[The short-term and long-term prognostic analysis in patients with chronic total occlusion acute non-ST segment elevation myocardial infarction].

Objectives: To investigate the clinical impacts of chronic total occlusion (CTO) in acute non-ST segment elevation myocardial infarction (NSTEMI) patients underwent primary percutaneous coronary intervention (PCI). Methods: A total of 2 271 acute NSTEMI patients underwent primary PCI from China Acute Myocardial Infarction Registry were enrolled in this study and divided into the CTO group and the non-CTO group according to the angiography. The primary endpoint was in-hospital mortality and mortality during a 2-year follow-up. The secondary endpoint was major adverse cardiovascular events (MACE) including revascularization, death, re-myocardial infarction, heart failure readmission, stroke and major bleeding. Results: Thirteen-point four percent of the total acute NSTEMI patients had concurrent CTO. In-hospital mortality (3.6% vs. 1.4%, P<0.01) and 2-year mortality (9.0% vs. 5.1%, P<0.01) were significantly higher in the CTO group than those in the non-CTO group, respectively. Multiple regression analyses showed that chronic obstructive pulmonary disease (HR 7.28, 95%CI 1.50-35.35, P=0.01) was an independent risk factor of in-hospital mortality, and advanced age (HR 1.04, 95%CI 1.01-1.07, P<0.01), and low levels of ejection fraction (HR 0.95, 95%CI 0.93-0.98, P<0.01) were independent risk factors of 2-year mortality. CTO (HR1.67, 95%CI 1.10-2.54, P=0.02) was an independent risk factor of revascularization, but not a risk factor of mortality. Conclusions: Although acute NSTEMI patients concurrent with CTO had higher mortality, CTO was only an independent risk factor of revascularization, but not of mortality. Advanced age and low levels of ejection fraction were independent risk factors of long-term death among acute NSTEMI patients.

[Gender differences in cardiovascular risk factors in patients with acute myocardial infarction in China].

Objective: To understand gender differences of cardiovascular risk factors in patients with acute myocardial infarction (AMI) in China. Methods: A total of 26 592 patients with AMI from 107 hospitals in 31 provinces in China from January 1, 2013 to September 30, 2014 were included. Self-designed questionnaire was used to collect patients' age, gender, height, weight, type of AMI, medical history of cardiovascular and cerebrovascular diseases, medication history, lifestyle and AMI risk factors, including high blood pressure, diabetes, dyslipidemia, overweight and/or obesity, smoking history and family history of early onset coronary artery disease. A total of 24 394 patients with complete clinical data were included in the analysis, and gender differences in cardiovascular risk factors were analyzed in all and subgroups with different characteristics. Results: The patients were (62.2±13.8) years old, including 18 162 (74.5%) males and 18 209 (74.6%) ST-segment elevation myocardial infarction (STEMI). The age of male patients was (60.2±13.7) years, which was younger than that of female patients [(68.2±12.3) years]. The body mass index of male patients was (24.2±3.0) kg/m2, which was higher than that of female patients [(23.8±3.4) kg/m2]. The proportions of patients with overweight and/or obesity, smoking history, dyslipidemia, family history of early onset coronary heart disease, fatty diet and history of AMI were 51.8%, 55.2%, 7.2%, 3.8%, 80.4% and 7.7%, which were higher than those of females (45.9%, 9.9%, 5.8%, 2.3%, 65.0% and 5.9%, respectively]. The proportions of hypertension, diabetes, physical inactivity and stroke history were 46.5%, 17.2%, 77.8% and 8.5%, respectively, which were lower than those in female patients [61.4% (3 829 cases), 24.8%, 81.7% and 11.1%, respectively] (all P values<0.05).The proportions of peripheral vascular diseases history in male and female patients were 0.6% and 0.7%, respectively, with no statistical significance in difference (P>0.05). Subgroup analysis showed inconsistent results comparing to analysis of all patients: there were no statistical significance in gender differences as for the proportion of dyslipidemia in the non-ST-segment elevation MI group, the proportion of family history of early onset coronary heart disease in the young and middle aged groups, the proportion of overweight and/or obesity, and the proportion of physical inactivity in the elderly group (all P values>0.05). Conclusions: There are gender differences in cardiovascular risk factors among Chinese patients with acute myocardial infarction. Hypertension and diabetes are more common in women, and overweight and/or obesity, fatty diet and smoking are more common in men.

[The acute and long-term outcome of patients with ST segment elevation myocardial infarction concurrent with chronic total occlusion].

