Progression Of Lesions In Patients Research Articles

Clinical prediction factors of nonchronic total occlusion lesion progression in patients with unstable angina receiving percutaneous coronary intervention for chronic total occlusion lesions

BackgroundIn this study, we investigated clinical prediction factors of nonchronic total occlusion lesion (NCTOL) progression in patients who underwent percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions. MethodsIn total, 450 patients with unstable angina (mean age = 57.1 ± 9.2 years) who underwent PCI for CTO lesions between January 2016 and December 2018 at Beijing Anzhen Hospital were enrolled in this study. A clinical and angiographic follow-up examination was performed 12 months postoperatively. The patients were divided into NCTOL progression (145 cases) and control (305 cases) groups based on the outcome of the 12-month angiographic follow-up. The clinical and angiographic features of the participants were analyzed. ResultsThe adenosine diphosphate-induced platelet aggregation (ADP-IPA) rate and levels of lipoprotein (a) (Lp(a)) in the NCTOL progression group were significantly higher than those in the control group (51.89 ± 14.81 vs. 39.63 ± 17.12, P < 0.01; 0.22 ± 0.26 vs. 0.14 ± 0.18, P < 0.05, respectively). Logistic regression showed that the ADP-IPA rate (odds ratio = 1.047, 95 % confidence interval: 1.014–1.082, P = 0.005) and Lp(a) (odds ratio = 11.972, 95 % confidence interval: 1.230–116.570, P = 0.033) were independent predictors of NCTOL progression. Partial correlation analysis demonstrated that the ADP-IPA rate was positively correlated with NCTOL progression (r = 0. 351, P < 0.001). Receiver operating characteristic curve showed that the boundary point of the ADP-IPA rate to predict NCTOL progression was 30 % (sensitivity, 86.2 %; specificity, 68.9 %). ConclusionsNCTOL progression is an important cause of recurrent PCI in patients with coronary artery disease after PCI for CTO lesions. The ADP-IPA rate is a useful predictor for NCTOL progression in patients with unstable angina who undergo PCI for CTO lesions.

Analysis of natural regression and influencing factors of HSIL in the cervix of childbearing age patients

Objective: To investigate the natural regression and related factors of high-grade squamous intraepithelial lesion (HSIL) in the cervix of childbearing age women, and to evaluate the applicability of conservative management for future fertility needs. Methods: This study included 275 patients of reproductive age with fertility needs, who were diagnosed as HSIL by biopsy from April 30, 2015 to April 30, 2022, including 229 cases (83.3%) cervical intraepithelial neoplasia (CIN) Ⅱ and 46 cases (16.7%) CIN Ⅱ-Ⅲ. They were followed-up without immediate surgery in the First Affiliated Hospital of Nanjing Medical University. The median follow-up time was 12 months (range: 3-66 months). The regression, persistence and progression of lesions in patients with HSIL were analyzed during the follow-up period, the influencing factors related to regression and the time of regression were analyzed. Results: (1) Of the 275 HSIL patients, 213 cases (77.5%, 213/275) experienced regression of the lesion during the follow-up period. In 229 CIN Ⅱ patients, 180 cases (78.6%) regressed, 21 cases (9.2%) persisted, and 28 cases (12.2%) progressed. In 46 CIN Ⅱ-Ⅲ patients, 33 cases (71.7%) regressed, 12 cases (26.1%) persisted, and 1 case (2.2%) progressed to invasive squamous cell carcinoma stage Ⅰ a1. There was no significant difference in the regression rate between the two groups (χ2=1.03, P=0.309). (2) The average age at diagnosis, age <25 years old at diagnosis were independent influencing factor of HSIL regression in univariate analysis (all P<0.05). There was no significant difference between HSIL regression and pathological grading, the severity of screening results, human papillomavirus (HPV) genotype, colposcopy image characteristics, number of biopsies during follow-up and pregnancy experience (all P>0.05). (3) The median regression times for patients aged ≥25 years and <25 years at diagnosis were 15 and 12 months, respectively. Kaplan-Meier analysis showed that age ≥25 years at diagnosis significantly increased the median regression time compared to <25 years (χ2=6.02, P=0.014). Conclusions: For HSIL patients of childbearing age, conservative management without immediate surgical intervention is preferred if CINⅡ is fully evaluated through colposcopy examination. Age ≥25 years at diagnosis is a risk factor affecting the prognosis of HSIL patients.

