Background The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index （LAAI） has predictive value for prognosis in pa...Background The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index （LAAI） has predictive value for prognosis in patients with unstable angina pectoris （UAP）. This study was aimed to assess the association between LAAI and outcomes in UAP patients. Methods We enrolled a total of 391 in-hospital patients diag- nosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of ad- verse cardiovascular （CV） events, including hospital readmission for angina pectoris, acute myocardial infarction （AMI）, congestive heart failure （CHF）, stroke and all-cause mortality. Results During a mean follow-up time of 26.3±8.6 months, 98 adverse CV events occurred （84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality）. In a multivariate Cox model, LAAI [OR： 1.140, 95% CI： 1.01±1.279, P = 0.026], diastolic blood pressure （OR： 0.976, 95% CI： 0.956-0.996, P = 0.020） and pulse pressure （OR 1.020, 95% CI： 1.007-1.034, P = 0.004） were independent predictors for adverse CV events in UAP patients. Conclusions LAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.展开更多
Neurofibromatosis type 1(NF-1) is commonly associated with benign or malignant tumors in both the central and peripheral nervous systems. However, rare cases of NF-1-associated multiplerectal neuroendocrine tumors hav...Neurofibromatosis type 1(NF-1) is commonly associated with benign or malignant tumors in both the central and peripheral nervous systems. However, rare cases of NF-1-associated multiplerectal neuroendocrine tumors have been reported. This report describes a case of a 39 year old female with NF-1 and intermittent hematochezia as a primary symptom. Physical examination showed multiple subcutaneous nodules and café au lait spots with obvious scoliosis of the back. Imaging examinations and colonoscopy found malformation of the left external iliac vein and multiple gray-yellow nodules with varying sizes and shapes in the rectal submucosal layer. Histological and immunohistochemical results suggested multiple rectal neuroendocrine tumors, a rare disease with few appreciable symptoms and a particularly poor prognosis. The patient with NF-1 presented here had not only multiple rectal neuroendocrine neoplasms but also vascular malformations, scoliosis and other multiple system lesions. This case therefore contributes to improving clinical understanding, diagnosis and treatment of related complications for patients with NF-1 who present with associated medical conditions.展开更多
Background Elevated left ventricular filling pressure （LVFP） is an important cause of exercise intolerance in patients with atrial fib- dilation （AF）. Exercise stress echocardiography could assess LVFP during exer...Background Elevated left ventricular filling pressure （LVFP） is an important cause of exercise intolerance in patients with atrial fib- dilation （AF）. Exercise stress echocardiography could assess LVFP during exercise. The objective of this study was to investigate the relationship between exercise induced elevation of LVFP and exercise capacity in patients with AF. Methods This study included 145 con- secutive patients （81 men and 64 women; mean age 65.5 ± 8.0 years） with persistent non-valvular AF and normal left ventricular systolic function （left ventdcular ejection fraction 〉 50%）. All patients underwent a symptom-limited cardiopulmonary exercise test （CPET）. Doppler echocardiography was performed both at rest and immediately after exercise. Five consecutive measurements of early diastolic mitral inflow velocity （E） and early diastolic mitral annular velocity （e＇） were taken and averaged. E/e＇ ratio was calculated. Elevated LVFP was defined as E/e＇ 〉 9, and patients with elevated LVFP at rest were excluded. Results Patients were classified into two groups according to LVFP estimated by E/e＇ ratio after exercise： 39 （26.9%） with elevated LVFP after exercise and 106 （73.1%） with normal LVFP. As compared with patients with normal LVFP, the ones with elevated LVFP after exercise had significantly lower peak oxygen uptake （VO2 peak） （21.7 ± 2.3 vs. 26.4 ± 3.8 mL/min per kilogram, P 〈 0.001）, lower anaerobic threshold （19.9 ± 2.5 vs. 26.0± 4.0 mL/min per kilogram, P 〈 0.001）, and shorter exercise time duration （6.2± 0.8 vs. 7.0 ±1.3 min, P 〈 0.001）. Multivariate analysis showed that age, gender and E/e＇ after exercise were significantly correlated with VO2peak. Conclusion Elevated LVFP estimated by E/e＇ ratio after exercise is independently associated with reduced exercise capacity in AF patients.展开更多
