Vaspin Alleviates Sepsis-Induced Cardiac Injury and Cardiac Inflammation by Inhibiting Kallikrein 7 in Mice.

Background: Vaspin is an important adipokine that is involved in cardiovascular diseases. This study is aimed at investigating whether vaspin participates in sepsis-induced cardiac injury and explored the possible mechanism. Methods: First, cecal ligation and puncture (CLP) and lipopolysaccharide (LPS) were used to establish a mouse model of sepsis, and cardiac vaspin expression was examined. In addition, after pretreatment with vaspin or phosphate-buffered saline (PBS), wild-type (WT) mice underwent CLP to establish a septic model and received sham as a control. Finally, WT mice and kallikrein 7 (KLK7-/-) mice were underwent CLP with or without vaspin pretreatment. Results: Mice that underwent CLP and were administered LPS exhibited increased vaspin expression in both the heart and serum compared with sham- or saline-treated mice. In CLP mice, pretreatment with vaspin reduced mortality and alleviated the expression of cardiac injury markers and cardiac dysfunction. In addition, vaspin reduced the cardiac levels of CD45+ cells and CD68+ cells, alleviated the cardiac inflammatory response, and reduced cardiomyocyte apoptosis. The protective effects of vaspin on CLP mice were masked by the deletion of KLK7, which was demonstrated to be a downstream signal of vaspin. Conclusions: Vaspin alleviates cardiac inflammation and plays a protective role in sepsis-induced cardiac injury by reducing KLK7 expression.

Trauma-induced pulmonary thromboembolism: What's update?

Trauma-induced pulmonary thromboembolism is the second leading cause of death in severe trauma patients. Primary fibrinolytic hyperactivity combined with hemorrhage and consequential hypercoagulability in severe trauma patients create a huge challenge for clinicians. It is crucial to ensure a safe anticoagulant therapy for trauma patients, but a series of clinical issues need to be answered first, for example, what are the risk factors for traumatic venous thromboembolism? How to assess and determine the status of coagulation dysfunction of patients? When is the optimal timing to initiate pharmacologic prophylaxis for venous thromboembolism? What types of prophylactic agents should be used? How to manage the anticoagulation-related hemorrhage and to determine the optimal timing of restarting chemoprophylaxis? The present review attempts to answer the above questions.

BMP2/Smad signaling pathway is involved in the inhibition function of fibroblast growth factor 21 on vascular calcification.

Vascular calcification is extremely common and associated with major adverse cardiovascular events. Fibroblast growth factor (FGF) 21 has been identified as a potent metabolic regulator and a protector of the cardiovascular system. In this study, we aimed to investigate the effect of FGF21 on calcification of vascular smooth muscle cell (VSMC) and its mechanism. FGF21 inhibited beta-glycerophosphate (BGP) induced mineralization in VSMCs as determined by calcium concentration and Alizarin Red S. FGF21 suppressed BGP-induced BMP2/Smad signaling pathway components as well as osteoblast differentiation markers. FGF21 and Noggin could synergistically inhibit BGP-induced BMP2/Smad pathway expressions and calcification. Taken together, FGF21 inhibits vascular calcification in vitro by modulating BMP2/Smad signaling pathway.

[Clinical efficacies of bilevel positive airway pressure ventilator treatment in uremic patients with acute heart failure].

