Comparison of liberal versus restrictive transfusion strategies after hip surgery in patients with coronary artery disease: a post hoc analysis of the FOCUS trial.

BACKGROUND: There are no clear recommendations for optimal transfusion thresholds for patients with coronary artery disease who undergo noncardiac surgery. By comparing restrictive and liberal transfusion strategies for coronary artery disease combined with hip surgery, this study hopes to provide recommendations for transfusion strategies in this special population. METHODS: A total of 805 patients from the FOCUS trial (Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair) with coronary artery disease combined with hip surgery were divided into two groups based on transfusion thresholds: restricted transfusion (a hemoglobin level of 8 g/deciliter) and liberal transfusion (a hemoglobin threshold of 10 g/deciliter). The primary outcome of this study was a composite endpoint including in-hospital death, myocardial infarction, unstable angina, and acute heart failure. The secondary endpoints included other in-hospital adverse events and 30- and 60-day follow-up events. Analyses were performed by intention to treat. RESULTS: Except for the proportion of congestive heart failure patients, the baseline levels of the two groups were comparable. The median number of transfusion units in the liberal transfusion group was 2 units, and the median transfusion volume in the restricted transfusion group was 0 units. The primary outcome was not significantly different between the two groups (9.2% vs. 9.4%, p = 0.91). The incidence of in-hospital myocardial infarction events was lower in the liberal transfusion group than in the restricted transfusion group (3.2% vs. 6.2%) (OR = 0.51, P = 0.048). The remaining in-hospital endpoint events, except for myocardial infarction, were not significantly different between the two groups. The 30-day and 60-day endpoints of death and inability to walk independently were not significantly different between the two groups, with ORs (95% CI) of 1.00 (0.75-1.31) and 1.06 (0.80-1.41), respectively. We also found no interaction between transfusion strategies and factors such as age, sex, or multiple underlying comorbidities at the 60-day follow-up. CONCLUSIONS: There was no significant difference in the in-hospital, 30-day or 60-day outcome endpoints between the two groups. However, this study demonstrated that a liberal transfusion strategy tends to reduce the incidence of in-hospital myocardial infarction events in patients with coronary artery disease combined with hip surgery compared to a restrictive transfusion strategy. More high-quality studies should be designed to investigate the optimal transfusion threshold in patients with coronary artery disease treated without cardiac surgery.

Tailoring Antithrombotic Regimens for Percutaneous Coronary Intervention Patients with High Bleeding and Ischemic Risk (TAILOR-BIRISK): Individualized Management and Genotype-Guided De-escalation.

Percutaneous coronary intervention (PCI) is a widely used reperfusion strategy for coronary artery disease, with millions of procedures performed annually. Attention has recently been drawn to a unique population, known as "bi-risk" patients, who have high ischemic and high bleeding risks and undergo PCI. However, there is currently no established definition or optimal antithrombotic therapy for this group. Genotype-guided antithrombotic therapy, which uses cytochrome P450 (CYP) 2C19 gene testing, may offer a more personalized and precise approach. Nevertheless, recent research has shown that routine genetic testing to guide treatment in the PCI population does not improve patient outcomes, preventing it from being routinely recommended in guidelines. This review proposes, for the first time, the definition of the bi-risk population and the concept of TAILOR-BIRISK for their treatment strategies. TAILOR-BIRISK emphasizes de-escalating antithrombotic treatment and suggests that a short course of dual antiplatelet therapy (DAPT) followed by monotherapy by either clopidogrel or ticagrelor 60 mg BID (BID, twice daily) could be a reasonable option for this population. Additionally, the use of CYP2C19 gene testing to guide P2Y 12 inhibitor selection can help better individualize and customize the antithrombotic regimen. However, more large-sample randomized control studies should be conducted to further explore the optimal antithrombotic strategy for the bi-risk population.

The Management and Antithrombotic Strategies of Patients with Coronary Artery Disease and High Bleeding Risk.

