Age and gender mediated the association between anemia and 30-day outcomes in patients with ST-segment elevated myocardial infarction.

Background: The higher prevalence of anemia in females and elderly may be attributed to its association with worsened outcomes in ST-elevation myocardial infarction (STEMI) patients. We aimed to evaluate the precise effects of age and gender on the association between anemia and 30-day outcomes. Method: We identified 4350 STEMI patients and divided into anemia and non-anemia. Effects were analyzed as categories using Cox proportional-hazards regression and as continuous using restricted cubic splines. Propensity score matching (PSM) and mediation analysis were applied to identify intermediate effects. Results: Anemic patients were older, more likely to be female, and experienced doubled all-cause death (7.3 % versus 15.0 %), main adverse cardiovascular and cerebrovascular events (MACCE, 11.1 % versus 20.2 %), heart failure (HF, 5.1 % versus 8.6 %), and bleeding events (2.7 % versus 5.4 %). After adjustment, the association between anemia and all-cause death (Hazard ratio (HR) 1.15, 95 % confidence interval (95 %CI) 0.93-1.14), MACCE (HR 1.14, 95 %CI 0.95-1.36) and HF (HR 1.19, 95 %CI 0.92-1.55) were insignificant, the effects persisted nullified across age classes (P-interaction > 0.05) and PSM (P > 0.05). Ulteriorly, age mediated 77.6 %, 66.2 %, 48.0 %, gender mediated 38.1 %, 15.0 %, 3.2 %, age and gender together mediated 99.8 % 72.9 %, 48.1 % of the relationship. Anemia was independently associated with bleeding events (HR 2.02, 95 %CI 1.42-2.88), the effects consisted significant regardless of PSM (P < 0.05), age, and gender classes (P-interaction > 0.05), and no mediating role of age and gender were observed. Conclusions: In STEMI patients, age and gender largely mediated the relationship between anemia and all-cause death, MACCE, and HF, anemia was independently associated with bleeding complications.

Age shock index and age-modified shock index are valuable bedside prognostic tools for postdischarge mortality in ST-elevation myocardial infarction patients.

BACKGROUND: The incidence of mortality is considerable after ST-elevation myocardial infarction (STEMI) hospitalization; risk assessment is needed to guide postdischarge management. Age shock index (SI) and age modified shock index (MSI) were described as useful prognosis instruments; nevertheless, their predictive effect on short and long-term postdischarge mortality has not yet been sufficiently confirmed. METHODS: This analysis included 3389 prospective patients enrolled from 2016 to 2018. Endpoints were postdischarge mortality within 30 days and from 30 days to 1 year. Hazard ratios (HRs) were evaluated by Cox proportional-hazards regression. Predictive performances were assessed by area under the curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI) and decision curve analysis (DCA) and compared with TIMI risk score and GRACE score. RESULTS: The AUCs were 0.753, 0.746 for age SI and 0.755, 0.755 for age MSI for short- and long-term postdischarge mortality. No significant AUC differences and NRI were observed compared with the classic scores; decreased IDI was observed especially for long-term postdischarge mortality. Multivariate analysis revealed significantly higher short- and long-term postdischarge mortality for patients with high age SI (HR: 5.44 (2.73-10.85), 5.34(3.18-8.96)), high age MSI (HR: 4.17(1.78-9.79), 5.75(3.20-10.31)) compared to counterparts with low indices. DCA observed comparable clinical usefulness for predicting short-term postdischarge mortality. Furthermore, age SI and age MSI were not significantly associated with postdischarge prognosis for patients who received fibrinolysis. CONCLUSIONS: Age SI and age MSI were valuable instruments to identify high postdischarge mortality with comparable predictive ability compared with the classic scores, especially for events within 30 days after hospitalization.

Changes in process and outcome for ST elevation myocardial infarction in central China from 2011 to 2018.

