Research on precise phenotype identification and growth prediction of lettuce based on deep learning.

In recent years, precision agriculture, driven by scientific monitoring, precise management, and efficient use of agricultural resources, has become the direction for future agricultural development. The precise identification and assessment of phenotypes, which serve as external representations of a crop's growth, development, and genetic characteristics, are crucial for the realization of precision agriculture. Applications surrounding phenotypic indices also provide significant technical support for optimizing crop cultivation management and advancing smart agriculture, contributing to the efficient and high-quality development of precision agriculture.This paper focuses on lettuce and employs common nutritional stress conditions during growth as experimental settings. By collecting RGB images throughout the lettuce's complete growth cycle, we developed a deep learning-based computational model to tackle key issues in the lettuce's growth and precisely identify and assess phenotypic indices. We discovered that some phenotypic indices, including custom ones defined in this study, are representative of the lettuce's growth status. By dynamically monitoring the changes in phenotypic traits during growth, we quantitatively analyzed the accumulation and evolution of phenotypic indices across different growth stages. On this basis, a predictive model for lettuce growth and development was trained.The model incorporates MSE, SSIM, and perceptual loss, significantly enhancing the predictive accuracy of the lettuce growth images and phenotypic indices. The model trained with the reconstructed loss function outperforms the original model, with the SSIM and PSNR improving by 1.33% and 10.32%, respectively. The model also demonstrates high accuracy in predicting lettuce phenotypic indices, with an average error less than 0.55% for geometric indices and less than 1.7% for color and texture indices. Ultimately, it achieves intelligent monitoring and management throughout the lettuce's life cycle, providing technical support for high-quality and efficient lettuce production.

Feasibility and prognostic value of tissue motion annular displacement in patients with heart transplantation.

BACKGROUND: Tissue motion of mitral annular displacement (TMAD) assessment has proved to be an effective method for several cardiovascular diseases including hypertrophic cardiomyopathy, heart failure, non-ST-elevation myocardial infarction, etc. However, there are no studies exploring the feasibility of TMAD in heart transplantation (HT) recipients, and the predictive value of this parameter for adverse outcomes in these patients remains unknown. Consequently, this study aimed to evaluate the feasibility of TMAD in the evaluation of left ventricular (LV) systolic function in clinically well adult HT patients, and further investigate the prognostic value of TMAD. METHODS: Echocardiography was performed in 155 adult HT patients and 49 healthy subjects. All the subjects were examined by conventional transthoracic two-dimensional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE) with evaluation of the LV end-diastolic diameter, LV end-diastolic volume index, LV end-systolic volume index, interventricular septal thickness, left atrial diameter, mitral annular plane systolic excursion (MAPSE), LV ejection fraction (LVEF), TMAD and LV global longitudinal strain (LVGLS). The end point was defined as all-causes mortality or posttransplant related hospitalization during follow up. Cox proportional hazards regression was performed to evaluate the prognostic value of the parameters for predicting poor outcomes in HT patients. RESULTS: A significant positive correlation was found between the measurements of TMAD and LVGLS (r = .714, p < .001). TMAD obtained by 2D-STE had good reproducibility. The LVGLS and TMAD were significantly lower in HT group than in control group (both p < .001). In HT patients, compared with event free group, adverse outcome group displayed reduced TMAD and LVGLS, and elevated age (p < .001, < .001, = .017, respectively). Patients with higher TMAD (> 9.1 mm) had comparatively better survival when stratified by cutoff value (log-rank p < .001). LVGLS and TMAD were independently associated with adverse outcomes in multivariable analysis (both p < .001). CONCLUSION: Assessment of TMAD is effective for evaluating LV longitudinal systolic function and predicting adverse outcomes in clinically well adult HT patients.

Prognostic Implications of Left Atrial Strain in Bicuspid Aortic Valve With Chronic Aortic Regurgitation.