OBJECTIVE: To explore the clinical efficacies of bilevel positive airway pressure (BiPAP) ventilation in uremic patients with acute heart failure. METHODS: Fifty uremic patients with acute heart failure on dialysis were recruited from February 2008 to October 2012 at our center. All of them received angiectasis, heart strengthening and continuous renal replacement therapy (CRRT), but their clinical symptoms had no relief 30 min later. Non-invasive ventilation was administered immediately. And the parametric changes of systolic pressure (SBP), diastolic pressure (DBP), heart rate (HR), breathing rate (R), partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) were observed at 30 min after conventional therapy and 1, 2 h later after non-invasive ventilation. And the levels of blood brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and clinical manifestations were observed at 2 h after non-invasive ventilation. RESULTS: Their clinical symptoms improved after BiPAP ventilation. And SBP, DBP, P, R and BNP showed a declining tendency, but PaO2 and LVEF showed a rising trend. Compared to conventional therapy, SBP ((160 ± 17), (147 ± 18) vs (172 ± 20) mmHg) (1 mmHg = 0.133 kPa), DBP ((90 ± 9), (85 ± 10) vs (98 ± 10) mmHg), HR ((95 ± 8), (88 ± 9) vs (102 ± 12) times/min), R ((20 ± 3), (17 ± 4) vs (26 ± 3) times/min) declined while PaO2 ((87 ± 9), (94 ± 12) vs (81 ± 9) mmHg) increased significantly, 1, 2 h later after noninvasive ventilator treatment (all P < 0.05); the blood level of BNP decreased ((1084 ± 398) vs (2686 ± 576) µg/L), LVEF elevated (52% ± 7% vs 39% ± 9%) significantly, 2 h later after noninvasive ventilator treatment (both P < 0.01). CONCLUSION: As a safe and effective intervention, early use of BiPAP ventilator-assisted breathing in uremic patients with acute heart failure effectively ameliorates their clinical manifestations and improve heart function.

AFM is used to study the biophysics of hypertension-induced tachyarrhythmia.

Patients with long-lasting hypertension often suffer from atrial or ventricular arrhythmias. Evidence suggests that mechanical stimulation can change the refractory period and dispersion of the ventricular myocyte action potential through stretch-activated ion channels (SACs) and influence cellular calcium transients, thus increasing susceptibility to ventricular arrhythmias. However, the specific pathogenesis of hypertension-induced arrhythmias is unknown. In this study, through clinical data, we found that a short-term increase in blood pressure leads to a rise in tachyarrhythmias in patients with clinical hypertension. We investigated the mechanism of this phenomenon using a combined imaging system(AC) of atomic force microscopy (AFM) and laser scanning confocal microscopy. After mechanical distraction to stimulate ventricular myocytes isolated from Wistar Kyoto rats (WKY) and spontaneously hypertensive rats (SHR), we synchronously monitored cardiomyocyte stiffness and intracellular calcium changes. This method can reasonably simulate cardiomyocytes' mechanics and ion changes when blood pressure rises rapidly. Our results indicated that the stiffness value of cardiomyocytes in SHR was significantly more extensive than that of normal controls, and cardiomyocytes were more sensitive to mechanical stress; In addition, intracellular calcium increased rapidly and briefly in rats with spontaneous hypertension. After intervention with streptomycin, a SAC blocker, ventricular myocytes are significantly less sensitive to mechanical stimuli. Thus, SAC is involved in developing and maintaining ventricular arrhythmias induced by hypertension. The increased stiffness of ventricular myocytes caused by hypertension leads to hypersensitivity of cellular calcium flow to mechanical stimuli is one of the mechanisms that cause arrhythmias. The AC system is a new research method to study the mechanical properties of cardiomyocytes. This study provides new techniques and ideas for developing new anti-arrhythmic drugs. HIGHLIGHT: The mechanism of hypertension-induced tachyarrhythmia is not precise. Through this study, it is found that the biophysical properties of myocardial abnormalities, the myocardium is excessively sensitive to mechanical stimulation, and the calcium flow appears to transient explosive changes, leading to tachyarrhythmia.

[Chinese consensus of cardiopulmonary resuscitation guides prevention, treatment and rescue of cardiac arrest in pregnancy].

Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.

Extracorporeal membrane oxygenation for critically ill patients with 2009 influenza A (H1N1)-related acute respiratory distress syndrome: preliminary experience from a single center.

