Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus.

BACKGROUND: The risk prediction of pregnancy-associated plasma protein-A (PAPP-A) for future cardiovascular (CV) events post acute coronary syndrome (ACS) in patients with type-2 diabetes mellitus (T2DM) was investigated in comparison to other risk factors. METHODS: PAPP-A was measured at hospital admission in 320 consecutive ACS patients (136 with T2DM and 184 without). All patients were followed for 2 years for occurrence of CV death, non-fatal MI or stroke. Effect of PAPP-A on the CV event risk was estimated using Cox regression models. Receiver operating characteristics (ROC) curves were generated to demonstrate the sensitivity and specificity of PAPP-A in predicting CV events. RESULTS: ACS patients with T2DM had higher PAPP-A (19.29 ± 16.36 vs. 13.29 ± 13.90 ng/ml, p < 0.001) and higher rate of CV events 2 years post ACS (27.2 vs. 13.6%, p = 0.002) than those without. Higher levels of PAPP-A were significantly associated with increased risk of CV events during 2-year follow-up [HR = 2.97 for 1 SD increase in log10(PAPP-A), 95% CI 2.11-4.18, p < 0.001] in T2DM and (HR = 3.16, 95% CI 2.27-4.39, p < 0.001) in non-T2DM. Among patients with T2DM, PAPP-A showed a larger area under the curve (AUC 0.79) that was significantly more predictive than hsCRP (AUC 0.64), eGFR (AUC 0.66) and LVEF < 50% (AUC 0.52); predictive ability did not improve significantly by including those factors into the model. CONCLUSIONS: Patients with T2DM had higher levels of PAPP-A and increased risk of CV events. Elevated PAPP-A compared to other risk factors was a stronger predictor for future CV events 2 years post ACS in patients with T2DM. Trial registration ISRCTN10805074. Registered on 20 January 2017, retrospectively registered.

Study on the Unsteady Characteristics and Radial Force of a Single-Channel Centrifugal Pump.

To research the internal flow characteristics of a single-channel centrifugal pump, the computational fluid dynamics method is used in this study. Several monitoring points are set on the volute to analyze the change of pressure pulsation and radial force when the impeller rotates at different angles. The results show that the pressure pulsation in the single-channel pump volute is induced by the rotor-stator interaction and its harmonics. The monitoring points close to the separation tongue along the rotation direction of the impeller are more affected by the flow rate.

CRP and TNF-α induce PAPP-A expression in human peripheral blood mononuclear cells.

OBJECTIVE: The effects of C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) on pregnancy-associated plasma protein-A (PAPP-A) expression in human peripheral blood mononuclear cells (PBMCs) require further investigation. METHODS: The PAPP-A levels in culture supernatants, PAPP-A mRNA expression, and cellular PAPP-A expression were measured in human PBMCs isolated from fresh blood donations provided by 6 healthy volunteers (4 donations per volunteer). Analyses were conducted by ultrasensitive ELISA, western blotting, and RT-PCR following stimulation with CRP or TNF-α cytokines. RESULTS: PAPP-A mRNA and protein levels after CRP stimulation peaked at 24 hours, whereas peak PAPP-A mRNA and protein levels were achieved after TNF-α stimulation at only 2 and 8 hours, respectively. These findings indicate the dose-dependent effect of CRP and TNF-α stimulation. Actinomycin D treatment completely prevented CRP and TNF-α induction of PAPP-A mRNA and protein expression. Additionally, nuclear factor- (NF-) κB inhibitor (BAY11-7082) potently inhibited both CRP and TNF-α stimulated PAPP-A mRNA and protein expression. CONCLUSIONS: Human PBMCs are capable of expressing PAPP-A in vitro, expression that may be regulated by CRP and TNF-α through the NF-κB pathway. This mechanism may play a significant role in the observed increase of serum PAPP-A levels in acute coronary syndrome (ACS).

Fault Tolerance Optimization of a Lithium Battery Pack Having a Damaged Unit.