PURPOSE OF REVIEW: In this review, we aim to summarize the current understanding of high bleeding risk (HBR) patients in coronary artery disease (CAD) and provide a comprehensive evaluation of the available antithrombotic strategies for both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures. RECENT FINDINGS: CAD is a major cause of mortality among cardiovascular diseases, resulting from insufficient blood flow in the coronary artery due to atherosclerosis. Antithrombotic therapy is a crucial component of drug therapy for CAD and multiple studies had been focusing on the optimal antithrombotic strategies of different CAD populations. However, there is no fully harmonized definition of the model of bleeding, and the optimal antithrombotic strategy for such patients at HBR is inconclusive. In this review, we summarize bleeding risk stratification models for CAD patients and discuss the de-escalation of antithrombotic strategies among HBR patients. Furthermore, we realize that for certain subgroups of CAD-HBR patients, more individualized and precise antithrombotic strategy development is needed. So, we highlight special populations, such as CAD patients combined with valvular diseases, with both high ischemia and bleeding risks, and those proceeding surgical treatment, which requires greater research attention. We note that de-escalating therapy for CAD-HBR patients is an emerging trend in managing this population, but the optimal antithrombotic strategies should be re-considered according to the patient's baseline characteristics.

An artificial intelligence-based risk prediction model of myocardial infarction.

BACKGROUND: Myocardial infarction can lead to malignant arrhythmia, heart failure, and sudden death. Clinical studies have shown that early identification of and timely intervention for acute MI can significantly reduce mortality. The traditional MI risk assessment models are subjective, and the data that go into them are difficult to obtain. Generally, the assessment is only conducted among high-risk patient groups. OBJECTIVE: To construct an artificial intelligence-based risk prediction model of myocardial infarction (MI) for continuous and active monitoring of inpatients, especially those in noncardiovascular departments, and early warning of MI. METHODS: The imbalanced data contain 59 features, which were constructed into a specific dataset through proportional division, upsampling, downsampling, easy ensemble, and w-easy ensemble. Then, the dataset was traversed using supervised machine learning, with recursive feature elimination as the top-layer algorithm and random forest, gradient boosting decision tree (GBDT), logistic regression, and support vector machine as the bottom-layer algorithms, to select the best model out of many through a variety of evaluation indices. RESULTS: GBDT was the best bottom-layer algorithm, and downsampling was the best dataset construction method. In the validation set, the F1 score and accuracy of the 24-feature downsampling GBDT model were both 0.84. In the test set, the F1 score and accuracy of the 24-feature downsampling GBDT model were both 0.83, and the area under the curve was 0.91. CONCLUSION: Compared with traditional models, artificial intelligence-based machine learning models have better accuracy and real-time performance and can reduce the occurrence of in-hospital MI from a data-driven perspective, thereby increasing the cure rate of patients and improving their prognosis.

Layer-specific strain echocardiography may reflect regional myocardial impairment in patients with hypertrophic cardiomyopathy.

Our study aimed to determine whether layer-specific strain (LSS) could reflect regional myocardial impairment in patients with hypertrophic cardiomyopathy (HCM). The study enrolled 50 patients with HCM and 30 age-matched healthy controls. Transmural gradient of longitudinal strain (TGLS), defined as the difference between the longitudinal strain of the endocardium and epicardium in a left ventricular segment, was used to reflect layer-specific myocardial impairment. Negative TGLS was consistently observed in healthy controls. The TGLS was relatively consistent within the basal, middle, and apical levels in healthy controls,but showed a significant gradient from the base towards the apex. In patients with HCM, the hypertrophic segments had significantly higher TGLS than the relatively normal segments or healthy controls at all 3 levels (0.14 % ± 3.48 % vs. -2.65 % ± 4.44 % vs. -2.17 % ± 1.66 % for basal, - 0.72 % ± 3.71 % vs. -4.02 % ± 4.00 % vs. -3.58 % ± 2.29 % for middle, and - 8.69 % ± 7.96 % vs. -11.44 % ± 6.65 % vs. -10.04 % ± 3.20 % for apex). Abnormal TGLS, defined as positive TGLS, in patients with HCM was associated with chest pain. In receiver operating characteristic curve analysis, a large area of abnormal TGLS (> 4 segments) had moderate accuracy for predicting chest pain (sensitivity, 73.3 %; specificity, 70.0 %). TGLS, a novel LSS derived parameter, may reflect regional myocardial impairment in patients with HCM.

