A metabolomics-driven model for early remission prediction following vedolizumab treatment in patients with moderate-to-severe active ulcerative colitis.

To predict early remission following anti-integrin therapy (vedolizumab [VDZ]) in patients with moderate-to-severe active ulcerative colitis (UC) using non-invasive biomarkers. The clinical data of a cohort of 33 patients with moderate-to-severe active UC admitted to the Department of Gastroenterology at Suzhou Municipal Hospital between January 2021 and December 2022 were collected. Of these, 9 patients declined VDZ treatment, and 21 received VDZ at doses of 300 mg weeks 0, 2, and 6, each administered within a 30-minute infusion period. The treatment regimen aimed to induce remission of clinical symptoms; hence, the same dose was administered every 8 weeks. At weeks 0 and 14, serum C-reactive protein (CRP) and erythrocyte sedimentation rate were measured using a modified Mayo score. In addition to clinical assessment, stool samples at baseline and weeks 14 were collected and evaluated using 16SrRNA gene sequencing and gas chromatography-mass spectrometry (GC-MS). Clinical remission was determined based on the clinical symptoms and partial Mayo scores. In patients who received VDZ, the strains of bifidobacterium longum (P = 0.022) and bacteroides sartorii (P = 0.039) significantly increased after treatment than before treatment. GC-MS analysis showed that taurine (P = 0.047) and putrescine (P = 0.035) significantly decreased after treatment. Furthermore, while acetamide exhibited a notable increase (P = 0.001), arachidic acid (P < 0.001) and behenic acid (P = 0.005) demonstrated statistically significant elevations. The combined prediction model of acetamide, taurine, and putrescine demonstrated a high predictive value of early remission in patients with moderate-to-severe active UC following VDZ treatment (area under the curve = 0.911, P = 0.014).

A-Site Nonstoichiometric BaxCo0.4Fe0.4Zr0.1Y0.1O3-δ Cathode for Protonic Ceramics Fuel Cells.

Highly active triple (proton, oxygen-ion, and electron) conducting materials BaxCo0.4Fe0.4Zr0.1Y0.1O3-δ (BxCFZY, x = 0.9-1.1) were prepared and characterized as potential cathodes for protonic ceramic fuel cells (PCFCs) in this work. The crystal structure, oxygen vacancy concentration, electrical conductivity, oxygen ion transfer properties, and electrochemical performance of BxCFZY oxides were systematically evaluated. The electrical conductivity of BxCFZY decreases but oxygen vacancies increase with increasing Ba content, indicating that the charge compensation was mainly achieved by the production of oxygen vacancy rather than the increase in the valence of transition metal cations. The power density of 1170 mW cm-2 and the polarization resistance of 0.05 Ω cm2 were achieved at 700 °C for the anode-supported single cells with B1.1CFZY cathode, suggesting that the excess A site on the BxCFZY had a positive effect on the catalytic activity for the oxygen reduction reaction. Furthermore, the distribution of relaxation time (DRT) analysis method was adopted to determine the electrochemical processes of the cells with BxCFZY cathodes. The calculated results confirmed that the cell with B1.1CFZY cathode exhibited the optimum performance due to the best oxygen ion transfer properties in BxCFZY cathodes.

High fat diet-induced hyperlipidemia and tissue steatosis in rabbits through modulating ileal microbiota.

