Abstract:Objective To investigate the long-term prognosis and its risk factors in elderly patients with grade Ⅱb vascular aging.Methods A total of 219 elderly patients with grade Ⅱb vascular aging admitted to our department between January 2013 and June 2015 were enrolled,and based on their prognosis,they were assigned into a poor prognosis group(n=71)and a control group(n=148).The clinical data were collected from all participants.Multivariate logistic regression analysis was performed to identify risk factors.Results The poor prognosis group exhibited significantly larger proportions of patients aged ≥80 years(23.9％vs 6.8％)and diabetes mellitus(54.9％ vs 28.4％),and lower rates of using aspirin(21.1％ vs 41.2％)and statins(22.5％ vs 43.2％)compared with the control group(P＜0.01).Multivariate logistic regression analysis revealed that advanced age(≥80 years old)and diabetes mellitus were independent risk factors for poor long-term prognosis(OR=3.500,95％CI:1.507-8.130,P＜0.01;OR=2.400,95％CI:1.282-4.492,P＜0.01),while aspirin and statins were protective factors(OR=0.389,95％CI:0.194-0.777,P＜0.01;OR=0.417,95％CI:0.211-0.824,P＜0.05).Conclusion Elderly patients with gradeⅡ b vascular aging have poor long-term outcomes.Aged ≥ 80 years and comorbid diabetes mellitus independently increase the risk of adverse outcomes,while the use of aspirin and statins appears to be associated with a reduced risk.

Abstract:Objective To explore the application value of eye movement assessment and scale scoring in the screening of cognitive impairment(CI).Methods A total of 147 patients who met our inclusion and exclusion criteria admitted to Department of Neurology of Changsha First Hospital and Community Health Service Center of Qingshuitang Street from February to October 2023 were recruited,and according to the score of Montreal cognitive assessment(MoCA),they were divided into a CI group(115 patients)and a control group(32 patients).The cognitive assessments included MoCA,Aging and Dementia 8-Item Questionnaire(AD8),digit span test,mini-cognitive assessment(Mini-cog),clock drawing test(CDT)and mini-mental state examination(MMSE).Eye movement data were collected from two groups of patients.ROC curves were plotted to analyze and calculate the area under curve(AUC)to evaluate the screening value of scales,eye movement indicator and their combination.Results The CI group exhibited significantly higher AD8 score,longer forward and reverse saccade latencies,and increased saccade error rate,while lower total score and subscores of sequences in forward and reverse order of digit span test,Mini-cog score,CDT score,MMSE score and MoCA score when compared with the control group(P＜0.01).The AUC values of digit span test,mini-cog score and CDT score in screening CI were significantly lower than that of MMSE score(P＜0.05).The AUC value of eye movement indicator in the screening was 0.756(95％CI:0.664-0.848),and its maximum value of Jordan index was 0.418,the sensitivity was 73.0％ and the specificity was 68.7％.The MMSE score showed notably higher AUC value than eye movement indicator(Z=4.004,P＜0.01).There was no statistical difference in the AUC value between AD8 combined with eye movement indicator and MMSE(Z=1.192,P＞0.05),but the test time was remarkably longer than that of eye movement assessment and MMSE evaluation(P＜0.05).Conclusion Eye movement assessment and scale evaluation have their own advantages in the screening of CI.Some eye movement indicators can be applied in early CI screening.Eye movement assessment combined with some scale scoring can be better applied in the CI screening.

Abstract:Objective To explore the correlation of peripheral blood lipoprotein-associated phospholipase A2(Lp-PLA2),serum amyloid A(SAA)and fibrinogen(Fib)with neurological impairment and prognosis of patients with acute cerebral infarction(ACI).Methods A total of 150 ACI patients(study group)admitted to Department of Neurology Heji Hospital Affiliated to Changzhi Medical College between February 2023 and March 2025 were enrolled,and according to their scores of National Institutes of Health Stroke Scale(NIHSS)at admission,they were divided into mild(score:0-4,65 cases),moderate(score:5-15,58 cases)and severe(score:16-42,27 cases)groups.Based on the scores of modified Rankin scale(mRS)after 90 d of follow-up,they were also assigned into good prognosis group(score:0-2,88 cases)and poor prognosis group(score:3-6,66 cases).Another 120 healthy individuals who taking physical examination during the same period were recruited and served as the control group.The levels of peripheral blood Lp-PLA2,SAA and Fib were compared among the groups.The influencing factors for poor prognosis were analyzed,and the predictive values of Lp-PLA2,SAA and Fib for poor prognosis were evaluated.Results The levels of peripheral blood Lp-PLA2,SAA and Fib were significantly higher in the study group than the control group(P＜0.01),and the levels were gradually increased in the mild,moderate and severe groups in turn(P＜0.05).The poor prognosis group exhibited obviously more advanced age,longer interval from onset to admission,higher proportions of stroke infarct size ≥5 cm and NIHSS score ≥ 16 at admission,and increased levels of Lp-PLA2,SAA and Fib than the good prognosis group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that stroke infarct size,and Lp-PLA2,SAA and Fib levels were independent risk factors for poor prognosis in ACI patients(P＜0.05).ROC curve analysis indicated that AUC value of Lp-PLA2 combined with SAA and Fib in predicting poor prognosis was significantly greater than that of single indicator(0.826 vs 0.710,0.698,0.746,P＜0.05).At the final follow-up,the levels of Lp-PLA2,SAA and Fib were notably higher in the poor prognosis group than the good prognosis group(P＜0.01).Conclusion The increases in peripheral blood Lp-PLA2,SAA and Fib levels are associated with the aggravation of neurological impairment and poor prognosis in ACI patients,and the combination of the three indicators can effectively predict poor prognosis of the patients.