It has been reported that up to 12% of patients underwent non-cardiac surgery or invasive procedures within the first year after the coronary stent implantation. Premature dis- continuation of antiplatelet therapy is ...It has been reported that up to 12% of patients underwent non-cardiac surgery or invasive procedures within the first year after the coronary stent implantation. Premature dis- continuation of antiplatelet therapy is associated with a sig- nificant increase in mortality and major adverse cardiac events, in particular, stent thrombosis. Thus, postpone- ment of elective surgery is advocated during the first year after the coronary stent implantation.展开更多
Acute obstruction of the right coronary ar-tery(RCA)can lead to right ventricular myocardial infarction(MI),which rarely lead to cardiogenic shock(CS).Hemodynamic sta-bility could be restored through fluid resuscitati...Acute obstruction of the right coronary ar-tery(RCA)can lead to right ventricular myocardial infarction(MI),which rarely lead to cardiogenic shock(CS).Hemodynamic sta-bility could be restored through fluid resuscitation and vasoactive drugs in most circumstances.Here,we present a highly representative case of refractory CS caused by massive right ventricular MI with api-cal aneurysm formation,who was successfully treated with extracorporeal membrane oxygenation(ECMO)post severe complication of acute right coronal dis-section.展开更多
China Jinping Underground Laboratory(CJPL)is ideal for studying solar,geo-,and supernova neutrinos.A precise measurement of the cosmic-ray background is essential in proceeding with R&D research for these MeV-scal...China Jinping Underground Laboratory(CJPL)is ideal for studying solar,geo-,and supernova neutrinos.A precise measurement of the cosmic-ray background is essential in proceeding with R&D research for these MeV-scale neutrino experiments.Using a 1-ton prototype detector for the Jinping Neutrino Experiment(JNE),we detected 264 high-energy muon events from a 645.2-day dataset from the first phase of CJPL(CJPL-I),reconstructed their directions,and measured the cosmic-ray muon flux to be (3.53±0.22_stat.±0.07_sys.)×-10^(-10)cm^(-2).The observed angular distributions indicate the leakage of cosmic-ray muon background and agree with simulation data accounting for Jinping mountain's terrain.A survey of muon fluxes at different laboratory locations,considering both those situated under mountains and those down mine shafts,indicates that the flux at the former is generally a factor of (4±2) larger than at the latter,with the same vertical overburden.This study provides a convenient back-of-the-envelope estimation for the muon flux of an underground experiment.展开更多
Background:Angiopoietin-2(Ang-2)is a type of endothelial growth factor involved in angiogenesis and vascular remodeling.Circulating Ang-2 levels are elevated in patients with obstructive coronary artery disease(CAD).T...Background:Angiopoietin-2(Ang-2)is a type of endothelial growth factor involved in angiogenesis and vascular remodeling.Circulating Ang-2 levels are elevated in patients with obstructive coronary artery disease(CAD).This study aimed to evaluate the association between serum Ang-2 levels and coronary microvascular dysfunction in patients without obstructive CAD.Methods:A total of 125 patients with angina in the absence of obstructive CAD were included in this cross-sectional study.Coronary flow reserve(CFR)was measured in the distal left anterior descending coronary artery by trans-thoracic Doppler echocardiography.The patients were divided into the following two sub-groups according to CFR:the impaired CFR group with CFR values<2.5 and the preserved CFR group with CFR values≥2.5.Serum Ang-2 levels were determined using enzyme-linked immunosorbent assay.Independent predictors for impaired CFR were identified by binary logistic regression analysis.The receiveroperating characteristic curve was determined to evaluate