Prognostic significance of inflammation in patients with coronary artery disease at low residual inflammatory risk.

Patients with coronary artery disease (CAD) at low residual inflammatory risk are often overlooked in research and practice. This study examined the associations between fourteen inflammatory indicators and all-cause mortality in 5,339 CAD patients with baseline high-sensitivity C-reactive protein (hsCRP) <2 mg/L who received percutaneous coronary intervention and statin and aspirin therapy. The median follow-up time was 2.1 years. Neutrophil-derived systemic inflammatory response index (SIRI) yielded the strongest and most robust association with all-cause mortality among all indicators. Lower hsCRP remained to be associated with a lower risk of all-cause mortality. A newly developed comprehensive inflammation score (CIS) showed better predictive performance than other indicators, which was validated by an independent external cohort. In conclusion, neutrophil-derived indicators, particularly SIRI, strongly predicted all-cause mortality independent of hsCRP in CAD patients at low residual inflammatory risk. CIS may help identify individuals with inflammation burdens that cannot be explained by hsCRP alone.

Rethinking the pathway to sustainable fire retardants.

Flame retardants are currently used in a wide range of industry sectors for saving lives and property by mitigating fire hazards. The growing fire safety requirements for materials boost an escalating demand for consumption of fire retardants. This has significantly driven both the industry and scientific community to pursue sustainable fire retardants, but what makes a sustainable flame retardant? Here an overview of recent advances in sustainable flame retardants is offered, and their renewable raw materials, green synthesis and life cycle assessments are highlighted. A discussion on key challenges that hinder the innovation of fire retardants and design principles for creating truly sustainable yet cost-effective fire retardants are also presented. This short work is expected to help drive the development of sustainable, cost-effective fire retardants, and expedite the creation of a more sustainable and safer society.

[Mechanism of Zhenwu Decoction in improving renal inflammatory injury in mice with DN of spleen-kidney Yang deficiency syndrome by regulating ROCK/IKK/NF-κB pathway].

To investigate the intervention effect and mechanism of Zhenwu Decoction on diabetic nephropathy(DN) mice of spleen-kidney Yang deficiency syndrome based on the Rho-associated coiled-coil kinase(ROCK)/IκB kinase(IKK)/nuclear factor-κB(NF-κB) pathway. Ninety-five 7-week-old db/db male mice and 25 7-week-old db/m male mice were fed adaptively for one week. The DN model of spleen-kidney Yang deficiency syndrome was induced by Dahuang Decoction combined with hydrocortisone by gavage, and then the model was evaluated. After modeling, they were randomly divided into a model group, high-dose, medium-dose, and low-dose Zhenwu Decoction groups(33.8, 16.9, and 8.45 g·kg~(-1)·d~(-1)), and an irbesartan group(25 mg·kg~(-1)·d~(-1)), with at least 15 animals in each group. The intervention lasted for eight weeks. After the intervention, body weight and food intake were measured. Serum crea-tinine(Scr), blood urea nitrogen(BUN), fasting blood glucose(FBG), urinary albumin(uALb), and urine creatinine(Ucr) were determined. The uALb/Ucr ratio(ACR) and 24 h urinary protein(UTP) were calculated. Renal pathological morphology was evaluated by HE staining and Masson staining. The levels of key molecular proteins in the ROCK/IKK/NF-κB pathway were detected by Western blot. Enzyme-linked immunosorbent assay(ELISA) was used to detect interleukin-1ß(IL-1ß), interleukin-6(IL-6), interleukin-8(IL-8), interleukin-10(IL-10), and tumor necrosis factor-α(TNF-α). Compared with the blank group, the model group showed increased content of BUN, uALb, and SCr, increased values of 24 h UTP and ACR, decreased content of Ucr(P<0.05), enlarged glomeruli, thickened basement membrane, mesangial matrix proliferation, inflammatory cell infiltration, and collagen fiber deposition. The protein expression of ROCK1, ROCK2, IKK, NF-κB, phosphorylated IKK(p-IKK), phosphorylated NF-κB(p-NF-κB), and phosphorylated inhibitor of NF-κB(p-IκB) increased(P<0.05), while the protein expression of inhibitor of NF-κB(IκB) decreased(P<0.05). The levels of inflammatory factors IL-1ß, IL-6, IL-8, and TNF-α increased(P<0.05), while the level of IL-10 decreased(P<0.05). Compared with the model group, the groups with drug treatment showed decreased levels of BUN, uALb, SCr, 24 h UTP, and ACR, increased level of Ucr(P<0.05), and improved renal pathological status to varying degrees. The high-and medium-dose Zhenwu Decoction groups and the irbesartan group showed reduced protein expression of ROCK1, ROCK2, IKK, NF-κB, p-IKK, p-NF-κB, and p-IκB in the kidneys(P<0.05), increased protein expression of IκB(P<0.05), decreased levels of serum inflammatory factors IL-1ß, IL-6, IL-8, and TNF-α(P<0.05), and increased level of IL-10(P<0.05). Zhenwu Decoction can significantly improve renal function and renal pathological damage in DN mice of spleen-kidney Yang deficiency syndrome, and its specific mechanism may be related to the inhibition of inflammatory response by down-regulating the expression of key molecules in the ROCK/IKK/NF-κB pathway in the kidney.

