Restenosis of a drug eluting stent on the previous bioresorbable vascular scaffold successfully treated with a drug-coated balloon: A case report

BACKGROUNDThe in-stent restenosis (ISR) rates are reportedly inconsistent despite the increased use of second-generation drug eluting stent (DES). Although bioresorbable vascular scaffold (BVS) have substantial advantages with respect to vascular restoration, the rate of scaffold thrombosis is higher with BVS than with DES. Optimal treatment strategies have not been established for DES-ISR to date.CASE SUMMARYWe report on a case of a 60-year-old man patient with acute coronary syndrome. He had a history of ST-segment elevation myocardial infarction associated with very late scaffold thrombosis and treated with a DES. Coronary angiography revealed significant stenosis, suggesting DES-ISR on the previous BVS. Optical coherence tomography (OCT) identified a plaque rupture and a disrupted scaffold strut in the neointimal proliferation of DES. To treat the DES-ISR on the previous BVS, we opted for a drug-coated balloon (DCB) after a balloon angioplasty using a semi-compliant and non-compliant balloon. The patient did not experience adverse cardiovascular events on using a DCB following the use of intensive dual antiplatelet therapy and statin for 24 mo. CONCLUSIONThis case highlights the importance of OCT as an imaging modality for characterizing the mechanism of target lesion failure. The use of a DCB following the administration of optimal pharmacologic therapy may be an optimal strategy for the treatment and prevention of recurrent BVS thrombosis and DES-ISR.     

直径≤10 mm进展期大肠癌的内镜和临床病理特点

目的：研究直径≤10mm进展期大肠癌的内镜和临床病理特点。方法：总结12例直径≤10mm进展期大肠癌的临床资料，并与直径＞10mm进展期大肠癌的直镜下特点和临床病理作比较。结果：直径≤10mm进展期大肠癌肉眼似Ⅱc 5例，似Ⅱa 3例，似Is 4例。病灶直径6－10mm，侵犯至肌层8例，侵犯至浆膜层4例。内镜下均有黏膜皱襞集中和表面略有凹陷，以及Vs型的腺管开口型的特点。无一例分布在直肠。淋巴结转移率为33％。结论：直径≤10mm进展期大肠癌可能由表面平坦凹陷型发展而来。此类病灶可以通过黏膜皱襞改变和腺管开口类型来进行辨别。     

Interaction analysis between genetic polymorphisms and pharmacodynamic effect in patients treated with adjunctive cilostazol to dual antiplatelet therapy: results of the ACCEL-TRIPLE (Accelerated Platelet Inhibition by Triple Antiplatelet Therapy According to Gene Polymorphism) study

AIMS

Although adjunctive cilostazol to dual antiplatelet therapy can reduce the risks of clinical events after percutaneous coronary intervention (PCI), whether genetic polymorphism can influence the pharmacodynamics of this regimen has not been evaluated.

METHODS

One hundred and twenty-seven patients treated with PCI and taking triple antiplatelet therapy (≥1 month) were enrolled. Platelet reactivity was assessed by conventional aggregometry and the VerifyNow P2Y12 assay. High on-treatment platelet reactivity (HPR) was defined as 5 µm ADP-induced maximal platelet reactivity (Agg_max) >46%. CYP3A5*3, CYP2C19*2/*3 and ABCB1 3435C > T were genotyped.

RESULTS

CYP3A5*3 and ABCB1 3435C > T variants did not affect the antiplatelet effect of triple antiplatelet therapy. For non-carriers, one and two carriers of the CYP2C19 loss-of-function (LOF) allele, Agg_max consecutively increased after the addition of 5 µm[mean (95% confidence intervals): 24.6% (20.8 to 28.5%) vs. 28.7% (25.4 to 32.0%) vs. 32.3% (25.8 to 38.7%), P = 0.062, respectively] and 20 µm ADP [34.2% (29.3 to 39.0%) vs. 41.7% (37.8 to 45.6%) vs. 44.9% (37.9 to 51.9%), P = 0.007, respectively]. Likewise, late platelet reactivity and P2Y12 reaction units proportionally changed according to the number of CYP2C19 LOF alleles. HPRs were observed in 9.2% of subjects: 6.3%, 7.4% and 20.0% with 0, 1 and 2 carriers of CYP2C19 LOF allele(s) (P = 0.099). In multivariate analysis, carriage of two CYP2C19 LOF alleles was a significant predictor for the prevalence of HPR (odds ratio 5.78, 95% CI 1.21, 27.78, P = 0.028).