As a kind of green and sustainable technology, electric vehicles are continuously highlighted for solving the significant problems of energy and air pollution. In this paper, fault tolerance optimization of an air-cooled lithium battery pack having a damaged unit was considered to improve the heat dissipation performance. For constructing the relationship between the objective function and the design variables, a quadratic polynomial response function was set up based on the experimental points, which were selected by the Latin-hypercube design of experiment method. Then, a multi-island genetic algorithm-based optimization of the battery pack having a damaged unit was performed under the condition of adjusting the flow velocity of each inlet. The results show that the acceptable temperature differences were obtained under the condition of fixing the total mass flow rate of the inlets. The simulation and fault tolerance optimization methods recommended in this study can be widely used to improve the real safety level of the systems.

[The effect of radial artery on coronary bypass surgery in patients aged 65 years and older].

OBJECTIVE: To investigate the effect of autologous radial artery (RA) on coronary artery bypass grafting (CABG) in the elderly aged 65 years and older. METHODS: Three hundreds and twenty-two patients aged 65 years and older underwent CABG with autologous RA from January 2000 to March 2007. Peri-operative complication and mortality were observed and follow-up was performed. RESULTS: Three hundreds and forty-four RA grafts including 300 cases of single and 22 cases of bilateral RA were collected. The total number of distal anastomosis was 974, with the mean of (3.0 +/- 0.4). The mean of RA distal anastomosis was (1.1 +/- 0.4). There were 321 single, 16 Y or T composite and 7 sequential grafts of RA constructed. The distal end of RA was anastomosed to right coronary artery system for 234 times, to obtuse marginal for 95 times, to diagonal or intermediate ramous artery for 22 times. The proximal end of RA was anastomosed to aorta for 328 times, to left internal mammary artery for 9 times and to saphenous vein for 7 times. Only 13 patients manifested transient paresthesia in the area of radial aspect of thumb and no other complication occurred in the forearm. During hospitalization, 7 patients died. No patient died after the follow-up of (46.5 +/- 6.7) months. Seventy-three patients were performed with coronary angiography postoperatively. It was showed by coronary angiography that all RA conduits were patent after the duration of (47.5 +/- 11.2) months after CABG. CONCLUSION: Utilization of RA to CABG in the elderly is safe and effective.

Low levels of ApoA1 improve risk prediction of type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) has reported to be a major public health crisis in China. OBJECTIVE: We examined the incidence of new T2DM over 4 years for association of clinical factors and lipids with development of T2DM in a community-based population. METHODS: We included 923 Chinese subjects who participated in community-organized health checkout in both 2009 and 2013. Health history was collected; physical examination was performed; biochemistry, lipids, and glucose were measured. Of 923, 819 were confirmed without T2DM in 2009 and included in the analysis. Unadjusted and adjusted logistic regression models were used to estimate the effects of clinical factors and biomarkers on the risk of new T2DM. RESULTS: Of 819 subjects without T2DM in 2009, 65 were identified as T2DM in 2013, 8% over 4 years. These 65 subjects, compared with those 754 without new T2DM, were older, more likely to be male and smokers. They had higher body mass index (BMI), fasting glucose, blood pressure and triglycerides, and lower levels of high-density lipoprotein-cholesterol and apolipoprotein A1 (ApoA1). Multivariate logistic regression identified larger BMI (odds ratio [OR] = 1.7; 95% confidence interval [CI], 1.22-2.39, P = .002), higher fasting glucose levels (OR = 4.2, 95% CI, 2.90-6.19, P < .001), and low levels of ApoA1 (OR = 0.51, 95% CI 0.33-0.76, P = .002) were independently associated with new T2DM. Furthermore, receiver operating characteristics curves for multivariate models for new T2DM showed that area under the curve improved from 0.87 to 0.89 when adding ApoA1 to the Framingham Diabetes Risk Scoring Model and from 0.85 to 0.89 when adding ApoA1 to a 4-variable (age, BMI, glucose, and triglycerides) Chinese model. CONCLUSIONS: There is a high incidence of new T2DM at 8% over 4 years among Chinese. Larger BMI, higher glucose levels, and lower levels of ApoA1 are significantly and independently associated with new T2DM. Lower ApoA1 improves the risk prediction of new type 2 diabetes when it was added to the existing risk models.