Association Between Free Fatty Acids and Cardiometabolic Risk in Coronary Artery Disease: Results From the PROMISE Study.

CONTEXT: The association between free fatty acids (FFAs) and unfavorable clinical outcomes has been reported in the general population. However, evidence in the secondary prevention population is relatively scarce. OBJECTIVE: We aimed to examine the relationship between FFA and cardiovascular risk in patients with coronary artery disease (CAD). METHODS: This study was based on a multicenter cohort of patients with CAD enrolled from January 2015 to May 2019. The primary outcome was all-cause death. Secondary outcomes included cardiac death and major adverse cardiovascular events (MACE), a composite of death, myocardial infarction, and unplanned revascularization. RESULTS: During a follow-up of 2 years, there were 468 (3.0%) all-cause deaths, 335 (2.1%) cardiac deaths, and 1279 (8.1%) MACE. Elevated FFA levels were independently associated with increased risks of all-cause death, cardiac death, and MACE (all P < .05). Moreover, When FFA were combined with an original model derived from the Cox regression, there were significant improvements in discrimination and reclassification for prediction of all-cause death (net reclassification improvement [NRI] 0.245, P < .001; integrated discrimination improvement [IDI] 0.004, P = .004), cardiac death (NRI 0.269, P < .001; IDI 0.003, P = .006), and MACE (NRI 0.268, P < .001; IDI 0.004, P < .001). Notably, when stratified by age, we found that the association between FFA with MACE risk appeared to be stronger in patients aged ≥60 years compared with those aged <60 years. CONCLUSION: In patients with CAD, FFAs are associated with all-cause death, cardiac death, and MACE. Combined evaluation of FFAs with other traditional risk factors could help identify high-risk individuals who may require closer monitoring and aggressive treatment.

The impact of fasting stress hyperglycemia ratio, fasting plasma glucose and hemoglobin A1c on in-hospital mortality in patients with and without diabetes: findings from the China acute myocardial infarction registry.