the ability of serum Ang-2 in predicting impaired CFR.Results:We found that age,percentage of female sex,N-terminal pro-B-type natriuretic peptide levels,Ang-2 levels(763.3±264.9 vs.579.7±169.3 pg/mL,P<0.001),and the left atrial volume index were significantly higher in patients with impaired CFR than in patients with preserved CFR.Serum Ang-2 levels were negatively correlated with CFR(r=0.386,P<0.001).Binary logistic regression analysis showed that Ang-2(odds ratio:1.004,95%confidence interval[CI]:1.001–1.006,P=0.003)and age(odds ratio:1.088,95%CI:1.023–1.156,P=0.007)were independently associated with impaired CFR.Furthermore,Ang-2 was a significant predictor of impaired CFR on the receiver-operating characteristic curve(P<0.001).The area under the curve was 0.712(95%CI:0.612–0.813).Conclusions:High serum Ang-2 levels are independently associated with impaired CFR in patients with angina in the absence of obstructive CAD.展开更多
Background:Innovative coronavirus disease 2019(COVID-19)vaccines,with elevated global manufacturing capacity,enhanced safety and efficacy,simplified dosing regimens,and distribution that is less cold chain-dependent,a...Background:Innovative coronavirus disease 2019(COVID-19)vaccines,with elevated global manufacturing capacity,enhanced safety and efficacy,simplified dosing regimens,and distribution that is less cold chain-dependent,are still global imperatives for tackling the ongoing pandemic.A previous phase I trial indicated that the recombinant COVID-19 vaccine(V-01),which contains a fusion protein(IFN-PADRE-RBD-Fc dimer)as its antigen,is safe and well tolerated,capable of inducing rapid and robust immune responses,and warranted further testing in additional clinical trials.Herein,we aimed to assess the immunogenicity and safety of V-01,providing rationales of appropriate dose regimen for further efficacy study.Methods:A randomized,double-blind,placebo-controlled phaseⅡclinical trial was initiated at the Gaozhou Municipal Centre for Disease Control and Prevention(Guangdong,China)in March 2021.Both younger(n=440;18–59 years of age)and older(n=440;≥60 years of age)adult participants in this trial were sequentially recruited into two distinct groups:two-dose regimen group in which participants were randomized either to follow a 10 or 25 mg of V-01 or placebo given intramuscularly 21 days apart(allocation ratio,3:3:1,n=120,120,40 for each regimen,respectively),or one-dose regimen groups in which participants were randomized either to receive a single injection of 50 mg of V-01 or placebo(allocation ratio,3:1,n=120,40,respectively).The primary immunogenicity endpoints were the geometric mean titers of neutralizing antibodies against live severe acute respiratory syndrome coronavirus 2,and specific binding antibodies to the receptor binding domain(RBD).The primary safety endpoint evaluation was the frequencies and percentages of overall adverse events(AEs)within 30 days after full immunization.Results:V-01 provoked substantial immune responses in the two-dose group,achieving encouragingly high titers of neutralizing antibody and anti-RBDimmunoglobulin,which peaked at day 35(161.9[95%confidence interval[CI]:133.3–196.7]and 149.3[95%CI:123.9–179.9]in 10 and 25 mg V-01 group of younger adults,respectively;111.6[95%CI:89.6–139.1]and 111.1[95%CI:89.2–138.4]in 10 and 25 mg V-01 group of older adults,respectively),and remained high at day 49 after a day-21 second dose;these levels significantly exceed those in convalescent serum from symptomatic COVID-19 patients(53.6,95%CI:31.3–91.7).Our preliminary data showthat V-01 is safe andwell tolerated,with reactogenicity predominantly being absent or mild in severity and only one vaccinerelated grade 3 or worse AE being observed within 30 days.The older adult participants demonstrated a more favorable safety profile compared with those in the younger adult group:with AEs percentages of 19.2%,25.8%,17.5%in older adults vs.34.2%,23.3%,26.7%in younger adults at the 10,25 mg V-01 two-dose group,and 50 mg V-01 one-dose group,respectively.Conclusions:The vaccine candidate V-01 appears to be safe and immunogenic.The preliminary findings support the advancement of the two-dose,10 mg V-01 regimen to a phaseⅢtrial for a large-scale population-based evaluation of safety and efficacy.展开更多