High-fat diet (HFD) and overnutrition are important starting factors that may alter intestinal microbiota, lipid metabolism, and systemic inflammation. However, there were few studies on how intestinal microbiota contributes to tissue steatosis and hyperlipidemia. Here, we investigated the effect of lipid metabolism disorder-induced inflammation via toll-like receptor 2 (TLR-2), toll-like receptor 4 (TLR-4), and nuclear factor-κB (NF-κB) pathways at the intestinal level in response to HFD. Twenty 80-day-old male New Zealand White rabbits were randomly divided into the normal diet group (NDG) and the high-fat diet group (HDG) for 80 days. Growth performance, blood biochemical parameters, lipid metabolism, inflammation, degree of tissue steatosis, and intestinal microbial composition were measured. HFD increased the relative abundance of Christensenellaceae_R_7_group, Marvinbryantia, Akkermansia etc., with a reduced relative abundance of Enterorhabdus and Lactobacillus. Moreover, HFD caused steatosis in the liver and abdominal fat and abnormal expression of some genes related to lipid metabolism and tight junction proteins. The TLR-2, TLR-4, NF-κB, TNF-α, and IL-6 were confirmed by overexpression with downregulation of IL-10. Serum biochemical indices (TG, TCHO, LDL-C, and HDL-C) were also increased, indicating evidence for the development of the hyperlipidemia model. Correlation analysis showed that this microbial dysbiosis was correlated with lipid metabolism and inflammation, which were associated with the intestinal tract's barrier function and hyperlipidemia. These results provide an insight into the relationship between HFD, the intestinal microbiota, intestinal barrier, tissue inflammation, lipid metabolism, and hyperlipidemia. KEY POINTS: • High-fat diet leads to ileal microbiota disorders • Ileal microbiota mediates local and systemic lipid metabolism disorders and inflammation • There is a specific link between ileal microbiota, histopathology, and hyperlipidemia.

Microbial short-chain fatty acids: a bridge between dietary fibers and poultry gut health - A review.

The maintenance of poultry gut health is complex depending on the intricate balance among diet, the commensal microbiota, and the mucosa, including the gut epithelium and the superimposing mucus layer. Changes in microflora composition and abundance can confer beneficial or detrimental effects on fowl. Antibiotics have devastating impacts on altering the landscape of gut microbiota, which further leads to antibiotic resistance or spread the pathogenic populations. By eliciting the landscape of gut microbiota, strategies should be made to break down the regulatory signals of pathogenic bacteria. The optional strategy of conferring dietary fibers (DFs) can be used to counterbalance the gut microbiota. DFs are the non-starch carbohydrates indigestible by host endogenous enzymes but can be fermented by symbiotic microbiota to produce shortchain fatty acids (SCFAs). This is one of the primary modes through which the gut microbiota interacts and communicate with the host. The majority of SCFAs are produced in the large intestine (particularly in the caecum), where they are taken up by the enterocytes or transported through portal vein circulation into the bloodstream. Recent shreds of evidence have elucidated that SCFAs affect the gut and modulate the tissues and organs either by activating G-protein-coupled receptors or affecting epigenetic modifications in the genome through inducing histone acetylase activities and inhibiting histone deacetylases. Thus, in this way, SCFAs vastly influence poultry health by promoting energy regulation, mucosal integrity, immune homeostasis, and immune maturation. In this review article, we will focus on DFs, which directly interact with gut microbes and lead to the production of SCFAs. Further, we will discuss the current molecular mechanisms of how SCFAs are generated, transported, and modulated the pro-and anti-inflammatory immune responses against pathogens and host physiology and gut health.

Essential meiotic structure-specific endonuclease1 (EME1) promotes malignant features in gastric cancer cells via the Akt/GSK3B/CCND1 pathway.