Predictors of Inappropriately Rapid Coronary Lesion Progression in Patients Undergoing Percutaneous Coronary Interventions

BackgroundPatients undergoing percutaneous coronary intervention (PCI) may experience rapid atherosclerotic plaque progression in nontreated vessels that is unlikely to result from natural de novo atherosclerosis. We hypothesize that intra-lesion bleeding plays a central role in this process. The aim of this study is to investigate the factors that may contribute to accelerated narrowing in coronary diameter. MethodsWe reviewed 65 interventional procedures and their consequent staged PCIs and mapped the coronary tree into 16 segments (as divided by the American Heart Association), grading the percentage of stenosis in each segment and spotting the rapidly progressing lesions. Demographic, procedural, and laboratory data were recorded and analyzed. ResultsFor the lesions that progressed rapidly in the time period between angiographies, the administration of eptifibatide intra-procedurally was associated with rapid progression of coronary lesions. Moreover, an increased white blood cell count prior to the index procedure was also associated with a trend toward rapid plaque progression. ConclusionsIn this hypothesis-generating study, treatment with a IIb/IIIa inhibitor in the index PCI was associated with an accelerated short-term progression of some of the nontreated lesions, suggesting that this mode of anti-aggregation therapy could facilitate plaque hemorrhage and consequent acceleration of coronary atherosclerosis in eroded plaques.

The clinical prediction factors for non-culprit lesion progression in patients with acute ST elevation myocardial infarction after primary percutaneous coronary intervention

BackgroundTo investigate the relationship between the clinical features and progression of non-culprit lesions in patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI).MethodsA total of 480 patients (57.1 ± 9.2 y) with STEMI who underwent PPCI between January 2016 and December 2017 in Beijing Anzhen Hospital were enrolled in this study. All patients underwent PPCI as a treatment for culprit lesions. Clinical and angiographic follow-up were performed for 12 months. All patients were divided into a non-culprit lesions (NCL) progression group (205 cases) and a control group (275 cases) based on angiographic follow-up outcomes at 12 months. The clinical and angiographic features were analyzed.ResultsBody mass index (BMI), serum creatinine (Scr), fasting blood glucose (FBG), glycated serum albumin, glycated hemoglobin and homocysteine levels in the NCL progression group were significantly higher than those in the control group (P < 0.05). A logistic regression analysis showed that FBG (odds ratio 1.274, 95% confidence interval 1.077–1.505, P = 0.005) and Scr (odds ratio 1.020, 95% confidence interval 1.002–1.038, P = 0.027) were independent predictors of NCL progression. A partial correlation analysis showed that FBG was positively correlated with NCL progression (r = 0.231, P = 0.001). A receiver operating characteristic curve showed that the boundary point of FBG to predict NCL progression was 5.715 mmol/L, and the sensitivity was 74.4% and the specificity was 46.4%.ConclusionFBG is a valuable predictor for NCL progression in patients with STEMI after PPCI.

Automated Registration and Color Labeling of Serial 3D Double Inversion Recovery MR Imaging for Detection of Lesion Progression in Multiple Sclerosis.

