Single-nucleus transcriptomic analysis reveals the relationship between gene expression in oligodendrocyte lineage and major depressive disorder.

BACKGROUND: Major depressive disorder (MDD) is a common mental illness that affects millions of people worldwide and imposes a heavy burden on individuals, families and society. Previous studies on MDD predominantly focused on neurons and employed bulk homogenates of brain tissues. This paper aims to decipher the relationship between oligodendrocyte lineage (OL) development and MDD at the single-cell resolution level. METHODS: Here, we present the use of a guided regularized random forest (GRRF) algorithm to explore single-nucleus RNA sequencing profiles (GSE144136) of the OL at four developmental stages, which contains dorsolateral prefrontal cortex of 17 healthy controls (HC) and 17 MDD cases, generated by Nagy C et al. We prioritized and ordered differentially expressed genes (DEGs) based on Nagy et al., which could predominantly discriminate cells in the four developmental stages and two adjacent developmental stages of the OL. We further screened top-ranked genes that distinguished between HC and MDD in four developmental stages. Moreover, we estimated the performance of the GRRF model via the area under the curve value. Additionally, we validated the pivotal candidate gene Malat1 in animal models. RESULTS: We found that, among the four developmental stages, the onset development of OL (OPC2) possesses the best predictive power for distinguishing HC and MDD, and long noncoding RNA MALAT1 has top-ranked importance value in candidate genes of four developmental stages. In addition, results of fluorescence in situ hybridization assay showed that Malat1 plays a critical role in the occurrence of depression. CONCLUSIONS: Our work elucidates the mechanism of MDD from the perspective of OL development at the single-cell resolution level and provides novel insight into the occurrence of depression.

Association between the triglyceride-glucose index and in-hospital major adverse cardiovascular events in patients with acute coronary syndrome: results from the Improving Care for Cardiovascular Disease in China (CCC)-Acute Coronary Syndrome project.

OBJECTIVE: Although the TyG index is a reliable predictor of insulin resistance (IR) and cardiovascular disease, its effectiveness in predicting major adverse cardiac events in hospitalized acute coronary syndrome (ACS) patients has not been validated in large-scale studies. In this study, we aimed to explore the association between the TyG index and the occurrence of MACEs during hospitalization. METHODS: We recruited ACS patients from the CCC-ACS (Improving Cardiovascular Care in China-ACS) database and calculated the TyG index using the formula ln(fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). These patients were classified into four groups based on quartiles of the TyG index. The primary endpoint was the occurrence of MACEs during hospitalization, encompassing all-cause mortality, cardiac arrest, myocardial infarction (MI), and stroke. We performed Cox proportional hazards regression analysis to clarify the correlation between the TyG index and the risk of in-hospital MACEs among patients diagnosed with ACS. Additionally, we explored this relationship across various subgroups. RESULTS: A total of 101,113 patients were ultimately included, and 2759 in-hospital MACEs were recorded, with 1554 (49.1%) cases of all-cause mortality, 601 (21.8%) cases of cardiac arrest, 251 (9.1%) cases of MI, and 353 (12.8%) cases of stroke. After adjusting for confounders, patients in TyG index quartile groups 3 and 4 showed increased risks of in-hospital MACEs compared to those in quartile group 1 [HR = 1.253, 95% CI 1.121-1.400 and HR = 1.604, 95% CI 1.437-1.791, respectively; p value for trend < 0.001], especially in patients with STEMI or renal insufficiency. Moreover, we found interactions between the TyG index and age, sex, diabetes status, renal insufficiency status, and previous PCI (all p values for interactions < 0.05). CONCLUSIONS: In patients with ACS, the TyG index was an independent predictor of in-hospital MACEs. Special vigilance should be exercised in females, elderly individuals, and patients with renal insufficiency.

Assoication between self-reported sleep duration, physcial activity and the risk of all cause and cardiovascular diseases mortality from the NHANES database.

