[The value of quantitative flow ratio in the hemodynamic evaluation of myocardial bridge].

Objective: To explore the application value of quantitative flow ratio (QFR) in the hemodynamic evaluation of myocardial bridge and to preliminarily evaluate the correlation and related influencing factors between deformation quantitative flow ratio (D-QFR) and QFR. Methods: This is a cross-sectional study. Patients with CAG-confirmed simple myocardial bridge of the middle anterior descending coronary artery from June 2012 to June 2022 at the Air Force Medical Center were retrospectively included in this study. Systolic stenosis of mural coronary arteries (MCA) and myocardial bridge length were measured using quantitative coronary angiography. The patients were divided into mild stenosis group (<50% systolic stenosis) and moderate-to-severe stenosis group (≥50% systolic stenosis) according to the Nobel grading criteria. At different time periods (systolic and diastolic), the QFR values were measured at 3 locations (1 to 2 cm before the MCA entrance, the middle segment of the MCA, and 1 to 2 cm after the MCA exit), denoted as QFRa, QFRb, and QFRc, respectively, and the D-QFR values, incorporating vessel deformation information, were recorded. The MCA distal QFR≤0.8 in either stage was defined as an abnormal QFR value. QFR values were compared between the two groups at different locations and within each group. Factors associated with abnormal QFR values were analysed using multifactorial logistic regression. Spearman rank correlation analysis was used to examine the correlation between D-QFR values and systolic and diastolic QFR values.Multiple linear regression was used to analyse the factors associated with D-QFR. Results: A total of 83 patients were enrolled, including 58 males, aged (57.1±13.1) years. There were 48 cases in the mild stenosis group and 35 cases in the moderate-to-severe stenosis group, and the differences in systolic and diastolic QFRb and QFRc values between the two groups were statistically significant (all P<0.05). Within-group comparisons showed the values of QFRb and QFRc in the systolic phase were lower than those in the diastolic phase; QFRb and QFRc were both lower than QFRa during the same period (all P<0.05). Multifactorial logistic regression analysis showed that MCA systolic stenosis (OR=1.225, 95%CI 1.093-1.372, P<0.001) was an influential factor for abnormal QFR. D-QFR values were positively correlated with both systolic and diastolic QFR values (correlation coefficients were 0.849 and 0.675, respectively, both P<0.01). Multiple linear regression analysis showed that D-QFR values were negatively correlated with age (ß=-0.208, P=0.029), systolic stenosis (ß=-0.500, P<0.001), and myocardial bridge length (ß=-0.211, P=0.036). Conclusions: The QFR values in middle and distal of myocardial bridge decrease. The systolic stenosis rate of myocardial bridge is an important factor affecting QFR value. D-QFR is positively correlated with both systolic and diastolic QFR values. Age, myocardial bridge systolic stenosis rate and length are factors influencing the D-QFR values.

[Detection rate and clinical characteristics of vulvar squamous intraepithelial lesion].