Automated co-registration and subtraction techniques have been shown to be useful in the assessment of longitudinal changes in multiple sclerosis (MS) lesion burden, but the majority depend on T2-fluid-attenuated inversion recovery sequences. We aimed to investigate the use of a novel automated temporal color complement imaging (CCI) map overlapped on 3D double inversion recovery (DIR), and to assess its diagnostic performance for detecting disease progression in patients with multiple sclerosis (MS) as compared to standard review of serial 3D DIR images. We developed a fully automated system that co-registers and compares baseline to follow-up 3D DIR images and outputs a pseudo-color RGB map in which red pixels indicate increased intensity values in the follow-up image (i.e., progression; new/enlarging lesion), blue-green pixels represent decreased intensity values (i.e., disappearing/shrinking lesion), and gray-scale pixels reflect unchanged intensity values. Three neuroradiologists blinded to clinical information independently reviewed each patient using standard DIR images alone and using CCI maps based on DIR images at two separate exams. Seventy-six follow-up examinations from 60 consecutive MS patients who underwent standard 3T MR brain MS protocol that included 3D DIR were included. Median cohort age was 38.5years, with 46 women, 59 relapsing-remitting type MS, and median follow-up interval of 250days (interquartile range: 196-394days). Lesion progression was detected in 67.1% of cases using CCI review versus 22.4% using standard review, with a total of 182 new or enlarged lesions using CCI review versus 28 using standard review. There was a statistically significant difference between the two methods in the rate of all progressive lesions (P < 0.001, McNemar's test) as well as cortical progressive lesions (P < 0.001). Automated CCI maps using co-registered serial 3D DIR, compared to standard review of 3D DIR alone, increased detection rate of MS lesion progression in patients undergoing clinical brain MRI exam.

Association between Carotid Intraplaque Neovascularization Detected by Contrast-Enhanced Ultrasound and the Progression of Coronary Lesions in Patients Undergoing Percutaneous Coronary Intervention

It is thought that the progression of vulnerable plaque is due in part to neovascularization, and plaque vulnerability is a useful approach for classifying cardiovascular risk. The aim of this retrospective study was to evaluate the correlation between carotid intraplaque neovascularization (IPN) detected on contrast-enhanced ultrasound and the progression of coronary lesions in patients undergoing percutaneous coronary intervention (PCI). Contrast-enhanced ultrasound and angiography were performed in 131 patients undergoing PCI. All patients had angiograms obtained ≥12months after PCI, and progression was defined using those angiograms. On the basis of angiographic images, patients were divided into progression and nonprogression groups. IPN was graded from 0 to 3 according to each plaque's microbubble appearance and extent, detected using contrast-enhanced ultrasound. The plaque with the highest IPN was used for analysis. Logistic regression and receiver operating characteristic analyses were applied to evaluate risk factors for predicting the progression of coronary lesions in patients undergoing PCI. In the progression group, the numbers of patients with IPN values of 0, 1, 2, and 3 were one (3.3%), nine (30.0%), 16 (53.3%), and four (13.3%), respectively. Significant differences were found in maximum plaque height and IPN between groups. IPN and maximum plaque height were independent risk contributors to coronary lesion progression in patients undergoing PCI. The sensitivity, specificity, positive predictive value, and negative predictive value of IPN of 1.5 and to predict the progression of coronary lesions were 67%, 91%, 68%, and 89%, respectively. The area under the curve was 0.822. Carotid plaque neovascularization was correlated with the progression of coronary lesions in patients undergoing PCI. IPN is a clinically useful tool for detecting the progression of coronary lesions and for risk stratification, especially in patients >60years old.

MO1025: Periostin as a Potential Biomarker of Renal and Arterial Damage in Children with Tuberous Sclerosis Complex