OBJECTIVE: The purpose of this study was to investigate the combined effect of self-reported sleep durations and physical activity (PA) on all cause and cardiovascular diseases mortality. METHODS: Twenty-nine thousand fifty-eight participants (48.5% male, median age 49 years) from the National Health and Nutrition Examination Survey cycles 2007 to 2016 were included. We classified sleep duration into five categories (< 5.5 h/d,5.5-6.5 h/d,6.5-7.5 h/d,7.5-8.5 h/d, ≥ 8.5 h/d) and classified PA levels into three groups (high, medium and low). PA information and self-reported sleep duration were obtained by questionnaire. We derived 15 PA-sleep duration combinations. The primary endpoint was all-cause mortality, and the major secondary endpoint was cardiovascular diseases (CVD) mortality as of December 2022. RESULTS: Median follow-up was 91 months. Compared with standard sleep duration (6.5-7.5 h/d), both shorter (< 5.5 h/d) and longer (≥ 8.5 h/d) sleep durations increased risks of all-cause mortality and CVD mortality in low PA. The deleterious associations of sleep duration with all outcomes was amplified by lower PA. There was no significant reduction in CVD mortality risk associated with increased physical activity during short sleep duration (< 6.5 h/d). During standard sleep, low PA significantly increased CVD mortality risk. At medium physical activity, both short and long sleep increased cardiovascular mortality. It was also found that sleep duration (≥ 8.5 h/d) was associated with a increase in all-cause and cardiovascular mortality at both low and high PA levels. CONCLUSIONS: This study suggested that low PA significantly increased the association of self-reported long and short sleep durations with all-cause and CVD mortality. All cause mortality appears to benefit from medium physical activity, while medium PA did not. Physical activity did not significantly reduce the risk of CVD mortality.

Increased plasma lipoprotein-associated phospholipase A2 levels are associated with coronary slow flow.

OBJECTIVE: Coronary slow flow (CSF) is characterized by delayed opacification of distal epicardial coronary arteries without significant coronary stenosis. In addition, The changes of lipoprotein-associated phospholipase A2 (Lp-PLA2) as a significant predictive factor for CSF remain controversial. The study aims to investigate the association between plasma Lp-PLA2 and CSF. METHODS: In this retrospective study, 170 consecutive patients who underwent coronary angiography were enrolled in Beijing Anzhen Hospital from January 2017 to September 2019, and were divided into CSF group and normal control groups. According to coronary blood flow rate measured by the thrombolysis in myocardial infarction frame count (TFC) method, CSF was defined as TFC > 27. Serum Lp-PLA2 levels were measured in an enzyme-linked immunosorbent assay. RESULTS: Lp-PLA2 levels were higher in the CSF group than in the control group (288.6 ± 50.3 versus 141.9 ± 49.7, P < 0.001) and were significantly correlated with the mean coronary artery thrombolysis in myocardial infarction (TIMI) frame count (r = 0.790, P<0.001). Logistic regression analysis showed that high Lp-PLA2 was independently associated with CSF after adjustment for conventional risk factors (OR = 1.040, CI = 1.022-1.059, P<0.001). Male sex (OR = 2.192, CI = 1.161-4.140, P = 0.016) and hypertension (OR = 1.965, CI = 1.034-3.736, P = 0.039) were also CSF risk factors. Receiver-operating characteristic curve (ROC) analysis showed that Lp-PLA2 levels can predict CSF severity; the predictive power was higher than the other risk factors. CONCLUSION: Our study demonstrated that patients with CSF had higher circulating levels of Lp-PLA2 than normal controls. After adjustment for potential confounders, increased Lp-PLA2 was independently associated with presence of CSF.

Variables associated with vaginal discharge after ultrasound-guided percutaneous microwave ablation for adenomyosis.