[Effects of C-reactive protein and tumor necrosis factor-alpha on mRNA expression of pregnancy-associated plasma protein-A in monocytes].

OBJECTIVE: Serum pregnancy-associated plasma protein A (PAPP-A) is increased in acute coronary syndrome patients and related to prognosis. We investigated the effects of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-alpha) on PAPP-A mRNA expression in monocytes. METHODS: Monocytes were isolated by Ficoll density gradient centrifugation from blood of healthy volunteers. The PAPP-A expressions at mRNA level post CRP or rhTNF-alpha stimulation were measured by RT-PCR. RESULTS: PAPP-A mRNA expression in peripheral blood monocytes increased 2 hours (0.2128 +/- 0.0136) and peaked 24 hours (0.6837 +/- 0.1360) after CRP (20 mg/L) stimulation compared with control group (0.1842 +/- 0.0101). PAPP-A mRNA expression increased rapidly, peaked 2 hours (1.2546 +/- 0.0866) and remained elevated up to 24 hours (0.8203 +/- 0.0413) after rhTNF-alpha (100 ng/ml) stimulation. The effects of CRP and TNF-alpha were dose-dependent. PAPP-A mRNA expression of monocytes were 0.2544 +/- 0.0611, 0.4177 +/- 0.1200, 0.5828 +/- 0.0152, 0.6837 +/- 0.1360 after stimulated with CRP (1, 5, 10, 20 mg/L), and 0.2424 +/- 0.1378, 0.3335 +/- 0.0196, 0.5742 +/- 0.0131, 0.6913 +/- 0.0219 and 0.8203 +/- 0.0413 after stimulated with rhTNF-alpha (5, 10, 25, 50 and 100 ng/ml). Actinomycin D, the DNA-directed RNA polymerase inhibitor, completely blocked CRP and TNF-alpha induced PAPP-A expression. CONCLUSIONS: PAPP-A mRNA expression could be stimulated by CRP and TNF-alpha in human peripheral blood monocytes which might be responsible for the increased serum PAPP-A level in patients with acute coronary syndromes.

A case of systemic amyloidosis beginning with purpura.

Primary systemic amyloidosis is a relatively rare disease, caused when abnormal extracellular deposition of fibrillary protein builds up in a variety of target organs, such as heart, kidneys, lungs liver, and so forth. The symptoms of the disease are usually vague, while many kinds of auxiliary or laboratory examinations especially pathologic biopsy can provide a clue for the diagnosis. Here we described a case who had purpura-like lesions in the initial stage, followed by progressive malfunctions in the kidneys, the heart, the lungs, as well as the liver. The final diagnosis was primary systemic amyloidosis determined by skin pathologic biopsy. And the disease led to a fatal outcome within three months after the diagnosis.

A rare case of tricuspid valve thrombus with acute pulmonary embolism.

The development of thrombus on the tricuspid valve is very rare. This report describes a case of acute pulmonary embolism (PE) with a mass on the tricuspid valve in a normal heart, detected by bedside transthoracic echocardiography (TTE). After successful surgical management, the histopathological examination revealed the mass from the tricuspid valve to be mixed thrombus. The early use of bedside TTE can facilitate the prompt diagnosis and aggressive therapy when PE is suspected.

An alternative surgical approach for aortic infective endocarditis: vegetectomy.

We describe a case of successful vegetectomy of the aortic valves for early infective endocarditis. An aortic vegetectomy was performed as an alternative to valve replacement for a 54-year-old man with three vegetations and mild regurgitation in aortic valve due to infective endocarditis. Postoperative clinical course was without signs of recurrent infection after follow-up of 19 months, and transesophageal echocardiography demonstrated aortic valve competence. We would suggest that vegetectomy with valve sparing may be a viable option in the context of early infective endocarditis involved aortic valve in selected patients.