Associations between Life's Essential 8 and abdominal aortic calcification among US Adults: a cross-sectional study.

BACKGROUND: Cardiovascular health (CVH) and abdominal aortic calcification (AAC) are closely linked to cardiovascular disease (CVD) and related mortality. However, the relationship between CVH metrics via Life's Essential 8 (LE8) and AAC remains unexplored. METHODS: The study analyzed data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) cohort, which included adults aged 40 or above. The research used the LE8 algorithm to evaluate CVH. Semi-quantitative AAC-24 scoring techniques were employed to assess AAC, categorized into no calcification, mild to moderate calcification, and severe calcification. RESULTS: The primary analysis involved 2,478 participants. Following adjustments for multiple factors, the LE8 score exhibited a significant association with ACC risk (Mild-moderate ACC: 0.87, 95% CI: 0.81,0.93; Severe ACC: 0.77, 95% CI: 0.69,0.87, all P < 0.001), indicating an almost linear dose-response relationship. Compared to the low CVH group, the moderate CVH group showed lower odds ratios (OR) for mild-moderate and severe calcification (OR = 0.78, 95% CI: 0.61-0.99, P = 0.041; OR = 0.68, 95% CI: 0.46-0.99, P = 0.047, respectively). Moreover, the high CVH group demonstrated even lower ORs for mild-moderate and severe calcification (OR = 0.46, 95% CI: 0.31, 0.69, P < 0.001; OR = 0.29, 95% CI: 0.14, 0.59, P = 0.001, respectively). Interactions were found between chronic kidney disease (CKD) condition, history of CVD, marital status and CVH metrics to ACC. Participants without CKD exhibited a more pronounced negative association between the CVH metric and both mild-moderate and severe ACC. Those lacking a history of CVD, and never married/widowed/divorced/separated showed a stronger negative association between the CVH metric and severe ACC. CONCLUSIONS: The novel CVH metrics demonstrated an inverse correlation with the risk of AAC. These findings suggest that embracing improved CVH levels may assist in alleviating the burden of ACC.

The Impact of Blood Sample Processing on Ribonucleic Acid (RNA) Sequencing.

In gene quantification and expression analysis, issues with sample selection and processing can be serious, as they can easily introduce irrelevant variables and lead to ambiguous results. This study aims to investigate the extent and mechanism of the impact of sample selection and processing on ribonucleic acid (RNA) sequencing. RNA from PBMCs and blood samples was investigated in this study. The integrity of this RNA was measured under different storage times. All the samples underwent high-throughput sequencing for comprehensive evaluation. The differentially expressed genes and their potential functions were analyzed after the samples were placed at room temperature for 0h, 4h and 8h, and different feature changes in these samples were also revealed. The sequencing results showed that the differences in gene expression were higher with an increased storage time, while the total number of genes detected did not change significantly. There were five genes showing gradient patterns over different storage times, all of which were protein-coding genes that had not been mentioned in previous studies. The effect of different storage times on seemingly the same samples was analyzed in this present study. This research, therefore, provides a theoretical basis for the long-term consideration of whether sample processing should be adequately addressed.

Association of the triglyceride-glucose index with all-cause and cardiovascular mortality in patients with cardiometabolic syndrome: a national cohort study.

