Case report: Acute ST-elevation myocardial infarction and cardiogenic shock caused by a giant right sinus of Valsalva aneurysm and right coronary artery compression.

A sinus of Valsalva aneurysm (SVA) is a rare aortic disease that may be congenital or acquired. Patients with an intact SVA are usually asymptomatic, whereas a ruptured SVA may cause acute chest pain and dyspnea. We present a rare case of acute ST-elevation myocardial infarction and cardiogenic shock in a 51-year-old man. Emergency coronary angiography revealed a giant aneurysm with an absence of flow in the right coronary artery. Both two-dimensional echocardiography and computed tomography angiography showed a giant right SVA, which ruptured into the pericardial sac and led to extrinsic compression of the right coronary artery. Surgical repair combined with coronary bypass grafting was performed. Unfortunately, the patient died from low cardiac output syndrome and postoperative multiple organ failure. This case highlights that the possibility of SVA rupture should be considered in acute myocardial infarction cases and that echocardiography and coronary computed tomography angiography are important in providing an accurate and rapid SVA diagnosis.

Review on Functional Testing Scenario Library Generation for Connected and Automated Vehicles.

The advancement of autonomous driving technology has had a significant impact on both transportation networks and people's lives. Connected and automated vehicles as well as the surrounding driving environment are increasingly exchanging information. The traditional open road test or closed field test, which has large costs, lengthy durations, and few diverse test scenarios, cannot satisfy the autonomous driving system's need for reliable and safe testing. Functional testing is the emphasis of the test since features such as frontal collision and traffic sign warning influence driving safety. As a result, simulation testing will undoubtedly emerge as a new technique for unmanned vehicle testing. A crucial aspect of simulation testing is the creation of test scenarios. With an emphasis on the map generating method and the dynamic scenario production method in the test scenarios, this article explains many scenarios and scenario construction techniques utilized in the process of self-driving car testing. A thorough analysis of the state of relevant research is conducted, and approaches for creating common scenarios as well as brand-new methods based on machine learning are emphasized.

Joint effects of serum ferritin and body mass index on the risk of coronary artery disease: a case-control study.

OBJECTIVES: Serum ferritin and body mass index (BMI) have been reportedly associated with coronary artery disease (CAD) risk. The aim of the present study was to explore the interaction between serum ferritin and BMI on CAD risk. DESIGN: Hospital-based case-control study. SETTING: Patients with CAD and the controls were recruited from Qilu Hospital, Shandong University. PARTICIPANTS: 258 CAD cases and 282 healthy controls. METHODS: Multiplicative interaction was assessed through a cross-product interaction term in a multivariate logistic regression model. The effect of serum ferritin and BMI were evaluated per 50 µg/L and per 2 kg/m(2), respectively. The presence of additive interaction between serum ferritin and BMI was evaluated by calculation of the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S). RESULTS: The ORs and 95% CI of the serum ferritin-BMI product term on a multiplicative scale in the univariate and multivariate models were 0.943 (0.904 to 0.984) and 1.004 (0.951 to 1.059), respectively. There was also evidence for interaction on an additive scale; the RERI (95% CI), AP (95% CI) and S (95% CI) in the univariate model were 0.314 (0.026 to 1.506), 0.107 (0.017 to 0.241) and 1.194 (1.053 to 1.406), respectively. After adjusting for the potential confounders, the estimates and 95% CIs for the aforementioned three measures were 0.004 (-0.016 to 0.311), 0.004 (-0.016 to 0.191) and 1.039 (0.774 to 1.285), respectively. CONCLUSIONS: Serum ferritin and BMI had an additive interaction on the risk of CAD in Chinese population. Further investigations with big sample size are necessary for confirming this additive interaction.

Effect of L-arginine supplementation on blood pressure in pregnant women: a meta-analysis of placebo-controlled trials.

OBJECTIVE: A meta-analysis of placebo-controlled trials was conducted to evaluate the effect of L-arginine supplementation on blood pressure (BP) in pregnancy. METHODS: Trials were searched in PubMed, Embase, and Cochrane Library. A total of five trials were included in the meta-analysis. RESULTS: L-arginine supplementation exhibited a mean decrease of 3.07 mmHg (p = 0.004) for diastolic blood pressure and a mean increase of 1.23 weeks (p = 0.002) for gestation age at delivery in pregnancy, but did not reduce systolic BP (p = 0.19) as compared to placebo. CONCLUSION: L-arginine supplementation had a significant effect of lowering diastolic blood pressure and prolonging gestation age in pregnancy.

