Comparison of intravascular ultrasound-guided with angiography-guided double kissing crush stenting for patients with complex coronary bifurcation lesions: Rationale and design of a prospective, randomized, and multicenter DKCRUSH VIII trial.

BACKGROUND: Double kissing (DK) crush approach for patients with coronary bifurcation lesions, particularly localized at distal left main or lesions with increased complexity, is associated with significant reduction in clinical events when compared with provisional stenting. Recently, randomized clinical trial has demonstrated the net clinical benefits by intravascular ultrasound (IVUS)-guided implantation of drug-eluting stent in all-comers. However, the improvement in clinical outcome after DK crush treatment guided by IVUS over angiography guidance for patients with complex bifurcation lesions have never been studied in a randomized fashion. TRIAL DESIGN: DKCRUSH VIII study is a prospective, multicenter, randomized controlled trial designed to assess superiority of IVUS-guided vs angiography-guided DK crush stenting in patients with complex bifurcation lesions according to DEFINITION criteria. A total of 556 patients with complex bifurcation lesions will be randomly (1:1 of ratio) assigned to IVUS-guided or angiography-guided DK crush stenting group. The primary end point is the rate of 12-month target vessel failure, including cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization. The secondary end points consist of the individual component of primary end point, all-cause death, myocardial infarction, and in-stent restenosis. The safety end point is the incidence of definite or probable stent thrombosis. An angiographic follow-up will be performed for all patients at 13 months and clinical follow-up will be continued annually until 3 years after the index procedure. CONCLUSIONS: DKCRUSH VIII trial is the first study designed to evaluate the differences in efficacy and safety between IVUS-guided and angiography-guided DK crush stenting in patients with complex true bifurcation lesions. This study will also provide IVUS-derived criteria to define optimal DK crush stenting for bifurcation lesions at higher complexity.

Role of the overexpression of TRAF4 in predicting the prognosis of intrahepatic cholangiocarcinoma.

The incidence of intrahepatic cholangiocarcinoma (ICC) is progressively increasing worldwide, and its prognosis remains poor. Accumulating evidence has demonstrated that tumor necrosis factor receptor-associated factor 4 (TRAF4), an adaptor protein, is involved in the carcinogenesis and progression of several tumor types. However, the function of TRAF4 in predicting prognosis, and mediating migration and invasion of ICC remains to be elucidated. In the present study, immunohistochemistry, western blotting and reverse transcription-quantitative polymerase chain reaction assays were used to determine that the expression of TRAF4 at the mRNA and protein levels in ICC tissues was significantly higher compared with that in non­tumor tissues. The overexpression of TRAF4 was positively correlated with poor differentiation, regional lymphatic metastasis, and high tumor­node-metastasis staging. Inhibiting the expression of TRAF4 using small interfering RNA decreased the migration and invasion of ICC cells in vitro. In addition, the AKT inhibitor perifosine eliminated the effect of TRAF4 on the invasion and migration of ICC cells in vitro. Clinically, the overexpression of TRAF4 was correlated with shorter overall survival rate and elevated recurrence rate in patients with ICC. Furthermore, patients with ICC with a high expression of TRAF4 and lymphatic metastasis were closely associated with a poorer prognosis compared with the other groups. Multivariate analysis indicated that the overexpression of TRAF4 was an independent prognostic indicator for patients with ICC. It was identified that a high level of TRAF4 facilitated the invasiveness of ICC cells via the activation of AKT signaling. The overexpression of TRAF4 may be a prognostic biomarker and candidate therapeutic target for patients with ICC.

Characterization and prognostic significance of mortalin, Bcl-2 and Bax in intrahepatic cholangiocarcinoma.