Objective: To explore the detection rate, clinical characteristics of vulvar squamous intraepithelial lesion (SIL). Methods: Women diagnosed with vulvar high-grade squamous intraepithelial lesions (HSIL) through colposcopy-guided biopsy from January 1, 2018 to August 31, 2022 in Obstetrics and Gynecology Hospital of Fudan University were included in a 1∶1 ratio with patients diagnosed with vulvar low-grade squamous intraepithelial lesions (LSIL) during the same period. Clinical characteristics including human papillomavirus (HPV) infection rate, genotype, cytology result, colposcopy impression, and lesion location were retrospectively analyzed. Results: (1) The proportion of vulvar SIL detected by colposcopy-guided biopsy increased annually from 2018 to 2022, with rates of 1.64% (740/45 057), 2.34% (1 110/47 402), 2.68% (1 108/41 335), 3.26% (1 536/47 078), 3.31% (667/20 155), with an average rate of 2.57% (5 161/201 027). (2) A total of 1 096 cases of vulvar HSIL and 1 096 cases of vulvar LSIL were included. The overall infection rate of HPV was 92.7% (1 993/2 150), with higher infection rate in vulvar HSIL patients than that in vulvar LSIL patients [96.0% (1 012/1 054) vs 89.5% (981/1 096); χ2=33.62, P<0.001]. Among vulvar HSIL patients, the common HPV genotype from high to low were HPV 16 (66.7%), HPV 52 (14.3%), and HPV 58 (10.0%). For vulvar LSIL patients, the most common HPV genotype were respectively HPV 16 (24.9%), HPV 6 (20.1%) and HPV 52 (17.1%). The overall sensitivity rate of cytology was 53.6%, with no significance difference between vulvar LSIL and HSIL groups (54.3% vs 52.9%; χ2=0.40, P=0.526). The accuracy of colposcopy impression for vulvar HSIL was lower than that for vulvar LSIL [40.2% (163/405) vs 81.7% (380/465); χ2=158.72, P<0.001]. About 57.3% (1 257/2 192) of the patients had concomitant cervical and vaginal lesions, with a higher rate in vulvar HSIL group than that in vulvar LSIL group [62.6% (686/1 096) vs 52.1% (571/1 096); χ2=24.67, P<0.001]. Unifocal lesion was the main type, with no significance difference between vulvar LSIL and HSIL groups [81.4% (381/468) vs 82.5% (386/468); χ2=0.18, P=0.671]. The most common lesion locations were the posterior commissure, followed by labia minora, vaginal vestibule, labia majora, perianal and clitoris. Conclusions: The detection rate of vulvar SIL under colposcopy is about 3%, and the infection rate of HPV is 92.7%. Vulvar SIL, especially vulvar HSIL, is likely to cause concomitant cervical and vaginal lesions. The accuracy of colposcopy in diagnosing vulvar HSIL is low. Therefore a comprehensive and careful examination of the vulva is necessary and suspicious vulvar lesions should be undergone colposcopy-guided biopsy for diagnosis.

[Detection trend of vaginal intraepithelial neoplasia diagnosed by colposcopy guided biopsy from 2013 to 2015].

Objective: To explore the detection trend of vaginal intraepithelial neoplasia (VaIN) of lower genital tract from 2013 to 2015. Methods: A retrospective analysis was undertaken of colposcopy-directed biopsy of cervical, vaginal and vulvar intraepithelial neoplasia lesions include cervical intraepithelial neoplasia (CIN), VaIN and vulvar intraepithelial neoplasia (VIN) in Obstetrics and Gynecology Hospital of Fudan University from January 2013 to December 2015. Results: (1) Overall data of CIN, VaIN and VIN: a total of 16 732 cases were diagnosed of lower genital intraepithelial neoplasia in 3 years, accounting for 23.20% (16 732/72 128) of total colposcopy-directed biopsy cases. Among them, CIN, VaIN and VIN accounted for 19.48% (14 053/72 128), 2.67% (1 923/72 128), 1.05% (756/72 128) of total colposcopy-directed biopsy cases of the lower genital tract, 83.99% (14 053/16 732), 11.49% (1 923/16 732), 4.52% (756/16 732) of total lower genital intraepithelial neoplasia, respectively. (2) Annual data of CIN, VaIN and VIN from 2013 to 2015. The annual proportion of CIN in all intraepithelial neoplasia of lower gential tract was basically stable, consisting of 86.02%(3 955/4 598),83.25%(4 795/5 760) and 83.20% (5 303/6 374), respectively. The annual proportion of VaIN was gradually increasing, consisting of 8.09%(372/4 598), 12.45%(717/5 760) and 13.08%(834/6 374), respectively. The annual proportion of VIN was gradually decreasing, consisting of 5.89%(271/4 598), 4.31%(248/5 760) and 3.72%(237/6 374), respectively. Conclusion: The increasing detection of VaIN from 2013 to 2015 might correlate with the increasing attention to inspection of the entire vaginal wall.