Objective: To evaluate the acute and long-term outcome of patients with ST segment elevation myocardial infarction (STEMI) concurrent with chronic total occlusion (CTO) undergoing primary percutaneous coronary intervention (PCI). Methods: 11 905 STEMI patients from the China Acute Myocardial Infarction Registry were enrolled in this study and divided into CTO group and non-CTO group according to the angiography results of primary PCI. 1∶3 propensity score matching was used to match the patients between the two groups. The primary endpoint was in-hospital mortality and mortality at 1-year post PCI. The secondary endpoint was major adverse cardiovascular events (MACE) including death, re-myocardial infarction, revascularization, heart failure associated readmission, stroke and major bleeding at 1-year post PCI. Results: There were 931 CTO patients (7.8%) in this cohort (male=755 (81.1%), mean age (62.2±11.4 years)). The rest 10 974 patients were STEMI without CTO (male=8 829 (80.5%),mean age (60.0±11.8) years). After propensity score matching, 896 patients were enrolled in CTO group and 2 688 in non-CTO group. In-hospital mortality was significantly higher in the CTO group than in non-CTO group (4.2% vs. 2.4%, P=0.006). The ratio of all cause death, cardiac death, and MACE at 1-year follow up was also significantly higher in the CTO group than in non-CTO group (8.5% vs. 4.4%, P<0.001, 5.3% vs. 2.6%, P=0.001, 35.1% vs. 23.3%, P<0.001, respectively). Multiple regression analysis showed that CTO (HR=1.54, 95%CI 1.06-2.22, P=0.022), advanced age (HR=1.06, 95%CI 1.04-1.08, P<0.001), and previous heart failure history (HR=4.10, 95%CI 1.90-8.83, P<0.001) were independent risk factors of 1-year mortality. Conclusions: The in-hospital and 1-year mortality increased significantly in STEMI patients concurrent with CTO. CTO, advanced age and history of heart failure are independent risk factors of 1-year death among STEMI patients.

Evaluation of Potato virus X mild mutants for cross protection against severe infection in China.

BACKGROUND: Cross protection is a promising alternative to control plant viral diseases. One critical factor limiting the application of cross protection is the availability of attenuated mutants or mild strains. Potato virus X (PVX) infects many crops and induces huge economic losses to agricultural production. However, researches on the variability and mechanism of PVX virulence are scarce. METHODS: The mutants were obtained by introducing mutations into the RNA dependent RNA polymerase (RdRp) gene of PVX via site-directed mutagenesis. Attenuated mutants were screen according to their symptoms in Nicotiana benthamiana plants. The protection efficacy against severe infection were evaluated with interval of 5, 10 and 15 days. RESULTS: Among the 40 mutants obtained, four mutants carrying substitutions of either Glu46, Asn863, Asn968 or Glu1001 to Ala in PVX RdRp showed drastically attenuated symptom, accompanying with reduced accumulation levels of coat protein, plus- and minus-sense RNAs. When the interval between protective and challenging inoculations was 15 days, mutant E1001A (with substitution of Glu1001 to Ala in RdRp) provided complete protection against severe infection in both Nicotiana benthamiana and tomato, while E46A (Glu46 mutated to Ala) provided incomplete protection. To reduce the risk of reverse mutation, we constructed mutant dM which carries double mutations of both Glu46 and Glu1001 to Ala in RdRp. The mutant dM could provide effective protection against severe PVX infection. CONCLUSION: Mutations of Glu46, Asn863, Asn968 or Glu1001 to Ala in PVX RdRp significantly reduced the viral symptoms. Mutants E1001A and E46A could provide effective protection against wild type PVX in both Nicotiana benthamiana and tomato. These results provide theoretical and practical bases for the control of PVX via cross protection.

[Clinical analysis of MRS and DWI in predicting delayed brain edema after spontaneous intracerebral hemorrhage].

Objective: Prediction of delayed brain edema after spontaneous intracerebral hemorrhage by magnetic resonance spectroscopy combined with diffusion weighted imaging, and to explore the causes and treatment of delayed brain edema after intracerebral hemorrhage. Methods: The patients with spontaneous cerebral hemorrhage diagnosed by CT from January 2015 to June 2018 in our hospital were analyzed. Magnetic resonance spectroscopy and diffusion weighted imaging examinations were performed on the third day after hemorrhage. It was diagnosed as delayed brain edema that the edema range enlarged more than 1 cm in CT scan on the 14th day Compare with the 7th Day. The patients were divided into the delayed brain edema group and the control group(n=27 for each). The NAA/Cr value and rADC value of the edema area in the two groups were analyzed by T test. Results: The NAA/Cr value (1.67±0.38) in the edema area of patients with delayed brain edema was significantly decreased Compare with the control group(1.92±0.42), and the rADC value (2.59±0.42) reduced significantly Compare with the control group (2.93±0.51), the differences were statistically significant (P<0.05). Conclusion: MRS and DWI were susceptive in showing delayed brain edema lesions at hyper-early phase. Combination of MRS and DWI can provide a basis for clinical individual treatment programs selection and prognostic evaluation.

[Prognostic value of TIMI and GRACE risk scores for in-hospital mortality in Chinese patients with non-ST-segment elevation myocardial infarction].