Abstract BACKGROUND AND AIMS Experimental data suggest that periostin is involved in the formation of renal cysts. Tuberous sclerosis complex (TSC) is a multisystem genetic disease characterized by the formation of lesions in virtually all organs, including the kidney—most commonly angiomyolipomas (AML) and cysts. There are no reliable markers of progression of renal lesions in patients with TSC. The study aimed to evaluate serum periostin levels in children with TSC and to assess the usefulness of periostin as a marker of renal lesion severity and arterial damage in this group of patients. METHOD In a group of 35 children with TSC (mean age 8.46 ± 5.64 years, 17 boys, 18 girls), serum periostin levels (ng/mL), anthropometric parameters, renal changes (by ultrasound and magnetic resonance imaging), blood pressure and biochemical parameters were evaluated. The control group consisted of 25 healthy children (mean age 8.72 ± 4.73 years, 14 boys, 11 girls). In addition, central pressure and parameters of arterial structure and function (cIMT, PWV, AIx75HR) were assessed in 20 children with TSC and 17 healthy children (age ≥ 4 years). RESULTS Arterial hypertension was found in two (5.7%) patients; AML was present in 20 (57.1%) children, including 9 (27.3%) atypical AML and 22 (62.8%) had cysts in the kidneys. Children with TSC did not differ in periostin levels compared with healthy children [67.46 ± 35.61 versus 68.14 ± 24.07 (ng/mL), P = .499]. In children with TSC, periostin concentration was negatively correlated with age (r = −0.614, P &amp;lt; .001), height (r = −0.634, P &amp;lt; .001), body weight (r = −0.658, P &amp;lt; .001), maximum cyst size (r = −0.481, P = .004) and office and ABPM systolic and diastolic blood pressure (r = −0.396 to −0.621, P &amp;lt; .050). There was no relationship between periostin levels and AML size or arterial damage parameters. In multivariate analysis, the only determinant of serum periostin levels in children with TSC was age [beta = −0.547, 95% confidence interval (95% CI) (−0.831 to −0.262)]. CONCLUSION The usefulness of serum periostin determination as a marker of renal cystic lesions in children with tuberous sclerosis requires further study.

Determining high risk for squamous intraepithelial lesion progression in patients with recurrent or persistent HPV 16/18 infection: is there a role for biomarkers?

Monitoring of low grade and early treatment of recurrent high grade squamous intraepithelial lesions (HSILs) are the cornerstones of cervical cancer prevention. Although current knowledge provides us with the ability to identify patients at risk for redeveloping HSIL, specifically patients with persistent human papilloma virus (HPV) 16 and 18 infection after conization, the danger of surgical overtreatment of these women with persistent infections remains. Complementary diagnostics encompassing the pathobiology of disease progression need to be evaluated. This perspective presents novel evidence that HPV methylation, c-MYC gene methylation, and co-expression of targeting protein for Xenopus kinesin-like protein and programmed death ligand 1 had a positive predictive value in determining which cervical lesions progress to high grade or spontaneously regress.

Abstract 37: Increased Mean Transit Time and Blood Brain Permeability in Asymptomatic White Matter Lesions of Ischemic Origin

Introduction: White matter lesions of presumed ischemic origin (WMH) have been associated with increased risk of stroke, cognitive and motor decline, and are a subject of public health research. Engineering new MRI pipelines allowing for determination of mean transit time (MTT), and blood brain barrier permeability (BBBP), within WMH lesions is required for long-term population-based studies of lesion progression in patients with dementia and vascular cognitive impairment. Methods: WMH lesion volumes in 24 asymptomatic individuals was determined using an automated segmentation methodology, S3DL, with manual correction to remove false positives. A double contrast injection scheme was used to measure both K trans using dynamic contrast enhanced (DCE) imaging and K 2 using dynamic susceptibility contrast (DSC) imaging which also provided perfusion-related measures. BBBP was measured as k 2 within segmented WMH lesions and compared with normal white and gray matter. Results: The mean transit time (MTT) was found to be significantly prolonged (8.11, p&lt;0.001Wilcoxon Signed-Rank Test) in WMH lesions when compared to normal appearing white and gray matter. There was no significant difference in DCE-K trans (0.018, p=0.351) between the lesions and the white/gray matter. Permeability measured in the WMH lesions using the DSC-K 2 method was increased and was correlated withincreasing total WMH lesion volume (spearman correlation 0.44; p&lt; 0.046). Conclusion: In this first study using an advanced WMH lesion automated segmentation pipeline, we measured DCE and DSC perfusion and permeability variables within WMH lesions and compared them to normal white and grey matter in healthy people. We observed increasing MTT, within WMH lesions as compared to unaffected white and gray matter. Using the DSC-K 2 method, BBBP was higher within WMH lesions in these asymptomatic people, and correlated with increasing total lesion volume.

