Objective To analyze the characteristics of preoperative CTO lesions by coronary CT angiography (CCTA) and to compare the lesion characteristics and clinical data of patients with subsequent vs failed PCI.Methods A total of 113 patients were randomly selected and 116 vessels were analyzed by CCTA before PCI.The patients were further investigated as PCI success group vs PCI failure group according to their PCI result.Multivariate logistic regression analysis was used to determine the factors that affected the success of CTO intervention.The ROC curve was used to determine and evaluate the CT-CTO score and J-CTO score for diagnostic efficacy.Results The success rate of PCI was 55.2％.64 lesions were successfully opened,with the success rate of 72.4％.The prevalence of smoking in patients in the PCI failure group was significantly higher than that in PCI success group (65.4％ vs.42.2％,P ＜ 0.05).There were no significant differences between the two groups in age,gender,history of hypertension,diabetes mellitus,and myocardial infarction(P ＞ 0.05).Statistical differences were observed between the PCI success group and the PCI failure group in the presence of occlusion segment head-end bifurcation,occlusion severe incision,severe calcification (calcification ≥ 180°),occlusion segment length ≥ 20 mm,occlusion of calcification lesions,occlusion segment distal shape of the unambiguous of fiber cap shape of the distal occlusion segment under CCTA(P ＜ 0.05).In the PCI failure group,approximately 17.3％ of the patients had previous attempt to open the CTO lesions,which were higher than the PCI success group (9.4％).However,The difference was not statistically significant (P ＞ 0.05).Multivariate logistic regression analysis showed that the unambiguous distal fibrous cap of the occlusion segment and the occlusion of the proximal branch and the occlusion length ≥20 mm were the main factors affecting the failure of CTO intervention.In terms of prediction,the predictive value 30 CT-CTO score yielded a higher area under the ROC curve than that of the J-CTO score (0.8776 vs 0.7387,P ≤ 0.05).Conclusion CT angiography can predict the success rate of intervention for CTO lesions.Compared with J-CTO score,CT-CTO score has a higher predictive value.Unambiguous fiber cap shape,occlusion segment head end bifurcation,occlusion segment length ≥20 mm were the independent risk factors that affecting the success of CTO operation.

Objective: Late gadolinium enhancement(LGE) cardiac magnetic resonance imaging(CMR) was used to evaluate the myocardial viability of chronic total occlusion(CTO) in patients with coronary heart disease and to observe the relationship between collateral circulation and myocardium viability in these patients. Methods: This retrospective study included 40 patients with CTO diagnosed by invasive coronary angiography (CAG) from September 2015 to June 2016 in our department, all patients performed CMR examination within one week after CAG.The collateral circulation of CTO was graded with Rentrop classification as follows: poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group.According to CMR images, the delayed enhancement transmural extent of myocardial segments were scored, the ventricular wall motion of the myocardial segment were graded, and the wall motion score index (WMSI) was calculated.Spearman correlation analysis was used to analyze the relationship between the delayed enhancement transmural extent of myocardial segments and WMSI. Results: In the no or poor collateral group of 6 myocardial regions, 1 myocardial region had viable myocardium and 3 myocardial regions had no viable myocardium; in the moderate collateral group of 16 myocardial regions, 11 myocardial regions had viable myocardium and 5 myocardial regions had no viable myocardium; in the good collateral group of 24 myocardial regions, 21 myocardial regions had viable myocardium and 3 myocardial regions had no viable myocardium, there was significant difference between the groups (P=0.002). The WMSI of poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group were 1.54±0.50, 1.21±0.34 and 1.26±0.40, respectively, there was no significant difference between the groups (P=0.063). Spearman correlation analysis showed that the extent of delayed enhancement transmural extent of myocardial segment was significantly associated with WMSI (r=0.638, P<0.01). Conclusion Collateral circulation in patients with chronic total occlusion can predict myocardial viability.Increase of Rentrop grade is linked with higher possibility of the presence of viable myocardium.

Objective To systematically evaluate the efficacy and safety of immune checkpoint inhibitors in the treatment of advanced gastric cancer or gastroesophageal junction cancer (GC/GEJC). Methods CNKI, Wanfang, PubMed, EMBASE, ClinicalTrials, Cochrane Library and other databases were searched to collect the clinical trials of immune checkpoint inhibitors in the treatment of advanced GC/GEJC. The retrieval time was from the inception to Nov. 2019. Outcome measures mainly included ORR, DCR, PFS, OS and toxicities. The adoption rate difference and hazard ratio were effect measures. Meta-analysis was performed using RevMan 5.3 software. Results We included seven literatures with a total of 1949 patients. Meta-analysis showed that for the patients with advanced GC/GEJC, the second-line or later immune checkpoint inhibitor therapy improved the overall survival rate at 12 and 18 months; the OS of the patients was prolonged, compared with chemotherapy/placebo therapy (all P < 0.05). The incidence of adverse reactions of any grade or ≥grade 3 caused by immune checkpoint inhibitor therapy was lower than that caused by chemotherapy/placebo. Conclusion Immune checkpoint inhibitor treatment could improve survival endpoints in some patients with advanced GC/GEJC, and the incidence of common adverse reactions is low.