文摘Background The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index （LAAI） has predictive value for prognosis in patients with unstable angina pectoris （UAP）. This study was aimed to assess the association between LAAI and outcomes in UAP patients. Methods We enrolled a total of 391 in-hospital patients diag- nosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of ad- verse cardiovascular （CV） events, including hospital readmission for angina pectoris, acute myocardial infarction （AMI）, congestive heart failure （CHF）, stroke and all-cause mortality. Results During a mean follow-up time of 26.3±8.6 months, 98 adverse CV events occurred （84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality）. In a multivariate Cox model, LAAI [OR： 1.140, 95% CI： 1.01±1.279, P = 0.026], diastolic blood pressure （OR： 0.976, 95% CI： 0.956-0.996, P = 0.020） and pulse pressure （OR 1.020, 95% CI： 1.007-1.034, P = 0.004） were independent predictors for adverse CV events in UAP patients. Conclusions LAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.
文摘Neurofibromatosis type 1(NF-1) is commonly associated with benign or malignant tumors in both the central and peripheral nervous systems. However, rare cases of NF-1-associated multiplerectal neuroendocrine tumors have been reported. This report describes a case of a 39 year old female with NF-1 and intermittent hematochezia as a primary symptom. Physical examination showed multiple subcutaneous nodules and café au lait spots with obvious scoliosis of the back. Imaging examinations and colonoscopy found malformation of the left external iliac vein and multiple gray-yellow nodules with varying sizes and shapes in the rectal submucosal layer. Histological and immunohistochemical results suggested multiple rectal neuroendocrine tumors, a rare disease with few appreciable symptoms and a particularly poor prognosis. The patient with NF-1 presented here had not only multiple rectal neuroendocrine neoplasms but also vascular malformations, scoliosis and other multiple system lesions. This case therefore contributes to improving clinical understanding, diagnosis and treatment of related complications for patients with NF-1 who present with associated medical conditions.
基金Acknowledgements This work was supported by the National Natural Sciences Foundation of China （81400177, CHEN SM） and Beijing Natural Science Foundation （7154249, CHEN SM）. The authors have no financial disclosures.
文摘Background Elevated left ventricular filling pressure （LVFP） is an important cause of exercise intolerance in patients with atrial fib- dilation （AF）. Exercise stress echocardiography could assess LVFP during exercise. The objective of this study was to investigate the relationship between exercise induced elevation of LVFP and exercise capacity in patients with AF. Methods This study included 145 con- secutive patients （81 men and 64 women; mean age 65.5 ± 8.0 years） with persistent non-valvular AF and normal left ventricular systolic function （left ventdcular ejection fraction 〉 50%）. All patients underwent a symptom-limited cardiopulmonary exercise test （CPET）. Doppler echocardiography was performed both at rest and immediately after exercise. Five consecutive measurements of early diastolic mitral inflow velocity （E） and early diastolic mitral annular velocity （e＇） were taken and averaged. E/e＇ ratio was calculated. Elevated LVFP was defined as E/e＇ 〉 9, and patients with elevated LVFP at rest were excluded. Results Patients were classified into two groups according to LVFP estimated by E/e＇ ratio after exercise： 39 （26.9%） with elevated LVFP after exercise and 106 （73.1%） with normal LVFP. As compared with patients with normal LVFP, the ones with elevated LVFP after exercise had significantly lower peak oxygen uptake （VO2 peak） （21.7 ± 2.3 vs. 26.4 ± 3.8 mL/min per kilogram, P 〈 0.001）, lower anaerobic threshold （19.9 ± 2.5 vs. 26.0± 4.0 mL/min per kilogram, P 〈 0.001）, and shorter exercise time duration （6.2± 0.8 vs. 7.0 ±1.3 min, P 〈 0.001）. Multivariate analysis showed that age, gender and E/e＇ after exercise were significantly correlated with VO2peak. Conclusion Elevated LVFP estimated by E/e＇ ratio after exercise is independently associated with reduced exercise capacity in AF patients.