BACKGROUND: Stress hyperglycemia was positively associated with poor prognosis in individuals with acute myocardial infarction (AMI). However, admission glucose and stress hyperglycemia ratio (SHR) may not be the best indicator of stress hyperglycemia. We performed this study to evaluate the comparative prognostic value of different measures of hyperglycemia (fasting SHR, fasting plasma glucose [FPG], and hemoglobin A1c [HbA1c]) for in-hospital mortality in AMI patients with or without diabetes. METHODS: In this prospective, nationwide, multicenter China Acute Myocardial Infarction (CAMI) registry, 5,308 AMI patients including 2081 with diabetes and 3227 without diabetes were evaluated. Fasting SHR was calculated using the formula [(first FPG (mmol/l))/(1.59×HbA1c (%)-2.59)]. According to the quartiles of fasting SHR, FPG and HbA1c, diabetic and non-diabetic patients were divided into four groups, respectively. The primary endpoint was in-hospital mortality. RESULTS: Overall, 225 (4.2%) patients died during hospitalization. Individuals in quartile 4 had a significantly higher rate of in-hospital mortality compared with those in quartile 1 in diabetic cohort (9.7% vs. 2.0%; adjusted odds ratio [OR] 4.070, 95% CI 2.014-8.228) and nondiabetic cohort (8.8% vs. 2.2%; adjusted OR 2.976, 95% CI 1.695-5.224). Fasting SHR was also correlated with higher in-hospital mortality when treated as a continuous variable in diabetic and nondiabetic patients. Similar results were observed for FPG either as a continuous variable or a categorical variable. In addition, fasting SHR and FPG, rather than HbA1c, had a moderate predictive value for in-hospital mortality in patients with diabetes (areas under the curve [AUC] for fasting SHR: 0.702; FPG: 0.689) and without diabetes (AUC for fasting SHR: 0.690; FPG: 0.693). The AUC for fasting SHR was not significantly different from that of FPG in diabetic and nondiabetic patients. Moreover, adding fasting SHR or FPG to the original model led to a significant improvement in C-statistic regardless of diabetic status. CONCLUSIONS: This study indicated that, in individuals with AMI, fasting SHR as well as FPG was strongly associated with in-hospital mortality regardless of glucose metabolism status. Fasting SHR and FPG might be considered as a useful marker for risk stratification in this population. TRIAL REGISTRATION: ClinicalTrials.gov NCT01874691.

Inverse Association of Lipoprotein(a) on Long-Term Bleeding Risk in Patients with Coronary Heart Disease: Insight from a Multicenter Cohort in Asia.

BACKGROUND: Lipoprotein(a), or Lp(a), has been recognized as a strong risk factor for atherosclerotic cardiovascular disease. However, the relationship between Lp(a) and bleeding remains indistinct, especially in the secondary prevention population of coronary artery disease (CAD). This investigation aimed to evaluate the association of Lp(a) with long-term bleeding among patients with CAD. METHODS: Based on a prospective multicenter cohort of patients with CAD consecutively enrolled from January 2015 to May 2019 in China, the current analysis included 16,150 participants. Thus, according to Lp(a) quintiles, all subjects were divided into five groups. The primary endpoint was bleeding at 2-year follow-up, and the secondary endpoint was major bleeding at 2-year follow-up. RESULTS: A total of 2,747 (17.0%) bleeding and 525 (3.3%) major bleeding were recorded during a median follow-up of 2.0 years. Kaplan-Meier survival analysis showed the highest bleeding incidence in Lp(a) quintile 1, compared with patients in Lp(a) quintiles 2 to 5 (p < 0.001), while the incidence of major bleeding seemed similar between the two groups. Moreover, restricted cubic spline analysis suggested that there was an L-shaped association between Lp(a) and 2-year bleeding after adjustment for potential confounding factors, whereas there was no significant association between Lp(a) and 2-year major bleeding. CONCLUSION: There was an inverse and L-shaped association of Lp(a) with bleeding at 2-year follow-up in patients with CAD. More attention and effort should be made to increase the clinician awareness of Lp(a)'s role, as a novel marker for bleeding risk to better guide shared-decision making in clinical practice.

Inflammation and Insulin Resistance in Diabetic Chronic Coronary Syndrome Patients.

Limited evidence exists on the combined and mediating effects of systemic inflammation on the association between insulin resistance and cardiovascular events in patients with diabetes and chronic coronary syndrome (CCS). This secondary analysis of a multicenter prospective cohort included 4419 diabetic CCS patients. Triglyceride-glucose index (TyG) and high-sensitivity C-reactive protein (hsCRP) were applied to evaluate insulin resistance and systemic inflammation, respectively. The primary endpoint was major adverse cardiac event (MACE). Associations of TyG and hsCRP with cardiovascular events were estimated using Cox regression. A mediation analysis was performed to assess whether hsCRP mediates the relationship between TyG and cardiovascular events. Within a median 2.1-year follow-up period, 405 MACEs occurred. Patients with high levels of TyG and hsCRP experienced the highest MACE risk (hazard ratio = 1.82, 95% confidence interval: 1.24-2.70, p = 0.002) compared to individuals with low levels of both markers. HsCRP significantly mediated 14.37% of the relationship between TyG and MACE (p < 0.001). In diabetic CCS patients, insulin resistance and systemic inflammation synergically increased the risk of cardiovascular events, and systemic inflammation partially mediated the association between insulin resistance and clinical outcomes. Combining TyG and hsCRP can help identify high-risk patients. Controlling inflammation in patients with insulin resistance may bring added benefits.

