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Background Percutaneous vertebroplasty (PVP) has become the mainstream method for the treatment of osteoporotic vertebral compression fractures(OVCF). Generally, surgeons manually plan the puncture path by themselves. This is time-consuming and laborious, which increases the working pressure of surgeons. Image processing algorithm is used to automatically segment contour of vertebral body, and plan the puncture path before operation. In order to obtain the contours of vertebral body and skin, binarization and contour extraction algorithm were performed. The connecting algorithm we proposed was used to connect the discontinuous contour of vertebral foramen. We determined the centerline of vertebral body by inscribed circle center of the contours of vertebral body and vertebral foramen, located the narrowest part of vertebral pedicle based on rotating segment algorithm and calculated medical parameters. The experimental results show that the segmentation accuracy of algorithm is 95.92%, the average relative error of extracted parameters was no more than 4.18%. This method realizes automatic and accurate planning of puncture path before PVP, and it is of great significance to reduce the workload of surgeons, the number of intraoperative fluoroscopy and the harm of radiation to surgeons.

Predictive modeling of new biochemical systems with small data is a great challenge. To fill this gap, transfer learning, a subdomain of machine learning that serves to transfer knowledge from a generalized model to a more domain-specific model, provides a promising solution. While transfer learning has been used in natural language processing, image analysis, and chemical engineering fault detection, its application within biochemical engineering has not been systematically explored. In this study, we demonstrated the benefits of transfer learning when applied to predict dynamic behaviors of new biochemical processes. Two different case studies were presented to investigate the accuracy, reliability, and advantage of this innovative modeling approach. We thoroughly discussed the different transfer learning strategies and the effects of topology on transfer learning, comparing the performance of the transfer learning models against benchmark kinetic and data-driven models. Furthermore, strong connections between the underlying process mechanism and the transfer learning model's optimal structure were highlighted, suggesting the interpretability of transfer learning to enable more accurate prediction than a naive data-driven modeling approach. Therefore, this study shows a novel approach to effectively combining data from different resources for bioprocess simulation.

High-temperature superconductor (Re)Ba2Cu3O x (ReBCO) conductor on round core cable (CORC®) has a large current carrying capacity for high field magnets. Lorentz forces acting on CORC conductors, cause a reduction of the critical current, or even permanent degradation of their performance when exceeding critical values. Transverse compressive stress is one of the principal mechanical stresses when CORC cables are bundled to cable-in-conduit conductors (CICC) conductors capable of operating at currents up to 100 kA in magnetic fields of up to 20 T. In this research, a mechanical-electromagnetic model is developed to study the effect of transverse compressive loads on the electromagnetic performance of CORC cables. A mechanical transverse load on the cable is implemented to simulate the electromagnetic force. A comparison of numerical simulations with experiments for a three-layer CORC cable is first performed to validate the model’s reliability, with particular attention to critical current reduction during the transverse compression process. A novel feature of this paper is that the model developed can analyze both mechanical response under transverse compressive loads and electromagnetic performance under applied AC magnetic fields with low amplitudes. On this basis, the model investigates the effects of winding parameters on the axial strain and critical current reduction of the ReBCO layer in a single-layer CORC cable. The numerical analysis shows that increasing the winding angle can reduce the axial strain and critical current reduction of the ReBCO layer in the contact area. Subsequently, a detailed comparative study is carried out studying the axial strain of the ReBCO layer in the non-contact area with and without taking the winding core into account. In addition, a sudden increase in the magnetization loss is explained when the transverse compressive load reaches a certain level. Finally, a six-layer CORC cable’s electromagnetic analysis is performed, and each tape layer’s critical current reduction is investigated and discussed. The comparison of magnetization loss and current density between six- and single-layer CORC cables in the no-strain case is also given. This finite element model can guide optimizing a cable design for specific application conditions.