Objective: To evaluate the prognostic value of the thrombolysis in myocardial infarction (TIMI) and global registry of acute coronary events (GRACE) risk scores for in-hospital mortality in Chinese non-ST-segment elevation myocardial infarction (NSTEMI) patients. Methods: Data of present study derived from the prospective, multi-center registry trial of Chinese AMI (CAMI). Among 31 provinces, municipalities or autonomous districts in China, at least one tertiary and secondary hospital was selected. From January 2013 to September 2014, 5 896 consecutive non-ST-segment elevation myocardial infarction patients who were admitted to 107 hospitals within 7 days of symptom onset were enrolled. For each patient, TIMI and GRACE risk scores were calculated using specific variables collected at admission. Their prognostic value was evaluated by the endpoint of in-hospital mortality. Results: Among 5 896 NSTEMI patients (age was (65.4±12.1) years old), 68.2% (n=4 020) were males. The in-hospital mortality was 6.0% (n=353) and the median length of hospital stay was 10.0 (7.0, 13.0) days. The incidence of pre-hospital cardiac arrest was 3.6% (n=213) among 5 896 NSTEMI patients. Six hundreds and forty five patients (10.9%) received primary percutaneous coronary intervention, and 6 patients underwent emergent coronary artery bypass grafting surgery (0.1%), and the median time of reperfusion was 529.5 (256.0, 1 065.0) minutes. The prescription percentage of statins, ß-blocker, angiotensin converting enzyme inhibitors or angiotensin Ⅱ receptor blockers, and aldosterone antagonists were 94.8% (n=5 587), 71.7% (n=4 228), 65.5% (n=3 864) and 26.0% (n=1 533) respectively. The area under the curve of GRACE risk score for in-hospital mortality (0.7930 (95%CI 0.767-0.818)) was better than that of TIMI risk score (0.5588 (95%CI 0.532-0.586), P<0.001). Conclusion: GRACE risk score demonstrates better predictive accuracy than TIMI risk score for in-hospital mortality in NSTEMI patients in this patient cohort.

[Status of intra-aortic balloon pump application and related factors in Chinese patients with acute myocardial infarction].

Objective: To investigate the current status of application of intra-aortic balloon pump(IABP) and analyze the factors which might impact the application of IABP in patients with acute myocardial infarction complicated with cardiac shock in China. Methods: In China Acute Myocardial Infarction (CAMI) Registry,a nationwide, multicenter(107 hospitals), prospective study, 26 592 patients with acute myocardial infarction were enrolled consecutively between January 1, 2013 and September 30, 2014. After excluding of 30 cases due to missing important data,26 562 cases were analyzed.The application status of IABP was analyzed and multivariate logistic regression analysis was performed to determine the factors related to IABP application. Results: A total of 785(3.0%) patients with acute myocardial infarction received IABP implantation, and 381(49.9%) patients belonged to preventive application of IABP before primary percutaneous coronary intervention,and 6(0.8%) patients were complicated with mechanical complications.There were 118(15.0%) patients with cardiac shock received IABP implantation, which accounted for 12.0%(118/984) of all patients with cardiac shock.Multivariate logistic regression analysis showed that the clinical independent factors of the decision of IABP insertion included dyslipidemia (OR=2.858, 95%CI 1.397-5.846, P=0.004),left ventricular ejection fraction (OR=0.977, 95%CI 0.961-0.994, P=0.009),usage of dopamine (OR=2.817, 95%CI 1.495-5.308, P=0.001), left main disease (OR=2.817, 95%CI 1.495-5.308, P=0.001), GRACE score (OR=1.006, 95%CI 1.000-1.011, P=0.034), receiving primary percutaneous coronary intervention (OR=4.508, 95%CI 1.673-12.146, P=0.003), teritiary hospitals (OR=2.562, 95%CI 1.498-4.384, P=0.001), and higher education of the patients (OR=2.183, 95%CI 1.056-4.509, P=0.016). Conclusions: Among the Chinese acute myocardial infarction patients who received IABP implantation, nearly half application of IABP are preventive implantation before primary percutaneous coronary intervention. Only a few patients complicated with cardiac shock received IABP insertion. The clinical conditions, grade of hospitals, degree of education impact the decision of IABP insertion for the patients with acute myocardial infarction. Clinical Trial Registry National Institutes of Health, NCT018746.

Analysis of Late Positive Component of Event-related Potentials by Face Expression Images in Traumatic Brain Injury Patients with Mood Disorders.

