Aim: To evaluate the prognostic value of triglyceride-glucose (TyG) index in nondiabetic patients with acute coronary syndrome (ACS) with low-density lipoprotein cholesterol (LDL-C) below 1.8 mmol/L. ...Methods: A total of 1655 nondiabetic patients with ACS with LDL-C below 1.8 mmol/L were included in the analysis. Patients were stratified into two groups. The incidence of acute myocardial infarction (AMI), infarct size in patients with AMI, and major adverse cardiac and cerebral event during a median of 35.6-month follow-up were determined and compared between the two groups. The TyG index was calculated using the following formula: ln fasting triglycerides (mg/dL)×fasting plasma glucose (mg/dL)/2. Results: Compared with the TyG index ＜8.33 group, the TyG index ≥ 8.33 group had a significantly higher incidence of AMI (21.2% vs. 15.2%, p=0.014) and larger infarct size in patients with AMI the peak value of troponin I: 10.4 vs. 4.8 ng/ml, p=0.003; the peak value of Creatine kinase MB: 52.8 vs. 22.0 ng/ml, p=0.006; the peak value of myoglobin: 73.7 vs. 46.0 ng/ml, p=0.038. Although there was no significant difference in mortality between the two groups, the incidence of revascularization of the TyG index ≥ 8.33 group was significantly higher than that of the TyG index ＜8.33 group (8.9% vs. 5.0%, p=0.035). A multivariable Cox regression revealed that the TyG index was positively associated with revascularization hazard ratio, 1.67; 95% confidence interval, 1.02–2.75; p=0.043. Conclusions: In nondiabetic patients with ACS with LDL-C below 1.8 mmol/L, a high TyG index level was associated with higher incidence of AMI, larger infarct size, and higher incidence of revascularization. A high TyG index level might be a valid predictor of subsequent revascularization.
•We retrieved the SDD products of hourly observations using the Geostationary Ocean Color Imager (GOCI) from 2011 to 2020 in the eastern China seas.•Superpixel image segmentation retrieved by a ...simple linear iterative clustering algorithm (SLIC) was applied to classify the transparency product.•The relationship between the diurnal variation of water transparency and environmental factors (Wind speed and SST) was been studied.
Polar-orbiting ocean color satellites can monitor daily to interannual variations in water transparency (or Secchi disk depth, SDD) from regional to global oceans. However, diurnal variations in SDD of coastal oceans remain poorly understood. Based on the bio-optical SDD algorithm, we retrieved the SDD products of hourly observations using the Geostationary Ocean Color Imager (GOCI) from 2011 to 2020 in the eastern China seas. The determination coefficient (R2) between the SDD product and the in situ dataset is 0.93, with a root mean squared error (RMSE) of 0.86 m. Based on the pixel-level tempo-spatial analysis, superpixel image segmentation retrieved by a simple linear iterative clustering algorithm (SLIC) was applied to classify the SDD product. The reconstruction SDD superpixel products not only match the spatial distribution well but can also more clearly express the spatial gradient. The percentage of the diurnal change in transparency was high in the nearshore (∼10 %), medium in transitional waters (∼5%), and low in offshore waters (∼3%). Finally, we found a significant negative correlation between SDD and wind speed (R2 = 0.65) and a significantly positive correlation between diurnal change range (DCR) and wind speed (R2 = 0.62). In contrast, sea surface temperature (SST) was positively correlated with SDD (R2 = 0.72) but significantly negatively correlated with DCR (R2 = 0.80). These results provide a basis for studying diurnal SDD changes in highly dynamic waters.
Triglyceride glucose (TyG) index is considered a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular (CV) outcomes. However, the prognostic value of TyG ...index in patients with type 2 diabetes mellitus (T
DM) and acute myocardial infarction (AMI) remains unclear.
A total of 1932 consecutive patients with T
DM and AMI were enrolled in this study. Patients were divided into tertiles according to their TyG index levels. The incidence of major adverse cardiac and cerebral events (MACCEs) was recorded. The TyG index was calculated as the ln fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2.