High-intensity statin therapy yields better outcomes in acute coronary syndrome patients: a meta-analysis involving 26,497 patients.

BACKGROUND: Whether high-intensity statin treatment provides more clinical benefits compared with standard statin regimens in acute coronary syndrome (ACS) patients remains controversial. This meta-analysis aimed to comparatively assess high-intensity and standard statin regimens for efficacy and safety in patients with ACS. METHODS: The PubMed, EMBASE, and Cochrane Library databases were searched for studies assessing high-intensity vs. standard statin regimens for ACS treatment from inception to April 2020. The publication language was limited to English, and 16 randomized controlled trials were finally included in this study, with a total of 26,497 patients. RESULTS: Compared to the standard statin regimens, the relative ratio (RR) of major adverse cardiovascular events (MACE) in ACS patients treated by high-intensity statin was 0.77 (95%CI, 0.68-0.86; P < 0.00001; prediction interval, 0.56-1.07). In subgroup analysis, high-intensity statin therapy resulted in more clinical benefits regarding MACE compared with standard statin treatment in both Asian (RR = 0.77; 95%CI, 0.61-0.98; P = 0.03) and non-Asian (RR = 0.79; 95%CI, 0.71-0.89; P < 0.0001) patients. Although adverse events were acceptable in patients with ACS administered high-intensity statin therapy, this treatment was associated with a higher rate of adverse events (4.99% vs. 2.98%), including myopathy/myalgia and elevated liver enzymes, as reflected by elevated serum aminotransferase or aminotransferase amounts. CONCLUSION: The current findings indicated that high-intensity statin therapy might be beneficial in patients with ACS, and close monitoring for adverse effects should be performed.

Quantitative structure-retention relationships of the chromatographic retentions of phthalic acid ester contaminants in foods.

The harmful health effects caused by phthalic acid esters have been supported from the increasing scientific evidence, developing the efficient methodologies to monitor the levels of phthalic acid esters in various foods become especially important from the aspects of human exposure assessment and their migration mechanistic understanding. In this study, quantitative structure-retention relationship studies on both the gas and liquid chromatographic retention times of 23 phthalic acid esters were performed by genetic function approximation, and the optimal quantitative structure-retention relationship models (r2  > 0.980, r2 CV  > 0.960, and r2 pred  > 0.865) passed the statistical tests of cross-validation, randomization, external prediction, Roy' rm 2 metrics, Golbraikh-Tropsha' criteria and applicability domain. The established predictive models elucidate the structural requirements for the retention of phthalic acid esters over different chromatographic columns, which were finally used to predict the retention times of 11 new phthalic acid esters. Hopefully, this work could provide useful guidelines for better understanding and accurate prediction of the retention behavior of undetermined phthalic acid esters when lacking standard samples or under poor experimental conditions, and make the simultaneous identification and quantification of numerous phthalic acid esters possible.

Right Ventricular Dissipative Energy Loss Detected by Vector Flow Mapping in Children: Characteristics of Normal Values.

