Effect of Thin-Walled Radial Sheath for Large-Bore Access On Reducing Periprocedural Radial Artery Occlusion Following Complex PCI: The REDUCE-RAO Randomized Trial.

Background: Transradial artery (TRA) access for percutaneous coronary intervention (PCI) was associated with lower risks of major bleeding and vascular complications compared to transfemoral artery access. Use of large-bore ( ≥ 7-Fr) guiding catheters through TRA approach increased the likelihood of radial artery occlusion (RAO). This study aimed to investigate whether use of the thin-walled 7-Fr Glidesheath Slender, allowing PCI with large-caliber guiding catheters, is superior to standard 7-Fr Cordis sheath with respect to periprocedural RAO within 24 hours after transradial coronary intervention (TRI) in complex lesions. Methods: A prospective randomized, controlled, single-blinded (patient-blinded) trial was conducted, randomizing 504 patients with TRI for complex lesions to either 7-Fr Glidesheath Slender or conventional 7-Fr Cordis sheath. The primary outcome was defined as the incidence of periprocedural RAO with Doppler ultrasound during the first 24 hours after TRI. Results: The incidence of early RAO was 10.3% for 7-Fr Glidesheath Slender and 13.5% for conventional 7-Fr sheath (p = 0.271). The procedural success rate for Glidesheath Slender was 92.9% and for Cordis sheath was 93.7% (p = 0.722). There was no signficiant difference between treatment arms in terms of local hematoma and radial spasm, whereas use of the Glidesheath Slender was associated with significantly less pain during the procedure (numeric rating scale [NRS], 2.27 ± 0.75 vs. 2.45 ± 0.95, p = 0.017). The assessment of radial artery in ultrasound parameters after complex TRI was improved with Glidesheath Slender. Conclusions: Among patients with complex coronary lesions undergoing TRI, 7-Fr Glidesheath Slender was not superior to conventional 7-Fr in the prevention of periprocedural RAO within 24 hours following complex PCI, without reducing RAO occurrence. Clinical Trial Registration: NCT04748068.

Early radial artery occlusion following the use of a transradial 7-French sheath for complex coronary interventions in Chinese patients.

OBJECTIVES: We aimed to explore the impact of 7-Fr sheaths on the incidence of early radial artery occlusion (RAO) after transradial coronary intervention (TRI) in Chinese patients. BACKGROUND: RAO precludes future use of the vessel for vascular access. Transradial catheterization is usually performed via 5-Fr or 6-Fr catheters; 7-Fr sheath insertion enables complex coronary interventions but may increase the RAO risk. METHODS: We prospectively enrolled 130 consecutive patients undergoing complex TRI using 7-Fr sheaths. Radial artery ultrasound assessment was performed before and after TRI. Early RAO was defined as the absence of flow on ultrasound within 6-24 hr after TRI. Multivariate logistic regression was used to determine the factors related to early RAO after TRI. RESULTS: 7-Fr sheaths were mainly used for chronic total occlusion (44.6%), bifurcation (30.0%), and tortuous calcification (25.4%) lesions. All patients were successfully sheathed. Percutaneous coronary intervention (PCI) procedural success was 96.2%; 119 patients (91.5%) had preserved radial artery patency after TRI. All 11 RAO cases (8.5%) were asymptomatic. The radial artery diameter was significantly larger postoperatively (3.1 ± 0.4 mm) than preoperatively (2.6 ± 0.5 mm) (p < .001). No parameters significantly differed between patients with and without RAO. TRI history was the only independent risk factor of early RAO (odds ratio: 6.047, 95% confidence interval: 1.100-33.253, p = .039). CONCLUSIONS: 7-Fr sheath use after transradial access for complex PCI is feasible and safe. Evaluating the radial artery within 24 hr after TRI allows timely RAO recognition, important for taking measures to maintain radial artery patency and preserve access for future TRIs.

[Value of body fat mass measured by bioelectrical impedance analysis in predicting abnormal blood pressure and abnormal glucose metabolism in children].