DNA damage plays a key role in various biological processes involved in malignant disease, the role of the DNA damage repair gene EME1 (essential meiotic structure-specific endonuclease 1) in gastric cancer (GC) development is unknown. This work aimed to investigate expression and role of EME1 in tumorigenesis. Quantitative real-time polymerase chain reaction (qRT-PCR), immunoblot, cell viability and dual-luciferase reporter assays, RNAi and gene transfection, and immunofluorescent staining were performed to assess EME1 regulation in GC tumorigenesis. Further, mouse xenografts were established for in vivo mechanistic studies. EME1 was found to be upregulated in both gastric cancer cells and clinically obtained tumors. Additionally, EME1 levels were strongly associated with the differentiation level of GC and lymph node metastasis. In vivo and in vitro knockdown of EME1 markedly suppressed the proliferative, migratory, and invasive abilities of GC cells and enhanced apoptotic cell death and cell cycle arrest rates. Mechanistically, EME1 modulated Akt/GSK3B/CCND1 signaling. MYB may also have contributed to EME1-dependent gastric carcinogenesis. Elevated EME1 expressions may enhance the proliferative and metastatic abilities of GC cells, thereby acting as a tumor-promoting factor via Akt. These findings reveal that EME1 is an important biomarker for GC prognosis and treatment in humans.Abbreviations: Essential meiotic structure-specific endonuclease 1 (EME1); MYB proto-oncogene (MYB); Cell counting kit-8 (CCK-8); 4,6-diamimo-2-phenyl indole (DAPI); Quantitative real-time PCR (qRT-PCR); Gastric cancer (GC); Immunofluorescence (IF); Small interfering RNA (siRNA); Small hairpin RNA (shRNA); Alpha serine threonine-protein kinase (Akt); Glycogen synthase kinase 3 beta (GSK3B); Cyclin D1 (CCND1); Glyceraldehyde-3-phosphate dehydrogenase (GAPDH); Disease-free survival (DFS); Overall survival (OS); Negative controls (NC); American Joint Committee on Cancer (AJCC); Coding sequence (CDS); Lymph node metastasis (LNM); Tris-Buffered Saline-Tween-20 (TBST); Horseradish Peroxidase (HRP); Electrochemiluminescence (ECL); Polyvinylidene Fluoride (PVDF); Excision repair cross complementation group 1 (ERCC1).

Consumption of Dietary Fiber from Different Sources during Pregnancy Alters Sow Gut Microbiota and Improves Performance and Reduces Inflammation in Sows and Piglets.

In pregnant and lactating sows, metabolism and immunity undergo drastic changes, which can lead to constipation, abortion, and intrauterine growth restriction (IUGR) and reduce production performance. Dietary fiber can regulate animal gut microbiota, alleviate inflammatory responses, and improve performance. Here, 48 sows (Large × Landrace) were randomly allocated to groups including, control, and with alfalfa meal (AM), beet pulp, and soybean skin dietary supplementation for 60 days of gestation. The AM diet decreased IUGR, increased food intake during lactation, and promoted the reproductive performance and physical condition of sows. Further, the AM diet significantly reduced markers of intestinal permeability (reactive oxygen species and endotoxin) in sow serum, and of systemic inflammation (interleukin-6 [IL-6] and tumor necrosis factor alpha) in sow feces and serum, as well as piglet serum, while it increased the anti-inflammatory marker, IL-10, in sow serum and feces. The AM diet also significantly affected gut microbiota by increasing the relative abundance of proinflammatory bacteria, while decreasing anti-inflammatory bacteria. Moreover, the total short-chain fatty acid (SCFA) content was higher in feces from sows fed an AM diet, with butyric acid content significantly higher during lactation, than in controls. Sow performance was correlated with intestinal permeability, inflammation, and gut microbiota, which were also vertically transmitted to piglets. Our results are significant for guiding feed management in the pig breeding industry. Further, the "sows to piglets" model provides a reference for the effect of dietary fiber on the gastrointestinal function of human mothers and infants.IMPORTANCE Although the direct effects of dietary fiber on gut microbiota composition have been studied extensively, systematic evaluation of different fiber sources on gut health and inflammatory responses of sows and their offspring has rarely been conducted. Excessive reactive oxygen species produced by overactive metabolic processes during late pregnancy and lactation of sows leads to increased endotoxin levels, disordered gut microbiota, decreased SCFA production, and secretion of proinflammatory factors, which in turn causes local inflammation of the gut, potential damage of the gut microbial barrier, increased gut permeability, increased blood endotoxin levels (resulting in systemic inflammation), and ultimately decreased sow and piglet performance. Our results showed that supplementation of the diet with alfalfa meal in mid and late pregnancy can reverse this process. Our findings lay a foundation for improving the gut health of sows and piglets and provide insights into the study of the gastrointestinal tract function in human mothers and infants.

Identification and Validation of a Potent Multi-lncRNA Molecular Model for Predicting Gastric Cancer Prognosis.