BACKGROUND: Limited data are available on the changes in the quality of care for ST elevation myocardial infarction (STEMI) during China's health system reform from 2009 to 2020. This study aimed to assess the changes in care processes and outcome for STEMI patients in Henan province of central China between 2011 and 2018. METHODS: We compared the data from the Henan STEMI survey conducted in 2011-2012 ( n = 1548, a cross-sectional study) and the Henan STEMI registry in 2016-2018 ( n = 4748, a multicenter, prospective observational study). Changes in care processes and in-hospital mortality were determined. Process of care measures included reperfusion therapies, aspirin, P2Y12 antagonists, ß-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were considered ideal candidates for treatment. RESULTS: STEMI patients in 2016-2018 were younger (median age: 63.1 vs . 63.8 years) with a lower proportion of women (24.4% [1156/4748] vs . 28.2% [437/1548]) than in 2011-2012. The composite use rate for guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% [5424/8901] vs . 82.7% [22,439/27,129], P <0.001). The proportion of patients treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% (2698/3440) ( P <0.001) with a prolonged median onset-to-first medical contact time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, statins, and ß-blockers increased significantly. The risk of in-hospital mortality significantly decreased over time (6.1% [95/1548] vs . 4.2% [198/4748], odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.50-0.88, P = 0.005) after adjustment. CONCLUSIONS: Gradual implementation of the guideline-recommended treatments in STEMI patients from 2011 to 2018 has been associated with decreased in-hospital mortality. However, gaps persist between clinical practice and guideline recommendation. Public awareness, reperfusion strategies, and construction of chest pain centers need to be further underscored in central China.

ST-segment elevation predicts the occurrence of malignant ventricular arrhythmia events in patients with acute ST-segment elevation myocardial infarction.

BACKGROUND: ST-segment elevation (STE) represents a repolarization dispersion marker underlying arrhythmogenesis in ST-segment elevation myocardial infarction (STEMI); however, its value for predicting malignant ventricular arrhythmia events (MVAEs) remains uncertain. METHODS: In total, 285 patients with STEMI and those with or without MVAEs who presented within 6 h of symptom onset were enrolled. The relationships between STE and clinical characteristics of MVAEs (defined as ventricular tachycardia or ventricular fibrillation) were analyzed using t-test, chi-square test, binary multivariate logistic regression, and receiver operating characteristic curve analysis. RESULTS: Patients with STEMI and MVAEs had a shorter time from symptom onset to balloon time (p = 0.0285) and greater STE (p < 0.01) than those without MVAEs. The symptom-to-balloon time, age, and STE were associated with MVAEs after stepwise regression analysis in all cases. Only STE was significantly associated with the occurrence of MVAEs (all, p < 0.01). The area under the curve (AUC) of STE for predicting MVAEs was 0.905, and the cut-off value was 4.5 mV. When only infarct-related arteries were included in the analysis, the AUC of the left anterior descending artery was 0.925 with a cut-off value of 4.5 mV, that of the right coronary artery was 0.915 with a cut-off value of 4.5 mV, and that of the left circumflex artery was 0.929 with a cut-off value of 4.0 mV. CONCLUSIONS: In patients with STEMI presenting within 6 h of symptom onset, age, symptom-to-balloon time, and STE were the main predictors for MVAEs. However, among these, STE was the strongest predictor for MVAEs and was an index for repolarization dispersion of cardiomyocytes in infarcted and non-infarcted areas.

Review of the Research Progress of Human Brain Oxygen Extraction Fraction by Magnetic Resonance Imaging.

In recent years, the incidence of cerebrovascular diseases (CVD) is increasing, which seriously endangers human health. The study on hemodynamics of cerebrovascular disease can help us to understand, prevent, and treat the disease. As one of the important parameters of human cerebral hemodynamics and tissue metabolism, OEF (oxygen extraction fraction) is of great value in central nervous system diseases. The use of BOLD (blood oxygen level dependent) effect offers the possibility to study cerebral hemodynamic and metabolic characteristics by MRI (magnetic resonance imaging) measurements. Therefore, this paper reviews the hemodynamic parameters of brain tissue, discusses the principles and methods of quantitative BOLD-based MRI measurements of OEF, and discusses the advantages and disadvantages of each method.

Sex Disparity in Characteristics, Management, and In-Hospital Outcomes of Patients with ST-Segment Elevated Myocardial Infarction: Insights from Henan STEMI Registry.