CONCLUSION

Among PCI-treated patients, the effect of triple antiplatelet therapy is influenced by the CYP2C19 LOF allele. Its clinical benefit needs to be validated according to the CYP2C19 metabolic phenotype in future clinical trials. [Adjunctive Cilostazol Versus High Maintenance dose ClopidogrEL in Acute Myocardial Infarction Patients According to CYP2C19 Polymorphism (ACCEL-AMI-2C19), NCT00915733 and Adjunctive Cilostazol Versus High Maintenance-dose Clopidogrel According to Cytochrome 2C19 Polymorphism (ACCEL-2C19), NCT01012193].     

湿疹患者食物过敏原特异性IgG检测及意义

目的探讨湿疹患者血清14种食物过敏原的特异性IgG抗体水平。方法采用酶联免疫吸附（ELISA）检测患者200例。结果湿疹患者血清食物过敏原特异性IgG抗体不同程度的增高,阳性率依次为：蛋清／蛋黄（51％）〉蟹（47％）〉牛奶（35％）〉虾（33．5％）〉鳕鱼（19．5％）〉大豆（18％）〉鸡肉（6％）〉西红柿（5．5％）〉蘑菇（4．5％）〉玉米（4％）〉小麦（2．5％）〉大米（2．5％）〉牛肉（1％）〉猪肉（0．5％）。结论血清食物过敏原检测可及时发现湿疹患者对哪些食物过敏,并及早将这些食物从患者食谱中排除,此为降低湿疹患者食物过敏患病率和减轻相关症状的重要措施之一。     

妇幼保健机构综合绩效评价指标体系构建

目的 探索构建妇幼保健机构综合绩效评价指标体系,为妇幼保健机构绩效管理提供思路和依据.方法 采用文献回顾、专家论证法、Delphi专家咨询法、离散趋势法、相关分析法、主成分分析与因子分析法和聚类分析法等建立指标体系,采用专家评分法和CRITIC法主客观权衡计算指标权重系数,并对指标体系的一致性信度及内部结构效度进行检验.结果 根据绩效评价指标体系框架,设定医疗保健工作质量、医疗保健工作效率、公共卫生服务质量和效率、社会效益、经济效益、发展潜力6大类一级指标.结论 通过科学研究,可以建立一套科学合理的适用于我国不同级别妇幼保健机构的综合绩效评价指标体系.     

Retinal nerve fiber layer thickness is associated with brain MRI outcomes in multiple sclerosis

The clinical significance of white matter changes including periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) on MRI in patients with normal pressure hydrocephalus is unclear. We investigated the correlation between ventricular size and white matter changes in healthy individuals. We performed MRI in 683 (mean age 59; 55% men) neurologically normal adults without a history or radiological findings of brain disease or trauma, who were undergoing brain health screening. The correlation between Evans' index and severity of white matter changes was analyzed. Multiple linear regression analysis was used to identify the main clinical factors influencing ventricular enlargement and white matter changes. Evans' index was 0.248 ± 0.026 (mean ± SD). Incidence of PVH was 40% and DWMH was 29%. Evans' index was weakly correlated with PVH grading (ρ = 0.24; P < .01) and DWMH grading (ρ = 0.24; P < .01). Multiple linear regression analysis showed that age (β = 0.034; SE = 0.003) diastolic blood pressure (0.004; 0.002), Evans' index (0.019; 0.009), and a history of hypertension (0.173; 0.053) had a significant impact on PVH grade, whereas age (0.030; 0.003) and history of hypertension (0.224; 0.049) were related to DWMH grade. It was suggested that there is an independent correlation between ventricular enlargement and PVH in normal adults. This finding in a normal population could be due to the presence of preclinical disease, but its bearing on the changes that occur in normal pressure hydrocephalus remain uncertain at the present time.     

The AGH score is a predictor of disease-free survival and targeted therapy efficacy after liver transplantation in patients with hepatocellular carcinoma

Background: Liver transplantation(LT) is the “cure” therapy for patients with hepatocellular carcinoma(HCC). However, some patients encounter HCC recurrence after LT. Unfortunately, there is no effective methods to identify the LT patients who have high risk of HCC recurrence and would benefit from adjuvant targeted therapy. The present study aimed to establish a scoring system to predict HCC recurrence of HCC patients after LT among the Chinese population, and to evaluate whether these patients...     

Isolated Benign Primary Cutaneous Plasmacytosis in a Child

Isolated benign primary cutaneous plasmacytosis in a child is a very rare and benign disease. Herein we present a case of this condition occurring in a child who showed good response to topical corticosteroid.