The association between P2Y12 receptor inhibitors reloading and in-hospital outcomes in non-ST-segment elevation acute coronary syndrome (NSTEACS) patients who were on chronic P2Y12 receptor inhibitors therapy remained underdetermined.The Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS project) is a national registry active from November 2014 to December 2019. 4790 NSTEACS patients on chronic P2Y12 receptor inhibitors therapy were included. Cox proportional hazard models, Kaplan-Meier curves, and subgroup analyses were conducted.The NSTEACS patients who received reloading of P2Y12 receptor inhibitors were younger and had fewer comorbid conditions. The reloading group had a lower risk of major adverse cardiac events (MACE) (0.51% vs. 1.43%, P = 0.007), and all-cause death (0.36% vs. 0.99%, P = 0.028), the risks of myocardial infarction and major bleeding were not significantly different between patients with and without reloading. In survival analysis, a lower cumulative risk of MACE could be identified (Log-rank test, P = 0.007) in reloading group. In the unadjusted Cox model, reloading P2Y12 receptor inhibitors was associated with a decreased risk of MACE [HR, 0.35; 95% CI 0.16-0.78; (P = 0.010)] and all-cause death [HR, 0.37; 95% CI 0.14-0.94; (P = 0.036)]. Reloading of P2Y12 receptor inhibitors was associated with a decreased risk of MACE in most of the subgroups.In NSTEACS patients already taking P2Y12 receptor inhibitors, we observed a decreased risk of in-hospital MACEs and all-cause mortality and did not observe an increased risk of major bleeding, with reloading. The differential profile in the two groups might influence this association and further studies are warranted.https://www.gov (Unique identifier: NCT02306616, date of first registration: 03/12/2014).
Despite advances in the treatment of ST-segment elevation myocardial infarction (STEMI), little is known about how this evolving knowledge is applied in current clinical practice in China.
Objective
To evaluate hospital performance and temporal trends in the management of STEMI.
Design, Setting, and Participants
This study used data from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome Project, a nationwide quality improvement registry, in collaboration with the American Heart Association and the Chinese Society of Cardiology. Participants included patients with STEMI admitted to 143 tertiary hospitals across China from November 2014 to July 2019, and data were analyzed from November 2020 to December 2021.
Main Outcomes and Measures
Levels, hospital-level variations, and trends for utilization rates of the 9 management strategies with Class I recommendations in Chinese and US guidelines.
Results
A total of 57 560 hospitalizations with STEMI were included. Overall, 20.0% of patients received all the care according to the 9 guideline-recommended strategies. The performance rate of quality measures was low for reperfusion therapy (61.0%, 35 115/57 560 patients), β-blocker at discharge (68.3%, 37 750/55 285 patients), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge (55.1%, 2524/4578 patients), and smoking cessation counseling (36.5%, 9586/26 265 patients) among those who were eligible. Of 25 563 patients who underwent primary percutaneous coronary intervention (PCI), 66.8% underwent this procedure within 90 minutes of hospital arrival. Of 1128 patients who underwent fibrinolysis therapy, 253 (22.4%) underwent this treatment within 30 minutes of hospital arrival. Measures with high performance rates included receipt of dual antiplatelet therapy within 24 hours (95.5%, 54 263/56 848 patients) and at discharge (91.8%, 51 452/56 019 patients) and receipt of statin at discharge (93.0%, 52 214/56 141 patients) for those eligible. There was significant variation between hospitals in all-or-none score (ranging from 0 to 61.9%) and performance of individual measures. The quality of care improved during the study period, especially for reperfusion therapy, primary PCI within the first 90 minutes of hospital arrival, and smoking cessation counseling.
Conclusions and Relevance
The quality of care for patients hospitalized with STEMI does not meet guideline-recommended strategies in China, with only 1 in 5 patients receiving all the care according to the 9 guideline-recommended strategies. Large disparities in the quality of care exist across hospitals.
To study the correlation between prognosis and different sequences of pulmonary artery and vein interruption during completely thoracoscopic lobectomy for early stage non-small cell lung cancer.Retrospective analysis of 334 cases underwent completely thoracoscopic lobectomy, which were identified as stage I~II non-small cell lung cancer by pathology. They were divided into three groups according to the order of vessel interruption: pulmonary vein first (Group V, n = 174), pulmonary artery first (Group A, n = 93), and artery-vein-artery group (Group M, n = 67). Their preoperative and operative conditions, and the postoperative survival, recurrence were compared.Group A had less cases with history of smoking but more with history of pulmonary infection. The average bleeding amount during the operation in Group A is significantly less Group V, and Group M fell in between them. The duration of operation and postoperative complications were similar among the three groups. The types of tumor recurrence were also similar, which were mostly distant metastasis. There was no statistically significant difference in tumor-free survival and overall survival among the three groups.For the treatment of stage I~II non-small cell lung cancer using completely thoracoscopic lobectomy, pulmonary artery interruption first can reduce the bleeding amount without affecting the operative difficulty and postoperative complications. The sequence of vessel interruption during lobectomy by thoracoscopic surgery would not affect tumor recurrence, metastasis and survival.