Factors Predicting Remission and Disease Progression of Pyoderma Gangrenosum Lesions in Patients With Inflammatory Bowel Disease

Factors Predicting Remission and Disease Progression of Pyoderma Gangrenosum Lesions in Patients With Inflammatory Bowel Disease

The Effects of Remineralization via Fluoride Versus Low-Level Laser IR810 and Fluoride Agents on the Mineralization and Microhardness of Bovine Dental Enamel

The objective of this study was to assess the mineralization and microhardness of bovine dental enamel surfaces treated with fluoride, tri-calcium phosphate, and infrared (IR) 810 laser irradiation. The study used 210 bovine incisors, which were divided into six groups (n = 35 in each): Group A: Untreated (control), Group B: Fluoride (Durapath-Colgate), Group C: Fluoride+Tri-calcium phosphate (Clin-Pro White-3 M), Group D: Laser IR 810 (Quantum), Group E: Fluoride+laser, and Group F: Fluoride+tri-calcium phosphate+laser). Mineralization was measured via UV-Vis spectroscopy for phosphorus and via atomic absorption spectroscopy for calcium upon demineralization and remineralization with proven agents. Microhardness (SMH) was measured after enamel remineralization. Mineral loss data showed differences between the groups before and after the mineralizing agents were placed (p &lt; 0.05). Fluoride presented the highest remineralization tendency for both calcium and phosphate, with a Vickers microhardness of 329.8 HV0.1/11 (p &lt; 0.05). It was observed that, if remineralization solution contained fewer minerals, the microhardness surface values were higher (r = −0.268 and −0.208; p &lt; 0.05). This study shows that fluoride has a remineralizing effect compared with calcium triphosphate and laser IR810. This in vitro study imitated the application of different remineralizing agents and showed which one was the most efficient for treating non-cavitated injuries. This can prevent the progression of lesions in patients with white spot lesions.

Hyperhomocysteinemia in patients with chronic kidney disease and its relationship with the functional status of the cardiovascular system

Chronic kidney disease (CKD) is an important medical, social and economic problem nowadays. Patients with CKD are known to have an increased risk of development and progression of cardiovascular diseases. However, the causes and pathogenesis of cardiovascular complications are not well understood. One of the recently recognized “non-traditional” risk factors for the increased development of cardiovascular pathology in severe stages of CKD is hyperhomocysteinemia (HHC). The article presents the results of study of HHC frequency in patients with different stages of CKD as well as the relationship between HHC and endothelial dysfunction and structural-functional status of the heart. The study involved 148 persons with different stages of CKD who underwent immunoenzyme determination of total plasma homocysteine (HC), echocardiography, carotid ultrasonograghy, endothelial function was assessed as well. It was found that among the patients with CKD, 26 (21.1%) had normal and 34 (27.7%) had subnormal HC levels, mild HHC was observed in 30 (24.4%) and moderate HHC – in 33 (26.8%) cases, i.e. the total number of patients with elevated HC level was 88.9%. It should be noted that no patients with normal HC level were found among those with stage four CKD as well as in dialysis patients. The increase of blood plasma HC level was actually proportional to the severity of renal failure, which in its turn led to the shift in the number of cases towards higher rank indices of HHC level. In particular, while there were no patients with HHC among those with CKD-I, more than 50% of such patients were found in the group with CKD-V. Reduced myocardial contractility and echocardiographic markers of left ventricular hypertrophy in patients with CKD were found to be closely associated with HC concentrations in blood plasma. The data presented clearly demonstrate strong inverse correlation between endothelial dysfunction indices and HC level. So, the endothelium-dependent brachial artery vasodilation in patients with CKD-IV was lower by 3.8 and 1.5 times compared with control group and CKD-III group, respectively, and endothelium-independent vasodilation of the brachial artery – by 2.4 and 1.9 times, respectively. Correlation analysis also confirmed that impaired endothelium-dependent and endothelium-independent dilation with high statistical significance inversely correlated with the level of HC in blood plasma. Thus, the population of patients with CKD is characterized by high HHC frequency, which is closely associated with cardiovascular disorders (endothelial dysfunction, structural and functional remodelling of the myocardium) and can be an important risk factor for the development of vascular lesions. We believe that adequate correction of HHC, including administration of folic acid preparations could reduce the progression of vascular lesions in patients with CKD.