Background: Women hospitalized with ST-elevation myocardial infarction (STEMI) experience higher risk of early mortality than men. We aimed to investigate the potential impact of risk factors, clinical characteristics, and management among gender-related risk differences. Method: We analyzed 5063 STEMI patients prospectively enrolled from 66 hospitals during 2016-2018 and compared sex differences in mortality, death, or treatment withdrawal and main adverse cardiovascular and cerebrovascular events (MACCE) using the generalized linear mixed model, following sequential adjustment for covariates. Results: Women were older and had a higher prevalence of hypertension (53.3% vs. 41.1%, P < 0.001) and diabetes (24.5% vs. 15.2%, P < 0.001). Eligible women were less likely to receive reperfusion therapy (56.1% vs. 62.4%, P < 0.001); the onset to first medical contact (FMC) (255 vs. 190 minutes, P < 0.001), onset to fibrinolysis (218 vs. 185 minutes, P < 0.001), and onset to percutaneous coronary intervention (PCI) (307 vs. 243 minutes, P < 0.001) were significantly delayed in women. The incidence of in-hospital death (6.8% vs. 3.0%, P < 0.001), death or treatment withdrawal (14.5% vs. 5.6%, P < 0.001), and MACCE (18.5% vs. 9.4%, P < 0.001) were notably higher. The gender disparities persist in death (OR: 1.61, 95% CI: 1.12-2.33), death or treatment withdrawal (OR: 1.68, 95% CI: 1.26-2.24), and MACCE (OR: 1.37, 95% CI: 1.08-1.74) after adjustment for covariates. Among possible explanatory factors, age (-58.46%, -59.04%, -62.20%) and cardiovascular risk factors (-40.77%, -39.36%, -41.73%) accounted for most of the gender-associated risk differences. Conclusions: Women experienced worse in-hospital outcomes, and age and cardiovascular risk factors were major factors influencing sex-related differences. The sex disparity stressed the awareness and importance of quality improvement efforts against female patients in clinical practice.

Comprehensive Analysis of N6-Methyladenosine RNA Methylation Regulators in the Diagnosis and Subtype Classification of Acute Myocardial Infarction.

Acute myocardial infarction (AMI) is still a huge danger to human health. Sensitive markers are necessary for the prediction of the risk of AMI and would be beneficial for managing the incidence rate. N6-methyladenosine (m6A) RNA methylation regulators have been confirmed to be involved in the development of various diseases. However, their function in AMI has not been fully elucidated. The purpose of this study was to determine the expression of m6A RNA methylation regulators in AMI as well as their possible functions and prognostic values. The GEO database was used to get the gene expression profiles of patients with and without AMI, and bioinformatics assays of genes with differently expressed expression were performed. We establish two separate m6A subtypes, and relationships between subtypes and immunity were studied. In this study, we identified IGF2BP1, FTO, RBM15, METTL3, YTHDC2, FMR1, and HNRNPA2B1 as the seven major m6A regulators. A nomogram model was developed and confirmed. The consensus clustering algorithm was conducted to categorize AMI patients into two m6A subtypes from the identified m6A regulators. Patients who have activated T-cell activities were found to be in clusterA; they may have a better prognosis as a result. Importantly, we found that patients with high METTL3 expressions had an increased level of Activated.CD4.T.cell and Type.2.T.helper.cell, while having a decreased level of CD56bright.natural.killer.cell, Macrophage, Monocyte, Natural.killer.cell, and Type.17.T.helper.cell. Overall, a diagnostic model of AMI was established based on the genes of IGF2BP1, FTO, RBM15, METTL3, YTHDC2, FMR1, and HNRNPA2B1. Our investigation of m6A subtypes may prove useful in the developments of therapy approaches for AMI.

Multi-Objective Optimal Planning for Distribution Network Considering the Uncertainty of PV Power and Line-Switch State.

With the construction of the smart grid, the distribution network with high penetration of the photovoltaic (PV) generator relies more and more on cyber systems to achieve active control; thus, the uncertainty of PV power and the line-switch state will inevitably affect the distribution network. To avoid the situation, a min-max multi-objective two-level planning model is proposed. Firstly, the uncertainty of PV power is considered, and a multi-time PV power model is established. Followed by the analysis of the line-switch state uncertainty in the distribution network, and according to Claude Shannon's information theory, the line-switch state uncertainty model is established under multiple scenarios. After the distribution network reconfiguration, the Latin hypercube sampling (LHS) method is used to determine the line-switch state when the uncertainty budget is different. Finally, considering the worstcase by the uncertainty of PV power and line-switch status, the control model is proposed to improve the stability of the distribution network with the minimal maintenance cost. The model feasibility is verified by the test system and the characteristics of PV power uncertainty, the line-switch state uncertainty is analyzed, and the influence of the scheduling strategy is discussed, thus providing practical technical support for the distribution network.

