Objective To explore the impact of diabetes on collateral circulation (CC) development in patients with chronic total coronary occlusion (CTO) and the underlying regulatory mechanism. Methods This study was conducted among 87 patients with coronary heart disease (CHD), who had CTO in at least one vessel as confirmed by coronary angiography. Among them 42 patients were found to have a low CC level (Cohen-Rentrop grades 0-1) and 45 had a high CC level (grades 2-3). In the 39 patients with comorbid diabetes mellitus and 48 non-diabetic patients, insulin resistance (IR) levels were compared between the subgroups with different CC levels. The steady-state mode evaluation method was employed for calculating the homeostatic model assessment for insulin resistance index (HOMA-IR) using a mathematical model. During the interventional procedures, collateral and peripheral blood samples were collected from 22 patients for comparison of the metabolites using non-targeted metabolomics analysis. Results NT-proBNP levels and LVEF differed significantly between the patients with different CC levels (P<0.05). In non-diabetic patients, HOMA-IR was higher in low CC level group than in high CC level groups. Compared with the non-diabetic patients, the diabetic patients showed 63 upregulated and 48 downregulated metabolites in the collateral blood and 23 upregulated and 14 downregulated metabolites in the peripheral blood. The differential metabolites in the collateral blood were involved in aromatic compound degradation, fatty acid biosynthesis, and steroid degradation pathways; those in the peripheral blood were related with pentose phosphate metabolism, bacterial chemotaxis, hexanoyl-CoA degradation, glycerophospholipid metabolism, and lysine degradation pathways. Conclusion The non-diabetic patients with a low level of CC had significant insulin resistance. The degradation pathways of aromatic compounds, fatty acid biosynthesis, and steroid degradation are closely correlated with the development of CC.

Objective To explore the impact of diabetes on collateral circulation (CC) development in patients with chronic total coronary occlusion (CTO) and the underlying regulatory mechanism. Methods This study was conducted among 87 patients with coronary heart disease (CHD), who had CTO in at least one vessel as confirmed by coronary angiography. Among them 42 patients were found to have a low CC level (Cohen-Rentrop grades 0-1) and 45 had a high CC level (grades 2-3). In the 39 patients with comorbid diabetes mellitus and 48 non-diabetic patients, insulin resistance (IR) levels were compared between the subgroups with different CC levels. The steady-state mode evaluation method was employed for calculating the homeostatic model assessment for insulin resistance index (HOMA-IR) using a mathematical model. During the interventional procedures, collateral and peripheral blood samples were collected from 22 patients for comparison of the metabolites using non-targeted metabolomics analysis. Results NT-proBNP levels and LVEF differed significantly between the patients with different CC levels (P<0.05). In non-diabetic patients, HOMA-IR was higher in low CC level group than in high CC level groups. Compared with the non-diabetic patients, the diabetic patients showed 63 upregulated and 48 downregulated metabolites in the collateral blood and 23 upregulated and 14 downregulated metabolites in the peripheral blood. The differential metabolites in the collateral blood were involved in aromatic compound degradation, fatty acid biosynthesis, and steroid degradation pathways; those in the peripheral blood were related with pentose phosphate metabolism, bacterial chemotaxis, hexanoyl-CoA degradation, glycerophospholipid metabolism, and lysine degradation pathways. Conclusion The non-diabetic patients with a low level of CC had significant insulin resistance. The degradation pathways of aromatic compounds, fatty acid biosynthesis, and steroid degradation are closely correlated with the development of CC.