Competing risk regression revealed that the TyG index was positively associated with CV death 2.71(1.92 to 3.83), p < 0.001, non-fatal MI 2.02(1.32 to 3.11), p = 0.001, cardiac rehospitalization 2.42(1.81 to 3.24), p < 0.001, revascularization 2.41(1.63 to 3.55), p < 0.001 and composite MACCEs 2.32(1.92 to 2.80), p < 0.001. The area under ROC curve of the TyG index for predicting the occurrence of MACCEs was 0.604 (0.578 to 0.630), p < 0.001, with the cut-off value of 9.30. The addition of TyG index to a baseline risk model had an incremental effect on the predictive value for MACCEs net reclassification improvement (NRI): 0.190 (0.094 to 0.337); integrated discrimination improvement (IDI): 0.027 (0.013 to 0.041); C-index: 0.685 (0.663 to 0.707), all p < 0.001.
The TyG index was significantly associated with MACCEs, suggesting that the TyG index may be a valid marker for risk stratification and prognosis in patients with T
DM and AMI. Trial registration Retrospectively registered.
Against the background of climate warming, marine heatwaves (MHWs) and terrestrial drought events have become increasingly frequent in recent decades. However, the combined effects of MHWs and ...terrestrial drought on CO2 uptake in marginal seas are still unclear. The East China Sea (ECS) experienced an intense and long-lasting MHW accompanied by an extreme terrestrial drought in the Changjiang basin in the summer of 2022. In this study, we employed multi-source satellite remote sensing products to reveal the patterns, magnitude, and potential drivers of CO2 flux changes in the ECS resulting from the compounding MHW and terrestrial drought extremes. The CO2 uptake of the ECS reduced by 17.0% (1.06 Tg C) in the latter half of 2022 and the Changjiang River plume region shifted from a CO2 sink to a source (releasing 0.11 Tg C) in July-September. In the majority of the ECS, the positive sea surface temperature (SST) anomaly during the MHW diminished the solubility of CO2 in seawater, thereby reducing CO2 uptake. Moreover, the reduction in nutrient input associated with terrestrial drought, which is unfavorable to phytoplankton growth, further reduced the capacity of CO2 uptake. Meanwhile, the CO2 sink doubled for the offshore waters of the ECS continental shelf in July-September 2022, indicating the complexity and heterogeneity of the impacts of extreme climatic events in marginal seas. This study is of great significance in improving the estimation results of CO2 fluxes in marginal seas and understanding sea–air CO2 exchanges against the background of global climate change.
Aim: In acute myocardial fraction (AMI) patients, the association between lipid parameters and new-onset atrial fibrillation (NOAF) remains unclear due to limited evidence.Methods: A total of 4282 ...participants free from atrial fibrillation (AF) at baseline were identified in Beijing Friendship Hospital. Fasting levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured at baseline. The study population was stratified based on tertiles of lipid profile and lipid ratios. Incidence of NOAF was observed at the follow-up visits. The associations between different lipid parameters and the incidence of NOAF were assessed by multivariate Cox regression analysis.Results: Over a median follow-up period of 42.0 months (IQR: 18.7, 67.3 months), 3.1% (N=132) AMI patients developed NOAF. After multivariable adjustment, higher TC (hazard ratios (HR): 0.205, 95% confidence intervals (CI): 0.061–0.696) levels were inversely associated with NOAF development. However, higher HDL-C (HR: 1.892, 95% CI: 1.133–3.159) levels were positively associated with NOAF development. LDL-C levels, TG levels, non-HDL-C levels, and lipid ratios showed no association with NOAF development.Conclusion: TC levels were inversely associated with incidence of NOAF; this was mainly reflected in the subgroups of male gender and older patients (65 years or older). HDL-C levels were positively associated with incidence of NOAF; this was mainly reflected in the subgroups of male gender and younger patients (age ＜65 years). There was no significant association of NOAF with LDL-C, TG, or non-HDL-C levels.