OBJECTIVE: This study aimed to evaluate the association of triglyceride-glucose (TyG) index with all-cause and cardiovascular mortality risk among patients with cardiometabolic syndrome (CMS). METHODS: We performed a cohort study of 5754 individuals with CMS from the 2001-2018 National Health and Nutrition Examination Survey. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multivariate Cox proportional hazards regression models assessed the associations between TyG index and mortality . Non-linear correlations and threshold effects were explored using restricted cubic splines and a two-piecewise Cox proportional hazards model. RESULTS: Over a median follow-up of 107 months, 1201 all-cause deaths occurred, including 398 cardiovascular disease-related deaths. The multivariate Cox proportional hazards regression model showed a positive association between the TyG index and all-cause and cardiovascular mortality. Each one-unit increase in the TyG index was associated with a 16% risk increase in all-cause mortality (HR: 1.16, 95% CI 1.03, 1.31, P = 0.017) and a 39% risk increase in cardiovascular mortality (HR: 1.39, 95% CI 1.14, 1.71, P = 0.001) after adjusting for confounders. The restricted cubic splines revealed a U-shaped association between the TyG index and all-cause (P for nonlinear < 0.001) and cardiovascular mortality (P for nonlinear = 0.044), identifying threshold values (all-cause mortality: 9.104; cardiovascular mortality: 8.758). A TyG index below these thresholds displayed a negative association with all-cause mortality (HR: 0.58, 95% CI 0.38, 0.90, P = 0.015) but not with cardiovascular mortality (HR: 0.39, 95% CI 0.12, 1.27, P = 0.119). Conversely, a TyG index exceeding these thresholds was positively associated with all-cause and cardiovascular mortality (HR: 1.35, 95% CI 1.17, 1.55, P < 0.001; HR: 1.54, 95% CI 1.25, 1.90, P < 0.001, respectively). Notably, a higher TyG index (≥ threshold values) was significantly associated with increased mortality only among individuals aged under 55 compared to those with a lower TyG index (< threshold values). CONCLUSIONS: The TyG index demonstrated a U-shaped correlation with all-cause and cardiovascular mortality in individuals with CMS. The thresholds of 9.104 and 8.758 for all-cause and cardiovascular mortality, respectively, may be used as intervention targets to reduce the risk of premature death and cardiovascular disease.

Prognosis value of EAS index in patients with obstructive coronary artery disease.

Background: EAS index is reported to be an adjunctive tool for risk stratification in addition to left ventricular ejection fraction (LVEF). This study aimed to verify the predictive value of EAS index among coronary artery disease (CAD) patients with different cardiac systolic function levels. Methods: A total of 477 patients with obstructive CAD were included in the exploratory analysis of a prospective cohort between October 2017 and January 2018 at Guangdong Provincial People's Hospital. EAS index, e'/(a' × s'), is a novel parameter assessed by tissue Doppler imaging (TDI) indicating combined diastolic and systolic performance. Any occurrence of major adverse cardiovascular event (MACE) was recorded, including first onset of myocardial infarction, stroke, readmission for heart failure, coronary revascularization, or cardiovascular death that occurred within 6 months of the first admission. Kaplan-Meier survival and Cox regression analyses were applied to testify the predictive value of EAS index for cardiovascular outcome. Results: A total of 415 patients (87.2%) completed the follow-up (median, 25.9 months) and experienced 101 (24.3%) MACEs, 17 (4.0%) deaths, and 139 (33.4%) composite events. Elevated EAS index was significantly associated with a higher incidence of MACE, even after adjustment for age, sex, body mass index, N-terminal pro brain natriuretic peptide, high-sensitivity troponin T, high-density lipoprotein, stenosis degree, and other TDI parameters [Model 3, hazard ratio: 1.81, 95% confidence interval (CI): 1.15-2.85]. For different levels of cardiac function, Kaplan-Meier survival analysis revealed that elevated EAS index was associated with higher MACE incidence only in patients with LVEF ≥50% (P<0.05). Conclusions: EAS index is an independent predictor of MACE in patients with obstructive CAD, which could be utilized as a tool for risk stratification in CAD patients or incorporated into a prediction model to improve efficacy.

Physical activity attenuates the association between blood cadmium exposure and cardiovascular disease: findings from the National Health and Nutrition Examination Survey 2007-2018.