OBJECTIVE: To explore the correlation of plasma N-acetyl-neuraminic acid level with Thrombolysis In Myocardial Infarction (TIMI) risk score and clinical outcomes of patients with acute coronary syndrome (ACS). METHODS: We consecutively enrolled 708 consecutive patients (401 male and 307 female, mean age 63.6±10.6 years) undergoing coronary angiography in our hospital between October, 2018 and July, 2019, including 597 patients with ACS and 111 without ACS (control group). The patients with ACS group were divided into high (=104), moderate (=425) and low (=68) risk groups according to their TIMI risk scores. All the participants were examined for plasma Neu5Ac level using liquid chromatography-tandem mass spectrometry and underwent coronary angiography with their Gensini scores calculated. The patients with ACS were followed up after discharge for a mean of 15 months for the occurrence of major adverse cardiac events (Mace). Binary logistic regression analysis was performed to identify the risk factors of Mace in these patients. RESULTS: Plasma Neu5Ac levels were significantly higher in ACS group than in the control group ( < 0.05). ROC curve analysis showed that plasma Neu5Ac level could assist in the diagnosis of ACS (0.648 [0.597-0.699]) with a sensitivity of 39.2% and a specificity of 86.5% at the cutoff value of 288.50 ng/mL. In the ACS patients, plasma Neu5Ac level was significantly higher in the high-risk group than in the moderate-risk and low-risk groups ( < 0.05) and could assist in the diagnosis of a high risk (0.645 [0.588-0.703]) with a sensitivity of 42.3% and a specificity of 80.1% at the cutoff value of 327.50 ng/ mL. Plasma Neu5Ac was positively correlated with age, serum uric acid, creatinine, lipoprotein a, Ddimer, C-reactive protein, MB isoform of creatine kinase and Gensini score and negatively correlated with high-density lipoprotein level. During the followup, 80 ACS patients experienced Mace, who had significantly higher plasma Neu5Ac level than those without Mace (=517). Logistic regression analysis showed that plasma Neu5Ac level and a history of previous stroke were independent risk factors for the occurrence of Mace. CONCLUSIONS Plasma Neu5Ac level can provide assistance in the diagnosis and risk stratification of ACS and is an independent risk factor for prognosis of ACS patients.

Objective To investigate the prevalence of dental fluorosis in children aged 8-12 in coalburning-borne endemic fluorosis areas in 23 counties in Guizhou Province,and to evaluate the effects of prevention and control measures.Methods In 2014,five towns were selected according to their location of the east,the south,the west,the north and the center of the 23 counties,one primary school in each town was chosen.All the students aged 8-12 in each school were selected,according to the Diagnosis of Dental Fluorosis (WS/T 208-2011),dental fluorosis was examined.At the same time,the detection rate of dental fluorosis of children aged 8-12 was investigated in 23 counties in 2000 and 2007.Analysis and comparison of the data in 2000,2007 and 2014 were done.Results The total detectable rate of dental fluorosis of children aged 8-12 was 32.31％ (5 803/17 962).The detection rate of 3 counties was lower than 15％,12 counties ranged from 15％ to 30％ and 8 counties more than 30％.Very light,mild,moderate,and severe cases of dental fluorosis cases accounted for 48.39％ (2 808/5 803),30.43％ (1 766/5 803),15.16％ (880/5 803) and 6.01％ (349/5 803).Male and female children's overall detection rate was 33.05％ (3 083/9 329) and 31.51％ (2 720/8 633),the difference was statistically significant (x2=4.86,P ＜ 0.05).The detection rates of dental fluorosis of children aged 8,9,10,11 and 12 were 17.79％ (224/1 259),26.02％ (871/3 348),30.28％ (1 255/4 144),34.07％ (1 595/4 682) and 41.02％ (1 858/4 529),indicating that the detection rate increased with age (x2 =345.78,P ＜ 0.01).After longitudinal comparison of the detection rates of dental fluorosis of children aged 8-12 in 2000,2007 and 2014,we found that 17 counties were gradually decreased (all P ＜ 0.05) except Xiuwen,Weining,Qianxi,Qingzhen,Liuzhi and Xixiu (x2 =0.84,4.19,3.67,5.03,1.98,2.37,all P ＞ 0.05).The ratio of dental fluorosis detection rate ＜ 15％,15％-30％ and ＞ 30％ was accounted for 21.74％ (25/115),32.17％ (37/115) and 46.09％ (53/115),respectively,in the 115 villages.Conclusion The detection rate of dental fluorosis of children aged 8-12 in coal-burning-borne endemic fluorosis areas is significantly dropped,and the comprehensive prevention and control effect is gradually apparent.