BACKGROUND: Left atrial reservoir strain (LARS) is a novel imaging biomarker of left ventricular diastolic dysfunction. This study aimed to examine the prognostic implications of LARS in patients with bicuspid aortic valve and significant (moderate-severe to severe) aortic regurgitation. METHODS AND RESULTS: A total of 220 patients with bicuspid aortic valve and significant aortic regurgitation were prospectively enrolled in our study. LARS and left ventricular global longitudinal strain were derived from speckle-tracking echocardiography. The end point was a composite of all-cause mortality, heart failure hospitalization, and aortic valve repair or replacement. The threshold value of LARS <24% was used to identify impaired left atrial mechanics based on prior results. During a median follow-up of 364 (interquartile range, 294-752) days, 46 patients (20.9%) reached the composite end points. On multivariable Cox analysis, impaired LARS (adjusted hazard ratio, 2.08 [95% CI, 1.05-4.11]; P=0.036) was a statistically significant predictor of composite end points after adjustment for other statistically significant predictors. Finally, adding impaired LARS to other statistically significant predictors (New York Heart Association functional class and left ventricular global longitudinal strain) significantly improved the global χ2 (from 32.19 to 36.56; P=0.037) and reclassification (continuous net reclassification index=0.55; P<0.001) of the prediction model. CONCLUSIONS: In patients with bicuspid aortic valve and significant aortic regurgitation, the impairment of LARS is a strong independent prognostic predictor and confers incremental prognostic utility over clinical and other echocardiographic parameters. These findings suggest that LARS could be considered in risk stratification for such populations.

Ambient Catalytic Spinning of Polyethylene Nanofibers.

A novel single-atom Ni(II) catalyst (Ni-OH) is covalently immobilized onto the nano-channels of mesoporous Santa Barbara Amorphous (SBA)-15 particles and isotropic Anodized Aluminum Oxide (AAO) membrane for confined-space ethylene extrusion polymerization. The presence of surface-tethered Ni complexes (Ni@SBA-15 and Ni@AAO) is confirmed by the inductively coupled plasma-optical emission spectrometry (ICP-OES) and X-ray photoelectron spectroscopy (XPS). In the catalytic spinning process, the produced PE materials exhibit very homogeneous fibrous morphology at nanoscale (diameter: ~50 nm). The synthesized PE nanofibers extrude in a highly oriented manner from the nano-reactors at ambient temperature. Remarkably high Mw (1.62×106  g mol-1 ), melting point (124 °C), and crystallinity (41.8 %) are observed among PE samples thanks to the confined-space polymerization. The chain-walking behavior of surface tethered Ni catalysts is greatly limited by the confinement inside the nano-channels, leading to the formation of very low-branched PE materials (13.6/1000 C). Due to fixed supported catalytic topology and room temperature, the filaments are expected to be free of entanglement. This work signifies an important step towards the realization of a continuous mild catalytic-spinning (CATSPIN) process, where the polymer is directly synthesized into fiber shape at negligible chain branching and elegantly avoiding common limitations like thermal degradation or molecular entanglement.

Application of an echocardiographic index to characterize right ventricular-pulmonary arterial coupling in heart failure.

Heart failure (HF), with its high morbidity and mortality, remains a global public health issue. Right ventricular (RV) dysfunction is a sign of deterioration in the natural history of HF, and a thorough evaluation of the relationship between RV contractility and its afterload through RV-pulmonary arterial (RV-PA) coupling can aid in accurately assessing overall RV function. The ratio of RV end-systolic elastance (Ees) to pulmonary arterial elastance (Ea) invasively measured by right heart catheterization served as the gold standard for evaluating RV-PA coupling. An echocardiographic index termed tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) has been shown to correlate well with Ees/Ea. TAPSE/PASP is recognized as a non-invasive surrogate of RV-PA coupling and has been extensively studied in patients with HF. This review briefly describes the methods of assessing RV-PA coupling, mainly discussing echocardiography, summarizes the clinical utility of TAPSE/PASP in patients with different HF types, and provides an overview of the available literature.

Lipid-lowering drugs affect lung cancer risk via sphingolipid metabolism: a drug-target Mendelian randomization study.

