Dongze Li

Lipoprotein-associated phospholipase A2 in coronary heart disease: Review and meta-analysis

BACKGROUND Risk associations between lipoprotein-associated phospholipase A2 (Lp-PLA2) and adverse outcomes in patients with coronary heart disease (CHD) remain unclear. The aim of the meta-analysis was to investigate the association between Lp-PLA2 and prognosis of CHD. METHODS PubMed and Embase were examined for prospective studies published before June 2016. Multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of adverse outcomes according to Lp-PLA2 activity or mass were extracted, pooled, and weighted using generic inverse-variance and random-effect modeling. RESULTS Fifteen studies with 30,857 participants were included. Overall, higher Lp-PLA2 activity or mass was not significantly related to increased risk of long-term all-cause mortality. However, higher Lp-PLA2 activity or mass was independently associated with an increased risk of long-term cardiovascular events, with pooled HR for cardiovascular events of 1.55 (95% CI, 1.08-2.23; P=0.018) and 1.62 (95% CI, 1.09-2.41; P=0.017), respectively. The prognostic value of Lp-PLA2 in predicting cardiovascular events was observed in patients with stable CHD who were not receiving therapies for inhibiting Lp-PLA2. CONCLUSIONS Greater Lp-PLA2 activity or mass was independently associated with cardiovascular events in patients with CHD, particularly in patients with stable CHD who were not receiving therapies for inhibiting Lp-PLA2.

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

Background The long‐term association between the status of the false lumen and poor patient outcomes in acute aortic dissection (AAD) remains unclear. This systematic review and meta‐analysis investigated whether the status of the false lumen was a predictor of poor long‐term survival in AAD. Methods and Results Eleven cohort studies (2924 participants) exploring the association between the false lumen status and long‐term outcomes (>1 year) in AAD were included. All studies reported multivariate‐adjusted hazard ratios (HRs) with 95% CIs for long‐term outcomes, according to false lumen status. Pooled HRs for mortality and aortic events were computed and weighted using generic inverse‐variance and random‐effect modeling. Residual patent false lumen was an independent predictor of long‐term mortality in AAD type A (HR, 1.71; 95% CI, 1.16–2.52; P=0.007) and type B (HR, 2.79; 95% CI, 1.80–4.32; P<0.001). AAD patients with residual patent false lumen exhibited an increased risk of aortic events (HR, 5.43; 95% CI, 2.95–9.99; P<0.001). Partial false lumen thrombosis was independently associated with long‐term mortality in type B AAD (HR, 2.24; 95% CI, 1.37–3.65; P=0.001). This association was not observed in AAD type A patients (HR, 1.75; 95% CI, 0.88–3.45; P=0.211). Conclusions The false lumen status influences late outcomes in AAD. Residual patent false lumen is independently associated with poor long‐term survival in AAD. However, only type B AAD patients with partial false lumen thrombosis had an increased late mortality risk.

Atrial Fibrillation is Associated With Poor Outcomes in Thrombolyzed Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

AbstractThe influence of atrial fibrillation (AF) on the clinical outcomes of patients with ischemic stroke (IS) has not been completely determined. We aimed to perform a systematic review and meta-analysis to assess the relationship between AF and adverse events in patients with acute IS treated with thrombolysis.PubMed, EMBASE, and the Cochrane Library were searched for relevant studies regarding the association between AF and the outcomes of patients with IS treated with thrombolysis. Random and fixed effect models were used for pooling data.Twelve cohort studies involving 14,801 patients with acute IS were included. Meta-analysis revealed that patients with AF were more likely to die within 90 days after thrombolysis (odds ratio [OR], 2.13; 95% confidence interval [CI]: 1.68–2.70, P < 0.001), whereas this association was not observed in hospitalized patients (OR, 1.50; 95% CI, 0.86–2.60; P = 0.150). AF was associated with a reduced incidence of favorable outcomes (modified Rankin Scale ⩽ 2) (OR, 1.95; 95% CI: 1.33–2.85, P = 0.001) and an increased risk of symptomatic intracerebral hemorrhage (OR, 1.28; 95% CI: 1.08–1.52, P = 0.006). No evident publication bias was found by Beggs test or Eggers test.Comorbidity of AF may increase the risk of adverse outcomes for patients with IS undergoing thrombolysis. Further well-designed trials are warranted to confirm this association.

Hypoalbuminemia predicts clinical outcome in patients with type B acute aortic dissection after endovascular therapy

BACKGROUND Few studies have reported that serum albumin (SA) levels on admission were associated with increased risk of long-term outcomes in patients with type B acute aortic dissection (AAD). The aim of this study was to investigate the effect of admission levels of SA on survival among patients with type B AAD undergoing endovascular therapy (EVT). METHODS A total of 131 patients with type B AAD undergoing EVT were retrospectively enrolled and followed up for 2.1years. They were divided into hypoalbuminemia and nonhypoalbuminemia groups. We analyzed the incidence of inhospital complications and long-term mortality. Kaplan-Meier curves and multivariable Cox regression analyses were used to investigate the associations between SA levels and survival. RESULTS Among 131 type B AAD patients, hypoalbuminemia was detected in 61 (46.6%) at admission. Compared to those without hypoalbuminemia, patients with hypoalbuminemia did not have higher inhospital complications; however, Kaplan-Meier analysis showed that they did have a significantly lower survival rate (73.8% vs 92.5%; log-rank χ(2)=9.8; P=.002). Multivariable Cox regression analysis further revealed that hypoalbuminemia was an independent predictor of long-term mortality among patients with type B AAD (hazard ratio, 4.28; 95% confidence interval, 1.36-13.47; P=.013), over 2.1years. CONCLUSIONS Hypoalbuminemia is common in type B AAD patients and is independently associated with increased risk of long-term death. Renal dysfunction may be the main pathophysiological mechanism underlying hypoalbuminemia in patients with type B AAD.