The Chlorella sorokiniana F31 is a promising lutein producer with high lutein content. Herein, different graphene/TiO

Background Spontaneous coronary artery dissection (SCAD) is defined as a splitting of the coronary artery wall exclusive of iatrogenesis or trauma. Since the last decades, our knowledge of the diagnosis and prognosis and therapy for SCAD has advanced; however, its causes remain unknown. Objectives This study sought to identify genes associated with SCAD development in the Chinese Han population. Methods Between November 2011 and January 2018, the authors enrolled 85 SCAD cases and 296 non-SCAD controls from the Chinese Han population. All 381 subjects enrolled underwent detection with whole exome sequencing, followed by Sanger sequencing for confirmation. Principle component analysis was used to evaluate the structure of the population. Haploview was used to analyze the linkage disequilibrium statistics of the variants. The author used 2 gene-based association tests, optimal sequence kernel association test and mixed effects score test, to identify the causal genes or variants of SCAD. Immunohistochemistry was used to detect the expression of TSR1 in coronary artery tissues. Results Four genes with a suggestive association with SCAD (p Conclusions This study describes the clinical characteristics of the Chinese Han population with SCAD and identified TSR1 as a potential causal gene, which might bring about a further progress in diagnosis and treatment of the disorder.

Fulminant myocarditis (FM) has unacceptable high mortality. This study aimed to evaluate the therapeutic efficacy of a life support-based comprehensive treatment regimen (LSBCTR), a completely novel treatment regimen, for FM. A total of 169 FM patients recruited from January 2008 to December 2018 were divided into two groups: patients receiving LSBCTR (81 cases), which includes (i) mechanical life support (positive pressure respiration, intra-aortic balloon pump with or without extracorporeal membrane oxygenation), (ii) immunomodulation therapy using sufficient doses of glucocorticoids and immunoglobulins, and (iii) application of neuraminidase inhibitors, and those receiving conventional treatment (88 cases). The endpoints were in-hospital death and heart-transplantation. Of all the population, 44 patients (26.0%) died in hospitals. In-hospital mortality was 3.7% (3/81) for LSBCTR group and 46.6% (41/88) for traditional treatment (P

Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock, with mortality rates as high as 50%–70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial (NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time, we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes (i) mechanical life support (applications of mechanical respirators and circulatory support systems, including intraaortic balloon pump and extracorporeal membrane oxygenation), (ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and (iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis.

One key challenge in zero-shot classification (ZSC) is the exploration of knowledge hidden in unseen classes. Generative methods such as generative adversarial networks (GANs) are typically employed to generate the visual information of unseen classes. However, the majority of these methods exploit global semantic features while neglecting the discriminative differences of local semantic features when synthesizing images, which may lead to sub-optimal results. In fact, local semantic information can provide more discriminative knowledge than global information can. To this end, this paper presents a new triple discriminator GAN for ZSC called TDGAN, which incorporates a text-reconstruction network into a dual discriminator GAN (D2GAN), allowing to realize cross-modal mapping from text descriptions to their visual representations. The text-reconstruction network focuses on key text descriptions for aligning semantic relationships to enable synthetic visual features to effectively represent images. Sharma-Mittal entropy is exploited in the loss function to make the distribution of synthetic classes be as close as possible to the distribution of real classes. The results of extensive experiments over the Caltech-UCSD Birds-2011 and North America Birds datasets demonstrate that the proposed TDGAN method consistently yields competitive performance compared to several state-of-the-art ZSC methods.

High Flux Engineering Test Reactor (HFETR) focuses on the irradiation test of reactor fuel elements, thus the accurate determination of power or flux distribution becomes important. Since HFETR contains complex geometry assembly and different types of irradiation channels, the traditional simulation methods such as Monte Carlo method and deterministic method based on rectangle and hexagonal mesh are not applicable in taking into account calculation accuracy and efficiency. In this study, based on “two-step” calculation scheme, a fuel management code named TRACS was developed. Homogenization of few-group cross-sections was performed by KYLIN-II lattice code, and reactor core calculation was performed by unstructured-mesh variational nodal method. Criticality position of control rod searching adopts difference method, and micro-depletion calculation is performed by solving microscopic burnup equation using an open source matrix exponential solver EXPOKIT of Chebyshev rational approximation method. Finally, two benchmarks of HFETR sample model with different irradiation channels were used to verify TRACS code, and the results by Monte Carlo code OpenMC serve as reference. The comparison results show that the keff error is less than 300 pcm for both two cases, and the relative power error of nearly all the fuel assembly and regions in irradiation assembly at both BOL and EOL stay below 5%, and the critical positions of control rods between TRACS and OpenMC during reactor operation are nearly the same. Overall, TRACS agrees well with OpenMC, and it can be used for fuel management calculation of HFETR with complex geometrical irradiation channel.