Existing studies could not separate the effects of heavy metal exposure on cardiovascular disease (CVD) risk from those caused by physical activity (PA). The possible interactive effect of heavy metal exposure and PA on the risk of CVD remains still unknown. We enrolled a total of 12,280 participants in 2007-2018 cycles of the U.S. National Health and Nutrition Examination Survey (NHANES) and discovered that both low blood concentrations of Cd and Pb were positively correlated with increased prevalence of CVD and subtypes, with a stronger association for blood Cd than Pb. Negative dose-response relationships between PA and the prevalence of CVD and subtypes were identified. Participants with inactive and active PA had lower risk of CVD than those having no PA, with multivariate adjusted ORs 0.8 (95% CI: 0.69, 0.94) and 0.76 (95% CI: 0.68, 0.85), respectively. The only evidence for negative interaction between regular PA and blood Cd concentrations was found with regard to the prevalence of CVD and subtypes, indicating that regular PA could well modify the adverse effect of blood Cd on CVD risk. We demonstrate for the first time to date that PA may have a beneficial effect against the hazardous impact of Cd exposure on elevated CVD risk, emphasizing the necessity to promote a healthy lifestyle with active PA.

Trends in unhealthy lifestyle factors in US NHANES respondents with cardiovascular disease for the period between 1999 and 2018.

Objectives: To examine national trends in unhealthy lifestyle factors among adults with cardiovascular disease (CVD) in the United States (US) between 1999 and 2018. Methods: We analyzed data from National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of participants with CVD who were aged ≥20 years, which was conducted between 1999 and 2000 and 2017-2018. CVD was defined as a self-report of congestive heart failure, coronary heart disease, angina, heart attack, or stroke. The prevalence rate of each unhealthy lifestyle factor was calculated among adults with CVD for each of the 2-year cycle surveys. Regression analyses were used to assess the impact of sociodemographic characteristics (age, sex, race/ethnicity, family income, education level, marital status, and employment status). Results: The final sample included 5610 NHANES respondents with CVD. The prevalence rate of their current smoking status remained stable among respondents with CVD between 1999 and 2000 and 2017-2018. During the same period, there was a decreasing trend in the age-adjusted prevalence rate of poor diet [primary American Heart Association (AHA) score <20; 47.5% (37.9%-57.0%) to 37.5% (25.7%-49.3%), p < 0.01]. Physical inactivity marginally increased before decreasing, with no statistical significance. The prevalence rate of sedentary behavior increased from 2007 to 2014 but subsequently returned to its original level in 2018 with no statistical significance. The age-adjusted prevalence rate of obesity increased from 32% (27.2%-36.8%) in 1999-2000 to 47.9% (39.9%-55.8%) in 2017-2018 (p < 0.001). The age-adjusted prevalence rate of depression increased from 7% (4.2%-9.9%) in 1999-2000 to 13.9% (10.2%-17.6%) in 2017-2018 (p = 0.056). Trends in mean for each unhealthy lifestyle factor were similar after adjustment for age. We found that respondents who had low education and income levels were at a higher risk of being exposed to unhealthy lifestyle factors (i.e., smoking, poor diet, and physical inactivity) than those who had high education and income levels. Conclusions: There is a significant reduction in the prevalence rate of poor diet among US adults with CVD between 1999 and 2018, while the prevalence rate of obesity showed increasing trends over this period. The prevalence rate of current smoking status, sedentary behavior, and depression was either stable or showed an insignificant increase. These findings suggest that there is an urgent need for health policy interventions targeting unhealthy lifestyles among adults with CVD.

Dietary lycopene is negatively associated with abdominal aortic calcification in US adults: a cross-sectional study.

BACKGROUND: Vascular calcification (VC) is one of the complications of chronic kidney disease (CKD) patients. Previous studies have confirmed that oxidative stress (OS) plays an important role in developing VC and that antioxidants have anti-VC effects. OBJECTIVES: Our study aimed to determine the relationship between the intake of antioxidants from dietary sources and the prevalence of VC, especially in the CKD population. METHODS: This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2013-2014). Participants were noninstitutionalized adults >40 years of age. Diet-derived antioxidants were obtained from the first 24-h dietary recall interviews. The abdominal aortic calcification (AAC) score was measured by a DXA scan. We divided the AAC scores into three groups: no calcification (AAC =0), mild to moderate calcification (0< AAC ≤6), and severe calcification (AAC >6). RESULTS: A total of 2897 participants were included in the main analysis. Our results showed that vitamin B6, α-tocopherol, and lycopene were associated with severe AAC in unadjusted models (odds ratio (OR): 0.81, 95% confidence interval (CI): 0.72-0.91, p = 0.001; OR: 0.97, 95% CI: 0.95-0.99, p = 0.008; OR: 0.98, 95% CI: 0.96-0.99, p = 0.01, respectively). However, only dietary lycopene was associated with severe AAC after adjusting covariates based on clinical and statistical significance. Per 1 mg higher intake of diet-derived lycopene per day, the odds of having severe AAC were 2% lower in the fully adjusted model (OR: 0.98, 95% CI: 0.95-0.999, p = 0.04). Moreover, in subgroup analysis, diet-derived antioxidant was not associated with AAC in patients with CKD.Our findings indicate that a higher intake of diet-derived lycopene was independently associated with lower odds of having severe AAC in humans. Therefore, a high intake of diet-derived lycopene may help prevent severe AAC.