Fibroblast growth factor receptor 4 polymorphisms and coronary artery disease: a case control study.

Fibroblast growth factors (FGFs) and their receptors (FGFRs) play important roles in vascular system. FGFR4 rs351855 (Gly388Arg) polymorphism has shown to be a risk factor for many diseases. The aim of this study was to investigate the association between FGFR4 polymorphisms and the susceptibility to coronary artery disease (CAD) in the Chinese population. We identified three polymorphisms in the FGFR4 gene, rs351855G/A (Gly388Arg), rs145302848C/G and rs147603016G/A, by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 658 CAD cases and 692 healthy controls. Results showed that frequencies of GA genotype, AA genotype and A allele in rs351855 (Gly388Arg) polymorphism were significantly lower in CAD patients than in controls [odds ratio (OR) = 0.79, 95 % confidence intervals (CI) 0.62-0.99, P = 0.042; OR = 0.58, 95 % CI 0.41-0.81, P = 0.002; and OR = 0.77, 95 % CI 0.66-0.90, P = 0.001, respectively]. The rs147603016GA genotype and A allele also showed lower numbers in CAD cases (OR = 0.58, 95 % CI 0.36-0.93, P = 0.025; and OR = 0.59, 95 % CI 0.40-0.95, P = 0.028). The rs145302848C/G polymorphism did not show any correlation with CAD. Haplotype analysis revealed that the prevalence of ACG haplotype (rs351855, rs145302848 and rs147603016) was significantly decreased in CAD patients (P = 0.002). Our data suggested that the FGFR4 rs351855G/A (Gly388Arg) and rs147603016G/A polymorphisms could act as protective factors against CAD in the Chinese population and indicated that a single gene polymorphism could have diverse functions in different diseases.

Association of serum ferritin with coronary artery disease.

BACKGROUND: Published results regarding the association of serum ferritin with coronary artery disease (CAD) were conflicting, thus a case-control study and a meta-analysis were performed to assess the association between serum ferritin and CAD risk. METHODS: A hospital-based case-control study was conducted with 258 CAD cases and 282 healthy controls. The restricted cubic spline (RCS) function with three knots was used to assess the concentration-risk association between serum ferritin and CAD risk. A meta-analysis was performed including 20 outcomes. Fixed or random effect pooled measure was selected on the basis of homogeneity test among studies. RESULTS: In our case-control study, compared with serum ferritin concentrations less than 200 µg/L as the reference, the trend of CAD risk increased by 4.2% for every 50 µg/L increase in serum ferritin (OR=1.042, 95% CI=0.946-1.147). In the meta-analysis and after excluding articles that were the key contributors to between-study heterogeneity, the standardized mean difference (SMD) of serum ferritin was associated with increased CAD risk (FEM: SMD=0.119, 95% CI=0.073-0.165). And the concentration-risk meta-analysis suggested that, for every 50 µg/L increase of serum ferritin, the risk of CAD increases by 2.4% (OR=1.024, 95% CI=1.001-1.048). CONCLUSION: These findings indicate that serum ferritin is weakly positively associated with CAD risk. This risk needs to be confirmed by further studies.

Association of total iron binding capacity with coronary artery disease.

OBJECTIVE: A case-control study and a meta-analysis were conducted to assess the association between total iron binding capacity (TIBC) and coronary artery disease (CAD) risk. METHODS: A hospital-based case-control study was conducted with 258 CAD cases and 282 healthy controls. Logistic regression was utilized to estimate odds ratio (OR) with 95% confidence interval (CI) and adjust potential confounders. Dose-response relation was investigated between TIBC and CAD risk by dividing TIBC concentration into quartiles. A meta-analysis was performed on the standardized mean difference (SMD) as well as OR. RESULTS: In our case-control study, TIBC was found associated with decreased CAD risk both in univariate (OR=0.981, 95% CI=0.975, 0.986) and multivariate (OR=0.979, 95% CI=0.972, 0.986) adjusted logistic regressions. The multivariate-adjusted OR for the highest quartile compared with the lowest quartile was 0.087 (95% CI=0.042, 0.181). After sensitivity analysis, the meta-analysis on SMD showed that TIBC was associated with decreased CAD risk (SMD=-0.211, 95% CI=-0.318, -0.104). The results of pooled measure on OR (OR=0.970, 95% CI=0.946, 0.995) were consistent with those of SMD analysis. CONCLUSION: A weak association was found between TIBC levels and decreased CAD risk, further investigations are necessary to clarify the dose-response relationship.

