Nomogram for Predicting the Severity of Coronary Artery Disease in Young Adults ≤45 Years of Age with Acute Coronary Syndrome

Background: A non-invasive predictive model has not been established to identify the severity of coronary lesions in young adults with acute coronary syndrome (ACS). Methods: In this retrospective study, 1088 young adults (≤45 years of age) first diagnosed with ACS who underwent coronary angiography were enrolled and randomized 7:3 into training or testing datasets. To build the nomogram, we determined optimal predictors of coronary lesion severity with the Least Absolute Shrinkage and Selection Operator and Random Forest algorithm. The predictive accuracy of the nomogram was assessed with calibration plots, and performance was assessed with the receiver operating characteristic curve, decision curve analysis and the clinical impact curve. Results: Seven predictors were identified and integrated into the nomogram: age, hypertension, diabetes, body mass index, low-density lipoprotein cholesterol, mean platelet volume and C-reactive protein. Receiver operating characteristic analyses demonstrated the nomogram’s good discriminatory performance in predicting severe coronary artery disease in young patients with ACS in the training (area under the curve 0.683, 95% confidence interval [0.645–0.721]) and testing (area under the curve 0.670, 95% confidence interval [0.611–0.729]) datasets. The nomogram was also well-calibrated in both the training (P=0.961) and testing (P=0.302) datasets. Decision curve analysis and the clinical impact curve indicated the model’s good clinical utility. Conclusion: A simple and practical nomogram for predicting coronary artery disease severity in young adults≤45 years of age with ACS was established and validated

Type IIn Supernova SN 2010jl: Optical Observations for Over 500 Days After Explosion

We present extensive optical observations of a Type IIn supernova (SN) 2010jl for the first 1.5 years after the discovery. The UBVRI light curves demonstrated an interesting two-stage evolution during the nebular phase, which almost flatten out after about 90 days from the optical maximum. SN 2010jl has one of the highest intrinsic H_alpha luminosity ever recorded for a SN IIn, especially at late phase, suggesting a strong interaction of SN ejecta with the dense circumstellar material (CSM) ejected by the progenitor. This is also indicated by the remarkably strong Balmer lines persisting in the optical spectra. One interesting spectral evolution about SN 2010jl is the appearance of asymmetry of the Balmer lines. These lines can be well decomposed into a narrow component and an intermediate-width component. The intermediate-width component showed a steady increase in both strength and blueshift with time until t ~ 400 days after maximum, but it became less blueshifted at t ~ 500 days when the line profile appeared relatively symmetric again. Owing to that a pure reddening effect will lead to a sudden decline of the light curves and a progressive blueshift of the spectral lines, we therefore propose that the asymmetric profiles of H lines seen in SN 2010jl is unlikely due to the extinction by newly formed dust inside the ejecta, contrary to the explanation by some early studies. Based on a simple CSM-interaction model, we speculate that the progenitor of SN 2010jl may suffer a gigantic mass loss (~ 30-50 M_sun) in a few decades before explosion. Considering a slow moving stellar wind (e.g., ~ 28 km/s) inferred for the preexisting, dense CSM shell and the extremely high mass-loss rate (1-2 M_sun per yr), we suggest that the progenitor of SN 2010jl might have experienced a red supergiant stage and explode finally as a post-red supergiant star with an initial mass above 30-40 M_sun.Comment: 34 pages, 9 figures, accepted for publication in A

Clinical risk factors of carbohydrate antigen-125, cytokeratin fragment 19, and neuron-specific enolase in liver metastases from elderly lung cancer patients

Objective: Lung cancer is a common malignant tumor characterized by challenging detection and lack of specificity in clinical manifestations. To investigate the correlation of tumor markers in the serum with liver metastasis and prognosis of lung cancer. Methods: A total of 3,046 elderly lung cancer patients were retrospectively studied between September 1999 and July 2020. Divided into liver metastasis group and non-liver metastasis group. We compared a series of serum biomarkers between the two groups of elderly patients to predict the prognosis in patients with lung cancer by fluorescence in situ hybridization (FISH), advanced flow cytometry (FCM) and multi tumor marker protein chip, including tumor markers in the serum included alkaline phosphatase (ALP), serum calcium, hemoglobin (HB), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin fragment 19 (Cyfra21-1), carbohydrate antigen-125 (CA-125), carbohydrate antigen-153 (CA-153), carbohydrate antigen-199 (CA-199), and free prostate specific antigen (free PSA). We used binary logistic regression analysis to determine risk factors, and used receiver operating curve (ROC) analysis to evaluate the diagnostic value of liver metastases in elderly patients with lung cancer. Results: The proportion of lung cancer in the liver metastasis group was higher than that observed in the non-liver metastases group. The expression levels of CA-125, Cyfra21-1, and NSE in the liver metastasis group of lung cancer were significantly higher than those reported in the non-liver metastases group (p < 0.05). ROC curve analysis shows that the area under the curve of CA-125, Cyfra21-1, and NSE are 0.614, 0.616 and 0.608, respectively. The sensitivity and specificity of CA-125 were 45.70% and 76.20%, the sensitivity and specificity of Cyfra21-1 were 60.10% and 57.10%, and the sensitivity and specificity of NSE were 44.10% and 75.00%, respectively. Conclusion: High levels of CA-125, Cyfra21-1, and NSE in the serum may be associated with liver metastasis in elderly patients with lung cancer. CA-125 and NSE are factors influencing the prognosis of elderly patients with liver metastasis of lung cancer

The predictive potential of altered voxel-based morphometry in severely obese patients with meibomian gland dysfunction