Dietary lycopene was inversely associated with vascular calcification (VC) in adults.Patients with chronic kidney disease (CKD) have a higher chance of having severe VC.Dietary antioxidants were not significantly associated with VC in patients with CKD.

Gender Differences in Unhealthy Lifestyle Behaviors among Adults with Diabetes in the United States between 1999 and 2018.

Lifestyle management is important to patients with diabetes, but whether gender differences exist in lifestyle management is unclear. Data from the US National Health and Nutrition Examination Survey (NHANES 1999 to 2018) was used for this research. Gender differences were evaluated descriptively and using an odds ratio (OR) with a 95% confidence interval (CI). A total of 8412 participants (48% women) were finally included. Across these surveys, the incidences of poor diet (OR: 1.26 (95% CI, 1.12, 1.43)), smoking (1.58 (1.35, 1.84)), alcohol consumption (1.94 (1.68, 2.25)) and sedentary behavior (1.20 (1.04, 1.39)) were more common in men, while depression (0.47 (0.37, 0.59)), obesity (0.69 (0.61, 0.78)) and insufficient physical activity (0.56 (0.49, 0.65)) were more common in women. Reductions in poor diet were greater in men between 1999 and 2000 and 2017 and 2018 (p = 0.037), while the mean body mass index (BMI) levels (p = 0.019) increased more among women. Furthermore, several gender differences were found to be related to age, race/ethnicity and marital/insurance/employment statuses. Our research found gender differences in diabetes-related unhealthy lifestyle behaviors and provides reference data for implementing measures to reduce the gender differences. Further work to reduce gender-specific barriers to a healthy lifestyle is warranted in order to further improve diabetes management.

Adherence to prescribed antihypertensive medication among patients with depression in the United States.

BACKGROUND: Hypertensive patients with depression have a higher mortality rate and a worse prognosis compared with hypertensive only. Depression may reduce medication adherence in hypertension patients. METHODS: This study includes respondents in the National Health and Nutritional Examination Survey (NHANES) database from 2005 to 2018 who had previously been diagnosed with hypertension. Medication adherence was defined as taking medication as recommended by a physician. The depressive state was assessed using the patient health questionnaire (PHQ)-9. RESULTS: Nine thousand one hundred eighty-six respondents were included in the analysis. Medication adherence was associated with depression (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.26 to1.75) and depression score (OR: 1.04 per each point increase, 1.03 to 1.05) in the unadjusted analyses. After adjusting for clinical and socioeconomic/demographic factors, there were significant statistical correlations between depression score and medication adherence (aOR: 1.02 per each point increase, 1.00 to 1.03, p < 0.05), but there was no significant statistical correlation between depression and medication adherence (p > 0.05). It was still statistically significant relationships between sex, age, body mass index (BMI), race, marital status, and health insurance with medication adherence after adjusted socioeconomic/demographic factors. CONCLUSION: Depression was marginally associated with poor medication adherence in hypertensive patients, and the correlation increased with depression degree. Moreover, socioeconomic/demographic factors have an independent impact on medication adherence including sex, age, BMI, race, marital status, and health insurance.

Underestimated prognostic value of depression in patients with obstructive coronary artery disease.

