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Background The role of triglyceride-glucose (TyG) index, an insulin resistance indicator, in glycemic management for diabetic patients with coronary artery disease (CAD) was still unknown. Therefore, we aimed to explore the association between glycemic control and cardiovascular (CV) outcomes in patients with diabetes and CAD according to different TyG index levels. Methods A total of 9996 diabetic patients with angiograph-proven CAD were consecutively recruited from 2017 to 2018 at Fuwai Hospital. Patients were assigned into 3 groups according to TyG index tertiles (T) (T1: <8.895; T2: 8.895-9.400; T3: ≥9.400). According to American Diabetes Association guidelines, controlled glycemia was defined as targeting glycosylated hemoglobin Alc (HbA1c) < 7%. The primary endpoint was CV events including CV death, nonfatal myocardial infarction, and nonfatal stroke. Results During a median 3-year follow-up, 381 (3.8%) CV events occurred. Overall, high TyG index (T3) was associated with increased risk of CV events (hazard ratio [HR]: 1.40; 95% confidence interval [CI]: 1.02–1.94) compared with the lowest TyG index (T1) after multivariable adjustment. Upon stratification by the TyG index, in fully adjusted models, controlled glycemia was associated with reduced risk of CV events in the high TyG index (T3) subgroup (HR: 0.64; 95%CI: 0.42–0.96) but not in the low (T1; HR: 0.79; 95%CI: 0.53–1.16) and moderate (T2; HR: 0.84; 95%CI: 0.56–1.25) TyG index subgroups. Conclusions Controlled glycemia was associated with improved CV outcomes in patients with diabetes and established CAD, especially in those with high TyG index levels. Our study, for the first time, provided valuable information that TyG index could help making risk stratification on the glycemic management in diabetic patients with CAD.

Background Insulin resistance (IR), a hallmark of proceeding diabetes and cardiovascular (CV) disease, has been shown to predict prognosis in patients undergoing percutaneous coronary intervention (PCI). The triglyceride-glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and metabolic score for insulin resistance (METS-IR) have been shown to be simple and reliable non-insulin-based surrogates for IR. However, limited studies have determined the associations between distinct non-insulin-based IR markers and CV outcomes in patients undergoing complex PCI who are at higher risk of CV events after PCI. Therefore, this study aimed to investigate and compare the prognostic value of these markers in patients undergoing complex PCI. Methods This was a descriptive cohort study. From January 2017 to December 2018, a total of 9514 patients undergoing complex PCI at Fuwai Hospital were consecutively enrolled in this study. The 3 IR indices were estimated from the included patients. The primary study endpoint was CV events, defined as a composite of CV death, nonfatal myocardial infarction and nonfatal stroke. Results During a median follow-up of 3.1 years, 324 (3.5%) CV events occurred. Multivariable Cox regression models showed per-unit increase in the TyG index (hazard ratio [HR], 1.42; 95% confidence interval [CI] 1.13–1.77), rather than per-unit elevation in either Ln(TG/HDL-C ratio) (HR, 1.18; 95%CI 0.96–1.45) or METS-IR (HR, 1.00; 95%CI 0.98–1.02), was associated with increased risk of CV events. Meanwhile, adding the TyG index to the original model led to a significant improvement in C-statistics (0.618 vs. 0.627, P < 0.001), NRI (0.12, P = 0.031) and IDI (0.14%, P = 0.003), whereas no significant improvements were observed when adding Ln (TG/HDL-C ratio) or METS-IR (both P > 0.05) to the original model. Conclusions The TyG index, not TG/HDL-C ratio and METS-IR, was positively associated with worse CV outcomes in patients undergoing complex PCI. Our study, for the first time, demonstrated that the TyG index can serve as the suitable non-insulin-based IR marker to help in risk stratification and prognosis in this population.