OBJECTIVES: To explore the application of event-related potentials （ERP） by positive, negative, and neutral face expression images in the evaluation of mood disorders in brain traumatic patients. METHODS: ERP was tested by face expression images in 24 patients mainly with anxiety and depression symptoms （depression group） and 19 patients mainly with hostile and suspicion symptoms （hostile group）, respectively. The findings were compared with those of the control group. RESULTS: There were no significant differences, between the depression group and the hostile group, on latencies and amplitudes of late positive potential （LPP） induced by the three types of face expression images, except the amplitude induced by negative face expression image. Compared with the control group, the latencies were extended and the amplitudes were lower in both depression and hostile groups. Within each group, the difference of latencies induced by the three images was not significant. The amplitudes induced by negative face expression image was higher than those induced by positive and neutral face expression images, with significant differences in the hostile group and the control group （P<0.05） but not in the depression group. CONCLUSIONS: Changes in latencies and amplitudes of LPP could be an objective indicator in the evaluation of mood disorders of brain traumatic patients. The LPP induced by negative face expression images could be more meaningful for patients mainly with anxiety and depression symptoms.

PVX-tolerant potato development using a nucleic acid-hydrolyzing recombinant antibody.

3D8 scFv, a catalytic recombinant antibody developed in the MRL mouse, exhibits nucleic acid-hydrolyzing activity. Previous studies have demonstrated that tobacco plants harboring 3D8 scFv antibodies showed broad-spectrum resistance to infection by both DNA and RNA viruses. In this study, potatoes were transformed with the 3D8 scFv gene and screened by potato virus X (PVX) challenge. Starting with the T0 and T1 potato lines, PVX-tolerant T1 potatoes were identified in the field and characterized by ELISA and RT-PCR analysis. T2 potatoes were propagated for T3 generation and additional virus challenges in the field, and 44% of the 3D8 scFv T3 transgenic potatoes grown in GMO fields were found to be tolerant to PVX infection. Tubers from PVX-tolerant T3 lines were 60% bigger and 24% heavier, compared with tubers from PVX-susceptible transgenic lines and wild-type potatoes. Three-step virus challenge experiments and molecular characterization techniques were used for plants grown in growth chambers or fields to identify 3D8 scFv-transgenic, PVX-tolerant potatoes. These studies also revealed that the viral tolerance enabled by 3D8 scFv persisted during asexual propagation.

[The clinical application of retractorless surgery in patients with hypertensive basal ganglia hemorrhage].

Objective: To discuss the clinical feasibility and practical application of retractorless surgical for patients with hypertensive basal ganglia hemorrhage. Methods: A total of 84 patients underwentretractorless surgery in The First People's Hospital of Huzhou from Jun 2014 to Jun 2016 were retrospectively reviewed.There were 53 male and 31 female of the 84 patients. Their mean age were 58.7 years with range: 29-74 years.Glasgow coma scale score(GCS) at admissionwereas follow: GCS 4-5 points 10 cases(including 3 cases companied dilated pupils), GCS 6-8 points 25 cases, GCS 9-12 points 32 cases, and GCS 13-14 points 17 cases.The average volume of hematoma was 50.2 (30-100) mL.Complications related tosurgery and postoperative activities of daily living (ADL) scorewere analyzed. Results: 0f the 84 cases, there were 76 (90.5%) patientswhose intracranial hematoma were removed more than 90%. Postoperative bleeding was occurred in 6 cases (7.1%), all without secondary surgery. Cerebral infarctionwas occurred in 2 cases (2.4%), subcutaneous effusion associated with infectionwas occurred in 7 cases (8.3%). Postoperative follow-up of 58 cases, 85.3% recovered well. Conclusions: With the proficiency in microneurosurgery methods, retractorless surgery couldreduce the related postoperative complications, such as postoperative cerebral infarction.

[Effects and mechanism of allogeneic platelet rich plasma on collagen synthesis in wound healing].

Objective: To investigate the effects and mechanism of allogeneic platelet rich plasma (PRP) on collagen in wound surface at different time. Methods: A total of 50 clean 7-week rats were selected for this study, including 10 rats for platelet-rich blood plasma preparation, 20 rats for PRP group and 20 rats for control group, 0.1 ml allogenic PRP and 0.1 ml saline were smeared respectively on wound surfaces of PRP and control group, wound regeneration and healing were examined. Cellular and histological morphology alteration was observed via Masson staining, type Ⅰ and type Ⅲ collagen protein and mRNA expression level were detected by Western blot and real-time PCR. T test was applied for comparison between two samples and one-way ANOVA was utilized for comparison between two groups. Results: The wound healing rate of PRP group was higher than that of control group on 3(rd,) 6(th,) 10(th) and 15(th) day (30.33±3.35 vs.18.35±2.04, 55.51±2.74 vs.36.83±2.34, 79.64±1.40 vs.56.92±1.44, 86.88±2.12 vs.65.80±1.76) after wound surface formation, there were statistic differences (t=13.66-50.48, all P<0.05). The wound collagen of PRP group form faster and coarser, and the fibers arrayed more densely in Masson staining. The protein expression of type Ⅰ collagen(1.92±0.09 vs.1.18±0.11) and type Ⅲ collagen(1.16±0.05 vs.0.74±0.11) of PRP group were higher than that of control group (t=22.99, P<0.01; t=17.62, P<0.05); the mRNA expression of type Ⅰ collagen(5.17±0.11 vs.1.79±0.18, 6.97±0.09 vs.1.96±0.08, 6.00±0.26 vs.2.10±0.05, 4.95±0.11 vs.3.58±0.09)and type Ⅲ collagen(2.35±0.08 vs.1.44±0.05, 3.08±0.05 vs.1.84±0.06, 3.48±0.07 vs.2.36±0.09, 4.42±0.07 vs.2.77±0.10) were higher than that of control group on 3(rd,) 6(th,) 10(th) and 15(th) day after wound surface formation, there were significant differences (t=43.37-188.37, all P<0.05). Conclusion: The allogeneic platelet rich plasma may promote fibroblasts secreted collagen by activated and releasing all kinds of growth factors, especially type Ⅰ and type Ⅲ collagen to accelerate the wound healing.