Aim: To explore the potentially important role of miRNA 146b-5p (miR-146b) during the development of atherosclerosis. Materials & methods: Proliferation, migration and luciferase assays and mouse models were used to determine the functions of miR-146b. Results: miR-146b was identified as substantially upregulated in the aortic plaques of ApoE-/- mice as well as in response to inflammatory cytokines. Overexpression of miR-146b repressed proliferation and migration of vascular smooth muscle cells by downregulating Bag1 and Mmp16, respectively. Adeno-associated virus-mediated miR-146b overexpression inhibited neointima formation after carotid injury and suppressed atherosclerotic plaque formation in western diet-induced ApoE-/- mice. Conclusion: miR-146b is a novel regulator of vascular smooth muscle cell function induced by inflammatory response, specifically in neointima formation, and offers a novel therapeutic strategy for treating atherosclerosis.

Background: Spontaneous coronary artery dissection (SCAD), defined as the dissection of coronary arterial intima and media, is a genetic disorder but currently only two genes, PHACTR1 and TSR1, have been reported as it is not strongly familial. Given the limitations of association tests such as genome wide association test and gene based association test, we applied a new strategy of machine learning for identification of new candidate genes. Methods: Whole exome sequencing (WES) was performed on 85 SCAD cases and 285 controls, as well as 60 SCAD cases in replication cohort, recruited from Tongji Hospital, Wuhan, China. Accumulated gene burden scores were computed based on average scores of VEST3, MetaLR and M-CAP annotated by ANNOVAR. A machine learning model was constructed to identify candidate causal genes of SCAD by logistic regression with penalty. Findings: The machine learning model identified 116 genes associated with SCAD, whose mutational burden was elevated in cases relative to controls and yielded an area under curve area of 0.83 in cross validation. Compared to control group, patients with SCAD carried more rare deleterious variants of machine learning identified genes. Multiple variants in different machine learning identified genes were more prevalent in SCAD cohort. In a replication cohort, 73 genes were confirmed, with FBN3 ranking the top. Specifically, two deleterious variants of FBN3 were exactly the same as in discovery cohort. Interpretation: We built a machine learning model and identified a profile of candidate genes associated with SCAD where rare deleterious and multiple variants were enriched in patients with SCAD. Funding Statement: This work was supported in part by key grants from National Key R&D Program of China (No. 2017YFC0909400), National Nature Science Foundation of China (No. 91839302 and 81790624), Shanghai Municipal Science and Technology Major Project (No. 2017SHZDZX01) and Major Project of Technological Innovation of Hubei province (No. 2017ACA170). Declaration of Interests: All authors declares no conflict of interests Ethics Approval Statement: The study protocol was approved by the Tongji Hospital Review Board and all participants have signed written informed content.

The aim of this report is to demonstrate a 2-year-2-month-old child who presented with a history of malignant hypertension. He was made the diagnosis of Takayasu arteritis by laboratory tests and angiography; we initiated a treatment with sequential balloon predilation. The patient's blood pressure improved dramatically, and patency of renal artery was demonstrated with renal arteriography over 8 months after the balloon predilation.

The high purity of target cells enriched from blood samples plays an important role in the clinical detection of diseases. However, non-specific binding of blood cells in the isolated cell samples can complicate downstream molecular and genetic analysis. In this work, we report a simple solution to non-specific binding of blood cells by modifying the surface of microchips with a multilayer nanofilm, with the outmost layer containing both PEG brushes for reducing blood cell adhesion and antibodies for enriching target cells. This layer-by-layer (LbL) polysaccharide nanofilm was modified with neutravindin and then conjugated with a mixture of biotinylated PEG molecules and biotinylated antibodies. Using EpCAM-expressing and HER2-expressing cancer cells in blood as model platforms, we were able to dramatically reduce the non-specific binding of blood cells to approximately 1 cell per mm2 without sacrificing the high capture efficiency of the microchip. To support the rational extension of this approach to other applications for cell isolation and blood cell resistance, we conducted extensive characterization on the nanofilm formation and degradation, antifouling with PEG brushes and introducing functional antibodies. This simple, yet effective, approach can be applied to a variety of microchip applications that require high purity of sample cells containing minimal contamination from blood cells.