Association of nicotinamide adenine dinucleotide phosphate oxidase p22phox gene 549C>T polymorphism with coronary artery disease.

BACKGROUND: The p22phox is a critical component of the superoxide-generating vascular nicotinamide adenine dinucleotide phosphate (NADPH) oxidase. Several polymorphisms in p22phox gene are studied for their association with cardiovascular diseases. However, no publication is available to assess the relation of 549C > T polymorphism in p22phox gene to coronary artery disease (CAD) risk. This study was to investigate the effect of the p22phox gene 549C > T polymorphism on CAD risk. METHODS: Hospital-based case-control study was conducted with 297 CAD patients and 343 healthy persons as the control group. Polymerase chain reaction and pyrosequencing using PSQ 96 MA Pyrosequencer (Biotage AB) were used to detect the polymorphisms. Multiple Logistic regression model was used to adjust the potential confounders and to estimate odds ratio (OR) with 95% confidence intervals (CIs). RESULTS: The observed genotype frequencies of this polymorphism obeyed the Hardy-Weinberg equilibrium in both cases (P = 0.439) and controls (P = 0.668). The frequency of mutant genotypes (TT + CT) in cases (41.08%) was higher than that in controls (36.73%) with an OR = 1.20 (95%CI = 0.87-1.65). After the adjustment of the potential confounders, there was a significant association of the mutant genotypes with increased risk of CAD (OR = 1.57, 95%CI = 1.01-2.46, P = 0.047). CONCLUSIONS: The mutant genotypes of the p22phox gene 549C > T polymorphism had a significant effect on the increased risk of CAD in this studied population.

Association of C47T polymorphism in SOD2 gene with coronary artery disease: a case-control study and a meta-analysis.

Oxidative damage promotes atherosclerosis. SOD2 is an important antioxidant enzyme. A case-control study and a meta-analysis were performed to assess the association of C47T polymorphism in SOD2 gene with premature, late-onset and overall coronary artery disease (CAD) risk. A hospital-based case-control study was conducted with 269 premature CAD cases, 278 late-onset CAD cases and 299 healthy controls. Polymerase chain reaction (PCR) and Pyrosequencing were used to detect the polymorphism. Multinomial logistic regression model was performed to estimate odds ratio (OR) with 95% confidence intervals (CIs) and adjust potential confounders. A meta-analysis was performed using eight outcomes including our result. Fixed or random effect pooled measure was selected on the basis of homogeneity test among studies. Heterogeneity among studies was evaluated using I (2). Meta-regression was used to explore potential sources of between-study heterogeneity. Publication bias was estimated using Peters's linear regression test. In our case-control study, compared with the TT as the reference, the mutant genotype of CC + TC was significantly associated with a reduced premature CAD risk both in univariate (OR = 0.60, 95% CI = 0.41-0.87) and multivariate (OR = 0.59, 95% CI = 0.40-0.87) logistic regressions, but not with late-onset CAD risk. After excluding one article that deviated from Hardy-Weinberg equilibrium in controls, this meta-analysis showed a significant association of the C allele with reduced risk of CAD in dominant (FEM: OR = 0.69, 95% CI = 0.61-0.78), recessive (OR = 0.64, 95% CI = 0.50-0.82), and codominant (FEM: OR = 0.73, 95% CI = 0.65-0.80) models. Our study suggested that the mutant genotype of CC + TC was significantly associated with a reduced CAD risk.

Joint effects of eNOS gene T-786C and ADH2 Arg47His polymorphisms on the risk of premature coronary artery disease.

