Background The clinical significance of ischemic chest pain before acute ST-elevation myocardial infarction （STEMI） remains an interesting issue of investigation particularly in the era of percutaneous coronary inte...Background The clinical significance of ischemic chest pain before acute ST-elevation myocardial infarction （STEMI） remains an interesting issue of investigation particularly in the era of percutaneous coronary intervention （PCI）. This study aimed to assess the impact of angina prior to STEMI on short-term clinical outcomes in patients with acute STEMI undergoing primary PCI. Methods Among a total of 875 consecutive patients with STEMI undergoing primary PCI, 292 had episodes of angina within 24 hours of STEMI （PA group） and the remaining 583 were free of anginal symptoms （non-PA group）. Clinical characteristics, angiographic and procedural features, and in-hospital and 30-day outcomes were compared between the two groups. Results Diabetes was less common （17.5% vs. 23.3%, P=-0.04） and symptom-to-door time was shortened （（191.6_＋96.8） minutes vs. （357.2_＋341.9） minutes, P 〈0.001） in the PA group than in the non-PA group. Patients with angina prior to STEMI had fewer totally or nearly totally occluded infarct-related artery （TIMI flow grade 0-1） at initial angiography （75.0% vs. 90.7%, P 〈0.001）, and achieved more TIMI flow grade 3 after primary PCI （84.2% vs. 78.2%, P=0.04）. These were associated with higher rates of overall procedural success （95.9% vs. 91.8%, P=0.02） and of complete ST-segment resolution at 90 minutes after the procedure （51.7% vs. 40.3%, P=0.001）. During a 30-day clinical follow-up, the left ventricular ejection fraction was significantly improved （（53.0±8.6）% vs. （51.1±9.7）%, P=-0.002） and the primary endpoint of major adverse cardiac events was reduced in the PA group （7.2% vs. 12.7%, P=0.01）. Conclusion Presence of angina prior to acute STEMI is associated with better outcome at a 30-day clinical follow-up in patients undergoing primary PCI.展开更多
Background The cardioprotective effects of soluble receptor for advanced glycation end-products （sRAGE） have not been evaluated in large animals and the underlying mechanisms are not fully understood. This study aim...Background The cardioprotective effects of soluble receptor for advanced glycation end-products （sRAGE） have not been evaluated in large animals and the underlying mechanisms are not fully understood. This study aimed to evaluate the effects of intra-coronary administration of sRAGE on left ventricular function and myocardial remodeling in a porcine model of ischemia-reperfusion （I/R） injury. Methods Ten male minipigs with I/R injury were randomly allocated to receive intra-coronary administration of sRAGE （sRAGE group, n=5） or saline （control group, n=5）. Echocardiography was performed before and 2 months after infarction. Myocardial expression of transforming growth factor （TGF）-β1 was determined by immunohistochemistry and fibrosis was evaluated by Sirius red staining. Results As compared with the baseline values in the control animals, left ventricular end-diastolic volume （from （19.5±5.1） to （32.3±5.6） ml, P 〈0.05） and end-systolic volume （from （8.3±3.2） to （15.2±4.1） ml, P 〈0.05） were significantly increased, whereas ejection fraction was decreased （from （61.6±13.3）% to （50.2±11.9）%, P 〈0.05）. No obvious change in these parameters was observed in the sRAGE group. Myocardial expression of TGF-β1 was significantly elevated in the infarct and non-infarct regions in the control group, as compared with sRAGE group （both P 〈0.01）. Fibrotic lesions were consistently more prominent in the infarct region of the myocardium in the control animals （P〈0.05）. Conclusion Intra-coronary sRAGE administration attenuates RAGE-mediated myocardial fibrosis and I/R injury through a TGF-β1-dependent mechanism, suggesting a clinical potential in treating RAGE/ligand-associated cardiovascular diseases.展开更多
The effect of sulphide(Na2S)concentration(SC)on the corrosion and cavitation erosion behaviours of a cast nickel aluminium bronze(NAB)in 3.5% NaCl solution is investigated in this study.The results show that when the ...The effect of sulphide(Na2S)concentration(SC)on the corrosion and cavitation erosion behaviours of a cast nickel aluminium bronze(NAB)in 3.5% NaCl solution is investigated in this study.The results show that when the SC exceeds 50 ppm,the hydrogen evolution reaction dominates the cathodic process,and a limiting current region appears in the anodic branch of the polarisation curve due to the formation of a copper sulphide film,which is a diffusion-controlled process.After longterm immersion,the increased mass loss rate of NAB with the sulphide additions of 20 and 50 ppm is attributed to the less protective films,which contains a mixture of copper oxides and sulphides.Moreover,NAB undergoes severe localised