Objective To survey on fluorosis awareness of children aged 8 - 12 in coal-burning type endemic fluorosis in key diseased districts of Guizhou Province, and to provide a basis for school health education. Methods In 2014, five towns were selected according to five locations as east, south, west, north and center of 23 key diseased districts of Guizhou Province, one complete primary school in each town was chosen to survey on fluorosis awareness of all the children aged 8 - 12. At the same time, datas of fluorosis knowledge awareness of 23 counties in 2010 were collected and compared with the results of this survey. Results In 2014, the students awareness knowledge on endemic fluorosis was 84.21% (247518/293940). The awareness of 9 counties was higher than 90%, 5 counties ranged from 80% to 90%, and 9 counties lower than 80%. Compared with 2010 (awareness:96.58%), 21.74%(5/23) of the counties with increased awareness, and 78.26%(18/23) of the counties with decreased awareness. In overall qustionnaines object, the awareness rates of fluorosis prevention, correct use of coal-fired stoves, correct maintenance method of coal-fired stoves, method of avoid soot pollution food were 81.91% (48154/58788), 83.72%(82026/97980), 85.11%(66709/78384), and 86.12%(50629/58788), respectively. The awareness rates of children aged 8, 9, 10, 11 and 12 were 80.47%(32359/40215), 83.36%(52581/63075), 85.04%(53882/63360), 84.79% (53328/ 62895), and 85.98% (55368/64395), respectively, the differences were statistically significant (χ2=658.93, P<0.01). The awareness rates of male and female students were 84.35%(128802/152700) and 84.05%(118716/141240), respectively , the difference was not statistically significant (χ2= 3.64, P>0.05).Conclusions The awareness rate of children aged 8 - 12 in key diseased districts of Guizhou Province is decreased. Work on school health education should be continued, to consolidate control outcomes.

Objective To investigate the usage of the stoves in the severe endemic areas of coal burning fluorosis, sum up experience timely, find problems and adjust strategy for making prevention and control measures. Methods In 23 counties of Guizhou Province in the severe endemic areas of coal burning fluorosis, a town was selected according to the east, west, south, north and center positions, three villages were selected from each town, and 20 families were selected from each village;household stoves and usage were investigated in 2013. And the data of 14 conties was compared with the survey results of 2007. Results A total of 6 916 families from 341 villages in 115 towns of the 23 counties were investigated. Average utilization rate of coal-fired furnace and electric cooker was relatively high, which was 91.34%(6 317/6 916) and 92.93%(6 427/6 916), respectively. Utilization rate of coal stove, firewood oven, gas stove and liquefied gas stove oven was 7.75% (536/6 916)-21.56%(1 491/6 916). The correct utilization rate of coal-fired furnace was 92.80%(5 862/6 317). The correct utilization rate of coal stove was 66.80%(839/1 256); 92.93%(6 427/6 916)of the families used electric cooker year around. Totally 89.82%(5 674/6 317) of the farmers used iron stove in winter. Compared with those of 2007, in 14 of the counties; the differences of coal-fired furnace, coal stove, firewood oven, electric cooker, gas stove, and liquefied gas stove utilization rate were statistically significant (χ2= 888.35, 6 210.71, 165.54, 9 194.29, 36.98, 729.76, all P<0.05). Conclusion After positive and effective comprehensive treatment for many years, great c hanges have taken place in energy structure, clean energy is widely used, the correct utilization rate of coal-fired stoves is increased, and indoor fluorine pollution caused by coal-burning is under control.