Abstract:Objective To explore the risk factors for occurrence of progressive cerebral infarction (PCI) in elderly patients with acute cerebral infarction (ACI) and the clinical effectiveness of combination of intravenous thrombolysis and sequential tirofiban therapy. Methods A retrospective analysis was conducted on 480 elderly ACI patients undergoing thrombolysis in Department of Neurology of Lu'an People's Hospital from January 2020 to August 2024. According to the occurrence of PCI after thrombolysis,they were divided into a PCI group (87 cases) and a non-PCI group (393 cases). The patients in the PCI group were further assigned into a control group (43 cases,sequential alteplase intravenous thrombolysis)and a combined group (44 cases,sequential alteplase intravenous thrombolysis combined with tirofiban treatment) according to different treatment regimens. The neurological deficit[National Institutes of Health Stroke Scale (NIHSS)],platelet-related indicators[platelet hematocrit (PCT),platelet distribution width (PDW),platelet aggregation rate (PAgT)]and adverse reactions were compared between groups. Results The PCI group exhibited significantly advanced age,larger proportions of hyperlipidemia,diabetes mellitus and hypertension,higher NIHSS score at admission,increased platelet count at admission,and higher ratio of large artery atherosclerosis type than the non-PCI group (P<0.05,P<0.01). Hyperlipidemia (OR=2.776,95％CI:1.347-5.722,P=0.005),hypertension(OR=2.861,95％CI:1.258-6.503,P=0.012),and NIHSS score at admission(OR=1.141,95％CI:1.024-1.271,P=0.016)were independent risk factors for PCI occurrence in elderly ACI patients.For the PCI group,the combined subgroup exhibited notably lower NIHSS scores at 3,5 and 7 d after treatment than the control subgroup(P<0.05,P<0.01).After treatment,PCT was significantly higher while PDW and PAgT were notably lower in the combined subgroup than the control group(P<0.01).Conclusion The incidence of PCI is quite higher in elderly ACI patients.Intravenous thrombolysis sequential therapy combined with tirofiban treatment has significant efficacy and good safety in treating elderly ACI patients with PCI,and it also can improve platelet-related indicators.

Abstract:Objective To investigate the correlation between serum brain-derived neurotrophic factor(BDNF)level and the risk of post-stroke cognitive impairment(PSCI)in patients with acute stroke.Methods A total of 168 patients with acute stroke admitted to our department between April 2021 and April 2024 were enrolled,and according to the score of Montreal Cognitive Assessment(MoCA)at 6 months after onset,they were divided into a PSCI group(MoCA score:<26,n=72)and a non-PSCI group(n=96).Clinical data,and laboratory indicators,including National Institutes of Health Stroke Scale(NIHSS)score,infarct volume,homocysteine(Hcy),neuron-specific enolase(NSE),and BDNF were compared between the two groups.Multivariate logistic regression analysis was used to identify independent factors for PSCI.Results The PSCI group had significantly older age,higher NIHSS score,larger infarct volume,and higher Hcy and NSE levels,while lower BDNF level when compared with the non-PSCI group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that NIHSS score,infarct volume,Hcy,and NSE were risk factors for PSCI(P<0.01),while BDNF was a protective factor in the elderly patients with acute stroke(OR=0.751,95%CI:0.722-0.780,P<0.01).The AUC values of NIHSS score,infarct volume,Hcy,BDNF and NSE in predicting PSCI were 0.811(95%CI:0.743-0.867),0.821(95%CI:0.754-0.875),0.606(95%CI:0.528-0.681),0.840(95%CI:0.776-0.892),and 0.757(95%CI:0.685-0.820),respectively.Conclusion The incidence of PSCI is quite high in patients with acute stroke,and is closely associated with serum BDNF level.

