Abstract
Background
The triglyceride-glucose index (TyG index) has been regarded as a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular outcomes. ...Whether the TyG index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome (ACS) remains uncertain. The aim of this study was to investigate the prognostic value of the TyG index in patients with diabetes and ACS.
Methods
A total of 2531 consecutive patients with diabetes who underwent coronary angiography for ACS were enrolled in this study. Patients were divided into tertiles according to their TyG index. The primary outcomes included the occurrence of major adverse cardiovascular events (MACEs), defined as all-cause death, non-fatal myocardial infarction and non-fatal stroke. The TyG index was calculated as the ln (fasting triglyceride level mg/dL × fasting glucose level mg/dL/2).
Results
The incidence of MACE increased with TyG index tertiles at a 3-year follow-up. The Kaplan–Meier curves showed significant differences in event-free survival rates among TyG index tertiles (P = 0.005). Multivariate Cox hazards regression analysis revealed that the TyG index was an independent predictor of MACE (95% CI 1.201–1.746; P < 0.001). The optimal TyG index cut-off for predicting MACE was 9.323 (sensitivity 46.0%; specificity 63.6%; area under the curve 0.560; P = 0.001). Furthermore, adding the TyG index to the prognostic model for MACE improved the C-statistic value (P = 0.010), the integrated discrimination improvement value (P = 0.001) and the net reclassification improvement value (P = 0.019).
Conclusions
The TyG index predicts future MACE in patients with diabetes and ACS independently of known cardiovascular risk factors, suggesting that the TyG index may be a useful marker for risk stratification and prognosis in patients with diabetes and ACS.
Abstract
Background
Mechanical ventilation is applied to unload the respiratory muscles, but knowledge about transpulmonary driving pressure (Δ
P
L
) is important to minimize lung injury. We propose ...a method to estimate Δ
P
L
during neurally synchronized assisted ventilation, with a simple intervention of lowering the assist for one breath (“lower assist maneuver”, LAM).
Methods
In 24 rabbits breathing spontaneously with imposed loads, titrations of increasing assist were performed, with two neurally synchronized modes: neurally adjusted ventilatory assist (NAVA) and neurally triggered pressure support (NPS). Two single LAM breaths (not sequentially, but independently) were performed at each level of assist by acutely setting the assist to zero cm H2O (NPS) or NAVA level 0 cm H2O/uV (NAVA) for one breath. NPS and NAVA titrations were followed by titrations in controlled-modes (volume control, VC and pressure control, PC), under neuro-muscular blockade. Breaths from the NAVA/NPS titrations were matched (for flow and volume) to VC or PC. Throughout all runs, we measured diaphragm electrical activity (Edi) and esophageal pressure (
P
ES
). We measured Δ
P
L
during the spontaneous modes (
P
L
_
P
ES
) and controlled mechanical ventilation (CMV) modes (
P
L
_
CMV
) with the esophageal balloon. From the LAMs, we derived an estimation of Δ
P
L
(“
P
L_LAM
”) using a correction factor (ratio of volume during the LAM and volume during assist) and compared it to measured Δ
P
L
during passive (VC or PC) and spontaneous breathing (NAVA or NPS). A requirement for the LAM was similar Edi to the assisted breath.
Results
All animals successfully underwent titrations and LAMs for NPS/NAVA. One thousand seven-hundred ninety-two (1792) breaths were matched to passive ventilation titrations (matched Vt,
r
= 0.99).
P
L_LAM
demonstrated strong correlation with
P
L
_
CMV
(
r
= 0.83), and
P
L
_
P
ES
(
r
= 0.77). Bland–Altman analysis revealed little difference between the predicted
P
L
_
LAM
and measured
P
L
_
CMV
(Bias = 0.49 cm H2O and 1.96SD = 3.09 cm H2O). For
P
L
_
P
ES
, the bias was 2.2 cm H2O and 1.96SD was 3.4 cm H2O. Analysis of Edi and
P
ES
at peak Edi showed progressively increasing uncoupling with increasing assist.
Conclusion
During synchronized mechanical ventilation, a LAM breath allows for estimations of transpulmonary driving pressure, without measuring
P
ES
, and follows a mathematical transfer function to describe respiratory muscle unloading during synchronized assist.
