PCSK9 Inhibitor Added to High-Intensity Statin Therapy to Prevent Cardiovascular Events in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: A Randomized, Double- Blind, Placebo-Controlled, Multicenter SHAWN Study.

BACKGROUND: It is currently uncertain whether the combination of a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor and high-intensity statin treatment can effectively reduce cardiovascular events in patients with acute coronary syndrome (ACS) who have undergone percutaneous coronary intervention (PCI) for culprit lesions. METHODS: This study protocol describes a double-blind, randomized, placebo-controlled, multicenter study aiming to investigate the efficacy and safety of combining a PCSK9 inhibitor with high-intensity statin therapy in patients with ACS following PCI. A total of 1212 patients with ACS and multiple lesions will be enrolled and randomly assigned to receive either PCSK9 inhibitor plus high-intensity statin therapy or high-intensity statin monotherapy. The randomization process will be stratified by sites, diabetes, initial presentation and use of stable (≥4 weeks) statin treatment at presentation. PCSK 9 inhibitor or its placebo is injected within 4 hours after PCI for the culprit lesion. The primary endpoint is the composite of cardiovascular death, myocardial infarction, stroke, re-hospitalization due to ACS or heart failure, or any ischemia-driven coronary revascularization at one-year follow-up between two groups. Safety endpoints mean PCSK 9 inhibitor and statin intolerance. CONCLUSION: The SHAWN study has been specifically designed to evaluate the effectiveness and safety of adding a PCSK9 inhibitor to high-intensity statin therapy in patients who have experienced ACS following PCI. The primary objective of this study is to generate new evidence regarding the potential benefits of combining a PCSK9 inhibitor with high-intensity statin treatment in reducing cardiovascular events among these patients.

Transoral anterior release, odontoid partial resection, and reduction with posterior fusion for the treatment of irreducible atlantoaxial dislocation caused by odontoid fracture malunion.

PURPOSE: Several techniques have been introduced to manage irreducible atlantoaxial dislocation (IAAD). However, no study has reported the surgical method for the management of IAAD caused by odontoid fracture malunion. This study aimed to introduce a surgical method of transoral anterior release, odontoid partial resection, and reduction with sequential posterior fusion for the treatment of IAAD caused by odontoid fracture malunion. We also evaluated the clinical efficacy of this surgery. METHODS: This study included seven cases of IAAD caused by odontoid fracture malunion, collected from January 2008 to January 2011. Anterior atlantoaxial release was performed through anterior transoral approach, followed by partial resection of the odontoid process. C1-C2 were then fixed through pedicle screws and rods, and then fused posteriorly by single stage. Neurologic status was evaluated using the Japanese Orthopaedic Association (JOA) scoring system. RESULTS: All seven patients had complete release, and satisfactory reduction. Bony fusion was seen in all patients postoperatively. The patients were followed up for an average of 19.6 months (ranged from 9 to 36 months). The average of patients JOA scores at the final follow-up was significantly higher than that of their preoperative scores. Furthermore, the average improvement in neurological function was 87.4 %. No screw loosening, implant migration or implant failures, atlantoaxial redislocation, or signs of instability were observed in any of the patients during the follow-up period. CONCLUSIONS: Transoral anterior release, odontoid partial resection, and reduction combined with posterior fusion are effective, reliable, and safe procedures for the treatment of IAAD caused by odontoid fracture malunion.

[Colorimetric assay of perfluorooctanesulfonate based on gold nanoparticles].