corrosion(selective phase corrosion,SPC)at the β’phases and eutectoid microstructureα+κⅢ.By comparison,NAB undergoes general corrosion and a copper sulphide film is formed in 100 and 200 ppm sulphide solutions.Cavitation erosion greatly increases the corrosion rate of NAB in all solutions and causes a negative potential shift in 3.5%NaCl solution due to the film destruction.However,a positive potential shift occurs in the solutions with SC higher than 50 ppm due to the accelerated mass transfer of the cathodic process.The cavitation erosion mass loss rate of NAB increases with the increase of SC.The occurrence of severe SPC decreases the phase boundary cohesion and causes brittle fracture under the cavitation impact.The corrosion-enhanced erosion is the most predominant factor for the cavitation erosion damage when the SC exceeds 50 ppm.展开更多
Background Late incomplete stent apposition （ISA） may occur after drug-eluting stent implantation, affecting long-term clinical outcomes. This study aimed to evaluate the impact of clinical presentations of coronary...Background Late incomplete stent apposition （ISA） may occur after drug-eluting stent implantation, affecting long-term clinical outcomes. This study aimed to evaluate the impact of clinical presentations of coronary artery disease on late ISA after percutaneous coronary intervention （PCI） with sirolimus-eluting stents （SES） by means of three-dimensional volumetric intravascular ultrasound （IVUS） analyses. Methods One hundred and thirty-seven patients with coronary artery disease received SES implantation during PCI and had repeat angiography with IVUS examination. All patients were followed up one year after the procedure. Results In overall 219 treated lesions （137 patients）, late ISA was identified in 25 lesions （16 patients）. Clinical diagnosis of acute coronary syndrome （ACS） and use of long stents were more common in patients with than in those without late ISA. Patients with late ISA had greater external elastic membrane （EEM） area in stented segment （（15.34±5.44） vs （13.83±4.51） mm^2, P=0.026）, stented-to-reference segment EEM area ratio （1.13±0.22 vs 1.02±0.18, P 〈0.001）, and plaque and media area （（8.43±3.93） vs （7.01±2.93） mm^2, P =0.002） than in those without late ISA. Multivariate Logistic regression analysis showed that clinical diagnosis of ACS and use of long stents were independent risk factors for late ISA （OR 6.477, 95%CI 2.297-18.263, P 〈0.001; OR 3.680, 95%Cl 1.181-11.469, P =0.025; respectively）. During one-year follow-up after IVUS examination, the rate of very late stent thrombosis tended to be higher in patients with than in those without late ISA （18.7% vs 3.3%, P =0.051）. Conclusions The occurrence of late ISA after SES implantation may be related to clinical status, use of long stents, and marked positive vessel remodeling. Late ISA tended to increase the rate of very late stent thrombosis during follow-up, highlighting the importance of long-term dual antiplatelet therapy for these patients.展开更多
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 30900589）.
文摘Background The clinical significance of ischemic chest pain before acute ST-elevation myocardial infarction （STEMI） remains an interesting issue of investigation particularly in the era of percutaneous coronary intervention （PCI）. This study aimed to assess the impact of angina prior to STEMI on short-term clinical outcomes in patients with acute STEMI undergoing primary PCI. Methods Among a total of 875 consecutive patients with STEMI undergoing primary PCI, 292 had episodes of angina within 24 hours of STEMI （PA group） and the remaining 583 were free of anginal symptoms （non-PA group）. Clinical characteristics, angiographic and procedural features, and in-hospital and 30-day outcomes were compared between the two groups. Results Diabetes was less common （17.5% vs. 23.3%, P=-0.04） and symptom-to-door time was shortened （（191.6_＋96.8） minutes vs. （357.2_＋341.9） minutes, P 〈0.001） in the PA group than in the non-PA group. Patients with angina prior to STEMI had fewer totally or nearly totally occluded infarct-related artery （TIMI flow grade 0-1） at initial angiography （75.0% vs. 90.7%, P 〈0.001）, and achieved more TIMI flow grade 3 after primary PCI （84.2% vs. 78.2%, P=0.04）. These were associated with higher rates of overall procedural success （95.9% vs. 91.8%, P=0.02） and of complete ST-segment resolution at 90 minutes after the procedure （51.7% vs. 40.3%, P=0.001）. During a 30-day clinical follow-up, the left ventricular ejection fraction was significantly improved （（53.0±8.6）% vs. （51.1±9.7）%, P=-0.002） and the primary endpoint of major adverse cardiac events was reduced in the PA group （7.2% vs. 12.7%, P=0.01）. Conclusion Presence of angina prior to acute STEMI is associated with better outcome at a 30-day clinical follow-up in patients undergoing primary PCI.