The treatment of vertebral metastases from renal cell carcinoma: a retrospective study.

Renal cell carcinoma (RCC) is among the ten most common cancers in both men and women. It comprises 2-3% of all malignancies. The most common site for metastasis from RCC is the lung (50% of patients), followed by the skeleton (20% to 50% of patients). We retrospectively reviewed our consecutive series of 63 patients surgically treated for spinal metastases from RCC. The surgical treatment for spinal metastases varied in each patient. Factors influencing the choice of surgery included age, disease status, symptoms, morbidity of the patient, the location, the number of repetitive lesions and the existence of extra-osseous metastases. For 42 patients (66.66%) the treatment included radiation two weeks after the surgical procedure. A total of 68 surgical procedures were performed in 63 patients. For all patients we collected data about type of RCC, locations of metastasis, type of spine metastasis, type of surgery and complications. In this way we had an exahustive vision of the natural history of this kind of patients. Spine metastatic RCC has a poor prognosis. The favorable prognostic factor is solitary spinal metastasis without involvement of visceral organs where the gold standard treatment is corpectomy en bloc. The negative prognostic factors are the presence of one or more pathological fractures and neurological deficits. Bisphosphonate as zoledronic acid reduce significantly skeletal morbidity and significantly prolong time to bone lesion progression in patients with spine metastases from renal cell carcinoma.

Early lesion-specific 18F-FDG PET response to chemotherapy predicts time to lesion progression in locally advanced non-small cell lung cancer

Background and purposeWe hypothesize that the lesion-to-lesion variability in FDG-PET response after one cycle of chemotherapy for NSCLC in an individual patient may inform radiation dose redistribution. To test this hypothesis, we investigate if time to lesion-progression in patients with multiple lesions is dependent on lesion-specific response to chemotherapy. Materials and methodsWe analyzed 81 patients with 184 lesions referred to curative chemo-radiotherapy for NSCLC 2010–2012. 18F-FDG PET scans were performed at diagnosis and after one series of chemotherapy. Response of each lesion was assessed as the change in FDG peak standardized uptake value. Variance of lesion response was compared within and between patients. Time to progression for each lesion was analyzed using the Kaplan–Meier method and the Cox proportional hazards model. ResultsWithin-patient variability in lesion responses was of the same magnitude as the between-patient variability. Lesion-specific time to progression was longer in lesions with a better response (log-rank p=0.038). Nodal lesions had a much lower risk of progression than T-site lesions (HR=0.09, p<0.0001). ConclusionsRecording an overall patient response involves a loss of biological information on heterogeneity between lesions. Poor lesion-specific response after one cycle chemotherapy may identify lesions that would benefit from an individualized radiotherapy strategy.

GW26-e3990 Lipoprotein-associated phospholipase A2 and Multi-vessel Disease Predict the Progression of Nonculprit Lesions in Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention

GW26-e3990 Lipoprotein-associated phospholipase A2 and Multi-vessel Disease Predict the Progression of Nonculprit Lesions in Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention

Percutaneous Coronary Intervention Rates and Associated Independent Predictors for Progression of Nontarget Lesions in Patients With Diabetes Mellitus After Drug-Eluting Stent Implantation.

Little is known about clinically driven percutaneous coronary intervention (PCI) rates and predictors for progression of nontarget lesions in diabetic patients who have undergone drug-eluting stent (DES) implantation. We retrospectively analyzed the clinical and angiographic data of 2187 diabetic patients undergoing DES implantation. The cumulative rate of nontarget lesion PCI was 6.3% at 1 year, 14.3% at 2 years, and 19.8% at 3 years. The independent predictors of need for clinically driven PCI in patients with diabetes mellitus after DES implantation included obesity (odds ratio [OR] 2.303, 95% confidence interval [CI] 1.657-3.199, P < .001), low levels of high-density lipoprotein cholesterol (OR 1.412, 95% CI 1.114-1.789, P = .004), statin use (OR 0.669, 95% CI 0.454-0.986, P = .042), insulin use (OR 1.310, 95% CI 1.030-1.665, P = .027), and Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (OR 1.061, 95% CI 1.045-1.077, P < .001) at baseline PCI. These findings may facilitate prediction of the risk of repeat revascularization and improve repeat revascularization rates in diabetic patients after DES implantation.