文摘It has been reported that up to 12% of patients underwent non-cardiac surgery or invasive procedures within the first year after the coronary stent implantation. Premature dis- continuation of antiplatelet therapy is associated with a sig- nificant increase in mortality and major adverse cardiac events, in particular, stent thrombosis. Thus, postpone- ment of elective surgery is advocated during the first year after the coronary stent implantation.
文摘Acute obstruction of the right coronary ar-tery(RCA)can lead to right ventricular myocardial infarction(MI),which rarely lead to cardiogenic shock(CS).Hemodynamic sta-bility could be restored through fluid resuscitation and vasoactive drugs in most circumstances.Here,we present a highly representative case of refractory CS caused by massive right ventricular MI with api-cal aneurysm formation,who was successfully treated with extracorporeal membrane oxygenation(ECMO)post severe complication of acute right coronal dis-section.
基金Supported in part by the National Natural Science Foundation of China(11620101004,11475093)the Key Laboratory of Particle&Radiation Imaging(Tsinghua University,the CAS Center for Excellence in Particle Physics(CCEPP),and Guangdong Basic and Applied Basic Research Foundation(2019A1515012216)Portion of this work performed at Brookhaven National Laboratory is supponted in part by the United States Department of Energy(DE-SC0012704)。
文摘China Jinping Underground Laboratory(CJPL)is ideal for studying solar,geo-,and supernova neutrinos.A precise measurement of the cosmic-ray background is essential in proceeding with R&D research for these MeV-scale neutrino experiments.Using a 1-ton prototype detector for the Jinping Neutrino Experiment(JNE),we detected 264 high-energy muon events from a 645.2-day dataset from the first phase of CJPL(CJPL-I),reconstructed their directions,and measured the cosmic-ray muon flux to be (3.53±0.22_stat.±0.07_sys.)×-10^(-10)cm^(-2).The observed angular distributions indicate the leakage of cosmic-ray muon background and agree with simulation data accounting for Jinping mountain's terrain.A survey of muon fluxes at different laboratory locations,considering both those situated under mountains and those down mine shafts,indicates that the flux at the former is generally a factor of (4±2) larger than at the latter,with the same vertical overburden.This study provides a convenient back-of-the-envelope estimation for the muon flux of an underground experiment.
基金This work was supported by grants from the National Natural Sciences Foundation of China(No.81400177)Natural Science Foundation of Beijing Municipality(No.7154249).
文摘Background:Angiopoietin-2(Ang-2)is a type of endothelial growth factor involved in angiogenesis and vascular remodeling.Circulating Ang-2 levels are elevated in patients with obstructive coronary artery disease(CAD).This study aimed to evaluate the association between serum Ang-2 levels and coronary microvascular dysfunction in patients without obstructive CAD.Methods:A total of 125 patients with angina in the absence of obstructive CAD were included in this cross-sectional study.Coronary flow reserve(CFR)was measured in the distal left anterior descending coronary artery by trans-thoracic Doppler echocardiography.The patients were divided into the following two sub-groups according to CFR:the impaired CFR group with CFR values<2.5 and the preserved CFR group with CFR values≥2.5.Serum Ang-2 levels were determined using enzyme-linked immunosorbent assay.Independent predictors for impaired CFR were identified by binary logistic regression analysis.The receiveroperating characteristic curve was determined to evaluate the ability of serum Ang-2 in predicting impaired CFR.Results:We found that age,percentage of female sex,N-terminal pro-B-type natriuretic peptide levels,Ang-2 levels(763.3±264.9 vs.579.7±169.3 pg/mL,P<0.001),and the left atrial volume index were significantly higher in patients with impaired CFR than in patients with preserved CFR.Serum Ang-2 levels were negatively correlated with CFR(r=0.386,P<0.001).Binary logistic regression analysis showed that Ang-2(odds ratio:1.004,95%confidence interval[CI]:1.001–1.006,P=0.003)and age(odds ratio:1.088,95%CI:1.023–1.156,P=0.007)were independently associated with impaired CFR.Furthermore,Ang-2 was a significant predictor of impaired CFR on the receiver-operating characteristic curve(P<0.001).The area under the curve was 0.712(95%CI:0.612–0.813).Conclusions:High serum Ang-2 levels are independently associated with impaired CFR in patients with angina in the absence of obstructive CAD.