Reperfusion strategy and in-hospital outcomes for ST elevation myocardial infarction in secondary and tertiary hospitals in predominantly rural central China: a multicentre, prospective and observational study.

OBJECTIVES: To assess differences in reperfusion treatment and outcomes between secondary and tertiary hospitals in predominantly rural central China. DESIGN: Multicentre, prospective and observational study. SETTING: Sixty-six (50 secondary and 16 tertiary) hospitals in Henan province, central China. PARTICIPANTS: Patients with ST elevation myocardial infarction (STEMI) within 30 days of symptom onset during 2016-2018. PRIMARY OUTCOME MEASURES: In-hospital mortality, and in-hospital death or treatment withdrawal. RESULTS: Among 5063 patients of STEMI, 2553 were treated at secondary hospitals. Reperfusion (82.0% vs 73.0%, p<0.001) including fibrinolytic therapy (70.3% vs 4.4%, p<0.001) were more preformed, whereas primary percutaneous coronary intervention (11.7% vs 68.6%, p<0.001) were less frequent at secondary hospitals. In secondary hospitals, 53% received fibrinolytic therapy 3 hours after onset, and 5.8% underwent coronary angiography 2-24 hours after fibrinolysis. Secondary hospitals had a shorter onset-to-first-medical-contact time (176 min vs 270 min, p<0.001). Adjusted in-hospital mortality (adjusted OR 1.23, 95% CI 0.89 to 1.70, p=0.210) and in-hospital death or treatment withdrawal (adjusted OR 1.18, 95% CI 0.82 to 1.70, p=0.361) were similar between secondary and tertiary hospitals. CONCLUSIONS: With fibrinolytic therapy as the main reperfusion strategy, the reperfusion rate was higher in secondary hospitals, whereas in-hospital outcomes were similar compared with tertiary hospitals. Public awareness, capacity of primary and secondary care institutes to treat STEMI, and establishment of deeper cooperation among different-level healthcare institutes need to further improve. TRIAL REGISTRATION NUMBER: NCT02641262.

Accurate Instance Segmentation in Pediatric Elbow Radiographs.

Radiography is an essential basis for the diagnosis of fractures. For the pediatric elbow joint diagnosis, the doctor needs to diagnose abnormalities based on the location and shape of each bone, which is a great challenge for AI algorithms when interpreting radiographs. Bone instance segmentation is an effective upstream task for automatic radiograph interpretation. Pediatric elbow bone instance segmentation is a process by which each bone is extracted separately from radiography. However, the arbitrary directions and the overlapping of bones pose issues for bone instance segmentation. In this paper, we design a detection-segmentation pipeline to tackle these problems by using rotational bounding boxes to detect bones and proposing a robust segmentation method. The proposed pipeline mainly contains three parts: (i) We use Faster R-CNN-style architecture to detect and locate bones. (ii) We adopt the Oriented Bounding Box (OBB) to improve the localizing accuracy. (iii) We design the Global-Local Fusion Segmentation Network to combine the global and local contexts of the overlapped bones. To verify the effectiveness of our proposal, we conduct experiments on our self-constructed dataset that contains 1274 well-annotated pediatric elbow radiographs. The qualitative and quantitative results indicate that the network significantly improves the performance of bone extraction. Our methodology has good potential for applying deep learning in the radiography's bone instance segmentation.

Multi-Dimensional Feature Fusion Network for No-Reference Quality Assessment of In-the-Wild Videos.