Schizochytrium sp. has been widely used for synthesizing polyunsaturated fatty acids (PUFAs). Cell damage resulted from oxidative stress is inevitable under aerobic fermentation conditions. In this study, the correlation between oxidative stress regulated by carotenoids biosynthesis and fatty acid accumulation in Schizochytrium sp. was investigated by fluoridone treatments. Results showed that addition of 50 mg/L fluoridone at 24 h increased β-carotene by 56.8% and eicosapentaenoic acid (EPA) content 44.2%, respectively. Compared to the control group, intracellular reactive oxidative species (ROS) activity in the fluoridone group reduced by 21.8% at 48 h and decreased afterwards to a stable level. Metabolomics analysis showed that the addition of fluoridone could supply more substrates for PUFAs biosynthesis by delaying cell growth and induce β-carotene accumulation in order to potentially resist ROS and protect PUFAs from oxidization. This work proposed a new perspective that the regulation of carotenoids biosynthesis could promote the accumulation of PUFAs by improving endogenous antioxidant capacity.

Contact resistance is key for stable operation of electrical contact equipment, and can also be extensively applied. For Tokomak devices in fusion reactors, contact resistance of the superconductor magnet system strongly relates to the alternating current (AC) loss of the cable, the cable is assembled using a certain number of contacting superconducting tapes coated with copper layers on both sides. The contact resistance of a metal solid surface is affected by many factors. In this work, the contact resistance of copper surface samples was studied experimentally under variable normal cyclic load, temperature and number of contact surfaces. This is consistent with real-world working conditions, as the structure of superconducting cables can be changed, and such cables are used under cyclic electromagnetic forces in temperatures which range from room to working temperature. Experimental results showed that contact resistance decreased rapidly with an increase of load. Further, when temperature was varied from 77 to 373 K, the load&ndash, unload contact resistance lag decreased. When the number of contact surfaces was increased, contact resistance increased. Finally, a fitted formula describing the relationship between contact resistance and cyclic times, temperature and number of contact interfaces was determined. This formula can be used to predict variation trends of contact resistance in complex environments and provide more accurate contact resistance parameters for calculating the AC loss of superconducting cables.

Rationale: Cardiac transthyretin amyloidosis is a progressive and fatal cardiomyopathy for which several promising therapies are in development. The diagnosis is frequently delayed or missed because of the limited specificity of clinical manifestations, routine electrocardiogram, echocardiography and the traditional requirement for endomyocardial biopsy confirmation. Patient concerns: A 68-year-old female had suffered from lumbago for 5 years with progressive weakness, numbness in both lower limb. Diagnosis: The patient's clinical signs were not specific, but cardiac amyloidosis was suspected based on relative left ventricular apical sparing of longitudinal strain on echocardiography and continuous elevated serum levels of cardiac biomarkers (ultrasensitive cardiac troponin I and NT-proBNP). She was finally diagnosed hereditary transthyretin-related cardiac amylodosis by specific findings of cardiovascular magnetic resonance imaging (CMR), 99m-technetium pyrophosphate (99mTc-PYP) scintigraphy and genetic testing. Interventions: The patient received medications including diuretics, beta-blockers and angiotensin-converting enzyme inhibitors at the time of hospitalization. Ultimately, however, she refused further treatments and requested discharge from our hospital. Outcomes: A series of noninvasive technique enables the diagnosis of hereditary transthyretin-related cardiac amyloidosis. Lessons: While endomyocardial biopsy is not able to performed, this case demonstrates that a combination of noninvasive techniques, especially CMR, nuclear imaging, and genetic testing, may help us to make a correct diagnosis of hereditary transthyretin-related cardiac amyloidosis.