OBJECTIVE: To study the value of body fat mass measured by bioelectrical impedance analysis (BIA) in predicting abnormal blood pressure and abnormal glucose metabolism in children. METHODS: Stratified cluster sampling was used to select the students aged 6-16 years, and a questionnaire survey and physical examination were performed. The BIA apparatus was used to measure body fat mass. Body mass index (BMI), body fat mass index (FMI), and fat mass percentage (FMP) were calculated. Fasting blood glucose level were measured. RESULTS: A total of 14 293 children were enrolled, among whom boys accounted for 49.89%. In boys and girls, the percentile values (P60, P65, P70, P75, P80, P85, P90, P95) of FMI and FMP fitted by the LMS method were taken as the cut-off values. Based on the receiver operating characteristic curve analysis, the P70 values with a better value in predicting abnormal blood pressure and blood glucose metabolism were selected as the cut-off values for excessive body fat. When FMI or FMP was controlled below P70, the incidence of abnormal blood pressure or abnormal glucose metabolism may be decreased in 8.25%-43.24% of the children. CONCLUSIONS: The evaluation of obesity based on FMI and FMP has a certain value in screening for hypertension and hyperglycemia in children, which can be further verified in the future prevention and treatment of obesity and related chronic diseases in children.

Establishing Reference Intervals of Aspartate Aminotransferase-to-Platelet Ratio Index for Apparently Healthy Elderly.

BACKGROUND: Aspartate aminotransferase (AST) to platelet ratio index (APRI) serves as a parameter in evaluating liver fibrosis in current clinical practice. However, reference standard (reference intervals, RIs) or baseline levels of APRI have not been previously reported. The purpose of this paper is to establish the reference intervals of APRI in apparently healthy elderly people from the region of Shuyang, China. METHODS: Blood specimens were collected from local elderly residents (selected 51,263 elderly Han Shuyang Chinese from 65 to 97 years old, 32.97% males and 67.03% females) by standard procedures. Complete blood counts were determined by Sysmex XE-2100 analyzer and the AST values were measured by a TBA2000FR automatic biochemical analyzer (Toshiba Co., Ltd., Japan). The 95% reference intervals were calculated by using the non-parametric method according to the document: Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Guideline-Third Edition (C28-A3) of CLSI. RESULTS: RIs established for healthy elderly include: 0.1398-0.6266 for males and 0.1282-0.5798 for females (0.1284-0.5086 for 65-74 years old; 0.1209-0.5704 for > or = 75 years old). Ris of APRI for elderly males were higher than those of females, and values of APRI increased with increasing age for females. CONCLUSIONS: We established scientific and reasonable RIs of APRI for the healthy elderly in our region.

Reference intervals for total bilirubin, ALT, AST and creatinine in healthy Chinese elderly.

BACKGROUND: The aim of this study was to establish the reference intervals (RIs) of total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate transaminase (AST), and creatinine (CREA) for apparently healthy elderly (Han ethnicity) in Shuyang, China. MATERIAL AND METHODS: A total of 54 912 blood specimens from elderly residents age 65-104 years were collected by standard procedures in Shuyang county of Jiangsu province. TBIL, ALT, AST, and CREA for each participant were determined by automatic biochemical analyzer. Distribution and differences of TBIL, ALT, AST, and CREA were analyzed and compared between the elderly of the same age of different sexes and different ages of the same sex. RIs of TBIL, ALT, AST, and CREA were compared with the current RIs. The RIs and 95% confidence intervals were calculated using nonparametric method (2.5th-97.5th percentiles) according to the guideline of the Clinical and Laboratory Standards Institute. RESULTS: RIs established for the healthy elderly include: TBIL 7.8~30.6 µmol/L for males and 7.3~26.1 µmol/L for females; ALT 8.7~47.3 U/L for males and 8.4~45.2 U/L for females; AST 15.7~46.9 U/L for males and 15.1~46.2 U/L for females; and CREA 45.1~100.9 µmol/L for males and 38.7~85.0 µmol/L for females. Reference intervals of TBIL, ALT, AST, and CREA for male elderly were higher than those of females, and values of CREA increased with increasing age. CONCLUSIONS: We have established a panel of locally relevant RIs. It is necessary to establish scientific and reasonable RIs of TBIL, ALT, AST, and CREA for the healthy elderly in our region, which will provide a reference for clinicians and inspection officers.

The effect of fasting plasma glucose on in-hospital mortality after acute myocardial infarction in patients with and without diabetes: findings from a prospective, nationwide, and multicenter registry.