For the property of persistent, bioaccumulation and genetic toxicity, perfluorooctanesulfonate (PFOS) is classified as a sort of persistent organic pollutants (POPs). It is significant to develop a novel assay for the determination of PFOS. In this work, we create a new colorimetric assay for PFOS in which the positively-charged gold nanoparticles (AuNPs) work as a nano-probe. This method works on the aggregation of AuNPs induced by PFOS via electrostatic interaction. The stable monodisperse AuNPs coated by cysteamine present color of red wine and the addition of PFOS can make the monodispersed AuNPs aggregated resulting in the color change from wine red to reddish purple with a red-shift in ultraviolet-visible absorption spectrum. The experimental results show that AuNPs has a characteristic absorption peak (524 nm), as well as a wide absorption peak (650 nm) and the absorption signal intensity is proportional to the PFOS content in a range of 0. 8-8. 0 µmo .l L-1. According to these, we developed a method based on ultraviolet-visible absorption and colorimetric to detect PFOS with the detection limit of 80 nmol . L-1. The scanning electron microscope (SEM) was investigated and the photos show that the stable AuNPs are made and the degree of AuNPs aggregation is related with PFOS concentration. The effect tests of coexisting substances in system show that common anions had less impact on the system and inorganic metal ions had some interference, which can be get rid of by cat- ion exchange resin in real sample. This assay was applied to detect PFOS in tap water with a recovery range of 87. 5%-118% and RSD 4. 4%. It is a novel application of AuNPs-based probe for PFOS detection. The proposed method has more advantages such as rapidity, low-cost and simplicity than conventional ones. In addition, it has the visual sensing function and the difference of color can be sensed by naked eyes directly, which produce ideas of real-time colorimetric strategies of nanoprobe application in environmental pollutant detection.

Tuberculous Spondylitis Following Kyphoplasty: A Case Report and Review of the Literature.

Tuberculous spondylitis of the augmented vertebral column following percutaneous vertebroplasty or kyphoplasty has rarely been described. We report an unusual case of tuberculous spondylitis diagnosed after percutaneous kyphoplasty (PKP). A 61-year-old woman presented to our institution complaining of back pain following a fall 7 days before. Radiologic studies revealed an acute osteoporotic compression L1 fracture. The patient denied history of pulmonary tuberculosis (TB) and there were no signs of infection. The patient was discharged from hospital 4 days after undergoing L1 PKP with a dramatic improvement in her back pain. Two years later, the patient was readmitted with a 1 year history of recurrent back pain. Imaging examinations demonstrated long segmental bony destruction involving L1 vertebra with massive paravertebral abscess formation. The tentative diagnosis of tuberculous spondylitis was made, after a serum T-SPOT. The TB test was found to be positive. Anterior debridement, L1 corpectomy, decompression, and autologous rib graft interposition, and posterior T8-L4 instrumentation were performed. The histologic examination of the resected tissue results confirmed the diagnosis of spinal TB. Anti-TB medications were administered for 12 months and the patient recovered without sequelae. Spinal TB and osteoporotic vertebral compression fractures are similar clinically and radiologically. Spinal surgeons should consider this disease entity to avoid misdiagnosis or complications. Early surgical intervention and anti-TB treatment should be instituted as soon as the diagnosis of spinal TB after vertebral augmentation is made.

Experimental study on pollutant movement in surf zone.

The experiments on pollutant movement in surf zone were conducted on the two gentle beaches (with slope of 1:100 and 1:40, respectively), for diverse wave cases. The movement contours and direction of pollutants, under the action of regular and random waves with diverse wave amplitudes, were provided and studied in this paper. It was shown that, due to complicated hydrodynamics in surf zone, the pollutant movement state is quite complicated and different from that in pure current zone.

Numerical model of flow and pollutant transportation in non-orthogonal curvilinear coordinates.

The planar 2D k-epsilon double equations' turbulence model was adopted and transformed into non-orthogonal curvilinear coordinates. The concentration convection-diffusion was introduced to planar 2D SIMPLEC algorithm of flow in non-orthogonal curvilinear coordinates. The numerical model of pollutant transportation in non-orthogonal curvilinear coordinates was constructed. The model was applied to simulate the flow and pollutant concentration fields. In the testing concentration field, two optimal operations of contamination discharging both along bank and in the centerline at the first bend of the meandering channel were adopted. Comparison with available data showed the model developed was successful, was valuable to engineering application.

[Relationships between Sabina przewalskii radial growth and climatic factors at upper timberlines in eastern mountainous region of Qaidam Basin].

Based on the investigation data of Sabina przewalskii tree-ring width at six sites at upper timberlines in eastern mountainous region of Qaidam Basin, the standard tree-ring chronologies of S. przewalskii were established. Cluster analysis indicated that there existed geographical differences in the radial growth of S. przewalskii among the sites. Higher similarity was observed between two northern sites, and among four central and southern sites. Climatic factors had different effects on the radial growth of S. przewalskii of the two clusters. The radial growth of S. przewalskii was positively correlated with the precipitation in current year's June at northern sites, and with the air temperature in previous year's November and current year's July at central and southern sites.