Crush is superior to Culotte in two-stent strategy for treatment of left main coronary artery bifurcations: A systematic review and meta-analysis.

PURPOSE: Crush and Culotte techniques have been used increasingly to treat patients with complex unprotected left main coronary artery bifurcation lesions. This article compares published data on these two techniques. METHODS: Databases, including PubMed, Embase, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure, were searched for articles published before Aug 21, 2019 to identify all relevant studies on left main coronary artery bifurcation lesions treated by Crush versus Culotte techniques. The pooled data were analyzed using either fixed- or random-effects model depending on heterogeneity (assessed via the I2 index). The endpoints were major adverse cardiac events, target lesion revascularization, cardiac death, stent thrombosis, myocardial infarction and target vessel revascularization. RESULTS: Eight articles with a total of 1,283 patients were included, and 710 patients were treated with Crush, and 573 ones with Culotte. Crush group was trend to decreased major adverse cardiac event compared with Culotte group [Relative ratio (RR) 0.63,95% confidence interval(CI) 0.39-1.04, I2 =72.7%], mainly driven by decreased cardiac death [RR 0.49, 95% CI(0.25-0.99), I2 =0%], decreased myocardial infarction [RR 0.40, 95% CI(0.21-0.76), I2 =21.6%],and lower stent thrombosis [RR 0.39, 95% CI(0.16-0.98), I2 =39.4%]. There was no significant difference in target lesion revascularization and target vessel revascularization between Crush and Culotte [RR 0.77, 95% CI 0.46-1.28, I2=61.1%; RR 0.78, 95% CI (0.30-2.02), I2 =73.1%, respectively]. CONCLUSION: Crush was superior to Culotte for treatment of left main coronary artery bifurcation lesions with a trend of lower incidence of long-term major adverse cardiac events, mainly derived from decreased myocardial infarction, stent thrombosis and cardiac death.

Prevalence and Predictors of Contrast-Induced Nephropathy (CIN) in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Percutaneous Coronary Intervention (PCI): A Meta-Analysis.

BACKGROUND: Contrast-induced nephropathy (CIN) becomes more and more frequent after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). There have been no reported meta-analyses to determine the role of these risk factors in predicting CIN in patients with STEMI undergoing PCI. So we made this meta-analysis to summarize the incidence of CIN in patients with STEMI undergoing PCI and to study associations between CIN and several risk factors that are mentioned in most prevention guidelines. HYPOTHESIS: The overall incidence of CIN in patients with STEMI undergoing PCI is not low. Many risk factors could influence the occurrence of CIN, such as hypertension, diabetes mellitus (DM), and lower estimated glomerular filtration rate. METHODS: Databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Chinese BioMedical (CBM), were searched for articles published before May 21, 2019, to identify all relevant studies on CIN. The pooled data were analyzed using either fixed-effects or random-effects models depending on heterogeneity (assessed via the I 2 index). RESULTS: Twelve articles encompassing a total of 6342 patients were included. The overall pooled CIN incidence was 13.3% (95% CI: 10.4-17.1). The forest plots showed positive associations between CIN and the presence of hypertension, diabetes mellitus, history of prior myocardial infarction, age, damaged left anterior descending artery, Killip class ≥2, decreased left ventricular ejection fraction, lower estimated glomerular filtration rate, and left ventricular ejection fraction <40%; the odds ratios for these factors were 1.85 (95% CI: 1.57-2.18; p < 0.00001), 1.83 (95% CI: 1.47-2.29; p < 0.00001), 2.14 (95% CI: 1.46-3.14; p < 0.0001), 7.79 (95% CI: 5.24-10.34; p < 0.00001), 1.92 (95% CI: 1.15-3.22; p=0.01), 3.12 (95% CI: 2.21-4.40; p < 0.00001), -6.15 (95% CI: -9.52 to -2.79; p=0.0003), -15.06 (95% CI: -24.75 to -5.36; p=0.002), and 5.53 (95% CI: 1.10-27.95; p=0.04), respectively. CONCLUSION: The overall incidence of CIN in patients with STEMI undergoing PCI was not low and was closely associated with hypertension, diabetes mellitus, history of prior myocardial infarction, age, damaged left anterior descending artery, Killip class ≥2, decreased left ventricular ejection fraction, lower estimated glomerular filtration rate, and left ventricular ejection fraction <40%.

Gclust: A Parallel Clustering Tool for Microbial Genomic Data.