Background and aims International guidelines recommend ticagrelor over clopidogrel as preferred antiplatelet agent in patients following coronary stenting. However, no large real-life evidence is available in East Asians in general, and Chinese in particular, with regard to associated clinical outcomes. The present study aimed to assess the early and delayed outcomes after ticagrelor versus clopidogrel in post stenting Chinese patients. Methods We conducted the pre-specified interim analysis of C omparison O f Efficacy and S afety Between TI cagrelor and C lopidogrel In Chinese (COSTIC), the ongoing prospective, observational, single-center trial. Primary outcomes include first occurrence of myocardial infarction, stroke, vascular death and Bleeding Academic Research Consortium (BARC) scale bleeding event. Propensity score matching (PSM) was carried out to adjust for differences in baseline characteristics between treatment arms. Results In total, 4,465 patients were enrolled. After PSM, the patients prescribed with ticagrelor had a lower incidence of primary efficacy endpoint relative to those with clopidogrel (0.6% vs. 1.4%, HR = 0.44, 95%CI: 0.22–0.89, p = 0.019) at 1 month, but similar at 7 days, 6 months and 12 months. Further analysis indicated that the difference only exists in the subgroup of acute myocardial infarction (AMI) patients. With regard to safety, ticagrelor consistently increased the risk of BARC type 2 bleeding compared to clopidogrel at 1 month, 6 months and 12 months. Conclusions These preliminary data indicate that ticagrelor is superior to clopidogrel with regard to major vascular thrombotic outcomes at 1 month, especially in the AMI population, but both groups are similar at 7 days, 6 months and 12 months. Ticagrelor consistently caused significantly more BARC type 2 bleeding.

Hypoxia may cause abnormal proliferation and migration of the vascular smooth muscle cells (VSMCs) from the media to the intima. This contributes to vessel narrowing and accelerates the process of atherosclerosis. The association of the aberrant expression of long noncoding RNAs (lncRNAs) with the development and progression of atherosclerosis is well known; however, it is not well investigated in hypoxic VSMCs. Using a microarray approach, we identified 1056 and 2804 differentially expressed lncRNAs and mRNAs, respectively, in hypoxic and normoxic mouse aorta smooth muscle (MOVAS) cells. Of them, we randomly chose several lncRNAs and validated the microarray data using the quantitative PCR (qPCR) assay. Advanced bioinformatics analyses indicated that the up-regulated mRNAs were mainly involved in inflammatory responses, lipid metabolism, clearance of amyloid-β peptide, citrate cycle (TCA cycle), TGF-β signaling, and chemokine signaling. The down-regulated mRNAs were mainly involved in the apoptosis pathway, glycerolipid metabolism, Wnt signaling pathway, and MAPK signaling pathway. The constructed coexpression network indicated interactions between 87 lncRNAs and ten mRNAs. In addition, we demonstrated that the silence of lncRNA NONMMUT002434 expression could abrogate the migration and proliferation of smooth muscle cells dramatically. Our data provide comprehensive evidence on the differential expression of lncRNAs and mRNAs in hypoxic MOVAS cells, which may be valuable biomarkers for atherosclerotic diseases, and thereby facilitating diagnosis of atherosclerosis.

Abdominal aortic aneurysm (AAA) is an asymptomatic, potentially lethal disease whose ruptures have a high mortality rate. An effective pharmacological approach to decrease expansion or prevent the rupture of AAAs in humans remains lacking. Previous studies have suggested that activator protein 1 (c-Jun/AP-1) and C/EBP homologous protein (Chop) are involved in the development of AAA. The purpose of the present study was to investigate whether c-Jun/AP-1 mediates Chop overexpression in AAA. c-Jun/AP-1 and Chop protein levels were determined in an angiotensin II (Ang II)-induced AAA model using apolipoprotein E-deficient mice. Additionally, mouse aortic smooth muscle cells (MOVAS cell line) were treated with Ang II. Apoptosis was evaluated via TUNEL assay, MOVAS cell migration ability was assessed by monolayer wound healing assay and the levels of c-Jun/AP-1 and Chop were determined by western blotting, immunofluorescence and immunocytochemical assays. Following c-Jun silencing using c-Jun-specific small interfering (si)RNA, Chop expression was evaluated. Furthermore, chromatin immunoprecipitation (ChIP) was used to investigate whether c-Jun/Ap-1 binds directly to the DNA damage-inducible transcript 3 protein (Ddit3) promoter. It was observed that c-Jun/AP-1 and Chop were synchronously overexpressed in Ang II-induced AAA and Ang II-treated cells, and that apoptosis and migration were induced by Ang II. In addition, Chop was suppressed when c-Jun was silenced by targeted siRNA. Notably, the ChIP assay demonstrated that the DNA fragments pulled down by primary antibodies against c-Jun/Ap-1 were able to be amplified by (Ddit3) promoter-specific primers. c-Jun/AP-1 may therefore mediate Chop expression in MOVAS cells via Ddit3. These results suggested that c-Jun/AP-1 may be a novel target for AAA therapy.