Stress hyperglycemia ratio and long-term prognosis in patients with acute coronary syndrome: A multicenter, nationwide study.

BACKGROUND: Stress hyperglycemia ratio (SHR), a novel biomarker of stress hyperglycemia, was proved to be a reliable predictor of short-term adverse outcomes in patients with acute coronary syndromes (ACS). However, its impact on long-term prognosis remained controversial. METHODS: A total of 7662 patients with ACS from a large nationwide prospective cohort between January 2015 and May 2019 were included. SHR was calculated by the following formula: SHR = admission glucose (mmol/L)/(1.59 × HbA1c [%]-2.59). The primary end point was a major adverse cardiovascular event (MACE) during follow-up, a composite of all-cause death, myocardial infarction, and unplanned revascularization. The second end point was the separate components of the primary end points. RESULTS: During a median follow-up of 2.1 years, 779 MACE events occurred. After multivariable adjustment, ACS patients with the highest SHR tertile were significantly associated with increased long-term risks of MACE (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.24-1.88), all-cause death (HR 1.80, 95% CI 1.29-2.51) and unplanned revascularization (HR 1.44, 95% CI 1.09-1.91). Although significant associations between the highest SHR tertile and risks of MACE and all-cause death were assessed in both diabetic and nondiabetic patients, the patterns of risk were different in these two groups. CONCLUSION: Elevated SHR was independently associated with a higher risk of long-term outcomes irrespective of diabetic status, suggesting that SHR was a potential biomarker for risk stratification after ACS.

Triglyceride glucose index predicts in-hospital mortality in patients with ST-segment elevation myocardial infarction who underwent primary angiography.

OBJECTIVES: To assess the correlation between triglyceride glucose (TyG) index and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 2190 patients with STEMI who underwent primary angiography within 12 h from symptom onset were selected from the prospective, nationwide, multicenter CAMI registry. TyG index was calculated with the formula: Ln [fasting triglycerides (mmol/L) × fasting glucose (mmol/L)/2]. Patients were divided into three groups according to the tertiles of TyG index. The primary endpoint was in-hospital mortality. RESULTS: Overall, 46 patients died during hospitalization, in-hospital mortality was 1.5%, 2.2%, 2.6% for tertile 1, tertile 2, and tertile 3, respectively. However, TyG index was not significantly correlated with in-hospital mortality in single-variable logistic regression analysis. Nonetheless, after adjusting for age and sex, TyG index was significantly associated with higher mortality when regarded as a continuous variable (adjusted OR = 1.75, 95% CI: 1.16-2.63) or categorical variable (tertile 3 vs. tertile 1: adjusted OR = 2.50, 95% CI: 1.14-5.49). Furthermore, TyG index, either as a continuous variable (adjusted OR = 2.54, 95% CI: 1.42-4.54) or categorical variable (tertile 3 vs. tertile 1: adjusted OR = 3.57, 95% CI: 1.24-10.29), was an independent predictor of in-hospital mortality after adjusting for multiple confounders in multivariable logistic regression analysis. In subgroup analysis, the prognostic effect of high TyG index was more significant in patients with body mass index < 18.5 kg/m2 (P interaction = 0.006). CONCLUSIONS: This study showed that TyG index was positively correlated with in-hospital mortality in STEMI patients who underwent primary angiography, especially in underweight patients.

Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China.

This study sought to investigate the prevalence and prognostic significance of malnutrition in patients with an abnormal glycemic status and coronary artery disease (CAD). This secondary analysis of a multicenter prospective cohort included 5710 CAD patients with prediabetes and 9328 with diabetes. Four objective tools were applied to assess the nutritional status of the study population. The primary endpoint was all-cause death. The association of malnutrition with clinical outcomes was examined using Cox proportional hazards regression. The proportion of malnutrition varied from 8% to 57% across the assessment tools. Diabetic patients were more likely to be malnourished than prediabetic patients. During a median follow-up of 2.1 years, 456 all-cause deaths occurred. The adjusted hazard ratios and 95% confidence interval for all-cause deaths of moderate-severe malnutrition defined by different tools ranged from 1.59 (1.03, 2.46) to 2.08 (0.92, 4.73) in prediabetic patients and 1.51 (1.00, 2.34) to 2.41 (1.78, 3.27) in diabetic patients. In conclusion, malnutrition is not rare in CAD patients with abnormal glycemic status. Moderate-severe malnutrition strongly predicted all-cause death regardless of the assessment tool. Assessing the nutritional status for all CAD patients with prediabetes and diabetes to identify individuals at high risk of all-cause death may help the risk assessment and prognosis improvement.