Background: The causal relationship between lipid-lowering drug (LLD) use and lung cancer risk is controversial, and the role of sphingolipid metabolism in this effect remains unclear. Methods: Genome-wide association study data on low-density lipoprotein (LDL), apolipoprotein B (ApoB), and triglycerides (TG) were used to develop genetic instrumental variables (IVs) for LLDs. Two-step Mendelian randomization analyses were performed to examine the causal relationship between LLDs and lung cancer risk. The effects of ceramide, sphingosine-1-phosphate (S1P), and ceramidases on lung cancer risk were explored, and the proportions of the effects of LLDs on lung cancer risk mediated by sphingolipid metabolism were calculated. Results: APOB inhibition decreased the lung cancer risk in ever-smokers via ApoB (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.70-0.92, p = 0.010), LDL (OR 0.82, 95% CI 0.71-0.96, p = 0.040), and TG (OR 0.63, 95% CI 0.46-0.83, p = 0.015) reduction by 1 standard deviation (SD), decreased small-cell lung cancer (SCLC) risk via LDL reduction by 1 SD (OR 0.71, 95% CI 0.56-0.90, p = 0.016), and decreased the plasma ceramide level and increased the neutral ceramidase level. APOC3 inhibition decreased the lung adenocarcinoma (LUAD) risk (OR 0.60, 95% CI 0.43-0.84, p = 0.039) but increased SCLC risk (OR 2.18, 95% CI 1.17-4.09, p = 0.029) via ApoB reduction by 1 SD. HMGCR inhibition increased SCLC risk via ApoB reduction by 1 SD (OR 3.04, 95% CI 1.38-6.70, p = 0.014). The LPL agonist decreased SCLC risk via ApoB (OR 0.20, 95% CI 0.07-0.58, p = 0.012) and TG reduction (OR 0.58, 95% CI 0.43-0.77, p = 0.003) while increased the plasma S1P level. PCSK9 inhibition decreased the ceramide level. Neutral ceramidase mediated 8.1% and 9.5% of the reduced lung cancer risk in ever-smokers via ApoB and TG reduction by APOB inhibition, respectively, and mediated 8.7% of the reduced LUAD risk via ApoB reduction by APOC3 inhibition. Conclusion: We elucidated the intricate interplay between LLDs, sphingolipid metabolites, and lung cancer risk. Associations of APOB, APOC3, and HMGCR inhibition and LPL agonist with distinct lung cancer risks underscore the multifaceted nature of these relationships. The observed mediation effects highlight the considerable influence of neutral ceramidase on the lung cancer risk reduction achieved by APOB and APOC3 inhibition.

Impact of concomitant medications on the efficacy of immune checkpoint inhibitors: an umbrella review.

Introduction: Cancer is a major global health concern, and immune checkpoint inhibitors (ICIs) offer a promising treatment option for cancer patients. However, the efficacy of ICIs can be influenced by various factors, including the use of concomitant medications. Methods: We searched databases (PubMed, Embase, Cochrane Library, Web of Science) for systematic reviews and meta-analyses for systematic reviews and meta-analyses on the impact of concomitant medications on ICIs efficacy, published from inception to January 1, 2023. We evaluated the methodological quality of the included meta-analyses, and re-synthesized data using a random-effects model and evidence stratification. Results: We included 23 publications, comprising 11 concomitant medications and 112 associations. Class II-IV evidence suggested that antibiotics have a negative impact on ICIs efficacy. However, ICIs efficacy against melanoma, hepatocellular carcinoma, and esophageal squamous cell carcinoma was not affected, this effect was related to the exposure window (class IV). Class III evidence suggested that proton pump inhibitors have a negative impact on ICIs efficacy; nevertheless, the efficacy against melanoma and renal cell carcinoma was not affected, and the effect was related to exposure before the initiation of ICIs therapy (class II). Although class II/III evidence suggested that steroids have a negative impact, this effect was not observed when used for non-cancer indications and immune-related adverse events (class IV). Class IV evidence suggested that opioids reduce ICIs efficacy, whereas statins and probiotics may improve ICIs efficacy. ICIs efficacy was not affected by histamine 2 receptor antagonists, aspirin, metformin, ß-blockers, and nonsteroidal anti-inflammatory agents. Conclusion: Current evidence suggests that the use of antibiotics, PPIs, steroids, and opioids has a negative impact on the efficacy of ICIs. However, this effect may vary depending on the type of tumor, the timing of exposure, and the intended application. Weak evidence suggests that statins and probiotics may enhance the efficacy of ICIs. Aspirin, metformin, ß-blockers, and NSAIDs do not appear to affect the efficacy of ICIs. However, caution is advised in interpreting these results due to methodological limitations. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO,identifier, CRD42022328681.

Noninvasive left ventricular pressure-strain myocardial work in patients with well-functioning bicuspid aortic valves and aortic dilation: a preliminary study.