From early May 2009, the novel influenza A (H1N1) pandemic affected mainland China. Of those infected, a small proportion of patients developed acute respiratory distress syndrome (ARDS) so rapidly and severely that conventional ventilation treatment was ineffective. As an alternative treatment, the effect of extracorporeal membrane oxygenation (ECMO) was evaluated. From November 2009 to January 2010, all patients suffering from influenza A (H1N1)-associated ARDS referred to Beijing Anzhen Hospital for treatment with ECMO were enrolled. We describe the characteristics, treatment, and outcomes of these patients at 1- and 3-month follow-up. Nine patients (four females; mean age, 31.2 [21-59] years) from four centers were enrolled. All females had a history of recent pregnancy or had recently given birth. Before ECMO, patients had severe respiratory failure despite advanced mechanical ventilatory support with a mean partial pressure of arterial oxygen/fraction of inspired oxygen of 52.9 ± 5.1 (45.0-63.8) mm Hg, positive end-expiratory pressure of 17.2 ± 4.2 cmH(2) O, and a Murray Lung Score of 3.6 (3.25-3.75). All nine patients were treated with veno-venous ECMO via percutaneous access. The mean duration of ECMO support was 436.6 ± 652.1 h (67.0-2160.0). At the end of 1-year follow-up, five patients (55.7%) were weaned from ECMO. Five patients (55.7%) survived to hospital discharge. Four patients (44.4%) died while undergoing ECMO. The mean length of intensive care unit and hospital stay was 4-204 days (median, 32) and 4-234 days (median, 38), respectively. There was no significant difference between survivors and nonsurvivors in the screened parameters. Use of ECMO for critically ill patients with 2009 influenza A (H1N1)-related ARDS is feasible and effective. However, this treatment is technically demanding. For success, careful selection of patients is crucial.

[Improvement in left ventricular filling properties after thrombolysis and anticoagulant therapy with heparin for acute pulmonary thromboembolism].

OBJECTIVE: The purpose of the present study mainly aimed to evaluate whether thrombolysis and heparin anticoagulation for acute pulmonary thromboembolism (PTE) could improve the abnormal left ventricular diastolic filling induced by acute PTE. METHODS: A total of 71 acute PTE patients (36 males and 35 females; age 64 ± 13 years, range 24 - 87 years) admitted to the emergency intensive care unit of Beijing Anzhen Hospital were consecutively recruited from January of 2006 to June of 2011. Fifty-one age-and gender-matched healthy controls (29 males and 22 females, age 61 ± 9 years, range 31 - 79 years) were also recruited from Health Center during the same period of time. PTE patients were classified into 2 treatment subgroups according to initial therapy, thrombolysis subgroup (n = 37) and direct anticoagulation subgroup with heparin (n = 34). Pre- and post-treatment, trans-thoracic Doppler echocardiography was used to assess left ventricular diameters and diastolic filling patterns. Trans-mitral flow velocities including early (E) and late atrial (A) filling velocities were measured, and E/A ratio was calculated reflecting the relative contribution of early and atrial filling. RESULTS: Compared with healthy controls, patients with acute PTE had significantly smaller left ventricular end-diastolic diameter (t = 3.629, P < 0.001), lower mitral E velocity and E/A ratio (t = 5.296, 6.510, both P < 0.001), and higher A velocity (t = 3.065, P < 0.01). After initial treatment including thrombolysis and direct anticoagulation with heparin for all patients with acute PTE, left ventricular end-diastolic diameter and end-systolic diameter were enlarged significantly (t = 5.284, 3.983, both P < 0.001), and mitral E velocity and E/A ratio were increased significantly (t = 3.452, 2.604, P < 0.05, respectively). Subgroup analysis revealed that, both thrombolytic therapy and anticoagulation with heparin could significantly enlarge left ventricular end-diastolic diameter (t = 4.145, 3.269, respectively) and end-systolic diameter (t = 4.145, 3.269, respectively, all P < 0.050), and increase mitral E velocity (t = 2.505, 2.492, P < 0.05, respectively). Compared with healthy controls, even after initial treatment with thrombolysis or heparin anticoagulation, PTE patients still showed lower mitral E velocity and E/A ratio (t = 2.615, 3.837, P < 0.05, respectively), and higher A velocity (t = 3.290, P < 0.01). CONCLUSION: The results strongly suggest that initial treatment for acute PTE with thrombolysis and heparin anticoagulation could improve the abnormal left ventricular diastolic filling induced by acute PTE.

[Assessment of left ventricular systolic function and diastolic filling characteristics in patients with pulmonary thromboembolism].