OBJECTIVES: The feasible application of vector flow mapping (VFM)-derived right ventricular (RV) energy loss (EL) is lacking. This study was designed to determine reference values of VFM-derived EL within the right ventricle and evaluate potential correlated variables. METHODS: A total of 90 healthy children were enrolled. Velocity vector fields of the intra-RV outflow tract and pulmonary trunk (OP) and RV blood flow were obtained from the parasternal short-axis view and RV focused apical 4-chamber view, respectively. RV-EL and OP-EL values during diastole and systole were calculated using VFM analysis. The potential relationships between demographic and echocardiographic parameters and the dissipative EL were also identified. RESULTS: Mean subject age was 8.99 ± 5.35 years. The median (interquartile range) values were 8.82 (5.47-14.30) W/m for RV diastolic EL, 3.17 (2.11-5.54) W/m for RV systolic EL, 18.82 (13.93-24.92) W/m for OP diastolic EL, and 29.88 (20.62-40.78) W/m for OP systolic EL, respectively. The dissipative EL values were negatively correlated with age and RV global strain, and positively correlated with heart rate and RV Tei index. Multivariate analysis showed that age was the primary independent predictor of these 4 types of EL, while heart rate and strain were contributors of the RV diastolic EL and OP systolic EL. CONCLUSIONS: The present study initially validated the application of vector flow mapping-derived EL analysis in right ventricle and established reference values for the future assessment of children with cardiopulmonary disease. Age, heart rate, and strain were independent variables correlated with the dissipative EL.

The relationship between alkylamide compound content and pungency intensity of Zanthoxylum bungeanum based on sensory evaluation and ultra-performance liquid chromatography-mass spectrometry/ mass spectrometry (UPLC-MS/MS) analysis.

BACKGROUND: Zanthoxylum bungeanum originating in different places varies in alkylamide content and pungency intensity. RESULTS: The pungency intensity of 19 Zanthoxylum bungeanum samples was first determined with Scoville pungency units (SPUs). The SPUs were found to range from 3.80E + 04 to 5.40E + 05. The chemical compositions and contents were measured next, using the ultra-performance liquid chromatography-mass spectrometry/ mass spectrometry (UPLC-MS/MS) method. The total alkylamide content ranged from 9.83 ± 0.15 to 89.98 ± 1.35 g kg-1 . Hydroxy-ϵ-sanshool, hydroxy-α-sanshool, hydroxy-ß-sanshool, hydroxy-γ-sanshool, bungeanool, and isobungeanool were found to be the key pungent compounds, ranging in proportion from 92.65% to 97.69%. The relationship between alkymide compound content and pungency intensity was also analyzed by ridge regression, and it was found that the ß values of independent variables were stable when k was more than 0.6. The regression coefficients of hydroxy-ϵ-sanshool, hydroxy-α-sanshool, hydroxy-ß-sanshool, hydroxy-γ-sanshool, bungeanool, isobungeanool, and other alkylamides were 0.105, 0.177, 0.386, -0.166, -0.006, 0.005, and -0.018, respectively. CONCLUSION: Hydroxy- sanshool compounds were important in determinant the pungency intensity of Z. bungeanum. Knowledge of the relationship between alkymide compound content and pungency intensity will assist in the creation of new methods to determine pungency intensity and provide a scientific basis for flavor design, development of pungent food products, and consumer choice evaluations. © 2018 Society of Chemical Industry.

Pungency Evaluation of Hydroxyl-Sanshool Compounds After Dissolution in Taste Carriers Per Time-Related Characteristics.

This study was conducted to investigate the sensory characteristics and temporal migration of hydroxyl-sanshool compounds at slight and moderate concentrations after dissolution in ethanol-water, saccharose, NaCl, and MSG via 2-AFC, time intensity (TI) and temporal dominance of sensations (TDS) methods. The pungency detection threshold (DT) was suppressed in saccharose while NaCl and MSG solutions showed no effect on pungency DT. The area under the curve (AUC) of pungency increased in NaCl and MSG solutions and decreased significantly in saccharose solution. Imax (maximal intensity) also increased in NaCl and MSG at low concentrations of hydroxyl-sanshool compounds. The temporally dominant sensations and migration of said sensations across the oral cavity differed among different carriers. Low levels of pungency compounds were characterized by tingling first in the tongue tip and ending in the lips, while moderate levels of the compound produced tingling, astringency, vibrating, and numbing from the tongue tip to the bilateral sides of the tongue, lips, palate, cheek mucosa, and surface of the tongue over time. There were significant differences in the maximum rate, peak time, and duration of any dominant sensation, as well as in the duration of sensation in the lips, tongue tip, and bilateral sides of the tongue. This study provides a dynamic profile of consuming pungent food, which provides a reference not only for the design of new food products with desirable pungency, but also as a scientific basis for the application of pungent compounds within the food and catering industry.