OBJECTIVES: To evaluate the predictive value of fasting plasma glucose (FPG) for in-hospital mortality in patients with acute myocardial infarction (AMI) with different glucose metabolism status. METHODS: We selected 5,308 participants with AMI from the prospective, nationwide, multicenter CAMI registry, of which 2,081 were diabetic and 3,227 were nondiabetic. Patients were divided into high FPG and low FPG groups according to the optimal cutoff values of FPG to predict in-hospital mortality for diabetic and nondiabetic cohorts, respectively. The primary endpoint was in-hospital mortality. RESULTS: Overall, 94 diabetic patients (4.5%) and 131 nondiabetic patients (4.1%) died during hospitalization, and the optimal FPG thresholds for predicting in-hospital death of the two cohorts were 13.2 mmol/L and 6.4 mmol/L, respectively. Compared with individuals who had low FPG, those with high FPG were significantly associated with higher in-hospital mortality in diabetic cohort (10.1% vs. 2.8%; odds ratio [OR] = 3.862, 95% confidence interval [CI]: 2.542-5.869) and nondiabetic cohort (7.4% vs. 1.7%; HR = 4.542, 95%CI: 3.041-6.782). After adjusting the potential confounders, this significant association was not changed. Furthermore, FPG as a continuous variable was positively associated with in-hospital mortality in single-variable and multivariable models regardless of diabetic status. Adding FPG to the original model showed a significant improvement in C-statistic and net reclassification in diabetic and nondiabetic cohorts. CONCLUSIONS: This large-scale registry indicated that there is a strong positive association between FPG and in-hospital mortality in AMI patients with and without diabetes. FPG might be useful to stratify patients with AMI.

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.

Chemoproteomics-based target profiling of sinomenine reveals multiple protein regulators of inflammation.

Although sinomenine (SIN) has been used to treat several inflammation-related diseases in the clinic for decades, the detailed anti-inflammatory mechanism remains elusive. Here, we present a chemoproteomic study that supports a polypharmacological mode of action for SIN to inhibit inflammation. Notably, functional validation revealed multiple new protein regulators whose knockdown could significantly affect inflammation.

Kα X-ray Emission from Nanowire Cu Targets Driven by Femtosecond Laser Pulses for X-ray Conversion and Backlight Imaging.

A high-quality X-ray source was proposed by modifying the target material structure characteristics driven by ultrahigh laser energy. The experiments were performed on the Ti:sapphire femtosecond laser beam device (4.3-6 J, 30 fs), one of the three XG-III lasers in Laser Fusion Research Center of China Academy of Engineering Physics. The femtosecond laser beam drove the nanowire copper material with an average length of 18-50 µm and a diameter of about 260 nm. A single-photon counting charge-coupled device was employed to measure the copper Kα X-ray emission of the nanowire and foil targets. A clear maximum photon yield of the nanowire target was calculated to be 3.6 × 108 photons sr-1 s-1, the conversion efficiency was up to 0.0087%, and the average yield was 2.5 times that of the copper foil targets. In addition, by using a pinhole imaging method of φ10 µm, the minimum full width at half maximum spot size of the X-ray source was calculated in the range of 85-240 µm, which was similar to that of the copper foil material with a long radius of 170 µm and a short radius of 63 µm. The experimental data illustrate that the nanowire has the potential to enhance the energy absorption of femtosecond laser for X-ray conversion and backlight imaging.

Densification and Phase Transformation in Multi-Layered Graded Si3N4-TiN Components Produced by Field-Assisted Sintering.

The structural and/or functional design of multiphase ceramics, along with their processing, are timely research topics in the area of field-assisted sintering techniques, such as spark plasma sintering, especially for systems containing both electrically insulating and conductive phases. In the present study, spark plasma sintering of Si3N4-TiN composites was investigated by changing the TiN particle size and electrical current waveform. Their combined effects on both the densification behavior and α-to-ß phase conversion of the Si3N4 matrix was studied and compared by means of a thermodynamic approach and dilatometric measurements. Through the control of TiN phase characteristics and heating mode, double-layered Si3N4-based components were also prepared using a one-step spark plasma sintering process, which was compared with conventional hot-pressing. It was shown that the size of the conductive TiN phase has a significant influence on the particle rearrangement, with the formation of a liquid phase, and the solution-diffusion-precipitation process, through the field-induced local heating and electrowetting mechanisms. Moreover, the contribution of current pulsing to the densification and α-to-ß conversion of the layered Si3N4-based components was mostly dependent upon the particle size distribution and content of the TiN phase, indicating that the electric-field effect is dependent upon current path.

