Dynamic fluctuations of advanced glycation end products and its C-terminal truncated receptor level in patients with acute ST-segment elevation myocardial infarction and undergoing diabetes or not: A retrospective study.

The role of advanced glycation end products (AGEs) and its C-terminal truncated receptor (soluble receptor for advanced glycation end products, sRAGE) in ST-segment elevation myocardial infarction (STEMI) patients with or without diabetes is unknown. We compared their levels in patients with and without STEMI, as well as with and without diabetes. A prospective observational study was performed between December 2014 and December 2015. Study group included STEMI patients with coronary artery disease; control group included patients without coronary artery disease. Levels of AGEs and sRAGE were tested on Days 0, 2, and 5 after STEMI. Levels of creatine kinase-MB (CK-MB), cardiac troponin I, and N-terminal pro-brain natriuretic peptide (NT-proBNP) were tested on Days 0, 1, 2, and 3. Patient's diabetic status was determined by medical history or oral glucose tolerance test. Compared to patients in the control group, STEMI patients showed elevated levels of AGEs and sRAGE. In the STEMI group, diabetic patients had higher levels of AGEs and sRAGE compared to nondiabetic patients. The level of AGEs correlated with peak level of CK-MB in the overall population of patients with STEMI and with peak level of NT-proBNP in diabetic patients with STEMI. Levels of AGEs and sRAGE were elevated after STEMI, especially among patients with diabetes. These markers could serve to indicate the severity of myocardial injury and cardiac insufficiency, and play a potential role in predicting the prognosis of patients with STEMI.

Pioglitazone inhibits high glucose-induced expression of receptor for advanced glycation end products in coronary artery smooth muscle cells.

Receptor for advanced glycation end products (RAGE) is critical in inflammatory diseases, including diabetes and atherosclerosis. The mechanism underlying the effect of peroxisome proliferator­activated receptor γ (PPARγ) agonist pioglitazone (PIO) on RAGE expression in coronary artery smooth muscle cells (SMCs) stimulated by high glucose concentrations remains to be elucidated. In the present study, the effect and mechanism of action of PIO on RAGE expression in SMCs was investigated following treatment with high glucose concentrations. Rat coronary artery SMCs were pretreated with PIO alone, PIO and GW9662 (a PPARγ antagonist), diphenyleneiodonium (DPI; a nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor) or the antioxidant pyrrolidine dithiocarbamate (PDTC; a nuclear factor­κB (NF­κB) inhibitor), followed by treatment with high glucose. RAGE mRNA and protein expression, reactive oxygen species (ROS) production and NF­κB nuclear translocation were investigated. Glucose induced RAGE expression in a dose­dependent manner, with maximal effect at a concentration of 25 mmol/l following treatment for 48 h. PIO, DPI and PDTC reduced high glucose­induced increases in RAGE protein and mRNA expression. PIO prominently downregulated RAGE expression and inhibited high glucose­induced increases in ROS production and NF­κB activation (P<0.05). Pretreatment with PIO and GW9662 did not exhibit this inhibitory effect. High glucose may stimulate RAGE expression in coronary artery SMCs through NADPH oxidase­mediated ROS generation and NF­κB activation. PIO downregulated RAGE expression and inhibited ROS production and NF­κB activation via PPARγ activation, which may prevent the inflammatory effect of AGE/RAGE system in diabetes.

[Transurethral resection of bladder neck for female bladder neck sclerosis: a prospective urodynamics study].

OBJECTIVE: To explore the probable unsuccessful reasons for transurethral resection of bladder neck (TUR-BN) of female bladder neck sclerosis. METHODS: Thirty eligible cases received urodynamic inspections at pre-operation, post-operation of months 1, 2, 3 and 6 and year 1. RESULTS: TUR-BN was effective in 27 patients (90%), but ineffective in 3 (10%). Among the effective cases, the urodynamic parameters of Qmax and Qave increased (P < 0.05) while the residual urine volume and maximum pressure of detrusor contraction decreased (P < 0.05). The above four parameters showed no difference in those ineffective cases (P > 0.05). CONCLUSION: TUR-BN is an effective therapy for female bladder neck sclerosis. Those ineffective cases are probably caused by functional obstruction. Further urodynamic imaging studies may help to confirm the causes.

