Predictive value of apolipoprotein for coronary atherosclerosis in asymptomatic non-diabetic population / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the potential correlation between apolipoprotein (Apo) levels and coronary atherosclerosis and investigate its predictive value for coronary artery lesions in asymptomatic population without diabetes.</p><p><b>METHODS</b>We performed a retrospective analysis of data collected from 401 asymptomatic patients who took health check-ups. They were divided into atherosclerosis group (n=224)and control group (n=177) based on the outcome of CT angiography and blood biochemical findings. The risk factors, lipid profiles, and Apo levels were compared between these two groups. The best biochemical indicators for predicting the coronary atherosclerosis were explored.</p><p><b>RESULTS</b>The levels of ApoB, ApoC2,ApoC3,and ApoE and ApoB/ApoA1 ratio were significantly higher in the atherosclerosis group than in the control group (all P<0.01), whereas the ApoA1,ApoA2, and lipoprotein a levels showed no such significant difference (all P>0.05). Logistic regression analysis revealed that age, male, hypertension,ApoC3(OR=1.572,95%CI 1.200-2.061) and ApoB/ApoA1 ratio (OR=1.767,95% CI 1.335-2.338) were independently correlated with coronary atherosclerosis (all P<0.01). In the prediction of the presence of plaque, ApoB had the largest area under curves, and the optimal cutoff point was 1.005 g/L.</p><p><b>CONCLUSIONS</b>ApoC3 is closely associated with subclinical coronary atherosclerosis,while the decrease of ApoA1 level is not obvious during this period. Compared with other lipid indicators, ApoB is the strongest predictor for coronary atherosclerosis in asymptomatic non-diabetic population.</p>

Correlation of creatine kinase with patency of stents using coronary computed tomography angiography / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the potential correlation between creatine kinase and the long-term patency of coronary drug eluting stents.</p><p><b>METHODS</b>The clinical data of 74 patients who had undergone coronary computed tomography angiography after drug eluting stents implantation were retrospecpectively analyzed. Based on the computed tomography angiography findings,these patients were divided into patency group and non-patency group. The mean follow-up time was (20.5 ± 13.1) months. The serum levels of creatine kinase and creatine kinase isoenzyme were measured to determine the relationship of stent patency with these oxidative-related biomarkers after long-term follow-up. The T test or non-parametric test was adopted to compare the intergroup difference of measurement data,whereas chi-square test was conducted to test the difference of enumeration data. Logistic regression was adopted to analyze the biochemical indexes and clinical information. Only variables with a P value of less than 0.05 in the univariable analyses entered the multivariate Logistic regression model.</p><p><b>RESULTS</b>Patients in the non-patency group had significantly higher serum creatine kinase level compared with patients in patency group [(115.5 ± 51.5)U/L vs.(75.9 ± 29.4)U/L, P=0.012] and significantly higher level of creatine kinase isoenzyme [(3.5 ± 5.3)U/L vs.(1.7 ± 1.3)U/L,P=0.034]. Furthermore,the Logistic analysis showed that serum creatine kinase level (odds ratio=1.573,95% CI=1.022-2.421, P=0.039)was an independent predictor of stent patency.</p><p><b>CONCLUSION</b>Creatine kinase is an independent risk factor associated with stent non-patency.</p>

Correlations between pathologic subtypes/immunohistochemical implication and CT characteristics of lung adenocarcinoma ≤ 1 cm with ground-glass opacity / 中国医学科学院学报