Daytime variation with regard to onset time of ST-elevation myocardial infarction (STEMI) symptoms has been observed. Nevertheless, with the advanced medical therapy, it is not uncertainty if a ...similar circadian pattern of STEMI symptom onset occurs, as well as its possible impact on clinical outcomes. Few long-term data are available. We assess the impact of circadian symptom-onset patterns of STEMI on major adverse cardiovascular events (MACE) in more contemporary patients treated with primary percutaneous coronary intervention (PPCI).
A total of 1099 consecutive STEMI patients undergoing PPCI ≤12h from symptom onset during 2013 to 2019 were classified into 4 groups by 6-h intervals according to time-of-day at symptom onset: night (0:00-5:59), morning (6:00-11:59), afternoon (12:00-17:59), and evening (18:00-23:59). Incidence of MACE including cardiovascular death and nonfatal MI during a median follow-up of 48 months was compared among the 4 groups. A morning peak of symptom onset of STEMI was detected during the period 06:00-11:59 (p < .001). Compared with other three 6-h intervals, the incidence of long-term MACE during night onset-time (18.8%, 10.1%, 10.7% and 12.4%, p = .020) was significant higher that was driven by more mortality (13.1%, 6.5%, 7.1%and 7.7%, p = .044). Night symptom-onset STEMI was independently associated with subsequent MACE (hazard ratio = 1.57, 95%CI: 1.09-2.27, p = .017) even after multivariable adjustment.
Circadian variation of STEMI symptom-onset with morning predominance still exists in contemporary practice. Night symptom-onset STEMI was independently associated with increased risk of MACE in Chinese patients treated with PPCI.
As one branch of deterministic approaches to disjoint bilinear programming, cutting plane methods are renowned for its ability to systematically reduce the search space by adding cutting planes that ...are able to cut off regions deemed infeasible or suboptimal. Polar cuts have been widely utilized as a dominating type of cut in terms of deepness. During the establishment of a polar cut, the modified Newton's method is employed to derive the cutting points along the positive or negative extensions of edges emanating from a local solution. Nonetheless, its performance can be further improved along the positive extensions. Drawing inspiration from integer programming, we develop a new approach based on the LP duality theory for this purpose. It re-formulates the original program with a piece-wise linear concave objective function as a single LP. Moreover, we propose a new technique to derive the edges as accommodation to degeneracy. Numerical results show that, by utilizing our newly developed dual method, computing time can be gradually saved as the percentage of generated cutting points along the positive extensions of edges rises.
Validation of remote-sensing reflectance (Rrs) products is necessary for the quantitative application of ocean color satellite data. While validation of Rrs products has been performed in low to ...moderate turbidity waters, their performance in highly turbid water remains poorly known. Here, we used in situ Rrs data from Hangzhou Bay (HZB), one of the world’s most turbid estuaries, to evaluate agency-distributed Rrs products for multiple ocean color sensors, including the Geostationary Ocean Color Imager (GOCI), Chinese Ocean Color and Temperature Scanner aboard HaiYang-1C (COCTS/HY1C), Ocean and Land Color Instrument aboard Sentinel-3A and Sentinel-3B, respectively (OLCI/S3A and OLCI/S3B), Second-Generation Global Imager aboard Global Change Observation Mission-Climate (SGLI/GCOM-C), and Visible Infrared Imaging Radiometer Suite aboard the Suomi National Polar-orbiting Partnership satellite (VIIRS/SNPP). Results showed that GOCI and SGLI/GCOM-C had almost no effective Rrs products in the HZB. Among the others four sensors (COCTS/HY1C, OLCI/S3A, OLCI/S3B, and VIIRS/SNPP), VIIRS/SNPP obtained the largest correlation coefficient (R) with a value of 0.7, while OLCI/S3A obtained the best mean percentage differences (PD) with a value of −13.30%. The average absolute percentage difference (APD) values of the four remote sensors are close, all around 45%. In situ Rrs data from the AERONET-OC ARIAKE site were also used to evaluate the satellite-derived Rrs products in moderately turbid coastal water for comparison. Compared with the validation results at HZB, the performances of Rrs from GOCI, OLCI/S3A, OLCI/S3B, and VIIRS/SNPP were much better at the ARIAKE site with the smallest R (0.77) and largest APD (35.38%) for GOCI, and the worst PD for these four sensors was only −13.15%, indicating that the satellite-retrieved Rrs exhibited better performance. In contrast, Rrs from COCTS/HY1C and SGLI/GCOM-C at ARIAKE site was still significantly underestimated, and the R values of the two satellites were not greater than 0.7, and the APD values were greater than 50%. Therefore, the performance of satellite Rrs products degrades significantly in highly turbid waters and needs to be improved for further retrieval of ocean color components.
