Whether diabetes mellitus (DM) is a predictor of long-term adverse clinical outcomes after repeat drug eluting stent (DES) implantation for DES in-stent restenosis (ISR) remains controversial. We sought to evaluate the effect of DM on the long-term clinical outcomes in patients undergoing repeat DES implantation for DES-ISR lesions. In the present study, 254 patients with DES-ISR were divided into DM or non-DM groups according to the presence or absence of DM. All patients received repeat 2nd generation DES implantation for DES-ISR. The occurrences of major adverse cardiac events (MACEs) over a 2-year follow-up period were compared between the two groups. MACEs were defined as cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). MACE free survival was investigated with Kaplan-Meier curve analysis. Cox regression analysis was used to identify factors associated with MACEs. Baseline clinical characteristics were similar between groups, except for the prevalence of early restenosis (lower) in the DM group. Differences in angiographic and procedural characteristics were not significant between groups. The rates of 2-year MACE (30.9 vs. 26.0%; P = 0.453) and TLR (24.7 vs. 19.7%; P = 0.411) were similar between groups. MACE-free survival and TLR-free survival were also similar between groups (P = 0.441 and P = 0.807). Subgroup analysis suggested a significant difference in the MACE (39.0 vs.15.3%, P < 0.001) and TLR occurrence (30.5 vs.8.2%, P < 0.001) and TLR-free survival (lower in early subgroup, P < 0.001) between early and late occurrence of ISR in the non-DM group of patients but not in the DM group. After adjustment for all significant clinical variables, Cox regression analysis indicated that DM was not associated with MACEs (hazard ratio [HR] 1.531, 95% confidence interval [CI] 0.882-2.658, P =0.130). Non-focal type ISR and early ISR were predictors of MACEs (HR 2.671, 95% CI 1.468-4.858,P = 0.001; HR 4.703, 95% CI 2.725-8.117, P < 0.001, respectively). Patients with DM have similar 2-year clinical outcomes to patients without DM when repeat 2nd generation DES was used for treatment of DES-ISR. DM is not the predictor of long-term prognosis in patients undergoing repeat 2nd generation DES for DES-ISR.

Background Coronary artery disease (CAD) is a major public health concern, yet reliable sources of relevant information are limited. TikTok, a popular social media platform in China, hosts diverse health-related videos, including those on CAD; however, their quality varies and is largely unassessed. Objective This study aimed to investigate the quality of CAD-related videos on TikTok and explore the correlation between video characteristics and high-quality videos. Methods A total of 122 CAD-related short videos on TikTok were analyzed on July 18, 2023. Basic video information and sources were extracted. Two evaluators independently scored each video using DISCERN (a health information quality scale), the Patient Education Materials Assessment Tool (PEMAT) and the Health on the Net (HONcode) scales. Videos were categorized into four groups based on their source, with the medical professional group further categorized by job titles. Simple linear analysis was used to examine the linear relationship across different scales and to explore the relationship between video characteristics (video length, time since posting, the number of “likes”, comments and “favorites”, and the number of followers of the video creator) and different scales. Results AQVideos were categorized into four groups based on their source: medical professionals (n = 98, 80.3%), user-generated content (n = 11, 9.0%), news programs (n = 4, 3.3%), and health agencies or organizations (n = 9, 7.4%). The score of DISCERN was 46.5 ± 7.6/80, the score rate of PEMAT was 79.2 ± 12.6%/100%, and the number of score items for HONcode was 1.4 ± 0.6/8. In Sect. 1 of DISCERN, user-generated content scored highest (29.1 ± 3.6), followed by medical professionals (28.6 ± 2.4), health agencies or organizations (28.0 ± 0.0) and news programs (28.0 ± 0.0)(P = 0.047). In HONcode, most videos met only one or two of the eight evaluation criteria. PEMAT scores varied slightly across categories without significant differences (P = 0.758). Medical professionals were further divided into senior (n = 69, 70.4%) and intermediate (n = 29, 29.6%) groups, with intermediate professionals scoring higher in DISCERN (P < 0.001). In simple linear analysis models, no linear correlation was found between DISCERN and PEMAT scores (P = 0.052). Time since posting on TikTok was negatively correlated with DISCERN (P = 0.021) and PEMAT scores (P = 0.037), and the number of “favorites” was positively correlated to DISCERN score (P = 0.007). Conclusion The quality of CAD-related videos on China’s TikTok is inconsistent and varies across different evaluation scales. Videos posted by medical professionals with intermediate titles tended to offer higher quality, more up-to-date content, as reflected by higher “favorite” counts. HONcode may not be suitable for short video evaluation due to its low score rate, while DISCERN and PEMAT may be effective tools for short video evaluation. However, their lack of consistency in evaluation dimensions highlight the need for a tailored scoring system for short videos.