Objective The aim of this study was to analyse the significant variables for vaginal discharge after ultrasound-guided percutaneous microwave ablation (PMWA) therapy. Materials and methods PMWA was performed on 117 patients with adenomyosis from October 2012 to July 2014. The presence or absence, colour, quantity and duration of vaginal discharge, which was different from pre-ablation, were recorded within 1 year after PMWA. Patients were categorised into G1 (n = 26, without vaginal discharge), G2 (n = 40, vaginal discharge lasting 1 to 19 days), and G3 (n = 51, vaginal discharge lasting ≥20 days) groups. The potentially correlative variables were analysed. Variables with significant correlations with vaginal discharge post-ablation were identified via binary logistic regression analysis. Results The differences in adenomyosis type, pre-ablation uterine volume, total microwave ablation energy, total non-perfused volume (NPV) and minimum distance from the non-perfused lesion (NPL) margin to the endomyometrial junction (EMJ) among groups were statistically significant (p = 0.005, p = 0.000, p = 0.000, p = 0.005 and p = 0.000, respectively). Minimum distance from the NPL margin to the EMJ was the strongest predictor of vaginal discharge post-ablation with odds ratio (OR) 0.632, p = 0.018, 95% CI 0.432-0.923. Patients with diffuse adenomyosis were more likely to have prolonged vaginal discharge (≥20 days) post-ablation (OR 3.461, p = 0.000, 95% CI 1.759-7.536). Conclusion The minimum distance from the NPL margin to the EMJ and adenomyosis type were significantly associated with vaginal discharge post-ablation.

Diagnostic performance of computed tomography for detection of concomitant coronary disease in hypertrophic cardiomyopathy.

OBJECTIVES: To evaluate the diagnostic performance of computed tomography (CT) in patients with hypertrophic cardiomyopathy (HCM) and suspected coexistent coronary artery diseases (CADs). METHODS: Sixty patients were enrolled in this study. Cardiac CT examination included CT coronary angiography (CTCA) and delayed enhancement CT. CT performance in evaluation of the coronary artery was assessed and compared with that of catheter-based coronary angiography (CA). The left ventricle (LV) wall thickness, functional indices and myocardial delayed enhancement (MDE) were measured via cardiac magnetic resonance (CMR) and CT images. RESULTS: Compared with catheter-based CA, CTCA produced a 100 % (24/24) sensitivity, a 94.4 % (34/36) specificity, a 92.3 % (24/26) positive predictive value and a 100 % (34/34) negative predictive value. CT-measured LV wall thickness and functional indices were correlated with those measured via CMR (P < 0.01), though the CT-measured values were smaller than the CMR-measured values. Bland-Altman analysis showed the volume of the focal MDE determined via CT was slightly smaller than that determined using CMR (mean difference: 0.3 cm(3)). CONCLUSIONS: For patients with HCM and suspected coexistent CAD, this comprehensive cardiac CT protocol can be helpful in ruling out coronary stenosis and can provide information regarding morphology, function and tissue characterization of the LV myocardium.

Ultrasound-guided percutaneous microwave ablation for submucosal uterine fibroids.

STUDY OBJECTIVE: To prospectively evaluate the efficiency and safety of ultrasound-guided percutaneous microwave ablation (PMWA) in treating symptomatic submucosal uterine myomas. DESIGN: Self-controlled study (Canadian Task Force classification II-1). SETTING: Single center. PATIENTS: Twenty-two premenopausal women with 22 symptomatic submucosal uterine myomas. INTERVENTION: All patients underwent ultrasound-guided PMWA. MEASUREMENTS AND MAIN RESULTS: PMWA was performed in 22 premenopausal women with 22 symptomatic submucosal uterine myomas. Mean (SD) patient age was 42 (4.60) years (95% confidence interval [CI], 39.96-44.04). Five symptomatic submucosal uterine myomas were identified as type 0, 7 as type 1, and 10 as type 2. Contrast-enhanced ultrasound and magnetic resonance imaging were performed before and after surgery. Myoma volume, hemoglobin concentration, and scores on the UFS-QOL (Uterine Fibroid Symptom and Quality of Life) questionnaire were recorded before and at 3 and 12 months after ablation. Complications were also recorded. In all patients, therapy was completed with a single ablation. The baseline diameter of the symptomatic submucosal uterine myomas was 4.90 (1.60) cm. Mean myoma volume reduction rate was 81.46% (16.33%) (95% CI, 73.06%-89.86%) at 3 months (p < .001) and reached 90.00% (9.79%) (95% CI, 85.07-95.13) at 12 months (p < .001). At 3 months after ablation, hemoglobin concentration increased from 88.64 (21.87) g/L (95% CI, 78.94-98.34) to 123.21 (15.77) g/L (95% CI, 115.10-131.32) (p < .001), and remained stable at 12 months, with a value of 125.92 (14.90) g/L (95% CI, 117.98-133.86). Scores on the UFS-QOL were comparable, with normal levels observed at 1 year. No major complications were observed. Nine patients were discharged with necrotic masses. CONCLUSION: PMWA seems to be effective and safe for treatment of submucosal myomas.