Coronary chronic total occlusions (CTOs) are related to increased risk of adverse clinical outcomes. The optimal treatment strategy for CTO has not been well established. We sought to examine the ...impact of CTO percutaneous coronary intervention (PCI) on long-term clinical outcome in the real world.
A total of 592 patients with CTO were enrolled. 29 patients were excluded due to coronary artery bypass grafting (CABG). After exclusion, 563 patients were divided into the no-revascularized group (CTO-NR group, n = 263) and successful revascularized group (CTO-R group, n = 300). The primary endpoint was cardiac death; secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, cardiac death, recurrent myocardial infarction, target lesion revascularization, re-hospitalization, heart failure, and stroke.
Percent of Diabetes mellitus (53.2% vs 39.7), Chronic kidney disease (8.7% vs 3.7%), CABG history (7.6% vs 1%), three vessel disease (96.2% vs 90%) and left main coronary artery disease (25.1% vs 13.7%) was significantly higher in the CTO-NR group than in success PCI group (all P < 0.05). Moreover, the CTO-NR group has the lower ejection fraction (EF) (0.58 ± 0.11 vs 0.61 ± 0.1, p = 0.001) and fraction shortening (FS) (0.31 ± 0.07 vs 0.33 ± 0.07, p = 0.002). At a median follow-up of 12 months, CTO revascularization was superior to CTO no-revascularization in terms of cardiac death (adjusted hazard ratio HR: 0.27, 95% conference interval CI 0.11-0.64). The superiority of CTO revascularization was consistent for MACCE (HR: 0.55, 95% CI 0.35-0.79). At multivariable Cox hazards regression analysis, CTO revascularization remains one of the independent predictors of lower risk of cardiac death and MACCE.
Successful revascularization by PCI may bring more clinical benefits. The presence of low left ventricular ejection fraction (LVEF) and LM-disease was associated with an incidence of cardiac death; CTO revascularization was a protected predictor of cardiac death. Successful revascularization by PCI offered CTO patients more clinical benefits, manifested by lower incidence of cardiac death during follow-up. The presence of LVEF < 0.5 and left main coronary artery disease (LM disease) was associated with an incidence of cardiac death; CTO revascularised was a protected predictor of cardiac death.
Current guidelines recommend angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARB) or β-blockers (β-B) for secondary prevention in patients after an acute myocardial ...infarction (AMI). However, there is limited data to evaluate ACEI/ARB/β-B (AAβ) used before AMI on major adverse cardiovascular events (MACE), in China patients.
This study sought to investigate whether AAβ treatment prior to AMI is associated with better hospital outcomes at the onset of AMI.
A total of 2705 patients were selected from the Cardiovascular Center Beijing Friendship Hospital Database Bank, and divided into two groups on the basis of admission prescription: AAβ (n = 872) or no-AAβ (n = 1833). The study was also designed using propensity-score matching (226 AAβ treated patients vs 452 no-AAβ treated patients). The primary outcome was a composite of cardiac death and heart function and infarct size during hospitalization follow-up.
The mean follow-up period was about 8 days in MACE. The Cox model showed the two groups had similar risk of cardiac death. The in-hospital mortality was 3.36% (3.33% of AAβ users and 3.38% of nonusers, p = 0.94). In adjusted analysis, there was still no difference in in-hospital mortality between the two groups (3.54% vs 2.88%, p = 0.64). However, the AAβ treated patients were associated with better heart function and smaller infarct size than the no-AAβ treated patients.
The in-hospital MACE was similar between AAβ treated patients and no-AAβ treated patients. However, treatment with AAβ before AMI was associated with improved heart function and smaller infarct size.
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