文摘Background The cardioprotective effects of soluble receptor for advanced glycation end-products （sRAGE） have not been evaluated in large animals and the underlying mechanisms are not fully understood. This study aimed to evaluate the effects of intra-coronary administration of sRAGE on left ventricular function and myocardial remodeling in a porcine model of ischemia-reperfusion （I/R） injury. Methods Ten male minipigs with I/R injury were randomly allocated to receive intra-coronary administration of sRAGE （sRAGE group, n=5） or saline （control group, n=5）. Echocardiography was performed before and 2 months after infarction. Myocardial expression of transforming growth factor （TGF）-β1 was determined by immunohistochemistry and fibrosis was evaluated by Sirius red staining. Results As compared with the baseline values in the control animals, left ventricular end-diastolic volume （from （19.5±5.1） to （32.3±5.6） ml, P 〈0.05） and end-systolic volume （from （8.3±3.2） to （15.2±4.1） ml, P 〈0.05） were significantly increased, whereas ejection fraction was decreased （from （61.6±13.3）% to （50.2±11.9）%, P 〈0.05）. No obvious change in these parameters was observed in the sRAGE group. Myocardial expression of TGF-β1 was significantly elevated in the infarct and non-infarct regions in the control group, as compared with sRAGE group （both P 〈0.01）. Fibrotic lesions were consistently more prominent in the infarct region of the myocardium in the control animals （P〈0.05）. Conclusion Intra-coronary sRAGE administration attenuates RAGE-mediated myocardial fibrosis and I/R injury through a TGF-β1-dependent mechanism, suggesting a clinical potential in treating RAGE/ligand-associated cardiovascular diseases.
基金financially supported by the National Natural Science Foundation of China (Nos.51601058 and 51879089)the Fundamental Research Funds for the Central Universities of P.R.China (No.2018B59614)+1 种基金the Natural Science Foundation of Jiangsu Province (BK20191161),the Changzhou Sci & Tech Program (Grant No.CJ20180045)the first group of 2011 plan of China’s Jiangsu province (Grant No.[2013] 56) (Cooperative Innovational Center for Coastal Development & Protection)
文摘The effect of sulphide(Na2S)concentration(SC)on the corrosion and cavitation erosion behaviours of a cast nickel aluminium bronze(NAB)in 3.5% NaCl solution is investigated in this study.The results show that when the SC exceeds 50 ppm,the hydrogen evolution reaction dominates the cathodic process,and a limiting current region appears in the anodic branch of the polarisation curve due to the formation of a copper sulphide film,which is a diffusion-controlled process.After longterm immersion,the increased mass loss rate of NAB with the sulphide additions of 20 and 50 ppm is attributed to the less protective films,which contains a mixture of copper oxides and sulphides.Moreover,NAB undergoes severe localised corrosion(selective phase corrosion,SPC)at the β’phases and eutectoid microstructureα+κⅢ.By comparison,NAB undergoes general corrosion and a copper sulphide film is formed in 100 and 200 ppm sulphide solutions.Cavitation erosion greatly increases the corrosion rate of NAB in all solutions and causes a negative potential shift in 3.5%NaCl solution due to the film destruction.However,a positive potential shift occurs in the solutions with SC higher than 50 ppm due to the accelerated mass transfer of the cathodic process.The cavitation erosion mass loss rate of NAB increases with the increase of SC.The occurrence of severe SPC decreases the phase boundary cohesion and causes brittle fracture under the cavitation impact.The corrosion-enhanced erosion is the most predominant factor for the cavitation erosion damage when the SC exceeds 50 ppm.
文摘Background Late incomplete stent apposition （ISA） may occur after drug-eluting stent implantation, affecting long-term clinical outcomes. This study aimed to evaluate the impact of clinical presentations of coronary artery disease on late ISA after percutaneous coronary intervention （PCI） with sirolimus-eluting stents （SES） by means of three-dimensional volumetric intravascular ultrasound （IVUS） analyses. Methods One hundred and thirty-seven patients with coronary artery disease received SES implantation during PCI and had repeat angiography with IVUS examination. All patients were followed up one year after the procedure. Results In overall 219 treated lesions （137 patients）, late ISA was identified in 25 lesions （16 patients）. Clinical diagnosis of acute coronary syndrome （ACS） and use of long stents were more common in patients with than in those without late ISA. Patients with late ISA had greater external elastic membrane （EEM） area in stented segment （（15.34±5.44） vs （13.83±4.51） mm^2, P=0.026）, stented-to-reference segment EEM area ratio （1.13±0.22 vs 1.02±0.18, P 〈0.001）, and plaque and media area （（8.43±3.93） vs （7.01±2.93） mm^2, P =0.002） than in those without late ISA. Multivariate Logistic regression analysis showed that clinical diagnosis of ACS and use of long stents were independent risk factors for late ISA （OR 6.477, 95%CI 2.297-18.263, P 〈0.001; OR 3.680, 95%Cl 1.181-11.469, P =0.025; respectively）. During one-year follow-up after IVUS examination, the rate of very late stent thrombosis tended to be higher in patients with than in those without late ISA （18.7% vs 3.3%, P =0.051）. Conclusions The occurrence of late ISA after SES implantation may be related to clinical status, use of long stents, and marked positive vessel remodeling. Late ISA tended to increase the rate of very late stent thrombosis during follow-up, highlighting the importance of long-term dual antiplatelet therapy for these patients.