Association of neutrophil/lymphocyte ratio with long-term mortality after ST elevation myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: Primary percutaneous coronary interventions (PCI) have been proposed as a novel superior management strategy in patients with ST elevation myocardial infarction (STEMI). This study tested the hypothesis that in the acute phase of myocardial infarction with ST-segment elevation, the neutrophil/lymphocyte (N/L) ratio is a predictor of long-term prognosis. METHODS: We analyzed 551 consecutive STEMI patients treated with primary PCI at a single university center. Patients were stratified according to quartiles of the mean neutrophil/lymphocyte ratio. RESULTS: Kaplan-Meier survival analysis showed a cumulative eight-year survival of 94.2% in the first quartile, 92.0% in the second quartile, 91.3% in the third quartile, and 75.4% in the fourth quartile (P < 0.001 by log rank). Relative to patients in the other three lower N/L ratio quartiles, patients in the highest quartile were more than four times more likely to die during hospitalization (P < 0.001) and during long-term follow-up (P < 0.001). By multivariate Cox regression analysis including baseline demographic, clinical, and angiographic covariables, the N/L ratio in the highest quartile remained an independent predictor of mortality (hazard ratio 2.38, 95% confidence interval (CI) 1.42 to 3.98; P = 0.001). CONCLUSION: The neutrophil/lymphocyte ratio is a strong independent predictor of long-term mortality after ST elevation myocardial infarction treated with very early revascularization.

[Glucose level on admission and outcome after primary percutaneous coronary intervention in patients with acute myocardial infarction].

OBJECTIVE: To investigate the influence of elevated glucose level on epicardial/microvascular flow and survival in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). METHODS: A total of 308 patients with STEMI underwent primary PCI were divided into 3 groups according to the glucose level on admission: group 1, < 7.8 mmol/L; group 2, 7.8-11.0 mmol/L, and group 3, > or = 11.0 mmol/L. RESULTS: Compared with group 1, patients in the group 2 and 3 were older, had higher triglycerides levels and more 2-vessel or 3-vessel diseases. Although TIMI flow after PCI were similar among groups (89.7%, 86.0% and 86.3%, P = > 0.05), corrected TIMI frame count (CTFC) in group 2 and group 3 were higher than that in group 1. Moreover, TIMI myocardial perfusion grade (TMPG) 0-1 grade rate post PCI was higher in group 2 and 3 (30.3% and 29.0%) than that of group 1 (17.3%, P < 0.05). There was less frequently complete ST-segment resolution (56.7%) and early T wave inversion (58.3%) in group 3 than that of group 1 after PCI (72.0% and 73.4% respectively, P < 0.05). Mortality rate at 30 days post PCI was significantly higher in the group 3 (10.4%) than that in the group 1 (2.6%, P < 0.05). CONCLUSION: Elevated glucose level on admission in ST-segment elevation myocardial infarction patients treated with primary PCI is associated with reduced myocardial microvascular flow. Abnormal myocardial microvascular flow might contribute to the poor outcomes observed in patients with hyperglycemia on admission.

The influence of admission glucose on epicardial and microvascular flow after primary angioplasty.

BACKGROUND: Patients with elevated admission glucose levels may be at increased risk of death after myocardial infarction, independent of other baseline risk factors and more severe coronary artery disease. However, data regarding admission glucose and epicardial and microvascular flow after primary angioplasty is limited. METHODS: Angioplasty was performed in 308 ST-segment elevated myocardial infarction patients. Patients were divided into 3 groups on the basis of admission glucose level: group 1, < 7.8 mmol/L; group 2, (7.8 - 11.0) mmol/L; and group 3, >or= 11.0 mmol/L. RESULTS: Compared with group 1, patients in group 2 and group 3 were more often female and older. Triglycerides (TG) in group 3 were significantly higher than group 1. At angiography, they more frequently had 2-vessel or 3-vessel disease. In the infarct-related artery, there was no relationship between hyperglycemia and thrombolysis in myocardial infarction (TIMI) 3 flow after percutaneous coronary intervention (PCI) (89.7%, 86.0% and 86.3%, P = NS). However, corrected TIMI frame count (CTFC) in group 2 and group 3 were more than group 1. TIMI myocardial perfusion grade (TMPG) 0 - 1 grade among patients with hyperglycemia after PCI were more frequent (30.9% and 29.0% vs 17.3%, P < 0.05). There was less frequent complete ST - segment resolution (STR) and early T wave inversion among patients with hyperglycemia after PCI. CONCLUSION: Elevated admission glucose levels in ST - segment elevation myocardial infarction patients treated with primary PCI are independently associated with impaired microvascular flow. Abnormal microvascular flow may contribute at least in part to the poor outcomes observed in patients with elevated admission glucose.