Abstract:Objective To explore the clinical predictive efficiency of serum chemokine C-X3-C motif ligand 1(CX3CL1),Apelin and homocysteine(Hcy)for cognitive dysfunction in elderly patients with cerebral small vessel disease(CSVD).Methods A total of 78 elderly CSVD patients admitted in the First Nanyang People's Hospital from February 2021 to March 2024 were recruited,and according to the score of Montreal Cognitive Assessment(MoCA),they were divided into a cognitive impairment group(MoCA score<26,31 cases)and a non-cognitive impairment group(MoCA score≥26,47 cases).The serum levels of CX3CL1,Apelin,and Hcy were measured in all participants.Pearson correlation analysis,and ROC curve analysis were used to assess the predictive capacities of these serum markers for cognitive impairment.Results The cognitive impairment group exhibited significantly higher serum levels of CX3CL1,Apelin,and Hcy than the non-cognitive impairment group(P<0.01).Correlation analysis showed that the serum levels of the three indicators were negatively correlated with MoCA score(r=-0.538,-0.443,-0.646,P<0.01).CX3CL1>248.65 μg/L,Apelin>87.57 μg/L and Hcy>24.39 μmol/L were independent risk factors for cognitive impairment in CSVD patients(P<0.05,P<0.01).ROC curve analysis revealed that the AUC values of CX3CL1,apelin,and Hcy in predicting cognitive impairment were 0.837,0.798,and 0.880,respectively,all demonstrating high sensitivity and specificity.Conclusion Serum CX3CL1,Apelin,and Hcy levels are closely associated with cognitive impairment in elderly CSVD patients,and show good predictive value,providing support for early diagnosis and treatment of CSVD.

Abstract:Objective To investigate the role of microRNA-423-5p(miR-423-5p)targeted-regulating glutathione S-transferase mu 1(GSTM1)in sub-hypothermia alleviating cerebral ischemia/reperfusion injury(CIRI)of rats.Methods A total of 100 8-week-old SD rats were randomly divided into 5 groups:sham operation group,cerebral ischemia/reperfusion group(IR),sub-hypothermia group,miR-423-5p agonist+sub-hypothermia group(AGH),miR-423-5p negative control+sub-hypothermia group(NCH),with 20 rats in each group.Rat CIRI model was established by inserting a thread bolt to block blood flow.In sham operation group,only the vessels were isolated without blocking.In the subhypothermia group,75%ethanol was used to cool the brain temperature at 32-33℃ for 3 h during reperfusion.The AGH and NCH groups were treated with intracerebroventricular injection of miR-423-5p agonist or negative control at 2 d before modeling.In 24 h of reperfusion,modified neurological defect scale score(mNSS)was scored,and the cerebral cortex samples in ischemic penumbra of brain tissue were removed to determine the protein expression of GSTM1,inducible nitric oxide synthase(iNOS),arginase-1(Arg-1),and the mRNA expression of GSTM1 and miR-423-5p,detect neuronal apoptotic rate and oberve morphological changes in the cerebral cortex samples.Dual luciferase reporter gene assay was applied to determine the targeting relationship between miR-423-5p and GSTM1 in vitro.Results Compared with the sham operation group,the other four groups exhibited significantly enhanced expression of iNOS,Arg-1 and miR-423-5p,increased mNSS and apoptotic rate,and notably decreased mRNA expression of GSTM1 and GSTM1(P<0.05).In the mild hypothermia group,the expression of iNOS(1.75±0.44 vs 4.06±1.08),miR-423-5p(1.83±0.21 vs 3.48±0.36),mNSS(4.05±1.15 vs 10.25±2.0)and apoptotic rate[(19.56±1.51)%vs(59.90±2.31)%]were significantly lower(P<0.05),the protein levels of Arg-1(15.30±4.05 vs 6.27±1.74),GSTM1(0.60±0.07 vs 0.26±0.04)and the mRNA level of GSTM1(0.72±0.07 vs 0.45±0.08)were notably higher when compared with the IR group(P<0.05).The AGH group had significantly enhanced expression of iNOS and miR-423-5p,increased mNSS and apoptotic rate,while reduced expression of Arg-1 and GSTM1 at a protein level and GSTM1 at a mRNA level than the sub-hypothermia group(P<0.05).HE staining displayed that a large number of damaged cells in the IR group,alleviated cell damage in the sub-hypothermia group,and weakened protective effect in the AGH group.Dual-luciferase reporter gene assay indicated that miR-423-5p targeted and bound to GSTM1.Conclusion Sub-hypothermia may promote the microglia polarization from M1 to M2 by down-regulating miR-423-5p and up-regulating GSTM1,and thereby alleviate CIRI.