Left Atrial Appendage Parameters Assessed by Real-Time Three-Dimensional Transesophageal Echocardiography Predict Thromboembolic Risk in Patients With Nonvalvular Atrial Fibrillation.

OBJECTIVES: In nonvalvular atrial fibrillation (NVAF) patients, the effect of left atrial appendage (LAA) morphology, structure, and hemodynamic characteristics evaluated by real-time 3D transesophageal echocardiography (RT3D-TEE) on thromboembolic risk has not been elucidated. METHODS: A total of 444 NVAF patients who underwent clinically indicated RT3D-TEE were enrolled in the study. The orifice size, orifice area, depth, and volume measurements of the LAA were assessed using Philips QLAB 9.0. The LAA characteristics were compared among different CHA2 DS2 -VASc thromboembolic risk subgroups, as well as between the thromboembolic event and nonevent groups. RESULTS: The orifice size, orifice area, and end-diastolic volumes of the LAA were increased with an increasing CHA2 DS2 -VASc risk score in the NVAF patients, whereas the emptying rate was decreased. The NVAF patients with LAA thrombus exhibited a significantly increased end-diastolic volume (7.39 ± 3.47 versus 5.21 ± 2.59 mL, P = .003) and higher prevalence of the cauliflower shaped LAA (64.3% versus 25%, P = .004) compared with those without thrombus. Logistic regression indicated that the LAA end-diastolic volume (P = .002; odds ratio 1.556; 95% confidence interval 1.176-2.057) and cauliflower shape (P = .001; odds ratio, 10.177; 95% confidence interval, 2.458-42.140) were independent predictors of thromboembolic events in patients with NVAF following adjustment for the CHA2 DS2 -VASc score. CONCLUSIONS: The LAA end-diastolic volume and cauliflower phenotype predict thromboembolic events independent of the CHA2 DS2 -VASc score, and these data improve stroke prediction in NVAF patients.

[Assessment of Left Atrial Appendage Size and Morphology by Enhanced Cardiac Computed Tomography in Patients with Non-valvular Atrial Fibrillation].

OBJECTIVE: This study was designed to investigate left atrial appendage (LAA) size and morphology characteristics in patients with non-valvular atrial fibrillation (NVAF) by enhanced cardiac computed tomography (CT) scanning,and to evaluate the predictive value of these parameters for thromboembolic risk. METHODS: A total of 189 NVAF patients were prospectively enrolled during December 2012 to January 2014 in West China Hospital of Sichuan University. Fifty-two atrial tachycardia patients without organ dysfunction were also recruited as controls. All subjects were scheduled for radiofrequency ablation and underwent enhanced cardiac CT scan. The clinical characteristics,comorbid diseases,anticoagulant therapy,and AF chronicity were collected and CHA2DS2-VASc score was calculated for the assessment of thromboembolic risk. The NVAF cohort was also divided further into LAA thrombus present (n=13) and absent (n=176) subgroup according to LAA with thrombus or not. Differencesin size and morphology characteristics of the LAA were compared among controls and different CHA2DS2-VASc thromboembolic risk subgroups,and between LAA thrombus and non-thrombus group. In addition,logistic regression analysis was used to identify whether these parameters predict thrombus formation independent of the CHA2DS2-VASc score in NVAF patients. RESULTS: Compared with controls,NVAF patients had significantly bigger orifice size. Windsock and cactus-type LAA were main morphology in controls,while the distribution of the four kinds of LAA types were similar in NVAF patients. The orifice and volume of the LAA were increased with increasing CHA2DS2-VASc riskscore,and chicken wing-type LAA was the predominant prevalence in low-intermediate thromboembolic risk subgroup while cauliflower in high thromboembolic risk subgroup. Compared with non-thrombus patients,LAA-thrombussubgroup exhibited a significantly increased orifice and volume,and higher prevalenceof the cauliflower shaped LAA. Logistic regression showed that the LAA orifice and cauliflower shape were independent predictors for thrombus formation in patients with NVAF following adjustment for the CHA2DS2-VASc score. CONCLUSION: Cardiac images obtained with CTis feasible for the analysis of LAA size and morphology,and these parameters provide incremental value in assessing the LAA thrombus risk in patients with NVAF.