OBJECTIVE: The purpose of the present study aimed to evaluate the left ventricular systolic function and diastolic filling characteristics in pulmonary thromboembolism (PTE). METHODS: A total of 102 patients with PTE, including acute or acute on chronic PTE, were consecutively recruited from January of 2006 to December of 2010. The patients [53 males and 49 females; age (64 ± 14) years, range 23 - 85 years] all underwent Doppler echocardiographic assessment before thrombolytic therapy or within 24 h of hospital admission to the emergency intensive care unit of Beijing Anzhen hospital. Fifty-one age- and gender-matched healthy controls [29 males and 22 females; age (61 ± 9) years, range 31-79 years] were recruited from the Health Center. One hundred and sixty age- and gender-matched coronary artery disease (CAD) patients [90 males and 70 females, age (61 ± 11) years, range 29 - 81 years] with positive coronary artery angiography were also included as controls during the period of January of 2009 through December of 2010. Trans-thoracic Doppler echocardiography was used to assess the trans-mitral filling pattern and left ventricular systolic function in all the subjects. The trans-mitral blood flow peak of early (E) wave less than that of the auricular (A) wave, or the ratio of E/A greater than 2, were defined as abnormal left ventricular diastolic filling. Left ventricular ejection fraction (LVEF) greater than 50% was defined as preserved systolic function. The prevalence of abnormal left ventricular diastolic filling and systolic dysfunction were compared with Chi-square test between the PTE patients and the 2 control groups. RESULTS: Tricuspid regurgitation was identified in 72.5% (74/102) of the 102 PTE patients, abnormal left ventricular diastolic filling was detected in 77.5% (79/102) of the PTE patients, and 95.1% (97/102) of the PTE patients had preserved left ventricular systolic function with LVEF of > 50%. Further analysis revealed that the abnormal left ventricular diastolic filling was more frequent in PTE patients with CAD and/or hypertension than in other PTE patients (χ(2) = 5.280, P < 0.05), 85.2% (52/61) and 65.9% (27/41), respectively. Overall, the prevalence of abnormal left ventricular diastolic filling in PTE patients (77.5%, 79/102) was significantly higher than that in healthy controls (25.5%, 13/51, χ(2) = 38.300, P < 0.001), and the fraction of left ventricular systolic dysfunction was significantly lower (4.9%, 5/102) than that in CAD patients (29.4%, 47/160, χ(2) = 23.450, P < 0.001). In the PTE patients with neither CAD nor hypertension, the abnormal left ventricular diastolic filling was still more frequent (65.9%, 27/41) than in healthy controls (25.5%, 13/51, χ(2) = 15.070, P < 0.001), but there was no significant difference when compared with that in CAD patients (73.8%, 118/160, χ(2) = 1.013, P > 0.05). CONCLUSIONS: The results strongly suggest that abnormal left ventricular diastolic filling constitutes a common and a major form of left ventricular dysfunction in PTE patients. It indicates that enhanced alertness to and early identification of abnormal left ventricular diastolic filling may play an important role in improving prognosis for PTE.

Lipocalin-2 Predicts Long-Term Outcome of Normotensive Patients with Acute Pulmonary Embolism.