Nonculprit Lesion Progression in Patients With ST Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

The majority of cardiovascular events in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PPCI) arise from the progression of nonculprit lesions (NCL) during the long-term follow-up period. However, the clinical and angiographic factors related to the progression of nonculprit lesions are unknown.The purpose of the study was to investigate the clinical and angiographic factors related to the progression of nonculprit lesions of patients with STEMI undergoing PPCI.A total of 492 patients with STEMI who underwent PPCI from January 2006 to December 2009 were enrolled. All patients underwent PPCI as a treatment for the culprit lesion. The clinical and angiographic follow-up was performed at 12 months. Primary endpoint: Clinically driven nonculprit lesion PCI. The levels of serum catecholamines [epinephrine (E), norepinephrine (NE)] and C-reactive protein (CRP) were assayed, and the clinical and angiographic features were also analyzed.The clinical and angiographic follow-up was performed in 492 patients, and 45 patients underwent clinically driven nonculprit lesions PCI (study group). A total of 447 patients were free of additional PCI (control group). There were significant differences in the level of catecholamines (E (621.48 ± 79.31) pg/mL versus (268.14 ± 73.26) pg/mL, P < 0.0001), NE (6212.43 ± 822.41) pg/mL versus (3218.34 ± 614.16) pg/mL, P < 0.0001), CRP (3.29 ± 1.31) mg/dL versus (2.51 ± 1.14) mg/dL, P < 0.0001, cTnI peak value (27.27 ± 4.02) ng/mL versus (16.12 ± 3.23) ng/mL, P < 0.0001), thrombotic lesion rate ((62.22% versus 23.04%), P < 0.0001), ≥ 2 vessel lesions rate (80.00% versus 46.09%), P < 0.0001), culprit lesion length ((33.2 ± 2.9 versus 28.1 ± 3.1), P = 0.013), and complex lesion rate ((57.78% versus 36.02%), P = 0.006) between the two groups. Correlation analysis between nonculprit lesion stenosis degree and serum E, serum NE, serum CRP, cTnI peak value, thrombotic lesion rate, ≥ 2 vessel lesions rate, culprit lesion length, and complex lesion rate showed that there were significant correlations between serum E, serum NE, serum CRP, cTnI peak value, thrombotic lesion rate, ≥ 2 vessel lesions rate, culprit lesion length, complex lesion rate, and nonculprit lesion stenosis degree. The correlation coefficients were 0.95, 0.97, 0.83, 0.90, 0.81, 0.84, 0.95, and 0.96, respectively, and P < 0.0001, P < 0.0001, P = 0.01, P = 0.01, P = 0.01, P = 0.01, P < 0.0001, and P < 0.0001, respectively.Recurrent PCI was mainly due to nonculprit lesion progression in patients with STEMI after primary PCI. Complex nonculprit lesions may be prone to for additional PCI. Chronic inflammation and sustained stress may be involved in the progression of nonculprit lesions in patients with STEMI.

Correlation of Diffusion MRI Findings with Lesion Progression in Patients with Traumatic Intracerebral Hemorrhage

The aim of this study is to evaluate the association between lesion progression and the ischemic or edematous area that can develop around the hemorrhage in intraparenchymal hemorrhagic lesions originating after head trauma. Thirty patients with intracerebral hemorrhage due to head trauma of a mild or intermediate degree were evaluated in this study. Brain diffusion MRI examinations were performed in the first 6 h after trauma in all patients. In addition, a computerized cranial tomography (CCT) was performed upon admission (in the first hour), and at 24 and 48 h after admission. Patients with or without progression of the lesion were compared. The increase in the risk of progression of the lesion in patients with an ischemia/hemorrhage rate > 2 identified in the diffusion MRIs by evaluation of the hemorrhagic and the surrounding ischemic area, obtained in the first 6 h after trauma was found to be statistically significant. The possibility of progression was found to be very low when this rate was less than two. As a result of the study, the ischemic area was found to be proportionally larger in patients with progression compared to nonprogressing patients with traumatic intracerebral hemorrhage. The ischemia/hemorrhage rate in the diffusion MRI is thought to be an important parameter, beneficial to identify the risk of lesion progression.

