of NaCl on growth, biomass and ion relations of two salt-tolerant isolates of Paxillus involutus, MAJ and NAU were investigated. The two Paxillusstrains were exposed to the following concentrations of NaCl: 0, 100, 200 and 500 mmol·L−1. Growth of MAJ and NAU was enhanced by 100 mmol·L−1NaCl but severely inhibited at the concentration of 500 mmol·L−1. NAU exhibited a greater capacity to exclude Na+and Cl−under all salinity levels, whereas the salt-includer MAJ had a higher capacity in nutrient uptake under salt stress. The ratios Na+/K+, Na+/Ca2+and Na+/Mg2+in NaCl-treated MAJ and NAU did not increase at levels of 100 and 200 mmol·L−1NaCl but markedly increased at 500 mmol·L−1. This suggests that the two strains, especially MAJ, enhanced nutrient uptake corresponding to the increased Na+influx at moderate salinity. We conclude that both MAJ and NAU are able to tolerate 500 mmol·L−1NaCl but there are species-specific differences in retaining ionic homeostasis in the two Paxillusstrains. NAU is a salt-excluder, MAJ is a salt-includer but retains a high capacity in nutrient selectivity under saline conditions. Their definite mechanisms to enhance salt tolerance of mycorrhizal hosts need further study.The effect of NaCl on growth, biomass and ion relations of two salt-tolerant isolates of Paxillus involutus, MAJ and NAU were investigated. The two Paxillusstrains were exposed to the following concentrations of NaCl: 0, 100, 200 and 500 mmol·L−1. Growth of MAJ and NAU was enhanced by 100 mmol·L−1NaCl but severely inhibited at the concentration of 500 mmol·L−1. NAU exhibited a greater capacity to exclude Na+and Cl−under all salinity levels, whereas the salt-includer MAJ had a higher capacity in nutrient uptake under salt stress. The ratios Na+/K+, Na+/Ca2+and Na+/Mg2+in NaCl-treated MAJ and NAU did not increase at levels of 100 and 200 mmol·L−1NaCl but markedly increased at 500 mmol·L−1. This suggests that the two strains, especially MAJ, enhanced nutrient uptake corresponding to the increased Na+influx at moderate salinity. We conclude that both MAJ and NAU are able to tolerate 500 mmol·L−1NaCl but there are species-specific differences in retaining ionic homeostasis in the two Paxillusstrains. NAU is a salt-excluder, MAJ is a salt-includer but retains a high capacity in nutrient selectivity under saline conditions. Their definite mechanisms to enhance salt tolerance of mycorrhizal hosts need further study.

We used callus of Populus euphraticaOlive to isolate protoplasts, and H+fluxes across plasma membrane were investigated. The concentration of enzymes for protoplast isolation, e.g. cellulase, pectolyase, macerozyme, hemicellulase, and sorbitol content, incubation time were systemically studied. High yield and viability of protoplast was achieved after 6–8 hours incubation of P. euphraticacallus in enzyme solution containing 1.5% (w:v) cellulase R-10, 0.1% (w:v) pectolyase Y-23, 0.2% (w:v) macerozyme R-10, 0.05% (w:v) hemicellulase and 0.75–0.80 mol·L−1sorbitol. Non-invasively ion selective microelectrode technique was used to access proton fluxes in the absence and presence of NaCl (20 mmol·L−1). Salt-induced transient net H+efflux was observed in the plasma membrane of P. euphraticacells. The shift of H+flux response to NaCl shock and the relevance to salt tolerance were discussed.We used callus of Populus euphraticaOlive to isolate protoplasts, and H+fluxes across plasma membrane were investigated. The concentration of enzymes for protoplast isolation, e.g. cellulase, pectolyase, macerozyme, hemicellulase, and sorbitol content, incubation time were systemically studied. High yield and viability of protoplast was achieved after 6–8 hours incubation of P. euphraticacallus in enzyme solution containing 1.5% (w:v) cellulase R-10, 0.1% (w:v) pectolyase Y-23, 0.2% (w:v) macerozyme R-10, 0.05% (w:v) hemicellulase and 0.75–0.80 mol·L−1sorbitol. Non-invasively ion selective microelectrode technique was used to access proton fluxes in the absence and presence of NaCl (20 mmol·L−1). Salt-induced transient net H+efflux was observed in the plasma membrane of P. euphraticacells. The shift of H+flux response to NaCl shock and the relevance to salt tolerance were discussed.