Abstract:Objective To explore the predictive value of 24-hour dynamic electrocardiogram(ECG)and 24-hour dynamic blood pressure monitoring indicators for the risk of atrial fibrillation(AF)in patients with essential hypertension.Methods A retrospective analysis was conducted on 170 essential hypertension patients admitted in Zhengzhou Seventh People's Hospital from March 2021 to March 2024.The patients were divided into an AF group(38 cases)and a non-AF group(132 cases).Heart rate variability(HRV)and blood pressure variability(BPV)indicators were obtained through 24-hour dynamic ECG and blood pressure monitoring,including 24-hour standard deviation of normal-to-normal intervals(24 h SDNN),mean of SDNN for all 5 min segments of the entire recording 5 min(SDNN index),SDNN in all 5 min segments of the entire recording,average for each 5-minute segment(SDANN),root mean square of SDNN(rMSSD),24-hour systolic blood pressure standard deviation(24 h-SSD),24-hour diastolic blood pressure standard deviation(24 h-DSD),and 24-hour systolic blood pressure coefficient of variation(24 h-SCV).Results The AF group exhibited significantly lower values of 24 h SDNN,SDNN index,SDANN index and rMSSD,and higher 24 h-SSD,24 h-DSD and 24 h-SCV levels than the non-AF group(P<0.01).24 h SDNN,SDNN index,SDANN index and rMSSD were protective factors for AF occurrence,while 24 h-SSD,24 h-DSD and 24 h-SCV were risk factors for AF occurrence(P<0.01).The combination of HRV and BPV indicators provided the best predictive performance,with an AUC value of 0.971(95%CI:0.911-0.995).Conclusion Combination of 24-hour dynamic ECG and 24-hour dynamic blood pressure indicators can effectively predict the risk of AF occurrence in patients with essential hypertension.

Abstract:Objective To explore the predictive value of left atrial function evaluated with transesophageal echocardiography(TEE)for early heart failure(HF)in elderly patients with atrial fibrillation(AF)after radiofrequency ablation(RFA).Methods A total of 154 elderly patients with diagnosed AF and undergoing RFA in our hospital from January 2022 to December 2024 were enrolled,and based on whether HF occurred within 30 d after surgery,they were divided into a HF group(28 cases)and a non-HF group(126 cases).The clinical data and TEE parameters were compared between the two groups.Logistic regression analysis was used to screen the independent risk factors for early postoperative HF.The predictive value of left atrial function parameters was evaluated through ROC curve analysis,and the area under the curve(AUC)was calculated.Results The HF group exhibited significantly advanced age,higher N-terminal pro-B-type natriuretic peptide(NT-proBNP)and troponin I levels,and higher recurrence of AF than the non-HF group(P<0.01).The left atrial appendage peak emptying velocity(LAA-PEV),peak filling velocity of the left atrial appendage,and left atrial appendage ejection fraction were obviously lower,while the maximum volume,minimum volume,opening diameter of the left atrial appendage,and incidence of left atrial spontaneous echo contrast(LASEC)were notably higher in the HF group than the non-HF group(P<0.01).Multivariate logistic regression analysis showed that LAA-PEV,LASEC,NT-proBNP,and AF recurrence were independent risk factors for early HF after RFA in elderly AF patients(P<0.05,P<0.01).ROC curve analysis indicated that the AUC values of LAA-PEV,LASEC and NT-proBNP in predicting early HF after RFA in elderly AF patients were 0.825,0.675,and 0.799,respectively.And the AUC value of LAA-PEV combined with NT-proBNP was 0.894,which was significantly higher than that of a single indicator(P<0.01).Conclusion The parameters of left atrial appendage function detected by TEE have significant predictive value for early HF in elderly AF patients after RFA.Combination of LAA-PEV and NT-proBNP can improve the predictive efficacy.

Abstract:Objective To analyze the relationship of serum CTRP-12 and FSTL1 with occurrence of HF in elderly patients with UAP after PCI.Methods A retrospective cohort study was conducted on 120 elderly UAP patients undergoing PCI in our hospital from January 2023 to December 2024.According to whether HF occurred after surgery,they were divided into a HF group(24 cases)and a non-HF group(96 cases).The serum CTRP-12 and FSTL1 levels were compared between groups.Logistic regression analysis was used to identify the risk factors of postoperative HF,and ROC curve was drawn to analyze the predictive value of CTRP-12 and FSTL1 for the occurrence of postoperative HF.Results The HF group exhibited significantly larger proportion of multivessel coronary artery disease,elevated white blood cell count,and higher levels of C-reactive protein(CRP),N-terminal pro-B-type natriuretic peptide(NT-proBNP),serum creatinine and Hcy,while lower albumin and CTRP-12 levels when compared with the non-HF group(P<0.05,P<0.01).Logistic regression analysis indicated that the number of lesioned vessels(OR=3.762,95%CI:1.604-8.825),NT-proBNP(OR=2.573,95%CI:1.256-5.272),CRP(OR=3.158,95%CI:1.362-7.322),CTRP-12(OR=0.372,95%CI:0.167-0.830)and FSTL1(OR=2.835,95%CI:1.386-5.797)were influencing factors of HF occurrence in elderly UAP patients after PCI(P<0.05,P<0.01).ROC curve analysis revealed that the AUC values of CTRP-12,FSTL1 and their combination in predicting HF after PCI were 0.724,0.786 and 0.857,respectively.Conclusion CTRP-12 and FSTL1 are influencing factors of HF occurrence in elderly UAP patients after PCI.Preoperative detection of CTRP-12 and FSTL1 is helpful to predict the occurrence of postoperative HF.