Fasting stress hyperglycemia ratio and in-hospital mortality after acute myocardial infarction in patients with different glucose metabolism status: Results from China acute myocardial infarction registry.

AIMS: To evaluate the predictive value of fasting stress hyperglycemia ratio (SHR) for in-hospital mortality in patients with acute myocardial infarction (AMI) under different glucose metabolism status. METHODS: We evaluated 5,308 AMI patients from the prospective, nationwide, multicenter China Acute Myocardial Infarction (CAMI) registry, of which 2,081 had diabetes. Fasting SHR was calculated by the formula [(first fasting plasma glucose (mmol/l))/(1.59 × HbA1c (%)-2.59)]. Patients were divided into high and low fasting SHR groups according to the optimal fasting SHR thresholds to predict in-hospital mortality for patients with and without diabetes, respectively. The primary endpoint was in-hospital mortality. RESULTS: The optimal cutoff values of SHR were 1.06 and 1.26 for patients with and without diabetes. Patients with high fasting SHR presented higher in-hospital mortality than those with low fasting SHR in both cohorts with diabetes (7.9% vs 2.2%; OR adjusted 3.159, 95% CI 1.932-5.165; OR IPTW 3.311, 95%CI 2.326-4.713) and without diabetes (10.1% vs 2.5%; OR adjusted 3.189, 95%CI 2.161-4.705; OR IPTW 3.224, 95%CI 2.465-4.217). The prognostic powers of fasting SHR for in-hospital mortality were similar in patients with different glucose metabolism status. Moreover, adding fasting SHR to the original model led to a significant improvement in C-statistic, net reclassification, and integrated discrimination regardless of diabetes status. CONCLUSIONS: This study firstly demonstrated a strong positive association between fasting SHR and in-hospital mortality in AMI patients with and without diabetes. Fasting SHR should be considered as a useful marker for risk stratification in AMI patients regardless of glucose metabolism status. TRIAL REGISTRATION: ClinicalTrials.gov NCT01874691.

Non-Isocyanate Polyurethane Bio-Foam with Inherent Heat and Fire Resistance.

Polyurethanes (PUs) are versatile and widespread, particularly as flexible and rigid foams. To avoid isocyanates and other toxic reagents required for synthesis, such as phosgene, alternative synthetic routes have been utilized to produce non-isocyanate polyurethanes (NIPUs). A thermally and flame-resistant rigid NIPU was produced from environmentally benign and bio-sourced ingredients, requiring no catalyst or solvents. A foamed structure was obtained by the addition of glutaraldehyde and four different carboxylic acids: malic acid, maleic acid, citric acid, and aconitic acid. The resulting morphology, thermal degradation, and flame resistance of each foam were compared. The properties vary with each carboxylic acid used, but in each case, peak thermal degradation and peak heat release are postponed by >100 °C compared to commercial rigid PU foam. Furthermore, in a butane torch test, NIPU foams exhibit an 80% higher remaining mass and a 75% reduction in afterburn time, compared to commercial polyurethane. This bio-based polyurethane eliminates the hazards of traditional PUs, while imparting inherent thermal stability and flame resistance uncharacteristic of conventional foams.

Effect of transradial catheterization and nifedipine on flow- and nitroglycerin-mediated dilations of distal and proximal radial artery.