Long non‑coding RNAs (lncRNAs) have been validated to mediate the development of atherosclerosis (AS). In the present study, the molecular mechanisms and functions of lncRNA nuclear paraspeckle ...assembly transcript 1 (NEAT1) in the advancement of human aortic endothelial cells (HAECs) were investigated. The levels of lncRNA‑NEAT1 and miR‑638 expression in clinical samples and cells were explored via quantitative reverse transcription polymerase chain reaction. Colony formation and CCK‑8 assays were performed to determine the proliferative capacity of cells, and the apoptotic capacity of cells was analyzed on the basis of apoptotic cell proportion and caspase‑3 activity. Then, the proportion of cells and correlations among phosphoglycerate kinase 1 (PGK1), NEAT1, and miR‑638 were determined through RNA immunoprecipitation and luciferase assays and bioinformatics analysis. Moreover, the expression levels of Ki‑67, proliferating cell nuclear antigen, PGK1, Bax, Bcl‑2, (p)‑mTOR, (p)‑AKT, and β‑catenin were analyzed via western blot analysis. In the serum of patients with AS and HAECs induced by oxidized low‑density lipoprotein (ox‑LDL), the expression level of miR‑638 was decreased, whereas that of NEAT1 was increased. After ox‑LDL therapy, NEAT1 knockdown suppressed HAEC proliferation and stimulated HAEC apoptosis, which could be reversed by the miR‑638 inhibitor. NEAT1 inhibited miR‑638 expression through direct mutual action. The following mechanical investigations revealed that PGK1 was a miR‑638 target, whose expression was increased by NEAT1, a competing endogenous RNA of miR‑638. Additionally, the miR‑638 inhibitor contributed to proliferation and suppressed apoptosis through the activation of the AKT/mTOR signaling pathway in ox‑LDL‑induced HAECs. NEAT1 adjusted the AKT/mTOR signaling pathway via miR‑638 in ox‑LDL‑induced HAECs to accelerate their proliferation and impede their apoptosis. This result revealed that NEAT1 may be valuable in the treatment of AS.
Due to the nonlinear characteristics of the vehicle speed system, its stability is difficult to control. This paper analyzes the stability and traceability of the vehicle speed system under nonlinear ...characteristics. A sliding mode control method of the nonlinear system state observation based on linear matrix inequalities (LMIs) is proposed. In the proposed control method, Lyapunov function is used as the control function to track the position and speed of the vehicle speed system in real time. In the design process of the controller, the successive scaling method (SSM) is designed to improve the tracking accuracy. The simulation results demonstrate that the sliding mode control can effectively track the position of the vehicle speed system, which has better stability and traceability for the nonlinear vehicle speed system.
Objective
We aimed to investigate the association between the 5A/6A promoter polymorphism in the matrix metalloproteinase 3 (MMP3) gene and in-stent restenosis (ISR) in a regional Chinese population.
...Methods
A total of 818 patients who underwent primary implantation of drug-eluting stents were enrolled and received a 6-month follow-up angiography and DNA genotyping of the 5A/6A polymorphism.
Results
ISR was found in 36.9% of all patients (302 ISR vs. 516 no ISR). The genotype proportion of 6A6A was significantly increased in ISRs (74.2% ISR vs. 66.8% no ISR), whereas the allele frequency of 5A was significantly decreased in ISR patients (25.8%) compared with controls who did not undergo ISR (33.1%).
Conclusions
Our data indicate that the MMP3 6A6A genotype is a genetic susceptibility factor for ISR after coronary stent placement, but the 5A allele can lower the risk for patients within 6 months after stenting. Therefore, genotyping 5A/6A in the MMP3 promoter is suggested for patients who undergo coronary stent implantation.
Summary
Aims
Glycogen synthase kinase‐3β (GSK‐3β) and mitochondrial permeability transition pore (mPTP) play an important role in myocardial ischemia–reperfusion injury. The aim of this study was to ...investigate whether postconditioning with rosuvastatin is able to reduce myocardial ischemia–reperfusion injury and clarify the potential mechanisms.
Methods
Isolated rat hearts underwent 30 minutes of ischemia and 60 minutes of reperfusion in the presence or absence of rosuvastatin (1‐50 nmol/L). The activity of signaling pathway was determined by Western blot analysis, and Ca2+‐induced mPTP opening was assessed by the use of a potentiometric method.
Results
Rosuvastatin significantly reduced myocardial infarct size and improved cardiac function at 5 and 10 nmol/L. Protection disappeared at higher concentration and reverted to increased damage at 50 nmol/L. At 5 nmol/L, rosuvastatin increased the phosphorylation of protein kinase B (Akt) and GSK‐3β, concomitant with a higher Ca2+ load required to open the mPTP. Rosuvastatin postconditioning also significantly increased superoxide dismutase activity and reduced malondialdehyde and radical oxygen species level. LY294002, phosphatidylinositol‐3‐kinase (PI3K) inhibitors, abolished these protective effects of rosuvastatin postconditioning.
Conclusion
Rosuvastatin prevents myocardial ischemia–reperfusion injury by inducing phosphorylation of PI3K–Akt and GSK‐3β, preventing oxidative stress and subsequent inhibition of mPTP opening.
Treatment of coronary bifurcation lesions remains challenging; a simple strategy has been preferred as of late, but the disadvantage is ostium stenosis or even occlusion of the side branch (SB). Only ...a few single-center studies investigating the combination of a drug-eluting stent in the main branch followed by a drug-eluting balloon in the SB have been reported. This prospective, multicenter, randomized study aimed to investigate the safety and efficacy of a paclitaxel-eluting balloon (PEB) compared with regular balloon angioplasty (BA) in the treatment of non-left main coronary artery bifurcation lesions.