Background Coronary three-vessel disease (CTVD) accounts for one-third of the overall incidence of coronary artery disease, with heightened mortality rates compared to single-vessel lesions, including common trunk lesions. Dysregulated glucose metabolism exacerbates atherosclerosis and increases cardiovascular risk. The stress hyperglycemia ratio (SHR) is proposed as an indicator of glucose metabolism status but its association with cardiovascular outcomes in CTVD patients undergoing percutaneous coronary intervention (PCI) remains unclear. Methods 10,532 CTVD patients undergoing PCI were consecutively enrolled. SHR was calculated using the formula: admission blood glucose (mmol/L)/[1.59×HbA1c (%)–2.59]. Patients were divided into two groups (SHR Low and SHR High) according to the optimal cutoff value of SHR. Multivariable Cox regression models were used to assess the relationship between SHR and long-term prognosis. The primary endpoint was cardiovascular (CV) events, composing of cardiac death and non-fatal myocardial infarction (MI). Results During the median follow-up time of 3 years, a total of 279 cases (2.6%) of CV events were recorded. Multivariable Cox analyses showed that high SHR was associated with a significantly higher risk of CV events [Hazard Ratio (HR) 1.99, 95% Confidence interval (CI) 1.58–2.52, P  < 0.001). This association remained consistent in patients with (HR 1.50, 95% CI 1.08–2.10, P  = 0.016) and without diabetes (HR 1.97, 95% CI 1.42–2.72, P  < 0.001). Additionally, adding SHR to the base model of traditional risk factors led to a significant improvement in the C-index, net reclassification and integrated discrimination. Conclusions SHR was a significant predictor for adverse CV outcomes in CTVD patients with or without diabetes, which suggested that it could aid in the risk stratification in this particular population regardless of glucose metabolism status.

Background/objectives The hemoglobin glycation index (HGI) has been demonstrated to serve as a substitute for the individual bias in glycosylated hemoglobin A1c (HbA1c). Our objective was to assess the correlation between HGI and cardiovascular (CV) outcomes in patients with diabetes and coronary artery disease (CAD). Subjects/methods We sequentially recruited 11921 patients with diabetes and CAD at Fuwai Hospital. The patients were categorized into five groups based on their HGI quintiles, ranging from Q1 to Q5. The primary endpoint was the occurrence of major adverse cardiac events (MACEs), which included CV death and nonfatal myocardial infarction. Results During the median 3-year follow-up, 327 (2.7%) MACEs were observed. A U-shaped relationship between HGI and 3-year MACEs was demonstrated by restricted cubic spline (RCS) after multivariable adjustment (nonlinear P  = 0.014). The Kaplan-Meier curves demonstrated that the Q2 group had the lowest risk of MACE ( P  = 0.006). When comparing the HGI Q2 group, multivariable Cox regression models showed that both low (Q1) and high (Q4 or Q5) HGI were linked to a higher risk of MACEs (all P  < 0.05). Patients with a low HGI (Q1) had a significantly increased risk of all-cause and CV death, with a 1.70-fold increase in both cases (both P  < 0.05). Conclusions In individuals with diabetes and established CAD, HGI levels were found to have a U-shaped relationship with the occurrence of MACEs over a period of three years. Significantly, those with low HGI had an increased risk of CV death.

Background Aging is intrinsically linked to diabetes pathogenesis, yet evidence gaps persist regarding organ-specific aging and risks of long-term diabetes complications. This study aims to estimate the association between plasma proteomics-based organ-specific aging and risks of long-term diabetes complications. Methods This cohort study quantified biological age gaps (residuals from linear regression of predicted versus chronological age) across 11 organ systems in 1979 baseline diabetes patients based on plasma proteomic profiling (Olink Explore 3072) of 2916 proteins and three validated different aging models. Extreme aging was defined as > 1.5 standard deviation from organ-specific mean age gaps. Multivariable Cox models assessed incident complication risks in 1707 complication-free patients. Results During a median follow-up time of 12.71 years, 356 incident all-cause deaths (20.86%), 348 incident cardiovascular disease (CVD) (20.39%), 227 incident diabetic retinopathy (DR) (13.30%), 88 incident peripheral artery disease (PAD) (5.16%), and 280 incident chronic kidney disease (CKD) (16.40%) occurred. Extreme cardiac aging showed strongest CVD risk association (adjusted HR: 2.92, 95% CI: 2.13, 3.99; P  < 0.001), with significant brain (adjusted HR: 1.43, 95% CI: 1.06, 1.92; P  = 0.019), arterial (adjusted HR: 1.59, 95% CI: 1.06, 2.39; P  = 0.024), and pancreatic (adjusted HR: 1.35, 95% CI: 1.04, 1.77; P  = 0.027) aging associations. Each complication demonstrated distinct organ-aging signatures. The association remains robust and consistent across three distinct aging models. Patients with baseline extreme aging in more than 3 organs faced significantly higher risks of incident diabetes complications compared to those with no or only one to three extremely aged organs. Additive interaction analysis revealed synergistic effects of organ aging on complications risk in diabetes. For example, concurrent heart and muscle aging substantially elevated CVD risk with a relative excess risk due to interaction (RERI) of 3.49 (95% CI: 0.74, 8.16) and an attributable proportion (AP) of 0.58 (95% CI: 0.14, 0.74). Conclusions Proteomics-based organ aging assessment identifies significant complication-specific vulnerability patterns and substantially elevated risks with multiorgan involvement, supporting comprehensive aging evaluation for diabetes risk stratification. These findings require further validation in larger and more diverse populations and warrant more precise characterization of organ-specificity to enhance their robustness and generalizability.