Infiltration of M2-polarized macrophages in infected lymphatic malformations: possible role in disease progression.

BACKGROUND: Lymphatic malformations (LMs), slow-flow vascular anomalies resulting from abnormal development of lymphatic channels, often progress rapidly after trauma or infection. OBJECTIVES: To explore the possible mechanism by which local infection promotes the progression of LMs. METHODS: Immunohistochemistry in serial sections and immunofluorescence were performed to label polarized macrophages. Tertiary lymphoid organs (TLOs) in LMs were identified using antibodies against CD3 (a T-cell marker), CD20 (a B-cell marker) and PNAd (a high endothelial venule marker). Pearson's correlation and cluster analysis were carried out to delineate the relationship between macrophage infiltration and TLO formation. Rat models of LM were established to examine the role of lipopolysaccharide in LM development. RESULTS: Compared with normal skin tissues, both M1- and M2-polarized macrophages were prevalent in LMs. Moreover, M2-polarized macrophages were significantly increased in infected LMs with an elevated density of TLOs. M2-polarized macrophages were observed in the centre of TLOs accompanied by intensive staining of macrophage colony-stimulating factor, a strong chemotactic factor for monocytes/macrophages, suggesting that macrophages might be recruited through TLOs. Cluster analysis and Pearson's correlation suggested a close relationship between macrophage infiltration and TLO formation. Furthermore, the expression of CD68 was also correlated with that of vascular endothelial growth factor (VEGF)-C and Ki67. Importantly, in an established LM rat model, lipopolysaccharide promoted the progression of the malformations with increased macrophage infiltration and TLO formation. CONCLUSIONS: M2-polarized macrophages that may be recruited through TLOs in infected LMs may contribute to the progression of the disease by secreting VEGF-C, and therefore accelerating the proliferation of lymphatic endothelial cells.

[Age-related coronary risk factors in Chinese patients with acute myocardial infarction].

Objective: To determine the age-related coronary risk factors in Chinese patients with acute myocardial infarction (AMI). Methods: Among 31 provinces, municipalities or autonomous districts in China, from January 1st 2013 to September 30th 2014, 24 394 consecutive AMI patients who were admitted to 107 hospitals were divided into five groups according to age. Cardiovascular risk factors of groupⅠ (<45 years, n=2 307), group Ⅱ (45-54 years, n=4 448), group Ⅲ (55-64 years, n=7 029), group Ⅳ (65-74 years, n=6 147) and group Ⅴ (≥75 years, n=4 463) patients were compared. Results: Among 24 394 AMI patients [with a mean age of (62.2±13.8) years, 18 162 males], 24.7% patients had three and more conventional modifiable cardiovascular risk factors. ST-elevation myocardial infarction (STEMI) was diagnosed in 18 209 (74.6%) patients. The ratios of female, hypertension and diabetes tended to increase with the increase of age. Young AMI patients were predisposed to smoking, overweight/obesity and hyperglycemia. Nearly 90% patients in group Ⅰ and group Ⅱ were male. The ratio of male patients (92.3% to 58.0%), overweight/obesity (63.9% to 37.4%), current smoking (68.7% to 19.8%), dyslipidemia (9.1% to 4.5%), family history of premature coronary artery disease (CAD) (6.2% to 1.2%) and eating greasy food (86.1% to 66.2%) decreased markedly from group Ⅰ to Ⅴ patients. Proportion of hypertension gradually increased from 34.3% in group Ⅰ patients to 57.9% in group Ⅴ patients. Diabetes was most common to group Ⅳ (65-74 years) patients. Conclusion: There were different risk factors for AMI patients in different age groups, and young AMI patients were predisposed to live an unhealthy lifestyle.

[Diagnostic values of mitral inflow and mitral annulus diastolic velocity for heart failure with preserved ejection fraction].