Hyperhomocysteinemia is an independent risk factor for multiple cardiovascular diseases. The pathogenesis of homocysteine-induced vascular remodeling has not yet been elucidated.

Aortic dissection (AD) is a heterogeneous genetic disease of the aorta with high mortality and poor prognosis. However, only few genetic causes of AD have been explored till date. After conducting a broad literature review focused on identifying potential pathogenic pathways, we designed a panel containing 152 AD-associated genes to conduct massively parallel targeted next-generation sequencing of 702 sporadic aortic dissection patients and 163 matched healthy controls. After validation by Sanger sequencing, we identified 21 definitely pathogenic and 635 likely pathogenic variants in 61.25% (430/702) of patients. In these patients, 34.88% (150/430) harbored more than one variant that was either definitely or likely to be pathogenic. Among the candidate genes, we identified 546 likely pathogenic variants in 47.72% (335/702) of patients. Importantly, we identified 94 loss-of-function (LOF) variants in 45 genes in AD patients, but only five LOF variants in the controls (P=1.34×10-4). With a burden test, we highlighted RNF213 as an important new gene for AD pathogenesis. We also performed transcriptome sequencing of human aorta tissues to evaluate the expression levels of these newly identified genes. Our study has compiled a comprehensive genetic map of sporadic AD in the Han Chinese population. We believe it will facilitate risk predicting and genetic diagnosis of this severe disease in the future.

Global longitudinal strain (GLS) measured by 2-D speckle-tracking echocardiography (2-D STE) at rest has been recognized as a sensitive parameter in the detection of significant coronary artery disease (CAD). However, the diagnostic power of 2-D STE in the detection of significant CAD in patients with diabetes mellitus is unknown. Two-dimensional STE features were studied in total of 143 consecutive patients who underwent echocardiography and coronary angiography. Left ventricular global and segmental peak systolic longitudinal strains (PSLSs) were quantified by speckle-tracking imaging. In the presence of obstructive CAD (defined as stenosis ≥75%), global PSLS was significantly lower in patients with diabetes mellitus than in patients without (16.65 ± 2.29% vs. 17.32 ± 2.27%, p < 0.05). Receiver operating characteristic analysis revealed that global PSLS could effectively detect obstructive CAD in patients without diabetes mellitus (cutoff value: -18.35%, sensitivity: 78.8%, specificity: 77.5%). However, global PSLS could detect obstructive CAD in diabetic patients at a lower cutoff value with inadequate sensitivity and specificity (cutoff value: -17.15%; sensitivity: 61.1%, specificity: 52.9%). In addition, the results for segmental PSLS were similar to those for global PSLS. In conclusion, global and segmental PSLSs at rest were significantly lower in patients with both obstructive CAD and diabetes mellitus than in patients with obstructive CAD only; thus, PSLSs at rest might not be a useful parameter in the detection of obstructive CAD in patients with diabetes mellitus.