Normotensive patients with acute pulmonary embolism (APE) are accompanied by heterogeneously adverse events. Responding to tissue injury, lipocalin-2 (LCN-2) is elevated in experimental APE model and associated with short-term prognosis. However, the prognostic value of LCN-2 in normotensive patients with APE for long-term major adverse events (MAEs) remains unknown. We evaluated the association of plasma LCN-2 levels with the median 467-day outcome in 170 normotensive patients with APE. We also assessed whether LCN-2 could improve risk stratification. MAEs consisted of mortality or recurrence of venous thromboembolism. During follow-up, 17 (10%) patients suffered from MAEs. These patients had higher LCN-2 levels compared with patients without MAEs (median: 13.97 vs. 8.55 ng/ml, P = 0.01). The proportion of MAEs in the intermediate-low-risk group (14.0%) was higher than that in the intermediate-high-risk group (5.3%). LCN-2 levels independently had prognostic value for MAEs in overall (HR = 3.40, 95% CI 1.46-7.90) and intermediate-risk group (HR = 3.88, 95% CI 1.63-9.23). LCN-2 also showed incremental value in overall (ΔC-index: 0.13, 95% CI 0.02-0.24; category-based NRI = 0.25, 95% CI 0.07-0.42) and intermediate-risk patients (ΔC-index: 0.13, 95% CI 0.05-0.31; category-based NRI = 0.44, 95% CI 0.24-0.65). Adding LCN-2 (cut-off value = 11 ng/ml) to the current risk algorithm improved MAEs of intermediate-risk reclassification (intermediate-high vs. intermediate-low = 25.6% vs. 6.0%, P = 0.002). Elevated plasma LCN-2 levels predict long-term MAEs among normotensive patients with APE. LCN-2 might be a useful biomarker for risk stratification in the intermediate-risk group.

Risk factors for noninvasive ventilation failure in patients with acute cardiogenic pulmonary edema: A prospective, observational cohort study.

PURPOSE: We identified risk factors for noninvasive ventilation (NIV) failure in patients with acute cardiogenic pulmonary edema (ACPE). MATERIALS AND METHODS: We conducted an observational cohort study over a 3-year period in a 28-bed emergency intensive care unit (EICU) and prospectively included all consecutive patients in whom NIV was attempted as initial ventilatory support for ACPE. The primary outcome variables were NIV failure rate and risk factors for NIV failure. RESULTS: Among the 118 patients in the study, NIV failed for 44 (37.3%) patients. Risk factors for NIV failure were Killip class IV (odds ratio [OR], 28.56; 95% confidence interval [CI], 2.17-375.73; p=0.011), left ventricular ejection fraction (LVEF) <30% (OR, 9.54; 95% CI, 1.01-90.55; p=0.050) and B-type natriuretic peptide (BNP) ≥3350pg/mL (OR, 39.63; 95% CI, 3.92-400.79; p=0.002) at baseline, and fluid balance ≥400mL within 24h after ACPE (OR, 13.19; 95% CI, 1.18-147.70; p=0.036). CONCLUSIONS: NIV failure occurred in 37.3% of ACPE patients in a real-world EICU. When patients had Killip class IV, a lower LVEF, a higher BNP, and a more positive fluid balance within 24h after ACPE, the risk of failure was higher. TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER: NCT02653365.

Changes in cardiac arrest patients' temperature management after the publication of 2015 AHA guidelines for resuscitation in China.

A survey was performed to assess the current management of targeted temperature management (TTM) in patients following cardiac arrest (CA) and whether healthcare providers will change target temperature after publication of 2015 American Heart Association guidelines for resuscitation in China. 52 hospitals were selected from whole of China between August to November 2016. All healthcare providers in EMs and/or ICUs of selected hospitals participated in the study. 1952 respondents fulfilled the survey (86.8%). TTM in CA patients was declared by 14.5% of physicians and 6.7% of the nurses. Only 4 of 64 departments, 7.8% of physicians and 5.7% of the nurses had implemented TH for CA patients. Since the publication of 2015 AHA guidelines, 33.6% of respondents declared no modification of target temperature, whereas 51.5% declared a target temperature's change in future practice. Respondents were more likely to choose 35∼36 °C-TTM (54.7%) after guidelines publication, as compared to that before guidelines publication they preferred 32∼34 °C-TTM (54.0%). TTM for CA patients was still in the early stage in China. Publication of 2015 resuscitation guidelines did have impact on choice of target temperature among healthcare providers. They preferred 35∼36 °C-TTM after guidelines publication.

Venous thromboembolism has the same risk factors as atherosclerosis: A PRISMA-compliant systemic review and meta-analysis.