Gastric cancer (GC) remains the third deadliest malignancy in China. Despite the current understanding that the long noncoding RNAs (lncRNAs) play a pivotal function in the growth and progression of cancer, their prognostic value in GC remains unclear. Therefore, we aimed to construct a polymolecular prediction model by employing a competing endogenous RNA (ceRNA) network signature obtained by integrated bioinformatics analysis to evaluate patient prognosis in GC. Overall, 1,464 mRNAs, 14,376 lncRNAs, and 73 microRNAs (miRNAs) were found to be differentially expressed in GC. Gene Ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses revealed that these differentially expressed RNAs were mostly enriched in neuroactive ligand-receptor interaction, chemical carcinogenesis, epidermis development, and digestion, which were correlated with GC. A ceRNA network consisting of four lncRNAs, 21 miRNAs, and 12 mRNAs were constructed. We identified four lncRNAs (lnc00473, H19, AC079160.1, and AC093866.1) as prognostic biomarkers, and their levels were quantified by qRT-PCR in cancer and adjacent noncancerous tissue specimens. Univariable and multivariable Cox regression analyses suggested statistically significant differences in age, stage, radiotherapy, and risk score groups, which were independent predictors of prognosis. A risk prediction model was created to test whether lncRNAs could be used as an independent risk predictor of GC or not. These novel lncRNAs' signature independently predicted overall survival in GC (p < 0.001). Taken together, this study identified a ceRNA and protein-protein interaction networks that significantly affect GC, which could be valuable for GC diagnosis and therapy.

Protective effects of alfalfa saponins on oxidative stress-induced apoptotic cells.

As is known, alfalfa saponins can be used as a feed additive in a pig's diet and the addition of alfalfa saponins to a pig's diet could improve its antioxidant capacity. However, the mechanism by which alfalfa saponins exert their antioxidant effects has not been studied. To address this issue, H2O2-induced rat intestinal epithelial cells were used to establish an oxidative stress model to explore the protective mechanism of alfalfa saponins in this study. The results demonstrated that alfalfa saponins could rescue the cell proliferation activity, elevate the amount of antioxidant enzymes and downregulate the release of MDA and LDH in H2O2-induced cells. The antioxidant activity of alfalfa saponins was achieved by restoring GSH homeostasis. Further results demonstrated that alfalfa saponins could inhibit cell apoptosis through activating the MAPK signaling pathway. These results elucidated the mechanism by which alfalfa saponins exert their antioxidant effects and provided a potential strategy for alleviating oxidative stress in monogastric animals.

Cardiac arrhythmias and cardiac arrest related to mushroom poisoning: A case report.

BACKGROUND: Mushroom exposure is a global health issue. The manifestations of mushroom poisoning (MP) may vary. Some species have been reported as rhabdomyolytic, hallucinogenic, or gastrointestinal poisons. Critical or even fatal MPs are mostly attributable to Amanita phalloides, with the development of severe liver or renal failure. Myocardial injury and even cases mimicking ST-segment elevation myocardial infarction (STEMI) have been previously reported, while cardiac arrhythmia or cardiac arrest is not commonly seen. CASE SUMMARY: We report a 68-year-old woman with MP who suffered from delirium, seizure, long QT syndrome on electrocardiogram (ECG), severe cardiac arrhythmias of multiple origins, and cardiac arrest. She was intubated and put on blood perfusion. Her kidney and liver functions were intact; creatine kinase-MB was mildly elevated, and then fell within normal range during her hospital stay. We sent the mushrooms she left for translation elongation factor subunit 1α, ribosomal RNA gene sequence, and internal transcribed spacer sequence analyses. There were four kinds of mushrooms identified, two of which were found to be toxic. CONCLUSION: This is the first time that we found cardiac toxicity caused by Panaeolus subbalteatus and Conocybe lactea, which were believed to be toxic to the liver, kidney, and brain. We suggest that intensive monitoring and ECG follow-up are essential to diagnose prolonged QT interval and different forms of tachycardia in MP patients, even without the development of severe liver or renal failure. The mechanisms need to be further investigated and clarified based on animal experiments and molecular signal pathways.