<p><b>OBJECTIVE</b>To discuss the correlation of pathologic subtypes and immunohistochemical implication with CT features of lung adenocarcinoma 1 cm or less in diameter with focal ground-glass opacity (fGGO).</p><p><b>METHODS</b>CT appearances of 59 patients who underwent curative resection of lung adenocarcinoma ≤ 1 cm with fGGO were analyzed in terms of lesion location, size, density, shape (round, oval, polygonal, irregular), margin (smooth, lobular, spiculated, lobular and spiculated), bubble-like sign, air bronchogram, pleural tag, and tumor-lung interface. Histopathologic subtypes were classified according to International Association for the Study of Lung Cancer/ American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma. Common molecular markers in immunohistochemical study included human epidermal growth factor receptor (HER)-1,HER-2,Ki-67, vascular endothelial growth factor (VEGF) and DNA topoisomerase 2Α.Patients' age and lesions' size and density were compared with pathologic subtypes using analysis of variance or nonparametric Wilcoxon tests. Patients' gender, lesion location, shape and margin, bubble-like sign, air bronchogram, pleural tag, and tumor-lung interface were compared with histopathologic subtypes and immunohistochemical implication using ψ² test or Fisher's exact test.</p><p><b>RESULTS</b>The patients' gender, age, lesion location, shape, air bronchogram, pleural tag, and tumor-lung interface were not significantly different among different histopathologic subtypes (P=0.194, 0.126, 0.609, 0.678, 0.091, 0.374, and 0.339, respectively), whereas the lesion size,density,bubble-like sign, and margin showed significant differences (P=0.028, 0.002, 0.003, 0.046, respectively). The expression of Ki-67 significantly differed among nodules with different shapes(P=0.015). Statistically significant difference also existed between tumor-lung interface and HER-1 expression (P=0.019) and between bubble sign and HER-2 expression (P=0.049).</p><p><b>CONCLUSIONS</b>Of lung adenocarcinoma ≤ 1 cm with fGGO,bubble-like sign occurs more frequently in invasive pulmonary adenocarcinoma and less frequently in atypical adenomatous hyperplasia. In addition, preinvasive lesions (atypical adenomatous hyperplasia and adenocarcinoma in situ) more frequently demonstrates smooth margin,while invasive lesions (minimally invasive adenocarcinoma and invasive pulmonary adenocarcinoma) more frequently demonstrates lobular and spiculated margin. Some CT features are associated with immunohistochemical implication of lung adenocarcinoma ≤ 1 cm with fGGO.</p>

Value of coronary computed tomography angiography in ruling out coronary artery disease before intermediate- and high-risk non-cardiac surgery / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the value of preoperative coronary computed tomographic angiography (CCTA) in the detection of coronary artery disease (CAD) in patients planned to undergo non-cardiac surgery at intermediate or high risk to avoid unnecessary invasive coronary angiography (ICA).</p><p><b>METHODS</b>The study protocol was approved by our institutional review board and informed consent was given. In this prospective study, 157 consecutive patients who underwent CCTA before undergoing non-cardiac surgery at intermediate or high risk was involved. The non-cardiac surgery included high-risk surgery (17 patients) and intermediate-risk surgery (140 patients). Follow-up was performed in 6-11 months to define cardiac events described as acute coronary syndrome (ACS) or death secondary to ASC, arrhythmias, cardiac revascularization, or cardiac failure. χ(2) test was performed to compare the differences in incidence of cardiac events among patients who had undergone or who had not undergone preoperative ICA.</p><p><b>RESULTS</b>CCTA was of diagnostic value in 145 of 157 patients. Thirty-seven of 145 had no CAD, and 88 of 145 had no significant CAD (<50% stenosis), and non-cardiac surgery was performed in them without preoperative ICA. No patients in those patients had postoperative ischemic events at follow-up; 20 had significant CAD (≥50% stenosis) and underwent surgery after preoperative ICA. CCTA was non-diagnostic in 12 patients who were referred for preoperative ICA, and 4 of 12 underwent surgery after PCI or CABG. There were no differences in cardiac events between patients who had undergone preoperative ICA and those who had not (P=0.45).</p><p><b>CONCLUSIONS</b>In patients with planned non-cardiac surgery at medium or high risk of cardiovascular events, preoperative CCTA is an effective diagnostic tool for detecting CAD. Preoperative ICA can be safely avoided in patients with normal findings or with stenosis<50% in CCTA.</p>