OBJECTIVE: Radial artery (RA) dysfunction after transradial access intervention is not limited to the distal portion but can also occur in the proximal portion of RA. The aim of the present study was to assess the effect of sublingual nifedipine administrated prior to puncture on the endothelial function of distal and proximal RA. METHODS: Eighty-nine patients who underwent coronary angiography (CAG) were randomly assigned to the nifedipine group ( n = 45) or control group ( n = 44). The flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) of distal and proximal RA were measured at baseline, 24 h, and 48 h after transradial angiography. RESULTS: Compared with the control group, the nifedipine group only limited the reduction of FMD in the distal RA at 24 and 48 h [6.52 ± 1.40% (24 h) vs. 5.85 ± 1.38% (24 h), P = 0.03; 7.41 ± 1.30% (48 h) vs. 6.65 ± 1.25% (48 h), P = 0.006], whereas FMD alterations in the proximal RA were not restored by nifedipine. Both groups were still lower than baseline values (11.66 ± 2.35% and 11.24 ± 2.22%). We observed similar effects of nifedipine on the NMD of the distal RA. CONCLUSION: Although transradial angiography-induced dysfunction was reported in both distal and proximal RA, nifedipine could help restore the distal endothelial function of the cannulated RA.

The impact of symmetry design of intangible cultural heritage souvenir on tourists' aesthetic pleasure.

Souvenirs play an important role in tourism development. They act not only as mementos, enabling tourists to relive and retain the memory of a particular journey, but also as main income sources for tourism destinations and stakeholders. Many intangible cultural heritages (ICH) have been developed into souvenirs, especially products made by traditional craftsmanship. ICH souvenirs facilitate cultural value that is understandable to tourists, who appreciate the design of the ICH souvenirs and their contributions to a pleasure and memorable journey. Based on the theory of beauty and the preference-for-prototypes theory, this study explored how symmetry design of ICH souvenirs influences tourist's aesthetic pleasure. As ICH souvenirs development is a commercialization process, and over-commodification would lead to cultures being lost and tourists' disappointment, the authenticity concept is applied in order to address over-commodification. Thus, this study analyzed the moderating role of tourists' authenticity perception of ICH souvenirs. Two lab-based between-subjects design experiments were employed to test the proposed hypotheses. Data analysis entailed multiple regression analysis, one-way ANOVA, and two-way ANOVA. The findings showed that symmetry of ICH souvenir design had a positive impact on tourists' aesthetic pleasure. Under the symmetric-design condition, tourists' typicality perception of ICH souvenirs positively mediated the main relationship, while under the asymmetric-design condition, tourists' novelty perception had a negative mediating effect. The moderated mediation effects were in accord with hypotheses to some extent; at a relatively high level of authenticity perception (above mean value), the indirect effect of symmetry on aesthetic pleasure via typicality perception increased as authenticity perception rose; at a relatively low level of authenticity perception (under mean value), the indirect effect of symmetry on aesthetic pleasure via novelty perception declined as authenticity perception rose. This study identified critical factors influencing tourists' aesthetic pleasure with ICH souvenirs, and it revealed the internal influencing mechanisms and moderating effects under different design conditions. These findings give some insights to ICH practitioners for using souvenir design to improve tourists' aesthetic pleasure.

Admission Blood Glucose and 2-Year Mortality After Acute Myocardial Infarction in Patients With Different Glucose Metabolism Status: A Prospective, Nationwide, and Multicenter Registry.