Lipoprotein-associated phospholipase A2 and risks of coronary heart disease and ischemic stroke in the general population: A systematic review and meta-analysis

BACKGROUND This study investigated the associations between lipoprotein-associated phospholipase A2 (Lp-PLA2) and the risks of coronary heart disease (CHD) and ischemic stroke (IS) in the general population. METHODS PubMed, Embase, and the Cochrane Library databases were searched for prospective cohort studies published prior to June 2016. Multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for CHD and IS risks according to Lp-PLA2 activity or mass were extracted, pooled, and weighted using random-effects modeling. RESULTS Twelve studies examining Lp-PLA2 activity or mass and long-term risks of CHD and IS were included. Combined HRs for CHD and IS risks for the highest category referring to lowest category of Lp-PLA2 were 1.46 (95% CI: 1.20-1.78, P<0.001) and 1.58 (95% CI: 1.21-2.07, P=0.001), respectively. The same patterns were observed for both mass and activity, with the exception of those for CHD. For every 1-standard deviation (SD) increase in Lp-PLA2 activity, CHD risk increased by 12% (HR: 1.12, 95% CI: 1.05-1.22, P=0.002); no association between 1-SD increases in Lp-PLA2 activity and IS was observed. Lp-PLA2 mass was associated with CHD risk (HR: 1.02-1.24, 95% CI: 1.02-1.24, P=0.021). Lp-PLA2 mass per 1-SD increase was not associated with IS risk. CONCLUSIONS Greater Lp-PLA2 activity or mass was associated with an increased risk of CHD and IS; however, additional well-designed trials are warranted to confirm this association.

Association of platelet to lymphocyte ratio and risk of in-hospital mortality in patients with type B acute aortic dissection

To the Editor, Type B acute aortic dissection (AAD) is a vascular emergency associatedwith high rates of earlymorbidity andmortality [1]. Therefore, predictive tools for identification of patients with type B AADwho are at an increased risk of mortality are valuable for both risk stratification and guiding treatment in the acute phase. Several risk factors have been associated with the prognosis of AAD, including older age, hypertension, hypoalbuminaemia, and partial false lumen thrombosis [2-4]. However, such risk factors are time-consuming tomeasure, or are unable to assess the full nature and severity of AAD. Recently, accumulating evidence has demonstrated that an elevated platelet to lymphocyte ratio (PLR) is positively associated with the development of hypertension, stroke, and acutemyocardial infarction (AMI) [5]. However, the prognostic capacity of PLR on admission is yet to be clarified in patients with type B AAD. We retrospectively enrolled 491 patients with type B AAD between January 2013 and September 2015 from West China Hospital, Sichuan University. The study endpoint was in-hospital all-cause mortality. Baseline characteristics, admission laboratory examination, echocardiography, treatment, and in-hospital clinical outcomes were collected. To be included in the study, patients required type B AAD. The exclusion criteria included malignancy, infectious diseases, hypersplenism, and a history of chronic hepatopathy or chronic renal disease. Platelet and lymphocyte counts were analysed with an automated haematology analysis system (LH750, Beckman Coulter Inc., Brea, CA, USA).

Significance of the thrombo-inflammatory status-based novel prognostic score as a useful predictor for in-hospital mortality of patients with type B acute aortic dissection