Simple Enterographic Activity Score for Crohn’s Disease: comparison with endoscopic, biochemical, and clinical findings

Magnetic resonance enterography (MRE) is believed to be a reliable diagnostic method in assessing the activity of small-bowel Crohn's disease (CD). However, there are no scales for quantifying MRE scores that could be used in everyday clinical practice. The aim of the study was to construct a simple scale for assessing the activity of CD (Simple Enterographic Activity Score for Crohn's Disease - SEAS-CD) in MRE and to investigate its clinical usefulness. We conducted a retrospective analysis of MRE findings in 122 patients with CD. Disease activity was assessed using the SEAS-CD. The reference standard was endoscopic assessment using the Simple Endoscopic Score for Crohn's Disease (SES-CD). We assessed correlations between SEAS-CD and endoscopic, clinical, and biochemical findings. We also proposed the Global Crohn's Disease Activity Score to assess total CD activity by summarizing the colonic SES-CD and SEAS-CD scores. In the validation group (n = 62), a significant correlation between the ileal SES-CD and ileal SEAS-CD scores was noted (r = 0.72, P <0.0001). In patients with isolated small-bowel CD, there was a significant correlation between SEAS-CD and Crohn's Disease Activity Index (CDAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin (Hb), albumin, and platelet count. In patients with ileocolonic CD, the Global Crohn's Disease Activity Score correlated with CDAI, CRP, ESR, Hb, and hematocrit. SEAS-CD is a useful tool for the quantification of small-bowel CD activity assessed by MRE. The Global Crohn's Disease Activity Score may be useful in assessing the progression of lesions in patients with ileocolonic CD.

Different impacts of C-reactive protein and lipid profile on coronary lesions following a percutaneous coronary intervention

In-stent restenosis (ISR) and lesion progression are major obstacles for a percutaneous coronary intervention (PCI). Although previous studies have suggested that inflammation and lipid profile may be involved in those pathophysiological events, it remains controversial to date. The aim of the present study was to investigate the impacts of inflammation and lipid profile on both ISR and lesion progression in patients receiving PCI and scheduled follow-up. A retrospective analysis of 513 patients was performed in patients who underwent PCI and received coronary angiography again at an average of 7 months. The data of lipid profile and C-reactive protein (CRP) at both pre-PCI and follow-up were analyzed in patients with 94 ISR group and 65 lesion progression (progression group) alone, which was compared with 307 patients with neither ISR nor lesion progression (control group). CRP levels at pre-PCI in the ISR group were higher than those in the control group (P<0.05). The multivariate analysis indicated that the CRP levels at both pre-PCI and follow-up were significantly correlated with ISR [odds ratio (OR)=1.095, 95% confidence interval (CI) 1.005-1.194 for pre-PCI, OR=1.156, 95% CI 1.054-1.267 for follow-up, P<0.05, respectively]. When the cut-off of CRP was 2 mg/l, logistic regression analysis suggested an increased risk of ISR in patients with greater than 2 mg/l (OR=1.89, 95% CI 1.031-3.465) at pre-PCI CRP. The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C) at follow-up in the progression group were higher than those in the control group (P<0.05, respectively). Logistic regression showed that the risk for lesion progression was associated with the concentrations of TC, LDL-C, and non-HDL-C (P<0.05). The levels of pre-PCI CRP were strongly associated with ISR, whereas diabetes, serum levels of TC, LDL-C, and non-HDL-C were significantly correlated with coronary lesion progression.