Primary pulmonary lymphoepithelioma-like carcinoma (PPLELC) was a sparse subtype of unclassified lung cancer. The clinicopathologic features, prognostic factors and multimodality treatment regimens of LELC remain inconclusive. We conducted this systematic review and meta-analysis to address this deficit in current knowledge. We searched PubMed, Embase, and Web of Science to filtrate studies investigating on clinical features and prognostic factors of LELC up to Sep 9th, 2020. Fixed and random effect models were generated to present the incorporated hazard ratios (HR) and odds ratios (OR) with 95% confidence intervals (CI). The quality and heterogeneity of the included studies were also evaluated carefully. This systematic review and meta-analysis included 13 retrospective studies with a total of 1294 patients. The incidence of programmed cell death-ligand 1 (PD-L1) expression in PPLELC varied from 63.3% to 75.8%. Positive PD-L1 expression was more likely to be found in patients under 60 years old (OR = 2.16, 95%CI: 1.19-3.89, P = 0.01) and was associated with worse disease-free survival (DFS) compared with negative PD-L1 expression (HR = 2.99, 95%CI: 1.23-7.28, P = 0.02). The pooled results showed that stage was the prognostic factor for both overall survival (OS) and DFS. Moreover, a significantly better outcome of PPLELC was observed in men (HR = 0.56, 95%CI: 0.33-0.95, P = 0.03) and patients who received radiation (HR = 0.46, 95%CI: 0.22-0.96, P = 0.04). PD-L1 expression was high in PPLELC patients. It was significantly associated with age under 60 and the unfavorable DFS. Stage and gender could be the prognostic factor for OS. Radiation could be the effective therapy for PPLELC.

Background Pulmonary sclerosing pneumocytoma is a kind of rare benign pulmonary tumor with potential malignancy. The clinical features, risk factors for prognosis, and optimal treatment have not been identified yet. This study aimed to investigate the clinical features and prognosis of pulmonary sclerosing pneumocytoma. Methods We retrospectively performed a review of pulmonary sclerosing pneumocytoma patients in West China Hospital from 2009 to 2019. The basic characteristics, treatment regimens, operation detail, postoperative variables, and follow-up time were recorded for each case. Differences in features between patients undergoing lobectomy and segmentectomy were compared. We also performed a case review and summarized reported clinical features in former studies. Results Altogether 61 pulmonary sclerosing pneumocytoma patients were retrospectively reviewed. Fifty-six patients were female and 5 were male. The patients’ median age was 51 (23-73). Seven (11.48%) patients had smoking history. Twenty tumors were located in the right lung [upper lobe ( n = 7), middle ( n = 2), and lower ( n = 11)] and 41 in the left [upper ( n = 12) and lower ( n = 29)]. The median tumor size was 2 (0.9-7) cm. Thirty-six (59.02%) patients underwent sublobectomy (segmentectomy or wedge resection) whereas 25 (40.98%) underwent lobectomy. All patients recovered uneventfully, and no perioperative mortality was identified. Sublobectomy showed a trend towards reduced chest tube duration and shorter postoperative hospital stays compared with lobectomy. Conclusions The findings showed good prognosis of pulmonary sclerosing pneumocytoma and proved its benign characteristics. Sublobectomy showed advanced efficacy regarding chest tube duration and postoperative hospital stay compared with lobectomy.