Resveratrol exerts protective effects on anoxia/reoxygenation injury in cardiomyocytes via miR-34a/Sirt1 signaling pathway.

OBJECTIVE: In this study, we investigated the regulation of resveratrol (RV) on miR-34a alteration due to ARI and further studied the involvement of miR-34a/Sirt1 signaling pathway in ROS generation and cell survival after ARI. MATERIALS AND METHODS: In-vitro anoxia and reoxygenation injury (ARI) model based on rat heart-derived H9c2 cells was established. The expression of miR-34a and Sirt1 in H9c2 cells with or without RV pretreatment was measured. Flow cytometric analysis of intracellular reactive oxygen species (ROS) generation, CCK-8 assay of cell viability and Western blot analysis of active caspase-3 expression were performed to study the role of miR-34a/Sirt1 signaling pathway in RV modulated ARI injury protection. RESULTS: Pretreatment with RV substantially restored Sirt1 expression in cardiomyocytes in a dose-dependent manner in the in-vitro ARI model. MiR-34a level was significantly increased due to ARI. But pretreatment with RV significantly suppressed its upregulation. MiR-34a overexpression significantly reduced the effect of RV on restoring Sirt1 expression in ARI. Both miR-34a overexpression and Sirt1 knockdown significantly reduced the effect of RV on reducing ROS generation and also abrogated the effect of RV on enhancing cell viability and reducing cell apoptosis. CONCLUSIONS: The present study demonstrated that RV has a suppressive effect on miR-34a upregulation in ARI and the miR-34a/Sirt1 axis is an important signaling pathway modulating the protective effect of RV on cardiomyocytes in ARI. Nonetheless, future in vivo studies are required to validate this mechanism.

Racial differences of endothelial function and plasma endothelin 1 level in preclinical Tibetan and Han male population.

OBJECTIVE: The differences in endothelial function between Tibetan and Han nationality population have not been fully investigated. The aim of this work is to investigate the differences in endothelial function and plasma endothelin 1 (ET-1) concentration between Tibetan and Han male population. PATIENTS AND METHODS: Totally 272 Tibetan male subjects aged 42.9 ± 9.4 years were enrolled in this study to stand for Tibetan population. All of them were native residents in Lhasa City. And 580 Qinghai-Tibet Railway constructors with Han nationality aged 41.8 ± 11.1 years were enrolled in this study to stand for Han nationality population. All of them were male subjects and lived in Lhasa City for at least 1 year. All subjects lived in the same high-altitude area (the altitude of Lhasa is 3658 m). Height, weight, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure were evaluated. Body mass index (BMI) was calculated. Brachial artery flow-mediated dilation (FMD) was measured in the fasting state using high-resolution B-mode ultrasound. Computer-assisted analysis software was used to calculate brachial artery diameters. Venous blood was sampled for the measurement of total cholesterol (CH), triglyceride (TG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL) and HbA1c. Plasma ET-1 was quantitated using a commercially available ELISA kits. RESULTS: Totally 272 Tibetan subjects and 580 Han nationality subjects were enrolled in this study. BMI and waist-hip ratio in Tibetan subjects were much higher than those in Han subjects (p < 0.01). LDL cholesterol level and plasma ET-1 concentration in Tibetan subjects were significantly higher than Han subjects (p < 0.01). The baseline brachial artery diameter in Tibetan group was much higher than that of Han group (p < 0.01). The absolute and percent changes in brachial artery diameter were lower in Tibetan population compared with Han population (p < 0.01). The linear regression analysis showed that LDL cholesterol, and plasma ET-1 were correlated with FMD (p < 0.01). CONCLUSIONS: Endothelial function and plasma ET-1 concentration were different between Tibetan and Han male populations.