Background: Noninvasive left ventricular pressure-strain myocardial work (MW) is a novel method for evaluating left ventricular function that integrates myocardial deformation and afterload and has certain advantages over global longitudinal strain (GLS). The study aimed to analyze MW in patients with well-functioning bicuspid aortic valve (BAV) and explore the influences of aortic dilation and arterial stiffness on left ventricular function. Methods: A total of 104 patients with well-functioning BAVs and 50 controls were enrolled in our study. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE), GLS, and aortic stiffness index were measured. Based on the ascending aortic diameter, patients with BAV were divided into 3 subgroups (nondilated, mildly dilated, and moderately dilated). Results: GWI, GCW, GWW, and aortic stiffness index were significantly increased (P<0.001, P=0.023, P<0.001, and P<0.001, respectively), while GWE and GLS were significantly decreased among patients with BAV compared with controls (all P values <0.001). Patients with BAV and mildly and moderately dilated aortas had an increased GWW and aortic stiffness index but a decreased GWE compared with patients with BAV and nondilated aortas (all P values <0.05); meanwhile, GCW and GLS did not differ among the BAV subgroups (all P values >0.05). GWI was elevated in patients with BAV and moderately dilated aortas compared with patients with BAV and nondilated aortas (P<0.05). On multivariable analysis, the aortic stiffness index was an independent influencer of GWI, GCW, GWW, and GWE (P=0.025, P=0.049, P<0.001, and P=0.001, respectively). The aortic diameter was highly correlated with the aortic stiffness index (r=0.863; P<0.001). Conclusions: MW could assess early myocardial impairment in patients with well-functioning BAV. MW may help to differentiate the detrimental effect of aortic dilation on left ventricular function, whereas GLS may not.

A critical review on selenium removal capacity from water using emerging non-conventional biosorbents.

Anthropogenic-driven selenium (Se) contamination of natural waters has emerged as severe health and environmental concern. Lowering Se levels to safe limits of 40 µg-L-1 (recommended by WHO) presents a critical challenge for the scientific community, necessitating reliable and effective methods for Se removal. The primary obectives of this review are to evaluate the efficiency of different biosorbents in removing Se, understand the mechanism of adsorption, and identify the factors influencing the biosorption process. A comprehensive literature review is conducted to analyze various studies that have explored the use of modified biochars, iron oxides, and other non-conventional biosorbents for selenium removal. The assessed biosorbents include biomass, microalgae-based, alginate compounds, peats, chitosan, and biochar/modified biochar-based adsorbents. Quantitative data from the selected studies analyzed Se adsorption capacities of biosorbents, were collected considering pH, temperature, and environmental conditions, while highlighting advantages and limitations. The role of iron impregnation in enhancing the biosorption efficiency is investigated, and the mechanisms of Se adsorption on these biosorbents at different pH levels are discussed. A critical literature assessment reveals a robust understanding of the current state of Se biosorption and the effectiveness of non-conventional biosorbents for Se removal, providing crucial information for further research and practical applications in water treatment processes. By understanding the strengths and limitations of various biosorbents, this review is expected to scale-up targeted research on Se removal, promoting the development of innovative and cost-effective adsorbents, efficient and sustainable approaches for Se removal from water.

Adsorption and photocatalytic degradation of quinolone antibiotics from wastewater using functionalized biochar.

Quinolone antibiotics are emerging environmental contaminants, which cause serious harm to the ecological environment and human health. How to effectively remove these emerging pollutants from water remains a major challenge worldwide. In this study, a novel Fe/Ti biochar composite (Fe/Ti-MBC) was prepared by facile one-step co-pyrolysis of wood chips with hematite and titanium dioxide (TiO2) for adsorption and photocatalytic degradation of ciprofloxacin (CIP) and norfloxacin (NOR) in water. The results showed that the degradation efficiencies of Fe/Ti-MBC to CIP and NOR were 88.4% and 88.0%, respectively. The π-π interactions and polar interactions are the main adsorption mechanisms for CIP and NOR. In the photocatalytic process, h+ and ·OH are the main active substances for the oxidative degradation of CIP and NOR. This study shows that Fe/Ti-MBC is an effective and recyclable composite, providing a novel alternative way for antibiotics degradation.