INTRODUCTION: Both T-786C mutation in endothelial nitric oxide synthase (eNOS) gene and alcohol dehydrogenase (ADH) gene polymorphism such as ADH3 gamma1/gamma2 have been reportedly associated with coronary artery disease (CAD). Since ADH2 Arg47His polymorphism is common in Asian population, the aim of this present study was to assess the interaction between eNOS gene T-786C and ADH2 Arg47His polymorphisms on premature CAD risk. MATERIALS AND METHODS: Hospital-based case-control study was conducted with 167 premature CAD and 235 late-onset CAD patients. Polymerase chain reaction restriction fragment length polymorphism was used to detect the polymorphisms. Multivariate logistic regression model was performed to adjust the potential confounders and estimate odds ratios (ORs) with 95% confidence intervals (CIs). Synergy index (S) was the measure to assess the interaction as departure from additivity. RESULTS: After the adjustment for the potential confounders, and compared with the carriers of TT and Arg/Arg as the reference, the ORs with 95% CIs in parentheses of premature CAD were that 1.13 (0.19-6.59) for CT or CC and Arg/Arg carriers; 2.24 (0.77-6.49) for TT and Arg/His or His/His carriers; 4.18 (1.32-13.22) for CT or CC and Arg/His or His/His carriers, respectively. Based on those ORs, S was 2.32 (95% CI: 0.37-14.72). CONCLUSIONS: The mutant genotypes of eNOS gene T-786C mutation and the fast form of ADH2 Arg47His polymorphism had an additive interaction on the risk of premature CAD in Chinese population. Further investigations with big sample size are necessary for confirming this additive interaction.

Facilitated PCI in younger Chinese patients with AMI.

Presently, facilitated percutaneous coronary intervention (PCI) in patients remains controversial. We evaluated the efficacy and safety of facilitated PCI, intravenous low-dose rt-PA administration prior to urgent PCI, in Chinese patients < 70 years of age with ST-segment elevation myocardial infarction. Our results suggest that the age and dosage of thrombolytics should be noticed seriously when considering facilitated PCI.

[Association between G894T mutation in endothelial nitric oxide synthase gene and premature coronary heart disease].

OBJECTIVE: To assess the association between G894T (Glu298Asp) mutation in exon 7 of the endothelial nitric oxide synthase gene and premature coronary heart disease (P-CHD). METHODS: Hospital-based case-control study was conducted. Newly-diagnosed CHD patients were recruited as study subjects. 132 CHD patients diagnosed at/before age 55 for males and 65 for females were assigned to P-CHD case group with other 172 CHD patients as the control group. Polymerase chain reaction with Ban II restriction enzyme digestion was performed to detect the G894T mutation. RESULTS: G894T mutant genotypes in P-CHD group (TT, GT and GG frequencies were 6.06%, 20.45% and 73.48%, respectively) were significant higher than those in control group (TT, GT and GG frequencies were 1.74%, 11.63% and 86.63%, respectively) (P = 0.01). Mutant T allele frequency in P-CHD group was also significantly higher than that in control group (16.29% versus 7.56%, P = 0.001, OR = 2.38, 95% CI: 1.38 - 4.16). Stepwise multiple logistic regression analysis at 0.05 significant level with sex, smoking, alcohol drinking, and overweight covariates indicated that G894T mutation also having significant effect on P-CHD (P = 0.01, OR = 2.25, 95% CI: 1.19 - 4.26). CONCLUSION: This study suggested that G894T mutation in endothelial nitric oxide synthase gene might serve as a major risk factor to the pathogenesis of P-CHD in this study population.

The T1128C polymorphism of neuropeptide Y gene in a chinese population.

BACKGROUND: Several papers have shown that the T1128C polymorphism of the neuropeptide Y (NPY) gene was related to certain diseases and disorders. However, the allele frequency of the 1128C showed significant differences among some populations with different genetic backgrounds, being absent in Japanese and Korean populations. Therefore, this present study was aimed to explore whether the T1128C polymorphism of the NPY gene exists in a Chinese population. METHODS: A total of 304 newly diagnosed inpatients with coronary heart disease (CHD) were selected as the subjects in the present study. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) analysis was performed to detect the T1128C polymorphism. RESULTS: Of the 304 CHD patients, only one patient showed the T1128/C1128 genotype in the NPY gene, the others were all the T1128/T1128 genotype. CONCLUSIONS: The T1128C polymorphism of the NPY gene is population specific and extremely low in a Chinese population.