Efficacy of second-look endoscopy in preventing delayed bleeding after endoscopic submucosal dissection of early gastric cancer.

The present study aimed to evaluate whether second-look endoscopy (SLE) is able to prevent delayed bleeding after endoscopic submucosal dissection (ESD) of gastric carcinoma and to identify which types of lesion require SLE. ESD of gastric cancer at the early stage was performed on 210 patients between October 2014 and September 2016. Mucosal damage-associated bleeding within 24 h after ESD was considered as delayed bleeding. The association of the characteristics of patients and lesions, as well as surgical factors, with the incidence of bleeding as a measure of outcome was analyzed. A total of 110 patients with melena and/or hematemesis underwent SLE on the second day following gastric ESD. Within the entire cohort (n=210), late delayed bleeding (LDB) was defined as hematemesis or melena occurring following second-look endoscopy. Early delayed bleeding (EDB) was defined as hematemesis or melena occurring from the end of ESD to second-look endoscopy, or as active or possible bleeding at the time of the second-look endoscopy was reported in 17 (8.1%) and 20 patients(9.5%), respectively. The median interval between late delayed bleeding and ESD was one day (range, 1-10 days). The incidence of late delayed bleeding was significantly decreased in the SLE group compared with that in the non-SLE group (4.5 vs. 12%, P=0.028). Multivariate analyses revealed that ulcer, flat gross type, lesion diameter (>2 cm), the resected tumor size of >40 mm and Helicobacter pylori infection were independently associated with late delayed bleeding after ESD, while flat gross type, ulcer, the resected tumor size of >40 mm and artificial ulcer diameter >3 cm were independently associated with early delayed bleeding. Thus, the data of the present study indicates that second-look endoscopy following gastric ESD may be useful in preventing post-ESD delayed bleeding and should be performed on the second day.

Enhancing the linear flow of fine granules through the addition of elongated particles.

Sandglasses have been used to record time for thousands of years because of their constant flow rates; however, they now are drawing attention for their substantial scientific importance and extensive industrial applications. The presence of elongated particles in a binary granular system is believed to result in undesired flow because their shape implies a larger resistance to flow. However, our experiments demonstrate that the addition of elongated particles can substantially reduce the flow fluctuation of fine granules and produce a stable linear flow similar to that in an hourglass. On the basis of experimental data and previous reports of flow dynamics, we observed that the linear flow is driven by the "needle particle effect," including flow orientation, reduced agglomeration, and local perturbation. This phenomenon is observed in several binary granular systems, including fine granules and secondary elongated particles, which demonstrates that our simple method can be widely applied to the accurate measurement of granular flows in industry.

Metabolic alterations in the sera of Chinese patients with mild persistent asthma: a GC-MS-based metabolomics analysis.

AIM: To character the specific metabolomics profiles in the sera of Chinese patients with mild persistent asthma and to explore potential metabolic biomarkers. METHODS: Seventeen Chinese patients with mild persistent asthma and age- and sex-matched healthy controls were enrolled. Serum samples were collected, and serum metabolites were analyzed using GC-MS coupled with a series of multivariate statistical analyses. RESULTS: Clear intergroup separations existed between the asthmatic patients and control subjects. A list of differential metabolites and several top altered metabolic pathways were identified. The levels of succinate (an intermediate in tricarboxylic acid cycle) and inosine were highly upregulated in the asthmatic patients, suggesting a greater effort to breathe during exacerbation and hypoxic stress due to asthma. Other differential metabolites, such as 3,4-dihydroxybenzoic acid and phenylalanine, were also identified. Furthermore, the differential metabolites possessed higher values of area under the ROC curve (AUC), suggesting an excellent clinical ability for the prediction of asthma. CONCLUSION: Metabolic activity is significantly altered in the sera of Chinese patients with mild persistent asthma. The data might be helpful for identifying novel biomarkers and therapeutic targets for asthma.

Kinetic model for microbial growth and desulphurisation with Enterobacter sp.