The accelerating growth of the public microbial genomic data imposes substantial burden on the research community that uses such resources. Building databases for non-redundant reference sequences from massive microbial genomic data based on clustering analysis is essential. However, existing clustering algorithms perform poorly on long genomic sequences. In this article, we present Gclust, a parallel program for clustering complete or draft genomic sequences, where clustering is accelerated with a novel parallelization strategy and a fast sequence comparison algorithm using sparse suffix arrays (SSAs). Moreover, genome identity measures between two sequences are calculated based on their maximal exact matches (MEMs). In this paper, we demonstrate the high speed and clustering quality of Gclust by examining four genome sequence datasets. Gclust is freely available for non-commercial use at https://github.com/niu-lab/gclust. We also introduce a web server for clustering user-uploaded genomes at http://niulab.scgrid.cn/gclust.

Correction: Hong Kong Hospital Authority resource efficiency evaluation: Via a novel DEA-Malmquist model and Tobit regression model.

[This corrects the article DOI: 10.1371/journal.pone.0184211.].

Hong Kong Hospital Authority resource efficiency evaluation: Via a novel DEA-Malmquist model and Tobit regression model.

The Hospital Authority (HA) is a statutory body managing all the public hospitals and institutes in Hong Kong (HK). In recent decades, Hong Kong Hospital Authority (HKHA) has been making efforts to improve the healthcare services, but there still exist some problems like unfair resource allocation and poor management, as reported by the Hong Kong medical legislative committee. One critical consequence of these problems is low healthcare efficiency of hospitals, leading to low satisfaction among patients. Moreover, HKHA also suffers from the conflict between limited resource and growing demand. An effective evaluation of HA is important for resource planning and healthcare decision making. In this paper, we propose a two-phase method to evaluate HA efficiency for reducing healthcare expenditure and improving healthcare service. Specifically, in Phase I, we measure the HKHA efficiency changes from 2000 to 2013 by applying a novel DEA-Malmquist index with undesirable factors. In Phase II, we further explore the impact of some exogenous factors (e.g., population density) on HKHA efficiency by Tobit regression model. Empirical results show that there are significant differences between the efficiencies of different hospitals and clusters. In particular, it is found that the public hospital serving in a richer district has a relatively lower efficiency. To a certain extent, this reflects the socioeconomic reality in HK that people with better economic condition prefers receiving higher quality service from the private hospitals.

[Application of electric coagulation treatment via bronchoscopy in the management of congenital vallecular cyst in children].

OBJECTIVE: To discuss the effect of electric coagulation through bronchoscopy in diagnosis and treatment of congenital vallecular cyst in children. METHOD: Ten cases of congenital vallecular cyst in the study with age ranged from 21 days to 4 years and 10 months were treated with electric coagulation through bronchoscopy. The therapeutic effect was evaluated by endoscopic and clinical manifestation. And all the patients were followed-up for 6-12 months. RESULT: All the patients obtained 3-5 times electric coagulation. After the operation, the cyst decreased in size, epiglottis softening was subsided, uplift uncompression, dyspnea and laryngeal stridor were improved obviously. After follow-up periods of 6-12 months, no capsule wall were left, and the activity of the epiglottis resumed.No severe complication was found in any patient. CONCLUSION: Electric coagulation through bronchoscopy is a simple, effective and safe method to treat congenital vallecular cyst in children.

[Pollution characteristics of microbial aerosols generated from a municipal sewage treatment plant].

To characterize the pollution characteristics of microbial aerosols emitted from municipal sewage treatment plants, microbial aerosols were sampled with an Andersen 6-stage impactor at different treatment units of a Xi'an sewage treatment plant between June 2011 and July 2011. The plate-culture and colony-counting methods were employed to determine the concentrations, particle size distributions and median diameters of the airborne bacteria, fungi and actinomycetes. The results showed that the highest concentrations of bacteria (7 866 CFU x m(-3) +/- 960 CFU x m(-3)) and actinomycetes (2 139 CFU x m(-3) +/- 227 CFU x m(-3)) were found in the sludge-dewatering house while the highest fungi concentration (2156 CFU x m(-3) +/- 119 CFU x m(-3)) in the oxidation ditch. The airborne bacteria, fungi and actinomycetes all showed a skewed distribution in particle size. The peaks of bacteria and fungi were in the size range of 2.1-3.3 microm, whereas the peak of airborne actinomycetes was between 1. 1-2.1 microm in size. In general, the order of the median diameters of different microbial aerosols generated from the sewage treatment plant was airborne bacteria > airborne fungi > airborne actinomycetes. In addition, the spatial variation characteristics of microbial aerosols showed that the larger the particle size of the microorganism, the faster the reducing rate of the aerosol concentration. The variations in the reducing rate of concentration with particle sizes can be ordered as airborne bacteria > airborne fungi > airborne actinomycetes.

[Protective effects of hypoxia-inducible factor-1 alpha on myocardial ischemia/reperfusion injury in rat and the role of protein kinase C in signal pathway].