Assessment of Left Ventricular Dissipative Energy Loss by Vector Flow Mapping in Patients With End-Stage Renal Disease.

OBJECTIVES: Dissipative energy loss derived from vector flow mapping represents the viscous dissipation of turbulent blood flow. We aimed to determine the left ventricular (LV) energy loss in patients with end-stage renal disease (ESRD). METHODS: Patients with ESRD and a preserved LV ejection fraction, who consisted of a group receiving peritoneal dialysis, a group receiving hemodialysis, and a group receiving preparation for dialysis initiation, were examined by echocardiography; a group of healthy control participants were examined as well. Vector flow mapping analysis was then performed from the apical 4-chamber view to calculate the energy loss during diastole and systole in the left ventricle. RESULTS: Conventional transthoracic echocardiography and LV energy loss calculations were successfully performed in 63 cases and 50 controls. The patients with ESRD had significantly higher diastolic energy loss [median (interquartile range), 71.73 (46.08-106.75) versus 23.32 (17.17-29.26) mW/m; P < .001] and higher systolic energy loss [25.28 (19.03-33.93) versus 12.52 (9.35-16.47) mW/m; P < .001]. A significant difference in diastolic energy loss between the peritoneal dialysis and preparation groups was found [54.92 (39.28-89.94) versus 84.82 (62.58-171.4) mW/m; P = .04]. In patients with ESRD, the log-transformed diastolic energy loss had a significant association with the peak early diastolic transmitral flow velocity (P = .011), peak early diastolic transmitral flow velocity-to-peak early diastolic mitral annular flow velocity ratio (P = .001), LV mass index (P = .017), and heart rate (P = .003). CONCLUSIONS: Impaired blood flow efficiency was detected in patients with ESRD by using dissipative energy loss derived from vector flow mapping. The energy loss value could be a novel parameter for evaluating the ventricular workload of uremic hearts in terms of fluid mechanics.

Coronary Bioresorbable metallic stents:Advancements and future perspectives.

Percutaneous coronary intervention is a critical treatment for coronary artery disease, particularly myocardial infarction, and is highly recommended in clinical guidelines. Traditional metallic stents, although initially effective, remain permanently in the artery and can lead to complications such as in-stent restenosis, late thrombosis, and chronic inflammation. Given the temporary need for stenting and the potential for late complications, bioresorbable stents have emerged as a promising alternative. However, bioresorbable polymeric stents have encountered significant clinical challenges due to their low mechanical strength and ductility, which increase the risks of thrombosis and local inflammation. Consequently, bioresorbable metals are being considered as a superior option for coronary stents. This review examines the progress of bioresorbable metallic stents from both preclinical and clinical perspectives, aiming to provide a theoretical foundation for future research. Iron, zinc, and magnesium are the primary materials used for these stents. Zinc-based bioresorbable stents have shown promise in preclinical studies due to their biocompatibility and vascular protective properties, although human clinical studies are still limited. Magnesium-based stents have demonstrated positive clinical outcomes, being fully absorbed within 12 months and showing low rates of late lumen loss and target lesion failure at 6- and 12-months post-implantation. Initial trials of iron-based stents have indicated favorable mid-term safety and efficacy, with complete absorption by the body within three years and consistent luminal expansion beyond six months post-implantation. Despite these advancements, further trials are needed for comprehensive validation. In conclusion, while current materials do not fully meet the ideal requirements, ongoing research should focus on developing bioresorbable stents with enhanced performance characteristics to better meet clinical needs.