[Follow-ups of mid-term and long-term outcomes for uterine intramural myomas after percutaneous microwave ablation therapy].

OBJECTIVE: To evaluate the mid-term and long-term clinical outcomes for symptomatic intramural uterine myoma after ultrasound-guided percutaneous microwave ablation therapy (PMAT). METHODS: A total of 123 women with intramural uterine myoma underwent PMAT. Prospective studies were conducted to compare the dominant fibroid volume (FV), hemoglobin (HGB) and Uterine Fibroid Symptoms and Quality of Life Questionnaire (UFS-QOL) at baseline and 1, 2, 3 and 4 years of follow-up RESULTS: Comparing with the baseline, the shrinkage rate of FV at 1 year follow-up was 74.5%. HGB of anemic patients pre-PMAT increased from 91 ± 11 to 114 ± 20 g/L. Two parts of UFS-QOL symptoms severity scores (SSS) and health-related quality of life (HRQL) changed from 43 ± 10 to 18 ± 16 and 41 ± 21 to 90 ± 16 respectively at 1year follow-up. All four items stayed nearly the same at 2, 3 and 4 years post-therapy. CONCLUSION: Ultrasound-guided PMAT of uterine fibroids can effectively ameliorate the mid-term and long-term clinical syndromes and improve quality of life by shrinking fibroids effectively or even disappearing completely.

Association between stress hyperglycemia ratio and in-hospital outcomes: findings from the improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) Project.

BACKGROUND: Stress hyperglycemia ratio (SHR) could provide accurate information on the acute status of hyperglycemia. The relationship between SHR and acute coronary syndrome (ACS) prognosis remains unclear. This study was conducted to identity the association between SHR and in-hospital outcomes in patients with ACS. METHODS: A total of 12,010 patients were eventually enrolled in the study. The relationship between SHR and in-hospital major adverse cardiovascular events (MACEs) was then modeled by restricted cubic spline (RCS) curves, and all patients were divided into three groups according to the results. The multivariate logistic regression analysis was used to determine the associations between the SHR and in-hospital outcomes, described as odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses were also performed on different diseases. RESULTS: The median age of this cohort was 63 (54, 71) years old, and 8942 (74.5%) were male. Group 1 was defined as SHR < 0.6 (n = 426), Group 2 was defined as SHR between 0.6 and 1 (n = 5821), and Group 3 was defined as SHR > 1 (n = 5763). Compared with Group 2, Group 1 (OR = 1.891, 95% CI: 1.028-3.479, P < 0.001) and Group 3 (OR = 1.868, 95% CI: 1.434-2.434, P < 0.001) had higher risks of suffering from in-hospital MACEs. SHR was associated with higher risks of in-hospital MACEs in the subgroups of DM [OR = 2.282, 95% CI: 1.477-3.524). CONCLUSIONS: Both low and high SHR levels were independently associated with in-hospital MACEs. Young males with DM, hypertension, and decreased renal function had much higher risks of suffering from SHR-correlated MACEs.

Elevated Plasma Lipoprotein(a) Level and Atherosclerotic Cardiovascular Disease Risks: A Large Clinical Retrospective Study.