Xiaoliu Pingyi Pecipe Inhibits Lung Pre-Metastatic Niche Formation and Prevents Myeloid-Derived Suppressor Cells Recruitment.

BACKGROUND: Metastasis, a leading cause of cancer-related deaths, involves complex mechanisms. The premetastatic niche (PMN) is a crucial contributor to this process. Myeloid-derived suppressor cells (MDSCs) play an important role in PMN formation and promote tumor progression and metastasis. The Xiaoliu Pingyi recipe (XLPYR), a traditional Chinese medicine, is effective in preventing postoperative recurrence and metastasis in cancer patients. OBJECTIVE: This study investigated the effects of XLPYR on MDSCs recruitment and on the expression of PMN markers and elucidated the mechanisms involved in the prevention of tumor metastasis. METHODS: C57BL/6 mice were subcutaneously injected with Lewis cells and treated with cisplatin and XLPYR. Tumors were resected after 14 days after the establishment of a model of lung metastasis, and tumor volume and weight were measured. Lung metastases were observed 21 days after resection. MDSCs in the lung, spleen, and peripheral blood were detected by flow cytometry. Western blotting, qRT-PCR and ELISA were used to detect the expression of S100A8, S100A9, MMP9, LOX, and IL-6/STAT3 in premetastatic lung tissue. RESULTS: XLPYR treatment inhibited tumor growth and prevented lung metastasis. Compared to mice without subcutaneous tumor cell transplantation, the model group had an increased proportion of MDSCs, higher expression of S100A8, S100A9, MMP9, and LOX in the premetastatic lung. XLPYR treatment reduced the proportion of MDSCs, S100A8, S100A9, MMP9, and LOX expression, and downregulated the IL-6/STAT3 pathway. CONCLUSIONS: XLPYR may prevent MDSCs recruitment and reduce the expression of S100A8, MMP9, LOX, and IL6/STAT3 in premetastatic lung tissue, thus reducing lung metastases.

Calcium alginate-nZVI-biochar for removal of Pb/Zn/Cd in water: Insights into governing mechanisms and performance.

Heavy metals pollution in water caused by the intensification of industrial processes and human activities has attracted worldwide attention. Finding an environmental-friendly and efficient remediation method is in need. In this study, the calcium alginate entrapment and liquid-phase reduction method were used to prepare calcium alginate-nZVI-biochar composite (CANRC), which was firstly used to remove Pb2+, Zn2+, and Cd2+ in water. The effects of pyrolysis temperature, solution pH, and coexisting ions, etc. during adsorption processes were explored. Scanning electron microscope-Energy dispersive spectrometer (SEM-EDS), X-ray diffraction spectroscopy (XRD), and X-ray photoelectron spectroscopy (XPS) were used to characterize the physicochemical properties of CANRC before and after adsorption. Different adsorption models and site energy analysis were used to analyze the possible mechanisms. The results showed that CANRC prepared at 300 °C and a 5 wt% Fe loading ratio had the maximum adsorption capacities with a dosage of 2.5 g/L and pH = 5.0- 6.0. The adsorption process was more in line with the Langmuir isotherm model dominated by monolayer adsorption. The maximum adsorption capacities of Pb2+, Zn2+, and Cd2+ were 247.99, 71.77, and 47.27 mg/g, respectively. Site energy analysis combined with XRD and XPS analysis indicated that surface complexation and precipitation were the main adsorption mechanisms. This study provides an alternative way for the removal of heavy metals from water.

Research progress on the mechanisms underlying poultry immune regulation by plant polysaccharides.

With the rapid development of poultry industry and the highly intensive production management, there are an increasing number of stress factors in poultry production. Excessive stress will affect their growth and development, immune function, and induce immunosuppression, susceptibility to a variety of diseases, and even death. In recent years, increasing interest has focused on natural components extracted from plants, among which plant polysaccharides have been highlighted because of their various biological activities. Plant polysaccharides are natural immunomodulators that can promote the growth of immune organs, activate immune cells and the complement system, and release cytokines. As a green feed additive, plant polysaccharides can not only relieve stress and enhance the immunity and disease resistance of poultry, but also regulate the balance of intestinal microorganisms and effectively alleviate all kinds of stress faced by poultry. This paper reviews the immunomodulatory effects and molecular mechanisms of different plant polysaccharides (Atractylodes macrocephala Koidz polysaccharide, Astragalus polysaccharides, Taishan Pinus massoniana pollen polysaccharide, and alfalfa polysaccharide) in poultry. Current research results reveal that plant polysaccharides have potential uses as therapeutic agents for poultry immune abnormalities and related diseases.