Comparison of the effects of contrast medium and low-molecular-weight dextran on coronary optical coherence tomographic imaging in relatively complex coronary lesions.

Background: Optical coherence tomography (OCT) has gained increasing popularity in coronary artery intervention due to its high resolution and excellent tissue correlation as a novel intravascular imaging modality. However, the current use of OCT requires contrast agent injection for imaging, and excessive use of contrast agents may adversely affect renal function, exacerbate cardiac burden, and even lead to contrast agent-induced nephropathy and heart failure. In recent years, several researchers have proposed the use of low molecular weight dextran (LMWD) as a substitute for contrast agents in OCT imaging because of its low toxicity, low cost, and wide availability. However, the inclusion of lesions in these studies is relatively simple, and the image quality criteria remain to be optimized. Methods: This study included 26 patients with coronary artery disease who were scheduled for OCT imaging in a real-world clinical practice involving various complex lesions. All patients underwent two OCT examinations at the same vascular site, one each using contrast agent and LMWD. Both contrast media and LMWDs were infused by an autoinjector. The primary endpoint of the study was the average image quality score. Secondary endpoints included clear image length, clear image segments, minimum lumen area, average lumen area, and contrast-induced nephropathy, among others. Results: In terms of image clarity, the average image quality score was similar when comparing contrast media with LMWD (3.912 ± 0.175 vs. 3.769 ± 0.392, P = 0.071). The lengths of the clear images and the segments of the clear images were also similar between the two groups (50.97 ± 16.25 mm vs. 49.12 ± 18.15 mm, P = 0.110; 255.5 ± 81.29 vs. 250.5 ± 89.83, P = 0.095). Additionally, strong correlations were noted between the two flushing solutions regarding the minimum lumen area and mean lumen area. During their hospital stay, none of the patient exhibited deterioration in renal function, and no patient experienced any major adverse cardiovascular events. Conclusions: The quality of coronary artery OCT imaging using LMWD may be comparable to that achieved with traditional contrast agents, even in real-world clinical practice involving various complex lesions. For high-risk patients, LMWD may serve as an excellent substitute for contrast agents in OCT examinations.

Diagnostic performance of angiography-derived fractional flow reserve and CT-derived fractional flow reserve: A systematic review and Bayesian network meta-analysis.

OBJECTIVE: Accumulating evidence has demonstrated that fractional flow reserves (FFRs) derived from invasive coronary angiograms (CA-FFRs) and coronary computed tomography angiography-derived FFRs (CT-FFRs) are promising alternatives to wire-based FFRs. However, it remains unclear which method has better diagnostic performance. This systematic review and meta-analysis aimed to compare the diagnostic performances of the two approaches. METHODS: The Cochrane Library, PubMed, Embase, Medline (Ovid), the Chinese China National Knowledge Infrastructure Database (CNKI), VIP, and WanFang Data databases were searched for relevant studies that included comparisons between CA-FFR and CT-FFR, from their respective database inceptions until January 1, 2023. Studies where both noninvasive FFR (including CA-FFR and CT-FFR) and invasive FFR (as a reference standard) were performed for the diagnosis of ischemic coronary artery disease and were designed as prospective, paired diagnostic studies, were pulled. The diagnostic test accuracy method and Bayesian hierarchical summary receiver operating characteristic (ROC) model for network meta-analysis (NMA) of diagnostic tests (HSROC-NMADT) were both used to perform a meta-analysis on the data. RESULTS: Twenty-six studies were included in this NMA. The results from both the diagnostic test accuracy and HSROC-NMADT methods revealed that the diagnostic accuracy of CA-FFR was higher than that of CT-FFR, in terms of sensitivity (Se; 0.86 vs. 0.84), specificity (Sp; 0.90 vs. 0.78), positive predictive value (PPV; 0.83 vs. 0.70), and negative predictive value (NPV; 0.91 vs. 0.89) for the detection of myocardial ischemia. A cumulative ranking curve analysis indicated that CA-FFR had a higher diagnostic accuracy than CT-FFR in the context of this study, with a higher area under the ROC curve (AUC; 0.94 vs. 0.87). CONCLUSIONS: Although both of these two commonly used virtual FFR methods showed high levels of diagnostic accuracy, we demonstrated that CA-FFR had a better Se, Sp, PPV, NPV, and AUC than CT-FFR. However, this study provided only indirect comparisions; therefore, larger studies are warranted to directly compare the diagnostic performances of these two approaches.