Biodesulphurisation was investigated by using Enterobacter sp. D4, which can selectively desulphurise and convert dibenzothiophene into 2-hydroxybiphenyl (2-HBP). The experimental values of growth, substrate consumption and product generation were obtained at 95 % confidence level of the fitted values using three models: Hinshelwood equation, Luedeking-Piret and Luedeking-Piret-like equations. The average error values between experimental values and fitted values were less than 10 %. These kinetic models describe all the experimental data with good statistical parameters. The production of 2-HBP in Enterobacter sp. was by "coupled growth".

Dynamics of inflammation resolution and symptom recovery during AECOPD treatment.

The association between increases in both systemic and airway inflammation and acute exacerbation of COPD (AECOPD) has been reported by many studies. However, relatively little is known about the dynamics of inflammation resolution and their correlations with the improvement of clinical indices during treatment. In this study, a total of 93 consecutively hospitalized patients with AECOPD were recruited. Sputum and serum inflammatory markers were measured on the day of admission before treatment (day 0), day 4, 7 and 14 during treatment as well as 8 weeks after discharge. Clinical indices (lung function, dyspnea and COPD assessment test (CAT) scores) were also measured at those time points. By day 4, all airway inflammatory measures rapidly decreased and returned to baseline level. Notably, lung function and dyspnea improved to the baseline level by day 4 as well, consistent with the resolution of respiratory inflammation. However, despite the significant decrease by day 4, systemic inflammation did not reach baseline until day 14, concordant with the decrease in CAT score. In summary, we observed a time lag between the resolution of systemic and airway inflammation, which were correlated with the improvements of different clinical indices.

[Bacteriology in acute exacerbation in patients hospitalized frequently for acute exacerbation of chronic obstructive pulmonary disease].

OBJECTIVE: To analyze the distribution of pathogens and bacterial drug resistance for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in patients hospitalized frequently for AECOPD versus those with infrequent admissions. METHODS: A total of 172 patients admitted into Peking University Third Hospital for AECOPD from January 2007 to December 2008 were recruited. According to the frequency of AECOPD-related hospitalization during the previous year, they were divided into two groups of frequently hospitalized ( ≥ 2 hospitalizations due to AECOPD during the previous year) and infrequently hospitalized (<2 hospitalizations due to AECOPD during the previous year). The distribution and drug resistance of pathogenic bacteria were compared between two groups. RESULTS: At the time of acute exacerbation, the frequently hospitalized patients had significantly higher rates of non-fermentative gram-negative bacteria (18.8% (9/48) vs 4.8% (6/124), χ² = 6.756, P = 0.009), enterobacteriaceae (18.8% (9/48) vs 7.3% (9/124), χ² = 4.877, P = 0.027) versus those infrequently hospitalized ones. The frequently hospitalized patients had more multidrug resistant bacteria isolated from sputum versus those infrequently hospitalized ones (25.0% (12/48) than 8.1% (10/124), χ² = 8.898, P = 0.003). CONCLUSION: The distribution and drug resistance of pathogenic bacteria are associated with the frequency of AECOPD-related hospitalization during the previous year.

Normal blood D-dimer concentrations: do they exclude pulmonary embolism?

BACKGROUND: Although pulmonary embolism (PE) with normal blood D-dimer (DD) concentrations is considered rare, in practice the incidence may be greater than is generally believed. Overlooking PE is potentially dangerous. The aim of this study was to explore the incidence and clinical features of PE with normal DD concentrations. METHODS: We retrospectively analyzed the records of 29 patients with PE and normal DD concentrations from the past seven years. We here compare relevant clinical characteristics of these patients with those of patients with PE and abnormal DD concentrations. We evaluated the probabilities of differences by computing pretest probability scores (Wells score and revised Geneva score). RESULTS: The frequency of normal DD concentrations in patients with PE was 4%. Previous episode(s) of PE were more common in patients with normal DD concentrations than in those with abnormal DD concentrations (P = 0.001). Fever, tachycardia, and tachypnea occurred less frequently in the former group (P < 0.05) and time between onset of symptoms and DD testing was longer (P = 0.001). The diagnosis of PE was delayed in 22 of the 29 cases. Nineteen and seven cases with normal DD concentrations were classified according to pretest scores as intermediate and low risk, respectively. CONCLUSIONS: PE with normal DD concentrations is uncommon. Although most diagnoses of PE are ruled out by normal DD values, a small number of cases with PE are missed. A combination of pretest probability score and normal DD concentration increases the probability of making the correct diagnosis, but cannot completely exclude patients with suspected PE. When the clinical manifestations cannot be otherwise explained, clinicians should be alert to the possibility of PE with normal DD concentrations in patients with previous episode(s) of PE or a long interval between onset of symptoms and DD testing.