Intrahepatic cholangiocarcinoma (ICC) is an aggressive type of cancer, and its incidence and mortality rates are increasing worldwide. Mortalin is a highly conserved chaperone protein involved in multiple pathological and physiological processes, including anti-apoptosis, carcinogenesis and metastasis. The Bcl-2 family of proteins can be divided into pro-survival and pro-apoptotic members, including B-cell lymphoma 2 (Bcl-2) and Bcl-2-like protein 4 (Bax). The aim of the present study was to investigate the association between mortalin, Bcl-2 and Bax, as well as the prognostic significance of the combined expression of mortalin, Bcl-2 and Bax in ICC. Immunohistochemistry was used to determine the expression of mortalin, Bcl-2 and Bax in 116 ICC samples and to assess the association between expression of 3 markers and clinicopathological features of ICC patients. This revealed that ICC tumor tissues overexpressed mortalin and Bcl-2 and exhibited low expression of Bax in ICC tumor tissues compared with that in corresponding peritumoral samples. According to Pearson's correlation coefficient analysis, high expression of mortalin in ICC was positively correlated with Bcl-2 expression and negatively correlated with Bax expression. Furthermore, multiple linear regression analysis demonstrated that mortalin was positively associated with Bcl-2, but not with Bax, in patients with ICC. Patients with ICC exhibiting high expression of mortalin/Bcl-2 or low expression of Bax were closely associated with a malignant ICC phenotype, a relatively low overall survival rate and a high recurrence rate. Multivariate analysis indicated that mortalin and Bcl-2 were independent prognostic indicators for ICC patients. Meanwhile, the concomitant overexpression of mortalin and Bcl-2 and the low expression of Bax were independent markers for predicting a relatively poor prognosis of ICC. The overexpression of mortalin and Bcl-2 and/or the low expression of Bax are implicated in the anti-apoptotic effect and tumor progression of ICC. Mortalin or Bcl-2, or a combination of mortalin, Bcl-2 and Bax may be used to predict the prognosis of ICC, as well as potential therapeutic targets.

[Changes of rice yield and quality in different accumulated temperature zones in Heilongjiang Province of Northeast China].

Field experiments were installed in different accumulated temperature zones in Heilongjiang Province to study the changes of the grain yield and quality of five major rice varieties with accumulated temperature. The rice yield changed with accumulated temperature in quadratic curve, and the correlation degree differed with the varieties. The panicle number and the grain number per panicle changed significantly in quadratic curve with accumulated temperature, while the 1000-grain mass had less correlation with accumulated temperature. The sterile spikelet rate of grain increased obviously from suitable accumulated temperature zone to low accumulated temperature zone, but had no obvious change from suitable accumulated temperature zone to high accumulated temperature zone. The rates of chalky and head milled rice also changed with accumulated temperature in quadratic curve, i. e., there were both the lowest and the highest values in suitable accumulated temperature zone. The protein and amylose contents of the grain as well as the taste varied little with accumulated temperature. According to the sensitivity to temperature, the test rice varieties were divided into sensitive, medium, and blunt types, with the optimal and allowable cultivation accumulated temperature limits being 300 degrees C and 420 degrees C, 360 degrees C and 440 degrees C, and 380 degrees C and 520 degrees C, respectively. It would be very important to select the rice varieties with higher yield and better quality according to the local conditions, especially the accumulated temperature.

[Relationships between rice empty grain rate and low temperature at booting stage in Heilongjiang Province].

Six major rice varieties (Longdao 3, Kendao 12, Kongyu 131, Longdao 7, Longjing 16, and Songjing 6) in Heilongjiang Province were treated with low temperature 15 degrees C, 17 degrees C, and 19 degrees C for 2, 4, 6 and 8 days at booting stage, and the relationships between their empty grain rate per panicle and low temperature at booting stage were analyzed by using linear interpolation and linear regression methods. In the province, the critical temperature of sterile-type cool injury was 17 degrees C for sensitive varieties, and 16 degrees C for resistant varieties. The most sensitive period of rice to low temperature was 14-18 days before heading. At 15 degrees C for 8 days, the empty grain rate of Songjing 6 and Kendao 12 increased significantly, while that of Kongyu 131 increased less, suggesting that the cold tolerance of Songjing 6 and Kendao 12 was relatively weak, while Kongyu 131 was insensitive to low temperature. There was a significant correlation between the accumulated cool temperature and the empty grain rate of Kendao 12, Longjing 16, and Kongyu 131 (P<0.01). With the increase of accumulated cool temperature, the rice empty grain rate increased significantly, but the increment varied with rice variety.