OBJECTIVE: To explore the diagnostic values of ratios of early diastolic peak transmitral velocity(E) to late velocity(A) (E/A) and E to early diastolic peak mitral annulus velocity (E/E') for heart failure patients with preserved ejection fraction (HF-PEF). METHODS: Two hundred and sixteen healthy people were divided into <50 years, 50-59 years, 60-69 years, and ≥70 years groups to clarify the impact of aging on E/A and E/E'. Two hundred and two newly diagnosed consecutive in-patients with HF-PEF and 221 age- and sex-matched non-heart-failure subjects with risk factors of HF-PEF (negative controls) were enrolled.The diagnostic values and cutoff points of E/A and E/E' for HF-PEF were derived from receiver operating characteristic curve (ROC) analysis. RESULTS: E/A and E/E' were significantly different among age groups in healthy controls (all P<0.01). Compared with <50 years group, average E/A was lower and average E/E' was higher in ≥70 years group(both P<0.01). E/A ratio was less than 1 in 68%(71/105), E/E' was >8 cm/s in 48% (50/105)healthy people with age≥60 years. Neither E/A nor E/E' of HF-PEF patients was statistically different regarding to NYHA classification (grade Ⅱ, Ⅲ, Ⅳ), but NT-proBNP value increased in proportion to higher NYHA classification(P<0.01). The area of E/E' under ROC for diagnosing HF-PEF was 0.839(P<0.01), and the corresponding cutoff point was 9.5 with a sensitivity of 86% and a specificity of 69%. The areas of E/A (larger value or smaller value indicating positive) under ROC for diagnosing HF-PEF were 0.469 and 0.531, respectively(all P>0.05). CONCLUSIONS: Aging exerts significant impacts on both E/A and E/E'. E/E' has moderate diagnostic accuracy while E/A is of limited value for diagnosing HF-PEF.

[Survey of medical care resources of acute myocardial infarction in different regions and levels of hospitals in China].

OBJECTIVE: To investigate the medical care resources of acute myocardial infarction (AMI) in Chinese hospitals of different regions and levels. METHODS: We selected 115 hospitals in China, including 61 northern hospitals, 54 southern hospitals, 52 eastern hospitals, 26 central hospitals, 37 western hospitals, 79 tertiary hospitals, 36 secondary hospitals, 34 pro vincial-level hospitals, 46 prefectural-level hospitals and 35 county hospitals. From November 2012 to August 2013, we sent questionnaire to the cardiologists in each hospital, to collect related information. RESULTS: (1) The number of AMI admitted each year of northern hospital was more than the number of southern hospital (220 (120, 400) cases vs. 220 (80, 350) cases, P=0.033), while number of coronary care unit (CCU), thrombolytic therapy, percutaneous coronary intervention (PCI), primary PCI and coronary artery bypass grafting (CABG) were similar (all P> 0.05). (2) The number of AMI admitted each year of eastern, central and western hospital was 295(150, 501) cases, 175(75, 300) cases and 170(50, 250) cases respectively(P=0.007), with no significant difference among them for setting CCU, carrying out thrombolytic therapy, PCI, primary PCI and CABG (all P>0.05). (3) The total number of the in-patient beds and AMI admitted each year of tertiary hospitals were significantly higher than that in the secondary hospitals(104(70, 152)vs. 47(30, 52), P<0.001) and (300(200, 460)cases vs.80(47, 135)cases, P<0.001) respectively. There was a significant difference between tertiary and secondary hospitals for the number of CCU (97.5% (77/79)and 75.0%(27/36)), PCI (98.7%(78/79)and 27.8%(10/36)), primary PCI (96.2%(76/79)and 22.2%(8/36)), CABG (81.0%(64/79)and 11.1%(4/36)), intra-aortic balloon pump (IABP) (91.1%(72/79) and 13.9%(5/36)) respectively (all P<0.001). (4) There were obvious differences among provincial-level, prefectural-level and country-level hospitals for the admitted AMI patient numbers annually which was 400(250, 600), 232(100, 380)and 80(50, 162)cases, CCU proportion which was 100 %(34/34), 95.7%(44/46) and 74.3%(26/35), thrombolytic therapy proportion which was 88.2%(30/34), 100%(46/46)and 91.4%(32/35), PCI proportion which was 100%(34/34), 89.1%(41/46)and 37.1%(13/35), primary PCI proportion which was 100%(34/34), 84.8%(39/46)and 31.4%(11/35), CABG proportion which was 97.1%(33/34), 67.4%(31/46) and 11.4%(4/35)respectively (P<0.01 or 0.05) . CONCLUSIONS: Different regional hospitals have no significant difference in number of CCU and reperfusion therapies, while there is a big difference on medical care resources of AMI between different-level hospitals, which may affect the diagnosis and treatment effect of patients with AMI. Clinical Trail Registry: National Institutes of Health, NCT01874691.

[Age-related differences in the clinical symptoms and triggering factors among Chinese patients with acute myocardial infarction].