[The value of D-dimer for etiological diagnosis of mortal chest pain: an analysis of 438 cases].

OBJECTIVE: To investigate the role of plasma D-dimer in differentiating fatal chest pain due either to acute myocardial infarction (AMI), acute pulmonary embolism (APE) or acute aortic dissection (AAD) in emergency department. METHODS: The data of a total of 445 consecutive patients complaining chest (back) pain and/or dyspnea who visited emergency department of Peking University Third Hospital from January 2011 to January 2012 were retrospectively analyzed. All cases were either diagnosed as AMI, APE or AAD finally. D-dimer concentrations were assessed and compared among different groups. The receiver operating characteristic curve (ROC curve) was established. The potency of D-dimer in distinguishing AMI, non-ST-segment elevation myocardial infarction (NSTEMI) by difference in values was assessed. RESULTS: Finally, 438 cases were enrolled, including 327 AMI [253 ST-segment elevation myocardial infarction (STEMI) and 74 NSTEMI], 76 APE and 35 AAD cases. The D-dimer concentrations in AMI group [0.21(0.15, 0.33) mg/L] were significantly lower than those in APE group [1.06 (0.86, 3.01) mg/L, Z=-11.416, P<0.001], AAD group [1.79 (0.83, 3.37) mg/L, Z=-8.715, P<0.001], APE/AAD group [1.15 (0.85, 3.13) mg/L, Z=-13.509, P<0.001]. The D-dimer concentrations in STEMI group were significantly lower than those in NSTEMI group [mg/L: 0.20 (0.15, 0.30) vs. 0.24 (0.17, 0.54), Z=-3.248, P=0.001]. The area under ROC curve (AUC) to discriminate AMI from APE/AAD was 0.929±0.015, and optimal value was 0.535 mg/L. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) with cut-off value of 0.535 mg/L were 86.2%, 93.7%, 97.6%, 69.8%,13.68, 0.15, while sensitivity, specificity, PPV, NPV, PLR, NLR with cut-off value of 0.5 mg/L were 84.4%, 93.7%, 97.5%, 67.1%, 13.40, 0.17. The AUC to discriminate NSTEMI from APE/AAD was 0.881±0.028. Sensitivity, specificity, PPV, NPV with cut-off value of 0.535 mg/L were 75.7%, 93.7%, 88.9%, 85.2%, while sensitivity, specificity, PPV, NPV with cut-off value of 0.5 mg/L were 70.3%, 93.7%, 88.1%, 82.5%, respectively. CONCLUSIONS: D-dimer is a better index in differentiating AMI from APE/AAD in emergency setting, guiding further examination and therapy, and increasing diagnosis efficiency.

Serum erythropoietin: a useful biomarker for coronary collateral development and potential target for therapeutic angiogenesis among the patients with coronary chronic total occlusion.

The study was to investigate the association of endogenous erythropoietin (EPO) and coronary collateral development. Forty-nine patients (31 with chronic total occlusion (CTO), 18 with normal coronary artery) were consecutively enrolled. The serum EPO was positively related with Rentrop class. Increased serum EPO was one of the independent predictors of good collateral development (odds ratio 1.31; p = 0.025). A significantly positive correlation was seen between serum EPO and vascular endothelial growth factor (VEGF) levels (r = 0.96, p < 0.001). Circulatory EPO may be a useful biomarker for coronary collateral development and potential target for therapeutic angiogenesis in patients with CTO.