OBJECTIVE: To study the expression of hypoxia-inducible factor-1 alpha (HIF-1 alpha) in a rat model of myocardial ischemia/reperfusion injury (IRI) and the role of protein kinase C (PKC) in signal pathway. METHODS: A rat model of myocardial IRI was reproduced by 30 minutes of left anterior descending coronary artery (LCA) occlusion followed by 180 minutes of reperfusion. Thirty-two healthy male Wistar rats were randomly divided into four groups. The first group was ischemic preconditioning (IPC) group; the second group was simple IRI group; the third group was IPC plus PKC inhibitor group (IPC+I group); the fourth group was the sham-operation group without ligation of LCA. Eight rats were used in each group. The heart was harvested 180 minutes post-reperfusion, the mRNA and protein expression of HIF-1 alpha and heme oxygenase-1 (HO-1) were assessed. Meanwhile, the protein expression of caspase-3 was assayed. Blood samples were obtained from heart to determine the levels of interleukin-8 (IL-8) and myeloperoxidase (MPO). RESULTS: The mRNA and protein expression of HIF-1 alpha and HO-1 increased significantly in the IRI group compared with the sham-operation group, while the protein expression of caspase-3 increased significantly in the IRI group (HIF-1 alpha mRNA: 0.849+/-0.032 vs. 0.356+/-0.022, HIF-1 alpha protein: 0.762+/-0.042 vs. 0.324+/-0.016, HO-1 mRNA: 0.862+/-0.045 vs. 0.332+/-0.012, HO-1 protein: 0.792+/-0.044 vs. 0.335+/-0.031, caspase-3 protein: 0.371+/-0.015 vs. 0.061+/-0.012, respectively, all P<0.01). The levels of IL-8 and MPO increased significantly in the IRI group [IL-8: (812+/-26) ng/L vs. (72+/-13) ng/L, MPO: (78.7+/-2.9) kU/L vs. (13.3+/-1.5) kU/L, both P<0.01]. The protein and mRNA expression of HIF-1 alpha and HO-1 increased significantly in the IPC group compared with IRI group (HIF-1 alpha mRNA: 1.412+/-0.039, HIF-1 alpha protein: 1.362+/-0.045, HO-1 mRNA: 1.523+/-0.038, HO-1 protein: 1.420+/-0.041, respectively), meanwhile the protein expression of caspase-3 (0.129+/-0.019) decreased significantly in the IPC group (all P<0.01). The levels of IL-8 [(432+/-59) ng/L] and MPO [(43.2+/-5.9) kU/L] decreased significantly in the IPC group compared with IRI group (both P<0.01). All above parameters showed no significant change between IPC+I group and IRI group. CONCLUSION: HIF-1 alpha plays a protective role in myocardial IRI, PKC is an important signal pathway of HIF-1 alpha gene expression in IRI.

Enhancement of CLAIM (clinical accounting information) for a localized Chinese version.

CLinical Accounting InforMation (CLAIM) is a standard for the exchange of data between patient accounting systems and electronic medical record (EMR) systems. It uses eXtensible Markup Language (XML) as a meta-language and was developed in Japan. CLAIM is subordinate to the Medical Markup Language (MML) standard, which allows the exchange of medical data between different medical institutions. It has inherited the basic structure of MML 2.x and the current version, version 2.1, contains two modules and nine data definition tables. In China, no data exchange standard yet exists that links EMR systems to accounting systems. Taking advantage of CLAIM's flexibility, we created a localized Chinese version based on CLAIM 2.1. Since Chinese receipt systems differ from those of Japan, some information such as prescription formats, etc. are also different from those in Japan. Two CLAIM modules were re-engineered and six data definition tables were either added or redefined. The Chinese version of CLAIM takes local needs into account, and consequently it is now possible to transfer data between the patient accounting systems and EMR systems of Chinese medical institutions effectively.

Enhancement of MML medical data exchange standard for a localized Chinese version.

Medical Markup Language (MML) is a standard for the exchange of medical data among different medical institutions. It was developed in Japan in 1995. Since version 2.21, MML has used eXtensible Markup Language (XML) as a meta-language. The latest version, 3.0, conforms to HL7 Clinical Document Architecture (CDA) and contains 14 modules and 36 data definition tables. In China, a standard which structures entire medical records in XML does not yet exist. Taking advantage of MML's flexibility, we created a localized Chinese version based on MML 3.0. Parts of the original specifications have been enhanced; these include a newly developed health insurance information module and 12 additional or redefined data definition tables. The Chinese version takes local needs into account and now makes it possible to exchange medical data among Chinese medical institutions.