Background Inflammation and thrombosis are associated with development and progression of acute aortic dissection (AAD). The aim of this study was to assess the prognostic significance of Simplified Thrombo-Inflammatory Prognostic Score (sTIPS), in patients with early phase type B AAD. Methods We retrospectively reviewed 491 patients with type B AAD between November 2012 and September 2015. sTIPS was calculated from the white blood cell count (WBC) and mean platelet volume to platelet count (MPV/PC) ratio, at the time of admission. Patients with both, WBC > 10 (109/L) and MPV/PC ratio > 7.5 (102fL/109L-1) were assigned a score of 2, while patients with high levels of either one or none of the above markers, were assigned scores of 1 and 0 respectively. Multivariable Cox regression analyses were used to investigate the associations between the score and hospital survival. Results Of the 491 type B AAD patients included in this analysis, 24 patients (4.9%) died during hospitalization. Kaplan-Meier analysis revealed that the cumulative mortality was significantly higher in patients with higher sTIPS (P = 0.001). Multivariable Cox regression analysis further indicated that higher sTIPS was a strong predictor of in-hospital mortality after eliminating all confounding factors (sTIPS 2: hazard ratio 4.704, 95%; confidence interval [CI] 1.184-18.685; P = 0.028; sTIPS 1: hazard ratio 1.918, 95%; CI 1.134-3.537; P = 0.045). Conclusions sTIPS at admission was a useful tool for stratifying the risk in type B AAD patients, for outcomes such as in-hospital mortality in the early phase.BACKGROUND Inflammation and thrombosis are associated with development and progression of acute aortic dissection (AAD). The aim of this study was to assess the prognostic significance of Simplified Thrombo-Inflammatory Prognostic Score (sTIPS), in patients with early phase type B AAD. METHODS We retrospectively reviewed 491 patients with type B AAD between November 2012 and September 2015. sTIPS was calculated from the white blood cell count (WBC) and mean platelet volume to platelet count (MPV/PC) ratio, at the time of admission. Patients with both, WBC > 10 (109/L) and MPV/PC ratio > 7.5 (102fL/109L-1) were assigned a score of 2, while patients with high levels of either one or none of the above markers, were assigned scores of 1 and 0 respectively. Multivariable Cox regression analyses were used to investigate the associations between the score and hospital survival. RESULTS Of the 491 type B AAD patients included in this analysis, 24 patients (4.9%) died during hospitalization. Kaplan-Meier analysis revealed that the cumulative mortality was significantly higher in patients with higher sTIPS (P = 0.001). Multivariable Cox regression analysis further indicated that higher sTIPS was a strong predictor of in-hospital mortality after eliminating all confounding factors (sTIPS 2: hazard ratio 4.704, 95%; confidence interval [CI] 1.184-18.685; P = 0.028; sTIPS 1: hazard ratio 1.918, 95%; CI 1.134-3.537; P = 0.045). CONCLUSIONS sTIPS at admission was a useful tool for stratifying the risk in type B AAD patients, for outcomes such as in-hospital mortality in the early phase.

Synthesis and bio-applications of targeted magnetic-fluorescent composite nanoparticles

Magnetic-fluorescent nanoparticles have a tremendous potential in biology. As the benefits of these materials gained recognition, increasing attention has been given to the conjugation of magnetic-fluorescent nanoparticles with targeting ligands. The magnetic and fluorescent properties of nanoparticles offer several functionalities, including imaging, separation, and visualization, while the presence of a targeting ligand allows for selective cell and tissue targeting. In this review, methods for the synthesis of targeted magnetic-fluorescent nanoparticles are explored, and recent applications of these nanocomposites to the detection and separation of biomolecules, fluorescent and magnetic resonance imaging, and cancer diagnosis and treatment will be summarized. As these materials are further optimized, targeted magnetic-fluorescent nanoparticles hold great promise for the diagnosis and treatment of some diseases.

Letter by Du et al Regarding Article, "Neutrophil-to-Lymphocyte Ratio Predicts the Outcome of Acute Intracerebral Hemorrhage".

With great interest and appreciation, we have read the article by Lattanzi et al1 The study revealed higher neutrophils, lower lymphocytes, and a higher neutrophil:lymphocyte ratio (NLR) predicted worse 3-month outcome after intracerebral hemorrhage (ICH) and could aid in the risk stratification of patients with acute ICH. However, results from the study should be interpreted with the following considerations. First, this is a retrospective cohort study conducted in a single hospital with limited sample size that has relatively low statistical powers. Some other diseases, such as neoplasm, autoimmune disease, infectious disease, systemic inflammatory disease, or surgery having an effect on NLRs were not excluded in this study. The general limitation of …

Evaluation of a novel prognostic score based on thrombosis and inflammation in patients with sepsis: a retrospective cohort study

Abstract Background: Inflammation and thrombosis are involved in the development and progression of sepsis. A novel thrombo-inflammatory prognostic score (TIPS), based on both an inflammatory and a thrombus biomarker, was assessed for its ability to predict adverse outcomes of sepsis patients in the emergency department (ED). Methods: This was a retrospective cohort study of sepsis patients. TIPS (range: 0–2) was predictive of adverse outcomes. Multivariable logistic regression analyses were performed to investigate the associations between TIPS and 28-day adverse outcomes. The study end points were mortality, mechanical ventilation (MV), consciousness disorder (CD) and admission to the intensive care unit (AICU). Results: In total, 821 sepsis patients were enrolled; 173 patients died within the 28-day follow-up period. Procalcitonin and D-dimer values were used to calculate TIPS because they had the best performance in the prediction of 28-day mortality by receiver operating characteristic curves. The 28-day mortality and the incidence of MV, CD and AICU were significantly higher in patients with higher TIPS. Multivariable logistic regression analysis indicated TIPS was an independent predictor of 28-day mortality, MV and AICU. TIPS performed better than other prognostic scores, including quick sequential organ failure assessment, Modified Early Warning Score and Mortality in Emergency Department Sepsis Score for predicting 28-day mortality, and similar to the Acute Physiology and Chronic Health Evaluation II, but inferior to sequential organ failure assessment. Conclusions: TIPS is useful for stratifying the risk of adverse clinical outcomes in sepsis patients shortly after admission to the ED.