OBJECTIVE: To analyze the age-related differences in the clinical symptoms and triggering factors among Chinese patients with acute myocardial infarction. METHODS: Acute myocardial infarction Patients (n=14 854) registered in the China Acute Myocardial Infarction Registry from January 2013 to March 2014 were included in this study. Patients were divided into 4 groups: <55 years old group (3 950 patients), 55-64 years old group (4 361 patients), 65-74 years old group ( 3 759 patients), and ≥75 years old group (2 784 patients). Demographic features, medical history, clinical presentation and triggering factors were obtained via electronic data capture system. RESULTS: (1)Persistent chest pain and sweat were the major typical symptoms 66.4%(9 863/14 854) and 63.8%(9 471/14 854)) in the whole cohort. Prevalence of persistent chest pain among four groups were 73.8%(2 915/3 950), 69.2%(3 016/4 361), 63.6%(2 394/3 759) and 55.2%(1 538/2 784), and radiating pain among four groups were 36.2%(1 428/3 950), 34.1%(1 487/4 361), 30.9%(1 160/3 759)and 25.9%(722/2 784), and sweat among four groups were 70.0%(2 765/3 950), 66.5%(2 898/4 361), 61.8%%(2 323/3 759)and 53.3%(1 485/2 784), and there were statistical significance for all above symptoms among groups (all P<0.001). (2)triggering factors before acute myocardial infarction could be found in 19.4%(2 879/14 854) of the patients. Prevalence of existed triggering factors among four groups were 23.8%(941/3 950), 21.0%(914/4 361), 16.6%(625/3 759) and 14.3%(399/2 784, P<0.001). Recent excessive unhealthy lifestyles among four groups were 20.8%(196/3 950), 11.9%(109/4 361), 10.1%(63/3 759) and 9.0%(36/2 784) among the 4 groups (P<0.001). CONCLUSIONS: Persistent chest pain and sweat are absent in nearly half of Chinese patients in ≥75 years old group. Triggering factors prior to acute myocardial infarction could be evidenced in about twenty percent patients, and which are more often in young patients. Clinical Trail Registry: National Institutes of Health，NCT018746.

First Report of Aspergillus niger Causing Root Rot of Peanut in China.

Peanut (Arachis hypogaea) is one of the most important oil crops and food legumes worldwide. China sows approximately 3.5 million hectares each year and produces 40% of the world's peanuts. Fungal diseases are among the main biotic stresses affecting peanut production. Root rot is a serious disease caused by several fungi. Pythium spp., Fusarium spp., and Rhizopus spp. are some of the root rot fungi that have been reported in China. In 2012 and 2013, root rot symptoms were observed in several fields in Laixi District, Qingdao City, Shandong Province, China. The first symptoms appeared in July. Initial symptoms of the disease were brown spots on the stem base and root. Affected plants were stunted, with leaf chlorosis, reduced growth, or sudden wilting. As disease progressed, the infected tissues showed brown discoloration and rot, and abundant dark brown and black powdery spores were visible on the surfaces of affected parts. Eventually, affected plants collapsed and died. To isolate the causal organism, roots and stems were cut into sections, which were surface-disinfected with 70% ethanol solution (v/v) for 20 s, soaked in 0.1% mercuric chloride solution for 50 s, rinsed with sterilized water three times, dried, placed on Czapek's Dox agar supplemented with chloramphenicol (100 µg/ml), and incubated at 28°C for 7 days. Fungal colonies were white initially and then covered with a dense layer of dark brown or black conidial heads. The conidial head was radiate; vesicles were nearly spherical and covered with irregular metulae and phialides. Conidia were globose or subglobose (3.0 to 5.5 µm in diameter), dark brown to black, with rough cell walls. Total genomic DNA was extracted from mycelia using the EasyPure Genomic DNA Kit (TransGEN, Beijing, China). The rDNA-ITS region was amplified using PCR with the universal fungal primers ITS1 and ITS4 (2). The purified products were separately sequenced in both directions using the same primer pair. The sequences (GenBank Accession No. KJ848716) obtained were 99% similar to the ITS sequence of isolates of Aspergillus niger. This, together with the morphological characters (1) described above, suggested that the microorganism we had isolated was A. niger. Koch's postulates were completed in the laboratory by inoculating peanut. Thirty Huayu20 peanut seeds were placed in a 500-ml sterile pot with 300 g of autoclaved soil. Twenty days after seedling emergence, 15 peanut plants were wounded with a needle and inoculated with 5 ml of conidia suspension (106 ml-1). The same number of peanuts were similarly wounded and inoculated with 5 ml of sterile distilled water to serve as controls in the same pot. All peanuts were kept in a randomized complete block design at 30°C under a 12-h photoperiod. After 7 days, disease symptoms similar to those observed in the field appeared in all inoculated but not in non-inoculated peanuts. The tests were repeated three times in the greenhouse. Koch's postulates were satisfied after re-isolating the A. niger from inoculated peanuts using the method described above. To our knowledge, this is the first report of A. niger causing root rot in peanut in China. References: (1) M. A. Klich. Page 12 in: Identification of Common Aspergillus Species. Centraalbureau voor Schimmelcultures, Utrecht, The Netherlands, 2002. (2) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

MEF2A gene mutations and susceptibility to coronary artery disease in the Chinese population.