Patients with well-controlled low-density lipoprotein cholesterol (LDL-C) levels still suffer from the progress of the atherosclerotic cardiovascular disease (ASCVD) and can develop adverse outcomes. We conducted this study to analyze the relationship between elevated lipoprotein(a) [Lp(a)] levels and ASCVD risk. We enrolled 8070 patients in the ASCVD group and 440 participants in the non-ASCVD group [median age of 60 years; 6376 (74.9%) were male]. Multivariate logistic regression models were used to identify the relationships between the lipids and ASCVD. These models showed that the Lp(a) level was a significant independent risk factor for ASCVD [odds ratio (OR) = 1.025, confidence interval (CI) = 1.020-1.029, P < .001]. The different categories analysis showed the OR of the high Lp(a)/low LDL-C group was 9.612 [CI = 6.206-14.887], P < .001. Our study demonstrated that elevated Lp(a) levels were associated with the increased ASCVD risk. Also, the patients with low LDL-C but high Lp(a) levels still had a higher risk of developing ASCVD than the low Lp(a)/high LDL-C group. In addition, elevated Lp(a) levels were associated with a higher ASCVD risk in males, hypertensive, and diabetic patients.

The Effect of Sleep Quality on Coronary Lesion Severity and Prognosis in the Young Acute Coronary Syndrome Population.

This study aimed to explore the effect of long-term (≥1 year) sleep quality on coronary lesion complexity and cardiovascular prognosis in young acute coronary syndrome (ACS) patients. We consecutively recruited young patients aged from 18 to 44 years old with first-episode ACS and significant epicardial stenosis on coronary angiography from January 2016 to January 2017. Coronary lesion complexity was evaluated based on SYNTAX scores. Long-term sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) (PSQI ≤ 5 and PSQI > 5 groups). The primary endpoints were major adverse cardiovascular events (MACEs). A total of 466 young ACS patients (93.13% male; median age, 41 years) were included. Poor sleepers (PSQI > 5) had higher SYNTAX scores. After adjusting for confounders, PSQI scores (continuous variables, OR: 1.264; 95%CI: 1.166-1.371; p < 0.001) and PSQI grade (binary variable, OR: 3.864; 95%CI: 2.313-6.394; p = 0.001) were significantly associated with an increased risk of complex coronary lesions. During a median follow-up of 74 months, long-term poor sleep quality (PSQI > 5) was significantly associated with an increased risk of MACEs (HR: 4.266; 95%CI: 2.274-8.001; p < 0.001). Long-term poor sleep quality was a risk factor for complex coronary lesions and has adverse effects on cardiovascular prognosis in the young ACS population.

Impact of urban agglomeration construction on urban air quality-empirical test based on PSM-DID model.

Urban agglomerations have become a new trend in the development of urbanization and regionalization in the world today. The construction of urban agglomerations has brought rapid economic development as well as a series of ecological and environmental problems, especially the impact on urban air quality. How to understand and evaluate the impact of urban agglomeration construction on air quality is a key issue that requires attention. City cluster construction is equivalent to a "quasi-natural experiment". This study empirically examines the impact of urban agglomeration construction on air quality in southwest China by constructing a PSM-DID model. It is found that: (1) City cluster construction has significantly improved urban air quality in urban clusters with lagging and forward-looking effects on air quality. (2) In terms of influencing factors, the level of economic development considerably improves the air quality of urban cluster cities, the industrial structure severely deteriorates the air quality of these cities, and meteorological factors highly affect their air quality. Among them, average annual urban rainfall significantly reduces urban air pollutant concentrations in urban clusters, average annual temperature significantly increases urban air pollutant concentrations, and average annual wind speed can reduce urban air pollutant concentrations. (3) Urban agglomerations are spatially heterogeneous in their impact on air quality. In this context, the topographical conditions and the level of development of urban agglomerations have a non-negligible influence on pollutant concentrations. (4) The distribution pattern of air quality pollutant concentrations in each urban agglomeration is unstable, and there are large differences in these concentrations between different urban agglomerations.