BACKGROUND: Previous studies have shown that idiopathic pulmonary embolism is positively associated with other cardiovascular events, such as myocardial infarction and stroke, suggesting a potentially important association between atherosclerosis risk factors and venous thromboembolism (VTE). We performed a meta-analysis to evaluate the correlation between risk factors for atherosclerosis and VTE. METHODS: In December 2014, we searched MEDLINE and EMBASE for studies evaluating the associations between VTE and risk factors for atherosclerosis and pooled outcome data using random-effects meta-analysis. In addition, we analyzed publication bias. RESULTS: Thirty-three case-control and cohort studies with a total of 185,124 patients met the inclusion criteria. We found that participants with body mass index (BMI) ≥30 kg/m had a significantly higher prevalence of VTE than those with BMI <30 kg/m in both case-control studies (odds ratio [OR] = 2.45, 95% confidence interval [CI]: 1.78-3.35) and cohort studies (relative risk [RR] = 2.39, 95% CI: 1.79-3.17). VTE was more prevalent in patients with hypertension than without hypertension (OR = 1.40, 95% CI: 1.06-1.84; RR = 1.36, 95% CI: 1.11-1.67). The findings were similar for VTE prevalence between patients with and without diabetes (OR = 1.78, 95% CI: 1.17-2.69; RR = 1.41, 95% CI: 1.20-1.66). Current smoking was significantly associated with VTE prevalence in case-control studies (OR = 1.34, 95% CI: 1.01-1.77), but not in cohort studies (RR = 1.29, 95% CI: 0.96-1.72). In addition, we found that total cholesterol and triglyceride concentrations were significantly higher in patients with VTE than without VTE (weighted mean differences [WMD] = 8.94 mg/dL, 95% CI: 3.52-14.35 mg/dL, and WMD = 14.00 mg/dL, 95% CI: 8.85-19.16 mg/dL, respectively). High-density lipoprotein cholesterol concentrations were significantly lower in patients with VTE than without VTE (WMD = -2.03 mg/dL, 95% CI: -3.42 to -0.63 mg/dL). Higher quality studies were more homogeneous, but confirmed the same significant associations. CONCLUSIONS: Based on our systematic review and meta-analysis, we observed a significant association between VTE and the risk factors for atherosclerosis. These results may make an important contribution to clinical practice regarding VTE treatment.

[Epidemiological survey of the incidence of bronchial asthma in occupational populations in Beijing area].

OBJECTIVE: To investigate the correlation of asthma incidence with environmental pollution. METHODS: We performed stratified-cluster-disproportional-random-sampling survey in the occupational populations from 10 professional systems by using an uniform protocol, questionnaire and procedure in this multicenter study. Original data were processed and statistically analyzed with SPSS 8.0 for windows. Prevalence rates were compared by chi(2) test. RESULTS: A total of 50,558 people supposed to cover more than 200,000 staff and workers were sampled. Six hundred and thirty asthmatics were identified and the overall prevalence rate in Beijing area was 1.25%. The incidence of asthma in occupational populations from urban commercial and trade circles, common chemical plants, and a certain petrochemical works was 0.51%, 1.06% and 2.81% respectively. The morbidity of asthma in the latter two populations was significantly higher than that in peasants (0.43%) in the remote outskirts of Beijing city (P < 0.01). The relative risk (RR) of asthma incidence in occupational populations from the commercial and trade circles, common chemical plants, the petrochemical works and the students in elementary and middle schools was 1.88, 2.79, 5.19 and 3.05 respectively as compared to peasants, the differences being statistically significant. CONCLUSION: The results suggest that the difference in asthma incidence in occupational populations may be attributable to environmental pollution.

Predicting value of serum soluble ST2 and interleukin-33 for risk stratification and prognosis in patients with acute myocardial infarction.