Background: The prognostic effect of admission blood glucose (ABG) for patients with acute myocardial infarction (AMI) has not been well validated, especially in patients with diabetes. We performed this study to assess the predictive value of ABG for all-cause mortality in AMI patients with different glucose metabolism status. Methods: We evaluated a total of 6,892 AMI patients from the prospective, nationwide, multicenter CAMI registry, of which 2,820 had diabetes, 2,011 had pre-diabetes, and 2,061 had normal glucose regulation (NGR). Patients were divided into high ABG and low ABG groups according to the optimal cutoff values of ABG to predict 2-year mortality for patients with diabetes, pre-diabetes and NGR, respectively. The primary endpoint was all-cause mortality. Results: The optimal cutoff values of ABG for predicting 2-year mortality was 9.0mmol/l, 7.2mmol/l and 6.2mmol/l for patients with diabetes, pre-diabetes and NGR, respectively. Overall, the risk of all-cause mortality in high ABG group was significantly increased compared with that in low ABG group among patients with diabetes (15.2% vs. 8.9%; hazard ratio [HR] 1.787, 95% confidence interval [CI] 1.413-2.260; P<0.0001), pre-diabetes (12.1% vs. 6.1%; HR 2.069, 95%CI 1.518-2.821; P<0.0001) and NGR (11.8% vs. 6.1%; HR 2.009, 95%CI 1.473-2.740; P<0.0001). After the potential confounders were adjusted, high ABG was significantly associated with higher risk of 2-year mortality in patients with diabetes (adjusted HR 1.710, 95%CI 1.327-2.203; P<0.0001), pre-diabetes (adjusted HR 1.731, 95%CI 1.249-2.399; P=0.001) and NGR (adjusted HR 1.529, 95%CI 1.110-2.106; P=0.009). Moreover, adding ABG to the original model led to a slight albeit significant improvement in C-statistic and net reclassification in patients with diabetes and NGR (all P<0.05). Conclusions: This study is the first to demonstrate a strong positive association between ABG and 2-year mortality in AMI patients with diabetes, pre-diabetes and NGR. ABG should be considered as a useful marker for risk stratification in patients with diabetes and NGR. Further randomized trials are warranted to investigate the effects of blood glucose control on the reduction of long-term mortality according to the corresponding ABG thresholds for different glucose metabolism status. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT01874691.

Stress hyperglycemia ratio and long-term mortality after acute myocardial infarction in patients with and without diabetes: A prospective, nationwide, and multicentre registry.

AIMS: To assess the predictive value of stress hyperglycemia ratio (SHR) for long-term mortality after acute myocardial infarction (AMI) in patients with and without diabetes. MATERIALS AND METHODS: We evaluated 6892 patients with AMI from the prospective, nationwide, multicentre China Acute Myocardial Infarction registry, of which 2820 had diabetes, and the remaining 4072 were nondiabetic patients. Patients were divided into high SHR and low SHR groups according to the optimal cutoff values of SHR to predict long-term mortality for diabetic and nondiabetic patients, respectively. The primary endpoint was all-cause mortality at 2 years. RESULTS: The optimal cutoff values of SHR for predicting 2-year mortality were 1.20 and 1.08 for the diabetic and nondiabetic population, respectively. Overall, patients with high SHR were significantly associated with higher all-cause mortality compared with those with low SHR, in both diabetic patients (18.5% vs. 9.7%; hazard ratio [HR] 2.01, 95% confidence interval 1.63-2.49) and nondiabetic patients (12.0% vs. 6.4%; HR 1.95, 95%CI 1.57-2.41). After the potential confounders were adjusted, high SHR was significantly associated with higher risks of long-term mortality in both diabetic (adjusted HR 1.73, 95%CI 1.39-2.15) and nondiabetic (adjusted HR 1.63, 95%CI 1.30-2.03) patients. Moreover, adding SHR to the original model led to a slight albeit significant improvement in C-statistic, net reclassification, and integrated discrimination regardless of diabetic status. CONCLUSIONS: This study demonstrated a strong positive association between SHR and long-term mortality in patients with AMI with and without diabetes, suggesting that SHR should be considered a useful marker for risk stratification in these patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT01874691.

The efficacy and safety of acupuncture and nicotine replacement therapy for smoking cessation: study protocol for a randomized controlled trial.

INTRODUCTION: Tobacco hazard is one of the most serious public health problems, accounting for up to 6 million deaths worldwide p.a. We aim to determine the efficacy and safety of acupuncture and/or nicotine replacement therapy on smoking cessation. METHODS: We will recruit 96 participants who are willing to quit smoking by acupuncture and/or nicotine replacement therapy in Chengguan, Xigu and Heping Districts, Lanzhou city, for multicenter randomized, double-blind, double-dummy controlled clinical trial. Following obtained the informed consent forms, all eligible participants will be randomly divided into 4 groups: (1) acupuncture combined with nicotine patch, (2) acupuncture combined with sham nicotine patch, (3) sham acupuncture combined with nicotine patch, and (4) sham acupuncture combined with sham nicotine patch. These participants will be treated with different intervention modalities for 8 weeks and then will be followed-up for 8 weeks. The SPSS 26.0 software will be applied to analyze the clinical effects and adverse reactions of different intervention measures for smoking cessation. DISCUSSION: This trial is a prospective, pragmatic, randomized, multicenter trial study protocol. The outcomes will illustrate the efficacy and safety of acupuncture and/or nicotine patches for smoking cessation. Provide smokers with a superior smoking cessation program. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100042912 . Registered on January 31, 2021.