Given the challenges faced during percutaneous coronary intervention (PCI) for heavily calcified lesions, accurately predicting PCI success is crucial for enhancing patient outcomes and optimizing procedural strategies. This study aimed to use machine learning (ML) to identify coronary angiographic vascular characteristics and PCI procedures associated with the immediate procedural success rates of PCI in patients exhibiting moderate to severe coronary artery calcification (MSCAC). This study included patients who underwent PCI between January 2017 and December 2018 in a cardiovascular hospital, comprising 3271 patients with MSCAC and 17,998 with no or mild coronary artery calcification. Six ML models-k-nearest neighbor, gradient boosting decision tree, Extreme Gradient Boosting (XGBoost), logistic regression, random forest, and support vector machine-were developed and validated, with synthetic minority oversampling technique used to address imbalance data. Model performance was compared using multiple parameters, and the optimal algorithm was selected. Model interpretability was facilitated by Shapley Additive Explanations (SHAP), identifying the top 6 coronary angiographic features with the highest SHAP values. The importance of different PCI procedures was also elucidated via SHAP values. Testing validation was performed in a separate cohort of 1437 patients with MSCAC in 2013. External validation was conducted in a general hospital of 204 patients with MSCAC in 2021. Sensitivity analyses were conducted in patients with acute coronary syndrome and chronic coronary syndrome. In the development cohort, 7.6% (n=248) of patients with MSCAC experienced PCI failure compared to 4.3% (n=774) of patients with no or mild coronary artery calcification. The XGBoost model demonstrated superior performance, achieving the highest area under the receiver operator characteristic curve (AUC) of 0.984, average precision (AP) of 0.986, F1-score of 0.970, and G-mean of 0.970. Calibration curves indicated reliable predictive accuracy. The key predictive factors identified included lesion length, minimum lumen diameter, thrombolysis in myocardial infarction flow grade, chronic total occlusion, reference vessel diameter, and diffuse lesion (SHAP value 1.65, 1.40, 0.92, 0.60, 0.54, and 0.47, respectively). The use of modified balloons for calcified lesions had a positive effect on PCI success in patients with MSCAC (SHAP value 0.16). Sensitivity analyses showed consistent model performance across subgroups with similar top 5 coronary angiographic variables. The optimized XGBoost model maintained robust predictive performance in the testing cohort, with an AUC of 0.972, AP of 0.962, and F1-score of 0.940, and in the external validation set, with an AUC of 0.810, AP of 0.957, and F1-score of 0.892. This study successfully revealed the important PCI failure risk factors, such as lesion length and modified balloons, using ML models to help clinicians manage PCI strategies in patients with complex coronary artery disease such as MSCAC.

Objective This study aims to evaluate the relationship between apolipoproteins (ApoA1, ApoB, and the ApoB/A1 ratio) and the incidence of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) and impaired kidney function, assessing their potential role in secondary prevention. Method A prospective cohort of 1,640 patients with impaired kidney function who underwent percutaneous coronary intervention in China was analyzed. Patients were categorized based on the measurements of ApoA1, ApoB, and ApoB/A1 ratio. MACE, defined as a composite of all-cause mortality, cardiovascular death, nonfatal myocardial infarctions, strokes, and unplanned revascularizations, was tracked post-procedure, with statistical analyses including Kaplan–Meier survival curves and Cox regression models to identify associations with apolipoproteins. Subgroup analyses according to kidney function were conducted. Result During a median follow-up of 3.1 years, 324 MACE events were observed. Multivariable Cox regression analyses illustrated higher levels of ApoB and the ApoB/A1 ratio were significantly associated with increased MACE incidence (adjusted HR [95%CI] 1.668[1.044–2.666]; adjusted HR [95%CI] 2.231[1.409–3.533], respectively), while lower ApoA1 levels correlated with a higher risk (adjusted HR [95%CI] 0.505[0.326–0.782]). ROC curve analyses indicated comparable predictive performances to traditional risk factors like LDL cholesterol. Subgroup analysis revealed that the above association was not statistically significant in the moderate-to-severe renal impairment CAD patients (eGFR < 45 mL/min/1.73 m 2 ). Conclusion Our findings illustrate that apolipoproteins, specifically ApoA1 and ApoB, along with their ratio, are significant predictors of major adverse cardiovascular events in CAD patients with impaired kidney function. These results emphasize the need for incorporating apolipoprotein measurements in secondary prevention strategies for this high-risk population.