We investigated mutations and polymorphisms of the coronary artery disease (CAD)-related myocyte enhancer factor 2A (MEF2A) gene in a Chinese population. Polymerase chain reaction-single-strand conformation polymorphism and DNA sequencing were used to detect exon 11 of the MEF2A gene in 210 Hubei patients with CAD and 190 healthy controls. The following mutations were identified: a) a synonymous heterozygous mutation (147191G→T) combined with a 6-base deletion (147123-147128); b) a synonymous heterozygous or homozygous mutation (147191G→T) combined with a 9-base deletion (147123-147131); c) a synonymous mutation (147143G→A); d) a synonymous mutation (147191G→T) combined with an 18-base deletion (147111-147128); and e) a 21-base deletion (147108-147128). Mutations (a) and (b) and a 3-base deletion (147126-147128) with or without the synonymous heterozygous mutation (147191G→T) occurred in more than 1% of controls. However, mutations (c), (d), and (e) were not observed in the control group. The polymorphism in exon 11 of the MEF2A gene was observed in the Chinese population. Six or seven amino acid deletions and synonymous mutations (147143G→A) may be correlated with susceptibility to CAD.

First Report of Wild tomato mosaic virus Infecting Tobacco (Nicotiana tabacum) in China.

Wild tomato mosaic virus (WTMV), a potyvirus, has been reported in Laichau, Vietnam, infecting Solanum torvum (wild tomato) in 2008 (3), and Kanchanaburi, Thailand, infecting Capsicum spp. in 2013 (KF250353). In mid-May 2013, Nicotiana tabacum showing yellowing, mosaic, and/or ringspot symptoms were found in natural tobacco fields of Nanxiong, Guangdong Province, China. Total RNA was extracted from symptomatic leaves and reverse transcribed with M4T (5'-GTTTTCCCAGTCACGAC (T)15-3') as the 3' anchoring primer (1). The cDNA was used as template in a PCR assay using primers M4: 5'-GTTTTCCCAGTCACGAC-3' and Sprimer: 5'-GGXAAYAAYAGYGGXCAZCC-3', which amplifies a region comprising part of the NIb protein gene, the entire coat protein (CP) gene and the 3' nontranslated region (UTR) of a potyvirus (1). A ~1,700-bp product was amplified from the cDNA derived from three of the five diseased plants. The product (KF639967) showed 87% and 84% nucleotide sequence identities with those of WTMV isolates KAN and Laichau, respectively. The CP deduced from the sequence of the product shared 87% and 86% nucleotide and 94% and 93% amino acid sequence identities with those of WTMV isolates KAN and Laichau, respectively. The 3'-UTR of the putative virus shared 93% and 92% nucleotide sequence identities to those of WTMV isolates KAN and Laichau, respectively. Thus, according to the molecular criteria for potyvirus species demarcation (2), the virus we identified should be an isolate of WTMV (isolate GD1). One of the diseased samples was homogenized in 0.1 mol/liter phosphate buffer (pH 7.0) and used to inoculate the potyvirus to healthy, two to four leaf-stage Capsicum annuum L., N. tabacum, and N. benthamiana. The inoculated, as well as mock-treated plants, which were inoculated only with phosphate buffer, were grown in soil under 12 h day/12 h night at 25°C. All inoculated N. tabacum and N. benthamiana plants developed yellowing and mosaic symptoms by 14 days post inoculation (dpi). For N. benthamiana, the symptom became very severe by 21 dpi and some diseased plants died prematurely. About 10% of inoculated C. annuum L. developed very mild veinal chlorosis 18 dpi. Cloning and sequencing experiments showed that all the symptomatic plants tested were WTMV positive, but Cucumber mosaic virus, Tobacco mosaic virus, and Tobacco etch virus negative. To our knowledge, this is the first report of WTMV in China. Also, it is the first report that WTMV infects Nicotiana spp. Although further experiments are needed to definitively attribute the disease observed in the field to WTMV, our results indicate that WTMV, which forms a monophyletic clade with a number of other potyviruses infecting Solanaceae species in phylogenetic analysis, is widely distributed, or is spreading in Southeast Asia. It may pose a threat to Solanaceae species cultivation in this region. References: (1) Chen et al. Arch. Virol. 146:757, 2001. (2) Adams et al. Arch. Virol. 150:459, 2005. (3) Ha et al. Arch. Virol. 153:25, 2008.