Over the past few decades, video quality assessment (VQA) has become a valuable research field. The perception of in-the-wild video quality without reference is mainly challenged by hybrid distortions with dynamic variations and the movement of the content. In order to address this barrier, we propose a no-reference video quality assessment (NR-VQA) method that adds the enhanced awareness of dynamic information to the perception of static objects. Specifically, we use convolutional networks with different dimensions to extract low-level static-dynamic fusion features for video clips and subsequently implement alignment, followed by a temporal memory module consisting of recurrent neural networks branches and fully connected (FC) branches to construct feature associations in a time series. Meanwhile, in order to simulate human visual habits, we built a parametric adaptive network structure to obtain the final score. We further validated the proposed method on four datasets (CVD2014, KoNViD-1k, LIVE-Qualcomm, and LIVE-VQC) to test the generalization ability. Extensive experiments have demonstrated that the proposed method not only outperforms other NR-VQA methods in terms of overall performance of mixed datasets but also achieves competitive performance in individual datasets compared to the existing state-of-the-art methods.

A complete heart regeneration model with inflammation as a key component.

The neonatal mice myocardial infarction (MI) has been established as one of the heart regeneration models. However, the role of inflammation in this model is still unclear. We sought to systematically evaluate this model and explore the role of inflammation in it. Postnatal day 1 (P1) or day 7 (P7) mice were conducted left anterior descending coronary artery (LAD) ligation. Cardiac damage, repair, and regeneration were examined by histology and echocardiography. Inflammation was detected by heart section hematoxylin and eosin (HE) staining and tissue qPCR. Dexamethasone (Dex) was used to inhibit inflammation and its effects on heart regeneration were evaluated. Two days after P1 mice MI, cardiomyocytes in ischemia area died and heart function decreased. Then surrounding cardiomyocytes proliferated to repair the injury. At day 28 after MI, hearts were almost fully regenerated with a little fibrosis existed. In contrary, P7 mice MI resulted in thinning and fibrosis of the ventricular wall. Inflammation was induced by LAD ligation after P1 mice MI and dynamic changed during the process. Inhibition of inflammation by Dex impaired heart regeneration. These demonstrated that cardiomyocytes death and heart regeneration occurred in this model and inflammation might play a crucial role in it. Modulating inflammation may provide a promising therapeutic strategy to support heart regeneration.

Research on BOLD-fMRI Data Denoising Based on Bayesian Estimation and Adaptive Wavelet Threshold.

The acquisition of functional magnetic resonance imaging (fMRI) images of blood oxygen level-dependent (BOLD) effect and the signals to be analyzed is based on weak changes in the magnetic field caused by small changes in blood oxygen physiological levels, which are weak signals and complex in noise. In order to model and analyze the pathological and hemodynamic parameters of BOLD-fMRI images effectively, it is urgent to use effective signal analysis techniques to reduce the interference of noise and artifacts. In this paper, the noise characteristics of functional magnetic resonance imaging and the traditional signal denoising methods are analyzed. The Bayesian decision criterion takes into account the probability of the total occurrence of all kinds of references and the loss caused by misjudgment and has strong discriminability. So, an improved adaptive wavelet threshold denoising method based on Bayesian estimation is proposed. By using the correlation characteristics of multiscale wavelet coefficients, the corresponding wavelet components of useful signals and noises are processed differently; while retaining useful frequency information, the noise is weakened to the greatest extent. The new adaptive threshold wavelet denoising method based on Bayesian estimation is applied to the actual experiment, and the results of OEF (oxygen extraction fraction) are optimized. A series of simulation experiments are carried out to verify the effectiveness of the proposed method.

Analysis of false data injection attacks in power systems: A dynamic Bayesian game-theoretic approach.

False data injection (FDI) attack is a malicious kind of cyber attack that targets state estimators of power systems. In this paper, a dynamic Bayesian game-theoretic approach is proposed to analyze FDI attacks with incomplete information. In this approach, players' payoffs are identified according to a proposed bi-level optimization model, and the prior belief of the attacker's type is constantly updated based on history profiles and relationships between measurements. It is proven that the type belief and Bayesian Nash equilibrium are convergent. The stability and reliability of this approach can be guaranteed by the law of large numbers and the central limit theorem. The time complexity and space complexity are O(nmnsnl) and O(1), respectively. Numerical results show that the average success rate to identify at-risk load measurements is 98%. The defender can efficiently allocate resources to at-risk load measurements using the dynamic Bayesian game-theoretic approach.

Diagnosis of left ventricular hypertrophy using convolutional neural network.