Between December 2014 and November 2015, a total of 222 consecutive patients with bifurcation lesions were enrolled in this study at ten Chinese centers. Patients were randomly allocated at a 1:1 ratio to a PEB group (n = 113) and a BA group (n = 109). The primary efficacy endpoint was angiographic target lesion stenosis at 9 months. Secondary efficacy and safety endpoints included target lesion revascularization, target vessel revascularization, target lesion failure, major adverse cardiac and cerebral events (MACCEs), all-cause death, cardiac death, non-fatal myocardial infarction, and thrombosis in target lesions. The main analyses performed in this clinical trial included case shedding analysis, base-value equilibrium analysis, effectiveness analysis, and safety analysis. SAS version 9.4 was used for the statistical analyses.
At the 9-month angiographic follow-up, the difference in the primary efficacy endpoint of target lesion stenosis between the PEB (28.7% ± 18.7%) and BA groups (40.0% ± 19.0%) was -11.3% (95% confidence interval: -16.3% to -6.3%, Psuperiority <0.0001) in the intention-to-treat analysis, and similar results were recorded in the per-protocol analysis, demonstrating the superiority of PEB to BA. Late lumen loss was significantly lower in the PEB group than in the BA group (-0.06 ± 0.32 vs. 0.18 ± 0.34 mm, P < 0.0001). For intention-to-treat, there were no significant differences between PEB and BA in the 9-month percentages of MACCEs (0.9% vs. 3.7%, P = 0.16) or non-fatal myocardial infarctions (0 vs. 0.9%, P = 0.49). There were no clinical events of target lesion revascularization, target vessel revascularization, target lesion failure, all-cause death, cardiac death or target lesion thrombosis in either group.
In de novo non-left main coronary artery bifurcations treated with provisional T stenting, SB dilation with the PEB group demonstrated better angiographic results than treatment with regular BA at the 9-month follow-up in terms of reduced target lesion stenosis.
ClinicalTrials.gov, NCT02325817; https://clinicaltrials.gov.
The de Winter electrocardiographic (ECG) pattern was characterized by upsloping ST‐segment depressions, tall and positive symmetrical T waves in precordial leads. This rare ECG pattern was recognized ...as an indication of proximal left anterior descending artery occlusion. Less commonly, this ECG pattern was reported in association with occlusion of other coronary artery segments. We present three cases of the de Winter pattern associated with acute total left main occlusion. This pattern may evolve to ST elevation within hours of presentation. Widespread upsloping ST‐segment depressions from V2–V6, centered on V5 were observed in these patients.
•The 3D numerical model for simulating the CO2 physical absorption in the entire RPB was established.•The predicted CO2 saturation rates by CFD simulations were close to the experimental data.•The ...effects of operational parameters on gas-liquid mass transfer in RPB were analyzed.
The rotating packed bed (RPB), a process intensification equipment, has been widely studied and applied to chemical engineering processes such as gas absorption, nanomaterial preparation, and polymer devolatilization. In this study, we presented a typical RPB model to study the intensification mechanism of high gravity on gas-liquid mass transfer. Based on this, three-dimensional computational fluid dynamics (CFD) simulations and experiments of CO2 physical absorption were conducted to investigate the gas-liquid mass transfer characteristics in the RPB. The predicted and experimental values of CO2 saturation rates of the liquid phase showed good agreement, and the errors were within ± 15 % under various operating conditions. Moreover, detailed flow field and mass transfer information that are difficult to measure experimentally, such as the distribution of CO2 mass fraction in the liquid, liquid holdup, turbulent kinetic energy dissipation rate, and gas-liquid interfacial area, were analyzed by CFD simulation results. These results provide a solid foundation for the further development and application of RPB.
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A sealed abdominal interface was positioned below the diaphragm (the "NeoVest") to apply synchronized and proportional negative pressure ventilation (NPV) and was compared to positive pressure ...ventilation (PPV) using neurally adjusted ventilatory assist (NAVA). Both modes were controlled by the diaphragm electrical activity (Edi).
Eleven rabbits (mean weight 2.9 kg) were instrumented, tracheotomized, and ventilated with either NPV or PPV (sequentially) with different loads (resistive, dead space, acute lung injury). Assist with either PPV or NPV was titrated to reduce Edi by 50%.
In order to achieve a 50% reduction in Edi, NPV required slightly more negative pressure (-8 to -12 cm H
O) than observed in PPV (+6 to +10 cm H
O). The efficiency of pressure transmission from the NeoVest into gastric pressure was 69.6% (range 61.3-77.4%). Swings in esophageal pressure were more negative during NPV than PPV, for all conditions, due to transmission of negative pressure. Transpulmonary pressure was lower during NPV. Transdiaphragmatic pressure swings were reduced similarly for PPV and NPV, suggesting equivalent unloading of the diaphragm. NPV did not affect hemodynamics.
It is feasible to apply NPV sub-diaphragmatically in synchrony and in proportion to Edi in an animal model of respiratory distress.
Negative pressure ventilation (NPV), for example, the "Iron Lung," may offer advantages over positive pressure ventilation. In the present work, we describe the "NeoVest," a system consisting of a sealed abdominal interface and a ventilator that applies NPV in synchrony and in proportion to the diaphragm electrical activity (Edi).
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