Abstract:Objective To investigate the impact of intracranial artery calcification on the prognosis of mechanical thrombectomy,identify independent risk factors for the prognosis of mechanical thrombectomy,and establish a nomogram model for predicting the prognosis.Methods A retrospective analysis was conducted on 194 elderly patients(aged≥60 years)with anterior circulation AIS who underwent mechanical thrombectomy in our department between January 2017 and December 2024.According to the 90-day mRS score,they were divided into a good prognosis group(56 cases)and a poor prognosis group(score:3-6,138 cases).Multivariate logistic regression analysis was applied to explore the risk factors for prognosis of mechanical thrombectomy.Then,a nomogram model for predicting postoperative prognosis was constructed,and the model was internally validated and evaluated.Results The good prognosis group exhibited significantly higher ASPECT score,and lower In(calcification volume on the lesion side+1)and In(overall calcification volume+1)than the poor prognosis group(P<0.01).Multivariate logistic regression analysis showed that ASPECT score(OR=1.506,95%CI:1.105-2.052,P=0.010)and total calcified volume(OR=0.729,95%CI:0.561-0.949,P=0.019)were independent risk factors for the prognosis of mechanical thrombectomy.The prediction curve of the nomogram model aligned closely with the calibration curve and approached the ideal reference line.Hosmer-Lemeshow goodness-of-fit test indicated its good fitness,and ROC curve analysis showed its AUC value of 0.762(95%CI:0.691-0.833),an accuracy of 0.737,a sensitivity of 0.625,and a specificity of 0.783.Conclusion ASPECT score and total calcified volume of intracranial arteries are independent risk factors for the prognosis of mechanical thrombectomy.

Abstract:Objective To investigate the clinical value of systemic immune-inflammation index(SII)combined with prognostic nutritional index(PNI)in the diagnosis and prognosis of sepsis-induced cardiomyopathy(SIC)in the elderly.Methods A retrospective analysis was conducted on 168 elderly patients with sepsis admitted to Emergency ICU of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2020 to February 2025.Based on the results of echocardiography,they were divided into an SIC group(77 cases)and a control group(91 cases).The patients in the SIC group were further assigned into a survival subgroup(n=35)and a death subgroup(n=42)based on their 28-day outcomes.Clinical data were collected,and ROC curve analysis and Cox regression analysis were performed to evaluate the predictive efficiency of SII,PNI and other indicators for the prognosis of the SIC patients.Results The SIC group exhibited significantly higher ratios of hypertension,coronary heart disease,and renal dysfunction,and higher respiratory rate than the control group(P<0.05,P<0.01).SII,age and sequential organ failure assessment(SOFA)score were risk factors for cardiac dysfunction in sepsis patients(P<0.05).Obviously higher heart rate and respiratory rate were observed in the death subgroup than the survival subgroup(P<0.01).PNI was an independent risk factor for 28-day death in the SIC patients(HR=0.919,95%CI:0.861-0.980,P<0.05).ROC curve analysis revealed that the AUC value of SII/PNI ratio in predicting the death in SIC patients was 0.730.Conclusion High SII is an independent risk factor for developing SIC in patients with sepsis,and low PNI is an independent predictor of death in patients with SIC.SII/PNI ratio has certain predictive value for death in SIC patients.

Abstract:Objective To investigate the relationship of CT scanning and CT perfusion imaging parameters with hemorrhagic transformation(HT)and prognosis after mechanical thrombectomy in patients suffering from AIS-LVO.Methods A total of 178 AIS-LVO patients admitted to the Department of Intervention of the First Affiliated Hospital of Soochow University from January 2022 to November 2024 were recruited,and based on the occurrence of HT within 24 h postoperatively,they were divided into an HT group(n=25)and a non-HT group(n=153).All patients underwent plain CT and CT perfusion examinations,and relevant imaging data were collected,including ASPECTS,hyperdense middle cerebral artery sign(HMCAS),CBF,CBV,mean transit time(MTT),and permeability surface(PS).Multivariate logistic regression analysis was performed to identify the influencing factors for HT occurrence and poor prognosis.ROC curves were plotted again to evaluate the predictive value of CT-related parameters for poor prognosis.Results The HT group exhibited significantly higher NIHSS scores,HMCAS,MTT,and PS at admission,while obviously lower ASPECTS,CBV and CBF when compared to the non-HT group(P<0.01).Multiple logistic regression analysis showed that baseline NIHSS score,baseline ASPECTS,HMCAS,CBF,and MTT were independent predictors of HT occurrence after mechanical thrombectomy in the AIS-LVO patients(P<0.05).Hypertension,baseline NIHSS score,baseline ASPECTS,HMCAS,CBF,MTT,and PS were independent predictors of poor prognosis after mechanical thrombectomy in the AIS-LVO patients(P<0.05).ROC curve analysis suggested that the AUC value of combined plain CT and CT perfusion parameters in predicting poor prognosis after mechanical thrombectomy in AIS-LVO patients was 0.960,with a sensitivity of 0.934 and a specificity of 0.863.Conclusion ASPECTS,HMCAS,CBF and MTT are related to HT and prognosis after mechanical thrombectomy in AIS-LVO patients.They can serve as auxiliary indicators for the prediction of HT and poor prognosis for AIS-LVO after mechanical thrombectomy.