BACKGROUND: Thoracic aortic dissection (TAD) is a life-threatening aortic disease without effective medical treatment. Increasing evidence has suggested a role for NE (neutrophil elastase) in vascular diseases. In this study, we aimed at investigating a causal role for NE in TAD and exploring the molecular mechanisms involved. METHODS: β-aminopropionitrile monofumarate was administrated in mice to induce TAD. NE deficiency mice, pharmacological inhibitor GW311616A, and adeno-associated virus-2–mediated in vivo gene transfer were applied to explore a causal role for NE and associated target gene in TAD formation. Multiple functional assays and biochemical analyses were conducted to unravel the underlying cellular and molecular mechanisms of NE in TAD. RESULTS: NE aortic gene expression and plasma activity was significantly increased during β-aminopropionitrile monofumarate–induced TAD and in patients with acute TAD. NE deficiency prevents β-aminopropionitrile monofumarate–induced TAD onset/development, and GW311616A administration ameliorated TAD formation/progression. Decreased levels of neutrophil extracellular traps, inflammatory cells, and MMP (matrix metalloproteinase)-2/9 were observed in NE-deficient mice. TBL1x (F-box-like/WD repeat-containing protein TBL1x) has been identified as a novel substrate and functional downstream target of NE in TAD. Loss-of-function studies revealed that NE mediated inflammatory cell transendothelial migration by modulating TBL1x-LTA4H (leukotriene A4 hydrolase) signaling and that NE regulated smooth muscle cell phenotype modulation under TAD pathological condition by regulating TBL1x-MECP2 (methyl CpG-binding protein 2) signal axis. Further mechanistic studies showed that TBL1x inhibition decreased the binding of TBL1x and HDAC3 (histone deacetylase 3) to MECP2 and LTA4H gene promoters, respectively. Finally, adeno-associated virus-2–mediated Tbl1x gene knockdown in aortic smooth muscle cells confirmed a regulatory role for TBL1x in NE-mediated TAD formation. CONCLUSIONS: We unravel a critical role of NE and its target TBL1x in regulating inflammatory cell migration and smooth muscle cell phenotype modulation in the context of TAD. Our findings suggest that the NE-TBL1x signal axis represents a valuable therapeutic for treating high-risk TAD patients.

Candida albicans is a ubiquitous fungus that can cause superficial and systemic infections in humans. Neutrophils play a crucial role in controlling C. albicans infections. When C. albicans enters the bloodstream, it tends to get trapped in capillary vessels. However, the behavior of neutrophils in combating capillary-residing fungi has not been fully characterized. In this study, we used transgenic mice and whole mount imaging to investigate the growth of C. albicans and its interaction with innate immune cells in different organs. We observed that C. albicans rapidly grows hyphae within hours of infection. Following intravenous infection, we observed two waves of neutrophil recruitment, both of which significantly contributed to the elimination of the fungi. The first wave of neutrophils was induced by complement activation and could be prevented by C5aR blockade. Interestingly, we discovered that the fungicidal effect in the lungs was independent of adhesion molecules such as Mac-1, LFA-1, and ICAM-1. However, these molecules played a more significant role in the optimal killing of C. albicans in the kidney. Importantly, the initial difference in killing efficiency resulted in significantly reduced survival in knockout mice lacking these adhesion molecules. We identified a second wave of neutrophil recruitment associated with hyphal growth and tissue damage, which was independent of the aforementioned adhesion molecules. Overall, this study elucidates the dual wave of neutrophil recruitment during C. albicans infection and highlights the importance of early fungal clearance for favorable disease outcomes.