Global longitudinal strain (GLS) at rest on two-dimensional speckle tracking echocardiography (2D STE) was demonstrated to help detect coronary artery disease (CAD). However, the optimal cut-off point of GLS and its diagnostic power for detecting critical CAD in non-diabetes mellitus (DM) patients are unknown. In the present study, 211 patients with suspected CAD were prospectively included, with DM patients excluded. All patients underwent echocardiography and subsequently coronary angiography within 3 days. Left ventricular (LV) GLSs were quantified by 2D STE. Territorial peak systolic longitudinal strains (TLSs) were calculated based on the perfusion territories of the 3-epicardial coronary arteries in a 17-segment LV model. Critical CAD was defined as an area stenosis ≥70% in ≥1 epicardial coronary artery (≥50% in left main coronary artery). Totally 145 patients were diagnosed as having critical CAD by coronary angiography. Significant differences were observed in all strain parameters between patients with and without critical CAD. The area under the receiver operating charcteristic (ROC) curve (AUC) for GLS in the detection of left main (LM) or threevessel CAD was 0.875 at a cut-off value of -19.05% with sensitivity of 78.1% and specificity of 72.7%, which increased to 0.926 after exclusion of apical segments (cut-off value -18.66%; sensitivity 84.4% and specificity 81.8%). The values of TLSs were significantly lower in regions supplied by stenotic arteries than in those by non-stenotic arteries. The AUC for the TLSs to identify critical stenosis of left circumflex (LCX) artery, left anterior descending (LAD) artery and right coronary artery (RCA), in order of diagnostic accuracy, was 0.818 for LCX, 0.764 for LAD and 0.723 for RCA, respectively. In conclusion, in non-DM patients with suspected CAD, GLS assessed by 2D STE is an excellent predictor for LM or three-vessel CAD with high diagnostic accuracy, and a higher cut-off point than reported before should be used. Excluding apical segments in the calculation of GLS can further improve the predictive accuracy of GLS. It is unsatisfactory for TLSs to be used to identify stenotic coronary arteries.

// Dating Sun 1, * , Hu Ding 1, * , Chunxia Zhao 1 , Yuanyuan Li 1 , Jing Wang 1 , Jiangtao Yan 1 and Dao Wen Wang 1 1 Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People’s Republic of China * These authors have contributed equally to this work Correspondence to: Jiangtao Yan, email: jtyan_tjh@163.com Dao Wen Wang, email: dwwang@tjh.tjmu.edu.cn Keywords: myocarditis, mortality, scoring systems Received: February 28, 2017 Accepted: May 22, 2017 Published: June 27, 2017 ABSTRACT Acute myocarditis is an uncommon and potentially life-threatening disease. Scoring systems are essential for predicting outcome and evaluating the therapy effect of adult patients with acute myocarditis. The aim of this study was to determine the value of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation IV (APACHE IV) and second Simplified Acute Physiology Score (SAPS II) scoring systems in predicting short-term mortality of these patients. We retrospectively analyzed data from 305 adult patients suffering from acute myocarditis between April 2005 and August 2016. The association between the value of admission SOFA, APACHE IV and SAPS II scores and risk of short-term mortality was determined. Multivariate Cox analysis showed that SOFA, APACHE IV and SAPS II scores were independent risk factors of death in patients with acute myocarditis. For each scoring system, Kaplan–Meier analysis showed that the cumulative short-term mortality was significantly higher in patients with higher admission scores compared with those with lower admission scores. For the prediction of short-term mortality in a patient with acute myocarditis, SAPS II had the highest accuracy followed by the APACHE IV and SOFA scores.

Background Gene variants contribute to variability in individual responsiveness to clopidogrel and influence cardiovascular outcomes in Caucasian patients with acute coronary syndrome (ACS). However, limited data is available in Asian populations. Methods We resequenced 14 genes in metabolizing and activity pathway of clopidogrel in 138 patients with ACS and prospectively assessed the modulating effects of 13 variants possibly related to clopidogrel efficacy on one-year cardiovascular event occurrence in 5820 ACS patients after percutaneous coronary intervention (PCI). In addition, platelet aggregation rate was measured in 1084 participants and plasma levels of active metabolite were determined in 15 patients to test whether increasing clopidogrel maintenance doses increases active metabolite exposure. Results No significant associations were found between any of the tested variants and risk of cardiovascular events ( P >0.05), although CYP2C19*2 carriers had slightly higher on-treatment platelet aggregation rate and lower active metabolite exposure compared with that of non-carriers (Median [IQR] 51.49 [35.43–66.75] vs. 49.05 [32.36–63.38], P =0.012) (means±SD AUC, 22.84±5.00 vs. 35.05±12.34, P =0.008). Switching from 75mg daily clopidogrel to 150mg daily fully overcomes low exposure to clopidogrel active metabolite in CYP2C19*2 carriers (means±SD AUC, 32.35±8.65 vs. 35.05±12.34, P =0.314). Conclusion Different from Caucasian populations, genetic variants have no significant influence on clinical outcomes and have much milder effects on inhibition of platelet and active clopidogrel metabolite levels in Chinese patients with ACS after PCI, an effect which could be overcome with a dose escalation to 150mg daily.