Spatiotemporal patterns and prediction of landscape ecological security in Xishuangbanna from 1996-2030.

In recent years, the landscape ecological security of Xishuangbanna in southwest China has become an essential factor affecting the cross-border ecological security in South Asia and Southeast Asia. Based on the change of land use in Xishuangbanna, with the help of "3S" technology, landscape ecology theory, and gray prediction model, the spatial and developmental trends of landscape ecological security in Xishuangbanna from 1996-2030 could be determined. In more than 20 years, the woodland landscape area in Xishuangbanna decreased, and the fragmentation of construction land has increased overall. In 1996, the overall landscape ecological safety was good, with 63.5% of the total area of grade I and II. In 2003, the proportion of the grade I and grade II areas decreased, with landscape ecological security problems appearing. In 2010, the overall landscape ecological security area reached 74.5%, the largest proportion in more than 20 years. The grade V area accounted for only 9% and was mainly distributed on the border of Menghai County and central Jinghong City. In 2017, The grade IV and V areas was further increased, and the ecological security problem intensified. The prediction results showed that from 2023 to 2030, the regions of grades I and II increased, but the proportion of level V regions increased. Furthermore, the grade IV transformed to grade V rapidly, reaching its highest value in more than 20 years. From 1996 to 2030, the landscape ecological security space significantly evolved, showing an evident "east-south" trend in movement and eventually shifting to the southeast.

Development and Validation of Deep Learning Models for the Multiclassification of Reflux Esophagitis Based on the Los Angeles Classification.

This study is to evaluate the feasibility of deep learning (DL) models in the multiclassification of reflux esophagitis (RE) endoscopic images, according to the Los Angeles (LA) classification for the first time. The images were divided into three groups, namely, normal, LA classification A + B, and LA C + D. The images from the HyperKvasir dataset and Suzhou hospital were divided into the training and validation datasets as a ratio of 4 : 1, while the images from Jintan hospital were the independent test set. The CNNs- or Transformer-architectures models (MobileNet, ResNet, Xception, EfficientNet, ViT, and ConvMixer) were transfer learning via Keras. The visualization of the models was proposed using Gradient-weighted Class Activation Mapping (Grad-CAM). Both in the validation set and the test set, the EfficientNet model showed the best performance as follows: accuracy (0.962 and 0.957), recall for LA A + B (0.970 and 0.925) and LA C + D (0.922 and 0.930), Marco-recall (0.946 and 0.928), Matthew's correlation coefficient (0.936 and 0.884), and Cohen's kappa (0.910 and 0.850), which was better than the other models and the endoscopists. According to the EfficientNet model, the Grad-CAM was plotted and highlighted the target lesions on the original images. This study developed a series of DL-based computer vision models with the interpretable Grad-CAM to evaluate the feasibility in the multiclassification of RE endoscopic images. It firstly suggests that DL-based classifiers show promise in the endoscopic diagnosis of esophagitis.

Remnant Cholesterol and the Risk of Coronary Artery Disease in Patients With Type 2 Diabetes.

Among statin-treated patients with type 2 diabetes mellitus (T2DM), there is still a great residual cardiovascular risk. Previous studies found that the level of remnant cholesterol (RC) could predict the coronary artery disease (CAD) risk. In the present study, we enrolled 4145 patients with T2DM; 2784 (67.2%) were male and their median age was 62 years. After multivariate logistic analyses, plasma RC level was significantly and independently associated with CAD [odds ratio (OR) 13.524, 95% confidence interval (CI) = 7.058-25.912, P < .001) after adjustment for conventional risk factors, such as age, gender, hypertension, and other lipid levels. Even in the presence of high high-density lipoprotein cholesterol (HDL-C) level, the elevated RC could still predict CAD in T2DM patients (OR 2.064, 95%CI 1.438-2.964, P < .001). Furthermore, RC had relationships with age, hypertension, and smoking status in promoting CAD progression in T2DM patients, with all p for interactive <.001. In conclusion, RC level was independently associated with CAD risk in patients with T2DM.