Objective
To establish a nomogram model for predicting posthepatectomy liver failure (PHLF) in patients with HBV-related hepatocellular carcinoma (HCC).
Methods
Clinical data of 628 patients with HBV-related HCC who underwent radical hepatectomy in Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University between January 2010 and December 2010 were retrospectively analyzed. According to the operation time, all patients were divided into the model establishment group (n=471) and validation group (n=157). In the model establishment group, 409 cases were males and 62 females, aged (52±21) years old on average. In the validation group, 135 cases were males and 22 females, aged (52±11) years old on average. The informed consents of all patients were obtained and the local ethical committee approval was received. The independent risk factors of PHLF in the model establishment group were identified by Logistic regression analysis. Based upon the independent risk factors, the nomogram model for predicting PHLF of HCC was established. The accuracy of nomogram model for predicting PHLF was respectively detected in two groups by computer consistency coefficient (C-index) and calibration graph method.
Results
Multivariate Logistic regression analysis for the model establishment group revealed that, PT>13 s (OR=2.522, 95%CI:1.384-4.596; P 17.1 μmol/L (OR=2.088, 95%CI:1.342-3.251; P 44 U/L (OR=1.710, 95%CI:1.141-2.562; P<0.05), positive HBeAg (OR=1.658, 95%CI: 1.058-2.597; P<0.05), intraoperative blood transfusion (OR=3.407, 95%CI:1.945-5.967; P<0.05) and liver cirrhosis (OR=1.835, 95%CI:1.200-2.805; P<0.05) were the independent risk factors for PHLF. After the establishment of nomogram model, the C-index was respectively 0.727 and 0.719 in the model establishment group and validation group. In the calibration graph, the standard curve was properly fit with the predicting calibration curve, suggesting that the model consistency was fine.
Conclusions
The nomogram model for predicting PHLF in patients with HBV-related HCC is successfully established. And the model offers certain guiding significance for clinical treatment of HBV-related HCC.
Key words:
Carcinoma, hepatocellular; Hepatitis B; Liver failure; Nomogram; Risk factors
Naringin (NRG) has been reported to exert cardioprotective effects against multiple cardiovascular diseases, including lipopolysaccharide‑induced and hyperglycemia‑induced myocardial injury. However, the role of NRG in myocardial ischemia/reperfusion (I/R) injury remains unclear. In the present study, the PI3K/Akt pathway was investigated to evaluate the possible mechanisms underlying the roles of NRG in myocardial ischemia/reperfusion (I/R) injury. The levels of cardiac enzymes were measured by ELISA to evaluate the optimal dosage of NRG that could protect against myocardial I/R injury. Rats were administered 100 mg/kg of NRG and activities of myocardial enzymes, the level of cardiac apoptosis and inflammation, oxidant response, autophagy indicators and echocardiography were evaluated. The level of corresponding proteins was measured using western blotting. The results indicated that NRG elicited the best cardioprotective effects at a dose of 100 mg/kg by significantly reducing the levels of myocardial enzymes, apoptosis, inflammation, oxidative response and infarct size. Furthermore, NRG alleviated contractile dysfunction by increasing the left ventricular ejection fraction and fractional shortening. In addition, NRG markedly promoted the phosphorylation of Akt, while decreasing the level of autophagy indicator beclin‑1 and the microtubule‑associated protein 1B‑light chain 3 (LC3B) II/ LC3BI ratio. However, PI3K/Akt inhibitor (LY294002) partially reduced the NRG induced phosphorylation of Akt and the reduction in beclin‑1, along with the LC3BII/LC3BI ratio. The results of the present study demonstrated that NRG could attenuate myocardial I/R injury.
