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Abstract Objective The predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with stable coronary artery disease (SCAD) in the drug-eluting stent era is not yet clear. We aimed to evaluate the prognostic value of NT-proBNP in SCAD patients after percutaneous coronary intervention (PCI). Methods We examined 4,293 consecutive SCAD patients who underwent PCI between January 2013 and December 2013 in Fuwai Hospital, China. The primary endpoint was all-cause death. NT-proBNP levels were measured before PCI using Elisa kits (Biomedica, Austria). The indication for PCI was based on the degree of coronary stenosis and evidence of ischemia. Results Among 3,187 SCAD patients with NT-proBNP data, after a 2-year follow-up, NT-proBNP levels were predictive for all-cause death in the SCAD population [area under the receiver operating characteristic curve, 0.768; 95% confidence interval (CI), 0.687–0.849; P < 0.001]. At the optimum cutoff point of 732 pg/mL, the sensitivity and specificity of death was 75.0% and 72.3%, respectively. In a multivariable Cox regression model, the death hazard ratio was 6.43 (95% CI , 2.99–13.82; P < 0.001) for patients with NT-proBNP levels ≥ 732 pg/mL, compared with < 732 pg/mL. Conclusion NT-proBNP is a strong predictor of 2-year death with SCAD after PCI in the drug-eluting stent era. [ABSTRACT FROM AUTHOR]

Long-term trends of atmospheric compositions are significant for assessing the influence of human activities on the atmosphere and protecting the atmospheric environment. In this study, based on heavy metal concentrations and Pb isotope ratios in a well-dated sediment core from a remote alpine lake in central North China, anthropogenic fluxes of As, Cd, Sb, and Pb were reconstructed and heavy metal evolutions in the atmosphere were revealed in the last 200 years. The heavy metals in the atmosphere were generally natural origins before 1980 A.D. Since the 1980s they began to increase gradually, but they increased the most in the 1990s resulting from rapid developments of rough and high energy-consuming industries in North China. After entering the 21st century the industries still developed rapidly, but the atmospheric Pb ceased increase and the As and Sb even decreased in the 2000s due to (1) phasing out of leaded gasoline and (2) implementing stricter industrial emission standards in 2000 A.D. in China. However, in the 2000s the atmospheric heavy metals still kept at a relatively high level and even likely began to increase again in the 2010s. Considering the lake relatively remote and seldom affected by local human activities, the results likely reflect heavy metal evolutions in the regional background atmosphere of central North China at the annual/decadal timescale in the last 200 years. [ABSTRACT FROM AUTHOR]

Reconstructing the long-term Hg history in major emission countries is important for understanding the global Hg cycle and controlling Hg pollution. In this study, the atmospheric Hg history was reconstructed over the last three centuries based on three lacustrine sediment records from southeastern Inner Mongolia in North China, and its relationship with global and regional Hg emissions was revealed. These records show little Hg pollution in the 18th and 19th centuries. This implies a limited influence of Hg emitted from Europe and North America in this region, which is confirmed by their different Hg trends during the two World Wars and the post-1970s. Atmospheric Hg in the region had increased gradually since the 1900s, primarily contributed by emissions from the former Soviet Union in Lake Dalihu (DLH) and Lake Zhagesitai (ZGST) and from the Beijing-Tianjin-Hebei region in Lake Kulunnao (KLN). In the last century, two decreases in Hg fluxes occurred in the KLN core due to the economic recession in the 1960s–1970s and reduced energy consumption and industrial production in the 1990s. In the DLH and ZGST cores, only one decrease occurred, corresponded with the dissolution of the Soviet Union in the 1990s. Although atmospheric Hg emissions in China had stabilized or even decreased in the last decade, atmospheric Hg continued to increase, particularly in KLN, because of emissions from small cities in the region. This study can help understand Hg sources and control Hg pollution in North China and supplement the understanding of the global Hg cycling. [Display omitted] • Atmospheric Hg in the region has increased since the 1900s. • The increase in Hg in the 20th century was mainly affected by regional Hg emissions. • Sediment records showed different increasing patterns related to various Hg sources. • Hg emissions from small cities in the region dominated the 21st century increase. [ABSTRACT FROM AUTHOR]