Novel Guanidinium-Functionalized Stigmasterol for Bile Salt Binding and Serum Cholesterol Reduction: Synthesis, Interaction Mechanisms, and In Vivo Function.

A novel amphiphilic guanidyl-functionalized stigmasterol hydrochloride (GFSH) was designed and synthesized as bile salt sequestrants for cholesterol reduction. GFSH exhibited a considerable in vitro capacity for bile salt binding in gastrointestinal digestion and alleviated hypercholesterolemia in vivo. GFSH spontaneously interacted with sodium cholate via synergistic electrostatic, hydrophobic, and hydrogen-bonding interactions. The effects of GFSH on serum cholesterol reduction in mice fed a high-fat-high-cholesterol diet were explored by measuring the expression of key transcription factors related to bile acid metabolism. GFSH produced a dose-dependent reduction in weight gain, hepatic fat accumulation, and fecal and blood markers. Real-time quantitative polymerase chain reaction (RT-qPCR) and western blot analyses demonstrated GFSH-induced expression of hepatic CYP7A, LXRα, and LDL-R. GFSH exerts the cholesterol-lowering activity by inducing the bile acid metabolism.

Metformin-Induced Invertase Unfolding: Enzyme Kinetics and Activity Regulation.

The effects of metformin on invertase activity and its inhibition on sucrose digestion were studied. The rapid unfolding kinetics of invertases, followed a two-state model with an inactive intermediate formation. The dynamic interaction between metformin and invertase caused the secondary structure of the enzyme to become less ß-sheet, more α-helix, and random coiling oriented, which weakened the binding force between enzyme and its substrate. Metformin acted as a chaotrope and disrupted the hydrogen bonds of water, which facilitated the unfolding of invertase. However, some sugar alcohols, which promoted the H-bond formation of water, could repair the secondary structure of metformin-denatured invertase and therefore regulate the enzyme activity. This research enriches our understanding of the mechanism of enzyme unfolding induced by guanidine compounds. Moreover, because metformin and sugar substitutes are of concern to diabetes, this research also provides useful information for understanding the activity of the digestive enzyme that coexists with metformin and sugar alcohols.

A portable test strip fabricated of luminescent lanthanide-functionalized metal-organic frameworks for rapid and visual detection of tetracycline antibiotics.

Tetracycline antibiotics (TCs) are commonly used antibiotics in the treatment of infections, but their overuse has a negative impact on human health and ecosystems. Thus, the development of a facile and on-site visualization method for TC detection is necessary. Here, we propose the potential of using lanthanide-functionalized metal-organic framework (MOF) composites (Ag+/Tb3+@UiO-66-(COOH)2, ATUC) as a probe for the rapid detection of tetracycline (TC), chlortetracycline (CTC), oxytetracycline (OTC), and doxycycline (DOX) residues, in which UiO-66-(COOH)2 (UC) could be utilized to provide an interaction microenvironment, Tb3+ as recognition units and Ag+ as a fluorescence enhancer. Upon exposure to TCs, significant luminescence quenching of ATUC excited at 255 nm was observed due to the inner filter effect (IFE) and photo-induced electron transfer (PET), and the established strategy has a detection limit (LOD) of 11.0, 20.1, 9.1, and 22.5 nM for TC, CTC, OTC, and DOX, respectively. More importantly, given its portability and conspicuous luminescence color gradation variation, a portable test strip based on ATUC was manufactured and the results could be distinguished immediately by the naked eye and smartphone analysis, allowing for on-site rapid quantitative assay of TCs, not only in the laboratory but also in a point-of-care setting.