Objective: To investigate voxel-based morphometry (VBM) by using magnetic resonance imaging (MRI) in meibomian gland dysfunction patients with severe obesity (PATs) and to explore the application of VBM in the early diagnosis, prevention of cognitive impairment and targeted treatment of this disease. Methods: Sixteen PATs and 12 healthy controls (HCs) were enrolled and underwent MRI. Whole-head images were analyzed using VBM and data were compared between groups using an independent samples t-test. Receiver operating characteristic (ROC) curves were utilized to assess the diagnostic value of this approach. Mini-mental state examination (MMSE) scores were used to assess cognitive impairment and were analyzed using an independent samples t-test. Results: Compared with HCs, the VBM values in PATs were reduced in the left cerebellum and right thalamus but increased in the right brainstem, right precuneus and right paracentral lobule. The results of ROC curve analysis indicated that VBM may be useful in meibomian gland disease diagnosis. Comparison of MMSE scores between groups showed mild cognitive impairment in PATs. Conclusion: PATs showed altered VBM values in some brain areas. These findings may provide information about the pathophysiology of meibomian gland dysfunction and may help to explain the underlying mechanisms of clinical manifestations in PATs, such as cognitive impairment. Abnormal VBM values in these brain areas may serve as predictive factors for development of meibomian gland disease in severely obese people and as indicators for individualized treatment

Liver enzymes mediate the association between aldehydes co-exposure and hypertriglyceridemia

Aldehydes are recognized environmental toxicants that may affect lipid metabolism. For instance, acrolein has been found to increase serum triglyceride (TG) levels exclusively. However, it remains unclear whether other aldehydes are also associated with hypertriglyceridemia (HTG), and what mechanisms may be involved. This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES, 2013–2014) to identify associations between serum aldehydes, liver enzymes, and HTG. Serum aldehydes included crotonaldehyde (CRAL), propanaldehyde (3AL), butyraldehyde (4AL), pentanaldehyde (5AL), isopentanaldehyde (I5AL), and heptanaldehyde (7AL). Liver enzymes included alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT). HTG was defined as fasting TG levels ≥ 1.7 mmol/L. Aldehyde co-exposure was quantified using weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR), while mediation analysis was performed to investigate the role of liver enzymes. Among 1474 participants (mean age 38.6 years, male 50.0%), 426 were diagnosed with HTG. 4AL, 5AL, I5AL, and 7AL were shown to be positively associated with HTG (all P values <0.05). Aldehydes co-exposure was also positively associated with HTG (OR 1.706, 95%CI 1.299–2.240), with 5AL contributing the highest weight (35.3%). Furthermore, aldehydes co-exposure showed positive associations with ALT, AST, and GGT (all P values <0.05), and all four liver enzymes were positively associated with HTG (all P values <0.05). Mediation analysis revealed that liver enzymes (ALT, AST, and GGT) may mediate the associations of 5AL and 7AL with HTG (all P values <0.05). This study identified a positive association between aldehyde co-exposure and HTG, which may be partially mediated by liver enzymes

Efficacy of Mobile-Based Cognitive Behavioral Therapy on Lowering Low-density Lipoprotein Cholesterol Levels in Patients With Atherosclerotic Cardiovascular Disease: Multicenter, Prospective Randomized Controlled Trial

BackgroundElevated low-density lipoprotein cholesterol (LDL-C) is an established risk factor for atherosclerotic cardiovascular disease (ASCVD). However, low adherence to medication and lifestyle management has limited the benefits of lowering lipid levels. Cognitive behavioral therapy (CBT) has been proposed as a promising solution. ObjectiveThis trial aimed to evaluate the efficacy of mobile-based CBT interventions in lowering LDL-C levels in patients with ASCVD. MethodsThis multicenter, prospective, randomized controlled trial enrolled 300 patients with ASCVD, who were randomly assigned to the mobile-based CBT intervention group and the control group in a ratio of 1:1. The intervention group received CBT for ASCVD lifestyle interventions delivered by WeChat MiniApp: “CBT ASCVD.” The control group only received routine health education during each follow-up. The linear regression and logistic regression analyses were used to determine the effects of a mobile-based CBT intervention on LDL-C, triglyceride, C-reactive protein, the score of General Self-Efficacy Scale (GSE), quality of life index (QL-index), and LDL-C up-to-standard rate (<1.8 mmol/L) at the first, third, and sixth months. ResultsFinally, 296 participants completed the 6-month follow-up (CBT group: n=148; control group: n=148). At baseline, the mean LDL-C level was 2.48 (SD 0.90) mmol/L, and the LDL-C up-to-standard rate (<1.8 mmol/L) was 21.3%. Mobile-based CBT intervention significantly increased the reduction of LDL-C change (%) at the 6-month follow-up (β=–10.026, 95% CI –18.111 to –1.940). In addition, this benefit remained when baseline LDL-C <1.8 mmol/L (β=–24.103, 95% CI –43.110 to –5.095). Logistic regression analysis showed that mobile-based CBT intervention moderately increased the LDL-C up-to-standard rates (<1.8 mmol/L) in the sixth month (odds ratio 1.579, 95% CI 0.994-2.508). For GSE and QL-index, mobile-based CBT intervention significantly increased the change of scores (%) at the 1-, 3-, and 6-month follow-up (all P values <.05). ConclusionsIn patients with ASCVD, mobile-based CBT is effective in reducing LDL-C levels (even for those who already had a standard LDL-C) and can improve self-efficacy and quality of life. Trial RegistrationChinese Clinical Trial Registry ChiCTR2100046775; https://www.chictr.org.cn/showproj.aspx?proj=12714