Characterization of the complete mitochondrial genome of Glyptothorax minimaculatus and phylogenetic studies of Sisoridae.

The entire mitochondrial genome (mitogenome) of Glyptothorax minimaculatus was sequenced; it spanned 16,536 bp in length and contained 13 protein-coding genes (PCGs), 2 ribosomal RNAs, and 22 transfer RNA genes. A total of 37 genes formed a typical vertebrate mitochondrial gene arrangement. The phylogenetic tree of Sisoridae based on 13 PCGs was constructed and supported that G. minimaculatus was closely related to Glyptothorax sinensis, Glyptothorax zanaensis, Glyptothorax longinema, Glyptothorax granosus and Glyptothorax lanceatus. The mitogenome of G. minimaculatus described in this study provided molecular evidence for its current taxonomic status and laid a groundwork for further study concerning phylogenetics within Sisoridae.

Stenting techniques for coronary bifurcation disease: a systematic review and network meta-analysis demonstrates superiority of double-kissing crush in complex lesions.

OBJECTIVE: This study was aimed to compare different stenting techniques for coronary bifurcation disease (CBD). BACKGROUND: Percutaneous coronary intervention (PCI) remains controversial for CBD; over the years, several stent techniques for bifurcation lesions have been used. Current guidelines recommend a provisional single-stent strategy as the preferred method for coronary artery bifurcation lesions. However, several randomized controlled trials (RCT) indicated that two-stent techniques showed better clinical outcomes. METHODS: We systematically searched Embase, PubMed, and Web of Science to include RCTs. The primary endpoint was the major adverse cardiovascular event (MACE). Secondary outcomes were cardiac death, myocardial infarction (MI), target-lesion or target-vessel revascularization (TLR or TVR), and definite or probable stent thrombosis (ST). Finally, we used 26 RCTs and a total of 7257 individuals were randomly assigned to one of the 6 stent techniques and included in this network meta-analysis. RESULTS: In our network meta-analysis, double-kissing (DK) crush was significantly more superior to other 5 stent techniques in MACEs: OR vs. provisional 0.40 (95% CI 0.28-0.55); vs. culotte 0.40 (95% CI 0.26-0.60). DK crush ranked the most effective treatment for MACE (100%), MI (75%), ST (83%), and TLR (100%) in the rank probabilities analysis. In patients with complex bifurcation lesion defined by DEFINITION criteria, DK crush was notably more efficacious than provisional, culotte, and T-stenting/T-stenting and protrusion (TAP) in MACEs (OR vs. provisional 0.26, 95% CI 0.13-0.52) and TLR (OR vs. provisional 0.24, 95% CI 0.10-0.58). CONCLUSION: Compared with other stenting techniques, DK crush had a lower incidence of MACEs in CBD. DK crush was significantly associated with a lower rate of MACEs in patients with complex bifurcation lesions defined by the DEFINITION criterion.

The Use of Three-Column Enhanced Percutaneous Vertebroplasty to Treat Kummell's Disease.