Synthesis of 1,5-bis(4,6-dichloro-1,3,5-triazinylamino)naphthalene and its application to spectrofluorimetric determination of aniline.

A new fluorescent reagent 1,5-bis(4,6-dichloro-1,3,5-triazinylamino)naphthalene (DTAN) was synthesized. The optimum conditions of fluorescent reaction of this reagent with aniline (PA) were also investigated. Based on this reaction, a new spectrofluorimetric method was developed for the determination of aniline. The fluorescent intensity was directly proportional to the concentration of aniline in the ranges 0.05-2.0 microg mL(-1) and 2.0-50 microg mL(-1) with the detection limits of 34 ng mL(-1) and 90 ng mL(-1). This method is simple, practical and can afford good precision and accuracy and can be successfully applied to assess aniline in water samples. A possible mechanism of the change of fluorescence intensity introduced by putting the aniline into the system is also discussed.

Gambogic acid improves non-small cell lung cancer progression by inhibition of mTOR signaling pathway.

Gambogic acid (GA) has been shown to inhibit cancer cell proliferation, induce apoptosis, and enhance reactive oxygen species accumulation. However, whether GA could improve multidrug resistance through modulating autophagy has never been explored. We demonstrated that the combination of GA and cisplatin (CDDP) resulted in a stronger growth inhibition effect on A549 and NCI-H460 cells using the MTT assay. Furthermore, treatment with GA significantly increased autophagy in these cells. More importantly, GA-induced cell death could be largely abolished by 3-methyladenine (3-MA) or chloroquine (CQ) treatment, suggesting that GA-induced cell death was dependent on autophagy. Western blot analysis showed that GA treatment suppressed the activation of Akt, mTOR, and S6. In addition, using a GA and rapamycin combination induced more cell death compared to either GA or rapamycin alone. In summary, GA may have utility as an adjunct therapy for non-small cell lung cancer (NSCLC) patients through autophagy-dependent cell death, even when cancer cells have developed resistance to apoptosis.

Evaluation of high-resolution esophageal manometry in patients with peroral endoscopic myotomy / 中国内镜杂志

Objective To observe the changes of esophageal pressure in patients with achalasia (AC) before and after peroral endoscopic myotomy (POEM), and to explore the value of high-resolution manometry (HRM) in evaluating the efficacy of POEM. Methods 38 cases were diagnosed as achalasia and treated with POEM from August 2015 to November 2016. Upper esophageal sphincter resting pressure (UESP), lower esophageal sphincter resting pressure (LESP), esophageal sphincter 4s integrated relaxation pressure (4sIRP) were detected by HRM before operation, at 1 week, 1 month after operation to evaluate the efficacy. Results A total of 38 patients with AC received POEM. At one week, one month after operation, the UESP were (45.34 ± 26.52) mmHg, (41.27 ± 20.09) mmHg, compared with that of before operation (49.58 ± 26.47) mmHg and the differences were not statistically significant. The differences in LESP, 4sIRP between before operation and at one week, one month after operation were statistically significant, P < 0.05. The differences in UESP, LESP and 4sIRP between 1 week and 1 month after operation were not statistically significant. Conclusion The pressure of lower esophageal sphincter was significantly reduced and the dysphagia was improved. HRM might play an important role in the assessment of AC received POEM.

Evaluation of high-resolution esophageal manometry in patients with peroral endoscopic myotomy / 中国内镜杂志

Objective To observe the changes of esophageal pressure in patients with achalasia (AC) before and after peroral endoscopic myotomy (POEM), and to explore the value of high-resolution manometry (HRM) in evaluating the efficacy of POEM. Methods 38 cases were diagnosed as achalasia and treated with POEM from August 2015 to November 2016. Upper esophageal sphincter resting pressure (UESP), lower esophageal sphincter resting pressure (LESP), esophageal sphincter 4s integrated relaxation pressure (4sIRP) were detected by HRM before operation, at 1 week, 1 month after operation to evaluate the efficacy. Results A total of 38 patients with AC received POEM. At one week, one month after operation, the UESP were (45.34 ± 26.52) mmHg, (41.27 ± 20.09) mmHg, compared with that of before operation (49.58 ± 26.47) mmHg and the differences were not statistically significant. The differences in LESP, 4sIRP between before operation and at one week, one month after operation were statistically significant, P < 0.05. The differences in UESP, LESP and 4sIRP between 1 week and 1 month after operation were not statistically significant. Conclusion The pressure of lower esophageal sphincter was significantly reduced and the dysphagia was improved. HRM might play an important role in the assessment of AC received POEM.