AbstractObjective:The goal of the study was to assess the values of scintimammography with 99mTc-methoxyisobutyl isonitrile (99mTc-MIBI) and 99mTc-methylenediphosphonate (99mTc-MDP) in detecting breast cancer. Methods:A total of 35 women with clinical findings of suspicious breast lesions were studied with both 99mTc-MIBI and 99mTc-MDP scintimammography. All patients underwent surgery within 1 week, and the results of the histopathological diagnosis were obtained. Results:Eighteen of 35 abnormalities of the breast were pathologically confirmed as primary breast cancer and 17 as benign lesions. In this group of patients, the sensitivity, specificity and accuracy of 99mTc-MIBI scintimammography were 77.8, 88.2 and 82.9%, respectively, while those of 99mTc-MDP scintimammography were 72.2, 88.2 and 80.8%, respectively. There was no significant difference between the results of 99mTc-MIBI and 99mTc-MDP scintimammography. Conclusion:This study demonstrated a high diagnostic accuracy of both 99mTc-MIBI and 99mTc-MDP scintimammography in detecting breast cancer. Both radiopharmaceuticals can be used as an adjunct method for the noninvasive assessment of breast cancer prior to surgery. However, 99mTc-MDP is less expensive and more readily available than 99mTc-MIBI.Copyright © 2001 S. Karger AG, Basel

Finding an appropriate soft-tissue grafting material to close a wound located over the dorsum of a finger, especially the distal phalanx, can be a difficult task. The boomerang flap mobilized from the dorsum of the proximal phalanx of an adjacent digit can be useful when applied as an island pedicle skin flap. The vascular supply to the skin flap is derived from the retrograde perfusion of the dorsal digital artery. Mobilization and lengthening of the vascular pedicle are achieved by dividing the distal end of the dorsal metacarpal artery at the bifurcation and incorporating two adjacent dorsal digital arteries into one.

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This study aimed to determine the benefits and correlated mechanisms of pulmonary artery denervation (PADN) for heart failure (HF) pulmonary hypertension (PH). PH secondary to HF is associated with poor clinical outcomes because there is no proper therapy for it. PADN showed improved outcomes for patients with HF-PH. However, the underlying mechanisms remain unknown. Supracoronary aortic banding (SAB) was used to create HF-PH models. Sprague-Dawley rats were randomly assigned to control, SAB, sham, SAB with PADN, and SAB without PADN groups. Surgical (longitudinally damaging vessel nerves) and chemical (10% phenol applied to the surface of nerves) PADN was performed for animals in the SAB with PADN group. Morphological, echocardiographic, hemodynamic, and protein expression changes were measured four weeks thereafter. Adrenergic receptor (AR) expressions of pulmonary arteries from four HF-PH patients and four patients without PH were measured. Ten HF-PH patients who underwent PADN were followed-up for six months. SAB-induced HF-PH was achieved by 50% of animals. Surgical and chemical PADN was associated with significant improvements in pulmonary artery muscularization, hemodynamics, and right ventricular functions. In pulmonary arterial specimens from HF-PH patients, β2-AR and α1A/B-AR, as well as eNOS, were downregulated and α1D-AR was upregulated compared to those from patients without PH. PADN led to a mean increase of 84 m during the 6-min walk distance for HF-PH patients at six-month follow-up. HF-PH was characterized by downregulated β2-AR, α1A-AR, and α1B-AR and by upregulated α1D-AR. PADN is associated with significant improvements in hemodynamics and pulmonary artery remodeling.

Oral targeted therapies play an important role in the treatment of pulmonary arterial hypertension (PAH). Several new oral agents have emerged for PAH in recent years. However, whether they provide a survival advantage is still not clear. This meta-analysis aimed to assess the efficacy and safety of oral targeted therapies, especially on predefined clinical worsening events. Trials were searched in the Cochrane Library, EMBASE, and PUBMED databases through June 2018. We calculated risk ratios for dichotomous data and weighted mean differences with 95% confidence intervals (CI) for continuous data. Twenty-five trials with a total of 6847 participants were included in the meta-analysis. Oral targeted therapies were associated with significant risk reduction in clinical worsening compared with placebo (relative risk [RR] 0.64; 95% CI = 0.58–0.70; P< 0.001). This reduction in risk was driven by reduction in non-fatal endpoints, including PAH-related admissions to hospital (RR = 0.66; 95% CI = 0.56–0.76; P< 0.001), treatment escalation (RR = 0.43; 95% CI = 0.28–0.66; P< 0.001), and symptomatic progression (RR = 0.55; 95% CI = 0.48–0.64; P< 0.001), but not by reduction of mortality (RR = 0.87; 95% CI = 0.68–1.12; P= 0.215). Oral targeted therapies were also associated with improvement in 6-min walk distance (26.62 m; 95% CI = 20.54–32.71; P< 0.001) and World Health Organization functional class (RR = 1.36; 95% CI = 1.20–1.54; P< 0.001). The results of this meta-analysis showed the benefits of oral treatments on clinical worsening events in PAH. However, these oral agents did not show any survival benefit in the short-term follow-up.

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