Objective: The aim of this study was to explore the different predictive values of depression among patients with different cardiac systolic function levels. Methods: Four hundred eighty-three consecutive patients with obstructive coronary artery disease (CAD) were included the depressive state was assessed using the Chinese version of the Patient Health Questionnaire 9 (PHQ-9). Depression was defined as have depressive symptoms with a PHQ-9 score ≥5. The level of cardiac systolic function was classified as left ventricular ejection fraction (LVEF) ≥50 and <50%. Results: Over a median of 26.2 months, 421 patients completed the follow-up and experienced 101 major adverse cardiovascular events (MACEs), 45 non-cardiac rehospitalizations, and 17 deaths. Predictors for clinical outcomes in patients with different cardiac systolic function levels were not the same. For participants with preserved LVEF, depression was associated with increased risks for cardiovascular events and composite outcomes. However, when focusing the whole population, predictive values of depression for MACEs, non-cardiac rehospitalizations, and composite endpoints all dropped. Receiver operating characteristic (ROC) analyses further confirmed that depression was the one of the main predictors for all clinical outcomes. With the combination of other simple features, area under curve (AUC) could reach 0.64-0.67. Conclusions: Inconsistent with the general impression, depression is found to have a closer linkage with clinical outcomes in CAD patients with preserved LVEF rather than in those with decreased LVEF. These findings appeal for more attention on CAD patients with depressive symptoms and comparatively normal LVEF. Including psychological factors may be a good attempt when constructing risk prediction models.

Long-Term Trends in Risk Factor Management in Respondents with Chronic Kidney Disease in the USA.

INTRODUCTION: Unhealthy lifestyle factors are known to increase the risk of chronic kidney disease (CKD) and its complications. The long-term trends in these factors are unclear. METHODS: The aim of the study was to assess temporal trends in the prevalence of risk factors in adults with CKD in the USA and identify sociodemographic subgroups at most risk. Subanalysis of data was carried out from a stratified, complex, multistage probability-based cross-sectional and nationally representative survey. We examined participants from National Health and Nutritional Examination Survey (NHANES) respondents aged ≥20 years with CKD from 1999 to 2018. CKD was defined as estimated glomerular filtration rate of 15-59 mL/min/1.73 m2. Evaluated risk factors included uncontrolled blood pressure, blood glucose, blood lipids, excessive sodium intake, excessive protein intake, poor diet, obesity, smoking, depression, physical inactivity, and sedentary behavior. Sociodemographic variables included age, sex, race/ethnicity, marital status, education level, family income, and employment status. RESULTS: Blood pressure control among respondents with CKD (n = 4,342) was poor but significantly improved from the 1999-2000 (82% uncontrolled) to 2017-2018 surveys (66%; p for linear trend = 0.02). Prevalence of uncontrolled blood glucose (15-22%; p < 0.01), excessive sodium intake (72-78%; p = 0.04), and obesity (32-51%; p < 0.01) significantly increased over this time. The proportion of respondents with uncontrolled blood lipids, depression, smoking, excessive protein intake, poor diet, physical inactivity, or sedentary behavior showed no significant change over the 10-year period. Older people were more likely to have high blood pressure, high blood glucose, and high blood lipids but healthier lifestyle habits than younger people. And respondents of males, non-Hispanic blacks, Hispanics, low income, low education, widowed/divorced/separated, and employed had worse risk factor control compared to reference groups. DISCUSSION/CONCLUSION: Although the control of several risk factors in US NHANES respondents with CKD improved from 1999 to 2018, further reductions remain of value.

Stroke risk evaluation for patients with atrial fibrillation: Insights from left atrial appendage with fluid-structure interaction analysis.