Purpose: To describe the operative technique and clinical effects of three-column enhanced percutaneous vertebroplasty used to treat Kummell's disease. Methods: From April 2017 to April 2020, 39 patients with Kummell's disease were treated via three-column enhanced percutaneous vertebroplasty. There were 12 males and 27 females of average age 70.23 ± 7.41 years. The operative time, volume of bone cement injected, and intraoperative cement leakage were recorded. The patients were re-examined postoperatively. The VAS was used to evaluate low back pain and the ODI score to evaluate improvement in the quality-of-life. Results: All patients were successfully operated upon; the average operation time was 35.1±4.7 min and average volume of bone cement injected 4.5±0.92 mL. Five cases exhibited bone cement leakage during operation, two into the intervertebral disc and three into the anterior upper margin of the vertebral body. No leakage into the vertebral canal occurred. The average hospital stay was 2.50±0.86 days. The VAS score before operation was 7.47±0.24, but low back pain symptoms were significantly relieved after operation (P < 0.05). The VAS scores at 1 day and 1, 3, 6, and 12 months after operation were 2.91±0.09, 2.04±0.07, 1.59±0.05, 1.28±0.15, and 0.8±0.18, respectively. The preoperative ODI score was 72.97±1.45 and significantly decreased postoperatively (P < 0.05), being 30.08±1.79 at 1 day, and 25.35±0.94, 23.19±1.76, 20.49±0.65, and 20.05±0.58 at 1, 3, 6, and 12 months after operation respectively. Conclusion: Three-column enhanced percutaneous vertebroplasty effectively treats Kummell's disease. The surgical trauma is low, recovery rapid, and bone cement fixation firm, especially in patients with stage I and II disease.

Remnant cholesterol and atherosclerotic cardiovascular disease: Metabolism, mechanism, evidence, and treatment.

This review aimed to summarize the evidence of elevated remnant cholesterol and the risks of atherosclerotic cardiovascular disease (ASCVD) and to search for further guidance in clinical therapy. The lipids-lowering treatments such as statins and ezetimibe targeted on low-density lipoprotein cholesterol (LDL-C) have always been the first-line therapy for ASCVD. However, even after statins or new lipid-lowering drugs lowered LDL-C to recommended concentrations, and with other risk factors well-controlled, such as high blood pressure, the risks of developing ASCVD remained. Remnant cholesterol (RC) referred to the cholesterol contained in all remnant lipoprotein particles, which was the cholesterol in the hydrolyzed very-low-density lipoprotein and intermediate-density lipoprotein in the fasting state, and the cholesterol in the chylomicron remnants in the postprandial state. Evidence from in vitro and animal pathogenic mechanisms studies, epidemiology, and genetic studies all indicated that RC played an important role in predicting the incidence of ASCVD. As a new indicator to reflect atherosclerosis, especially when LDL-C has been controlled to a recommended level, RC was considered as a priority treatment target for people at high risk of ASCVD. The use of statins, fibrates, APOC3 inhibitors, PCSK9 inhibitors, and omega-3 fatty acids to reduce RC levels in the plasma may provide long-term benefits. However, the standardized detection of RC was still controversial, and more studies on appropriate treatments of elevated RC are urgently needed. These positive trials may benefit more patients at high ASCVD risks worldwide in the future.

Association of Plasma MiRNA-204 and the Presence and Severity of Coronary Artery Calcification in Patients With Type 2 Diabetes.

We investigated the association between plasma microRNA (miR)-204 and coronary artery calcification (CAC) in patients with type 2 diabetes mellitus (T2DM). We consecutively enrolled 179 individuals with T2DM who underwent coronary computed tomography at Anzhen Hospital from January 2015 to September 2016. The CAC score (CACS) was expressed in Agatston units and >10 Hounsfield units were defined as CAC-positive status. Significant CAC was observed in 98 (54.7%) patients. Plasma miR-204 levels (relative expression) were significantly lower in patients with significant CAC than controls (1.001 ± 0.100 vs 0.634 ± 0.211, P < .001). Plasma miR-204 levels were also negatively correlated with the glycosylated hemoglobin A1c (HbA1c) level (r = -0.702, P < .001), CACS (r = -0.710, P < .001), and the United Kingdom Prospective Diabetes Study (UKPDS) score (r = -0.355, P < .001). After multivariate logistic analyses, plasma miR-204 levels were still significantly and independently associated with the presence of CAC (odds ratio = 0.103, CI = 0.018-0.583, P < .001) after adjustment for conventional risk factors. Receiver operating characteristic curve analysis showed that plasma miR-204 levels can predict the severity and extent of CAC, and the specificity was higher than that of the traditional risk factors UKPDS score and HbA1c. In conclusion, the downregulation of miR-204 was independently associated with CAC in patients with T2DM.