Objective To evaluate the effects of health education and improved stoves on control of coalburning-borne endemic fluorosis in Guizhou Province.Methods In 2014,according to the detectable rate of dental fluorosis of children aged 8-12 before implementing control measures,11 counties were divided into three layers:low detection rate (detection rate was less than 60％),medium detection rate (detection rate from 60％ to 90％) and high detection rate (detection rate was greater than 90％).One county was selected from each layer and two towns were selected in each county.According to the Diagnosis of Dental Fluorosis (WS/T 208-2011),dental fluorosis of all children aged 8-12 was examined in all towns;At the same time,in the 2 villages in each town,20households and students of one class in grade 4 to 6 were selected to survey knowledge about prevention and control of coal-burning-borne endemic fluorosis;and to survey the situation of improved stoves,drying and elutriation of corn and chillies,and related life behavior.Results The detectable rate of dental fluorosis of children aged 8-12was 5.49％ (198/3 607),8.33％ (72/864),12.46％ (179/1 437),and it was significantly lower than before implementing control measures [41.88％ (931/2 223),61.91％ (4 863/7 855),91.25％(2 439/2 673),x2 =1 166.43,909.56,2 508.96,all P ＜ 0.01].Correct answer rates of students about knowledge on endemic fluorosis were 78.03％ (792/1 015),84.93％ (1 465/1 725) and 80.18％ (910/1 135),the correct answer rates of knowledge were significantly higher than those before implementing control measures [23.19％ (640/2 760),47.41％ (2 368/4 995) and 40.25％ (3 405/8 460),x2 =947.96,736.61,644.69,all P ＜ 0.01].Correct answer rates of family householders about knowledge on endemic fluorosis were 86.75％ 047/400),95.25％ (381/400) and 86.25％ (345/400),the correct answer rates of knowledge were higher than those before implementing control measures [17.78％ (80/450),37.20％ (279/750) and 25.27％ (139/550);x2 =402.97,359.49,344.55,all P ＜ 0.01].The percentages of households whose stoves were qualified and can be used correctly to the total households were 96.25％ (77/80),96.25％ (77/80) and 93.75％ (75/80),and before implementing control measures [4.92％ (348/7 078),21.51％ (7 461/34 693) and 6.73％ (475/7 062)],and the differences were statistically significant (x2 =1 181.55,262.63,842.82,all P ＜ 0.01).The percentages of households using clean energy in heating season to the total households increased from 0 (0/7 078),0 (0/34 693),0(0/7 062) to 98.75％ (79/80),98.75％ (79/80),96.25％ (77/80).The rates of the three counties whose inhabitants could bake the chillies correctly were 96.25％ (77/80),95.00％ (76/80) and 97.50％ (78/80),which were significantly higher than before implementing control measures [5.55％(5/90),26.00％ (39/150),52.73％ (58/110),x2=139.52,99.36,45.64,all P ＜ 0.01].Who cooked chillies after washing were 93.75％ (75/80),95.00％ (76/80),93.75％ (75/80),which were significantly higher than before implementing control measures [74.44％ (67/90),87.33％ (131/150),34.55％ (38/110),x2 =11.47,3.91,67.36,all P ＜ 0.05].Conclusion The effects of health education and improving stoves on coal-burning-borne endemic fluorosis in the three counties of Guizhou Province are remarkable.

Objective To provide a basis for specific intervention by dynamic observation of the households'related health life behavior and the children fluorosis change trend caused by the coal-burning-borne endemic fluorosis in Pu'an County.Methods Three villages were chosen using simple random sampling method in 2011-2013 for continuous monitoring.Every monitoring year in each monitoring village,according to the principle of every household survey,10 households were selected to survey related health life behavior;,and in the monitoring village all the children aged 8-12 years old were selected for Diagnosis of Dental Fluorosis (WS/T 208-2001),and in each age group,10 urine samples (half male half female) were collected,the fluoride content was determined by the ion selective electrode method (WS/T 89-1996).Results In 2011-2013,the households stoves qualified rate,stoves correct usage rate and the corn or chili correct drying rate were all 100.00％ (30/30).The dental fluorosis incidences of 8-12 years old children were 63.60％ (332/522),25.44％ (173/680) and 14.29％ (80/560),respectively,decreased year by year (x2 =324.67,P ＜ 0.05).In 2011-2013,children urinary fluoride levels were 0.83,0.84 and 0.68 mg/L,respectively.The difference between years was statistically significant (x2 =26.89,P ＜ 0.05),and the level in 2013 was significantly lower than those of 2011 and 2012 (all P ＜ 0.01).Conclusion In 2011-2013,the residents in Pu'an have good health life behavior,and the condition of children's dental fluorosis is decreased year by year.