Deferred revascularization of mildly stenotic coronary vessels based exclusively on physiological evaluation is associated with up to 5% residual incidence of future adverse events at 1 year. We aimed to evaluate the incremental value of angiography-derived radial wall strain (RWS) in risk stratification of non–flow-limiting mild coronary narrowings. This is a post hoc analysis of 824 non–flow-limiting vessels in 751 patients from the FAVOR III China (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease) trial. Each individual vessel had ≥1 mildly stenotic lesion. The primary outcome was vessel-oriented composite endpoint (VOCE), defined as the composite of vessel-related cardiac death, vessel-related myocardial infarction (nonprocedural), and ischemia-driven target vessel revascularization at 1-year follow-up. During 1-year follow-up, VOCE occurred in 46 of 824 vessels, with a cumulative incidence of 5.6%. Maximum RWS (RWS max) was predictive of 1-year VOCE with an area under the curve of 0.68 (95% CI: 0.58-0.77; P < 0.001). The incidence of VOCE was 14.3% in vessels with RWS max >12% vs 2.9% in those with RWS max ≤12%. In the multivariable Cox regression model, RWS max >12% was a strong independent predictor of 1-year VOCE in deferred non–flow-limiting vessels (adjusted HR: 4.44; 95% CI: 2.43-8.14; P < 0.001). The risk of deferred revascularization based on combined normal RWS max and Murray–law-based quantitative flow ratio (μQFR) was significantly reduced compared with μQFR alone (adjusted HR: 0.52; 95% CI: 0.30-0.90; P = 0.019). Among vessels with preserved coronary flow, angiography-derived RWS analysis has the potential to further discriminate vessels at risk of 1-year VOCE. (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease [FAVOR III China Study]; NCT03656848) [Display omitted] [ABSTRACT FROM AUTHOR]

• High platelet reactivity and gastric mucosal injury after aspirin (ASA) treatment compromise clinical efficacy. • Adding Panax notoginseng saponin (PNS) to ASA potentiates platelet inhibition without increased bleeding. • PNS alleviates ASA-related dyspepsia symptoms and mitigates ASA-induced gastric mucosal injury. • These effects are associated with intraplatelet and gastric arachidonic acid metabolism modulation by lipidomic analysis. High platelet reactivity and gastric mucosal injury after aspirin (ASA) treatment are associated with poor compliance and an increased risk of cardiovascular events. Panax notoginseng saponins (PNS) have been widely used for the treatment of coronary heart disease (CHD) in addition to antiplatelet drugs in China; however, the joint effect and possible mechanism of PNS in addition to ASA on platelet activation and gastric injury remain unclear. This study was designed to investigate the combinational effects of PNS with ASA, and to explore the underlying mechanism via arachidonic acid (AA) metabolism pathway using lipidomic analysis. In a randomized, assessor-blinded trial, 42 patients with stable coronary heart disease (SCHD) and chronic gastritis were randomly assigned to receive ASA (n = 21) or PNS + ASA (n = 21) for 2 months. Compared with ASA alone, PNS + ASA further inhibited CD62p expression, GPIIb-IIIa activation and platelet aggregation and led to increased platelet inhibition rate. PNS + ASA suppressed the activity of platelet cyclooxygenase (COX)-1, and decreased the production of TXB 2 , PGD 2 , PGE 2 , 11-HETE, the downstream oxylipids of AA/COX-1 pathway in platelets, compared with ASA alone. The severity of dyspepsia assessment (SODA) results showed that patients in PNS + ASA group exhibited relieved dyspeptic symptoms as compared with those in ASA group, which might be associated with enhanced secretion of gastrin and motilin. In vivo study of myocardial infarction rats demonstrated that PNS attenuated ASA-induced gastric mucosal injury, which was related to markedly boosted gastric level of 6,15-diketo-13,14-dihydro-prostaglandin (PG)F1α, 13,14-dihydro-15-keto-PGE 2 and PGE 2 from AA/PG pathway in response to PNS + ASA compared with ASA alone. In summary, our study demonstrated that the combination of PNS and ASA potentiated the antiplatelet effect of ASA via AA/COX-1/TXB 2 pathway in platelets, and mitigated ASA-related gastric injury via AA/PG pathway in gastric mucosa. [ABSTRACT FROM AUTHOR]