基金the Emergency Key Program of Guangzhou Laboratory(No.EKPG21-21)。
文摘Background:Innovative coronavirus disease 2019(COVID-19)vaccines,with elevated global manufacturing capacity,enhanced safety and efficacy,simplified dosing regimens,and distribution that is less cold chain-dependent,are still global imperatives for tackling the ongoing pandemic.A previous phase I trial indicated that the recombinant COVID-19 vaccine(V-01),which contains a fusion protein(IFN-PADRE-RBD-Fc dimer)as its antigen,is safe and well tolerated,capable of inducing rapid and robust immune responses,and warranted further testing in additional clinical trials.Herein,we aimed to assess the immunogenicity and safety of V-01,providing rationales of appropriate dose regimen for further efficacy study.Methods:A randomized,double-blind,placebo-controlled phaseⅡclinical trial was initiated at the Gaozhou Municipal Centre for Disease Control and Prevention(Guangdong,China)in March 2021.Both younger(n=440;18–59 years of age)and older(n=440;≥60 years of age)adult participants in this trial were sequentially recruited into two distinct groups:two-dose regimen group in which participants were randomized either to follow a 10 or 25 mg of V-01 or placebo given intramuscularly 21 days apart(allocation ratio,3:3:1,n=120,120,40 for each regimen,respectively),or one-dose regimen groups in which participants were randomized either to receive a single injection of 50 mg of V-01 or placebo(allocation ratio,3:1,n=120,40,respectively).The primary immunogenicity endpoints were the geometric mean titers of neutralizing antibodies against live severe acute respiratory syndrome coronavirus 2,and specific binding antibodies to the receptor binding domain(RBD).The primary safety endpoint evaluation was the frequencies and percentages of overall adverse events(AEs)within 30 days after full immunization.Results:V-01 provoked substantial immune responses in the two-dose group,achieving encouragingly high titers of neutralizing antibody and anti-RBDimmunoglobulin,which peaked at day 35(161.9[95%confidence interval[CI]:133.3–196.7]and 149.3[95%CI:123.9–179.9]in 10 and 25 mg V-01 group of younger adults,respectively;111.6[95%CI:89.6–139.1]and 111.1[95%CI:89.2–138.4]in 10 and 25 mg V-01 group of older adults,respectively),and remained high at day 49 after a day-21 second dose;these levels significantly exceed those in convalescent serum from symptomatic COVID-19 patients(53.6,95%CI:31.3–91.7).Our preliminary data showthat V-01 is safe andwell tolerated,with reactogenicity predominantly being absent or mild in severity and only one vaccinerelated grade 3 or worse AE being observed within 30 days.The older adult participants demonstrated a more favorable safety profile compared with those in the younger adult group:with AEs percentages of 19.2%,25.8%,17.5%in older adults vs.34.2%,23.3%,26.7%in younger adults at the 10,25 mg V-01 two-dose group,and 50 mg V-01 one-dose group,respectively.Conclusions:The vaccine candidate V-01 appears to be safe and immunogenic.The preliminary findings support the advancement of the two-dose,10 mg V-01 regimen to a phaseⅢtrial for a large-scale population-based evaluation of safety and efficacy.