Characteristics of Pulse Parameters in Patients with Polycystic Ovary Syndrome Varied at Different Body Mass Index Levels.

Objective: To analyze the characteristics of pulse graph parameters in patients with polycystic ovary syndrome (PCOS) varied at different body mass index (BMI) levels and to provide pulse diagnosis basis for syndrome differentiation and treatment of PCOS. Methods: Pulse graph parameters of 152 patients with PCOS (26 lean patients, 63 patients with moderate weight, and 63 overweight patients) were measured by a Z-BOX pulse meter, and the pulse graph parameters of patients with PCOS varied at different BMI levels were analyzed. Results: Fine pulse, slippery pulse, and string-like pulse were the most common pulse conditions in patients with PCOS. The common pulse conditions of patients with PCOS varied at different BMI levels. The order of pulse conditions was as follows: lean group: fine pulse > string-like pulse > slippery pulse; moderate group: fine pulse > slippery pulse > string-like pulse; and overweight group: slippery pulse > fine pulse > sunken pulse. Compared to the overweight group, the pulse graph parameters h1, h3, h4, h5, h4/h1, As, and Ad increased in the moderate group (P < 0.05), and the parameters h1, h3, and Ad increased (P < 0.05) and the parameter t1 decreased (P < 0.05) in the lean group. Conclusion: Pulse graph parameters among patients with PCOS varied at different BMI levels, which can probably provide pulse diagnosis basis for syndrome differentiation and treatment of PCOS by traditional Chinese medicine (TCM).

Thermal Stability and Flammability Studies of MXene-Organic Hybrid Polystyrene Nanocomposites.

Polystyrene (PS) is widely used in the plastics industry, but the application range of PS is limited due to its inherently high flammability. A variety of two-dimensional (2D) nanomaterials have been reported to impart excellent flame retardancy to polymeric materials. In this study, a 2D nanomaterial MXene-organic hybrid (O-Ti3C2) was applied to PS as a nanofiller. Firstly, the MXene nanosheets were prepared by acid etching, intercalation, and delamination of bulk MAX (Ti3AlC2) material. These exfoliated MXene nanosheets were then functionalized using a cationic surfactant to improve the dispersibility in DMF. Even with a small loading of functionalized O-Ti3C2 (e.g., 2 wt%), the resulting PS nanocomposite (PS/O-Ti3C2) showed good thermal stability and lower flammability evidenced by thermogravimetric analysis (TGA) and pyrolysis-combustion flow calorimetry (PCFC). The peak heat release rate (pHRR) was significantly reduced by 32% compared to the neat PS sample. In addition, we observed that the temperature at pHRR (TpHRR) shifted to a higher temperature by 22 °C. By comparing the TGA and PCFC results between the PS/MAX and different weight ratios of PS/O-Ti3C2 nanocomposites, the thermal stability and 2D thermal- and mass-transfer barrier effect of MXene-organic hybrid nanosheets were revealed to play essential roles in delaying the polymer degradation.

Zwitterionic Graphene Quantum Dots to Stabilize Pickering Emulsions for Controlled-Release Applications.

Graphene quantum dots (GQDs) are a subset of the nanocarbon material family, which promise a wide spectrum of applications. Herein, we describe amphiphilic graphene quantum dots with zwitterionic features (ZGQDs), which are able to stabilize the oil/water interface. ZGQDs were fabricated by modifying GQDs with tertiary amine groups and alkyl groups. Moreover, the blocking and unblocking behavior of ZGQDs at the oil/water interface could be tuned by adjusting pH values in the aqueous phase. It would provide a flexible and adjustable method to manipulate interfacial properties of ZGQDs, which enabled a switchable molecular diffusion through a fluid-fluid interface. ZGQDs have shown well-controlled interfacial behavior under different pH conditions, indicating great potential for applications in controlled molecular diffusion based on nanoparticles demonstrated in this work.