Abstract:Objective To investigate the mechanism of action of microRNA-144-5p(miR-144-5p)and autophagy-related protein 5(Atg5)for myocardial ischemia/reperfusion(I/R)injury in rats and its relationship with autophagy.Methods A total of 24 male Sprague-Dawley(SD)rats were randomly divided into sham operation group,model group,blank transfection group,and low-expression group,with 6 rats in each group.The rat model of myocardial I/R injury was established by ligation of the left anterior descending coronary artery for 30 min of ischemia followed by 2 h of reperfusion.The low-expression group was injected with adeno-associated virus(AAV)-miR-144-5p antagonist(5×1011 vg),while the blank transfection group was injected with AAV-blank transfection control vector.2,3,5-triphenyltetrazolium chloride(TTC)staining was used to detect the area of myocardial ischemic region;HE staining was applied to observe the pathological changes of myocardial tissue.Western blotting was employed to measure the expression of microtubule-associated protein light chain 3(LC3-B),Atg5,and autophagic degradation substrate P62 in the cardiomyocytes.Dual-luciferase reporter gene assay was conducted to determine the binding effect between miR-144-5p and Atg5.Results Compared with the sham operation group,the model group exhibited significantly increased expression of miR-144-5p in myocardial tissue(2.91±0.12 vs 0.93±0.04,P<0.05),severer myocardial injury,larger myocardial infarction area,elevated P62 expression and decreased expression of Atg5 and LC3-B(P<0.05).Lowering the expression of miR-144-5p attenuated myocardial injury,decreased myocardial infarction area and P62 expression,and up-regulated the expression of Atg5 and LC3-B when compared with the blank transfection group(P<0.05).Dual-luciferase reporter assay revealed that Atg5 and miR-144-5p had a binding interaction.Conclusion MiR-144-5p can target Atg5 to regulate myocardial autophagy,thereby alleviating myocardial I/R injury in rats.

Abstract:Objective To investigate the influence of low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)and the ratio(LDL-C/HDL-C)on cognitive function in elderly Chinese individuals.Methods Chinese Longitudinal Healthy Longevity Survey(CLHLS)cohort was subjected to derive the data from 4 waves of survey during November 2008 and September 2018.Finally,1081 individuals were enrolled in this study.Cognitive function was assessed using Mini-Mental State Examination(MMSE),and all the participants were divided into an accelerated cognitive decline group(participants who initially exhibited a decline in MMSE score by>2 between a follow-up and baseline,125 cases)and cognitive stability group(956 cases).At baseline,serum levels of LDL-C and HDL-C were measured,and the LDL-C/HDL-C ratio was calculated.After the last follow-up,restricted cubic splines were used to describe the dose-response relationships,Cox proportional hazards regression models were employed to determine the effects of LDL-C,HDL-C,and the LDL-C/HDL-C ratio on the risk of accelerated cognitive decline,and sensitivity analysis was performed to evaluate the robustness of the model.Results The accelerated cognitive decline group exhibited significantly older baseline age,lower male ratio,shorter years of education,and fewer smokers at baseline when compared with the cognitive stability group(P<0.05,P<0.01).At the last follow-up,the scores in the dimensions of general capacity,response,attention and calculation,memory,language,and self-coordination were obviously lower in the accelerated cognitive decline group than the cognitive stability group(P<0.01).The results of restricted cubic spline analysis showed a positive correlation between LDL-C and HDL-C ratio and risk of accelerated cognitive decline,while HDL-C level was negatively correlated with the risk of accelerated cognitive decline.After adjusting for relevant factors,Cox proportional hazards regression analysis indicated that LDL-C/HDL-C ratio was a risk factors for accelerated cognitive decline(HR=1.18,95%CI:1.04～1.34),and HDL-C level was a protective factor for cognitive function(HR=0.58,95%CI:0.42～0.80).The results of sensitivity analyses were consistent with the main findings,indicating the robustness of the model(P<0.05).Conclusion An elevated LDL-C/HDL-C ratio is a risk factor for accelerated cognitive decline in the elderly,while higher HDL-C level has protective effect.