Objective To investigate the epidemic situation of coal-burning-fluorosis,and to explore key areas for implementing prevention and control measures in Guizhou Province.Methods Survey data of dental fluorosis of children aged 8-10,anti-fluoride knowledge and health-related behaviors of target students and their families before implementing the comprehensive disease control measures in 2010,were analyzed and evaluated using the method of factor analysis in 23 diseased districts.Results ①The three main factors (F) related to the endemic of coal-burning-fluorosis were economic factor (F 1),knowledge factor (F2) and behavior factor (F3):F1 included the detection rate of 8 to 12 years old children's dental fluorosis,iron stove ownership,corn correct drying rate and chili correct drying rate; F2 included stove correct utilization rate,students awareness and head of the household awareness; F3 included corn food washing rate before cooking and chili food washing rate.②In the economic factor score arrangement,the first three were Zunyi,Xiuwen and Qingzhen.In the F2 score arrangement,the first three were Zunyi,Xishui and Xixiu.In the F3 score arrangement,the first three was Liuzhi,Bijie and Xixiu.③After comprehensive score,Zunyi,Qingzhen,Xishui,Xixiu,Puding and Liuzhi Counties were found to be relatively stronger in control of the epidemic of coal-burning-fluorosis; Xiuwen,Renhuai,Guanling and so on 13 counties were found to be relatively moderate,and Tongzi,Hezhang,Shuicheng and Nayong Counties were found to be relatively weak.Conclusions ①The endemic of coal-burning-fluorosis is related with many factors,and the indexes we selected in this study have a strong correlation and sensitivity,which may be used in evaluating the prevention effect of control measures to coal-buming-fluorosis.②The endemic of coal-burning-fluorosis in Guizhou Province is quite different,and key prevention and control measures can be applied according to a comprehensive factor analysis.

Objective To assess the concordance of MRI diagnosis for patients suspected of lumbar disk herniation by using Kappa statistic.Methods One hundred patients(48 males and 52 females)with lumbosaeral radicular pain,aged from 17 to 86(average 61).All patients underwent fast spin-echo T1 and T2 weighted imaging on a 3.0 T MR scanner and spine surface coil.Two radiologists(doctor A and doctor B)evaluated the lumbar disks from L3-4,L4-5.and L5-S1 in 50 out of the 100 patients independently.The presence of a bulging disk or a herniation was reported.Images were interpreted twice:once before and once after disclosure of clinical information.And disks of 52 patients out of the 100 samples were interpreted by the two radiologists independently without clinical information as well.The Kappa statistics was employed to assess the concordance of each radiologist's diagnoses as well as the observer variation of the two radiologists.Results Diagnoses before and after disclosure to clinical information were concordant in 114 disks for doctor A and in 109 for doctor B.respectively.Diagnoses before and after disclosure to clinical information were not concordant in 36 disks for doctor A and in 41 disks for doctor B,respectively.The Kappa values were 0.60±0.06 and 0.57±0.06 for doctor A and doctor B,respectively.The concordance was moderate.After disclosure to elinical information.the numbers of reported bulging disks increased significantly.by 10 and 31 for doctor A and doctor B,respectively.Without clinical information,the diagnoses of the two radiologists were concordant in 77 disks,while not concordant in 79 disks.The interobserver agreement was poor(Kappa=0.24±0.06).The diffcrence on diagenoses made between with and without clinical information mainly happened on the differential diagnosis of normal disks and bulging disks.The different,diagnoses made between with and without clinical information were on 20 disks and on 30 disks for doctor A and doctor B,respectively;that accounted for 55.6%(20/36)and 73.2%(30/41)of total variation respectively.The diagnostic difference between the 2 doctors happened mainly on differentiation of bulging disks and normal disks,which happened in 56 disks,aceountiong for 70.9%(56/79)of total variation.Conclusion Variation on diagnoses of the same radiologist or between tworadiologists was mainly caused by disagreement on bulging disks.