The majority of cardioembolic strokes in patients with non-valvular atrial fibrillation (NVAF) are resulted from clot formation in the left atrial appendage (LAA). Current stroke risk stratification is based on the overall risks estimated from demographic and clinical profiles but not on individual anatomy or physiology. We aim to explore the differences in LAA morphological and hemodynamic parameters by comparing patients with and without a stroke history. Thirty-nine patients with persistent NVAF were included. Of these, 17 patients without a stroke history (non-stroke group) were compared with 22 patients with a history of stroke (stroke group). Their LAA geometric models were first reconstructed, and the morphological parameters were then measured. Furthermore, their LAA hemodynamic parameters were calculated by fluid-structure interaction analysis. Moreover, particle residual rates (PRR) and blood renewal rates (BRR) analyses were also employed to characterize the thrombogenesis dynamics. The results showed that compared to the non-stroke group, the stroke group had significant smaller LAA tortuosity and LAA orifice area, and significantly lower LAA orifice velocities (0.16 ± 0.10 vs 0.15 ± 0.06 cm/s; p = 0.044), but higher PRR (14.58 ± 9.43 vs 9.25 ± 4.67; p = 0.040) and BRR (52.41 ± 18.11 vs 38.36 ± 24.07; p = 0.044). These LAA morphological and hemodynamic parameters may be used to assess stroke risk in patients with NVAF.

Antifeedant Mechanism of Dodonaea viscosa Saponin A Isolated from the Seeds of Dodonaea viscosa.

Dodonaea viscosa is a medicinal plant which has been used to treat various diseases in humans. However, the anti-insect activity of extracts from D. viscosa has not been evaluated. Here, we found that the total saponins from D. viscosa (TSDV) had strong antifeedant and growth inhibition activities against 4th-instar larvae of Spodoptera litura. The median antifeeding concentration (AFC50) value of TSDV on larvae was 1621.81 µg/mL. TSDV affected the detoxification enzyme system of the larvae and also exerted antifeedant activity possibly through targeting the γ-aminobutyric acid (GABA) system. The AFC50 concentration, the carboxylesterase activity, glutathione S-transferases activity, and cytochrome P450 content increased to 258%, 205%, and 215%, respectively, and likewise the glutamate decarboxylase activity and GABA content to 195% and 230%, respectively, in larvae which fed on TSDV. However, D. viscosa saponin A (DVSA) showed better antifeedant activity and growth inhibition activity in larvae, compared to TSDV. DVSA also exerted their antifeedant activity possibly through targeting the GABA system and subsequently affected the detoxification enzyme system. Further, DVSA directly affected the medial sensillum and the lateral sensillum of the 4th-instar larvae. Stimulation of Spodoptera litura. with DVSA elicited clear, consistent, and robust excitatory responses in a single taste cell.

Associations Among Depression, Hemoglobin A1c Level, and Prognosis in Patients With Coronary Artery Disease: A Prospective Study.

Background: Depression is ubiquitous in patients with coronary artery disease (CAD). The relationship between depression and hemoglobin A1c (HbA1c) is controversial. The combined effect of high HbA1c and depression on prognosis is unclear, especially in non-diabetic CAD patients. We sought to explore these associations. Methods: 558 CAD patients were included in this prospective study. Patients were grouped by HbA1c levels and the status of clinical depression. The average follow-up period was about 2.2 years, and Cox proportional hazards models were used to compare the differences of prognosis in all the groups. Results: Clinical depression had no associations with HbA1c in all CAD patients (P for Pearson correlation = 0.74). In the all four groups, compared to group 1 (patients without clinical depression and low HbA1c), group 3 (without clinical depression and high HbA1c) had a higher risk of MACE (adjusted hazard ratio [aHR], 1.97; 95% confidence interval [CI], 1.2-3.25) and composite events (aHR, 1.67; 95% CI, 1.09-2.053). Group 4 (patients with clinical depression and high HbA1c) had higher HRs for MACE (aHR, 2.9; 95%CI, 1.32-6.38) and composite events (aHR, 2.12; 95% CI, 1.06-4.25). In CAD patients without diabetes, patients with clinical depression and high HbA1c had a higher risk of MACE (HR, 2.71; 95% CI, 1.02-7.19), non-cardiac readmission (HR,3.48; 95% CI, 1.26-9.57) and composite events (HR,2.44; 95% CI, 1.08-5.53) than those with no clinical depression and low HbA1c. In patients with comorbidities of depression and diabetes, patients with depression and high HbA1c more likely to experienced non-cardiac readmissions (HR, 4.49; 95% CI, 1.31-15.38) than patients with no depression and low HbA1c only. In all the above analysis, p-values for interaction between clinical depression and HbA1c were not statistically significant. Conclusions: The presence of both depression and high HbA1c lead to a worse prognosis in CAD patients than one risk factor alone, no matter with or without the comorbidity of diabetes in these CAD patients. For patients with CAD and depression, lower HbA1c may be required.