Abstract:Objective To explore the application value of coronary computed tomography angiography(CCTA)based on artificial intelligence(AI)post-processing in the diagnosis of coronary artery lesions.Methods 200 elderly patients with suspected coronary heart disease admitted in our hospital from February 2023 to February 2025 were selected.All patients received CCTA at admission,and coronary angiography(CAG)within 3 months after CCTA.The results of CAG were regarded as the gold standard.All CCTA images were imported into the workstation for manual post-processing and AI software post-processing to analyze the main blood vessels,such as the left main coronary artery(LMCA),left anterior descending artery(LAD),left circumflex artery(LCX),and right coronary artery(RCA)and their lesion conditions.Based on different post-processing methods,they were divided into a manual group and an AI group.The time for post-processing and subjective and objective scores of image quality were compared between the two groups.Kappa test was used to compare the consistency,sensitivity,specificity,and accuracy of the diagnosis of the above coronary lesions in the two groups.Receiver operating characteristic(ROC)curves were drawn to analyze the diagnostic efficacy of the two post-processing methods for coronary artery lesions.Results There were no statistical differences in subjective and objective scores of image quality between the post-processing methods(P>0.05).The AI group exhibited a significant shorter time for image post-processing than the manual group(2.67±0.26 min vs 13.31±0.60 min,P<0.01).There were no obvious differences in the diagnostic results of coronary artery lesions by CAG,and AI and manual post-processing(P>0.05).The Kappa value for the consistency in diagnosing the lesions in LMCA,LAD,LCX,and RCA was 0.827,0.900,0.657,and 0.661,respectively,between the AI group and CAG examination,and the Kappa value for the consistency in diagnosing above lesions was 0.641,0.669,0.904 and 0.863,respectively,between the manual group and CAG examination.The AUC value of AI post-processing in diagnosing coronary artery lesions was 0.848(95%CI:0.807-0.889),and the AUC value of manual post-processing was 0.842(95%CI:0.797-0.890).There was no statistical difference in the AUC values between the two post-processing methods(P>0.05).Conclusion CCTA based on AI post-processing has the advantage of shorter processing time in the diagnosis of coronary artery lesions.It also shows high diagnostic efficacy for coronary artery lesions,and can be used as an auxiliary tool for clinical diagnosis of coronary artery lesions.

Abstract:Objective To explore the status quo of polypharmacy in elderly patients with cardiovascular and metabolic diseases and analyze its influence on medication compliance.Methods A total of 205 elderly eligible patients admitted to our department from December 2023 to December 2024 were enrolled,and based on the medication situation,the patients were classified into hyperpolypharmacy group(42 cases)and non-hyperpolypharmacy group(163 cases).According to Morisky medication compliance scale score,the patients were also divided into compliance group(122 cases)and non-compliance group(83 cases).Multimorbidity and polypharmacy statuses and medication compliance were investigated in all participants,and the related factors affecting the medication compliance were analyzed.Results Among the 205 elderly patients with cardiovascular and metabolic diseases,there were 138 cases(67.3%)with two comorbidities and 67 cases(32.7%)with more than three comorbidities.The hyperpolypharmacy group exhibited significantly larger proportions of improper dosage of polypharmacy and pharmacological than the non-hyperpolypharmacy group(31.0%vs 9.8%,35.7%vs 7.4%,P<0.01).Obviously older age,larger divorced/widowed ratio,having education level of junior high school and below,higher proportions of hyperpolypharmacy,oral administration+subcutaneous/intravenous medication and self-paying,and elevated patient health questionnaire-9(PHQ-9)score and generalized anxiety disorder-7(GAD7)score were observed in the non-compliance group than the compliance group(P<0.05,P<0.01).Multivariate logistic regression analysis indicated that age,divorced/widowed,education level of junior high school and below,hyperpolypharmacy,oral administration+subcutaneous/intravenous medication,self-paying,PHQ-9 score and GAD7 score were risk factors for medication compliance(P<0.05,P<0.01).The hospitalization rate for adverse reactions caused by non-compliance in the hyperpolypharmacy group was significantly higher than that in the non-hyperpolypharmacy group(42.4%vs 22.0%,P<0.05).Conclusion The phenomenon of polypharmacy is quite common in elderly patients with cardiovascular and metabolic diseases,which aggravates the difficulty of clinical medication management.The types and ways of medication,education level,emotions and other issues have great impacts on medication compliance.Clinically,it is necessary to formulate some targeted measures to strengthen the management.