BACKGROUND: Clinically, doctors obtain the left ventricular posterior wall thickness (LVPWT) mainly by observing ultrasonic echocardiographic video stream to capture a single frame of images with diagnostic significance, and then mark two key points on both sides of the posterior wall of the left ventricle with their own experience for computer measurement. In the actual measurement, the doctor's selection point is subjective, and difficult to accurately locate the edge, which will bring errors to the measurement results. METHODS: In this paper, a convolutional neural network model of left ventricular posterior wall positioning was built under the TensorFlow framework, and the target region images were obtained after the positioning results were processed by non-local mean filtering and opening operation. Then the edge detection algorithm based on threshold segmentation is used. After the contour was extracted by adjusting the segmentation threshold through prior analysis and the OTSU algorithm, the design algorithm completed the computer selection point measurement of the thickness of the posterior wall of the left ventricle. RESULTS: The proposed method can effectively extract the left ventricular posterior wall contour and measure its thickness. The experimental results show that the relative error between the measurement result and the hospital measurement value is less than 15%, which is less than 20% of the acceptable repeatability error in clinical practice. CONCLUSIONS: Therefore, the measurement method proposed in this paper has the advantages of less manual intervention, and the processing method is reasonable and has practical value.

Laparoscopic-based perivascular renal sympathetic nerve denervation: a feasibility study in a porcine model.

BACKGROUND: This study aims to evaluate the effects and safety of laparoscopic-based perivascular renal sympathetic nerve denervation (RDN) in a porcine model fed a high-fat diet. METHOD: Thirty-six high-fat diet-fed Bama minipigs were randomly divided into an RDN group (n = 18), in which minipigs received laparoscopic-based perivascular RDN, and a sham group (n = 18). All pigs were fed the high-fat diet after the operation to establish a model of obesity-induced hypertension. Bama pigs in the RDN and sham groups were killed at 3 time points [2 days after RDN (n = 6), day 90 (n = 6) and day 180 (n = 6)]. RESULT: The systolic blood pressure (SBP) and noradrenaline (NE) concentration in the kidney tissue were significantly lower in the RDN group than in the sham group at 2 days (113.83 ± 3.26 mmHg vs 129.67 ± 3.32 mmHg, P = 0.011, and 112.02 ± 17.34 ng/g vs 268.48 ± 20.61 ng/g, P < 0.001, respectively), 90 days (116.83 ± 3.88 mmHg vs 145.00 ± 4.22 mmHg, P = 0.001, respectively) and 180 days (129.33 ± 2.87 mmHg vs 168.57 ± 2.86 mmHg, P < 0.001, and 152.15 ± 16.61 ng/g vs 318.97 ± 24.84 ng/g, P < 0.001, respectively) after the operation. The diastolic blood pressure (DBP) was significantly lower in the RDN group than in sham group at 90 and 180 days after the operation (72.17 ± 2.7 mmHg vs 81.50 ± 2.22 mmHg, P = 0.037, and 76.83 ± 2.75 mmHg vs 86.33 ± 2.22 mmHg P = 0.021, respectively). Based on the pathological evaluation, the renal sympathetic nerve fascicles were successfully disrupted by radiofrequency energy after laparoscopic-based perivascular RDN, but the intima was intact. Tyrosine hydroxylase (TH) expression was decreased, while the expression of the S100 protein was increased in treated renal arteries after RDN. CONCLUSIONS: Laparoscopic-based perivascular RDN prevented the occurrence and development of hypertension, and thus it may be an efficient and safe method for controlling blood pressure in an experimental model.

Aggravated endothelial endocrine dysfunction and intimal thickening of renal artery in high-fat diet-induced obese pigs following renal denervation.