High level of ezrin expression in colorectal cancer tissues is closely related to tumor malignancy.

AIM: To investigate the ezrin expression in normal colorectal mucosa and colorectal cancer tissues, and study the correlation between ezrin expression in colorectal cancer tissues and tumor invasion and metastasis. METHODS: Eighty paraffin-embedded cancer tissue samples were selected from primary colorectal adenocarcinoma. Twenty-eight patients had well-differentiated, 22 had moderately differentiated and 30 had poorly differentiated adenocarcinoma. Forty-five patients and 35 patients had lymph node metastasis. Forty-five patients were of Dukes A to B stage, and 35 were of C to D stage. Another 22 paraffin-embedded tissue blocks of normal colorectal epithelium (> 5 cm away from the edge of the tumor) were selected as the control group. All patients with colorectal cancer were treated surgically and diagnosed histologically, without preoperative chemotherapy or radiotherapy. The immunohistochemistry was used to detect the ezrin expression in paraffin-embedded normal colorectal mucosa tissues and colorectal cancer tissue samples. RESULTS: Ezrin expression in colorectal cancer was significantly higher than in normal colorectal mucosa (75.00% vs 9.09%, P < 0.01), and there was a close relationship between ezrin expression and the degree of tumor differentiation, lymph node metastasis and Dukes stage (88.46% vs 50.00%, P < 0.01; 94.28% vs 51.11%, P < 0.01; 94.28% vs 51.11%, P < 0.01). CONCLUSION: Ezrin expression is obviously higher in colorectal cancer tissues than in normal colorectal mucosa tissues, and the high level of ezrin expression is closely related to the colorectal cancer invasion and metastasis process.

RNAi-mediated silencing of ezrin gene reverses malignant behavior of human gastric cancer cell line SGC-7901.

OBJECTIVE: To investigate the effects of ezrin targeting gene of RNA interference (RNAi) on human gastric cancer cell line SGC-7901 in vitro. METHODS: The highly metastatic human gastric cancer cell line SGC-7901 transfected with a small interfering (siRNA) lentivirus vector was selected for this research study. Expressions of ezrin mRNA and ezrin protein in the SGC-7901 cells were detected using RT-PCR and Western blot. Cell apoptosis was observed using flow cytometry. Transwell invasion and the cell adhesion test were used to verify the effect of RNAi on ezrin expression in the human gastric cancer cell line SGC-7901 in vitro. RESULTS: Ezrin gene targeting via a RNAi-mediated lentivirus vector had obvious inhibitory effects on ezrin expression in the human gastric cancer cell line SGC-7901. The results of the RT-PCR show the obvious inhibition of ezrin mRNA expression in Eai and Ebi groups (0.22 +/- 0.01 vs 0.95 +/- 0.04, P < 0.05; 0.31 +/- 0.01 vs. 0.95 +/- 0.04, P < 0.05). Western blot analysis revealed a 72.35 +/- 3.74% reduction of the ezrin protein level after interference with the ezrin targeting gene. Moreover, the inhibition of ezrin expression clearly inhibited SGC-7901 cell migration and invasion, and improved cell adhesion as well as increased sensitivity to camptothecin-induced apoptosis. CONCLUSION: Ezrin gene targeting by RNAi can inhibit the metastatic growth and migration of SGC-7901 human gastric cancer cells.

Spectrofluorimetric determination of dopamine using 1,5-bis(4,6-dicholro-1,3,5-triazinylamino) naphthalene.

A new fluorescent reagent, 1,5-bis(4,6-dichloro-1,3,5-triazinylamino)naphthalene, containing two active chlorines, was synthesized by a one-step reaction. Under the optimum conditions for the determination of dopamine, the enhanced fluorescence intensity is proportional to the dopamine concentration. The fluorescence intensity was measured at lambda(ex/em) = 400/460 nm, with and without dopamine. The linear range and detection limit for the determination of dopamine were 1.0 x 10(-7) mol/L-5.0 x 10(-5) mol/L and 4.0 x 10(-8) mol/L. This method is simple, practical, can afford good precision and accuracy and can be successfully applied to assess dopamine in injections and human serum samples.