Objective:To explore the differences of physical activity levels between Chinese and British patients with cardiovascular disease (CVD) and its influencing factors.Methods:Based on the baseline survey of China Kadoorie Biobank (CKB) and United Kingdom Biobank (UKB), we identified the case and control group according to the self-reported disease history in the questionnaire. Metabolic equivalent of task, as the assessment of physical activity level, was graded according to the tertiles of specific ages and genders. Multiple logistic regression models were used to analyze the correlation between CVD status and physical activity levels.Results:We included 509 170 Chinese adults and 360 360 British adults in the analysis. After adjusting for multiple factors, we found a positive correlation between CVD patients and low physical activity levels in both CKB and UKB populations (CKB: OR=1.21, 95% CI:1.17-1.25; UKB: OR=1.24, 95% CI:1.20-1.28). There was a high correlation between the prevalence of CVD and low physical activity levels in males with CKB ( OR=1.33, 95% CI:1.27-1.40).Unlike the UKB population, as the length of CVD increased, the physical activity levels of CKB patients gradually approached that of the non-CVD population, and stroke was positively correlated with low physical activity levels ( OR=1.46, 95% CI:1.38-1.53). The decline in physical activity was more pronounced among CKB and UKB CVD patients with lower educational levels, current or former smokers or drinkers, and those with other chronic diseases. In CKB, there showed a high correlation between CVD disease and low physical activity levels in rural areas and non-retired populations. In UKB, there appeared a higher correlation between CVD disease and low physical activity levels in urban and non-working populations. Conclusions:The physical activity levels of CVD patients in both China and the UK were lower than that in non-CVD population. In addition to low-educated individuals, current or former smokers or drinkers, and those with other chronic diseases, it is critical to pay attention to the physical activity levels of rural, male, and non-retirees among Chinese patients.

Due to the limited reliability of traditional self-completed questionnaire, the accuracy of measurement of physical behaviors (physical activity, sedentary behavior and sleep) is not high. With the development of technology, wearable devices (e.g. accelerometer) can be used for more accurate measurement of physical behaviors and have great application potential in large-scale research. However, the data of objective measurement of physical behaviors from large-scale cohort research in Asian populations is still limited. Between August 2020 and December 2021, the 3 rd resurvey of China Kadoorie Biobank (CKB) project used Axivity AX3 wrist triaxial accelerometer to collect the data of participants' daily activity and sleep status. A total of 20 370 participants from 10 study areas were included in the study, in whom 65.2% were women, and the age was (65.4±9.1) years. The participants' physical activity level varied greatly in different study areas. The objective measurement of participants' physical behaviors in CKB project has provided valuable resources for the description of 24-hour patterns of physical behaviors and evaluation of the health effect of physical activity, sedentary behavior and sleep as well as their association with diseases in the elderly in China.

Objective:To describe the distribution of lipoprotein (a) [Lp(a)] levels in non-arteriosclerotic cardiovascular disease (ASCVD) population in China and explore its influencing factors.Methods:This study was based on a nested case-control study in the CKB study measured plasma biomarkers. Lp(a) levels was measured using a polyclonal antibody-based turbidimetric assay certified by the reference laboratory and ≥75.0 nmol/L defined as high Lp(a). Multiple logistic regression model was used to examine the factors related to Lp(a) levels.Results:Among the 5 870 non-ASCVD population included in the analysis, Lp(a) levels showed a right-skewed distribution, with a M ( Q1, Q3) of 17.5 (8.8, 43.5) nmol/L. The multiple logistic regression analysis found that female was associated with high Lp(a) ( OR=1.23, 95% CI: 1.05-1.43). The risk of increased Lp(a) levels in subjects with abdominal obesity was significantly reduced ( OR=0.68, 95% CI: 0.52-0.89). As TC, LDL-C, apolipoprotein A1(Apo A1), and apolipoprotein B(Apo B) levels increased, the risk of high Lp(a) increased, with OR (95% CI) for each elevated group was 2.40 (1.76-3.24), 2.68 (1.36-4.93), 1.29 (1.03-1.61), and 1.65 (1.27-2.13), respectively. The risk of high Lp(a) was reduced in the HDL-C lowering group with an OR (95% CI) of 0.76 (0.61-0.94). In contrast, an increase in TG levels and the ratio of Apo A1/Apo B(Apo A1/B) was negatively correlated with the risk of high Lp(a), with OR (95% CI) of 0.73 (0.60-0.89) for elevated triglyceride group, and OR (95% CI) of 0.60 (0.50-0.72) for the Apo A1/B ratio increase group (linear trend test P≤0.001 except for Apo A1). However, no correlation was found between Lp(a) levels and lifestyle factors such as diet, smoking, and physical activity. Conclusions:Lp(a) levels were associated with sex and abdominal obesity, but less with lifestyle behaviors.