Statin ameliorates endothelial dysfunction and insulin resistance in Tibet women with polycystic ovary syndrome.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. In Tibet population, little is known about the correlation between PCOS and endothelial function and insulin resistance. In this study, we investigated the efficacy of simvastatin on ameliorating endothelial dysfunction and insulin resistance in Tibet patients with PCOS. PATIENTS AND METHODS: A group of 21 PCOS women was compared with 21 age-paired controls for blood pressure, body mass index (BMI), lipids, glucose and insulin levels. Plasma ET-1 was quantitated using a commercially available ELISA kits. The invasive vascular endothelial function was evaluated through the measurement of brachial artery flow-mediated dilation (FMD) in the fasting state using high-resolution B-mode ultrasound and ankle-brachial index (ABI) by using a blood pressure cuff and a Doppler instrument. RESULTS: PCOS women had higher BMI (p < 0.05), blood pressure (p < 0.05), cholesterol (p < 0.05), triglyceride (p < 0.05), LDL cholesterol (p < 0.05) and lower HDL cholesterol (p < 0.05). Fasting insulin (p < 0.001) and 2-hour plasma glucose (p < 0.001) of PCOS were also found to be higher than that of controls. HOMA-IR of PCOS was calculated to be much higher than that of the control group (p < 0.001). ET-1 levels were significantly higher in the PCOS women compared with the control group (p < 0.001). FMD and ABI were impaired in the PCOS group when compared with the controls (p < 0.001). After simvastatin intervention for 6 months, FMD, ABI, HOMA-IR, lipid profile, BMI were ameliorated in PCOS women. Also, FMD, ABI, HOMA-IR, lipid profile were nearly normalized in PCOS women after statin treatment compared with the control women. Tibet PCOS patients present a clustering of atherosclerosis risk factors (obesity, adverse lipid profile, hypertension and hyperglycemia) and more prevalent in insulin resistance and endothelial dysfunction than non-PCOS women. CONCLUSIONS: The endothelial function and insulin resistance of PCOS patients were ameliorated CONCLUSIONS: The endothelial function and insulin resistance of PCOS patients were ameliorated after statin administration.

Daidzein improves insulin resistance in ovariectomized rats.

OBJECTIVE: To determine whether daidzein improves insulin resistance by modifying weight gain, visceral fat accumulation, blood lipids and serum cytokines levels in ovariectomized Sprague-Dawley rats. MATERIALS AND METHODS: Twenty-eight 12-week-old female rats were divided into three groups: the sham-operated group (SHAM) (n =10), the ovariectomized group receiving daidzein therapy (DAID) (n =10), and the ovariectomized control group (Control) (n =8). The rats in the DAID group received 50 mg/kg daidzein via gavage daily. Weight and food intake were recorded every 2 weeks. All of the animals were euthanized 12 weeks after ovariectomy, after which their fasting insulin, glucose, blood lipids, estradiol, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), adiponectin and leptin levels were measured. RESULTS: After 12 weeks, the ovariectomized rats demonstrated an increase in their body weight and visceral fat; compared to the SHAM rats, the ovariectomized rats also experienced a significant increase in their serum IL-6 levels and insulin resistance, which was calculated using the homeostatic model assessment of insulin resistance (HOMA-IR) (p <0.05). Daidzein therapy decreased weight gain, visceral fat, the HOMA-IR index and IL-6 levels that were induced by ovariectomy. Rats which had received daidzein therapy had lower levels of TNF-α, leptin and blood lipids (except for high density lipoprotein cholesterol) than the other two groups. IL-6 levels positively correlated with the HOMA-IR index in all of the rats after adjustment for body weight (r =0.495; p =0.016). CONCLUSION: We conclude that daidzein can improve insulin resistance induced by ovariectomy by decreasing weight gain, visceral fat accumulation, blood lipids, TNF-α, leptin and IL-6 levels.