The Prognostic Value of Thyroid-Stimulating Hormone in Patients with Coronary Artery Disease and Depression.

Purpose: Patients with the comorbidity of coronary artery disease (CAD) and depression are very common and always have poor prognosis. The relationship between thyroid-stimulating hormone (TSH) levels and major cardiovascular event (MACE) in these patients is still unknown. We aimed to explore this association. Patients and Methods: We enrolled 203 CAD patients proven by coronary angiography (CAG). In the meanwhile, they were all assessed to have depression symptom by professional psycho-cardiologists. After an average follow-up of 23.7 months, patients were divided into two groups (high TSH group with TSH ≥ 1.395µIU/mL and low TSH group with TSH < 1.395µIU/mL) according to the cut-off value of baseline TSH. The impact of two different TSH groups for adverse events in CAD patients with depression was evaluated. Results: The average age of these patients was 64.9 years old. The two TSH groups had no significant difference in the comparison of other baseline data. Area under the receiver operating characteristic (ROC) curves (AUC) analysis indicated the well-discriminatory power of TSH levels for the occurrence of MACE (AUC = 0.61, 95% CI: 0.52-0.70, P = 0.03). In the KM survival analysis, high TSH group had a higher risk of MACE (P = 0.029). After multi-factor adjustment, there still existed a higher risk of MACE in high TSH group (HR = 2.05, 95% CI: 1.08-3.88, P = 0.028). Conclusion: In patients with the comorbidity of CAD and depression, higher TSH levels are associated with the occurrence of MACE. More researches need to be conducted to prove this association and explore whether the drug-related TSH reduction can decrease the occurrence of adverse events in the future.

Associations Between Adult Triceps Skinfold Thickness and All-Cause, Cardiovascular and Cerebrovascular Mortality in NHANES 1999-2010: A Retrospective National Study.

Background: The association between triceps skinfold (TSF) thickness and mortality in previous studies was controversial. This study aimed to explore how TSF thickness affects all-cause, cardiovascular, and cerebrovascular mortality among the United States (U.S.) general population. Methods: Our research included 25,954 adults in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. Participants were categorized by the baseline TSF quartiles [quartile 1 (Q1): < 11.8, (Q2): 11.8-17.4, (Q3): 17.4-25, and (Q4): ≥25; unit: millimeter (mm)]. Cox regression models were used to assess the association of TSF with all-cause, cardiovascular, and cerebrovascular mortality. The association between mid-arm muscle circumference (MAMC) and mortality was also explored. Subgroup analyses were conducted to assess heterogeneity in different subgroups. Results: The highest TSF group (Q4) had the lowest risk to experience all-cause (HR, 0.46; 95% CI, 0.38-0.59; P < 0.001) and cardiovascular mortality (HR, 0.35; 95% CI, 0.23-0.54; P < 0.001) than the lowest TSF group (Q1) after multivariate adjustment. However, there was no relationship between TSF quartiles and cerebrovascular mortality (HR, 0.98; 95%CI, 0.42-2.30; P = 0.97). The protective effects of TSF thickness on mortality still existed after adjusting for BMI and MAMC. For every 1 mm increase in TSF thickness, the risk of all-cause and cardiovascular death decreased by 4% (HR, 0.96; 95% CI, 0.95-0.97; P < 0.001) and 6% (HR, 0.94; 95% CI, 0.93-0.96; P < 0.001), respectively. In the stratified analysis, the relationships between TSF and mortality risk were generally similar across all subgroups. Conclusions: Higher TSF thickness was associated with lower all-cause and cardiovascular mortality, independent of BMI and MAMC. Our study revealed that the TSF thickness may be a convenient and credible indicator to predict mortality, especially in those with severe cardiovascular diseases.