Abstract Background Intrahepatic cholangiocarcinoma (ICC) is a highly aggressive malignancy characterized by a poor prognosis and closely linked to tumor stemness. However, the key molecules that regulate ICC stemness remain elusive. Although Y‐box binding protein 1 (YBX1) negatively affects prognosis in various cancers by enhancing stemness and chemoresistance, its effect on stemness and cisplatin sensitivity in ICC remains unclear. Methods Three bulk and single‐cell RNA‐seq datasets were analyzed to investigate YBX1 expression in ICC and its association with stemness. Clinical samples and colony/sphere formation assays validated the role of YBX1 in stemness and sensitivity to cisplatin. AZD5363 and KYA1979K explored the interaction of YBX1 with the phosphatidylinositol 3‐kinase (PI3K)/protein kinase B (PKB/AKT) and WNT/ β ‐catenin pathways. Results YBX1 was significantly upregulated in ICC, correlated with worse overall survival and shorter postoperative recurrence time, and was higher in chemotherapy‐non‐responsive ICC tissues. The YBX1‐high group exhibited significantly elevated stemness scores, and genes linked to YBX1 upregulation were enriched in multiple stemness‐related pathways. Moreover, YBX1 expression is significantly correlated with several stemness‐related genes ( SOX9 , OCT4 , CD133 , CD44 and EPCAM ). Additionally, YBX1 overexpression significantly enhanced the colony‐ and spheroid‐forming abilities of ICC cells, accelerated tumor growth in vivo and reduced their sensitivity to cisplatin. Conversely, the downregulation of YBX1 exerted the opposite effect. The transcriptomic analysis highlighted the link between YBX1 and the PI3K/AKT and WNT/ β ‐catenin pathways. Further, AZD5363 and KYA1979K were used to clarify that YBX1 promoted ICC stemness through the regulation of the AKT/ β ‐catenin axis. Conclusions YBX1 is upregulated in ICC and promotes stemness and cisplatin insensitivity via the AKT/ β ‐catenin axis. Our study describes a novel potential therapeutic target for improving ICC prognosis.
Abstract Background Liver cancer is one of the most common malignancies in the world with a poor prognosis. Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer, accounting for 80–90% of cases. The initiation and progression of HCC are closely associated with chronic liver inflammation. In addition, HCC is often accompanied by cell senescence. Senescent hepatocytes can secrete various inflammatory factors, collectively called the senescence-associated secretory phenotype (SASP). The SASP has been confirmed to promote the occurrence of liver cancer by affecting the inflammatory microenvironment. However, its role and the underlying mechanism of hepatic SASP in hepatocarcinogenesis are not clearly understood. Therefore, a better understanding of the pathogenic mechanisms of the effect of the hepatic SASP on the occurrence of HCC is still needed. Methods The study aims to explore the role of SASP factors and the underlying mechanism in tumorigenesis and the progression of HCC in vivo. We used diethylnitrosamine (DEN) combined with carbon tetrachloride (CCl 4 ) (DEN-CCl 4 ) to establish liver cancer model in wild-type ( WT ) mice and Bcl3 knockout ( Bcl3 −/− ) mice. β-galactosidase (β-gal) staining was performed to evaluate the degree of cellular senescence. Immunohistochemistry (IHC) were used to detect the degree of cellular senescence and the activation of macrophage. PCR chip and clinical tissue chip assays were used to estimate the RNA levels of SASP factors and NF-κB related genes, and their protein levels were examined by Western blot assays. Results DEN-CCl 4 induced cellular senescence in mouse hepatocytes. In addition, senescent hepatocytes might release a variety of inflammatory factors that further activate macrophages, thereby changing the microenvironmental state and promoting the occurrence of HCC. Mechanistically, the NF-κB pathway is important because it regulates the SASP. Therefore, we used a PCR chip to detect the expression of NF-κB-related genes in senescent liver tissue. Our results showed that the expression of Bcl3 was increased in senescent hepatocytes, and knocking out Bcl3 significantly inhibited the secretion of hepatocyte SASP factors and the activation of macrophages, thereby inhibiting hepatocarcinogenesis. Finally, in clinical tissues adjacent to HCC tissues in patients, the expression of Bcl3 and IL-8 correlated with poor prognosis in HCC patients. Conclusion The hepatic SASP can further induce the activation of macrophages during hepatocarcinogenesis, thereby promoting the occurrence of HCC, and that this process is closely related to the expression of Bcl3 in hepatocytes.
Objective
To investigate the indication, techniques, safety and efficacy of medical suture versus traditional suturein thoracoscopic surgery incision closure.
Methods
From October 2014 to January 2016, 121 patients undergoing thoracoscopic surgery were divided into two groups according to the method of incision closure: 53 cases of traditional suture group and 68 cases of medical suture hasp group. The time of closure, healing time, wound healing scores and patient′s satisfaction were recorded and statistically analyzed.
Results
All patients were successfully operated without perioperative death. One patient underwent postoperative bleeding in the medical suture hasp group. The medical suture hasp was found to be reliable and easy to remove in secondary operation. The postoperative incision was changed to traditional suture. Two patients in each group had delayed healing. Two patients of medical suture hasp group were caused by incision bleeding, of whom one case switched to traditional suture, and one patient was treated with pressure bandage and healed. The wound closure time of the medical suture hasp group was significantly shorter than that of the traditional suture group: (110.0 ± 12.7) s vs.(305.0 ± 31.6) s, P 0.05). The satisfaction scores of the patients in medical suture hasp group were higher than those in traditional suture group (P < 0.01).
Conclusions
The use of medical suture hasp in the thoracoscopic surgical incision closure process is safe and reliable. It canaccelerate the early repair of incision, and improve patient′s satisfaction.
Key words:
Thoracoscopes; Wound healing; Suture techniques; Cicatrix
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