Abstract:Objective To explore the relationship between changes in serum dickkopf-related protein 1(DKK-1)and leucine-rich α-2-glycoprotein-1(LRG1)levels and cognitive impairment in elderly patients with non-disabling stroke.Methods A retrospective study was conducted on 114 elderly patients with non-disabling stroke admitted to our department from January 2023 to December 2024.According to Montreal cognitive assessment(MoCA)score,they were divided into a cognitive impairment group(score<26,35 cases)and normally cognitive group(score≥26,79 cases).The serum levels of DKK-1 and LRG1 were detected,and the relationship between the changes in the levels and cognitive impairment in the elderly patients was analyzed.Results The cognitive impairment group exhibited significantly advanced age,larger stroke lesion size,and higher National Institutes of Health Stroke Scale score than the normal cognition group(P<0.01).At 2 weeks of onset,the DKK-1 and LRG1 levels in both groups were obviously lower than the levels at admission(P<0.05),and the levels were notably higher in the cognitive impairment group than the normal cognition group(P<0.01).Multivariate logistic regression analysis revealed that DKK-1(OR=1.049,95%CI:1.024-1.074,P<0.01)and LRG1(OR=1.043,95%CI:1.008-1.079,P<0.05)at 2 weeks of onset,age(OR=1.290,95%CI:1.073-1.552,P<0.01)and stroke lesion size(OR=1.977,95%CI:1.175-3.327,P<0.05)were risk factors for cognitive impairment in elderly patients with non-disabling stroke.ROC curve analysis found that the area under curve values of DKK-1 and LRG1 levels at 2 weeks of onset,age and lesion size were 0.807,0.720,0.661 and 0.729,respectively in evaluating cognitive impairment in elderly patients with non-disabling stroke(P<0.01).Conclusion The continuous high levels of serum DKK-1 and LRG1 in elderly patients with non-disabling stroke may be associated with the risk of cognitive impairment.These two indicators can be used for auxiliary evaluation in clinical practice.

Abstract:Objective To analyze the relationship between multimodal CT imaging and neurological function in elderly patients with acute ischemic stroke(AIS)and its predictive efficacy for stroke recurrence events.Methods A total of 160 elderly AIS patients admitted in our hospital from January 2021 to December 2023 were retrospectively recruited,and based on the occurrence of stroke recurrence events or not,they were divided into a recurrence group(28 cases)and a non-recurrence group(132 cases).General clinical data were collected in all the patients.ROC curve was plotted to evaluate the efficacy of the parameters from multimodal CT imaging and the National Institutes of Health Stroke Scale(NIHSS)score in predicting stroke recurrence.Results The recurrence group had significantly higher uric acid and IL-6 levels,increased NIHSS score,longer mean transit time(MTT)and time to peak(TTP),and obviously lower cerebral blood volume(CBV)and cerebral blood flow(CBF)as well as decreased ratio of endovascular intervention when compared to the non-recurrence group(P<0.05,P<0.01).There were a statistically significant difference in the severity of cerebral infarction and intracranial vascular stenosis between the two groups(P<0.05,P<0.01).The MTT and TTP were positively correlated with the NIHSS score(r=0.671,r=0.704,P<0.05),while the CBV and CBF were negatively correlated with the NIHSS score(r=-0.546,r=-0.667,P<0.05).Multivariate logistic regression analysis indicated that NIHSS score,MTT,TTP,CBV,CBF,and severity of intracranial large vessel stenosis were independent influencing factors for stroke recurrence events(P<0.05,P<0.01).ROC curve analysis showed that the AUC values of MTT,TTP,CBV,and CBF were significantly lower than that of their combined detection,and the AUC values of multimodal CT imaging parameters and NIHSS score were notably lower than that of theire combined detection(P<0.01).Conclusion The parameters of multimodal CT imaging are closely associated with neurological function in elderly AIS patients.Combined detection of multimodal CT imaging parameters and NIHSS score has a high predictive value for stroke recurrence events.

Abstract:Objective To develop a risk prediction model for Alzheimer's disease(AD)based on multi-delay arterial spin labeling(ASL)technology.Methods A total of 125 patients who underwent cerebral magnetic resonance imaging,magnetic resonance angiography,and multi-delay ASL in Chinese PLA General Hospital between November 2024 and July 2025 were enrolled in this study.According to scores of neuropsychological scales and results of 11C-Pittsburgh compound B positron emission tomography-computed tomography,the participants were categorized into an AD group(65 cases)and a healthy control group(60 cases).Then,they were randomly divided into a training set(n=87)and a testing set(n=38)at a ratio of 7:3.Demographic data,laboratory test indicators,routine MR indicators,and cerebral blood volume(CBV),cerebral blood flow(CBF),and arterial transit time(ATT)from 268 brain regions were collected,and then multivariate logistic regression and least absolute shrinkage and selection operator(LASSO)regression analyses were performed to screen prediction factors of AD.The prediction models were established in the training set and verified in the testing set.Results Multivariate logistic regression analysis showed that SBP and stenosis of the posterior cerebral artery≥50%were independent risk factors for AD(OR=1.05,95%CI:1.01-1.10,P<0.05;OR=3.77,95%CI:1.02-13.95,P<0.05).LASSO regression analysis indicated that the CBF values in the left superior frontal gyrus and right angular gyrus,and the right superior occipital gyrus,as well as ATT values in the right temporal lobe and left inferior temporal gyrus were identified as effective predictive indicators of AD.ROC curve analysis revealed that the clinical-routine MR-cerebral perfusion model had significantly higher efficacy in predicting AD than the clinical model and the clinical-routine MR model alone,with an AUC value of 0.924(95%CI:0.847-0.969)in the training set and 0.950(95%CI:0.828-0.989)in the testing set.Conclusion Multi-delay ASL provides significant clues for early screening of AD and shows excellent efficacy in AD risk prediction.