In Vitro Fermentation of Hyaluronan with Different Molecular Weights by Human Gut Microbiota: Differential Effects on Gut Microbiota Structure and Metabolic Function.

Hyaluronan (HA) has various biological functions and is used extensively as a dietary supplement. Previous studies have shown that the probiotic effects of polysaccharides are closely associated with their molecular properties. The intestinal microbiota has been demonstrated to degrade HA; however, the regulatory effects of different molecular weights (MW) of HA on gut microbiota and metabolites are unknown. In the present study, we performed in vitro fermentation of human-derived feces for three MWs of HA (HA1, 32.3 kDa; HA2, 411 kDa; and HA3, 1510 kDa) to investigate the differences in the fermentation properties of HA with different MWs. We found that gut microbiota can utilize all HAs and, consequently, produce large amounts of short-chain fatty acids (SCFAs). In addition, we showed that all three HA MWs promoted the growth of Bacteroides, Parabacteroides, and Faecalibacterium, with HA1 being more effective at promoting the growth of Bacteroides. HAs have various regulatory effects on the structure and metabolites of the gut microbiota. Spearman's correlation analysis revealed that alterations in gut microbiota and their metabolites were significantly correlated with changes in metabolic markers. For instance, HA1 enriched α-eleostearic acid and DL-3-aminoisobutyric acid by regulating the abundance of Bacteroides, and HA3 enriched Thymidin by regulating Faecalibacterium. Collectively, the fermentation properties of HA vary across MW, and our results provide insights into the potential association between the MW of HA and its fermentation characteristics by the gut microbiota. These findings provide insights into the influence of the gut microbiota and HAs on the health of the host.

Investigation of mitochondrial targeting ability of sydnones and sydnonimines and mitochondria-targeted delivery of celecoxib.

Mitochondria are considered to be a promising target in cancer diagnosis and therapeutics. Recently, sydnone and sydnonimine, as mesoionic bioorthogonal reagents, have been used in cell labeling and drug delivery. Here we investigated the mitochondrial targeting ability of sydnones and sydnonimines for the first time. Experimental results show that sydnone and sydnonimine themselves have high mitochondrial distribution. However, the introduction of a phenyl group into the C4 position of sydnone dramatically decreases the mitochondrial affinity. In addition, we took advantage of mitochondrial targeting ability and click-and-release reaction of sydnonimine to evaluate anticancer activities of in-mitochondria delivery of celecoxib against HeLa and HepG2 cells, indicating that celecoxib-induced cancer cell death may not involve mitochondria-related pathway.

Coronary artery disease in a patient with Addison's disease: a case report and literature review.

BACKGROUND: Addison's disease which is due to dysfunction of the adrenal gland, with abnormal secretion of glucocorticoids and mineralocorticoids, is rare. By inducing inflammation and disorders of water and electrolyte metabolism, Addison's disease may accelerate progression of co-existed cardiovascular diseases. Addison's disease combined with cardiovascular disease is infrequent, only 10 cases in the literature. CASE PRESENTATION: We reported a 51-year-old male patient with unstable angina pectoris and hypotension. Changes on coronary angiography within 2 years suggested rapid progression of coronary artery disease in a patient with low cardiovascular risk. An additional clue of skin hyperpigmentation, fatigue and further examination confirmed the diagnosis of Addison's disease caused by adrenal tuberculosis. After hormone replacement treatment, the frequency and severity of the angina pectoris were alleviated significantly, as were hypotension, hyperpigmentation and fatigue. CONCLUSIONS: The combination of Addison's disease and coronary artery disease in one patient is rare. Addison's disease can induce inflammation and disorders of water and electrolyte metabolism, which may further accelerate the course of coronary artery disease. Meanwhile, the hypotension in Addison's disease may affect the coronary blood flow, which may result in an increased susceptibility to unstable angina in the presence of coronary stenosis. So, we should analyze comprehensively if the coronary artery disease progress rapidly.