Red Blood Cell Distribution Width: A Prognostic Marker in Patients With Type B Aortic Dissection Undergoing Endovascular Aortic Repair.

Background: Red blood cell distribution width (RDW) is associated with cardiovascular mortality. However, the relationship between preoperative RDW and outcomes after thoracic endovascular aortic repair (TEVAR) in type B aortic dissection (TBAD) remains to be determined. Methods: We review the records of 678 patients with TBAD and treated with TEVAR in three centers. Patients were divided into two groups according to the admission RDW cut-off by receiver operating characteristic curve analysis [≤13.5% (n = 278) and >13.5% (n = 400)]. The association between RDW and long-term mortality was evaluated using Cox survival analysis. Additionally, we used general additive models (GAM) with restricted cubic splines (RCS) to explore non-linear relationships between RDW and outcomes. Results: Subjects with a high RDW had significantly higher in-hospital mortality rates (1.4 vs. 4.3%, P = 0.038). A total of 70 subjects died after a median follow-up period of 3.3 years. Kaplan-Meier analysis showed that subjects with an RDW >13.5% had worse survival rates than those with lower RDW values (P < 0.001). Multivariate Cox proportional hazard modeling revealed that an RDW >13.5% was an independent predictor of long-term mortality (adjusted HR = 2.27, P = 0.006). Also, we found that there was a non-linear relationship between RDW and mortality from RCS, and RDW of 13.5% might be an inflection point to distinguish the long-term mortality risk of TBAD patients. Conclusion: As an inexpensive and routinely measured parameter, RDW holds promise as a novel prognostic marker in patients with TBAD receiving TEVAR. We found that an RDW >13.5% on admission was independently associated with increased long-term mortality.

Nanopore Detection of Cancer Biomarkers: A Challenge to Science.

Cancer is the most complex and leading cause of fatality worldwide. Despite meritorious research in the field of cancer, it is still a substantial threat to human life. In this article, we address a question on the present strategies and manifest the importance of critical biomarkers for cancer screening and early diagnosis before the symptoms appear. However, this goal can only be achieved if scientists will focus on ultra-sensitive detection techniques such as "Nanopore." Nanopore sensing is a simple and rapid single-molecule detection technique that can detect multiple cancer biomarkers in femto-Molar concentrations in real time. Last but not least, we propose a systematic policy to win the war against cancer that is a big challenge to science.

The Effect of Total Cholesterol Variability on Clinical Outcomes After Percutaneous Coronary Intervention.

AIM: Exploring the risk factors of prognosis in patients undergoing percutaneous coronary intervention (PCI) is of great importance. Our aim of the study is to investigate the association between variability in total cholesterol (TC) level and major adverse cardiovascular and cerebrovascular events (MACCE) in patients after PCI. METHODS: Between April 2004 and December 2009, 909 patients who underwent primary PCI and with at least three TC values were included in the final study. TC variability was calculated using four indices: standard deviation (SD), coefficient of variation (CV), the average successive variability (ASV), variability independent of the mean (VIM). MACCE comprised all-cause mortality, non-fatal myocardial infarction (MI), unplanned revascularization, hospitalization for heart failure, and non-fatal stroke. RESULTS: There were 394 cases of MACCE during the follow-up period. When the subjects were divided into quartile groups by CV of TC, high CV groups were associated with a higher hazard ratio of MACCE than for lower CV groups. In multivariable adjusted models, TC variability and MACCE remained correlated [HR (95% CI): Q2, 1.17 (0.86-1.58); Q3, 1.38 (1.03-1.85); Q4, 1.63 (1.22-2.17)]. Similar patterns of MACCE were noted by quartiles of SD, ASV, and VIM. CONCLUSION: Visit-to-visit TC variability is positively correlated with MACCE in patients after PCI.