BACKGROUND: Renal denervation (RDN) targeting the sympathetic nerves in the renal arterial adventitia as a treatment of resistant hypertension can cause endothelial injury and vascular wall injury. This study aims to evaluate the risk of atherosclerosis induced by RDN in renal arteries. METHODS: A total of 15 minipigs were randomly assigned to 3 groups: (1) control group, (2) sham group, and (3) RDN group (n = 5 per group). All pigs were fed a high-fat diet (HFD) for 6 months after appropriate treatment. The degree of intimal thickening of renal artery and the conversion of endothelin 1 (ET-1) receptors were evaluated by histological staining. Western blot was used to assess the expression of nitric oxide (NO) synthesis signaling pathway, ET-1 and its receptors, NADPH oxidase 2 (NOX2) and 4-hydroxynonenal (4-HNE) proteins, and the activation of NF-kappa B (NF-κB). RESULTS: The histological staining results suggested that compared to the sham treatment, RDN led to significant intimal thickening and significantly promoted the production of endothelin B receptor (ETBR) in vascular smooth muscle cells (VSMCs). Western blotting analysis indicated that RDN significantly suppressed the expression of AMPK/Akt/eNOS signaling pathway proteins, and decreased the production of NO, and increased the expression of endothelin system proteins including endothelin-1 (ET-1), endothelin converting enzyme 1 (ECE1), endothelin A receptor (ETAR) and ETBR; and upregulated the expression of NOX2 and 4-HNE proteins and enhanced the activation of NF-kappa B (NF-κB) when compared with the sham treatment (all p < 0.05). There were no significant differences between the control and sham groups (all p > 0.05). CONCLUSIONS: RDN aggravated endothelial endocrine dysfunction and intimal thickening, and increased the risk of atherosclerosis in renal arteries of HFD-fed pigs.

Rationale and design of the Henan ST elevation myocardial infarction (STEMI) registry: a regional STEMI project in predominantly rural central China.

BACKGROUND: Cardiovascular disease including ST elevation myocardial infarction (STEMI) is increasing and the leading cause of death in China. There has been limited data available to characterize STEMI management and outcomes in rural areas of China. The Henan STEMI Registry is a regional STEMI project with the objectives to timely obtain real-world knowledge about STEMI patients in secondary and tertiary hospitals and to provide a platform for care quality improvement efforts in predominantly rural central China. METHODS: The Henan STEMI Registry is a multicentre, prospective and observational study for STEMI patients. The registry includes 66 participating hospitals (50 secondary hospitals; 16 tertiary hospitals) that cover 15 prefectures and one city direct-controlled by the province in Henan province. Patients were consecutively enrolled with a primary diagnosis of STEMI within 30 days of symptom onset. Clinical treatments, outcomes and cost are collected by local investigators and captured electronically, with a standardized set of variables and standard definitions, and rigorous data quality control. Post-discharge patient follow-up to 1 year is planned. As of August 2018, the Henan STEMI Registry has enrolled 5479 patients of STEMI. DISCUSSION: The Henan STEMI Registry represents the largest Chinese regional platform for clinical research and care quality improvement for STEMI. The board inclusion of secondary hospitals in Henan province will allow for the exploration of STEMI in predominantly rural central China. TRIAL REGISTRATION: [NCT02641262] [29 December, 2015].

Acute changes in morphology and renal vascular relaxation function after renal denervation using temperature-controlled radiofrequency catheter.

BACKGROUND: Resistant hypertension and renal sympathetic hyperactivity are closely linked, and catheter-based renal denervation (RDN) is regarded as a new treatment strategy. However, the acute changes in vascular morphology and relaxation function have yet to be evaluated, and these may be important for the efficacy and safety of the procedure. In this study, we explored these questions by conventional temperature-controlled cardiac radiofrequency catheter-based RDN in a pig model. METHODS: Six mini-pigs were randomly divided into the renal denervation (RDN) group (n = 3) and the Sham-RDN group (n = 3). Animals in the RDN group underwent unilateral radiofrequency ablation, and those in the Sham-RDN group underwent the same procedure except for the ablation. The pigs were examined by angiography pre- and post-RDN and were euthanized immediately thereafter. Renal arteries were processed for histological and molecular biology analyses as well as for in vitro vascular tension testing. RESULTS: Compared with the Sham-RDN group, the RDN caused vascular intima and media injury, renal nerve vacuolization, mild collagen fiber hyperplasia and elastic fiber cleavage (all p < 0.05). The RDN group also significantly exhibited nitric oxide synthase pathway inhibition and decreased endothelium-independent vascular relaxation function Compared to the Sham-RDN group (all p < 0.05). CONCLUSIONS: In this porcine model, renal artery denervation led to vascular wall injury and endothelial dysfunction in the acute phase, which negatively affected vascular relaxation function. Thus, this process may be detrimental to the prognosis and progress of hypertension patients.