BACKGROUND: Acute myocardial infarction (AMI) is a common cardiac emergency with high mortality. Serum soluble ST2 (sST2) is a new emerging biomarker of cardiac diseases. The present study is to investigate the predictive value of sST2 and interleukin-33 (IL-33) for risk stratification and prognosis in patients with AMI. METHODS: Fifty-nine patients with AMI, whose chief complaint was chest pain or dyspnea, were selected for our study. Physical examination, chest radiograph, electrocardiograph (ECG), biomarkers of myocardial infarction, NT-proBNP, echocardiography and other relevant examinations were performed to confirm the diagnosis of AMI. Thirty-six healthy people were chosen as the control group. Serum samples from these subjects (patients within 24 hours after acute attack) were collected and the levels of sST2 and IL-33 were assayed by enzyme-linked immuno-sorbent assay (ELISA) kit. The follow-up was performed on the 7th day, 28th day, 3rd month and 6th month after acute attack. According to the follow-up results we defined the end of observation as recurrence of AMI or any causes of death. RESULTS: Median sST2 level of the control group was 9.38 ng/ml and that of AMI patients was 29.06 ng/ml. Compared with the control group, sST2 expression in the AMI group was significantly different (P < 0.001). In contrast, the IL-33 level showed no significant difference between the two groups. Serum sST2 was a predictive factor independent of other variables and may provide complementary information to NT-proBNP or GRACE risk score. IL-33 had no relationship to recurrence of AMI. Both sST2 and the IL-33/sST2 ratio were correlated with the 6-month prognosis; areas under the ROC curve were 0.938 and 0.920 respectively. CONCLUSIONS: Early in the course (<24 hours) of AMI, sST2 usually increases markedly. The increase of sST2 has an independent predictive value for the prognosis in AMI patients and provides complementary information to NT-proBNP or GRACE risk score. The IL-33/sST2 ratio correlates with the 6-month prognosis of AMI patients. However, there is no significant relationship between IL-33 and the prognosis of AMI patients.

Recombinant tissue plasminogen activator plus heparin compared with heparin alone for patients with acute submassive pulmonary embolism: one-year outcome.

OBJECTIVE: To evaluate the long-term effects of thrombolysis on patients with submassive pulmonary embolism (PE). METHODS: Data of 136 patients with acute submassive PE and low risk of bleeding were prospectively collected from January 2005 to October 2011 in a single medical center. Patients received recombinant tissue plasminogen activator (r-tPA) plus low molecular weight heparin (LMWH, TT group, n = 79) or LMWH alone (AT group, n = 57), depending on treating physician's recommendation and patient's preference. Echocardiography was performed at admission, 24 h, 6 and 12 months to evaluate right ventricular function. Computed tomography pulmonary angiography (CTPA) and lung perfusion scan were performed on admission, at 7 days, 6 and 12 months to evaluate clot burden. RESULTS: Seventy-nine patients received r-tPA plus LMWH (TT group) while 57 received LMWH alone (AT group). The baseline characteristics and risk factors did not differ between the two groups. Respiratory rate, heart rate, and systolic blood pressure improved within two hours in both groups. Systolic pulmonary arterial pressure and tricuspid regurgitation improved to a greater extent in the TT group at 24 h, and at 12 months (P < 0.001), as compared to those in the AT group. At one week, and 12 months, clot burden decreased more in AT group, as compared to that in AT group (P < 0.001). There was no death due to bleeding in both groups. Recurrent PE were similar in both groups (2.5% in TT vs. 1.8% in AT). The rates of minor hemorrhages were 6.3% in TT group and 1.8% in AT group (P < 0.05). CONCLUSION: In submassive PE patient who has low risk of bleeding, thrombolysis plus anticoagulation can lead to greater improvement of right ventricular dysfunction and clot burden reduction as compared to anticoagulation therapy alone.

Enhanced solar energy conversion in Au-doped, single-wall carbon nanotube-Si heterojunction cells.

The power conversion efficiency (PCE) of single-wall carbon nanotube (SCNT)/n-type crystalline silicon heterojunction photovoltaic devices is significantly improved by Au doping. It is found that the overall PCE was significantly increased to threefold. The efficiency enhancement of photovoltaic devices is mainly the improved electrical conductivity of SCNT by increasing the carrier concentration and the enhancing the absorbance of active layers by Au nanoparticles. The Au doping can lead to an increase of the open circuit voltage through adjusting the Fermi level of SCNT and then enhancing the built-in potential in the SCNT/n-Si junction. This fabrication is easy, cost-effective, and easily scaled up, which demonstrates that such Au-doped SCNT/Si cells possess promising potential in energy harvesting application.